Nothing works for everybody.
Our Advanced TMS with the NeuroStar Therapy System is a fabulous treatment. The numbers show that in Georgia doctors treating patients with this system are seeing a 90% response rate (response means a 50% reduction of depressive symptoms) and a 75% remission rate (remission means the symptoms have disappeared). These are impressive numbers by any standard, but particularly impressive compared with the results seen using medicines which have as their repetitive number one side effect the fact that they so often don’t work.
Psychiatrists are able to boost the numbers. Part of the trick to achieving high response rates, and high remission rates is proper and careful patient selection. Matching the patient, and their particular tendencies, and the symptoms, and the diagnosis, and the treatment, and doing this very, very well improves the odds of treatment response.
It’s a balancing act. Physicians take an oath to do no harm. There is no perfect treatment. Still, we want to help people. Sometimes that means doing nothing. Sometimes it means carefully trying something which isn’t perfect.
When it comes to using medications, we look at a number of factors in deciding which medicine might have a good chance of helping someone. Doing this improves the odds of a good response with the first medicine used. That’s important, as STAR*D shows us that our patient’s odds of a new medicine working to achieve remission and response decrease with each new medicine tried. We want to try to get it right the first time. Of course, that’s not as simple to do as we’d like it to be, but there are some new tricks which improve the odds.
The odds improve remarkably, too, when we avoid trying to treat things which don’t very well respond to medicines with them. Personality disorders, for instance, aren’t as responsive to medications as are some psychiatric illnesses.
The problem of which patient to treat with which treatment becomes considerably more complicated when we consider that a person can have more than one diagnosis. Diagnoses are not mutually exclusive. Our patients have their own unique blend of symptoms, diagnoses, and problems. So, trying to tease it all apart, and understand it all, and make enough sense of things to enable us to help people is rather a tall order.
It would be incorrect to say that any of us who practice medicine are anywhere near being as good at all this – knowing it all, understanding it all, diagnosing everything correctly – as we’d like. We have to always keep in mind that the doctors of the future are going to look back on us like we look back on physicians who treated every patient with leeches! We don’t know everything, and we never will.
In spite of the fact that physicians in most specialties have available to them as diagnostic tools things we psychiatrists don’t have – the physical exam, labs tests, imaging studies, tissue biopsies – our diagnostic understanding of our patients, and our patient selection when it comes to matching treatments to patients, symptoms, and diagnosis has improved since I opened my private practice in 1985. We will continue to improve, I believe.
Does that answer the question? Transcranial magnetic stimulation is not for everyone. Even though TMS very often works when medicines have failed, no treatment is for everyone! Even with perfect patient selection nothing works 100% of the time.
Our goal with TMS is to have it work at least 90% of the time in the patients for whom it should work.
We may err sometimes in advising someone for whom TMS will end up not working to try TMS. We think that a better mistake than the error of not advising someone for whom TMS will end up working well to have TMS. We want to succeed in helping as many people as possible, and we want to have a high batting average.
Some treatments, for carefully selected patients, and for the right problems, work remarkably well. Nothing is perfect, but our Advanced TMS using the NeuroStar Therapy System is a good treatment, and an excellent treatment for carefully selected people. Perhaps you know someone you think might be a good candidate for treatment at TMS Augusta. If so, would you do them the favor of letting them know about TMS? You may very well help save their life.