A media webinar co-hosted by the Science Media Centre of Canada

2. Tuesday, November 18, 2014 Brain stimulation therapies for mental illness A media webinar co-hosted by the Science Media Centre of Canada

3. Speakers Dr. Mark George, Distinguished University Professor, Medical University of South Carolina Dr. Jeff Daskalakis, Temerty Chair in Therapeutic Brain Intervention, CAMH Gail Bellissimo Dr. Benoit Mulsant, Physician-in-Chief, CAMH

4. How rTMS became a useful therapyfor treatment-resistant depression • rTMS – repetitive transcranial magnetic stimulation: focused magnetic field pulses are applied externally to stimulate brain regions involved in regulating emotions • a non-invasive treatment with few side effects (unlike ECT, rTMS does not induce a seizure) • Developed in 1985, with many studies throughout the 1990s on TMS as a treatment for depression • more than 100 randomized controlled trials on TMS for depression

5. Current rTMS research on suicidality

6. Who can benefit from rTMS? • 4.8% of Canadians surveyed reported a major depressive episode in the previous year • 1 in 3 people with depression do not respond to current medications or psychotherapy • Up to 274,000 people with treatment-resistant depression in Ontario alone in 2014 • Symptoms improve in half of those receiving rTMS, and more than one-third achieve complete remission

7. Temerty Centre for Therapeutic Brain Intervention at CAMH

8. Access to rTMS • rTMS approved by Health Canada for depression treatment in 2002 (US FDA in 2008) • treatment fee reimbursed in Saskatchewan, Quebec; other provinces are considering reimbursement • limited availability e.g. approx. 10 clinics in Ontario vs. 50 for ECT • estimated costs of untreated treatment-resistant depression: $19,182 per person • estimated cost per full remission for rTMS: $6,580* • *based on same session fee as ECT

9. Gail Bellissimo “rTMS is allowing me to thrive, not just survive.”

10. tDCS for Alzheimer’s prevention • tDCS - transcranial direct current stimulation: a constant, low-intensity electrical current passes through two electrodes on the head to stimulate specific parts of the brain • a non-invasive and painless procedure • a procedure that has led to temporary cognitive improvements • currently being studied in a novel prevention intervention in combination with cognitive exercises

11. Who could benefit from tDCS? • in 2011, about 15 per cent of Canadians aged 65 or older were living with cognitive impairment, including dementia • current treatments provide symptom management, but the disease is progressive • delaying diagnosis of Alzheimer’s disease could have a huge impact on reducing the burden of illness

12. tDCS kit

13. Current study: PACt-MD • Preventing Alzheimer’s and dementia with Cognitive remediation plust tDCS in MCI and Depression • target population is older adults at high risk of Alzheimer’s disease: those with mild cognitive impairment and/or a recent depression • goals are to prevent or slow down cognitive impairment, thus delaying diagnosis of dementia • five-site study with 375 people who will be followed for up to five years to assess the impact of this novel intervention

14. PACt-MD PreventingAlzheimer’s dementia withCognitive remediation plustDCS inMCI andDepression Contact: Sara GambinoResearch AnalystCAMH 416-535-8501ext. 33657