TMS

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Mindfulpsych22

Full Member
10+ Year Member
Joined
Mar 14, 2013
Messages
73
Reaction score
163
Hi everyone,

I know someone that was referred for TMS for depression by another provider. The patient was concerned that the treatment was presented in an unrealistically positive light and wants to make sure it will be worth the time commitment. I do not know the TMS literature well so I was wondering if someone could point me to some resources or articles that cover the outcome literature for this treatment, possibly some that I could send to this person. Any additional thoughts/knowledge about the treatment and its effectiveness that I could pass onto this person would be helpful as well.

Thanks!

Members don't see this ad.
 
Cochrane review in 2002 did not find evidence of efficacy. I haven't seen any good meta-analyses since then that have examined change made to the treatment, although I also haven't looked all that exceptionally hard either. My view on what I know is that, while safe, it's probably not ready for wide use until we have a better handle on when it would be appropriate for use over treatments with a better empirical base of efficacy.
 
  • Like
Reactions: 1 users
Like anything else, it would probably be wise to eschew the results from the manufacturers. In general, there is around a 40-50% symptomatic relief and an additional 20-60% of patients who gain some symptom improvement. IIRC, the cost is around 40k, so there has to be placebo effect.

F0r 40k, I am relatively positive that I could achieve similar results with daily therapy, medication, and a really nice vacation.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
There is some recent positive evidence, but I don't think it is remotely well-established at this point. Effect size varies.

If we're talking about a refractory case of severe depression that hasn't responded to therapy or medication, I'd be inclined to give it a try. My read of the safety data is that there is little evidence it will cause any lasting problems, which is my primary concern for these procedures. For run-of-the-mill depression in which the standard treatments (e.g. several different antidepressants, good CBT/IPT, etc.) have not yet all been tried - I think its VERY premature to refer for TMS.
 
  • Like
Reactions: 1 user
There is some recent positive evidence, but I don't think it is remotely well-established at this point. Effect size varies.

If we're talking about a refractory case of severe depression that hasn't responded to therapy or medication, I'd be inclined to give it a try. My read of the safety data is that there is little evidence it will cause any lasting problems, which is my primary concern for these procedures. For run-of-the-mill depression in which the standard treatments (e.g. several different antidepressants, good CBT/IPT, etc.) have not yet all been tried - I think its VERY premature to refer for TMS.
I would add to this by placing an emphasis on severe. Too many clinicians think any patient with Borderline PD or PTSD with SI is severely depressed.
 
Top