$1 million grant funds suicide treatment trials at EAMC

By David M. WSeptember 2, 2016

Depression
(Photo Credit: U.S. Army) VIEW ORIGINAL

The Behavioral Health Clinic at Eisenhower Army Medical Center received a boost earlier this year when it was awarded a grant of nearly $1 million to study an advanced treatment for rapidly reducing acute suicidal crisis in active duty service members.

Since 2014 patients with depression who have not benefitted from antidepressant medications have been treated at EAMC with transcranial magnetic stimulation, a Food and Drug Administration-approved non-invasive procedure. EAMC is one of only three facilities in the Army that provide this treatment. According to Dr. Christopher Hines, chief of Outpatient Behavioral Services at EAMC, TMS therapy provides an electromagnetic pulse to a targeted region within the brain that scientists believe is responsible for causing depression.

Conventional TMS treatments are administered for one hour per day, five days per week for four to six weeks. There is pilot data from previous research to support the idea of using an alternative schedule and the study here seeks to determine if a shorter course, three times a day for three days, will reduce suicidal thinking.

If this treatment is valid, Hines said, it will lead to "shorter hospital stays, reduced costs for prescription medicines, increased quality of life and, ultimately, save lives."

The three-year grant, totaling $975,000, is from the U.S. Army Medical Research and Materiel Command's Congressionally Direct Medical Research Programs.

"Suicidal thinking is relatively common among service members as well as the general public," Hines said. Many people have those thoughts, he said, but the difference is intent.

"Ideation is having passive thoughts of suicide," he said. "Most people with ideation will not progress to the more dangerous areas of planning and intent. When the thoughts reach the planning stage, the person is contemplating actual ways to hurt themselves. Intent, which includes accessing means and the possibility of acting on the plans, of course, is the most dangerous and generally past the point when health care professionals want to become involved and render treatment. The earlier we intervene the more likely we are to have a positive outcome."

"In 2010, the most recent year comprehensive data is available from the Centers for Disease Control and Prevention, there were 38,364 suicides in the United States. Meanwhile, suicidal thoughts and plans are even more widespread: 8.3 million American adults reported having suicidal thoughts in the past year, 2.2 million went as far as to make plans, and 1 million made a suicide attempt," according to a March 16, 2015, article entitled "Suicide: Statistics, Warning Signs and Prevention," on LiveScience.com.

TMS' therapeutic treatment of depression has the potential to suppress suicidal thinking. During the TMS treatment process, a doctor or technician places a magnetic coil against the patient's scalp at a specific point determined by the physician through an MRI or a clinical calculation. The coil produces a series of electromagnetic pulses. While the patient hears a series of clicks with each pulse and feels the magnet on his scalp, the procedure is noninvasive.

EAMC's grant funds the treatment of 115 soldiers in a two-line, double-blind study, Hines said. A new treatment apparatus has been installed at EAMC that provides one "live" magnet and two additional magnets that, and this is the "blind" portion of the study, neither the patient nor the technician knows if the dosage is an actual treatment or a placebo. Study results will make comparisons between the treatment group and the placebo control group, and all participants will receive conventionally available treatment that is clinically indicated.

The new equipment was installed in the Behavioral Health Clinic in late August. The clinical staff will be trained in early September and a manager for the study is being brought onboard to oversee administration, recordkeeping, and tracking statistics and subjects.

Dr. Mark S. George, MD, distinguished professor of Psychiatry, Radiology and Neuroscience, Layton McCurdy Endowed Chair and director of the Brain Stimulation Laboratory at the Medical University of South Carolina, is serving as a consultant on the project. George, a world-renowned expert in brain stimulation and depression, was featured in the PBS show, "NOVA scienceNOW," regarding his work treating depression and pain using TMS. He spent four years at the National Institutes of Health in Bethesda, Maryland, where he performed the first-ever studies of TMS for depression.

Having George attached to this project as a consultant lends weight to an already-significant research study by EAMC's Behavioral Health clinical staff.

"Being able to conduct this level of research is cool," Hines said. "We're not Walter Reed" [National Military Medical Center] but we're very good at what we do.

"Currently there is no active treatment for acutely suicidal people," Hines said, "we typically keep them is a secure facility while waiting for medications to have effect which can take anywhere from two to 12 weeks. If positive, this study will be ground breaking because it would reduce that treatment time to three days."

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