Digital Social Hour - Depression Reversed in 2.6 Days: The New Breakthrough | Dr. Nolan Williams DSH #815

Episode Date: October 20, 2024

Discover the groundbreaking treatment that reverses depression in just 2.6 days! 🧠✨ In this episode of Digital Social Hour, Sean Kelly is joined by Dr. Nolan Williams to unravel the latest advancements in mental health treatments. Tune in now to explore how cutting-edge neuromodulation is reshaping the landscape of depression therapy with an astounding 80-90% effectiveness rate. Don't miss out on this deep dive into personalized medicine and brain health. 🤯 Join the conversation as we delve into the challenges of modern mental health and the future of brain-based therapies. Packed with valuable insights, this episode sheds light on revolutionary techniques that might just transform lives. Watch now and subscribe for more insider secrets. 📺 Hit that subscribe button and stay tuned for more eye-opening stories on the Digital Social Hour with Sean Kelly! 🚀 Keywords: Digital Social Hour, Sean Kelly, Podcast, Apple Podcasts, Spotify, Dr. Nolan Williams, Depression Treatment, Mental Health Breakthrough. #transcranialmagneticstimulation #treatmentresistantdepression #mentalhealth #ketamine #mentalhealthawareness CHAPTERS: 00:00 - Dr. Williams’s TMS Protocol 02:01 - Rising Depression Rates 03:40 - Understanding TMS Mechanism 07:10 - Concussions Without Impact 12:22 - Depression Statistics 14:51 - Anxiety-Depression Connection 17:00 - Role of Supplements 18:24 - ADHD and Autism Overview 22:49 - Elon Musk's Influence 25:48 - Importance of Context in Treatment 26:20 - Frequency of TMS Treatment 28:04 - Accessing TMS Treatment 28:10 - College Student Depression 31:50 - Impact of Depression Disability 33:10 - Mental Health Destigmatization 34:05 - Dr. Nolan Williams Online Resources 34:42 - Goodbye APPLY TO BE ON THE PODCAST: https://www.digitalsocialhour.com/application BUSINESS INQUIRIES/SPONSORS: [e-mail] GUEST: Dr. Nolan Williams https://x.com/NolanRyWilliams https://nolanrwilliams.com/ https://bsl.stanford.edu/ LISTEN ON: Apple Podcasts: https://podcasts.apple.com/us/podcast/digital-social-hour/id1676846015 Spotify: https://open.spotify.com/show/5Jn7LXarRlI8Hc0GtTn759 Sean Kelly Instagram: https://www.instagram.com/seanmikekelly/ Learn more about your ad choices. Visit podcastchoices.com/adchoices

Kick off an exciting football season with BetMGM, an official sportsbook partner of the National Football League. Yard after yard, down after down, the sportsbook, born in Vegas, gives you the chance to take action to the end zone and celebrate every highlight reel play. And as an official sportsbook partner of the NFL, BetMGM is the best place to fuel your football fandom on every game day. With a variety of exciting features, BetMGM offers you plenty of seamless ways to jump straight onto the gridiron and to embrace peak sports action. Ready for another season of gridiron glory? What are you waiting for? Get off the bench, into the huddle, and head for the end zone all season long.

Visit BetMGM.com for terms and conditions. Must be 19 years of age or older. Ontario only. Please gamble responsibly. Gambling problem? For free assistance, call the Connex Ontario helpline at 1-866-531-2600. BetMGM operates pursuant to an operating agreement with iGaming Ontario. You can treat depression within a couple of days.

So within an average of 2.6 days, we're able to get people from being in a pretty bad state to being well. That's impressive. Yeah. Some people go to therapy for years. And we just tried to find a kind of an engineering solution for modulation to pull out the same thing, right, where you can get people out of depression in these kind of quick time frames.

Now we know you can actually shift people's mood really quickly if you have the right tools. All right, guys, Dr. Nolan Williams here today. We are going to talk mental health and depression, right? Yeah, definitely. Thanks for having me. Exciting to be here. What a topic. And there's a lot of new research being done on it, right? Yeah. I think a lot of new therapeutics coming out over the next couple of years, some that are already approved. Yeah, there's a huge focus on trying to make more rapid acting treatments and trying to treat people really quickly, get them out of these emergency settings and states that people get into.

