DBS vs TMS for treatment-resistant depression: A comparison
The lack of insurance coverage for DBS for treating depression is a deterrent to its use. Because DBS is not FDA-approved for treating depression, the costs (approximately $65,000) that are not covered by a facility or study will fall on the patient.4 Patients may abandon hope for a positive therapeutic outcome if they must struggle with the financial responsibility for procedures and follow-up.4
Serious potential adverse events of DBS include infections, skin erosions, and postoperative seizure.4 Patients who are treated with DBS should be educated about these adverse effects, and how they may affect outcomes.
Transcranial magnetic stimulation
Transcranial magnetic stimulation is FDA-approved for treating depression, OCD, and migraine. Randomized, sham-controlled trials have found that TMS is effective for TRD.5 Studies have demonstrated varying degrees of efficacy, with response rates ranging from 47% to 58%.6
The most commonly used target area for TMS for patients with depression is the left dorsolateral prefrontal cortex.7 Potential adverse effects are relatively few and benign. The most serious adverse effect of TMS is a risk for seizure, which is reported to occur at a frequency of <0.1%.7
Although it varies by practice and location, the cost for an acute course of TMS (20 to 30 sessions) may range from $6,000 to $12,000.8 Most insurance companies cover TMS treatment for depression.
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