Services offered at TMS Therapeutics in San Diego:
Transcranial Magnetic Stimulation
Theta Burst Stimulation
- Spravato (esketamine)
- Ketamine injections
- Genesight testing
Transcranial Magnetic Stimulation:
Transcranial Magnetic Stimulation (TMS) is a non-invasive treatment for Major Depression cleared for use by the FDA in October 2008. TMS has been researched for decades and is now clinically available. Given in an office setting without anesthesia, treatments last about 30 minutes and are typically given 5 days a week for four to six weeks. Magnetic pulses, generated by a treatment coil, are used to stimulate specific mood centers of the brain.
TMS is the only non-invasive form of magnetic brain stimulation therapy available today. However, brain stimulation as a treatment for depression is hardly new. Electroconvulsive Therapy (ECT) is an effective form of brain stimulation that has been used for decades and is still in use today. It is usually done in an inpatient hospital setting and requires general anesthesia. ECT uses an electrical current to trigger a generalized seizure in the brain, this causes firing of neurons throughout the brain but can have significant side effects such as memory loss.
In recent years, the FDA has cleared the use of Vagal Nerve Stimulation (VNS) as another treatment for depression. In VNS, a pace-maker like battery pack is implanted in the chest and an electrode is attached to the Vagus nerve which runs down the center of the body. The nerve, which goes to the brain, is regularly stimulated by the electrode. This depression treatment seems to help about 30% of patients with refractory depression. Deep Brain Stimulation (DBS) is another type of stimulation therapy using a battery pack and electrodes. In DBS the electrodes are surgically placed directly into or on the brain. This has been shown to be an effective treatment for several conditions such as Parkinson’s disease and Obsessive Compulsive Disorder (OCD) and is currently in clinical trials for use in depression.
With TMS, electrical currents are induced in brain cells in a very specific region using pulsed magnetic fields. The TMS machine uses a strong electrical pulse in the treatment coil to create a magnetic pulse that travels across the hair, scalp, and skull, to induce electrical currents in the nerve cells of the brain. Directed at a very specific area of the brain, the pre-frontal cortex, these currents are strong enough to stimulate brain activity but mild enough so as not to induce a seizure.
For FDA clearance, TMS was studied in patients who had failed at least one adequate trial of an antidepressant medication. In this population, in an open clinical trial, about half the patients showed good response to the treatments with about a third of patients feeling completely better. TMS has been cleared for use by the FDA as a treatment for Major Depression. TMS is now being studied for use in other conditions as well.
Theta Burst Stimulation:
Theta burst stimulation (TBS) is a form of patterned TMS which makes it possible to induce strong and long-lasting effects using a lower stimulation intensity and a shorter time of stimulation compared to standard TMS protocols. This means that if you use TBS instead of standard TMS to treat your patients, you will be able to treat 5 times more patients which makes TBS depression treatment much more cost-effective.
In the FDA cleared TBS protocol, the theta burst stimulation is applied in 50Hz triplet bursts five times per second. It is an intermittent theta burst stimulation (iTBS) which means that the stimulations are delivered in a cycle of 2 seconds on and 8 seconds off. This pattern is found to have an excitatory effect whose potency matches or exceeds much longer sessions of standard TMS.
Spravato (esketamine):
Spravato (esketamine) is a prescription medicine, used along with an oral antidepressant to treat:
Adults with treatment-resistant depression (TRD)
- Depressive symptoms in adults with major depressive disorder (MDD) with suicidal thoughts or actions
- Spravato (esketamine) is given twice a week for four weeks, after which your HCP will determine if continued treatment is necessary
- Administered in a certified medical office where the health care provider can monitor the patient
- FDA approved in 2019
Pharmacogenetic testing:
Finding the right treatment:
“Personalized medicine” is a somewhat new medical model that uses patient specific information, such as your own genetic makeup (or genotype) in order to enable an individualized approach to treatment.
There are several commercially available tests to determine your unique DNA profile. This information can be used to guide treatment decisions.
Most of the available tests provide information about how the body works to metabolize a medication (pharmacokinetic interactions). An abnormality may predict increased side effects or suggest higher than usually doses will be required to achieve the desired effect. There are also markers that predict what a medication will do to the person’s body based on genetically coded proteins and receptors (pharmacodynamic interactions).
Pharmacogenomics versus pharmacogenetics:
The term pharmacogenomics is often used interchangeably with pharmacogenetics. Although both terms relate to drug response based on genetic influences, pharmacogenetics focuses on single drug-gene interactions, while pharmacogenomics encompasses a more genome-wide association approach.
While other factors may be involved, someone’s DNA profile remains the same throughout their lifetime. Therefore, once pharmacogenomic testing has been completed, information regarding tolerability and response to medications and treatments that haven’t even been developed yet will be possible.
What to expect:
At your appointment, I will take a brief history and determine if pharmacogenomic testing is indicated. A sample will be collected, usually via a check swab or from saliva. Once the results are available, I will forward a copy to you for your records and discuss the results with you (this can be done in person or over the phone).
My fee is payable at the time of service. This is expressly for testing and does not establish a patient-doctor relationship.
There will be a separate fee for laboratory services. This may or may not be covered by your insurance. I suggest you contact the billing department of the company running the test prior to ordering.