Welcome to our first installment of the “Blossom Provider Spotlight,” where we feature insightful conversations with the exceptional providers using the Blossom TMS device. This week, we had the pleasure of speaking with Nicholas Goodwin, a psychiatric nurse practitioner and the founder of Goodwin Health Cafe in Spokane, Washington. Tell us a little bit about your background in the field of mental health. I’m Nicholas Goodwin, a psychiatric nurse practitioner. I obtained my nurse practitioner degree and doctorate in nursing practice from Washington State University in 2019. Before opening my private practice, Goodwin Health Cafe, I worked as a psychiatric nurse in a state hospital for five years and taught undergraduate psych nursing. I also have experience working in residential treatment centers for adolescents, dealing with both mental health and substance use programs. What led you to incorporate TMS into your practice? I started with esketamine (SPRAVATO) treatments, which allowed for in-office visits where patients could see the same staff regularly, fostering a collaborative and therapeutic environment. The success of these treatments led me to explore Transcranial Magnetic Stimulation (TMS), which shares a similar in-office treatment model. The non-invasive, drug-free nature of TMS, along with its high efficacy rates, made it a perfect addition to my practice. Can you elaborate on the importance of patient compliance and in-office treatments? One significant advantage of esketamine and TMS is that they require patients to come into the office for their treatments. This increases compliance and ensures patients receive their treatment as prescribed. The in-office model fosters honesty and transparency, allowing us to address issues promptly. This approach also has a strong therapeutic aspect. Patients build rapport with the staff, from casual interactions with front-end staff to more therapeutic engagements with nurse practitioners. Sometimes I wonder if patients come more for the therapeutic environment than the treatment itself! What inspired you to pursue a career in mental health? A series of events led me to the field of mental health. My mother was a social worker, which influenced my interest in helping others. During nursing school, I realized I wanted to specialize in psychiatric nursing because I found it both challenging and fulfilling. The connection I felt with patients and the opportunity to make a significant impact on their lives solidified my commitment to this career path. What has been your favorite part about introducing TMS into your clinic? I enjoy the in-office visits and the opportunity to offer more treatment options for patients with treatment-resistant depression. TMS machines are fascinating, and their non-pharmacological approach is a significant advantage, especially for patients who have had negative experiences with medications. Providing an effective treatment that doesn’t involve daily medication is a tremendous benefit for both the patients and the clinic. Why did you choose the Blossom TMS device over other manufacturers? Several factors influenced my decision to choose the Blossom TMS device. The Blossom machine is compact and easily movable, which is essential for our small office space. Additionally, it doesn’t require a special electrical setup, unlike some other machines. The simplicity and user-friendliness of the Blossom device were also major selling points. After researching and comparing different machines, I found Blossom to be the best fit for our clinic’s needs. What advice would you give to other providers considering adding TMS to their practice? I recommend visiting a facility where multiple TMS machines can be seen in action, preferably without the influence of sales representatives. Investing time and money in understanding the technology and its practical applications is crucial. Additionally, ensure that your state’s regulations and insurance policies are favorable for TMS treatments. Speaking with other clinics that have experience with different machines can provide valuable insights and help make an informed decision. What are your hopes for the future of mental health treatment? I hope to see more innovative treatments that go beyond traditional pharmaceuticals. The potential of psychedelics, for example, is fascinating, as they seem to offer significant benefits not always captured by conventional efficacy measurements. As we learn more about these treatments and how to measure their impact on well-being, I believe the overall effectiveness of mental health care can improve. My goal is to continue providing cutting-edge treatments and quickly adopt new, effective approaches as they become available. Thank you, Nicholas, for sharing your experiences and insights with us! Stay tuned for more interviews in our “Blossom Provider Spotlight” series. For more information about Goodwin Health Cafe, visit Goodwin Health Cafe.

