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.
More information: www.tmsofknoxville.com