Summary of Efficacy of Repetitive Transcranial Magnetic Stimulation for
Treatment Resistant Depression
Transcranial magnetic stimulation (TMS) has been studied as a treatment for depression for over 20 years. The procedure appears to work by modulating specific brain regions, such as the left dorsolateral prefrontal cortex, with an electromagnetic field. In 2008, the FDA approved a TMS device for the treatment of depression in patients who had not responded to antidepressant medication. In 2013, Brainsway received approval for its TMS device, which has a different electromagnetic coil configuration designed to penetrate deeper into the brain.
The evidence that TMS is an effective treatment for depression is strong. A recent systematic review and meta-analysis (Gaynes et al, Journal of Clinical Psychiatry, 2014) included 18 randomized controlled trials comparing TMS with “sham” TMS. 13 of these trials included only patients with major depressive disorder, while 5 included a mix of patients with major depressive disorder and bipolar depression. All studies included required that patients had failed at least 2 or more antidepressant trials of adequate dose and duration. Patients receiving active treatment had a decrease in their Hamilton Rating Scale of 4.5 points relative to sham, with a response rate of 29% for active treatment (compared to 8% for sham treatment) and a remission rate of 30% for active treatment (compared to 6% for sham treatment).
Treatment Resistant Depression
Transcranial magnetic stimulation (TMS) has been studied as a treatment for depression for over 20 years. The procedure appears to work by modulating specific brain regions, such as the left dorsolateral prefrontal cortex, with an electromagnetic field. In 2008, the FDA approved a TMS device for the treatment of depression in patients who had not responded to antidepressant medication. In 2013, Brainsway received approval for its TMS device, which has a different electromagnetic coil configuration designed to penetrate deeper into the brain.
The evidence that TMS is an effective treatment for depression is strong. A recent systematic review and meta-analysis (Gaynes et al, Journal of Clinical Psychiatry, 2014) included 18 randomized controlled trials comparing TMS with “sham” TMS. 13 of these trials included only patients with major depressive disorder, while 5 included a mix of patients with major depressive disorder and bipolar depression. All studies included required that patients had failed at least 2 or more antidepressant trials of adequate dose and duration. Patients receiving active treatment had a decrease in their Hamilton Rating Scale of 4.5 points relative to sham, with a response rate of 29% for active treatment (compared to 8% for sham treatment) and a remission rate of 30% for active treatment (compared to 6% for sham treatment).
The Brainsway Deep TMS device, which we use at our clinic, was approved on the basis of a 16 week study (available on the FDA website) in which patients had a decrease in their Hamilton Rating Scale of 3.1 points relative to sham at the primary endpoint of 5 weeks. Patients receiving the active treatment had a response rate of 38% (compared to 21% for sham treatment) and a remission rate of 33% (compared to 15% for sham treatment).
As TMS treatment recommendations become more individually tailored, the number of sessions needed to achieve response or remission may vary. A recent study showed that 61% of unmedicated treatment resistant depression patients who did not respond to acute TMS treatment (4 weeks) responded after four weeks of twice weekly deep TMS (Yip et al., 2017).
It is important to remember that all of these studies involved patients who were defined as treatment resistant, indicating that their depression was more severe and more difficult to treat. Currently, the FDA has approved the use of the Brainsway Deep TMS device for treatment resistant depression, but research indicates that the future holds many other potential indications for TMS including anxiety disorders, chronic pain, schizophrenia, migraine headaches, tinnitus, and smoking cessation.
For more information about TMS, please contact us at (206) 535-6292 or send us a message here.
It is important to remember that all of these studies involved patients who were defined as treatment resistant, indicating that their depression was more severe and more difficult to treat. Currently, the FDA has approved the use of the Brainsway Deep TMS device for treatment resistant depression, but research indicates that the future holds many other potential indications for TMS including anxiety disorders, chronic pain, schizophrenia, migraine headaches, tinnitus, and smoking cessation.
For more information about TMS, please contact us at (206) 535-6292 or send us a message here.
