Our Review Summary
A few key issues were missed:
- All patients had "moderately" treatment resistant depression, meaning they failed 1-4 prior treatment trials (but not TMS or ECT); TMS is not FDA approved as first-line treatment for depression
- No discussion of costs or coverage by insurance
- No discussion of limited TMS availability
Finally, it would have been ideal if the story had briefly mentioned the major treatment options for a patient with major depression who fails the first treatment: change in medication or combinations of medication, psychotherapy with or without medication, and neurostimulation such as TMS or ECT. An independent expert perspective could have helped with this.
Why This Matters
Although drugs can be effective for many patients with depression, they can cause a host of adverse effects and don’t work for everyone. Electroconvulsive therapy (ECT) can be helpful for some patients who don’t respond to medication, but it too carries a risk of adverse effects, including confusion, memory loss, and harms related to the anesthesia. TMS has the potential to be a safer, less invasive alternative to ECT for patients who don’t respond to antidepressant drugs.
Criteria
Not Satisfactory
The story doesn’t discuss the cost of the TMS machine or the cost of a typical course of treatment. This is a significant oversight considering that many health insurance plans offer limited coverage for mental health expenses. Does a patient who pays out of pocket have any hope of affording TMS treatment? The article doesn’t say.
Satisfactory
The article describes the percentage of patients who benefited from TMS in absolute terms and tells us that 12 patients would need to be treated with TMS to achieve 1 treatment success. These descriptions give readers a realistic idea of how likely a patient will be to benefit from TMS.
An even clearer approach would have been to say that 13 of 92 (14%) benefited from TMS and that 5 of 98 (5%) benefited from sham treatment. The other critical missed opportunity is to remind readers that these are remission rates in those who failed at least 1 prior treatment. For patients who have never been treated for depression, remission rates are much higher with any first-line treatment.
Satisfactory
The story notes that people in the TMS and sham treatment groups were equally likely to experience side effects including headache, discomfort at the TMS site, and eye twitching. The story could have pointed out that we don’t know much about long-term adverse effects of this treatment, and that a short-term study of 190 subjects has limited ability to identify rare but potentially serious adverse effects.
Satisfactory
The story gives a satisfactory summary of what happened in this placebo-controlled trial and why it represents an advance over previous research. It provided good detail regarding the researchers’ efforts to develop a sham treatment that would mimic a real TMS treatment session. Although the story states that the optimal length of TMS treatment "is not yet clear," we think the story could have been a bit stronger in cautioning about the short duration of the study and lack of long-term outcomes data.
Satisfactory
This story doesn’t resort to disease-mongering.
Not Satisfactory
As noted above, the story relied on a single source who was also lead investigator on the study being covered. It failed to note that this source has received research grants from, and is an advisor to, several different companies involved in the manufacture of TMS-related technology. To avoid the appearance of any conflict of interest, the article should have disclosed these ties.
Not Satisfactory
This story doesn’t do enough to describe the treatment options for a patient with major depression who fails the first treatment: These options include a change in medication or combinations of medication, psychotherapy with or without medication, and neurostimulation such as TMS or ECT. This type of information could have been obtained from an independent expert.
Not Satisfactory
The story states that TMS is approved by the FDA for the treatment of depression, but this characterization may give the impression that TMS is more widely available than is actually the case. TMS is cleared for use only in patients with major depression who don’t get better after treatment with an antidepressant medication. Also, while we couldn’t locate data as to how widely available TMS treatment is, it is safe to say that most practitioners don’t have a TMS device in their office. Obtaining access to the machine and trained operators is likely to be a challenge for many patients, especially those in rural areas. The story should have pointed out these important restrictions on the treatment’s availability.
Satisfactory
The story does not attempt to portray TMS as more novel than is appropriate and notes similarities between TMS and a more established treatment approach known as electroconvulsive therapy.
Not Applicable
This story doesn’t appear to have lifted any copy directly from an NIH news release about the study. Since it included only one expert source who was also the lead investigator on the study, however, we can’t say for sure how much the story relied on the release. We’ll call it not applicable.
Total Score: 5 of 9 Satisfactory
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