Repetitive Transcranial Magnetic Stimulation (rTMS) does not get nearly as much media coverage as it ought. Especially given how effective a treatment we know it to be. It was therefore a pleasant surprise to find Jeremy Vine and Dr Sarah Jarvis discussing TMS for depression on daytime national radio.
Overall, the coverage was well balanced. If you would like to listen, the show is available on BBC Sounds and the discussion was broadcast on 04 July 2022, starting at 1hr 05.
Jeremy opened the discussion by asking about the similarities between TMS and ECT. Dr Jarvis dealt with these questions by stating that TMS and ECT should not be confused for each other. ECT is Electroconvulsive Therapy which requires anaesthetic, as you must be unconscious. An electric shock is then passed through the brain, effectively inducing a seizure.
TMS is not that, TMS allows the patient to be awake and is described by Dr Jarvis as “as simple as going and sitting in a chair” and keeping your head still. Dr Jarvis also explained that during treatment you could listen to music, read a book or magazine and following treatment you can even drive home.
Another treatment that TMS is confused with is Vagus Nerve Stimulation. Dr Jarvis explains that these are not the same by advising this treatment “involves implanting something, basically a vagal nerve stimulator sends regular but very mild pulses of electrical energy into your brain via the Vagus Nerve”.
Some Important Points were Discussed
Dr Jarvis spoke throughout the feature on Jeremy Vine’s show, and we wanted to touch on some points that were discussed.
One point that we take issue with, is Dr Jarvis’ suggestion that TMS is only applicable to people for whom talking therapies and antidepressants don’t work. Whilst this may be the case within the NHS, it is not true within the NICE guidance limits. TMS could and should be considered by those who don’t want to take medication, perhaps because of the likely side effects. It could also be considered for those who are too unwell to engage effectively with talking therapy.
Dr Jarvis suggested that TMS is not a treatment for “mild depression” – again this is not in line with the NICE guidance. We have seen patients with mild depression experience great success in their recovery with TMS treatment.
Dr Jarvis highlighted the lack of certainty on the mechanism of action of TMS. However, this should not be a concern. As it is not known what exactly causes depression in the first instance, it is hardly surprising that the mechanisms of “repairing” it are also unclear.
What a TMS practitioner had to say
A caller to the show Richard, who is a TMS practitioner and former patient, described how he “got his life back” through receiving 25 sessions of TMS treatment in 2016.
Richard quite rightly highlighted that one session of TMS will not have a clinical effect. For depression we recommend 30 sessions of treatment as most patients will see a positive response to repetitive transcranial magnetic stimulation.
It is true that not all patients respond to TMS. But that is also true of anti-depressants or talking therapies. Working out what exact treatment works for each individual patient remains elusive.
Why is NICE approval so important?
Dr Jarvis says “the fact of the matter is, it (depression) is a huge problem. We have a vast number of people who need treatment. And in some cases, it does settle over time, but until we have a single panacea, which I am afraid is probably not going to happen, precisely because, as Graham said, people are so different. Then we are going to need to continue to have, what we call an armamentarium, so I think about having a whole selection of treatments.”
Which lead Dr Jarvis to talk about why NICE is so important, a body to weigh up all the evidence and outcomes of a variety of treatment options and bring those effective treatments to the forefront of treatment options. As TMS is NICE approved, we think it very important to recognise as an option for the treatment of depression and other mental health conditions.
Another caller prompted Dr Jarvis to highlight the depth of TMS evidence that NICE have reviewed, to conclude that TMS is safe and effective as a depression treatment. Confirming that NICE put forward treatments on the NHS once there is sufficient evidence that they are effective. Dr Jarvis quoted how randomized control trials had been carried across a total of 3,236 patients which had conclusively shown that TMS was more effective than sham treatment (patients set up in a clinic receiving a placebo effect but believing they were receiving TMS treatment).
Building on Dr Jarvis’ point, it is worth adding that since the NICE review (which was published in 2015), much more evidence has been forthcoming, all of which is supportive of TMS. In the US TMS is much more widely used than it is in the UK with over 20 million treatments administered.
TMS for depression through private medical insurers
Throughout the radio programme, there was a lot of talk about TMS being a private medical treatment or in some cases that it is available with the NHS. Richard pointed out early on in his involvement in the conversation, that medical aid is available through Private Medical Insurers (PMI). PMIs cover TMS treatment for Depression, something we are very versed in dealing with. Find out more about PMI coverage for depression on our website page, here.
Thank you to Radio 2
Overall, it was a very positive piece about Transcranial Magnetic Stimulation, which should help to raise awareness of it as an effective treatment for depression. Unsurprisingly, there was no discussion of the other conditions that TMS can be used to treat as NICE has not reviewed them yet: these include OCD, PTSD, borderline personality disorder and various addictions namely cocaine, alcohol and nicotine.
We thank the Vine Show for covering this important treatment and extend an open invitation to Jeremy Vine and Dr Sarah Jarvis to visit one of our Smart TMS clinics to see TMS treatment for themselves.
Want to find out more about TMS treatment for your condition?
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Screenshot sourced from BBC Sounds website, Jeremy Vine Channel, found via this link https://www.bbc.co.uk/programmes/b006wr3p.