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An interview explaining the role of a nurse practitioner and the type of patient that may be referred for TMS (transcranial magnetic stimulation)

My name’s Amy Newstrom and I’m a nurse practitioner at Manlove Psychiatric Group. I’ve been here for about five years.

And what’s your main role here?

I prescribe medications, I help with TMS and then I also do some counseling services.

Do you refer patients for TMS as a nurse practitioner?

I do.

Have you ever tried it yourself?

Well, I’ve had pulses for when we’re checking and learning about how to find somebody’s motor threshold but I’ve never had a full treatment myself.

How long have you worked with TMS?

It’s been a little over three years that we’ve been doing it.

What has your experience been with your patients who you have referred TMS for?

Mostly positive. I haven’t had any negative experiences other than no reaction or minimal improvement but, statistically, I don’t know what that is, but it’s a small amount of people. If it was a large amount, I wouldn’t keep sending them for TMS.

What in your mind makes somebody a candidate for TMS and somebody who you would refer? Is there some characteristics or qualities about a person that you look for before you say that this person would be a good fit for TMS?

The process that we do here is, we check their Montgomery-Asberg Depression Scale and they have to be in the severe range. Then we record all the medications they’ve ever tried, and they’ve usually been on a significant amount of medication and not had positive results or minimal results, so I definitely look for that, at least four medication failures – most people easily meet that criteria. Also, that they have the ability to drive in and out every day, they live in the area, they don’t have any implanted devices – all of the TMS safety questionnaires.

So I think the people that I mostly referred have been very severe cases where I’m beginning to have concerns that they are losing hope and they have tried lots of medicines, they’ve had side effects, they don’t feel good and they really do want to get better and continuing medication trials is just not in them. So I think TMS is a really relatively safe thing for them to try and I’ve had some of those clients do really really well.

Do you have any stories about clients that stick out to you? Obviously, we don’t need any details but were there any clients or cases in particular that you found interesting or surprising in some way where TMS was also involved?

Sometimes it’s surprising how fast people start to get better and that’s great to see. They’re hesitant, they’re scared and once they know that it’s not going to be painful and it’s not going to make them feel different or they’re going to have these major side effects, they’re kind of excited so it’s nice to see them getting better. Some of them, like I said, within a couple of weeks, start to feel some improvement and that’s very encouraging when they haven’t felt that on medicine before.

Is there a particular case that stands out in your mind?

Well, there’s a couple. We’ve had a lot of really great successes. I think that’s because we do a lot of combination, we do genetic testing and we also change medications and also do TMS, so it’s really this package thing and then Mandy’s working on them with some didactic throughout their TMS treatment, about how to get better and how to have coping skills and a healthier lifestyle, so I think that whole package is helpful. But there have been people that have lost their passion for playing music or writing or whatever it is and they find that again and it’s just a really neat thing to see.

In a ballpark figure, what is the usual amount of sessions that you would refer someone who’s severely depressed? How many sessions would you usually refer that person for?

Thirty plus. It’s six or twelve weeks of follow-ups so it’s just the standard protocol – five days a week for six weeks plus once a week for six more weeks.