MeRT stands for Magnetic qEEG-guided Resonance Therapy. MeRT is a treatment that combines transcranial magnetic stimulation (TMS, an FDA cleared therapy), Quantitative Electroencephalogram (qEEG), and Electrocardiogram (ECG/EKG) to deliver treatments tailored for each individual’s unique brain pattern.

The patient’s qEEG and EKG are analyzed to determine the brain’s pattern of function and activity. The resulting information is used to develop a personalized treatment aimed at shifting brain connectivity to an individual’s ideal brainwave frequency, which can lead to significant clinical improvements.

Common benefits of TMS and MeRT include reduction of symptoms and behaviors interfering with daily functioning  and the following:

• Better sleep
• More relaxed; less anxiety
• Mood improvement and increased emotional stability
• Increased ability to adapt to change
• Improved self-confidence, self-esteem, and sociability
• More “presence” with Autistic patients (interaction and awareness with the world around them)
• Better concentration and focus
• Improved memory
• Greater ability to cope with stress
• Increased motivation
• Decreased cravings for drugs and alcohol

Results are individual in nature, depending on the initial presenting symptoms, and are not guaranteed. 

TMS therapy has shown a clinically significant response in around 50% to 80% of individuals with depression who did not experience beneficial results from medication therapy. About one-third of these individuals experience full remission, meaning that their depressive symptoms go away completely.

Based on our patient feedback, MeRT therapy has shown clinically significant response in up to 80% of individuals with depression; 66% of individuals with anxiety disorders; 70% of individuals autism; and 80% of individuals with TBI.

As with all depression treatments, TMS is not a cure. TMS benefits may last anywhere from a few months to 1 year after completing treatment. Insurance coverage for additional TMS varies by insurance provider. Please check your insurance plan TMS policy for “retreatment”.

Depending on the condition treated, MeRT benefits may last anywhere from a few months to years after completing treatment. Patients may choose to opt for additional treatment in the future if they wish to “refresh” benefits or pursue additional benefits. We recommend that patients take a 3 month break before pursing additional MeRT. 

For MeRT, 30 sessions over the course of 6 weeks is recommended. Treatments are once per day, five days per week (Monday through Friday), at the same time every day. MeRT treatment session last approximately 30-45 minutes depending on your individualized protocol. Follow-up qEEG recordings and a qEEG reviews with the clinician are scheduled near the end of each 2 weeks (10 MeRT treatments) to monitor your progress and inform continued care.

For TMS, 36 sessions over the course of 8 to 9 weeks is recommended. The first 6 weeks of treatment are once per day, five days per week (Monday through Friday), at the same time every day. The last 2 weeks of treatment are tapering sessions to wean patients off of TMS. Initial TMS sessions last 30 minutes. After initial sessions, TMS sessions last ~20 minutes. TMS patients meet with our clinician near the end of each 2 weeks (10 TMS treatments) to monitor your progress.

Every individual’s response to treatment is different. Generally, most people start experiencing benefits after 2-3 weeks of treatment.

For those being treated for depression, common signs of improvement include:

• More energy and motivation to do things
• ‘Sense of humor returns
• Ability to manage and accomplish daily tasks that are important to life improve
• Brighter and more hopeful mood
• Feeling more present  
• Start to enjoy activities and hobbies again or discover new things that bring joy
• Increased energy and motivation in daily life

Transcranial Magnetic Simulation (TMS) therapy delivers a standardized treatment approach that stimulates the same location of the brain at a fixed frequency for all patients. MeRT delivers an individualized treatment approach that varies in treatment location, treatment frequency, and stimulation intensity based on each patient’s quantitative EEG and EKG data.

Another difference is MeRT’s treatment intensity is lower than TMS. Less intense magnetic stimulation is needed to generate the same level of results due to MeRT’s use of individually tailored treatment location(s) and frequencies. Thus, less side effects are associated with MeRT compared to TMS.

For MeRT, a diagnosis is not necessary to start therapy. 

For  TMS, a diagnosis of Major Depressive Disorder is needed prior to starting therapy. For those seeking insurance-covered TMS, insurances usually require a Moderate to Severe Major Depressive Disorder diagnosis, 2+ failed trials of anti-depressants, and 1 failed trial of psychotherapy to qualify for coverage. We are able to provide assessment for Major Depressive Disorder, medication management, and refer for psychotherapy for those wishing to meet their insurance’s TMS criteria to qualify for TMS coverage. 

