Stanford neuromodulation therapy effective against treatment-resistant depression

The Stanford neuromodulation therapy (SNT), a high-dose intermittent theta-burst stimulation (iTBS) protocol with functional-connectivity-guided targeting, demonstrates better efficacy than sham stimulation for treatment-resistant depression, according to the results of a double-blind, randomized controlled trial.

Previously referred to as Stanford accelerated intelligent neuromodulation therapy, or SAINT, SNT was associated with a remission rate of ∼90 percent after 5 days of open-label treatment.

In this trial, the investigators randomized patients with treatment-resistant depression currently experiencing moderate to severe depressive episodes to receive active or sham SNT. They used resting-state functional magnetic resonance imaging to individually target the region of the left dorsolateral prefrontal cortex most functionally anticorrelated with the subgenual anterior cingulate cortex.

Score on the Montgomery-Åsberg Depression Rating Scale (MADRS) 4 weeks after treatment was the primary outcome of the study.

Thirty-two participants with treatment-resistant depression had been enrolled at the planned interim analysis. Of these, 29 met the eligibility criteria and received either active (n=14) or sham (n=15) SNT. Four weeks after treatment, the mean percent decrease in MADRS from baseline was 52.5 percent in the active treatment group and 11.1 percent in the sham treatment group.

Further trials are warranted to determine the durability of SNT and to compare it with other treatments, the investigators said.

Approved by the US Food and Drug Administration for the treatment of treatment-resistant depression, iTBS demonstrates suboptimal efficacy and a 6-week duration. Such limitations were addressed by the development of a neuroscience-informed accelerated iTBS protocol, SNT.

“Depression is the leading cause of disability worldwide, and half of patients with depression have treatment-resistant depression,” the investigators said.