Since December 2009, the doctors and staff of Lenox Hill TMS Psychiatric Associates have treated over 200 patients suffering from treatment-resistant depression. 70% of these patients have shown significant improvement in their depression symptoms. 30% have experienced a full remission. “During the past six years, we have been especially impressed with not only the acute effectiveness of TMS in alleviating depression, but also its long term beneficial impact on patients.”, states Dr. Bryan Bruno.
“It is a testament to the efficacy of TMS as a treatment for depression that insurance carriers are now providing coverage for their members and in so doing, making it accessible to millions of Americans who suffer from depression.” — Dr. Roberto Estrada
Bobby Guntli joined our New York team at Lenox Hill TMS Psychiatric Associates in September. He has received both B.S. and M.A. degrees in Psychology. In addition to earning these degrees, Bobby also completed three years of clinical research in diagnostics and neuropsychological evaluations in the Psychiatry Department of Washington University in Saint Louis. He enjoys the duality of providing the practical application of the TMS treatment, in addition to the clinical aspect of treating patients.
Parampreet Sandhu, native to the Bay Area, has always held an interest in healthcare—from working in the emergency room to teaching CPR while pursuing her EMT license in college. Parampreet joined our San Francisco center in the fall of 2014 as a Patient Care Coordinator. She believes that TMS allows patients to have options when they think to do not have any, and finds it truly amazing seeing lives change in a matter of weeks with TMS.
Violeta Reyes, or Violy as she is fondly called, is the newest member of our practice. She graduated with a Bachelor’s degree in Nursing in the Philippines and an MBA in the U.S. It has been her passion to take care of patients especially the geriatric population, partly, due to her attachment with her grandmother and senior military veterans that she volunteers to work for. As an RN Patient Care Coordinator, Violeta aims to provide the best clinical, personal, and compassionate care. Nothing is more satisfying for her than to see patients improve their conditions and bring life back to them! Violeta loves to travel and do sightseeing. She enjoys the company of friends and relatives.
Chavi Bhardwaj promoted to Practice Manager in Our San Francisco office.
“The best part of working at Lenox Hill TMS is not only that it’s so rewarding, but also being able to experience and witness this amazing, life-changing journey with my patients.”
Chavi has been an integral part of our San Francisco TMS center since 2012. Her previous experience working in the field of mental health furthered her resolve to make a difference in a previously underserved area. In her current role as Practice Manager, Chavi is responsible for ensuring optimal treatment for every patient, further developing the TMS practice, and the handling day-to-day operations for the center. Chavi’s hands-on experience in our TMS practice have kindled her interests in the clinical world, as well as in healthcare administration, encouraging her to pursue graduate work. She received her B.S. in Physiology from San Francisco State University (2009).
Doctor Adam Nelson
Dr. Adam Nelson is in full-time private practice in Marin County and in San Francisco, where he specializes in treatment of mood and anxiety disorders, complications due to trauma, loss, abuse, or neglect, and co-occurring substance use disorders. He is a Diplomate of the American Board of Psychiatry and Neurology and recognized as a Distinguished Fellow of the American Psychiatric Association with over 25 years of patient care and leadership experience. He is past Chair of the Department of Psychiatry at Marin General Hospital, where he also served as Medical Director for Outpatient Mental Health Service as well as for Psychiatric Emergency and Consultation-Liaison Services.
Dr. Nelson has extensive knowledge of medication management, psychotherapy, complementary and alternative treatments, and innovative treatment technologies, including TMS. He collaborates with other providers in the care of his patients, and offers consultation to mental health practitioners in the community. Dr. Nelson also consults with patients and families to help with access to mental health services, and works locally and nationally to improve mental healthcare delivery. Dr. Nelson received a B.A. in Psychology, with a minor in Chemistry at the University of Pennsylvania, where he was inducted into the Psi Chi Psychology Honor Society. He was awarded a full scholarship by the United States Air Force to attend at the University of Pittsburgh School of Medicine, where he obtained his Medical Degree. He completed his internship and Psychiatry residency at the Long Island Jewish Medical Center, Zucker-Hillside Hospital in Queens, New York.
As of February, 2014, United Healthcare now has a policy in place to provide coverage for TMS. UHC Optum and UHC Oxford are now granting authorizations for patients to receive TMS treatment as long as the patients meet the UHC criteria—4 or more medication trials.
Our San Francisco office is now contracted to provide TMS services with Kaiser Permanente and Anthem Blue Cross. Other insurance companies that now have a policy for TMS in California are:
Blue Shield of CA
United Behavioral Health/Optum
American Psychiatric Association
Dr. Bruno and Dr. Estrada attended the American Psychiatric Association’s annual meeting held in New York. Among the most innovative developments discussed at the APA conference relating to TMS and its effects on depression include the results of the double-blind study involving efficacy and remission duration.
