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Integrative Psychiatry

TMS: It’s not just for TRD anymore by Earle Shugerman, MD

By April 17, 2021March 6th, 2024No Comments

Check out this awesome video as Dr. Earle Shugerman talks about the significance and risks of TMS.

FULL TRANSCRIPT
I want to highlight some of the reasons I think TMS is of interest to integrative psychiatry. Very significant efficacy with difficult mood disorders. It’s compatible with almost any treatment that one can imagine. Medications, supplements, other therapies, very few problems with interactions or complications involved with other treatments.

Off label application for TMS
● Depression during pregnancy
● Postpartum depression
● Bipolar depression
● Substance dependence disorders

And then in off label applications of TMS, we’ll talk about several of these – depression during pregnancy, postpartum depression, maintenance treatment for chronic depressive disorders, which is a very important area. Bipolar depression, depressive disorders that are non-treatment resistant, most of the FDA approval has focused on patients who had failed to respond to an adequate course of antidepressant therapies. And that’s still mostly how TMS is used.

Acute phase: Procedure and outcome
At the end of the acute treatment phase, this four to six weeks of acute TMS, the average PHQ-9 had dropped from 18 to 8.8. And we’re going to see what happened, following those patients then out for about a year.

These are people who had improved significantly, their depression inventory had dropped by about 50% or more. And they maintain that response over the course of 12 months, essentially, fully. And this has been our experience in our clinic as well, that many people who get a good acute response to TMS will maintain that response for months or years after their acute treatment.

Risks for TMS
● Mild headache is most common
● Seizures
● Treatment emergent hypomania or mania
● Hearing loss, if used without at least 30 dB hearing protection
● Exposure risk for COVID 19

The risks of TMS are very low. Mild headache is the most common side effect. Usually, this is something that’s noted in the first week of treatment and tends to diminish over the course of the first couple of weeks. Some patients will take Tylenol or Ibuprofen before they’ll come in for treatment. But usually by the second or third week, they’re no longer needing to do that. TMS has to be done with hearing protection. The coil makes a fairly loud clicking noise during the treatment. So, patients are given ear protection to wear, ear plugs that they wear during their treatment.

How will TMS evolve and improve?
One thing that would be very valuable is if we could identify better likely non-responders. Even when TMS is well covered by insurance coverage, if somebody spent six weeks coming into our clinic daily for an hour, they’ve invested a lot of time, many times they’ve invested a lot of money in copays and if they’re in the one-third non-responder group, that’s painful. And so, if we could use some kind of functional imaging to better advise patients on their likelihood of response and there’s some research going on on this with some promising early results, but nothing that has been useful outside of a research setting quite yet.

Sara Reed, MS, LMFT

Sara Reed is a Licensed Marriage and Family Therapist and CEO of Mind’s iHealth Solutions, a digital health company that provides evidence based and culturally responsible mental health services for underserved groups. As a mental health futurist and clinical researcher, Sara examines the ways culture informs the way we diagnose and treat mental illness. Sara’s prior research work includes participation as a study therapist in psychedelic therapy research at Yale University and the University of Connecticut’s Health Center. Sara was the first Black therapist to provide MDMA-assisted psychotherapy in a clinical trial and continues to engage in ongoing advocacy work around health equity in psychedelic medicine.

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Jeffrey Guss, MD is a psychiatrist, psychoanalyst, and researcher with specializations in psychoanalytic therapy and the treatment of substance use disorders. He was Co-Principal Investigator and Director of Psychedelic Therapy Training for the NYU School of Medicine’s study on psychedelic-assisted psychotherapy in the treatment of cancer-related existential distress, which was published in Journal of Psychopharmacology, 2016. He currently is a study therapist in the NYU study on Psychedelic-Assisted therapy in the treatment of Alcoholism, a collaborator with Yale University’s study on psychedelic-assisted therapy for Major Depressive Disorder and a study therapist with the MAPS (Multidisciplinary Association for Psychedelic Studies) study on treatment of Post Traumatic Stress Disorder with Psychedelic-Assisted Psychotherapy. 

