EDITOR’S NOTE: Each quarter, the NNBW publishes a special “B2B Industry Focus” edition that centers on a certain industry. The fourth quarter’s B2B Industry Focus is on healthcare. This is the fifth in a five-part series of stories on that topic; parts 1-4 are below. You can also read the Wednesday, Oct. 20, print edition for the full lineup.
Before the coronavirus pandemic took hold, Duncan Family Healthcare, a nurse-managed mental health clinic in Reno, typically saw 85 patients on any given week. Now, the practice is seeing roughly 110 patients a week, said Dr. Cameron Duncan, founder and CEO. “We’re constantly busy,” Duncan said. “We’ve hired two new clinicians within the past year because the demand was so needed.” Duncan’s growth is just one example of the heavy impact the pandemic has had on the mental health of people in Nevada and across the U.S., where a wave of mental health crises has grown into a tsunami. In fact, U.S. Centers for Disease Control and Prevention surveys have found that 38% of respondents reported symptoms of anxiety or depression between April 2020 and February of this year, up from about a mere 11% in 2019. As a result, the mental healthcare system, already stretched thin before the pandemic, has been flooded with patients over the last year and a half.
Dr. Cameron Duncan
“Isolation definitely will cause you to have more depressive symptoms,” Duncan said. “But at the same time, being isolated can make it so that you have more anxiety to go back out in public because of the fear of getting sick and putting themselves or their families at risk.” While many hospital emergency departments and behavioral healthcare clinics in Reno-Sparks and beyond have seen a surge in patients seeking care for depression and anxiety, mental healthcare providers that offer alternative treatment options are also seeing a rise in demand. One of those is Duncan’s clinic, which offers NeuroStar Advanced Therapy, a transcranial magnetic stimulation (TMS) therapy for the treatment of major depressive disorder. TMS uses magnetic pulses to stimulate areas of the brain that are underactive in depression. The therapy offers doctors real-time feedback and delivers enhanced care with its precise and accurate targeting, Duncan said. “The neurons in our brain connecting are like power lines, and we have all of these electrical currents going through, they’re communicating and releasing these neurotransmitters,” he explained. “What the TMS treatment does is it tells those neurons that are not working correctly in our brain to start firing again and release those neurotransmitters. The magnetic pulse from the TMS machine is teaching your brain the new habit to fire and release those neurotransmitters. “And over time, an eight-week course of treatment that is TMS, the hope is that your brain continues to fire and release neurotransmitters the way it was during the treatment itself.” Duncan was quick to point out that TMS is meant for clients with major depressive disorder who have tried therapies and medications with little or no success. In other words, the treatment is “not for someone who hasn’t tried anti-depression medications or therapy before.” “It’s an alternative, non-drug, non-invasive treatment for people who either can’t tolerate medications or what we call ‘non-responders’ to medication,” said Duncan, noting that TMS is widely covered by major insurance plans and is available by prescription. “There are many people who don’t want to try medication or don’t want to try another medication, and it’s an alternative approach to the standard medication and therapy options that are typically offered.” Duncan said he has treated patients who have tried as many as 10 medications throughout their lives. Some have seen significant improvements while continuing to stay on medication, while others have reached remission of depressive symptoms and got off their medication entirely. Since 2017, Duncan Family Healthcare has seen 68% of its patients show a reduction in symptoms and 45% have full remission of symptoms, Duncan said. He added that the practice sees about four people a day for TMS treatment, specifically. “I think it’s important for everyone to have options,” he said. “I don’t think that care should just be dictated by their provider, it should be a collaboration between the two. “And if our typical therapeutic techniques aren’t working, it’s my responsibility as a clinician to figure out a solution of what might help.” CASE FOR KETAMINE Another doctor doing just that is Dr. Robert Watson at WellCentric Health in Reno. To help treat patients with depression, anxiety and substance abuse, among others, Watson uses what a growing body of research shows could be a new hope for mental health issues: ketamine.
Dr. Robert Watson
When infused at low doses into patients with depression, ketamine induces neuroplasticity and synaptogenesis in patients’ brains, Watson said. In other words, ketamine causes physical changes to the neurons in the brain, as opposed to just a chemical change that fades after a drug is metabolized, which is the case for typical antidepressants. What’s more, Watson pointed out the effectiveness of antidepressants is underwhelming and the number of side effects associated with them can often be overwhelming. Of the hundreds of ketamine patients that he’s treated, about 92% of them “consider it a success,” according to Watson. “If you consider that depression is the No. 1 cause of disability in the U.S., that says something about the demand and need for something effective,” he said. “And sadly, our current antidepressants just don’t do the job, or only for a small percentage of people, but they’re also riddled with side effects.” In 2018, Time magazine reported that an estimated 300 million people worldwide suffer from depression, and one-third of them do not find relief from antidepressants or other treatment options. This is why Watson sees ketamine treatment as such a game-changer, not only because of its efficacy, but also the speed at which it can work. Some patients can be treated in as little as four to eight weeks before recovery, although other cases may take three to six months. “One of the consequences of chronic depression is atrophy or pruning of the nerves in the prefrontal cortex and the hippocampus,” Watson said. “And what we’re causing is a growth of nerves in those areas of the brain.” During the first wave of the pandemic, Watson said WellCentric Health saw its business drop by 80% during the shutdowns. When the volume of clients returned to normal, he said many clients, old and new, had their anxiety and depression amplified by financial hardships and general pandemic-related distress. While WellCentric Health’s numbers have not “gone up dramatically” over the past year and a half, Watson said the clinic still sees an average of eight patients a day for ketamine infusions. “One of the major causes of depression is loss of control, and feeling like you don’t have control over your situation,” Watson said. “And a lot of people are feeling that way these days.” HOLISTIC HEALING Other practitioners help clients with even more non-traditional methods.
Take Andrea Sullivan, owner of Holistic Healing NV in Reno, who uses energy medicine techniques and therapeutic treatments to assist her clients suffering from anxiety, depression and addiction, among others. Sullivan, who has been in practice for 12 years as an energy therapist and life coach, helps her clients by teaching them emotional freedom technique (EFT) tapping. Specifically, she guides clients through tapping on a sequence of “meridian points” that clear a neural pathway associated with trauma that is “stuck” in the body. “You’re actually clearing the trauma from your body, and the trauma is considered a disruption in the energy system, which is why it works so well,” Sullivan said. Sullivan also performs reiki, a palm healing technique that she said channels energy into the clients to activate the natural health processes of the client’s body and restores physical and emotional wellbeing. Because of the pandemic, Sullivan decided to close her office and has been doing all of her appointments via Zoom for the past 18-20 months. She said most of her patients have grown accustomed to virtual appointments, and are receiving the same results. “My clients that are open to distance or were already doing it before the pandemic still receive the same benefits and I get the same feedback, so that’s been validating,” she added. The pandemic and decision to operate as a virtual practice for the foreseeable future, Sullivan said, resulted in her business being cut in half compared to pre-pandemic levels. On average, she is currently seeing about eight clients per week. She anticipates that demand might grow as more people seek non-medication options for mental healthcare — and as mental health issues become less stigmatized. “People need mental healthcare in a big way right now,” she said. “People are coming out of the woodwork going, yeah, I’m more affected by this than I thought I was. Maybe the holistic aspect of it isn’t for everyone, but definitely, the mental health aspect is going to need to be addressed in one way or another.”