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Friday, Mar 29, 2024

Magnetic Stimulation Machine Offers New Therapy

Psychiatrist Kira Stein has a handsome white leather couch in her office, where she sees patients for talk therapy. But in an adjacent office, she also has a $100,000 machine that uses magnetic stimulation to treat patients who don’t respond well to anti-depressants. She may be on to a totally new model, not only for the treatment of a disease that costs U.S. businesses hundreds of millions in lost time and productivity, but also in the way psychiatry is practiced. “It’s a totally new paradigm in psychiatry,” said Dr. Stein, whose West Coast TMS Institute in Sherman Oaks is one of a handful of new centers that have popped up in the Valley since transcranial magnetic stimulation (TMS) was approved by the FDA for the treatment of depression in 2008. “It involves a lot of education, training, and keeping up with the research.” It also involves a major capital investment for psychiatrists. But some psychiatrists are embracing the potential, hoping that the adverse affects of medications and the rising cases of depression will lead more people to give less conventional treatments like TMS a try. Dr. Stein hopes to one day turn her new institute in Sherman Oaks into a holistic mental health center that, alongside conventional treatments like medication and therapy, will offer TMS and other therapies known to help alleviate depression. The other Valley region TMS center is Calabasas TMS, headed by Dr. Mindy Werner-Crohn and Joel Crohn. TMS uses a highly focused, pulsed magnetic field to stimulate function in targeted regions of the brain. Adoption has been gradually expanding. Since 2008, Neuronetics Inc., the Malvern, Penn., company that makes the NeuroStar TMS Therapy System, has sold about 400 systems. Roughly 8,000 patients across the country are under treatment, a figure that pales in comparison with sales of antidepressants, which peaked in 2003 at $15 billion, according to Thomson Reuters Pharma. Those sales, however, have been declining for years due to cheaper generic alternatives and the complications many people experience from the pills. Thomson Reuters projects 2016 antidepressant sales of just $6 billion. Meanwhile, the number of people suffering from depression keeps rising. In LA County, the department of public health recently reported a 50 percent rise in the rate of depressive disorders to 14 percent of the population, up from 9 percent in 1999. At Dr. Stein’s office, patients are escorted to a room lit by a sun lamp and painted with clouds. Patients sit in what looks like a dentist’s chair, while Dr. Stein places a metal coil against their head. Rapid magnetic pulses penetrate the scalp and skull and produce mild electrical current in the left prefrontal cortex of the brain. The machine produces a tickling sensation and emits a knocking sound. Dr. Stein says she has seen remarkable results among patients for whom medication alone is ineffective. The first trial of antidepressants, she said, achieves remission from depression in only 27.5 percent of cases; successive doses decline in their effectiveness. Dr. Stein’s results may be unusual and have not been scientifically tested, but she claims that 80 percent of her patients responded positively to TMS. A small minority of patients experience a relapse after six months, but patients who stay on antidepressants after treatment do even better. Jessica Dennis of Thousand Oaks has suffered from major depression for 10 years. After medication alone failed to help her, she tried an eight-week course of TMS last summer, which required daily 40-minute sessions. The cost was steep — more than $8,000 — she said. But she is feeling better. “It’s helped me tremendously,” she said. For Dr. Stein, similar results from other patients was enough to convince her to make the investment in the machine with the hope that she can attract more psychiatrists to join and build the practice. To recoup the investment, she is also marketing more. Since opening her institute, she has administered about 400 treatments. She acknowledges it’s a slow growth curve. Insurance coverage would certainly help, and she and patients are pushing on that front. But with an estimated cost of $6,000 to $8,000 per treatment course, insurance companies are balking at the idea. So far, no California insurance company covers treatment and just one state, Nebraska, has mandated coverage for it, and some patients have won coverage on appeal on a case-by-case basis. Bruce Shook, CEO of Neuronetics, said he expects insurance companies to eventually cover treatment, and wider adoption as word gets out about TMS. He compared TMS to an intervention similar to angioplasty catheters commonly used today by cardiologists. “TMS has introduced the idea of interventional psychiatry,” he said.

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