Transcranial Magnetic Stimulation No Better Than Placebo for Treatment-Resistant Depression

Peter Simons
19
1186

A new study, published in JAMA Psychiatry, found that transcranial magnetic stimulation (TMS) was no better than placebo for treatment-resistant depression in a population of veterans. The research was led by Jerome A. Yesavage, MD, at Stanford University, and included the VA Cooperative Studies Program Study Team.

39% of the participants improved so much that they were considered to have remitted from their symptoms—but this was true of both the veterans who received TMS as well as those who received the placebo. There was no difference in remission rates between the two groups.

By Kevan Goff-Parker, 72nd Air Base Wing Public Affairs / Published February 14, 2018

The study participants were 164 veterans, mostly men, with treatment-resistant depression (defined as no significant improvement after two previous trials of antidepressant medication). Many also had post-traumatic stress disorder (PTSD) and substance abuse problems.

The participants were separated into two groups—the “active treatment” group, which received repetitive transcranial magnetic stimulation (TMS); and the control group, who received a placebo known as “sham stimulation.” In “sham stimulation,” the participants are hooked up to the same machine and told they are receiving active TMS, but are actually not receiving any magnetic stimulation. The study was double-blinded, meaning that medical staff were also unaware of whether the participant was receiving active TMS or “sham.”

The researchers write that they were surprised by the high rate of remission in the placebo group. They suggest that it might be due to “the importance of close clinical surveillance, rigorous monitoring of concomitant medication, and regular interaction with clinic staff in bringing about significant improvement in this treatment-resistant population.” That is, according to the authors, veterans who are labeled “treatment-resistant” may need medical staff to monitor their treatment more regularly.

In an accompanying editorial, Charles B. Nemeroff, MD, PhD, stated that he also found the high remission rate “puzzling.” He cites previous studies that have found remission rates ranging from 28% to approximately 50%. His explanation for this discrepancy is that the participants were engaged more often by the treatment team:

“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.”

Although the participants were labeled with treatment-resistant depression, according to this acclaimed depression researcher, they may have needed supportive therapy rather than multiple trials of antidepressant medications.

 

****

Yesavage, J. A., Fairchild, J. K., Mi, Z., Biswas, K., Davis-Karim, A., Phibbs, C. S. . . . George, M. S. (2018). Effect of repetitive transcranial magnetic stimulation on treatment-resistant major depression in US veterans: A randomized clinical trial. JAMA Psychiatry. Published online ahead of print. doi:10.1001/jamapsychiatry.2018.1483 (Link)

19 COMMENTS

  1. I did a report on this. “The circuitry used to generate the magnetic field pulses is usually based on a capacitor discharge system (shown in its simplest form in figure 4) with typical peak coil currents in the range of several kiloamps and discharge voltages of up to a few kilo volts. The relatively high voltage is required to give the required rapid rise of current into the inductance of the stimulating coil.”

    They want you to think of harmless refrigerator magnets but its very high energy, IMO its more like magnetic ECT. A magnetic field is used to cause electric current to flow in the brain via induction.

    https://www.madinamerica.com/forums/topic/how-transcranial-magnetic-stimulation-works/

    It includes videos, you can see hobbyists playing with the “inductance of the stimulating coil” crushing cans and destroying things and some idiot experimenting with it on himself.

  2. The researchers all sound so disappointed that so many recovered with the placebo. Shouldn’t they be happy they cured the “treatment-resistant”? I know, the doctors don’t want to cure anyone, no money in that!

    “Although the participants were labeled with treatment-resistant depression, according to this acclaimed depression researcher, they may have needed supportive therapy rather than multiple trials of antidepressant medications.”

    No kidding, haven’t they figured it out yet? The antidepressants themselves work no better than placebo, but they can cause great harm.

    • Yeah, they’re a bit slow on the uptake, aren’t they? How can you call these people “treatment resistant” when you haven’t even tried talking to them? Does this not strongly suggest that it is not “resistance” but “incompetence” that is the reason they have not recovered?

  3. The placebo effect continues to grow in recent studies. The better the participants are blinded, the better are the results in the control group. As the placebo effect is better understood and better controlled, we will see that many psychiatric treatments are just a little effective, or ineffective.

    • EXACTLY! If they created “remission” by essentially doing nothing but telling them they might get better, and more than a third improved as a result, there’s no telling what might happen if they actually started giving clients the impression that THEY could do something about it without any “clinical intervention!” Add in specific, empowering supports and a caring support system, and the “treatment resistant” suddenly start getting better in droves!

  4. OK, so this is important. These people were judged “treatment resistant.” Translated into “responsible adult” language, this means that anything they’ve done to date has utterly failed to have any lasting impact. Then we find that pretending to do something that is supposed to help now “remits” 39% of these people for whom STANDARD ‘TREATMENT’ did ABSOLUTELY NOTHING! And Nemeroff, the Big Pharma shill, is “puzzled” by these results, and attributes them to “engagement with the treatment team!”

    Obvious conclusions:

    1) “Standard treatment” doesn’t work for these people, but pretending to do something while doing nothing does work. Seems less like “treatment resistance” and more like “incompetent clinicians” to me.
    2) “Engagement with the treatment team” is MORE IMPORTANT than the “treatment” that you are providing
    3) Ergo, STOP PROVIDING ‘TREATMENT’ and START PROVIDING ENGAGEMENT!

    Why does this seem obvious to me and yet it is “puzzling” to Dr. Nemeroff?

  5. Well maybe they should tray Skywalker light sword on psychiatrists. It’s touch could turn them into humans again, who knows.
    Diagnosis of authoritarian mind -psychopathy, no own thoughts, imagination impairment, lack of empathy, tendency to drugging and killing people for money

    cure -DEHUMANIZATION, imprisonment, Szasz and Hillman twice a day, and give them some pills or torture them if they were psyche resistant.

    psychiatry must be abolished and people who thinks that psyche is EVIL and a state enemy, rather than THE PSYCHIATRY itself – SHOULD BE PUNISHED for not being humans and for not seeing humans in the others, for stealing their identities for not having respect for psyche.
    PHENOMENOLOGY OF THE PSYCHE IN THE PLACE OF DSM/ EMPTY NOMINALISM AND PROPER PSYCHOLOGICAL HIERARCHY WITH APOLLONIAN EGO AS THE LEAST PSYCHOLOGICAL ARCHETYPE.

    Without phenomenology and without builiding the proper language for describing human psyche, nothing will change. Hillman and Szasz books should be a handbooks in every school.