Neuromodulation

CO-CHAIRS

Daniel Maixner, MD | University of Michigan
Shan Siddiqi, MD | Brigham and Women’s Hospital

WHY A TASK GROUP?

Formed in June 2021, the Neuromodulation Task Group combined the efforts of two previous task groups, Electroconvulsive Therapy (ECT) & Repetitive Transcranial Magnetic Stimulation (rTMS). This combined group has several broad goals, notably to identify best practices in ECT and rTMS, to educate practitioners and the general public about the safety and efficacy of ECT and rTMS, and to advocate for expanding the use of ECT and rTMS for the treatment of depressive illnesses.

ECT has been shown to be a safe and effective method of treatment for a variety of psychiatric illnesses, including depression, bipolar illness, and schizophrenia. ECT is commonly recommended for depressed patients who cannot tolerate medication, as well as those whose depression has not responded to other treatments, or those who require a more rapid response than that offered by medications or psychotherapy. In its 70-plus year history, the technique has been stigmatized by negative portrayals in the media, but in reality ECT can be safely and comfortably administered, with favorable results.

In 2008, the FDA approved the use of rTMS for the treatment of Treatment-Resistant Depression. Since that time, the evidence continues to mount supporting the use of rTMS to help patients whose depression does not respond to traditional treatments. In order to realize the full potential of rTMS, more large-scale clinical research is needed to establish its effectiveness, encouraging more widespread utilization and insurance reimbursement.

CURRENT PROJECTS

In 2022, on behalf of the Neuromodulation Task Group, Nicholas Trapp, MS, MD applied for and was subsequently awarded an NNDC Momentum Grant titled “Neuromodulation Task Force Consensus Recommendations for TMS in Depression”. These funds will support the efforts of a newly established Work Group to update the TMS guidelines released by the NNDC in 2018 (McClintock et al.) Several new, practice-changing studies and publications have emerged in the interim. The team led by Dr. Trapp is undertaking a comprehensive review of the relevant literature and taking steps to come to an agreement about a revised set of TMS recommendations.
In 2022, Peter Zandi, PhD received a Baszucki Brain Research Fund grant award to work with the Neuromodulation and Bipolar Disorders Task Groups on a project titled “Leveraging a collaborative network to test a novel iTBS treatment for bipolar depression”. The objective of this study is to use the resources of the NNDC to examine the effects of this intervention on symptoms of treatment-resistant depression in bipolar disorder and to assess changes in neuroimaging biomarkers that may predict treatment response. Participant recruitment is expected to begin in 2023.
Members of this Task Group are also interested in harmonizing the collection and documentation of ECT and rTMS data. As a step in this direction, they published the manuscript:
- Zandi, P. P., Morreale, M., Reti, I. M., Maixner, D. F., McDonald, W. M., Patel, P. D., Achtyes, E., Bhati, M. T., Carr, B. R., Conroy, S. K., Cristancho, M., Dubin, M. J., Francis, A., Glazer, K., Ingram, W., Khurshid, K., McClintock, S. M., Pinjari, O. F., Reeves, K., … Weiner, R. D. (2022). National Network of Depression Centers’ Recommendations on Harmonizing Clinical Documentation of Electroconvulsive Therapy. The Journal of ECT. https://doi.org/10.1097/YCT.0000000000000840
In 2021, one of the Neuromodulation Work Groups was awarded an NNDC Momentum Grant to (1) examine the attitudes and ethical concerns regarding rTMS and TBS among adolescents with depression; (2) characterize the views of their parents; (3) compare the attitudes and ethical concerns for rTMS and for TBS. Participant recruitment is ongoing, and more information may be found at Penn State Neuroethics Lab TMS Adolescent Project.
This same Work Group is also beginning to develop a research project that will aid in identifying factors that improve the efficacy of rTMS on mood in adolescents.

PAST ACCOMPLISHMENTS

In 2018, the ECT Task Group was awarded an NNDC Momentum Grant to conduct a genome-wide association study of ECT for treatment-resistant depression. The aims were to identify genetic factors that 1) are associated with treatment resistant depression and indicate which patients are likely candidates for ECT, and 2) influence ECT response and predict which patients would benefit clinically from treatment or are at risk for neurocognitive adverse effects. This successful effort led a larger grant titled “Genetics at an Extreme: An Efficient Genomic Study of Individuals with Clinically Severe Major Depression Receiving ECT” (NIMH 1R01MH121542-01 Zandi 2019-2024).
Also in 2018, the rTMS Task Group published guidelines for treating depression with rTMS:
- McClintock, S. M., Reti, I. M., Carpenter, L. L., McDonald, W. M., Dubin, M., Taylor, S. F., Cook, I. A., O’Reardon, J., Husain, M. M., Wall, C., Krystal, A. D., Sampson, S. M., Morales, O., Nelson, B. G., Latoussakis, V., George, M. S., Lisanby, S. H., National Network of Depression Centers rTMS Task Group, & American Psychiatric Association Council on Research Task Force on Novel Biomarkers and Treatments. (2018). Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. The Journal of Clinical Psychiatry, 79(1). https://doi.org/10.4088/JCP.16cs10905