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Greenbrook TMS Care Team Spotlight: A Conversation with Dr. Will Sauvé
Daniel Hageman
"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."
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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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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