August 26, 2024 • 37 mins
Welcome to another insightful episode of the Mental Wealth Moves podcast, hosted by Casey Dubravcic, owner of Revitalize Ketamine Clinics, ROHCT Wellness Bar, and co-founder of Epik Biosciences. In today's episode, Casey delves into the world of Transcranial Magnetic Stimulation (TMS), more properly referred to as rTMS (with the r denoting the rapidity). Casey speaks with the device representative Cayce Howe of Sebers Medical, the manufacturer of the rTMS device they use at their Revitalize Clinics, the Blossom.
Join Casey and Cayce as they discuss who can benefit from TMS, why it works, and who should consider it as a treatment option. Casey also shares his personal journey into the mental health field and his ethos on treating mental health disorders. This candid conversation reveals how TMS can help individuals become their best selves.
Casey and his wife, Jill, along with their world class team, operate Revitalize Ketamine Clinics in Flagstaff, Sedona, and Prescott Valley, Arizona. With TMS now offered at their Flagstaff and Prescott Valley locations, they are excited to provide this valuable service alongside their expertise in ketamine infusions.
Throughout the episode, Casey sheds light on the misconceptions about TMS, its effectiveness, and the unique benefits it offers compared to traditional treatments. He also highlights the importance of a supportive and positive environment in the healing process.
Tune in to learn more about how TMS is revolutionizing mental health treatment and why it might be the right choice for you or a loved one.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hello and welcome to another Mental Wealth Moves podcast by your host,
Casey Dubrovik, owner and operator of Revitalize Ketamine Clinics, Rocked Wellness Bar,
and co-founder of Epic Biosciences.
In today's episode, Casey and Casey talk TMS, Rapid Transcranial Magnetic Stimulation.
(00:28):
Who is it for, why it works,
who should consider it, a little bit also about Casey's origin story and some
of his ethos going into treatment of all mental health disorders.
It's a great candid conversation that talks about how to become your best self
(00:49):
and what got you into the field of mental health. My name is Casey Dubrovik.
I'm the owner and operator of Revitalize ketamine clinic with my wife, Jill DeRivick.
And we're up here in Flagstaff, Arizona.
We also have clinics in Sedona and Prescott Valley. We just recently started
offering TMS in our Flagstaff and Prescott Valley locations.
(01:12):
And yeah, it's super awesome to be able to provide such a valuable service in
addition to kind of our wheelhouse, which is ketamine infusions.
So I've been in healthcare since 2004.
It was an ICU, CICU, pre-op PACU.
And then I thought I wanted to be a certified registered nurse anesthetist.
(01:32):
And then I spent a bunch of time in the operating room and realized you have
to really like your coworkers to be able to stay in that, you know,
literally sterile environment.
And I actually found my love for psychiatry and mental health while I was working in the ICU.
Because you could actually, you know, boy, your clients were,
you know, pretty much invented and sedated they weren't great
(01:53):
to talk with and you know it's kind of one-way conversation it's kind of morbid
sense of humor that we get from working there i was able to ease some of that
burden working with their family and their loved ones and that was incredibly
rewarding work you know just being able to hear some of their stories and sit with them and so.
Really found, you know, kind of my passion for mental health in that environment.
(02:14):
Worked in the inpatient and outpatient units at the behavioral health unit,
trained electroconvulsive therapy, and worked at the community mental health
center or inpatient, outpatient units there.
And worked in, I was the only child provider for a couple years.
Years and you know i was providing long-acting injectables
and you know all sorts of polypharmacy and recognized
really that you know in large part depression anxiety you know a lot of these
(02:39):
symptoms are based in trauma and so being able to help people kind of explore
that and you need to feel it to heal it and so being able to really expedite
that process and provide a safe place to do it.
You know, there's so much moves right now for psychedelic medicine and ketamine's
here now and it's legal and it's safe and, you know, really fired up on the
(03:01):
transcranial magnetic stimulation as well because there's no medication needed for that.
And, you know, really helps people get to where they need to be.
There's also some cool evidence coming out about the human optimization protocol.
Tim Ferriss just had the TMS on his four-hour work week guy,
you know, and so that was super cool and yeah i'm just
(03:22):
excited to be here i always say in mental health field takes one to
know one so yeah i've been
through my own stuff like grew up kind of bounced around i
lived in something like 50 something houses with my
parents before i was 18 and i lived out of my car for
you know a number of times with my parents and it was finally lots
of love in the household just not a ton of money consistent yeah
(03:43):
yeah we had fun though it was always
fun with you yeah so and that you know helped
me be more outgoing because you just got to make friends when
you're moving to new places yeah i love
it my wife and i are having a lot of fun running the practices we got three
kids 10 11 and 13 and they're like my favorite humans hanging out with them
(04:04):
yesterday and today and we just do all sorts of fun stuff so that's awesome
that's awesome Awesome. Thank you so much for the background.
And yeah, the take one to know one, it's like, I always think,
you know, it's not a prereq, you know, to be in mental health,
but the good ones seem to have gone through some shit.
The good ones, the relatability, you know, it's, yeah, you can't,
(04:28):
you can't go to school for and you can, you know, it's just, yeah.
So, it's the school of hard knocks, right? Yeah.
Well, your patients are lucky to have you. For sure. We appreciate you. For sure. Likewise.
Yeah, so what made you choose the Blossom device specifically when you're looking for devices?
(04:54):
Other than the cool little sales dude right i know
the sales guy is amazing and i do want to
say you know that was one thing you know fretful of with
any sort of big capital investment so you're like what do you you know what's
the best way to get a capital sales person to to not talk to you is like fire
the capital right and that has not been the case at all so i just you know say
(05:18):
that the after has been amazing. And I really appreciate you for that.
And, you know, your company that you're resenting or representing by proxy.
And, and then I would say, you know, the, I did interview quite a few other,
you know, companies, I looked at Magstam, I looked at a brain sway, I looked at Neurostar.
And, you know, there's a reason we went with Severs Medical and the Blossom
(05:42):
TMS in particular, you know, for one, it is workhorse, you know,
it's oil cooled, just seems really beefy.
I really like that the CEO is, you know, a clinician or not a clinician,
but he's really like on the brass tacks of things.
Like he understands what makes a good TMS machine.
Obviously, you know, you've got to kind of gauge all the different aspects of
(06:04):
implementing a new service into your practice.
And so, you know, I'm a big proponent of the TMS technology in general.
And so I knew I was going to do something. I just didn't know who I was going
to work with. And so it was just, you know, kind of fortuitous that I came across
Blossom because, you know, you don't hear about it nearly as much.
And I'm sure that's, you know, the advertising dollars that go into the other bigger ones.
(06:28):
But then, you know, you end up paying for their advertising.
And so, yeah, it's a great machine. I really like working with it.
You know, the arm is super solid and, you know, really easy to work.
It's got Theta Burst, which is awesome. You know, a lot of other companies don't
have Theta Burst. So that'll really open up a lot of different options for the,
again, the human optimization and, you know, cash pay.
(06:51):
And so, yeah, I'm, I'm super happy with our purchase.
Wonderful, wonderful. And what's your experience been like so far offering TMS?
Like, how's it been good? Yeah, how's it going? Yeah, good. We're definitely ramping up on interest.
