Jessi Gold: I'd imagine patients don't get exposed to magnets in their brains very often. Probably the only thing they know from magnets would either be like, the little kid toys or maybe an MRI or something like that. Does that come up? Are people nervous about the idea of a magnet on their brain?
Bermudes: We get a lot of responses when we talk to patients about this procedure. I think it really depends on the patient, how they're conceptualizing their depression, or how they've been taught to think about their depression. Certainly, the experience of treatments and then, what treatments they're also being offered. For example, if I'm talking to a patient who's been on five, six, ten antidepressants and has suffered a lot of side effects, maybe have had an MRI in their life. The fact that it's a magnetic field, you know, they've had the MRI before, they know that's tolerable. Had side effects from the antidepressants, it's generally not a big deal to think about. Particularly for patients with moderate or moderately high or severe depression. They've been suffering for years.
It's not a first line of treatment. It's generally third, fourth, fifth line treatment. For the right patient population, it's actually pretty acceptable. Sometimes we have to clarify that it's not ECT. Patients will ask, "Are you going to shock my brain?" We're not generating a seizure. This is sub-seizure threshold. TMS actually introduced the idea that we could do neuro-modulation without generating a seizure and improve mood.
Jessi Gold: Since you brought up ECT, is there a reason why TMS doesn't get the reaction that ECT has? You know, right outside there were protestors. People tend to be pretty scared of ECT. The press has kind of destroyed it at one point and it's come back into fruition. They don't necessarily know it's better. Is there a reason TMS hasn't had that same reaction?
Bermudes: I'm a big believer in ECT. I used to do ECT. It's a very powerful treatment, very effective treatment. We don't have to overcome the kind of stigma that I used to have with patients who were getting consultated for ECT. I think some of the reasons, you know, not having to go under general anesthesia. It's a treatment that is accessible for patients who aren't as severely ill as those who are getting ECT. It's an outpatient setting. There's been no cognitive side effects associated with this procedure. All the modern day stimulation protocols for ECT, the cognitive side effects are pretty mild to non-existent.
You know, you started battling that legacy with ECT. I think people have been able to differentiate the two treatments.
David Carreon: You say it's not shocking the brain, but come on, it's a pretty powerful magnet you're putting out. 1.5 Teslas for a lot of these guys. That's a pretty hefty stimulation, isn't it?
Bermudes: Yeah, so it's kind of an interesting dynamic when we're demonstrating this with patients, because on the one hand, I'm saying, "Yeah, it's a fairly benign procedure. The seizure is rare. It's a benign procedure. The seizure is rare. It's not what we're trying to induce. Here I'm going to place this over your meta-cortex, and I'm going to get your thumb to move." That's a pretty powerful demonstration of how we can do non-invasive neuro-modulation at this point in time. It is powerful, but it doesn't have that stigma.