If two antidepressants fail, TMS may offer relief.

The FDA approved transcranial magnetic stimulation (TMS) to treat anxiety, depression, and OCD about 15 years ago. Most insurers cover this treatment. However, it remains highly underutilized.

A study just published by Dutch researchers in Psychiatry Online compared TMS with a third antidepressant in people who did not respond well to two different antidepressants.

Both treatments were combined with psychotherapy.

• 89 people with depression who hadn’t improved with at least two previous treatments took part.

• They were randomly assigned to either TMS or a new antidepressant.

• The treatment lasted eight weeks.

• TMS involved 25 sessions of magnetic stimulation.

• The medication group switched to a new antidepressant following standard guidelines.

The primary outcome measure was the degree of improvement in depression symptoms.

TMS was more effective than switching medications. More people responded well to MS (38% vs 15%) and more people’s depression went into remission with TMS (27% vs 5%).

TMS was better at improving symptoms of anxiety and lack of enjoyment (anhedonia)

Both treatments were equally effective for improving sleep, overthinking, and negative thought patterns. People’s expectations about their treatment were linked to how much their depression improved.

In conclusion, for people with depression that hasn’t responded well to a couple of medication attempts, TMS might be a more effective option than trying another antidepressant. The study also suggests that the choice between TMS and medication might depend on which specific symptoms a person struggles with most.

We started using TMS for people with migraine headaches if they do not respond to multiple standard therapies. About half of these patients respond well. However, we do not have large controlled trials to confirm that TMS effectively treats migraines.