Research Spotlight - Spring 2013

Hope for the Future: The Promise of Deep TMS for Treatment Resistant Depression

Duke Investigators: Sarah H. Lisanby, MD and Andrew D. Krystal, MD

Dr. Lisanby and Dr. Krystal were recently interviewed by a local North Carolina news station about their translational research testing a new Deep Transcranial Magnetic Stimulation (dTMS) device, which eventually led to its FDA approval in January 2013. 
Transcranial Magnetic Stimulation is an innovative method for treating depression that is not responsive to medication or psychotherapy. A magnetic coil sends short electromagnetic pulses, about the strength of an MRI, through skull to stimulate nerve cells in the prefrontal cortex. 

A new dTMS device, with a unique H-shaped magnetic coil, was tested in a multi-site clinical study involving a total of 233 patients at 21 medical centers across the globe to determine whether it was safe, tolerable, and effective in treating major depression. “This particular study used a different coil – called an H coil – which penetrates more deeply than the previously FDA approved figure 8 coil,” said Dr. Sarah Lisanby. In an April 2012 press release, the manufacturer announced that this study proved the device to be safe and effective in treating depression, and on January 10, 2013 it received FDA approval.

The study was designed as a double-blind, randomized trial where neither the research subjects nor the administering physician knew whether they were delivering the actual treatment, or a “sham” (placebo) treatment. Five patients enrolled in the Duke trial, which ran from March 2011 through May 2012. One of these patients, Mary Margaret, experienced a profound improvement in her depressive symptoms throughout the study. She later learned that she had received the real treatment. 

“I wasn’t surprised,” she shared, “I noticed a gradual shift in my mood and realized that I started to feel better. By the time the study was over, I felt competent and confident again and I experienced a sense of peace that I hadn’t felt in a long time.” Mary Margaret was drawn to participate in this study after 15 years of struggling with recurrent bouts of severe depression. “I had been on multiple medications in various combinations and undergone psychotherapy but nothing really cured me. Depression was robbing me of who I was and I didn’t want to live that way any longer.” Now, nearly a year after the study, she is still medication free. “I felt like it got back to where I was 15 years ago. It was a very wonderful gift and it has given me hope for the future. I am eternally grateful.” 

For patients like Mary Margaret, who fail to experience significant, lasting symptom relief from psychotherapy and psychotropic medications, dTMS offers a safe alternative with no systemic side effects. "It is exciting that in psychiatry we now have a broadened array of effective treatment options. When therapy or medications alone are not enough, these new brain stimulation technologies mean that hope is on the horizon. We are proud to offer the full array of FDA-approved depression treatments at Duke Psychiatry, as well as a range of research options."

The television segment aired on Tuesday, February 5, 2013. It is now available on the WRAL website, which you can view here.