Do you specialize on the treatment side or more the preventative? Yeah. My lab is focused on new treatment development, so we try to take any tools that work that are acceptable to patients and try to see if they work for a given condition, get people out of these bad depression states or PTSD, TBI, that sort of thing. And that's why you developed the same protocol, right? Yeah. And so we wanted to find a personalized medicine way of treating people really quickly

and getting them out of these really bad depression crises in a couple of days instead of over the course of months, like what normal treatments take. So you can treat depression within a couple of days? Yep, yep. So within an average of 2.6 days, we're able to get people from being in a pretty bad state to being well.

Wow, that's impressive. Some people go to therapy for years, decades. Yep, yep. Yeah, no, it's, you know, ketamine as a treatment for depression has shown us that you can treat people really quickly, you know? And we just tried to find kind kind of an engineering solution when they're a modulation to pull off the same thing,

right. Where you can get people out of depression in these kinds of quick timeframes. And it used to be that people didn't think you could do that, that it would take a long time to get people out of these States. But now we know you can actually shift people's mood really quickly if you have the right tools. That's impressive.

Yeah. And do you see depression rates going up? Cause almost everyone I know has gone through a spurt of it. Yeah. Yeah. Depression's going up. Pandemic wasn't helpful for that. I think modern life isn't that helpful for that. And it's something I think that more people are talking about and thinking about now and being able to have tools that are brain based and taking it out of this framework that it's something about the person's personality or who they are or any of that stuff and taking all that off the table and saying it's a brain circuitry issue and being able to have

tools that treat brain circuitry problems. And your results are phenomenal, 80 to 90% effective. That's the highest I've ever heard for something like this. Yeah. Yeah. Yeah. We're very excited about that. That led to an FDA clearance, breakthrough status, and now Medicare is paying for this inpatient and outpatient. So the national government payer for people over 65 and disabled folks can get a hold of this. That's huge. So even people without a ton of money can do something like this? Yep. So anybody that's on disability that has Medicare from disability can get it, as well as folks that are 65 or older.

And so private insurance hopefully will kick in after that. Incredible. Yeah, I know people that have been depressed and on medication for years. I wonder how they would do with this. Yeah, you know, I mean, we, you know, we treated people in the trials that we've done so far that were, you know, pretty severe, right? You know, our average number of med failures for that last trial led to the clearance was like five plus or minus two, you know, so up to kind of seven meds. Some of the trials before that, we had people that had like 20 med failures, you know, so up to kind of seven meds. Some of the trials before that, we had people that had like 20 med failures.

Damn. You know, nine years in the current depressive episode. So they were depressed almost a decade before we treated them. We were able to get them out of it in an average of 2.6 days. Whoa. So just to give you a sense of things. So 10 years to reverse in 2.6 days. That's insane.

Yeah, it's pretty wild. And what is the exact treatment? Like, is it something you take orally? No, so what it is is the idea is that we can use this neuromodulation approach, which is effectively magnets. And we can take these really high-powered magnets that are the same field strength as an MRI scanner. And when you pulse them, we know from 200 years of physics, Faraday's law, that if you pulse a magnet, you can generate current in electrically conducting substances. And so if you pulse a magnetic field over the brain, you're able to induce current in brain tissue. Not in the skull or the scalp or the skin or the hair or any of that stuff.

That's not electrically conducting. Only the brain and the CSF around the brain. And so the nice thing about it is that it bypasses all those tissues and it goes straight into the brain wow and interacts directly with the brain and then it's this um idea of where how and how much right so where in the brain are you stimulating how are you stimulating and how much in that given condition you know so um if you stimulate in the right place with the right biologically relevant signal yeah then you know where you're stimulating into. You know what message you're sending into that spot in the brain.

And we have a good sense of how much you're supposed to send in order to achieve a change. Kick off an exciting football season with BetMGM, an official sportsbook partner of the National Football League. Yard after yard, down after down, the sportsbook, born in Vegas, gives you the chance to take action to the end zone and celebrate every highlight reel play.

