Healing The Brain Through TMS

 

You must know the right type of depression that a person is going through to provide them with appropriate treatments – but not with TMS. Tim Westbrook, MS sits down with Dr. Robbie Westerman, who breaks down how Transcranial Magnetic Stimulation works even without knowing someone’s exact medication or diagnosis. He explains how TMS rebalances neurotransmitters without limitations of traditional pharmacologic approaches to help patients freely feel their emotions. Dr. Robbie also discusses how TMS differs from ketamine-assisted therapies and what must be done to make this treatment method more accessible to the public.

—

Watch the episode here

 

Listen to the podcast here

 

Healing The Brain Through TMS

What is Transcranial Magnetic Stimulation? What is TMS? What’s the difference between TMS and a psychedelic, or ketamine, or ketamine-assisted therapy, or psilocybin, or any of the others? We’re going to talk about how it works on the brain because it’s different. I’ve seen people relapse as a result of doing ketamine. For some people, early on in recovery, ketamine might not be the best solution for them. TMS is another route. Chad, you wanted to learn more about it. You want to use this as a resource. We want to use you as a resource. I’m going to hand things over to Robbie. I want this conversation to be more between you two.

Thanks, Tim. Chad, welcome. It’s important to understand how TMS works first. You look at this thing and you’re like, “How does this work?” I was skeptical, too. I always look at stuff and I’m like, “What’s the science behind it? Is it some kind of snake oil? How does it work?” When I was first introduced to it, I did not know how it worked. I was unfamiliar with how it works.

How To Diagnose And Treat Different Types Of Depression

I’ll explain how it works and then why we find more superior results with this than medications. It’s on an even playing field with ketamine, given what I’ve seen. First of all, when we’re diagnosing somebody and we’re looking at depression or anxiety, we have to understand that there are different types of depression. With the type of depression you had, was it a tired depression?

It was a major depression.

Everyone’s depression looks a little different. Some people are depressed, and they’re walking around fine. They don’t have low-energy depression. We call that anergic depression, where they’re able to get around, but they feel like crap. There are people who have tired type depression. They can’t get out of bed. There are some people who have anxious depression. Their minds are always spinning, and all those thoughts are wearing them down.

It’s important as a diagnostician to identify what kind of depression that person has because that’s going to drive a pharmacologic choice. I’m not going to give somebody who has certain types of depression stimulating medications like Wellbutrin or Effexor. If somebody has a tired type of depression, I’m going to give them something more stimulating because I want the dopamine and norepinephrine to get them up and get them going.

With all that being said, when you’re a clinician, sometimes, it’s very difficult to get the right diagnoses off the bat because people present differently. Not only that, but we have genetic factors. How many of you, with the raise of hands, have tried more than one different antidepressant? That’s everyone. You know the answer to this. How many of you have tried different antidepressants in the same class? That’d be Lexapro, Prozac, and Zoloft. Why would you think we tried different antidepressants in the same class? Anybody?

No clue.

It’s because we have different enzymes that break down the antidepressants into their active metabolites, and how they become available or bioavailable. If Lexapro is not working for them, we go to a different antidepressant that’s broken down by a different enzyme. We may move classes to SNRI, like Effexor, Bupropion, or even to some old ones like Mirtazapine, TCA, or some different kind of antidepressant.

We have enzymatic differences that break down medications, and then we also have getting the diagnoses right. You look at how many permutations of how that can go wrong. If I get the wrong diagnosis and I say someone has anergic depression and they don’t, and then I go to this stimulating medication, and then there are 5 or 6 different meds in that class, every 6 weeks, you’re changing a medication. How long did you spend cycling through meds?

Twenty years.

That takes a long time. If you start out with the wrong diagnoses, you’re going to start out with a whole class of medications that aren’t even targeting your true symptoms. That’s why getting the diagnosis accurate is important. I’m not a big fan of diagnoses. I’m more of a big fan of symptoms. Symptoms are more important than a label. The DSM is so vague and broad that everyone can qualify for seven different diagnoses. Has anyone ever looked at it and said, “I got that.” We’ve all looked at it.

