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.
“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)
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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:
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.
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.
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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.
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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.
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Our work involves learning the intricacies of the immune system in order to better understand autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, juvenile diabetes and multiple sclerosis. The Lab is particularly focused on an autoimmune disease called immune thrombocytopenia (ITP), a condition characterized by low platelets (thrombocytopenia), which are particles in the blood that are important in the process of maintaining the integrity of the blood vessels. Disorders affecting the numbers of blood platelets can put patients at risk of bleeding. Dr. Lazarus and some of the members of the team study, the ability of novel monoclonal antibodies, as well as antibodies taken from the plasma of healthy blood donors (IVIg) to inhibit disease progression in autoimmunity. Dr. Lazarus and his team are having success in determining how IVIg suppresses ITP, and by uncovering IVIg’s mechanism of action, a replacement treatment may be developed that will be less costly, in continuous supply and free of viral disease. His Lab has discovered a replacement for IVIg to treat some autoimmune disorders in animal models (ITP & inflammatory arthritis) and we hope to be testing new therapies in human clinical trials within the next three to five years.
His group is also engaged in studies on how an antibody called “anti-D” is able to prevent a disease known as hemolytic disease of the fetus and newborn from occurring. Anti-D, like IVIg (above) is a plasma derived protein (antibody) that is collected from many blood/plasma donors and is currently injected into pregnant mothers as well as mothers who have just delivered babies to prevent hemolytic disease of the fetus and newborn. Understanding how anti-D the works will aid us in the development of a monoclonal substitute.
Click on one of our projects below for more information
Dr. Baker’s research laboratory focuses on understanding the pathophysiology of traumatic brain injury and investigates therapeutic approaches to improve outcome. The lab has numerous ongoing research streams. These include the development and use of a model of low-intensity shockwave exposure to understand the effects of blast on the brain, investigations into the pathophysiological response of the blood brain barrier to modelled brain trauma and cellular mechanisms contributing to cerebral vascular dysfunction after trauma, the use of various stem cells as a treatment for traumatic brain injury, and development of zebrafish models of traumatic brain injury for medium and high throughput screening of therapeutic compounds. The lab employs a range of scientific tools and techniques using both in vivo and in vitro systems. The lab has personnel with extensive expertise in small animal surgery and physiology, microscopy, immunohistochemistry, protein analysis, electrophysiology, cell culturing and model development.
Our research priorities include fracture treatment, fracture prevention in osteoporotic patients, prognostic cohort studies, e-data collection and reporting, measurement and outcomes research, and knowledge translation (facilitative best practice). We have expertise in qualitative and quantitative methods to explore these areas, and place a strong emphasis on the application of the results in clinical practice and health policy.