You know, I think a lot of the people that are going to qualify for our ketamine
treatments also will qualify for transcontinental stimulation,
(07:12):
probably even more so, you know, and so being able to get people in where they
can drive themselves and,
you know, pretty short appointment in the grand scheme of things and
pretty inobtrusive it gets it's just
a really great treatment modality that can quite literally change
your mind and so a lot
more interest on it i think there's there's more and more kind of knowledge
(07:34):
about it coming out and people are so interested in alternative modalities right
now you know i think you know personally i would want to to do treatment like
tms you know far before like traditional monoamine modulation
you know that being said i understand that a lot
of insurance companies are you know the prior
(07:55):
authorization process does necessitate failed
past medication trials and right you know those
are waters you have to navigate and i think there's
going to be more and more evidence coming out about you know
going even possibly first-line treatment yeah i
would love to love to see that happen at some point you've hit upon this a little
(08:17):
bit already in in in different aspects but maybe a little bit more explicitly
what do you like about tms in regards to tms versus all.
The other treatments out there but whether it be yeah pharmacology therapy like
the ketamine that you do what do you like about tms specifically little little
(08:40):
pieces of it that you like better Yeah, for sure. Than others.
Yeah. Yeah, great question. So, I think it's a super exciting time to be in
medicine, because we're actually proving past wisdom with science.
And you look back on some of the historical things that they were doing,
they were navigating certain areas of the world and they were trying to...
(09:02):
People have understood that there's resonance energy for a long time,
you know, sound healing, singing, these types of things.
And TMS is just a really vocalized version of a resonant type healing.
And so, you know, being able to like, it's at one of our practitioners in Sedona,
she says that, you know, that it really resonates a lot of people.
(09:23):
And I can agree with that.
It's like, we're at that time in medicine where we're blending the sacred with the science.
And so being able to offer transcannular
magnetic stimulation as an alternative treatment
modality so many people are turned off by meds at this point
and there's so much evidence honestly to support that with the monoamine theory
(09:43):
basically being debunked you know we know the more avenues you address a problem
from the more likely you are to get capture and i poopoo a lot i mean said you
know there's there's a great place for daily medications when there's aspects
of your situation right here.
You cannot change for whatever reason, you know, so like having a team and so you can get out.
Makes sense. That being said, you know, like I said, if TMS was available for
(10:07):
more people easier, I think people are going to jump on that bandwagon a lot quicker.
Like what, like, you know, five or six weeks and I could be done for the rest
of my life or, you know, years before I need to come back again or,
you know, maintenance treatments every one to three months.
Like that that's huge for people to drive themselves to
and from the appointments not having any sort
(10:29):
of medication be introduced is a big thing
for a lot of people and again i don't blame them the side effect profile for
you know ssri's sri's and say whether there's any psychotic spend with azapine
from the addiction potential you know from a cellular level is something that
should be considered and right you know medicine we don't get that like strong
(10:49):
aversion it's like you know.
Like diagnosed and prescribed and then follow up
and it's like should we be going that fast you know to these things that are
doing neuromodulation that you know aren't like stoppable and have like such
a gnarly scientific profile like tms like everyone's been tolerating it really
well oh yeah and it's that it's just you know like this super focal super localized,
(11:15):
non-pharmacological treatment that people are loving and has a ton of science to back it up.
And how's the experience been?
One of the unique aspects about ketamine too, but also TMS is that the patient
comes to you and they're in your environment.
And I've seen your environment. It's super cool. You guys have just a great
(11:38):
vibe. Where you are is very, very positive.
And I felt visiting your clinic that it's a very therapeutic environment just
being in the presence of what you set up there.
And what's been been that
experience of having people in so you're
you're you're giving them the the medicine
(11:59):
if you will in real time right there with you
with you guys right with your with your team what's that experience been like
yeah yeah so like again holistic care right trying to meet people where they're
at and i think we're in a unique and beautiful position you know people People
come from all over the world to visit Flagstaff and Sedona as well.
(12:19):
You know, like really kind of natural wonders of the world.
And so we're super lucky to be up here and be able to provide,
you know, such a wonderful healing modality and modalities.
Very passionate about both the ketamine and the TMS, obviously.
And such a beautiful, like healthy environment for people.
Being able to go outside and quite literally hug a tree.
(12:42):
Yeah, yeah, yeah. yeah just be in
nature so quickly and be able to experience that
you know it's kind of continuation yeah yeah
and one provider said like you know
and i kind of felt this too where sometimes you're not quite sure if the patient
is coming for the medicine or the treatment or to be around the positivity like
(13:07):
they might not have that positivity like in their in their world and it's It's
therapeutic to be there.
I think one hurdle people think is a hurdle is, oh, I have to come in every
day or 36 sessions, five days a week for TMS. And then you notice...
Like oh wow but they want to come in like once they
(13:30):
start coming in they're like i actually want to come
in like this is quite nice you know where if you're prescribing medication let's
say from from that standpoint it's it's here you go take this and then you know
you don't really see them until the check-in you know right and then interesting
yeah it's so like not therapeutic you you know,
(13:53):
a good, healthy kind of human interaction,
like TMS naturally is, you know, we're, you know, we're obviously noticing for
side effects and, you know, we talk a little bit about that and it's,
it really is, you know, like toxic positivity, right?
Like you got this person who's excited for you and cheerleading you in your
space while you're, you know, hopefully cautiously optimistic.
(14:17):
That's like, you know, getting my clientele, it's like, you know, oh yeah, we're helpful.
Like there's no guarantees of these treatments.
And we know, you know, it takes like two weeks to notice much of anything.
And so you've got to kind of believe in it enough to show up.
Right, right. And with med management, oh my gosh, like med management is just
kind of exhausting, really.
(14:37):
Any thought-provoking result, thoughts around people, any hallucinations,
delusions, you know, substance abuse, you know, any hospitalizations, any side effects.
It's just like you ramble off all these questions and then like 20 minutes later,
or you're on to the next person and you're like okay what do they give them right
it's like we're in the community mental health center you
know it's like 15 to 30 minute appointments and
(14:59):
you're just like you can't get to know people either yeah
so it's nice about having like a tms clinician
where you're hanging out in the room with that client for
the whole 20-30 minutes and you get to know them and talk about them and their
family and their situation and what else they're doing you know it's a great
opportunity to talk about augmentation strategies and talk about lifestyle and
(15:21):
you know and kind of cheer him on like yay what's good yeah the universe right yeah that's so cool.
And I think it's also interesting where, you know, the actual medication,
if you will, like in this, it's not medication, but the actual treatment,
you know their schedule.
(15:41):
So maybe, I don't know if you talked to anything about that.
It's kind of unique. In other words, if you say, you know, take two of these a day and whatnot,
it's out of your hands as far as, you know, something is dose dependent and
you're not quite sure exactly what the doses have been and whatnot.
Not so it's fairly unique with tms where you're there
if they miss a day okay everybody knows they missed a day or
(16:04):
something like this a little a different experience i
don't know if you could speak to that a little bit about just being part of
the actual program so intimately yeah for sure you know it's it's that's the
thing i think it goes down the medication compliance but like 40 percent right
every time you add a new medication onto a patient's medication profile you
(16:24):
know you You get like twice a day,
three times a day, and it goes down even further dramatically.
Yeah. You know, yeah, you speak to a great point. With TMS, we know when someone's
showing up. Yeah, right.
Playing an active part, too, you know, by driving yourself, by showing up,
by being physically and mentally and spiritually present, you know,
(16:45):
for the provider and being able to provide feedback.
And, you know, I always want to empower my clients to feel like they're driving
their bus because they ultimately are.
I was listening to a podcast the other day is like
I'm not in the you know the camp of convincing like
you know I'm here to like give you those tools and
I'll be your resources and I'll be your cheerleader and you know that being
(17:06):
said like I'm not gonna convince you that you want to get better like people
are showing up because they do want you know their situation to be better like
with traditional mental health that's more like oh you know this person told
me I should go So it's like, yeah. Yeah.
It's like you inform them and then, yeah. As I think, especially too with TMS where.
(17:27):
There's so much like showing up to do, but then informing them because it is
newer to, it's not new, it's not a new technology at all, but it can be new to them.
