Dr. Dmitriy Sivtsov of Silverlining Psychiatry in La Jolla has an insurance-based psychiatric practice and has managed to get reimbursement for all his patients. Dr. Dmitriy Sivtsov of Silverlining Psychiatry in La Jolla has an insurance-based psychiatric practice and has managed to get reimbursement for all his patients.

Silverlining Psychiatry: TMS will soon become as mundane as pills

 

 


Dr. Dmitriy Sivtsov of Silverlining Psychiatry in La Jolla, California, had been running a successful psychiatric practice for 10 years, helping many patients to recover from their mental illnesses such as depression.

However, a portion of his patients were not benefiting from the antidepressant medication. Statistically, this is not extraordinary: studies show that approximately half of the patients with depression do not recover fully from antidepressants. It was therefore clear to Dr. Sivtsov that a different approach was needed for these hard-to-treat patients. “I had already heard of TMS and wanted to try it on those of my patients who were not responding to antidepressants,” says Dr. Sivtsov. Before proceeding with the purchase, he did some thorough research as well as consulting with other psychiatrists. Not only did this convince Dr. Sivtsov that he should start offering TMS at his own practice, he was also given a unique opportunity to learn more about how to set up his own TMS practice as well as how to actually treat patients.

Reimbursement was vital

One particular area of concern to Dr. Sivtsov was reimbursement. With an insurance-based practice and a strong reputation for being successful in getting compensation for his patients, he knew that his ability to ensure reimbursement for his patients was pivotal to his future success as a TMS practitioner. The paperwork and administration linked to reimbursement is somewhat of a hurdle, but Dr. Sivtsov and his team at Silverlining Psychiatry do manage to get insurance coverage for all their patients. He is certain that once the insurance companies start to see things from a cost-benefit angle, the reimbursement process will be much easier.

TMS investment secured with just a few patients

With a handful of patients willing to commit to the TMS treatment, Dr. Sivtsov’s investment in a TMS system was already secured. “My patients were all very eager to get started on the treatment, so I was happy to get my MagVita TMS Therapy system delivered in only 3 weeks,” he says. The training – provided by MagVenture – was completed quickly, and within a week, the first five patients were getting TMS treatment for their depression.

Better sleep comes first

According to Dr. Sivtsov, the first changes his patients notice after starting on the TMS treatment, are typically of a physical nature such a more energy, and better sleep. One of his patients had, for instance, gone without a decent night’s sleep in 20 years – until she tried TMS. The psychological/behavioral changes often start to kick in a little later, he explains. Dr. Sivtsov follows the standard, FDA cleared protocol with treatments 5 times per week for a total of 30 treatments. His treatment room has a TV with Netflix and some patients enjoy watching their favorite show during their treatment session while others prefer to relax, listen to music, or read.

Full remission for 2/3 of the patients

Since his first five patients started in the fall of 2016, Dr. Sivtsov has taken in several other TMS patients, and now sees 5-7 patients per day. According to Dr. Sivtsov, "The depression symptoms improved for all my patients, whereas about two-thirds of them achieved a full remission.
started in the fall of 2016, Dr. Sivtsov has taken in several other TMS patients, and now sees 5-7 patients per day. According  to Dr. Sivtsov,  the depression symptoms improved for all my patients, whereas about twothirds of them achieved a full remission.”
TMS goes well in hand with Dr. Sivtsov’s approach of “integrative psychiatry” which involve several elements such as nutritional supplements, genetic and hormonal testing.  

TMS as common as pills

Dr. Sivtsov is still relatively new in the world of neuromodulation but plans to have follow up consultations with all his patients – including those in full remission. He sees great potential in the technology which he believes is “seriously under-saturated but will become as mundane as pills in the near future.” As for future indications, Dr. Sivtsov is hopeful that more will be added soon, and is eagerly awaiting more data from ongoing research, for instance the treatment of addiction, which Silverlining Psychiatry specializes in.

silverlining psychiatry
TMS operator Karla is here seen in the treatment room at SilverLining Psychiatry
in La Jolla, California. The room is equipped with a TV where the
patients can watch their favorite series on Netflix while getting treatment.
 
