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Minds and magnets: A new depression treatment?

Rating

5 Star

Minds and magnets: A new depression treatment?

Our Review Summary

The story describes two people's experiences with repetitive transcranial magnetic stimulation, a potentially new treatment for depression.  Anecdotal stories can be biasing and the two people featured in the story had pretty positive results.  For balance, perpsectives of patients with less successful results would have improved the story.  There are no scientific sources or independent opinions obtained, which could have also improved the story.  But, in general, the story did a nice job explaining the availability of treatment, its novelty as a potential depression treatment, the overall state of the evidence (including cautions to readers about study limitations), potential benefits, and potential harms.  The story doesn't tell readers what the entire research body states, only that the latest studies are encouraging.  The story also reports benefits from only two trials, which could have been chosen for their positive findings and could be misleading.  But, overall the story provides cautions about the evidence to readers and does a nice job of covering the major criteria.   

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story does report the out-of-pocket cost per session ($300), although this may be an underestimate of the true cost.  There is probably a hospital charge, a procedure charge, and a physician charge.  It's also unclear how one would go about paying for the treatment if it's not widely available. For instance, would one have to have been part of a research study in the first place in order to have treatment beyond the research period?  But, the story does report cost per session and the maximal duration of treatment effect (about 4 months), giving readers some idea how frequently this treatment would be required.  What's less clear is how long treatment would need to be maintained (years?). 

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

Two examples of randomized controlled trials are given and benefits are reported in absolute numbers, which is appropriate.  What's harder to describe is what counts as a significant response to treatment, which is a problem in depression research and not necessarily a problem in reporting.  What's also not known is whether the two studies picked represent the best responses and could thereby be biasing in the context of other well-conducted studies (if available) that show less promising results.  However, the story does caution readers that early results were inconsistent and that the studies to-date are limited by the small numbers of people treated and the limited number of controlled trials. 

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story reports that some patients may experience headache or scalp discomfort, although details about how often these occurs and how severe they may be is not provided.  The study also mentions other disadvantages, such as the need for specialized equipment, specially trained technicians, and patient inconvenience and cost.  While more information about the frequency and severity of side effects would improve the story, overall, the story does provide a range of downsides or side effects to consider, which serves to balance the reporting of potential benefits. 

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story reports on a depression treatment, in general, and not on one study for this particular treatment.  It does provide results from at least two examples of randomized controlled trials and does mention how these findings are limited by small sample size and difficulty in devising a placebo treatment, in which either providers or patients wouldn't be aware of actual intervention assignment.  The story also cautions against interpretation of the evidence in general due to small numbers of patients treated and small numbers of controlled trials. 

Does the story commit disease-mongering?

Satisfactory

The story describes depression as a serious, debilitating condition, which is true.  It would have been helpful to include more information about the total numbers of people with depression and treatment resistant depression.  These numbers are relatively high and may surprise people.  This could have added to the description of the seriousness of this disease.  And, the anecdotal accounts of people's individual experiences are potentially biasing and not ideal, but the health states conveyed are probably representative of people with treatment-resistant depression. 

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

There are no quotes from any expert interviewee. 

Does the story compare the new approach with existing alternatives?

Satisfactory

Other treatments for depression are mentioned, including medications, psychotherapy, and ECT.  Some information is given about ECT and medications for readers to compare and contrast this latest technology with.  People with treatment resistant depression have usually failed medications and psychotherapy, so a discussion of VNS in addition to ECT–the usual other options to TMS in this group–would have been helpful.  It would have particularly strengthened the story to include VNS (vagal nerve stimuation) because this is also an uNPRoven, but FDA-approved, option for treatment resistant depression. 

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story tells readers that the FDA is considering approval of transcranial magnetic stimulation for depression and that a decision may come in early 2007.  So, the treatment is not yet FDA approved and doesn't seem to be widely available outside of research settings.  The story mentions this treatment is available in other countries. 

Does the story establish the true novelty of the approach?

Satisfactory

The story tells readers that the technology was developed 20 years ago.  It also describes this technology being used in research settings about 10 years ago.  So, it seems clear that this is not new technology, per se, but because it's not widely available in the U.S. or FDA approved, this technology would be a new treatment for depression, if approved. 

Does the story appear to rely solely or largely on a news release?

Not Applicable

it's unclear if the story relied solely or largely on a news release, although it did dwell on the experience of only one center in Boston. 

Total Score: 8 of 9 Satisfactory

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