Novel Personalized Neuromodulation Approach May Rapidly Treat Depression

In this video, Nolan Williams, MD, Stanford University, Palo Alto, California, discusses his recent session presented at the virtual 2021 American Psychiatric Association (APA) Annual Meeting that explained the shift from oral daily antidepressants to neuromodulation or medication based rapid-acting interventions.

Dr. Williams’ talk as part of the session “Developing Rapidly Acting Antidepressants: Neurosteroids, Dissociative Agents (Ketamine Analogues and Psilocybin), and Accelerated Theta Burst r-TMS” suggests repetitive transcranial magnetic stimulation may be a novel, rapid, and effective way to treat acute depression.

Hi. My name is Nolan Williams. I'm an Assistant Professor at Stanford University in the Department of Psychiatry and Behavioral Sciences. I'm the Director of Clinical Interventional Psychiatry and Director of the Stanford Brain Stimulation Lab.

I was a medical student and resident for both of my residences in research and clinical fellowships at the Medical University of South Carolina, Charleston, under Mark George, and have been interested in neuromodulation for more than a decade.

Q. What were the main takeaways from your recent APA session as a whole?

A:  The key takeaway for the entire group is this idea that we're moving away from oral daily antidepressants that work over weeks to months, and we're working towards developing antidepressant interventions that are rapid-acting, whether they be neuromodulation or medication-based interventions.

The goal is to achieve a rapid action within the time frame of hours to days, which is a change in the way that we are conceptualizing treating depression and acute suicidality.

Q:  What were the key takeaways from your section of the session?

A:  My talk was centered around this idea that one can use repetitive transcranial magnetic stimulation in a novel way to treat acute depression quickly. We developed a personalized rapid-acting neuromodulation approach, which we called Stanford Accelerated Intelligent Neuromodulation Therapy.

The idea with this approach is that we get an MRI of everybody's brain before they get treated, and we are able to personalize the coil location, and then we apply a very dense amount of stimulation over the course of only five days. We're able to achieve really high response remission rates acutely right after the treatment is over.

Our goal with this pragmatically is to apply it in psychiatric inpatient settings, in emergency settings, to be able to treat people rapidly in those contexts.

Q: How do the recent findings in theta burst TMS impact clinical practice?

A: The goal of my lab is to develop experimental therapeutics, to be able to develop new treatments that could be eventually FDA-approved treatments that are paid for by insurance. This approach, the Stanford Accelerated Intelligent Neuromodulation Therapy approach, the idea is ultimately to get it into emergency settings, so emergency rooms and psychiatric inpatient units.

This takes more data, more experiments over the next several years, and get a larger patient base, and do this and apply it in these contexts, in these inpatient contexts. If we continue to see positive trials in this context, we're hoping to see an FDA approval, and we're hoping to eventually see insurance payment to do rapid-acting TMS in that context.

Q: Are there any misconceptions on this topic that you would like to clear up?

A:  I think that as a generality, people see repetitive transcranial magnetic stimulation as something that is before electroconvulsive therapy (ECT) or before very severe depression. What we're trying to say is if you use a more aggressive TMS approach, one is capable of treating the most severe individuals.

We've even seen people who've failed electroconvulsive therapy respond to this approach. TMS, when applied in novel ways, has the capacity to produce really dramatic clinical effects in quite severe individuals.

Nolan Williams, MD, is an Assistant Professor within the Department of Psychiatry and Behavioral Sciences and the Director of the Stanford Brain Stimulation Lab at Stanford University, Palo Alto, California. Dr. Williams is triple board certified in general neurology, general psychiatry, and behavioral neurology and neuropsychiatry. His work has been published in journals such as Brain, the American Journal of Psychiatry, and the Proceedings of the National Academy of Science.