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Pandemic-based stay-at-home orders and social distancing of the COVID-19 era exposed a somewhat hidden need in society: greater access to a wider variety of mental health services.
With many people in self-imposed isolation, depression and anxiety are on the rise like never before. According to a recent Pew Research Center survey, 33% of all Americans experienced some sort of psychological distress in March and April. By late June, as the pandemic wore on, that number increased to 40%, according to the Centers for Disease Control and Prevention.
But antidepressant and anti-anxiety drugs don’t work for everyone, and even when they do, their effectiveness can be accompanied by side effects that cause people to stop taking them. Enter transcranial magnetic stimulation, a nonpharmaceutical treatment for depression and anxiety that uses magnetic pulses to restore normal function to the area of the brain that governs mood control.
NeuroSpa TMS, a Tampa company that specializes in the technique, believes TMS represents the future of mental health care. Led by founder and Medical Director Dr. Nate Upshaw, a board-certified psychiatrist, the rapidly growing firm, founded in 2018, has aggressively gone to market, establishing clinics in Citrus Park and Wesley Chapel in Hillsborough County and Pinellas Park in Pinellas County. It's also signed leases on properties in Brandon and Lakewood Ranch.
“You ask a person on the street if they've ever heard about [TMS], and most haven't,” Upshaw says, “but this is a mainstream treatment that's safer and more effective than medication.”
TMS has been approved by the Food & Drug Administration and is covered by most major health insurance plans, including Medicare. Upshaw, 41, says it’s gaining traction with psychiatrists in private practice, who have been buying TMS equipment for their offices and getting trained in how to deliver the treatment. The treatment is also appearing more frequently in articles and studies published by the American Psychiatric Association.
But TMS winning validation from regulators and insurers doesn’t mean it will prove to be a commercial hit. That makes customer education —will enough people opt to receive TMS, which requires 20-minute sessions delivered several times per week, as opposed to the convenience of taking a pill for their conditions? — a core company challenge.
“You know how things go,” Upshaw says. “No one's ever heard about something, and then six months later, everyone's doing it. Once people understand what TMS is and that it's covered by insurance, everyone's going to want to do it, and there's going to be clinics available everywhere. There’s a tidal wave coming. … I think we're just a little bit ahead of our time on that.”
DELIVER THE GOODS
Upshaw and his business partner, investor Jason Conley, 35, contend the results of TMS speak for themselves. They believe that once the treatment’s positives are more well known, more people will seek it out as a safe, nonpharmaceutical option to reduce stress, anxiety, depression and sleeplessness, even though it requires more effort than simply swallowing a pill. Most patients are prescribed 36 20-minute TMS sessions as a course of treatment. (Upshaw declines to say how much the sessions cost, but BetterHelp, a telehealth company that specializes in mental health services, says a typical TMS session, for someone without any insurance coverage, would be priced at $400-$500 out of pocket.)
“It’s a fun industry to be a part of because everybody sees the change that occurs with the patients and the positive outcomes that we're able to provide for people who've been struggling with a disorder for decades, without a good solution.” Jason Conley, managing partner of NeuroSpa TMS
About 60% of TMS patients receive some benefit from the treatment, Upshaw says, and 40% go into full remission, meaning they no longer exhibit symptoms associated with clinical depression and other mental health disorders. He says NeuroSpa’s rates of effectiveness — 88% positive response and 60% remission — are higher than the industry standard because he and his staff of 20 are more experienced and technically savvy than newer entrants into the field.
“Most people who do the treatment get a good benefit from it and end up being on less medication or getting off their medication entirely,” Upshaw says. “It's shocking, to be honest with you. The fact that not everyone knows about this makes me feel like a crazy person sometimes.”
Although much more likely to be prescribed by doctors, drugs like Prozac and Zoloft have lower rates of effectiveness — around 50%, Upshaw says. And the prescription process can be a total crapshoot that leads to ever-diminishing returns.
“The reason why psychiatrists are so excited about this,” Upshaw says, “is that once a patient tries a medication like Prozac, and it doesn't work for them or gives them a side effect, the chance that the next medication is going to work goes way down.”
Investors including Conley, NeuroSpa TMS’s managing partner, are excited about TMS, too. He’s part of an informal group of private investors who provide seed funding to promising health care startups. (Conley declines to disclose how much the group invested in NeuroSpa TMS.) Conley says his group’s objective is to “get the business to a point where we could scale and get this treatment out to as many potential people and patients as we possibly can. We believe very strongly in the alternative, nonmedication-based nature of TMS, and that’s what drove us to get involved.”
The growth capital has allowed NeuroSpa TMS to prepare for rising demand for the treatment. Its clinics have two TMS treatment rooms and are seeing at least 20 patients per day at present, with the potential to serve up to 40 per day if needed. Upshaw says the new clinics in Brandon and Lakewood Ranch will have an option for a third treatment room.
Each TMS device, known as a “chair,” costs between $50,000 and $100,000, Upshaw says, and they’re available from a wide variety of vendors, including NeuroNetics, a publicly traded company that helped pioneer TMS technology and continues to be a leader in the field. (Although privately held NeuroSpa TMS declines to disclose revenue, NeuroNetics’ sales increased from $34.23 million in 2016 to $62.66 million in 2019 — up 83% and a sign of the treatment method’s growing popularity.)
“It’s a fun industry to be a part of,” Conley says, “because everybody sees the change that occurs with the patients and the positive outcomes that we're able to provide for people who've been struggling with a disorder for decades, without a good solution. That creates a tremendous amount of positivity in the industry.”
UPHILL BATTLE
TMS providers including NeuroSpa face a big institutional challenge — Big Pharma — when it comes to building awareness of the treatment method as an effective, safe and side-effect-free alternative to prescription drugs. Not only does the pharmaceutical industry have one of the most powerful political lobbying forces in the country, but its products are also pushed by insurance companies, many of which require patients to try multiple antidepressant and anti-anxiety medications before agreeing to cover alternative therapies, such as TMS.
“No one's recommending this yet — it’s crazy,” Upshaw says. To combat that, he says it’s essential to spread the word, a grassroots process that involves developing good working relationships with primary care physicians. To that end, Upshaw says he’s joined an APA-affiliated TMS industry outreach committee.
“I'm really interested in how we explain TMS to primary care doctors and other doctors, so that they will tell their patients about it,” he says. “Right now, a doctor might say: ‘Oh yeah, I’ve heard of that. It helps a lot of people.’ But they don't bring it up to the patient. They don't say: ‘Hey, you're on your 30th antidepressant. Have you thought about going to TMS?’ And I have a feeling that's because they didn't have anywhere to send them.”
Upshaw’s efforts appear to be gaining traction. He’s been interviewed by the Huffington Post and Shape magazine, as well as website Lifehacker.com and Tampa TV stations WTSP, WFTS and WFLA, the latter of which aired a live demonstration of a TMS therapy session.
“The market is there,” Upshaw says. “It just hasn’t been tapped.”
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