How Does TMS Works Even Without The Right Diagnosis

With TMS, we’re doing the same thing. We’re targeting neurotransmitters. Let’s say people who have depression may have issues with serotonin, dopamine, and norepinephrine. Typically, what we would do is we’d give an antidepressant that would target those neurotransmitters. For instance, we give an SSRI, a Selective Serotonin Reuptake Inhibitor.

What happens is when you take that, it blocks serotonin from getting pulled back up into the cell, so it’s able to be bioavailable longer in the body to be used. That’s what an SSRI does. The body says, “We’re not getting a reuptake of our serotonin. We need to make more.” Your body starts making more because there’s a blockage of the serotonin returning into the cell. That’s how we make more of those neurotransmitters that we’re deficient in, like dopamine, serotonin, or norepinephrine. We’re using the medications to do that.

With TMS, what we are doing is using magnets to depolarize and polarize neurotransmitters. We’re turning them on. We have calcium-gated ion channels and all this other stuff that happens, and we’re turning them on. That’s why we see people’s hands move. If you’ve ever done it, we can move your hands with it. We’re turning on neurotransmitters and turning them off very fast.

What the body is able to do is it’s able to recognize those deficits and excesses. The body starts rebalancing the neurotransmitters without blocking or impeding certain neurologic processes. We don’t have to get the diagnoses. It’s not dependent on the enzymes. We call them the CYP enzymes, the 2D6, and the 3A4. We have all these different enzymes that work on medications. We don’t have to get any of that because, globally, we’re firing everything. We don’t have to get the right diagnoses. We don’t have to use the right medication. We don’t have to know exactly what’s going on for TMS to work.

TMS does not need to know the right diagnosis or use the right medication to work effectively. Share on X

It’s not new science. The science has been around for a very long time since the ‘80s. TRICARE or the Military believes heavily in it, too, because there’s no prior authorization needed for it. They cover it right off the writ. With insurance companies, that tells you something. There are a lot of insurance companies out there that cover it without any prior authorization or two failed medications.

It used to be four failed medications, right?

It used to be four. When you think about how insurance works, what are they all about? Saving money. When you start to see services that don’t require prior authorization, you’ve got to think in your head, “Why are they doing that?” It must result in less medications, less hospitalizations, and less treatment care in the long run. They’re not stupid, these insurance companies. They’re very profit-driven. When you start to see stuff approved without any insurance authorization, you start to ask some questions. They’re seeing something. It used to be very hard to get it approved. Now, it’s fairly easy to get approved. I’ll start with that, and then I’ll start taking any questions you may have.

Difference Between EMDR And TMS

For me, I always hear EMDR. What is the difference between EMDR and TMS?

I’m not an EMDR expert, but TMS is working on electrical circuits. It’s more of a neurologic approach. In EMDR, we’re trying to bring stuff up and work through painful, distressing memories and reprocess those. In TMS, we’re trying to get you into a homeostatic neurologic setting so your brain is working as it should. All those other therapies work even better. If you start a good neurological balance, all those other therapies work much better. It doesn’t just work for depression.

TMS tries to get you into a homeostatic neurologic setting to increase the effectiveness of therapies. Share on X

How would TMS have worked for someone like Chad with PTSD and trauma?

For PTSD and trauma, we go back to how the body responds. We have the fight or flight response. It’s interesting. A lot of people live in that response all the time. When we live in that response, there are physiological changes that happen to our bodies. Have you guys ever heard of fight or flight? What happens when we go into fight or flight is that we have an increase in cortisol, and we have a shunting or a change in blood flow. Blood moves into the heart, lungs, hands, and feet, and it moves away from the frontal lobe. When we’re in fight or flight, or we have test anxiety or something like that, do any of you relate to not being able to recall information, speak, or maybe your chest is tight when you’re trying to talk in public?

Yeah.

You’re going into that fight or flight response. We have those physiological changes in our bodies. There are some interesting studies of people in war-torn countries and the moms who are constantly in that kind of state. They see children born with slightly elongated limbs, a smaller frontal lobe, a bigger heart, and bigger lungs because that shunting and blood flow is passed in utero.

