tag:theconversation.com,2011:/fr/topics/transcranial-magnetic-stimulation-25997/articlesTranscranial magnetic stimulation – The Conversation2023-08-28T20:03:47Ztag:theconversation.com,2011:article/2114172023-08-28T20:03:47Z2023-08-28T20:03:47ZTranscranial magnetic stimulation can treat depression. Developing research suggests it could also help autism, ADHD and OCD<p>Since the start of the COVID pandemic, there has been more attention given to problems of mental ill-health including depression <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01328-9/fulltext">than ever before</a>. A new therapeutic option, especially for depression, transcranial magnetic stimulation, is slowly helping to address some of these considerable unmet needs in our community. </p>
<p>Research is also exploring the use of transcranial magnetic stimulation in many other conditions, including obsessive compulsive disorder, autism, attention deficit hyperactivity disorder, chronic pain and perhaps to slow the progression of dementia symptoms.</p>
<p>What do we know so far about this emerging form of treatment? And is it living up to its promise for people with depression?</p>
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Read more:
<a href="https://theconversation.com/treating-mental-illness-with-electricity-marries-old-ideas-with-modern-tech-and-understanding-of-the-brain-podcast-195071">Treating mental illness with electricity marries old ideas with modern tech and understanding of the brain – podcast</a>
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<h2>How does it work and who’s getting it now?</h2>
<p><a href="https://theconversation.com/what-is-repetitive-transcranial-magnetic-stimulation-and-how-does-it-actually-work-160771">Transcranial magnetic stimulation</a> involves the application of a series of magnetic pulses through a coil placed on the scalp. While the patient sits in a chair awake and relaxed, the magnetic field activates nerve cells in the brain, gradually changing the activity of brain circuits disrupted in depression. This is thought to help restore the normal interaction between brain regions.</p>
<p>Side effects are <a href="https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625#:%7E:text=Serious%20side%20effects%20are%20rare,t%20well%2Dprotected%20during%20treatment.">usually mild</a> and temporary. They may include scalp discomfort, headache, tingling or facial twitching, and feeling lightheaded for a short time after a treatment session.</p>
<p>There is consistent evidence for the <a href="https://journals.sagepub.com/doi/10.1177/00048674211043047">effectiveness</a> of transcranial magnetic stimulation treatment for acute episodes of depression. Its use is supported by many clinical trials as well as real-world studies showing benefits in more than <a href="https://pubmed.ncbi.nlm.nih.gov/32799106/">50% of patients receiving treatment</a>. It attracted Medicare funding several years ago and is now being progressively rolled out around Australia. </p>
<p>But there are several remaining problems with the use of transcranial magnetic stimulation treatment. First, it involves a patient coming into the clinic daily, Monday to Friday, for four to six weeks. This is inefficient and costly. </p>
<p>Both these problems may ultimately be solved through the development of what are referred to as “accelerated” protocols – treatments that give higher doses on fewer days. A patient may have four or five days of high-dose treatment in one week rather than having all of the treatment dose spread out over a month or more. </p>
<p><a href="https://www.nature.com/articles/s41386-023-01599-z">Studies</a> both locally and overseas have started to show more efficient delivery and <a href="https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.19070720">very rapid clinical benefits</a> with these new treatment regimes.</p>
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<a href="https://images.theconversation.com/files/543401/original/file-20230818-4259-mewpzs.png?ixlib=rb-1.1.0&rect=65%2C5%2C3928%2C1988&q=45&auto=format&w=1000&fit=clip"><img alt="man sits in lab setting with equipment on" src="https://images.theconversation.com/files/543401/original/file-20230818-4259-mewpzs.png?ixlib=rb-1.1.0&rect=65%2C5%2C3928%2C1988&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543401/original/file-20230818-4259-mewpzs.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543401/original/file-20230818-4259-mewpzs.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543401/original/file-20230818-4259-mewpzs.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543401/original/file-20230818-4259-mewpzs.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543401/original/file-20230818-4259-mewpzs.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543401/original/file-20230818-4259-mewpzs.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The lasting effects and need for maintenance doses of transcranial magnetic stimulation need further study.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/patient-transcranial-magnetic-stimulation-tms-experiment-426901186">Shutterstock</a></span>
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<h2>What about for other conditions?</h2>
<p>Alongside the clinical rollout of transcranial magnetic stimulation for depression, research is increasingly demonstrating its potential value in other conditions. </p>
<p>A series of studies have demonstrated that a somewhat different type of transcranial magnetic stimulation, which is able to stimulate deeper regions of the brain but which still comes from a scalp based coil, can be effective in the treatment of symptoms in some patients with <a href="https://iocdf.org/about-ocd/ocd-treatment/tms/">obsessive compulsive disorder</a> (OCD). This is a critical development as many patients with OCD fail to improve with medication and psychological treatments and there are few new therapies in development for the condition. </p>
<p>Transcranial magnetic stimulation for OCD has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864803/#:%7E:text=Aside%20from%20MDD%2C%20the%20next,adults%20in%202017%20(DEN170078).">approved</a> for clinical use in the United States and is available in a limited number of clinical services in Australia.</p>
<p>The treatment is showing promise for <a href="https://www.mdpi.com/2077-0383/11/3/624">addiction disorders</a>, including the development of an approach using transcranial magnetic stimulation to <a href="https://www.sciencedirect.com/science/article/pii/S0165178123002901">help patients stop smoking</a>. The initial trial of this approach showed at least a doubling of the percentage of patients who did not smoke over the first six weeks. </p>
<p>Transcranial magnetic stimulation may also help people manage chronic pain. Multiple approaches that use the technology show promise and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0987705319301789?via%3Dihub">guidelines are emerging</a>, but a consistent clinical pathway has not yet been well defined.</p>
<p>A group of researchers across the country, led by <a href="https://tmsautism.com/">Professor Peter Enticott in Melbourne</a>, are conducting world-leading research trying to develop ways of using transcranial magnetic stimulation to help adolescent and adult patients with autism, especially to improve capacity for social understanding and interaction.</p>
<p>As clinical need escalates, early research is also exploring whether transcranial magnetic stimulation might alleviate symptoms of <a href="https://mecp.springeropen.com/articles/10.1186/s43045-022-00210-3">attention deficit hyperactivity disorder (ADHD)</a>. </p>
<p>Research has already demonstrated transcranial magnetic stimulation may improve, at least temporarily, thinking abilities in a range of disorders including <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2022.984708/full">Alzheimer’s disease</a>. This is now being applied to see if it can improve attention for patients with ADHD. For now, this research remains in its infancy.</p>
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<h2>Do the effects last?</h2>
<p>So far, the quality of the <a href="https://doi.org/10.1016/j.jad.2021.09.040">evidence</a> on the persistence of effects and the need for maintenance treatment with the use of transcranial magnetic stimulation in depression is patchy. Research is looking at whether ongoing transcranial magnetic stimulation less often (for example one treatment every two weeks) may prevent the recurrence of depression in patients who have responded well. <a href="https://pubmed.ncbi.nlm.nih.gov/31399997/">Preliminary studies</a> suggest maintenance treatment is effective, but there there have been insufficient high-quality studies to convince Medicare to provide a subsidy for it. </p>
<p>Medicare funding also does not fund the provision of transcranial magnetic stimulation for patients who experience the return of their depression on more than one occasion.</p>
<p>This is highly unusual. Patients with depression can have multiple courses of antidepressant medication, psychotherapy or electroconvulsive therapy based on similar levels of evidence. This is also true of most other medical therapies. </p>
<p>In clinical practice, and from the <a href="https://doi.org/10.1016/j.jad.2020.06.067">limited evidence available</a>, it seems clear that if a patient has responded on one occasion to transcranial magnetic stimulation, they are likely to again. Until this is resolved, patients are in an unenviable situation. They know there is an effective treatment that has worked for them already, but they can only access it at considerable expense or via lengthy private hospital admission.</p><img src="https://counter.theconversation.com/content/211417/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Fitzgerald is a founder of TMS Clinics Australia / Monarch Mental Health Group which provides rTMS therapy through 21 clinics in three states of Australia. He has received grant funding from the NHMRC to support clinical trials into the use of rTMS. He was the author of several applications to the Medicare Services Advisory Committee seeking an item number for rTMS therapy for depression which led to the current approval.</span></em></p>What do we know so far about this promising form of treatment and how it might help people with a range of neurological conditions? And is it living up to its promise for people with depression?Paul B. Fitzgerald, Professor of Psychiatry, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2060222023-06-06T16:35:14Z2023-06-06T16:35:14ZMagnet therapy for depression is available on the NHS – here’s how it works<p>Magnets to treat depression? It may sound bizarre, but this treatment is now <a href="https://www.bbc.co.uk/news/uk-england-somerset-65609340">available on the NHS</a>. It’s called transcranial magnetic stimulation, or TMS. </p>
<p>People who have tried antidepressants but they haven’t worked, may be offered TMS. It involves zapping areas of the brain associated with depression with pulsing magnetic fields.</p>
<p>Treatment usually involves <a href="https://www.southernhealth.nhs.uk/our-services/a-z-list-of-services/repetitive-transcranial-magnetic-stimulation-rtms">daily half-hour sessions</a> five days a week for two to six weeks.</p>
<p>TMS is not just used to treat depression, it has been used as a diagnostic tool for <a href="https://pubmed.ncbi.nlm.nih.gov/36131925/">multiple sclerosis</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/10449127/">motor neuron disease</a>. And its effectiveness in treating <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790310/">mood disorders</a>, such as depression and anxiety, has been under investigation for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4815479/">more than 30 years</a>.</p>
<p>It works by sending a magnetic pulse into the brain through a device placed on the skull. </p>
<h2>Developing the right device</h2>
<p>So-called “refractory depression” – depression that does not respond to antidepressants or talk therapy – can be effectively treated with <a href="https://theconversation.com/electroconvulsive-therapy-does-work-and-it-can-be-miraculous-76381">electroconvulsive therapy</a> (ECT). But ECT is fairly invasive, sending bolts of electricity through the skull and into the brain. With TMS, an electrical change in the brain happens because of the magnetic field happening outside of the skull. This is called electromagnetic induction and was <a href="https://www.britannica.com/science/electromagnetism/Faradays-discovery-of-electric-induction">discovered by Michael Faraday in 1831</a>.</p>
