No treatment is perfect, but TMS is an amazingly effective therapy for depression.
In the scientific literature the discussion about TMS for depression has appropriately now shifted from asking whether it works to examining methods to maximize its effectiveness.
When depression is treated with TMS response and remission rates are very high, but they’re not 100%.
Georgia TMS Data
The recently analyzed Georgia TMS treatment data shows the NeuroStar Therapy System relieves at least 50% of depressive symptoms in 90% of depressed people, and leads to clinical remission in 75% of depression’s victims.
According to this information there is a good chance (90%) that TMS will be of significant help with depression, and a likelihood (75%) that it will work so well that a formerly badly depressed person would, following treatment with TMS, be in full remission.
Following TMS, 90% feel significantly improved, and 75% feel well. Good odds.
Chances are good TMS will work, but there is a small chance (10% according to the Georgia data) that there will be less than a 50% reduction in symptoms.
We notice that the Georgia TMS data shows response and remission rates considerably better than the clinical trials. This is somewhat unusual in medicine, but it’s typical when comparing TMS clinical trials with TMS in the real world of everyday psychiatric practice. TMS works better in the doctor’s office! Perhaps it’s because the clinical trials did not allow simultaneous antidepressant medicines and TMS. Perhaps it’s because doctors use higher doses of TMS than the clinical trials studied. At any rate, we want to mention this finding, even though no one is entirely sure what it means.
What are odds that medicines will work?
Maybe medicines are a better answer. Let’s look at the data…
Here’s the bottom line with antidepressant drugs: Research shows if the first medicine tried for depression doesn’t work, there is at least a 79% chance that no antidepressant will lead to remission!
Research shows when medications are used to treat depression, the remission rate is about 33% with the first antidepressant drug used. The second drug tried has a 21% chance of achieving remission. The third, 16%. The fourth, 7%. Keep in mind that each new drug tried has a significantly lower chance of causing remission of symptoms.
At best, medicines have no better chance of achieving remission than the TMS clinical trials, and a far worse chance than the Georgia data. People suffering from depression have considerably better odds of remission with our Advanced TMS therapy than they do with a second trial of medication.
It makes sense to provide TMS as a treatment option early on in a patient’s struggle with depression!
Can we increase the odds?
Yes, sometimes we can. At TMS Augusta we know that the research is only part of the story. Individuals sometimes respond to the 15th antidepressant tried. We know a lot of tricks which increases our odds of finding the right medicine for each patient, but far too often the medicines still don’t work. What’s left?
- Repeated attempts with medications – likely to fail
- TMS – likely to work
- TMS + medications to which a patient had a partial response (<50% symptom reduction) – likely to work
The odds of medicines working – unless TMS is added to the mix – go way down if the first medicine tried doesn’t work, according to the research, but keep in mind that another question has to be considered.
What will happen to depression’s victims if TMS isn’t tried?
Even therapy as effective as TMS isn’t perfect, but one thing is 100% certain.
If TMS isn’t tried it can’t possibly work! We’ll never know, unless we give it a try, whether TMS might lift the darkness of depression.
We’re not quite sure what happens next if TMS doesn’t work, but it’s not the end of the rope.
We’re also not at all sure how to determine that TMS hasn’t worked because the research and clinical community studying TMS has yet to determine the necessary dose of TMS and number of TMS treatments for all patients.
One of our colleagues told us of a patient for whom the first course of TMS therapy was not effective. The patient decided to have a second complete series of TMS treatments, and this course of treatment did the trick; they had a full recovery. We know of many people who have remitted after more than the standard number of TMS treatments.
We also know of many people for whom the full effect of TMS treatment occurred some time after the course of treatment was concluded.
TMS begins a process. The process continues to percolate after the treatment.
We don’t give up on our patients no matter what, and we’re always on the lookout for effective, safe treatments for depression. Sometimes we refer patients who don’t respond to our treatments, or who don’t want to try TMS to other psychiatrists, sometimes even doctors in other states, because we want people to get well.
We have a big bag of tricks when treating depression. We use a variety of methods, and we sometimes suggest an array of alternative therapies. Some people are very willing to change their lifestyles if that is what it takes to be healthier, happier, or less depressed. Some people only want standard Western medicine treatments. It’s their choice, but for us, it’s about whatever works and is safe.
Depressed Augusta patients deserve the best. We meet regularly with other psychiatrists who use TMS to compare notes, and to share what we find beneficial, and to discuss the research. All of us are interested in learning everything we can – all the little tricks of the trade, as well as the methods well grounded in research – to maximize the benefit of this treatment in the lives of our patients.