TMS - Care for Treatment-Resistant Depression

Welcome to Thriving with ADHD, a podcast where we'll share everyday practical tips to thrive in life as an adult with ADHD. This podcast is brought to you by Animo Sanu Psychiatry, a behavioral health practice with a specialist ADHD clinic based in North Carolina. And this is your host, Nada Pupovac. Welcome to Thriving with ADHD, dear ADHD community. I am honored to have a special guest today. His name is Dr. Caleb Whiteneck, a psychiatrist who joined Animo Sanu's team recently,

and whose specialty is TMS treatment for depression and OCD. As our listeners certainly know, ADHD as a condition is not usually present alone. People with ADHD have approximately... 50% chance of having another associated psychiatric condition or comorbidity and depression and OCD are some of them. TMS as a treatment modality is a proven method in helping treatment-resistant depression and OCD.

And we are delighted to have Dr. Whitenack in our team who will be able to provide more information about this type of treatment. Before we jump into the conversation with Caleb, here is a bit more about him. Dr. Whitenack received his doctor of medicine degree from the University of Texas Medical School at Houston.

After medical school, he completed his adult psychiatry residency at the University of North Carolina in Chapel Hill. During the last year of training, he was appointed chief resident over the large residency program. Dr. Whitenack specializes in the diagnosis and treatment of women's mental health issues, ADHD, panic attacks, social anxiety, generalized anxiety, depression, and bipolar disorder.

He utilizes TMS treatment for depression. When not working, Caleb, originally from Denver, Colorado, enjoys the mountains, snowboarding, good food, home brewing beer and traveling with his family. Caleb, welcome to The Thriving with ADHD. Thank you for having me. As I mentioned in the announcement of the episode, ADHD doesn't happen in a vacuum and it is often showing with other mental health conditions and depression and OCD are just some of them.

I think we are very lucky to have someone with your expertise in our team who will be able to tell us more about treatment options when the usual therapy for these mental health conditions is just not working. as it should. That's right. Although we specialize in ADHD, we also specialize in mood disorders. it is really common to have multiple diagnoses at the same time. And case in point,

When you're struggling with ADHD, a lot of times you're also struggling with either or both depression and anxiety as well. And kind of the triad of. adhd depression and anxiety i see pretty often so uh i really look forward to jumping into this conversation and uh

I want to get on with the first question. So what is TMS? This is an aberration. It stands for something. So let's clarify that. And how does it work? Sure. So TMS is transcranial magnetic stimulation and it's a FDA cleared treatment for treatment. resistant depression and it's a non-invasive treatment. So it's not a medicine and it's not a surgery. It's you don't go under anesthesia or anything like that. And it's an outpatient procedure and it.

works and it treats the depression by stimulating the brain with magnetic pulses. Okay. We use a same strength magnet as an MRI, only you don't go in a tube. It's on the outside of just apparatus. sits on the outside of your head and it sends repeated magnetic pulses uh creating magnetic fields and from uh physics right faraday's law that a

magnetic field over an electrically charged substance creates current. And so we create just enough current to actually fire the neurons. And it's a very focused. magnetic field that fires only the neurons that we really want and how it works right is okay we're firing the neurons great why how does that what does that do By firing the neurons over and over and over again, we can then create change. Okay. I look at it as sending your brain to the gym.

You don't go to the gym once and then come out all bulky and big, right? You know, you had to go and work hard at it, right? So we fire the magnet. thousands of times uh over the course of treatment and by doing that it's stimulating the neurons to cause intracellular change downstream effects with neurotransmitters and an actual physical change. It's inducing neuroplasticity and causing increased connections between the neurons.

We have a saying in the TMS world that neurons that fire together, wire together. And that's really important for...

control of these really hard to treat sometimes symptoms. Okay. My next question is, is TMS safe? So TMS is generally considered... a safe procedure. As with any, you know, procedure, there can be some side effects. And so the biggest side effect that we are worried about is a seizure. And that's a big side effect, right? And so statistically, it's less than one in 10,000. Patients will get a seizure with that. And that's why we do such an extensive.

consult and looking at all of the history and making sure that each patient that we set up for TMS is as... good a candidate as possible. And we ask probably about five different times in five different ways, have you or any of your family ever had a seizure? And so we really don't want that to happen, right? But generally, it's just a it's a quick outpatient procedure. The actual treatment lasts about 18 minutes and a half. And you will feel a kind of tapping or thumping.

