Dr. Teresa Anderson: Mental health can be approached from so many different directions from the physical side to have people who were mindfulness, meditation, and movement instructors. There is hope. If you have tried and failed multiple antidepressants or multiple therapies for depression, anxiety, or PTSD, you're not at the end of the road.
You're not at the end of the rope. Ketamine is a great offering. PR TMS is a great offering and just. Investing in yourself, even though it can be a...
Dr. Teresa Anderson: Mental health can be approached from so many different directions from the physical side to have people who were mindfulness, meditation, and movement instructors. There is hope. If you have tried and failed multiple antidepressants or multiple therapies for depression, anxiety, or PTSD, you're not at the end of the road.
You're not at the end of the rope. Ketamine is a great offering. PR TMS is a great offering and just. Investing in yourself, even though it can be a little scary.
Dr. Diana Mercado-Marmarosh: Hi, welcome to Beyond ADHD, A Physician's Perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh. I'm a Family Medicine doc, with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age.
And in the past year, I have undergone radical transformation after discovering ADHD coaching, and life-coaching. For the past decade, my typical day consisted of having 300 charts backlog, a graveyard of unfinished projects, and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes. The last year I figured out the secret; learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius. So they too can reclaim their personal lives back like I have.
Well, hello. I am so excited today to have my good friend, Dr. Teresa Anderson. She's an adult outpatient psychiatrist, and she specializes in depression, anxiety, and PTSD. And she's been in practice for more than 13 years in Cincinnati, Ohio, and six years ago, she started to. ketamine infusions to her treatments.
And I'm so excited for her to come and talk to us about this. It's like state of the art treatment. And we are trying to make sure that, you know, everybody is aware of other possibilities other than just, you know the standard so that we can see if, you know, they get more personalized treatment in her clinic is our really state of the art.
And we're so excited to have her here today. So why don't you tell us a little bit about yourself and what you're up to, and I am so excited to have this talk with you today.
Dr. Teresa Anderson: Well, thank you so much for having me. I'm excited too. So, like you said, I've been in practice for about 13 years in Cincinnati, Ohio.
I'm an adult outpatient psychiatrist. And, there are three different parts to our clinic. I do the standard psychotherapy and medication management for folks with depression, anxiety, and PTSD. For folks who aren't responding as well to treatment, who've tried and failed multiple options, either got nasty side effects or didn't get a great outcome on the medications that, that we've tried them on.
We can offer ketamine infusions, and we can also offer PR TMS. I thought I'd talk a little bit about ketamine infusions first. So ketamine has been on the news of late. It's sort of like the latest, greatest craze in mental health. It's been touted as a rapid acting antidepressant, which we don't really have those and it's been around for eons.
So it went generic in the 1970s. Traditionally, it was used as a dissociative anesthetic. So that means that it's not only going to take you out of your pain, but you're gonna be on Mars and forget that you were ever in pain, but it's fairly unusual. In terms of a medication, because most anesthetics slow your heart rate and your respiratory drive way, way, way, way down.
And so ketamine does the opposite. As a matter of fact, this was actually used as a buddy drug in Vietnam and some of the soldiers carried it on their person. If their mate got blasted or in severe pain and the medic wasn't around, they could give them the ketamine without needing an anesthesiologist nearby monitor their cardiovascular rate or a sympathetic tone.
So recently it has been shown to act very quickly as an antidepressant. Especially in folks who are in the case of like acutely suicidal and it can have its effects in as little as one treatment, or it might take several, our standard course of treatment was set forth by the national institutes and mental health.
In that we use 0.5 milligrams per kilo of body. And infuse over a time of like 45 to 60 minutes. We give six infusions over the course of two to three weeks. For whatever reason past the three week market seems to lose its efficacy. But it's really well tolerated. It can be done in an outpatient setting without the presence of an anesthesiologist.
We just monitor their cardiovascular rate. We, you know, monitor their vitals, um, make sure that they're comfortable. And the biggest side effects about 30% of the time that people have is mild headache or mild nausea, which we can treat in house. People are free to leave of their own volition. After the fact they do.
People to drive them home. cause they're not with it enough to drive. But outside of that, it's tolerated really well and works really beautifully about 70 to 80% of the time, depending on what other medications that you're taking, or if you have any like major other medical risk factors or whatnot.
