Using Magnetic Stimulation to change the Depressed or OCD brain! TMS Northwest

LHC: Hey there, welcome to Let's make a health connection. In this podcast, we introduce the interview and highlight the numerous healthcare providers and resources that we feature on our website, localhealthconnect.com. I'm Jennifer Barber, and I'm a licensed clinical social worker in Washington & Oregon, and I'm happy to be part of the local health connect provider network. Hello everyone. Today's guest is Brendan Roe, one of the three owners of TMS Northwest and Med Rx Partners. Brendan has been practicing psychiatric medicine for the past nine years, following seven years as a nurse specializing in pediatric and adult hospice care for graduate school. He received additional training and certification in TMS through Duke University's visiting fellowship. He is an outspoken advocate for mental health care and is passionate about a variety of social justice issues confronting the community he serves. Thank you so much for being here today to talk a little bit about TMS Northwest, and I just want to remind you that, you know, there may be some people out there who have no idea what TMS even stands for, and so I think we kind of need to start at the very basics and just explain to us what TMS is.

BR: Definitely. Yeah, so TMS stands for transcranial magnetic stimulation, and it's where we use an MRI strength magnet. It's just a magnet, a very strong magnetic coil pulsing and stimulating an action potential, so what I mean by that is getting those neurons firing again and helping them rewire and normalize what's become abnormal due to chronic stress hormones and environmental factors.

LHC: So tell us a little bit about TMS Northwest, how it got started, and what services you provide?

BR: TMS Northwest is the name of our company. We started back in 2017. I was exposed to the science of TMS and really dug into the efficacy of TMS at a conference and just really became fascinated by the data. and thought it was too good to be true, but the more I looked into it, the more I couldn't let go, and so I brought the idea of partnering with a couple providers that I deeply respected, and they also became intrigued and we decided to move forward. Migraines associated with smoking cessation mean, you know, it's more than just depression, but I tend to talk about depression the most because it's fascinating, so that's where it started. I just wanted to offer something besides medication and therapy to those really sick clients, and then it went from there.

LHC: Very cool. Can you tell us what makes TMS unique to mental health treatment?

BR: Yeah, we do transcranial magnetic stimulation at our clinic, so TMS, I guess. What's different, what's unique is that it's non-invasive, it's non-systemic, so what I mean by that is if I prescribe, let's say, Zoloft, you know, an antidepressant to a client for their depression, Well, I can't control where that medication goes. It's going to attach to all the serotonin receptors. A large portion of our serotonin receptors are heavily saturated in our gut, not just our brain. So there might be gastrointestinal upset. Someone might have nausea, they might have diarrhea, they might have constipation. Other side effects might be decreased libido. You name it. Headaches aside, there are a variety of systemic side effects that come along with medication, right? So the beauty of TMS is that the MRI strength magnetic coil doesn't penetrate below about five centimeters from the site of application, so it's not reaching the level of your heart, your kidneys, your gut, so you're never going to have those systemic side effects, so that really separates, sets it apart from other treatment options. Yes, another important factor or fact that distinguishes it is the remission rates. So a person who has tried, let's say, depression, OCD is very similar in terms of the data, but let's just talk about depression for a minute. So for someone who has depression and they've tried three, let's say they've tried three antidepressants. The chances of them achieving remission of their symptoms, that is, being completely free of depression by the time they try their fourth antidepressant, are less than 7%. And our clinic's data suggests that our remission rates are closer to 65 to 70 percent. be because we offer additional services such as a TMS workbook, which is like cognitive behavioral therapy while you're getting TMS. And we also do something called medication optimization, which means that if we have someone who has insomnia or ADHD and it's poorly managed, I might try to manage those concomitant disorders and then OBV depression. So I'll just make sure that I understand what's going on in your situation, and then we'll devise a treatment plan, which is where medication optimization may come in. If I believe that we can do better with your medications than with your current regimen, then we'll discuss that, but the first day of treatment consists of something called "cortical mapping," which is simply where I'll come in and map out exactly where the magnetic coil needs to be placed. So it's not painful, but it's annoying. It feels like a little flick on the scalp or a little tap. I always joke that a woodpecker is tapping on your scalp. So then we find your dose, which is essentially what we call it. The motor threshold is the lowest setting possible that still gets those neurons firing. We have three devices, so we can generally accommodate most appointment start times. So for the depression protocol, it's Monday through Friday. Each treatment is 90 minutes long, so you're looking at seven weeks of treatment. It's a time commitment. I mean, you're in and out, but it's something you have to commit to. Each treatment builds on the last. The vast majority of people are good to go again. We've been open since 2017, so we have about five years of data. Among the clients who do return, they typically report that it was like the best year that they'd had in the last decade. So that's why they're returning. They started to feel the return of depression, and one was able to catch it early. They knew that TMS worked, so they returned for additional treatment. I've noticed that we've had clients return three or four times now, and it does seem like each time they return, the effects last longer, so it could be that they had eight months where they felt depression free after the first round of TMS, and then the next time they got a whole year or a year and a half out of it. So it does seem like there's a trend there, but that's a smaller minority.

