Major Depressive disorder (MDD) is a debilitating condition that robs millions of people worldwide of joy, productivity, and quality of life. When two or more antidepressants fail to provide relief despite adequate treatment duration and adherence, patients find themselves navigating the challenging landscape of treatment-resistant Depression (TRD).
The Hidden Burden of Treatment-Resistant Depression
MDD is a serious mental health condition that includes symptoms such as a persistently low mood, low energy, anhedonia (loss of pleasure in activities), significant changes in appetite and sleep patterns, and in severe cases, suicidal thoughts.
What makes TRD particularly challenging is its prevalence and impact. Approximately one-third of patients with MDD do not respond to initial treatment attempts. The consequences extend far beyond emotional suffering. Patients with TRD often experience a dramatic decline in their quality of life, facing increased risks of physical health complications, social isolation, and professional setbacks.
The economic and personal toll is substantial. Many individuals with TRD find themselves on long-term sick leave or unable to maintain employment. The burden of the disorder increases with its duration, leading to hospitalization rates that are double those of patients with treatment-responsive Depression. These statistics highlight the critical need for innovative treatment approaches.
Two Emerging Treatment Strategies: TMS and Abilify
Two prominent options have emerged in recent years for patients who don’t respond adequately to traditional antidepressants: transcranial magnetic stimulation (TMS) and aripiprazole (Abilify).
Abilify: A Pharmaceutical Intervention
Abilify represented a significant breakthrough when it became the first atypical antipsychotic approved by the FDA in 2008 as an augmentation strategy for Depression. The medication works by modulating dopamine receptors, offering a different mechanism of action compared to traditional antidepressants.
Studies have shown promising results. Pooled analyses of multiple randomized trials demonstrated response rates of 44.2% compared to 29.9% for placebo, with remission rates of 30.7% vs. 17.2% for placebo. These numbers offer a glimmer of hope for patients who have exhausted multiple treatment options.
However, the medication comes with a complex profile of potential side effects that patients and healthcare providers must carefully weigh. Short-term side effects can include drowsiness that significantly impacts daily functioning, uncomfortable heartburn, and persistent headaches. Some patients also experience akathisia, a distressing condition characterized by an uncontrollable urge to move or fidget.
More concerning are the long-term risks associated with Abilify. Tardive dyskinesia, a potentially irreversible movement disorder, can develop with prolonged use. Perhaps most alarming is the increased risk of cardiac complications, which can pose serious and potentially life-threatening health risks.
It is also important to note that while Abilify is approved as an augmentation agent for major Depressive disorder, it is not specifically approved for TRD.
TMS: A Revolutionary Non-Pharmaceutical Approach
Transcranial magnetic stimulation (TMS) offers a fundamentally different approach to treating Depression. Approved by the FDA in 2008 for Treatment-Resistant Depression, TMS represents a breakthrough in neural modulation and mental health treatment.
TMS is backed by a substantial amount of research demonstrating its efficacy. One systematic literature review conducted in 2019 found the following response and remission rates for TMS: 95% response and 63% remission rate in treatment-naïve patients, 43% response rate after one failed medication trial, 36.6% remission after 1-2 failed medication trials, and 28.9% remission rate after 3-4 failed medication trials.
The key advantages of TMS are profound. Unlike medication-based treatments that affect the entire body, TMS provides a targeted intervention. The treatment is entirely non-invasive, eliminating the need for general anesthesia or systemic pharmaceutical interventions. Patients do not experience the cognitive adverse effects common with many psychiatric medications, and the treatment focuses on specific brain regions associated with mood regulation.
TMS and Abilify vs. SNRI
A recent multi-site clinical trial by Papakostas et al. provided compelling evidence for greater effectiveness of TMS than for Abilify. Three treatment approaches were compared for patients with treatment-resistant Depression: Abilify augmentation, TMS augmentation, and switching to a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant.
The study included 235 participants who scored at least 20 on the Montgomery-Asberg Depression Rating Scale (MADRS) at baseline and who experienced less than 50% symptom improvement with at least two antidepressant trials of adequate dose and duration. While the study did not directly compare TMS and Abilify to each other, there was a greater reduction in Depression symptoms among the TMS vs. SNRI arm when compared to the Abilify vs. SNRI arm. Participants receiving TMS demonstrated a 17.4-point reduction in Depression symptoms as measured by the MADRS, substantially outperforming Abilify’s 14.9-point reduction and the 13.2-point reduction seen among patients switching to an SNRI antidepressant.
Additionally, greater improvement was also observed among the TMS group compared to the Abilify group on the self-rated symptoms of Depression questionnaire (SDQ). The model estimated mean change in SDQ scores for Abilify augmentation vs. switching to an SNRI was -37.8 vs. -32.9, while the change in SDQ scores for TMS augmentation vs. switching to an SNRI was -43.0 vs. -34.5.
Looking to the Future
The recent study on TMS and Abilify represents more than just a medical breakthrough; it signifies a paradigm shift in understanding and treating Depression. Researchers are increasingly emphasizing the need for larger, more comprehensive studies that explore various augmentation strategies and personalized treatment protocols. Further research should be conducted to directly compare TMS augmentation vs. Abilify augmentation, as this is lacking in the current literature.
Find Relief for Treatment-Resistant Depression at Mid City TMS
For people struggling with treatment-resistant Depression, TMS offers a beacon of hope. This groundbreaking approach provides an alternative where medications have fallen short. Its non-invasive nature, minimal side effects, and demonstrated effectiveness make it a compelling option for TRD.
If you or a loved one is battling TRD, please don’t hesitate to contact us today. Our team here at Mid City TMS can conduct a comprehensive intake and consultation to determine if TMS is the right choice for you.
Cited Sources
- National Center for Biotechnology Information. “Treatment-Resistant Depression in Real-World Clinical Practice: A Systematic Literature Review of Data from 2012 to 2022.” PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10796703/
- PsychiatryOnline. “Atypical Antipsychotic Augmentation in Major Depressive Disorder: A Meta-Analysis of Placebo-Controlled Randomized Trials” The American Journal of Psychiatry. Available at: https://psychiatryonline.org/doi/10.1176/appi.ajp.2009.09030312?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
- HealthCentral. “Abilify (Aripiprazole).” HealthCentral. Available at: https://www.healthcentral.com/condition/anxiety/abilify-aripiprazole
- National Center for Biotechnology Information. “A systematic literature review of the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in non-treatment resistant patients with major depressive disorder” PubMed Central. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6325728/
- Psychiatric Times. “Augmentation Strategies for Treatment-Resistant Depression.” Psychiatric Times. Available at: https://psychiatrictimes.com/view/augmentation-strategies-for-treatment-resistant-depression
- Nature. “A systematic literature review of the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) in non-treatment resistant patients with major depressive disorder” Molecular Psychiatry. Available at: https://www.nature.com/articles/s41380-024-02468-x