Dr. Diana Mercado-Marmarosh: So have you noticed that this has helped like the emotional dysregulation part of like the ADHD that sometimes some of the stimulants necessarily don't hit?
I know that in the US, the emotional dysregulation is not like a must needed criteria to diagnose ADHD, but like in Europe it is. And so I think it's just a matter of time that maybe in the US we start to recognize. This part of it and wonder if that would be complimentary per se.
Dr. Teresa Anderson: Yeah, I agree wholeheartedly it's it gives the patient two things outside of like lessening of anxiety and depressive symptoms, but it gives the patient significantly two things.
And one is the ability to take a step back from reacting, which I know is a problem. A lot of folks with ADHD have the impulse control thing. And gives you just an extra second or two to add that filter in, like, is this how I really wanna respond before you, you know, before it automatically just hits your brain and out your mouth.
Right? And so it gives you that little bit of space, that little bit of objectivity to decide how you wish to respond instead of reacting automatically. The other big takeaway that a lot of patients and I said, have said to me is a huge blessing for them is that it really cuts down on the negative internal, constant judgmental running commentary that a lot of people have with depression, anxiety, ADHD, all that.
And it's. Again, providing some space for your brain to breathe a little bit and to decide how you want to behave, decide how you want to react instead of respond instead of react. So,
Dr. Diana Mercado-Marmarosh: and that's great that, you know, within, like you said, if it works for you within a couple of treatments, like six treatments, you know, Three week span of that could now be an area that you could target because some of that impulsivity can get us into a lot of trouble at work or with our spouses or with our kids.
Right. Sometimes we just. We don't mean to say what we said, and then we're in trouble because we said it and then we are like, oops, I didn't really mean it that way. It was just, you know, it happened, I think like obviously meditation and running and getting away from people can help, but like, wow, this is like a cool way to be able to target that.,
Dr. Teresa Anderson: Absolutely. And, you know, PR TMS, the other offering that we have the personalized, repetitive transcranial magnetic stimulation, we've actually brought people down off their stimulants, or at least able to reduce the dose significantly because we are stimulating the underactive areas of the brain that help with that filter.
Dr. Diana Mercado-Marmarosh: So, do people have to be like your patient just at the clinic to be able to get this? Or can somebody else like refer them to you? Like another psychiatrist or another family medicine doc or internal medicine doc.
Right. So any, any other clinician can refer us patients I'm actually full on the psychotherapy and med management side ever since COVID surprise, surprise.
Dr. Teresa Anderson: But that's amazing. Yeah. Any other physician, any other psychiatrist who doesn't offer this and, and wants their patient to seek out this type of therapy, as long as we, you know, get a referral and a release of information. So we're not practicing medicine and avoid. Yes. It's absolutely acceptable.
Dr. Diana Mercado-Marmarosh: And do you just take people from your state or would you be willing to let other people come from other states or is it insurance dependent or is it just if they can pay out of pocket or how does, does that usually work?
Dr. Teresa Anderson: So our clinic is all self pay and we have people visiting their families from different states all the time. Again, as long as we can get ahold of their treating doctor, you know, we know they're not like using an alias or something. And as long as we have a list of their current medications and we have a good communication, open communication with their current treating provider, I am totally fine with it.
Dr. Diana Mercado-Marmarosh: That's amazing. So you've been doing this for the past six years, is that correct?
Dr. Teresa Anderson: We've been doing the ketamine for the past six and a half years. We've been doing the PR TMS for the past almost four years.
Dr. Diana Mercado-Marmarosh: Wow. What do you think, what got you into this side of side of it? I mean, it's such cutting edge stuff. Like I'm so intrigued.
Dr. Teresa Anderson: A number of things. One is sort of a silly answer, right place, right time. I was finishing up my maternity leave and I had. Drop down my patient load to 20 hours a week. And a group outside of Boston approached me about the possibility of ketamine infusions. And I had studied it for a long time and I thought it was the coolest thing since slice bread, but I assumed that you had to be affiliated with a major hospital to do it or needed, you know, large services or actually, no, you just need an infusion nurse and a place to keep drugs locked up and safe.
So. At the time I was coming back from maternity leave, the doctor who I was renting space from was getting ready to sell the building. So I was gonna need a new place to live anyway. And so in terms of my business. And so I just decided to go ahead and get a space big enough to be able to provide the ketamine infusions.
