Lecture – Personalizing Psychiatric Neuromodulation

Presented by Shan H. Siddiqi, MD, Beth Israel-Deaconess Medical Center – Visiting Scholar Series lecture

Treatment-resistant psychiatric disorders are often treated with neuromodulation techniques. These approaches use electrical currents and other methods to modulate brain circuits related to specific conditions. Brain neuromodulation techniques include transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), and ablative neurosurgery.

Watch now to learn more about:

• Current indications for clinical TMS
• Subtyping patients by circuit-based phenotypes in addition to traditional diagnostic categories
• Predicting response to different circuit-based interventions

Neuromodulation techniques have shown great promise for treating many psychiatric conditions, including treatment-resistant depression. Yet, our methods for targeting these circuits are imprecise. Our inability to target brain circuits with precision limits the usefulness in clinical settings.

In this lecture, Siddiqi details the advantages of neuromodulation techniques in addressing treatment-resistant conditions. Approaches like TMS, he says, have been shown to be safer and more effective than some standard treatments for depression. Still, many clinicians are reluctant to recommend these approaches to their patients.

Targeted neuromodulation, he says, holds great promise for treatment because it “links brain circuits to clinical treatments that are relevant to patients.”

Still, concerns persist regarding imprecise targeting of brain circuits. Siddiqi says that brain mapping is a complicated computational task and our existing approach to targeting brain circuits for treatment are “quite crude.” Rather than using brain imaging, some clinicians rely on simple scalp measurements, performed by hand.

Fortunately, Siddiqi reports, researchers are now using brain imaging techniques, such as magnetic resonance imaging (MRI), to improve the ways they target brain circuits. This increase in precision allows for a more personalized approach to neuromodulation treatment and better outcomes.

During this talk, Siddiqi cites research studies that examine novel approaches to individualizing neuromodulation targets. He describes several approaches based on clinical subtyping and individualized functional imaging.

Also, he discusses improvements in the ways that clinicians can predict responses to neuromodulation interventions. These advances enable more individuals with treatment-resistant conditions to receive effective care.

Looking to the future, Siddiqi describes neuromodulation studies on patients with coexisting depression and anxiety, as well as research into optimal brain targets related to PTSD. He also explains how investigators are looking at ways to apply targeted neuromodulation on people with addiction disorders and personality disorders.