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<img alt="Photo of Michael Faraday" src="https://images.theconversation.com/files/530319/original/file-20230606-15-bln4rc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/530319/original/file-20230606-15-bln4rc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=863&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530319/original/file-20230606-15-bln4rc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=863&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530319/original/file-20230606-15-bln4rc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=863&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530319/original/file-20230606-15-bln4rc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1085&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530319/original/file-20230606-15-bln4rc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1085&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530319/original/file-20230606-15-bln4rc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1085&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Michael Faraday discovered electromagnetic induction.</span>
<span class="attribution"><a class="source" href="https://wellcomeimages.org/indexplus/obf_images/86/76/b53d681751b952d72142c23a2b24.jpg">Wellcome Collection/Wikimedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Over the <a href="https://journals.sagepub.com/doi/abs/10.1177/1073858413491145?journalCode=nroa">next century</a>, scientists and doctors such as Jacques-Arsèn d’Arsonval and Sylvanus P. Thompson created devices that sought to artificially stimulate the nervous system, the former for an early defibrillator device and the latter to stimulate the brain. But they were so bulky and the amount of power needed to produce the rapidly changing magnetic field that was required made their development difficult.</p>
<p>It wasn’t until 1985 and the work of medical physicist <a href="https://www.youtube.com/watch?v=1DI3EC2pQ44">Anthony Barker at Sheffield University</a> that led to the creation of a compact, relatively inexpensive device that allowed scientists to stimulate 1cm³ area of the brain at time intervals of their choosing for fractions of a second. It is safe and is applied while the patient is awake.</p>
<p>The technique is used to treat depression and anxiety in two specific ways. Sending repetitive pulses into the brain at different frequencies can have different effects. </p>
<p>In depression, we know that <a href="https://thebrain.mcgill.ca/flash/i/i_08/i_08_cr/i_08_cr_dep/i_08_cr_dep.html#:%7E:text=And%20indeed%2C%20in%20depressed%20people,such%20goals%20can%20be%20achieved.">activity is low in the left prefrontal cortex</a> – the area of the brain that is important in planning and thought processes. So using a higher frequency pulse switches on those neurons to help them work as they should, thus alleviating the depression symptoms. </p>
<p>In contrast, the prefrontal area on the right side of the brain, which is known to be overactive in cases of anxiety, is treated with lower frequencies to calm the activity in that area.</p>
<p>Using this effect of changing how neurons talk to each other (called neuroplasticity), it is hoped that with regular treatment, symptoms will be alleviated. </p>
<p>The treatment is administered as the patient sits in an armchair and feels something akin to a light tapping on the skull. </p>
<h2>Safe, but long-term results are needed</h2>
<p>A <a href="https://gpsych.bmj.com/content/32/4/e100074">review of TMS for treating depression</a> found mixed evidence and called for longer-term studies. But it is clear that there is <a href="https://pubmed.ncbi.nlm.nih.gov/30249416/">benefit</a> for people with refractory depression, and it is safe in older adults and pregnant people.</p>
<p>TMS is safe to administer to those who do not have metal, such as aneurysm coils, metal dental appliances or non-removable piercings in their head or metal-containing pigments on their faces. But it is not advised for people who have epilepsy. </p>
<p>The treatment has several advantages over ECT. With TMS, the patient does not need to be anaesthetised; they do not experience a seizure, and they do not have memory loss after the treatment.</p>
<p>Using TMS in more clinics will provide scientists with more data to determine when it works and for whom, and what protocols are optimal. For example, TMS may have greater and longer-lasting benefits when paired with cognitive behavioural therapy (a type of talk therapy) – as has been shown with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918025/">antidepressants combined with CBT</a>. </p>
<p>But it is certainly a technique – forged in the fire of cognitive neuroscience – that can have a great effect on those desperate for help.</p><img src="https://counter.theconversation.com/content/206022/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amanda Ellison does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Transcranial magnetic stimulation is a safe, well-tolerated way to treat depression.Amanda Ellison, Professor of Neuroscience, Durham UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1950712022-11-24T11:09:42Z2022-11-24T11:09:42ZTreating mental illness with electricity marries old ideas with modern tech and understanding of the brain – podcast<figure><img src="https://images.theconversation.com/files/497106/original/file-20221123-26-b9b1b1.png?ixlib=rb-1.1.0&rect=64%2C27%2C962%2C556&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In deep brain stimulation, electrodes – the pale white lines – are implanted into a patient's brain and connected to a battery in a person's chest.
</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:X-ray_of_deep_brain_stimulation_in_OCD,_L.png#/media/File:X-ray_of_deep_brain_stimulation_in_OCD,_L.png">Jmarchn/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Mental illnesses such as obsessive compulsive disorder, depression and addiction are notoriously hard to treat and often don’t respond to drugs. But a new wave of treatments that stimulate the brain with electricity are showing promise on patients and in clinical trials. In this episode of <a href="https://theconversation.com/uk/topics/the-conversation-weekly-98901">The Conversation Weekly</a> podcast, we talk to three experts and one patient about the history of treating mental illness, how new technology and deeper understanding of the brain are leading to better treatments and where the neuroscience of mental illness is headed next. </p>
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<p>It’s not uncommon to hear people joke about how their “OCD” makes them want to straighten a crooked picture or clean a smudge on a countertop, but for people actually living with severe obsessive compulsive disorder, the reality is anything but funny.</p>
<p><a href="https://som.ucdenver.edu/Profiles/Faculty/Profile/30555">Moksha Patel</a> is a physician and professor at the University of Colorado and has severe OCD. “OCD was really taking over my life. The most obvious of my symptoms were not being able to use any public restrooms, showering for an hour after using the restrooms each time and using chemical cleaners on my skin and my mouth,” he says. After struggling for years, Patel eventually connected with <a href="https://www.uchealth.org/provider/rachel-davis-md/">Rachel Davis</a>, a psychiatrist and researcher also at the University of Colorado. Davis suggested that he could be a good candidate for deep brain stimulation as a treatment for his OCD. </p>
<p>“Deep brain stimulation involves the implantation of electrodes in the deeper areas of the brain,” Davis explains. These electrodes then transfer into the brain itself small electrical currents that a doctor and their patient try to tune correctly. As Davis explains, “Basically we’re looking to find the settings where the patient feels that their mood is better, their anxiety is less and they have more energy.”</p>
<p>Deep brain stimulation works well for a lot of patients and has only started to get mainstream attention in the past decade or so, but ideas underlying this treatment are nearly 60 years old. As explained by <a href="https://directory.weill.cornell.edu/person/profile/jjfins">Joseph Fins</a>, a neuroethicist and professor of medicine at Weill Cornell Medical College, part of Cornell University in the US, it all started with a Spanish neuroscientist named Jose Manuel Rodriguez Delgado in 1964. “He put a thing called the stimoceiver, a deep brain stimulator, into the brain of a charging bull. And with an electrical current controlled by radio frequency, he was able to stop the bull in its tracks.”</p>
<p>While this work got Delgado on the front page of The New York Times, it came on the heels of a horrific era of mental health treatment that involved lobotomies, electroshock therapy and many other destructive and deeply unethical interventions. So when researchers began to discover drugs that could help people with mental illness, Fins says “psychosurgery and these types of somatic therapies began to fall out of favor and physicians moved away from more physical interventions.”</p>
<p>As modern neuroscience led to better understanding of how the brain works, and stigma surrounding physical treatments faded, deep brain stimulation got its second chance in the sun. And as technology has improved, researchers like <a href="https://scholar.google.com/citations?user=BD8dNTUAAAAJ&hl=en&oi=ao">Jacinta O'Shea, a neuroscientist</a> at the University of Oxford have begun to study a noninvasive technique for stimulating the brain with electricity, called transcranial magnetic stimulation. </p>
<p>“If you place a ferromagnetic coil on the scalp and pass a rapidly changing electrical current through that coil, it will induce an electric field that passes painlessly through the skull and into the brain tissue underneath,” O'Shea explains. And just as with deep brain stimulation, these electrical fields can help people overcome mental health issues like depression.</p>
<p>Researchers still don’t quite know how deep brain stimulation or transcranial magnetic stimulation work, but with every new treatment, they are learning more about the complicated world of the brain and taking steps toward the treatments of tomorrow.</p>
<p>Listen to the full episode of The Conversation Weekly to find out more. </p>
<p>This episode was produced and written by Katie Flood and Daniel Merino, with sound design by Eloise Stevens. The executive producer was Gemma Ware. Our theme music is by Neeta Sarl. </p>
<p>You can find us on Twitter <a href="https://twitter.com/TC_Audio">@TC_Audio</a>, on Instagram at <a href="https://www.instagram.com/theconversationdotcom/">theconversationdotcom</a> or <a href="mailto:podcast@theconversation.com">via email</a>. You can also sign up to The Conversation’s <a href="https://theconversation.com/newsletter">free daily email here</a>. A transcript of this episode is <a href="https://cdn.theconversation.com/static_files/files/2792/Ep82_Neural_Psychiatry_Transcript.pdf?1694452606">available now</a>.</p>
<p>Listen to The Conversation Weekly via any of the apps listed above, download it directly via our <a href="https://feeds.acast.com/public/shows/60087127b9687759d637bade">RSS feed</a>, or find out <a href="https://theconversation.com/how-to-listen-to-the-conversations-podcasts-154131">how else to listen here</a>.</p><img src="https://counter.theconversation.com/content/195071/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jacinta O'Shea has consulted for Welcony Inc and is currently on the Scientific Advisory Board of Plato Science. She receives research funding from the Wellcome Trust/Royal Society and the Academy of Medical Sciences in the U.K.
Joseph Fins receives funding from the U.S. National Institutes of Health BRAIN Initiative, Dana Foundation, Greenwall Foundation, Robert Wood Johnson Foundation, Buster Foundation, NIH CTSC, NIH Eunice Kennedy Shriver National Institute of Child Health, Blythedale Children’s Hospital and from numerous editorial boards. He is also the president of the International Neuroethics Society, Chair-Elect and board member of The Hastings Center and a Trustee Emeritus at Wesleyan University</span></em></p><p class="fine-print"><em><span>Rachel Davis consults for Medtronic, Inc. She receives funding from the U.S. National Institutes of Health.
