Summary
Two interventional psychiatrists discuss how accelerated TMS and psychedelics are being adapted for OCD treatment. Dr. Noah DeGaetano, who founded a TMS program at Palo Alto Medical Foundation, explains how Nolan Williams' accelerated approach at Stanford produced some of the most effective results for major depression and is now being adapted for OCD by targeting the medial prefrontal cortex and orbital frontal cortex. Dr. Ryan Vidrine discusses the emerging evidence for psychedelics, particularly psilocybin, as a complementary treatment that may open patients up to better therapy outcomes. Both emphasize that TMS and psychedelics serve as bridges to make psychotherapy more effective rather than standalone cures.
Key Points
- Accelerated TMS from Nolan Williams' Stanford lab is being adapted for OCD by targeting the medial prefrontal cortex and orbital frontal cortex
- Standard TMS has FDA indication for both major depression and OCD
- A Stanford pilot study for OCD showed 57% response rate in a small sample, with improvement continuing at 10 weeks post-treatment
- The accelerated protocol condenses two months of daily sessions into a concentrated five-day course
- TMS and psychedelics are best understood as bridges that make the brain more receptive to psychotherapy
- Psilocybin shows promise for OCD treatment with some studies showing effects lasting up to a year
- Cost of accelerated TMS is significant upfront but may compare favorably to months of out-of-network therapy
Key Moments
Adapting the accelerated TMS protocol from depression to OCD
Dr. DeGaetano explains how Nolan Williams at Stanford developed the accelerated TMS approach by hypothesizing that traditional TMS was underdosing patients, leading to breakthrough results for depression now being adapted for OCD.
"What happened a few years ago, namely with Nolan Williams at Stanford University and School of Medicine, was that he thought that maybe we're underdosing TMS essentially."
Accelerated TMS for OCD targets different brain regions
The discussion reveals that while accelerated TMS for depression targets the left DLPFC, OCD treatment adapts the approach to target the medial prefrontal cortex and orbital frontal cortex.
"This is a podcast about OCD, and we have been adapting that accelerated approach with a different target. Instead of going to the left side of the brain, we're going right down the middle of the head on what's called the medial prefrontal cortex and anterior cingulate cortex."
TMS as a bridge to better therapy outcomes
Dr. DeGaetano describes TMS as creating a different brain that is more receptive to therapy, with patients reporting that although the therapeutic work is the same, they can finally engage with it.
"I say, you know, is a bridge. It is not the whole answer. And so it's like you have a different brain after you've had TMS. And now you really have an opportunity, maybe, you know, and I've heard people say either like, oh, I was hearing the therapist say something, but it didn't really resonate with me. And now I kind of get it. Like I feel it in my bones or I knew what I needed to do, but I just couldn't get myself to do it."
