TMS Explained - A Clear, Compassionate Conversation

Hello there, fearfully and wonderfully made human. Welcome to another episode of the Holistic Counselor Podcast, where I try my best to honor God, the one the God that heals, the brain that he designed, and the whole person he created you to be. I'm your host, Diana S.

Rice, licensed mental health counselor and certified integrative mental health professional. And today we're stepping into a conversation that so many people in our communities have been quietly searching for. Recently I attended Dr. Kate Johnson's domestic violence presentation and afterward I met today's guest, someone whose calm, grounded presence instantly stood out.

We started talking and when she told me she specialized in TMS, I felt that familiar nudge from both the clinician in me and the Holy Spirit. This is something people need to understand because let's be honest, there are moments in our healing when prayer, community, and therapy are vital, but sometimes they're not the full picture.

Sometimes the brain needs additional support, and that doesn't make you weak. It makes you human. So today I'm honored to welcome Jacquelyn Simon, MSRN PMHNP-BC, a psychiatric mental health nurse practitioner who has served individuals and families across hospitals, the VA, and major treatment centers.

What I appreciate most is that she sees mental health the way I do and she approaches each person with compassion, curiosity, and evidencebased care. My hope is that this conversation brings clarity and removes shame. If your brain needs support, that does not mean your faith is weak.

It means your nervous system has been carrying more than it was ever designed to carry alone. And before we begin, I just want to gently ask if this podcast has been a blessing to you. It would truly mean so much if you've left a ver if you leave a review, like the video on YouTube, or visit the merch store to support the mission.

Not for me, but because every bit of encouragement and engagement helps this message reach someone who feels stuck, discouraged, or ashamed to ask for help. We are building a community where mental health, faith, and truth can coexist without stigma. All right, so let's step into this conversation.

Jackie or Jacqueline, thank you for being on the show. Wait, can I call you Jackie?

Yes, call me Jackie.

And thank you. Absolutely. I'm happy to be here.

All right. So, I know we talked about um you went to one of the local private schools that I used to sub at and stuff and I was so excited about that. I was like, "Oh, how cool is this?" But anyway, um what inspired to you to move from nursing, right, to into psychiatry and what moment made you realize this was your calling?

Um let's see. So, I've always, you know, had an interest in science, had an interest in, you know, behavior and how people interact with one another. Um, and then when I was in, you know, when I went to college, I took a psychology class and I just thought it was very interesting.

Um, and you know, I wasn't, you know, conscious at the time, but it kind of never left that that was something I really wanted to do. And then, um, you know, I come from a family of medical providers. It was kind of, you know, in the blood, I guess you could say.

Yeah.

And I went to nursing school, which was great. I've always, you know, been passionate about helping people. And um and then again I got to do a clinical at a psychiatric hospital while I was in nursing school and I just thought this is fascinating.

This is amazing. Um and I wanted to learn more about it and it just there's been like multiple different forks in the road along the way I guess you could say that have just kind of led me to where I am now.

Natural progression. Absolutely. That's something that I realized, too.

I I really didn't uh My youngest son right now is at UVA and he's doing his psych rotation as a nurse and he's just like, "Wow, mom, now I I like you know, like you can't talk all about like everything, but it's just like, okay, now he sees like, wow, that's really interesting." like of so what was it that interested you the most like just like behavior or like wow because I know why I decided you know it it was a calling and I

honestly for me it was more of like why did the people in my family behave this way

that's always part of it a little bit right from me too right and me too though like I was feeling certain ways and I was trying to understand myself as well which I think a lot of people that go into our field and into this field, you know, there everyone has a story.

So, to me, it's just like um yeah, like the psychiatric mental health nurse practitioner. What is the difference? And and what like you know, people people think nurse or automatically they want to probably call you Dr. Simon because sometimes they call me Dr.

Rice. I'm like, "Oh, no, no, no. I'm in a master's degree. I did not go to med school." So can you just describe a little and what what's the difference from like a psychiatrist or a therapist?

Sure, absolutely. So um so I am an advanced degree nurse. So I became a nurse. I became a an RN, a registered nurse after graduating from nursing school. Um and then you know I worked in the field for a little bit and decided I wanted to continue to pursue the uh psychiatric care component of nursing.

So, I went back to school and got a master's degree, a bachelor of science, um, in in nursing, specifically in mental health nursing.

Um, and then, um, typically you'll pass, you know, a national certification exam and then you'll become board certified and become a psychiatric mental health nurse practitioner. And um that you know this job allows me to I can provide therapy which is which is great.

