How Deep TMS Could Decrease the Economic Burden of MDD

Updated on July 9, 2023

Deep TMS treatment can alleviate the economic strain of MDD, offering hope and relief to individuals and society

Affecting nearly 350 million worldwide, major depressive disorder (MDD or depression) is a leading cause of disability globally. According to PharmacoEconomics, the economic burden of MDD is more than $325 billion in the U.S. alone. That includes the direct costs of treating depression, costs from treating comorbidities, suicide-related costs, and workplace productivity effects.

In light of its tremendous toll on patients, their families, and the economy, it is important to measure the success of depression treatments. Most depression assessments focus on symptom reduction using scales like the Hamilton Depression Rating Scale (HDRS) to evaluate outcomes. These scales measure the deficits or suffering from depression including suicidality, difficulties with sleep, work, sadness, worry, physical complaints, appetite, etc.

Medications are the most commonly used treatments for depression and are studied against placebo. A broad and recurring finding in medication and psychotherapy studies shows that while the treatments are superior to placebo at reducing depressive symptoms, they are no better than placebo when assessing improvements in quality of life. In summary, when depressed patients’ quality of life improves, it is due to the placebo response – or the expectation of getting better and natural healing response – rather than the drug or psychotherapy. 

This limitation of drugs and therapy to address a patient’s quality of life is one reason why patients are referred for combined psychotherapy and pharmacotherapy. 

Are There Quality of Life Benefits to MDD Treatment?

Unfortunately much less is known about how treatments for depression affect quality of life. Just because a person is no longer suicidal does not necessarily mean they have a positive quality of life. Their ability to enjoy other domains of life like relationships or leisure activities may still be suboptimal, putting them at risk of relapse. Quality of life scales allow patients to rate their satisfaction and enjoyment in various domains such as work, relationships and hobbies on a range from very poor to very good.

Studies about medications commonly used to treat depression show that they are superior to placebo at reducing depressive symptoms, but they are not better than placebo when assessing improvements in quality of life. A possible explanation is that when depressed patients’ quality of life improves, it is due to the placebo response (the expectation of getting better and natural healing response) rather than the drug or psychotherapy. This limitation of drugs and therapy to address patients’ quality of life is one reason patients are referred for combined psychotherapy and pharmacotherapy.

Adding further complexity to the treatment of depression, a significant percentage of patients are deemed treatment resistant, meaning they do not find sufficient relief of their symptoms from pharmacotherapy and psychotherapy.

Research Suggests that Supplemental MDD Treatments Show Promise

A second-line treatment for those patients is Transcranial Magnetic Stimulation (TMS), which uses electromagnetic fields to create a more stable rhythm of activation within the targeted neural structures in the brain (stimulate the bilateral prefrontal cortex and dorsolateral prefrontal cortex), thereby alleviating the frequency and severity of the patient’s presenting symptoms. 

Deep Transcranial Magnetic Stimulation (Deep TMS™) is a newer form of TMS that reaches deeper and broader areas of the brain than traditional TMS. The H1 Coil stimulates the bilateral prefrontal cortex with a left preference, stimulating neurons 3 cm from the coil to modulate the neural activity of brain structures related to MDD. Many patients report improvement in depression symptoms within three to four weeks of the initial session.

In a recent study, researchers at BrainsWay and Ben Gurion University sought to shed light on the impact of quality of life for treatment-resistant depress patients following Deep Transcranial Magnetic Stimulation (Deep TMS™) therapy. They measured the effect of Deep TMS treatment on both symptom reduction and reported quality of life. 

Using data on 181 patients from the Deep TMS sham-controlled 20-center trial in treatment-resistant MDD, researchers investigated the effect of Deep TMS treatment on quality of life. All the patients had their antidepressants discontinued several weeks prior to starting the treatments. The treatment protocol consisted of five Deep TMS sessions per week for four weeks (the acute treatment phase) followed by 12 weeks of two sessions per week (the continuation/maintenance phase).

Quality of life was measured using the Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). This rating scale asks patients: taking everything into consideration, during the past week, how satisfied have you been with… health, mood, work, household, family, social, leisure time, sex, hobbies, economics, and more. 

The study, which was presented in poster form at the Annual Meeting of the Clinical TMS Society’s (CTMSS) and the American Psychiatric Association (APA) annual meetings, identified improvement in the active Deep TMS group versus the sham group at week five and at week 16. 

The results showed that at week five, the active Deep TMS group improved significantly in quality of life compared to sham (14.4vs.2.5). Not surprisingly, there was a correlation between extent of improvement in quality of life and extent of depressive symptom improvement. To be more specific, responders – those who showed greater than a 50% decrease in their HDRS score from baseline – demonstrated a significantly larger improvement in reported quality of life (133%) compared with non-responders (25%).

At week 16, 59% of the patients who showed improvement in Q-LES-Q scores from baseline at week five sustained their improvement or improved further.

These findings are significant because low quality of life is a potent and intransigent factor that contributes to the global disability associated with depression. It relates to the concept of recovery from illness, not just response and remission. We know that patients need to get beyond the crippling impact of depression and be able to embrace a productive life and fully engage with family and society.

Any remaining symptoms, which may be within normal limits on depression symptom rating scales but evident on quality- of-life scales, put patients at risks of relapse. If someone is improving in quality of life, then they are at lower risk of disability and relapse. 

Alleviating the Economic Strain of MDD

If we can improve symptoms and quality of life for those suffering from depression, we would not only improve the overall health of nearly 350 million people worldwide, we could potentially reduce the risk of relapse and start to chip away at the massive economic burden of MDD.

When first-line treatments fail to improve quality of life, clinicians need to consider second-line treatments like TMS and Deep TMS that have clinically demonstrated not only safety and efficacy, but also the ability to improve quality of life.

Dr. Aron Tendler, M.D., is the chief medical officer of BrainsWay, a global leader in advanced noninvasive neurostimulation treatments for mental health disorders. BrainsWay is boldly advancing neuroscience with its proprietary Deep Transcranial Magnetic Stimulation (Deep TMS™) platform technology to improve health and transform lives. Dr. Tendler has been a practicing clinical psychiatrist for nearly two decades. 

Aron Tendler 2022
Aron Tendler, M.D.

Aron Tendler, M.D., is the chief medical officer of BrainsWay, a global leader in advanced noninvasive neurostimulation treatments for mental health disorders. BrainsWay is boldly advancing neuroscience with its proprietary Deep Transcranial Magnetic Stimulation (Deep TMS™) platform technology to improve health and transform lives. Dr. Tendler has been a practicing clinical psychiatrist for nearly two decades.