Welcome to the Blossom Provider Spotlight series, where we highlight exceptional providers in the mental health field. This week, we’re excited to feature Casey Dubravcic, owner and operator of Revitalize Ketamine Clinic. Based in Flagstaff, Arizona, with additional locations in Sedona and Prescott Valley, Casey and his team are dedicated to offering innovative treatments like Ketamine infusions and Transcranial Magnetic Stimulation (TMS) to their patients.  Interview with Casey Dubravcic Blossom TMS: What got you into mental health, and can you tell us a little about your background?  Casey Dubravcic: My name is Casey Dubravcic, and I’m the owner and operator of Revitalize Ketamine Clinic, along with my wife, Jill Dubravcic. We’re based in Flagstaff, Arizona, with additional clinics in Sedona and Prescott Valley. We recently started offering TMS in our Flagstaff and Prescott Valley locations. My journey in healthcare began in 2004. I worked in ICU, CDICU, and pre-op PACU, and initially thought I wanted to be a certified registered nurse anesthetist. However, after spending time in the operating room, I realized my true passion was in psychiatry and mental health. Working in the ICU, I found great reward in helping the families of patients, which sparked my interest in mental health.  Blossom TMS: What led you to establish Revitalize Ketamine Clinic?  Casey: My wife and I founded Revitalize Ketamine Clinic to provide innovative and effective treatments for mental health conditions. Our primary focus has been on Ketamine infusions, which have shown great promise in treating conditions like depression and anxiety. We’ve always been passionate about mental health, and expanding our services to include TMS has been a natural progression for us. Before we started offering TMS ourselves, a dear friend of mine, a military veteran, experienced a complete turnaround in his chronic suicidality after undergoing TMS, and he’s been symptom-free since the treatment. This was very inspiring to see.   Blossom: Why did you choose the Blossom TMS technology for your clinic?  Casey Dubravcic: We chose Blossom TMS technology for several reasons. Firstly, the Blossom TMS machine is incredibly durable and effective, with an oil-cooled system that ensures it can handle continuous use without issues. It’s a real workhorse. Another significant factor was the CEO of Blossom TMS. He isn’t just a business person but has a deep understanding of what makes a good TMS machine. His expertise and hands-on approach gave us confidence in the technology. Moreover, the aftercare and support provided by the Blossom team have been outstanding. When making a substantial capital investment, you want to ensure you’ll have ongoing support, and Blossom has exceeded our expectations in this regard.   Blossom TMS: How has your experience been with offering TMS at your clinic so far?  Casey: The experience has been very positive. We’re seeing a lot of interest in TMS.  TMS is an appealing alternative because it doesn’t require medication and has minimal side effects. Patients appreciate the short, unobtrusive appointments and the fact that they can drive themselves to and from sessions. It’s exciting to offer a treatment that can significantly improve their quality of life.   Blossom TMS: What do you like most about TMS compared to other treatments?  Casey: One of the things I love about TMS is that it offers a non-pharmacological treatment option that is highly effective. The treatment resonates with people because it combines the science of neuromodulation with a holistic approach to mental health. There’s also compelling evidence supporting its effectiveness, and it’s encouraging to see patients benefit from a treatment that doesn’t involve medication. TMS offers a unique way to help people achieve better mental health without the side effects associated with traditional medications. Additionally, the positive, supportive environment we create at our clinic plays a huge role in patient recovery.  Blossom TMS: Can you address some common misconceptions about TMS?  Casey: A common misconception is that TMS is painful or invasive. In reality, most patients only feel a tapping sensation on their scalp, and it’s generally well-tolerated. Another misconception is that TMS is similar to electroconvulsive therapy (ECT), but it’s quite different. TMS is non-invasive and doesn’t require anesthesia. It’s also important to note that many people believe they need to have tried multiple medications before qualifying for TMS, but that’s not always the case. Many patients who have tried just one or two medications, or even those who have primarily relied on therapy, can be good candidates for TMS.  Blossom TMS: What misconceptions did you have about TMS as a provider, and how did your views change?  Casey: Initially, I had concerns about TMS being perceived as a placebo or “snake oil” treatment. I wondered if the benefits were largely due to patients spending time with an engaged provider rather than the treatment itself. However, after diving into the science behind TMS and witnessing the motor threshold determination and actual patient outcomes, my perspective changed. Seeing the tangible effects has helped me understand the genuine impact of TMS. Additionally, I realized how straightforward it is to administer the treatment and how well patients respond to it. This experience has reinforced my confidence in TMS as a robust, effective treatment modality.  