Interview with David Penner MD

(Interviewer questions are in bold)

Hey Everyone hope today is finding you well today. My name is Zach Currier and I have the pleasure of being joined by Dr. David Penner. How are you doing today?

I’m doing just fine, how are you doing?

Good, it’s so good to have you joining us from Olympia, Washington. You are the founder of David Penner MD and also Olympia TMS, out there in Olympia Washington. Love to have you on today, we just want to hear a little bit of your story, what you guys are doing out there. Just take us from the beginning how you got into mental health and then started those practices.

OK, going way back, going into mental health was a little bit of a surprise for me. I come from one of these small Northwest logging towns where there’s not a whole lot known about mental health. A and I actually went to medical school to become an emergency room physician because I like variability. And on my psychiatric rotation, I was actually on the adolescent unit, and I was just amazed at the resilience of some of these adolescents that I saw with really significant family histories of things like schizophrenia, and how they were more brave than I think I ever would have been in similar situations. And that the only reason that I was in medical school on the rotation and they weren’t, was because I had a different set of genetic cards if you will. I happen to have been born without a significant family history of mental illness and other than that the the patients that I saw had more resilience and impressed me in their insight than I think I would have had. So you know, you grow up in a small logging town, you know people with mental health issues, it’s kind of seen as a character thing or something you can just overcome, and to have these these these adolescents have more insight, acceptance and responsibility. That was very amazing and I found it very rewarding work so I didn’t look back from that, I decided to go into psychiatry after that. So residency, and then I sub-specialized in child and adolescent psychiatry.

After that I trained in Boston, but since I’m from the area, I moved back here. There’s no groups to join because it’s a relatively underserved area, very few providers. I purposely went into therapy-heavy training programs because I knew I’d probably be pretty good with medication management for depression. But the most important thing I’ve done is figuring out when something is a therapy thing, what therapist, what type of therapy you need, and then after that if it’s more kind of a biologically-based then then go after that.

So I’ve been practicing since 2011 and when people get better, I don’t see them again, which is great. They find something that works, so for them I tell them I’m not really nice to look at, so if we get you feeling better and back to your primary care doctor that’s wonderful. So over the course of a practice, people who have difficult-to-treat symptoms you just see them more and more, because the people who get better you don’t see again. So we we we set up a transcranial magnetic stimulation a bit over the a year ago, we were first in the area because when you do everything you possibly can to get someone feeling better and their depression improves a little bit, or a lot of side effects. You go in this because you want help people, you really do, and when you see people that you care about your patients, and they don’t get better despite you trying your hardest, it eats at you, makes you ache. So I knew transcranial magnetic stimulation had wonderful benefits, I had some people were able to go up to Seattle which is about an hour north of here in good Traffic sometimes a day round trip.

Your great freeway system…

So we knew the results and kind of out of desperation, we started doing it. And it has been absolutely a game-changer in terms of the efficacy rates, which i know you’ve interviewed plenty of TMS providers, so that’s how I ended up here.

Amazing. Well, we’ll get to TMS in a second, but you start the TMS side of things last year, you’ve been in practice 2011. 2020’s been a wild year for so many people worldwide, nationally, and not to mention mental health professionals. So to that end, what are some of the biggest, most common mental-health related issues that you’re seeing now or stressors that are bringing people in to see you?

So we live in unprecedented times, obviously. And all of us, every person, I believe will get depressed under the right circumstances. It just has to do with your genetic risk factors, your predispositions. Sometimes people are able to go through, not have depression even through a major national disaster. Sometimes that’s what it takes, sometimes if you’ve got to high of genetic loading for depression, or bipolar or whatever, it takes relatively little stressors — if any at all – and we’re all along that spectrum somewhere. And so there’s this scale which I sent you, and sounds like you’re going to a reference it, called the life change index scale stress test, published in 1967 which gives a probability of having illness. Which they find is usually depression, based on life events, even good life events. The human body, we like predictability, we like security, we like feeling like we know what’s going to happen. So it lists from zero to a hundred, a number of different stressors which can happen.Which are even good things like a marriage or a positive job change but any amount of stress.

