Doctor Treats Depression With TMS
NEW BEDFORD — When Dr. Jonathan Schwartz was first introduced to transcranial magnetic stimulation (TMS) via cold call advertisements in 2015, he felt it was “like science fiction” and didn’t think anything of it.
At a conference one year later, after a guest speaker shared TMS success stories, Schwartz was shocked by the results.
“My training didn’t teach me anything about magnetic waves being an effective treatment,” Schwartz said. “The batting average was so high, I thought, ‘this is so amazing.'”
Now, after five years of offering treatment to those with major depressive disorder, Concierge TMS has helped more than 300 patients get their lives back.
Mary Ann Breault has suffered from clinical drug resistant depression for more than 20 years.
“TMS is the only treatment that gives me relief from the depression I was suffering with,” Breault said in a press release. “Prior to TMS treatment I felt hopeless, and discouraged on what my life would be like. This treatment has been a miracle for me and has greatly improved the quality of my life.”
What is TMS?
TMS is a treatment that utilizes magnetic waves to stimulate neurons in the left prefrontal cortex of the brain, mimicking the effects of antidepressants without the physical side effects. It was approved by the Food and Drug Administration in 2008, with insurance companies following around 2014.
Concierge TMS uses NeuroStar for TMS treatment. Patients are treated in a chair, similar to one found in a dentist’s office, with a metal coil housed in plastic machinery resting above the prefrontal cortex, the part of the brain that is closest to the surface.
The first appointment is a mapping of the brain, testing the primary motor strip that runs laterally across the brain for reflexes of voluntary muscles. A white band is placed on the patient’s head not for restraint, but rather guidance. After sending small pulses of energy in hopes of short reflex twitches in the hands, Schwartz is able to pinpoint the location of the prefrontal cortex where treatment will take place.
Schwartz makes sure the patient is as comfortable as possible, confirming throughout the entire process, as this is the exact alignment that the patient will resume for each treatment. Patients receive treatment 17 minutes per session, five times per week for the first few weeks, for a total of 36 treatments. With offices now in New Bedford, Mashpee and Plymouth, patients don’t have to travel long distances for the frequent appointments.
“It’s a pain to go somewhere five times per week, but when you’ve struggled and you haven’t found anything that works or gives you side effects, it doesn’t seem like such a big deal,” Schwartz said.
A patient receiving treatment traveled to the New Bedford office from Chatham for almost eight weeks. When Schwartz asked about the long commute, she said, “if I have to come here for eight weeks once a year for the rest of my life, it’s well worth it because this is the only thing that has only given me my life back.”
Treatments are typically 10 pulses per second for four seconds with a 10 second interval rest period for the coil to cool down, totaling to about 3000 pulses for a daily treatment.
Schwartz said Concierge TMS’s batting average is identical to the national average, with 90% of patients having anywhere from 50 to 100% improvement.
Who is best suited for TMS?
TMS treatment is recommended for those who have been diagnosed with major depressive disorder and have failed on at least four antidepressants and two adjuncts, or booster medications. These are the requirements specifically for insurance coverage purposes, but Schwartz said he had patients come to him without meeting those qualifications, willing to pay out of pocket.
“When people come, they are generally pretty hopeless,” Schwartz said. “They’re coming because they don’t know what else to do.”
Schwartz said that he recommends TMS for anyone who would not have gone through that many drug failures, as he recommends that after two to three failed medications, genetic testing should be completed. Schwartz said that a lot of people don’t respond to medications due to “genetic makeup interference” which is when he recommends genetic testing. Genetic testing will give a marker of why a medication won’t work and help guide the choice the medications down the road.
“People turn to TMS after giving up on medications, especially after experiencing side effects,” Schwartz said. “Some will pay out-of-pocket to be done with drugs. If insurance companies would lower the bar so that maybe they would only require two drug failures, that would be more reasonable.”
Schwartz, who has been prescribing medications for more than 40 years, said that medications do help, but they don’t work for everyone and they affect all other parts of the body, resulting in weight gain and sedation.
“TMS is a very focalized, local treatment that is only stimulating that part of your brain,” Schwartz said. “Magnetic energy is strong enough to be activating these neurons, but not so strong that it’s causing problems other than what you want.”
Unlike medications, if TMS fails to work, the patient experiences no negative side effects.
“The brilliant thing about TMS is that it’s essentially completely safe, the worst thing that could happen is that it fails to work,” Schwartz said. “Historically, people might go through multiple medications looking for something that will work, and when they’re not able to find one, the next stop is ECT (electroconvulsive therapy).”
The other most common condition in patients are anxiety disorders, between one-third to one-half of Schwartz’s patients. About 10 to 12 weeks into treatment, Schwartz will offer the same procedure to treat severe anxiety disorders as an add-on, free of charge, by simply moving the coil over to the right prefrontal cortex. While magnetic waves stimulate and “wake up and excite” neurons in the left prefrontal cortex to help with depression, they can also help calm neurons in the right prefrontal cortex for anxiety. Anxiety treatments use only one tap per second.
Reversal of symptoms
Unfortunately, TMS isn’t a one-size-fits-all treatment, and most certainly does not provide an absolute cure to major depressive disorder. About one-third of successful TMS patients have another bout of depression and return for another course of TMS, Schwartz said, but some patients stay well indefinitely.
“We don’t have any treatment for depression that’s guaranteed to be a cure,” Schwartz said.
Concierge TMS has seen patients return at various points, between four months to one year for another round of treatment, which may also vary. The office keeps in touch with patients throughout treatment and follow up after to make sure patients are responding well. Schwartz said that most patients feel better about midway through treatments, some within the first 10 days, but some have no response throughout the entire 36 treatments only for depression to completely evaporate about two to four weeks after completion.
Supplemental treatments may be required. Schwartz said the goal is to be on the lowest dose of medications in combination with the least frequent TMS treatments to keep you feeling well.
“There’s a good chance that if TMS works for you, you’ll be able to continue feeling well on less meds,” Schwartz said. “The odds are you probably won’t be able to do with no medicine. If we can substantially reduce the amount of medicine or number of medicines you’re on, that’s a victory.”