LHC: Did you say OCD?

BR: Yes, treatment resistant obsessive compulsive disorder. Anyone else who might be a prime candidate if they're listening to this, they might say, "Oh, that's me." Another is smoking cessation. People who have tried other medication or non-pharmacological means of trying to quit smoking and still need to quit. Also, TMS is good for migraine treatment protocol. But really, our passion and our true focus at our clinic are major depressive disorder and obsessive-compulsive disorder.

LHC: You've talked a lot about what clients could expect from a treatment course. Is there anything else that you might want to just say, you know, if you're going to go through this, this is what you can expect?

BR: Yeah, at our clinic, we like to provide boutique level care. I mean, at most clinics, you're just a number. You're just a person who has a major depressive disorder. You're going to go through the depression protocol and that's it. But, at our clinic, we're going to take care of your anxiety. If you have anxiety that's really interfering with your ability to achieve remission with depression, what’s very different and unique about our clinic is that we always have a medical provider on site, whereas most clinics don't. With most clinics, their provider is remote, and they might have a technician running the clinic, and we just don't believe in that. We believe that you should have direct access to us at all times.

LHC: So that leads me to my next question. If someone has been working toward mental health for quite some time, they may come to you already with a team in place. They may have a prescriber. They may have a therapist, and I'm wondering if somebody comes into the clinic and says, "You know, I want my therapist to be involved or I want my prescriber to be involved," do those people continue working with this client? Do they hand off to your clinic for a full multi-disciplinary engagement with just your clinic?

BR: We love that, and that's the best case scenario. We love to collaborate with other providers. We're not here to steal your client. We want the therapists out there and the other medical providers out there to refer their most challenging clients. As a med provider, I know what it's like when you see that client on your schedule that you've just not been able to make a dent in their depression. And they're coming back to you week after week or month after month, and you just know that they're going to be suffering. I just remember feeling like, "What else can I do?" I want the providers in the community to send those clients to us so we can stabilize them and then refer them back to you. We're not here to steal your clients. For those patients who are self-referred or don't have a team of providers outside of our clinic, we don't provide ongoing medication optimization at TMS Northwest. We do own another clinic called Med RX Partners. It's right next door, and that's where we do long-term medication management. We always have openings, which is a surprise right now for sure. We have about a week to wait for an evaluation. So we can definitely refer to Med-RX partners and get someone taken care of if they need a support team. But we love to collaborate with providers in the community. So the nice thing is that because the patient is coming to us five days a week, for seven weeks, if they need an adjustment in their medication, if we see if that makes sense to us, then we can just do that and we can collaborate with the provider as well. We're not going to send them back to their provider so that they have two or three medical appointments a day. That's nonsense.

LHC: Yes. Is there anything else that distinguishes TMS Northwest from its competitors?

BR: Yeah, like I said, medication optimization is unheard of. Having a medical provider, like a licensed nurse practitioner, that's just unheard of. Having us on site. All of our technicians that run the daily treatment are CNAs or medical assistants, which is also unheard of, surprisingly. A lot of clinics might just hire a non-clinician. A big misconception is that something TMS is not pseudoscience or, you know, um, something new. It's not. It's been around since 1985. We have long-term data to support its safety and efficacy, so we know it works. It's part of evidence-based medicine, so if you've tried two antidepressants or more, if you've had six to eight weeks of therapy and you're still depressed or struggling with OCD, you should come to us sooner rather than later. We were pioneers in this community. We were the first to open a clinic in Clark County and now in Vancouver. We were also the first to open a clinic in Cowlitz County. We’re a mile east of the Vancouver mall, right off of the SR500 and Garrett Road.

LHC: Okay, and where can people find you online?

BR: They can find us at TMS-NW.com.

LHC: Thank you, Brendan. Thank you so much for meeting today.

BR: I appreciate it.

LHC: Thanks again for listening to Let's make a health connection. Find us online at localhealthconnect.com as well as on Facebook, Instagram, and Twitter. Links and show notes for this interview are available on our podcast page. These interviews are really fun, and I hope you made a health connection today. We'll talk again next time. Let's make a health connection, copyright 2022, is the property of MBS Therapy, LLC, a Washington-based company. Local health care is inclusive and does not endorse any political or religious group. Thank you again for listening, and we'll see you next time on localhealthconnect.com.

By Jennifer Barber, LICSW 5-10-2022