So just, yeah, informing them. And then I think TMS cells itself,
once you get the nuts and bolts of it, you're like, wow, okay,
I stay on all my medication.
(17:49):
If I'm on medication, I don't need to get off of it. I don't need to change it.
It and it there's no real side
effects of of tms and not
evasive non-systemic doesn't go through the whole body it
sells itself i i've always in my clinical like not
as a clinician but working at the clinics i've always
thought that it sold itself in those because of that you
(18:11):
know saying hey just why not i mean if you've
tried these like you're mentioning why wouldn't i
try something something like this high efficacy no side
effects i'm in you know yeah for sure no
i guess it's like um i feel like we're on the precipice
of the human evolution to some extent and the biggest part of
that will be going from the no because to the yes and
(18:31):
and so i think tms is like really one of the harbingers of that yeah you know
the evidence-based studies speak for themselves you know with all the insurance
covering it pretty much and and you know like i said there's ancient wisdom
to support the usage showed frequency healing and that's ultimately what TMS is.
Yeah, that's so cool that you brought that up. I did a summit the last company I was with, we did a.
(18:59):
Kind of a caring for physicians summit so
we had all these amazing speakers come and about
600 physicians and in in the
for the summit and one of them was she was
a singer and and and sound healer.
She was just just absolutely amazing
(19:20):
but it reminded me of that how she
was talking about the frequencies and and all of these different things
and yeah there's there's so much power to
it and it's very like you said there's so much it's almost
primal like what we maybe used to do back then
the the chanting and the singing and and and
the instruments that we would use throughout our human human history
(19:42):
and cultures and and whatnot so yeah
i never thought i never thought of that of like of
of tms being in that same in
that same world but you're right you know it is it
is within within that yeah that's really
cool have you found or
i know and you found some of this what are the most common misconceptions
(20:03):
about tms that you've
encountered along the way maybe people calling
in and getting getting their first introduction to tms what's the biggest misconceptions
well i mean biggest fear that people have is gonna hurt you know and really
doesn't for most everyone and then you know there can be like a little it feels
(20:25):
like it's tapping on your scalp or something and so when they they normally try it out like oh.
I was, you know, I was afraid of that actually hurting and obviously it didn't
hurt. And so I think that's a big misconception that can be painful.
You know, being said, like, I think as you crank up the frequency,
sometimes there is like more of a headache for some people, but it's definitely
not as uncomfortable as some people are afraid of it being.
(20:48):
Some people put it in the same camp as like electroconvulsive therapy.
I'm like, ooh, we're far away from that.
You know, having been trained in both modalities, like,
you know, you see T or you're putting people under full anesthesia you're
paralyzing them and then you're elucidating a seizure you know
we're not doing any of those things and you
know uct can be really helpful and it's kind of barbaric and like a lot of people
(21:12):
like really smart people end up a lot of memory loss issues and obviously we
don't have that with tms either we have more human optimization so people actually
shown increased cognizance awareness and that sort of thing so that's pretty
cool another thing I think is,
you know, you have to do these other things for it to work and really don't
like you just let me show up.
(21:33):
Chances are pretty good. It's going to do something for you.
And so that was another popular misconception.
And then another misconception is that people, you know, they,
they have to do a lot of other things to qualify for it.
And really, you know, a lot of people have tried like Lexapro or Certillion
or Zoloft or, you know, some other therapy sessions in the past and,
(21:54):
you know, they notice they're just kind of stuck,
you know, doing all these other
things like going to the gym and social connection. And then, you know,
whatever else eating healthy and they're just keeping their
head out of water you know they're surviving they're i mean check a
phq-9 on these people and you're like oh actually you're not as good of a head
place as you you know you're trying to make yourself out to be yeah kind of
(22:15):
stuck like trying to fill up your cup from below right yeah yeah sustainable
and so you know a lot of more people actually have this available to them as
a treatment modality than they're probably aware
of and so you know most people like think that tms pretty heavy hitter as far
as like you know i need to be like
it's pretty true yeah it's another misconception that it's not accurate.
(22:39):
That's a good one yeah yeah i was just i was traveling and i was speaking with,
i forget what specialty he was he was a doctor just you know chit-chatting and
yeah he thought the same thing he's like oh so i just thought that was like
you know people had to be really bad off, like almost,
you know, admitted, you know, that kind of a thing before they'd even attempt TMS.
(23:02):
And I was like, no, no, no, that's, that's a misconception.
It's, it's not that evasive. It's, you know, I think that for a long time,
it was because of the cost, you know, it was expensive back in the day.
So insurance companies would much rather try, you know, So something else before
they paid that much for TMS.
(23:23):
But now the machines are getting more affordable.
It's just getting more widely used and all of that.
And we've seen this. We've seen that the medications used to be four to six
pharmaceuticals plus therapy and all of this stuff.
And now it's two to four, which is a huge difference, right?
To pharmaceuticals, and then you go ahead and get approved.
(23:48):
We see things like TRICARE, we see insurances like TRICARE, Medicare with no prior auth.
So these are huge, huge steps.
And then, yeah, you and I were looking at the multiple sessions per day being covered coming in July.
So all of these are moving towards more frequency, wider populations being able
(24:12):
to get this treatment and just having a more common treatment overall in the space.
Yeah, that's great. Yeah, I know. That was super cool seeing that from Medicare.
Care you know yeah able to say hey you know you
can do you can build two of the 908 six days a day
which is you know the subsequent tms so being
(24:34):
able to do that like in a morning and afternoon like
most people who've been suffering with depression for a
while they're pretty secure in the routine and being able
to to do that twice a day you know
and then by be financially feasible you know people can do
multiple treatments a day like up to five i think or 10 or even
15 of the theta burst you know which is
(24:55):
like the shortened protocol you talked about pretty
well but being able to you know expedite
the standard 36-day protocol into you
know three and a half weeks like that's amazing because people
are going to notice improvements faster you know clinics are.
Going to be able to increase access like there's a lot of
wonderful things about that so i was very energized to
(25:16):
see that yeah yeah that's great of course
stanford is doing the saint protocol which is
like 10 sessions a day i've been lucky
enough to be at one of the clinics there's only
six clinics offering that right now to do the
actual tradition like the actual protocol with with
the with stanford involved and all of that and yeah it's exciting
(25:38):
just to see you know multiple sessions a day and
obviously those things are not covered yet but it'd be great once once they
do get covered because yeah you can come in and get you know your full treatment.
Done in a couple weeks or maybe one week but you know definitely safely within
a few within within a few weeks so yeah it's great it's moving moving in that direction you know.
(26:02):
How about for you like as a provider like so
you went from obviously like like everybody everybody
and for for all things we don't know anything about anything and then we start
to learn about it and then we start to learn more and then we take the plunge
so for you as a provider what are maybe some misconceptions that you kind of
(26:23):
had early on compared to the reality of now offering TMS at your clinic?
Yeah, so one of my...
Great mentors jay collier i
followed him the biker staff medical center really
cool psychiatric provider awesome dude
and he was fired up on tms a while back and
(26:45):
so you know i i guess i drank the bullet a while
ago prior to that probably
some of my concerns were you know there's some placebo effect
with that like you know you're and you know i think
a lot of providers still have that where you know
you're telling people you're doing something and it's kind of snake oily
and and then you actually look at
(27:05):
the science of it and you look at the stimulation you know there's you
know that's negated and i've been down the rabbit hole for
a while so right there's a lot of clinicians that still
have those misconceptions about oh you know like well
yeah anyone's going to be less depressed if they get to hang out with
a human being who's engaged and talkative to them
and they're on their digital devices for you know half
(27:26):
an hour a day or you know six weeks
like you're actually getting out of the house you know there's a lot of
things there right that probably does work in concurrence at
least a little bit you know and you know
having just the simulation by itself is as incredible
benefit so many and i'm sure you know.
