Personalised therapy offers new path for treatment-resistant depression

In Australia, an estimated 10-30% of individuals with depression do not respond to antidepressant medications, and another 30-40% experience only partial remission. Now, a personalised brain stimulation technique is showing promise for people with depression, especially those who have found little relief from current treatments.

At the heart of this innovation is transcranial magnetic stimulation (TMS), a non-invasive method that uses magnetic pulses to rebalance brain activity. What sets this approach apart is its precision. Instead of applying a one-size-fits-all solution, researchers are using advanced MRI imaging to map each individual’s unique brain structure, identifying the exact spot to target for the best possible outcome.

Over the past three years, the team at QIMR Berghofer’s Clinical Brain Networks laboratory has improved how TMS is delivered. Each patient undergoes an MRI scan, followed by 20 to 30 TMS sessions across several weeks. The impact? Promising.

“Just over half of the patients reduced their symptoms by more than 50%, and around one-third achieved full remission,” said QIMR Berghofer neuroscientist Dr Luke Hearne. “This is particularly exciting for people who have not responded to standard treatments like medication or talk therapy.”

This new frontier in brain-based treatment arrives as Australia marks another important milestone in tackling treatment-resistant depression. Johnson & Johnson Innovative Medicine recently secured the Pharmaceutical Benefits Scheme (PBS) listing for its glutamate receptor modulator, Spravato (esketamine) nasal spray – the first new type of medicine for treatment-resistant depression to be funded in three decades.

Dr Hearne emphasised the importance of personalisation, saying “The brain is incredibly complex, and even millimetre-level adjustments in stimulation sites on the surface of the brain can make a significant difference to clinical outcomes. By tailoring TMS to each person’s unique brain structure, we’re seeing much better responses compared to traditional approaches.”

Interestingly, the study found that people with depression responded more positively than those managing more complex neurological or psychiatric conditions, such as bipolar depression or neurological disorders.

Associate Professor Luca Cocchi, who led the research, reflected on the journey. He stated, “This work is a testament to how cutting-edge neuroscience can directly improve lives. Translating research into clinical practice is always challenging, but seeing patients experience relief after years of struggling with depression is deeply gratifying for our team.”

Now, the QIMR researchers are pushing for the next step: randomised clinical trials. Their goal? Make this highly targeted form of TMS accessible beyond city clinics, especially to rural, regional and remote communities where equitable access to treatment options are limited.

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