Welcome to the Frontier Psychiatrists….it’s a newsletter. It’s a Podcast. It is a revolution! My readership has enjoyed this author cheering for Accelerated Transcranial Magnetic stimulation, particularly Stanford Neuromodulation Treatment. A.k.a. SAINT. The Magnus Medical technology has a New Technology Add-on Payment thanks to your support of the 2024 CMS IPPS update final rule.
Today, I want to share a publication that I am a co-author on. It’s still in pre-print!
This treatment was not done using the SAINT system. It uses a different stimulator made by the company Brainsway. Many of these treatments occurred three, four, or more years ago.
I started providing transcranial magnetic stimulation (TMS) as part of my practice in 2017. I was still a fellow in my day job as a child psychiatrist at the NYU School of Medicine program. I had already graduated from an adult psychiatry residency and was running a Private Practice as a fully board-certified adult Psychiatrist.
In April 2017, we began treating patients with TMS in our office. It was located in Brooklyn, New York, in what is now a torn-down building. The building was mostly used for recording studios before my psychiatric practice moved into it and gradually took over studio after studio, which was clunky. However, the original TMS treatments described in this paper were done in a recording studio in the basement of a building in Brooklyn that no longer exists.
The first patient treated with accelerated TMS was given that treatment because we didn't have other options. She flew in from out of town. She lives on a remote island across the country, and I still hear from her occasionally. She’s awesome. She got to remission quickly. We had to use the alternative method of Stimulation, intermittent theta burst stimulation because the machine I was using at the time could not generate enough power to give her traditional high-frequency TMS without overheating. I had to call the senior author of the above paper, Aron Tendler, M.D., and ask him what to do.
At 9 o'clock at night, I think it was on a Sunday, he walked me through adjusting the device. Aron is a Mench—a doctor who lives and breathes what is best for patients—not even “just” his. I'm grateful. He got on the phone and walked me through an arcane series of menus on a device that was never intended to do what we needed, the way more modern devices now make easy.
He knew it was possible to do the treatment at a lower power, which turned out to be faster and more efficient, which turned out to be the kind of thing you can do multiple times a day. In the next week, more patients were treated. Those early results were published.
My patient had flown from a remote island across the country and could only stay in New York for so long, so this treatment was the only option to help her recover to wellness.
It worked. I can imagine a world where Dr. Tendler, the chief medical officer of the device manufacturer, was not gracious. I would've had to tell the patient sitting in my office that I couldn't help her because the technology wasn't powerful enough to treat her.
That graciousness changed the life of my patient. It changed my life, too. As I remember hearing the story, Aron Tendler is the only son in his family who isn't a rabbi. There are nine sons, although I may be getting it wrong. He was willing to hold my hand. That allowed me to hold my patient’s hand. And many, many more patients ever since I have been well, thanks to his graciousness.
Dr. Nolan Williams, the Director of the brain simulation lab at Stanford, and I were set up on a science date by a shared mentor later that year. Nolan is tall. Noticeably tall. I am only 5’8”, and depending on when you met me, between slightly tubby and obese.
Over brunch in Vancouver—a bunch of really nerdy physicians—compare notes. In Brooklyn, we had to figured out that doing one treatment a day was probably not the best way to do it. Nolan was systematically investigating how to do the same thing in his lab. We all knew that something different and better could happen with TMS. It could be faster. He had gotten a grant to use fMRI guidance for the treatment. That science would turn into SAINT neuromodulation, an FDA breakthrough treatment. Using the Brainsway devices, which have a broader target area, we accomplished a similar degree of remission from depression. That data is what is published in the above paper.
The takeaway, for me, is that depression can be over in five days. This is a real-world sample. Greater than 50% of the patients were in remission with the Treatment. It was not a medication treatment. It is direct stimulation of the brain using a Pulsed magnetic field.
This is the same mechanism by which SAINT causes its remarkable outcomes. In the future, we will learn which patients need which stimulator for which part of the brain. I look forward to having that conversation with my colleagues. I look forward to the replication of the data. I look forward to my most precious hypotheses being proven wrong. That is science. I will be wrong about many things in the future, as I have been in the past!
But I wanted to call the attention of my readers to the fact that any of these accelerated approaches to brain disorders? They share effects that are orders of magnitude better than oral anti-depressants. Oral medications suck wind compared to brain stimulation. That, for now, is the bottom line. If you read the SNT trial and thought, “well, it's a small sample,” it is “probably fake…” This is a bigger sample. It's not using the same device, it's not using the same targeting, it's not doing many of the same things— other than not using oral medication to cause a change.
The change is the remission of depression. Over half of people have depression in remission more quickly than any SSRI, SNRI, MAOI, TCA, or any other… “antidepressants.”
There is a better future for people with depression. It is here. It is brain stimulation. SNT’s methodology is real. This paper’s data is from the real world, supporting my overarching argument that brain simulation is the future of depression treatment. Psilocybin also gets depression to remission rapidly. I have to finish editing a series of papers on psychedelic medicines, but I promise you the data is strong.
Depression can be over. There are many shots on goal. Neuroscience and imaging are a crucial part of that better future. Nobody wants a world with only one option for depression. We want so many options that work quickly and reliably that we no longer have to worry about it.
Depression can be over. It can be over rapidly. And this paper, which I am thrilled to have co-authored, along with colleagues including
, is yet another massive step forward regarding hope for suffering patients.Depression can be over sooner than we thought.