This week, we got the biggest news in psychiatry ever. I’ve been waiting for this since 2018, and publishing on the steps leading to this regularly, so I’m glad this treatment got the FDA clearance so I don’t sound like a quack. There will be a number of caveats.1
Depression, as a thing that haunts the minds and lives of millions of people, could be over2 in five days. It doesn’t mean over forever. It does mean for now. Endless medical caveats aside3, it’s big deal news. No, you can’t go just get it yet. But it has been on the today show.4 It has to be made generally available through an extensive effort in manufacturing, distribution, systems of care, integration with existing systems, education of providers, sub-specialist training, new payment models, new staffing models, maybe even new business models etc. etc. etc. etc. etc. etc.
People who suffer with depression are likely to be a bit pessimistic, to put it mildly. The obvious question is: define the word could in the above sentence? You know, the sentence about it only being five days?
In this context the word “could” is defined as follows:
The American Journal of Psychiatry published results from a double-blinded randomized controlled trial (RCT) evaluating SAINT, showing that 79% of people in the active treatment arm entered remission from their depression compared to 13% in the sham treatment arm.
How likely?: “More often than not.”
That is it. That’s my message of hope.
I could go on and on about this treatment, but I’m not going to. It’s all people in my world could talk about this week.
Your depression can be over so soon it boggles the mind.
Turn that news over in your head…. depression5 is able to be over6 in five days. It’s FDA cleared. Do you honestly care about anything else?
Do you care how much it costs?7 Probably. But probably on the order of how can I possibly get enough money to pay for whatever this is.
Do you care what the side effects are?8 Probably, inasmuch as you’re likely willing to suffer anything to have this horrible demon leave you alone, finally.
Do you care what the treatment consists of?9 Probably, inasmuch as you’ll do anything to do the things they ask you to do to have the demon leave you alone.
Depression is so bad10 people kill themselves11 instead of continue to live with it. Tell me that’s true about any other common illnesses?
We’re not talking about response rates. We’re not talking about people feeling somewhat better half of the time. We’re talking about remission. “No more depression for now.” I’ve been talking about this for some time now.
This is different from most existing depression treatments12 because they are approved based on meeting a response threshold, meaning that depression got 50% better, and it happened in enough people that it’s good enough for us.
This treatment is measured against a different threshold, and that threshold is remission, and remission means your symptoms are so much better that you don’t count as having any depression anymore, as far as rating scales for depression go.
That’s what the studies show.13 It doesn’t keep it it bay forever. But then again, that would be a bit much to ask from a brand-new treatment, wouldn’t it now?
It’s a new day. Everyone needs to get this treatment who needs to get this treatment when it is available. That is not now. That is soon. We need to be prepared. It is a moral imperative.
What do you wanna bet your insurance isn’t gonna pay for it?
The company that makes the device is called Magnus.
By the way, this is the point in time that I remind you to share this piece. This is the biggest news for depression ever. Everyone should know about it. That will happen quicker if you forward this piece to everyone you know. Don’t sleep on it. Now is the time.
Even with all the caveats, it’s a big deal.
—O. Scott Muir, M.D.
To simplify things, I’m just gonna define the word caveat and move on:
In this context over means in remission. Which means that on a depression rating scale, you would no longer meet the criteria for major depressive disorder. It’s an episodic condition. Whatever episode you were in would be over. Could there be another episode? Yes. How long does this last? Well, we don’t know, but it’s something like 12 to 18 months on average.
Just kidding. This is not medical advice. Please don’t construe this as medical advice. Speak to your doctor before pursuing any medical treatment for any condition. If you’re feeling suicidal, speak to your doctor about speaking to your doctor about speaking to your doctor about caveats about depression treatment.
The today show is a program on television. You know that thing your spouse is watching while you’re busy reading things on your phone? Yeah, that thing.
Diagnostic caveat. Health insurance coverage caveat. Medical necessity criteria caveat.
Caveat caveat caveat caveat caveat caveat caveat caveat caveat caveat caveat caveat.
In places where we’ve been replicating this research, prior to this approval, with existing technology, in the outpatient setting, the list price is around $22,500.
Headache, fatigue, scalp tenderness, a theoretical risk of seizure which has never actually happened with this particular protocol. Hearing loss if you don’t wear earplugs. It’s literally safer than water. You can overdose on water. You can’t overdose on this.
It’s an FMRI guided version of transcranial magnetic stimulation (TMS). We take an fMRI scan, an AI algorithm tells us where on your scalp to point a magnetic stimulator, and you sit in a chair for 8 minutes at a time, 10 times a day, 5 days in a row, and at the end of it your depression is over, more often than not. Sometimes your depression will be over the very first day, sometimes it takes all five days. Sometimes it doesn’t work. Sometimes you might need little bit more.
Lack of caveats. It’s really that bad. I don’t have to qualify how bad depression is. It’s the number one leading cause of disability worldwide.
As a brief note from everybody who loves you: please don’t kill yourself. No caveats here. Not the place for them. None at all.
Caveat caveat caveat caveat caveat ketamine caveat esketamine caveat psychedelics caveat electroconvulsive therapy caveat.
Reference reference reference reference reference, caveat, reference caveat sample size caveat reference caveat placebo response rates caveat sham-controlled caveat randomized controlled trial caveat time to effect caveat reduce spending on CNS interventions caveat profitability caveat caveat caveat caveat sample selection bias caveat publication bias caveat caveat caveat caveat.