About this author
Zack Lynch is author of The Neuro Revolution: How Brain Science Is Changing Our World (St. Martin's Press, July 2009).
He is the founder and executive director of the Neurotechnology Industry Organization (NIO) and co-founder of NeuroInsights. He serves on the advisory boards of the McGovern Institute for Brain Research at MIT, the Center for Neuroeconomic Studies, Science Progress, and SocialText, a social software company. Please send newsworthy items or feedback - to Zack Lynch.
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Brain Waves

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April 13, 2006

Depression Targeted with Neurodevices Not Drugs

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Posted by Zack Lynch

From this month's Neurotech Insights investment newsletter focused on the depression market:

While drugs to treat depression have proven effective for millions of individuals there exist a significant number of patients who do not respond to antidepressants. Treatment resistant depression, or refractory depression, is a condition that affects an estimated 4 million people in the U.S. and 11 million worldwide. Until recently, there were no options for these individuals beyond treatment with electroconvulsive therapy (ECT), which commonly induces memory loss among other issues. Today, several neurodevice approaches for the treatment of refractory depression are emerging including Vagus Nerve Stimulation (VNS), Deep Brain Stimulation (DBS) and repetitive Transcranial Magnetic Stimulation (rTMS).

The first neurodevice to be approved by the FDA for depression was Cyberonics’ VNS Therapy system. On July 15, 2005, the FDA approved Cyberonics’ VNS Therapy as a long-term adjunctive treatment for patients 18 years of age or older with chronic or recurrent treatment-resistant depression in a major depressive episode that have not responded to at least four adequate antidepressant treatments. Chronic treatment-resistant depression is defined as being in the current depressive episode for more than two years. Recurrent treatment-resistant depression is defined as having a history of multiple prior episodes of depression. The approved indication for use includes patients with unipolar or bipolar depression in a major depressive episode.

This is the first time an implanted device has been approved by the FDA for treatment of a psychiatric illness. VNS Therapy was already approved for sale in the European Union and in Canada as a treatment of depression in patients with treatment-resistant or treatment-intolerant major depressive episodes including unipolar depression and bipolar disorder, also known as manic depression. Currently over 550 people have a VNS implant for treatment resistant depression. Another 7,000 people are currently seeking approval from their insurance companies for the $25,000 operation, according to the Washington Post.

170_Neurotech_Insights_cover_c_copy.jpgThe second neurodevice technique being investigated as a potential treatment for refractory depression is Deep Brain Stimulation (DBS). Over 30,000 people have been implanted with DBS systems for the treatment of movement disorders in people with severe tremor or Parkinson’s disease and now there are attempts to use it to treat depression. DBS devices resemble cardiac pacemakers, except that the stimulation electrodes are implanted in specific areas of the brain rather than the heart. Medtronic is currently developing a DBS product called Kinetra for depression. For the foreseeable future, the market for neurostimulators for depression is limited to the severest population of approximately 300,000 in the U.S. with 15,000 new cases emerging each year.

A third neurostimulation technique that is currently being used to treat severe depression is repetitive Transcranial Magnetic Stimulation (rTMS). rTMS has one very important advantage over the other techniques, it does not require brain surgery. Instead the external devices deliver brief magnetic field pulses through the cranium. The pulses induce a perpendicular electrical current that affect neurons in the superficial cortical layers—either increasing or diminishing activity. There are some studies that suggest that TMS directed at the left dorsolateral prefrontal cortex might be useful as an alternative to electroconvulsive therapy in treating severe or treatment-resistant major depression.

Canada’s MindCare Centres opened their first rTMS clinics for depression in 2004 where rTMS is now approved for treatment resistant depression. MindCare uses a computer controlled magnetic beam applied 20 minutes a day. Some researchers believe that rTMS may apply to many treatment resistant patients in the following markets: depression, anxiety, PTSD, OCD, tinnitus, pain, Parkinson's, migraines, aphasia, stroke (right after event), eating disorders, and addiction.

Note, more technologies, like transcranial direct current stimulation may be on the way.