And as an official sportsbook partner of the NFL, BetMGM is the best place to fuel your football fandom on every game day. With a variety of exciting features, BetMGM offers you plenty of seamless ways to jump straight onto the gridiron and to embrace peak sports action. Ready for another season of gridiron glory? What are you waiting for? Get off the bench, into the huddle,

and head for the end zone all season long. Visit BetMGM.com for terms and conditions. Must be 19 years of age or older. Ontario only. Please gamble responsibly. Gambling problem? For free assistance, call the Connex Ontario helpline at 1-866-531-2600. BetMGM operates pursuant to an operating agreement with iGaming Ontario. When you know that information, then you can push a system in a

direction pretty strongly, you know, and push a network in a direction that it maybe hasn't been in a while because it's in a depressed state. And so we do that because we're able to basically play the memory system signaling back into the brain itself. So we're sending a memory signal into this control region in the brain called the dorsolateral prefrontal cortex. And we tell that area to turn on, stay on, and remember to stay on. And its role when it is turned on and working well is it suppresses negative emotion and a whole lot of craving and all sorts of things. And so if we can turn that up, then it can then govern down onto those structures.

Incredible. Right? And so that's what it is. And in many ways, it's the core of the problem. And it's, it's in some ways of thinking about a natural solution, not in the way that people think about it normally, where you're taking a supplement, but if you're able to restore brain function in the way that it normally functions, that's, that puts people into a state that they feel good, right? They feel like themselves again, all that sort of thing. Yeah. I love how analytical it is. It's not just guessing.

No, no. It's all data-driven. Yeah, it's all data-driven. The personalized medicine part of it is that everybody gets a brain MRI, and we analyze their specific network arrangements, and we're able to, with those specific network arrangements, zoom in on positions within this bigger named brain region, the dorsolateral prefrontal cortex,

into smaller regions that are connected to deeper regions. So we have a sense of what that region is doing, what its relationships are for that person. And so it's the same idea of if you're a violinist, your hand representation in your brain is going to be very large. If you're a soccer player, your foot representation is going to be very large. And so you actually shrink or expand certain brain regions kind of like functional allotment based

off of use or pathological activation or whatever it is. And so we know that's true also for other brain regions outside of just the motor cortex. We think that's true for the dorsolateral prefrontal cortex. We can actually subdivide it based off of that person's neural anatomy. Holy crap. You mentioned TBIs earlier. I got a brain scan at Dr. Amen Clinic last month, and I had to pass through TBI front and back. Crazy part is I never had a concussion growing up. Have you seen something like that before? Yeah. So there's a lot of scans out there that are being explored in that kind of research level.

I think this is the only brain scan that's been approved as part of an FDA clearance. You know what I mean? And so you want to, for anybody that's kind of going through approaches like this or looking at all these different options,

you want to ask important questions around what data and evidence are driving these kind of conclusions and what's the kind of FDA status of that test. Got it. Yeah, I didn't do any research or compare it to any other test, to be honest. I just saw a lot of people use them and I went. Yeah, that's fair. Yeah, that's fair. But I was surprised. Yeah, I mean, I think these are emerging tools that may not necessarily be at the final stage. want yeah that's fair yeah that's fair but i was surprised yeah i mean i think um you know these

are emerging tools that may not necessarily be like at the final stage so you may have you may not have i think uh the fact that you don't remember having one is um you know it's kind of a clue that you know you don't know but but um but i think that uh you could have you know a lot of people have had concussions and they didn't know necessarily because the symptoms are different depending upon how the brain's hit, basically. So there's an initial hit in one part of the brain and then the brain, in many cases, accelerates forward with the head and the speed in which the head and the brain accelerate are different because of the density differences. And so you actually can get an injury at the site of the strike, you can get an injury at the exact opposite

pole of the head, right? And so that's what makes TBI quite difficult to deal with as far as a diagnostic. And, you know, and so some people come in and they don't have the classic post-concussive syndromes. There's data suggesting that some people with a history of you know of traumatic brain injury concussion actually have um have new site you know new onset psychiatric illness wow yeah and so so these are all like open research questions we don't have like a test or a solution to figure that out yet but um but i think that uh it's a it's an exciting field and hopefully we will in the next 10 years have you had any boxers or fighters or NFL guys do this process? Yeah, we've had a handful of people go through and get neuromodulation for traumatic brain injury.

