Comments on: At last some good news about rTMS? http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/ A Neurostimulating Blog Wed, 28 Jul 2010 22:45:52 +0000 http://wordpress.org/?v=2.9.1 hourly 1 By: Georges Otte http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/comment-page-1/#comment-1845 Georges Otte Mon, 29 Dec 2008 13:03:32 +0000 http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/#comment-1845 Good lord !!! Thanks for claryfing things out. As the authors were different I did not immediately realise that this is just a post hoc analysis of identifying so called predictive variables on data of two previous older and already separately published studies "lumped" together: one good (RCT) and one bad (open label). As in the movie it gives me a bit of an "ugly" end feeling. OK It is not really deceptive for he or she who reads attentively but a casual reader could think of it as "new" evidence. I agree with You completely that methodologically it would have been much better to skip this and get to a real prospective (new data) study instead. I am a bit baffled that nature reviewers allowed this to pass so easily. Making it public could be dangerous as it will enhance picking the low fruit for those doing a survey on rTMS efficacy. Thanks again for Your critical and vigilant EBM attitude !! Dr. G. Otte Good lord !!! Thanks for claryfing things out. As the authors were different I did not immediately realise that this is just a post hoc analysis of identifying so called predictive variables on data of two previous older and already separately published studies “lumped” together: one good (RCT) and one bad (open label). As in the movie it gives me a bit of an “ugly” end feeling. OK It is not really deceptive for he or she who reads attentively but a casual reader could think of it as “new” evidence. I agree with You completely that methodologically it would have been much better to skip this and get to a real prospective (new data) study instead. I am a bit baffled that nature reviewers allowed this to pass so easily. Making it public could be dangerous as it will enhance picking the low fruit for those doing a survey on rTMS efficacy. Thanks again for Your critical and vigilant EBM attitude !!

Dr. G. Otte

]]> By: Dr Shock http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/comment-page-1/#comment-1843 Dr Shock Mon, 29 Dec 2008 12:38:43 +0000 http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/#comment-1843 This study is only a study for clinical predictors to rTMS. This study is done following a RCT and an openlabel follow up study. You can read a discussion about those two studies here: RCT:http://tinyurl.com/9lw6j9 Follow up open label study here: http://tinyurl.com/726u8b I didn't discus this study for obvious reasons, it's a analysis of data available from an good RCT and a worse openlabel study. It doesn't add much to the knowledge already provided. These hypothesis generating trials should be followed up by prospective trials with their hypothesis to test. Waiting for those trials. Not another "look what I have found this time..." By the way I don't believe rTMS should be tested with therapy resistant depression, whatever that is ( see:http://tinyurl.com/8q62qs). It should be tried by outpatients with depressive disorders. Kind regards Dr Shock Kind regards Dr Shock This study is only a study for clinical predictors to rTMS. This study is done following a RCT and an openlabel follow up study.
You can read a discussion about those two studies here: RCT:http://tinyurl.com/9lw6j9
Follow up open label study here: http://tinyurl.com/726u8b
I didn’t discus this study for obvious reasons, it’s a analysis of data available from an good RCT and a worse openlabel study. It doesn’t add much to the knowledge already provided. These hypothesis generating trials should be followed up by prospective trials with their hypothesis to test. Waiting for those trials. Not another “look what I have found this time…” By the way I don’t believe rTMS should be tested with therapy resistant depression, whatever that is ( see:http://tinyurl.com/8q62qs). It should be tried by outpatients with depressive disorders.
Kind regards Dr Shock
Kind regards Dr Shock

]]> By: Georges Otte http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/comment-page-1/#comment-1836 Georges Otte Sun, 28 Dec 2008 21:13:03 +0000 http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/#comment-1836 A recent multicentre trial was published in Neuropsychopharmacology (2009)34,522-534 www.neuropsychopharmacology.com (http://www.nature.com/npp/journal/v34/n2/full/npp2008118a.html) RCT study. > 300 patients included. LOCF design. In patients that failed to respond to one adequate trial with antidepressants the effect size was 0.83. Not to bad , I guess. What is Your comment on this study ? Sincerely, Dr. G. Otte A recent multicentre trial was published in Neuropsychopharmacology (2009)34,522-534 http://www.neuropsychopharmacology.com (http://www.nature.com/npp/journal/v34/n2/full/npp2008118a.html)

RCT study. > 300 patients included. LOCF design.

In patients that failed to respond to one adequate trial with antidepressants the effect size was 0.83. Not to bad , I guess.

What is Your comment on this study ?