For some of us, who maybe our mothers had a stressful pregnancy, we’re more prone to live in that fight or flight response. When that fight or flight response, or we call it the alarm system, overtakes our salient system, which is our reward system, that’s a problem. People live in that all the time. Different triggers can trigger that alarm system to take over the salient system, which goes into fight or flight.

What TMS does is it recalibrates the neurotransmitters, so we don’t have so much shifting into that response. We’re living in the moment. We’re able to experience motions in real time. The best way I can explain it, and people tell me this all the time, is when people are depressed or anxious, they usually wake up and see everything through the lens of that depression. Even if something good happens, like you get a job or whatever, you’re still looking at everything through that lens of being mildly depressed.

When people complete TMS, what they describe to me is that they’re able to experience emotions in real time. Somebody makes you mad or pissed, and then you’re over it. When you have a good event or something, you feel jazzed up, and then you’re moving on. You’re shifting through emotions in real time. You’re not wearing glasses of being depressed or living in the future of what you think may go wrong, or living in the past of what did go wrong and how you can’t go back. It’s being in conscious contact with your higher power or whatever you want to call that. People who live in that conscious state tend to have better outcomes and live happier and healthier lives.

What are you seeing as far as how many sessions before you start seeing a turnover?

Typically, at about twenty sessions, you start to notice a difference. The protocol calls for 36 sessions. That’s what the FDA indicated amount is, but we give a lot more than that here. We give at least 72, which is double. When we’re looking at the FDA and how they approve things, when there’s enough separation from a sham or a fake helmet, then that’s when they say, “This is effective. We can stop the studies.”

Insurance isn’t going to keep paying for it if there are small incremental gains after the big gain. What we’ve seen is that people who do more sessions get better, but it’s slower after the 36. Typically, payers will pay for the ten-point drop in the PHQ-9 because that’s what led to approval, but they’re not going to keep paying if it’s dropping down 1 point every 3 or 4 weeks.

What’s the longevity of this?

In my 4 years of doing this, I’ve had 1 re-treatment, so it’s very durable. I know with ketamine, the first couple of sessions are not very durable. That’s why you have to go back. The durability builds up after you do a few sessions. The same is true with TMS. In the long run, though, it is durable. I’d put it up against any modality, for sure.

The Need For A Bigger Push For TMS

Why do you think there’s not a bigger push for something like this with the success rate that it has?

It was very niche for a long time. Celebrities would get it. People who had money would go get TMS. It’s been around. This machine’s been FDA-approved since 2003. TMS has been around since the ‘80s.

 

I’ve barely heard of it.

There was no coverage for it. It was very expensive. The machines were expensive. The machines are still expensive, so not everyone can offer it. With technology and costs going down to make these kinds of things, it’s becoming more widespread. There is quite a bit of attention on it. It’s still coming more into the mainstream.

I have a medical student here. He is a year four medical student from Tennessee. He’s in year four, and he has never heard of this. I work with a psychiatrist online, doing some mentoring and coaching. He is a psychiatrist who did four years of residency. He had heard of it, but he didn’t know anything about it, though. Nothing. Zero. They don’t teach it like nutrition in medical school.

To use this as an example, let’s say the brain is a battery and it dies out. That jumpstarts not necessarily to reality, but to get your motions balanced.

As far as rebalancing neurotransmitters and doing a hard reset on the wiring of the brain, that’s exactly what it does. Especially people with anxiety, and this is so interesting, anxiety is fueled by a neurotransmitter called glutamate. I call glutamate the Tigger chemical. We got Tigger, and then we got Eeyore. The other chemical, the Eeyore chemical, is called GABA. We have GABA, and we have glutamate. Those two neurotransmitters work exactly opposite.

When we’re drinking alcohol, we’re potentiating or making more GABA. We’re calming ourselves down. What the body does when we’re putting alcohol or benzodiazepines into the system and calming down that glutamate response is the body says, “We still need glutamate to fire our muscles and run our thoughts.” The body counter responds and starts making more glutamate or making more Tigger.