on the left side of your head. And sometimes that can be, it's a very, it's a unique feeling. You've never felt this feeling before. And so it can take a little bit of time to get used to it, but it shouldn't. hurt there shouldn't be pain associated with it um maybe some discomfort but the word that we use is tolerable it should be tolerable and uh

The first couple days, first two or three days of treatment, you'll feel it more. And then by about the third or fourth treatment, your scalp kind of just... desensitizes or tightens up and, and it just very much becomes a routine procedure and you come in, get the treatment and then you, you leave. Okay. So yeah, no, go ahead. Yeah, I suppose maybe we can talk about, so you touched on this, how the session looks and feels like, but maybe you would like to elaborate on that.

Sure. Yeah. So your very first session with TMS, you'll come in, you'll fill out some rating scales and consents and paperwork and get that all out of the way. You'll meet the tech. You'll get comfortable in the treatment chair. We'll talk through what the apparatus is, the magnet, and all of that. Then you'll get... comfortable and we'll make measurements in the chair so that it's repeatable. And the tech will have your chair all set up, ready to go for you each session. And so you sit down.

I then take some measurements of your head and start trying to find the treatment location. And so that's a process that we use. We make little micro movements up and down and left and right and fire the magnet.

in single pulses and what we're doing is we're actually looking for a movement in your right hand so we stimulate the left side of the brain but we're looking for a movement in the right because of the way that there's a crossover in the brain is pretty neat, but we're going to be able to stimulate your hand and we're looking to try to isolate movements in your thumb or.

in between your thumb and pointer finger or your pointer finger. And that gives the computer a... roadmap so to speak of how to calculate the treatment location the treatment location is a very specific part of the brain called the left dorsolateral prefrontal cortex or basically the kind of left front side of your brain. And that's where we're trying to treat.

once we find that location the computer calculates that for us and then then you're ready for your first treatment so what patients can expect

from TMS as a treatment. Yeah. So a good patient for TMS is someone who is depressed. and has tried so many different medicines. They've done their hard work in taking the medicine. They've gone to the appointments and they've been through therapy and they've tried. So many different ways, but they just haven't had success in their treatment goals. That's a great patient for TMS because it's not a medicine.

that you don't have to worry about those kind of, you know, chemical kind of side effects. And so what to expect is... Hopefully a big improvement in depression. The numbers are really, really good. And improvement numbers are just. much better than any medicine that we have on the market. But it doesn't happen immediately.

Right. So just like remembering going to the gym and it doesn't happen overnight. Most people don't notice anything that first week of treatment. Okay. So you get through the first week of treatment. Then into the second week of treatment, some people start noticing small changes. They have a little more motivation. It's a little easier to sleep.

Their energy might be a little bit better. Maybe their negative thoughts are not quite as intense or not quite as often. Something. They're noticing something, but they're still very depressed. By week three, now we're starting to gain some traction and symptoms are improving. Numbers are dropping on the depression rating scales. There's a little hope building that, wow, maybe this is actually going to make a difference. Hopefully by the end of treatment.

There's been a steady improvement, a steady decline in depressive symptoms, and we reach remission. of depression, meaning that on the depression rating scales, you don't even meet criteria for depression anymore, which that's our goal. Not everybody reaches that, but that is always our goal.

Okay. And I would like to wrap up this conversation with the questions we like to ask oral guests. If there is... one important thing you would like our listeners to remember from this session and this conversation what that would be so i would want everybody

with depression to know that TMS is a non-invasive option for treatment of the depression without... changing medicine, without trying another medicine, but just that there is another option besides trying another medicine to treat the depression and it works. really well. And so don't give up hope. There is another option if medicine hasn't worked for you and consider the TMS as an option for the treatment.

That's excellent. Thank you so much, Caleb, for this informative conversation. I am impressed by science and technology and that... It's now able to help people in mental health field. And there is loads of hope for our patients, of course. Yes. It's so rewarding to see people. Sometimes who have struggled for decades, you know, 30, 40 years of depression. And within a few weeks, give some relief that they've never had.

before um so it keeps me doing it and uh just is uh encouraging to me that's that's fantastic news and we are very lucky to have you on our team and that this treatment option will be available to our patients. That's so amazing. Thank you. Thank you so much. And I hope to have you in some other episode that so we can talk more about TMS. Thanks so much. Sounds great. Yeah. Bye-bye. Thank you for listening to Thriving with ADHD.

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