6 ms·

> “The treatment, known as Stanford accelerated intelligent neuromodulation therapy (SAINT) or simply Stanford neuromodulation therapy, is an intensive, individ

> “The treatment, known as Stanford accelerated intelligent neuromodulation therapy (SAINT) or simply Stanford neuromodulation therapy, is an intensive, individualized form of transcranial magnetic stimulation. In the study, remission typically occurred within days and lasted months. The only side effects were temporary fatigue and headaches.” > “Twenty-nine people with treatment-resistant depression participated in the study: About half received SAINT, and the rest underwent a placebo procedure that mimicked the real treatment. After five days of treatment, 78.6% of the participants in the treatment group were no longer depressed, according to several standard methods of evaluation. “It’s quite a dramatic effect, and it’s quite sustained,” said Alan Schatzberg, MD, the Kenneth T. Norris, Jr. Professor in Psychiatry and Behavioral Sciences, who was a co-author of the study.” Makes me wonder what percentage of the placebo group improved? > The transcranial magnetic stimulation treatment currently approved by the Food and Drug Administration requires six weeks of once-daily sessions. Only about half of patients who undergo the treatment improve, and only about a third experience remission from depression.

carabiner 5y ago
> Within four weeks after treatment, 12 of the 14 participants who had received the treatment improved, and 11 of them met FDA criteria for remission. In contrast, only two of the 15 participants who had received the placebo met the criteria for remission.
ggm 5y ago
Within four weeks after treatment, 12 of the 14 participants who had received the treatment improved, and 11 of them met FDA criteria for remission. In contrast, only two of the 15 participants who had received the placebo met the criteria for remission From the article further on.
- argsv 5y ago
  The two mentioned in the article met the FDA definition of remission. It doesn’t say, how many improved in general. This is important specifically since the sample size of the trial is small.
  - KarlKemp 5y ago
    It's the important & useful of the two endpoints they measured. Anything will have a positive effect on depression if it comes with a lot of high-tech vodoo and people in lab coats. Only it won't last and it will the "yeah, I guess I'm feeling better"-level of improvement.
    - eru 5y ago
      > Only it won't last and it will the "yeah, I guess I'm feeling better"-level of improvement. Who says it won't last? Most depressions actually do get better by themselves. How do you think humanity has survived so far? (Most, but not all. And even if it eventually gets better without meds, there was still a lot of suffering.)
      - lazyasciiart 5y ago
        It's quite possible humanity has survived because most people never get depressed. You need to be quite clear about definitions to have a meaningful conversation on this.
        eru 5y ago
        Maybe. So please ignore the part where I speculate about evolution, if you want to. Empirically, most clinical depressions get better by themselves today. Similarly, most alcoholics improve by themselves. (Of course, effective treatment is still useful!)
        webinvest 5y ago
        Unfortunately your genes don’t care about whether you’re happy or not beyond your gene’s needs for survival and reproduction.
        eru 5y ago
        Yes. And given the prevalence of continued prevalence of depression, there might be some evolutionary benefit for the genes that also cause depression. No clue whether it's the depression itself, or whether that's just a side-effect of something else that's useful.
- Terry_Roll 5y ago
  Considering we are chemical based, I wonder how of it is the serotonin receptors are plugged with LSD, an effect similar to SSRI's. https://edition.cnn.com/2020/02/27/health/lsd-overdoses-case-studies-wellness/index.html https://edition.cnn.com/2020/02/27/health/lsd-overdoses-case... But what about other chemicals, Glycine contributes to an increase in 5alpha Reductase which helps reduce Cortisol one of the stress hormones. It can be used in place of sugar in hot beverages and food, how much does stress contribute to depression? https://en.wikipedia.org/wiki/5%CE%B1-Reductase#List_of_conversions https://en.wikipedia.org/wiki/5%CE%B1-Reductase#List_of_conv... And then there is Glutathione which increases light sensitivity, could this help reduce Seasonally Affect Disorder (SAD) also known as the winter blues, knowing that it also helps management of ROS, peroxides, lipid peroxides and heavy metals? Glutamine, N-Acetyl Cysteine and Glycine help to increase Glutathione in the body. I wonder if fMRI has a similar effect on the brain to homogenising milk, namely it softens the fat walls in milk. Is fMRI having an effect in the brain or in the vascular system with plaques that contribute to atherosclerosis, because induction hobs or magnetic induction reduces inflammation https://peerj.com/articles/929.pdf https://peerj.com/articles/929.pdf does this demonstrate that depression is caused by a variety of factors not just one's linked to serotonin even though serotonin plays a part with the immune system?
