Singapore launches targeted brain stimulation trials to manage treatment-resistant depression

SINGAPORE: Singapore launches trials for targeted brain stimulation to manage treatment-resistant depression (TRD).

These trials, spearheaded by the Institute of Mental Health (IMH) and the Yong Loo Lin School of Medicine at the National University of Singapore (NUS Medicine), employ personalised transcranial magnetic stimulation (TMS) specifically designed for Asian brains.

TMS is a non-invasive therapy that uses magnetic fields to modulate neural activity in specific brain regions.

The trials, named the Asia Pacific Individual Connectomics—Transcranial Magnetic Stimulation (APIC-TMS) and Singapore’s Precision Approach for Relief from Depression (SPARK-D), are inspired by the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol.

What sets these trials apart is using a locally developed targeting algorithm created by Dr Ruby Kong and Associate Professor Thomas Yeo from NUS.

This algorithm enhances the accuracy and reliability of TMS targets using less functional magnetic resonance imaging (fMRI) data, making it more applicable to Asian populations.

According to Singapore Business Review, Dr Thomas Yeo, co-principal investigator of the trials, highlighted the algorithm’s relevance to Asian brains and its potential for more precise analyses compared to the SAINT protocol, tested and developed for the Caucasian population.

The trials aim for an 80% remission rate, similar to SAINT, but tailored for an Asian population. Dr Tor Phern Chern, senior consultant at IMH and principal investigator for both trials, reported positive results from the initial participants, all of whom showed remission of depressive symptoms.

A total of 20 participants will be recruited for the APIC-TMS trial and 70 for the SPARK-D trial. Dr Tor expressed that it gives them confidence in achieving outcomes similar to SAINT, demonstrating significant improvements in patients’ lives.

Personalised TMS, employed in the trials, utilises fMRI to identify the optimal stimulation site in each patient’s brain, enhancing precision with a high-precision robot arm.

Dr Yeo emphasised that the algorithm aims to personalise and increase treatment precision, potentially leading to better outcomes and faster recovery times.

The introduction of the Singapore version of the SAINT protocol marks a milestone in the region’s healthcare system, addressing the significant prevalence of depression.

The 2016 Singapore Mental Health Study revealed 6.3% of the population experiencing major depressive disorder, indicating the pressing need for effective treatments.

While specific figures on TRD cases in Singapore are unavailable, global estimates range from 12% to 55%, highlighting the importance of alternative treatments beyond conventional pharmacology and psychotherapy.

Dr Tor emphasised Singapore’s commitment to addressing mental health with the “seriousness and sophistication it demands.” /TISG

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