With the amount of human beings provided that providing it
(27:48):
not everyone's amazing probably a lot of people are playing with their
phone you know while the patient's just sitting there nodding off
so and they're still getting amazing benefits so yeah
i think probably that the snake oil
is the biggest like misconception because it's obviously not true you know coming
from you know what you don't know what you don't know like you said right yeah
(28:09):
and then like how easy it is you know like it really is if you're following
the measurement protocols and guidelines and you're making sure the cap well,
it doesn't have to be scary to provide it. Like, you're like,
oh, you know, look at the seizure.
I got this magic wand that I'm gonna mess this person up with.
You know, you do just a couple of treatments, you're like, oh,
(28:31):
this isn't so bad and you know, the blossom is so accessible.
I think some of the machines like the brains where we're pushing it and you're
kind of like in this kind of electrocution device looking thing where you're.
Actually synonymizing that with it, because I looked in that one and you know,
there's great outcomes with all the TMS machines if you get into them and you
(28:51):
know, just having this the wand, you know, just on the side of the head,
you know, gentlest pressure,
and nice, comfy chair, because we got the chair too that went with it.
And i think you know most people like that it's a massage function yeah
i support all the bells and whistles and nice italian
leather i'm like oh this is nice i just want to sit in here on my time off yeah
yeah yeah and i think a lot of the providers i don't know about yourself but
(29:15):
like when you first hear about the mt like getting the motor threshold determined
and the thumb to move and the location right and the intensity right it can
feel oh wow like that's that's a lot like i I got to get right.
But then, yeah, in practice, it's pretty easy, you know?
Yeah, absolutely. Yeah, it really isn't that scary. You know,
(29:37):
and you're right, though. Like, the first time you do it, you're like, what?
And then, you know, I think that negates all of your concerns about the snake
oil, too, when you start seeing, like, the thumb move. Yeah. Okay.
That's true. Yeah.
And for the patients, too, when they see their thumb move.
Because there's other units, like I know when I was there, I talked to you about
(29:58):
this, some stuff, like there's other things online where they say this is better
than TMS and do it at home.
And then you look, it's a nine volt battery.
And so the misconception there is that that's not TMS, everybody,
like TMS goes three centimeters into the brain.
And yeah, when you see the thumb move, you're like, wow, this is something that's obvious.
(30:19):
Yeah, it's getting into my, my brain. like for
real yeah and also think about
like the placebo and stuff correct me if i'm wrong not
as i'm not a clinician but if that was the case it
wouldn't have such a long lasting effect i could
see it working like in the treatment period or
for 36 sessions even or something but then as
(30:41):
it continues to work you know 12 months longer than
that it's and it really re-maps what's
going on in the brain i don't think
that the sham would work for that long you know
right yeah exactly and you know the placebo
effect is a really good thing that potentiates a lot of things
you know it's got a bad rap but basically the placebo's effect
(31:03):
dumbed down as saying your body's natural healing ability
right and so when you're gonna tell
people you know all the time when they're in the pucker state the fight
flight or freeze when they're able to get out of that then their
natural healing abilities come along anyways you know
so i see a lot of people with like their aces scores you
know the adverse childhood experience scores like five or above you
(31:25):
see this chronic inflammatory illness you see a lot of crohn's disease see a
lot of myalgia see a lot of like autoimmune disorders and then like you know
with the ketamine and been offering as long as we haven't imagined based on
the treatment response we're seeing so far the tms and a lot of people are using them in concurrence.
We see this kind of downstream effect where a lot of those inflammatory biomarkers
(31:47):
go down because you're actually not living in that. And then your body's like.
Oh i can take a breath like oh okay like
my natural killer cells are back online my lymphocytes macrophages
are doing their jobs like i'm not like in this
inflamed state yeah get away from everything seems
potentially traumatizing and yeah not having
(32:07):
is a pretty valuable thing i know tms
does that too or you kind of like you
said literally remap the mind you don't have
to you know hold on to all those things that
don't necessarily serve you and obviously the the
duration of the effectiveness you know
the that's the durability you know
(32:28):
the treatment is is very robust like i
have a friend and partner in in
some of my business ventures he's a military veteran
and he went through tms and he was dealing with
this kind of chronic suicidality and he's okay
with me sharing this yeah and then he went through a round
of tms and he hasn't had any suicidality since that
(32:49):
course of tms finished and so i mean that's
a that's a great testament for tms right there you
know and it's so it's so wonderful you
know seeing that over and over and over
again so i've been you know around tms for over 10 years now full-time you know
tms technician for seven years and seeing seeing this over and over and over
(33:11):
and over again like like you mentioned the the suicidal ideations and just the
characteristics and symptoms of depression being lifted.
And you just get a lot of confidence in it. You're like, wow, this is really cool.
And yeah, again, very little side effects at all. So it's wonderful to see that over and over again.
(33:32):
So it's such rewarding work, right? Yeah. Oh, okay.
You really feel like, yeah, you're living your best life. And it's like,
I want to be, I want to do something where I'm helping people.
It's kind of like, I don't know. I think it's like most people's dream,
you know, like easier cliche or something, but it's like, but it's true.
Like you really feel that like, like, cause it's so drastic sometimes,
(33:55):
like six weeks is not long. And then you have somebody who is not feeling well at all.
And, and then in six weeks time, to make that shift, it just,
it's pretty incredible.
Sometimes, you know, obviously not everyone's so extreme.
It's not always like that. And doesn't work for everybody.
(34:15):
But yeah, you really do feel like the lion's share of, of the patients coming
through are definitely feeling that lift.
You know there's that there's that there's that there's a
few days within the treatment period usually where you just feel
that it's lifted but it's
it's interesting because not to get off track here but it feels like almost
(34:36):
like a negation of so it's not almost like it's not like a bliss where i think
a lot of patients think it is going to be like a bliss we're like i'm not i'm
you know i'm not i'm happy it's really like oh where did it go where the depression
go it's not here it's It's like a negation.
You know what I mean? So it's just interesting.
They're like, did I have depression? There's a monkey on my back.
(34:58):
I feel like there was a monkey there. Yeah.
Yeah, like you were really depressed when you came in. They're like, yeah, I was, huh?
Yeah, yeah.
Just a couple more questions for you. You hit upon this a little bit already,
but what are you most excited about in the future of TMS? Where would you like it to go?
(35:20):
Obviously you've been like you said you've been around it for a while and drank
the kool-aid a while ago and you're hip to some of the new stuff coming out and all that but.
And what are you excited about? You know, I think it's already happening,
just the increased availability, you know?
Yeah. I think that's huge just because we want, you know, more people to remember
(35:41):
that they're capable of living better lives, you know?
The TMS is a great way to fast track that for people.
And it isn't scary, you know? People are like, what? I can come in and just
drive myself to and from?
And, you know, like six weeks later, there's a probability that I'm feeling
a world away from where I'm feeling right now.
You know like that's like it's going to be huge for people and pretty
(36:04):
much everyone can navigate that you just have to commit to
it being able to provide that to
more people i'm super excited about it you know i think more and more
accessible from an insurance payer perspective like
you're saying you see like four to eight meds taking consistently and
gold dosing and now it's like two to four
or less you know where you you don't even
(36:26):
like you're prescribed to them and you have like two or five days of
intolerable side effects i'm not taking this right now
you know that's enough for the the payers to
be like okay well you know like the last time they had maybe risk
of serotonin syndrome and they had to go in you know because they were prescribed
a necessary they responded to very poorly right so
we probably don't want to do that to them again and you know they seem like
(36:49):
a good candidate for tms and it's really great to see people come through and
do well with TMS when they've been through the gambit of the traditional medications
without much of any improvements.