We treat adults and children ages 3 years and older. 

Absolute contraindications for TMS and MeRT treatment at Mālama Manaʻo:

• Pacemaker
• Defibrillator
• Vagal Nerve Stimulator
• VP Shunt/ Magnetic intracranial shunts
• Deep Brain Stimulator
• Epidural Cortical stimulator
• Steel shunts/stents
• Cranial metal fragments (i.e. shrapnel, excluding titanium)
• Schizophrenia or history of psychosis (i.e. hallucinations, delusions)
• Cochlear implant
• Aneurysm clips, coils, pipelines flow diversion
• Pregnant or breastfeeding
• Primary brain cancer/metastatic lesions in brain (unless palliative care)
• Magnetic dental implants
• Implanted cardio-verter defibrillators (ICD)
• Ocular implants
• Recent history or active seizure(s) or seizure disorder (febrile seizures ok)
• Recent or active substance abuse
• Homicidal or Suicidal Ideation and/or Behavior with intent

Relative contraindications (requiring closer protocol attention, but not disqualifying someone from receiving treatment:):

• History or recent episode of seizure/seizure disorder
• Titanium shunts/stents
• Spinal Cord Stimulator
• Hearing aids
• Ferrous cortical implants
• Magnetic ink tattoo
• Baha Implant
• Bipolar Disorder Type I/II
• Schizophrenia or Schizoaffective Disorder
• Psychosis (e.g. hallucinations, delusions)

Our clinician is able to provide assessment and diagnosis for depression, anxiety, and other mental health conditions.  We can also refer adult patients for psychological assessment with Manakai O Malama’s behavior health team.

Unfortunately, we are unable to assess and diagnose Autism Spectrum Disorder. 

Side effects are few, generally mild, and short-lived. The most commonly reported side effect is a mild tension headache, which typically responds well to over-the-counter painkillers. Other possible side effects are hyperactivity, fatigue, increased agitation, or euphoria. If side effects occur during treatment, inform your technician so that treatment may be adjusted accordingly.

With brain stimulation there is also a risk of seizures; however the risk is minimal for  TMS (0.1% per patient) MeRT therapy (0.00001 % per patient). At Mālama Manaʻo, MeRT treatment protocols take into account past or present seizure activity to reduce the risk of seizure caused by treatment.

MeRT is painless and non-invasive. MeRT stimulation is accompanied by a clicking noise and often feels like light to firm tapping in the stimulation area. If any discomfort is reported by a patient, our technicians are trained to adjust treatment intensity accordingly.

TMS stimulation is typically stronger and more intense than MeRT. It may feel like firm tapping and/or pressure in the stimulation area accompanied by a loud clicking noise. 

Generally, we recommend that you continue taking your prescribed medications while receiving TMS or MeRT and do not add, stop, or change any medications or activities while receiving TMS or MeRT to ensure accurate progress monitoring. 

Benzodiazepines, baclofen, and anticonvulsants may reduce treatment response.

Please inform our clinician if you are taking these and other medications. Let your technician know if any changes in medication occur during treatment. 

We highly recommend that you pursue other modalities of treatment for you or your loved one’s condition in addition to TMS or MeRT. Best practice for most health conditions is a multimodal approach as there are various components to treating different conditions (i.e. medical, psychological, educational, environmental, etc.).  Many past patients report that TMS MeRT increased their rate and level of benefits in other forms of treatment such as counseling, Applied Behavior Analysis, neurofeedback, etc. which increased their total level of clinical gains(s). 

Our FDA-approved magnetic stimulator and coil to treat treatment-resistant depression is from MagVenture. 

Our office is in the Gold Bond Building at 677 Ala Moana Blvd Honolulu, Hawaii 96813, across from SALT in Kaka’ako. 

We are within the Manakai O Mālama office, 9th floor, Suite 950. We recommend entering the parking garage from Coral St. and using the Ewa Wing elevators. Our office is right outside the the elevators. 

Paid parking is available in the Gold Bond Building at 677 Ala Moana Blvd. Honolulu, HI 96813. We recommend entering the parking garage from Coral St. and using the Ewa Wing elevators. Parking validation is available for a discounted rate ($1.75/hour) for up to 3 hours. Street parking around the Kaka’ako area is also available.