The Cost of Stimulating Happiness

The Cost of Stimulating Happiness

“Sit back and relax. The treatment takes less than 30 minutes,” said the technician, gesturing toward the futuristic, pale plastic seating of a machine that looks like the intersection of a dentist chair and command center out of Star Trek.

The technician hands the patient foam ear plugs then lowers the top of the machine down to lightly rest on the top left of the patient’s head.

A whirring sound rattles the chair slightly, vibrating at upwards of 10 hertz per second.

Every 10 to 30 seconds loud clicking noises are emitted with the firing of electromagnetic pulses into the the patient’s left prefrontal dorsal cerebral cortex. Susan Burchett, 52, claimed with every click, she felt a slight thumping on her head, like a capped pen repeatedly tapping with a medium amount of force on the same spot.

Burchett, a mother of three and a regular court-appointed special advocate (CASA) and guardian ad litem (GAL) for Denton County, Texas, has utilized this unconventional treatment since 2015.

This machine is not a torture device or command center out of a sci-fi film. Transcranial magnetic stimulation therapy (TMS), the first non-invasive treatment for depression, might revolutionize treatment of mental illness across the U.S.

Cost, seems to be the one insurmountable barrier for many. Three months of treatment begins at $10,000 — cash.

“TMS changed my life,” Burchett said. “It didn’t just control my symptoms, it put my depression in remission.”

Brechett sought TMS as an alternative treatment option after she failed to improve with conventional pharmaceutical treatments for her clinical diagnosis of late onset bipolar II disorder and treatment resistant depression. For Burchett, TMS was a logical choice, its non-invasive, requiring no anesthesia and has essentially no side effects.

The most popular producer of the TMS machine is Neuronetics Inc., a commercial medical device company founded in 2002 and based in Malvern, Penn. They offer the only FDA approved TMS treatment that can be delivered in under 17 minutes, and has been a leader in the TMS industry since its founding.

Despite the availability of Neuronetics’ TMS therapy since 2008, the company’s President and CEO, Chris Thatcher, stated in a press release that he is surprised “many people still haven’t heard about it.”

Depression affects 300 million people around the world, with 16.2 million in the United States alone. That’s about 6.7% of the total U.S. population, according to the Anxiety and Depression Association of America.

“Depression is an epidemic,” said Dr. Grant Brenner, a Manhattan based psychiatrist who specializes in progressive psychoanalytic and cognitive behavioral therapies. “Right now, we don’t have good enough treatments for it.”

According to Harvard Health Publishing on completion of their treatment with TMS, 50% to 60% of patients with treatment-resistant depression reported an improvement in their symptoms. In the depressed individual, there is a decrease in nerve activity and blood circulation to certain parts of the brain. The electromagnet in the TMS machine, stimulates these sluggish neurons, enabling them to fire once again. This improves mood and reduces or eliminates depressive symptoms.

“After the treatment they can walk out, drive, go to work, go on a jog,” said Irma Ramirez, who has worked as a TMS technician at El Paso Counseling Associates in Texas for the last eight years.

Patients are required to come in every day for around 30 treatments. Each treatment lasts and average of 30 minutes.

“There’s no systemic side-effects,” Dr. Brenner said. “That’s big.”

Antidepressants: The Not-So Happy Pill

The traditional treatment for depression is antidepressants, known for their often severe side-effects. Antidepressant use increased by 65% from 1999–2002, and continues to rise, according to the National Center for Health Statistics.

But, Dr. Alan Manevitz M.D., a clinical psychiatrist in New York City, explains only about one third of patients report an improvement in symptoms on antidepressants.

Burchett tried several different antidepressants, and suffered side effects such as manic episodes and tremors. “I took one drug that made me gain 25 pounds in six weeks,” Burchett said.

McKenzie Rodriguez, 23, a stay at home mother from New Mexico, says taking the wrong pill isn’t just uncomfortable, but could be life-threatening.

“Getting properly diagnosed and prescribed the proper medications is difficult,” Rodriguez said. “It can be a dangerous experience. The wrong pill can make all your symptoms worse.”

Antidepressants help only about 30% of patients, reported the Sequenced Treatment Alternatives to Relieve Depression (STAR* D) study. Conducted by the National Institute of Mental Health, this was the largest and most comprehensive trial researching depression ever completed.

When antidepressants fail or side effects escalate, many patients feel they are out of options.

“This might sound bleak, but when you’ve been struggling with depression and anxiety as long as I have, you’re willing to give anything a try,” says Nick Gulley, 25, a data analyst from New York City who was diagnosed with depression at the age of 11.

The NeuroStar Advanced Therapy System, the TMS machine produced by Neuronetics, is the first of its kind to be mass marketed; however, competitors such as BrainsWay, founded in 2003, and MagVenture in 2007 are vying for a share of the market. Currently, there are eight companies producing TMS machines.

