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 symptomsâbut 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.
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 groupsâthe âactive treatmentâ group, which received repetitive transcranial magnetic stimulation (TMS); and the control group, who received a placebo known as âsham stimulation.â In âsham stimulation,â 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 âsham.â
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 âthe 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.â That is, according to the authors, veterans who are labeled âtreatment-resistantâ 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 âpuzzling.â 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:
âThe repeated engagement of the subjects by the treatment team is not a neutral experience but tantamount to at least supportive psychotherapy, if not more.â
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.
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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)
Get that machine off of me! 1:24 in Happy Happy Joy Joy https://www.youtube.com/watch?v=DyJibB4cwec
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Ha ha! That’s what the MI System promised me. But even they couldn’t turn me into a Pollyanna.
Being socially ostracized, unable to have a family, start a career, and gaining over 100% of my body weight did not make me happy. Wow!
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Another psychiatric success story!
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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.
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if it is a magnetic ECT, it looks harmless. no one has complained of memory loss , died from the heart going into Asystole no one went into a continuous seizure.
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True. I get it.
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Maybe they could just start giving people tinfoil hats with sciency-sounding names. They could charge people’s insurance just as much as they do for ECT — but at least no one would get brain damage.
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I bet that would work! But you can’t make billions off of tinfoil. They’d have to come up with some titanium-infused superheated alloy that has to be made in outer space so they could charge bunches of money for their tin hats.
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They can charge anything they want, they’re doctors.
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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.
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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?
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Yes, very slow on the uptake. My psychiatrist who’d never listened to me, once confronted with reality, ended up declaring my entire life a “credible fictional story.” I called that “incompetence,” and walked away. Seems complete incompetence is par for the course with today’s psychiatric industry.
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I hear this too often that clients feel unheard by their doctors. Many clients of mine who have been inpatient tell me they hardly saw a doctor. Glad to hear you walked away.
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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.
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Great article and paper!
After 2 failed antidepressants and a godawful prognosis, you basically treat people nicely, do absolutely nothing, and 39% get to complete remission. Looks like the final answer to antidepressants!!
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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!
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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?
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Amen. Actually just talking to people makes a difference. Let’s engage!!!
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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.
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Not that this study isn’t relevant and valid but it has be be included in the broader body or research to see if it’s an outlier or it generally parallels other studies. Anything less is misleading. The placebo effect may be large because, unlike meds, TMS requires some
effort from the patient triggering the effort = results expectation. Just a thought.
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