College of Psychiatrist Statement on TMS treatment
Psychiatrist Statement: The latest review submitted by the Royal College of Psychiatrists’ on TMS treatment. In the ‘Statement on Repetitive Transcranial Magnetic Stimulation for Depression’ document.
The Royal College of Psychiatrist statement introduces TMS treatment by stating the following:
“Transcranial magnetic stimulation (TMS) is a non-invasive technique used to stimulate neuronal tissue. This technique involves the placement of an electromagnetic coil to deliver a rapidly changing magnetic field. As a result, this alters the electrical properties of the cortical neurons. Repetitive TMS is a relatively new treatment modality for psychiatric disorders where the stimulus train is repeated at pre-set intervals.
This method has been well established in neuroscience research experiments and also in clinical application for neurological conditions. Additionally, it has been used as an investigative tool in neuronal diseases.”
The document goes on to explain the mechanism of action of TMS, stating:
“Like most other antidepressant treatments that are available in clinical practice, the precise mechanism of action is not yet fully understood. Several studies suggest that large-scale brain networks are altered in patients with depression. Thus, the degree of the change in their connectivity predicts the severity of depression.
Repetitive stimulation of focal nodes of these networks can result in the reorganization of connectivity patterns in the brain due to the brain’s inherent plasticity (use-dependent strengthening of existing pathways). Many studies suggest that rTMS indeed results in changes in regional brain activity and metabolism. Additionally, applying rTMS at Dorsolateral Prefrontal Cortex (DLPFC) can enhance this region’s connectivity with other regions that are crucial for regulating emotional processing.”
The Statement
The statement covers the importance of NICE guidelines approval of the treatment and goes on to discuss the track record of the treatment in treating severe depression, stating:
“Efficacy of rTMS treatment for the major depressive disorder (MDD) and treatment-resistant depression (TRD) has been well established over recent years. Many systematic review and meta-analysis of randomized, double-blind and sham-controlled rTMS trials for treating MDD have shown rTMS to be effective as augmentation therapy or as monotherapy with benign tolerability profile (Berlim, et al. 2013, Gross et al. 2007, Schutter 2009). The NNT (Number Needed to Treat) is around 5 for treating depression (Dell’ Osso et al., 2011), OR (odds ratio) =3.4 (Gaynes et al 2012).”
The Royal College of Psychiatrist statement goes further to explore future directions of brain stimulation therapies, stating:
“Neuromodulation is an emerging new therapeutic field for treatment of neuropsychiatric conditions. Over the last decade, rTMS has been used widely for the treatment of depression and is now an established safe and effective treatment option for depression and treatment-resistant depression. We envisage more treatment centers will be established in the future as a result of the updated guidance from NICE.”
