Nashville TMS- Offering effective new treatment for depression

“Seven months ago I was so depressed I wasn’t able to function. After six weeks of NeuroStar TMS Therapy, I was back to work; feeling great; I was enjoying my kids again and I had my life back.” -Craig, 38 years old

TMS (Transcranial Magnetic Stimulation) therapy is a new therapy that involves no drugs and has been proven safe and effective. TMS is free of the negative side effects often associated with taking antidepressants.

TMS – Acute Treatment for Suicidal Ideation and Suicidal Behavior?

Suicide is one desicion away from HOPE

Suicide is on the rise. According to the BBC, “more people in the United States now die of suicide than in automobile accidents.” It’s a stunning statistic. And many people think that it’s time to focus on a new treatment modality that has already proven to save lives. One of them has taken the lead.

Dr. Mark George, a physician at the Ralph H. Johnson VA Medical Center in Charleston, SC., was the Chief Investigator of a TMS clinical study conducted at two sites from 2010 and 2013; at Ralph H Johnson VA and Walter Reed National Military Medical Center. Dr. George is also a distinguished professor of psychiatry, radiology, and neurosciences and director of the Brain Stimulation Laboratory at the Medical University of South Carolina.


Suicidal Study Participants

Forty-one participants were enrolled for the study, each one in the midst of a suicidal crisis. "We had patients with bandages on their wrists from suicide attempts, patients who had just come from the ICU after purposefully overdosing on medication. We even had a person who was standing on a bridge one day contemplating suicide and sitting in our chair the next," says George.

TMS (Transcranial Magnetic Stimulation) Therapy is a non-invasive medical treatment for patients with Major Depressive Disorder (MDD) who have not benefited from antidepressant medication or other depression treatments. TMS is precisely targeted at a key area of the brain known to be underactive in depression sufferers – the left prefrontal cortex. TMS treatment uses highly focused magnetic pulses to stimulate that area to restore it to normal function and lift depression.

In 2008, the US FDA cleared TMS for treatment of Major Depressive Disorder (MDD) in treatment-resistant patients. TMS treatment of MDD patients consists of 3,000 pulses per day, five days per week, for four to six weeks. Dr. George designed the Study to treat suicidal patients by speeding up that process - increasing daily pulses to 9,000 while delivering the treatment for only three days.

High doses of magnetic stimulation to the part of the brain controlling emotion effectively cut suicidal thoughts in half after only one day, according to a VA study reported in the May 2014 issue of Brain Stimulation. The TMS treatment, approved by the FDA at lower doses to treat depression, could offer an acute care option for doctors and families trying to help a suicidal patient in crisis, say the researchers.

"One of our goals was to show that the higher doses were safe, and we were able to do that," says George.


The VA Envisions Future Suicidal Crisis Care

"Every 17 minutes a Veteran attempts suicide. This gives us a quick, effective treatment for patients in crisis. Right now all we can do is hospitalize them and change their medication. The idea is that TMS might buy enough time to stabilize a patient and get them through a crisis."

George compares the technology to breakthroughs in heart care. "Only a few years ago, if someone came into the hospital with heart problems they would be sent home if they weren't actually having congestive failure," he says. "The same goes for patients having a stroke. We just didn't have effective acute treatment. Now we have protocols for heart attacks and strokes even in the ambulance. Public awareness has gone up. People can tell when something is wrong and they know to get to their doctor for treatment."

"Maybe we can do the same thing with suicide ideation. If we could get people to realize they have a physical problem, a medical problem, and get them to come in for treatment, and then help them quickly, can you imagine how many lives we could save?"

Suicide is preventable.


Know the Warning Signs of Suicide

It is important to be able to recognize the warning signs of suicide and know what action to take if you know  someone who has suicidal tendencies or is making threats of suicide.