Moksha Patel has nothing to disclose. </span></em></p>Deep brain stimulation and trasncranial magnetic stimulation treat mental illness by sending electrical currents into parts of the brain. Every new patient provides researchers with a wealth of information. Listen to The Conversation Weekly podcast.Daniel Merino, Associate Science Editor & Co-Host of The Conversation Weekly Podcast, The ConversationGemma Ware, Editor and Co-Host, The Conversation Weekly Podcast, The ConversationLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1867372022-11-16T13:29:25Z2022-11-16T13:29:25ZPatients suffering with hard-to-treat depression may get relief from noninvasive magnetic brain stimulation<figure><img src="https://images.theconversation.com/files/477266/original/file-20220802-18-nnapcv.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5218%2C3931&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Transcranial magnetic stimulation has worked when medication and other therapies have not.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/patient-in-transcranial-magnetic-stimulation-royalty-free-image/548557027?adppopup=true">Monty Rakusen/Image Source via Getty Images</a></span></figcaption></figure><p>Not only is depression a debilitating disease, but it is also widespread. Approximately 20 million adult Americans experience at least <a href="https://www.nimh.nih.gov/health/statistics/major-depression">one episode of depression per year</a>. </p>
<p>Millions of them <a href="https://www.cdc.gov/nchs/products/databriefs/db377.htm#:">take medication</a> to treat their depression. But for many, the <a href="https://www.webmd.com/depression/guide/treatment-resistant-depression-what-is-treatment-resistant-depression">medications don’t work</a>: Either they have minimal or no effect, or the side effects are intolerable. These patients have what is called <a href="https://www.mayoclinic.org/diseases-conditions/depression/in-depth/treatment-resistant-depression/art-20044324">treatment-resistant depression</a>. </p>
<p>One promising treatment for such patients is a type of brain stimulation therapy <a href="https://www.healthline.com/health/tms-therapy#What-is-TMS-therapy">called transcranial magnetic stimulation</a>. </p>
<p>This treatment is not new; it has been around since 1995. The U.S. Food and Drug Administration <a href="https://doi.org/10.1016/j.brs.2021.11.010">cleared transcranial magnetic stimulation in 2008</a> for adults with “non-psychotic treatment-resistant depression,” which is typically defined as a failure to respond to two or more antidepressant medications. More recently, in 2018, the FDA cleared it for <a href="https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder#">some patients with obsessive-compulsive disorder</a> and <a href="https://www.fda.gov/consumers/consumer-updates/want-quit-smoking-fda-approved-and-fda-cleared-cessation-products-can-help#">smoking cessation</a>. </p>
<p>Insurance <a href="https://www.mytransformations.com/post/the-ultimate-guide-to-tms-therapy-and-insurance-coverage">generally covers these treatments</a>. Both the psychiatrist and the equipment operator must be certified. While the treatment has been available for years, the equipment to perform the procedure remains expensive enough that few private psychiatry practices can afford it. But with the growing recognition of the potential of transcranial magnetic stimulation, the price will likely eventually come down and access will be greatly expanded.</p>
<h2>Does it work?</h2>
<p>Transcranial magnetic stimulation is a noninvasive, pain-free procedure that has minimal to no side effects, and it often works. Research shows that 58% of once treatment-resistant patients experience <a href="https://doi.org/10.1002/da.21969">a significant reduction in depression</a> following four to six rounds of the therapy. More than 40 independent clinical trials – with more than 2,000 patients worldwide – have demonstrated that repetitive transcranial magnetic stimulation <a href="https://doi.org/10.1136/gpsych-2019-100074">is an effective therapy</a> for the treatment of resistant major depression. </p>
<p><a href="https://medicine.fiu.edu/about/faculty-and-staff/profiles/psychiatry-and-behavioral-health/junquera,-patricia.html">As a professor and psychiatrist</a> who has used transcranial magnetic stimulation to treat some of my patients, I have seen depression symptoms decrease even within the first two weeks of treatment. What’s more, the effects continue after the treatment has ended, typically for six months to a year. After that, the patient has the option of maintenance treatment. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/pfy0t5Yapco?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Transcranial magnetic stimulation helps increase blood flow and dopamine levels in the brain.</span></figcaption>
</figure>
<h2>About the procedure</h2>
<p>For the patient, the procedure is easy and simple. One sits in a comfortable chair with a snug pillow that holds their head in place, puts on earplugs and can then relax, check their phone, watch TV or read a book.</p>
<p>A treatment coil, which looks like a figure 8, is placed on the patient’s head. A nearby stimulator sends an electrical current to the coil, which transforms the current into <a href="https://www.livescience.com/38059-magnetism.html">a magnetic field</a>. </p>
<p>The field, which is highly concentrated, turns on and off rapidly while targeting a portion <a href="https://neuroscientificallychallenged.com/posts/know-your-brain-prefrontal-cortex">of the prefrontal cortex</a> – the area of the brain responsible for mood regulation. </p>
<p>Researchers know that people suffering from depression have reduced blood flow and less activity in that part of the brain. Transcranial magnetic stimulation causes increases in both blood flow and in the levels of <a href="https://www.healthdirect.gov.au/dopamine#">dopamine</a> and <a href="https://doi.org/10.1007/s00702-014-1180-8">glutamate</a> – two neurotransmitters that are responsible for brain functions like concentration, memory and sleep. It’s the repeated stimulation of this area – the “depression circuit” of the brain – that brings the antidepressant effect. </p>
<h2>It is not ‘electroshock’ or deep brain stimulation</h2>
<p>Some people confuse transcranial magnetic stimulation with <a href="https://www.psychiatry.org/patients-families/ect#">electroconvulsive therapy</a>, a procedure used for patients with severe depression or catatonia. With electroshock therapy, the anesthetized patient receives a direct electrical current, which causes a seizure. Typically, people who undergo this procedure experience <a href="https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894#:">some memory loss after treatment</a>. </p>
<p>Transcranial magnetic stimulation is very different. It doesn’t require anesthesia, and it doesn’t affect memory. The patient can resume daily activities right after each treatment. Dormant brain connections are reignited without causing a seizure.</p>
<p>It should also not be confused with <a href="https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562">deep brain stimulation</a>, which is a surgical procedure used <a href="https://theconversation.com/deep-brain-stimulation-can-be-life-altering-for-ocd-sufferers-when-other-treatment-options-fall-short-186109">to treat obsessive-compulsive disorder</a>, tremors, epilepsy and Parkinson’s disease. </p>
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<figcaption><span class="caption">Transcranial magnetic stimulation stimulates the ‘depression circuit’ in the brain.</span></figcaption>
</figure>
<h2>Side effects and access</h2>
<p>Transcranial magnetic stimulation patients undergo a total of <a href="https://www.mindpath.com/resource/what-a-typical-tms-treatment-looks-like/">36 treatments, at 19 minutes each</a>, for three to six weeks. Research has concluded that this is the best protocol for treatment. Some patients report that it feels like someone is tapping on their head. Others don’t feel anything. </p>
<p>Some very minor side effects may occur. The most common is facial twitching and scalp discomfort during treatment, sensations that go away after the session ends. Some patients report a mild headache or discomfort at the application site. Depending on how effective the therapy was, some patients return for follow-ups every few weeks or months. It can be used in addition to medications, or with no medication at all. </p>
<p>Not everyone with depression can undergo <a href="https://www.clinicaltmssociety.org/content/who-cannot-have-tms">this type of brain stimulation therapy</a>. Those with epilepsy or a history of head injury may not qualify. People with metallic fillings in their teeth are OK for treatment, but others with implanted, nonremovable metallic devices in or around the head are not. Those with pacemakers, defibrillators and vagus nerve stimulators may also not qualify, because the magnetic force of the treatment coil may dislodge these devices and cause severe pain or injury. </p>
<p>But for those who are able to use the therapy, the results can be remarkable. For me, it is amazing to see these patients smile again – and come out on the other side feeling hopeful.</p><img src="https://counter.theconversation.com/content/186737/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Junquera does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Patients who undergo transcranial magnetic stimulation say it’s painless, with few to no side effects. The treatment isn’t yet widely accessible, but for those who use it, the effects can be profound.Patricia Junquera, Associate Professor and Vice Chair of Clinical Services, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1607712021-05-13T04:46:07Z2021-05-13T04:46:07ZWhat is repetitive transcranial magnetic stimulation and how does it actually work?<figure><img src="https://images.theconversation.com/files/400433/original/file-20210513-15-crbl5n.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C561&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/human-brain-anatomical-model-3d-illustration-1133561621">from www.shutterstock.com</a></span></figcaption></figure><p>A line in this week’s federal budget <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/historic-23-billion-national-mental-health-and-suicide-prevention-plan">allocating A$288.5 million</a> to repetitive transcranial magnetic stimulation (rTMS) therapy might pass most people by.</p>
<p>This is a brain stimulation technique that’s been used to treat conditions such as depression for almost ten years in Australia, but which has not been funded through Medicare and so has had very limited availability. </p>
<p>Soon, it will be available on the Medicare Benefits Schedule for people with depression that hasn’t responded to other treatments, funding I’ve led applications for since 2012, and treatment I provide.</p>
<p>While we know rTMS <a href="https://pubmed.ncbi.nlm.nih.gov/32799106/">can work, and is generally safe</a>, we’re not entirely sure <em>how</em> it works. Here’s what the evidence says so far.</p>
<h2>What is it?</h2>
<p>In rTMS, a machine produces and applies a highly targeted, pulsed magnetic field to a specific area of the brain, towards the front, known as the prefrontal cortex. This is an area we believe isn’t working normally in people with depression.</p>
<p>During treatment, an electrical current passes through an electromagnetic coil held near the scalp to stimulate the nerve cells.</p>
<p>The person sits in a comfortable chair, awake and alert during treatment. It’s quite different from <a href="https://theconversation.com/electroconvulsive-therapy-a-history-of-controversy-but-also-of-help-70938">electroconvulsive therapy</a> (ECT, the modern version of shock treatment). Unlike ECT, rTMS does not involve producing a seizure and does not require the person to be asleep and under an anaesthetic.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/400191/original/file-20210512-16-1ypi6mm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man receiving treatment, lying down with magnetic coil on head" src="https://images.theconversation.com/files/400191/original/file-20210512-16-1ypi6mm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400191/original/file-20210512-16-1ypi6mm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400191/original/file-20210512-16-1ypi6mm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400191/original/file-20210512-16-1ypi6mm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400191/original/file-20210512-16-1ypi6mm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400191/original/file-20210512-16-1ypi6mm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400191/original/file-20210512-16-1ypi6mm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People are awake and alert during rTMS treatment.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>How does it work?</h2>
