Driven by the limitations of traditional approaches to treating depression, there has recently been a surge of studies examining the utility of various noninvasive neuromodulation technologies in the treatment of depression. In this issue, Rohan et al [1] report substantial improvement in mood immediately following one twenty-minute treatment application of low-field magnetic stimulation (LFMS), performed with a novel portable tabletop device. The stimulation paradigm they utilize consists of a 1 kHz oscillating magnetic field, adapted from the component of the MRI protocol that they previously serendipitously found to have beneficial mood effects [2]. In the current study, LFMS was applied in a double-blind, sham-controlled design to a heterogeneous group of 63 patients with either bipolar depression or major depressive disorder, and effects on mood were assessed primarily using a self-rated visual analog scales (VAS) and observer-rated Hamilton depression rating scale (HDRS-17). The authors found that real LFMS produced an immediate improvement on several scales across the combined population of depressed patients as compared to sham. Although they must be interpreted with caution and much additional work is necessary before the clinical utility of the approach can be determined, these results are highly intriguing.A particularly striking aspect of the LFMS effect is that a mood-elevation was found immediately after one brief treatment. Psychiatric treatments, including the neuromodulatory gold standard of electroconvulsive therapy [3], generally show much slower onset of effect, typically requiring weeks before separating from placebo in sham-controlled clinical trials. While ketamine has been shown to have a rapid antidepressant effect within twenty-four hours [4], durability and clinical utility need further elucidation. Rohan et al. [1] were able to demonstrate improvement in mood ten to fifteen minutes after completion of the intervention, although whether these effects had any durability could not be determined by their study design. Rapidity of onset can be an essential factor in the clinical realm, where there are few effective treatment options available to rapidly assist the high-risk acutely suicidal patient. The LFMS approach features other notable strengths, including a
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript completely non-invasive approach with no known adverse effects. The absence of any physical sensation with stimulation enables fairly robust blinding, of benefit for future trials. The device is also small and portable, thus enabling potential future home use, and utilizes technology and physical properties that are relatively well known.However, there are a number of unanswered questions that cloud an assessment of the clinical significance of the present results. Most importantly, the study was not designed to measure the durability of mood improvement. Mood effects were evaluated immediately (10 to 15 minutes) after the intervention, but there were no sub...