In principle, the success of the treatment of depression with psychotherapy and medication can vary greatly. However, it remains unclear why some sufferers respond to antidepressive therapy and others do not. It is also not yet possible to predict which antidepressant will work in whom, and whether brain stimulation might be more effective.
“According to the WHO, around 4.1 million people in Germany suffer from depression – and the trend is rising,” the expert association stated. Although psychotherapeutic methods and antidepressant drugs are effective and established forms of therapy, non-invasive brain stimulation (NIBS) has become increasingly important in recent years alongside traditional treatment methods. In this method, the brain is stimulated from outside by means of magnetic fields or direct current.
Psychotherapy and antidepressants are the most commonly used treatments for depression, but non-invasive brain stimulation is also gaining in importance as a treatment option, according to a recent press release issued by the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) at its 64th annual conference.
Improving individualized treatment
Innovative approaches to depression treatment
To improve the possibilities of individualized treatment is the goal of the research group around Professor Dr. med. Frank Padberg, Head of the Section for Psychosomatic Medicine and Psychotherapy, Clinic for Psychiatry and Psychotherapy at the Ludwigs-Maximilians-University (LMU) Munich. However, until now, there has been a lack of clinically useful biomarkers for a reliable prognosis, according to Prof. Padberg.
Treatment success difficult to predict
The latest results of the research group on individualized treatment for depression will be presented at the online advance press conference for the 64th Annual Meeting of the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) on November 09. The possibilities of transcranial magnetic stimulation (TMS) and direct current stimulation will also be given special consideration.
For TMS, a magnetic coil is applied to the forehead of the affected person and the brain is stimulated from outside with magnetic fields. Repetitive transcranial magnetic stimulation (rTMS) is a special “NIBS procedure in which nerve cells in the cerebral cortex are stimulated (i.e. depolarized) by means of a series of very short but strong magnetic field pulses,” explains the DGKN.
In the case of depression, rTMS is used to stimulate frontal areas of the brain (located behind the forehead) and the treatment takes place in 20 to 30 sessions over several weeks.
“TMS and tDCS are treatment methods with few side effects that can be used in any doctor’s practice, in the case of tDCS even at home,” emphasizes Professor Padberg. The aim of current research is now to find suitable markers to predict which form of therapy will work best for which patients.
Another therapeutic option is transcranial Direct Current Stimulation (tDCS), in which a weak direct current is applied to electrodes on the scalp for 20 to 30 minutes, which can be used to change the ability of nerve cells to activate, according to the DGKN.
According to the DGKN, MRI imaging data show that the larger the volume of gray matter in certain frontal regions of the brain, the better the response to direct current stimulation, for example. Similar indications for predicting the success of treatment based on MRI images have also been proven for transcranial magnetic stimulation (see references).
Last but not least, in a recently published study, the response to tDCS could be predicted in comparison to an antidepressant drug by means of innovative statistical procedures (so-called machine learning methods), according to the DGKN.
A first clue could be the examination by means of magnetic resonance imaging (MRI), which can be used to identify the severity and course of depression.
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