Summary
Dr. Nolan Williams, director of the Stanford Brain Stimulation Lab, discusses breakthrough electroceutical treatments achieving 70-90% remission rates for depression. Triple board certified in neurology, psychiatry, and behavioral neurology, he shares how brain stimulation may represent the future of mental health treatment in the next 5-10 years.
Key Points
- Electroceuticals achieving 70-90% remission rates for depression
- Stanford Brain Stimulation Lab's cutting-edge research
- How transcranial magnetic stimulation (TMS) works
- The future of mental health treatments
- Why brain stimulation may replace some medications
- Timeline for these treatments becoming mainstream
Key Moments
Accelerated TMS produces delayed remission in older adults: the brain keeps improving weeks later
Ketamine hits about 30% spot remission with a single infusion, but accelerated TMS shows a puzzling delayed remission effect in older adults. Williams speculates reduced brain plasticity with age means the intensive stimulation protocol -- cramming for a test -- takes longer to consolidate changes.
"I just cannot figure out a plausible mechanism for the accelerated TMS and that delayed remission. How do you think about that?"
Ibogaine for military TBI: Nature Medicine paper shows dramatic results for depression and PTSD
Williams partnered with a nonprofit sending veterans to receive ibogaine treatment. Despite ibogaine's known death risk, the Stanford IRB approved the study. The resulting Nature Medicine paper showed striking results for military traumatic brain injury patients with comorbid depression, anxiety, and PTSD.
"We have a paper coming out soon in Nature Medicine on looking at ibogaine as a potential treatment for military traumatic brain injury."
Patients who got better from TMS often didn't believe it worked: the anti-placebo effect
In blinded TMS trials, patients who dramatically improved often guessed they got the sham treatment. Their significant others noticed huge changes, but they attributed improvement to luck or natural recovery. This anti-placebo pattern -- getting better while thinking you got nothing -- is seen across many treatments.
"And so what we found, which is really interesting for St. was that I didn't know what people got, but I talked to some of these people and I heard some of this. So it was really interesting, you know, patients who'd gotten totally better and they'd say things like, yeah, you know, I just got lucky with placebo this time. They ended up getting active. And then the folks that didn't get any better that they got sham would say things like you know i'm not even good enough to respond to like the active treatments so they so so it was confusing enough for them where they were making the wrong guess 50 of the time which is what you what you're looking for is about 50 error rate and it's a coin toss sidebar on that i know this is kind of staccato the way that I'm trying to hold this conversation, but having gone through two weeks, different hardware, different practitioners, et cetera, and having had a lot of conversations with technicians and so on, it also seems like for some people, it takes a while for or maybe I don't really feel that much."
Metabolic psychiatry is the next frontier: the ketogenic diet equivalent of accelerated TMS
Williams sees metabolic psychiatry -- using ketogenic diets and metabolic interventions for psychiatric conditions -- as the most promising emerging field. People get off half a dozen medications. Ferriss calls for a more ethical menu of psychedelic options given diminishing natural supplies of peyote.
"I would probably make the case around what Chris Palmer at Harvard has called metabolic psychiatry -- the accelerated TMS equivalent of a ketogenic diet."
