Neuromodulation and depression
Neuromodulation and depression
This thesis aims to contribute to the improvement of the treatment of major depressive disorder (MDD) by using non-invasive neuromodulation: stimulation of the brain by using electromagnetic forces. It will focus specifically on patients with treatment resistant depression and the use of a particular novel neuromodulation device to treat MDD: transcranial Pulsed Electromagnetic Fields (tPEMF).In seven chapters (including introduction and discussion), first the effects of tPEMF and related neuromodulation devices will be described. Then a study will be presented focusing on quantification and prediction of treatment resistant depression using the Maudsley Staging Method (MSM). Last, the results will be presented of a randomized placebo-controlled double blind clinical trial to study the efficacy of tPEMF as a potential novel treatment for MDD. This last part will focus on the short- and long-term effects of tPEMF on TRD and on the effect of tPEMF on brain activation. Although tPEMF seemed like a promising new treatment option for depression, no clinical effects of tPEMF were found in our study. This suggests that tPEMF is less efficacious then previously thought. However, we did find an effect of tPEMF on brain activation, showing a change in the regulation of the reward-system as a possible result of tPEMF stimulation. This does suggest that tPEMF has a small effect on the brain. In the discussion of this thesis the relevance is emphasized of employing biological markers besides clinical markers to study efficacy and underlying mechanisms of novel neuromodulation treatments for MDD.