The Columbia Brain Stimulation Service is a unique specialty program offering expert consultations, treatment, and referrals for individuals seeking novel therapeutic interventions for psychiatric conditions such as treatment resistant depression (TRD). These interventions include the newest developments in electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and vagus nerve stimulation (VNS).
Introduction
The Brain Stimulation Service is a unique specialty program offering expert consultations, treatment, and referrals for individuals with psychiatric conditions such as treatment-resistant depression (TRD). Our mission is to better the lives of people with treatment-resistant psychiatric disorders by discovering new therapeutic strategies using emerging brain stimulation and neuromodulation techniques. Currently approved treatments include new forms of electroconvulsive therapy (ECT) that reduce the risk of side effects as well as two recently developed treatments: transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS). In addition, research is underway by our group at Columbia to test deep brain stimulation using surgically implanted electrodes.
Program Goals
The goals of the program are to:
What is Treatment-Resistant Depression?
While currently available medications and psychotherapies are effective for many people with depression, unfortunately a substantial number of people do not respond. When depression is resistant to treatment, it can become chronic, lasting for long periods of time in some cases. Depression can also recur, making long-term maintenance strategies very important.
What is Brain Stimulation?
Brain stimulation represents a new discipline in psychiatry focused on using magnetic or electrical energy to improve brain function. These techniques are used both for research and for treatment in major psychiatric disorders that do not always respond fully to conventional treatments, such as medication or psychotherapy. Stimulation with electrical or magnetic energy interacts with neurons, causing them to release chemicals called neurotransmitters, and possibly also helping form more healthy synapses, or connections, between nerve cells. Repeated stimulation can modulate or “reset” the activity of specific regions of the brain to exert significant changes. Brain stimulation therapy uses both traditional and brand new methods of applying energy. It is not a replacement for medications, but it may be added onto medications to improve outcome. As with other treatments, brain stimulation has a risk of side effects that should be discussed thoroughly with your doctor before making a decision.
Approved Brain Stimulation Techniques
Electroconvulsive Therapy (ECT) has been modernized substantially since it was first introduced over 70 years ago. ECT remains the most effective and rapidly acting treatment for severe treatment-resistant depression and other disorders. Modifications in ECT technique, electrode placement, and dosage can dramatically affect the side effects and tolerability of the treatment. NewYork-Presbyterian Hospital and the New York State Psychiatric Institute have long been recognized as leaders in the field of ECT research and clinical practice. We specialize in individualizing ECT dosage to each patient’s needs, and in selecting treatment parameters that research has shown have the lowest risk of side effects.
Transcranial Magnetic Stimulation (TMS) was approved by the United States Food and Drug Administration in October, 2008, for the treatment of major depression that has not responded to at least one adequate trial of an antidepressant medication in the current episode. Columbia was one of the main research sites that demonstrated the safety and efficacy of TMS prior to its approval, and is the first location in the New York area to offer it now for treatment. TMS is a non-invasive form of brain stimulation that modulates brain activity using focused magnetic pulses. To treat depression, this stimulation is delivered to an area of the brain linked to depression in 30-60 minute sessions administered on an outpatient basis. Treatment typically occurs daily (Monday - Friday) for 4-6 weeks. TMS is not a replacement for antidepressant medications, but may be added onto existing medications. More information about TMS can be found at the Division of Brain Stimulation and at Neuronetics.
Vagus Nerve Stimulation (VNS) was approved by the FDA for the long-term treatment of chronic major depression that has not responded to antidepressant treatments. VNS is performed with an electrical device like a pacemaker that is implanted in the chest. Electrical leads are connected to the vagus nerve in the neck. The vagus nerve sends impulses to the brain. VNS is indicated for the adjunctive long-term treatment of chronic (more than 2 years) or recurrent depression for patients 18 years of age or older who are experiencing a major depressive episode and have not had an adequate response to four or more adequate antidepressant treatments. VNS is not a replacement for medications or electroconvulsive therapy (ECT), but it can be added onto other treatments for adjunctive therapy and long-term management. NewYork-Presbyterian Hospital and New York State Psychiatric Institute played a role in the initial clinical trials of VNS for depression. For more information about VNS, click here.
Future Directions
We are actively engaged in research with experimental forms of brain stimulation to help identify safe and effective treatments for medication-resistant depression and other disorders such as obsessive-compulsive disorder (OCD), anxiety disorders, and autism spectrum disorders. Areas of research include transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), deep brain stimulation (DBS), and transcranial direct current stimulation (tDCS).
Clinical Services
In-depth evaluations are conducted by a team of psychiatrists with expertise in brain stimulation techniques. They are assisted by consultants from our research faculty and other medical and neurological specialists as needed. Integrating this information, we provide a comprehensive assessment, second opinion on prior treatment strategies, and recommendations regarding state-of-the-art clinical care. Where appropriate, FDA-approved brain stimulation treatments may be prescribed and administered.
Staff
Sarah H. Lisanby, MD, Director
Peter Bulow, MD
Joan Prudic, MD
Alexandra Sporn, MD
Additional Information
For more information about brain stimulation research, see:
Division of Brain Stimulation & Therapeutic Modulation
Referrals
Referrals may be made by treating clinicians or patients themselves.
Contact
To receive a clinical evaluation to help you and your doctor determine whether brain stimulation might be right for you, you may contact us by phone at 212-543-5767, via fax at 212-543-4340, or by e-mail at depression@columbia.edu.
Location
Neurological Institute
710 W. 168th Street, 12th Floor
New York, NY 10032
Mailing Address
New York State Psychiatric Institute, Unit 21
1051 Riverside Drive
New York, NY 10032
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