Major Depressive Disorder (MDD), often simply referred to as depression, is a serious mood disorder that affects up to 15 million adults in the United States. Now believed to result from a combination of genetic and environmental factors, major depression is a biological disorder characterized by severe symptoms that can alter how one thinks, feels, and moves through their daily life. In addition to persistent feelings of sadness and anxiety, those affected may experience a loss of appetite, trouble sleeping, and generalized bodily pain. We are going to go over the effectiveness of multiple treatments in these upcoming TMS Studies.
Since the advent of antidepressants in the early 1950’s, depression has typically been treated with a combination of counseling and prescription drugs. In the past two decades, the use of antidepressants has increased drastically. Research suggests that as many as 1 in 10 Americans take some form of antidepressant. This trend is not without controversy though, as several recent studies have questioned the safety and efficacy of these treatments. Statistically, antidepressant therapies provide a response rate of 67%, compared to a 33% response rate of placebos. This figure, however, does not fully encapsulate the frequency for which many patients fail drug trials. Some patients experience pharmacoresistant depression and may attempt four or more drug trials without any significant symptom relief. Other patients may simply find the side effects of these drugs intolerable, quitting treatment due to experienced nausea, diarrhea, weight gain, insomnia or sexual dysfunction.
ECT Compared to TMS Therapy Results from Studies
Many patients with pharmacoresistant depression turn to alternative, drug-free treatments, such as Electroconvulsive therapy (ECT) or Transcranial Magnetic Stimulation (TMS). Electroconvulsive Therapy, sometimes referred to as Electroshock Therapy, is an older technique that has been practiced for the treatment of severe depression since the 1930’s. The technique boasts generally good results, with a full remission rate of over 50%. However, ECT is relatively unpopular with patients. It is far more invasive than TMS and carries the risk of cognitive side effects, like memory loss. The procedure requires patients to be hospitalized and anesthetized as an electrical current is passed through the brain in order to trigger a short seizure.
By comparison, TMS is a newer therapy that was developed as a non-invasive alternative to ECT. The FDA-approved therapy, which has been practiced in the U.S. since 2008, painlessly delivers magnetic stimuli to the brain in order to induce a small electrical current. The treatment is focused on a specific region of the brain called the left dorsolateral prefrontal cortex (LDPFC), a region that is typically underactive in clinically depressed individuals. The magnetic stimulus causes the neurons in that cortex to fire. Repetitive stimuli can ostensibly train this portion of the brain to be more active, which has clinically proven to improved depressive symptoms.
A series of double-blinded, randomized, placebo-controlled trials conducted in the mid-2000’s unequivocally established the medical efficacy of TMS treatment for depression and led to the technique’s FDA approval. The first of these studies, the Neuronetics Clinical Trial in 2007, found that patients randomly assigned to a real-TMS treatment group demonstrated a “clinically meaningful improvement” when compared to subjects in the placebo-TMS group. An even larger study conducted by the National Institute of Mental Health (NIMH) shortly thereafter, found those treated with real-TMS were four times more likely to see symptom remissions than those in the placebo-control group. From this evidence, the authors concluded that “daily left prefrontal TMS as a monotherapy produced statistically significant and clinically meaningful antidepressant therapeutic effects greater than that of the placebo-control.
TMS Studies Grow and Find Better Results
In the past decade since, new technologies and procedures have continued to be developed and tested with better results. A 2014, study by Dr. David Dunner was one of the largest clinical studies documenting the effectiveness of these updated techniques since TMS’s initial approval. He and his team pooled data from 42 clinical practices with a combine 257 participants. Tracking the subjects’ depressive symptoms over 52 weeks, the study demonstrates TMS’s improved clinical effectiveness. Nearly 50% of patients saw full symptom remission and an even greater percentage saw some symptom response. The study also demonstrated the durability of TMS treatment, finding that a majority of patients who showed full symptom remission at the end of treatment continue to experience symptom relief at the end of the year long follow-up.
Peer-review studies like these not only validate the use of TMS in the treatment of depression, but continue to meaningfully shape and improve both clinical procedure and ultimately patient outcomes. Neuro Wellness Spa closely follows the developments in the field of academic psychiatry in order to stay at the forefront of TMS practice. Our self-collected data on our own TMS protocols shows an even higher effectiveness than those published in major journals. Of the patients we’ve treated since switching to the latest device (The Magventure), 93.3% met response criteria and 86.7% saw full symptom remission. In part, these impressive results reflect the effectiveness of our patient selection procedure—we only treat patients who we are confident will respond to TMS. Additionally, unlike many of the controlled studies, our patients can stay on all their medications during treatment, so the TMS augments any other ongoing therapies. In this way, our incredibly encouraging results at Neuro Wellness Spa corroborate the results from larger, published, controlled studies and further demonstrate the potential of TMS as an effective, drug-free treatment for Major Depressive Disorder.