After a tough pregnancy with a long stint in the hospital, Becky Bay promised herself that if her child survived, she would attend medical school and assist an underserved population. A couple of years later, the Seattle native did just that: she moved from Israel back to the United States to attend the University of Washington School of Medicine.
Bay then worked as a doctor in prisons for more than a decade, but began to feel she didn’t have the skills to properly treat the mentally ill patients she met. That’s when she went back to UW, this time for a second residency in psychiatry. While there, she learned about transcranial magnetic stimulation (TMS), a non-invasive treatment for depression. “The [most effective] treatment for depression is electroconvulsive therapy,” Bay says. “The problem with it is that it needs to be done in an operating room with an anesthesiologist, it’s extremely expensive, and people are afraid of it, so this outstanding treatment becomes really a treatment of last resort.”
That’s where TMS comes in. Instead of the electricity used in electroconvulsive therapy, TMS uses a powerful magnet to stimulate certain areas of the brain. It doesn’t result in a generalized full-body seizure, require a hospital visit, or run the risk of memory loss. “If you weigh everything in — the impact on someone’s life, safety, time, and cost — I think it’s the very best treatment we have for depression,” she says.
While Bay didn’t end up returning to the prison system, she used her newly acquired skills to open Binnacle Psychiatry & TMS in downtown Kirkland this past May. She offers a TMS system from Brainsway, a company based in Jerusalem that has pioneered deep TMS. The Brainsway coils have an H shape, which allows them to go a little deeper into the brain than other coils do.
The treatment, approved by the FDA in 2013, requires only brief daily sessions of 20 minutes over four to six weeks, with a couple of sessions a week for a few weeks after that. In each session, the patient sits in a chair with a cushioned helmet that generates brief magnetic fields. An operator stays in the room the whole time; rarely, patients will experience a seizure, but there have been no cases in which it didn’t stop when the machine was turned off. Bay says her patients describe the sensation not as painful, but as a woodpecker pecking at their brains. Afterward, patients are safe to drive and resume their normal activities.
Insurance will typically only cover TMS if a patient has failed to respond to four or more medications, known as treatment-resistant depression. While research is ongoing into the effectiveness of TMS, so far results are promising. In a study presented at the American Psychiatric Association’s annual meeting, 68 percent of patients with treatment-resistant major depressive disorder experienced improvement in their symptoms after a year, and 45 percent of those reported complete remission. The Brainsway Deep TMS technology is also being studied for treating Parkinson’s disease and autism, and for smoking cessation. “For people who have not responded to medication,” Bay says, “this is an excellent option.”