TMS, Hyperbaric Oxygen and Vitamin Drips: What Does the Science Actually Say?

A new clinic is opening locally, currently offering three treatments according to its website: transcranial magnetic stimulation (TMS), low-pressure hyperbaric oxygen therapy and intravenous vitamin infusions.

Why am I writing about this?

I am a GP who has lived and worked locally for many years and now practises in Windsor. Much of my work and writing is increasingly focused on prevention: helping people understand what actually improves their chances of living longer and, more importantly, staying well for longer.

I have no connection with the clinic, and this isn’t a review of the people running it. I haven’t visited it, and I am not commenting on the standard of care it provides. 

I do miss Julian and his wonderful art, now that was good for our wellbeing!

I am commenting because these treatments raise a much bigger question that increasingly confronts all of us.

How do you tell the difference between good medicine and good marketing?

That’s becoming surprisingly difficult. Modern wellness treatments can come wrapped in medical technology and convincing scientific language: neuroplasticity, oxygenation, cellular repair, antioxidants, immune support and maximum absorption.

Some of that science is perfectly genuine.

But genuine science surrounding a treatment is not the same thing as good evidence that the treatment will make you healthier.

As a doctor, that’s the distinction I’m interested in.

So I’ve taken the three treatments currently advertised by the clinic and asked the same question of each:

What does the scientific evidence show?

All three sound impressively medical. Magnetic fields acting on the brain. Oxygen delivered under pressure. Vitamins injected directly into the bloodstream.

And all three involve genuine science.

But that isn’t the question we should be asking.

The important question is whether that science translates into evidence that the treatments can make us better.

And when you look at the evidence, these three treatments are very different propositions.

TMS: real medicine — but not where we normally start

Repetitive transcranial magnetic stimulation — rTMS — is a genuine, evidence-based medical treatment for depression.

A magnetic coil placed against the scalp produces magnetic pulses which induce electrical activity in targeted areas of the cerebral cortex. Treatment usually involves repeated sessions over several weeks.

NICE reviewed the treatment in 2015 and concluded that the evidence for short-term efficacy in depression was adequate and that there were no major safety concerns.

So this is not simply a treatment with an interesting theoretical mechanism. Clinical trials have shown that it can actually help patients.

But that does not mean that somebody diagnosed with depression should move rapidly from conventional treatment to having their brain stimulated with magnetic pulses.

Most people with depression do not need rTMS. Treatment should start much more conventionally: addressing contributing circumstances, self-help and behavioural approaches, exercise, psychological therapies such as CBT or counselling, and, where appropriate, antidepressant medication. For more severe depression, antidepressant medication and psychological therapy are often used together.

And I would want the basics properly addressed too: sleep, physical activity, alcohol, nutrition, relationships, loneliness and social connection.

Depression occurs in a whole person living a whole life, not simply in an underperforming patch of prefrontal cortex.

rTMS generally enters the conversation much further down the treatment pathway, particularly when depression has proved resistant to conventional treatment. Treatment-resistant depression is usually defined as depression that has shown no or limited response to two adequate courses of treatment.

So before I personally considered rTMS, I would want to know that the diagnosis had been carefully reviewed; that important physical, psychological and social contributors had been considered; that lifestyle factors such as exercise, sleep, alcohol, nutrition and social connection had been properly addressed where relevant; that appropriate psychological therapy had been tried; and, in someone for whom medication was appropriate, that adequate trials of antidepressant treatment — commonly more than one — had been unsuccessful or not tolerated.

I would also be slightly more cautious than the clinic’s description that TMS triggers the brain’s ability to “repair and rebuild connections between nerve cells”. Neuroplasticity is implicated in how TMS may work, but its precise therapeutic mechanism remains incompletely understood.

rTMS is therefore not alternative medicine. Quite the opposite. It is a specialist medical treatment for a selected group of patients whose depression has proved really difficult to treat.

That distinction becomes particularly important when an established psychiatric treatment is offered alongside wellness therapies. The fact that rTMS has a genuine evidence base should not confer scientific credibility on everything else appearing on the same treatment menu.

Hyperbaric oxygen: this is where things become more complicated

Hyperbaric oxygen therapy is also real medicine.

It is used for conditions including decompression sickness, carbon monoxide poisoning and selected difficult wounds and radiation injuries.  None of these are common diagnoses here in Datchet and Wraysbury. 

But there is another important detail.

That is not the treatment being offered.

Medical hyperbaric oxygen therapy generally involves breathing very high concentrations of oxygen at substantially raised atmospheric pressures.

The advertised wellness treatment operates at relatively low pressure 1.3–1.4 ATA.

That is a very different intervention.

The Undersea and Hyperbaric Medical Society distinguishes these low-pressure exposures from established therapeutic HBOT. Evidence that conventional medical HBOT works for particular diseases cannot simply be transferred to a lower-pressure wellness chamber.

And this illustrates an important principle in medicine:

A treatment doesn’t become evidence-based simply because something physiological happens when you use it.

Pressure changes physiology.

Oxygen changes physiology.

Exercise changes physiology.

Standing on your head changes physiology.

The important question isn’t whether something happens inside the body.

It is whether good clinical trials show that the intervention produces a worthwhile health benefit.

