Our Research

Theme Overview

Stress, anxiety, distress and depression are exceptionally high among healthcare workers at the frontline of the COVID-19 pandemic. Factors underlying distress and resilience are unknown and there are no evidence-based interventions to impact the mental wellbeing of frontline healthcare workers. Our study evaluates a novel mobile platform to gather the “distress experience” of frontline healthcare workers at Unity Health Toronto in real time during the ongoing COVID pandemic, uses automated personalized mobile interventions (e.g. routine, sleep, exercise) to nudge active/passive parameters to manage distress, and examine the role of add-on remote cognitive behavioural therapy (CBT) when automated mobile interventions do not suffice.

Ongoing Studies

“Could Mobile-Based Interventions Aids to “Understand and Flatten the Curve” of Stress, Anxiety, Distress and Depression Among Healthcare Workers at Unity Health Toronto During the COVID-19 Pandemic?”

    Study Coordinator: Sharadha Kolappan (Sharadha.Kolappan@unityhealth.to)

    Eligibility:

    • UHT employee
    • 18 years or older
    • Owns a mobile phone (Android phones with OS version 6.0 and above, iPhone 6 with OS 11 and above)

    Invervention Protocol:

    • A customized version of an open source mobile-based platform, LAMP [https://www.digitalpsych.org/lamp.html], which is fully compliant with patient/participant confidentiality standards (US HIPPA and corresponding Canadian law compliant), will be used.
    • The platform allows for collection of various forms of active data (data collected while the participant is using the app, e.g., anxiety, mood surveys), and passive data (data collected whether or not the user is actively using the app, e.g., accelerometer data).
    • Participants will automatically be randomized to receive (for 4 weeks) personalized automated alerts (e.g., to practice bibliotherapy, exercise, etc.), which are based on their active and passive data, with the objective of nudging the active and passive parameters to remain within acceptable range of distress. This feature will be made available to all participants after 4 weeks.
    • Participants who are unable to manage stress with daily mobile monitoring/feedback and meeting threshold scores for moderate to severe anxiety and depression based on the active (survey data) will have links to access internet-based cognitive behavioural therapy (iCBT).
    • The anticipated duration for the study is 1 year.

Theme Overview

Neuromodulation is an evolving therapy for treatment-resistant depression that involves the application of electromagnetic stimuli (magnetic field or electric current) to the brain. Applied magnetic or electrical stimulus stimulates nerve cell activity and employs the body’s natural biological response by releasing neurotransmitters – specialized chemicals that allow brain cells to communicate with each other. Brain stimulation modulates the firing pattern of nerve cells and stabilizes the interaction between different parts of the brain. The treatment is non-invasive, meaning that no surgery is required.

The Interventional Psychiatry Program at St. Michael’s Hospital carries out a number of research studies to explore the clinical efficacy and functional outcomes of the following brain stimulation treatments:

  1. Repetitive transcranial magnetic stimulation (rTMS);
  2. Transcranial alternating current stimulation (tACS);
  3. Temporal interference stimulation (TI)
  4. Functional electrical stimulation
  5. Electroconvulsive therapy (ECT)

The ultimate goal of this research is to develop novel clinical tools for the diagnosis, prognosis, and treatment of resistant depression. The studies explore how certain biological markers in the form of behavioural measures, EEG, or MRI can be used to clinically quantify and predict treatment response to brain stimulation. This research focuses on personalized medicine approaches and aims to determine optimal individual treatment parameters in each patient for the most beneficial outcome.

Below is a list of our current clinical trials, and the contact information for the study coordinator, who can answer any questions you many have about the study, including the referral and intake process. Research funds are available to cover the full cost of treatment for participants who wish to enroll in these trials.

Ongoing Studies


Study One: Temporal Interference (TI) for Depression

    Study Coordinator: Ilya Demchenko (Ilya.Demchenko@unityhealth.to)

    Overview: Temporal Interference (TI) stimulation is a novel promising form of non-invasive transcranial electrical stimulation that is the first of its kind to modulate brain regions located deep below the surface. Brain stimulation techniques have been around for a while but their functional application has been limited to the outer parts of the brain. Depression, however, is known to be associated with a brain area called the subgenual cingulate cortex located deep below the surface. The unique ability of TI to target this region gives it an unlimited potential in advancing scientific knowledge of brain function and offers a promising therapeutic application for major depression.

    Eligibility Criteria:

    • Diagnosis of Major Depressive Disorder
    • Have not seen results following a previous course of treatment for the Major Depressive Disorder such as pharmaceuticals, psychotherapy, or rTMS
    • Male or Female, aged 18-65 years old

    Treatment Protocol:

    • 2 weeks of daily TI sessions administered during weekdays only, for a total of 10 TI sessions
    • An MRI will be taken both prior to and following the course of treatment
    • Weekly assessments throughout treatment


Study Two: Transcranial Alternating Current Stimulation (tACS) for Depression

    Study Coordinator: Ilya Demchenko (Ilya.Demchenko@unityhealth.to)

    Overview: Transcranial Alternating Current Stimulation (tACS) is a safe, tolerable non-invasive stimulation technique. By passing weak electrical currents through the brain, the technique is thought to boost the brain’s own oscillations, which can be used to treat disease or enhance brain function. Brain oscillations (or brain rhythms) are always happening in the brain and impact how we think, feel, and relate to depression. Due to its unique ability to normalize disturbed brain rhythms, tACS is now considered a promising therapeutic tool for major depression and other psychiatric disorders.

    Eligibility Criteria:

  • Diagnosis of Major Depressive Disorder
  • Have not seen results following a previous course of treatment for the Major Depressive Disorder such as pharmaceuticals, psychotherapy, or rTMS
  • Male or Female, aged 18-65 years old
  • Treatment Protocol:

  • 4 weeks of daily take-home tACS sessions administered during weekdays only, for a total of 20 tACS sessions
  • An EEG will be taken prior to, during, and following the course of treatment
  • Weekly assessments throughout treatment


Study Three: Functional Electrical Stimulation (FES) for Depression

    Study Coordinator: Ilya Demchenko (Ilya.Demchenko@unityhealth.to)

    Overview: Functional Electrical Stimulation (FES) applies small electrical pulses to facial muscles making them contract, which improves their function and is commonly used for exercise. Research on facial expressions has shown that facial movements can induce the corresponding emotions, particularly when specific attention is paid to voluntarily activating muscles that are typically only activated involuntarily while expressing emotions (smiling, for example). Applying FES to the facial muscles associated with smiling may increase the activity of brain structures related to positive emotions, which can potentially counteract symptoms of depression.

    Eligibility Criteria:

  • Diagnosis of Major Depressive Disorder
  • Have not seen results following a previous course of treatment for the Major Depressive Disorder such as pharmaceuticals, psychotherapy, or rTMS
  • Male or Female, aged 18-65 years old
  • Treatment Protocol:

  • 4 weeks of daily FES sessions administered during weekdays only, for a total of 20 TI sessions
  • Weekly assessments throughout treatment
X