It's incredibly rewarding work, and I'm very happy to be part of this.
(37:10):
And thanks for taking the time today, Casey. I really appreciate you.
If you or a loved one has been suffering with depression for some time and has
tried some traditional modalities and has not noticed improvements,
you may be a good candidate for TMS.
Try reaching out to our ketamine clinic, Revitalize Ketamine Clinic,
(37:33):
in either Flagstaff or Prescott Valley, and we can work together with you and
your loved ones to see if you may benefit from TMS.
Rapid TMS, rapid transcranial magnetic stimulation used for treatment-resistant
depression with great efficacy here at Revitalize.
Thank you and make it a great day.
Hello and welcome to another Mental Wealth Moves podcast by your host,
Casey Dubrovik, owner and operator of Revitalize Ketamine Clinics, Rocked Wellness Bar,
and co-founder of Epic Biosciences.
In today's episode, Casey and Casey talk TMS, Rapid Transcranial Magnetic Stimulation.
(00:28):
Who is it for, why it works,
who should consider it, a little bit also about Casey's origin story and some
of his ethos going into treatment of all mental health disorders.
It's a great candid conversation that talks about how to become your best self
(00:49):
and what got you into the field of mental health. My name is Casey Dubrovik.
I'm the owner and operator of Revitalize ketamine clinic with my wife, Jill DeRivick.
And we're up here in Flagstaff, Arizona.
We also have clinics in Sedona and Prescott Valley. We just recently started
offering TMS in our Flagstaff and Prescott Valley locations.
(01:12):
And yeah, it's super awesome to be able to provide such a valuable service in
addition to kind of our wheelhouse, which is ketamine infusions.
So I've been in healthcare since 2004.
It was an ICU, CICU, pre-op PACU.
And then I thought I wanted to be a certified registered nurse anesthetist.
(01:32):
And then I spent a bunch of time in the operating room and realized you have
to really like your coworkers to be able to stay in that, you know,
literally sterile environment.
And I actually found my love for psychiatry and mental health while I was working in the ICU.
Because you could actually, you know, boy, your clients were,
you know, pretty much invented and sedated they weren't great
(01:53):
to talk with and you know it's kind of one-way conversation it's kind of morbid
sense of humor that we get from working there i was able to ease some of that
burden working with their family and their loved ones and that was incredibly
rewarding work you know just being able to hear some of their stories and sit with them and so.
Really found, you know, kind of my passion for mental health in that environment.
(02:14):
Worked in the inpatient and outpatient units at the behavioral health unit,
trained electroconvulsive therapy, and worked at the community mental health
center or inpatient, outpatient units there.
And worked in, I was the only child provider for a couple years.
Years and you know i was providing long-acting injectables
and you know all sorts of polypharmacy and recognized
really that you know in large part depression anxiety you know a lot of these
(02:39):
symptoms are based in trauma and so being able to help people kind of explore
that and you need to feel it to heal it and so being able to really expedite
that process and provide a safe place to do it.
You know, there's so much moves right now for psychedelic medicine and ketamine's
here now and it's legal and it's safe and, you know, really fired up on the
(03:01):
transcranial magnetic stimulation as well because there's no medication needed for that.
And, you know, really helps people get to where they need to be.
There's also some cool evidence coming out about the human optimization protocol.
Tim Ferriss just had the TMS on his four-hour work week guy,
you know, and so that was super cool and yeah i'm just
(03:22):
excited to be here i always say in mental health field takes one to
know one so yeah i've been
through my own stuff like grew up kind of bounced around i
lived in something like 50 something houses with my
parents before i was 18 and i lived out of my car for
you know a number of times with my parents and it was finally lots
of love in the household just not a ton of money consistent yeah
(03:43):
yeah we had fun though it was always
fun with you yeah so and that you know helped
me be more outgoing because you just got to make friends when
you're moving to new places yeah i love
it my wife and i are having a lot of fun running the practices we got three
kids 10 11 and 13 and they're like my favorite humans hanging out with them
(04:04):
yesterday and today and we just do all sorts of fun stuff so that's awesome
that's awesome Awesome. Thank you so much for the background.
And yeah, the take one to know one, it's like, I always think,
you know, it's not a prereq, you know, to be in mental health,
but the good ones seem to have gone through some shit.
The good ones, the relatability, you know, it's, yeah, you can't,
(04:28):
you can't go to school for and you can, you know, it's just, yeah.
So, it's the school of hard knocks, right? Yeah.
Well, your patients are lucky to have you. For sure. We appreciate you. For sure. Likewise.
Yeah, so what made you choose the Blossom device specifically when you're looking for devices?
(04:54):
Other than the cool little sales dude right i know
the sales guy is amazing and i do want to
say you know that was one thing you know fretful of with
any sort of big capital investment so you're like what do you you know what's
the best way to get a capital sales person to to not talk to you is like fire
the capital right and that has not been the case at all so i just you know say
(05:18):
that the after has been amazing. And I really appreciate you for that.
And, you know, your company that you're resenting or representing by proxy.
And, and then I would say, you know, the, I did interview quite a few other,
you know, companies, I looked at Magstam, I looked at a brain sway, I looked at Neurostar.
And, you know, there's a reason we went with Severs Medical and the Blossom
(05:42):
TMS in particular, you know, for one, it is workhorse, you know,
it's oil cooled, just seems really beefy.
I really like that the CEO is, you know, a clinician or not a clinician,
but he's really like on the brass tacks of things.
Like he understands what makes a good TMS machine.
Obviously, you know, you've got to kind of gauge all the different aspects of
(06:04):
implementing a new service into your practice.
And so, you know, I'm a big proponent of the TMS technology in general.
And so I knew I was going to do something. I just didn't know who I was going
to work with. And so it was just, you know, kind of fortuitous that I came across
Blossom because, you know, you don't hear about it nearly as much.
And I'm sure that's, you know, the advertising dollars that go into the other bigger ones.
(06:28):
But then, you know, you end up paying for their advertising.
And so, yeah, it's a great machine. I really like working with it.
You know, the arm is super solid and, you know, really easy to work.
It's got Theta Burst, which is awesome. You know, a lot of other companies don't
have Theta Burst. So that'll really open up a lot of different options for the,
again, the human optimization and, you know, cash pay.
(06:51):
And so, yeah, I'm, I'm super happy with our purchase.
Wonderful, wonderful. And what's your experience been like so far offering TMS?
Like, how's it been good? Yeah, how's it going? Yeah, good. We're definitely ramping up on interest.
You know, I think a lot of the people that are going to qualify for our ketamine
treatments also will qualify for transcontinental stimulation,
(07:12):
probably even more so, you know, and so being able to get people in where they
can drive themselves and,
you know, pretty short appointment in the grand scheme of things and
pretty inobtrusive it gets it's just
a really great treatment modality that can quite literally change
your mind and so a lot
more interest on it i think there's there's more and more kind of knowledge
(07:34):
about it coming out and people are so interested in alternative modalities right
now you know i think you know personally i would want to to do treatment like
tms you know far before like traditional monoamine modulation
you know that being said i understand that a lot
of insurance companies are you know the prior
(07:55):
authorization process does necessitate failed
past medication trials and right you know those
are waters you have to navigate and i think there's
going to be more and more evidence coming out about you know
going even possibly first-line treatment yeah i
would love to love to see that happen at some point you've hit upon this a little
(08:17):
bit already in in in different aspects but maybe a little bit more explicitly
what do you like about tms in regards to tms versus all.
The other treatments out there but whether it be yeah pharmacology therapy like
the ketamine that you do what do you like about tms specifically little little
(08:40):
pieces of it that you like better Yeah, for sure. Than others.
