TMS In Depression
A considerable proportion of the research I have conducted has been dedicated towards the development and improvement of repetitive transcranial magnetic stimulation (TMS) in the treatment of depression. This research began 20 years ago with studies dedicated towards helping establish whether TMS methods were effective: usually by comparing these to a placebo or sham treatment. The research also has had a major focus on evaluating alternative forms of TMS. Studies were conducted that established that low frequency right-sided TMS is an effective antidepressant treatment, that bilateral TMS could be used effectively but that it was no more effective than unilateral stimulation and that established the effectiveness of ‘priming’ TMS.
In more recent year my research program has conducted the most definitive exploration of the effect of TMS dose on clinical outcomes and developed and tested several intensive or accelerated TMS treatment approaches, showing that these can be as effective as standard TMS stimulation.
An additional interest of our research program has been in exploring whether modern neuroscience tools can be used to improve clinical outcomes. In the first application of this, we showed that TMS outcomes were improved if the stimulation site was localized using MRI scanning. More recently studies have been conducted which have indicated that certain forms of MRI scanning as well as recordings of electrical brain activity with electroencephalography (EEG) can potentially be used to predict the outcome of TMS therapy.
Studies are continuing to be conducted in this area. We’re currently continuing to explore the use of accelerated forms of TMS as well as considering how individualization of therapy based on EEG recordings can be used to optimize clinical outcomes.
Doing TMS treatment with a hand held coil in 2002
Our first TMS treatment machine
TMS in Other Disorders
My research program has also had a significant interest in the development of TMS as a treatment for several other mental health and brain disorders. This began with my interest in the use of TMS in the potential treatment of patients with schizophrenia: studies were conducted exploring the use of the treatment in managing persistent auditory hallucinations (voices) and the negative symptoms experience by some patience with this condition.
Studies have been conducted within our group exploring the application of TMS is several other disorders. These have included using TMS to try and improve the social cognitive problems experienced by individuals with autism spectrum disorder, trying to improve pain in fibromyalgia and trying to lessen the symptoms experienced by patience with post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). The research has also extended to trying to improve cognition in patients with Alzheimer’s disorder.
TMS is not applied in the same way across all of these disorders: it is not a matter of a ‘one size fits all’ approach. Data from neuroimaging and other studies is used to establish individual treatment targets and new therapy approaches developed from this.
Using Brain Stimulation and Neuroscience tools to improve our understanding of Neuropsychiatric Disorders
We continue to lack a well developed understanding of the brain processes that underlie conditions such as schizophrenia and depression. Another substantive component of our research program trying to use tools such as transcranial magnetic simulation in combination with neuroimaging and electrophysiology (EEG) to try to provide insights to help us understand these conditions better. This has included an extensive series of studies using TMS methods to demonstrate problems in cortical inhibition and cortical plasticity in patients with schizophrenia and mood disorders. To do this, studies required the development of novel techniques combining TMS with EEG and near infrared spectroscopy.
Set up for an early TMS-EEG experiment
Screenshot from DBS planning software
Developing other Brain Stimulation Approaches in the Treatment of Mental Health Conditions
Beyond the use of TMS, an expanding focus of the research within my team has been on the development of other forms of brain stimulation in relation in the treatment of depression and other conditions.
This has included conducting some of the first pioneering clinical trials of Magnetic Seizure Therapy, a potential replacement or alternative to electroconvulsive therapy. It has included developing and evaluating the use of the deep brain stimulation applied to the bed nucleus of the stria terminalis in the treatment of severe refractory depression. In addition, my team has been involved in a series of experimental studies and clinical trials helping to evaluate the antidepressant and pro-cognitive effects of transcranial direct current stimulation (tDCS). This has included conducting some of the first studies showing the substantial benefits of combining tDCS with engagement in cognitive tasks, both when tDCS is being used as an antidepressant strategy or an approach to improve cognitive function.
Transcranial alternating current stimulation: a potent approach for the future?
My team has a significant interest in the development of transcranial alternating current stimulation (tACS) as a way of therapeutically improving brain function. tACS is a form of electrical stimulation where the weak electrical current used to stimulate the brain is applied in an alternating (regularly varying) frequency. Importantly, tACS can be highly individualized by applying stimulation at a frequency that matches some aspect of characteristic of the subjects condition or intrinsic brain activity. My team is engaged in series of studies investigating the use of more personalized forms of tACS in the treatment of mental health conditions. We also interested in developing new technology to allow personalized tACS to be provided in a more effective manner, especially in a manner that would allow fully home-based treatment.
Our BrightStim home use tACS device