<p>We know repeated rTMS stimulation, over the course of weeks, <a href="https://pubmed.ncbi.nlm.nih.gov/21158543/">increases nerve activity</a> in the area under the coil. It also changes the <a href="https://www.sciencedirect.com/science/article/pii/S105381191730770X">strength of connections</a> between different areas of the brain. This is thought to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181968/">help restore</a> the normal interaction between brain regions, although these ideas are still theoretical and definitely not proven. </p>
<p>Antidepressant medications may act in similar ways, but less directly. The chemicals they affect can influence brain function quite widely: <a href="https://www.frontiersin.org/articles/10.3389/fnhum.2015.00582/full">tuning activity</a> or connectivity in brain circuits up or down. rTMS probably does this more directly. By directly making nerve cells fire we can directly change their activity levels. These more direct actions could possibly explain why rTMS may work in some people who have not responded to medication.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/21158543/">Trials show</a> rTMS treatments result in a gradual improvement in depression. A person’s mood will slowly lift, usually over the course of several weeks, they will become more interested in things, sleep better, be more motivated and have more energy. </p>
<p>In people who respond, depression can go away for several months up to many years. If depression returns, <a href="https://journals.sagepub.com/doi/abs/10.1080/j.1440-1614.2006.01881.x">most people</a> will get better again with further treatment.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/a-bigger-budget-for-mental-health-services-wont-necessarily-improve-australias-mental-health-160767">A bigger budget for mental health services won't necessarily improve Australia's mental health</a>
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</p>
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<h2>Does it work? Is it safe?</h2>
<p>Evidence collected over the past 25 years and collated <a href="https://pubmed.ncbi.nlm.nih.gov/33111776/">shows</a> rTMS is a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0006322307001461">safe and effective</a> treatment for people with treatment-resistant depression. These are the <a href="http://www.psyche-laurier.com/litterature_psychiatrique/prevalence_and_management_of_treatment2dresistant_depression_2d_aout_2007.pdf">30-40%</a> of people diagnosed with depression who have tried antidepressant medications, usually two or more, and haven’t seen any or sufficient relief. They have persistent, ongoing depression with major effects on their ability to function, work and lead normal family lives.</p>
<p>The treatment is <a href="https://pubmed.ncbi.nlm.nih.gov/23507264/">usually well-tolerated</a>. Although some people experience a strong tapping sensation on the scalp, scalp pain during treatment, or a headache afterwards. </p>
<p>Some 25 years of research have failed to identify any <a href="https://pubmed.ncbi.nlm.nih.gov/33111776/">long-term negative consequences</a>. People are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781064/">much more likely</a> to experience significant side-effects with antidepressant medications than with rTMS.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/electrical-stimulation-of-the-brain-is-a-safe-treatment-for-depression-5721">Electrical stimulation of the brain is a safe treatment for depression</a>
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<p>Studies have also <a href="https://www.tandfonline.com/doi/full/10.1080/03007995.2016.1277201">compared the effectiveness</a> of rTMS with other treatments, such as different medications. This study, written by authors from the pharmaceutical industry, only reports the benefits of medications in the study abstract but rTMS was clearly the superior intervention on outcomes across the full analysis.</p>
<p>Finally, <a href="https://pubmed.ncbi.nlm.nih.gov/32799106/">research</a> including more than 5,000 people having the treatment shows it provides meaningful and valuable clinical benefits in the real world, outside clinical trials.</p>
<h2>This treatment isn’t perfect</h2>
<p>Like many medical treatments, rTMS is not perfect. We are trying to develop ways to improve outcomes by better individualising the treatment. For example, we are trying to better understand the exact spot to target in the brain and how to match the frequency of stimulation to an individual person’s pattern of brain activity. </p>
<p>We’re also trying to get around one of the biggest issues: its relative inefficiency. </p>
<p>A course of rTMS typically involves going to a clinic for a 30-minute treatment session, five days a week, for up to six weeks, which is time-consuming and requires a significant commitment. We are working to make the application less time-consuming and potentially shorten the duration of therapy.</p>
<p>One of the most significant implications of the government funding of rTMS therapy through Medicare is that it will become more widely available, including in outer suburban and rural areas. </p>
<p>The funding will take some months to be implemented but once available will be accessible by a referral from a GP or psychiatrist.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone
you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/160771/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Fitzgerald is a founder of TMS Clinics Australia which provides rTMS therapy through 21 clinics in three states of Australia.
He has recevied grant funding from the NHMRC to support clinical trials into the use of rTMS. He was the author of several applications to the Medicare Services Advisory Committee seeking an item number for rTMS therapy for depression which led to the current approval.</span></em></p>In this week’s federal budget we heard how this non-drug treatment for depression will be available on Medicare for people who’ve not responded to antidepressants.Paul B. Fitzgerald, Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1265822019-12-11T18:56:06Z2019-12-11T18:56:06ZHow junk food shapes the developing teenage brain<figure><img src="https://images.theconversation.com/files/306215/original/file-20191210-95130-6ls5fh.jpg?ixlib=rb-1.1.0&rect=109%2C8%2C5464%2C3152&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The teenage brain has a voracious drive for reward, diminished behavioural control and a susceptibility to be shaped by experience. This often manifests as a reduced ability to resist high-calorie junk foods.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Obesity is increasing worldwide, especially among children and teenagers. <a href="https://childhoodobesityfoundation.ca/what-is-childhood-obesity/statistics/">More than 150 million children in the world are obese</a> in 2019. These children have <a href="https://www.canada.ca/en/public-health/services/publications/healthy-living/obesity-excess-weight-rates-canadian-children.html">increased risk of heart disease, cancers and Type 2 diabetes</a>. </p>
<p>Teenagers with obesity are <a href="https://www.who.int/dietphysicalactivity/childhood_consequences/en/">likely to remain obese</a> as adults. If these trends continue, <a href="https://childhoodobesityfoundation.ca/what-is-childhood-obesity/statistics/">70 per cent of adults</a> aged 40 years could be either overweight or obese by 2040.</p>
<p>I am a neuroscientist and my research investigates how diet changes the brain. I want to understand how <a href="https://doi.org/10.1002/bdr2.1173">unhealthy diets impact the developing brain</a>, and also why young people today are so prone to developing obesity. </p>
<p>Adolescents are the greatest consumers of <a href="https://theconversation.com/your-brain-on-sugar-what-the-science-actually-says-126581">calorie-rich “junk” foods</a>. During puberty, many children have an insatiable appetite as rapid growth requires lots of energy. Heightened metabolism and growth spurts can protect against obesity, to an extent. But excessively eating high-calorie junk foods and increasingly sedentary lifestyles can outweigh any metabolic protection.</p>
<h2>The teenage brain is vulnerable</h2>
<p>The teenage years are a <a href="https://science.howstuffworks.com/life/inside-the-mind/human-brain/teenage-brain1.htm">key window of brain development</a>. Adolescence coincides with a new-found social autonomy and the independence to make personal food choices. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/your-brain-on-sugar-what-the-science-actually-says-126581">Your brain on sugar: What the science actually says</a>
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<p>During adolescence, connections between different brain regions and individual neurons are also being refined and strengthened. The adolescent brain is malleable because of <a href="https://brainworksneurotherapy.com/what-neuroplasticity">increased levels of “neuroplasticity.”</a> </p>
<p>This means the brain is highly receptive to being shaped and rewired by the environment — including diet. In turn, these changes can become hardwired when development is complete. So the adolescent brain is vulnerable to <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/2756132">diet-induced changes</a>, but these changes may endure through life. </p>
<h2>Resisting junk food is tough</h2>
<p>Neuroscientists use <a href="https://www.sciencedaily.com/terms/functional_neuroimaging.htm">functional brain imaging</a> to examine how the brain responds to specific events. Brain scans show that the <a href="https://www.neuroscientificallychallenged.com/blog/2014/5/16/know-your-brain-prefrontal-cortex">prefrontal cortex</a> — a key brain area for behavioural control and decision-making — <a href="http://www.dx.doi.org/10.3238/arztebl.2013.0425">doesn’t fully mature until the early 20s</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/306217/original/file-20191210-95125-6w25t1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306217/original/file-20191210-95125-6w25t1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306217/original/file-20191210-95125-6w25t1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306217/original/file-20191210-95125-6w25t1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306217/original/file-20191210-95125-6w25t1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306217/original/file-20191210-95125-6w25t1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306217/original/file-20191210-95125-6w25t1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Feelings of reward after eating food can be exaggerated due to increased numbers of dopamine receptors in the teenage brain.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>The prefrontal cortex controls and overrides urges triggered by events in the environment. Resisting eating a whole bag of candy or buying cheap junk foods can be particularly difficult for teenagers.</p>
<h2>Voracious drive for rewards</h2>
<p>In contrast to the immature prefrontal cortex, the <a href="https://www.neuroscientificallychallenged.com/glossary/mesolimbic-pathway">brain’s reward system</a> — the <a href="https://www.psychologytoday.com/ca/basics/dopamine">mesocorticolimbic dopamine system</a> — is fully developed at a much earlier age. </p>
<p>Teenagers are particularly drawn to rewards, including sweet and calorie-dense foods. This is due to <a href="https://doi.org/10.3389/fnbeh.2016.00189">increased numbers of dopamine receptors</a> in the adolescent brain, so the feeling of reward can be exaggerated. Frequent stimulation of the reward system results in enduring brain adaptations. </p>
<p>During adolescence, these changes may cause long-lasting shifts to the balance of brain chemicals.</p>
<p>Taken together, the teenage brain has a voracious drive for reward, <a href="https://www.seeker.com/teen-brain-wired-to-take-risks-discovery-news-1767182366.html">diminished behavioural control</a> and a susceptibility to be shaped by experience. </p>
<p>This manifests as a reduced ability to resist rewarding behaviours. So it’s not surprising that teenagers prefer to eat foods that are easy to obtain and immediately gratifying, even in the face of health advice to the contrary. But what are the enduring brain consequences?</p>
<h2>Transcranial magnetic stimulation</h2>
<p>Functional imaging studies show brain activity during tasks or viewing images of foods. Brain circuits <a href="http://www.jneurosci.org/content/36/26/6949.long">that process food rewards are more active</a> in adolescents with obesity compared to those considered normal weight. </p>
<p>Interestingly, lower activity is seen in regions of the <a href="https://doi.org/10.1111/ijpo.241">prefrontal cortex</a>. This shows that obesity can both heighten activation of the reward system and reduce brain activity in centres that can override the desire to eat.</p>
