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BRIGhTMIND: People with severe depression have longer lasting benefit from novel MRI technique

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19 January 2024

The BRIGhTMIND study used MRI neuronavigated Transcranial Magnetic Stimulation (TMS) to treat patients with severe depression and found improved quality of life and eased symptoms over the following 6 months.

TMS treatment involves magnetic pulses delivered to the left side of their head. The technique has been used to treat severe depression since the 1980s but neuronavigation now allows for the same area of the brain to be pinpointed and stimulated in each session. The neuronavigation method uses light from both ear lobes and the top of the nose to measure the stimulation point from the first time a patient has the treatment. The MRI personalises the site of stimulation and then neuronavigation makes sure the same site is being stimulated at each treatment session.

The trials results have been published this week in Nature Medicine, co-authored by Dr Mohamed Abdelghani, consultant psychiatrist at Camden and Islington NHS Foundation Trust.

Camden and Islington NHS Foundation Trust, now part of the North London Mental Health Partnership, delivered of the study in London, with members of the research delivery team performing the intervention. Participants were invited from across the trust and GP Practices across the area supported by the Noclor Primary Care Team. All participants in the trial needed to be referred by their GP.

Across England, 255 patients participated in the trial and had 20 sessions each with TMS being delivered over a 4-6 week period. The results showed patients experienced clinically substantial improvements in their depression. Over two thirds of participants responded to the treatment, with a third showing 50% improvement in terms of their symptoms and a fifth managing to move into remission and stay there.

Richard Morriss, Professor of Psychiatry in the School of Medicine and Lead for the Centre for Mood Disorders at the Institute of Mental Health at the University of Nottingham, said:

“Given these patients are people who have not responded to two previous treatment attempts and have been ill for an average of 7 years, to get such a significant response rate and a fifth who have a sustained response is really encouraging,”

“Patients who responded to the treatment could stay relatively well compared to how they were previously, with as little as one or two treatments a year. The changes we saw were substantial, not only in reducing their depression symptoms, but they were large enough to improve concentration, memory, anxiety and subsequently their quality of life.”

A participant on the trial had the following to say of their research experience:

“It has been a privilege to work alongside the research and clinical teams and feel that you are making an important contribution to such a groundbreaking study from a patient perspective. The next challenge is to make transcranial magnetic stimulation a standard and universally available treatment option for difficult to treat depression." 

Along with Camden and Islington NHS Foundation Trust, the study had four other centres across the UK in Nottingham, Newcastle, Northampton and Oldham. The study was led from University of Nottingham and Nottinghamshire Healthcare NHS Foundation Trust. Funding for the trial was from an NIHR and MRC partnership Efficacy and Mechanism Evaluation (EME) Programme.

The study was a randomised control trial with a sample that was noted as being large, with diversity in age, ethnicity and other demographic features. The team leading the study also evaluated the efficacy, cost effectiveness and mechanism of action of the intervention.

The study results are available to read in Nature Medicine: Connectivity-guided intermittent theta burst versus repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial

The National Institute of Health and Care Research have published an article on the results: Novel MRI technique improves treatment for severe depression

Further information on the BRIGhTMIND trial is available on Nottingham’s study website



Image: Milad Fakurian