Collaborative Care Team: A Winning Strategy for Depression Treatment

Effectively treating depression requires a committed team effort across the continuum of care, beyond just between the therapist and the patient. This is especially true when utilizing innovative technologies like Transcranial Magnetic Stimulation (TMS) Therapy to target depression.

As a psychiatrist, I have been specializing in TMS Therapy for 10 years. This treatment approach calls for a larger, more collaborative care team from start to finish.

adolescent depression

New Year’s Resolution: Treat Your Depression

Following New Year’s Day, many people will pursue changes in their life directed toward an improvement in the quality of their lives. Frequently, this includes health and finance. However, an often unrecognized and underappreciated issue is depression. One of the blessings of being in the clinical practice of psychiatry is hearing from people who are feeling better. Recently, a number of my patients have mentioned that they feel so much better than they did a year ago.


Understanding the Range and Severity of Depression Comorbidities

Depression is a complex and challenging brain disorder for those who suffer to manage. But, what happens when other illnesses are added to depression? It only creates more challenges. In the medical field, we call this comorbidity, and it happens with frequency. Conditions associated with depression include anxiety, post-traumatic stress disorder (PTSD), substance abuse, pain, and borderline personality disorder (BPD).

Top 4 Most Prevalent Depression Comorbidities: (1, 2, 3)

9% of people with depression have substance use disorder (40.8% have alcohol use disorder)
52% of people with PTSD have depression
8% of people with depression have anxiety
5% with depression have BPD.

adolescent depression

How Mental Health Impacts Teen and Young Adult Development

Growing up is difficult, and growing up to be a healthy and functional adult is a challenge in itself. Several things complicate the process. The development process is similar to what happens when we build something. Think of it like constructing a house. If we have the structure of the house built, the electrical wiring or other means of communication throughout the house needs to be established.

Likewise, once we are born, and our basic structure is there, we grow and develop. As far as the brain is concerned, this is mostly a result of the development process beginning in the back region and stem area of the brain and finishing in the prefrontal cortex.


Discovering TMS and Its Importance

Recently a couple of patient discussions happened that prompted me to reflect on my own TMS journey, which I'd like to share in this blog as three stages: discovery, adoption, and advocacy.

In the early-mid '90s, I referred a young lady who had been struggling with depression to a residential treatment center in New England. While there, she deteriorated and was hospitalized at McLean Hospital. When she returned to Nashville, she told me about the research that was being done at McLean and Harvard, which included transcranial magnetic stimulation (TMS).

I closely followed the medical and scientific journals as research developed and was intrigued with the technology and the clinical possibilities. The study looked positive, and when the FDA cleared TMS to treat depression for individuals who had not responded to a course of antidepressant medication, I assumed it would be in the academic space. When I found out that was not the case and that TMS was an outpatient procedure available to clinicians, I investigated further.


Improving TMS Therapy as Technology Advances

Healthcare treatment approaches change over time as discoveries and new technologies are tested and refined. The process of evidence-based research, learning and continuous improvement carries over for Transcranial Magnetic Stimulation (TMS) Therapy for depression treatment.

As a refresher, TMS Therapy utilizes a safe, non-invasive magnetic pulse technology to stimulate brain activity at the area where humans experience depression in the brain. TMS is an FDA-cleared, non-drug treatment option, where the patient is not sedated or medicated and can immediately return to their normal day following the short in-office procedure.

For nearly a decade, my practice has specialized in providing TMS Therapy as a treatment for depression with 75 percent of our patients having a positive response. Historically, the vast majority of our patients had undergone numerous depression treatments including various antidepressants before trying TMS. And while we continue to have a strong track record for relief of depression symptoms, we strive to analyze ways to improve the TMS methodology when it comes to targeting the treatment location.


What does Esketamine have to do with TMS Therapy?

What does Esketamine have to do with TMS?

While this blog focuses on Transcranial Magnetic Stimulation (TMS) Therapy for depression, as good practice, I like to share my thoughts on new treatment options as they become available. Whether it's advances in technologies, psychotherapy approaches or the latest medication, I'm committed to informing my patients on all treatment paths.

In recent weeks, you've probably noticed news outlets abuzz about esketamine - a newly FDA-approved treatment option for depression. So I wanted to take this opportunity to explain the treatment and make some comparisons between esketamine and TMS.

First, let me provide a snapshot of each treatment, TMS Therapy and esketamine.


Industry Meeting: Highlights and Insights in the TMS Field

Last week, February 21 - 23, 2019, I attended the Clinical TMS Society's annual meeting held in vibrant Vancouver, Canada. For the sixth year, this conference bought together TMS providers and researchers from across the globe to discuss the pulse of the industry, discoveries, and what's on the horizon for Transcranial Magnetic Stimulation (TMS) technology as the therapy continues to be a safe and effective treatment for depression.

The three-day conference boasted more than 540 attendees and offered 30+ presentations, panel discussions and workshop breakout sessions—all packed with top-notch data and impactful stories of research success and patient progress.


Snapshot of Patient Success Stories with TMS Therapy for Depression

In this blog feature, while I typically discuss more of the mechanics and scientific aspects of Transcranial Magnetic Stimulation (TMS) Therapy for depression, this time I wanted to sidestep and highlight a handful of patient success stories for individuals that I'm currently treating to share their journey back to health.

As a practicing psychiatrist, I have been involved with TMS Therapy for the past nine years and continue to follow many of the patients we treat, usually meeting with one to two patients a day, and keeping track of their well-being beyond TMS Therapy.

74% of our patients have responded to TMS Therapy meaning that their depressive symptoms improve. So what does this really mean in the life of a patient? Let's explore.


What do we know about Transcranial Magnetic Stimulation (TMS) Therapy?

It is sometimes helpful to recap where we are so we can make the best decisions about how to move forward. It helps to look at the facts and be realistic about where we are, what we know and what more we can learn to gain a fuller understanding of something in its current state and what’s ahead. With this logic in mind, as a practicing psychiatrist, I wanted to expand on what is know about Transcranial Magnetic Stimulation (TMS) Therapy from a clinical perspective.

TMS was cleared by the FDA in 2008 to treat Major Depression that has not responded to one antidepressant treatment. This clearance was expanded to previous antidepressant treatment, no matter the number.