Brain Stimulation Update: ECT, TMS and Beyond
The field of brain stimulation in psychiatry continues to evolve as technology improves and as we learn more about brain function and how these treatment methods affect it. Brain stimulation is most often considered when other treatments fail or when medications elicit unpleasant or dangerous side effects. Electroconvulsive therapy (ECT) is the most applied and tested brain stimulation treatment and is far and away the most effective treatment for depression and a variety of other psychiatric conditions. ECT involves passing a carefully controlled electrical current through a person’s brain to trigger a seizure. Though highly effective, it is commonly associated with cognitive side-effects such as memory loss. Although it is more than seven decades old, there continues to be controversy surrounding ECT, not about its efficacy or its safety, which have been proven, but instead regarding fears that the procedure is barbaric and brain-altering, which can be attributed to a lack of knowledge about the procedure and its benefits. There have also been new developments in how ECT is delivered both to improve efficacy and decrease cognitive side effects associated with the treatment that are important for mental health professionals to know. For example, recent studies have demonstrated that very narrow pulses, known as ultra-brief pulses, reduce cognitive side effects without negatively impacting efficacy. We are increasingly using ultra-brief pulses and they are now part of our default setting for new ECT patients.
New brain stimulating technologies have emerged in recent years which can directly and focally regulate brain function without producing the cognitive side-effects associated with ECT and which do not require anesthesia. Repetitive transcranial magnetic stimulation (rTMS) is one of these technologies that has proven effective in clinical trials. rTMS is non-invasive and relies on electromagnetic induction using an insulated coil placed over the scalp, focused on an area of the brain thought to play a role in mood regulation. rTMS is a recently FDA approved treatment for depression and is becoming increasingly available to patients as clinics are being opened. Accordingly it is important for practitioners to learn about how it works, who would benefit from it and how well it is tolerated.
Deep brain stimulation (DBS) is an emerging treatment option showing promise in clinical trials for mood and cognitive disorders such as Major Depression and Alzheimer’s Disease. However, it is not currently FDA approved for these conditions like it is for Parkinson’s Disease and chronic and severe Obsessive-Compulsive Disorder, which is the first DBS psychiatric indication to receive FDA approval. Electrodes are implanted in specific regions targeting the underlying pathophysiology of the disease. Several target sites for stimulation have been proposed for the treatment of refractory depression including Brodmann area 25. PET imaging studies on depressed patients have shown DBS can reverse pretreatment blood flow changes much like antidepressant medication.
This conference will update mental health care professionals on advances in ECT, rTMS and DBS.
Who Should Attend
This activity is intended for physicians, family practitioners with a focus on mental health care, psychologists, psychiatric nurses and social workers.