Typically most of the people in you know who are psych NPs um do primarily medication management and we usually work alongside you know a psychiatrist or other you know medical providers in um you know you can find us in inpatient hospital settings um a lot of outpatient clinics also.

Okay. um different than a therapist. I'd say probably our training um doesn't focus as much on providing therapy as it does on medicine and you know biology and anatomy and things like that. And then different from a psychiatrist or a medical doctor, it's not as long of a education program typically for most of us.

Although there are some nurse practitioners that do um do a doctorate level program and are doctors.

Um yeah,

but it's still different than a MD.

It's still different than an MD. Yep. It's not medical school,

right? Well, or residency like did you have to do a residency?

Um no, I didn't do a residency. I did what they called it um like a practicum or internship

kind of. Yeah. It wasn't an internship, but it was before I graduated and it was just I spent a lot of clinical hours in one facility with a preceptor.

Right. Okay.

Yeah. Really?

So, it's kind of like I I did a year a year practicum it was called at hands-on. So, I'm thinking it's the same but different because yours is geared towards understanding like the science of probably the brain more than I did. Mine was more like did you learn like CBT or other modalities in therapeutic or was it more just focus on here's the medication and this is what it will help or or how was that?

It was mostly geared towards medication, I'd say, and kind of underlying biological components of mental illness, but we did get a little taste of different therapeutic interventions, which was great because then as I, you know, got more into the field and have gotten to work with therapists over the years and had um the opportunity to continue my education like where we met.

Yeah. Um, I kind of had a a base to start from.

Yeah, I loved that. I loved seeing you there because to me that's where I was like, "Oh, I'm gonna like I want to have a conversation because for me, for a psych any psychiatric anybody that comes in that wants to learn other things or holistic things to me, I'm like, okay, good.

They're open-minded and they're not just in the conventional insurance mindset that many of us are trained in, you know, to and honestly I rather go to a nurse practitioner of whatever like specialty I I would go to just because they seem to have a little more time and just a more um it's not like the r not saying all doctors are like this but you know like the rush 10 minute 15 minute let's go move on

but a nurse practitioner it's like that's you know because I remember people like I don't want to go to the nurse practic practitioner.

I'd rather go to the doctor. They're the ones that are trained. And I'm like, yeah, there's a shift in the culture of understanding like, no, they're trained and now they're newer coming in with a newer training as well and has has the patience of of being able to, you know, be with I think that's the biggest thing I hear now that I have clients that come out of certain, you know, community health, you know, or conventional.

And what I mean by conventional, I know that we have, you know, people have to go. They have to go and get the help they need. And I totally understand that.

It's just understanding too that like to take the time to really get in tune with yourself of what you need because sometimes what happens, we trust so many professionals out there and now we've lost all agency,

right? Yeah. it can, you know, and part of the reason I started my private practice about a year and a half ago now is because I really kind of wanted to be able to take that extra time and to, you know, explore more so like the client presents this problem to me and they, you know, want assistance and need assistance.

What are they okay with trying? What have they tried? And what do they feel comfortable doing? And then I try to, you know, use all the different resources and information that I've learned to really come up with something that they feel good about, I feel like, you know, will be good for them and safe for them.

And yeah, it's really kind of tailored to their needs. Yeah.

And the more I learn about, you know, different domestic violence or different types of therapies, um, the better understanding I I have when I'm when I meet with people.

Okay. So, talking about different kinds of therapies because this is what is intriguing. I have not spoke to anyone yet that will hopefully teach me, educate me, learn, learn me, as I would used to say back when I worked in alternative high schools.

Uh um TMS. All right, let's let's discuss this because I I know it's I think it's magnets. I should know a little more, but I never went down that rabbit hole completely because I've never I I don't I can't use it. I'm not a practitioner of it or anything like that.

But I want people to understand what that is. Like all of it, the good, the bad, and the ugly. So,

uh tell me, can you explain it in real simple terms? Just pretend you're talking to a ninth grader because sometimes that's how I that's why I would have to read things over and over. But

um you know what is TMS? T as in Tom, M as in Mary, S as in Sam. So TMS is transcranial magnetic stimulation and it is indeed a magnet. So, it's a high-owered magnet and um you know it's it when you see the machine it's there's a machine and then a chair and then they have a paddle that has the magnet in it.

Okay.

And they'll place it against your scalp and then depending on I guess well the first step would be you do a psychiatric evaluation to determine like okay what are we going to try to treat potentially with TMS? And TMS was actually I believe originally FDA approved in 2008.