If you think about someone who’s been using chronic alcohol and they’re putting all that Eeyore into their body, and they stop drinking, what do we have a lot of leftover? That’s what seizures are. That’s how we have alcohol-induced seizures. We have excess glutamate. Your body has been suppressed for so long that it’s been trying to make more to offset it. That’s why we see people who use long-term benzodiazepines and alcohol are usually very anxious people.

People who have generalized anxiety also have excess glutamate in the brain. That’s why when I put the machine on someone who has anxiety, I barely turn that machine on, and their hand starts moving like crazy. Whereas I get someone that’s chronically depressed, I can crank that machine almost all the way up, and I get no hand movement at all.

What we’re doing is if somebody has high anxiety and their hands are moving with very low energy, over the course of time, I’m able to turn that machine up. It takes less energy to fire those neurotransmitters, which tells me they’re having an easier time balancing their emotions and staying levelheaded. They are able to normally shift through emotions instead of being hyperadrenergic or always on edge.

I got out of rehab. There was a girl there who needed a seizure dog because when she drank, she had seizures. That would be perfect for her, right?

Remember, what we’re doing is we’re firing neurotransmitters with this. We would not want to give it to somebody who has any kind of seizure problem because it can potentiate seizures, because they already have a low seizure threshold.

If the VA knows this thing works, why is this not on every floor in the VA? As soon as you get out, why are you not sitting with one of these machines?

I ask myself that all the time. The VA is a fan of it because they approve of it, no questions asked. They’ve never denied a veteran TMS or even active duty. I’ve never seen it denied. It helps them. I think that there’s still so much mystery about what it is. The VA is a very overcrowded system, and it’s antiquated, too. A lot of my patients come in, and they’re still on medications that I haven’t seen since 1945. I’m like, “I didn’t even know they make that anymore.” That tells me that the doctors in the VA system may be overworked, and they’re not able to explore these new therapies.

They are tuned out, essentially.

Maybe they don’t have the time. Maybe it’s the caseload. It’s not like private practice, where I have time to explore these new things, research them, and try them. I call it track meet medicine. It’s track meet medicine. It’s like, “You. Next.” They do have some TMS offerings at the VA, but it’s very minimal or few and far between. Also, it costs money to do. You’ve got to pay the technicians to run the machines. The machines require upkeep.

If you hand out pills, that’s pretty easy.

A lot of times, farm companies have deals with the VA and insurance companies, so it’s very low cost for them.

They get back pay on that, too.

It’s very low-cost and easy to do.

Difference Between Ketamine And TMS

How would you compare the results of TMS versus the results of ketamine or another?

When we look at what ketamine does, ketamine is a disassociate. It’s not technically a psychedelic, but people can have a psychedelic experience on ketamine. What ketamine does is it works on a system called NMDA, which is GABA and glutamate. NMDA is the same system as benzos and alcohol, which is GABA and glutamate. What ketamine is doing is inhibiting a response in the brain through that mechanism, and we’re having firing of neurotransmitters. We call it burst firing. That’s what ketamine is causing. What are we doing with TMS?

Burst firing.

It’s by and large some of the same principles that ketamine works. It’s through the same kind of electrical mechanism and getting stuff to fire, rewire, and talk again to each other.

Does ketamine work better for certain diagnoses than other things?

What we notice is that the people who are good candidates for ketamine have a lot of trauma that they’re not able to bring to the forefront of their minds. Maybe it’s locked away. Maybe it’s childhood. Maybe it’s something that happened at seven that you’re not sure of. Your brain is always in this protective mode. It’s always trying to protect you from physical threats or emotional threats.

Something comes up that’s very distressing, and your body’s response is to close that off. It’s like, “Let’s try to drink it away. Let’s act out. Let’s run away from it.” What ketamine does is it removes that blockade from the trauma in the frontal lobe. It’s able to come in, and you’re able to experience it. That’s why the prep work and the integration are so important. It’s not advisable to throw someone in a room and give them ketamine. The stuff comes up, and then what do you do with it? That’s why a lot of the home programs, you have to be careful with that kind of stuff.

