TMS Brain Health Doctor in the Dugout with Ben Spielberg

Welcome back to Doctor in the dugout. I’m your host, Dr. Alan Beyer, and I’m thrilled to be joined today by phone with our special guest, Ben Spielberg, the CEO and founder of Bespoke Treatment. Ben, thanks so much for being with us today.

Of course, I’m happy to be here.

So, first of all, what I always like to do with the new guest who hasn’t been on the show before is just give you a minute or two to briefly introduce yourself to our listeners. Tell us a little bit about your educational background, where you grew up, where you went to school, did you graduate studies and how you wound up back out here in southern sunny Southern California?

I’d love to. So I’m from here originally, but I grew up between Los Angeles and New York. I studied psychology in undergrad and I went to graduate school at Columbia University, where I got a Master’s of science in neuroscience and education. After that, I started Bespoke Treatment, which is basically an innovative mental health center in Santa Monica. So we do treatments for people with depression that are sort of not common. So for people who don’t respond to traditional antidepressants or therapy, we have options for them.

So first of all, let’s dig right into what’s part of your name, which is TMS. Why don’t you explain and kind of simple terms for our listeners, most of whom are not simple. They listen to me. Right. But what TMS stands for, what it means and what it really is.

Yeah. So TMS stands for transcranial magnetic stimulation, which is quite a mouthful. But, you know, basically, if you look at the brain of someone who’s depressed and compare that to a brain of someone who’s not depressed, you’re going to see these very clear patterns where specific parts of the brain are underactive. So that means there is less blood flow. Well, there’s less metabolism. There’s overall less neurotransmitter activity. And people come in and do this treatment called TMS, where we essentially put something on their head that creates these gentle magnetic pulses, that literally turns these brain cells on in these regions that control mood. So over time, as people keep coming to us, neuroplasticity increases in their brains and the symptoms of depression and anxiety start to go away.

So typically, how long is somebody in the machine that’s delivering these magnetic waves?

Just three minutes, which is pretty unique to us and used to take a lot longer, but we actually specialized in a three-minute iteration of TMS.

So now I’m going to ask the next obvious question that I know people out there are thinking about. I just had an MRI scan, which is also magnetic resonance scan on my head. Did that deliver similar magnetic waves? Are all magnetic waves created equal?

That’s a great question. And actually, it’s delivered a similar type of magnetic wave. But the difference is TMS of the waves are extremely focused. So you’re targeting these very small parts of the brain, whereas an MRI, you’re basically it’s basically a very diffuse magnetic field that’s going into the whole body. But it’s the same kind of magnetic energy.

Exactly. So that’s gonna to that’s gonna beg me to the next question, which is a lot of people that I even see in the orthopedic world in sports medicine who have an MRI scan for some condition, not necessarily of their head, but their knee or the shoulder or something else. And they’ll say afterwards, my knee or my shoulder or my head felt better. Let’s talk about that a little bit. What is magnetic waves do to an area, the body that could possibly make it feel better? It’s not just a placebo effect.

So your body is made up of all of these different cells. Right. And cells communicate two primary mechanisms. So there are these chemical mechanisms or in the brain we call these neurotransmitters, but there’s also these electrical mechanisms. So when a brain cells communicating with another brain cell, there is an electrical impulse from that cell which tells the next cell to release the neurotransmitter. So what was the magnetic wave do is they basically act as a big neuron that is telling these cells to release neurotransmitters and increase activity.

So this is all not pharmacologic. We’re not giving any drugs to make these cells secrete their substance. It’s no no X-ray exposure. So people are always worried when they get CT scans or even conventional X-rays, they’re being exposed to X-ray radiation. This is magnetic resonance. It doesn’t have that effect. So it sounds like (exactly) it’s a way of getting. These results without resorting to pharmaceuticals. Exactly. You don’t have to resort to pharmaceuticals and it’s actually been FDA approved for almost 12 years now.

So now I’m going to take what you said because I know most of your practice is taking care of people with mental illness. And maybe we’ll get into that in the next segment because lord knows, mental illness today is a large contributor to just our homeless population if nothing else.

Yeah, but we’re in a crisis exactly

Instead of taking the depressed person and saying, I’m going to treat your depression. What about using science such as this to take a regular person and putting them into an excitatory state? And now obviously where I’m going, this is the athlete. Is it possible that technology such as this can be used to stimulate normally working brain cells to stimulate the types of substances that allow an athlete to perform at a more peak level of performance?

Well, that’s a great question. And the answer is complicated, right? So it depends. And if someone’s coming in and they’re really at peak performance all around, there may not be that much that we can do. But if someone comes in and says, I want to increase my energy level, I want to increase my motivation level, I want to regulate my sleep because I’m having sleep issues, then we can really try to target those symptoms and a and hopefully increase them.

Are you actually good enough with your targeting to aim at the area of the brain that controls, say, sleep or, you know, athletic concentration or something like that? We’re pretty good, and I think that’s what makes us special because of my neuroscience background and the psychiatrist that I’ve partnered with, we really developed a systematic approach to target what people want to work on instead of looking at something like a diagnosis. So it’s common for us to have people come in and say, I want to increase my focus. And we’ve been very successful with that.

How about kids who have certain attention deficit disorders and things like that? Do you feel that they’re amenable to treatment such as this rather than the the use of Adderall and other substances like that that we hear being bandy are up probably overused in today’s society?

So overused, you know, you know, something like TMS is probably not the best the best modality for children because their brains are still developing, but they are more suitable for something like neurofeedback, where people can really learn how to control their brain activity without having this external device do it for them, essentially.