So it's actually been and being used prior to but FDA approved in 2008 and I feel like just more recently has it been more available to people and a big a big reason for that is the cost. It can be expensive and insurance companies are are covering it now mostly I see for depression

which is really wonderful. Um, but I think getting it covered can sometimes be an issue. They typically want you to have, you know, tried a couple different medications for depression before, you know, they'll approve your treatment. But I I'm hoping that that's changing.

Um, and so it's FDA approved for depression. Now, anxiety associated with depression.

Okay. um OCD, smoking sessation, and there's a couple other indications that aren't um you know, mental health related necessarily.

Um but it can be used in other things. I've seen it um be used for other addictions. Yeah.

I was wondering, it's not electro comp whatever the stuff that back in the you know,

it's not ACT.

Okay. Because let me tell you like that stuff and I've seen some side effect people that that have gone through this and I'm like it breaks my heart like I'm and then you know it's not a labbotomy either. So

no right.

Well it's just you got Yeah. You got some scary stuff out there. So I just want to know more about like

you know when you're messing with the brain because many of us don't we're still learning about the brain. Like there's just it's amazing. This is just like the I don't want to say the wild wild west, but her brains are just spectacular organ.

That's amazing, right?

Yeah. So, tell me more about like the results that you've seen with TMS, especially for people that have not responded to traditional medication. Do do you do medicine and that or do they have to like um be deprescribed the medication first and tapered off and then use it?

like tell me a little more of how that works.

So, you can be on psychiatric medications while you do TMS. Um, you you also don't you that's not necessary. You don't have to be taking a psychiatric medication to do TMS, right?

Um, if you are taking psychiatric medication, it's recommended that you don't make any major changes while you're um doing your TMS uh protocol just because, you know, it's another factor kind of thrown in there. But you can absolutely take medication while you're on TMS.

Some medications may affect what they, you know, your sensitivity to the stimulation, but you'll still have a response. You might just require a higher or lower dose, if you will, of the stimulation.

So, okay. Do you have to shave your head?

You don't have to shave your head. So, so they they take that magnetic coil, right? and and they'll um so they'll find your motor threshold. That'll be your first appointment. So you'll come in, they'll do some measurements um on your your scalp and then they'll determine um what amplitude or strength of the stimulation you need.

Wow.

To cause your brain to respond. Um, and once they kind of are able to calculate that dose, then the next time you come in, or if you end up doing it that day, they'll use a percentage of that number that they've calculated to administer whatever protocol it is. and they have different protocols that they'll use for depression or anxiety or, you know, trauma, OCD, um, and also different brain areas that they'll that they'll target with the magnetic stimulation.

So, do they so do they do a a a brain scan first? Is that what you said that they would do they put like tell me like do they put a hundred little things or is it a cap or is it just one big magnet and someone's just holding So different so different TMS devices and software will use different methods to kind of determine where they're going to target the stimulation.

So sometimes they'll use a cap, sometimes they'll use um software that you know they'll place sensors on, you know, on your head just superficially and it will um communicate with a sensing device that will communicate with the software and it'll kind of give a generalized area to target based on multiple what we consider normal patient scalps, right, are giving us a pretty good idea.

Maybe not normal, but

every time I hear the word normal, I'm like, gosh, I've been on this earth for 54 years and I'm still trying to figure out what that is.

Right. Right. Yeah. just um I guess a better word would be kind of or a better way to think about it is based on all these different images that we've been able to collect.

Okay,

we can use all of that information to kind of standardize based on what your p your brain and scalp are shaped like to determine where we're going to focus. So with a psychiatric evaluation, right, are you sitting there and you have to you have to figure out weight, right?

Like is that how you age, weight? I mean, how how thorough is a psych psychiatric evaluation? I mean, I know you probably do a biocschosocial, but uh um to to find out I'm just think here goes my brain like how I I probably need TMS to calm me down.

Uh but I'm just wondering how you know you walk into say we're doing because it it could be scary.

I can imagine like being you doing anything first time in this field is sometimes especially when you're messing with the brain or taking a substance or something like that like sometimes you know I I I hear about ketamine or you know because everything we do even supplements can have a side effect right if you take too much magnesium you can get diarrhea like it's just things like that so I just want to know

you know honestly like you walk in say with you to your office because it's going to be different with you than the next psychiatric nurse and this is what makes you so unique, right? Um it's just do you spend like 30 minutes with them?