The clinic website suggests that people undergoing wellness HBOT may feel refreshed, revitalised, relaxed, better recovered and mentally clearer.

Perhaps they do.

But these are subjective outcomes particularly susceptible to expectation, attention, relaxation and placebo effects.

At present there is no convincing clinical evidence that sitting in a chamber at 1.3–1.4 ATA makes an otherwise healthy person meaningfully healthier.

Interestingly, the clinic itself acknowledges this distinction. Its website explicitly states that its wellness HBOT “is not medical treatment and is not intended to diagnose, treat, cure, or prevent any medical condition.”

That is an important disclaimer.

Potential customers should probably read it carefully.

IV vitamin drips: convincing marketing, much less convincing science

Of the three offerings, this is the one about which I am most sceptical.

Intravenous vitamins unquestionably have important medical uses.

If somebody has a significant deficiency, cannot absorb a nutrient normally or has a medical condition requiring intravenous replacement, putting vitamins directly into their bloodstream can be entirely appropriate.

But giving vitamins intravenously to otherwise healthy people is a completely different proposition.

The clinic says that bypassing the digestive system ensures “maximum absorption”, allowing people to feel the benefits “quickly and effectively”.

The first part is broadly true.

The second does not automatically follow.

Getting more of something into your bloodstream does not mean that more of it will make you healthier.

Our bodies require vitamins in particular quantities. Once requirements are met, producing an artificially high blood concentration has not been shown to provide additional health benefit.

 For most of us, a healthy Mediterranean-style diet provides the vitamins and minerals we need. Supplements have an important role when a deficiency is identified, when dietary intake or absorption is inadequate, or in specific circumstances where supplementation is recommended. But if you are already getting enough of a vitamin, there is little reason to assume that putting much more of it directly into your bloodstream will make you healthier.

Yet wellness IV therapy is frequently marketed using words such as energy, immunity, recovery, hydration and skin radiance.

These are attractive claims.

Where are the convincing clinical trials?

A review published in Drug and Therapeutics Bulletin concluded that there was a lack of high-quality evidence that high-dose vitamin infusions provide health benefits in people without a specific deficiency or medical condition.

The Advertising Standards Authority has examined these claims in considerable detail. Its current guidance states that it has ‘yet to see convincing evidence’ supporting the claimed benefits of specific IV nutritional therapies. It has previously ruled against claims involving energy, immunity, hydration, exercise recovery and skin benefits where adequate evidence was not provided.

And IV therapy isn’t completely innocuous.

Every intravenous cannula carries some risk of infection, bruising and inflammation. Depending upon what is infused and at what dose, there can also be metabolic consequences and particular risks for people with underlying disease.

That doesn’t make vitamin drips inherently dangerous.

It simply raises an obvious question.

Why accept even a small medical risk from an invasive procedure if there is little good evidence that you need it or that it will improve your health?

The problem with “wellness science”

There is a broader lesson here.

Modern wellness marketing has become extremely good at borrowing the language of medicine.

Neuroplasticity.

Cellular repair.

Oxygenation.

Antioxidants.

Inflammation.

Immune support.

Maximum absorption.

Every one of these can describe a genuine biological phenomenon.

But describing a biological mechanism is not the same thing as demonstrating a health benefit.

You can construct an impressive scientific explanation for almost anything.

Medicine asks for something harder:

Show me that it works.

Ideally, show me in properly controlled clinical trials.

Show me that people receiving the treatment do better than people who don’t.

Show me that the difference is large enough to matter.

And show me that the benefits outweigh the risks.

Apply that standard to these three treatments and they land in very different places.

rTMS for appropriately selected patients with treatment resistant depression: established medical treatment supported by clinical evidence, generally considered further down the treatment pathway when conventional approaches have proved inadequate.

Low-pressure hyperbaric treatment at 1.3–1.4 ATA for general wellness: interesting physiology, but convincing evidence of meaningful health benefits in healthy people is currently lacking.

IV vitamin infusions for people without a deficiency or specific medical indication: medically impressive delivery system, but little good evidence of additional health benefit.

That does not mean you could not walk out of a wellness treatment feeling fantastic.

Relaxation feels good. Being looked after feels good. Taking active steps towards your health feels good. Placebo effects are real effects.

But we should be careful about turning those experiences into medical claims. It is worth noticing that the website carefully avoids claiming that these wellness treatments diagnose, treat, cure or prevent disease — and before spending good money on them, we should perhaps ask ourselves why that distinction matters.

There is a remarkably useful question to ask whenever somebody offers an expensive new treatment:

“Has this actually been shown to make people like me healthier — or does it just sound as though it should?”

Those are not the same thing.

And increasingly, separating the two is becoming an essential part of looking after our health. I hope this helps you decide for yourself.

I wish the clinic every success and leave you with the rather lovely stock photograph of "our" riverside village taken from their current website.

This article is a personal review of the published evidence relating to the treatments discussed and is intended for general information only. It is not individual medical advice, nor is it an assessment of the clinic, its staff or the standard of care it provides. Anyone considering these treatments should discuss their individual circumstances, potential benefits, risks and alternatives with an appropriately qualified healthcare professional.