The treatment of mental disorders using TMS at Redemption Psychiatry
My name is Dr. Jason Friday, I’m a psychiatrist. I’m board certified in general psychiatry and child adolescent psychiatry. I decided when I got out of training that I wanted to make a big change in my community and a big change for psychiatry in general. A big part of what I wanted to change was to bring the most advanced treatments, the most cutting-edge and effective treatments that we can bring to this community and certainly a lot of what I’ve found to be lacking was the lack of progress that a lot of psychiatrists just weren’t daring enough, I’d say, to try some of the newer technologies. And so it was not growing as much as maybe other major educational centers like you might find in New York or Chicago or something like that. I wanted to have doctors that were going to be able to learn about some of these new technologies in a way that was going to further our treatments and compliment everything that the psychiatrists medicate with medication treatments and therapies and help to get the best outcomes possible.
Where is Redemption Psychiatry located?
Over the last five years as we’ve been growing we’ve opened up many different locations. We started out in Gilbert, Arizona and then we moved to Chandler and Central Phoenix and then opened in Glendale and a West Phoenix area as well so we have five location.
When did you first hear about TMS, how did you hear about it and when did you decide it would be a right fit for Redemption Psychiatry?
There is very little training in TMS in residency which I think is a really sad state of affairs right now. Residents coming out should know the most about the most advanced treatments and be up on the research so it was really disappointing that we didn’t get very much in residency, but it’s not uncommon.
It wasn’t until I founded Redemption Psychiatry that we were really trying to look at those advanced treatments, things that are really going to help people to get beyond medication and therapy. As we were looking at all these different treatments, my doctors brought the idea of doing TMS (transcranial magnetic stimulation) to me and they were really passionate about it. I have to be honest, I was kind of skeptical about TMS because I hadn’t had any patients that had actually tried it and actually had any improvements, so I think some healthy skepticism is normal. But we were also looking to the future, looking to say, let’s give things a try, let’s look at the research and let’s try to bring that research to our patients and to find out how effective that can be and I’m glad that we did.
When we started doing TMS in 2015 we took our most difficult, most challenging patients that we were constantly making medication changes for, trying and failing several different treatments, all sorts of therapies and frankly the patients that we were the most concerned about. In between visits, we didn’t know what was going to happen. Were they going to end up in hospital? Were they going to going to have a suicide attempt? Were they going to have severe side effects from medication? And so being able to take those patients as we started it and challenge the effectiveness of TMS and seeing that it can be so effective in ‘treatment resistant depression’.
We said, “okay, that’s fine , we’ve got plenty of treatment-resistant patients that we are kind of finding we’re reaching a dead end on, that we don’t know what to do next” and I can’t say enough about how astonished I was, how pleased I was to see the response to these patients. I can honestly say, I’ve never had any treatment that I’ve prescribed to anybody, whether it was a medication or recommending a course of therapy or sending to any kind of program, to have the same response that I’ve seen with TMS. To have those patients come back after the first month of treatment and walk in the door, have a regular medication follow up, TMS follow up and have them leap up from the chair, give me a big hug with tears in their eyes saying, “I can’t believe I’m better” and I’ve never had that. And so I was immediately sold on TMS after the first few patients that we had treated.
From that point on we have really been so much more interested to see where we can take that. What else can we do with TMS because to see how much better patients can get with that treatment-resistant depression, and to see all of the research that’s going on, it’s exploding. It’s very hard to keep up with all the different article and publications that are coming out with so many different uses and trying to see how different groups are replicating those studies and when we can bring that to bear, when can we start those kinds of treatments for people.
Some of the most amazing results that we’ve been seeing have actually been in treating things that I never thought as a psychiatrist, I’d be treating and frankly that there isn’t really even sometimes any good treatments for. So I’m really excited about the results that we’re seeing with tinnitus treatment. People are suffering so much from this annoying, sometimes crippling sound that they’re constantly hearing in their ears and it can affect them emotionally, can affect their sleep and can make it very difficult to be able to function in life because of that – the hearing issue that comes with the tinnitus. We are seeing that we’re able to get some immediate results with this treatment and in most individuals, a long-lasting condition to being at a lower state or even resolved, so that’s one that’s definitely big on our list.
Chronic pain syndromes, neuropathic pain syndromes have been responding to TMS treatment and especially Theta burst treatment extremely well. A lot of individuals that have the chronic neuropathic pain are not getting adequate relief. You look at the statistic and see 7% of people have some form of neuropathic pain and less than half of them are getting adequate relief from medication treatment and many of them later who may be getting adequate relief don’t want to have to be reliant on medications or they’re having side effects. So to have a non-medication option that’s really effective and gives them long-term relief without having to be in every day, to constantly take something and risk side effects is really amazing I think. It’s going to be changing the way that we treat pain in the future.
