Serving Up Solutions for Mental Heath

rTMS therapy making a difference for people with depression

Advantage: Modirrouta.

Thanks to the skill and passion of clinician researcher Dr. Mandana Modirrousta, great strides are being made in the treatment of depression and other mental health conditions in Manitoba.

“It was always fascinating to me how the cells in our brain affect our behaviour, who we are, what personality we have, what we do, what we feel, and how we think,” says Dr. Modirrousta, a tennis enthusiast.

The most important tool at her disposal is St. Boniface Hospital’s rTMS unit, which has been in use since 2012. rTMS stands for repetitive transcranial magnetic stimulation and it’s a therapy that has been used in Canada since 2002.

“The idea is to normalize the abnormal brain function that is involved in different neuropsychiatric disorders.”

“It’s a relatively novel treatment, formatted to stimulate the brain cells,” says Dr. Modirrouta. “It is non-invasive and there is no anesthesia required. The idea is to normalize the abnormal brain function that is involved in different neuropsychiatric disorders, such as depression, traumatic brain injury, obsessive compulsive disorder, dementia, etc.”

To undergo rTMS therapy, the patient sits in a barber-like chair while special equipment is attached to the head. A clinician applies targeted magnetic pulses to stimulate brain activity. Beyond occasional scalp irritation and some headaches, the treatment is painless. Treatments are typically 40 minutes long and patients usually need 20–30 treatments over several weeks. Some patients require maintenance treatments in the months following the initial cycle.

Dr. Modirrousta and her colleagues are very excited about the evolution of rTMS as an alternative or complementary treatment for conventional approaches, including medications, talk therapy, shock therapy, or electroconvulsive therapy. That said, she cautions that rTMS doesn’t work for everyone. “Not every depression is similar to each other so people, depending on the type of depression they have, respond differently to different treatment,” she says. “But if people are good candidates for rTMS, they respond extremely well.”

After pursuing a fellowship at Harvard, the Iranian-raised Modirrousta was attracted to a position in Winnipeg because St. Boniface Hospital’s rTMS lab was already in place. She was eager to use the system to treat patients with depression, and to spend time researching the potential of rTMS to treat other conditions. St. Boniface Hospital gave her that chance.

At the Hospital, she has been studying the use of rTMS with patients who have obsessive compulsive disorder and she has become keenly interested in working with concussion and other brain injury patients.

“Every week, I see many people who come in either after a motor vehicle accident or a sports-related injury, and just say that they are not themselves,” says Dr. Modirrousta. “The symptoms could be the feeling that they’re in a fog, or feeling depressed, irritable, they can’t concentrate well, their memory is affected, they feel dizzy, they have headaches, or they have sensitivity to light. Yet, when we look at the MRI, it’s totally normal.”

Dr. Modirrousta is helping these patients with cognitive rehabilitation and using rTMS to help deal with their depression symptoms. And her clinical research with patients, while challenging, is making a difference in their lives.

“It’s very rewarding and satisfying if you find something, and if you see that you can help someone. It’s kind of a balance of both feeling overwhelmed, but at the same time feeling rewarded and happy,” she explains. “It’s just like a different type of joy that you can get out of research. The same thing, like when you see someone in the clinic, you treat someone and you see that you’re helpful. This is also very rewarding.”

Also rewarding to Dr. Modirrousta is the fact that her work successfully treats depression as a physiological condition, thereby helping to combat persisting stigmas about people with depression and other mental health challenges. Even when current clinical imaging technology can’t detect changes in the brain as it relates to depression, Dr. Modirrousta is treating the affliction at a cellular level.

Prior to St. Boniface Hospitals’ acquisition of an rTMS unit in 2012, local candidates for rTMS treatment needed to travel out of province at their own expense. Dr. Modirrousta estimates that patients needed to spend up to $7,500 to get the care they needed (not including travel and accommodations). Having a unit here makes good clinical and economic sense as it has the potential to reduce emergency room visits and psychiatric admissions. About 11 per cent of people will face depression in their lifetimes and, according to the World Health Organization, the condition is the second leading cause of disability globally.

Donors to St. Boniface Hospital Foundation played a key role in acquiring the initial unit in 2012, and funds are currently being raised to purchase and operate a second unit. The new unit, says Dr. Modirrousta, will help reduce wait times that are currently up to nine months long. And it will help move the research forward for the benefit of future generations.

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