Dr. Vincent Agyapong to Launch Study on Effectiveness of Combining rTMS and Online CBT to Treat Depression

Dr. Vincent Agyapong has been awarded a $97,500 grant from Edmonton's Mental Health Foundation to conduct a study on the effectiveness of using dual technology-based therapies to treat patients with Depression.

01 October 2019

Dr. Vincent Agyapong has been awarded a $97,500 grant from Edmonton's Mental Health Foundation to conduct a study on the effectiveness of using dual technology-based therapies to treat patients with Depression.

Dr. Agyapong, a Clinical Professor in the Department of Psychiatry, aims to recruit 100 patients to participate in a randomized controlled trial employing both rTMS and online-based Cognitive Behavioural Therapy (CBT) to treat patients with Depression.

"We're finalizing the protocol now for our ethics application and registering the trial with ClinicalTrials.gov, so we'll be publishing the protocol in the next few months," says Dr. Agyapong, who is also Edmonton Zone Clinical Section Chief for Community Mental Health with Alberta Health Services (AHS).

"We expect to start the trial early in the new year, probably in January, once we hire some graduate students to help set the program up. We'll be recruiting patients at the AHS Mental Health Clinic on 108 Street over the following 12 months, and hope to complete the study in about 18 months."

Repetitive Transcranial Magnetic Stimulation - or rTMS - is a noninvasive form of brain stimulation that employs magnets to generate an electric current to stimulate targeted areas of the brain. There are now five rTMS machines in the Edmonton Zone, including three at the 108 Street clinic and two at Alberta Hospital Edmonton's Day Hospital.

The Mental Health Foundation funded the purchase of all five Edmonton-area rTMS machines. Previously, the only publicly available rTMS machine in Alberta was located at Ponoka's Centennial Centre for Mental Health and Brain Injury.

"Most patients with Depression are treated with antidepressants to correct biochemical imbalances in the brain, typically targeting chemicals such as Serotonin and Norepinephrine. But sometimes antidepressants are not effective. That's why rTMS and ECT (Electroconvulsive Therapy) are often used for patients with treatment-resistant Depression, to enhance these biological processes," he explains.

In addition to rTMS treatments, trial participants will also receive Internet-delivered Cognitive Behavioural Therapy, or CBT. CBT is a psycho-social treatment that teaches patients the skills needed to help them better manage anxiety, Depression or other mental health challenges. Dr. Agyapong hopes the trial results will show whether a combination of the two treatments produces better patient outcomes.

"When CBT is delivered in person, one-on-one, it is very human resource intensive, and therefore very capital intensive. There is also a very long wait list for patients to access CBT. Many people need it but there are very few therapists available to provide it," says Dr. Agyapong, noting that the current wait time to see a therapist at the 108 Street clinic is 56 days.

"By using Internet-based, Internet-delivered CBT - or iCBT - in combination with rTMS we can reduce that wait time. Another benefit of using i-CBT is that patients will have their subscription to the program for a year, so apart from what is delivered to them while they attend the clinic, they will continue to have access to the i-CBT program for one year."

Although online CBT can be an effective way to treat Depression, it can be difficult to motivate patients to use it. By providing simultaneous rTMS treatments, Dr. Agyapong believes this will "kick start" patients into being more proactive about accessing i-CBT.

"The program includes videos and exercises that one has to follow and they are all designed to be similar to what you'd experience in a face-to-face CBT session," he explains.

"Once the trial starts, participants will come in two days per week, one hour before their rTMS session, to access online CBT. For each cohort in the trial, the rTMS treatments will be offered every weekday for six weeks. By the end of six weeks, each participant will have completed 12 hours of online CBT, which is similar to what a patient receives in face-to-face sessions."

Trial participants will subsequently be monitored at one-month, three-month and six-month intervals using standardized assessment scales.

The study is just the latest example of Dr. Agyapong's willingness to harness the power of technology in an effort to better serve the needs of mental health patients.

In 2016, AHS launched Dr. Agyapong's Text4Mood program, a daily supportive text messaging service for patients struggling with Depression and Anxiety. Since it was unveiled Text4Mood has been used by tens of thousands of subscribers, and Dr. Agyapong has developed a series of related spin-off programs.

In honour of his pioneering work, Dr. Agyapong was named Physician Innovator of the Year at the March 2018 Edmonton Zone Mental Health Staff Association (EZMSA) Awards. More recently, he was the recipient of the Alberta Medical Association Award for Compassionate Service.

At an awards dinner in late September, AMA President-Elect Dr. Paul Boucher praised Dr. Agyapong for his ongoing commitment to serve the mental health needs of children and youth in Fort McMurray in the wake of the devastating wildfire that besieged the city in 2016.

"In addition to his work in Edmonton and Fort McMurray, Dr. Agyapong continues to volunteer in his home country of Ghana. In 2009 Ghana had only four resident Psychiatrists for a population of 28 million. Dr. Agyapong began travelling there annually, at his expense, to teach undergraduate medical students at Kwame Nkrumah University," Dr. Boucher told guests.

"He also launched a program to enable Ghanian medical students to receive fully sponsored elective placements in Psychiatry at Irish institutions. The number of Psychiatrists in Ghana has subsequently increased from four to 18 with another 27 Residents in Psychiatry currently training with the Ghana College of Physicians and Surgeons," he added.

"Dr. Agyapong has demonstrated enormous compassion and a willingness - indeed an eagerness - to go out of his way to care for people who would otherwise not have access to the care they need. The people of Alberta and Ghana in particular have benefited greatly from his work on their behalf."

As part of his efforts to encourage medical students in Ghana to pursue a career in Psychiatry, Dr. Agyapong launched an annual debating competition for the country's medical students in 2010.

"The whole idea was to run an annual inter-medical schools public speaking competition, with each of Ghana's medical schools selecting two students to speak about a topic of public health interest. The winners of the competition were sponsored to go to Dublin for four weeks to study Psychiatry," he says.

"Initially I had two hospitals as sponsors but one withdrew. I'm now hoping the Department of Psychiatry will support this. The Royal College of Physicians and Surgeons of Canada has put out a call for funding for programs in middle-income countries, so I'm planning to file an application in the name of the department to assume control of this program and sponsor two Ghanian students to come to Alberta."

The Royal College is offering $30,000 a year of funding for three years - more than enough to cover the program's costs, as well as a series of guest lectures by faculty members at Ghana's medical schools, says Dr. Agyapong.

"If the application is successful this won't cost the department anything, but it will be a huge benefit to Ghana's medical students and it will help us to continue to promote Psychiatry as an exciting career option for them."