Is Transcranial Magnetic Stimulation (TMS) the revolutionary mental health treatment you’ve been hearing about, or just another fad? Dr. Robert Westerman, a Psychiatric Nurse Practitioner with a seriously powerful backstory from Camelback Integrated Health and Wellness, joins Tim Westbrook to cut through the BS and give it to us straight. In this episode, we ditch the medical jargon and get real about how TMS actually works, using magnets—not electricity like those scary ECT movies!—to fire up neurotransmitters and tackle issues like depression, anxiety, OCD, and PTSD. Dr. Westerman, who’s seen it all and treated thousands, breaks down why this could be a game-changer for folks struggling with those “treatment-resistant” conditions, plus spills the tea on the different ways you can access this treatment, making it more flexible and affordable than you might think.
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Beyond Meds: How TMS Is Rewiring Brains And Transforming Lives With Dr. Robert Westerman
Welcome back to another episode. I’m joined by Dr. Robbie Westerman. He’s a brilliant Physician and Mental Health Advocate. He also has an incredible story of transformation. We call him Dr. Robbie but his name is Dr. Robert Westerman. Before he was a doctor, he was just Robbie, a hopeless drug addict and alcoholic. You can refer back to another interview that I did with him years ago if you want to know more about his story.
The Science Of TMS: Demystifying Neurotransmitters & How It Works
He’s one of the most brilliant site providers that I know of. He works with us and a partner with us at Camelback Integrated Health and Wellness. He provides services at Camelback recovery as well. In this episode, we’re going to talk about transcranial magnetic stimulation and any of the other new modalities that are working these days. Let’s talk about TMS. Robbie, for people that don’t know, what is Transcranial Magnetic Stimulation or also known as TMS? How does it work?
First, let me correct you. I’m not a physician before they all hate on me. I have a doctor degree from University of Arizona in Psychiatric Nurse Practitioner. I am a Advanced Practice Nurse with a doctor degree, which a lot of extra training. Transcranial magnetic stimulation essentially is a treatment that involves the use of magnets. It’s not electricity like we see ECT. It uses magnets to depolarize and that’s a fancy word for fire or turn on and polarized.
It turns off neuro transmitters in the brain over and over again. When we look at different mental health elements, we look at depression, anxiety, OCD, and PTSD. We know most of those ailments have to do with neurotransmitter imbalance. We know that people with anxiety, they perhaps have too much of chemical we call glutamate. People with depression may have not enough serotonin or epinephrine or dopamine. All of these neurotransmitters are basically little electrically controlled particles. What TMS does is it fires them over and over again. The body is identifying where it’s shortages of, so like, “We need to make more,” and where it has deficits in.
How do you know that someone has deficits?
This is usually for treatment resistant depression. For most people, they’ve tried a few things before they just jump into TMS. More often than not, people have tried some psychotherapy, a couple of different medication trials and haven’t had any success with any of these trials. Let’s get into a little bit of how we would identify, where the shortfalls are and what we do for them. As a site provider, our job is to identify what ailment they have and what subtype of ailment they have. When we look at depression, we mainly think of people that are mopey, very sad, have low energy, low motivation, in the dark in their room, won’t get out of the bed and don’t want to be around anyone in 5:00 shadow and eating Oreos.
Those images come in your head but in actuality, there’s a ton of different subtypes of depression. We see people that they’re fine. They’re able to get up and go to work but they may just be very sad inside and things are hard to find out sometimes without knowing the patient, interviewing them long enough, and getting out of the details. You also have the people that are not able to get out of bed. They’re very inertia. They’re not able to get moving and get motivated. You have people that have anxious depression.
They’re just very nervous, very on edge and racing thoughts. That takes a toll having those racing thoughts running through their head and those doubts and securities going all the time. It bogs the brain down. As a provider, our job is to identify what type they may have. Based on that type, we pick what agent or pharmaceutic maybe best for that patient and their subtype. Somebody that has a flat depression, so they’re very sad but they’re able to get up and get moving. We probably give them something that works on serotonin.
