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Scott Webb (Host): Internationally renowned as a pioneer in innovative treatments and integrative therapies, Sierra Tucson offers NeuroStar TMS therapy, transcranial magnetic stimulation for treating depression. And this treatment is non-invasive, FDA cleared and safe. So let's learn more about TMS and how it treats depression. Here with us today is Michelle Chacon. She's a Registered Nurse and the TMS Coordinator and Clinical Operator at Sierra Tucson. This is Let's Talk: Mind, Body Spirit by Sierra Tucson. Sierra Tucson ranked number one best addiction treatment center, 2021 in Arizona by Newsweek. I'm Scott Webb.

Michelle, thanks so much for your time. As I mentioned here, we're going to talk about TMS, which spelled out is transcranial magnetic stimulation. And you're going to talk a whole bunch about that today. It's a really interesting topic. So as we get rolling here, what is TMS?

Michelle Chacon, RN (Guest): So the short answer of that is that this is something that is similar to MRI technology, but it's targeted towards particular brain regions and it will just activate them. So, this is a treatment that you would typically find in a psychiatrist's office or outpatient clinics where someone who has depression that's not responded to antidepressants or medication or psychotherapy, this could be an option for them.

And the benefits of it is that it's FDA cleared, it's noninvasive. So that's a big deal. There is no systemic side effects. So unlike medications that would have systemic side effects such as nausea or weight gain, et cetera, the side effects with TMS are very minimal and localized to the area that we're treating, which is the head. And it is something that's done under the supervision of a psychiatrist or a medical provider.

Host: You used the MRI analogy. So that definitely helps. I think a lot of us are familiar at least with an MRI and it does sound like there's a lot of benefits. So naturally I'm wondering how long has Sierra Tucson been providing this treatment and is it unusual for a treatment center to provide TMS?

Michelle: We have been doing TMS here just over six years at Sierra Tucson. And as a matter of fact, it's not something that's commonly seen in residential settings. We actually were the trailblazers with bringing TMS into an inpatient or residential setting. And with that, we had paved the way so to speak. We had to figure things out as we went along, but the beauty of it is it seems like a really natural place to actually do TMS due to the course of treatment and what that normally looks like.

Host: Yeah, not surprising at all to hear that Sierra Tucson is blazing trails, and as you say, maybe there were some things to figure out and work out, but just like Sierra Tucson to go ahead and do that. And it does seem like such a natural in the setting that you're describing, especially at Sierra Tucson. So you've kind of given us a visual image of what the therapy looks like or what the machine looks like, the stimulation. And so on. Maybe you could describe the actual like course of treatment, for listeners.

Michelle: Well, a single individual treatment session is anywhere from 19 minutes up to 30 minutes long. And during that time, people will be awake and alert. There's no anesthesia or sedation required to do TMS. During their treatment, I chit chat with them. They can watch a video, they can listen to music. That treatment is typically done five days a week for four to six weeks. So the full course of therapy involves 20 to 30 sessions. And sometimes more. That's going to be up to the medical provider who's prescribing it. During the treatments, the patient just gets reclined in a comfortable chair. And afterwards they can go about their day.

There's no downtime afterwards. The side effects are so minimal that, folks can continue to attend all of the other programming that they have scheduled while they're here. In other words, they don't miss out on the rest of the things that they may have scheduled while they're here.

Host: Yeah, that's good to know. And you mentioned earlier kind of the buzzword for all of us when it comes to any kind of treatment is noninvasive. We all seem to be in favor of noninvasive. So much good information here. Wondering what's the efficacy, like what do your success rates, maybe you have a success story that you can tell us about.

Michelle: This is one of the biggest benefits of doing TMS, is that looking at national studies or clinical trials, and then also the data that we've gathered over the last six years. What we see is 83% of people who do a course of TMS will experience measurable depression relief and a full 62% of those people have remission, which is a complete absence of depressive symptoms.

So it's a powerful treatment that is extremely effective. The fact that it's been FDA cleared since 2008 is also reassuring because it's not something that's investigational or experimental, it's not even brand new. This has been offered in outpatient settings for quite a while. I still run into people, a lot of people actually, who don't know what TMS is nor have they ever heard of it. So I'm always happy to share a little bit about what it is because so many people still have never heard of it.

Host: Yeah, do you have a, maybe a sample case study or maybe just anecdotally, what are patients saying?

Michelle: I get asked this question quite a bit. And what I can tell you is broadly, once folks have completed, maybe their first two or three sessions, they begin to really look forward to it and it becomes their favorite part of the day. So that's really the main thing. But as far as a specific experience, I always think back to a patient that I had, it was probably in the first year that we started TMS and she was actually local to Arizona. But she had come here for depression, nothing was working for her. She did begin the TMS and slowly she just blossomed. And I remember I came back in to do her treatment on Monday and she said, I got my hair done at the salon yesterday here at Sierra Tucson.