This article was originally published here:
MAGVENTURE NEWS #11 

 

l London is widely known and recognized for the large number of private specialists in medicine and surgery, dating back to the 19th century. One such privately owned practice is “Living Mind” at Harley Street no 10. Here, Dr. Arghya Sarkhel and wife Malini Sarkhel have taken on a holistic approach to treating mental illness, offering what they describe as “integrated and personalised care” for the patients. Part of this care has, since 2018, included TMS.

sarkhel webDr. Arghya Sarkhel greets us in the door with a warm, but apologetic smile: He is between two patient appointments and on his way to see another patient at his clinic in Essex. Just over a year ago he had one clinic and no TMS equipment – he now has three clinics, each with a TMS device. A fourth one may even be on the way soon. When asked why he decided to venture into TMS, he explains that he simply wished to optimize his treatment options, especially for those of his severely depressed patients who were not responding well to antidepressants. Being open to new technology, he had therefore also become acquainted with TMS, which has been approved by NICE (National Institute for Health Care and Excellence) since 2015.  

Excellent remission rates

Dr. Sarkhel looked at different TMS solutions before finally investing in his first TMS device in the early spring of 2018. He admits that since his treatment portfolio was more based within conventional treatment offerings such as antidepressants, he was initially rather sceptic of TMS, even referring to it as “mumbo-jumbo”. However, that conception has now been changed: By now, he has treated numerous patients suffering from treatment-resistant depression with TMS. The results have astounded him: Almost all of them have achieved full remission, he says, adding that he “really wasn’t expecting this”.

Essential: Training and ongoing support

Dr. Sarkhel has both attended the CME accredited Clinical TMS Course offered by Maastricht University and also received inhouse training by one of MagVenture’s inhouse application experts who also provides ongoing support. This has, in Dr. Sarkhel’s opinion, not only been vital for his good results, but has also given him more confidence and knowledge of the technology and has encouraged him to expand his TMS practice. 

Integrated TMS

Living Mind offers what they call Integrated TMS to their patients. This means that TMS is part of a larger treatment package which also include complementary therapies such as  mindfulness, medical acupuncture, and reflexology. With this approach, Arghya and Malini Sarkhel are able to offer individualized treatment protocols for each of their patients. In Dr. Sarkhel’s experience, this concept also attracts patients who may have otherwise been reluctant to try TMS. Most of his patients find him through his website and pay for the treatment themselves.   

Very limited side effects

Some patients also receive maintenance TMS – whether this is needed is based on Dr. Sarkhel’s psychiatric assessment. Dr. Sarkhel ends the interview with explaining that the treatment tolerance of his patients has been very high with, as he puts it, only “minor to no side effects”. We wave goodbye to Dr. Sarkhel, as he dashes off in the pouring London rain: another patient is waiting in Essex. 

TMS and acupuncture
Dr. Dr. Arghya Sarkhel: “Acupuncture is an incredibly effective tool when it comes to complimentary therapy in mental disorders i.e depression and anxiety as well as in pain management. I have already been practicing Acupuncture in my outpatient clinics for a number of years and observed many successful outcomes. More recently when I became familiar with rTMS, I realized that during rTMS treatment, if more neurons are recruited in the brain, outcome of rTMS would be better and secondly synergistic beneficial effects (i.e anxiolytic and antidepressant in particular) could only make the recovery easier and perhaps faster. These are the principles behind my application of acupuncture during rTMS. This is not too dissimilar to using one antidepressant or mood stabilizer as an augmenting agent to boost the effect of another antidepressant; the only difference is in this case both types of interventions are non-pharmacological ones. “

The views and opinions expressed in this article do not necessarily reflect the official policy or position of MagVenture or any of its affiliates.
The usage of rTMS for any other purpose than the cleared indication, in the country in which the product is intended to be used, is considered investigational.

 

Additional Info

  • news-gallery-image: news-gallery-image

contact us

Talk to an expert

Do you need help? Let us know how our experts can help you.



Subscribe to the MagVenture Newsletter

By clicking on the submit button, I confirm that I have read and agree to MagVenture’s Terms of Use.