With someone that’s very tired, we’d probably give them something that works more endorphin or epinephrine or dopamine. Sometimes, we use classes that work on all of them but if you look at all the different medication classes and what they do then all the different subtypes of depression. There’s like 5,000 permutations of how things can go wrong. You pick the wrong subtype of depression then you’re using all these medications that are like, “We’re going to use Prozac or Zoloft or Celexa or Paxil.” We have all these different meds. Those are all in the same class.
Typically, a site provider put them on the medication for four weeks and raise the dose. Four weeks later, raise the dose. If it’s not working, switch to different med and four weeks, raise the dose. Not working, different meds and you’re doing that forever. You haven’t even jump to another class of medications yet. You haven’t jumped to the meds that work on your epinephrine or on dopamine or just on serotonin still. People can be stuck in that rut for a long time like trying different things. Depending on your body’s makeup, some meds don’t work for you.
We have people with different enzymatic problems, so different sub enzymes, we call them. They’re not able to break down medications properly, so that’s why we rotate different medications. With all that being said, what TMS allows us to do is we don’t even have to identify correctly what subtype it is. We don’t have to know if it’s anxious or depression or if it’s like an inertia depression or flat affect type depression or whatever depression because what TMS does stimulates everything.
We’re stimulating dopamine or epinephrine and serotonin. We’re hitting every separate neurotransmitter like glutamine. By hitting everything, we essentially were taking out the guesswork and the vulnerability in the system of either, we have a problem with the diagnoses, which is common or we have a problem with the agent which is also common. That’s why with antidepressants, they say they’re 30% effective.
TMS: TMS stimulates everything. We’re hitting every separate neurotransmitter like glutamine. By hitting everything, we essentially were taking out the guesswork.
It’s not because they don’t work. It’s because it’s so darn hard to figure out exactly what the patient has exactly for that patient and what medication works for their body. TMS eliminates the guesswork because it’s like, “Let’s not try to guess what they have. Let’s target everything. Let’s target everything involved with depression.”
What percentage of people does TMS work on?
I’ve been doing TMS for six years and I’ve treated thousands and thousands of patients with TMS. This is my personal experience and I’ll share what I think. I’ve never had somebody not respond to TMS, never. Now, I hear it sometimes. TMS is FDA approved for 36 sessions. Basically, to get FDA approval on a medication, product, equipment, and get insurance approval, you have to show enough separation from placebo or sham to say that, “This works.”
If I give somebody a sham TMS and give somebody real TMS. The person that’s getting the real TMS, their PHQ-9 or their depression index score improves by five points. The device manufacturer can say, “FDA, our machine beat sham by five points,” and that’s enough to get approval oftentimes but it’s not to say that doing more will make you better. In insurance, I don’t want to pay more. It’s not like, At 36, will get you four points.
Sixty sessions will get you eight 8 points. Maybe, but that’s not how things get approved. They don’t ask how much better can they get. It’s like, did they get enough to meet approval? That’s it. For instance, at Camelback, what we do, instead of the 36 typical sessions and we have a lot of late responders with TMS. Some people don’t start responding until 30 sessions. People respond late. It’s very common. We give everyone 72 sessions.
Why 72 Sessions? Unlocking The Potential Of Late Responders With TMS
Let’s go back for a second. Tell me why do some people respond late versus some people that respond early.
Everyone’s neurotransmitters are different. I have different theories about why people respond late. Sometimes, we may have someone that’s very anxious at first. For some people, you can turn the machine up high and you get no movement like when you’re firing the stimulator. Some people, you turn the machine just barely on and they’re flailing around a little bit. You’re like, “They’re activated.” If you have someone that has that anxiety on top of the depression, sometimes it takes a little longer to get through that anxiety first before you can crank that machine up to start working on the depression. You have to go through that anxiety first. You can’t just crank up the machine.