One of my colleagues, Sean Siddiqui, who's at Harvard, has done a bunch of work on this and depression after traumatic brain injury. And what he's seen is improvements in the depression related to traumatic brain injury and that kind of brain abnormality or difference in the neural networks is different than normal depression, which is important to understand. Oh, so it's different. Yeah. So how is it different? So it's just the nature of the connectivity patterns, like the way that the brain is connected or disconnected in normal depression. That's a certain kind of fingerprint, if you will. And he's shown that that fingerprint

and the fingerprint of depression related to traumatic brain injury, but not in people that have traumatic brain injury without depression, these are different brain kind of network arrangements. Got it. And so that's the sort of work people are trying to do, figuring out are there footprints in the brain,

these kind of unique connection differences that can be used as a way of determining differences in the various symptomatology people show up with. And it's like super early stages. Like all of our work with the thing I described earlier with Saint with the neurostimulation approach, that ends up being work that's basically just asking a question of where in the brain to place the coil from a position standpoint. It's agnostic to depression. So this idea that we can look into the brain and know everything about everybody's psychiatric illness, we just don't have enough data to show that yet. But now that these tools are being utilized within the context of these stimulation procedures, we're going to be in a place where we can do some of that. So depression can be kind of anywhere in the brain then?

It's not like one spot? It's a distributed neural network, right? So there's data suggesting that there's potentially a hub in the left dorsolateral prefrontal cortex, this area that I was talking about earlier that we stimulate. So if you look at Mike Fox's work, you look at putting all the strokes that cause depression on the human connectome map versus all strokes that don't cause depression,

and then asking the question of what's common to the strokes that cause depression versus not, and is there functional connection to this brain region, the dorsolateral prefrontal cortex. But very few of those strokes were in the dorsolateral prefrontal cortex a lot of them were in places that were just connected right so it's more like the internet yeah instead of like the house right it's like you you may you may have a stroke in a house but if you had like this you know kind of very early stage internet kind of set up like arpa or whatever like at the beginning you may have like eight different nodes in that internet connection or something you knock one of these out and has an effect on all the other you know connections and so that's the idea it doesn't necessarily

have to be that it's one place in the brain or another but it's the connected network where they're all these particular sub-regions of the brain are all connected one another so a lot of people say they're depressed but do you know what the actual numbers are? Yeah. So the numbers of depression and the rates of diagnosis are different because of stigma and because of diagnostic questions. So your question's a little bit complicated to answer because depression's multiple things that we put under the

umbrella of depression and so one of the things that we have to figure out is are there unique brain signatures for that and so we're working on a project now with connor liston around this the nih funded where we're trying to type different brain network arrangements you know and so how many people are in each one of those network arrangements we're trying to figure that out right because these are probably subdivisions or different things. And then there's these issues around underdiagnosis because of the stigma issues, right? And so are there people that aren't being diagnosed that have depression? Absolutely.

Are there people that have a diagnosis of depression and it's really bipolar disorder, PTSD, or something else that's also there? You know, and so the most important thing from my perspective to really answer the question that you're answering in a real way, in a data driven way, is that we, over the next hopefully decade, come up with real biological tests that can tell us how many people actually are depressed in this way, in the brain in this way, instead of a paper and pen. Yeah, that'd be great. Because right now it's subjective, right? Doctors are pretty much saying, oh, I think you're depressed. Let me give you this medication or whatever.

Yeah. And the certainty level goes up as the severity goes up. So when you see a severely depressed person, you don't need to be a doctor sometimes to know that. I mean, sometimes you do, but sometimes, you know, family members can say, man, I, you know, and so-and-so is depressed, right? Like it's pretty clear. They're not leaving the room. They're sleeping all day. They're not really eating. You know, they're not making eye contact, all that kind of thing. They look really sad. And so the certainty goes up as the severity goes up. But there's a lot of people that are in that mild zone. And when it's mild, it's tough because it can be other things too. And so that's one of the complexities. And depression as a diagnosis has these

opposites. So one of the opposites is depression can come with sleeping too much. Depression can come with sleeping too little. Depression can come with eating too much or eating too little or being overactive or being underactive. So these are, you know, polar opposite symptomatology and yet we clump it under depression, you know, and that's, that's one of the complexities and part of what we have to figure out is how to deal with that, resolve that from a biological perspective. Right. Hopefully we could get there soon. That'd be cool. Have you seen any linkage between anxiety and depression for people that are anxious?

