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 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 with a $10,000 price tag— cash.
“TMS changed my life,” Burchett said. “It didn’t just control my symptoms, it put my depression in remission.”
Burchett 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 the 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 percent 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.”
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.”
Before the TMS treatment, depression was fought with pills. Antidepressant use increased by 65 percent from 1999–2002, and continues to rise, according to the National Center for Health Statistics. Antidepressants help only about 30% of patients, reported the Sequenced Treatment Alternatives to Relieve Depression (STAR* D) study.
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.
“When you’ve been struggling with depression and anxiety as long as I have, you’re willing to give anything a try.”
- Nick Gulley, 25,
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.”
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.
Despite the treatment having a good reputation amongst patients, it is not a common treatment. 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 percent 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. The other part is the stigma around a brain zapping procedure.
“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.”
*Some names have been changed to protect the identity and integrity of the patients involved.