A Waimea clinic has become the first to offer transcranial magnetic stimulation.

A new option for people with treatment-resistant depression and anxiety will be available on the Big Island starting Monday.

It’s called transcranial magnetic stimulation, a noninvasive method developed in the 1980s and approved by the U.S. Food and Drug Administration in 2008.

Kipuka O Ke Ola, the Native Hawaiian rural health clinic in Waimea, recently acquired a TMS machine, making it the first and only one on the island to date.

Dr. Michael Farnsworth, a psychiatrist who works at the clinic three days a week, said he’ll start offering TMS therapy to certain patients this week.

“The magnetic field stimulates the neurons in the prefrontal cortex which are connected to the limbic system in the interior of your brain. That is the mood center,” he said.

Farnsworth, who relocated to the Big Island from Minnesota a couple of years ago, demonstrated how the machine works last week. He had used it in his practice on the mainland and wanted to offer TMS to his patients in Hawaii.

Patients typically receive 18-minute sessions of TMS five days a week for six weeks. They stay awake the entire time and do not require any sedation. They can typically return to work or school or go about their daily activities with no down time.

Dr. Michael Farnsworth, a psychiatrist in Waimea, adjusts a new transcranial magnetic stimulation machine. (Paula Dobbyn/Civil Beat/2023)

The treatment will help an entirely new class of patients with depression who don’t respond to medications or talk therapy, Farnsworth said.

“It’s a fantastic treatment and I wish it was more readily accessible to people,” said Dr. Doreen Fukushima, a Honolulu-based psychiatrist who offers TMS at her clinic, Hoola Pono.

Dr. Doreen Fukushima (Courtesy: Doreen Fukushima)

For people who live in Honolulu or surrounding areas on Oahu, they can drive to Hoola Pono for their TMS appointments. But it’s not feasible for people living on other islands unless they’re willing to move to Honolulu for six weeks.

Patients also need to have failed three or four anti-depressant medication trials before insurance will cover the costs, which is unfortunate, Fukushima said.

Up to one third of all patients don’t benefit from taking anti-depressants or by seeking help from counselors or therapists, according to the American Psychiatric Association and numerous scientific studies. And two-thirds of people with depression don’t get relief from the first anti-depressant they try while each subsequent one is less likely to help than the previous one.

Depression is a widespread public health issue and the leading cause of disability in the United States among people ages 15 to 44, according to the Centers for Disease Control and Prevention. An estimated 21 million Americans suffered at least one depressive episode in 2020, according to the National Institute of Mental Health. That’s about 8% of the population.

Dr. Michael Farnsworth demonstrates how transcranial magnetic stimulation works. (Paula Dobbyn/Civil Beat/2023)

Depression among teen girls in the United States is at record highs.

A new report from the CDC found that almost 60% of girls said they had persistent feelings of sadness or hopelessness in 2021, up from 36% in 2011. The same study found that nearly 1 in 4 had made a plan for suicide.

The percentage of teenagers in Hawaii who reported having a major depressive episode nearly doubled between 2015 and 2020, according to data analyzed by the National Association of State Boards of Education for the Hawaii Board of Education.

A Civil Beat investigation last year reported that in 2020, more than 18% of Hawaii teenagers reported struggling with depression, up from 9.9% in 2015.

Given the widespread scope of the problem and the overall shortage of mental health resources in Hawaii, particularly on the neighbor islands, the addition of a TMS option on the Big Island is welcome news, said therapist Vikki Catellacci, who treats patients in the Hamakua and Kohala districts of the Big Island.

“It’s a great idea and I would love to see it more widely available to help an array of people,” Catellacci said.

A few clinics in Honolulu offer TMS as well as one on Maui.

While the treatment is geared toward a subset of depressed patients, it will still go a long way toward shortening waiting lists and easing the backlog of people waiting to get in to see a provider, Farnsworth said.

Up to 80% of patients who complete a full course of TMS therapy will see their depression recede, according to a study conducted by Stanford University. Other studies have found somewhat lower but still clinically significant success rates.

TMS treatment is not indicated for people with metal objects or implanted stimulator devices in their heads. Such devices include cochlear implants, deep brain or vagus nerve stimulators, bullet fragments, aneurysm clips, or stents.

For many years, the standard course of treatment for stubborn cases of depression was electroconvulsive therapy, also called shock therapy or ECT. It involves sending a small electric current through the brain of an anesthetized patient which causes a seizure.

Electroconvulsive therapy is still used but for some patients it’s difficult to tolerate because a common side effect is memory loss.

The only common side effects from TMS are headache, scalp discomfort, muscle twitching or lightheadedness, according to providers. Uncommon side effects can include seizures, mania and hearing loss.

Headaches are not uncommon because the machine makes a tapping noise when it’s sending magnetic pulses to the brain. But usually it’s only experienced during the first few sessions.

“It feels like a woodpecker on your head. And I always tell people, ‘No one is used to a woodpecker on their head,” Fukushima said.

Civil Beat’s community health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, the Cooke Foundation and Papa Ola Lokahi.

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