What drew you to psychiatry initially, and how did you hear about TMS Therapy? When I began my clinical rotation in psychiatry I just fell in love with it. I’d been practicing psychiatry for about 6 years before training with TMS— when the United States Navy Medical Center in San Diego began providing TMS Therapy to active duty sailors and veterans in 2010, it was the first time I’d heard of it. Once I learned about the science behind TMS Therapy, I was in. I was drawn to it because I’ve always enjoyed the procedural side of psychiatry—I’ve never been the type to want to sit in an office, meet with a patient once a month to prescribe medication, then send people on their way.
What’s a common question you get from patients? Finances are a big one. The thing that I love the most about Greenbrook is that the majority of the time, I can reassure people that the finances won’t be a worry. People are afraid of whether or not TMS will be covered, they’re afraid of the paperwork, they’re afraid of the insurance process. And usually in my pre-assessment with patients, I’ll look them in the eye and tell them “Your work is done. We’ll take it from here.” We know how to fill out the forms, we know how to make the phone calls— all you need to do is show up for treatment and we’ll do the rest. TMS therapy is covered by nearly every health insurance provider, including Medicare and Medicaid.
What are some of the most common symptoms of depression? Cognitive impairment is a major symptom and probably the most common. Word finding, processing speed, maintaining attention, switching attention—all of these cognitive skills are diminished in those with depression. It can often be very subtle—for example, I’ve had patients who are professionals or executives in careers that require sharp decision-making skills. On the outside, their coworkers wouldn’t notice anything wrong. But my patients feel a little more slowed down, or like it’s taking more energy to focus and get work done.
So many people with depression are prescribed medication—are most of your TMS Therapy patients people who are already on prescription meds? Most of my patients have tried multiple prescription medications before coming to Greenbrook TMS, and they’re split about 50-50 in terms of any medication-related issues: for about half of them, the antidepressants aren’t doing much to help. For the other half, they are experiencing side effects that are difficult to deal with—nausea, sleepiness. Weight gain is a big issue, and lots of people have trouble maintaining the body composition that they’d prefer while they’re on medication.
What should I do if my antidepressant isn’t working? You’ll know if a medication is working within weeks, so you should never stay on a drug that isn’t doing anything for months or years. One thing that always irks me is the idea that someone has to be on antidepressants for the rest of their lives, even when the drug isn’t doing much for them. If a patient does achieve remission from antidepressants, there’s no need to be on them forever. 6 months or 12 months later, you should be looking into stopping taking the medication. And interestingly, if you do get someone into remission on a drug and they later develop depression again, it’s highly unlikely for that drug to ever work for them again. And that’s something that’s interesting about TMS Therapy: it almost always works twice. I’ve noticed that for younger patients, they’re completely unimpressed with medication—they’ve tried one antidepressant, it didn’t work, and they’re ready to move on to something that will get them where they need to be instead of losing good years.
What’s the best way to find out if I’m a good candidate for Greenbrook TMS Therapy? There’s a consultation form on our website, or if you’d like to speak with someone you can always call us at 855-940-4867. Generally, TMS Therapy isn’t for people with seizure disorders or any metallic implants in the head—but even if you’re not sure if you’re a good candidate or not, definitely talk to us to find out. It’s a case-by-case basis and everyone is different, so we’ll sit down with you and get your individual medical history to see if you’d be a good fit.
What’s the most rewarding part of your work? Seeing people get better—and this is something my colleagues and I often talk about: there are no psychiatrists in the country who get to spend as much time talking to people in remission as much as we do as TMS providers. At least once a week, I have people who tell me they haven’t felt this good in 30 years, or haven’t felt this way since they were a little kid.
What else do patients experience when they start to feel better with TMS Therapy? People start to do the things they used to—they start to enjoy their hobbies again. I get a lot of patients that are so excited that they’re reading books for fun again. They used to read years and years ago, but their depression makes it hard for them to concentrate. They’ll sit down with a book and read the same page 3 times, then they give up because it’s too frustrating. So when people tell me that they’re reading for fun like they used to, it’s a huge deal for them. And it’s incredible to me because it means their brain is firing up like it used to!
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