And I did notice that she had her hair cut and colored, and she was so excited about that. And she said that was one of the things that she realized that she had turned a corner, that something is finally working. And I believe this woman was in her fifties. And had tried every medication under the sun, but once it struck her that she was looking forward to going home, returning to her family and she went through the trouble of getting a salon appointment to have her hair done for the first time in two years.

That just is still, it just speaks to me so powerfully. In addition to that, this brings to mind a patient that I actually am currently treating, and he is about 15 treatments in, and I think it was just last Thursday, when we were doing his treatment, he said, this is amazing. This has been life-changing because I didn't remember what it was like to feel like my normal self or feel the emotions that I feel again, and to feel this happy that the depression is completely gone. He was just really blown away. And I think this happens quite a bit here, that people are really surprised at the effect that they get. It's very much unlike the type of relief that medications provide. It's a different mechanism of action. So the way that people feel when it begins to take effect and it starts working is really amazing. And most of the patients can identify that the TMS is what is actually working. That's what's doing it. If that makes sense.

Host: Yeah, I'm sure that's really gratifying. And you know, I'm certainly not the expert that you are, but I know a little bit about depression, some family members and hosted some podcasts and things. And what I've learned of course is that it's not a one size fits all. And certain things work for some folks and not for others.

And so, you know, when you're on the treatment side and you're trying to help folks at Sierra Tucson and trying to find something that works and when you finally find it and you know that it works and you see immediately, wait a minute, something's different here. This is a good thing. We're making some progress. I'm sure that's just really gratifying, right?

Michelle: Oh, absolutely. It's the reason that I come into work every day, because I do get to develop a relationship with people. I see every weekday for their treatment. And over time, I actually see the transformation. We also collect data from every patient. We give them short depression surveys to fill out before during and after treatment.

So this is how we have tracked outcomes and been able to measure how people are improving. We can put a value to it, and there's a way of actually measuring these improvements. But just observationally I see it happens so much and it's always so rewarding.

Host: I am sure that it is and education is always so important. And so we hope that folks, of course, listen to these and learn, really take in the expertise that, that all the guests bring. But let's just say that they have more questions that we didn't answer every question we could, Michelle, in the 10 or 12 minutes, we're doing this right, despite our best efforts. Where else can folks turn to learn more?

Michelle: On our website at sierratucson.com. You can find out more about TMS in general under the tab, our therapies. So the title of that is Our Therapies. And additionally, the TMS device that we use is called the NeuroStar machine and their website also is a good resource. And that is neurostar.com.

That's N-E-U-R-O-S-T-A-R.com. And so either of those places will be really good resources to find out more about TMS and get a look at what the TMS machine looks like and go into more detail than we had time for today. But as far as overview, that covers quite a bit.

Host: Just thinking about depression broadly, Michelle and treatment and the work being done at Sierra Tucson, what would be your final thoughts and takeaway for folks about how you believe TMS can help them if they've been diagnosed, if they're suffering from depression and why they should reach out, maybe as soon as today.

Michelle: This is what I tell my patients all the time. There's always more options. If one thing doesn't work, just keep trying. TMS is, the beauty in it is that for people where medications have been tried, different combinations, years and years of talk therapy, there's something out there that actually is effective, is science-based, it's very much validated through quite a bit of research. It is effective. It requires no hospitalization or anesthesia and again, minimal side effects. So there's really not any downsides. The main thing is the course of treatment length, but it goes by just as quickly as say, starting a new antidepressant and maybe waiting four to six weeks to see if it works.

Even if that looks like a downside, I usually reply well, when you've started a new antidepressant, how long do they tell you that it'll take to, to see the effect? So really it's worth looking into, and it's FDA cleared for adult patients who have tried at least one antidepressant without success. There is a screening that's done by the medical professional. And usually what I do is before treatment, we go through all of the things that might exclude someone from being able to do TMS. Some of those things might include metallic implants in the brain, cardiac devices and certain neurological conditions.

Host: Yeah, as you say that there's not a lot of downsides or side-effects, there's a lot of good reasons, you know, when it comes to mental health as you say if you've tried this, if you've tried that, why not try TMS? It's there, it's at Sierra Tucson, which is an awesome place. And we hope that folks enjoyed the podcast. Thanks for your time. You stay well.

Michelle: Thank you so much, Scott.

Host: For more information, visit sierratucson.com or call 800-842-4487. Sierra Tucson, we work with most insurance. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest.

This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.