<p>Importantly, successful weight loss in adolescents <a href="https://doi.org/10.1002/oby.21004">restores levels of activity</a> in the prefrontal cortex. This provides critical knowledge that the prefrontal cortex is a key area of the brain for <a href="https://doi.org/10.1016/j.tics.2019.01.005">controlling food intake</a>, and that diet interventions increase activity in brain regions that exert self control. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/306214/original/file-20191210-95111-epoxrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/306214/original/file-20191210-95111-epoxrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/306214/original/file-20191210-95111-epoxrv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/306214/original/file-20191210-95111-epoxrv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/306214/original/file-20191210-95111-epoxrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/306214/original/file-20191210-95111-epoxrv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/306214/original/file-20191210-95111-epoxrv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Physical exercise boosts brain plasticity.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625">Transcranial magnetic stimulation</a> (TMS), a way scientists can modify brain activity in the prefrontal cortex, can <a href="https://doi.org/10.1016/j.neuroimage.2018.05.013">change inhibitory control</a> of eating behaviour. Repeated <a href="https://clinicaltrials.gov/ct2/show/NCT03009695">TMS treatment could be a new therapy</a> to restore cognitive control over eating, helping with long-term weight loss.</p>
<h2>Exercise boosts brain plasticity</h2>
<p>Excessively eating junk foods during adolescence could alter brain development, leading to lasting poor diet habits. But, like a muscle, the brain can be exercised to improve willpower. </p>
<p>Increased brain plasticity during adolescence means the young mind may be more receptive to lifestyle changes. <a href="https://australiascience.tv/brain-gains-how-exercise-improves-your-brain/">Physical exercise boosts brain plasticity</a>, helping to set in place new healthy habits. Identifying how the brain is changed by obesity provides opportunities to identify and intervene. </p>
<p>Functional brain imaging adds a new layer of information where clinicians can identify at-risk individuals and track brain changes during nutritional and lifestyle interventions. </p>
<p>Even more, TMS could be a new treatment approach to improve re-calibration of the young brain to prevent enduring changes into adulthood.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/ca/newsletters?utm_source=TCCA&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/126582/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Reichelt receives funding from The Australian Research Council and Canada First Research Excellence Fund (BrainsCAN, Western University).</span></em></p>Excessively eating junk foods during adolescence could alter brain development, leading to lasting poor diet habits. But, like a muscle, the brain can be exercised to improve willpower.Amy Reichelt, BrainsCAN Research Fellow at Western University’s Schulich School of Medicine & Dentistry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/818862017-09-21T00:39:18Z2017-09-21T00:39:18ZExperimental brain technology can rewind Alzheimer’s disease<p>Alzheimer’s disease is considered a <a href="http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(09)70298-4/abstract">global challenge of the century</a>. Alzheimer’s disease is a thief. It comes and takes away the most precious memories with which people identify themselves. It is a very clever thief. People whom it affects don’t even remember what they have lost — they just feel lost; lost in space and time.</p>
<p>Alzheimer’s can affect anybody: intellectuals, professors, artists, musicians and handymen. My mother’s Alzheimer’s motivated me to start the very first Repetitive Transcranial Magnetic Stimulation (rTMS) treatment for Alzheimer’s in Canada. </p>
<p>The treatment is a non-invasive procedure that doesn’t involve any medication. This technology has been used to successfully treat depression, and it is also being studied for a number of other neurological conditions (for example, Parkinson’s, concussion and stroke). </p>
<p>In rTMS, an electromagnetic coil is placed on the scalp and uses magnetic pulses to cause neurons (nerve cells) in the brain to activate. The goal is to train the neurons to perform better in the future. The rTMS treatment has no, or only mild side effects: some people report a slight headache that is easily treated with a pain relief pill. And the risk of seizure is very low. (Individuals with a history of epilepsy and/or seizures are excluded from rTMS treatments for that reason.)</p>
<h2>‘I remember’</h2>
<p>Our very first patient was a challenging 82-year-old lady at a relatively advanced stage of Alzheimer’s, who hated the treatment. Every time I asked her if she had children, she said: “Not yet; I’m still in my twenties!” </p>
<p>On the seventh day of the treatment, in the middle of session, she asked us to stop. Her husband tried to calm her and convince her to continue, saying: “Didn’t you want to remember our children?” </p>
<p>She replied: “But I do remember Susan, Sam and Dona; why do I need this stupid treatment?”</p>
<p>That moment was what I had dreamed to see in my late mother: the way she used to be, even for a few minutes. That patient’s cognitive state did not show any significant improvement over the course of treatment. However, her short moment of memory retrieval encouraged me to continue the rTMS treatment study on others as well — particularly on those at earlier stages of Alzheimer’s.</p>
<p>One thing to note and remember is that Alzheimer’s is a progressive degenerative disease. If we intervene to plateau the state of the patient or slow the progression, that is indeed an improvement and can be considered a positive effect of the treatment. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/n-2kE8hnobs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How rTMS treatment for Alzheimer’s disease works and is administered. (Zahra Moussavi)</span></figcaption>
</figure>
<p>In our pilot study, we gave a maintenance treatment every three months, to seven of our initial 10 participants, for up to a year and a half. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457230/">Our results</a> showed that as long as patients were receiving the treatment, they did not decline. Some improved slightly. </p>
<p>As soon as we stopped the treatment (due to lack of funding), all patients started to show some decline. Three of them declined so severely that, within three months of stopping treatment, they ended up in a nursing home and passed away within a year.</p>
<p>Overall, our pilot study and similar small-sample studies around the globe showed encouraging results of rTMS treatment on Alzheimer’s, especially when it was applied at early and moderate stages. </p>
<h2>Encouraging steps to new Alzheimer’s treatment</h2>
<p>As a result of those pilot studies, the Weston Brain Institute has now funded the very first large placebo-controlled double-blind study of rTMS treatment on Alzheimer’s. This is a collaboration of three universities: University of Manitoba, McGill University and Monash University. The team includes engineers, psychiatrists, clinical psychologists, neurologists and statisticians. </p>
<p>The study is to investigate the effect of rTMS treatment on Alzheimer’s patients at early and moderate stages. All participants have to be diagnosed by one of the study doctors. And there are several assessments for before and after treatment to assess the efficacy of the treatment and how long it may last.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/183664/original/file-20170828-1572-34zp08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183664/original/file-20170828-1572-34zp08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/183664/original/file-20170828-1572-34zp08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183664/original/file-20170828-1572-34zp08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183664/original/file-20170828-1572-34zp08.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183664/original/file-20170828-1572-34zp08.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183664/original/file-20170828-1572-34zp08.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183664/original/file-20170828-1572-34zp08.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dr. Zahra Moussavi (centre) tests the rTMS unit with a single pulse, aided by members of her research team.</span>
<span class="attribution"><span class="source">(Zahra Moussavi)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>While this current study is an encouraging step towards finding new treatment methods for Alzheimer’s, there are several other parameters in the rTMS treatment protocol whose investigation is not currently funded. They include: the method by which rTMS pulses are delivered, the location of the stimulation and the duration of treatment. Our current study investigates only the standard protocol of rTMS treatment. We hope after some preliminary results to apply for, and receive, more funding to continue the research.</p>
<p>The number of people affected by Alzheimer’s disease is on the rise. Alzheimer’s not only steals precious aspects of life from affected individuals but also from their families. Alzheimer’s forces the relatives of a patient to hopelessly watch a tragedy progress over a prolonged period of time, day after day. </p>
<p>Alzheimer’s disease is a multifold condition that requires a multidisciplinary approach for its treatment. It is only through our collective efforts that we can hope to find a solution for such a grim and dreadful disease. Despair may fly on the wings of morning; out of the heart of darkness comes the light.</p><img src="https://counter.theconversation.com/content/81886/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zahra Moussavi receives funding from Weston Brain Institute and Natural Science and Engineering Research Council (NSERC) of Canada merely for research. She works at the University of Manitoba as a professor in Biomedical Engineering. She is affiliated with the Riverview Health Center as a research affiliate. </span></em></p>When Zahra Moussavi’s mother developed Alzheimer’s, the scientist pursued a technology that directly stimulates the brain with electromagnets to mitigate the effects of the disease. It worked.Zahra Moussavi, Professor of Biomedical Engineering, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/694482016-11-28T14:07:44Z2016-11-28T14:07:44ZAnthill 7: On belief<figure><img src="https://images.theconversation.com/files/147743/original/image-20161128-22761-ocve7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What do you believe in?</span> <span class="attribution"><span class="source">shutterstock.com</span></span></figcaption></figure><p>In this episode of <a href="https://theconversation.com/uk/podcasts/the-anthill">The Anthill</a>, a podcast from The Conversation, we’re taking a critical look at the idea of belief. You might not consider yourself to be religious or have a particularly clear cut belief system. But, make no mistake, belief permeates everything we do. </p>
<p>For most, the simple belief that the sun will rise every day means not living in fear of the apocalypse. Yet this isn’t the case for everyone. History is replete with doomsday cults, predicting or ushering in the end of the world. To find out why these cults and others are so effective at sucking people in, we speak to psychologists Linda and Rod Dubrow-Marshall who have spent years investigating their popularity. </p>
<p>Similarly, for some people conspiracy theories can be easier to believe than the truth. Was 9/11 an inside job? Did the British government run Princess Diana off the road? Is climate change a Chinese invention, geared toward making US manufacturing less competitive? Stephan Lewandowsky shares his thoughts on the logic employed by conspiracy theorists – and the prospect of having one in the White House. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"265895292191248385"}"></div></p>
<p>If there’s one thing that we would not consider to be driven by belief, it’s science. As our science editor, Miriam Frankel, finds out, however, even scientific discovery has been shaped by certain ways of seeing the world. David Papineau, a professor of the philosophy of science, explains how religious ideas have driven scientific discoveries throughout history and neuroscientist Gina Rippon ponders the pervasive effect of gender biases in her field today.</p>
<p>From embedded beliefs shaping scientific research, we switch to attempts by scientists to change what people believe. Our society editor, Gemma Ware, speaks to Colin Holbrook about his experiment using a technology called transcranial magnetic stimulation, which he suggests can temporarily shift people’s attitudes toward the afterlife and immigrants. But ethicist Nathan Emmerich says we shouldn’t be too worried yet about this technique being used on mass to control our minds. </p>
<p>And finally we hear from a researcher who’s investigated the effects of trauma on people’s belief systems. Karen O'Donnell, who has researched post-traumatic stress disorder, explains how belief is both rocked by trauma and plays a fundamental role in recovery. </p>