I can put that in the bio there too of course, so people who would want to reference it in conjunction with this for sure.

I’d recommend everyone just taking a glance at it and scoring themselves. So with with Covid-19, job insecurity, what do you do with your children, your social isolation, your sense of unpredictability, health concerns, decreased exercise because gyms aren’t open, and then inability to engage in the things that recharge your batteries: hobbies, travel, things that aren’t super remote outdoors. So we are seeing a lot of depression, understandably, from that because people are isolated, people aren’t able to enjoy the things that recharge them. They’re feeling unsettled because no one knows what’s going to happen and jobs are insecure and I’m sure you know that.

True, exactly, the scale is real. These are all very real life issues that people are going to come in contact with, put a global pandemic on top of that, can really throw people off for sure. But what can we do you know what is some advice you have to keep a healthy mental state in this great year 2020.

A couple of things that have come to mind is that some people I’ve given prescriptions to for various different things, for people who are very socially isolated during this situation particularly with high health problems. I have prescribed daily Zoom meeting with their family members, you know, these are individual things. We are social beings, so maintaining as much as possible the social connections. If you can’t get out, I prescribe one Zoom meeting with one family member every single day as a help.

Structure to life is critical and so I mention a little bit about the TMS, which we’ll get into later, but we found that — TMS treatment are 5 times a week for 6 weeks — that people who are undergoing TMS, because those sessions offered just structure to their life. The contact with the technician, the treatment itself, but you know it was every day at 10 o’clock, but people people seem to get benefit not just from the TMS just having a rhythm to their day they had something to wake up for if they weren’t working or something like that but just the structure. Obviously I might, you know I don’t want to beat a dead horse as a doctor about exercise and these are very difficult times to get exercise and you have to be relatively creative in doing so because a lot of gyms are shut down so anything that involves the outdoors, anything creative even just a walk. So I’d advise people set an alarm for 9am or 7am. And just even if you can just get out of the house for 5 minutes on a walk, you know just just the success of doing that, most of the time the walk turns out longer than that, or the bike ride or whatever. Just feeling the accomplishment of getting off the couc,h by itself can be enough, and then so yeah enjoyment out of the outdoors as much as possible and the social contact is needed.

Absolutely, I think you said words like rhythm and you know, routine, and it’s sort of prioritization of time, right? You know, if this has affected your job or school or whatever how are you going to kind of fill in the blanks there right now. Exactly, so let’s get back to your clinics, right, between between the TMS spot, what options are you offering you know kind of Interventional therapies or group therapies or things like that could you walk us through what what people can expect?

Sure, so I am a solo practitioner right now, we’ll probably have additional people working for us, right now I have kind of of two niches. Right now I have a first responder post-traumatic stress disorder clinic because I’ve been doing that for a while, so you know firefighters who have experienced quite a bit and I’ve been seeing them for PTSD. So that’s kind of been a niche of mine, so lately because of the need, because of the severity of the depression, I’ve been mostly focusing on the TMS treatments lately. Not necessarily treatments, but because we’re in such an underserved area, I am finding myself — I do a lot of consultations for people. I’m not able to assume more medication management patients except through the TMS process, but if I do an evaluation on someone, or we meet and we we figure out someone’s story, sometimes they’re good candidate for TMS, and sometimes they’re not.

And if they’re not, I provide a list of recommendations, make referrals, send them to another person that might be more individually matched for their particular disorder. So in that way in a consultation role, I’m able to help more people than I otherwise would. Even if I can’t manage things themselves, it’s not uncommon that we pick up something other than Garden variety depression that might be a better match for them. Re pick up like an underlying bipolar type 2 is a great example of this, and a sort of, you know, I think this is your next best intervention to do, or you need this type of therapy. So it’s essentially a consultation role and then for the the ongoing depression severe depression we do the TMS treatments.

Absolutely. When do you feel like is a good time for someone to actually seek out a mental health professional? When the load maybe gets too big, or what advice do you have for people out there that may be kind of on the fence? Do i see someone, do I just try to figure it out?

