Healthy Outlook: Prime TMS hopes to expand access to alternative depression treatment

photo by: Ashley Hocking

One of the deep TMS machines at Prime TMS, 1811 Wakarusa Drive, Suite 102, is shown April 6, 2018. The shade allows patients to see out, but no one can see inside.

“What are those funny helmets hooked up to the big machines, and who let that woodpecker inside?”

That might have been my first question walking into Prime TMS, 1811 Wakarusa Drive, Suite 102, if I hadn’t done a bit of research beforehand.

The business, which opened in February, offers deep transcranial magnetic stimulation, or deep TMS. It’s an alternative treatment for people whose depression has not responded to various antidepressants.

In other words, for those patients who have tried medication after medication and achieve no measurable results, TMS could be a good next step.

The way it works is complicated, but Garrett Hages, the executive director of Prime TMS who also administers clients’ treatments, explained it this way: Deep TMS uses an MRI-like technology to target the limbic system deep within the brain, because lack of activity there has been correlated with depression. So it stimulates that area, and it promotes restoration and production of neurotransmitters.

First, patients meet with Dr. Ty Porter, a psychiatrist and Prime’s medical director, to verify their diagnoses, go over any concerns and rule out any possible contraindications. For instance, Porter said he has metal in his neck, so he would be unable to use deep TMS because of the magnet in the helmet.

Hages then maps patients’ brains to determine where their motor strip is, to find the optimal spot for treatment.

Treatments take 20 minutes, and they encourage patients to have five sessions per week for the first six weeks.

“We try really hard to stick with what the research shows,” Porter said. “Who knows, someday we might find out over years that it’s OK to deviate some, but since it’s new, we like to stick with the way they studied it.”

During the treatment, the machine makes a repetitive noise that sounds very much like a woodpecker — several ticks in a row, every minute or two.

In training to learn to use deep TMS technology, Hages volunteered to have his brain mapped, so he’s experienced it. He said it “feels like something’s kind of nudging within your brain.”

“Really the only side effect that’s reported with any sort of consistency is a slight headache at the beginning of the treatment course, and they really describe that as scalp discomfort. That has to do with, I believe, the new sensation occurring,” Hages said.

The treatment itself is still relatively new — this particular machine received FDA approval in 2013 — but Hages said clinical trials have found it to be effective for roughly 70 percent of patients.

photo by: Ashley Hocking

Garrett Hages, executive director of Prime TMS

Of course that’s not the 100 percent Porter would like to see, but he said it’s much better odds compared with what research shows about antidepressants. When someone is on to his or her fourth medication, Porter said there’s about a 10 percent chance of it working.

“I’ll look forward to days that they find something even better than this, but this (deep TMS) is exciting because as far as what we have now, it’s a breakthrough,” Porter said. “… In some ways it’d be tempting to say, ‘Why bother (trying different medications)?’ This works so well with so few side effects, why not just do this first?'”

Porter explained it’s because insurance companies in general tend to insist on trying the cheaper options — i.e., any number of available medications — first. Deep TMS isn’t cheap, but some plans do cover it.

“The mission here is to expand access to deep TMS treatment, and that means being able to accept everybody in any situation,” Hages said. He noted that Medicaid doesn’t currently reimburse providers for deep TMS, but “they may in the future, and when they do, we’ll be sending in our application to contract with them the next or same day.”

Those with questions about costs can call Prime at 785-371-4921 or email

photo by: Ashley Hocking

Dr. Ty Porter, medical director of Prime TMS

“When we’re more than two months old and more busy, that will give us more leeway in figuring out ways to creatively help people that have trouble affording it,” Porter said.

Prime TMS is not the only business in town offering deep TMS, but it seems to be the only one that focuses its practice solely on that treatment.

“There’s lots of things that help people, help depression, help (other mental health) conditions; we’re going to try to be really good at this piece, so we’re not planning on doing a lot of every other kind of treatment out of here,” Porter said.

Hages wants Prime TMS to set itself apart from others by truly connecting with clients.

“I realized that you actually have a great opportunity, interacting with people on a daily basis, to not just be an expressionless, monotonous person that gives them medical treatment, but somebody that — you can be the bright point in their day,” he said. “You can be the appointment they look forward to going to. … Following up every day, you really get to know somebody.”

Porter concurs.

“It is unfortunate how many times in the medical field we forget that we should treat people the way we would like to be treated,” he said. “It actually goes a long way if you just do that simple thing.”