#714: A Glimpse of the Future: Electroceuticals for 70%–90% Remission of Depression, Brain Stimulation for Sports Performance, and De-risking Ibogaine for TBI/PTSD

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Jan 5, 2024

Nolan Williams, an associate professor at Stanford and director of the Brain Stimulation Lab, discusses groundbreaking advancements in mental health treatment. He explores the promise of electroceuticals and rapid transcranial magnetic stimulation, showcasing their revolutionary effects on treatment-resistant depression. Williams also dives into the therapeutic potential of ibogaine for conditions like PTSD, emphasizing careful clinical approaches. With a focus on personalized care and innovative therapies, he highlights the future of mental health treatment as both hopeful and transformative.

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INSIGHT

Accelerated TMS Patient Population

Accelerated TMS trials focused on patients with treatment-resistant depression, averaging nine years of illness.
The severity of depression correlated with the abnormal brain activity sequencing biomarker.

INSIGHT

Accelerated TMS Trial Results

Accelerated TMS trials achieved 79% remission in treatment-resistant depression, versus 16% with conventional TMS.
Some patients, especially older adults, experience delayed remission up to one month post-treatment.

INSIGHT

Ibogaine for Trauma and Mental Health

Ibogaine, derived from an African root bark, shows promise for treating TBI, depression, anxiety, and PTSD.
It carries a 1 in 300 risk of death from cardiac arrhythmia but has a high success rate.

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Welcome to a very special episode of The Tim Ferriss Show, an episode that might be an example of peeking around corners and catching a glimpse of the future of mental health treatments in the next five to ten years.

My guest is Nolan Williams, MD (@NolanRyWilliams). Nolan is an associate professor within the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine and director of the Stanford Brain Stimulation Lab. He has a broad background in clinical neuroscience and is triple board certified in general neurology, general psychiatry, and behavioral neurology and neuropsychiatry. Themes of his work include examining spaced learning theory and neurostimulation techniques, development and mechanistic understanding of rapid-acting antidepressants, and identifying objective biomarkers that predict neuromodulation responses in treatment-resistant neuropsychiatric conditions.

Nolan specializes in looking at cutting-edge treatments and new technologies that can be applied to treatment-resistant psychiatric disorders—so, treatment-resistant depression, disorders that are notoriously difficult to address, such as OCD, and many others.

Nolan's work resulted in an FDA clearance for the world's first noninvasive, rapid-acting neuromodulation approach for treatment-resistant depression. And I've tested this myself, and we get into this in the conversation. He has published papers in Brain, American Journal of Psychiatry, and Proceedings of the National Academy of Sciences. Results from his studies have gained attention in Science and NEJM Journal Watch. He has received two NARSAD Young Investigator Awards, the Gerald L. Klerman Award, and the National Institute of Mental Health Biobehavioral Research Award for Innovative New Scientists.

We also discuss things like ibogaine that are seemingly unrelated to neuromodulation, as Nolan is very well-versed in multiple disciplines and in multiple toolkits, both pharmacological and non-invasive neuromodulatory. It's this combination, actually, this rare Venn diagram, that makes him incredibly interesting to me. I really enjoyed this conversation. I think it is very important, highly tactical, and I hope you enjoy it as much as I did.

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[00:00] Start

[07:49] How SAINT helped Deirdre Lehman.

[13:59] Typical vs. atypical sequences of activation.

[21:00] Psychiatry 1.0, 2.0, 3.0.

[26:41] How SAINT (Stanford Accelerated Intelligent Neuromodulation Therapy) came to be.

[34:00] TMS vs. ECT.

[35:26] Rewards and risks of shortening treatment timeframe.

[43:43] Numbers treated and common side-effects.

[46:32] Patient demographics.

[49:51] Where to find current open trials.

[51:01] Observed benefits of SAINT over more conventional treatments.

[52:45] Adapting treatment when symptoms prove misleading.