Comments (5) + TrackBacks (0) | Category: Neurodevices


1. Ger Rooseman on April 14, 2006 4:00 AM writes...

Dear Sir,
I have no comment but only a question about tinnitus, because this was mentioned in this article Brain Wave dated April 13, 2006.Posted by Mr.Zack Lynch.
I am not suffering from all named problems, I only wonder how effective can treatment be with this rTMS to get rid of my relatively small tinnitus problem.
Both my MD plus hearing specialist (we call it K.N.O doctor for throat, nose and ear here in The Netherlands) say I have to live with it.
Being 69 and living with this noise in my ear or head for now almost a year and a half, I have my own opinion that there must be a cure because sometimes there is no noise at all but the most typical thing is that if I am watching tv and fall asleep for 15 or 20 minutes after such a noiseless daqy, never longer, this noise right thereafter is back.
Therefore I think it has to do with someting,
nerves?? in the neck area.
Anyway your suggestion is most welcome.
Ger Rooseman.
Tel: + 31 162 429143.
Fax: + 31 162 438144

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2. Cyrus Eierud on April 14, 2006 8:27 AM writes...

Dear Ger Rooseman,

I too have a slight tinnitus that rarely goes away. However I've accepted it and "hear" it only if I focus at it.
I too think my tinnitus is correlated to my neck in certain ways. If I have a neck lock my tinnitus gets screamingly loud.
If I study or sit by computer into the late hours (such as when reading Zack's articles ;-) without any breaks my tinnitus increases. Also if I'm tense/nervous (such as the day before an exam) I believe tinnitus gets multiplicative.
I'm pretty sure my tinnitus is correlated to sleep debt accumulated too. I experience this when I cut down sleeping hours before my exams at KI Medical University.
My tinnitus varies a lot and a few times it is even totally gone. Usually at times I'm relaxed and well rested.

Once I had a special type of massage (I think acupressure massage) and I know the person massaging me did something helping to take my tinnitus away since I could feel it being degrading step by step until it finally died out during the 1h massage. Of course I tried the same massage by the same person one week later and even though I got the exact same massage I felt no effect at all in any way - guess tinnitus is more complicated than only external factors.

First year I experienced my tinnitus (age 19) I was totally freaked and I went to see all kinds of doctors for about two years until I surrendered to my high pitched noise. Since I surrendered to it it kind of stopped bothering me. Some times I even use it as a kind of health-indicator that warns me if I'm pushing myself too hard.

(hope this isn't focusing away too much from the original subject Zack initially brought up)


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3. Ger Rooseman on April 14, 2006 5:15 PM writes...

Dear Cyrus Eierud,
Apart from tinnitus problem I now have a second also small problem, namely how did my message arrive on your computer, although it was good to hear your situation.
The thing is that when sending the message I got a remark/warning that due to some problems my message could not been relayed for the time being.
Now all of a sudden your tinnitus experience showed up and I conclude that basically we both have an idea that there is some thing wrong in the neck area and the question is still there: can something be achieved with said rTMS treatment.
Please revert directly to:

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4. Richard Petty on April 18, 2006 9:52 AM writes...

This whole post is thoughtful and interesting.

We still don't really know just how effective these treatments are, even for depression. On balance it does appear that rTMS can help some people as can VNS. Any possible benefit is welcome. The people who are candidates for VNS have already failed other treatments, and many are at significant risk of trying to harm themselves. Treatment resistant depression is a very serious and life-threatening illness.

There are still many questions about how these treatments might work. There are a great many theories, but not much empirical evidence. So it is difficult to predict what kinds of conditions might respond. Tinnitus is on the list because of case reports of people receiving rTMS for depression who also happened to have tinnitus that improved after treatment. We also know that VNS has been associated with cognitive improvement, so plans are afoot to look at it for mild age-related cognitive decline.

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5. Martijn Arns on October 6, 2007 5:24 AM writes...

rTMS is indeed quite a promising tool for disorders such as depression and tinnitus.
We are currently offering rTMS treatment for depression, and are seeing dramatic improvements on BDI scales within 10 treatment sessions. I think rTMS will even be more promising when it is used as one of the first treatment choices, rather then at the end of the line (i.e. when drugs, ECT etc. have all failed).
We also notice no side effects at all.

The only question now is, for how long will rTMS be effective?

Martijn Arns
Brainclinics Treatment

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