Is it a thorough like hey because I'm still trying to figure out how this work? I know we're electrical beings. I get it. Like EKGs and stuff of the heart and stuff because but people that don't really understand this are going in and like what is this like witchcraft?

like how do you how do you explain it with evidence science along with just normal terminology that can actually make a person understand oh that's how it works because it could be scary like is my personality going to change what are the side effects of this

right okay so you know a psychiatric evaluation I'll usually you know not just cons physical things we want to know too right age weight things like that but

um you know I really want to know about like what brought you to see me today? What are you struggling with? What's been happening in your life? Um and then also what you know what has been your history? What has been you know medical is super important, right?

But also what's your psych history been? Have you you know struggled with anxiety a lot? Did were you know did you have a lot of anxiety when you were a little kid and maybe didn't notice that you were anxious because you've been anxious your whole life and now you're an adult and you're struggling with this anxiety or any history of substance use things like that.

So we go we do a very thorough just kind of history and you know what your experience has been and then I'll typically take a patient to go see the TMS machine just to kind of get an idea of like what it looks like.

Right. It's

Yeah,

it's um

Is it huge and scary?

It's not. It's, you know, but it looks techy. It's

okay.

Um but it's really, you know, I I guess the thing I would probably equate it to the most is it sort of looks like a dental chair, right? And then we have this Yeah. We have a the TMS machine and the paddles, which are typically not too terribly big.

Mhm. Um, and we can actually turn the machine on and let you feel what the magnetic stimulation feels like, which is typically like a tapping feeling.

Oh, really? It's not like being electrocuted or anything like that.

No, no, not so bad.

Okay.

Um, it's a tapping feeling actually. Some people while they're getting their treatment will actually just fall asleep. It's not

Wow.

And there's no sedation. And you can, you know, you come in, do your TMS treatment, which can range from just a few minutes up to like, you know, maybe it can take 20 to 30 minutes,

okay?

And then you're you're done for the day. You can go about your day. There's no sedation involved, nothing like that. Um, as far as side effects go, I haven't seen too much cuz typically, you know, the most common side effect would be a headache or discomfort at the stimulation site.

Um, and they're transient, you know, the the pain will stop when we take the stimulation away. Um and then you know if you get a headache from the treatment then over-the-counter medication and typically resolves you know quickly end of the day you know

anything terrible and then we'll reduce the stimulation that you're um getting and hopefully you won't have that side effect again. Okay. I'm I'm wondering how long how many do you need or is it like if say you have a client who at 13 years old started anti-depressants,

right?

Okay. At 13 and now she's 23, so it's 10 years on anti-depressants and it's she's still depressed.

Mhm. How do you how do you how do you utilize the TMS with those kinds of clients that or patients that have been, you know, really trying to and they're t they've been on or antiscychotics or anti-anxiety medicine or, you know, benzo or so many different um medications and now they're like, "Okay, this is now they're going to try something different because they're not feeling right still."

Right. Yeah. It's it can absolutely be used as a adjunct uh treatment. Um actually it was FDA approved for adolescent depression 15 and up

really.

Um fairly recently.

So there's no blackbox warning?

No blackbox warning. No. As a matter of fact, I've seen it be very helpful for people who have kind of chronic suicidal ideation, you know, where it comes up a lot. That's, you know, in the more persistent and severe depression. I've seen a very significant noticeable improvement, which has been really amazing.

No wonder you you like are so excited. I mean, like that's

because that's that's that's

I guess because I work with a lot of of clients that come to me after they've been into the system for a while or or they've never been to therapy at all and they think, you know, they're they come to me and it's the first time ever.

And so this is why I work with psychiatric nurses and psychiatrists and other MDs, you know, functional integrative doctors or nutritionists or stuff like that because it is having that un that holistic approach to to understanding that the human being, right, is like they're unique.

They're they're a thumbrint,

right?

But but at the same time, you study brains and then you understand the science. It's like trying to have the the person in front of you un like have some agency and control too without just giving it all up. And that's the hard part with adolescence.

They you know they don't have a lot of choices really.

Right. And so with with TMS, I I'm still like, you know, how many sessions does it take before they are people receiving results right away or does it like go after the three or four or I mean I know it's going to vary depending on what the person is carrying,

right? It dep so and it would also depend on you know the protocol you're doing. So there's some typically they're more inpatient type facilities where you'll do multiple TMS sessions in a single day and then you'll see results much more quickly.

In one day you could do more than one.

You can. Yes, it it's recommended that you take you know a 45 minute or 50 minute break in between treatments to allow for you know kind of neuroplasticity to take place. Um, let's stop there for those that don't know what neuroplasticity is because some people remember like I'm I'm talking to people well I'm talking to whoever listens but I'm talking to people that uh hopefully that are wanting are learning at in this in this uh show.

