With a remission rate of 80%, Dr. Bill Stubbeman’s clinic attracts patients from across the USA, Japan and Canada who have struggled with depression for years. Stubbeman hopes that Theta Burst treatment in combination with neuronavigation will one day become the standard of care instead of the currently used protocols.
At his psychiatric clinic in West Los Angeles, Dr. Bill Stubbeman is treating patients suffering from refractory major depression. Five years ago he began offering TMS treatment at his practice after having extensively researched TMS and felt that it was the future of psychiatry practice. His patients have typically had a lifetime struggle with depression and have failed to receive benefits from medication or even Electroconvulsive Therapy.
“We have an 80% remission rate using a high frequency protocol combined with neuronavigation. All of our patients who have reached remission with TMS were previously severely refractory,” explains Dr. Stubbeman. Usually the patients find his clinic after having well-researched TMS and neuronavigation, but he also gets referrals from colleagues who have been unable to bring their patients to remission. “Many of my patients are skeptical when they first come to my clinic because nothing else has worked for them. Luckily, TMS has a low placebo effect, yet high remission rate. Education about TMS and attentive care allow patients to better evaluate TMS results. When nearing the end of treatment, all patients are generally amazed that the results are unbelievable yet real, and they hope that it lasts,” says Dr. Stubbeman who is afforded a lot of gratitude by patients finally in remission who are very appreciative of their treatment results.
A great day at the office
“When current patients are in remission or moving toward remission, that is a good day. When TMS is a known option for those who are not getting medication benefits, and they are in my office getting well, that’s a great day,” says Bill Stubbeman who is motivated by the fact that he is able to help people who have failed all other treatments get their lives back. Unfortunately TMS is not that well-known among psychiatrists. “It is my impression that most psychiatrists in the USA are not very familiar with TMS and its high potential for treating patients who have failed everything else. Gradually, TMS is becoming more known to the general public through word of mouth and it is being covered on more and more insurance policies,” says Dr. Stubbeman.
An expensive treatment, but…
The price for a TMS treatment remains the Achilles’ heel for many patients, but according to Dr. Stubbeman it is also necessary to take into account the long term cost of psychiatric care, including therapy, medications, hospitalization, and loss of work days when the price is evaluated. “When all this is taken into account, the total cost of TMS treatment becomes relatively low. We also emphasize the cost of depression on relationships and the joy of living. All of our patients are private patients at the moment, but given the high rate of remission we have had, we wish to offer this treatment to as many depressed patients as possible, including those who are unable to afford the treatment themselves. In the near future, we are planning to work directly with insurance carriers who support TMS,” says Dr. Stubbeman.
More suppliers, more competition, lower prices
MagVenture’s recent FDA clearance of the MagVita TMS Therapy brings the number of FDA cleared TMS devices for depression treatment up to four. According to Dr. Stubbeman this is likely to make TMS available to a greater number of people. “Every new FDA clearance creates some level of noise in the ears of the public, medical and health insurance entities. Competition for the same technology drives down costs and thus makes it more available to physicians with TMS becoming available to a greater number of people – but unique and clinically effective treatments provide the value to warrant higher reimbursements,” stresses Stubbeman.
The future of TMS
According to Dr. Stubbeman the future of TMS depression treatment lies not in the rTMS protocol currently in use, but rather in Theta Burst stimulation. “I think that the future of TMS is in patterned treatment protocols like Theta Burst, and MagVenture’s TMS devices have much greater flexibility than other devices on the market. This should allow for higher remission in the US. I hope that someday 20Hz Theta Burst treatment will become the standard of care because in my experience, this works much better than the protocols currently used. Theta burst is arguably both safer as it uses lower intensity, and more tolerable with less total time per treatment than conventional TMS. This would allow even more patients to benefit from TMS treatment,” says Dr. Stubbeman who encourages doctors to use TMS in combination with neuronavigation.
“In the future, I hope to convince more doctors to use MRi-guided neuronavigation for precision targeting as well as take weekly motor threshold measurements on the patient using EMG electrode to accurately account for fluctuations,” ends Dr. Stubbeman, of his hopes for the future of TMS depression treatment.
William Stubbeman, MD
Dr. Stubbeman graduated with high honors from Princeton with a degree
in Mechanical and Aerospace Engineering and received his MD
from Columbia University. He began his training at UCLA as an Ear,
Nose and Throat Surgeon specializing in auditory pathology, but his
growing interest in the brain caused him to switch focus to psychiatry.
He subsequently built a private psychiatry practice in West Los Angeles
specializing in treatment-refractory psychopharmacology.
After realizing the potential of TMS to help patients that were
beyond the reach of medication, he changed the focus of his
practice to TMS treatment.
More information at: www.drstubbeman.com