Yeah, there's a lot of linkage between anxiety and depression. Most people that have refractory anxiety end up getting depressed, and then a good chunk of the people with depression have an anxious component to it. Not everybody, but a good percentage of those folks. And so they run hand-in-hand. And what's interesting is that where that information is in the brain seems to be subdivided within these named brain regions. And so work from the colleagues I was telling you about earlier from Harvard have shown that you can subdivide the dorsolateral into regions that are more anxiety-related or more dysphoric-related,

right? So this idea that there's even like a unique signature of that in the brain. And we're going to hopefully get to a point with personalized medicine where we're able to go and say, okay, it's this target or that one as far as treating anxious depression or non-anxious depression. Wow, that'd be great. I'm very excited about the future, man. Because I feel like growing up, there was very little known about this kind of stuff. Yeah, that's right. Yeah.

Yeah, it's tough because the brain itself, like if somebody dies of suicide and you look at the brain in the way that pathologists look in the brain for a stroke or for Parkinson's disease or for Alzheimer's disease, you don't see anything, you know? So, you know, we figured out Parkinson's and Alzheimer's and all that based off of these autopsies in, you know, deceased individuals that had that condition. And then you could try to figure it out from the pathology. But in depression, the normal ways that we do pathology don't really show us anything. There's new ways that people are developing that show some really interesting things. But the original ways don't show anything, and so you need to have a test that's effectively evaluating the functional arrangements of these network nodes

with each other in the brain. And can they be alive for that test test or do they have to be dead? That's the beauty of functional imaging, right? And some of these other newer procedures is that we can actually capture the sort of information that we think we need to capture in order to understand depression more in alive people. Got it. Any supplements you've researched that actually help with brain health? Because that's a controversial topic. Yeah, it's a super controversial topic.

I mean, I think that the biggest thing that's very, very clear in study after study after study is the most important thing is exercise more than anything else. Because that seems to prevent off a lot of the various neurodegenerative conditions, a lot of the, you know, you can treat kind of mild to moderate depression. And so exercise, I think, is the most important thing as like a base. And then, you know, I think that the Mediterranean diet, you know, seems to be an important thing to do for overall brain health. And that's very non-controversial. And the thing is, is that that's also very good for heart health, you know, and so it's one of these things where, you know, if you get kind of a signal that somewhere else in the body is also really kind of positively reacting to a dietary change, you know, then you can feel, I think, more confident than if it's just like a kind of more theorized brain kind of supplement. But it's like, all right, we're going to focus on this kind of Mediterranean diet that's like whole foods and like has like, you know, a high omega-3 content, all that stuff that that ends up being very helpful.

Got it. Magnesium and omega-3s though, you take those? I have in the past. I mean, I'm not currently taking any of that stuff, but I have, you know, at various points in the past, I've tried both of those things. I think, you know, I think those are reasonable things to try. I don't think there's any negative for either one of those. Yeah. How do you feel about the ADHD and autism rates skyrocketing lately? Yeah, it's an interesting question.

We don't know what the kind of reason autism rates are going up. There's a lot of work that needs to be done. We don't have a fundamental knowledge of what autism is, which I think is one of the big things that, you know, various colleagues of mine are trying to work through and figure out right now. And then I think once you know what the pathogenesis is of something, like what's causing it, then you can try to figure out why things are going up. Interesting. You know, similar with ADHD, it's tough.

The problem with ADHD in some cases is that, you know, the symptoms of ADHD are like highly overlapping over some of the symptoms of depression, right? Concentration issues are common for both of those conditions. And so there may be, you know, a lot of those folks with just straight up ADHD, there may be some people, there's likely some people that have comorbid depression. Yeah. I think I have ADHD. Yeah. Yeah. Yeah. It's, um, you know, it's a. It's a common problem. It's highly treatable. People end up doing quite well when they're treated.

