Greenbrook TMS Care Team Spotlight: A Conversation with Dr. Kim Cress

What initially drew you to psychiatry and to TMS Therapy in particular?

I always had an interest in medicine and in helping others. What really drew me to psychiatry was getting the time to be with my patients and get to know them. In 2010, I was working with one particular patient who, no matter which depression medication she tried, she had side effects to everything. She was so drained by depression that she was willing to try anything. While ECT (electroconvulsive therapy) was an option, she wouldn’t consider it because of the side effects and she was afraid of the memory loss that’s associated with ECT. I knew there had to be less invasive options we should explore first, so I looked into TMS Therapy and I dug into the literature.

The more I dug into it, rather than referring this patient to TMS Therapy through another provider, I elected to start using it in my own practice. I saw the utility in being able to use it not just for individuals like my patient who had so many side effects to medications that prevented them from getting to remission but also because I had patients who weren’t able to get to remission despite being on multiple medications. I felt like TMS would have value to not just that one particular patient but to many.

What’s the difference between ECT and TMS Therapy?

Individuals treated with ECT undergo anesthesia and there are concerns with retrograde amnesia. Individuals can have problem with recall of previous events, which can be of concern to patients. For some patients who are professionals, they don’t want to put themselves at that type of risk cognitively and won’t entertain ECT as a treatment option.

I would always pick TMS Therapy over ECT except in select cases where someone is actively suicidal or catatonic because with TMS Therapy, individuals can come in, they can drive on their own, they can resume normal activities— getting back to school or work or whatever their situation may be, after receiving the TMS treatment. There’s no concerns in regard to cognitive side effects.

What’s the most common question patients have about Greenbrook TMS Therapy?



The most common question is Will this work for me? Most individuals come to me with not years of depression, but decades, and they find themselves feeling kind of hopeless. They’ve tried multiple medications and are asking Why is this going to be any different? I failed this medication and that medication, why should I have any hope that this is going to work? So then we have a conversation in the context of how TMS Therapy is different, and how it isn’t another medication.

What happens during the TMS Therapy consultation?

Once someone has contacted us either through the website or called 855-940-4867, we’ll schedule the consultation to learn about the individual’s history and background. We love to have family in on the consultation because they provide such pivotal information. Oftentimes individuals who are depressed don’t see the value or the struggles, because they tend to minimize it or they’re better but not where they need to be.

I have a patient who I’ve known for a very long time, who had completed a treatment course years and years ago with me. She said she was “okay,” but her definition of okay was having one shower a week and getting up in the morning but going back to bed for a couple hours. To her it was okay because she wasn’t suicidal or in the very depths of depression like she had been in times past. So oftentimes, individuals can’t discern that there’s still dysfunction and a loved one can see that, and help them identify that Hey, you’re really still struggling and really have to force yourself to do things, and there’s really not the joy in life that there used to be.

What’s the first Greenbrook TMS Therapy treatment session like?

During the first TMS Therapy session, the psychiatrist is assessing, prescribing and administering the initial treatment protocol. It’s also the longest session because we’re setting up treatment that is specific for that patient. The treatment course is established with putting the chair to their height to get them comfortable, we work to identify the intensity of the magnetic field we need to treat them, and then the localization of where we are treating. We spend that time to tailor each treatment to the individual. It’s important to educate patients and let them know what to expect.

What does the treatment feel like?

My very first patient said the treatment feels like Woody Woodpecker-- they describe it as a tapping sensation, as if I’m tapping on your leg. You’ll get to a point where you desensitize and you’re able to ignore it. And you’ll find yourself able to watch TV, talk, to listen to music, and be very comfortable and not find yourself in any type of discomfort or pain during the course of treatment.

How long does it take to know that TMS Therapy is working?

After a couple of weeks patients have more energy, they’re sleeping better. They’ll mention running errands or meeting with a friend for lunch—going out and doing things which were challenging for them before. We’ll see the smiles and the changes within them—they’re engaging in conversation more readily rather than coming in and being quiet during treatment, they’re taking initiative in conversation.