“This comparative, propensity-score matched analysis is important because it demonstrates that a higher proportion of patients with major depressive disorder are likely to achieve greater symptom relief by six weeks with NeuroStar TMS when compared to the improvement seen with the conventional next-choice approach with oral antidepressants,” said Mark A. Demitrack M.D., Vice President and Chief Medical Officer, Neuronetics. “As successive medication attempts fail to produce relief for a patient, later treatments are increasingly associated with poorer tolerability, further complicating the course of this disabling illness. This latest data analysis is very encouraging and consistent with previous studies that show NeuroStar TMS is a safe and effective non-drug treatment option that offers relief and possible remission for patients.”
For more information on that study, read the Wall Street Journal’s article https://www.marketwatch.com/story/non-drug-neurostar-tms-therapy-shows-favorable-outcomes-compared-to-oral-antidepressants-in-treating-major-depressive-disorder-2014-05-06.
Other panels and seminars attended at the APA conference focusing on TMS were: the Role of the Psychiatrist in Deep Brain Stimulation; Neuromodulation: Expanding the Scope of TMS: New Disorders, New Brain Targets, Integration with Neuroimaging/EEG, Better Patient Selection; Transcranial Magnetic Stimulation for Depression Also Improves Anxiety Symptoms: A Meta-Analysis of Randomized-Controlled Trials. Some of the Interactive Sessions attended involved newer Brain Stimulation Techniques presented by Dr. Sarah Lisanby and Dr. Mustafa Husain, M.D.
2014 Clinical TMS Society Meeting Presentations Highlights
Adapted from his keynote speech, presented by Mark George, M.D., “Clinical TMS: A Brief Look Back and Glimpses of the Exciting Future”
“The brain is an electro-chemical organ. Every thought we have is actually electrical signals going through our brains. The electrical signal goes down through and then causes the release of chemicals.
Modern TMS started in 1985 by Tony Barker, who was actually trying to stimulate the spine and he realized that when he built the machine that with stimulation that was deep enough to stimulate the spine, he could stimulate the brain.”
The Next Steps
“I think we need to find other diseases that respond to TMS, and that’s going to happen. There is data in pain, in migraines, and FDA approval for migraines. There’s been work on addictions, stroke recovery, OCD, epilepsy, Parkinson’s and others.”
The History of the Development of TMS, and Some Lessons for the Field
Presented by Harold Sackheim
“TMS has surprisingly high remission rates, and even higher in clinical practice than in research, which is unusual, and durability of effect has been good . . . As compared to ECT, the durability of TMS has been surprisingly good. With ECT, the depressive relapse rate in the first six months, if the patient is given placebo after finishing a course of ECT, is 84%. That drops to 60% if the patient is given an antidepressant. In meta-analysis overall, the relapse rate for ECT after one year is about 50%. In TMS, the response rate is much more persistent, with up t0 70% maintaining their response.”
Effectiveness of TMS Application in Treatment of Tinnitus
J Craniofac Surg. 2014 July; 25 (4): 1315-8
Yimaz M, Yener MH, Turgut NF, Aydin F, Altug T.
Sixty patients aged between 15 and 70 years old with the complaint of tinnitus between January 2009 and July 2009. The treatment group and the placebo group were separated randomly as to include 30 patients. The tinnitus loudness, frequency, subjective score, and tinnitus handicap inventory results were compared before application of TMS and after 1 month.
The studies show that low-frequency repeating TMS is useful in the treatment of chronic tinnitus. In the current study performed on the patients with chronic tinnitus, it was shown that low-frequency repeating TMS has a statistically significant success when compared with the placebo group.
Some Addictions May Respond to TMS Treatment
“Among the many promising treatments for addiction that researchers are actively pursuing, transcranial magnetic stimulation (TMS) may be the most intriguing. TMS may not only potentially suppress cravings for smoking and drinking, but may also reveal brain locations and activities related to addiction.
Unlike psychoactive drugs, which alter brain activities chemically, TMS does so with electricity. TMS has been used primarily to treat major depressive disorder since it was approved by the FDA in 2008. However, researchers hope it can also work for other neurological and psychiatric disorders.
In a study in the January 2010 Addiction, Biswa Mishra and colleagues gave TMS to 30 patients with alcohol dependence. After 10 sessions, these patients reported statistically significant decreases in cravings for alcohol compared with 15 patients who received sham stimulation.”