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M any people don't realize that 80 percent of mental health care treatment in the U.S. is addressed at the primary care level. If you are experiencing depression or severe anxiety, the first person you are going to speak to about it is your primary care physician," says Georgine Nanos, MD, MPH, who has been practicing family medicine for more than 20 years. Typically, primary care doctors refer patients for psychotherapy, write a prescription for an antidepressant, or both. "at's the best-case scenario in mental health care these days," says Nanos. It's something she is working hard to change. Last year, Nanos, who leads Kind Health Group in Encinitas, a concierge primary care practice and wellness center she founded in 2017, participated in a landmark study of transcranial magnetic stimulation (TMS), a noninvasive, medication-free process that condenses treatment for depression and anxiety into a single day. "I was introduced to TMS about four years ago. I had never heard of it, and even today, many people, including doctors, are unaware of it," says Nanos, who until this past January also served as the medical director of Rancho Valencia Resort & Spa. Patients with depression show decreased electrical activity in the part of the brain associated with mood regulation and thought patterns. TMS delivers localized magnetic pulses to that specific region, stimulating nerve cells to create new synapses and pathways. e treatment has been available for over 40 years and FDA-approved for more than 15 years for people with medication- resistant depression, but until recently it involved both lengthy treatment and a clumsy, helmet-like device the patient had to wear. Now, a new device simply rests against the patient's head, which "makes it very easy to administer and much more comfortable for the patient," says Nanos. In Nanos' experience, the treatment has a 92 percent response rate and a remarkable 72 percent remission rate, which means patients have reported more than a 50 percent reduction in symptoms. But most significant, unlike traditional drug treatments and even newer therapies such as ketamine and psychedelics, after years of use and more than 20,000 studies, there are no reported risks or substantial side effects. "is is the start of a big paradigm shift in terms of how we deal with mental health," says Nanos, whose goal is to make TMS a first-line treatment, and who believes there is a wide range of patients who could benefit from it. Depression and anxiety often involve a repetitive or looping series of negative thoughts. But as Nanos points out, "anxiety and depression often accompany other mental health issues, including insomnia, OCD, and PTSD." Nanos has used TMS to treat all three, and has even used it to help patients with autism and schizophrenia, not as a cure for those conditions, but to relieve the associated depression and anxiety. "By creating new synapses and pathways in the brain, TMS builds emotional resilience," says Nanos. A Paradigm Shift New treatment offers a breakthrough in mental health care BY BILL ABRAMS COURTESY PHOTOGRAPHY Focus health ranchandcoast.com 46 JUNE 2025 RANCH & COAST MAGAZINE Georgine Nanos, MD, MPH