Treatment Key to Reducing Cost of Crime

Abstract

Somatic treatments benefit some people whose depression persists after treatment with medication, psychotherapy, and a combination of these two, said Mark George, MD, professor of psychiatry and director of the brain stimulation laboratory at the Medical University of South Carolina, in Charleston. Refinements of electroconvulsive therapy that use a shorter pulse width yield efficacy comparable with older techniques, with less cognitive dysfunction, George said. In 2005, the US Food and Drug Administration approved vagus nerve stimulation for treatment-resistant depression. This technique requires implantation of a pacemaker in the neck to stimulate the left vagus nerve. Repetitive transcranial magnetic stimulation (rTMS) has generated the most excitement among researchers in therapeutic neuromodulation, George said, as rTMS is non-invasive, and, in studies to date, has not been shown to have deleterious cognitive effects. This still-investigative technique involves external application of magnetic fields that stimulate the cortex. A 20-site study of 301 patients with difficult-to-treat depression who received either rTMS or sham rTMS as outpatients for 35 min/d, 5 d/wk, for up to 6 weeks, followed by a 3-week taper phase, found greater improvement on standard depression rating scales in the active treatment group than in the sham treatment group, according to a report at another symposium at the Toronto meeting. John O’Reardon, MD, assistant professor of psychiatry at the University of Pennsylvania School of Medicine, Philadelphia, principal investigator at that site, described findings from this study, funded by Neuronetics Inc, a TMS device manufacturer. A replication trial sponsored by the National Institutes of Health is now in progress.