So neuroplasticity for those that don't know what that is because that's a word that we use that's like you know but someone that's like going what is that? That sounds I'm like what? I know it's like the plastic brain but you know do you want to explain a little what neuroplastic talk about that for a minute?

It's the ability for your brain to form new connections and you know forge new pathways and kind of develop new ways of functioning.

Yeah.

Yeah.

Yeah. So, it's basically understanding that your brain can learn and rewire itself. And it's amazing the science behind that to a place where a lot of people don't understand that, Jackie. I'm serious. They don't think that, you know, because remember back in the day, back in the late 1900s, they taught us like, "Here's your brain.

Here's your brain's on drugs. Any questions?" Like, you weren't able to rewire anything. It was like back in the day they thought

we only had a certain amount of cells and that was it or neurons and that was it. And they were thinking that's it. And I know because of my son, the young son that I was telling my youngest son that I was telling you about had a brain injury.

That's when I went into the deep dive of neuroplasticity in 2012.

Yeah.

And that's when I started learning. I'm like, "Wait, what? Huh? Oh, I can do this. I could try that." And there was some weird uh movie that showed people I don't know if you ever got to see it, but it's like oh my gosh.

I'm going to see if I could find it guys and put it in the show notes, but it showed no like the guy who couldn't use he had a stroke and couldn't use but they put a mirror and the mirror image. So then he was able to it was so cool

and they studied the brain. So, back with the with TM TMS. Is there any myths you wish uh people would stop believing about it?

Um, I guess, you know, something that I can see would be something that people might be concerned about is that it's something a little bit more intense, like something more like ECT, right? Which is the induction of a a seizure while you're under anesthesia. um which is does amazing things for people and for some people you know they've tried everything else and it's all that works for them and it can do amazing things.

Um but it does have more side effects than something like TMS does and it is more um you know again it requires that you be sedated. Um, and I feel like there could be a little fear, especially with that, you know, the movie of One Flew Over the Cuckoo's Nest or it's, you know, it looks scary, but but TMS, I mean, we talked about the side effect of a headache.

Um, there's also, um, the possibility if you have a seizure disorder that it can induce a seizure. So, that's definitely something you'd want to talk about with your provider. Mhm.

Um, also if you have um the propensity towards bipolar disorder or psychosis, that would be another thing that you'd want to discuss with your provider because we are stimulating brain activity typically depending on the protocol. And that stimulation can sometimes go a little bit overboard in people who um are sensitive to, you know, experiencing those things,

right? So that would be another thing we'd want to um kind of keep a a lookout for. But um you typically will so let's say you do a typical depression protocol that's typically around 36 sessions. So you'd want to go you know 5 days a week

36 sessions. Um there's some variability there but um and then

typically we start to see improvement in depressive symptoms within the first few weeks. It takes a little bit of time. Mhm.

Um to kind of get the depression symptoms to start to improve. But once we see that improvement, I've noticed that it's pretty, you know, pretty significant improvement. And and typically even after completing your 36 sessions, there'll be a period of I mean, we hope remission, right?

Longlasting remission.

That's what I was going to ask. It's like how long would it last or is it something you have to do continually forever now? Kind of like having to take the the the

prescription or medication or something like that. Is it something you have to do? Do you um combine lifestyle change too or how's that work? Do you have a conversation on those things too or no?

Definitely. You know, part of the psychiatric evaluation we talk about lifestyle. What's your diet like? How are you sleeping? Um are you getting any exercise? What are your, you know, are you in a really stressful job? Are you in a really toxic relationship?

Like what, you know, what other factors are contributing to like how you're feeling?

Mhm.

And TMS will, you know, will work. I mean, it it stimulates uh blood flow to the area of the brain that we're targeting. it, you know, causes the release of neurotransmitters in that area and decreases inflammation. So, it will definitely have an effect, but like anything else, if you're not also kind of working on

the dayto-day things, then there's only, you know, so much it can do and and so long it will last, right?

Yeah. Because Yeah. Because then it's like neuroplasticity, right? You're rewiring the brain, but if you go back to old patterns, it's going to start rewiring that way again.

Right.

Right.

Right. It can do that. Yes.

I I want to know how does it Well, first of all, here's here's my thing. Can you take it and like put it in different parts of your body to stimulate and make it better there or just the brain?

Um, you know, that that I'm not sure. Um, I imagine there could be some similar device that would work that way. Um but not that I'm aware of. Yeah.

