By Frank Whitman
Todu Guam Foundation recently added a full-time psychiatrist to its staff. As with other Todu Guam services, consultation or treatment by Dr. Danny McClure, a board-certified psychiatrist who recently arrived in Guam from Arizona, is available regardless of the patient’s ability to pay.
In addition to a much-needed increase in the number of health care providers practicing in Guam, McClure has experience and training in some of the latest psychiatric treatments, including transcranial magnetic stimulation, or TMS.
“I did my residency in Arizona,” he said during a media open house Nov. 26. During his residency he worked with criminally insane patients and with underserved, underprivileged patients. He also worked with highly affluent patients.
“So I had a broad brush stroke of education and training,” said McClure, who is certified by the American Board of Psychiatry and Neurology to practice general psychiatry.
"Right out of residency, I worked at a federally qualified community health center. I worked there for a few years, but became a little bit frustrated that I didn't have the tools needed to adequately treat my patients," McClure said.
The frustration led him to change jobs and spend the last five years using genetic testing and TMS.
The former involves having the genetic material from a cheek swab analyzed to help providers formulate an individualized treatment regimen.
“(The analysis) assesses the mechanisms of the liver that metabolize medications,” he said. “Imagine, what if my liver metabolizes a medication uniquely slow? It breaks down the active ingredients of a medication very slowly, leading to a surprisingly high concentration of that medicine in my blood, available to my system.”
Conversely, the test may indicate faster than desired metabolization of medication. “leading to a less than expected potential benefit,” he said.
So the treatment can be adjusted taking into account genetic variations among patients.
TMS requires a piece of equipment to be fitted on the patient’s head that resembles a “funny helmet.”
“This is a whole new treatment that we have and are bringing to our patients,” McClure said, adding that he has been treating patients with TMS for about five years.
McClure started his description of TMS by dispelling preconceived ideas patients may have. “It's not shock therapy,” he said. “It's not electroconvulsive therapy. There are no IVs. There's no sedation. You don't have to go to another facility. We do it right here at Todu Guam Foundation."
TMS was approved by the Food and Drug Administration in 2008 for the treatment of depression and obsessive-compulsive disorders. It is covered by practically all health insurance policies, including Medicaid.
“It is an outpatient procedure,” he said. “It's a 30-minute treatment done in the office. ‘Patients walk in and they walk out.’ So you leave just as you came in.”
TMS involves 30 to 40 treatments. “(The number of treatments) varies a little bit depending on insurance and what we're doing and the patient's response,” McClure said.
“It's one treatment daily, generally five days a week. So it is a series of treatments. But where medications are typically being prescribed to patients for years, perhaps decades, perhaps forever, this, after the series of the treatments are done, the patients receive the benefit and then there's no more treatment.”
He provided the caveat that occasionally a patient's symptoms of depression or mental illness return. But that seldom happens. The treatment is painless, he said.
McClure offered a brief explanation of how TMS works.
“We've always thought that … the brain is just a big organ of quite complex chemical reactions - and it is,” he said. “But the brain is not just chemical reactions. It's also a very intricate array of electrical activity and electrical circuits.”
Scientists are still learning about how regions of the brain are electrically connected. “While we're learning what normal electrical functioning is, we're also learning what abnormal electrical functioning does,” McClure said.
Scientists now believe abnormal functioning may lead to such symptoms as depression, anxiety, obsessive-compulsive disorder, PTSD and others.
McClure said he tells patients the brain is as much chemical as it is electrical.
Every medical treatment will only treat the “50 percent of the brain that has abnormalities to do with the chemical abnormalities,” he said. “What about this functional aspect of the brain that's electrical? That's where transcranial magnetic stimulation comes in.”
During the treatment, patients wear the helmet as magnetic pulses are administered. McClure underwent the treatment himself and said it felt as if his scalp muscles were “kind of twitching.”
Monitoring patients after TMS treatment, providers have been able to see an increase in electrical activity in the brain leading to an improvement in mood, he said. “And maybe depression, electrically speaking, is just kind of a lack of electrical activity.”
McClure is optimistic that in the next 10 years, TMS may effectively treat a host of brain-related disorders.
“We'll start growing in our frequency of using this treatment for different types of conditions,” he said.
Former senator, Dennis Rodrigues, who founded Todu Guam in 2017, met McClure in 2023.
McClure’s decision was based on the island’s unique behavioral health needs.
“Every place, every people has a unique need in all of health care. But behavioral health care seems to be becoming more and more recognized as a real burden,” he said. “I just want to be a part of the solution of healing and helping here on the island. And I would love to be able to be the first one that brings what I call some newer approaches to care.”
Todu Guam is a nonprofit organization providing access to health care for those who cannot afford.
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