Nearly 4 million people in the United States suffer from treatment resistant depression. Antidepressant medications and existing forms of therapy are unable to provide relief from their most severe depression symptoms, which can greatly effect a persons ability to work, go about day to day activities, and maintain healthy relationships.
There is a medication-free, noninvasive form of treatment that has been gaining popularity over the past decade; it’s called, Transcranial magnetic stimulation (TMS) and it involves the use of magnetic fields that stimulate nerve cells in the brain. Though there is still much to be learned about exactly why TMS seems to be effective at relieving depression symptoms in treatment resistant patients, TMS is showing a lot of promise.
In fact, previous studies have demonstrated that over half of patients suffering from treatment resistant depression experience improvement in their symptoms and over one third experience complete remission when treated with NeuroStar TMS Therapy
During TMS treatments, many psychiatrists still prescribe antidepressants to these patients (despite their ineffectiveness.) But a recent study has found that TMS may be effective all on it’s own.
Neuronetics, Inc. published a new study in Brain Stimulation that is making quite the stir in the world of psychiatry. This new research has found that depression patients who are successfully treated with TMS therapy may not need antidepressant medication to maintain results.
NeuroStar TMS Therapy is a non-systemic (i.e. it does not circulate through the body via the bloodstream) and non-invasive form of neuromodulation. Highly focused MRI-strength magnetic field pulses are delivered to the nerve cells in the brain where they activate the cortical and deep brain structures known to be involved in mood regulation. The treatment is available with a prescription from a doctor and is typically administered daily for a duration of 4-6 weeks.
Without definitive evidence, the medical community hasn’t been able to find consensus on whether or not the patients who respond to TMS therapy should remain on antidepressant medications post-treatment in order to maintain their response. This was the purpose of Neuronetic’s study. Doctors and patients alike need to know: can TMS be used as the sole maintenance therapy to prevent relapse of depression for patients who initially responded to it?
Looking to medication-free patients who had shown a clinical response to acute TMS treatment, their study examined the efficacy of the therapy over one year in which once-monthly maintenance treatments with NeuroStar TMS Therapy were administered, as compared to monthly observation, for the prevention of recurring or worsening symptoms.
67 patients took part in the study, each with pharmacoresistant MDD who were treated with an acute course of NeuroStar TMS Therapy administered for six weeks. Forty-nine patients who had completed the 6-week treatment were randomized to either maintenance treatment with a single session given once every four weeks, or to monthly observation with no additional NeuroStar TMS Therapy treatment. NeuroStar TMS reintroduction was made available for symptomatic worsening for either group. All patients remained antidepressant-free for the duration of the study. Of the 49 randomized patients, sixteen (32.7%) completed all 53 weeks of the study. Although there was no statistical advantage of monthly maintenance treatment to observation alone, both groups yielded similar stability of outcome over time.
Researchers concluded that TMS is able to maintain the clinical benefits with occasional reintroduction only and that patients do not require antidepressant medication. A secondary finding of the study also revealed a remission rate of 61.2% among patients from the acute treatment phase, prior to randomization (an impressive number when dealing with treatment resistant depression.)
Noah S. Philip, MD, Assistant Professor of Psychiatry and Human Behavior at the Alpert Medical School of Brown University represented the study site at Butler Hospital in Providence, RI. He summarized the importance of this study as such, “While data has been published on the efficacy of repetitive TMS therapy for acute treatment of resistant MDD, until now there has been limited prospective data about using TMS in medication-free patients to maintain clinical improvement after an initial response.”
He continued, “This study addressed an important question about whether a once-per-month TMS regimen would prolong the time until depressive relapse. Although this schedule was not optimal for the sample we studied, publication of this data in Brain Stimulation shows that re-introduction of TMS has a high likelihood of “rescuing” patients who may be at the brink of slipping back into a major depressive episode.”
About one-third of patients continued to receive benefit from NeuroStar TMS Therapy after acute treatment without the need for treatment with antidepressant medication during the 12-month duration of the study. These results suggest that long term management for patients after initial treatment may require a sequenced approach to treatment such as beginning with observation, moving to maintenance NeuroStar TMS Therapy as a second stage, and perhaps combination with pharmaceuticals as a last step. The findings of this study are consistent with previous studies of long term outcome data for NeuroStar TMS Therapy which have suggested long-term benefits of acute remission in long term follow up.
TMS is typically used when other depression treatments haven’t been effective. More and more studies are getting under way to better explain the mechanisms at play, the degree of effectiveness, and potential applications.