Intensive magnetic stimulation tested in the treatment of adolescent depression
Robert Bodén monitors an adult receiving magnetic stimulation. The coil that emits the magnetic pulses is held against the frontal lobe of the brain. Photo: Mikael Wallerstedt, Uppsala University.
Magnetic stimulation of the brain has proven effective in treating depression in adults. However, it has not yet been effective in treating young people. A new research project will now investigate whether a more intensive variant could be effective in difficult-to-treat adolescent depression. The project is a collaboration between Uppsala University/Uppsala University Hospital, Karolinska Institutet and Stockholm Health Care Services.
“This will be the first study in the world to test this type of accelerated magnetic stimulation on adolescents. It has been done before on adults, with very good results, but not on adolescents. The dampening effect was shown to effectively reduce suicidal thoughts in adults. And that bodes really well for the study with adolescents,” says Robert Bodén, Senior Physician and Professor of Psychiatry, who is leading the study.
He explains that epidemiological studies show that approximately 11 percent, or on average one in three pupils in a school class, suffer from depression. Just over 20 percent of them have serious suicidal thoughts. Despite the widespread nature of the problem and the fact that suicide is the most common cause of death among young people, there are few effective treatments for depression.
“The difference between adolescent depression and adult depression is that we have a lot of evidence-based treatments to choose from for adults. In contrast, there is really only one truly evidence-based drug for adolescent depression, and that is fluoxetine,” says Robert Bodén.
Gentler magnetic stimulation
The new study will involve 80 participants aged 13–18 who have not responded satisfactorily to antidepressant medication and have been offered psychotherapy. They will be randomly assigned to receive either a new type of magnetic stimulation, known as accelerated continuous theta burst stimulation (acTBS), or a sham treatment.
Previous research has shown that the method works well for adults. The advantage is that it is gentler than conventional magnetic stimulation (TMS) and is only administered for two weeks instead of six.
“We will be administering a very short treatment that only takes 40 seconds. Instead of one treatment per day, we will give six treatments per day. The patients will arrive at three o'clock and receive a 40-second treatment, followed by another 40-second treatment 15 minutes later. Six such treatments will be administered in total. By half past four, they will be finished,” explains Robert Bodén.
A pilot study he led a few years ago showed promising results.
“We performed a different kind of dampening TMS that involved administering treatment once a day, as opposed to the accelerated variant. The main objective of the study was to determine whether it is feasible to conduct such studies among adolescents. We saw that they tolerated the treatment well. We also measured symptom changes and saw that they improved. Both they themselves, their doctor and their parents felt that they had improved. So the results were cautiously positive,” he says.
New knowledge about the brain activity
Regardless of the outcome this time, Robert Bodén says that the study will contribute important new knowledge about the brain activity of this patient group.
“We will also measure a few things in their brains. While they are undergoing this treatment, we want to take the opportunity to learn more about depression itself and its neurobiology. For example, we will perform an EEG (electroencephalography) to measure electrical activity in the brain. We will do this before and after the treatment series to see how the treatment affects brain waves,” says Robert Bodén.
They will also study oxygenation in the outer part of the participants’ brains to examine in real time how the brain works before, during, and after treatment.
Åsa Malmberg
Determination Of Neurobiology and efficacy of Theta Burst Stimulation for Adolescent Depression (DONT-B-SAD)
The project will run for four years, with 80 patients included on an ongoing basis. The patients will be randomly assigned to receive either theta burst stimulation (acTBS) or a sham treatment, and they will not be informed which treatment they are receiving.
One month after the end of treatment, there will be a follow-up of the participants.
The Swedish Research Council has granted SEK 5.4 million in funding to the project, which is led by Robert Bodén, Professor of Psychiatry at the Department of Medical Sciences and Senior Physician at Uppsala University Hospital.