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Is TMS Therapy Boston Effective?

In the 10 years since a TMS device was first cleared for market in the U.S., researchers have sought to improve the effectiveness. Treatment is consistently given 5 days/week but, studies have been conducted to evaluate the following changes to TMS to determine which are most effective:

• Frequency, length of treatment, intensity, and pattern of the pulses;
• Treating different areas of the frontal cortex (left/right/both dorsolateral prefrontal cortex and the anterior cingulate cortex);
• Number of treatments per day;
• Number of weeks of treatment;
• Types of patients appropriate for treatment; and
• Maintenance schedule for patients who respond well to treatment.

Even today there is no established effective treatment. For example, in a 2018 JAMA editorial commenting on a new TMS study of patients at Veterans Affairs medical centers, psychiatrist Charles Nemeroff concluded that the lack of efficacy compared to placebo “are puzzling for several reasons. What might explain these findings? First, this population is largely male, in clear contrast to most depression clinical trials, which typically are about two-thirds female. Second, one cannot underestimate the psychological benefits of participation in clinical trials. The repeated engagement of the subjects by the treatment team is not a neutral experience but tantamount to at least supportive psychotherapy, if not more…. This is an important negative study, but it does not fully answer the question of what the appropriate role for rTMS is in the treatment of TRD [treatment resistant depression] in veterans.”15

Over the years, concerns about TMS efficacy have been expressed even by those who strongly support it. For example, Dr. Philip Janicak, a consultant to Neuronetics who has written numerous articles that support its use, wrote in 2015, “In summary, TMS is a promising, novel antidepressant treatment still relatively early in its development.“16  In a 2015 review of TMS research for depression, Dr. Paul Holtzheimer from Dartmouth Medical School, who also supports the use of TMS, admitted in 2015 that there are many unanswered questions about how to ensure effectiveness of the treatment, stating “the stimulation parameters required to optimize efficacy are not known and administration of repetitive TMS is thus not standardized……The number of treatments necessary for patients with acute major depression is not clear.”17

In 2016, the Canadian health agency, Health Quality Ontario, conducted a meta-analysis on the effectiveness of TMS. “We calculated changes in depression scores measured by Hamilton Rating Scale for Depression from baseline to the end of treatment and conducted a meta-analysis on the mean changes in scores of the two groups of rTMS-treated and sham-treated patients. The weighted mean difference was 2.31 points [which is] below the mean value deemed a priori to be clinically important [at least 3.5 points]… On average, rTMS reduced depression scores by about two points more than sham rTMS.”18

TMS Therapy Boston: Insurance Accepted

At Neuroheal TMS we work with most major insurers to get the cost of your TMS Therapy Boston

covered by your insurance. Send us a contact form below to get the process started.