Memory-Related Regions of the Brain Function Differently in Those with Treatment-Resistant Depression
Depression doesn’t just affect the way people feel, it also affects the way people think. Specifically, a lot of people with depression notice that their memory might have become worse: they may have difficulty studying for school exams, misplace their things, or forgetting what they needed from the store. Many studies have looked into why this might be, looking particularly at the structure of our brain’s memory center, but not its function. The researchers of the current study were wondering if changes in the brain structure (size) and function (activity) were related to differences in memory among people with treatment-resistant depression, when compared to those without.
How the Brain Reacts to rTMS can Predict Who Will Benefit Most From this Depression Treatment
rTMS is a safe, non-invasive neurostimulation technique used to treat depression. It works by applying a coil to the scalp, which then delivers magnetic pulses that disrupts the way the brain functions in depression. Importantly, it is effective even for people who did not benefit from antidepressants. Predicting who might benefit best from rTMS is an important topic for researchers: it can help direct patients and clinicians to whatever treatments would be best for them. The researchers of the current study were wondering if how the brain reacts to rTMS can be used to predict whether someone with depression would benefit from this treatment. Specifically, how the functional connectivity between brain areas changes with rTMS.
Memory can improve after rTMS treatment for those with depression-related cognitive symptoms
Did you know that poor mood is not the only way to diagnose depression? In fact, cognitive impairment – worsened thinking, concentration, and decision making – is one of nine criteria for the disorder. This impairment is even more common and severe among those who have treatment-resistant depression: a particular case where someone does not improve with standard antidepressant medications. This study assessed changes to cognition 3 months post-rTMS among a group of people with treatment-resistant depression and compared it to people without depression.
Four Paths of Response to rTMS in Treatment-Resistant Depression
rTMS treatment outcomes are very diverse. Some may improve almost instantly, others may require a higher number or intensity of treatments, and others may not respond at all. Understanding the diversity of rTMS treatment responses can be important in order for clinicians and patients to find the best, personalized treatment approach for their depression. The aim of this study was to describe the number and pattern of unique pathways (i.e., trajectories) of improvement to rTMS among a large group of people with treatment-resistant depression.
People are most likely to respond to rTMS if they have attempted less than 3 trials of antidepressants in the past, without success
Interestingly, the likelihood to respond (i.e., improve) with antidepressants is thought to decrease with every attempt. It is unclear whether someone’s past history with antidepressants affects the likelihood for someone to respond to rTMS or iTBS in the future. Knowing who might benefit most from neurostimulation therapies can help clinicians and patients understand the best treatment route for them.
Accelerated magnetic seizure therapy (aMST) for treatment of major depressive disorder: A pilot study
Electroconvulsive therapy (ECT) is often the recommendation for severe and treatment-resistant depression. However, treatments need to be spaced out over long periods of time to prevent cognitive side effects. Magnetic seizure therapy (MST) uses magnetic—not electrical—stimulation to similarly treat depression. Because of its unique approach and less side effects when compared to ECT, researchers wonder if MST treatments can be safely and effectively accelerated to reduce treatment time.
Clinical Practice Guidelines for the Management of Depression
Depression is known to cause difficulty in daily functioning, self-esteem, sleep, and emotions. With all the research we’ve done with depression, guidelines are needed to organize this information into comprehensible and universal standards of care, informed by our most up-to-date understanding of diagnosis and treatment. The guideline in question comes from India in 2017 and is a keystone because it was the first to officially recommend the use of neuromodulatory treatments (specifically, electroconvulsive therapy; ECT) in severe cases of depression.
Electroconvulsive Therapy (ECT) in Treatment-Resistant Depression
When all else fails, treatment-resistant depression can be especially debilitating: it is associated with recurring depressive episodes, higher risk of suicide, and a greater amount of hospitalizations. For those who fail ≥ 2 gold-standard antidepressants or otherwise have a need for rapid improvement, electroconvulsive therapy (ECT) may be the solution. ECT (in its modern sense) has been used for more than 90 years, but the persisting stigma and media portrayal related to treatment procedures mean it is rarely used in clinical treatments – even though it could help many recover from even persistent depression. This review article examines myths and facts about ECT, including its current use, safety, and side effects.
Differential symptom cluster responses to repetitive transcranial magnetic stimulation (rTMS) treatment in depression
Everyone experiences depression differently. Few studies have looked at how individual symptoms change across treatment, and how they might be related. Specifically, this study was interested in individuals with treatment-resistant depression and how they respond to new, effective repetitive transcranial magnetic stimulation (rTMS) treatments (or the shortened version, iTBS).
Cognitive Impairment in Treatment-Resistant Depression
Depression is well-known to negatively impact mood, but relatively few studies have looked at how this disorder may impact cognition, or thinking ability. This is important because better cognitive ability is linked to better functioning in daily life (e.g., work or home responsibilities). This information could inform how we help people with depression. We do not know whether everyone with depression has difficulties with their cognition. We also do not know whether these difficulties span across all cognitive domains, or are specific to just a few (e.g., memory, learning). This study looked to answer these questions and identify what may predict worse cognitive impairment in those with treatment-resistant depression.