Signs of suicide include:

  • threatening suicide;

  • talking about death or suicide;

  • seeking access to, or obsession with, drugs, guns, weapons, or other means of personal harm;

  • substance abuse;

  • depression and expression of hopelessness;

  • withdrawal from friends, family, or work;

  • giving away possessions that have family or personal meaning; and

  • making statements like "they will understand or miss me when I am gone."


What to Do If Someone Exhibits Suicidal Warning Signs

If you know someone demonstrating any of the warning signs, do not be judgmental or confrontational. If they will talk about it, ask if the person is thinking about suicide. For example:

  • Are you feeling hopeless about the present or future?

  • If yes ask… “Have you had thoughts about taking your life?

  • If yes ask… “When did you have these thoughts?”

  • and “Do you have a plan to take your life?”

  • and “Have you ever made a suicide attempt?

You should also work to assure the person’s immediate safety. Possible options include:

  • inform and involve someone close to the person;

  • limit access to means of suicide;

  • increase contact and make a commitment to help the patient through the crisis; and/or

  • refer for mental health treatments and assure the follow–up appointment is made.


Need help?

National Suicide Prevention Lifeline United States: 1 (800) 273-8255

Hours: 24 hours, 7 days a week

Languages: English, Spanish



About Nashville TMS:

In April of 2010, Dr. West brought the technology of NeuroStar TMS to Nashville, becoming the first physician in Tennessee to offer the option of Transcranial Magnetic Stimulation for patients whose severe depression has not responded to a course of antidepressant medication. The Nashville TMS Team has treated patients from Tennessee, Kentucky, Colorado, California, Missouri, New York, Florida and Alabama.

Hear what Nashville TMS patients have to say about their depression treatment experiences and outcomes!

Written by: Lisa Chapman

Being with Someone Through Depression

Anne Wheaton interviewed about being with someone who is going through depression

An Interview with Anne Wheaton

Is depression really less common in men than in women? Studies have indicated so, but it just may be that men experience depression differently. As you will read in this interview with Anne Wheaton, Wil Wheaton’s wife, she experienced his frustration, irritability, anger and discouragement. But for years they didn’t associate these emotions with depression.

Perhaps many men aren’t as open about their emotions, so they discuss their feelings less and don’t seek treatment as often. This interview reveals authentic insights to a relationship in which one partner deals with the effects of the other’s depression, both before and after the diagnosis.


Q: How long have you been with your husband? 

A: “Wil and I have been married for 15 years, together for 18.”


Q: What were his first symptoms of depression and how did they progress? 

A: “When Wil and I first met, he was 23 and I was 26. When Wil was 27, we met with a therapist because he was feeling sad. We were about to get married, so we wanted to talk with someone to make sure these feelings weren't a result of something in our relationship. We decided that they weren't, but the therapist was concerned that it might be depression. Wil figured the feelings would pass, which they mostly did. But by the time he was 33, the feelings of sadness turned into insecurity and self-doubt about his life, his career, and his ability to be a good parent to our boys and a good partner in our marriage. He also developed irrational anger toward the most random things: the computer not working right, sitting in traffic, even driving over a pothole. He would never, ever yell at me, our kids, or our pets. It was always at things that seemed irrational to be mad at. When it escalated to the point that he didn't want to leave our house, I knew something was really wrong.” 


Q: Can you explain how the changes in your husband's behavior affected you and your relationship? 

A: “As Wil's depression got worse, I felt like I couldn't say or do much to help him. He stopped wanting to visit friends, because he didn't want to deal with sitting in traffic. Eventually, I started visiting them without him, because I missed them and missed going out after so many times of choosing to stay home with Wil instead. When Wil would get really angry at whatever inanimate thing upset him, I would ask him not to yell, partly because I didn't want him to scare our pets, but more importantly, I didn't want our kids to grow up thinking this was acceptable behavior. I began to feel like my desire to help him was turning into enabling. It really upset me to see Wil slowly become this sad, anxious, angry person instead of someone enjoying his life.” 


Q: When did you realize your husband needed to get help?