I am not a big fan of the home programs.

You have to be careful with it because if you’re bringing all that stuff up, what do you do next? It’s not just about bringing it up. The next part is the more important part. The therapeutic process is the most important part. Ketamine is a tool to get us the material to work on. It’s not the solution. It’s the same thing with TMS. It’s to get us into a place where we’re able to process things without dysregulating. We’re able to work through those things without becoming dysregulated.

In your opinion, why do you think ketamine is addictive? We’ve seen lots of people who have relapsed.

There’s a criterion. First of all, the definition of addiction is any chemical that causes a dopamine release in this area of the brain we call the nucleus accumbens. That’s our pleasure center. There are lots of things that are addictive, not just drugs. There’s sex, gambling, you name it. Anything that can cause that release is addictive. Any chemical that causes that release is, by definition, an addictive substance, and it has to be labeled as such, like ketamine. That’s the criteria for a drug to be labeled as potential addiction or dependence on it.

We’re using a substance to not feel. I wouldn’t call it to feel better, but to not feel. Most of us don’t use alcohol or drugs to feel better. We use alcohol and drugs to not feel. We don’t want to feel right. That’s why people are like, “I need my Xanax so I don’t have a panic attack.” You need your Xanax because you don’t want to feel life because it’s too hard. When we’re using it in the sense to not feel and not experience emotions, then that’s where we see a big problem.

We do not use alcohol or drugs to feel better. We use them to not feel anything. Share on X

People in early recovery get sober. They see this mountain of shit that they got to take care of, whether it be all the people they hurt or all the harm they’ve caused. It’s a lot to look at right at the beginning. As you get deeper into your work and you start having some successes where you maybe get a job and get married, and you’re deeper through that stuff, the mountain of crap is smaller, but there are those big things there that you’ve never attacked. That would be someone who’s a better candidate.

When you’re first staring at that stuff and you’re new in recovery, it feels pretty good to not feel again. That can be very alluring to go back to that because you don’t have to deal with it. Whereas for somebody deeper in their recovery, they may have a lot of responsibilities. In early recovery, we’re foregoing a lot of those to get better.

You think differently about things. It’s like people coming off Suboxone. I was on Suboxone. After five years of being on it and improving my life, I’m like, “I don’t care about having the flu for five days. I can handle it. My life’s great. I don’t care if I’m sick for five days.” If I were three months into recovery and I came off it, I don’t know what would’ve happened to me because I would feel like crap. I have nothing going for me. I’m sober living. I don’t have a driver’s license. It’s a lot about where you are in your journey. That can dictate whether you’re ready.

When the brain is compromised, the neurotransmitters are all blurry. The brain heals itself. Going back to the battery, does this help speed it up or help you grow that connection again?

There are a ton of different reasons, too. That’s why I do genetic testing on every patient, too. Raise your hand if you’ve had GeneSight here. A lot of my patients have. I do it to everyone. There are a lot of different reasons why medications don’t work. We have different MTHFR mutations. We have rapid metabolizers, poor metabolizers, and all these different enzymes. Sometimes, it’s very difficult to find an agent, an exercise, or a diet that will speed that up. This jump-starts it.

Some are slower than others to regain all that once you are detoxing. How about genetic testing?

We swab your cheek. It’s usually covered by insurance. We offer it to everybody. If you’ve been through the residential treatment center here at Camelback Recovery, you’ve gotten GeneSight, for sure. Most of you who are patients in the PHP and IOP, a good chunk of you have gotten it as well.

You talk about that big pile of stuff that somebody feels newly in recovery and maybe doing ketamine. Ketamine is a way to numb. Could TMS be a way for someone to numb? When is somebody a good candidate for TMS?

TMS is not there to numb you. It’s there to make you feel. That’s what we’re going after. It’s there for you to react normally, not live in the alert system, and be able to shift through emotions. People are candidates for TMS usually immediately. There are no real requirements other than you don’t have a seizure disorder. This uses magnets, so you don’t want any metal implanted in the head. That could be nasty if a magnet turns on. Probably TBI, even though they may say the ligature is okay. Right off the beginning or right at the start, people are candidates.

