When traditional antidepressant medications fail to produce results, research published in the American Journal of Psychiatry suggests that transcranial magnetic stimulation therapy (TMS) offers more favorable results than switching the patient to another medication following two or more unsuccessful trials.
Globally, close to 300 million individuals grapple with severe depression. While two-thirds of patients show positive responses to a combination of psychopharmacology and talk therapy, there remains a significant subset that does not experience improvement even after trying one or more antidepressants. Furthermore, the likelihood of finding success with a third or fourth medication diminishes with each attempt in this particular group of individuals.
A team of researchers from Radboudumc with participation from neurocare clinics and others, have explored the potential of magnetic brain stimulation (TMS) as a viable alternative in cases where traditional antidepressant medications prove ineffective.
Dr. Iris van Oostrom, a Clinical Neuropsychologist and experienced TMS clinician working at neurocare clinics in The Netherlands is a co-author of the study.
"During rTMS treatment, we place a magnetic coil at a specific location on the skull. Magnetic pulses are released from the coil and stimulate a network in the brain that is involved in depression."
The study involved 89 patients who had not responded well to at least two treatments for depression. According to Dr. van Oostrom, "Half of them received 25 sessions of TMS, while the other half received another antidepressant medication, following the usual treatment guidelines. Both groups also received talk therapy."
The study’s findings revealed a significant advantage for TMS over traditional medication. "After 8 weeks of treatment, we found that the group that received TMS had significantly lower depression rates than the group that received medication during these 8 weeks," says Dr. van Oostrom.
"It was already known that when antidepressant medication does not work, few people benefit from a switch to another medication, while TMS is found to be effective even when earlier treatments were not successful," she continues. This insight underscores the growing recognition of TMS as a more reliable option for patients who have not found relief through conventional methods.
Another key observation from the study was the difference in patient adherence between the two groups. "What was also interesting to note is that the patients taking medications were more likely to drop out of treatment than those being treated with TMS," Dr. van Oostrom points out. This suggests that TMS not only proves to be more effective but also aligns better with patient preferences and tolerability.
Although reimbursement for TMS therapy is available in countries like The Netherlands and the US, it typically requires multiple unsuccessful trials with pharmacological treatments before being approved. The findings of this study support the latest update in the Dutch depression treatment guidelines, where rTMS has been formally recognized as a viable treatment option for patients with depression.
Dr. van Oostrom notes the significance of this update:
"This study is the first to compare both options directly. When the study was ongoing, we saw that patients also clearly preferred TMS over medication. It was quite hard to find patients who wanted to participate in the study because many of them did not want to take the risk of being put in the medication group."
With TMS added to the guideline, clinicians and patients now have more options in how depression is treated, offering hope to those who have not found relief through traditional medication options. Innovative approaches such as TMS not only provide a new avenue for treatment but also show a shift towards personalized and targeted interventions for individuals struggling with depression.
In the Netherlands, organizations like the Brain Stimulation Foundation and the neurocare group are dedicated to advocating for the responsible use of TMS therapy and ensuring its accessibility to patients in need. The neurocare academy stands as a reputable source for clinicians seeking to master TMS therapy in their clinical practice. They offer a pioneering online course in TMS therapy, followed by hands-on training workshops conducted at neurocare clinics worldwide, including locations in The Netherlands, Australia, and the United States.
Dalhuisen, I., van Oostrom, I., Spijker, J., Wijnen, B., van Exel, E., van Mierlo, H., de Waardt, D., Arns, M., Tendolkar, I., & van Eijndhoven, P. (2024). rTMS as a next step in antidepressant nonresponders: A randomized comparison with current antidepressant treatment approaches. American Journal of Psychiatry. Advance online publication. https://doi.org/10.1176/appi.ajp.20230556