Yeah. Yeah, great question. So, I think it's a super exciting time to be in
medicine, because we're actually proving past wisdom with science.
And you look back on some of the historical things that they were doing,
they were navigating certain areas of the world and they were trying to...
(09:02):
People have understood that there's resonance energy for a long time,
you know, sound healing, singing, these types of things.
And TMS is just a really vocalized version of a resonant type healing.
And so, you know, being able to like, it's at one of our practitioners in Sedona,
she says that, you know, that it really resonates a lot of people.
(09:23):
And I can agree with that.
It's like, we're at that time in medicine where we're blending the sacred with the science.
And so being able to offer transcannular
magnetic stimulation as an alternative treatment
modality so many people are turned off by meds at this point
and there's so much evidence honestly to support that with the monoamine theory
(09:43):
basically being debunked you know we know the more avenues you address a problem
from the more likely you are to get capture and i poopoo a lot i mean said you
know there's there's a great place for daily medications when there's aspects
of your situation right here.
You cannot change for whatever reason, you know, so like having a team and so you can get out.
Makes sense. That being said, you know, like I said, if TMS was available for
(10:07):
more people easier, I think people are going to jump on that bandwagon a lot quicker.
Like what, like, you know, five or six weeks and I could be done for the rest
of my life or, you know, years before I need to come back again or,
you know, maintenance treatments every one to three months.
Like that that's huge for people to drive themselves to
and from the appointments not having any sort
(10:29):
of medication be introduced is a big thing
for a lot of people and again i don't blame them the side effect profile for
you know ssri's sri's and say whether there's any psychotic spend with azapine
from the addiction potential you know from a cellular level is something that
should be considered and right you know medicine we don't get that like strong
(10:49):
aversion it's like you know.
Like diagnosed and prescribed and then follow up
and it's like should we be going that fast you know to these things that are
doing neuromodulation that you know aren't like stoppable and have like such
a gnarly scientific profile like tms like everyone's been tolerating it really
well oh yeah and it's that it's just you know like this super focal super localized,
(11:15):
non-pharmacological treatment that people are loving and has a ton of science to back it up.
And how's the experience been?
One of the unique aspects about ketamine too, but also TMS is that the patient
comes to you and they're in your environment.
And I've seen your environment. It's super cool. You guys have just a great
(11:38):
vibe. Where you are is very, very positive.
And I felt visiting your clinic that it's a very therapeutic environment just
being in the presence of what you set up there.
And what's been been that
experience of having people in so you're
you're you're giving them the the medicine
(11:59):
if you will in real time right there with you
with you guys right with your with your team what's that experience been like
yeah yeah so like again holistic care right trying to meet people where they're
at and i think we're in a unique and beautiful position you know people People
come from all over the world to visit Flagstaff and Sedona as well.
(12:19):
You know, like really kind of natural wonders of the world.
And so we're super lucky to be up here and be able to provide,
you know, such a wonderful healing modality and modalities.
Very passionate about both the ketamine and the TMS, obviously.
And such a beautiful, like healthy environment for people.
Being able to go outside and quite literally hug a tree.
(12:42):
Yeah, yeah, yeah. yeah just be in
nature so quickly and be able to experience that
you know it's kind of continuation yeah yeah
and one provider said like you know
and i kind of felt this too where sometimes you're not quite sure if the patient
is coming for the medicine or the treatment or to be around the positivity like
(13:07):
they might not have that positivity like in their in their world and it's It's
therapeutic to be there.
I think one hurdle people think is a hurdle is, oh, I have to come in every
day or 36 sessions, five days a week for TMS. And then you notice...
Like oh wow but they want to come in like once they
(13:30):
start coming in they're like i actually want to come
in like this is quite nice you know where if you're prescribing medication let's
say from from that standpoint it's it's here you go take this and then you know
you don't really see them until the check-in you know right and then interesting
yeah it's so like not therapeutic you you know,
(13:53):
a good, healthy kind of human interaction,
like TMS naturally is, you know, we're, you know, we're obviously noticing for
side effects and, you know, we talk a little bit about that and it's,
it really is, you know, like toxic positivity, right?
Like you got this person who's excited for you and cheerleading you in your
space while you're, you know, hopefully cautiously optimistic.
(14:17):
That's like, you know, getting my clientele, it's like, you know, oh yeah, we're helpful.
Like there's no guarantees of these treatments.
And we know, you know, it takes like two weeks to notice much of anything.
And so you've got to kind of believe in it enough to show up.
Right, right. And with med management, oh my gosh, like med management is just
kind of exhausting, really.
(14:37):
Any thought-provoking result, thoughts around people, any hallucinations,
delusions, you know, substance abuse, you know, any hospitalizations, any side effects.
It's just like you ramble off all these questions and then like 20 minutes later,
or you're on to the next person and you're like okay what do they give them right
it's like we're in the community mental health center you
know it's like 15 to 30 minute appointments and
(14:59):
you're just like you can't get to know people either yeah
so it's nice about having like a tms clinician
where you're hanging out in the room with that client for
the whole 20-30 minutes and you get to know them and talk about them and their
family and their situation and what else they're doing you know it's a great
opportunity to talk about augmentation strategies and talk about lifestyle and
(15:21):
you know and kind of cheer him on like yay what's good yeah the universe right yeah that's so cool.
And I think it's also interesting where, you know, the actual medication,
if you will, like in this, it's not medication, but the actual treatment,
you know their schedule.
(15:41):
So maybe, I don't know if you talked to anything about that.
It's kind of unique. In other words, if you say, you know, take two of these a day and whatnot,
it's out of your hands as far as, you know, something is dose dependent and
you're not quite sure exactly what the doses have been and whatnot.
Not so it's fairly unique with tms where you're there
if they miss a day okay everybody knows they missed a day or
(16:04):
something like this a little a different experience i
don't know if you could speak to that a little bit about just being part of
the actual program so intimately yeah for sure you know it's it's that's the
thing i think it goes down the medication compliance but like 40 percent right
every time you add a new medication onto a patient's medication profile you
(16:24):
know you You get like twice a day,
three times a day, and it goes down even further dramatically.
Yeah. You know, yeah, you speak to a great point. With TMS, we know when someone's
showing up. Yeah, right.
Playing an active part, too, you know, by driving yourself, by showing up,
by being physically and mentally and spiritually present, you know,
(16:45):
for the provider and being able to provide feedback.
And, you know, I always want to empower my clients to feel like they're driving
their bus because they ultimately are.
I was listening to a podcast the other day is like
I'm not in the you know the camp of convincing like
you know I'm here to like give you those tools and
I'll be your resources and I'll be your cheerleader and you know that being
(17:06):
said like I'm not gonna convince you that you want to get better like people
are showing up because they do want you know their situation to be better like
with traditional mental health that's more like oh you know this person told
me I should go So it's like, yeah. Yeah.
It's like you inform them and then, yeah. As I think, especially too with TMS where.
(17:27):
There's so much like showing up to do, but then informing them because it is
newer to, it's not new, it's not a new technology at all, but it can be new to them.
So just, yeah, informing them. And then I think TMS cells itself,
once you get the nuts and bolts of it, you're like, wow, okay,
I stay on all my medication.
(17:49):
If I'm on medication, I don't need to get off of it. I don't need to change it.
It and it there's no real side
effects of of tms and not
evasive non-systemic doesn't go through the whole body it
sells itself i i've always in my clinical like not
as a clinician but working at the clinics i've always
thought that it sold itself in those because of that you
(18:11):
know saying hey just why not i mean if you've
tried these like you're mentioning why wouldn't i
try something something like this high efficacy no side
effects i'm in you know yeah for sure no
i guess it's like um i feel like we're on the precipice
of the human evolution to some extent and the biggest part of
that will be going from the no because to the yes and
(18:31):
and so i think tms is like really one of the harbingers of that yeah you know
the evidence-based studies speak for themselves you know with all the insurance
covering it pretty much and and you know like i said there's ancient wisdom
to support the usage showed frequency healing and that's ultimately what TMS is.