Everyone’s neurotransmitters are different. Share on XIt will start flailing around. It’ll be very uncomfortable. If you have that twitchy anxiety with the machine, it takes more sessions to work through that before you can start getting to the depression, which we call it remapping. We have to remap the patient 15-20 sessions in. You notice they’re less responsive to the TMS after 15-20 sessions. That gives me the queue of, we’re working through the anxiety and now we’re going to work through the depression.
We see it the other way, too. That’s my theory in why people may be late responders and the helmet placements, are they getting the right dose delivered, what medications are they on and did they have alcohol intake that day. There’s so many different variables but to eliminate all those variables, what I do and I found effective. I’ve had one retreatment, but I offered just to give her twenty sessions for free as like a touch up two years later but I’ve never had a patient like need a retreatment.
Insurance will cover it, too. It’s a bad business model for us to do the retreatment. It’s not a good business model and giving the extra sessions. There’s a cost there, but if you give a patient enough treatments, consistent enough and they finish all 72 sessions, and what I’ve seen anecdotally. You don’t have to do retreatments.
TMS: If you give a patient enough consistent treatments and they finish all 72 sessions, you don’t have to do retreatments.
You say 72 sessions and FDA cleared for 36 sessions. How do you provide the 72 sessions? That said, do they have to come 72 times? How does work?
That’s a good question. We’ll start with insurance first because they dominate everything. Insurance approves one 20-minute session, 5 days a week over the course of six weeks with one little taper week in one on-boarding week, which is a three week ramp up and a three week taper down then you have the 30-session smashed in between. It’s typically 3 days a week and then 5 days a week for 6 weeks, and then 3-day a week taper.
That’s to get paid from insurance. To submit available claim, you have to follow the protocol. That’s a twenty-minute session. What we do is, we can do a lot of different things. If they’re using in utilizing insurance, what we will do is we will provide them a Theta burst session after their twenty-minute session free of charge. Basically, everyone gets a session and then they get another session right after.
The regular session is twenty minutes. Tell me about the Theta burst.
The Theta burst is essentially the same thing as TMS. It’s just quicker. With normal TMS machine, you hear the magnets firing. You’ll hear tap, tap, tap. Essentially, you’re getting the same amount of bursts in a way condensed period of time. You can look up the literature. There’s great literature that it’s just as effective as standard.
Why would somebody not want to just do Theta burst? Why do the twenty-minutes sessions?
Insurance coverage. With cash pay, you get a lot of flexibility.
With insurance, they’ve got to use the Deep TMs and twenty minutes sessions but if they’re cash pay, you can do 100% Theta burst.
You get a lot more flexibility because you’re no longer limited to one session per day. If somebody’s cash paying, we give people ten sessions per day. We can give them three 3-minute Theta burst sessions in a row then wait an hour and do it again. A lot of people come in and if they cash pay, they can get 9 to 12 sections done a day. Over the course of two weeks, they can complete their entire TMS treatment because people got vacation plans. It’s hard to commit eight weeks. It’s a lot to ask if somebody to come into the clinic for eight weeks almost every day.
To your point, there’s more flexibility. If someone wants to get it done more quickly, they can just focus for a couple of weeks and get the entire thing done regardless or if they come in and have these Theta burst sessions back-to-back and get through it more quickly.
I love the flexibility of doing that. In all honesty and practicality, insurance pays a lot more than what we charge for cash. Insurance pays a heck of a lot more. Financially, it’s like why don’t we have everyone do the twenty-minute session but I like to see people get better quicker. People feel good when their money is more better invested when they start to see the rewards quick. You can have someone in three days come back and like, “I’m already like feeling it.” Usually, in session 15 or 20, that’s when people start to feel it and that’s pretty much the norm. If you’re going by that metric, 15 or 20 like, you’re waiting 4 weeks or 3 weeks before the patient notices anything. Some patients, it’s like, you’re like questioning it at that point.