Yeah. They looked at it really bad growing up, but I feel like it's not the worst. There's a lot of entrepreneurs that have it, I noticed. Elon Musk and a few other big ones. Yeah. I think it's a gift and a curse. I say that about dyslexia too. It's a gift and a curse that you have these differences in the way that you kind of attend to the environment and learn,

which isn't that great for a standard classroom. It ends up being much better when you're having to hold attention across a bunch of different projects and timelines and all that because it aligns more with the way the brain's working. And so 38%, I think, of CEOs are dyslexic. Wow. That's super high. So there's something there then. Yep. So Charles Schwab is public about that. And that's unlikely to be random, right? Yeah. That's likely to be a self – to be a CEO, you have to be a – you're self-selecting to kind of get there, and that's a very hard road to get to, right? and have a hard time with doing some of the more base level operations that have a lot to do with drawing on reading and memorizing and stuff like that. They don't have to do as a CEO. They actually can just delegate things. So yeah, there's a lot of that kind of thing, this idea of neurodiversity.

Autism kind of falls in there. Dyslexia, other brain conditions, this idea that there's kind of maybe not necessarily like a completely pathologizing way of looking at these problems, but actually thinking about it more on this spectrum. Some people have kind of theorized that autism is on one end of the spectrum and dyslexia is on the other. Normal non-dyslexic, non-autistic folks are in the middle. And it makes some sense to me that that kind of conceptual arrangement because of the strengths and weaknesses for all three of those groups. And so it's an interesting time.

I think what we're going to figure out is that there are these kind of brain types, and with those brain types come some advantages and disadvantages and some in the extreme form, some symptoms, which I think is different than the way that we think about it with the DSM where we're trying to like have this bird hunting tool, like this bird, you know, typing tool where you're saying, oh, the beak's this long and the bird's this color. And so it's this, which doesn't really work that well unless you have this perfect specimen of a bird. Instead, thinking about it like brain types, right? Like a lot of these things run together, you know, the ADHD dyslexia, the ADHD kind of autism spectrum. Like is there something about certain individuals

where they have these symptoms? We call them different diagnoses, but it's the same brain kind of arrangement differences. And those folks are quite good at some things, but they become very symptomatic in other areas in that our role maybe isn't as much about pathologizing. It is saying, okay, in this brain type, these folks can do these things really, really well.

And these things, they have symptoms, instead of saying, symptoms, you know, instead of saying, oh, you've got this diagnosis or whatever. And I hope we go more towards something like that in the future because I think it's more helpful for people to think about it like that, I think, than to think about it like I've got this label of things, you know. I agree. It would help in business too when hiring people. Yeah, I agree with you. Because then it's just purely data-driven. There's no other emotion involved. Like, you have this brain type. You'd be good at these tasks.

Yeah. No hard feelings, you know? Yeah, that's exactly right. I mean, we've got a lot. I mean, there's a lot. Like this is a theory, right? So there's a lot to go. You know, we don't have any real tools to do that yet.

But I think that that's my kind of sense of it if you look at it, right? If you look at all of these kind of Elon Musk types out there, they all have similar sort of kind of symptom clusters. And it's really just like a brain that's very good at a bunch of things and then has some symptoms, you know? Yeah. Has Elon discovered this yet? Cause I know he does ketamine therapy and stuff, right? I don't know. You know, I don't, I don't know if he knows anything about neuromodulation. I know, yeah, I'm very familiar with him, uh, you know, his public statements about, about ketamine and, and, um, some of their psychedelics. And yeah, I think, uh, you know, I haven't had an audience

to talk to him about it. I'd always be open to chatting with anybody that had interest in that. I know from other people that are in the Valley that are in that same kind of general startup, top tier landscape, that it's becoming more apparent that this is another tool in the toolbox, right?

And it's an important one from my perspective because the risk-benefit calculation is about as good as you're going to get in psychiatry from my viewpoint and about as good as you're going to get in the rest of medicine. There's a theoretical seizure risk with this form of neuromodulation. Oh, really? It's the same seizure risk with conventional TMS as Wellbutrin, the oral antidepressants. It's like 1 in 30,000. Oh, okay. We haven't seen it with this yet, knock on wood.