Yeah, that's so cool that you brought that up. I did a summit the last company I was with, we did a.
(18:59):
Kind of a caring for physicians summit so
we had all these amazing speakers come and about
600 physicians and in in the
for the summit and one of them was she was
a singer and and and sound healer.
She was just just absolutely amazing
(19:20):
but it reminded me of that how she
was talking about the frequencies and and all of these different things
and yeah there's there's so much power to
it and it's very like you said there's so much it's almost
primal like what we maybe used to do back then
the the chanting and the singing and and and
the instruments that we would use throughout our human human history
(19:42):
and cultures and and whatnot so yeah
i never thought i never thought of that of like of
of tms being in that same in
that same world but you're right you know it is it
is within within that yeah that's really
cool have you found or
i know and you found some of this what are the most common misconceptions
(20:03):
about tms that you've
encountered along the way maybe people calling
in and getting getting their first introduction to tms what's the biggest misconceptions
well i mean biggest fear that people have is gonna hurt you know and really
doesn't for most everyone and then you know there can be like a little it feels
(20:25):
like it's tapping on your scalp or something and so when they they normally try it out like oh.
I was, you know, I was afraid of that actually hurting and obviously it didn't
hurt. And so I think that's a big misconception that can be painful.
You know, being said, like, I think as you crank up the frequency,
sometimes there is like more of a headache for some people, but it's definitely
not as uncomfortable as some people are afraid of it being.
(20:48):
Some people put it in the same camp as like electroconvulsive therapy.
I'm like, ooh, we're far away from that.
You know, having been trained in both modalities, like,
you know, you see T or you're putting people under full anesthesia you're
paralyzing them and then you're elucidating a seizure you know
we're not doing any of those things and you
know uct can be really helpful and it's kind of barbaric and like a lot of people
(21:12):
like really smart people end up a lot of memory loss issues and obviously we
don't have that with tms either we have more human optimization so people actually
shown increased cognizance awareness and that sort of thing so that's pretty
cool another thing I think is,
you know, you have to do these other things for it to work and really don't
like you just let me show up.
(21:33):
Chances are pretty good. It's going to do something for you.
And so that was another popular misconception.
And then another misconception is that people, you know, they,
they have to do a lot of other things to qualify for it.
And really, you know, a lot of people have tried like Lexapro or Certillion
or Zoloft or, you know, some other therapy sessions in the past and,
(21:54):
you know, they notice they're just kind of stuck,
you know, doing all these other
things like going to the gym and social connection. And then, you know,
whatever else eating healthy and they're just keeping their
head out of water you know they're surviving they're i mean check a
phq-9 on these people and you're like oh actually you're not as good of a head
place as you you know you're trying to make yourself out to be yeah kind of
(22:15):
stuck like trying to fill up your cup from below right yeah yeah sustainable
and so you know a lot of more people actually have this available to them as
a treatment modality than they're probably aware
of and so you know most people like think that tms pretty heavy hitter as far
as like you know i need to be like
it's pretty true yeah it's another misconception that it's not accurate.
(22:39):
That's a good one yeah yeah i was just i was traveling and i was speaking with,
i forget what specialty he was he was a doctor just you know chit-chatting and
yeah he thought the same thing he's like oh so i just thought that was like
you know people had to be really bad off, like almost,
you know, admitted, you know, that kind of a thing before they'd even attempt TMS.
(23:02):
And I was like, no, no, no, that's, that's a misconception.
It's, it's not that evasive. It's, you know, I think that for a long time,
it was because of the cost, you know, it was expensive back in the day.
So insurance companies would much rather try, you know, So something else before
they paid that much for TMS.
(23:23):
But now the machines are getting more affordable.
It's just getting more widely used and all of that.
And we've seen this. We've seen that the medications used to be four to six
pharmaceuticals plus therapy and all of this stuff.
And now it's two to four, which is a huge difference, right?
To pharmaceuticals, and then you go ahead and get approved.
(23:48):
We see things like TRICARE, we see insurances like TRICARE, Medicare with no prior auth.
So these are huge, huge steps.
And then, yeah, you and I were looking at the multiple sessions per day being covered coming in July.
So all of these are moving towards more frequency, wider populations being able
(24:12):
to get this treatment and just having a more common treatment overall in the space.
Yeah, that's great. Yeah, I know. That was super cool seeing that from Medicare.
Care you know yeah able to say hey you know you
can do you can build two of the 908 six days a day
which is you know the subsequent tms so being
(24:34):
able to do that like in a morning and afternoon like
most people who've been suffering with depression for a
while they're pretty secure in the routine and being able
to to do that twice a day you know
and then by be financially feasible you know people can do
multiple treatments a day like up to five i think or 10 or even
15 of the theta burst you know which is
(24:55):
like the shortened protocol you talked about pretty
well but being able to you know expedite
the standard 36-day protocol into you
know three and a half weeks like that's amazing because people
are going to notice improvements faster you know clinics are.
Going to be able to increase access like there's a lot of
wonderful things about that so i was very energized to
(25:16):
see that yeah yeah that's great of course
stanford is doing the saint protocol which is
like 10 sessions a day i've been lucky
enough to be at one of the clinics there's only
six clinics offering that right now to do the
actual tradition like the actual protocol with with
the with stanford involved and all of that and yeah it's exciting
(25:38):
just to see you know multiple sessions a day and
obviously those things are not covered yet but it'd be great once once they
do get covered because yeah you can come in and get you know your full treatment.
Done in a couple weeks or maybe one week but you know definitely safely within
a few within within a few weeks so yeah it's great it's moving moving in that direction you know.
(26:02):
How about for you like as a provider like so
you went from obviously like like everybody everybody
and for for all things we don't know anything about anything and then we start
to learn about it and then we start to learn more and then we take the plunge
so for you as a provider what are maybe some misconceptions that you kind of
(26:23):
had early on compared to the reality of now offering TMS at your clinic?
Yeah, so one of my...
Great mentors jay collier i
followed him the biker staff medical center really
cool psychiatric provider awesome dude
and he was fired up on tms a while back and
(26:45):
so you know i i guess i drank the bullet a while
ago prior to that probably
some of my concerns were you know there's some placebo effect
with that like you know you're and you know i think
a lot of providers still have that where you know
you're telling people you're doing something and it's kind of snake oily
and and then you actually look at
(27:05):
the science of it and you look at the stimulation you know there's you
know that's negated and i've been down the rabbit hole for
a while so right there's a lot of clinicians that still
have those misconceptions about oh you know like well
yeah anyone's going to be less depressed if they get to hang out with
a human being who's engaged and talkative to them
and they're on their digital devices for you know half
(27:26):
an hour a day or you know six weeks
like you're actually getting out of the house you know there's a lot of
things there right that probably does work in concurrence at
least a little bit you know and you know
having just the simulation by itself is as incredible
benefit so many and i'm sure you know.
With the amount of human beings provided that providing it
(27:48):
not everyone's amazing probably a lot of people are playing with their
phone you know while the patient's just sitting there nodding off
so and they're still getting amazing benefits so yeah
i think probably that the snake oil
is the biggest like misconception because it's obviously not true you know coming
from you know what you don't know what you don't know like you said right yeah
(28:09):
and then like how easy it is you know like it really is if you're following
the measurement protocols and guidelines and you're making sure the cap well,
it doesn't have to be scary to provide it. Like, you're like,
oh, you know, look at the seizure.
I got this magic wand that I'm gonna mess this person up with.
