FIn July, the French National Authority for Health (HAS) published its report on repeated transcranial magnetic stimulation (rTMS) in the treatment of resistant depression in adults. This report was eagerly awaited by the psychiatric community and the verdict is in: 70 pages for a negative opinion on the interest of high-frequency rTMS in the treatment of depression after failure of two antidepressant treatments.
About 150 rTMS centers have nevertheless been structured, mostly in public hospitals, to meet a major public health need: the management of depression, affecting one in five people during their lifetime and whose incidence is exploding. since the start of the Covid-19 crisis. The principle of rTMS is to modulate areas of the brain using magnetic pulses delivered by a coil to the patient’s skull, daily for several weeks to help neurons reestablish cerebral connections.
The negative opinion issued by HAS contrasts with all the expert recommendations and the favorable position of health authorities in many countries around the world, which recognize the therapeutic efficacy of rTMS when depressive symptoms are moderate and that the level of resistance to antidepressants is low to moderate. The medico-economic analyzes all show overall costs equivalent to or lower than other therapeutic drug strategies or electroconvulsive therapy (ECT, the old electroshock) with relevant results in terms of improving health status and quality. life of patients.
Lack of rigor in evaluation procedures
This opinion is all the more surprising since the HAS issued a favorable opinion in June for the use of rTMS but also direct current electrical stimulation (tDCS) in post-stroke aphasic disorders (language and communication secondary to a stroke) even though the recommendations of experts report a low level of scientific evidence! To issue its opinion on the place of rTMS in the rehabilitation of post-stroke aphasia, the HAS expert group relied on a single meta-analysis (scientific method aimed at grouping the results of studies different). The theme of post-stroke motor rehabilitation, which nevertheless has a higher level of proof of effectiveness, has not been evaluated. This testifies to a lack of scientific rigor in the evaluation procedures, giving rise to a feeling of “double standards”. Should we see in this one more mark of the stigmatization that patients suffering from depression can suffer?
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