Blossom TMS: What are you most excited about for the future of TMS?  Casey: I’m excited about the increasing accessibility of TMS. As more people become aware of its benefits and as insurance coverage expands, more individuals will have the opportunity to improve their mental health with this treatment. The prospect of TMS becoming a more common and accepted treatment modality is incredibly promising. It’s a great time to be involved in this field, and I’m looking forward to seeing how TMS continues to evolve and help more people.  Blossom TMS: Thank you, Casey, for sharing your insights and experiences with us! We look forward to seeing the continued success of Revitalize Ketamine Clinic and the positive impact it will have on the community.  … Learn More   Revitalize Ketamine Clinic, led by Casey Dubravcic, is making significant strides in the mental health field by offering innovative treatments like Ketamine infusions and TMS. We are proud to feature such dedicated providers in our Blossom Provider Spotlight series, showcasing their

A Primer on Its Physical Principles, Practicalities, Protocols and Evidence Base Authors: Leo Chen and Linda L. Carpenter Excerpt from our magazine: This blog post is an excerpt from our magazine. For a free digital or print version to read the full article and much more, visit us at https://sebersmedical.com/. Introduction Repetitive transcranial magnetic stimulation (rTMS) has gained global recognition as an effective and safe treatment for depression. Initial research trials conducted nearly 30 years ago demonstrated its potential, leading to extensive investigations into its physiological and therapeutic effects. Today, rTMS is a well-established treatment for major depressive disorder, particularly for patients who do not respond to antidepressant medications. Fundamental Principles of rTMS rTMS operates by applying electromagnetic pulses to stimulate nerve tissue beneath the stimulation coil and indirectly affecting remote brain areas through connections. The process involves discharging a pulsed electrical current from a stimulator to a TMS coil, producing a transient electromagnetic field. This field induces electrical fields in neurons located near the coil, resulting in increased or decreased neuronal excitability. Repeated rTMS sessions enhance neuroplastic effects, which are believed to contribute to its therapeutic efficacy. Practical Application of rTMS During rTMS therapy, patients remain awake, comfortably seated in a reclinable chair. Anesthesia or sedation is not required. The initial session involves locating the stimulation target, typically the left dorsolateral prefrontal cortex (DLPFC), and calibrating the stimulation intensity based on the patient’s motor threshold. Treatment sessions range from a few minutes to half an hour, usually conducted once daily for four to six weeks, followed by a tapering phase. Evidence-Based Efficacy of rTMS rTMS is endorsed by various clinical practice guidelines as an effective treatment for depression. Seminal trials have established the efficacy of 10 Hz rTMS delivered to the left DLPFC for treatment-resistant depression (TRD). Subsequent studies and meta-analyses have consolidated the evidence, confirming rTMS’s antidepressant efficacy, tolerability, and safety. Comparisons with other treatments, such as electroconvulsive therapy (ECT) and pharmacological augmentation strategies, have shown rTMS to be a highly effective intervention. Alternative rTMS Protocols Research has explored various rTMS protocols, including different stimulation frequencies and targets. Studies have shown that 1 Hz rTMS to the right DLPFC and sequential bilateral rTMS are also effective for treating depression. The H-coil, which stimulates broader cortical areas, has demonstrated superior efficacy in some trials. These findings highlight the versatility and adaptability of rTMS in clinical practice. Future Directions As rTMS continues to evolve, future research aims to address knowledge gaps, optimize treatment protocols, and personalize therapy through neuroimaging. The ongoing development of accelerated rTMS protocols and advancements in targeting specific brain regions hold promise for improving treatment outcomes and expanding the application of rTMS to other neuropsychiatric conditions. About the Authors Dr. Leo Chen is a Senior Research Fellow and Head of the Brain Stimulation Lab at Monash University, Melbourne, Australia. He is a Consultant Psychiatrist at Alfred Mental and Addiction Health and has contributed extensively to the field of therapeutic brain stimulation through clinical trials, peer review, and the development of clinical practice guidelines. Professor Linda L. Carpenter is the Director of the TMS Clinic and Neuromodulation Research Facility at Butler Hospital and a Professor of Psychiatry at Brown University. Her research focuses on developing new treatments for depression, including device-based therapies, and she has served as Principal Investigator on numerous clinical trials. For more detailed information and references, please refer to the original article published in our magazine. This blog post provides an overview of the key points and highlights the significant contributions of rTMS therapy in treating depression. Contact Us