> The researchers are conducting a larger, double-blinded trial in which half the participants are receiving fake treatment. The researchers are optimistic the second trial will prove to be similarly effective in treating people whose condition hasn’t improved with medication, talk therapy or other forms of electromagnetic stimulation.
Went into the comments to find out about this, this is ridiculous, there have been numerous studies on precisely that, take for a popular example Vsauce’s Power of suggestion video (soooorry, not sure if its free now for non-red subscribers, but valuable anyway) https://youtu.be/QDCcuCHOIyY
The why is obvious: It's #1 on Hacker News right now, and spreading like a wildfire across my social media. People love to hear about promising new depression treatments, because we all know someone who suffers from depression.
Strangely, most rTMS papers follow similar patterns: No control groups, small sample sizes, questionable methodology.
The methodological issues would have been trivially easy to correct from the start, so I assume the omission of control groups is intentional. I think it's geared toward generating publicity and drumming up grant money. The core rTMS technique seems to do something for depression, so it would be great if someone could translate that into a practical, sustainable treatment.
... without randomization or controls to randomize to.
n=21, no control group, zero blinding. Placebo response is notoriously high in depression studies, so it's unacceptable that they didn't include a control group.
This technique is a variant of rTMS, which has been around for a long time. We've had years of positive rTMS study results that failed to replicate in real-world conditions. There's some early evidence that it might do something positive, but it's not clear that it's a viable treatment option. In most major cities you can usually find at least one obscure rTMS clinic somewhere, but they won't offer the exact rTMS technique studied here. They also won't give you 50 sessions across 5 days as used in this study.
It's very disappointing, even suspicious, that they didn't include a control group. It's trivially easy to include a sham rTMS treatment because the patients can't see the magnetic field. At minimum, they could have split the group into low-dose and high-dose to demonstrate a dose-response relationship. Yet they deliberately chose to avoid any control group or dose-response measurements.
I can't access the full text, so I don't know when they measured the patients' depressive symptoms. If they scored the depression inventory on the final day of the 5-day treatment, this wouldn't be very promising as a long-term treatment. The real test would be how the depression remission holds up after the rTMS treatment is discontinued. If the remission persists for months, that would be truly impressive. On the other hand, if this only works with 50 in-office rTMS sessions per week, it's not a practical outpatient treatment.
I would love to be wrong and for this to be the holy grail of depression treatment, but given the circumstances I think it's best interpreted as an outlier study unless/until someone else reproduces it. I don't think we'll all be going in for 50 sessions of rTMS across 5 days any time soon.