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Release: Oct. 31, 2001

UI researchers receive $2.3 grant to study depression treatment

IOWA CITY, Iowa -- University of Iowa Health Care researchers have received a five-year, $2.3 million grant from the National Institute of Mental Health to investigate an experimental new treatment for geriatric depression associated with abnormal blood flow of the brain.

The study is the first to investigate transcranial magnetic stimulation for older patients who have not responded to usual methods for treating vascular depression. This type of depression generally occurs in the elderly and is characterized by loss of blood flow to small areas of the brain. The blood loss is similar to what happens when a person has a stroke. However, people with vascular depression often do not have the physical or cognitive symptoms that usually accompany known strokes.

"Other investigators are using transcranial magnetic stimulation for patients with depression but not in older patients who have depression that seems to be related to a loss of blood supply to the brain," said Robert G. Robinson, M.D., the Paul W. Penningroth Chair and Head of Psychiatry. "We will study the effectiveness of magnetic stimulation for people for whom conventional treatments such as psychotherapeutic treatment, behavior therapy or drug therapy have not worked." Robinson is the study's principal investigator.

The UI team expects to recruit up to 140 patients for the study. Recruitment will begin later this year.

People with vascular depression usually have never had a depression before age 55 or a family history of depression. People with the condition may lose their drive or motivation, feel hopeless, have difficulty sleeping and making decisions, or lose weight.

"We think the depression is caused by loss of blood supply to a particular area of the brain," Robinson said. "It's not related to genetics or to a particular stressful event in a patient's life. It's related to brain injury that changes the chemistry and circuitry of the brain."

The treatment involves using magnets to produce minor electrical stimulation of the frontal lobes of the cerebral cortex, the part of the brain that deals with thinking and reasoning as well as mood and emotion.

A figure-eight-shaped coil is placed against the skull, and an electrical current is run through the coil, creating a magnetic field. The shape of the coil focuses the field so that a small, painless electrical current is created in the brain. Unlike other treatments, no anesthesia is needed, and there is no discomfort or memory loss for the patient.

Robinson said he and other investigators who are using this new technique hope that it ultimately will be a replacement for eletroconvulsive therapy (ECT), which requires a patient to undergo anesthesia, to sustain a seizure and to have some temporary memory loss.

"We became interested in transcranial magnetic stimulation because it has such potential for treating depression that has not responded to other methods, and it seems to treat depression but without the negative effects associated with ECT," Robinson said.

A UI pilot project demonstrated that transcranial magnetic stimulation is very effective for elderly patients with stroke or other obvious kinds of vascular injury who had not responded to other treatments. For more than 25 years, Robinson has led studies on geriatric patients with depression caused by stroke.

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