“Medicines, in my experience, don’t get you where you want to be,” said Dr. Richard Harrison,* an emergency medicine doctor who has struggled with clinical depression for over 20 years. “You feel like you’re taking a mild poison with antidepressants. TMS seemed to pull me out of it without medicine.”

If TMS truly is a miracle treatment for depression, why aren’t more people jumping on the bandwagon?

Happiness Costs — A Lot

The average $10,000 price tag for treatment is too steep for most. If the patient requires follow-up mini treatments, called “boosters,” these run around $350 per session.

To make matters worse for patients, treatments are not covered by many insurance companies.

“The sad tragedy is TMS is unattainable to the average person diagnosed with depression,” Dr. Harrison said. “It’s absolutely cost prohibitive to the average household because it’s primarily a cash industry. If you want to do this treatment, you are on your own. And, you are taking a big risk.”

Neuronetics maintain a market cap of $313 million. Analysts expect a 4.7 % annual growth increase in earnings in the next three years. Yet, their revenues barely break even with debt and cash flow.

Dr. Brenner wonders about their financial stability, and if this is affecting their price strategy.

If you’re first to the market you can determine the prices,” says Dr. Brenner. “Whoever decided to commercialize TMS saw an opportunity to make it like a medical device. And so the reason it’s not more affordable is because the company that makes it doesn’t need it to be. NeuroStar is older. They have the most market-share. They were the first ones out there to start selling these machines, and it seems they have a say in these prices.”

Neuronetics Inc. declined to comment.

The cost of depression, in the United States alone, is estimated at $83 billion ($26 billion in costs of treatment and $57 billion in losses such as absenteeism, reduced productivity and value or lifetime earnings due to suicide), according to the National Institute of Mental Health.

And according to MarketWatch, the market size for transcranial magnetic stimulators is projected to reach 130 million by 2024.

There seems to be a market for TMS, yet current pricing eliminates many prospective patients. If the pricing could be restructured and offered at an affordable rate, more people may benefit, Dr. Brenner explained. The industry could experience a surge due to an increase in access.

Dr. Harrison, who has worked in the medical industry for over 20 years, believes the issue boils down to greed.

“When you see greed and selfishness in the context of the medical world, it’s usually counter balanced by human suffering,” Harrison said. “This makes it obvious, disturbing, and sad. Whether it’s the medical device manufacturer or the pharmaceutical company, it’s everywhere.”

Rodrigues echoes his view. “The medical field cares more about making money off of sick people rather than helping them,” Rodriguez said. “This can cause treatments like these to cost a lot.”

But pricing isn’t solely dependent on the producer — it’s a part of a much larger, and complex relationship between insurance companies, the medical technology industry, the medical community, treatment requirements, lack of competition and stigmas surrounding mental illness.

“I don’t see insurance companies as solely the enemy, but I do think they often use unsavory practices,” Dr. Brenner said.

Some insurance companies, such as Medicare, United Healthcare, Blue Cross and Blue Shield do offer partial coverage, but often have tricky rules, because they consider TMS therapy “experimental,” according to Dr. Manevitz.

They often refuse service unless the patient “has already tried and failed [antidepressants],” Dr. Manevitz said. He says this can force patients to take antidepressants instead of receive TMS.

The Final Wall to Leap: Stigma

Depression and other mental health issues have a greater stigma than common medical conditions such as diabetes. Some patients wonder if its discriminatory.

“Depression isn’t accepted like a physical handicap is,” Dr. Harrison said. “If people were more open to talking about it, better treatments like TMS would’ve caught on.”

Brenner says it also takes time for the medical community to accept unconventional treatment options.

“When I first started doing TMS people thought I was doing something bad to the brain, like I’m a mad scientist,” Brenner said. “It had a lot of negative associations. One person even referenced an episode of Star Trek where Kirk is being tortured this brain device.”

TMS treatment may seem like a slightly barbaric brain zapping procedure now, but Dr. Brenner believes it’s a only matter of time before the culture shifts.

“The culture isn’t quite there yet, but people are more interested in this biohacking type of stuff,” Dr. Brenner said. “I think younger generations are going to be more into it. Probably within 10 years it’ll just be no big deal.”

Many analysts believe bio-hacking and neuro-nutrition will become popular in the following years as many are searching for less side-effect producing, chemical inducting alternatives.

“We’re learning a lot about the brain,” Dr. Manevitz said. “We didn’t used to know as much about the genetics of the body and the whole genome project.”

Emerging alternative treatments for mental health include microdosing with LSD, ketamine therapy, and cannabis therapy.

“The whole community of people treating depression and those suffering is groaning, saying we need something different, something better,” Dr. Harrison said. “That’s why TMS is catching on, and will continue to. After TMS therapy, I don’t need to be afraid to hope anymore.”

*Some names have been changed to protect the identity and integrity of the patients involved.

The Cost of Stimulating Happiness

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