Clinical Support Department of Shenzhen Yingchi Technology Co.,Ltd.

Stanford Neuromodulation Therapy (SNT) is an accelerated, high-dose iTBS treatment regimen guided by resting-state functional MRI (FCMRI), and is currently approved by the US FDA for the treatment of major depression ( MDD). Compared with current conventional depression treatments, this therapy is more effective, faster-acting, and has a wider range of application scenarios. SNT has become the focus of research in this field. The latest research report points out that the antidepressant effect of this therapy is reproducible, which is undoubtedly a new hope for patients with relapse of MDD.

SNT protocol

Stimulation target: The left dorsolateral prefrontal region with the greatest negative correlation with subgenual anterior cingulate functional connectivity.

Stimulation intensity: 90% RMT.

Treatment course: Receive 1800 pulses of iTBS 10 times a day, with a 50-minute interval between each treatment.

A total of 5 days of treatment (i.e. 90,000 pulses in total).

Process

1 Subject

Twenty-six patients with MDD who met the criteria for a depressive episode of moderate severity (MADRS score ≥20) and one patient with mild severity were included.

2 Treatment

All subjects received initial treatment and retreatment, and the interval between these two SNTs was 26.5 ± 25.1 weeks (mean ± standard deviation).

3 Evaluation

The evaluation included 6 items on the Hamilton Depression Scale (HAMD-6), 17 items on the Hamilton Depression Scale (HAMD-17), Montgomery Depression Rating Scale (MADRS), and an exploratory analysis of the MADRS Suicidal Ideation Project (SI).

Result

Twenty-two patients achieved immediate remission after initial treatment, and 20 of them (91%) also achieved immediate remission after retreatment. Therefore, 74% of patients achieved remission after two treatments. This suggests that the efficacy of retreatment is comparable to that of primary treatment.

Paired samples t-tests comparing the percentage change from baseline to the immediate post-treatment assessment and the 1-month post-treatment assessment showed no significant difference in the percentage change between the two treatments.

However, there was a significant difference between initial treatment and re-treatment in terms of score changes on SI items (SI: t=3.43, df=25, p=0.002). Compared with the baseline SI scores in the initial treatment, the baseline in re-treatment was SI scores were significantly lower (SI: t=?3.3, df=25, p=0.003).

Conclusion

1 The efficacy of re-treatment

This study found that the re-treatment effect and remission rate of SNT were similar to those of initial treatment, indicating that SNT may be an effective intervention for MDD relapse.

2 Changes in depressive symptoms

There was no significant difference in the percentage change in depressive symptoms between the two treatments, and both showed significant antidepressant effects, supporting the efficacy of retreatment.

3 Symptoms of suicidal ideation

The milder symptoms of suicidal ideation assessed at baseline during retreatment may be driven in part by timely retreatment or the patient's expectations after response to previous treatment.

4 Outlook

Maintenance SNT may be a viable strategy to maintain mood stability or reduce the severity of relapses, but future studies are needed to further explore the efficacy and safety of this type of protocol.

Statement 

1.This content is organized by the Clinical Support Department of Shenzhen Yingchi Technology Co.,Ltd. Criticisms and corrections are welcome. For reprint, please indicate the source.

2.Reference: 

Geoly, A. D., Kratter, I. H., Toosi, P., Cole, E. J., Sahlem, G. L., & Williams, N. R. (2024). Sustained efficacy of Stanford Neuromodulation Therapy (SNT) in open-label repeated treatment. American Journal of Psychiatry, 181(1), 71-73.

Cole, E. J., Stimpson, K. H., Bentzley, B. S., Gulser, M., Cherian, K., Tischler, C., ... & Williams, N. R. (2020). Stanford accelerated intelligent neuromodulation therapy for treatment-resistant depression. American Journal of Psychiatry, 177(8), 716-726.