The Agenda with Steve Paikin (Audio) - How Science is Silencing Depression with Magnetic Waves

Episode Date: April 24, 2026

Millions take medications like SSRIs and SNRIs for mental-health conditions and feel the benefits. But what if your depression is hard to treat? One option: something called transcranial magnetic stimulation. Rundown producer Eric Bombicino learns more from Daniel Blumberger, scientific director of the Temerty Centre for Therapeutic Brain Intervention and a senior scientist at the Centre for Addiction and Mental Health.See omnystudio.com/listener for privacy information.

Hi, I'm Nam Kiwanuka, host and producer of mistreated, a podcast on women's health. There just hasn't been a lot of money put into researching women's health issues. If women are in pain, it's hysteria, it's an emotional issue. And this is what you see consistently. Women's health is not taken seriously. How did we get here? Find us wherever you get your podcasts, and be sure to check out the video version of the show on the TVO Today YouTube channel. Hope to see you then. I'm Eric Bombachino and I'm standing outside of CAMH. That's the Center for Addiction and Mental Health.

And today we're going to be looking at a cutting edge treatment for depression that kind of feels like it's from the future. 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. brain that can release them from the clutches of depression. Oh, depressions that for some folks have existed for many years. Now, how exactly does this technology work?

Is it safe? And how promising of the results been to this date? I want to welcome Daniel Bloomberg onto the show. Thank you for letting us come and hang out at Camage. Thank you for having me. The work you are doing is absolutely fascinating. It feels like it's from the future a little bit, like from a sci-fi movie, a very helpful maybe like early Star Trek.

So we can go in a little slowly here. TMS, transcranial magnetic stimulation. What is it? Transcranial magnetic stimulation is 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 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 can't see it in real time, but if you put someone in a brain scan it, you could actually see what happens to the brain when you deliver a magnetic field pulse to the brain.

Oh, very cool. So before we get really deep on that science, I wanted to kind of go through the process of, let's say today I was coming in to do TMS. I come in, I say hey. You say hey. What happens next? Take me through it. When someone comes in for treatment, and this treatment is a personalized treatment, even at its most basic form, 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 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. Will my hands move sometimes if? So yeah. So what happens is someone sits in a chair and we put the magnetic coil over the motor cortex.

Yeah. And we cause the hand muscles to move. Is it painful? So it's not painful, per se. We had planned to visit the treatment room after the interview. But what I did not expect was Dr. Bloomberg offering to hook me up to the machine and test my motor sensitivity. I was obviously super brave about the whole thing.

Max, maybe you want to do it? Are you nervous? No fear? No fear. Just like the T-shirt in the 90s. Tell me what to do, and please be gentle. 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, I'm just going to stimulate the area of your brain that controls your right hand.

So typically this treatment is delivered to the left side of the brain. Okay. Left side of the brain controls the right side of your body. Exactly. Right. And I'm going to... So you have a relatively low motor threshold. So you see you're like, you're like puppeting me.

Whoa. Oh, you're doing different fingers now. Yes. You just did my ring finger and then my middle finger. Correct. So it's, and really what we want to get are, you know, any muscles within the hand. Okay. But it is very precise.

So we can cause the muscle that controls the thumb or we can cause the muscles that control the finger muscles. Right. Can you do my thumb? Sorry, I'm making demands. There. Oh yeah? Wow, you got that first try. I've been doing this, I've done this a couple of times.

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. Okay, can I hear it again? Here we go. So in there, there are bursts of pulses that are being, that are being delivered at a so the bursts are being delivered at right 50 hertz and in between them there's triplets which are at 5 hertz so in that 5 hertz is the theta frequency and the

50 hertz is the gamma frequency so you're kind of like a DJ like you're hitting like like like different parts to sort of hit the waves just right in synchronicity correct it's it we're kind of tuning yeah to get the response exactly we use this arm and the coil rests on your scalp and a treatment typically takes about three minutes. What's the sort of frequency of this? Once a week, twice a week for how long, how many sessions? Yeah, so a typical course of treatment is every day for about 30 sessions. So it's 30 trips to the clinic.

We're exploring different ways of doing that and kind of compressing the course of treatment into a matter of days. When you think of someone body language, just demeanor early on in the sessions, and then they come in 25, 26, 27 days later. Can you see, not even talking to them, not even asking them how they're feeling, can you see a difference in just, like literally they're walking down the hallway

and you're like, okay, all right, yeah. You can totally see the difference. You can see the brightness in their eyes. You can see the way that they walk. It's transformative. So TMS is in its most basic form, about 50% of people will respond to the treatment. And that's a 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. And so that 50% is an important number. There are more advanced ways of delivering TMS. And those advanced ways are potentially going to make it more effective, even more effective than 50% of people. challenge that people experience is 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. So the university student who's had to drop a semester of school and has finished a course six weeks of treatment and is now interested and motivated again, has been able to re-enroll in school. Yeah. You know, those are really impactful. In general, people describe kind of 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 gray scale and into a spectrum of color again? Yeah, it's really interesting that, you know, it's multiple patients describe this experience. that they can start to see the world in real colors again. There's a story that I think I shared with you. We talked before this, and it was with Dr. Helen Mayberg. And Helen Mayberg works on DBS, deep brain stimulation. And I'm probably going to take up too much time saying this story, but it's,

so deep brain stimulation is like surgically implanted. The electrodes are directly on the brain. And this was like early days doing it. And she had this woman, a mother in who had been depressed for, I think, four years. and they had four different sites to do it on. The first site, she didn't feel anything. The second site, she didn't feel anything. The third site, nothing.

