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Question for you: Would you take your car to a mechanic if they told you there was a 14 percent chance that they could fix your car?
There have been dozens of stories in the media about a new trial of a treatment for depression called repetitive transcranial magnetic stimulation (rTMS). See examples. These stories are announcing the findings of a study coming out in the May issue of the flagship psychiatric journal, Archives of General Psychiatry. The stories promise hope because (rTMS) did better than a treatment that simulated the pulsing electromagnet.
The lead study author Mark George is quoted as saying, "This study should help settle the debate about whether rTMS works for depression. We can now follow up clues suggesting ways to improve its effectiveness, and hopefully further develop a potential new class of stimulation treatments for other brain disorders."
But what do we mean by work? In this case, rTMS treatment accounted for remissions in 14 percent of antidepressant-resistant patients actively treated for three weeks. The treatments were intensive and patients recieved a total of 15 treatments.
The stories will talk about the cleverness of the treatment (a pulsing electromagnetic coil aimed at the brain area to be stimulated generates a magnetic field that passes readily through the skull, inducing an electrical current in the immediately adjacent brain tissue). They will also talk about the cleverness of this study (which contained of a convincing simulation control treatment that mimics transient tapping and twitching sensations produced by the magnet). It is a clever treatment and it is a clever study. rTMS treatment development should be encouraged. But for me nothing can distract me from that number and what it seems to say about the state of play for the treatment of severe depression.
How have we gotten to the point where we consider a 14 percent success rate for the treatment of severe depression to be an encouraging finding heralded as a landmark study. Would we accept this success rate for cancer? for heart disease?
