Attitudes towards repetitive transcranial magnetic stimulation among depressive patients and medical students

Abstract

Introduction/Objective. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and safe brain stimulation method for the treatment of therapy resistant depression in adulthood. The German S3 guideline for unipolar depression recommends the use of high frequency rTMS of the left dorsolateral prefrontal cortex for depressive patients who did not respond primarily to antidepressant pharmacotherapy. Although a number of meta-analyses demonstrated its antidepressant efficacy on a high evidence level, rTMS is rarely offered to patients with mental disorders in German psychiatric hospitals. Methods. We introduced a questionnaire-based survey examining patients? (n = 122) and medical students? (n = 53) attitude towards rTMS. The questionnaire consisted of 10 questions with a 5-point Likert-scale. When testing for group differences, we conducted ?2 tests. Results. The majority of students and patients are not aware of rTMS as a psychiatric treatment of depression, with more patients than students not being aware (?2(1) = 9.462, p = 0.002; 39.3% vs. 17%). However, participants wish to be informed in more detail about rTMS. In general, positive attitudes cover the assumption of safety, while negative attitudes show concerns regarding the efficacy and a lack of trust in the method, mainly due to the fear of irreversible brain damage. Most participants would rather take psychiatric medication than rTMS. rTMS was assumed to be a helpful [?2(2) = 16.710, p < 0.001 (patients: 32.8% vs. students: 5.7%)] and well-tolerated treatment [?2(1) = 9.110, p = 0.003 (36.1% vs. 15.1%)] significantly more often by patients than by students. Conclusion. Our results show a clear need for more information on rTMS as a psychiatric treatment for patients and medical students to fight present prejudices and negative assumptions so that this treatment method with fewer side effects than medication may be used more often.

The influence of prior awareness on views about psychiatric electroceutical interventions among non-clinician stakeholders

“…While non-clinicians’ PEI views differed only minimally across stakeholder groups and by depression severity, they do vary considerably by PEI modality. For the most part, non-clinicians viewed rTMS, DBS, and ABIs more positively than ECT, which is consistent with earlier studies documenting rather negative public perceptions of ECT 8 , 26 , 45 , 49 , 50 and lesser acceptability of ECT than of other treatments 21 , 51 , 52 . Further, non-clinicians viewed the two implantable PEIs (i.e., DBS and ABIs) to be more invasive than ECT.…”

“…These results provide insights about the under-utilization of PEIs that are FDA-approved for treating depression (i.e., ECT and rTMS) and the potential limitations to the future adoption of PEIs that are under investigation for treating depression (i.e., DBS and ABIs). Compared to first-line depression treatments, non-clinicians reported considerably less prior awareness of any PEI in this study—a pattern similar to that in other studies 8 , 26 , 42 – 44 . Yet, with the exception of a small positive influence on perceived affect, which corresponds with earlier results from Griffiths and O’Neill-Kerr 22 and Tsai et al 2 , prior PEI awareness was not associated with any other PEI views.…”

“…rTMS, which uses a magnetic field to stimulate targeted cortical brain regions, has been FDA-approved for treating depression since 2008 and is currently being investigated for use in other disorders. rTMS is considered a non-invasive, safe, and evidence-based treatment for treatment-resistant depression (TRD) in adults 8 – 10 . Deep brain stimulation (DBS), which involves the surgical implantation of electrodes within specific brain regions, is considered the riskiest of the PEIs, primarily due to the invasiveness of the surgical procedure 11 , 12 .…”

“…Despite their clear efficacy, PEIs that are FDA-approved for treating mood disorders (such as ECT and rTMS) remain under-utilized 8 , 10 , 16 . Such under-utilization, at least in part, may be due to limited awareness of and/or negative attitudes about PEIs from non-clinicians (e.g., depressed patients, their caregivers, and the general public).…”

“…Much less research has been done examining public views of newer PEI modalities such as rTMS, DBS, or ABIs. Some work suggests that people who lack specific knowledge of newer PEI interventions may rely on general attitudes toward more well-known PEIs (like ECT), which are largely negative 8 . In the absence of reliable information, negative attitudes toward PEIs proliferate and influence perceptions of these treatments’ efficacy, safety, and side effects 1 , 8 , 21 , 25 .…”