I’ve seen people come in here and feel a result the first day.
I’ve seen it.
Many times.
I’ve seen him many times, too.
Beyond Depression: Expanding The Scope Of TMS Treatment
What types of mental health conditions are most commonly treated with TMS? I know depression is one. What else do you see that works well with?
Let’s start with the FDA indications, so obsessive compulsive disorder works. It’s FDA cleared for obsessive compulsive disorder. For smoking cessation, we’re probably going to see some of approval for stuff beyond smoking cessation soon with that same modality. Anxious and depression, of course. Anecdotally, I’ve seen it work for ADHD, people with migraines, and people with OCD. That’s indicated for OCD. PTSD, alcoholism, and all sorts. There’s protocols for tinnitus and for pain.
Pain doctors are starting to buy these because it works well for pain, especially neuropathic pain with the nerves. Essentially, any psychiatric condition you can see some benefit from TMS because most of our patients have comorbid conditions. They don’t just have depression. Usually, people come in and they have a couple different things going on. They usually see great benefit in all those areas.
How do you explain the benefits of TMS to someone who’s skeptical or unfamiliar with it?
I would say if you just think about it in terms of the ailment, it’s typically due to we are lacking something. We’re usually lacking one of those neurotransmitters and you think about what like jump starting a car does and what we’re doing by firing those neurotransmitters. We’re essentially jump-starting our brain and calling for the body to make more.
I would say 90% of the patients that come in are skeptical. Most of them are. I was skeptical when I first saw the machine. I was like, “What the hell is this thing?” When you think about what it’s doing like, “That makes sense. We have a shortage of this. How do we make more?” We stimulate the brain to make more. It makes perfect logical sense when you think about it. You start breaking down the science behind it. I would say most patients are skeptical and I try to get them to those 15 or 20 sessions. I also try to make them comfortable like, “If it doesn’t work, we’ll give you your money back or we’ll treat you till it works.”
That’s one of the things that we do at Camelback Integrated Health and Wellness. We’ve got 100% money back guarantee.
We’ll give you your money back.
It’s for someone that goes to the program and says it didn’t work. We’ll give them their money back and I don’t think we’ve ever given a refund.
We’ve never given anyone’s money back. They’ve never asked for their money back. I’ve never had a patient not respond. We try to put the rest of those concerns. They’re like, “What if 60 sessions isn’t enough?” I’m like, “We’ll treat you until you feel better.”
Insurance & TMS: Navigating Coverage And Accessibility In Mental Healthcare
What makes TMS different from other forms of treatment like medication or talk therapy?
For the medication, you get to afford all to adverse side effects. Weight gain is a big one for a lot of people, especially people that want to stay healthy and maintain active lifestyle. They can harm your metabolic system, so typically weight gain and some sexual dysfunction, which is an issue with most people. you get to avoid those side effects. TMS is a therapy that has none of those adverse side effects. Most people stop taking medications due to some of the side effects.
Most people stop taking medications due to some of the side effects. TMS is a therapy that has none of those adverse side effects. Share on XFor TMS to be covered by insurance, it used to be they had to try four different types of medications. It was treatment resistant depression. That doesn’t make sense to me. Explain to me why do they have to try out four different types of medications? Now I think it’s gone down to two and sometimes even zero.
For some different insurance carriers like the VA, Tricare and then there’s some good carve out plans that sometimes you see like maybe male medical offers one. I don’t know all of them but, oftentimes, you will call on some of these plans you haven’t heard of. They’re like, “There’s no prior authorization needed. They’re all set to do it.” You’re like, “Wow.” That leads me to think one thing because insurance companies aren’t dumb. They’re not in the business of losing money. No insurance company is.
