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How MADRS is used at Manlove Psyciatric Group

Tell us a little bit more about yourself and what you do here at Manlove Psychiatric Group.

My name is Mandy Meredith-Dunlop, I’m a TMS tech here at the Manlove group and I joined the team in February of 2018. My job is to safely oversee the administration of TMS treatments and offer health and fitness guidance while people are receiving their care.

While you’ve seen patients undergo TMS treatment here, what kind of changes have you seen them go through?

I’ve seen dramatic changes in MADRS scores. Patients who came with scores that were in the severe category above 34, dropping down into the normal range between four and six. The quality of life that they have been able to share with me – how it’s improved – has been absolutely indescribable.

You just mentioned something called MADRS scores. Can you explain to us a little bit more about what that means?

(Interviewer passes Mandy a set of the scores.)

Here at the Manlove group, we use the Montgomery-Asberg Depression Scale as a gauge to determine who’s right for treatment and also as a way of charting their progress. With our MADRS, it’s just ten questions gauging everything from how sad they appear to their level of suicidality. With our MADRS, 34 and above is considered severely impaired by depression and a score of 6 or below is considered within normal range.

Is that the case with that score of 34 and 6 for example that you had mentioned; are those the usual range for MADRS scores? Is 34 a universally bad number to have on that or is it a good number?

Lower is better. With this metric, 34 and above is considered severely impaired by depression and it’s kind of like golf. You want to have a lower score, the lower the better. Six to zero is considered within the range of normal functioning.

How often do you administer the questionnaire?

At least weekly.

Are there any other questionnaires that they take?

Not from me, no.

What about the practice, do they administer other questionnaires to measure progress?

I do believe that the other practitioners usually stick with the MADRS as well and they administer it on a slightly different timetable with whatever works for them.

With MADRS, is that basically similar to PHQ-9?

Yes, it gauges the same impact on people lives that depression has.

Have you had any personal experience with TMS?

Not until I had had a chance to move up here. I come from a background of working in a residential treatment center for almost 15 years in Utah, and I wish it was something that had been available to the students that I worked with there.

How do you describe TMS to patients who are undergoing it for the first time?

Well, I’ll tell them that TMS is a machine that is going to administer a very low dose of electric stimulates that will stimulate a part of their brain that is involved with mood regulation. They will hear little clicks and they may feel a little bit of tingling in their scalp but it will not be painful, and it will not impair their ability to go on with their daily life after the treatment.

Your role in coordinating their physical health program with exercise training; have you seen any correlation between them doing TMS and being more motivated to do the exercise or vice versa. And what does the program consist of? What do you start them out on?

Generally, what I’ve observed is when people start to feel better after a week or two of TMS, they’re a lot more motivated and able to do the things that they know they probably should be doing anyway with their health. Where I generally start them out is, we fill out a wellness journal every week, especially as I’m getting to know them so we can see what their strengths are and where we can see some opportunities for improvement. My guideline recommendations is that we shoot for at least half an hour of exercise – preferably closer to an hour – four to six days a week. If it’s strength training, if it’s aerobic exercise, walking, dancing, running, swimming, whatever it is that brings them joy and that they’re able to stick with is what I recommend.