Many patients suffering from depression, who are interested in transcranial magnetic stimulation (TMS) as a solution, wonder to themselves how does TMS work? In this context, a treatment for depression “working” would be evidenced by a positive response (improvement in depressive symptoms) or remission (complete and sustained absence of depressive symptoms).
Certain features of a depressive episode can be observed by a clinician, but the severity or frequency of depressive symptoms are often self-reported. A diagnostic tool often used, both for patients to independently complete and for clinicians to use with patients, is the Patient Health Questionnaire, module 9 (PHQ-9). The PHQ-9 directs users to identify the frequency of their experience along nine key metrics of depression from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
An additional measurement of the effects of depression treatments is the 30-question Inventory of Depressive Symptomatology (IDS), which has a clinician and self-rated (IDS-SR) version. Based on the depressive symptom criteria outlined in the DSM-4 and -5, it is a tool primarily used to assess the severity of a depressive case. Other metrics exist that are primarily for clinicians to use during structured interviews with patients. One of these is the Hamilton Depression Rating Scale (HDRS), a 17-question assessment of depressive symptoms’ severity as experienced by the patient in the past week. The Montgomery-Asberg Depression Rating Scale (MADRS) is a ten-question diagnostic, also used by clinicians, that was developed to support the HDRS. Its key function is to be more sensitive structurally to the potential affective changes antidepressants can have on patient responses to such questionnaires.
When answering the question “does TMS work”, examining some of the more decisive studies on the efficacy of TMS as a depression treatment can be helpful.
In 2012, a study was published in Depression and Anxiety by Linda L. Carpenter, MD, a researcher at Brown University, et al. That study assessed the TMS therapy success rate among 307 patients with major depressive disorder (MDD) across 42 TMS clinical practice sites in the US.
The primary metric for improvement of patient symptoms in this study was the Clinician Global Impressions – Severity of Illness scale, a general rating tool practitioners use to identify where a patient falls on a seven-point scale from “1” or “normal, not at all ill” to “7”, “among the most extremely ill patients”. The secondary metric was patient responses to the PHQ-9 and the IDS-SR.
According to this study, the TMS success rate in lessening depressive symptoms was 58.0 percent, with a remission rate (total cessation of depressive symptoms) of 37.1 percent. The study found that TMS is an effective treatment for patients who were unable to find relief from initial antidepressant regimens.
In 2014, Dunner et al published in Journal of Clinical Psychiatry their study on 257 adults suffering from MDD with treatment-resistant features. The purpose of the study was to identify the durability of benefit, or how sustainable the TMS therapy success rate was at various time intervals after the end of active treatment.
This study also used the Clinical Global Impressions – Severity of Illness scale, with the metrics during post-treatment follow-ups being PHQ-9 and IDS-SR. 120 patients met IDS-SR criteria for either remission of depression or response to depression treatment by the end of the initial TMS treatment period. 75 patients continued to meet criteria for response at the end of the long-term follow-up period (12 months), a TMS success rate of 62.5 percent.
301 patients who were not taking medication for their MDD and had not benefited from prior treatment methods underwent either sham or active TMS therapy every weekday for 4-6 weeks in a 2007 study by O’Reardon et al. Patients were first assessed for improvement against their intake responses to the MADRS at four weeks, with both the MADRS and HAMD used to assess TMS therapy success rates at the end of the study period.
Patients who received active TMS consistently reported higher response rates according to both metric tools. The remission rate for patients who received active TMS was nearly double that of those who received sham. Not only was the TMS success rate in this study high, but the participant withdrawal rate due to adverse events was a low 4.5 percent.
The O’Reardon et al study suggests that TMS is a tolerable and effective option for those who suffer from major depressive disorder with resistant features.
In 2015, Levkovitz et al published in World Psychiatry the results of a 212-person study, in which participants aged 22-68 years and who had recently underwent between two and four unsuccessful antidepressant trials. They received either deep TMS or sham TMS, every weekday for four weeks and then biweekly for an additional 12. The primary measurement for TMS success rate was a change in the HDRS scores from intake, with a secondary assessment of response and remission rates at week five.
Deep TMS participant response rates at week five were 38.4 percent, with a remission rate of 32.6 percent. There was also a 6.39 point improvement in HDRS among the treatment group. There were few and minor side effects reported by the treatment group, indicating that deep TMS is not only effective among a particularly difficult-to-treat population, but not particularly uncomfortable for said group to undergo.
The treatment through TMS is a viable and effective therapy for people who suffer from depressions. Each person has different needs and the recommended course of action is to speak with a provider about TMS therapy. Patients are encouraged to read the reveiws and studies and discuss them with their care provider.
Active Recovery TMS provides no-cost consultations to see how TMS can fit into each patient’s treatment plan. Please contact us for more information about this non-medication depression therapy.
Yes. The questionnaire is available here http://activerecoverytms.com/phq-9-test-online/
The most common side effects of TMS are scalp discomfort and headache.
Yes, there have been multiple studies. Each have shown that TMS is successful at treating depression and note that the treatment is effective and tolerable and offers an option to those suffering to those exhibiting resistance to other forms of treatment.
Yes, TMS was approved by the FDA in 2008.
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