My thought is like, “If there are so apt to give this treatment first line now, there must be some return because they are not dumb.” They’re not going to give a $10,000 treatment away for no return. I’m thinking that they must see, “These people that are completing TMS, there’s less office visits down the line, less medications we’re paying for it and less hospitalizations.” There’s other things going on because previously, a lot of those insurance payers are like, there was no way you were getting it approved unless they had to go through all those step therapies.
Now, it’s different. They approved it in children like fourteen and up. They approved it in geriatrics now. You think about all these different things that are happening and the insurance companies are in the business of saving money. If they want something to be first line, that’s usually like it’s cheap. That’s what I think. When they want some first line, it’s cheap for them. This is not a cheap treatment. When you’re trying to get a drug for a patient, they’re like, “You got to try this drug from 1982 first for $0.6 for a bottle of 30. You know they’re cheap.
That just makes me feel like what they’re doing with the TMS now is like, “It must be cheap to them somehow.” A cheap patient for the insurance company is a well patient. Maybe not for the hospital system or for us but mean we want all the patients to be well. They don’t want them coming to the office. They don’t want them get on a bunch of meds and going to the hospital. You look at it like that. You can start to be like, “Maybe there is something to this.”
Should someone consider TMS by itself or is it better paired with other modalities?
Paired because to get into the state you were, there had to have been things going on. Typically, you just don’t like fall into a state of depression. A lot of times, it’s like, you stopped working out. Maybe your wife left you or maybe you’re using drugs and alcohol or you lose your job or some like unsetting event has gone on or you’ve let something get out of control or a snowball. You can’t just re-regulate everything like feel good and then go back into that dark area.
Your body’s going to say, “We don’t need all this serotonin or dopamine or epinephrine. We have way too much of it flowing around. Let’s cut back a little bit.” You’re right back where you were. You got to change the environment around you or change your environment in which caused you to be in that deficit in the first place. We can help by giving you the capability back to have the motivation and the energy to participate in life again but you can’t not. You’ll just go right back.
TMS: You have to change the environment around you or change your environment which caused you to be in that deficit in the first place.
What are some of the top other modalities or things that you recommend for somebody that’s going to start TMS to help them get through their depression, anxiety, PTSD or whatever they’re struggling with?
A couple big ones are connection like being around other people. That’s a huge one because other people around you notice even before you if you’re doing TMS. Sometimes, I’ll have a couple come in like husbands bringing his wife and the wife is very depressed. I’ll ask the wife, “How are you feeling? Do you feel like it’s working?” “I don’t know.” They’re 15-20 session and the husband will be behind her going, “It’s working.”
If you’re doing that alone or you’re not around family or around friends, you miss out on that experience for someone to say, “You’re acting different. You’re coming alive.” Connecting with others is a big one. The isolation is a huge, in my opinion, push into those depressive type symptoms. Don’t isolate is big. Exercise is big because once we get that dopamine going again and those neurotransmitters flowing again, we want to be able to keep those firing.
Going to the gym, getting that workout and getting that high end. It doesn’t just have to be going to the gym. You can walk. You can do just anything active. Play sports, getting out and getting natural light. Not being inside that dark space I was talking about. That’s a big one. Getting outside is a big one. Adequate rest is a huge one. We know that not getting enough rest can cause your brain to break down. Talk therapy is helpful but sometimes you get that just hanging around your friends. I would say those are the big ones.
Not getting enough rest can cause your brain to break down. Share on XMapping The Brain For TMS: A Step-by-Step Journey
Can you walk us through what a typical TMS session looks like for a patient? You can start with the brain mapping.
The first thing we want to do when we’re getting a patient set up for TMS, we do something called Cortical Mapping. Our job is, we need to find the landmarks. We’re working with this part of the brain called the dorsolateral prefrontal cortex and working on the right side. What we do is we position the helmet towards the back of the head and we fire the machine or turn the machine on a part of the brain that we call the motor cortex.