So a couple of things about that. So there’s some obvious ones, there’s some obvious kind of things that come up. If you’re having thoughts that you’d be better off dead, maybe you don’t want to be alive, is life not worth living, those are fairly obvious things that need to kind of clue you in that yeah, it’s time to do something. Or people around you have been commenting about changes, you know it’s often our loved ones are the people who see the changes in us before we do. So if people around us are commenting about how we’re doing, those are kind of obvious things.

Also, if you find yourself gravitating towards substances, alcohol, marijuana, whatever it is, most people feel intense shame around that. But they’re often treating something underneath that needs to be addressed, or should be addressed, because no no one wants to engage in excessive substance use. But if you’re in pain and maybe you can’t even admit it to yourself that you’re in pain, this is a way of feeling better in the short term that can clue you in.

When I look for depression symptoms, the things I really gravitate towards in terms of diagnosing or screening further are: depression causes changes to your body and your brain and so I tend to think, and this is kind of colloquial, about biological changes of depression. Things that you can’t really will yourself out of, you know difficulties falling asleep, or sleeping too much, it’s not quite something you have the same amount of voluntary control. Or decreased appetite, so if I have people who are having worsening insomnia and you know, issues either not eating enough or eating too much, to me those are the biggest indicators that something else is going on. And even if you you don’t realize you’re depressed, that can set off information that you may need a may need to do something about it.

I think that makes sense and that’s super valuable and again not to belabor the point but you know, something like suicidal ideation, I think it’s important to to get across that that’s in no way a natural thought. That is something that needs to be addressed, and indicative of something going on in the brain that needs needs to be addressed.

And now is actually a good time to be seeking treatment, which is kind of an unusual thing to say, given the current climate. Because of the expansion of telehealth and telemedicine, a lot of good therapist have openings. I work with a lot of therapists and they’ve told me that about half of their long-standing clients were able to make the transition over to telehealth, and and about half weren’t.

So I have this experience where I’ve been trying to get people into a really good therapist for years and I never can, but since now lot of them have good openings and basically every insurance or most insurers are covering telehealth, just as as well as in person. So now you can get in, or you’re more likely to get in with high-quality therapists who you wouldn’t otherwise be able to get into. So now is actually a great time to be doing it, and it’s so much more convenient when you’re at home over over a platform like this, and not have to go some more check-in in the waiting room. And then also for depression, a primary care doctor is a good place to start. Primary care doctors aren’t psychologists or psychiatrists, but a large component of primaru care family doctor practice is first-line treatment of depression. And so that’s actually a pretty easy starting place, people often have, you know, trust their primary care doctors, and and there’s no need to feel the shame about it. You’re not the only person, it might be 10% of what a primary care doctor deals with, so whatever feelings you’re having, your doctor sees it a lot. A lot of people don’t realize that.

Absolutely, it’s been an absolute pleasure to have you today and to give us some of your your background, and your expertise, and really did break some of this down for us. We really appreciate it for joining — any last advice for someone that’s struggling with mental health right now?

My last advice is it’s not your fault. Take a look at that rating scale I gave you, it’s unprecedented stress — every human, under the right circumstances, will suffer from the mood disorder. It’s just we’re all at the, you know, all based on genetic risks in life, upbringing, are all in a risk somewhere. We are under such a huge and unprecedented times that, if you’d previously never had depression before, it’s completely understandable why it’s the case and it’s not your fault. We have some genetic programming and genetic risk factors. Now is actually great great time, to not even seek help — if you seek help you’re not committing to anything — you’re just committing to talk to someone. That’s it, that’s all you commit to.

Absolutely, and I love you are going back to the — I love that you prescribe Zoom meetings with family members, things like that, it’s just these kind of basic steps, well that doesn’t sound too daunting. If that’s my prescription, if that’s my homework to lead to a better healthy mental state. We really appreciate talking to you today, and we hope you keep up the good work for sure.

It’s been an absolute pleasure

Thank you so much. Take care.