It's called TMS. That's transcranial magnetic stimulation. Folks, often with these very difficult to treat depressions, will come into a treatment room in this building. A device will be hooked up to their heads and they will be bombarded with magnetic waves in a certain area of their brain that can release them from the clutches of depression.

TMS, transcranial magnetic stimulation. What is it? Transranial magnetic stimulation. It's a treatment that's been around since the late 1990s. It's a way of stimulating the brain using electrical and magnetic stimulation. So our brains communicate through electricity and a magnetic field can cause changes in electrical signals. So our body communicates on electrical signals. Our heart pumps on electrical signals and our brain thoughts and feelings are really electrical signals. So what transcranial magnetic stimulation does is change the way that the brain is firing and and it specifically targets the areas involved in emotions and thinking and concentration and it works by changing how the brain is firing and you can see that real time while you're doing it. We we can't see it in real time but if you put someone in a brain scanner you could actually see what happens to the brain when you deliver a magnetic field pulse to the brain.

When someone comes in for treatment, and this treatment is a personalized treatment, even at its most basic form, we we deliver the stimulation based on how someone's brain reacts to the magnetic field pulses. So every brain is different and everyone's brain is different and and each person has a certain level that it will react to the magnetic stimulation. So we first come in and we deliver magnetic field pulses to the area of the brain that controls motor movements, hand movements specifically.

Someone sits in a chair and we put the magnetic coil over the motor cortex. And we cause the hand muscles to move. So this is the way I was telling you how we understand each individual person's brain excitability levels. So what I'm going to do is I'm just going to stimulate the the area that of your brain that controls your your right hand. So you have a relatively low motor threshold. So you see you're like you're like puppeting me. Whoa. You're doing different fingers now. Correct. So it's and really what we want to get are, you know, any muscles within the hand. but it is very precise. So we we can cause the muscle that controls the the thumb or we can cause the muscles that control the the finger muscles.

After they test your motor sensitivity, they now know how powerful to make the different pattern of waves for the actual TMS therapy. That's the sound of typical treatments. That's what's called theta burst stimulation. So in there there are bursts of pulses that are being delivered at a So the bursts are being delivered about 50 Hz. And in between them that there's triplets which are at five hertz. So that five hertz is the theta frequency and the 50 Hz is the gamma frequency. So you're kind of like a DJ like you're hitting like like different parts to sort of hit the waves just right in synchronicity. Correct. It's it we're kind of tuning. To get the response. Exactly. We use this arm and the coil rests on your scalp. And a treatment typically takes about 3 minutes.

So TMS uh is in its most basic form about 50% of people will respond to the treatment and that's very important number because most of the people that come for TMS haven't responded to other treatments. You're getting the tougher cases. So we're getting people that haven't responded to talk therapy or to medications. The challenge that people experience is is the the lack of hope that they feel when other treatments haven't worked. And so when something does work, when something resonates and allows them to experience joy again, it's transformative. In general, people describe kind of the the cloud of the depression lifting to some extent. They're able to see colors and things seem brighter. So, there is a really transformative quality to this treatment, like they're stepping out of grayscale and into spectrum of color again.

What happens with TMS is more of a kind of gradual shift in the brain. And it's not kind of like a a linear straight line. What people experience is kind of a rapid shift in emotions over the course of multiple weeks. And then towards the end of it, that's when it all kind of sets in. It's not that instantaneous awakening but it's kind of a gradual awakening that people experience when the treatment works.

What's happening in the brain is that depression is kind of seeping into other areas of the brain, other ways of thinking. And so this, you know, big blob is kind of expanding within the brain. It's called the the the salience network. that salance network expands within the brain. So it's you know people obsessively ruminate on decisions. What the TMS does is it kind of shrinks that overexpanded circuit. It kind of puts it back into place and it kind of trains the brain to be stronger at resisting that encroaching negative circuitry. Correct. We're kind of tapping at that blob repeatedly, causing it to shrink.

Is TMS allowing people to kind of essentially step outside of themselves and be back in the world? Yeah. I I I think the the self becomes kind of overexpanded. And and what we're doing is trying to make the self u or or make that kind of way of thinking more functional and kind of not be over focused on oneself and over concerned about everything. Allow people to experience life without being preoccupied with the the impacts of of what they've done or what they've said. You can be in the moment and experience that. That's how people experience pleasure. They they lose kind of their self-consciousness and experience the moment.

Like all of these treatments work on the principle of neuroplasticity. So by stimulating the brain, we cause the brain to take on a different way of operating. So the way I describe it is we make the brain stronger a and and essentially that's what we do when we're doing exercise training. We we stress the system and that makes the muscles stronger. Similarly in the brain when you stimulate it it it becomes stronger and that can get people out of these stuck states.

What I tell people is that receiving the treatment is one part there. It takes time to re-engage a and to you know part of it is becoming active again engaging in activities and that transition from being depressed to feeling better to re-engaging is a process. where does therapy fit in there? Psychotherapy. So you've kind of warmed up the brain. You made it more neuroplastic. feels like the perfect time to hand the baton off to a therapist. I think that that's absolutely a pathway towards staying well.

What does further personalization look like in TMS? we're actually able to read what's happening in the brain and in real time deliver our magnetic field pulses to the brain waves that are occurring. And we know that when we stimulate matters. So we can get a more powerful response if we stimulate at a certain point in the wave. those kind of incremental improvements in precision causes more plasticity and are more powerful. And by understanding what's happening in each individual person's brain, we may be able to shift that 50% to let's say 75% or 80%.

We we need to catch the area both where it is and when it's actually moving. there are cheap tools what's called EEG is electromphilography. detect what happens when we deliver that TMS pulse. and um yeah, I I think that that we're we're kind of in a space that where we can understand the the each individual person's depression because you know depression is one thing but within a person the the circuitry can be different.

The circuitry of depression is highly connected to the circuitry of pain. the pain circuitry overlaps with the circuitry of depression and so there is potential that by understanding the circuitry of depression we can also impact and reduce pain. Absolutely. this treatment is approved for patients who have obsessive compulsive disorder. It it's approved for patients with substance use disorders. fascinating interesting work happening in the area of treating trauma with this treatment being able to activate the circuitry in of trauma and being able to deliver stimulation and and quieting down that trauma circuitry. there is tremendous potential for this treatment across disorders.