An Interview with Michelle Cochran, MD, FAPA: Clinical TMS Society Board President

I recently sat down with an industry colleague, and we had an open discussion on the Clinical TMS Society’s role and impact on TMS Therapy and the future of the treatment for depressed patients.

Below are insights from Clinical TMS Society Board President and fellow psychiatrist, Michelle Cochran, MD FAPA.

Clinical TMS SocietyQ: What is The Clinical TMS Society?

Cochran: The Clinical TMS Society (CTMSS) is an organization of 400+ U.S. and international clinicians, researchers and technicians dedicated to optimizing clinical practice, awareness and accessibility of Transcranial Magnetic Stimulation (TMS).

How did you get involved with the Society?

Cochran: In 2013, I attended the American Psychiatric Association meeting in San Francisco, California, which was also when the first CTMSS meeting was being held. I heard about the Society and registered to attend and learn more. At that point, I joined the Annual Meeting Committee, and helped organize the 2014 New York City meeting. I was later charged with planning the CTMSS Annual Meeting in Toronto, Canada in 2015 as well. This conference grew our membership and established a different directive for our organization by providing significant education for TMS clinicians and technicians. I have remained active on the Annual Meeting Committee, but was invited to participate on the Board of Directors and became a member-at-large on the Executive Committee in 2015. The following year I became the Vice President (2016), and in May of 2017, I was elected President of the Board.

I have developed deep working relationships with Board members and committee members across the world through my activities with CTMSS. I find it an indispensable organization as a physician offering TMS in my practice.

How has the Society developed since it began?

Cochran: The Society has grown from approximately 100 clinicians to currently more than 400 clinicians, technicians, researchers and business associates worldwide. We have boosted our committee activities with an ever-increasing number of members who join and actively participate in these committees.

The various activities of the Society are designed to:

  1. Make individuals more skilled TMS practitioners
  2. Help individuals remain current on the most relevant and reliable research
  3. Explore new vistas of TMS options in a host of neuropsychiatric conditions
  4. Become adept in getting insurance coverage
  5. Acquire the requisite practice management skills for success

With the progress and new goals by the Board, CTMSS has increased its year-round activity to include more educational activities. The growing annual educational conference consists of the world’s brightest researchers and clinicians who offer didactic and hands-on lectures. This conference provides opportunities to learn, network with colleagues and business partners, and explore existing tools (via our sponsors) to develop a neuromodulation clinical practice.

The Society’s quarterly newsletter offers a number of interesting and exciting articles as well as pragmatic pearls of wisdom. Multiple new online activities such as the “Grand Rounds” series, with CME courses on TMS, are now available throughout the year. Two of the non-CME grand rounds this year are designed to help current CTMSS members market TMS to other doctors and patients.

The most significant focus for this year by the Society has been to increase education to new clinicians thereby increasing the availability of TMS for patients. The introductory course which I directed for the 2017 Annual Meeting, PULSES, is being expanded and will be offered internationally (in London, England February 2018) and again in May 2018 in Brooklyn, New York. Registration for these programs is open now. Finally, this year the Society’s website is being overhauled to include better access to these programs.

What role does TMS have in clinical practice?

Cochran: Transcranial Magnetic Stimulation or TMS is a neuro-modulative tool to help patients who suffer from depression when they do not respond to antidepressants.

In my humble opinion, TMS is frequently used too late in the course of care, because of lack of insurance coverage. There is evidence that TMS treatment works better earlier in the course of care. However, financial matters must be considered for each patient. We find that insurance often will cover the cost of treatment in appeals, but many patients cannot afford to extend themselves financially while waiting for reimbursement, which can take up to a year.

TMS is effective at any point in the care of a depressed patient. However, I refer to other forms of neuromodulation (ECT) when patients are psychotic, need hospitalization or are suicidal and cannot contract for safety.

What are some of the biggest hurdles for TMS Therapy in the treatment of depression?

Cochran: I see many patients whose treatment is stopped too early before they are in remission because the clinician lacks knowledge or skill to negotiate or advocate extending the care with an insurance reviewer. Most TMS care ends at approximately 36 treatments; however, some patients can require upwards of 60 treatments in their course of care. Research supports this extension (Avery 2009, Yip 2017).

For people suffering from depression, what is the most compelling reason(s) for them to explore TMS Therapy over a traditional treatment plan?

Cochran: TMS Therapy works to get patients into remission when medications alone do not.

What advice would you give a doctor(s) who’s on the fence regarding referring a patient(s) for TMS Therapy?

Cochran: I’d recommend calling a clinician who offers TMS and discussing their patient outcomes or visiting a TMS office to see the care first-hand. Or explore patient testimonials to learn about their personal stories of success through TMS Therapy.

What do you think is the future for TMS?

Cochran: I hope that all psychiatrists will embrace this office-based treatment. Most depressed patients treated by psychiatrists have failed a number of medications and meet criteria to use TMS treatment.

TMS is invaluable in the care of depressed patients. And I believe that TMS will eventually have an adolescent depression indication and that the science will emerge to treat other conditions such as pain, migraine, dementia, anxiety and among others.

Thank you, Dr. Cochran, I greatly appreciate you sharing your thoughts and participating in this interview.

Michelle Cochran, MD is the medical director at The Nashville Center for Hope & Healing and NeuroScience & TMS Treatment Center.