Old School 

Pharmaceutical medication is the most common and conventional method for treating patients suffering from depression, anxiety, and other mental health conditions. Antidepressants have helped millions of people resume normal lives by keeping depression and anxiety at bay. They often help to reduce symptoms of depression and anxiety, but not infrequently they only work short term and frequently cause systemic side effects.

Complementary Talk Therapy 

The introduction of counseling and talk therapy like Cognitive Behavioral Therapy-CBT also supports treatment for people with mental health conditions and/or those dealing with stressful or traumatic events. Therapy endeavors to unravel root causes of mental health symptoms, strengthen positive coping skills, and reduce negative thought processes and actions; thereby initiating recovery.

Cost of therapy and antidepressants

The National Center for Health Statistics found in a 2017 study that 13% of Americans over 18 years of age had taken antidepressant medication in the previous 30 days. 

It also revealed that about 66% had been on medication for over 2 years and 25% for a minimum of 10 years. Other studies have shown that a significant portion of those trying antidepressants often have to try multiple medications due to lack of response or side effects and use multiple medications due to incomplete response to treatment. Even when medications work, they often tend to lose response in time. Eventually, patients and providers are forced to try newer and more expensive medications.  As a result, the cost of long-term medication use and associated doctor’s visits can be quite expensive. 

Read More: TMS therapy cost →

Medication Efficacy

Medications typically take anywhere from 4-8 weeks to effect changes in the brain resulting in potential relief of symptoms. The largest study looking at response to antidepressants in real world settings was the STAR*D trial.¹ This trial involved “stepped-treatment” over 4 levels that involved different medication trials or combinations of medications to treat depression. After the first two treatment levels, about half of the participants achieved remission of depression. After all four levels of treatment some two-thirds of all participants achieved remission.

Unfortunately, this left another one-third who did not achieve remission and a significant portion of participants dropped out of the study at each level (21 percent at level 1, 30 percent at level 2, and 42 percent at level 3).² Further, participants that needed to progress to additional levels of treatment also showed a higher likelihood for recurrence of depression and subsequent treatment failure and in general, relapse rate was high regardless of treatment. In a 12 month follow-up to the study, participants who initially had remitted, relapsed at an increasing rate. Level 1 remitters already had a high 40% relapse rate and this increased to 71% for those requiring treatment across all four levels of treatment. The graph following also shows two general patterns with antidepressant use - remission from depression decreases with each failed medication trial and the likelihood of discontinuing medication secondary to side effects increases.

Medication Side Effects

Some degree of side effects are highly likely when you are introducing a pharmaceutical substance into your body. Antidepressants have become more targeted and are better tolerated than in the past, but they still react at other places in the body outside the specific site that relates to depression or anxiety. Unfortunately, as the graph above shows, side effects frequently occur with antidepressant treatment and they become more likely as additional medications are needed or added in. This commonly results in stopping treatment.

Transcranial Magnetic Stimulation-TMS Therapy

rTMS or Repetitive Transcranial Magnetic Stimulation has been developing since 1985, although its origins in theory date back to the 1800s. Anthony Barker and his colleagues in the UK provided empirical evidence that transcranial magnetic stimulation could stimulate electrical firing in the brain. In turn, modulating the intensity and pattern of stimulation affected brain pathways. By tailoring the stimulation parameters and location, TMS was found to correct depressed and anxious brain circuitry.

Long Term Efficacy

The largest current patient registry utilizing TMS treatment is showing somewhere in the range of ⅔ to ¾ of all patients experiencing response and ⅓ to ½  experiencing complete remission of depressive symptoms.³

TMS has historically been used for patients who have not responded to treatment with one or more antidepressant trials and a majority of patients typically have failed numerous antidepressant treatments. This makes the response and remission rates even more noteworthy. If TMS studies included patients who had never previously been in treatment, it stands to reason that response and remission rates would be even higher.

Read More: TMS Therapy Success Rate →

Cost of TMS

TMS for treatment-resistant depression is covered by all insurance companies now as they become more familiar with its long-term treatment outcomes and comparative costs. Multiple studies have studied the long-term cost-effectiveness of rTMS vs pharmacotherapy and have repeatedly shown that costs are lower in the long term when comparing rTMS to pharmacotherapy.⁴⁵⁶  As an example, one of these studies showed the following:

Side Effects

Transcranial Magnetic Stimulation is a non-invasive and external treatment that only influences electrical brain conduction at the treatment target. The magnetic field only induces electrical changes a few centimeters into the surrounding brain tissue. It does not induce systemic side effects like antidepressants.  

Apart from a slight scalp prickling sensation during treatment and/or a mild headache after initial treatments, side effects do not occur and even these side effects typically resolve after a few treatments.

Read More: TMS pros & cons →

As you can see from the comparative table to follow, the response rate (some improvement) and remission rate (full improvement) for TMS is significantly higher compared to medication use following an initial treatment course and over a 12 month follow-up period.

TMS vs antidepressants for Treatment-Resistant Depression*

*Above table compared with similar rating scales - IDS-SR or QIDS-SR -> Quick Inventory of Depressive Symptoms-Self Report. Participants averaged 2.6 prior medication failures for TMS and 2 prior medication failures for antidepressant. Response and remission rates and tendency for relapse only worsen with increased medication trials. 

TMS therapy and Medications at Inspire TMS Denver

The team at Inspire TMS Denver offers individual consultations to explore if and how TMS can support you with depression and associated mental health conditions. Medications are often an important part of depression treatment, but they have their limitations. TMS offers a novel treatment option that is safe, with no invasive side effects, and improved short and long-term response. Sometimes medications have provided some benefit and can be continued along with TMS treatment and other times, the poor response and side effects warrant tapering off one or several medications. Should you elect to pursue TMS therapy, rest assured that Inspire TMS Denver will tailor treatment protocols to your individual symptoms and situation. We will coordinate with your Psychiatrist and/or Primary Care Provider to ensure the best approach to medications is being utilized and that you are comfortable with any medications you are taking. We promise to keep you informed and comfortable with your individual care plan.

It is our belief at Inspire TMS Denver that TMS should be utilized after one to max two antidepressant trials. Unfortunately, a number of insurance companies still require up to four medication trials before approving TMS. In light of this, Inspire TMS Denver offers affordable TMS treatment and maintenance packages should patients elect to pursue care out-of-pocket.  

More questions about TMS vs medication, how it compares to other standard treatments, or other information on this page? Please contact us to see about a free consultation.