OCD Helmet And Other New Products Coming Out

There are some new indications that may come about.

They’re looking at it for all sorts of different things. When we look at TMS, there are different helmets. There’s this one we call the H1 helmet. It targets the dorsal lateral prefrontal cortex. We have other coils that target different parts of the brain, and they may work on different ailments. OCD is one. We have an OCD helmet. The H1 targets everything, but the OCD helmet specifically targets that part of the brain.

We have smoking cessation. It’s FDA-approved for smoking addiction, but we know that for any type of addiction, they all work very similarly. We’ve seen it help in all sorts of different addictions. We’ve seen PTSD. It’s very helpful in PTSD, which may be an indication coming soon for the Brainsway helmets here. I’ve seen it work very well on ADHD, too.

Chad, do you want to try out the helmet?

We don’t have a plug for it here. It requires a special plug. We can do it after. With the staff here, I always offer to them. If people are doubtful about it, we always try to test them and say, “Come try it then, or talk to people who have done it.”

For me, with all the people that we get that reach out to us, immediately, I know psychedelics or ketamine is not a good entry point. Having a viable option like this would be huge because then we can get someone through the doorway to slow down the brain to think in a different manner and start feeling the feels. If they go to step two, which is the rabbit hole, then we could guide them in that process. This would be a huge tool for us to offer.

Remember, what ketamine does, too, is ketamine replicates neural pathways. It makes more of neurogenesis. We make more neural pathways and more neurons. Why wouldn’t we want to regulate our neurotransmitter activity before we replicate? Doesn’t that make sense to you? We want to regulate activity. We want to regulate dopamine, glutamate, norepinephrine, serotonin, and all those neurotransmitters.

There’s a lot of good data behind this that comes in with ketamine to replicate that. We don’t want to build crappy roads and then make more of them. That’s not a good idea. If we have a construction site going and we’re making roads with potholes and cracks in them, we don’t want to make more of them. Wouldn’t you rather clean those up first and then make more of them? We see a lot of good data. That’s why Dr. Bermudes does ketamine after TMS. There’s very good data that shows that after we regulate neurotransmitter activity with TMS, we can go in and replicate.

Is there a certain age at which you shouldn’t use this? What about kids?

We treat kids all the time. It’s FDA approved for fifteen and up, but I’ve treated younger. It’s more at the discretion of the treating provider.

Is it still at 36 where you start seeing the wheels turn?

After twenty sessions, you start seeing the wheels turn, but there are different protocols. There’s a protocol called the Saint Protocol. You’re getting a bunch of sessions each day. You can do it in a week or finish it in one week. You do 10 sessions a day for 5 days, which is super cool. You do 3 sessions, take an hour break, 3 sessions, take an hour break, 3 sessions, take an hour break, and then 1 session. You do that for five days. You can do it very quickly. The problem is, insurance doesn’t cover that protocol, although it is FDA-approved. They’re behind on what they pay for, but insurance will cover 1 session a day for 5 days, and you do that over 6 weeks. There are different ways to get better faster.

You said the ketamine falls afterwards. After 1 or 2 sessions, what does the person feel?

There are almost no side effects.

That’s even better.

For the sake of the discussion, we can say there’s nothing wrong.

Usually, the people around them tell you first. It’s always the patient last. We had a woman in here a few months ago. Her husband was a physician. He’s like, “I’ve tried everything.” She was in here crying and yelling at me because I didn’t read her intake forms. I didn’t know that they were there. You could tell she was in a very bad place. After three weeks, when she came in, she looked a lot better. She was smiling. I said, “Do you feel better?” She’s like, “No, not really.” Her husband brought me to the side and was like, “She’s so much better. Don’t listen to her.” I’m like, “Okay.”

Sometimes, we’re the last to notice. It takes a while for people’s own self-awareness to catch up to how they’re presenting. Oftentimes, the family members will tell us first, “They look so much better.” The patients, usually at the end, say they feel a lot better, less emotional, and less angry. They wake up in a better mood, feel more productive, and all those things.

