Case Studies supporting PEMF benefits for Depression
Identifying Patients with Therapy-Resistant Depression by using Factor Analysis
Introduction: Attempts to identify the factor structure in patients with treatment-resistant depression have been very limited.
Methods: Principal component analysis was performed using the baseline datasets from 3 add-on studies [2 with repetitive transcranial magnetic stimulation and one with transcranial pulsed electromagnetic fields (T-PEMF)], in which the relative effect as percentage of improvement during the treatment period was analysed.
Results: We identified 2 major factors, the first of which was a general factor. The second was a dual factor consisting of a depression subscale comprising the negatively loaded items (covering the pure depression items) and a treatment resistant subscale comprising the positively loaded items (covering lassitude, concentration difficulties and sleep problems). These 2 dual subscales were used as outcome measures. Improvement on the treatment resistant subscale was 40 % in the active treatment group compared to 17 – 30 % improvement in the sham treatments.
Discussion: It is possible to describe patients with therapy-resistant depression by a factor structure. Both rTMS and T-PEMF had a clinical effect on the factor-derived scales when compared to sham treatment.
The Pharmacopsychometric Triangle to Illustrate the Effectiveness of T-PEMF Concomitant with Antidepressants in Treatment Resistant Patients: A Double-Blind, Randomised, Sham-Controlled Trial Revisited with Focus on the Patient-Reported Outcomes
Background: Our T-PEMF trial has been revisited with focus on the pharmacopsychometric triangle in which effect size is used when comparing wanted versus unwanted clinical effects and quality of life as outcomes. In this analysis, we have especially focused on the self-reported HAM-D6.
Methods: The antidepressive medication which the patients were resistant to was kept unchanged during the five weeks of active versus sham T-PEMF.
Results: : In total, 21 patients received active T-PEMF, and 19 patients received sham T-PEMF. The effect size was 1.02 and 0.90, respectively, on HAM-D6 and HAM-D6-S. Concerning side effects, the active TPEMF reduced the baseline score on concentration problems with an effect size of 0.44 while inducing more autonomic symptoms than sham T-PEMF with an effect size of −0.41. The advantage of active over sham T-PEMF obtained an effect size of 0.48.
Conclusion: Active T-PEMF was found superior to sham T-PEMF within the pharmacopsychometric triangle with a clinically significant effect size level above 0.40.
Transcranial Low Voltage Pulsed Electromagnetic Fields in Patients with Treatment-Resistant Depression
Background: Approximately 30% of patients with depression are resistant to antidepressant drugs. Repetitive transcranial magnetic stimulation (rTMS) has been found effective in combination with antidepressants in this patient group. The aim of this study was to evaluate the antidepressant effect of a new principle using low-intensity transcranially applied pulsed electromagnetic fields (T-PEMF) in combination with antidepressants in patients with treatment-resistant depression.
Methods: This was a sham-controlled double-blind study comparing 5 weeks of active or sham T-PEMF in patients with treatment-resistant major depression. The antidepressant treatment, to which patients had been resistant, was unchanged 4 weeks before and during the study period. Weekly assessments were performed using both clinician-rated and patient-rated scales. The T-PEMF equipment was designed as a helmet containing seven separate coils located over the skull that generated an electrical field in tissue with orders of magnitude weaker than those generated by rTMS equipment.
Results: Patients on active T-PEMF showed a clinically and statistically significant better outcome than patients treated with sham T-PEMF, with an onset of action within the first weeks of therapy. Effect size on the Hamilton 17-item Depression Rating Scale was .62 (95% confidence interval .21–1.02). Treatment-emergent side effects were few and mild.
Conclusion: The T-PEMF treatment was superior to sham treatment in patients with treatment-resistant depression. Few side effects were observed. Mechanism of the antidepressant action, in light of the known effects of PEMF stimulation to the brain, is discussed.
Treatment of depression with low strength transcranial pulsed electromagnetic fields: A mechanistic point of view
Background: Mood disorders constitute a high burden for both patients and society. Not with standing the large arsenal of available treatment options, a considerable group of patients does not remit on current antidepressant treatment. There is an urgent need to develop alternative treatment strategies. Recently, low-strength transcranial pulsed electromagnetic field (tPEMF) stimulation has been purported as a promising strategy for such treatment-resistant depression (TRD). The mode of action of this new technique is however largely unknown.
Methods: We searched PubMed for literature reports on the effects of tPEMF and for information regarding its working mechanism and biological substrate.
Results: Most studies more or less connect with the major hypotheses of depression and concern the effects of tPEMF on brain metabolism, neuronal connectivity, brain plasticity, and the immune system. Relatively few studies paid attention to the possible chronobiologic effects of electromagnetic fields.
Limitations: We reviewed the literature of a new and still developing field. Some of the reports involved translational studies, which inevitably limits the reach of the conclusions.
Conclusion: Weak magnetic fields influence divergent neurobiological processes. The antidepressant effect of tPEMF may be specifically attributable to its effects on local brain activity and connectivity.
Case Study Reference Source:
1. Identifying Patients with Therapy-Resistant Depression by using Factor Analysis
(Authors: K. Andreasson, V. Liest, M. Lunde, K. Martiny, M. Unden, S. Dissing, P. Bech)
2. The Pharmacopsychometric Triangle to Illustrate the Effectiveness of T-PEMF Concomitant with Antidepressants in Treatment Resistant Patients: A Double-Blind, Randomised, Sham-Controlled Trial Revisited with Focus on the Patient-Reported Outcomes
(Authors: P. Bech, M. Gefke, M. Lunde, L. Lauritzen and K.Martiny)
3. Transcranial Low Voltage Pulsed Electromagnetic Fields in Patients with Treatment-Resistant Depression
(Authors: Klaus Martiny, Marianne Lunde and Per Bech)
4. Treatment of depression with low strength transcranial pulsed electromagnetic fields: A mechanistic point of view
(Authors: S.M. van Belkum, F.J. Bosker, R. Kortekaas, D.G.M. Beersma, R.A. Schoevers)