And I don't know, 500 people are in trials or treatments or whatever. We haven't seen a single seizure. And my suspicion is that it's going to be a really low rate. And at Stanford, we've seen exactly one seizure in the whole time we've had a TMS clinic there in 20 years. And that one person woke up and they're like, this doesn't mean I don't get to do TMS anymore if she wants to sign back up. And so it's one of these things where for a depressed patient, that's the least of their worries. And outside of that, the only real more frequent the only real, you know, more, um, frequent risk is, uh, is headache that's Tylenol responsive, you know, but people will get, you know, get some

headaches. Um, and, uh, otherwise there's not really, um, seemingly a downside or a negative or risk there. And I think that's an important thing to really highlight. I love that. Yeah. Is that there, you know, with some of these other things with, with, um, you know, with ketamine, with, with some of the psychedelics, you know, they seem to be safe as a general, you know, as a generality, but there are, you know, I think more risks and non-invasive neuromodulations. I have seen the dark side of psychedelics. If you take a little too much. Yeah. Yeah. Yeah. Some weird college experiences there. Yeah. Yeah. No, it's, it's a tricky, it's a tricky game. I mean, these are non-specific kind of experience enhancers, right? And so it's very context-dependent.

Neuromodulation, the nice thing is it may be context-dependent, but the context that we treat people in seems to be the right context for most people. And people actually have the same sort of like afterglow that I've seen with the participants who run through psychedelic trials or ketamine or whatever after the neuromodulation too. Wow. Say some of the same sorts of things. And so they're able to basically avoid a lot of the symptomatology. But yeah, that's the, you know, that's kind of the nutshell of it.

How often do they have to get the neuromodulation? It's variable, you know. So we ran a trial in frequent relapsers. And what we found is in frequent relapsers. And what we found is in frequent relapsers, they needed an average of – they needed the five days. They needed an average of like one to two days every two and a half months. Oh, that's it? Wow.

Yeah. That's not that often. Yeah. So it's – I mean it's a full day. It's like 10 hours or something. But people can come in on a weekend. You can essentially do your taxes and catch up on emails and stuff like that every quarter. It's pretty pleasant. People have some sensory experience, but they largely just have a Netflix movie or whatever that they're watching.

I sit in the chair, looks at Dennis' chair, and they're watching a show. That's incredible. And I feel better at the end of it. So it's pretty chill. Um, and, it's very reproducible, which I think is useful. And so it's one of these things where people kind of get into this rhythm and then we know we can kind of keep them well, you know,

out into perpetuity. And that's the data that we have now. It looks like we can keep retreating people and keep reestablishing remission. So, um, so yeah. I mean, no,

when you're in Vegas, man, I'd love to try it out. Where do you do it right now? So the lab has studies, and then the company that's commercializing this is called Magnus Medical. It's a company that my students left, some of my students from the lab left to run. And they are commercializing this in Southern California at Kaizen Brain Health Center. It's in, in like San Diego. And then in Northern California at Acacia Clinics, which is in Sunnyvale. And then University of Arkansas

and the Medical University of South Carolina. And there's like, I think University of Iowa is about to start. So there's a bunch of places that are getting going. I mean, this is like since like two months ago. So it just started being commercialized recently. They need this on every college campus, man. There's so many depressed students, especially in med school. Yeah, I agree with you. That's the dream, right, is that somebody could have one of these in a college mental health clinic, and you have a student who's in crisis,

and you could treat them that same day and get them to a place where they need to go to the hospital. Because the reality, especially in college campuses, and you see this all the same day and get them to a place where they didn't go to the hospital. Because the reality, especially in college campuses, and you see this all the time and it's heartbreaking, is that you've got these students who start to get depressed and their grades start slipping and they start failing. They may even be super on it when they first start getting depressed. They go to the mental health clinic.

The third day they're feeling bad. You can imagine something like that. They get put on drug one. It doesn't work, but you don't know that because it takes two months to fully know that. Then you got to switch to drug two, and then that one's not going to work in most people. Then you end up being in a situation where it's two more months. Well, that's a whole semester, and now you failed. That's really the problem with that scenario. If you have somebody who's feeling depressed and you have something like this, you could literally turn it around an average of 2.6 days. And maybe the person has missed a couple of classes.

And if it's in their finals or something, maybe they have to delay their finals. But it's one of these things for people that would respond to this where you could literally get a student from being in a really bad position to being able to go back to work and do school stuff pretty straight away. I mean, we had, for a number of years when we were doing some 18 to 21-year-old subjects, we had this group of four college students who came in every spring break, spent their week with us, and then they were well for another year. Wow. Right? And so they got through all of college like that. They just came in every spring break. That's incredible. Yeah. And then they went from for another year. Wow. Right? And so they got through all of college like that. They just came in every spring break. Yeah.