Another really exciting development for me personally – because of being a child and adolescent psychiatrist – is treating a lot of children with developmental delays, autism and tic disorders. The efficacy that we’re seeing for autism, for different movement disorders like tic disorders and tourettes has been absolutely amazing. We’re just so excited about the direction that it’s going in because many things that we’re trying to do to help treat these children have limited efficacy and there are even people going in and spending thousands of dollars on treatments for their autistic children, that have no basis and research as to how effective they can be, but they’re willing to do anything that they can find.
To see that we can reduce the level of irritability and rigidity and improve their executive functioning is just amazing. Families hear those areas of improvement that we can have with TMS for autism and they immediately are like, “wow, those are all the things that we’re struggling with, those are all the things that I’m trying to help my child with, that impedes our day to day life and also impedes their ability to get adequate therapy”. As we’re reducing some of these obstacles that they have, to get adequate autism treatment, they’re going to make progress well beyond what they would in just the therapeutic aspect of doing ABA therapy (applied behavior analysis) or any other kind of school interventions so I feel like it’s’ going to drastically change the way that we treat autism as well.
Do you have any personal stories to share about a child that you treated with autism that improved with TMS treatment and how did they notice the improvement?
What’s interesting so far is that a lot of the times, it’s really difficult to get people to give TMS a try, no matter how much you tell people this is an amazing treatment, that we’re seeing results that we wouldn’t be able to see with therapy and medications. They are really hesitant to try something new and so what we’ve been able to do is, those individuals who are getting TMS for depression using the FDA approved treatment – that is also covered by their insurance in most cases – we can often do an additional treatment that can help out with a particular problem.
So I’ve had individuals that have gotten the FDA approved depression treatment and also doing some targeted autism treatment. What we found is, not only the improvement in the depression – which would of course make it very difficult for an autistic child to make progress – but also the big benefit that we were seeing is that reduction in irritability, having fewer outburst, reductions in rigidity and the difficulty in being flexible with a routine and being able to prevent those stuck moments where kids are just not able to shift their attention. Oftentimes that’s one of the most challenging things for parents to be able to deal with because until the child gets out of that loop and stops being stuck then they’re not able to move on to the next activity and that’s just not how our lives work. We really have to be a lot more flexible, it can’t all be routine and so when they saw that difference in having improved flexibility and reduction in the amount of irritability and outbursts, it’s just amazing how much that changes the whole dynamic in the home.
If I were a patient considering treatment and my options for depression or another related mental disorder, what is it that I should know that you’d want me to know about Redemption Psychiatry as to why Redemption is different from other practices in the area or in general, and why would I consider coming to Redemption over another psychiatric ops?
At Redemption Psychiatry, I have put together a team of people that are really passionate about progress. They want to help to redeem families and our profession in general. There’s a lot of negativity surrounding mental health and the whole idea of Redemption Psychiatry is that we are trying to change the way that people view mental health treatment. The redemption for an individual or for a family comes when that difficulty, that treatment-resistant problem, is finally seen in the results that we’ve been trying to get for them for sometimes decades. What sets us apart is that we have not just one person who specializes in TMS and understands ketamine. Nobody can know everything. Nobody can be the right doctor for every person and so even though we think, “I’m going to go to the greatest mind in the country”, if they don’t see you and they don’t see who you are, then it doesn’t matter how much they know.
We have a team of doctors that are all dedicated to learning the most about these advanced treatments and becoming experts at it and consulting with each other and really trying to help further the advanced treatments for depression, for anxiety, for PTSD (post-traumatic stress disorder), for OCD (obsessive-compulsive disorder, for bipolar disorder and you can see that we can treat the untreatable. It’s exciting to see the passion that comes with that from all the doctors. We share all our experiences, our research and you don’t get that from most practice – most people are on their own, they’re maybe in some academic institution, the passion isn’t about building up that practice necessarily and the treatment of all the patients. It is much more either about the institution or it’s about themselves and here it’s not about that. That’s really what sets us apart. It is about changing the whole dynamic of our community and treating those patients in our community so that we get the best outcomes possible.
The other doctors that you work with, they’re also psychiatrists who specialize in adolescents?
We have a lot of different psychiatrists and different approaches that everybody has and there are some of the greatest minds that I know. I feel privileged to work with them every day. We’re learning from each other all the time but we have quite a few that are specialized in children adolescents as well as those that are just specializing in adults and it helps I think to have the range because, especially when we’re talking about treating some adolescent disorders like autism, tic disorders, tourettes and things like that, these are things that may persist into adulthood but the adult psychiatrist doesn’t have the same kind of training that the child adolescent psychiatrist has in just that first exposure, in seeing how things are when they are at their worst when the kids are trying to make progress. They see how things maybe get when they’re into adulthood and they’ve settled into a different state of being and sometimes they’ve kind of become complacent with, “this is as good as it gets, I’m not going to make any more progress”. So having the specialist of all ages I think really helps to understand the whole person.