This issue of Psychiatric Annals focuses on transcranial magnetic stimulation (TMS), guest edited by Philip G. Janicak, MD. The articles in this issue review the theory behind and clinical outcomes attained with TMS thus far and consider some of the issues that require clarification before definitive studies will be available to determine the efficacy of TMS as a treatment in psychiatry.
We rarely publish an issue about a treatment that is not studied fully enough to be approved for use in the treatment of our patients. Our readership consists of psychiatrists who we know are struggling to provide adequate treatments while burdened with the limitations of managed care, the threat of frivolous lawsuits, and treatments with limited efficacy. Why would we introduce treatments they may not yet be able to use for their patients?
There are several reasons we've chosen to address this subject. First, TMS could become a very helpful treatment for patients with absent or inadequate response to the medications we have available. Second, in some ways, the development of TMS is going through similar stages as I observed with psychotropic medications in the mid-1950s to 1960s. On the other hand, the standards of assessment of the efficacy of TMS for psychiatric and related disorders are much more rigorous than I remember being the case early in the psychopharmacologic revolution. Third, newer imaging techniques such as blood oxygen level dependent functional magnetic resonance imaging studies may tell us much more about etiologic factors in depression and other conditions. Most important, I have hope that TMS will fill an important treatment need of our patients in the relatively near future.
Like other new treatments, TMS also faces much more stringent requirements than did the “new” medications back in the mid-1950s to 1960s. I remember when the giants of research could get funding to try several agents in a small group of patients — no controls, no double-blinding — to see if an impressive number of patients showed improvement. Now, sham or placebo treatments and ratings by clinicians naïve to the treatment status of the patient are routine requirements from the very beginning.
Then, we were without effective treatments and desperate for them. Now we certainly need more effective treatments for our patients. What will the future bring? Will TMS prove to be a valuable treatment for our patients for years to come? Will enough resources and venture capital be available to give this treatment a chance to survive the rigors of proof? What do you think?
Don't forget to join us in Manhattan April 1–3 for the third annual Psychiatric Annals Symposium. Our subject this year will be treatment-resistant and bipolar depression. For more information, see the advertisement on pages 106–107 of this issue.