Community Health & Wellness

Clinic in Bremerton to host cutting-edge treatment for depression

Posted on May 22nd, 2024 By: Conor Wilson

As the leader of Kitsap Mental Health Services, CEO Monica Bernard knows as well as anyone how easy it can be for someone facing serious mental illness to dismiss any anticipation of recovery.

“Maybe their lives are weighed down by poverty, or housing instability, or chronic illness. It’s all too easy for them to give up hope altogether,” she said. “That’s where this TMS Clinic comes in.”

Last week, KMHS celebrated the opening of the Neil S. Hirsch TMS Clinic on its East Bremerton campus. The clinic will make the cutting-edge psychiatric treatment available to low-income patients who suffer from medication-resistant depression.

TMS explained

TMS — or transcranial magnetic stimulation — is a non-invasive procedure that uses magnetic pulses to stimulate parts of the brain involved in depression. Treatment can be effective for those with depression that is not improved through talk therapy, antidepressants or other medications.

Research has found around 50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a meaningful response to TMS, according to Harvard Health. About a third of those patients go into a full remission.

Kitsap Mental Health Services Chief Medical Officer James Hughes, center, cuts a ribbon to celebrate the opening of the Neil S. Hirsch TMS Center opening on May 16 in Bremerton. Photo by Conor Wilson

Although the FDA approved TMS as a treatment for depression over 15 years ago, it has typically only been available to patients with commercial insurance. The new clinic in Kitsap is thought to be one of the first – if not the only – TMS facilities specifically offering care to the uninsured or those on Medicaid.

Over 40% of clients served at the Kitsap clinic will be within the federal poverty level. That’s equal to an income of $15,000 a year for an individual or about $31,000 for a family of four.

All clients at the facility will be KMHS patients, but the facility is open to the community. Referrals could become members at KMHS to use the facility.

The center started receiving referrals last month and expects to begin treatments in June.

Broadening access to TMS therapy

Work on the clinic began in February, after the Foundation for the Advancement of Clinical TMS (FACTMS) selected KMHS from a group of over 50 applicants. The Clinical TMS Society established FACTMS, a nonprofit, in 2022 to broaden the access to TMS therapy.

Funding to start the center was provided by the Neil S. Hirsch Foundation, the clinic’s namesake. Magtism, a TMS company, also donated a Horizon Lite TMS machine.

“Today marks a milestone in our journey towards advancing the availability of transcranial magnetic stimulation therapy,” said Randy Pardell, president of FACTMS. “In less than six months, FACTMS, through its collaboration with (KMHS), transformed this vision into reality, ensuring TMS therapy reaches those in need regardless of financial barriers.”

TMS has been something of a passion for KMHS Chief Medical Officer James Hughes, who led efforts to partner with FACTMS and bring the clinic to Bremerton.

Before starting his current role in 2021, Hughes and his wife, Christina – who serves as a medical director overseeing clinics in Poulsbo and Tacoma that offer TMS – were among the first doctors to bring the therapy to the Northwest in 2009. They also ran their own TMS clinic in Edmonds until 2020.

“I’ve been eager to bring TMS into community mental health,” Hughes said in an interview, calling the science behind the treatment fascinating.

Not shock therapy

During TMS therapy, a patient sits in a dentist-like chair. A coil placed against their scalp delivers magnetic pulses. Those pulses stimulate nerve cells in regions of the brain that typically have decreased activity when a patient has depression.

The treatment is not shock therapy, Hughes said.

“TMS is a very simple idea,” said Dr. Rebecca Allen, president of the Clinical TMS Society, who cares for patients with treatment-resistant depression. “[Y]ou put the coil on the person’s scalp such that the magnetic field goes down into the head and stimulates the brain.”

After an initial hour-long appointment, known as mapping, TMS patients receive daily treatments of about 3 minutes over a span of four to six weeks. The average treatment is 36 sessions, Hughes said.

The therapy does not provide a permanent fix. But patients can see improvement for many months after completing treatment. The average patient sees a year of benefits from the therapy. After that, patients can go back for a booster treatment, Hughes said.

Less guess work

The benefit of TMS is it removes much of the guessing and side effects typically involved in treating depression through antidepressants or other medications, Hughes said. There is no way to look into someone’s brain and see what they need, and often it can take several attempts to choose the right medication for a patient, at the right dosage – if they respond to medication at all.

Compared to medication, TMS has rather minimal side effects, the most common being a headache. Seizures are also a rare, but possible, side effect.

For Hughes, the greatest benefit of TMS is it has the potential of giving patients, who have been trying for years, to get their lives back.

“We’re not talking about sadness. When people are depressed it makes it hard for them to function. Being able to offer TMS gives them the opportunity to turn their life around.”