Posted by tom2228 on June 21, 2014, at 23:24:25
In reply to TMS Effective in 14% Of Patients, posted by Babbler20 on June 20, 2014, at 22:38:11
> As a depressed person, I'm naturally a skeptic of everything. Fortunately, about half the time I assume the worst, I'm pleasantly surprised. I hoped this would be the case with TMS, but it did absolutely nothing. It was expensive and an enormous waste of time. The article below is proof of what I experienced. According to this article, TMS works for 14 % of the people that try it. With a success rate like that, you have to question the credibility of the FDA. http://well.blogs.nytimes.com/2013/07/01/new-approach-to-depression/?_php=true&_type=blogs&_r=0
Okay, to start, the article says:
"TMS is approved specifically for patients whose depression does not respond to antidepressants or who cannot tolerate the drugs side effects..."
which is a highly weasel-worded statement. As it's worded the article makes it seem like the FDA approval is for people who have run the whole gamut of meds and have not responded.... which sets the stage for their larger point that this procedure that is approved for people for whom (most/all) antidepressants don't work isn't even that effective for them! -- i.e. that TMS is just another failure for the (truly) treatment-resistant just like the meds.In actuality, however the FDA approved it for people who have failed to achieve satisfactory improvement from just ONE(!!) prior antidepressant medication at or above the MINIMAL effective dose and duration in the current episode. I.e., the article is referring to TMS as a procedure for "antidepressant resistance/ intolerance" when by definition of the FDA approval that person includes someone who has tried nothing but say 5mg Lexapro for 4 weeks!! That's hardly a fraction of a degree of "antidepressant resistance" (as the article proclaims) considering the multitude of medications many of us here, myself included, have tried with unsatisfactory results. So really, TMS is largely used in, and has mostly been studied in, people who are NOT truly antidepressant-resistant as we know it here, and includes people who simply do not want to be on meds rather than the meds not working for them.
As well, the official TMS studies are mostly of people who are NOT taking medications when they undergo treatment, By theoretical logic, TMS has has a synergistic effect with medications, and this is not accounted for the studies. Many people in the clinical setting who are not studied, like myself, ARE taking multiple meds while doing TMS.
As the article states:
"In industry-financed studies that allowed subjects to continue their antidepressant medications while undergoing TMS treatment, which experts say is a more likely situation in the real world, response rates were significantly higher than in the randomized trial conducted by Dr. George. "
Like so most of the official studies follow the conditions of the FDA approval and do not necessarily reflect the population that TMS is used in in the clinical setting, where results and success rates may be different. For example, TMS is approved and insured for people with *unipolar* depression but doctors including mine have successfully fought insurance companies to cover TMS for bipolar patients and are treating them as well.And these numbers -- 14% and 30% -- are for *remission*. The article touches upon the phenomenon that concurrent medications increased success rates, but it leaves out that there is a greater percentage for whom TMS is still "effective" on their symptoms even though they don't reach remission. SSRIs "don't work" for at least 2/3 of patients.
Either way, it is working for some people who have had a troublesome experience with meds (whatever that may be). If a treatment allows some population to get better in a new way, in my opinion that warrants merit.
poster:tom2228
thread:1067129
URL: http://www.dr-bob.org/babble/20140609/msgs/1067183.html