Sincerely,

Dr. G. Otte

]]> By: Transcranial Magnetic Stimulation Gains approval of the FDA for Depression | Dr Shock MD PhD http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/comment-page-1/#comment-966 Transcranial Magnetic Stimulation Gains approval of the FDA for Depression | Dr Shock MD PhD Fri, 17 Oct 2008 04:27:52 +0000 http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/#comment-966 [...] In another trial was very well done but results with rTMS for depression were not very impressive. [...] [...] In another trial was very well done but results with rTMS for depression were not very impressive. [...]

]]> By: Herb http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/comment-page-1/#comment-100 Herb Tue, 27 Nov 2007 18:56:00 +0000 http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/#comment-100 Doc,<br/><br/>Media or sponsor hype? I don’t know.<br/><br/>Maybe it is paid professional hype along the lines of Dr. Carlat’s recent expose or contrition in the New York Times if you happened not to read the piece or the various commentaries on the subject.<br/><br/>http://carlatpsychiatry.blogspot.com/2007/11/dr-drug-rep.html#links<br/><br/>Warmly,<br/>Herb<br/>VNSdepression.com Doc,

Media or sponsor hype? I don’t know.

Maybe it is paid professional hype along the lines of Dr. Carlat’s recent expose or contrition in the New York Times if you happened not to read the piece or the various commentaries on the subject.

http://carlatpsychiatry.blogspot.com/2007/11/dr-drug-rep.html#links

Warmly,
Herb
VNSdepression.com

]]> By: Dr. Shock http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/comment-page-1/#comment-99 Dr. Shock Tue, 27 Nov 2007 18:13:00 +0000 http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/#comment-99 Dear Herb,<br/>I've seen articles like this one by the dozens in my RSS reader, what is puzzling me is why does this article, one of many about depression treatment and rTMS get so much attention? <br/>It only strengthens my opinion expressed in the post.<br/>Regards Dr Shock Dear Herb,
I’ve seen articles like this one by the dozens in my RSS reader, what is puzzling me is why does this article, one of many about depression treatment and rTMS get so much attention?
It only strengthens my opinion expressed in the post.
Regards Dr Shock

]]> By: Herb http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/comment-page-1/#comment-98 Herb Mon, 26 Nov 2007 23:20:00 +0000 http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/#comment-98 Hi Doc,<br/><br/>I thought you might have interest in reading the following press release.<br/><br/>http://www.eurekalert.org/pub_releases/2007-11/uops-prs112607.php#<br/><br/>Since I’ve already read your thoughts relating to the study would you care to comment about this press release?<br/><br/>Warmly,<br/>Herb<br/>VNSdepression.com Hi Doc,

I thought you might have interest in reading the following press release.

http://www.eurekalert.org/pub_releases/2007-11/uops-prs112607.php#

Since I’ve already read your thoughts relating to the study would you care to comment about this press release?

Warmly,
Herb
VNSdepression.com

]]> By: Herb http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/comment-page-1/#comment-88 Herb Sat, 17 Nov 2007 01:56:00 +0000 http://www.shockmd.com/2007/11/15/at-last-some-good-news-about-rtms/#comment-88 Hi Doc,<br/><br/>I owe you several thanks. First thanks for opening the door on Flickr. Apparently I didn’t pay much attention to the sidebar on your site. Those are wonderful photos that you’ve taken and then I spent an evening perusing some of the other work.<br/><br/>Most importantly, thanks for expressing your viewpoint as it relates to your reading of the study results. I’ve come to learn even you professionals differ over the interpretation of the same study results making it even more difficult for me as a lay-person and care giver to make the best possible decision(s) for my charge.<br/><br/>Of note also from my perspective was the apparent lowering of the bar as to the acceptability of study subjects when compared to the VNS study.<br/><br/>Once again, thank you and thanks for taking the time to share with me.<br/><br/>Warmly,<br/>Herb<br/>VNSdepression.com Hi Doc,

I owe you several thanks. First thanks for opening the door on Flickr. Apparently I didn’t pay much attention to the sidebar on your site. Those are wonderful photos that you’ve taken and then I spent an evening perusing some of the other work.

Most importantly, thanks for expressing your viewpoint as it relates to your reading of the study results. I’ve come to learn even you professionals differ over the interpretation of the same study results making it even more difficult for me as a lay-person and care giver to make the best possible decision(s) for my charge.

Of note also from my perspective was the apparent lowering of the bar as to the acceptability of study subjects when compared to the VNS study.

Once again, thank you and thanks for taking the time to share with me.

Warmly,
Herb
VNSdepression.com

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