Yeah. I wonder if they're studying that. If the companies are studying that and it's going to come out

surprise me,

right?

Yeah. So um how does it actually work? So it's stimulating the brain, but is it like what what is it like electric or how is it how?

So yes, electric

Uhhuh.

Um electrical activity between neurons. It's stimulating the depolarization of neurons so that they are releasing neurotransmitters communicating with each other. The stimulation itself is very you know affects very surface areas of the brain. It doesn't deep it's not uh penetrating that deeply. Although there are certain coils that will penetrate more deeply than others.

But even just when you're stimulating these more superficial areas,

they communicate downstream with deeper brain areas. And then if we're increasing uh blood flow, we're increas increasing oxygenation and you know decreasing inflammation. I mean that's a big deal. Like inflammation I've learned throughout the whole body that causes so many different things uh in people and people don't even understand what that actually means.

What do you mean inflammation? You know, and I'm just like, well, there's certain foods you eat that can inflame your brain. There are certain things in your gut that can inflame your brain or just just

chronic stress. Yeah.

Stress. That's like one of the number one things. And PE but we live in this society that is we run on chronic stress,

right?

And and it it becomes to a it comes to a place where running on that chronic stress is like a a badge of honor.

Yeah. you know, it's uh you know, maybe not the healthiest, you know, way

function. Right.

Right.

Um there's something to be said for getting a lot done and being really productive, but also our bodies need rest.

Yes. Right. And that's why I think collaboration is so important. This is why like I invite people like you on to collaborate because Yeah. Somebody can hire me to help them in a certain area, but then they can hire you to help them in that move them forward to a in a different area of what they need or someone else like, you know, a holistic provider.

We all work together for a reason. Like we're we're in this Well, I know I'm not in it for money because that's just not I'm in it because I'm trying to break stigma and have people understand, especially in the faith community and in the black and brown community.

It's because you know it's hard because sometimes we I know I was raised not to trust many systems,

right? And I don't and I'm glad kind of now that I'm looking back I'm like thank you.

Thank you. But but I also have a big respect for um new scientific um creations or modalities because this is this is moving forward. We have evolved. I really think it's just the intention of the heart of the provider because you could I I mean I can tell when a provider is just about seeing humans as a number and that's that's it, right?

And that's why I try to get people to understand as they listen hopefully to all, you know, by the time this comes out, like all 99 episodes that they'll understand that no, like you have rights in informed cons informed consent and not all of us in these fields are corrupted by the by, you know, big pharma or the insurance company because that's a hard thing for us, Jackie.

Like honestly, cuz sometimes when I'm like I'm a therapist, a licensed therapist, some people will come across and be like, oh, you know, oh, so you're this or you're that. All these assumptions and all these myths about certain things like how do you handle that, you know, when if because you this is I've heard it.

I know that sometimes I get angry at the psychi psychiatric parts of our of our system. I do just because I worked in alternative high schools for so long and I saw some of the damage.

What's different about you?

Well, um, you know, I hear what you're saying about the system and how it can be corrupt and things like that. Um, and I have, you know, I've heard stories about that, but most of the healthcare providers that I've experienced and worked with, including myself, we really do want to help.

We may be limited by the insurance industry, right? We may not be able to suggest certain things or utilize certain things because we're kind of pigeonholed into using these other things that are approved by insurance. But I'd say what kind of separates um you know a really great provider is someone who really cares.

They really listen to you. Um, again, they need to have enough time to listen to you. But, right, um,

they listen to you. They're willing to kind of work with you if you, you know, if you don't want to try something for whatever reason, you can explain your reason. they can go ahead and tell you, you know, maybe if you have this concern and there's evidence that the provider can explain to you that maybe that concern is really like not very common or whatever it might be, that might make you feel more comfortable and then you're like, "Okay, like now I feel better about it."

But if you still don't want to try it, then they, you know, absolutely there's so many options out there now that it's, you know, important to try to find a provider who can work with you on what you're willing to try cuz, you know, we we talked about teenagers.

We don't want to force them into doing something that they don't want to do, especially, you know, if they're going to have a side effect that they don't like,

right? you know, this is, you know, the the patient's life and we're here to just help them have a have a better life,

right? To provide a service. And I think it's to make the human understand that they have rights and that we respect them because that's something I saw back in the day. I mean, things have changed and shifted a lot since I I was working, you know, at the alternative high school and they're going they're going to keep changing.

And so this is why I thought it was important for someone to listen about TMS and exploring that like um when should they consider meeting with with a nurse practitioner like you and exploring the options like TMS like if someone like you know when cuz if they feeling stuck for years you know who do they talk to?

