SINGAPORE: In a Southeast Asian first, Singapore researchers are embarking on a promising approach to combat treatment-resistant depression.

The pilot program utilizes personalized transcranial magnetic stimulation therapy, offering a potential lifeline to patients struggling with mental health conditions.

The trials, named APIC-TMS (Asia Pacific Individual Connectomics-Transcranial Magnetic Stimulation) and SPARK-D (Singapore’s Precision Approach for Relief from Depression), are a collaborative effort between the Institute of Mental Health (IMH) and the Yong Loo Lin School of Medicine at the National University of Singapore (NUS Medicine).

The trials, funded by the Temasek Foundation and the National Medical Research Council (NMRC) with grants of S$1 million each, aim to assess the effectiveness of personalised treatment-resistant depression in achieving remission for patients.

Both clinical trials will run concurrently from March 2024 to 2026. The trials will only recruit individuals who have exhausted conventional treatment options, such as psychiatric treatment for major depressive disorder, and failed to achieve remission.

“The severity of depression lies on a spectrum – many people will see their symptoms improve or remit with initial treatments such as medication and psychotherapy.

But there are some whose conditions are treatment-resistant and who require a longer treatment period to achieve remission or sufficient alleviation to resume day-to-day functioning,” said Dr Tor Phern Chern, Senior Consultant, Department of Mood & Anxiety, Head of Neurostimulation Service, IMH, and Principal Investigator for the clinical trials.

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Singapore is the first country in Southeast Asia to conduct clinical trials of personalised TMS, which is modelled after the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) protocol.

In pilots done with American subjects who had treatment-resistant depression, approximately 80% of patients achieved remission with SAINT.

The Singapore pilots will pair IMH’s clinical expertise in standard TMS with NUS Medicine’s expertise in brain MRI to personalise a treatment plan for each participant, study its efficacy and recommend implementing this as a mainstream treatment.

“Published evidence from SAINT has shown us that personalised TMS can potentially bring about a paradigm shift in the management of treatment-resistant depression, going from a months-to-years long treatment to a rapid procedural one that delivers significant outcomes in a much shorter period.

The success with SAINT – which enabled patients to participate more fully in their lives and that of their loved ones after treatment, or return to work and find more fulfilment – gives us confidence that similar outcomes may be achieved in Singapore.

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With these clinical trials, we hope to validate the efficacy of this precision modality in helping persons with treatment-resistant depression achieve remission and improve their quality of life,” explained Dr Tor.

Highlighting the significance of brain imaging, Assoc Prof Thomas Yeo, Deputy Director of the Centre for Translational Magnetic Resonance Research at NUS Medicine, pointed out that functional magnetic resonance imaging (fMRI) offers a unique advantage: it safely captures activity within the living human brain, a crucial step for personalizing treatment plans.

“By using this newly-developed machine-learning algorithm to clearly outline high-quality individualised brain networks from the limited quantity of functional MRI data, we are able to locate the exact spot unique to each patient, and stimulate it to treat their depression disorder as accurately as possible,” mentioned Assoc Prof, who is also a co-Principal Investigator for both the clinical trials.

‘Major Depressive Disorder’, commonly known as depression, is a prevalent mental health issue affecting one in 16 adults in Singapore.

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While psychotherapy and medication offer a lifeline for many in mild to moderate cases, a significant portion grapples with treatment-resistant depression, where symptoms stubbornly persist despite standard therapies and treatment.

“Major depressive disorder is a serious public health challenge. According to the Singapore Mental Health Study conducted in 2016, it affects one in 16 adults in Singapore.

Temasek Foundation is committed to catalyse our support for breakthrough efforts in healthcare innovations such as this.

The milestone pilot trials by IMH and NUS will be a transformative step to open up opportunities for patients with treatment-resistant depression and their families.

Temasek Foundation is heartened to partner both IMH and NUS on this journey, creating impactful work together with NMRC,” expressed Heng Li Lang, Head of Climate & Liveability at Temasek Foundation.

Treatment-resistant depression can be incredibly challenging, impacting daily life and overall well-being.

With new technology and trials being tested, personalised transcranial magnetic stimulation, which is a form of magnetic brain stimulation, may just offer a beacon of hope to those suffering from treatment-resistant depression.