Dr. Guss is interested in the integration of psychedelic therapies with contemporary psychoanalytic theory and has published in Studies in Gender and Sexuality and Psychoanalysis, Culture and Society. He has published (with Elizabeth Nielson, PhD) a paper on “the influence of therapists’ first had experience with psychedelics on psychedelic-assisted psychotherapy research and therapist training” in The Journal of Psychedelic Studies, August, 2018. He is an Instructor and Mentor with the California Institute of Integral Studies’ Center for Psychedelic Therapies and Supervisor in NYU’s Fellowship in Addiction Psychiatry. 

Dr. Guss maintains a private practice in New York City.

Will Van Derveer, MD

Will Van Derveer, MD is Co-Founder of Integrative Psychiatry Institute and Integrative Psychiatry Centers. Dr. Van Derveer was co-investigator on a phase 2 MAPS study of Psychedelic-assisted psychotherapy for treatment-resistant PTSD, and co-authored the publication of this study in 2018. He has also provided Psychedelic-assisted psychotherapy in two MAPS training studies. An active provider of KAP at his clinic in Boulder, CO, he has been teaching others KAP therapy for several years. Dr. Van Derveer contributed a chapter on mescaline in the 2021 "Handbook of Medical Hallucinogens" (edited by Charles Grob and Jim Grigsby). He is co-host of the Higher Practice Podcast.

Dr. Van Derveer regards unresolved emotional trauma as the most significant under-recognized root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass.


Scott has been a student of consciousness since his honors thesis on that topic at the University of Arizona in the 1970s under the tutelage of Dr. Andrew Weil. Following medical school, Scott studied Jungian therapy and acupuncture while working as a primary care physician in a rural area for four years. Psychedelic-assisted psychotherapy became a facet of his practice before this medicine was scheduled in 1985. He then completed a psychiatry residency at Columbia program in New York. Scott studied cross-cultural psychiatry and completed a child/adolescent psychiatry fellowship at the University of New Mexico.

In 2010 he founded Wholeness Center in Fort Collins. This innovative clinic provides cross-disciplinary evaluation and care for all mental health concerns. Scott serves as a site Principal Investigator and therapist for the Phase III trial of psychedelic-assisted psychotherapy for PTSD sponsored by (MAPS). He has also published numerous articles about his research on (CBD) in mental health. Currently, Scott works extensively with psychedelic-assisted-psychotherapy. He lectures all over the world to professional groups interested in a deeper look at mental health issues, safer tools, and a paradigm-shifting perspective about transformative care.

Will Van Derveer, MD is co-founder of Integrative Psychiatry Institute (IPI), along with friend and colleague Keith Kurlander, MA. He co-created IPI as an expression of what he stands for. First, that anyone can heal, and second that we medical providers must embrace our own healing journeys in order to fully command our potency as healers.

Dr. Van Derveer spent the last 20 years innovating and testing a comprehensive approach to addressing psychiatric challenges which transcends the conventional model he learned in medical school at Vanderbilt University and residency at University of Colorado, while deeply engaging his own healing path.

He founded the Integrative Psychiatric Healing Center in in 2001 in Boulder, CO, where he currently practices. Dr. Van Derveer regards unresolved emotional trauma as the most significant root cause of psychiatric symptoms in integrative psychiatry practice, along with gut issues, hormone imbalances, inflammation, mitochondrial dysfunction, and other functional medicine challenges. He is trained in Somatic Experiencing, EMDR, Internal Family Systems, and other psychotherapy techniques. His current clinical passion is psychedelic-assisted psychotherapy, which he mentors interested doctors in providing. An avid meditator, he has been a meditation instructor since 2004.

For the past several years Dr. Van Derveer has taught psychiatrists and other psychiatric providers integrative psychiatry in a number of settings, including course directing the CU psychiatry residents’ course as well as with Scott Shannon and Janet Settle at the Psychiatry MasterClass. In addition to his clinical work and teaching, he was co-investigator in 2016 a Phase II randomized clinical trial, sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS). He continues to support this protocol, now in a Phase III clinical trial under break-through designation by FDA.

Dr. Van Derveer is a diplomate of the American Board of Integrative and Holistic Medicine (ABoIHM) since 2013, and he was board certified in the first wave of diplomates of the new American Board of Integrative Medicine (ABIM) in 2016.