What we’re looking for is movement in the hand. Once we turned the machine up enough to where we get just slight movement in the hand, we start to turn it down. What we want to see is the minimal amount of energy it takes to get that hand movement. Thus, telling us we’re firing neurotransmitters because we’re firing neurons. The hands are moving and we’re firing neurons. After we know that we’re giving enough energy to fire the neurons, we know the landmark is six centimeters forward from that spot that caused the movement of the hand.
We know the dose to give because it was the minimum amount of energy it took to move the hand. We rotate the element six centimeters forward. For most people, it’s right at the top of the eyebrow and then what we do is we have that, we call it a motor threshold setting. If you think of the term threshold motor, it’s the threshold of energy which causes a motor movement. That’s what we’re looking for.
We’re looking for how much energy it takes or the threshold in which to get the motor neurons moving. That’s how we know how much energy to deliver to somebody and everyone’s different. People that are anxious need very little motor threshold like Desiree who works here. She goes in the TMS here sometimes and I barely turn the machine on. Her arms are like flailing if I barely touch it. There’s some people, I think you have a pretty high one where you crank that thing up and you barely see any movement.
Why do you think that is that there’s more movement with her and less movement with me?
It’s because some people may not need it as much as others. That’s a very interesting point. People like you and there’s some other people that maybe didn’t need it quite as much. They won’t see the huge yield. They see some benefit but it’s not like somebody that’s in a dark room for ten years doing TMS versus you doing TMS. It’s not going to be as big of a gain a function but people that are very depressed, we got a crank that machine very high.
People that are pretty stable and want a little extra boost. They want maybe to optimize what they have going on. They may be on the upper end, so that’s someone like you or someone like Joe. Some other people that have came on and talked about it. I usually find their motor threshold pretty elevated as well. People that are stable got their stuff together pretty well. People you don’t see, at least on the outside, going through it all the time can feel it.
Do you have any favorite success stories of patients who stand out in your mind?
There’s been a couple. I had a husband and wife. That’s why that story stuck in my head. He spent all sorts of money on all sorts of crazy treatments. He’s doing like ketamine treatment. I think they went and did Ayahuasca. All sorts of different stuff and he was willing to do whatever. I was like, “This is how much money it is.” He’s like, “I don’t even care. We got to do something.” She was so depressed. She couldn’t even talk. She just started crying and then she’d be irritable and angry, too.
She’s the one where I started asked her, “How’s TMS working for you?” The husband was behind her like, “This is good.” She was an extreme case and she came back very quickly. It was about like a week where I saw a huge change night and day. That’s probably one that sticks out the most but there’s been hundreds.
I can think of a few people off the top of my head that I’ve seen it. I’ve seen drastic results and life-changing results for some people. Who’s not a good candidate for TMS?
That’s a good question, too. In TMS, we’re firing a magnet. It’s using a magnet. If you have anything as magnetic in your head. We don’t want to be turning on a magnet when you got something magnetic in your head. That can be very messy. We don’t want to do that. People that may have electrical stimulating devices planted in their heads or stimulators in their chest area. We have 32 inches, I believe, from any feral magnetic objects.
Also, people that are actively manic or psychotic. We don’t want to do because people that are psychotic usually have too much dopamine in one area and not enough in the other. Giving them more can make them more psychotic. We don’t want them firing more dopamine when they’re already have a little too much. That’s another caution indication. People with seizure history because we’re stimulating with electricity and magnets the brain. It causes seizure. Very rare. It can cause it and people that don’t have previous seizure history as well but it’s very rare. I believe 1 in like 10,000 or something like that, but those would be non-candidates.
TMS Myths Vs. Reality: Pain, Side Effects, And Common Misconceptions
What are some of the myths or misconceptions about TMS?
It hurts. That’s something I hear all the time. It’s a little uncomfortable at first but most people, after they do it like 5 or 6 sessions. They’re on their phone or napping. That’s a big misconception or they think of the old movies where they got like the bite block in and the doctor is coming in with paddles. For the most part, it’s pain-free. There is a little bit of a headache the next day. I would say that’s the biggest one that it’s like painful or going to hurt. That’s the biggest misconception.