So the device is big. It’s not a portable device that a person could use it at home kind of on a PRN basis.

Yeah, it’s pretty large. People have to come into the office and do it and they actually have to come in pretty regularly about five days a week for six weeks or so.

All right, Ben, I got to take a quick break here for my sponsors. You’ve opened a couple of great doors for me that I want to go into in our next segment. So hang on. We’re going to take a quick break here. Listeners, you’re listening to Dr. Alan Beyer, your doctor in the dugout. I’m on the phone with Ben Spielberg. We’re talking about magnetic brain stimulation. It’s really stimulating my brain. We’ll be right back.

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You are listening to that doctor in the dugout with orthopedic surgeons, Dr. Alan Beyer and Dr. Jonathan Kaplan, brought to you by Hoag Orthopedic Institute.

Welcome back to Talk in the dugout, I’m your host, Dr. Alan Beyer joined on the phone today by Ben Spielberg. We’re talking about magnetic stimulation of the brain for various psychiatric and psychological disorders. Ben, thanks again for being here with us today.

Of course, I’m so glad to be here. So let’s go into a couple of things that came up in that first segment. First of all, pediatric use and children. OK, so I’m in a field where lots of times parents will hear about something that can be used to to treat issues or mental issues and anxiety issues, depression. And right away they want to jump on it because their kid has this or it’s going to make him a better athlete. So get into a better college. He’ll get a scholarship. I don’t have to worry about paying for him to go to school. Let’s underscore once again that treatment such as this is probably not the right way to go in the young the under 16 or even under 18 kid who’s looking to maximize performance or treat a psychological disorder.

Right TMS is really not an appropriate option for those under the age of 18. But there are other options, like I mentioned, neurofeedback, cognitive training, and things like that that really can be used to to increase those abilities.

And the other thing I want to once again just remind our listeners about early on, this is five days a week for six weeks. This is a real commitment to a program for somebody who’s seeking out something like just for what they’re suffering from. It’s not just an occasional oh, I’ve got a big game tomorrow. I’m going to drop in for my little TMS session.

Mm-hmm. Exactly.

So now let’s broaden some of the other things we talked about. Obviously, the mental illness issue is a hot button today in the world and especially in this country. Homelessness is tied to it. There are so many things that are tied to mental health, gun control. Right. You don’t hear anybody talk about gun control without in the same sentence talking about mental illness. A lot of that mental illness is obviously things like schizophrenia, bipolar disorder, which are usually traditionally pharmacologically treated. But a lot of it is depression and a lot

of it Yeah is depression is actually the leading cause of disability worldwide at this point.

And PTSD, which is another big thing we see out there today. This is the kind of therapy that is useful for those diagnoses, is it not?

Right. So depression, anxiety, PTSD, that’s really where PMAs is most effective. So

how do you bring a modality such as this that requires somebody to come in five days a week for six weeks to the masses? I mean, that almost becomes a logistical nightmare.

It is a logistical nightmare. And so much of it if geo-specific. So, you know, our clinics, for instance, is centrally located in West L.A., in Santa Monica. But there really are some TMS clinics in a lot of different cities, which which I think people don’t know about. But, you know, the the big push is that we have to educate physicians about TMF ways to educate other mental healthcare providers about it, because like I was saying, it’s been FDA approved for a dozen years now, but still not that many people know about it. So routinely, we’ll see people come into our clinic who have just been suffering and have tried medication after medication for, you know, 10, 20 years. And the first time they heard about this was a couple of months ago.

So Lord knows a lot of work to be done.

Lord knows there are enough mentally ill and depressed people in L.A. alone just to keep you busy. You know, just in Hollywood, you need to open a little SUB-STANDARD just in Hollywood to take care of all them. But seriously, is there any use for this kind of treatment in this kind of technology? In some of the things that we see a lot in sports medicine, such as post-concussivesyndrome or things like that or not really.

Well, I’m glad you mentioned post-concussivesyndrome because, you know, a lot of people are sort of confused about what happens during a concussion. You know, is it just you just have to treat it, you know, that day or that week. But the effects of concussion really can linger for quite a long time. And there are a number of cognitive components to post-concussionsyndrome as well as emotional components. So there’s a high percentage of people who suffer from concussions. I think about 40 percent of kids with concussions have insomnia after and back and persist for many years. And insomnia, of course, is, you know, what can cause this cascade of worse in school performance, worse than anxiety worse depression and so forth. So so to answer your question, yes.

So I see a lot of high school kids concussed post-concussionsyndrome. Who had exactly the things that you’re talking about, insomnia, poor performance in school is is the FDA approval allow you to care for, say, a 16 or 17 year old with this type of modality?

Well, that was the situation specifically. So the FDA has only approved this for major depressive disorder specifically. But we can treat people off-label. They would just have to come in for an evaluation to make sure it’s right for them.

So this has been really fascinating for me. I’ve learned a lot in today’s segment. I hope my listeners have to. How do they reach out to you? What resources are available to them? To find out more about this technology, find out if it’s appropriate for them, perhaps consult with you or your people in that regard. So give us your advertising spiel.

All right. Great. So our website is Our phone number is 833 TMS today. That’s two days. And the number two via watch. Give us a call were in-network with all of the major insurance plans.

Then I want to thank you again for taking time to spend with us today. I mean, this is something that I follow tremendously. My daughter’s a marriage and family therapist and I’m sure I’m going to be talking with her about it this weekend after our segment today. I’d love to have you back on the show as this technology becomes more widespread and and more available. And I just can’t thank you enough again for taking time out of your weekend to spend a couple of minutes with us here today.

Fantastic. Thanks so much for having me.

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