So it just kind of worked out timing wise, three years later, PR TMS sort of fell in my lap. I had a young lady who was very brittle bipolar patient and, and she's given me permission to share like generic parts of her story. And she was a stay at home mom to two kiddos on the autism spectrum. And I mean, her life was hell on a daily basis. And she came to visit me once a month and she was on five different medications. Her moods weren't stabilized, she wasn't sleeping well. And she had a lot of stress, but she was mostly focused on her kiddos and mostly wanting to get help for them. And she'd come to me and say, so I'm gonna try a natural path this month.
I'm gonna try chiropractor next month. And we're gonna try this. We're gonna try an elimination diet, this, and, you know, Whatever works and you're not hurting your kids. You're trying to get them treatment. You're trying to help their lives be better. I very much respect that. But so one month she comes to me and said, have you heard of PR TMS?
I said, well, I've heard of TMS, transcranial magnetic stimulation. She said, no. PR TMS is this guy out of San Diego who, is a radiation oncologist. He found a way to target the treatment using an E EEG. And so he's looking specifically at your brain, which areas are most underactive or overactive and can actually target the TMS.
It has like a 90% advocacy. So he has a clinic set up in Indiana. I'm gonna move my family there for six weeks and see how it goes. I'm like, good luck, God bless. I mean, I didn't know what else to say but six weeks later she comes back and she got the whole family treated. She is on less than half of the medications that she was on prior to leaving.
And her mood is better. She's sleeping through the night. Her husband, who was a footballer in high school and college no longer was multiple concussions, no longer had headaches sleeping through the night, her kiddo, uh, on the spectrum who was super, super, super uncoordinated was now riding a bike. And her kiddo who was barely verbal, now wouldn't stop talking. And I said, who the hell is this guy? I've gotta meet him. And so I sent in my information and told them my interest and that I'd been in business already for, you know, like 10 years or so. And they flew their whole team out to meet me and gave me a presentation. And he actually, Dr.
Murphy actually showed me. A video of a family member who was on the spectrum and who was basically nonverbal, you know, beating his head against the wall, biting mom and six months of twice daily treatment. And he lost him, his IEP.
Dr. Diana Mercado-Marmarosh: Wow.
Dr. Teresa Anderson: So I said, I don't care what I have to do to get involved with this. I'm doing it because this to me felt like for the first time the brain was no longer a black box.
Dr. Diana Mercado-Marmarosh: Yes.
Dr. Teresa Anderson: We could see. What areas were underserved, what areas were overactive? We could temper both. It wasn't a one size fits all treatment and standard TMS is great for who it's great for, but it only works about 30% of the time.
All the treatment is given at one place. There's the lateral prefrontal cortex, where we think the seat of the emotions lay, right. It's given it one frequency at one amplitude, one dosage, one size fits all. That's great and all, but what if your brain doesn't work in the average range of 10 Hertz? Then you might actually screw up the things that you're doing well.
Dr. Diana Mercado-Marmarosh: Right. Kind of like when you think about chemo, right? Like the way that now they've been able to do target radiation and stuff before, right? Like they would just be like, here's all this chemo, they were. Things you wanted, right? You didn't wanna lose your hair. You didn't wanna be vomiting. You didn't wanna, you know, you just wanted the area that was not was the cancer to be killed, but not everything else.
And so this is amazing that with such precision, you could personalize now what you need to target. Wow. What a blessing, this type of treatment is.
Dr. Teresa Anderson: It is huge. And I can't tell you, it's so exciting to see patients, not only like verbally reporting that they're feeling better, but like also the EEG changes. We give an EEG every, week essentially.
And we do neurocognitive exams based off of what they need, either PTSD, depression, anxiety, ADHD, sleep, or concussion symptom inventory, and all of those things improve as well as you can see the EEG starting to. Like tighten up and be cleaner. It's just, it's just phenomenal. I've never seen anything like it.
I tell people that I'm so nerdy about it. Cause it's like star Trek medicine. I still can't believe it. Yes.
Dr. Diana Mercado-Marmarosh: That is like star Trek. I mean, it's just unheard of, you know, we hear all and we try all kinds of things, right? Like people have tried, acupuncture, people have tried all kinds of things, and then you finally have something that, you know, starting to be so, so well received.
Do you get to go to like different conferences and teach others to also do something similar?