And then they went from being, you know, starting to kind of backslide and feeling somewhat depressed again after having a year of wellness, maybe a couple of weeks where they're feeling bad. And then we'd treat them and then they'd get the whole nother year and come back in.

We were able to do that. And it was pretty non-obstructive to their life, you know? Some of those guys came in, I think, over Christmas break instead of, you know know spring break or summer whatever it is but but it was one of these things where that was you know that was enough and so that's super cool right because you you know you have this problem you know you still have the problem but it doesn't become like a problem that like changes the trajectory of your life and I

think that's the part that is really hard about depression is that it changes the trajectory of people's lives oh it can i know there's colleges like suicides at colleges all the time that's right that's right so there's there's there's suicides or suicide attempts and people end up getting hospitalized which even in the absence of the suicide happening right you still those folks even if they're they're saved or they survived or whatever their life is pretty wrecked after that right for at least a while right and even people that are just chronically thinking about it, you know, and then they can't get, they can't get out of it. And so, you know, that's the dream is, can we find ways to, you know, people won't necessarily, um, be completely free of it,

but it won't change that trajectory of their life. If they're destined to, you know, run for president of the United States or whatever, and if the depression didn't derail them, maybe they do. That sort of thing, right? And it's one of these things where how many young people are in a situation where they were destined to do something great, except this depression just tripped them off and ruined their life in a way they couldn't get to that goal, right?

100%. It almost took me over. I had agoraphobia for a bit. Couldn't even leave my house, man. Oh, man. Yeah, that was rough. Is that a form of depression? It's a different thing. It's a certain type of phobia,

but it's the same basic idea of disability. If you look at disability in psychiatry, you look at the disability from depression, it's very bad, right? So severe depression, it's as bad, right? And so severe depression, it's as disabling as dying of cancer without treatment. Moderate depressions as disabling as having a heart attack. Holy crap. Moderate depression? Yep. What do you mean by as disabling? Yeah. If you look at the disability metrics for having an acute heart attack and

having a moderate severity depression episode, it's the same disability. Damn. That's pretty crazy. Because when you think of heart attack, you think of like extreme like yeah can't get much worse than that yeah that's right that's right i mean if you talk to people you know i've talked to physicians who've had severe depression and they'd say you know i'd rather have cancer than have this because my family would understand me better you know whoa yeah because that's the other thing you can't really talk about it right that's right yeah yeah it's you know when you have a cancer diagnosis or you have a heart attack of stroke whatever it whatever it is, the family groups around. They look at the brain image, the heart image, whatever it is.

The doctor points out the problem. The family cries together and then everybody kind of supports each other or whatever. My dream and hope and I think shared vision with other friends of mine and colleagues is that we have a world where that's what happens for psychiatric illness in the future, that people can have that same response as what we do with cancer and what we do with heart attacks. But we're not there yet, for sure. I mean, we're still in this realm of we need to try to explain it and explain that it's not a problem of this person not trying hard enough or whatever it is, it really is an illness that's affecting them. Agreed, I was so embarrassed to admit I had anxiety for a while. It's one of those things.

Well, I think the younger generations are now more tolerant of it. I think when I was in college like 20 years ago, no one would ever even mention on a show like this, you have a lot of courage in talking about it. And I think that that's the good thing is that people are de-stigmatizing it. And it's important because the more people talk about it, the more normalizing it is. I think the World Health Organization said half of

people will have a mental health diagnosis at the end of their life. Dang, half? Holy crap. And that's just diagnosis so it could be even higher. So I mean that also extends into kind of brain illness and dementia and stuff too but it just goes to show that like you know these are highly prevalent conditions. These are

not things that are rare illnesses or to your point like a huge societal problem. Absolutely. Dr. Nolan, it's been really interesting. Where can people learn more about you and learn more about Saint? Yeah, so I have Nolan Williams Stanford into Google and you'll get my Stanford website. I have a Twitter or X account, Nolan R.Y. Williams. And yeah, happy to follow our work R.Y. Williams so at Nolan R.Y. Williams and

yeah happy to follow our work or reach out to the lab to do trials we're always like one of the big reasons why I do a lot of these podcasts

is just to get the word out so we study participants being able to see this possibility so yeah happy to have folks reach out

perfect reach out guys we'll link the stuff below thanks for coming on thanks for watching see you guys tomorrow.