 

Episode Wrap-Up And Closing Words

Anything else that we should have asked you that we missed?

Not unless you guys can think of anything. This is the best available treatment we have. I believe that in my heart. This is coming from somebody who’s very skeptical about everything. Even with medications, it’s 30% effective. That’s not very good odds.

Placebo is better.

If you look at trials, too, they put people in nice hotel rooms, and you’re taking antidepressants in a trial. Are you going to feel better at the Ritz, getting taken care of while you’re doing a placebo-controlled trial? Probably.

You said 36 sessions or whatever. After that, is there a maintenance session that you want to do every couple of months?

No. There’s no maintenance. In my experience, I’ve never seen anyone do maintenance sessions.

Insurance will pay for a re-treatment after 6 months or 12 months.

They’ll pay for a re-treatment.

Our experience is that we haven’t needed to re-treat.

We try to give people extra sessions. We give people twice as many sessions as insurance covers. Insurance pays us for 36 sessions. We give everyone 72. Every single patient gets 72 sessions, so they get twice as many sessions. They get basically half. They get another 36 for free because it works. They refer people, which is great, to come do it and feel better, too.

I wouldn’t say I wouldn’t have to depend on re-treatments, but we don’t want people to come back. We want people to get better and not come back. If you do a good job, you’re not going to have repeat customers in this field. You shouldn’t. Whereas you know, hospital systems depend on people coming back through the door. We want people to get better and not come back. This speaks volumes..

We’re in this program for a reason. How does one know if you need that? How would you know I’ve had enough sessions?

If you have a major insurance carrier, such as UnitedHealthcare, Blue Cross, Blue Shield, Aetna, and the big ones, and you’ve failed two antidepressants, then you could be a candidate. These are antidepressants. You have to look this up because some people are like, “I failed Xanax.” That’s not an antidepressant. That’s a benzo. They’re like, “I failed Buspar. Right. That’s not an antidepressant. That’s an anxiolytic. It’s an anxiety medication. Two antidepressants. That’d be Paxil, Prozac, Zoloft, Wellbutrin, Effexor, and those kinds of medications. ABILIFY counts. Olanzapine counts. A couple of them count.

You have to be on an antidepressant.

You don’t have to be in two failed trials. In insurance, some of them are picky about whether it’s been in the last five years, to which some of them are not. If you’ve tried two antidepressants and they have not worked, and you’re still depressed, then the likelihood is we can get TMS approved.

 

What if I’ve never had antidepressants?

It depends. Not for insurance coverage. They’re very picky about that. We do a good job of getting it to people who need it, trying to be reasonable with pricing, and working stuff out if we can. We’ve given a lot of TMS away more than we should have.

That’s good for now.

I appreciate you coming down.

Thank you.

Thanks, Chad. Thanks, Robbie.

If you guys have any questions, come see me or when Connor is here. If you guys want GeneSight and you haven’t had it yet, or you’re interested in TMS and you want to see if you’re a candidate and what coverage would look like, then let us know. We’ll take a look. Our team’s great. Desiree and Ryan are great. If you’re a candidate and you can get approved, then there’s a 99% likelihood that you will.

 

Important Links

• Robbie Westerman on LinkedIn
• Chad McLean on LinkedIn
• Mental Joe

 

About Robbie Westerman

Dr. Robbie is a psychiatric mental health nurse practitioner who has been working in the recovery field for over 9yrs. He has worked at the world renowned Meadows for the last nine years providing the most advanced treatments in trauma and addiction medicine.

Robbie’s own development including social and neurobiological models have stood out amongst his peers and is becoming a sought after consultant by many agencies.

He uses his Urge Theory combined with Developmental Trauma to explain complicated disorders and target treatment.

 

About Chad McLean

Chad McLean is a U.S. Army veteran, mental health advocate, and the founder of Mental Joe Apparel, a company created to raise awareness and funds for non-traditional mental health therapies.

The brand emerged from his own struggles with mental health and a subsequent suicide attempt in 2020, which ultimately led him to find healing through alternative treatments.