The Neuromodulation Program specializes in studying and treating psychiatric disorders with the use of non-invasive neuromodulatory techniques, namely:
- Repetitive transcranial magnetic stimulation (rTMS)
- Transcranial direct current stimulation (tDCS)
- Deep transcranial magnetic stimulation (DTMS) (starting late 2010)
Target population
We offer treatments based on the latest scientific evidence and according to rigorous safety standards. As a corollary, we avoid the indiscriminate use of neuromodulatory techniques for clinical conditions where scientific data is lacking. Neuromodulation has been shown to be effective for:
- People suffering from major depression and schizophrenia (rTMS)
- People suffering from major depression in an experimental/research context (tDCS and DTMS)
- Additional clinical conditions in response to new published studies
Patients with the following conditions are not eligible for neuromodulation treatment because of safety issues:
- Current drug or alcohol abuse/dependence (within the past 6 months)
- Current unstable medical disease (cardiovascular, renal, pulmonary)
- Pregnancy and/or lactation
- Personal history of epilepsy and/or lifetime primary or secondary convulsion(s)
- Presence of any metallic objects in the head (with the exception of the mouth), such as inner ear prosthesis, piercings, aneurism clips, shrapnel, screws, etc.
- Presence of implanted pacemakers or medication pumps
Services offered
Repetitive Transcranial Magnetic Stimulation (rTMS)
The Douglas Institute currently offers rTMS for the following conditions:
- Non-psychotic unipolar major depression of at least moderate intensity that has not improved after 1 to 4 adequate antidepressant trials
- Medication-resistant auditory hallucinations in schizophrenia
- Persistent negative symptoms in schizophrenia
We may also consider off-label (compassionate) rTMS treatment for additional selected conditions such as obsessive-compulsive disorder, post-traumatic stress disorder and bipolar disorder. Off-label use of rTMS will be considered on a case-by-case basis.
For complete information about rTMS, how it works, its main advantages, common side effects, and health risks, and what a typical rTMS session looks like, please consult the FAQ.
Transcranial Direct Current Stimulation (tDCS)
The Douglas Institute currently offers tDCS in an experimental/research context for the following condition:
- Non-psychotic unipolar major depression of at least moderate intensity that has not improved after 1 to 4 adequate antidepressant trial(s) and after 4 to 6 weeks of standard rTMS treatment.
Further studies are needed to clarify the efficacy and safety of tDCS for other psychiatric disorders. Thus, newer indications might be offered in the near future.
For complete information about tDCS, how it works, its main advantages, common side effects, health risks, and how a typical tDCS session looks like, please consult the FAQ.
Access to services
Physicians wanting to refer a patient for neuromodulation treatment must provide us with the following information:
- Duly completed request form for therapeutic neuromodulation
- Medical consultation request
- Copy of recent laboratory exam results (less than 6 months old)
These documents should be sent by mail or fax to the Neuromodulation Program at the address mentioned below. We will not proceed before we have all the documents, duly completed by a licensed medical doctor. Physicians who need more information about the treatment may contact the Neuromodulation Program directly.
All eligible patients will meet with a psychiatrist for a pre-neuromodulation assessment, which includes:
- brief medical examination
- safety evaluation
- review/signing of a consent form
Patients will then be scheduled to start their neuromodulation treatment on the first available spot. As spots are limited, patients will be automatically included in a waiting list whose wait-time varies from 2 to 8 weeks.
In the case where a patient is accepted for treatment, the Douglas Institute will be only responsible for neuromodulation-related issues (e.g., side effects); thus, the referring physician will remain responsible for all other aspects of treatment care. If a patient is not eligible for neuromodulation treatment, he/she will be immediately referred back to his/her treating physician.
Presently, rTMS and tDCS are being offered free of charge, but patients are responsible for their transportation and/or accommodation arrangements.
An attestation regarding neuromodulation treatment could be provided for employment and/or insurance reasons.
Research
A team of researchers carries out cutting-edge studies on the experimental and clinical aspects of non-invasive neuromodulatory methods in both psychiatry and neurosciences. A new Translational Neuromodulation Laboratory will be inaugurated early 2011.
Teaching and Knowledge Transfer
The program transfers knowledge through teaching or training activities for health professionals, interns, and residents. For example:
- The organization of a 2010 Conference entitled “Recent Advances in Brain Stimulation”
- Starting in 2011: a 2-day, hands-on workshop on the use of non-invasive neuromodulation for treating psychiatric disorders. It will be carried out twice a year.
Marcelo Berlim, MD, also reviews the PubMed database for clinical trials on non-invasive neuromodulation techniques for treating major psychiatric disorders (e.g., mood, psychotic, eating, and anxiety disorders). His findings are published on his diigo webpage.
An interdisciplinary team
Coordination
Marcelo T. Berlim, MD, MSc
Director, Neuromodulation Program, Douglas Institute
Coordinator, Neuromodulation Program, Mood & Anxiety Disorders Section
Assistant Professor, Department of Psychiatry, McGill University
Psychiatrist, Depressive Disorders Program, Douglas Mental Health University Institute
Martin Lepage, PhD
Co-Director, Neuromodulation Program, Douglas Institute
Coordinator, Neuromodulation Program, Psychotic Disorders Section
Howard Steiger, PhD
Coordinator, Neuromodulation Program, Eating Disorders Section
Gustavo Turecki, MD, PhD
Coordinator, Neuromodulation Program, Suicidal Behavior Section
Clinical Staff
Karen Blumhoff, R.N., Nurse
Louise Nadeau, Technician in Neuromodulation & Electroencephalography
Graduate Students
Audrey Benoît, BSc, PhD Student, UQAM
Cindy Hovington, MSc, PhD, Student, McGill University
Contact information
Neuromodulation Program
Douglas Institute
FBC Pavilion
6875 LaSalle Blvd.
Montreal, Quebec H4H 1R3
