CHELMSFORD — One in six Americans will experience a depressive episode at some point in life, and for a third of them, medication and therapy won’t offer significant relief, according to Dr. Rebecca Knapp.
For that subset with treatment-resistant depression, Achieve TMS East offers a different approach, said Knapp, who is one of the Northampton-based company’s lead psychiatrists.
“For that group of people, it’s really tough to maintain hope, and without hope, you don’t survive,” Knapp told attendees at the grand opening of Achieve TMS East’s latest location at 1 Meetinghouse Road on Tuesday. “It’s just a disease that derails lives, and in some situations, takes lives. So with that treatment-resistant population, we have this new cutting-edge treatment that is very successful in about 75 percent of people who would otherwise have a 5 or 6 percent chance of responding to another medication.”
That treatment is deep transcranial magnetic stimulation, or dTMS, delivered through a Brainsway Deep TMS device, according to Operations Manager Stacey Kronenberg.
Where many other places use surface TMS that penetrates 2 to 3 centimeters into the brain, dTMS penetrates the deeper structures of the brain at 6 centimeters, she said. Kronenberg said the bilateral coil used in dTMS can also access a wider area than surface TMS, which uses a smaller, figure eight-shaped coil.
The treatment sends bursts of magnetic pulses to neurons in the left prefrontal cortex, energizing them to “start firing, wiring more and more, making deeper connections,” Kronenberg said. It also stimulates blood flow to the deeper structures of the brain, which can increase the effectiveness of medications, allowing them to get where they need to go to create serotonin and boost mood, she said.
Achieve TMS East was founded about 2 1/2 years ago as the East Coast counterpart to Achieve TMS, based in California, according to Director of Operations Margie Pierce. The company opened its first practice in Northampton in January 2017, and has since expanded to 11 sites around Massachusetts, she said.
Before the Chelmsford location opened a couple weeks ago, the closest locations were Leominster and Newton, which both opened earlier this year. Pierce said they tend to target areas where patients would otherwise have to travel to larger urban centers for specialty medical care.
Achieve TMS East treats an average of 10 to 12 patients per location each day, and is now using deep TMS to treat obsessive-compulsive disorder (OCD) in addition to depression, she said.
Most of the patients Achieve sees have been through nearly every type of treatment imaginable — they’ve tried at least four anti-depressants, cognitive and dialectical behavior therapies, and been hospitalized, Kronenberg said. Deep TMS offers them a new hope, she said.
“It’s not jumpstarting the car, it’s fixing the alternator, so it doesn’t have to get jumpstarted every time,” Kronenberg said. “So once we fix that, it starts running like it’s supposed to.”
An initial course of treatment is typically conducted five days a week for six weeks, with sessions of about 20 minutes each, she said. A small amount of patients may experience fatigue or headache from the tapping sensation, but these minor side effects generally subside after the first week or two, Kronenberg said.
Typically, patients begin to notice they’re sleeping better in those first couple weeks, and waking up more refreshed, she said. In the middle weeks of the treatment, they begin to feel their focus and motivation returning, and by the later weeks, “they feel the fog and heaviness start to lift,” Kronenberg said.
“It’s pretty incredible to see with your own eyes the transformation that can take place with people,” said Lead Technician Indy-Rae Jones.
Paul Crowley, 69, of Gardner, has struggled with depression most of his life. For 26 years, he cycled on and off a number of medications with limited results.
When he began dTMS treatment at Achieve TMS East’s Leominster location in July, he said he was skeptical that this therapy would be any different from the others he’d tried. He didn’t start to notice a difference until the fifth week.
He wonders now if dTMS had been available sooner, how different his life would have looked.
“I once described it as taking a hike up a mountain with friends,” Crowley said. “They get to hike up, and you have to carry a 50-pound pack. Up at the top, everyone is excited about how great it was. You thought it looked great, too, but as much as you tried, you couldn’t be excited. I’ve always had that 50-pound pack.”
Crowley said the combination of dTMS, talk therapy and meditation have him feeling the best he’s felt in a long time. The overall cloudiness he felt is gone. He has the energy to do everyday tasks that once felt overwhelming, and he feels more creative. On Dec. 1, he took his last Prozac pill.
“I’m now actually waking up and feeling good for the first time in my life,” Crowley said. “Finally, after almost 30 years, I feel like I have got a leg up on combatting this thing. It’s a nice place to be.”
Kronenberg said results depend on the patient and severity of their depression.
“We’ve had patients that are still in remission two years out, from our first set of patients, which we’re pretty proud of,” she said. “Then we’ve had people that need to come back every six months for a ‘tune-up.'”
Some with more severe depression may need to come back every three months, Kronenberg said. Maintenance treatments will typically consist of six to eight treatments, as needed, she said.
TMS is covered by all major commercial health insurances, MassHealth and Medicare, generally up to 36 treatments for patients that meet clinical criteria, Kronenberg said. Providers differ and many do not cover later maintenance treatments, but she believes that will change, she said.
For more information, visit achievetmseast.com.
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