kolinko 5y ago
The article says 2 out 15 improved in the control group.
- mlyle 5y ago
  Likely more than 2 of 15 improved. The numbers to compare are 2 of 15 remission vs. 11 of 14 remission-- not <<unknown>> of 15 improved vs. 12 of 14 improved.
nine_k 5y ago
For a treatment-resistant condition, 50% success rate can be worth the effort.
- Jeff_Brown 5y ago
  Hell, 5% is worth the effort if it's little enough effort or the condition is severe enough. 80% is incredible if it holds up.
  - bencollier49 5y ago
    Not if it utterly ruins the remaining 20%. Or results in Lewy-Body Dementia in old age, or, or.. That's my concern here.
Lammy 5y ago
Does this also imply the possibility of the inverse, magnetically making people depressed?
- jrumbut 5y ago
  This is a great comment. I've always been a little uncomfortable with the thought of this magnetic treatment in a way I couldn't put into words and this nails it. I'm willing to trust, perhaps naively, that everyone is getting the same Prozac tablets. But how does the skill of the practitioner and maintenance of their magnetic treatment device affect outcomes? It's almost like a surgery, but I'm not sure who's actually been trained to perform it. Which isn't to say someone shouldn't do it, just my own feelings based on limited understanding. Perhaps if I knew more I would have greater faith.
  - nvrspyx 5y ago
    The trial used fMRI data to find a cortical area that has functional connectivity with the DLPFC. That area is then targeted with a neuronavigation system (similar to AR), that helps the clinician place the TMS coil at the right spot and the right angle. This in addition to the magnitude of the pulses being based on the patient's threshold (e.g. minimum amount of stimulation that causes motor movement when used over the motor cortex) is what is meant by "personalized". It's also of note that the treatment takes place over multiple days and there's multiple sessions in a day. During that time, patients are continuously evaluated. This trial was also only used on patients with treatment-resistant depression (i.e. have tried many different medications and forms of therapy, some included ECT) and were screened as such. From my understanding, the treatment was explored as a "last resort" for those that could find no other medical relief, but this obviously has further implications.
  - Benjammer 5y ago
    Do you have the same feelings about radiation therapy for cancer?
    - mlyle 5y ago
heavyset_go 5y ago
> Makes me wonder what percentage of the placebo group improved? For future reference, assuming this is a clinical trial, data from clinical trials is available online. This is the kind of statistic that you'd be able to find.
- Noumenon72 5y ago
  But it must be difficult to do so, or you would have done a lmgtfy link or comment like "Just search the study title and look at table 12."
londons_explore 5y ago
I wonder what results you'd get if you tried a treatment which was literal torture...? Eg. "We'll poke this red hot poker into you 10 times to cure your depression"... Many painful screams later... "So, is the depression any better now, or should we do more treatment?".. "Yes, yes, I'm pretty much cured!". How can we be sure that this 'torture effect' isn't whats being measured here? Especially when the treatment appears to have unpleasent side effects, and the success of the treatment is measured with patient feedback...
- deleted 5y ago
  [deleted]
- arcticfox 5y ago
  Wouldn't the patients just opt out of the trial rather than continue and lie to the researchers? Nobody's being forced into it
  - hsn915 5y ago
    You can't assume that. Part of being depressed is you don't even have the will to resist being treated in a way that you don't like. In fact, I'd say that feeling powerless against conditions that you don't like is the core of what depression is. It's why someone who is depressed doesn't feel like doing anything, because they feel like no matter what they do nothing will ever change so nothing they do is ever worth the effort.
- hsn915 5y ago
  It doesn't need to be that intrusive. Just mildly uncomfortable .. for a period of time longer than one would be willing to tolerate. Something like being at the dentist when you have many cavities in your teeth. You can tolerate one or two sessions. But the idea of doing it every day for two weeks straight is unbearable enough that you decide on the third day to report feeling well.
robbedpeter 5y ago
>>In contrast, only two of the 15 participants who had received the placebo met the criteria for remission.

