The following article appeared in The Canadian Journal of Psychiatryon October 6, 2016, the same day that a second study appeared in JAMA Psychiatry
Posted on December 14th 2019, 11:54 pm
One involved a retrospective cohort study with 3234 patients, and a second one was a prospective cohort study with 2,600 patients, both done by researchers at the Kaiser Permanente Center for Health Research. The researchers found that, for people treated with TMS, there was a 25% increase in suicide attempts for a period of about 3 years. The authors suggest that this increase may be related to adverse effects from the medication like decreased appetite, nausea, and constipation. So, does this mean that some people are more susceptible to mood swings from TMS than others? No, not necessarily. The researchers also tested four antidepressant drugs, and found that patients treated with TMS received slightly different benefits in the form of improved depressive symptoms. One of the antidepressant drugs that experienced the greatest benefit was venlafaxine (Effexor XR), a pharmaceutical that doesn't have any effect on mood swings. The authors suggest that the benefits of TMS are better than the side effects. And if the side-effect profile was less than ideal, why were more patients prescribed it? Well, to be honest, the reasons are a bit more complex. One factor is that TMS is much cheaper than a number of the other treatments available. Another is that there was simply less interest in it. I don't know how many people I know that are reading this blog or that have seen videos of me speaking on this topic to take advantage of this treatment. When TMS was first introduced in the early to mid-90s, there was a major push for better treatments to improve patient outcomes. The study results, and lack of interest in taking advantage of these results, suggest the opposite. In fact, it also suggests that the drugs on the market are not as effective as there once was, or at least not as effective as what we used to think we had. But if this study is true, these treatments just seem like better antidepressants for people who can afford them. I guess it doesn't make a ton of sense, as mood changes happen pretty slowly for most people, but people will still pay a lot more for a pill that gives them just a little more comfort than they would for something that may produce a lasting effect. And the side effects are not quite as scary. Some people take TMS for life.