You know, you do just a couple of treatments, you're like, oh,
(28:31):
this isn't so bad and you know, the blossom is so accessible.
I think some of the machines like the brains where we're pushing it and you're
kind of like in this kind of electrocution device looking thing where you're.
Actually synonymizing that with it, because I looked in that one and you know,
there's great outcomes with all the TMS machines if you get into them and you
(28:51):
know, just having this the wand, you know, just on the side of the head,
you know, gentlest pressure,
and nice, comfy chair, because we got the chair too that went with it.
And i think you know most people like that it's a massage function yeah
i support all the bells and whistles and nice italian
leather i'm like oh this is nice i just want to sit in here on my time off yeah
yeah yeah and i think a lot of the providers i don't know about yourself but
(29:15):
like when you first hear about the mt like getting the motor threshold determined
and the thumb to move and the location right and the intensity right it can
feel oh wow like that's that's a lot like i I got to get right.
But then, yeah, in practice, it's pretty easy, you know?
Yeah, absolutely. Yeah, it really isn't that scary. You know,
(29:37):
and you're right, though. Like, the first time you do it, you're like, what?
And then, you know, I think that negates all of your concerns about the snake
oil, too, when you start seeing, like, the thumb move. Yeah. Okay.
That's true. Yeah.
And for the patients, too, when they see their thumb move.
Because there's other units, like I know when I was there, I talked to you about
(29:58):
this, some stuff, like there's other things online where they say this is better
than TMS and do it at home.
And then you look, it's a nine volt battery.
And so the misconception there is that that's not TMS, everybody,
like TMS goes three centimeters into the brain.
And yeah, when you see the thumb move, you're like, wow, this is something that's obvious.
(30:19):
Yeah, it's getting into my, my brain. like for
real yeah and also think about
like the placebo and stuff correct me if i'm wrong not
as i'm not a clinician but if that was the case it
wouldn't have such a long lasting effect i could
see it working like in the treatment period or
for 36 sessions even or something but then as
(30:41):
it continues to work you know 12 months longer than
that it's and it really re-maps what's
going on in the brain i don't think
that the sham would work for that long you know
right yeah exactly and you know the placebo
effect is a really good thing that potentiates a lot of things
you know it's got a bad rap but basically the placebo's effect
(31:03):
dumbed down as saying your body's natural healing ability
right and so when you're gonna tell
people you know all the time when they're in the pucker state the fight
flight or freeze when they're able to get out of that then their
natural healing abilities come along anyways you know
so i see a lot of people with like their aces scores you
know the adverse childhood experience scores like five or above you
(31:25):
see this chronic inflammatory illness you see a lot of crohn's disease see a
lot of myalgia see a lot of like autoimmune disorders and then like you know
with the ketamine and been offering as long as we haven't imagined based on
the treatment response we're seeing so far the tms and a lot of people are using them in concurrence.
We see this kind of downstream effect where a lot of those inflammatory biomarkers
(31:47):
go down because you're actually not living in that. And then your body's like.
Oh i can take a breath like oh okay like
my natural killer cells are back online my lymphocytes macrophages
are doing their jobs like i'm not like in this
inflamed state yeah get away from everything seems
potentially traumatizing and yeah not having
(32:07):
is a pretty valuable thing i know tms
does that too or you kind of like you
said literally remap the mind you don't have
to you know hold on to all those things that
don't necessarily serve you and obviously the the
duration of the effectiveness you know
the that's the durability you know
(32:28):
the treatment is is very robust like i
have a friend and partner in in
some of my business ventures he's a military veteran
and he went through tms and he was dealing with
this kind of chronic suicidality and he's okay
with me sharing this yeah and then he went through a round
of tms and he hasn't had any suicidality since that
(32:49):
course of tms finished and so i mean that's
a that's a great testament for tms right there you
know and it's so it's so wonderful you
know seeing that over and over and over
again so i've been you know around tms for over 10 years now full-time you know
tms technician for seven years and seeing seeing this over and over and over
(33:11):
and over again like like you mentioned the the suicidal ideations and just the
characteristics and symptoms of depression being lifted.
And you just get a lot of confidence in it. You're like, wow, this is really cool.
And yeah, again, very little side effects at all. So it's wonderful to see that over and over again.
(33:32):
So it's such rewarding work, right? Yeah. Oh, okay.
You really feel like, yeah, you're living your best life. And it's like,
I want to be, I want to do something where I'm helping people.
It's kind of like, I don't know. I think it's like most people's dream,
you know, like easier cliche or something, but it's like, but it's true.
Like you really feel that like, like, cause it's so drastic sometimes,
(33:55):
like six weeks is not long. And then you have somebody who is not feeling well at all.
And, and then in six weeks time, to make that shift, it just,
it's pretty incredible.
Sometimes, you know, obviously not everyone's so extreme.
It's not always like that. And doesn't work for everybody.
(34:15):
But yeah, you really do feel like the lion's share of, of the patients coming
through are definitely feeling that lift.
You know there's that there's that there's that there's a
few days within the treatment period usually where you just feel
that it's lifted but it's
it's interesting because not to get off track here but it feels like almost
(34:36):
like a negation of so it's not almost like it's not like a bliss where i think
a lot of patients think it is going to be like a bliss we're like i'm not i'm
you know i'm not i'm happy it's really like oh where did it go where the depression
go it's not here it's It's like a negation.
You know what I mean? So it's just interesting.
They're like, did I have depression? There's a monkey on my back.
(34:58):
I feel like there was a monkey there. Yeah.
Yeah, like you were really depressed when you came in. They're like, yeah, I was, huh?
Yeah, yeah.
Just a couple more questions for you. You hit upon this a little bit already,
but what are you most excited about in the future of TMS? Where would you like it to go?
(35:20):
Obviously you've been like you said you've been around it for a while and drank
the kool-aid a while ago and you're hip to some of the new stuff coming out and all that but.
And what are you excited about? You know, I think it's already happening,
just the increased availability, you know?
Yeah. I think that's huge just because we want, you know, more people to remember
(35:41):
that they're capable of living better lives, you know?
The TMS is a great way to fast track that for people.
And it isn't scary, you know? People are like, what? I can come in and just
drive myself to and from?
And, you know, like six weeks later, there's a probability that I'm feeling
a world away from where I'm feeling right now.
You know like that's like it's going to be huge for people and pretty
(36:04):
much everyone can navigate that you just have to commit to
it being able to provide that to
more people i'm super excited about it you know i think more and more
accessible from an insurance payer perspective like
you're saying you see like four to eight meds taking consistently and
gold dosing and now it's like two to four
or less you know where you you don't even
(36:26):
like you're prescribed to them and you have like two or five days of
intolerable side effects i'm not taking this right now
you know that's enough for the the payers to
be like okay well you know like the last time they had maybe risk
of serotonin syndrome and they had to go in you know because they were prescribed
a necessary they responded to very poorly right so
we probably don't want to do that to them again and you know they seem like
(36:49):
a good candidate for tms and it's really great to see people come through and
do well with TMS when they've been through the gambit of the traditional medications
without much of any improvements.
It's incredibly rewarding work, and I'm very happy to be part of this.
(37:10):
And thanks for taking the time today, Casey. I really appreciate you.
If you or a loved one has been suffering with depression for some time and has
tried some traditional modalities and has not noticed improvements,
you may be a good candidate for TMS.
Try reaching out to our ketamine clinic, Revitalize Ketamine Clinic,
(37:33):
in either Flagstaff or Prescott Valley, and we can work together with you and
your loved ones to see if you may benefit from TMS.
Rapid TMS, rapid transcranial magnetic stimulation used for treatment-resistant
depression with great efficacy here at Revitalize.
Thank you and make it a great day.
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