TMS vs. Medication for Treatment Resistant Major Depressive Disorder
Treatment resistant major depression, defined as three or more failed medication trials, is a serious clinical issue. In multiple controlled studies, patients who have already failed several medication trials responded significantly better to rTMS than sham treatment.
In the STAR-D trial, the antidepressant remission rate dropped significantly with each failed medication. As shown in chart below, once a patient has failed three medication trials, rTMS is almost three times as likely as a fourth medication to produce remission.
In observational studies, up to 58% of patients are responders and 37% remitters. The effect is durable but, as major depression tends to be a chronic illness, eventually many patients do require follow-up treatments. Well over 80% of the time these follow-up treatments are successful, and often the treatment course is significantly shorter.
Side effects include mild headaches, site pain, muscle tension or twitching, and GI upset. There is a low incidence of seizures, with an estimated seizure risk of 0.003% per treatment, or 0.1% of patients. The discontinuation rate tends to be approximately 10%, as compared with a 20%-30% rate for medication trials.
We accept most health plans from the insurances listed below:
- Tufts Health Plan
- Blue Cross Blue Shield
- United Health Care
- Cigna
- Optum
- United Behavioral Health
- Pacificare
- Harvard Pilgrim
- Medicare