From Medications to TMS for Dr. SteinAB: What was your initial fascination with TMS? Where did you see the first piece of TMS equipment being demonstrated?
KS: I have always had a passion for both neurology and psychiatry and while I find affecting the way brain cells behave on a molecular level with psychiatric medications very interesting and fulfilling, I missed the anatomically-based medicine that I so enjoyed in my neurology training.
It all came together for me when I saw a prototype of a user-friendly TMS device at an American Psychiatric Association (APA) conference about 10 years ago. After that, I kept up on the TMS research, and by 2008, the Neurostar TMS device became FDA-approved for the treatment of depression in patients who were unresponsive to medication. (See: Food and Drug Administration.)
What was amazing about TMS is that it is a safe, non-invasive means to stimulate the brain more gently in a precise and localized way using magnetic pulses instead of direct electrical stimulation. TMS makes it possible to normalize the brain's activity and treat depression without inducing the seizures and side effects of ECT (electroconvulsive therapy). TMS was what I had been waiting for - a device that could bring about a perfect blend of psychiatry and neuroanatomy.
AB: Without TMS, would we just be left with psychiatrists experimenting with medications and using ECT as a last resort?
KS: Prior to 2008, before TMS became FDA-approved, the APA treatment guidelines for the treatment of a major depressive episode were limited to psychotherapy plus multiple medication attempts, followed by ECT. With TMS becoming FDA approved in 2008, we now have a non-invasive, non-drug antidepressant treatment alternative that is effective and safe with much fewer side effects. It has been very exciting to be on the crest of the wave of innovation that TMS brings to psychiatric care. It is rewarding to see patients who have been suffering for long periods of time finally respond to TMS and move on with fuller, more hopeful lives, depression-free.
Final ThoughtsAB: TMS is almost thirty years old (the first studies were done by Anthony Baker in Sheffield, England). Why did it take so long to develop TMS equipment, and what took the FDA so long to approve TMS?
KS: This is a good question. I can only surmise that the engineering of a consistent and safe device that was user-friendly and suitable for clinical use in the outpatient setting took a lot of investment and time to develop.
AB: Do you believe it is your role to educate both patients and professionals about the technology of TMS?
KS: As one of the first to use TMS and to witness first hand how TMS has benefited so many patients when medications have failed, I feel that my role goes beyond that of TMS practitioner and extends to TMS educator. Patients deserve to be made aware of their treatment options so that they can truly make an informed decision about their own healthcare. The only way this will happen is if the medical community is made more aware of the TMS option.
Interview with Dr. Kira Stein, West Coast TMS Institute, November 2012
Learn more on Dr. Stein's website at westcoastTMSinstitute.com. Follow Dr. Stein on Twitter and Facebook. NOTE: Dr. Stein's interview responses are for general information purposes only and are not intended to be professional medical, psychological, or legal advice for any specific situation or individual. This information is intended for individuals and their families to use in consultation with a qualified healthcare professional. Dr. Stein does not warrant or make any representations, and disclaims any and all liability, concerning any treatment or action by any individual who has made decisions based on information from this interview.