carabiner 5y ago

> Within four weeks after treatment, 12 of the 14 participants who had received the treatment improved, and 11 of them met FDA criteria for remission. In contrast, only two of the 15 participants who had received the placebo met the criteria for remission.

ggm 5y ago

Within four weeks after treatment, 12 of the 14 participants who had received the treatment improved, and 11 of them met FDA criteria for remission. In contrast, only two of the 15 participants who had received the placebo met the criteria for remission From the article further on.

argsv 5y ago
The two mentioned in the article met the FDA definition of remission. It doesn’t say, how many improved in general. This is important specifically since the sample size of the trial is small.
- KarlKemp 5y ago
  It's the important & useful of the two endpoints they measured. Anything will have a positive effect on depression if it comes with a lot of high-tech vodoo and people in lab coats. Only it won't last and it will the "yeah, I guess I'm feeling better"-level of improvement.
  - eru 5y ago
    > Only it won't last and it will the "yeah, I guess I'm feeling better"-level of improvement. Who says it won't last? Most depressions actually do get better by themselves. How do you think humanity has survived so far? (Most, but not all. And even if it eventually gets better without meds, there was still a lot of suffering.)
    - lazyasciiart 5y ago
      It's quite possible humanity has survived because most people never get depressed. You need to be quite clear about definitions to have a meaningful conversation on this.
      - eru 5y ago
        Maybe. So please ignore the part where I speculate about evolution, if you want to. Empirically, most clinical depressions get better by themselves today. Similarly, most alcoholics improve by themselves. (Of course, effective treatment is still useful!)
      - webinvest 5y ago
        Unfortunately your genes don’t care about whether you’re happy or not beyond your gene’s needs for survival and reproduction.
        eru 5y ago
        Yes. And given the prevalence of continued prevalence of depression, there might be some evolutionary benefit for the genes that also cause depression. No clue whether it's the depression itself, or whether that's just a side-effect of something else that's useful.
Terry_Roll 5y ago
Considering we are chemical based, I wonder how of it is the serotonin receptors are plugged with LSD, an effect similar to SSRI's. https://edition.cnn.com/2020/02/27/health/lsd-overdoses-case-studies-wellness/index.html https://edition.cnn.com/2020/02/27/health/lsd-overdoses-case... But what about other chemicals, Glycine contributes to an increase in 5alpha Reductase which helps reduce Cortisol one of the stress hormones. It can be used in place of sugar in hot beverages and food, how much does stress contribute to depression? https://en.wikipedia.org/wiki/5%CE%B1-Reductase#List_of_conversions https://en.wikipedia.org/wiki/5%CE%B1-Reductase#List_of_conv... And then there is Glutathione which increases light sensitivity, could this help reduce Seasonally Affect Disorder (SAD) also known as the winter blues, knowing that it also helps management of ROS, peroxides, lipid peroxides and heavy metals? Glutamine, N-Acetyl Cysteine and Glycine help to increase Glutathione in the body. I wonder if fMRI has a similar effect on the brain to homogenising milk, namely it softens the fat walls in milk. Is fMRI having an effect in the brain or in the vascular system with plaques that contribute to atherosclerosis, because induction hobs or magnetic induction reduces inflammation https://peerj.com/articles/929.pdf https://peerj.com/articles/929.pdf does this demonstrate that depression is caused by a variety of factors not just one's linked to serotonin even though serotonin plays a part with the immune system?

kolinko 5y ago

The article says 2 out 15 improved in the control group.

mlyle 5y ago
Likely more than 2 of 15 improved. The numbers to compare are 2 of 15 remission vs. 11 of 14 remission-- not <<unknown>> of 15 improved vs. 12 of 14 improved.

nine_k 5y ago

For a treatment-resistant condition, 50% success rate can be worth the effort.

