Since he first began to offer TMS in 2013, Dr. Lane Cook has helped a large number of patients beat their severe depression. By the time of their referral, they have already failed many antidepressants and/or psychotherapy.
At the Knoxville-based clinic, however, the majority of these patients find new hope: 50% achieve full remission whereas 66-70% achieve response (at least a 50% reduction in depression rating scales). “By the time our patients need TMS they are fairly discouraged and they meet us with a mixture of hopefulness and hopelessness,” says Dr. Cook. He gets half of his referrals from fellow local psychiatrists who have exhausted their medication and psychotherapy trials for treatment resistant depressed patients. The patients usually do not have any reservations about trying the treatment, except one big fear: that it won’t work. An important part of the job for Dr. Cook and his staff is therefore to provide encouragement to the patients: “We tell them how easy the treatment is, that TMS will feel like a woodpecker on the head [from the tapping of the magnetic pulses on the head, ed.] but typically without any pain,” he says.
A 50% full remission and 66-70% response rate among these, until now, treatment-resistant severely depressed patients, would by many healthcare providers be seen as astounding results. To Dr. Cook, however, the numbers are not all that
surprising, having been told “years ago” from a friend that her results with TMS were much better than what had previously been published.
“The early studies of TMS were done in patients taken off antidepressants and the protocols were not fully maximized to their potential,” reports Dr. Cook. Consumable costs top priority Dr. Cook was among the first to offer MagVita TMS Therapy in the US shortly after it received FDA clearance in 2015. According to Dr. Cook, there are several issues to consider when choosing TMS equipment, with consumable costs ranking the top of his priority list. “High consumable costs are not cost-effective and in some states in the US, insurance reimbursement is actually less than the cost of consumables,” he explains.
“We were paying as much to operate our first device to the manufacturer in one year as it cost to purchase the MagVita,” Dr. Cook explained. “In addition, the chair, the neck rest, and the cooled coil are more comfortable, quieter and the experience for patients who have tried earlier TMS devices is much more acceptable.”
Easier to get reimbursement
Most insurance companies have specific criteria that the patient must meet before being eligible for TMS.
Typically the patient must have failed 4 antidepressants with or without psychotherapy. However, problems of getting reimbursement from health insurance companies are now – more and more – a thing of the past, according to Dr. Cook, who finds it increasingly easy to obtain reimbursement, especially from companies he is already in network with.
As far as the others, “you can always do single case agreements,” he says. This change of tides among the insurance companies also makes it easier for the patients who no longer have to pay up front for the treatment. Most insurance companies require reasonable copay.
Spreading awareness of TMS
The advantage of having a TMS practice as opposed to a typical psychiatric practice also pertains to the logistics: In a TMS practice, the psychiatrist only has to be present in the initial motor threshold or repeat MT, Dr. Cook explains. From there
on, the technician/coordinator usually does the rest. His office manager handles the paper work, and has, for instance, solid expertise within insurance issues. This enables Dr. Cook to take time out of his busy work schedule to further spread awareness of TMS to help ensure that more people can get the help they need. It is, for instance, necessary that “more primary care physicians become aware of this excellent treatment resource,” he stresses. Dr. Cook has given CME (Continuing Medical Education) talks on TMS, as well as several discussions for the public. He finds that both are good ways “to get the word out and help people grasp the concept of how this is different from psychotropic meds.”
Helpful peer and mentor network
Training as well as a peer and mentor network are also important factors. Dr. Lane Cook has participated in advanced TMS courses, something which is even a requirement by some insurance companies – and finds it extremely valuable to be able to get advice from renowned researchers at Duke or Harvard University. He completed advanced training at Medical
University of South Carolina with Dr. Mark George who is widely considered as one of the founding fathers of TMS for depression. He enjoys being able to occasionally consult with Dr. George on TMS matters.
Hope for more indications
As for the future, Dr. Cook is confident that the future of TMS for the treatment of depression is “very bright” and furthermore hopes for an FDA clearance of Theta Burst TMS for rapid treatment of Major Depressive Disorder. Further down the line, Dr. Cook also hopes “that with research we can help more people, suffering for instance from Panic Disorder, Bipolar Depression, Generalized Anxiety Disorder, and PTSD.”
Dr. Lane M. Cook
Lane Cook, M.D., received his board-certification to practice psychiatry in 1981 and has been practicing in Knoxville, Tennessee, ever since. He is the owner as well as Chief Medical Officer of TMS of Knoxville, LCC. The clinic first began to offer TMS for the treatment of depression in 2013 and has since then treated more than 85 patients.
Lane Cook was appointed Assistant Professor of Psychiatry at both the Baylor College of Medicine as well as the University of Tennessee in 1981 and 1983, respectively.
Dr. Cook is a well-known clinician and a frequent lecturer around the Southeastern part of the US. He has given CME lectures as well as talks on TMS to the local National Association for Mental Illness and a mental health coalition group.
35 years ago, Robert McMullen, MD opened his private practice in general psychiatry on the West Side of New York City. In 2010, he added
TMS depression treatment to his long list of treatments. Being a psychiatrist, Dr. Robert McMullen found himself looking for a way to treat his many patients suffering from major depressive disorder who did not respond to the medication he prescribed to them. To Dr. McMullen, TMS was the solution. “I was first interested in TMS because I had been reading about its benefits for years, and I needed an alternative for the many patients who failed to achieve full remission from antidepressants,” says Robert Mc-Mullen of his decision to finally invest in TMS equipment to make the – at the time – novel treatment available to his many patients.
No per-use fee
“The purchase price of the TMS equipment that I first bought was very expensive, and it has actually cost me a lot of money that I had to pay a fee to the company for every treatment I did. I am therefore very pleased that it is now possible to get FDA cleared TMS equipment from other manufacturers such as MagVenture who do not operate with a ‘per-use fee’. That makes a big difference to me and my practice,” says Robert McMullen.
TMS is worth travelling for
So far, around 300 patients with major depressive disorder have undergone TMS treatment at TMS BrainCare. “What has sustained us has been the enormous benefits, as well as long acting benefits, for so many of my patients,” says Robert McMullen, who in the past five years since he first began to offer TMS has been treating men and women of all ages from all over New York City and even further away.
MD Robert McMullen graduated from Georgetown University
Medical School in Washington DC in 1976.
He is founder and owner of TMS BrainCare in New York.
For 35 years he has had a private practice in general
psychiatry. He treats patients with a wide range of mental
illnesses. He specializes in the treatment of mood disorders
and anxiety disorders and is particularly experienced
with the treatment of resistant depression.
In 2010, he began offering TMS treatment.
More information at: www.tmsbraincare.com
2300 Lakeview Parkway,
Alpharetta, GA 30009
Phone: +1 888-MAGPRO-4
Fax: +1 678-809-1415
Link to FDA clearance
Caution: US Federal law restricts this device to sale by or on the order of a physician. The treatment may not be effective or appropriate for all patients, and additional side effects may occur. Please see the complete instructions for use, including warnings, precautions, and side effects, prior to use. Licensed physicians considering the application of rTMS must consult MagVenture Inc. and the relevant scientific literature to learn more about the treatment and potential risks.