Greenbrook TMS Care Team Spotlight: A Conversation with Dr. Misty Borst

How did you become interested in psychiatry? Once I was into my psychiatry rotation during medical school, I loved it. I loved the amount of grey area in psychiatry—for four patients, even if they all have depression, that depression was different in each of them. I really appreciated that the grey area felt artistic- a lot of thought had to be put into each particular person’s situation. I’m sure that’s true for all types of medicine, but it really resonated with me in the world of psychiatry.

What drew you to TMS? The statistics are quite compelling. When you look at the success rates once a patient has tried a certain number of medications, TMS Therapy is statistically a far better option for many depressed patients. In addition, TMS is personalized for each patient and as a treatment modality, it has such low side effects. When it comes to psychiatry, anything that is new and can help our patients, any psychiatrist should be interested in that. 

Does medication work for everyone with depression? If a person feels very depressed and the antidepressants work even a little bit, they are initially pleased with that because it is better than where they were. Even if they’re still very depressed compared to everybody else, their symptoms are less severe than before. And oftentimes, that result can stick for a while. But over the course of months, some people will realize that it’s just not enough. Some people may feel somewhat better with the medication and get used to that and accept that this is their new normal, but it doesn’t necessarily have to be. There are patients who get a partial response and then just think that’s the best it’s going to get. They will say they’re fine, but we know from a clinical standpoint, there can be further improvement. We want them to be better than fine.

Do people have to stop taking their medication before starting Greenbrook TMS Therapy? Generally, we keep people on the same medications they were on prior to starting TMS Therapy unless they were having a particular side effect and want to be off a medication. In general if a person does well with TMS and gets a good response, I recommend they wait a few months to see things are remaining as they want them to be. Then, if they want to try decreasing their medication, that is a perfectly okay time to talk with their doctor about it.

What are patients often surprised by? Many people find it a little daunting that treatments are five days a week for several weeks. And then they are surprised when they find themselves looking forward to TMS sessions each day. Patients like taking a break from their day and having time where outside stressors can’t get to them. During treatment they can reliably get away from everything and they don’t mind it as much as they thought they would, especially since the sessions are fairly quick, patients can drive themselves, and they can get in and out efficiently.

What’s the most rewarding part of your work? Seeing the changes in patients. I had a patient just last month who had tried many different anti-depressants over the course of years and hadn’t had much success with any of them. Once he went through TMS Therapy, he was like a different person. A very happy, new person. He was bright, excited, and he recognized that he felt completely different and much better. His family saw it, too.

What happens when Greenbrook TMS Therapy begins working? People around the patient will notice the patient looks a little brighter or less weighed down. Once the treatment starts working, when someone walks into the office, we can get a sense things are starting to turn around a little bit and people feel lighter. Throughout the course of treatment, the physical manifestations of depression will start to change: a patient’s sleep will improve, their energy and motivation will pick up. And then people will start to feel relief from their sadness or hopelessness.

How can depression affect a person’s family life or career? Depression can certainly affect everything in a negative way. I see patients who end up just spending their time after work in their bedroom instead of hanging out with their kids. It can diminish relationships between parents and kids and can cause strain between spouses. Depression is great at facilitating distance between people. At work, depression can decrease a person’s productivity to the point where managers might notice. I’ve seen patients with depression become less able to tolerate stressors, so they’re getting irritable or snappy at a coworker when normally, if they weren’t depressed, they would be able to handle the stress and brush it off. All those little micro-insults are so much harder to handle if you’re depressed.

If you think someone you know is depressed, how do you bring it up? If you notice a friend or family member isn’t wanting to hang out as much, if they aren’t as social or if they are isolating, that’s a sign something is going on with them and maybe they are struggling. If they look more disheveled or are having major changes with their sleep or their weight, those can be more obvious signs. But socially and emotionally, if they seem like they aren’t themselves that’s enough to warrant concern. If you’re worried about someone, you can start out simply by asking how that person is doing. You might have to persist a little bit in asking. Sometimes you have to risk having an awkward conversation or feeling a little uncomfortable to pull it out of a person. Maybe they’re okay, or maybe it’s something else, but it’s worth double checking.

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