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Fargo Clinic uses powerful magnetic pulses to help people with treatment-resistant depression – InForum

FARGO — Sometimes Heidi Ruff feels like Rip Van Winkle.

Much like the story of the kind farmer who dozed off and woke up 20 years later, the Fargo woman feels like she’s lost years and years of her life to a disorder. major depression.

Since 1996, Ruff says she has tried numerous medications and electroconvulsive therapy in an attempt to feel happy and whole again.

Meanwhile, depression clouded every corner of her life – forcing her to drop out of college, become agoraphobic and ultimately depend on disability benefits to live.

But, as Rip had to wake up eventually, so did Ruff.

His awakening came from a new non-invasive treatment, which the FDA has approved to treat particularly stubborn forms of major depression.

Every weekday since early December, Ruff has been visiting the Upper Midwest TMS at 5621 36th Ave. S. in Fargo to receive transcranial magnetic stimulation, a treatment that delivers powerful magnetic impulses through a coil to reactivate nerve endings in our brains that regulate depression and mood.

Study results vary, although a common statistic is that TMS has a 60-70% success rate – meaning the majority of individuals find significant relief after treatment, says Dr. Jonathan Olivas , a psychiatrist who co-founded Upper Midwest, the only TMS practice in North Dakota and western Minnesota. This may be especially promising for people who do not respond to antidepressants or are unable to tolerate them.

“Most of our patients took eight or nine medications,” says Olivas. “So I think if a patient commits to driving here every day for treatments, that’s a reasonable treatment modality.”

In Ruff’s case, she was willing to try anything after taking more than 20 different antidepressants over the years. During her daily TMS sessions, Olivas says doctors and technicians at the clinic explained to her that she probably wouldn’t notice much improvement until the fourth week. Until then, she was reassured to know that the treatments were helping to carve out new, healthier neural pathways.

After completing her last TMS treatment last week, Ruff says she feels more alive than she has in a long time. At age 50, she plans to return to school to complete the final courses needed for her degree in social work.

“I’m afraid to go to school without a notebook, pen and book,” she says, referring to today’s digital classrooms. “But it’s also exciting. I’m just grateful that some of the fog lifted.

Another “tool in the tool belt” against depression

Tucked away in a strip mall, Midwest TMS opened its modest office suite last May.

Drs. Jonathan Olivas and Lisa Schock are general psychiatrists in Sanford who started the business as a side project to give locals another “tool in the tool belt” for hard-to-treat depression, says Dr Joel Schock, Lisa’s father.

Based on the advice of Dr. Simon Kung, TMS expert at Mayo Clinic,

they invested in a $90,000 TMS machine, completed the required courses, and pressed their first TMS customers before 8 a.m. and after 5 p.m. on weekdays, Olivas says.

Jen Wolf, technician and office manager, shows Dr. Schock how TMS is administered. Sessions usually last 30 minutes or less.

Tammy Swift / The Forum

Several months ago, the doctors sold the business to Lisa’s father, Dr. Joel Schock, a longtime general practitioner in Fargo and co-founder of Plains Medical Clinic. He plans to go to Duke University in early April to take the required TMS courses, but will continue his day job at Plains Medical Clinic. Lisa has retired from practice, although Olivas and another psychiatrist will continue to do periodic after-hours consultation work for the TMS clinic.

A typical treatment begins with a consultation with one of the psychiatrists. Patients learn that the therapy has minimal side effects – in addition to occasional, localized scalp pain in the treated area, headaches and dizziness. Some recipients experience slight eye and facial twitching, but these are temporary. “It’s really nothing but slight inconvenience,” says Schock.

He adds that a tiny percentage of patients may have seizures, “but it’s extremely rare.”

People who are not candidates for TMS include anyone who has had metal implanted in their skull or brain, has tattoos on their head or neck, or has cochlear implants, according to court documents. clinical.

A typical treatment consists of 30-minute sessions five days a week for six weeks. After the initial consultation session, the doctor initiates the series of treatments with a “brain mapping” procedure to determine the ideal location for treatment and the appropriate “dose” of electromagnetic pulses for that particular patient.

This helps the provider identify the left dorsolateral prefrontal cortex (DLPFC), a location above the left temple where TMS is applied. This part of the brain processes a variety of cognitive functions, including our emotional responses to the people and world around us. In people with depression, the DLPFC tends to be underactive, according to the National Institutes of Health.

Once the treatment area is targeted, a device containing a metal coil is placed against the head in the desired area to deliver the appropriate level of electromagnetic pulses.

During treatment, the patient will hear a series of loud clicks and feel a tapping sensation from the device.

21 out of 30 local patients report improved mood

Some patients report a slight uplift in mood within two weeks of the daily TMS, though the majority don’t report significant results until at least four weeks into treatment, Olivas says.

So far, suppliers have been satisfied with their results. Olivas estimates that of the 30 patients they treated locally, 21 or 22 reported improvement.

The approximate cost of 30 treatments is around $5,000. However, most major carriers will now cover TMS to some extent — as long as patients can show they’ve tried at least four different medications without success, Olivas says.

Olivas believes TMS can be used in conjunction with existing medications and psychotherapy. “There’s good data that it can be synergistic, which means sometimes with other drugs things can be more effective,” he says.

Upper Midwest TMS is located at 5621 36th Ave. S., Fargo.

Tammy Swift / The Forum

He also thinks it can be an effective tool in people who no longer respond well to medication. Studies show that only 10 to 12 percent of depressed patients will get better after trying two or three drug trials, he says.

TMS also offers a viable option to electroconvulsive therapy (ECT), in which electrical currents are sent through the brain to induce a seizure and ‘reset’ the brain,” says Olivas.

Today’s ECT is much more refined and gentle – and is traditionally one of the strongest weapons against particularly deep, persistent and debilitating depression. However, it is expensive, must be done in a hospital and requires anesthesia, which turns away some of the people who could benefit from it, says Olivas.

“And then what is the next step? It’s ECT (electroconvulsive therapy) and it’s such a big hurdle that very few people will be referred to it. So now we have another treatment modality that people can use,” Schock says.

Research suggests that depression may be just the tip of the iceberg when it comes to the usefulness of TMS. The FDA has already approved its use

for smoking cessation,



Obsessive Compulsive Disorder,

although this requires a “deeper coil” and focuses on a different location of the skull.

Additionally, TMS has been studied to ease the symptoms of everything from anxiety and bipolar disorder to ADHD and Parkinson’s disease.

But at this point, the most established and evidence-backed research has focused on what Upper Midwest TMS specializes in: severe depression.”

It’s something that Ruff is extremely grateful for. “I’m thrilled for these young people who don’t have to do this for 25 years and who are struggling,” she said. “They don’t have to waste decades of their life.”

Learn more about Upper Midwest TMS at