<p>Click <a href="https://theconversation.com/uk/topics/the-anthill-27460">here to listen again</a> to any of The Anthill podcasts – which each take a theme and ask academics from a variety of disciplines to talk about their research. Listen to some of our previous episodes, such as <a href="https://theconversation.com/anthill-6-into-the-darkness-67267">Into the darkness</a>, <a href="https://theconversation.com/the-anthill-5-reboot-part-2-65765">Rebooting</a>, <a href="https://theconversation.com/anthill-4-fuel-64021">Fuel</a> and <a href="https://theconversation.com/anthill-3-rooting-for-the-underdog-62368">Underdogs</a>. Subscribe via <a href="https://itunes.apple.com/au/podcast/the-anthill/id1114423002">iTunes</a> or <a href="https://soundcloud.com/user-959768434">Soundcloud</a>. </p>
<hr>
<p><em>The Anthill theme music is by Alex Grey for Melody Loops. The music for the conspiracy theories section is called <a href="http://freemusicarchive.org/music/sun_pack/treximer/05_channeling_johnny_ripper_remix">channeling (johnny ripper remix)</a>, by sun mix. Music in the segment on the way that belief shapes scientific discovery is <a href="http://freemusicarchive.org/music/Wall_Matthews/Live_on_WFMU_with_Irene_Trudel_April_14_2014/Waltz_For_Django">Waltz For Django</a> by Wall Matthews. Music in the segment on transcranial magnetic stimulation is called <a href="http://freemusicarchive.org/music/Simon_Mathewson/Some_electronic_tunes/Simon_Mathewson_-_Philae">Philae</a>, by Simon Matthewson and music. All were found on the Free Music Archive. The earthquake sound effect in the segment on trauma and belief is by <a href="http://www.freesound.org/people/uagadugu/sounds/222521/">uagadugu</a> and the choral music by <a href="http://www.freesound.org/people/klankbeeld/sounds/185532/">Capella Dulcis</a>, recorded by <a href="http://www.freesound.org/people/klankbeeld/sounds/185532/">klankbeeld</a>.</em></p>
<p><em>A big thank you to City University London’s Department of Journalism for the use of their studios.</em></p><img src="https://counter.theconversation.com/content/69448/count.gif" alt="The Conversation" width="1" height="1" />
Four stories on belief: from the allure of cults and conspiracy theories, to the effect of trauma on faith, to the way dogma has influenced science – and if technology can actually shift our beliefs.Will de Freitas, Environment + Energy Editor, UK editionAnnabel Bligh, Business & Economy Editor and Podcast Producer, The Conversation UKGemma Ware, Head of AudioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/678582016-11-06T20:26:01Z2016-11-06T20:26:01ZInformation before regulation to make amateur brain stimulation safer<figure><img src="https://images.theconversation.com/files/144320/original/image-20161103-25353-t3eb2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Talk to users of electronic brain stimulation.</span> <span class="attribution"><span class="source">Shutterstock OH studio image gallery</span></span></figcaption></figure><p>In the comfort of their own home, an unknown number of people are electrically stimulating their brains.</p>
<p>People are doing it because they believe it can boost mental agility, help with disorders such as depression, or just for the pleasure of exploring a scientific frontier outside the constraints of professional science.</p>
<p>And apparently some computer <a href="https://theconversation.com/brain-stimulation-is-getting-popular-with-gamers-is-it-time-to-regulate-it-66845">gamers are doing it</a> because they think it can improve their performance.</p>
<p>But <a href="https://www.eurekalert.org/pub_releases/2016-07/bidm-nwa070816.php">home brain stimulation is opposed</a> by most neuroscientists on safety grounds. That has helped create a knowledge vacuum that leaves brain stimulation enthusiasts piecing together information on which devices to purchase, and how to use them, from whatever online sources they can find, most often from other home users.</p>
<p>It’s the Wild West of neuroscience. And that needs to change.</p>
<h2>Methods of stimulation</h2>
<p>Whether home users <a href="https://cosmosmagazine.com/biology/buzz-around-brain-stimulation">get the brain boost they seek</a> is unclear. One technique, TMS or transcranial magnetic stimulation, is approved by the US Food and Drug Administration for clinical treatment of <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm378608.htm">migrane headaches</a> and <a href="http://www.apa.org/monitor/2015/02/magnets.aspx">severe depression</a>. Large trials are also planned for autism, schizophrenia and stroke.</p>
<p>But the jury is out on the go-to technique for home use which is tDCS, or transcranial direct-current stimulation. Lab tests suggest that tDCS changes language and maths abilities, attention, video gaming ability (part of its popular appeal) and other cognitive skills, but more evidence is needed to be sure.</p>
<p>And here’s the rub. If electrical stimulation does boost brain function, it can also harm it. That’s why brain researchers are careful to limit risk by being conservative about how long and how often they stimulate someone’s brain. Home users won’t be so cautious, especially without access to information.</p>
<p>The research community’s response to home use is to draw attention in carefully-couched terms to its dangers, still largely unknown but generally considered likely to be slight, such as in this <a href="http://onlinelibrary.wiley.com/doi/10.1002/ana.24689/full">open letter in the Annals of Neurology</a>.</p>
<p>Or researchers’ reaction is to <a href="https://theconversation.com/brain-stimulation-is-getting-popular-with-gamers-is-it-time-to-regulate-it-66845">ask for more regulation</a>.</p>
<h2>Regulations</h2>
<p>Consumer brain stimulation devices, which can be legally purchased online, are already regulated by the general consumer rules set out by the <a href="https://www.accc.gov.au/consumers/consumer-protection/buying-safe-products">Australian Competition and Consumer Commission</a> and in the US by the <a href="https://www.accc.gov.au/consumers/consumer-protection/buying-safe-products">Consumer Product Safety Commission</a>.</p>
<p>But overzealous regulation has the potential to do harm as well as prevent it. It could, for example, slow the development of these devices to treat mental health disorders, an area in which there is a pressing need for effective therapies and where brain stimulation shows much promise.</p>
<p>The consumer market for brain stimulation devices provides an opportunity to optimise design. John Reppas, director of public policy at the Neurotechnology Industry Association, told the US Food and Drug Administration meeting <a href="http://www.fda.gov/downloads/MedicalDevices/NewsEvents/WorkshopsConferences/UCM480906.pdf">Noninvasive Neurostimulation Devices and Cognitive Function</a> last year:</p>
<blockquote>
<p>It [may also] allows an eventual next-generation medical grade product to be developed and financed a lot more quickly […]</p>
</blockquote>
<p>Then there’s the case for personal autonomy. Allowing adults to learn more about their own bodies and brains, even to alter their function, is not necessarily bad. We allow adults to change body and brain function with caffeine, alcohol, exercise, and learning. Is the use of electrical brain stimulation devices different?</p>
<h2>Talk to the users</h2>
<p>We suggest a more pragmatic approach to harm reduction. Don’t stop with just a warning to home users, or calls for greater regulation.</p>
<p>Why not also work with home users to understand what drives them, to test the devices they use, and fill the information void with scientist-sanctioned safety guidelines and easily-accessible translations of new findings. These would include the limitations and side-effects.</p>
<p>Nick Davis, a neuroscientist at Manchester Metropolitan University, <a href="http://jlb.oxfordjournals.org/content/early/2016/04/05/jlb.lsw013.full">goes further</a> to suggest harnessing this “pool of creative and engaged self-experimenters [to] shape and inform the future uses of tDCS”.</p>
<p>Health agencies could also step in with a similar approach to that taken to <a href="https://theconversation.com/stem-cell-tourism-exploits-people-by-marketing-hope-29146">stem cell tourism</a>, in which people with life-limiting illnesses travel overseas for what are often unproven therapies. </p>
<p>Stem cell tourism and lounge room brain stimulation share similarities. In both cases, users have moved a new technology out of the lab before the evidence is in.</p>
<p>Both technologies promise game-changing treatments for intractable health problems, firing a scientific optimism that has gushed into public consciousness, driving demand for an under-developed technology.</p>
<p>When first faced with stem cell tourism, scientists tended to protest its foolishness. But after listening more carefully to the tourists to understand what was driving them (in a nutshell, no other options), some changed tack.</p>
<p>They brought together stem cell scientists, people who wanted the technology in its unbaked state, and those who wanted it developed and approved first. They talked through issues of <a href="http://www.palgrave.com/la/book/9781137470423">safety, evidence, autonomy and hope</a>.</p>
<p>Their efforts culminated in advice from various bodies, including the National Health and Medical Research Council <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/rm001a_stem_cell_treatments_faq_131220.pdf">providing information</a>, to assist people contemplating stem cell tourism. Why not a similar approach to the lounge room use of brain stimulation devices?</p>
<p>Brain stimulation is cheap, accessible and potentially of interest to anyone who ever wished they could think faster, or at least better than their colleagues, their ageing self, their class mates or their competitors.</p>
<p>Nobody knows how many people currently home use, or who they are. Recreational gamers are clearly not the whole story. We know of people who home use in attempts to treat age-related cognitive decline and severe, uncontrolled mental disorders.</p>
<p>What we do know is that if the brain stimulation makes good on its early promise those numbers will surely grow, never mind how many cautious warnings and calls for greater regulation are issued.</p>
<hr>
<p><em>Peter Simpson-Young, who is a masters student of health technology innovation at University of Sydney, was a co-author on this article. He has used brain stimulation at home.</em></p><img src="https://counter.theconversation.com/content/67858/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Nowak is director of The Brain Dialogue, an initiative of the Australian Research Council Centre of Excellence for Integrative Brain Function. She is also principal at Rachel Nowak and Associates, a consultancy working to connect universities, industry, and society. </span></em></p>People who electrically stimulate their brains at home need more information to do it safely… and neuroscience needs to find out more about how and why they do it.Rachel Nowak, Director, The Brain Dialogue, ARC Centre of Excellence for Integrative Brain Function, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/652152016-09-14T10:05:33Z2016-09-14T10:05:33ZConsidering ethics now before radically new brain technologies get away from us<figure><img src="https://images.theconversation.com/files/137669/original/image-20160913-4955-1hxmw14.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Now's the time to think about what we're getting into with neurotechnologies.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic.mhtml?id=133182821">Brain image via www.shutterstock.com.</a></span></figcaption></figure><p>Imagine infusing thousands of wireless devices into your brain, and using them to both monitor its activity and directly influence its actions. It sounds like the stuff of science fiction, and for the moment it still is – but possibly not for long.</p>
<p>Brain research is on a roll at the moment. And as it converges with advances in science and technology more broadly, it’s transforming what we are likely to be able to achieve in the near future. </p>
<p>Spurring the field on is the promise of more effective treatments for debilitating neurological and psychological disorders such as <a href="http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm">epilepsy</a>, <a href="http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm">Parkinson’s disease</a> and <a href="https://www.nimh.nih.gov/health/topics/depression/index.shtml">depression</a>. But new brain technologies will increasingly have the potential to alter how someone thinks, feels, behaves and even perceives themselves and others around them – and not necessarily in ways that are within their control or with their consent.</p>
<p>This is where things begin to get ethically uncomfortable.</p>
<p>Because of concerns like these, the U.S. National Academies of Sciences, Engineering and Medicine (NAS) are <a href="http://www.nationalacademies.org/hmd/Activities/Research/NeuroForum/2016-SEP-15.aspx">cohosting a meeting of experts this week</a> on responsible innovation in brain science.</p>
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<figcaption><span class="caption">Berkeley’s ‘neural dust’ sensors are one of the latest neurotech advances.</span></figcaption>
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<h2>Where are neurotechnologies now?</h2>
