Physicians Update

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Depression Neuromodulation Offers New Options for Treatment-Resistant Depression STORY HIGHLIGHTS Trigeminal nerve stimulation delivers low-energy electrical stimulation to specific areas of the brain associated with epilepsy, depression, attention deficit hyperactivity disorder and post-traumatic stress. Transcranial magnetic stimulation uses magnetic energy to stimulate parts of the brain that regulate mood. UCLAHEALTH.ORG A major clinical trial has shown that only about one-third of adults with major depression will respond after their first medication trial, and the likelihood that similar therapies will succeed declines with each new attempt, leaving about 20-to-30 percent of patients with treatment-resistant depression (TRD). However, newer neuromodulation therapies, along with refinements in older ones that deliver electrical impulses to specific areas of the brain, can help to restore normal function and improve outcomes. Mental disorders, including depression, affect an estimated one-in-four adults in the United States each year, and for many patients the first line of treatment is medication. But for those who are unable to tolerate the side effects from prescribed medicines or have tried without success many different drugs, so-called neuromodulation offers the hope of meaningful benefit, says Ian Cook, MD, director of the Depression Research & Clinic Program at UCLA. 1-800-UCLA-888 (1-800-825-2888) “With neuromodulation, we can use noninvasive or minimally invasive techniques to change the levels of activity within targeted circuits of the brain that are important for treating illness, while providing clinically significant benefits, with fewer side effects,” Dr. Cook explains. One of the newest neuromodulation strategies, trigeminal nerve stimulation (TNS), delivers low- energy electrical stimulation through a patch placed on the forehead to specific areas of the brain that are associated with epilepsy, depression, attention deficit hyperactivity disorder (ADHD) and post-traumatic stress (PTS). TNS was invented at UCLA, by Dr. Cook, neurologist Christopher DeGiorgio, MD, and their colleagues, for treatment of drug-resistant epilepsy, and later has been studied for treatment-resistant depression. Although it is approved in Canada and Europe for those conditions, TNS must still be evaluated in U.S. clinical trials before being considered for FDA-approval. In preliminary studies, TNS has