Is TMS Right for Me?

The team at TMS Solutions Spokane is pleased to welcome Dr. Meaghan Sprague as the first 4th year psychiatry resident in the Psychiatry Residency Spokane program to combine a TMS componentDr.-Bob-in-Chair with her ECT rotation.

Maybe it’s because of the 50th anniversary of 2001: A Space Odyssey, but I have been thinking that psychiatry is like the scientist on the moon starring into the monolith buried there as they are about to make a second evolutionary jump in development. (If you’ve never read Arthur C. Clark’s book of the same name, it’s a must read and explains everything).

In a reminiscent theme, psychiatry’s first evolution was when psychopharmacology and its biological approach to biological illnesses took over the field from Freudian psychoanalysis. Today, we psychiatrists are the scientists at the monolith on the moon on the verge of the next transition as psychiatry has begun the next great transition to brain neuromodulation that advances our ability to treat patients’ illnesses. The first step in this process is a noninvasive, low side effect therapy for treatment resistant depression.

For most of my medical career I have focused on the interaction between two cells in the synaptic cleft, the space between the endings of two brain cells. It involves focusing on the various neurotransmitters and how to increase their number in that small space which induces the cells to fire more like normal, with the normalization of their firings leading to the improvement in depression.

The neuromodulation process of Transcranial Magnetic Stimulation (TMS) allows us to go directly to the site in the brain involved in an illness, such as the dorsal lateral prefrontal cortex, and directly stimulate that area of the brain to make changes that result in the improvement of a medical condition, which in this case is depression. The mounting evidence that neuromodulation can improve an ever-expanding list of psychiatric conditions, means a psychiatrist, like Dr. Sprague, will be able to understand the basics of biological treatment of psychiatric conditions that have remained elusive and resistant to our patients in the past.

Dr. Sprague’s rotation through our TMS Solutions clinic will involve both theoretical and practical issues in TMS. She will learn what TMS is, how it arrived at its place in psychiatry today and how the theories of TMS work. She will understand the thoughtful and careful considerations about safety and the indications, contraindications and limitations for therapy. Her readings will detail the advances in treating depression, a look at the current research, and the promise of TMS treating such diverse conditions as anxiety, PTSD, OCD, chronic pain, strokes, hallucinations and other medical conditions.

Practically she will be trained to use two similar but different TMS machines. She will learn how to obtain a motor threshold, which is the strength of a magnetic pulse needed to elicit a muscle twitch. She will learn how to find the anatomical spot for the left dorsal lateral prefrontal cortex that has been a successful location for treating depression, and how to initiate treatment. Over the course of treatment, she will hopefully witness the remarkable journey out of depression that patients experience.

TMS Solutions is proud to be a part of Psychiatry Residency Spokane in giving residents the opportunity to learn about and participate in this cutting-edge technology. We are proud of our relationship with the University of Washington Medical School. And we are pleased to give back to the Spokane community which has been so supportive of us.

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Robert A. Sammons, Jr., M.D., Ph.D.

Written by Robert A. Sammons, Jr., M.D., Ph.D.

Dr. Bob Sammons received a bachelor's and master's degree from Auburn University, a PhD in clinical psychology from the University of North Carolina at Greensboro, and a medical degree from the University of North Carolina at Chapel Hill. He did a residency in psychiatry at the University of Virginia as well as a forensic psychiatry fellowship. While a Captain in the Air Force he helped set up and run the treatment phase of the Air Force Drug Treatment program in 1971. He has practiced adult psychiatry in Grand Junction for 29 years. He received training in TMS in 2006 from Dr. Alvaro Pascual-Leone, from Dr. Mark George in 2017 and returned to Harvard for Dr. Pascual-Leone's intensive course in TMS in 2018. He is Medical Director for TMS Solutions with TMS offices in various locations in the West. He has been known to cook a little BBQ.

  

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