September 30, 2017
Dear Patient or Colleague:
I write to you today as the new Chief Medical Officer (CMO) of AchieveTMS. We are the largest provider of DeepTMS in the world. My own background includes being the founder (2009) and currently head of TMS at McLean Hospital, the first in the Harvard system dedicated to TMS psychiatric clinical care, teaching, education, and research. McLean is the largest Harvard Medical School affiliate psychiatric facility.
One of the reasons I joined Achieve TMS is that the Principles wanted to take advantage of a large organization to standardize treatment by patient type, so that the most current (best) treatment is given to each patient. TMS resides in a world which can be cutting edge technology and clinical service or less evidence-based practice, depending on the provider. For instance, Brainsway, the only Deep TMS stimulator system, is currently applying to FDA for clearance for new disease treatment using new device configurations. We are very optimistic that we will see Obsessive Compulsive Disorder approved this year in the USA. Many other TMS device manufacturers say that “in Europe” they can treat ringing of the ears (tinnitus). Yet, no single study in the USA supports that conclusion and many providers treat tinnitus.
Achieve TMS is unique and a distinctive private company. It is a large network of Deep TMS treatment for depression centers (seven in California, five in Massachusetts and three in Oregon). At Achieve, each of our centers are committed to providing the highest quality of care with the best possible outcomes. Each center looks like a modern, private practice setting. Our Staff is compassionate, committed and highly qualified. We are taking major steps to build a system that ensures timely, accurate, safe and effective treatment. Standardization of treatment intervention is the first comprehensive initiative. After a successful TMS treatment patients will be followed for one year and a relapse prevention protocol will be implemented. Achieve TMS recognizes its social role and responsibility, is a generous company with a charitable care program where we match any discount given by a referring source and we have a sliding scale for any other patient who needs one.
The basics of our plan involve the following concepts and ideas about TMS and depression:
- After a successful acute course of #36 TMS treatments, clinicians use some variation of re-treatment intervention at 3-month,
- 6-month and one year follow-up.
- Early diagnosis and intervention at 3-month, 6-month and one year is an effective strategy. If a patient is clinically depressed (most likely mild to moderate severity) and his depression scale score confirms it, a minimal treatment of #2 sessions weekly for 3-weeks usually induces a response.
- We know that after a successful treatment over 50% of patients will have a new episode of depression in the first year.
- We know that if we identify and re-treat those patients, 70% of them will have a clinically significant reduction in symptoms (after a shorter course of TMS treatment) and will have a faster recovery.
Now, we want to take advantage of our platform to change the follow-up on all of our patients for a year. We call this the “depression vigilance method”. In vastly increases the follow-up and because health insurance companies may not cover Achieve TMS will cover the expenses.
Depression Vigilance Method:
The method involves technical activities of clinical surveillance that consist of routine measurements of symptoms of depression and intermittent analysis to identify changes in Major Depression Disorder (MDD) over a period of one year.
- We would like to administer a depression rating scale every 3 months. If the scores and clinical assessments are consistent with an episode of depression we will arrange with the referring source and with our Staff to see the patient within one week.
- If the patient is symptomatic for several days in one week, the patient will be brought directly to any Achieve TMS site. An evaluation and assessment (scales and clinical) will be completed and if indicated a short course of TMS will be initiated. We hope to treat the patient as cover by his health insurance company however if treatments not cover, Achieve TMS will deliver the treatments free of charge. We are committed to maximize and sustain a clinically significant reduction in symptoms.
- If clinically appropriate, antidepressant medication will remain stable without adjustments
Our Staff will work in close collaboration with the referring source throughout the year. We expect to reduce relapse rate of depression to the lowest possible. We will have three groups for comparison of treatment outcomes: 1) MDD patients treated with TMS as reported in the literature. 2) MDD patients treated at Achieve TMS under our standard protocol. 3) MDD patients treated at Achieve and followed for one year with periodic schedule assessments and early intervention.
The development of effective depression relapse prevention strategies in clinical populations using deep TMS will change how psychiatry treat patients. Identification of symptoms and early deep TMS treatment intervention are central in this project. Achieve TMS believes that all efforts will benefit our patients and as a consequence many others, helping them to recover, develop their full potential and live a full life.
On behalf of Achieve TMS leadership,
Oscar G. Morales, MD
Chief Medical Officer (CMO)
47 Pleasant St. # 1-NW, Northampton
Massachusetts 01060, USA