How do you see TMS fitting into the future of mental health and addiction treatment?
I know in in Arizona, it’s still getting its footing but we look at around the country and around the world, it’s taking off. We’re seeing great results with TMS and more people are learning about it or hearing about it. Honestly, it would be awesome to get a TMS machine in every clinic. It would be. It makes you feel good as the provider knowing that you feel pretty confident that you’re treatments can work for this patient. I don’t know how many times like I’m sitting there when I’m not using TMS.
I’m like at a hospital and I’m just like, “I hope this works.” For their sake, I want them to get better but this is a tough case and I don’t know. I’m sure. I don’t want them to be unhappy with me. I don’t want them to walk out feeling worse than they did or walk out not feeling any different. For a clinician and for the clients, it would feel good knowing that you’re giving something that is most likely going to work.
I love that it’s not invasive. People can drive to the clinic and drive home. There’s no side effects. I haven’t seen anything else out there that works like TMS works because it always works. There’s no side effects. It doesn’t affect your appetite. You’re not going to gain weight. You can drive to the clinic and home. All the things. There’s just no reason not to give it a shot. I’m excited about the future of TMS. We have two machines here and it’s just becoming more popular. More people are able to utilize the treatment. I’m into it.
When we did our dinner, I was telling some of the therapists. I challenged him. I was like, “Bring me your toughest patient, I’ll treat him for free if you don’t believe in it and if you’re a skeptical. If you want to see this thing in action, send him to me.” We can’t extend this to everybody.
Now, we’re getting a lot of referrals from other providers that don’t offer TMS yet.
We’re going to but another machine.
It’s interesting. More people are becoming aware of it, so more people are going to start wanting the treatment. We’re one of the few providers in Phoenix that offer the treatment, so it’s nice. I’m just grateful that we’re able to offer it. What are some of the other newer treatments that are on the market that you’re excited about?
The Evolution Of Mental Health Treatment: NAD+, Cold Plunges, And Beyond
A big evolution in the medicated assisted treatment offerings. Even know the medications been out for a little while just like TMS. It’s been FDA approved since 2005. It’s a long time. For OPDs disorder, we have long-acting injectable medications that can keep people essentially opioid free for 6 months or 8 months after a couple injections. Different long acting injectables have a lot of promise. It’s one thing I’m excited about and all the different wellness stuff we’re learning and all the longevity stuff and seeing how it’s benefiting people.
I know we got the cold plunge at the at the residential. I already knew because I started doing it. You got me into it and how good I felt after. People are starting to see that these different health benefits that they usually see as maybe taboo or see them online or a certain set of people would be doing those things like the Hubermanns and those people. They try it and they’re like, “I feel good.”
Me watching someone’s anxiety go from a 10 out of 10 to a 2 out of 10 in after 3 minutes in the cold plunge is like, “No medication needed for that.”
Sometimes I’ll do it. I’ll come out and I explained to people like I feel like my body had a mentos. That’s how I feel for like three hours. It feels very good and they say it’s it just as powerful as cocaine or more powerful than cocaine, the dopamine.
It increases dopamine by 250% to 300% for several hours.
Cocaine is like twenty minutes. This is several hours. Seeing people learn about those different treatments and some of the longevity and things like the methylene blue. There’s some other things people are doing, too. NAD and NAD+.
What’s your opinion of NAD? I’ve heard some mixed results.
People that I know that have been doing it, doing the injectable NAD, the subcutaneous injections. I hear that their energy levels are better. They feel more rested when they wake up. I haven’t heard anything bad about NAD+, for sure. You’re seeing a lot more people that even call our treatment center. They’re asking, “Do you guys offer NAD+?” It’s catching on and things usually catch on because they work for a lot of people and that’s a big one. The health and wellness space on that end, we’re using it so much in the treatment industry now.
