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Depression is the most common of all mental disorders, with more than 300 million individuals suffering from major depressive disorder around the globe. Fortunately, the array of available treatment options and diagnostic tools has grown more vast and sophisticated than ever. On the diagnostic end, the Patient Health Questionnaire (known as the PHQ-9) has proven to be a “reliable and valid measure of depression severity” in the 20 years since its inception. Moreover, the brevity and internal consistency of this self-administered test make the PHQ-9 an indispensably practical instrument for gauging depression, as well as the effectiveness of treatment.

On the treatment end, clinicians and psychiatrists now have a panoply of depression therapy strategies to choose from. However, while the spectrum of treatment options has increased exponentially over the last few decades, most cases of depression continue to be treated with a narrow set of pharmaceutical antidepressant options — typically selective serotonin reuptake inhibitors (SSRIs) — despite the proven effectiveness of other fast-acting treatments, such as Transcranial Magnetic Stimulation (TMS). In fact, TMS efficacy is statistically superior to that of other more commonly prescribed options, including even the most effective first-line antidepressants.

So, does TMS really work for depression?

In numerous clinical trials utilizing PHQ-9 assessments, TMS has been consistently shown to improve depressive symptoms. For example, a 2009 clinical study, involving 22 medical centers located across the United States, Canada, Europe, and Israel, recorded a high TMS success rate including “significant remission (32.6 percent) and response (38.4 percent).” TMS also lacks the risk of long-term side effects associated with many other options, leading a growing number of clinicians to utilize this fast-acting treatment.


The U.S. Preventive Services Task Force recommends certain depression screening procedures, including the PHQ-9, to “ensure accurate diagnosis, effective treatment, and follow-up.” In the case of major depressive disorder, PHQ-9 scores have demonstrated a sensitivity and specificity of 88 percent, according to the American Psychological Association. In fact, patients with a high PHQ-9 (defined as a score of 10 or higher) are “between 7 to 13.6 times more likely to be diagnosed with depression by the mental health professional.”

However, the PHQ-9 is much more than a diagnostic tool; it can also be used to monitor and measure the improvement (or lack thereof) of depressive symptoms. Statistically meaningful symptom relief, signified by lower scores on assessments like the PHQ-9, is common with TMS therapy. In fact, TMS depression success rates far exceed those of popular pharmaceutical options. According to a 2012 Brown University study, nearly 60 percent of patients receiving TMS treatment reported a significant reduction in depressive symptoms.

These high TMS efficacy rates have led doctors to recommend the treatment for patients who have not experienced remission with prior antidepressant therapies. TMS is also used as an alternative to last-resort treatment options like electroconvulsive therapy (ECT).


As clinicians and patients know all too well, although antidepressants may work for some, a worrisome percentage of individuals do not experience symptom relief with their first depression medication. In fact, a mere one-third of patients respond to their first prescribed antidepressant, and only about 25 percent of patients switching to a second antidepressant can expect to experience remission.

This trial-and-error process of pharmaceutical treatment can be frustrating, and it may never produce results for some patients. However, the American Psychological Association has resoundingly heralded TMS as a “promising treatment alternative for the estimated 30 percent to 50 percent of people with depression who don’t respond sufficiently to antidepressant medications.”

Typically, antidepressants take up to six weeks (if ever) to offer any symptom relief. Many TMS patients, however, experience positive results by the fourth week of treatment. The comparative quickness of TMS also makes the treatment a promising alternative to ECT for individuals with a high risk of suicide. TMS eliminates the danger and long-term side effects associated with ECT, which include, but are not limited to, memory loss and anesthesia-related risks.

TMS uses a noninvasive magnetic field to activate brain cells in the prefrontal cortex. The most common TMS side effect is mild discomfort along the scalp, and this can easily be treated with over-the-counter medications.

TMS efficacy rates have routinely surpassed typical first-line antidepressants. Rush University Medical Center of Chicago concluded that “TMS is effective in the acute treatment of [major depressive disorder],” based on PHQ-9 depressive symptom reductions. The aforementioned Brown University study also found that 37 percent of participating TMS patients experienced a complete remission of their major depressive disorder. Furthermore, a 2011 study found that half of TMS therapy patients experienced symptom improvement by the end of the treatment.

Despite a comparatively high failure rate and lack of PHQ-9-evidenced symptom improvement, depression treatment today is still largely focused on pharmacological solutions. Since the late 1990s and early 2000s, there has been an increase of nearly 65 percent in the use of antidepressants. As it was once so pertinentlyposed: “Why, if the biological causes of depression are so varied, is such a singular approach taken to treat it?”

Fortunately, this doesn’t have to be the case — TMS is a promising and proven alternative to drug therapy. If your patients are consistently demonstrating resistance to antidepressant drug therapy trials, it could be time to consider a TMS referral.


Can I take the PHQ-9 online?

Yes. The questionnaire is available here: Depression Quiz

Is TMS an FDA approved treatment?

Yes, TMS was approved by the FDA in 2008.

What is TMS?

TMS stands for transcranial magnetic stimulation. It’s a treatment that uses magnets to stimulate the prefrontal cortex to promote brain cell activity to decrease depressive symptoms. It’s a drug free therapy with contraindications so limited that patients require no post-treatment monitoring and are able to drive home straight away.

What are the most common side effects of TMS?

The most common side effects of TMS are scalp discomfort and headache.

All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Active Path website is solely at your own risk.

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