A: “About five years ago, Wil was set to perform at sold-out shows in Minneapolis and Chicago with our friends, Paul and Storm, in a sort of nerd vaudeville-style show called “w00tstock.” When we arrived at the airport, the airline check-in area was packed with people. Wil was so anxious about making our flight on time that he asked an attendant how long the wait would be. The attendant was really rude and dismissive and told him there was no way we'd make our flight, so we should just reschedule. Wil was so full of anxiety and frustration that he just wanted to go home. As often as I caved to this behavior with Wil, I knew this was not an option this time. And honestly, I was so tired of missing out on things because of his feeling this way. I walked him over to a bench, sat him down, and told him I would call customer service to get us new flights. But the minute we got home from our trip, he needed to talk to someone to get help, because neither one of us could live with his behavior anymore. He completely agreed, and while I was on the phone with customer service in the airport, he actually called to schedule an appointment with a psychiatrist for the following week.” 


Q: How did he react when you suggested he visit a health care professional? 

A: “Wil was aware of his anxiety, anger, and his feelings of sadness and insecurity. But I think we both had gotten so used to me handling everything that we didn't realize how bad he was feeling and how negatively it was affecting me. We talked about it a lot over the next few days while we were traveling, so he was looking forward to getting home and seeing the psychiatrist (and, later, to talk to a psychologist) to get to the root of the problem.


Q: What changes did you notice following your husband's diagnosis? 

A: During his first visit with the psychiatrist, Wil was very surprised to hear that his symptoms were signs of depression. Neither one of us had considered depression, since we assumed depression meant deep sadness and the inability to get out of bed every day. He learned that depression affects people in different ways, and so does medication to treat it. The psychiatrist wanted him to take medication and to talk to me about how he was feeling in between visits with the doctor, because some medications could make symptoms worse…”


Q: Your husband is a well-known actor and writer who has been very open about his depression. Why do you think it's important he shares his story with others? 

A: “For so long, depression seemed to be a thing that was more common in women than men. I don't know if that was because more women were talking about it than men, or if it was because what we perceive as telltale signs of depression are only a small fraction of how many different symptoms there actually are. It seems that depression can affect men much differently than women, so Wil wanted to talk about it openly because he knows first-hand how much better he feels as a result of just asking for help. He wants to remove the unnecessary and dangerous stigma our society seems to have when it comes to talking about and treating mental illness. When more people share their symptoms and what they did to get help, the more it will help others see in themselves what they may not have otherwise known was a problem and talk to their doctor about it.” 


Q: What advice would you give to other women who may be living with someone struggling with symptoms of depression? 

A: It is never easy to see a loved one struggle, especially when it comes to depression or any other mental illness. If we had only known Wil was suffering from depression all those years, I would have encouraged him to see a doctor long before he finally did. If your loved one were diabetic or had a heart problem, they'd seek medical help immediately. The brain is just another organ that, for some people, may need a little help to function properly. Getting help for depression is nothing to be ashamed of or to feel too prideful to do. You get one life, so you should do anything and everything you can to live it to its full potential.”


Anne and Will decided to go public with this interview, in hopes of reaching others who are dealing with the same or similar issues.


About Anne Wheaton

Anne Wheaton lives in Los Angeles with her husband, two cats, and three dogs. She is a member of the Board of Directors for the Pasadena Humane Society & SPCA, a nonprofit organization. She blogs at and is on Twitter @AnneWheaton.


About Nashville TMS:

In April of 2010, Dr. West brought the technology of NeuroStar TMS to Nashville, becoming the first physician in Tennessee to offer the option of Transcranial Magnetic Stimulation for patients whose severe depression has not responded to a course of antidepressant medication. The Nashville TMS Team has treated patients from Tennessee, Kentucky, Colorado, California, Missouri, New York, and Alabama.

Hear what Nashville TMS patients have to say about their depression treatment experiences and outcomes!

Written by: Lisa Chapman

Will Seasonal Affective Disorder (SAD) Darken Your Days This Winter?