Is there is there like a specialized website or something or like how can someone learn more about this? Is there do you know of anything

about finding a provider or

well TMS just if someone's now curious about that is there a book or a resource that we can I put in the show notes that can you know maybe they could see the paddles or they could see it happening to someone like because that's a scare you're right that is a scary thing.

I know like when I first went into EMDR I'm like oh my gosh they're going to hypnotize me and put thoughts and I'm going to start clucking like a chicken. No, I'm just kidding. I wasn't. But you know what I mean? Like is there anything that you know of that can help uh like a patient or or someone that's like curious about it?

So the TMS device, so the company that I've worked with that, you know, the that makes the machine that I've used is Mag Venture. Okay. and they have videos you can watch in a website that will teach you more about and and show you some things about TMS.

Um there's also, you know, IMH has some papers about TMS and usefulness and improvement. Um as far as book goes, I haven't seen a book yet, but I'm sure there is one.

No, that's okay. That's perfect. I could I could put those two in the show notes and and stuff like that.

Well, what about exploring because how would you bring this up to say a psychiat if like or wait can um just medical prof because I know that's one thing too that's a whole another hour to talk about where you have like regular general practitioners giving out medication like crazy psychiatric medication and I swear causing some harm not all of them but you know they they did not study like you did right

right they didn't study like I did the the the the the behavioral and the psych psychology behind of a human being, right? So then when you have these pediatricians or general practitioners that are just say, "Okay, you have anxiety, you know, and I'm like, wait a minute, did you do an A score?

Did you spend some quality time understanding their trauma background? Did you, you know, I could keep going on with the list and in 15 minutes they're now on benzo and addicted,

right?

You see what I'm saying? So, how what what do you say like um to a person listening right now going, "Oh, I didn't even think about that." Like how TMS like where how do you ask about that? Do you just say, "Hey, I'm curious about TMS." or what do you look

so you know if you've been struggling with with mental health um you know depending on what you're going through right a therapist can be a great first stopping place to just kind of talk about what's been going on

I encourage pretty much all of my patients to work with a therapist while you know while we're doing TMS or adjusting medications um but you could also you know if you're working with a primary care provider and you have been struggling with mental health issues, you can let them know and I would, you know, I would meet with a specialist.

I would recommend that definitely just because they know more about those the different resources that are available.

Okay?

And then, you know, maybe your PCP can refer you to either a psychiatrist or a psychiatric mental health nurse practitioner or they also have PAs that specialize in psychiatry. Um, and then they can talk to you more about, you know, your different options.

Um, you know, and if TMS is something you're interested in, if you'd be a good candidate for it or not, or if there might be something different.

Yeah.

So, it's very thorough then. It's not just like, oh, hop on the on the the the bed or hop on the chair. I'm sure if you contacted like a a place where all they do is TMS and you called them first that maybe it would be a little bit more of a quick

okay

you know quick transition to do that but I you know they would still have to do a thorough assessment

but that's why I would kind of touch base with you know someone who specializes in the psychiatric field just so you can kind of talk about your different options and let them know before you you know schedule, maybe your psychiatric evaluation that that's something you're interested in and see if they have any experience or would be potentially willing to refer you out for that.

If not,

um just to make sure that that they would be kind of the right fit for you and know about the things that you're interested in doing.

How long have you been um practicing TMS?

So, let's see. So I I've been doing it for about a year now.

Okay. So you had to have a special training in it then.

So I did training. There are there are trainings that you can go to. Absolutely. Um that's more so for clinicians than patients but um

Okay.

Yep. There's special training. Um you know I also collaborate with different uh psychiatrists who

will you know in the state of Florida I'm I enjoy collaborating with them but also I have to right

yeah exactly

so um you know we talk about different protocols and things like that that can be done and if this patient's appropriate or not appropriate. Okay, good. So, if somebody is wanting to work with you and they want to come to you because they they now notice how kind and gentle and how caring you are.

How do they work with you? So, I have a private practice called Rising Tide Psychiatry. Um, and it's a tea tellahalth practice. I'm licensed in the state of Florida and the state of New York. So, I can work with uh patients in those states and you can just call me.

Um, you know, I just give people my number. They can call me, tell me about what they're experiencing, and we can determine if I'm the right person for them or if I can help them find someone who would be a better fit for them.

Um, yeah. Or I have a a TRA or a TERA page, which is my EMR, um, where you can, you know, just look me up. It's a long address, but

and I'll put it in the show notes for sure.

Okay.

