How TMS is Rewiring Psychiatry with Martha Koo, MD

Dr. Martha Koo bought her first TMS machine in 2009 when colleagues thought she was "crazy"—now she runs 11 centers across California as immediate past president of the Clinical TMS Society. Her biggest revelation came when longtime therapy patients said "I'm good, but I'm not my true full self," showing how psychiatrists often settle for partial recovery. Unlike medications, TMS doesn't require patient belief to work—as one skeptical patient discovered when he achieved complete remission despite thinking the treatment was "silly." Early billing operated in a regulatory gray zone where insurers accidentally processed TMS sessions like MRIs, inadvertently funding the field's growth. She envisions a future with accelerated one-day protocols, mobile devices in oncology and OB-GYN settings, and implantable brain stimulators. Her blunt advice to hesitant colleagues: "The cat's out of the bag—I don't see a world in future psychiatry that's just medicine and therapy."



Timestamped Show Notes:
‍[08:09] The $100K gamble and early TMS adoption[
13:25] Insurance loopholes and money-back guarantees
[15:57] "Not my true full self": what patients really want
[19:44] Santa's sleigh and the belief problem
[22:50] Military medicine and the polypharmacy solution
[25:05] Why TMS is five days a week (blame Dr. George's wife)
[28:33] Accelerated, mobile, implantable: what's next
[34:05] VNS comeback and combination approaches[37:21] Interventional psychiatry as evolution, not revolution
[48:09] Advice for hesitant psychiatrists

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