That Time of Year is Approaching Fast

Seasonal Affective Disorder SAD Treated with Cognitive Behavioral Therapy (CBT), Antidepressants, and TMS

For more than three decades, researchers at the National Institutes of Health (NIH) have been studying a recurrent malady known as the “Winter Blues”, and a more severe type of depression called “Seasonal Affective Disorder” (SAD). They’ve learned about possible causes and found treatments that seem to help many people. Still, much remains unknown about these winter-related shifts in mood.


Winter Blues

“Winter Blues is a general term, not a medical diagnosis. It’s fairly common, and it’s more mild than serious. It usually clears up on its own in a fairly short amount of time,” says Dr. Matthew Rudorfer, a mental health expert at NIH. The so-called Winter Blues are often linked to something specific, such as stressful holidays or reminders of absent loved ones.


Typical symptoms of Winter Blues include:

  • Sad, anxious or "empty" feelings

  • Irritability, restlessness

  • Loss of interest or pleasure in activities you used to enjoy

  • Fatigue and decreased energy

  • Difficulty concentrating, remembering details and making decisions

  • Difficulty sleeping or oversleeping

  • Cravings for carbohydrates, especially sugar

  • Weight gain

Seasonal Affective Disorder

“Seasonal Affective Disorder, though, is different. It’s a well-defined clinical diagnosis that’s related to the shortening of daylight hours,” says Rudorfer. “It interferes with daily functioning over a significant period of time.” A key feature of SAD is that it follows a regular pattern. It recurs - appearing each year as the seasons change, and it goes away several months later, usually during spring and summer.

Not everyone with SAD has the same symptoms. In addition to many of the symptoms of Winter Blues, people may also experience:

  • Depression

  • Feelings of hopelessness and/or pessimism

  • Feelings of guilt, worthlessness or helplessness

  • Thoughts of death or suicidal ideation

Without treatment, these symptoms generally last until the days start getting longer.


What Causes SAD?

SAD is more common in northern than in southern parts of the United States, where winter days last longer. “In Florida only about 1% of the population is likely to suffer from SAD. But in the northernmost parts of the U.S, about 10% of people in Alaska may be affected,” says Rudorfer.

Shorter days seem to be a main trigger for SAD. Reduced sunlight in fall and winter can disrupt your body’s internal clock, or circadian rhythm. This 24-hour “master clock” responds to cues in your surroundings, especially light and darkness. During the day, your brain sends signals to other parts of the body to help keep you awake and ready for action. At night, a tiny gland in the brain produces a chemical called melatonin, which helps you sleep. Shortened daylight hours in winter can alter this natural rhythm and lead to SAD in certain people.


Types of Treatment for SAD

NIH researchers first recognized the link between light and seasonal depression back in the early 1980s. These scientists pioneered the use of light therapy, which has since become a standard treatment for SAD.

Light Therapy

“Light therapy, also known as Bright Light Therapy (BLT) is meant to replace the missing daylight hours with an artificial substitute,” says Rudorfer. In light therapy, patients generally sit in front of a light box every morning for 30 minutes or more, depending on the doctor’s recommendation. The box shines light much brighter than ordinary indoor lighting.

Studies have shown that light therapy relieves SAD symptoms for as much as 70% of patients after a few weeks of treatment. Some improvement can be detected even sooner. “Our research has found that patients report an improvement in depression scores after even the first administration of light,” says Dr. Teodor Postolache, who treats anxiety and mood disorders at the University of Maryland School of Medicine. “Still, a sizable portion of patients improve but do not fully respond to light treatment alone.”

Light therapy is usually considered a first line treatment for SAD, but it doesn’t work for everyone.

Antidepressant Medications

Studies show that certain antidepressant drugs can be effective in many cases of SAD. The antidepressants Prozac and Wellbutrin are approved by the U.S. Food and Drug Administration (FDA) for treating SAD. Doctors sometimes prescribe other ‘off-label’ antidepressants as well.