Yes. And and so if they're working with or they're trying to reach out to you, um do you take insurance?

I don't take insurance just kind of partially because of those limitations that it

I don't take insurance either. So I get it. I get it. And it's just, you know, people get frustrated, but at the same time, like when they realize you have a little more freedom to be able to do genu, not genuine, but

how would we say it? Very um we we spend more time. We we are able to spend more time and and give you quality therapeutic services. That's how I explain it. So, okay. But how would you do TMS? you send the person to a TMS center.

So I also so they can there's different TMS centers in the South Florida area. Um but I also do um I work part-time at Rico in Delray and they have um TMS there.

I just got an email from them today inviting me to come take a tour.

What are the odds?

Yeah, that wasn't you, was it? No, some guy.

It was me.

Yeah. So, you can, you know, go check out the facility and

Yeah, I'm going to

Yeah.

Now, now that I've had a conversation with you, I'm going to now RSVP.

Yeah,

that's cool.

Um, and the, you know, the program there is a PHP and IOP mental health program, but you can still participate in TMS as an outpatient there.

Oh, okay. And so, that's how they can work with you there. Yep. We can look together there. Um,

do you have a place in New York, too, or just in Florida?

As far as TMS referrals go, just in Florida at this point.

Okay. All right. No, that's good to know. That's good to know. So, you work in uh Oh, do you prescribe?

Do you help?

Prescribe. I do micro tapers. I, you know, I utilize supplements. all the, you know, all the kind of things that I get to do now that um

Yeah.

Yeah. that

Oh, good. Do you know Dr. Furer?

I do.

Oh, good. Because to me, I'm just like, you two could be a a system together because I I I this is why I'm so excited because I meet when I'm networking and then I meet these humans that are understanding the holistic approach. I guess because I was so angry back in the early 2000s when I was learning and working with psychiatrists.

I'm just like, "Oh, come on. Human beings are more than just this medication thing." Like, you know, and and I'm not putting medication down. I'm not one of those either that's like, "No, I understand that

the science like it it's like we need to see the human and see exactly what they need holistically."

Absolutely. Yep. There's a time and a place.

Exactly. So, all right. So, just before we go and before we say goodbye, because I could keep talking to you for another hour, but I'm sure we both have clients after this. And so, um, if if someone is wanting to improve their mental health or they're or wanting to feel like themselves again, is there any kind of practical steps or tips or anything you want to say to a person right now that's listening?

Um, well, I would say there's some things you can do that are totally free and can be done today, right? So go outside. Go outside. Walk walk outside for 20 minutes. Look around. Listen to the sounds of the wind and the leaves and you know the water.

You know, we live in a beautiful area where we get to look out at the vast ocean. I mean that's that's healing.

Yes. um

or or any or any nature space because for those that are outside of the country or outside of the state of Florida,

any nature Well, I mean, there's been more and more um talk about forest bathing now where you're amongst the trees. Absolutely. Um

and just walking. I mean, even if you're not outside, just walking around, the bilateral movement that's been shown to help people process things, you know, blood flow again, inflammation again, right?

Yeah.

Um, social media, I, you know, the more we use social media, it kind of like can be harmful to our mental health and well-being sometimes. a lot of, you know, especially if we're comparing ourselves to other people or um, you know, reading things that make us feel bad about oursel, whatever it is, or stress us out.

Mhm.

Um so maybe limit your exposure to that or um and also you know spend time with someone you love whether that be someone in your family or or a friend or an animal just another being being present with I would say like those are all or plan something that you can look forward to right yeah event bright meetup I mean that's here like that's something that I encourage my clients to do is to sometimes s I'm like, "You need to go volunteer, but I'm so depressed I can't get out of bed."

I'm like, "Then you need to go volunteer." And they're like, and they're like, "That doesn't make sense." But then when we figure something out that they love it, it reconnects. It makes them realize that they have a purpose because each one of us have a purpose.

I don't care where you are, each one of us have a purpose.

Wow, Jackie. So, it was such a pleasure to have this conversation with you. Thank you so much to to to educate me on TMS and and I'm going to put I'm going to go watch some videos now on TMS and and I'll put uh the the Mag You said Mag Venture, correct?

Mag Venture Magenture. There are different machines. Um also um

Okay.

Neurostar is one, Brain Sway is one. So,

okay. Yeah. I just want to understand it more. And just because we recommend things doesn't mean you guys go out and do it. Go to a medical professional. This is just educational information only. All right, Jackie, thank you so much. And listener, please, please do not forget to trust in the Lord.

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