We never did that before. It’s usually like, “Here’s meds. Here’s group counseling and go to AA.” Now it’s like, “Here’s meds. Here’s group counseling. Here’s the gym, the cold plunge, sauna. We’re doing contrast therapy, NAD, vitamin bags, a guided meditation, and breath work.” There’s so many different things that are being Incorporated now. There’s so many more spokes in that wheel of if feeling.
Mind, body and spirit. What keeps you inspired to do this work every day?
I would say it makes me feel good. For my own recovery, I feel like it’s gaming the system for myself. I’ve always felt like I’ve got more reward helping somebody that never getting anything. I don’t know if that’s just me or maybe you feel that way, too. It feels good to give and much better than receiving. I feel like the more I give, the more I get, which is pretty cool cheat codes. It’s like the more you’re able to give back. It’s like the more I give, the more I feel like I’m blessed in other areas.
I think about AA and doing twelve steps work. The reason why I sponsor someone isn’t necessarily to help them. I sponsor people. I do service work. Yes, I am helping other people but at the end of the day, the reason why I sponsor people, why I chair meetings, and why I do service work is because I want to feel better exactly.
At the end of the day, that’s it. I want to feel better. I want to stay sober. I want to feel good about my behavior. I want to feel good about my life and the things that I do. That’s why I don’t lie, cheat and steal because I don’t want to carry around that guilt and that shame, which makes me feel terrible which is what would lead me potentially back to drink or drug.
For me, growing up, it was always about, what can I get? There’s all these people in the world it’s like they’re always so obsessed with what they can get and what they have and how can they get more. I’ve learned and this is like a good cheat code. It’s like, the more you focus on helping people and giving, the more you just get. It’s weird a concept karma.
The more you focus on helping and giving to people, the more you just get. Share on XCall it karma or whatever you want to call it.
It works. If I’m going to donate money or help somebody out and I’m like, “I don’t want to do.” Whatever. Helps someone. Fix the tires and their car. Nobody’s going to know I did this and it’s like $1,000. I don’t want to do this. You do it and then something cool happens the next day. You’re like, “I know that’s why.” For sure it happens all the time. I’m always able to look back and that keeps you wanting to do more, too.
TMS Affordability & Accessibility: Breaking Down Costs & Equitable Treatment Options
Is there any anything I missed? Is there anything else you wanted to talk about or any other questions I should have asked you?
No questions you should ask. I’ll just touch on the affordability of TMS. This is often not discussed. TMS used to be an expensive treatment. There are so many different ways to get TMS. Either covered by insurance now and very affordable cash rates payment plans. It’s not as expensive as you would think. With people that want TMS or interested in TMS, we always try to find a way to make it equitable. We want everybody to be able to get it and sometimes, we have to work our magic and move things around.
Maybe move appointments around and stuff like that but we want everybody that’s interested in it. Maybe they don’t have the means altogether right at that moment to work with us to be able to figure it out. We want to be equitable. That’s one thing I want to put out there because people look online at the cost of it. If you type in cost of TMS, you’re going to see $200 a session and then you’re going to think about what I told you, 70 sessions. You like, “It’s $15,000. That’s a lot.” If we’re doing Theta burst sessions in two minutes sessions, there’s lots of things we can do to make it affordable.
Dr. Robbie, thank you so much for your time for your time. I appreciate you. For anyone that’s watching or reading, if you or a loved one is struggling with mental health or addiction, you want to learn more about TMS or any of the other things that we talked about. You can give us a call (480) 618-5430 or you can visit CamelbackRecovery.com. Thanks for reading and watching.
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About Dr. Robert Westerman
A leader bridging innovative approaches coupled with gold-standard practice in addiction medicine, Dr. Robbie has spent the last ten years focused on equitable and effective care delivery to thousands of patients seeking mental health treatment.
In 2022, he co-founded Camelback Integrated Health and Wellness to expand access to innovative treatments while reducing barriers to care.
