This Encinitas doctor is leading a mental health breakthrough with one-day depression treatment

Many people don’t realize that 80 percent of mental health care treatment in the U.S. is addressed at the primary care level. If you are experiencing depression or severe anxiety, the first person you are going to speak to about it is your primary care physician,” says Georgine Nanos, MD, MPH, who has been practicing family medicine for more than 20 years.

Typically, primary care doctors refer patients for psychotherapy, write a prescription for an antidepressant, or both. “That’s the best-case scenario in mental health care these days,” says Nanos. It’s something she is working hard to change.

Last year, Nanos, who leads Kind Health Group in Encinitas, a concierge primary care practice and wellness center she founded in 2017, participated in a landmark study of transcranial magnetic stimulation (TMS), a noninvasive, medication-free process that condenses treatment for depression and anxiety into a single day.

“I was introduced to TMS about four years ago. I had never heard of it, and even today, many people, including doctors, are unaware of it,” says Nanos, who until this past January also served as the medical director of Rancho Valencia Resort & Spa.

Patients with depression show decreased electrical activity in the part of the brain associated with mood regulation and thought patterns. TMS delivers localized magnetic pulses to that specific region, stimulating nerve cells to create new synapses and pathways.

The treatment has been available for over 40 years and FDA-approved for more than 15 years for people with medication-resistant depression, but until recently it involved both lengthy treatment and a clumsy, helmet-like device the patient had to wear.

Now, a new device simply rests against the patient’s head, which “makes it very easy to administer and much more comfortable for the patient,” says Nanos.

In Nanos’ experience, the treatment has a 92 percent response rate and a remarkable 72 percent remission rate, which means patients have reported more than a 50 percent reduction in symptoms. But most significant, unlike traditional drug treatments and even newer therapies such as ketamine and psychedelics, after years of use and more than 20,000 studies, there are no reported risks or substantial side effects.

“This is the start of a big paradigm shift in terms of how we deal with mental health,” says Nanos, whose goal is to make TMS a first-line treatment, and who believes there is a wide range of patients who could benefit from it.

Depression and anxiety often involve a repetitive or looping series of negative thoughts. But as Nanos points out, “anxiety and depression often accompany other mental health issues, including insomnia, OCD, and PTSD.”

Nanos has used TMS to treat all three, and has even used it to help patients with autism and schizophrenia, not as a cure for those conditions, but to relieve the associated depression and anxiety. “By creating new synapses and pathways in the brain, TMS builds emotional resilience,” says Nanos.

Currently, the only FDA-approved use of TMS covered by insurance is the original protocol, which lasts 40 days. And obtaining insurance approval can be challenging, often requiring patients to have tried and failed multiple antidepressant medications.

For the past four years, Nanos has been working closely with Jonathan Downar, MD, PhD, one of the world’s leading TMS experts. An adjunct professor in the Department of Psychiatry and Institute of Medical Science at the University of Toronto, Downar, who has published more than 180 peer-reviewed articles on TMS, is part of a group of neuroscientists and psychiatrists who gathered at Stanford University to develop ways to make TMS more accessible. Together they developed a protocol that reduced the 40-day regimen to five days, but it is not covered by insurance and can cost $30,000.

Last year, however, Nanos, took part in a study of a new one-day, ten-hour protocol, a paper on which Downar presented at Stanford this past April. Though still expensive, the one-day protocol costs $10,000, and Nanos, who is currently the only physician offering the treatment in the United States, coordinates with numerous nonprofit groups to provide the treatment to veterans, at-risk teens, and others who cannot afford it on their own.

To date, Nanos has successfully treated hundreds of patients from across the country for a range of issues, the youngest of whom was 12 while the oldest was in their nineties. For them, accelerated TMS has provided profound improvement, and offers new hope to the millions of American adolescents and adults battling depression. kindtms.com

“After the treatment, I felt a shift in my mood and mindset immediately. It was like a weight had been lifted,” says John Van Cleef, CEO of the Community Resource Center in Encinitas and a combat veteran who has battled depression for decades.

For years, when depression flared, Van Cleef used diet and exercise as positive coping mechanisms to get himself through. “As a young man with a military attitude, my thought was to run it out. Get your mind right and move on,” says Van Cleef. Still, the trauma of combat takes time to sort through, and by his early 40s, diet and exercise were no longer effective. “Every day was an effort,” says Van Cleef, now 55. “Focusing on tasks was a challenge. Engaging in social activities was something I forced myself to do. I could barely do what was required each day.”

Van Cleef began seeing a therapist and then added an antidepressant through his primary care physician. Whether one or the other or both, Van Cleef regained what he calls his buoyancy, the strength to face the challenges of daily life.

“As director of the CRC, I work with people experiencing extreme crises of their own,” says Van Cleef. Like combat, that can take a toll, and at the beginning of last year, Van Cleef once again found the weight of everyday life daunting. Naturally, he threw himself into diet and exercise, but even with his therapy and medication, last summer he was still sinking. Van Cleef knew he had to do something, and he had friends who had achieved positive results with ketamine and psychedelics.

Van Cleef chose to start with TMS because it was both one day and noninvasive, and he compares the experience to his initial response to antidepressants in that it helped him regain his resilience, only this time more quickly.

While medications can take weeks to take effect, the impact of the ten-hour TMS treatment, which involves four minutes of stimulation every 25 minutes, can begin that very day. The patient is free to move about during the 25 minutes between sessions, and “even that day I noticed a difference,” says Van Cleef. “I did some reading and some peaceful adult coloring with pencils. All in all, it was a relaxing experience, and then at the end of the day I walked the Coastal Rail Trail at sunset. The day before, I would have just gone home.”