The old joke goes: you always find the thing you lost in the last place you look. The corollary joke says you ought to look there first, instead. The joke’s reasoning flaws are obvious, of course. You find your lost item in the last place you look because why would you continue looking elsewhere after finding it? And if you knew in advance where the last place to look was going to be, your item wouldn’t be lost – you would know exactly where it was.
When it comes to treatment for depression, many patients experience a similar situation as the joke. The treatment that works best is always the last one you try, so why not try that one first instead? If patients and doctors knew in advance which treatment would provide the best result, they obviously would attempt that one first. Alas, medicine is not yet at the level where we can predict with perfect accuracy how each individual patient will respond to a given treatment.
Doctors treat depression using their best clinical knowledge, backed by evidence from research studies. When one treatment option doesn’t work, another is attempted. If that one fails, yet another option is tried. While this approach can be time-consuming, it is the best method available when dealing with such a wide variation in patient response to standard treatment options.
Patients, meanwhile, grow frustrated at the trial-and-error approach and wonder why nothing is helping. They just want the treatment that will work. Let’s save time and money and skip directly to the last treatment. If only it were that easy…
While we can’t precisely predict which treatment option will be best for a given patient, we do have substantial evidence from research studies on the likelihood a given treatment option will be successful.
Is TMS More Effective Than Antidepressants?
Antidepressants and TMS (Transcranial Magnetic Stimulation) are both popular treatment options for depression. They both offer high success rates at treating depression. But which is better? Do antidepressants work better than TMS? Or does TMS work better than antidepressants at treating depression?
Let’s look at what the studies show.
How Well Do Antidepressants Treat Depression?
The STAR*D trial is the landmark trial for efficacy of antidepressants. It is the largest and longest study to evaluate the use of antidepressants for depression treatment. The STAR*D study contained four levels. If a patient did not achieve satisfactory relief from depression at Level One, they were moved to Level Two and a different medication was tried. The same process was used for Levels Three and Four. Once a patient found satisfactory relief from depression, they stopped at their current level and did not move to a subsequent level.
The methodology of the STAR*D trial was intentionally designed to mimic the real-world experience of patients. Similar to finding a lost item, once a patient finds a successful medication, they don’t keep looking for others. A total of 2,876 patients were accepted into Level One during the study.
How Effective are Antidepressants at Treating Depression?
At Level One of the STAR*D trial (first antidepressant tried), about one third of patients achieved remission from depression. Based on these results, there is about a 27.5 percent chance a patient will find adequate relief from depression with the first antidepressant they try. Unfortunately, this also means that about two-thirds of patients will not find adequate relief with the first antidepressant they try. (Source)
How Long Do Antidepressants Take to Work?
The STAR*D trial also yielded valuable information on how long it takes antidepressants to work for the average patient. For patients who had a successful outcome with an antidepressant, on average, it took six weeks for a patient to reach a response (partial alleviation of symptoms) and about seven weeks to achieve a remission of depressive symptoms.
How Effective Is a Second Antidepressant?
Since only about a third of trial participants achieved remission with the first antidepressant, that means two-thirds did not. That group of patients moved to Level Two and tried a different medication. In the Level Two group, about 25 percent of patients achieved remission, meaning that 42 percent of the original trial group had not achieved remission from depression after two antidepressant attempts.
After two unsuccessful antidepressant attempts, patients are typically diagnosed as having treatment-resistant depression. For this group, the STAR*D trial demonstrated that each additional medication attempt is much less likely to be successful than the previous attempt. TMS may be the best option to treat depression for those who have already attempted at least two antidepressants.
How Effective is TMS at Treating Depression?
A study published in 2012 (Efficacy of high-frequency repetitive transcranial magnetic stimulation in treatment-resistant depression) examined the efficacy of TMS at treating depression in patients who had been diagnosed with treatment-resistant depression. This patient group would be similar to the Level Three patient group in the STAR*D study.
The study achieved a 64 percent response rate (the patient’s severity of depression decreased by at least 50 percent) and a 33.4 percent remission rate (patient no longer clinically diagnosed as depressed).
How Long Does TMS Take to Work?
TMS treatment is typically conducted over a six to seven week period, similar to the time period to achieve remission with antidepressants. However, the patient response for TMS is typically felt at four weeks – two weeks faster than the response time for antidepressants.
Which is Better: TMS or Antidepressants?
For a direct comparison of the success rate of TMS and antidepressants, it is essential to compare similar patient populations. The Level Three patients in the STAR*D study are most comparable to the patient population in the 2012 TMS study (patients diagnosed with treatment-resistant depression). The results of the two groups are:
Which Option to Choose: TMS or Antidepressants?
The answer for most patients isn’t an either/or between antidepressants and TMS. They likely will need to try both. While TMS is covered by most major insurance carriers, it is not a first-line treatment. Patients typically will need to try at least two antidepressants before their insurance company will approve TMS treatment as a covered service.
Based on the evidence of the studies examined above, after a patient has tried two antidepressants without achieving remission, their chances of a successful outcome increase if they choose TMS over another medication attempt. In fact, a patient is twice as likely to achieve remission through TMS rather than through an antidepressant if they have already tried two antidepressants.
Where to Get TMS Treatment in Utah
Wondering whether medication or TMS is the right depression treatment for you? Our skilled depression experts at Ampelis Health are fully qualified to properly diagnose you and identify the best possible treatment that offers the greatest chance of remission. Setup an appointment today by calling us at 435-776-5909.