Dr. Teresa Anderson: So we haven't yet Dr. Murphy's in the process of writing a textbook about his findings and about, and sort of using the clinical data from our different clinics around the United States. So far, I think there's about 10 of us up and running. So he's, he's in the process of running a textbook, but, the hope is that eventually that we could train other physicians to do what we do. .
Dr. Diana Mercado-Marmarosh: Yeah. I mean, you are definitely a trailblazer there and wow. In 10 clinics, you know, when we think about how big the US is, 10 clinic is like, you know, nothing, I wonder if are y'all gonna be expanding to other parts of the world or do you know if there's something alike that is being done elsewhere?
Dr. Teresa Anderson: So there are lots of different TMS types. And there are lots of different like experimentations with different types of train length, or amplitude or frequency or location. A lot of people are experimenting with this and having different kinds of results. The nice thing about PR TMS is that it's not painful.
At all, very few side effects and the treatment can be targeted to the individual specific needs. For instance, a person with ADHD, we would target more of the frontal lobes, the executive functioning, the attention concentration decision making and impulse control. Right. A person who had more depression than anything else who'd be targeting where our standard TMS brothers would be, you know, using their paddle, a person who was recovering from a stroke and had motor difficulties, we would be actually, you know, treating it on the motor strip.
And so, the way that we can personalize it, it unlike anything that we've ever seen. I know Dr. Murphy had been in talks with some folks, outside the us, and I don't know where those have gone so far, but, he's in the process of opening up like 10 to 15, more, mostly around the coastal regions. He had no plans whatsoever to expand to Cincinnati.
We just sort of stumbled upon him. because of my patients. So I feel incredibly blessed in that regard, but yeah, it's, it's a work in progress, but we're partnering with him to try to help onboard docs and answer any questions that, you know, if they need anything.
Dr. Diana Mercado-Marmarosh: That's so amazing. So where do you see your current business? Like in the next three to five years? Like what are, what is up and the works for you?
Dr. Teresa Anderson: Oh, that's a fantastic question. So it's been on my mind greatly. I would love to set up more of a holistic mental health clinic because I think mental health can be approached from so many different directions from the physical side to have people who were mindfulness meditation and.
Movement instructors like yoga Tai Chichi. I would love to have nutritionists on board as a person who suffers from celiac disease. I know it made a tremendous improvement in my own mental health. When I gave up gluten not to mention, I don't have cystic acne anymore and you know, not chained to the toilet 24/7. So noticing changes in diet, especially for kiddos with ADHD and, you know, removing the process. I would love to have float tanks. Because you can actually being submerged for an hour, three, one hour sessions can reduce your cortisol without any medication intervention whatsoever. And so for my PTSD folks, that's huge.
There are lots of folks who still have the stigma of, oh my God, your strength. I don't wanna look at you. I don't wanna talk to you. You're reading my mind kind of scenario. And so for those people, maybe we could introduce them more gently, so to speak. Two ways of movement, two ways of nutrition to the float tanks, to vitamin infusions, that sort of thing, to get people interested in their own mental health and wellbeing on the back end and say, oh, I wonder what else they offer.
There are people who are in dire need, who are in emergent circumstances who need more the PR TMS, ketamine psychotherapy, med management. And then they think, okay, well, you know, I could do kind of a step down. I don't need this anymore, but I could still do other things. And so to have more holistic sort of care for people, that would be my ultimate goal when we're working towards.
Dr. Diana Mercado-Marmarosh: That sounds amazing trailblazer all the way. So what about like in the next three to five years for fun? Like, do you see yourself traveling anywhere or doing any other extra stuff?
I would love to travel. And my seven year old has ADHD as well. And so he, more than anything, I'm always like future oriented, right? Like I'm always thinking about like, 10 20 steps ahead.
Dr. Teresa Anderson: And he always says, mommy, what do you want to do today? And I say, well, I have to drop you off at camp. Then I have to go to work. And then we probably need to pick up something for dinner and then we probably need to do this and that he goes, no, that's what you have to do. What do you want to do? So he is my, in the present guy.
Right. I would love to experience like Canada or Mexico or Europe with him through his eyes because he keeps me grounded in the present moment. He's very good. Like that.
Dr. Diana Mercado-Marmarosh: That's amazing. You know, I, I've been sharing with a couple of people in different episodes that I would love to, you know, and in the next three to five years, as my kids get a little bit older, maybe during the summers, like pick a country and like go for a month to that country and verse in the food, the language, the history of it, like how amazing would it be to be.
