DEEP TMS ARRIVES IN MICHIGAN!!! TRANSCRANIAL MAGNETIC STIMULATION (TMS) – REGULAR VS DEEP Transcranial Magnetic Stimulation (TMS) is a non-medication treatment for depression that was approved by the FDA in 2008. TMS uses an MRI-strength magnet to activate the part of the brain found to be underactive in depression. In an effort to expand and improve upon the original magnet, the National Institute of Mental Health (NIMH) developed a new magnet which penetrates even deeper into the brain for the purpose of improved patient outcomes. This deeper type of TMS is called “Deep TMS”, or dTMS, and was approved by the FDA in 2013. The patent for this newer magnet continues to be held by the National Institute of Mental Health. Michigan Integrative Holistic Psychiatry (MIHP) is the first provider in the state of Michigan to offer this treatment. IS THIS ECT? No. ECT (Electroconvulsive Therapy, or “Shock Therapy”) requires general anesthesia, time off from work, and may result in memory loss. In contrast, TMS is an outpatient procedure, patients can drive independently to and from their appointments, and the most common side effect is a temporary headache. WHAT’S INVOLVED? A cap is placed on the patient’s head and the magnetic coil inside the cap generates electrical activity that to the patient feels like a woodpecker. The most common side effect is a mild headache which is temporary. Treatments are 20 minutes long. Patients require daily treatment, five days per week, for a total of 20 treatments. Of note, regular TMS (as opposed to deep TMS) requires treatments which are 40 minutes long, also five days per week, for a total of 30 treatments. The headache from regular TMS appears to be more painful than from deep TMS. REMISSION OF DEPRESSION, SUCCESS RATES  Trial of one antidepressant - 33 – 35%  TMS – 60%  ECT – 80% The above remission rates are based on the studies presented to the FDA. In the real world, as practitioners become more familiar with TMS technology and available protocols, the remission rates seem to be climbing higher than the 60% originally reported. DOES IT HOLD? Yes. Preliminary studies indicate that 6 months after a successful course of TMS, patients have low relapse rates – possibly lower than the relapse rates after ECT. However, further studies are required to quantify this more precisely. DOES INSURANCE COVER THIS? It is just starting to. Priority Health does. BCBS may (after much paperwork). At MIHP, we are dedicated to educating the medical insurance payers about the importance of covering this treatment. If insurance does not pay, average out-of-pocket cost for a full course of TMS (whether dTMS at MIHP or regular TMS elsewhere) is $8500 - $10,000. THE FUTURE OF dTMS In Europe, dTMS has been approved for multiple indications besides depression, including Bipolar Depression. At MIHP, we are familiar with the dTMS treatment parameters that are being used to treat Bipolar Disorder (though this would be considered an “off-label” treatment). Deep TMS is also being studied for the treatment of PTSD, negative symptoms of Schizophrenia, Alzheimer’s & Parkinson’s dementia, autism, smoking cessation, and obesity, among others. More information about deep TMS, and the studies supporting it, can be found online at www.Brainsway.com. ABOUT US Michigan Integrative Holistic Psychiatry (MIHP) is a psychiatric clinic specializing in treatmentresistant mood disorders. While we ultimately believe that the “cure” for mood disorders is counseling, we offer a variety of biological treatments to expedite the time it takes for a client to feel well. We provide biological treatments in the form of advanced Psychopharmacology (aka “Conventional Medicine”), in addition to Complementary & Alternative Medicine approaches including herbals/nutraceuticals and electromagnetic treatments supported by research. Psychiatric care at MIHP is provided by two physician assistants (clients will be assigned to one physician assistant who will remain the primary provider), hand-picked and excruciatingly trained by Lila Massoumi, MD, Chair of the American Psychiatric Association’s Caucus on Complementary, Alternative, & Integrative Medicine; Clinical Associate Professor of Psychiatry at Michigan State University; and past-chair of the inpatient psychiatric unit of an underserved medical hospital (Hurley Medical Center). In most cases, new clients who call for a psychiatric evaluation will be seen within 24 – 48 hours. CONTACT US Michigan Integrative Holistic Psychiatry 31555 W 14 Mile Rd, Suite 103 (corner of Orchard Lake & 14 Mile) Farmington Hills, MI 48334 (248) 468-1889 www.DrLMassoumi.com