In America, clinical depression is a serious public health issue, and treating it can be as frustrating and painful as the illness itself.
Therapy and medication are traditional treatments, but they don’t always work. When they are ineffective, more involved treatments are often sought. In the early 2000s, a new technology called transcranial magnetic stimulation, or TMS, began to be used as an alternative when more standard treatments failed.
TMS is a noninvasive procedure that uses magnetic fields to stimulate certain parts of the brain to improve symptoms of depression. The technology has been around for more than 30 years, but it wasn’t until 2008 that the FDA cleared the first TMS therapy for clinical use. In 2013, the founders of Israel-based neurotech startup BrainsWay decided to take TMS to the next level, to what’s called Deep TMS.
BrainsWay’s main product is a hair steamer-like helmet that the company says can relieve depression symptoms in 20-minute sessions (five times a week for four to five weeks) without the need for anesthesia or hospitalization. The device is now used at 500 medical facilities across the U.S.
Last year, BrainsWay went public on NASDAQ and moved its management team to the U.S. In August, Observer interviewed the company’s new CEO, Chris von Jako, about how its depression-detecting helmet is rewriting rules in mental health treatment.
BrainsWay’s central technology is what’s called “Deep TMS.” How is it different than regular TMS, which has been around for over three decades?
The difference between our technology and traditional TMS is that we go broader and deeper into the brain.
Traditional TMS devices have coils that look like a figure 8. Because of that shape, the electromagnetic pulse coming out is concentrated at the center of the “8” and is very shallow. Our patented H-coil design has a lot more coils that are strategically positioned to provide a broader and deeper coverage of the brain.
In the case of depression, we are treating the left dorsolateral prefrontal cortex. It’s important for the electromagnetic pulse to go deep into the folds of cerebral cortexes, because sometimes in elderly patients the brain tends to shrink, making those “folds” harder to reach.
How do those coils work inside a brain to improve symptoms of depression?
A human brain is like a big electrical circuit. When you have brain disorders, it means there are certain parts of your brain that aren’t functioning correctly. One way to fix it is to “reboot” the circuit.
What we do is basically putting an electric current through the coil, and that creates an electromagnetic field in particular areas inside a brain that we’re trying to re-jumpstart.
Why is deep TMS a groundbreaking technology in depression treatment?
Traditionally, the first thing depression patients get coming out of primary care is either medication or psychotherapy, which is cognitive behavioral therapy.
Anti-depression medications have side effects and don’t work for everyone. If you are not responding to medication, you are clinically classified as “treatment-resistant” to depression. Then you will be sent to a general psychiatrist. The psychiatrist then has to make a better diagnosis and usually try more aggressive medication. If that fails, too, in the old days, they would send patients to have shock therapy, like in One Flew Over the Cuckoo’s Nest.
What a shock therapy does is essentially trying to induce seizures in a brain. It’s kind of like hooking up a car battery to your brain. Again, the potential side effects are really bad. You could have a lot of memory loss afterward.
Since the helmet is non-invasive and you say it doesn’t have many side effects, hypothetically what would happen if a healthy person uses it? If someone is just in a bad mood, will they be instantly happier after wearing the helmet for 20 minutes?
I haven’t tried myself, but I’ve spoken to some psychiatrists who have treated themselves. They say, yes, you get clearer thoughts after treatment. But, depression is a serious thing. It’s not like having a bad mood.
How big is the potential demand for noninvasive deep TMS depression treatment like BrainsWay’s?
The market for this is huge. In the U.S., about half of depression patients don’t respond to their first medication. And a third are treatment-resistant. Each year, roughly 17 million people suffer at least one major depressive episode, and six million of them are treatment-resistant. So that’s more than 10 million patients who could benefit from our helmet.
You’ve worked in the neurosurgical field for nearly 30 years. How do you think this technology is changing the world, if not just for the depression community?
I’ve been with the company for only nine months, but this is already the best job I’ve ever had.
Before BrainsWay, I spent over 20 years dealing with brain tumors, epilepsy and a number of other things around the brain. But mental health dwarfs them all. It’s a huge problem, especially now with everything that’s going on around COVID-19. There are about 30,000 psychiatrists in the U.S. That’s a lot, but we actually don’t have enough of them now. It’s such a rewarding feeling to know that our product is helping people and making a difference in their lives.