We all love it when our patients get better...
Robert A. Sammons, Jr., M.D., Ph.D.
When asked to do a blog for this website, I must admit that I was less than interested in doing so for a number of reasons. It did not seem very professional and although I enjoy seeing photos of friends and hearing what they were doing, I did not think it was either of interest or appropriate for a medical site. Then, I realized "I have come early to a party", metaphorically speaking, for the second time in my life.
Back in the mid 60’s, my mentor, Dr. Jack Turner, had come to the conclusion that insight into psychological issues did not usually or necessarily change behavior and he was immersed in the developing field of behaviorism. A mentor isn’t a mentor if one does not come under his influence, and like Jack, I was fascinated and impressed with the philosophy and success of this psychological approach in helping others. I was fortunate to have met and learned directly from the giants of that era including Skinner, Ferster, Wolpe, Lazarus and many others. It was an exciting time as the field was small but expanding rapidly due to the enthusiasm and success of its application and use. In an identical manner, I find myself at the beginning of a technology, the use of Transcranial Magnetic Stimulation (TMS), that I anticipate will become as widely influential and successful in helping others as behavioral therapy has been in the field of psychological and psychiatric treatment. The field is new, exciting and there is an abundance of new information that I find fascinating and I think worthy of commenting on in a blog. Sometimes my comments will be aimed more at the general population and patients and others will be more scientific and aimed at colleagues. Each, I hope, will be of some interest to the other.
In 2006, my wife and I attended the week-long training workshop In Dr. Alvaro Pascual-Leone’s TMS lab. Dr. Pascual-Leone was then and remains one of the seminal researchers and great minds in the field of TMS and had just published Transcranial Magnetic Stimulation: A Neurochronometrics of Mind (2005). As a biological psychiatrist fully immersed in the psychopharmacological treatment of depression, I use antidepressants continually and aggressively to try to abate the suffering this devastating illness can cause my patients. In doing so, I am pleased with the success many patients enjoy but I am acutely aware of the many patients who only receive a partial or no response. Some patients cannot find a medication that works well for them and others are unable to find a medication without unacceptable side effects. More than once I have had a patient only respond to a class of medication called SSRI’s only to have significant sexual side effects. They tell me they have to decide if they want to be pleasant and have a partner interested in having sex with them when the patient has no interest or have a sex drive but be so unpleasant their sex partner does not want to have sex with them. My initial readings in TMS indicated that this treatment did not come with sexual side effects, or any other systemic side effects often associated with the taking of medications. It also treated the more severe forms of depression that were often not responsive to medications. In 2006 it appeared that such a safe and widely researched treatment procedure for depression was just months away from being approved by the FDA, so I decided it was time to get trained in the field and the best place to do so was at Dr. Pascaul-Leone’s lab at Harvard. Did I mention that the Federal Government was involved? The training was intense, exciting and held the promise of providing treatment to the most recalcitrant forms of depression but FDA approval did not occur for another two years.
By the time the FDA approved TMS for the treatment of depression, the euphoria of the training had given way to the harsh realities of private practice. When FDA approval came, it was accompanied by the knowledge that the TMS machine was quite expensive and no insurance companies would cover the cost of treatment. Doctors are not known for being very good businessmen but even I knew this was not a good business decision unless you lived in areas where there were a lot of rich, depressed patients who could pay out-of-pocket for the treatment or if you were in a research facility. This is where TMS began its treatment career in what is called a “fee-for-service” model, meaning that there is no insurance coverage and the patients pay cash for their services.
Insurance companies do not care about us. Maybe there was a time in the past when they did but even then it was in a self-serving way. Insurance companies were interested in us doing well and were engaged in health care prevention because it saved them having to pay money later for medical consequences of a poor livestyle. Recently I read that the average amounts of time insurance companies insure us is three years; as individuals and HR departments are constantly looking for cheaper coverage and will change insurance companies to save money. With little customer loyalty, insurance companies do not anticipate having to pay for your venal sins when you get older. There is little incentive for the insurance company to keep your stress or depression reduced today in hopes of making you healthier when you get older. In a similar manner, Medicare does not care about us as individuals as Medicare’s goal is to also save money. So, when Medicare did their analyses on TMS and decided to cover it as a treatment for depression in 2013 because of the substantial money it would save from the normal (and varied) expense of treating depression, commercial insurance companies began to follow suit. These companies reasoned that if Medicare did the calculations and decided TMS treatment would save money in the cost of treating moderate to severe depression, the private insurance companies would similarly save money in treating these depressions.
What all of this means is that individual psychiatrists, such as myself, are now able to introduce this treatment modality of TMS into our private practices and offer an effective, albeit not perfect, treatment to our moderate to severely depressed patients. We all want our patient’s depressions to improve thus giving them a better quality of life. I am reminded of a time when I was younger and was accompanying my father as he made rounds in the hospital. I was marveling at his wonderful bedside manner (effectively hidden from his children) when an older woman said “Dr. Sammons, it is wonderful that you love sick people.” My father replied, as only he could, “I hate sick people. They make me feel like I am not doing my job.”
These are exciting times in my field of psychiatry. We are at the beginning of the modern neuromodulation era with TMS. It will increasingly grow in its scope of treatment and popularity in its treating a wide range of pathology. More about this in future blogs. We really do love it when our patients get better.
To tie up a loose end, I like coming to the party early, especially when it's a BBQ...
Depression is a serious illness, affecting approximately 16.1 million people in the U.S, and 350 million people worldwide. Depression is a "life stealer”, it grays over and weights down joy and vitality, and is becoming the largest health burden in world health. For years, medication has helped manage symptoms, however, many patients are just not satisfied with the results, nor the nasty side effects they get with the “cocktail” of standard drug based therapy. There is hope…
TMS Therapy, “Transcranial Magnetic Stimulation” (TMS) is about giving lives back. TMS Solutions utilizes patented, FDA cleared, NeuroStar TMS Therapy® to provide a proven, successful approach to achieving remission from depression (not just manage symptoms!). Many insurance companies, including Medicare and Blue Cross (in most states), and now Humana and the VA are now covering and allowing this process. In addition to treating depression, it is also proving helpful in treating anxiety, PTSD, Tinnitus and Postpartum depression.
- TMS efficacy is showing better results than traditional medication, with far fewer, less severe side effects.
- TMS Therapy has provided relief for over 24,000 depression sufferers to date.
- Approximately 1 out of 3 people have experienced complete remission from depression.
- 50% of patients have drastic reductions in their symptoms.
- TMS Therapy is bringing new hope to patients and families every day.
Patients have been heard to say, "The gray is gone!"
For more information about Transcranial Magnetic Stimulation, TMS Therapy, and where to get help for depression, call us at TMS Solutions at 1-970-697-1020 or visit the Web site at www.tmssolutions.com.
To learn more about TMS Therapy and clinical trials, or search for other TMS studies, please visit www.tmssolutions.com . You can also click on the button below for more info.