Adding TMS vs Switching Medication for Treatment Resistant Depression
by Dr. Rose George
Today we are reporting on a study published in Molecular Psychiatry by Papakostas et al entitled “Comparative Effectiveness Research Trial for Incomplete and non-responders with treatment resistant depression (ASCERTAIN-TRD) a randomized control trial”. The standard of care for treatment resistant depression so far as established by studies is to either switch antidepressants to a different class or add an atypical antipsychotic (such as aripiprazole) but there hasn’t been studies comparing which of these two approaches is more effective. The authors wanted to see which of these two methods is superior and also added in rTMS as a new alternative. Multiple sites were employed for this 8 week rater blinded trial with 3 treatment groups. Group a) had aripiprazole (Abilify) added to their antidepressant as an augmenting agent, group b) had rTMS added to their antidepressant, group c) switched patients to venlafaxine,Effexor (or duloxetine, Cymbalta). What they discovered was that rTMS was significantly more effective than switching to a different antidepressant medication. The authors did not compare the performance of adding aripiprazole verses adding rTMS. This provider feels the potential side effects of an atypical antipsychotic verses the very minimal side effects of TMS make TMS the superior option.
What this tells us is that the best treatment for depression is not to try another medication but rather to use an FDA approved non-medication treatment option – TMS. TMS has very minimal side effects that are very short lived, mild headache. Whereas medication such as atypical anti-psychotics can have side effect such as muscle stiffness, weight gain, akathisia, and tardive dyskinesia.
In the study mentioned above they used rTMS – this means a TMS machine with a figure 8 coil. At Brighter Day TMS we use deepTMS, a unique TMS coil in the Brainsway TMS device. The reason for our choice of deepTMS is the deeper and broader stimulation afforded by this coil shape. The larger area of effect helps more individuals reach improvement and more reach remission. We have treated over 165 patients with deepTMS and are in awe of the change in these individuals who start out with severe depression and find relief from so many of their symptoms. Many of our patients describe this treatment as “life changing” and are thrilled to be free of the life restrictions that come with severe depression. How many antidepressant medication trials do you need to have tried to be considered treatment resistant? For Medicare, one failed (either not effective or intolerable side effects) antidepressant trial qualifies, for many commercial insurance plans two antidepressants from two different antidepressant classes meet criteria. If you or a loved one are struggling with severe depression that has not responded to an antidepressant, do yourself a favor try TMS treatments and get better – you deserve it!