Cognitive Behavioral Therapy

Growing evidence suggests that Cognitive Behavioral Therapy (CBT)—a type of talk therapy—can also help patients who have SAD. “For the ‘cognitive’ part of CBT, we work with patients to identify negative self-defeating thoughts they have,” says Dr. Kelly Rohan, a SAD specialist at the University of Vermont. “We try to look objectively at the thought and then reframe it into something that’s more accurate, less negative, and maybe even a little more positive. The ‘behavioral’ part of CBT tries to teach people new behaviors to engage in when they’re feeling depressed, to help them feel better.”

Behavioral changes might include having lunch with friends, going out for a walk or volunteering in the community. “We try to identify activities that are engaging and pleasurable, and we work with patients to try to schedule them into their daily routine,” says Rohan.


Cognitive Behavioral Therapy vs. Light Therapy

A preliminary study by Rohan and colleagues compared CBT to light therapy. Both were found effective at relieving SAD symptoms over 6 weeks in the winter. “We also found that people treated with CBT have less depression and less return of SAD the following winter compared to people who were treated with light therapy,” Rohan says. A larger NIH-funded study is now underway to compare CBT to light therapy over 2 years of follow up.


Light Therapy vs. Antidepressant Treatment

Since there is little evidence comparing light therapy with antidepressant medication, the choice between these alternatives relies on individual assessment of risks and benefits. Generally, light therapy is very well accepted by patients. Availability and costs of a light therapy device are sometimes limiting factors, as is the time patients need to commit for daily light therapy.

However, BLT should be considered first-line treatment for moderately depressed patients and patients with prominent atypical depressive symptoms. Generally, light therapy alone or in combination with antidepressants should be given for the duration of the dark time of year - until April or May in the northern hemisphere.

A trial of light therapy should last at least 2 to 4 weeks. A trial of antidepressants should last 4 to 6 weeks. Initially, light therapy and medication trials should be applied sequentially, as combining them from the beginning on will lead to a loss of information about which treatment is beneficial, or which treatment is causing side effects.


Combination Therapy

A combination of both treatments should be considered if there is insufficient response to either pharmacological or light treatment. If a depressive episode is resistant to the combination of BLT and an antidepressant, options are lengthening light treatment time, raising the dose of the antidepressant, or switching to a drug of a different class.



Although there are no specific data available for SAD, treatment should follow algorithms for treatment-resistant depression if a sufficient response still cannot be achieved.

If you’re feeling blue this winter, and if the feelings last for several weeks, talk to a health care provider. “It’s true that SAD goes away on its own, but that could take 5 months or more. Five months of every year is a long time to be impaired and suffering,” says Rudorfer. “SAD is generally quite treatable, and the treatment options keep increasing and improving.”


About Nashville TMS:
In April of 2010, Dr. West brought the technology of NeuroStar TMS to Nashville, becoming the first physician in Tennessee to offer the option of Transcranial Magnetic Stimulation for patients whose severe depression has not responded to a course of antidepressant medication. The Nashville TMS Team has treated patients from Tennessee, Kentucky, Colorado, California, Missouri, New York, and Alabama.

Hear what Nashville TMS patients have to say about their depression treatment experiences and outcomes!

Written by: Lisa Chapman

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Nashville TMS Patients Tell Their Stories

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About Scott West, MD

Dr. Scott West has dedicated his professional career to helping people overcome clinical depression. He has practiced psychiatry in Nashville Tennessee since 1986, when he finished his residency in psychiatry at Vanderbilt University Medical Center.

Prior to that, he graduated Magna Cum Laude from the University of Tennessee, Knoxville and received his medical degree from the University of Tennessee Medical Center in Memphis. He is a Diplomate of The American Board of Psychiatry and Neurology in the specialty of Psychiatry and a Distinguished Fellow of the American Psychiatric Association.

More about Scott West, MD