Revolutionizing Mental Health: Exploring TMS and Beyond

I’m honored to have Dr. Richard Bermudez, the National Medical Director at Brainsway, joining us. Dr. Bermudez is a pioneer in transcranial magnetic stimulation (TMS), a groundbreaking treatment for mental health conditions like depression and anxiety. With years of expertise in neuroscience and psychiatry, he has made it his mission to expand the accessibility and efficacy of innovative mental health therapies. Today, he’ll share his journey from electrical engineering to medicine and how it shaped his passion for non-invasive brain stimulation treatments.

We dive into the science behind TMS and how it differs from traditional mental health treatments like medication and talk therapy. Dr. Bermudez explains the evolution of TMS technology, including its ability to stimulate specific brain networks through advanced coil designs. We’ll also discuss the transformative outcomes TMS provides for patients, as well as its potential for treating conditions beyond depression, from obsessive-compulsive disorder to nicotine dependence. Whether you're a clinician, a mental health advocate, or simply curious about this cutting-edge therapy, this discussion promises to be both educational and inspiring.

As we explore TMS, Dr. Bermudez highlights its safety, versatility, and unique role in fostering neuroplasticity. He compares TMS with other emerging treatments like ketamine therapy and discusses the collaborative innovations underway at Brainsway. This episode is a must-listen for anyone interested in mental health, neuroscience, or the future of non-invasive treatments. 

• [03:32] We've had great success with TMS at Camelback Integrated Health and Wellness.
• [04:14] Dr. Bermudes started out as an engineer and ended up switching to biology in college. 
• [05:38] He worked in a physiology lab doing neurophysiology research and brain stimulation. He learned that the brain was an electrochemical organ.
• [06:22] He ended up going into medicine and psychiatry. He became clinically interested in non-invasive brain stimulation.
• [08:44] Brainsway is like a family with a very collaborative culture. They want to transition into a true neuroscience technology company.
• [10:03] It's an exciting time for the organization and for neuroscience.
• [13:23] How TMS differs from traditional medications or therapies. Transcranial means it's across the skull but it's not invasive. They use a high-powered magnet to induce a small electrical current.
• [15:40] Brainsway developed their technology in conjunction with the NIH and their coils are what are called complex coils.
• [16:47] 8 out of 10 patients have had a clinically significant change in their depression score.
• [19:07] There are three brain networks responsible for our mental health and Brainsway has three different helmets and coils. Each one modulates a different network.
• [21:47] TMS is safe and good for all of our brains. It induces neuroplasticity.
• [23:22] Deep TMS and standard TMS. Deep TMS stimulates more areas of the networks.
• [26:54] Functional MRIs and studies related to TMS.
• [28:33] Neurological changes that TMS produces in the brain. TMS belongs with the other pillars of substance abuse treatments.
• [30:01] We learn about conditions that TMS is cleared to treat. 
• [39:58] There are different targets or areas of the brain that need to be modulated to affect different brain networks. There's not a lot of evidence that TMS would work for bipolar mania or autism or ADHD.
• [43:22] We learn about the typical TMS protocol and how long it takes to start to see results.
• [51:20] Dr. Bermudes talks about accelerated protocols and the use of TMS and ketamine.
• [55:00] Avoiding toxic conversations and watching the news. You don't want negative experiences on your plastic brain. The patient experience is important and it's good to have a calm, safe, welcoming environment.
• [57:17] TMS and psychedelics like ketamine. They both have glutamate which is our excitatory neurotransmitter.
• [59:06] Things to think about when deciding between TMS or ketamine. 
• [01:03:22] Safety profiles of TMS versus ketamine. Safety concerns for TMS include not having any metal in your head and likelihood of having seizures.
• [01:12:00] Misconceptions about TMS.
• [01:14:11] Accessibility and insurance cost for TMS.
• [01:20:34] A device based treatment that doesn't require a doctor or a psychiatrist will help address the shortage of psychiatric prescribers.
• [01:21:53] It's surprising how many research articles about TMS are available now.

Links mentioned in this episode:

• Camelback Recovery
• I Love Being Sober YouTube
• BrainsWay Knowledge Center
• Dr. Richard Bermudes Brainsway
• Dr. Richard Bermudes LinkedIn