The most recent update from the World Health Organization’s Global Burden of Disease Study reported that unipolar major depression alone is the leading cause of disability worldwide. However, medication-based depression treatment faces several challenges, including adverse side effects and/or failure of medication to relieve symptoms. In addition, clinical evidence argues that the greater the number of treatment failures, the less likelihood of a good treatment response to subsequent interventions.
4.5 million people in the United States who have depression don’t benefit from antidepressants.
Transcranial Magnetic Stimulation for Patients with Depression
Transcranial magnetic stimulation is a non-invasive, nonsystematic device delivering magnetic resonance imaging (MRI)-strength pulsed magnetic fields to induce an electric current in the cerebral cortex. When used as an antidepressant, TMS produces clinical benefit without the systemic adverse effects associated with medications, and has no adverse cognitive effects.
Patients may be referred for TMS treatment if they meet the following criteria:
- Have tried antidepressant medications and have either not tolerated the medication or have not found relief from symptoms
- Have been treated with psychotherapy and have not found sufficient relief from symptoms
- Do not have a seizure disorder or a history of seizures
- Do not have any kind of neural implant
TMS may be beneficial for patients wishing to avoid the side effects brought on by antidepressant medications, or who need to discontinue antidepressants for another reason, like planning for pregnancy. Patients may continue psychotherapy throughout TMS treatment.
Commitment to Care Coordination
Dr. David Woo strongly believes that close collaboration between specialists is a cornerstone of effective patient care. Referring physicians can expect ongoing updates and an open flow of communication throughout their patient’s TMS treatment.
TMS is currently an FDA-approved treatment for depression only. To take advantage of insurance coverage, patients must have a diagnosis of major depression. We take care of submitting pre-authorizations for patients, and have been successful in negotiating single-case agreements with many major insurance providers.
The evidence for the clinical efficacy of TMS in treating major depression spans more than 30 randomized, controlled trials in over 2,000 patients. Below are several key studies.
Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial.
This study was the first large multisite, randomized controlled trial for rTMS monotherapy, with 23 study sites encompassing 301 drug treatment-resistant patients with major depression who were treated with TMS for 6 weeks. The active TMS group was more than twice as likely to achieve remission compared with sham. Response rates (>50% improvement but not remission) were 24% in the active group compared with 14% with the sham group. 14.2% of patients in the active treatment group attained remission compared to 5.2% in the sham control group.
Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice.
This is one of the few multisite studies characterizing the utility and effectiveness of TMS in routine clinical practice. Subjects in forty-two US-based clinical TMS practice sites treated 307 outpatients with major depressive disorder with persistent symptoms despite antidepressant pharmacotherapy. Patient-reported response rate ranged from 41.5% to 56.4% and remission rate ranged from 26.5% to 28.7%.
A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period.
In this observational study, 257 patients with major depression who were antidepressant-resistant received TMS treatment in 42 clinical practices. Patients were then followed for 52 weeks. Among patients who met response or remission criteria, 62.5% continued to show improvement. One other important piece of information gathered from this study was that 2 weeks of TMS beyond the up-until-then standard of 4 weeks of treatment had a significant impact. Remission rates doubled during that period of time.
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