<p>Brain research is intimately entwined with advances in the “neurotechnologies” that not only help us study the brain’s inner workings, but also transform the ways we can interact with and influence it.</p>
<p>For example, researchers at the University of California Berkeley recently <a href="http://news.berkeley.edu/2016/08/03/sprinkling-of-neural-dust-opens-door-to-electroceuticals/">published the first in-animal trials of what they called “neural dust”</a> – implanted millimeter-sized sensors. They inserted the sensors in <a href="http://dx.doi.org/10.1016/j.neuron.2016.06.034">the nerves and muscles of rats</a>, showing that these miniature wirelessly powered and connected sensors can monitor neural activity. The long-term aim, though, is to introduce thousands of neural dust particles <a href="http://arxiv.org/abs/1307.2196">into human brains</a>.</p>
<p>The UC Berkeley sensors are still relatively large, on par with a coarse piece of sand, and just report on what’s happening around them. Yet advances in nanoscale fabrication are likely to enable their further miniaturization. (The researchers estimate they could be made <a href="https://arxiv.org/abs/1307.2196">thinner than a human hair</a>.) And in the future, combining them with technologies like <a href="http://www.scientificamerican.com/article/optogenetics-controlling/">optogenetics</a> – using light to stimulate genetically modified neurons – could enable wireless, localized brain interrogation and control.</p>
<p>Used in this way, future generations of neural dust could transform how chronic neurological disorders are managed. They could also enable hardwired brain-computer interfaces (the <a href="https://arxiv.org/abs/1307.2196">original motivation behind this research</a>), or even be used to enhance cognitive ability and modify behavior.</p>
<p>In 2013, President Obama launched the multi-year, multi-million dollar <a href="https://www.whitehouse.gov/BRAIN">U.S. BRAIN Initiative</a> (Brain Research through Advancing Innovative Neurotechnologies). The same year, the European Commission launched the <a href="https://www.humanbrainproject.eu/">Human Brain Project</a>, focusing on advancing brain research, cognitive neuroscience and brain-inspired computing. There are also active brain research initiatives in <a href="https://www.sfn.org/news-and-calendar/neuroscience-quarterly/spring-2016/china-qa">China</a>, <a href="http://rstb.royalsocietypublishing.org/content/370/1668/20140310">Japan</a>, <a href="http://english.yonhapnews.co.kr/business/2016/05/30/0504000000AEN20160530008200320.html">Korea</a>, <a href="http://www.labman.org/">Latin America</a>, <a href="http://israelbrain.org/">Israel</a>, <a href="http://bluebrain.epfl.ch/">Switzerland</a>, <a href="http://www.braincanada.ca/">Canada</a> and even <a href="http://www.ncbi.nlm.nih.gov/pubmed/21870466">Cuba</a>.</p>
<p>Together, these represent an emerging and globally coordinated effort to not only better understand how the brain works, but to find new ways of controlling and enhancing it (in particular in disease treatment and prevention); to interface with it; and to build computers and other artificial systems that are inspired by it.</p>
<h2>Cutting-edge tech comes with ethical questions</h2>
<p>This week’s <a href="http://www.nationalacademies.org/hmd/Activities/Research/NeuroForum/2016-SEP-15.aspx">NAS workshop</a> – organized by the <a href="https://www.innovationpolicyplatform.org/project-emerging-technologies-and-brain-oecd-bnct">Organization for Economic Cooperation and Development</a> and supported by the National Science Foundation and my home institution of Arizona State University – isn’t the first gathering of experts to discuss the ethics of brain technologies. In fact there’s already an active international community of experts addressing “<a href="https://en.wikipedia.org/wiki/Neuroethics">neuroethics</a>.”</p>
<p>Many of these scientific initiatives do have a prominent ethics component. The U.S. BRAIN initiative for example includes a <a href="https://www.braininitiative.nih.gov/about/newg.htm">Neuroethics Workgroup</a>, while the E.C. Human Brain Project is using an <a href="https://www.humanbrainproject.eu/2016-ethics">Ethics Map</a> to guide research and development. These and others are grappling with the formidable challenges of developing future neurotechnologies responsibly.</p>
<p>It’s against this backdrop that the NAS workshop sets out to better understand the social and ethical opportunities and challenges emerging from global brain research and neurotechnologies. A goal is to identify ways of ensuring these technologies are developed in ways that are responsive to social needs, desires and concerns. And it comes at a time when brain research is beginning to open up radical new possibilities that were far beyond our grasp just a few years ago.</p>
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<a href="https://images.theconversation.com/files/137650/original/image-20160913-4936-dt595m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/137650/original/image-20160913-4936-dt595m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/137650/original/image-20160913-4936-dt595m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=540&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137650/original/image-20160913-4936-dt595m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=540&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137650/original/image-20160913-4936-dt595m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=540&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137650/original/image-20160913-4936-dt595m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=679&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137650/original/image-20160913-4936-dt595m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=679&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137650/original/image-20160913-4936-dt595m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=679&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Transcranial magnetic stimulation uses a powerful and rapidly changing electrical current to excite neural processes in the brain, similar to direct stimulation with electrodes.</span>
<span class="attribution"><span class="source">Eric Wassermann, M.D.</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>In 2010, for instance, researchers at MIT demonstrated that Transcranial Magnetic Stimulation, or TMS – a noninvasive neurotechnology – <a href="http://news.mit.edu/2010/moral-control-0330">could temporarily alter someone’s moral judgment</a>. Another noninvasive technique called <a href="https://www.wired.com/2014/01/read-zapping-brain/">transcranial Direct Current Stimulation</a> (tDCS) delivers low-level electrical currents to the brain via electrodes on the scalp; it’s being explored as a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270156/">treatment for clinical conditions from depression to chronic pain</a> – while already being used in <a href="http://foc.us/">consumer products</a> and by <a href="http://www.wsj.com/articles/the-weird-world-of-brain-hacking-1447096569">do-it-yourselfers</a> to allegedly self-induce changes in mental state and ability.</p>
<p>Crude as current capabilities using TMS and tDCS are, they are forcing people to think about the responsible development and use of technologies which have the ability to potentially change behavior, personality and thinking ability, at the flick of a switch. And the ethical questions they raise are far from straightforward.</p>
<p>For instance, should students be allowed to take exams while using tDCS? Should teachers be able to use tDCS in the classroom? Should TMS be used to prevent a soldier’s moral judgment from interfering with military operations?</p>
<p>These and similar questions grapple with what is already possible. Complex as they are, they pale against the challenges emerging neurotechnologies are likely to raise.</p>
<h2>Preparing now for what’s to come</h2>
<p>As research leads to an increasingly sophisticated and fine-grained understanding of how our brains function, related neurotechnologies are likely to become equally sophisticated. As they do, our abilities to precisely control function, thinking, behavior and personality, will extend far beyond what is currently possible.</p>
<p>To get a sense of the emerging ethical and social challenges such capabilities potentially raise, consider this speculative near-future scenario:</p>
<p>Imagine that in a few years’ time, the UC Berkeley neural dust has been successfully miniaturized and combined with optogenetics, allowing thousands of micrometer-sized devices to be seeded through someone’s brain that are capable of monitoring and influencing localized brain functions. Now imagine this network of neural transceivers is wirelessly connected to an external computer, and from there, to the internet.</p>
<p>Such a network – a crude foreshadowing of science fiction author <a href="http://www.goodreads.com/author/show/5807106.Iain_M_Banks">Iain M. Banks</a>’ “neural lace” (a concept that has <a href="http://www.newsweek.com/elon-musk-neural-lace-ai-artificial-intelligence-465638">already grabbed the attention of Elon Musk</a>) – would revolutionize the detection and treatment of neurological conditions, potentially improving quality of life for millions of people. It would enable external devices to be controlled through thought, effectively integrating networked brains into the Internet of Things. It could help overcome restricted physical abilities for some people. And it would potentially provide unprecedented levels of cognitive enhancement, by allowing people to interface directly with cloud-based artificial intelligence and other online systems. </p>
<p>Think Apple’s Siri or Amazon’s Echo hardwired into your brain, and you begin to get the idea.</p>
<p>Yet this neurotech – which is almost within reach of current technological capabilities – would not be risk-free. These risks could be social – a growing socioeconomic divide perhaps between those who are neuro-enhanced and those who are not. Or they could be related to privacy and autonomy – maybe the ability of employers and law enforcement to monitor, and even alter, thoughts and feelings. The innovation might threaten personal well-being and societal cohesion through (hypothetical) cyber substance abuse, where direct-to-brain code replaces psychoactive substances. It could make users highly vulnerable to neurological cyberattacks.</p>
<p>Of course, predicting and responding to possible future risks is fraught with difficulties, and depends as much on who considers what a risk (and to whom) as it does the capabilities of emerging technologies to do harm. Yet it’s hard to avoid the likely disruptive potential of near-future neurotechnologies. Thus the urgent need to address – as a society – what we want the future of brain technologies to look like.</p>
<p>Moving forward, the ethical and responsible development of emerging brain technologies will require new thinking, along with considerable investment, in what might go wrong, and how to avoid it. Here, we can learn from thinking about responsible and ethical innovation that has come to light around <a href="https://en.wikipedia.org/wiki/Asilomar_Conference_on_Recombinant_DNA">recombinant DNA</a>, <a href="https://cns.asu.edu/viri">nanotechnology</a>, <a href="https://experimentearth.org/">geoengineering</a> and other cutting-edge areas of science and technology. </p>
<p>To develop future brain technologies both successfully and responsibly, we need to do so in ways that avoid potential pitfalls while not stifling innovation. We need approaches that ensure ordinary people can easily find out how these technologies might affect their lives – and they must have a say in how they’re used.</p>
<p>All this won’t necessarily be easy – responsible innovation rarely is. But through initiatives like this week’s NAS workshop and others, we have the opportunity to develop brain technologies that are profoundly beneficial, without getting caught up in an ethical minefield.</p><img src="https://counter.theconversation.com/content/65215/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Andrew Maynard is a member of the ASU School for the Future of Innovation in Society, which is co-organizing the September 15-16 workshop on responsible innovation in brain science. </span></em></p>How will neurotech evolve? An NAS workshop this week focuses on social and ethical opportunities and challenges we face both now and down the road.Andrew Maynard, Director, Risk Innovation Lab, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/622392016-07-21T12:37:01Z2016-07-21T12:37:01ZStudy shows direct manipulation of brain can reverse effects of depression<figure><img src="https://images.theconversation.com/files/131422/original/image-20160721-32615-dpffqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-432067909/stock-photo--d-illustration-neurons-cell-brain-on-science-background.html?src=VV5YIjNSTE_lBi9V0R4tsA-2-37">www.shutterstock.com</a></span></figcaption></figure><p>Manipulating the brain has been a tool used in the treatment of mental illness for centuries, and treatments have often been controversial. From psychosurgery, including <a href="http://www.bbc.co.uk/news/magazine-15629160">lobotomy and leucotomy</a>, to electro-convulsive therapy, which is still used to treat depression and psychotic illness today, more modern methods include <a href="http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml">deep brain stimulation</a> and <a href="http://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/home/ovc-20163795">transcranial magnetic stimulation</a>. </p>
