Non-Invasive Brain Stimulation (NSCI) is a promising alternative for the treatment of depression and other neuropsychiatric disorders. The application of ECNI offers an innovative and safe approach, since it allows brain activity to be modulated and thus improve the patient's mental health. To delve deeper into this and discover all the possibilities of this treatment, we spoke with Dr. María Ángeles Idiazabal Alecha, specialist in Clinical Neurophysiology and director of the Incia Neurocognitive Institute.
Dr. Idiazabal, 44,000 new cases of resistant depression per year in Spain are alarming data. Why is ECNI a treatment to consider?
According to the World Health Organization (WHO), more than 300 million people suffer from depression, which is one of the leading causes of disability and can often become a chronic illness. Furthermore, despite these alarming data, it is estimated that between 30-40% of patients do not respond to antidepressant treatments, and this is when we speak of treatment-resistant depression. In Spain alone, it is estimated that each year there are 44,000 new cases of resistant depression, and this is where treatment using ECNI techniques plays an important role.
Classic treatments to overcome depression consist of a combination of antidepressant drugs and psychotherapy. These treatments are often ineffective, cause significant side effects, or there is a lack of adherence to the prescribed drugs. We know that around 40% of depression cases are resistant to antidepressant treatment. In these cases, treatment using Transcranial Magnetic Stimulation (rTMS) becomes a first-line treatment in patients with resistant depression, with a response rate of 60-70%, improving the quality of life of patients without side effects. of the drugs. Our brain is an organ that works by electrical impulses and we can modulate the “maladaptive” electrical activity that underlies neuropsychiatric disorders through non-invasive brain stimulation techniques that apply electrical or magnetic stimuli to the part of the brain affected by a specific pathology.
Doctor, we previously said that ECNI allows electricity or magnetic stimulation to be applied to the brain when “something is not working”, but what exactly is it based on?
As we said, ECNI is based on applying magnetic or electrical fields to the brain in a non-invasive way, that is, without the need for surgery or anesthesia. The two main techniques of ECNI are Repetitive Transcranial Magnetic Stimulation (rTMS), which uses magnetic pulses, and Transcranial Electrical Direct Current Stimulation (tDCS), which applies a low-intensity electrical current to different areas of the brain affected by a pathology. concrete. The two techniques allow the electrical activity of the brain to be modulated in a safe, painless and non-invasive way, producing changes in neuronal plasticity that last over time and allow the functional modulation of neuronal circuits related to the symptoms of the disease.
What will the rTMS session with the patient consist of?
rTMS allows the activity of the cerebral cortex to be modulated through a magnetic field that is generated with a coil that is placed on the surface of the skull. The applied magnetic field induces tiny electrical currents that change the activity of neuronal pathways, being able to stimulate or inhibit the activity of certain brain areas. Treatment should always be carried out under medical supervision, evaluating each patient individually to establish a specific treatment protocol.
Normally between 20 and 30 consecutive sessions are carried out (five sessions per week). At the end of the session, the patient can return to his or her work and family routine as normal.
Which patient will be the ideal candidate for rTMS treatment?
Suitable patients will therefore be those with treatment-resistant depression, those who present side effects to medication or those with drug interactions (especially in older patients who take a lot of medication that can inhibit or interact with the effect of psychotropic drugs). It is in these cases that rTMS becomes a first-line treatment in patients with resistant depression but also in other mental health problems.
rTMS is not only indicated in the treatment of resistant depression, but is also indicated in other psychiatric disorders such as Obsessive-Compulsive Disorder (OCD), anxiety, bipolar disorder, schizophrenia or the treatment of addictions, especially against tobacco addiction.
Are these therapies complementary or do they replace traditional treatments?
They are techniques that can be used in combination, and this is how they tend to be more effective, since we approach the problem from more than one angle, which can be synergistic and more beneficial for the patient. If different treatments are combined, the options for the patient will increase, obtaining results more quickly and effectively. It has been shown that rTMS can induce changes in brain connectivity and function, promoting neuroplasticity and neuronal reorganization.
This allows the brain to compensate for the change in the disease and adapt, which translates into clinical improvement not only in mental illnesses but also in neurological diseases such as stroke or in the treatment of pain.
What advantages does rTMS offer?
It is important to emphasize that rTMS is a non-invasive, effective and safe treatment, which does not require hospital admission or prior preparation. Its effect is faster and is better tolerated than pharmacological treatment by the patient, reducing dependence and the risks inherent to drugs.
In addition, it has few side effects, which are reduced to mild local discomfort and headache. These symptoms are usually transient and short-lived, highlighting the safety and comfort of the treatment. We know from experience that the sooner treatment is started, the better the outcome: a 95% response rate and a 63% remission rate are achieved when rTMS is used as a first-line treatment for depressive episodes.
In conclusion, TMS constitutes an effective, safe and side-effect-free treatment for depression and other psychiatric disorders that allows modulating brain activity and improving patients' mental health, as well as their quality of life.
