A local retired police officer was suffering from depression. He’d struggled with it almost 40 years.
After being on numerous medications to help with his major depressive disorder, a treatment called transcranial magnetic stimulation (TMS) was able to help.
Dr. Kalyan Dandala is a psychiatrist and treated this officer. Dandala said when he took his patient through the treatment, the officer asked, “Why wasn’t this around 20 years ago?”
Technically, it was. The magnetic resonance imaging (MRI) based technology has been around since 1985. But it was cleared by the Federal Drug Administration (FDA) in 2008, and classified as a class II medical device in March 2019. Dandala said the medicine-free treatment is also getting new attention now that insurance companies are recognizing it.
“The biggest barrier has been the domination of big pharma,” Dandala said. “You have an industry that’s been ruled in medicine-management for over 70 years, and the younger psychiatrists are more eager to do this.”
Dandala is a national advocate for the treatment, a member of the TMS Clinical Society and a consultant for Neurostar, the company of the equipment he uses in his clinic. In Dandala’s new clinic DAN MED TMS, located by Valley Medical Center at 350 S. 38th Court in Renton, this treatment is the focus. Patients walk into a room, put on headphones and sit in a reclining chair, with devices connected to it not unlike a dentist’s office.
Dandala points to the small panel that sits on a patient’s head, and explains the small focalized magnet (electromagnetic coil) targets the dorsolateral prefrontal cortex of the brain, where about three centimeters deep the brain is dealing with memory, inhibition and reasoning. The magnet is meant to re-stimulate the neuron-to-neuron activity there, he said, as it does a series of taps, or pulses, on the head of the patient.
Dandala started his journey using TMS after working at a rehabilitation center named Schick Shadel Hospital for 10 years, where he was medical director. He said it was there that he realized patients would relapse due to depression or anxiety, not necessarily addiction.
After doing some homework on the latest depression treatments, when medication fails, he came upon TMS. And he was impressed with the data on results, and has seen it clinically as well, first as chief medical officer at Associated Behavioral Health Care in Bellevue, and now as the owner of DAN MED TMS, which has the Renton location and one in Bellevue.
Dandala said he split from Associated Behavioral Health Care to give TMS more attention. Now he does “off label” treatment, where he goes over the 3,000 FDA-approved pulses during a session, if he sees a patient with serious anxiety, social phobia, Post Traumatic Stress Disorder (PTSD), Obsessive Compulsive Disorder (OCD), chronic pain, migraines, Alzheimer’s or Dementia. Dandala said a lot of medications are prescribed “off label use” in certain cases, and this is no different.
He also wanted to make TMS more accessible; the Renton clinic might be the only one to take Medicare and Medicaid, as well as other insurance carriers. And this time of year, a lot of people have already paid their out-of-pocket deductible.
Dandala said the only side effect is a headache or pain where the magnet pulsates on the patient’s head, which he said is normally gone after the first few treatments. According to the classification ruling from the FDA, the identified risks with TMS includes seizure, thermal injury, hearing loss, scalp discomfort, dizziness, nausea, pain in neck or jaw, headache and electrical shock, which are all able to be mitigated with special controls.
TMS does carry a risk of seizure, but Dandala said that is more common with the full “helmets,” whereas Neurostar’s equipment rests over one portion of the brain. He hasn’t had any seizures in his office. Often patients want to fall asleep by the time they’re in the second week of the 19-to-37 minute sessions at his clinic, but they have to stay awake.
The treatment is a front-end commitment: a session everyday, Monday through Friday, for six weeks, followed by three weeks of tapered sessions.
For those who are skeptical, Dandala said he tells patients to do their own research. He said it’s essentially a MRI scan magnet, but concentrated to a specific part of the brain that is believed to be the source of these issues.
“Obviously something brought you through the door, you tried a bunch of meds and they didn’t work. Are you going to keep trying? What are your other options,” he said. “If this is five times as effective as your next antidepressant trial, why not?”
Dandala said he also receives high-functioning patients that are drudging through life, including staff at major companies like Amazon, Boeing and Microsoft. He said the earlier someone can come in, the better.
“There’s very limited resources for mental health, especially in South King County and I just think people need to know that they have options,” Dandala said. “We’ll take on as many patients as possible.”
DAN MED TMS was also recently nominated in the Chamber of Commerce Ahead of the Care awards, in the behavioral health and doctor’s categories. More information is available at DANMEDTMS.com.