<p>These direct interventions to the brain aim to relieve the symptoms of severe mental disorders, but are generally a last resort for sufferers or <a href="http://www.healthline.com/health/depression/repetitive-transcranial-magnetic-stimulation#2">used in the context of specialist clinical centres and research trials</a>.</p>
<p>We know that <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873772/">the brain undergoes changes when a person is depressed</a> or has a similar mood disorder. But part of the problem with neuroscientific research is that it is unclear whether these structural changes cause, or are caused by, the illness.</p>
<p>In an intriguing new study of depression published in the journal Neuron, researchers have investigated a <a href="http://bit.ly/29OTbQa">new direct intervention technique</a> to combat the symptoms and effects of depression. The team induced abnormal brain activity similar to depression in mice, and then manipulated various circuits of the brain to successfully control and reverse the effects. This suggests that brain changes could indeed be responsible for, and predate, the development of mental disorders. The implication is that with the right techniques, these changes could be reversed and so improve the patient’s mental disorder.</p>
<p>The new technique works by implanting electrodes in four key areas in the mouse’s brain – the prefrontal cortex, and three sub-areas of the limbic system: <a href="http://biology.about.com/od/anatomy/a/aa042205a.htm">the nucleus accumbens, the ventral tegmental area and the amygdala</a>. By measuring electrical signals between these areas, neuroscientists were able to determine the functional connections between them and understand how these parts of the brain communicate with each other during normal brain activity. </p>
<p>The mice were then repeatedly exposed to chronic stress in the form of <a href="http://ilarjournal.oxfordjournals.org/content/55/2/221.full">“social defeat”</a>, which refers to losing a confrontation in a social setting, and is known to cause behaviours in animals similar to human depression. Previously observed connections between areas of the brain were actually altered by this stress, creating a “neural signature” of depression in the brain as the researchers recorded how the neural signalling changed.</p>
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<img alt="" src="https://images.theconversation.com/files/131408/original/image-20160721-32639-14e8h9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/131408/original/image-20160721-32639-14e8h9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/131408/original/image-20160721-32639-14e8h9n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/131408/original/image-20160721-32639-14e8h9n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/131408/original/image-20160721-32639-14e8h9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/131408/original/image-20160721-32639-14e8h9n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/131408/original/image-20160721-32639-14e8h9n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A World War I soldier being treated with an early analogue of ECT. ECT as we know it was developed in 1934.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Bergonic_chair.jpg">Reeve041476</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Amazingly, the team were able to reverse this abnormality in the stressed mice’s brain activity. By stimulating a key area of brain tissue which interfaces with other nodes to form a network between the prefrontal cortex and the amygdala, normal communication between the areas of the brain was restored, returning the mice’s brain activity to their pre-stressed state. Their behaviour returned to normal and their stress disappeared.</p>
<p>This marks the first time a clear parallel has been demonstrated between a model of depression and a functional neural network.</p>
<p>What’s more, these findings are well backed-up. The prefrontal cortex and limbic areas are already <a href="http://www.ncbi.nlm.nih.gov/pubmed/25662294">known to be connected to depression in humans</a>. The amygdala is thought to have a key role in processing how important emotional material is to an individual, and how they respond to it – as the mice respond to their stressful situations. The wider limbic system and prefrontal cortex are important in regulating the impact that our emotions have on our cognitive abilities, such as memory, which causes us to behave differently when we are stressed or depressed. </p>
<p>The key element of this research is manipulating the connectivity of the prefrontal cortex, for which there is further evidence that reinforces the idea that this could be crucial to treating depression. Transcranial direct current stimulation, which manipulates the brain in a similar way, <a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9308371&fileId=S1461145714000418">is already being trialled as a treatment for depression</a>, with results showing some evidence of a positive effect for sufferers.</p>
<p>Since this study concurs with what we know about mood disorders, this could certainly open up new avenues for treatment. Exploring these new causal links between stress, the brain’s neural connectivity and depression might make it possible to tweak brain circuitry in order to reverse whole mood disorders – at least in mice, to begin with.</p>
<p>The team’s findings not only help us to understand depression and other psychiatric illnesses, but also provide a powerful impetus toward developing treatments. Having a distinct “signature” of the mental disorder in question could be extremely useful as a reference point for new clinical treatments, and such a “screen” would facilitate <a href="http://bjp.rcpsych.org/content/207/4/283">more rapid and cost-effective testing of novel methods</a>, encouraging more innovation and investment in these neglected areas.</p><img src="https://counter.theconversation.com/content/62239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Broome receives funding from the Medical Research Council, National Institute for Health Research, The Wellcome Trust, the John Fell Fund at the University of Oxford, and Oxford Health NHS Foundation Trust. He is series editor to the Oxford University Press book series, International Perspectives in Philosophy and Psychiatry. He is also an associate and handling editor for the British Journal of Psychiatry.</span></em></p>Fresh hope for sufferers of mental illness.Matthew Broome, Senior Clinical Research Fellow, Department of Psychiatry and Faculty of Philosophy, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/566932016-03-24T16:32:13Z2016-03-24T16:32:13ZBrain stimulation helps people with anorexia, new study suggests<figure><img src="https://images.theconversation.com/files/116062/original/image-20160322-32300-1pfy2sp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jessica McClelland delivering rTMS to the dorsolateral prefrontal cortex.</span> <span class="attribution"><span class="source">King's College London</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Stimulating parts of the brain with magnetic fields appears to reduce symptoms and improve decision-making in people with anorexia nervosa, according to the findings of new study we conducted at King’s College London. </p>
<p>Anorexia is associated with a morbid fear of fatness, extreme food restriction and dangerously low body weight. About 4% of women will <a href="http://www.ncbi.nlm.nih.gov/pubmed/24060914">suffer from anorexia</a> at some point in their life. It has one of the highest mortality rates of all psychiatric illnesses, with about one in five people <a href="https://www.b-eat.co.uk/about-beat/media-centre/information-and-statistics-about-eating-disorders">dying prematurely</a> as a result of the disorder. </p>
<p>The longer a person suffers from anorexia, the more entrenched it becomes and the harder it is to treat. At best, recovery rates from talk therapies are <a href="http://bit.ly/1OXTmVf">only 20-30%</a>. And there is not much evidence that drug therapies, such as antidepressants and antipsychotics, are effective. We desperately need new treatments. </p>
<h2>Re-wiring the brain</h2>
<p>Brain imaging studies show that people with anorexia have altered neurocircuitry. New treatments that target these neural pathways are <a href="http://www.ncbi.nlm.nih.gov/pubmed/24123463">urgently needed</a>. In <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148606">our study</a>, we investigated the potential of a non-invasive brain stimulation technique called repetitive transcranial magnetic stimulation (rTMS) in improving symptoms of anorexia.</p>
<p>rTMS has been approved by NICE (National Institute for Health and Care Excellence) for treating depression. It has also shown potential in <a href="http://www.ncbi.nlm.nih.gov/pubmed/24155246">reducing symptoms</a> of eating disorders. It’s safe, relatively painless and is very rarely associated with severe side-effects. </p>
<p>rTMS applies magnetic pulses to the brain and these pulses are able to alter neural activity. The therapeutic effects of rTMS in psychiatric disorders are thought to occur as a result of “neuroplasticity” – the malleable nature of the brain. The gentle magnetic stimulation helps the brain form new neural connections. </p>
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<h2>Promising results</h2>
<p>For our research, we got 49 people with anorexia to complete food exposure and decision-making tasks, both before and after a single session of either real or placebo rTMS. The rTMS was applied to the dorsolateral prefrontal cortex, an area of the brain thought to be involved in some of the self-regulation difficulties associated with anorexia. Symptoms and decision-making were measured immediately before and after rTMS, and symptoms of anorexia were also measured 20 minutes and 24 hours after the session. </p>
<p>The food exposure task sought to provoke symptoms by asking participants to watch a two-minute film of people eating appetising food, such as chocolate and crisps, while the same items were in front of them. Participants then had to rate the perceived smell, taste, appearance and urge to eat these foods. </p>
<p>Decision-making was measured using a hypothetical monetary reward task. Participants had to choose between a smaller, variable amount of money (£0-£99) available immediately, and a larger, fixed amount (£100), available after four different time delays (a week, month, year or two years). An inclination to choose the smaller, sooner reward is thought to reflect impulsivity, while waiting for the larger, later reward demonstrates an ability to delay gratification. </p>
<p>Compared with those who received placebo rTMS, we found that participants who had just one session of real rTMS reported reduced symptoms of anorexia (for up to 24 hours), specifically the urge to restrict food intake, levels of feeling full and levels of feeling fat. </p>
<p>Also, a single session of real (but not placebo) rTMS encouraged more prudent decision-making in people with anorexia. That is, following real rTMS, participants waited for larger, later rewards demonstrating improved self-control. </p>
<p>Most of the participants (90%) said they would consider having 20 daily sessions of rTMS, suggesting it is a viable treatment for people with anorexia.</p>
<h2>What next?</h2>
<p>Our findings suggest that rTMS may reduce symptoms of anorexia by improving control over compulsive features of the disorder, such as food restriction. Although our findings were only a statistical trend, there is a clear improvement in symptoms and decision-making following just one session of rTMS. It’s likely that with a larger sample and multiple sessions of rTMS these effects would be even stronger. </p>
<p>These preliminary findings support the potential of brain-directed treatments for anorexia. Given the promising findings from our study, we are now assessing whether rTMS has longer-lasting therapeutic benefits. We are also using brain imaging to try and understand the neural mechanisms of these promising results.</p><img src="https://counter.theconversation.com/content/56693/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This study represents independent research part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King’s College London.
</span></em></p>Repetitive transcranial magnetic stimulation is an approved treatment for depression. A new study suggests that it may be effective at treating anorexia too.Jessica Mcclelland, Researcher, King's College LondonLicensed as Creative Commons – attribution, no derivatives.