Although we're living in uncertain times where incidents of depression may be heightened, it is only a coincidence that a Portland psychiatrist who specializes in transcranial active recovery for treatment of depression recently opened two new locations — one in Tualatin, the other in Hillsboro.
Dr. Jonathan Horey, chief medical officer and co-founder of the Portland Active Recovery TMS clinic, now has offices at Hillsboro's Orenco Station and Tigard's Bridgeport Village.
TMS, which stands for transcranial magnetic stimulation, involves the use of a highly focused, pulsed magnetic field that targets regions of the brain that regulate mood, according to Horey. The procedure is conducted in short, 20-minute sessions.
"The best way to understand it is it's essentially an MRI," said Horey, who opened his Portland clinic in 2017. The procedure is approved by the U.S. Food and Drug Administration. "TMS has been FDA-cleared since about 2008, so it's been around for a while," Horey added.
The Mayo Clinic, which has been ranked by U.S. News & World Report as one of the top psychiatry hospitals in the nation, has performed repetitive TMS treatments since 2002. It was a leader in gaining the FDA's approval for the treatment, according to its website.
Like MRIs, TMS follows the same principle, except that the magnet is placed very close to a person's skull where it "actually stimulates the neurons of the brain so it actually causes them to fire," Horey explained.
Horey attended both medical school and completed his residency at Columbia University, which was one of the earlier universities to conduct research in transcranial magnetic stimulation, he said.
Moving out to Portland in 2013, he started his private practice as a psychiatrist the next year and along the way discovered that some of his patients didn't respond to traditional types of treatment.
"One of the options I was used to having in New York was TMS, so I started looking around Portland for who did TMS, and I quickly realized no one did it," Horey said, adding, "The only exception to that was Kaiser (Permanente). So, Kaiser has had a TMS program for a while, but if you don't have Kaiser insurance, you can't access that."
Horey said initial treatments of TMS include sessions five times every week for six weeks, then they taper off. He noted that having two clinics in Washington County will make for an easier drive for patients to attend the sessions.
To be a candidate for TMS treatment, a person has had to have had at least one failed trial of medication and one failed trial of therapy, although some insurance companies require more medication trials, he said.
"Most people start to feel better about three weeks in. Between three and five weeks, we usually see people feel better," said Horey, a 1995 Lakeridge High School graduate who now lives in West Linn.
Even with the TMS treatments, continuation of some type of medication and therapy is usually needed.
"The data seems to indicate that doing all of those is more effective," said Horey. "That's probably because the patients we see tend to have more severe depression."
Horey said TMS side effects are minimal but could include some tenderness for the first couple of sessions, which goes away. He said in treating more than 200 patients in his clinic, only two couldn't tolerate the treatment. The procedure does not require the use of anesthesia, and patients can return immediately to their normal daily activities.
With the new offices, Horey has added 12 new employees, which include two new nurse practitioners and two new technicians who work the machines.
Because of the current COVID-19 pandemic, Horey said at the moment, all evaluations are being conducted over the phone.
"The message I'm trying to get to people is we're still open, so they shouldn't wait to treat severe depression," he said "It's a severe enough disease that it warrants treatment, just like any other severe medical condition."
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