Jeff_Brown 5y ago
Hell, 5% is worth the effort if it's little enough effort or the condition is severe enough. 80% is incredible if it holds up.
- bencollier49 5y ago
  Not if it utterly ruins the remaining 20%. Or results in Lewy-Body Dementia in old age, or, or.. That's my concern here.

Lammy 5y ago

Does this also imply the possibility of the inverse, magnetically making people depressed?

jrumbut 5y ago
This is a great comment. I've always been a little uncomfortable with the thought of this magnetic treatment in a way I couldn't put into words and this nails it. I'm willing to trust, perhaps naively, that everyone is getting the same Prozac tablets. But how does the skill of the practitioner and maintenance of their magnetic treatment device affect outcomes? It's almost like a surgery, but I'm not sure who's actually been trained to perform it. Which isn't to say someone shouldn't do it, just my own feelings based on limited understanding. Perhaps if I knew more I would have greater faith.
- nvrspyx 5y ago
  The trial used fMRI data to find a cortical area that has functional connectivity with the DLPFC. That area is then targeted with a neuronavigation system (similar to AR), that helps the clinician place the TMS coil at the right spot and the right angle. This in addition to the magnitude of the pulses being based on the patient's threshold (e.g. minimum amount of stimulation that causes motor movement when used over the motor cortex) is what is meant by "personalized". It's also of note that the treatment takes place over multiple days and there's multiple sessions in a day. During that time, patients are continuously evaluated. This trial was also only used on patients with treatment-resistant depression (i.e. have tried many different medications and forms of therapy, some included ECT) and were screened as such. From my understanding, the treatment was explored as a "last resort" for those that could find no other medical relief, but this obviously has further implications.
- Benjammer 5y ago
  Do you have the same feelings about radiation therapy for cancer?
  - mlyle 5y ago

heavyset_go 5y ago

> Makes me wonder what percentage of the placebo group improved? For future reference, assuming this is a clinical trial, data from clinical trials is available online. This is the kind of statistic that you'd be able to find.

Noumenon72 5y ago
But it must be difficult to do so, or you would have done a lmgtfy link or comment like "Just search the study title and look at table 12."

londons_explore 5y ago

I wonder what results you'd get if you tried a treatment which was literal torture...? Eg. "We'll poke this red hot poker into you 10 times to cure your depression"... Many painful screams later... "So, is the depression any better now, or should we do more treatment?".. "Yes, yes, I'm pretty much cured!". How can we be sure that this 'torture effect' isn't whats being measured here? Especially when the treatment appears to have unpleasent side effects, and the success of the treatment is measured with patient feedback...

deleted 5y ago
[deleted]
arcticfox 5y ago
Wouldn't the patients just opt out of the trial rather than continue and lie to the researchers? Nobody's being forced into it
- hsn915 5y ago
  You can't assume that. Part of being depressed is you don't even have the will to resist being treated in a way that you don't like. In fact, I'd say that feeling powerless against conditions that you don't like is the core of what depression is. It's why someone who is depressed doesn't feel like doing anything, because they feel like no matter what they do nothing will ever change so nothing they do is ever worth the effort.
hsn915 5y ago
It doesn't need to be that intrusive. Just mildly uncomfortable .. for a period of time longer than one would be willing to tolerate. Something like being at the dentist when you have many cavities in your teeth. You can tolerate one or two sessions. But the idea of doing it every day for two weeks straight is unbearable enough that you decide on the third day to report feeling well.

robbedpeter 5y ago

>>In contrast, only two of the 15 participants who had received the placebo met the criteria for remission.