Transcranial Magnetic Stimulation Therapy for Depression [Interview][Transcript]

Dr_Kimberly_Cress_TMS_therapyGuest: Dr. Kimberly Cress
Presenter: Neal Howard
Guest Bio: Kimberly Cress, MD, has been in private practice in Psychiatry since 2000. A graduate from the University of Texas Health Science Center, San Antonio Medical School, Dr. Cress’ experiences include treating patients with treatment refractory depression, anxiety and bipolar disorders at the Mood Disorder Center at Baylor College of Medicine. Dr. Cress founded the TMS Serenity Center in April 2010 and has administered over 10,000 TMS treatments. She completed Harvard Medical School’s Intensive Course in Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation, along with courses at Duke University in TMS.

Segment overview: Dr. Kimberly Cress, MD, a psychiatrist and founder of the TMS Serenity Center in Sugarland, TX, discusses the field of Transcranial Magnetic Stimulation and neuromodulation.

Transcription
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Neal Howard: Welcome to the program, I’m your host Neal Howard. Thank you for joining us here on Health Professional Radio today. Our guest in studio is Dr. Kimberly Cress. Doctor Cress is a Psychiatrist and Founder of the TMS Serenity Center in Sugar Land, Texas and she’s here with us on Health Professional Radio today to discuss the field of Transcranial Magnetic Stimulation and Neuromodulation. Welcome to Health Professional Radio Dr. Cress.

Dr. Kimberly Cress: Thank you Neal.

N: Thank you. You’re the Founder of the TMS Serenity Center in Sugar Land, Texas. What exactly is TMS or Transcranial Magnetic Stimulation?

C: So TMS is a new and innovative way of helping to treat depression. We use the term neuromodulation which is a hefty word but basically what we’re doing is an in-office procedure for treatment of depression where individuals come in and we place an MRI strength magnet and that magnet is localized to stimulate an area of the brain that’s involved with mood regulation. So we are trying to target the dorsolateral prefrontal cortex… you will the left front portion of the brain that’s again the area involved with mood regulation and as this magnet pulses over a 37 minute period of time, that magnetic field will actually stimulate electrical current in the brain. And when you stimulate electrical current, nerves will then fire and as nerves fire they release neurotransmitters or chemicals such as dopamine, norepinephrine and serotonin. Those are neurotransmitters that we’re providing artificially through antidepressants. Antidepressants that individuals typically think of for example Prozac or Lexapro or Effexor, we are able to help facilitate the release of these neurotransmitters directly into the brain to help in treating depression and what’s so exciting is we have the opportunity to make changes and help individuals in their treatment of depression in ways that they’ve never been able to see responses with medications.

N: You’re stimulating an area of the brain with this magnetic field. How do you ensure that only these mood regulating areas of the brain are affected?

C: Well through making various measurements of an individual’s head we can specifically locate the area of the brain, again the dorsolateral prefrontal cortex and place the magnet in that location. It’s similar to if an individual was going in and receiving an EEG where they place looking for the electrical activity of the brain and place what with little stickers if you will on to the head. We know where we need to place the stickers in order to find what’s called the F3 in doing EEG, that’s the dorsolateral prefrontal cortex. So we can target that area of the brain but what’s exciting is not only are we stimulating just that area of the brain but as one nerve gets another nerve to fire we can actually then facilitate stimulation in the inner parts of the brain. What we call the subcortical regions of the brain that would be like the hippocampus, the thalamus, the hypothalamus, again those are areas that are involved in mood regulation. So as one nerve gets another nerve to fire and stimulating these inner parts of the brain, we are also facilitating changes within circuits. TMS helps the brain rewire itself to getting release of the depression and so we’re not only making changes in the neurotransmitters but we also help make circuit changes and the idea is ‘Circuits that fire together wire together.’ And so we know through various studies that have been done that when individuals are struggling with illness of depression that in certain regions of the brain for example the hippocampus, neurons will shrink or atrophy and we can facilitate regeneration of these neurons from various treatments like neuromodulation. Now this regeneration of neurons can occur through medications, it can occur through exercise as well that TMS is one of the fastest ways to help facilitate this neurogenesis. Again, important to help individuals get their life back and get some relief from their depression.

N: How often is TMS used in conjunction with as you say these drugs or various exercises?

C: So I have been a provider of TMS since 2010. The vast majority of individuals that will come to me are individuals that have struggled with depression not just for a year but often times decades and through the years they’ve been on various medication trials and so they find themselves having maybe some relief from the depression but still not getting complete remission from the depression and/or they might find themselves really struggling with side effects from the medications that it really limits their ability to get relief from the depression. So most individuals I find will come to me on some type of medication regimen and it may not just be one medication, it maybe multiple medications and again still struggling with the depression. We can then add on TMS to their current medication regimen with the goal of again getting them remission or complete relief of the depression but their even longer term goal is not only getting them that relief but it’s to help facilitate if we can simplify their medication regimen down the road so that they’re on less medications and therefore less risk of side effects.

N: What about any discomfort or pain? Is there any discomfort associated with TMS?

C: It’s a great question. So patients come in and they will describe as a magnet is pulsing and it’s similar to woody woodpecker if you will. So it’s a little tapping that’s there, that tapping is something that they quickly get used to or desensitized so they find themselves the first day or two they notice that and then they find themselves getting distracted by conversations as the treatment is continuing on or they may watch TV, listen to music and they get to the point where they just completely ignore it and they know what to expect with it. Individuals may have a transient headache as they’re in the process of getting used to the medications but thus far I haven’t had anybody who can tolerate the treatment.

N: Now you mentioned early on that this is a new type of depression treatment. Are we talking about something that we’re gonna wait years down the road before the, I guess research and development drops the cost or is it relatively inexpensive now? What about the cost of this treatment?

C: Well the cost can be variable certainly between clinics and where you’re receiving the treatment within the country. The cost of living, providing services, etc. can play a role in that but what we are seeing TMS was FDA cleared for treatment of depression in 2008 and so over the years we have seen how insurance coverage has increased vastly that now major insurance companies: Tricare, Aetna, Medicare and most commercial insurance plans are helping to provide insurance coverage for TMS that it helps to minimize that economic cost for receiving the treatment.

N: Where can we go and learn more about TMS and the TMS Serenity Center there in Sugar Land, Texas?

C: So to find out about the TMS Serenity Center best way to find that information is going to our website, so tmsserenitycenter.com. We’re located in the Houston area, you’re not in that vicinity individuals can go to neurostar.com in order to then search for a provider in your area to find individuals that are TMS providers.

N: Well I appreciate you coming in today Doctor.

C: Thank you.

N: Thank you. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio with Dr. Kimberly Cress, Founder of the TMS Serenity Center in Sugar Land, Texas and she’s been with us in studio today discussing Transcranial Magnetic Stimulation or TMS. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.