Not just reading books. Right. But at least you experience it. Right. Like the combination of both things. So, yeah, I think that's really cool to be able to pick Mexico or Canada or Europe or any place. Right. And, just live in the moment, like you said, because so often we forget to live in the moment.
We're like, like you said, we're like we have all these checks. List. And then we forget, like, why are we even doing the checklist? Right.
Dr. Teresa Anderson: These babies and grand babies. I totally get it. Yes, absolutely.
Dr. Diana Mercado-Marmarosh: All right, well please tell us, where can our people find you? Like, where can they reach out to you? Give us your website, give us your, social handles. That way we can get ahold of you.
Dr. Teresa Anderson: Oh, absolutely. So it's super easy. On the web it's www.andersonclinic.net. So that was easy. If you wanna give us a call it's (513) 321-1753. If you would like to give us an email because you have questions. It's admin A D M I N @ anderson clinic.net. And if you want to take a peak at my very, very, very, very, very fledgling TikTok channel it's Andersoncliniccincy, C I N C Y. And we're working on, we already have content written for 12 podcasts. So we're hoping to get that up and launched in August or September, and that's gonna be on apple and all that kinda good stuff.
And that'll be called psych waves.
Dr. Diana Mercado-Marmarosh: That's so great. So the last question that I say, you know, my viewers have ADHD, so sometimes we zone out so let's say they just started paying attention, like right this second, what is a nugget you want them to take away from?
Dr. Teresa Anderson: There is hope. If you have tried and failed multiple antidepressants or multiple therapies for depression, anxiety, or PTSD, you're not at the end of the road. You're not at the end of the rope. Ketamine is a great offering. PR TMS is a great offering and just investing in yourself, even though it can be a little scary. Absolutely.
Dr. Diana Mercado-Marmarosh: Well, there, you have it. We had an amazing interview with Dr. Teresa Anderson and she's cutting edge on all things, mental health, as we know, COVID really has brought up to front how underdiagnosed and undertreated it can be.
But. When you do invest in yourself, everything else you can think more clearly, and you can make decisions from a place of calm instead of overwhelm, that makes a world of difference. So reach out to Dr. Anderson, cuz she can really help you. And if you're somebody who is interested in maybe providing this for your patient, Definitely reach out to her because you know, you gonna join her as a trail trailblazer.
Dr. Teresa Anderson: Yeah. And if, if there are folks out there who are interested in providing this type of treatment within their clinic, I would reach out to Dr. Murphy's website because he can onboard you or at least lead you in the right direction. And that's www.prtms.com.
Dr. Diana Mercado-Marmarosh: Awesome. Thank you so much for your time.
Dr. Teresa Anderson: You're very welcome. Thanks for having me.
Dr. Diana Mercado-Marmarosh: As someone who understands that time is our most valuable asset. I am so honored that you have shared your time with me. Please click the subscribe button and join my Facebook group: Beyond ADHD, A Physician's Perspective so that you never missed an opportunity to create time at will. Do share this podcast with your friends they too can can learn to live life and stay in their own lane
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About Dr. Anderson:
Hello, my name is Dr. Teresa Anderson. I'm an adult outpatient psychiatrist specializing in depression, anxiety, and PTSD. I have been in practice for the past 13 years in Cincinnati, Ohio. Six years ago, we added ketamine infusions to our available treatments and became the first psychiatrist-run ketamine clinic in the state of Ohio. This treatment offers hope to people who have tried and failed multiple medications and therapies, with an efficacy rate of 70-80%. Three years ago, we added PrTMS (or personalized repetitive transcranial magnetic stimulation) and became one of 8 clinics in the nation providing EEG-guided personalized TMS treatment. Standard TMS treatment only works as well as medications, about 30% of the time. Using an EEG to pinpoint lower-functioning areas of the brain, we nearly triple the efficacy to closer to 90%! And because the treatment is so specialized to the individual, it is safer to use on a wider variety of conditions. In addition to mood disorders, we have improved the outcome for post-stroke victims, ADHD, concussions, post-COVID, and perimenopausal brain fog!
If you'd like to learn more, check out our website at www.andersonclinic.net
Call (513) 321-1753 or
Email us at: admin@andersonclinic.net
Follow us on our fledgling TikTok: @AndersonClinicCincy
Instagram: @ theandersonclinic
And be on the lookout for our Psychwaves podcast starting in August of 2022!
