As Director of the Neuromodulation Division, Dr. Leuchter’s research aims to enhance treatment outcomes in major depressive disorder (MDD). A major challenge in treatment of MDD is that fewer than 30% of patients have complete remission of depressive symptoms with their first antidepressant treatment. Many patients must try series and combinations of medications or other treatments, often taking months or years in order to achieve remission. Dr. Leuchter’s research focuses on shortening the time to achieve remission by examining brain function both before and shortly after the start of antidepressant treatment. Published studies indicate that effective, individualized treatments can be identified more rapidly by examining the brain in an initial state prior to treatment alongside the later state during response.
Dr. Leuchter’s TMS Service integrates comprehensive longitudinal symptom assessment, cognitive performance tasks, and brain neurophysiologic monitoring to allow for the collection of research-level data from patients undergoing clinical treatment who elect to participate as research subjects. Treatment parameters including brain site and pulse parameters will be evaluated alongside clinical and neurophysiologic measures to investigate potential evidence for refining treatment protocols based upon specific patient characteristics. The clinical program currently utilizes a standard form of repetitive TMS (rTMS) delivered via FDA-approved systems. Research projects include investigational pulse sequences such as “theta burst stimulation” (TBS) and sham-controlled studies for new disease states. A different neuromodulation technology, Trigeminal Nerve Stimulation (TNS), is currently under study at the Greater Los Angeles Veteran’s Administration as a novel treatment in veterans with Post Traumatic Stress Disorder (PTSD). This aim of this project, funded by the Department of Defense, is to determine whether adjunctive treatment with active TNS is more effective than sham TNS for reducing symptoms of stress, anxiety, and depression among veterans with PTSD. Learn more about this work at www.brain.ucla.edu.
Other research in Dr. Leuchter’s laboratory aims to understand the mechanisms of the placebo response in MDD. Up to 40% of patients with MDD show significant improvement in depressive symptoms during treatment with placebo. The improvement during placebo treatment usually is short-lived, and is not as of great a magnitude as that achieved with medication. Nevertheless, placebo response studies are important as they represent one of the few scientific approaches to examining interpersonal interaction, expectations, conditioning, and other non-specific factors that may contribute to the benefits of medication treatment. Dr. Leuchter’s research was the first to demonstrate changes in brain function in subjects who improve during placebo treatment; these changes were different from those observed during medication treatment. He now is conducting studies aimed at discerning the relative roles of interpersonal clinical interaction, conditioning, expectation, and medication in recovery from depression. Learn more about this work at www.placebo.ucla.edu.
Dr. Leuchter also is involved in research projects examining brain functional predictors of adverse reactions to antidepressants, including treatment-emergent increases in suicidal ideation. He also is examining predictors of treatment response in fibromyalgia. Dr. Leuchter’s work is supported by 20 years of uninterrupted funding from the Federal government and industry.