National Study Confirms Long Term Benefits, Safety and Durability
One of my patients is an accountant with a demanding job at a large accounting firm. He is responsible for dozens of clients, and has a large staff of accountants reporting to him. He has been with the firm for over 16 years. The most stressful times for him are around IRS due dates and during times of change in his clients’ business’ ownership, such as a merger or purchase of another company. However, his job is generally high stress most of the time, which has been a major contributor to his chronic major depression over the years, even with anti-depressant medications.
I have been treating him regularly with a combination of psychotherapy and antidepressant medications, changing them when needed to help him cope. But just recently he experienced a crisis which has affected him deeply, and he has had a difficult time functioning, both at work and at home. He just can’t seem to shake his depression, and he reports that it’s getting worse. He continues to go to work, but has begun to notice that he consistently makes mistakes that he didn’t previously make. He also reports a disturbing inability to focus. So now we have been discussing TMS therapy, which was FDA cleared in 2008 and has literally changed lives ever since.
Could TMS Treatment Help This Patient?
I am strongly supportive of this patient’s interest in pursuing TMS treatment. Some of the key points we discuss include:
- TMS therapy is precisely targeted at a key area of the brain, the prefrontal cortex, thought to control mood, and found to be underactive in depression sufferers.
- It uses highly focused magnetic pulses, much like MRI technology, to stimulate neurons in this area of the brain, causing them to become active and release neurotransmitters, the brain’s chemical messengers.
- These pulses affect the remaining areas of the brain involved in mood, serving to restore normal function and lift the symptoms of depression.
- TMS therapy is non-invasive, and free from the side effects typically experienced with antidepressant medications.
We’ve explored TMS therapy in general, and my patient has read about other patients’ experiences with TMS. With TMS, he can come to the clinic for a treatment session during his lunch break. Without the side effects of other treatments, he will go back to work feeling at least as well as he did before his treatment session (which lasts roughly a half hour). Over time, it is highly likely that his depression will lift. And he will quite likely experience no ‘downtime’, as with some other alternative depression treatments.
What Are The Success Rates Of TMS Therapy?
We are quite pleased with the high success rates of TMS. Patients in our clinic have experienced unprecedented response rates – well over 75%. And all of them are ‘treatment resistant’ patients – who have previously not responded to several different treatments for Major Depression – otherwise known as Major Depressive Disorder (or MDD).
But for this patient, one last question remained to be satisfied before he made his final decision. He wanted to know more about the ‘Durability of Benefit’ of TMS. In other words, after a successful outcome, how long will these positive effects last? That is a great question. I wish all patients with MDD would take such an interest.
How Long Will These Positive Effects Last?
An article published December 2014 in the Journal of Clinical Psychiatry discussed a long term TMS study entitled, “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”.
According to this article, “Acute TMS benefits patients with pharmacoresistant major depression and shows a sustained durability of effect across 12 months of follow-up. Approximately two-thirds of those who were responders to treatment maintained that level of benefit under conditions of clinician-selected, continuation pharmacotherapy with general access to TMS reintroduction as needed. These data are particularly notable because of the difficult-to-treat nature of illness in this population.”
What Are The Important Points In This Study, As They Relate To Patient Treatment?
While it’s easy – and often tempting – to grasp at something that promises relief from painful depressive symptoms, I encourage my patients to look at the medical support behind any depression treatment they consider.
Regarding TMS treatment and the related aspects of this study, it’s important to understand the…
- objectives of this study:
“Transcranial Magnetic Stimulation (TMS) is an effective and safe acute treatment for patients not benefiting from antidepressant pharmacotherapy. Few studies have examined its longer term durability. This study assessed the long-term effectiveness of TMS in naturalistic clinical practice settings following acute treatment.”
- method of the study:
“Adult patients with a primary diagnosis of unipolar, nonpsychotic major depressive disorder (DSM-IV clinical criteria), who did not benefit from antidepressant medication, received TMS treatment in 42 clinical practices. Two hundred fifty-seven patients completed a course of acute TMS treatment and consented to follow-up over 52 weeks. Assessments were obtained at 3, 6, 9, and 12 months. The study was conducted between March 2010 and August 2012.”
- results of the study:
“The proportion of patients who achieved remission at the conclusion of acute treatment remained similar at conclusion of the long-term follow-up.”
- conclusions of the study:
“TMS demonstrates a statistically and clinically meaningful durability of acute benefit over 12 months of follow-up. This was observed under a pragmatic regimen of continuation antidepressant medication and access to TMS retreatment for symptom recurrence.” (Source: PubMed)
What Is The Summary Of This Study?
“In summary, the results of this study demonstrated that TMS delivered a “sustained durability of effect over 12 months of follow-up in a population receiving minimal to no benefit with antidepressant medications. These clinical outcomes are as good as, or superior to, those seen with other treatment alternatives.”
TMS has literally changed lives. And the medical studies confirm that the success rates are sustained long term. My patient has decided to start TMS Treatment next week.
- The study’s full article is available in PDF format here: http://www.jcfpm.com/local/upload/file/A%20Multisite,%20Naturalistic,%20Observational%20Study%20(2014).pdf
- gov identifier: NCT01114477.
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