Repetitive transcranial magnetic stimulation offers relief from depression: Expert


PUNE: Rakesh used to feel low. Soon he lost interest in his job. He took to alcohol to feel better and things kept going downhill after his wife walked out. When he approached doctor for treatment of depression, he had already spent two years in depression.

Today, Rakesh has almost recovered and leading a normal and productive life. Thanks to a new treatment modality called repetitive transcranial magnetic stimulation (rTMS). Rakesh is just one of many suffering from depression and one of the few who got it treated.

According to WHO ( World Health Organization) report depression is going to be second leading cause for disability and India is going to have maximum number cases in world by 2020. Problem however is not the illness but lack of awareness and stigma attached to it.

"Depression if not treated can last for more than a year. Treatment is necessary as depression can lead to professional, family, financial, and physical health related complications including suicide," said psychiatrist Swapnil Deshmukh of Shreeyash Hospital who has treated Rakesh with rTMS.

Various types of treatment modalities are available depending on severity of illness including cognitive behavioural therapy (CBT), medicine, electro convulsive therapy (ECT), and latest - rTMS ( re-petitive Transcranial magnetic stimulation). All these are standard, well proved and accepted worldwide -FDA approved treatment modalities.

"Around 20% of cases are mild and can be treated with CBT itself but remaining requires medications in addition to counselling. Around 30 to 40% of depression cases can be severe, resistant to treatment, and may require long term medications in these shock treatment (ECT) is very effective," Deshmukh said.

"rTMS is a resent treatment modality in depression and other psychiatric illness in which magnetic waves can directly stimulate affected- less functioning brain areas non-invasively. It is considered to be safest, non-medicine dependent, cost effective treatment modality getting very popular in west. Combination of above mentioned treatment work better," Deshmukh said

Usually, patients with milder depression respond within 3 to 6 weeks, but severe resistant depression may take longer duration, he added.


Human stem cells help regenerate liver function in mice


Human stem cells help regenerate liver function in mice
WASHINGTON: Researchers transplanted derived functional hepatocytes from human stem cells into mice suffering from acute liver injury, and found that these liver cells functioned normally and raised survival of the treated animals.

Massoud Vosough and co-authors demonstrate a large-scale, integrated manufacturing strategy for generating functional hepatocytes in a single suspension culture grown in a scalable stirred bioreactor.

In the article 'Generation of Functional Hepatocyte-Like Cells from Human Pluripotent stem cells in a Scalable Suspension Culture' the authors describe the method used for scale-up, differentiation of the pluripotent stem cells into liver cells, and characterization and purification of the hepatocytes based on their physiological properties and the expression of liver cell biomarkers.

David C Hay, MRC Centre for Regenerative Medicine, University of Edinburgh, UK, comments on the importance of Vosough and others' contribution to the scientific literature in his editorial in Stem Cells and Development entitled 'Rapid and Scalable Human Stem Cell Differentiation: Now in 3D.'

The researchers 'developed a system for mass manufacture of stem cell derived hepatocytes in numbers that would be useful for clinical application,' creating possibilities for future 'immune matched cell based therapies,' Hays said.

Such approaches could be used to correct mutated genes in stem cell populations prior to differentiation and transplantation, he adds.

The findings have been published in Stem Cells and Development.

E-psychiatry software to treat patients in remote, disaster-hit areas


CHANDIGARH: Following Uttarakhand-like disasters, where it is sometimes not possible to reach the interiors and provide timely psychological assistance, an e-psychiatry software, jointly developed by PGIMER and Tata Consultancy Services (TCS), is all set to take off at the primary hospitals in remote regions of Bilaspur (Himachal), Srinagar (J&K) and Uttarakhand.

Gradually this will expand to other regions of the country. "After successfully passing a three-year field trial in these remote areas, the software has been developed to detect, diagnose and treat mental disorders, which even a non-medico can use," said Savita Malhotra, main investigator of the project at the department of psychiatry, PGIMER.

The project has been funded by the department of science and technology, and the Indian Council of Medical Research ( ICMR). Using the e-psychiatry, total 1,000 patients have been already assessed to check the reliability factor.

The software can be used as a diagnostic and treatment tool by social workers (non-medicos), who can assess the mental disease using a set of validated questionnaires fed into the software. The technology also generates a database of patients' history and alerts the user if there is a case of diabetes or hypertension or pregnancy.

The software includes comprehensive management of 18 psychiatric disorders each in adults, children and adolescents. Explaining about how the tool works, Malhotra said, "Questions are asked from the patient. These questions are fed into the software. After the screening questionnaire is answered, only those modules open for which the patient seems likely to suffer from. For instance, if its schizophrenia, modules which have symptoms close to this disease will open. Finally, after a few responses, which are automated, the diagnosis is confirmed."

Once the disease is diagnosed, treatment is generated on the basis of assessment and few scales, which the software responds to. "Currently, the application is at the secondary level health care. We are now working on to make it useful for primary level health care. Gradually, it will be incorporated in the mobile phones and used by the households," said Malhotra.

According to the WHO, 65 persons per 1,000 suffer from mental disorders. For every one lakh patients there are only 0.2 psychiatrists in India.