Targeting Previously Unreachable Frontiers
One of the focuses of your research over the years has been TMS, what led you to study this field so intensely?
In psychiatry, so many patients suffer from various types of comorbidities. Because of the scarcity of studies for various combinations of medications or disorders, many patients have unmet needs, and very few patients get on-label treatment. Consequently, psychiatrists practice in ways that have not been studied for the majority of their day, and many of them actually enjoy treating patients in a personalized fashion.
When I first encountered TMS, I was fascinated with this entirely new perspective: Brain areas that were affected, overactive, underactive, not acting in concert with other areas and more. When I graduated in 2002, these aspects were not discussed or addressed. TMS felt like a really novel methodology, allowing us to tackle brain diseases in a completely new way. With each patient, you can look at symptoms and think about how the circuitry is different from that of other patients.
Brainsway Deep TMS H-Coils pushes the frontiers of treatment even further, as these deep-reaching coils allow us to target areas unreachable with any other treatment.
"Deep TMS is More Benign than Medication"
How would you compare Deep TMS and medication treatment?
Deep TMS is a benign treatment, as its side effects, such as headaches and face pain, are both mild and temporary. By contrast, when we prescribe a medication, we may make (unfortunate) permanent changes. Antipsychotic medication can cause diabetes or movement disorders, and in elderly patients there is even a risk for death.
This aspect of Deep TMS is one of the reasons why psychiatrists feel incredibly comfortable using it.
Overcoming People's Reluctance to Change
What is our greatest challenge in driving Deep TMS adoption?
Deep TMS is a new technology, which was introduced when there was an existing TMS treatment in the market. Conventional TMS opened up and educated the market for Deep TMS, but it also created barriers of false beliefs.
The most significant barrier for Deep TMS adoption is people's reluctance to confront their own beliefs and admit they have not made the best choice. It's a well-known phenomenon that we always convince ourselves after-the-fact that we've done the right thing. When someone bets on a horse, enters a relationship or takes a job, they tend to stick with the commitment.
Many people don't understand the difference between Deep TMS and conventional TMS. It takes a lot of education. Even rock-hard data doesn't always help. Sometimes when I show doctors Deep TMS efficacy studies, they'll say: This may be so, but with my patients it's different.
To educate people, you need to show them the actual treatment, how small the device is and how easy it is to find a motor threshold. My role as CMO of Brainsway is to support these efforts and educate the market.
"I've Seen that Brainsway Deep TMS's Remission Rates are Much Higher"
How would you compare Deep TMS with Surface TMS?
In my experience, some patients show more and faster improvement with Deep TMS after not improving with figure-8 coils. When we give them a booster, many need only a single treatment with Brainsway Deep TMS.
Across the years of my work, I've seen that the remission rates are much higher with Deep TMS. In the case of TRD patients, very few patients achieve remission with figure-8 coils, while with Deep TMS, a lot of them do.
Last but not least, the treatment session is very short, and it's very easy to find the motor thresholds, which makes it easier on both the caregiver and the patient.
"Deep TMS Tremendously Changed My Patient's Life"
Can you describe a memorable patient reaction to Deep TMS?
One of my patients, a 54 year old man with depression, had developed diabetes due to the antidepressant medication combination he was taking. Following successful Deep TMS treatment, we were able to reduce his medication intake and he was cured of his diabetes. Before Deep TMS, he led a very limited and solitary life. He kept a job but was never what you might call social. Now he's completely transformed. He is animated, dances, has hobbies, and is engaged to a girl he had known for many years prior to the treatment. They currently live together, and they both think Deep TMS is amazing, and even life-changing.