And then it was down to the fourth and final site. And Dr. Mayberg asked her, do you feel any different? And she said, nothing, and began to cry. And I think Dr. Mayberg told me this like 15 years ago. But there was a moment where I think she was thinking, oh, it's not working. But instead, this woman said, I just realized how much you care about me and how much you've been helping me. Thank you.

And then the woman really broke down and started crying saying, this is the first time I thought about my children and felt the love that I should be feeling. That's one story, that's a big story. I heard that 15 years ago and it still sticks with me. Does that relate to some experiences you've had in these treatment rooms?

Yeah, I would say that we get that similar experience, that experience of being re-engaged with life, re-engaged with relationships. It doesn't happen on that instantaneous scale that occurs. When you turn on the signal, what happens with TMS is more of a kind of gradual shift in the brain. Okay. And it's not kind of like 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. And interestingly, in newer ways of delivering the treatment, a large dose of is a given very quickly over a number of days and then people feel something but then it continues to take effect weeks later and and so it's not that instantaneous awakening but it's kind of a gradual awakening that people experience when the treatment works the problem of rumination the problem of these looping toxic thoughts that you can't get away from and that are this like maelstrom in your head that are just worrying around you can walk into different rooms you can be in

different places and that scene plays over and over again for people. I've had friends that were deep in that depression who have described when they've come out of it, it's like, oh, I got to step out of my head and back into the world. Is that what, is that an important thing you'd understand what's happening in the brain? Is TMS allowing people to kind of essentially step outside of themselves and be back in the world? Yeah, I think that's, that's one way to think about it. From a kind of neurobiological standpoint, what's happening in the brain is the 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 salience network. That salience network expands within the brain. So, you know, people obsessively ruminate on decisions. And, you know, every decision is like a great mountain to climb it. And they get stuck. What the TMS does is it kind of shrinks that over expanded circuit, kind of puts it back into place. And it kind of trains the brain to be stronger at resisting that encroaching negative circuitry. And so we're kind of training the brain to resist those kind of negative thoughts and to get more on,

and more productive and back to those healthy circuit pathways. I'm picturing the old movie The Blob, where it's literally just the blob, and you guys with TMS are essentially like making it scurry away get very tiny and you're hiding it in a little cupboard. Correct. We're kind of tapping at that blob repeatedly causing it to shrink. Okay. Yeah, contraction. Is it quieting the self? And the reason I ask that is there's an area in the brain called the default mode network where your self narrative is in. And so folks with major depressive disorder, generalize anxiety disorder, OCD, you can go down the list. This area is often exploits. floating in activity, which I think is connected to that rumination. When you are able to get the blob back in its cupboard, are you quieting the self for these people? Yeah, I think the self becomes kind of overexpended. Yes, okay.

And what we're doing is trying to make the self or make that kind of way of thinking more functional and kind of not be over-focused on oneself and over-concerned about everything. people to experience life without being preoccupied with the impacts of what they've done or what they've said and to get out of that kind of over-expanded, ruminatory way of thinking. Yeah. Yeah, you drop the self-consciousness so you can maybe be at a concert and just be like, well, I forgot I was listening to that for the last four minutes. Correct. You can be in the moment and experience.

That's how people experience pleasure. They lose kind of their self-consciousness and experience the moment. Can I bring up Dr. Mayberg once more? Of course. I'll just do it twice. I do want to keep bringing her up. You know, she's a giant in the field. And a lot of the work in TMS relates back to her work.

So it's important to talk about. Again, this is a conversation from 15 years ago. So if she's watching this now, she can correct me on if she said this. But she uses this great analogy of a parking break that's stuck, right? It's like fully pulled up and wrench shut. And this is the blob sort of taken over. And then with DBS or TMS or other methods. you're you're basically releasing it.

That idea of like being captured or like being stuck, is that, are those two important words here to use and trying to understand what's happening? Yeah, I think in some respects, there's another analogy that I use to help kind of explain what's happening when people are depressed and what TMS might be doing so that the traffic signals are stuck

in all kinds of dysfunctional, They're not coordinated. Right. And so what the TMS is doing is starting to get those circuits or their signals back in a coordinated fashion. Yeah. Not in this kind of stuck way where things are kind of over expanding, going down roads and paths that are dark and dangerous. It kind of reducing the pathways and getting them more on those kind of healthy roads. I love that analogy.

Can I throw another analogy out there? Hopefully. This is the one I heard with psilocybin. So that's an active ingredient in magic mushrooms. And I'm curious if this relates to TMS. So my favorite analogy is like that of a ski hill. So you get these worn in tracks. These are those ruminating toxic patterns.

Maybe when you wake up, they're not fully online, but then they groove in and you can't get out of them. And a single dose of psilocybin is like a fresh coat of snow. And it's like, ah, I can find new tracks. Does that relate or is that specific only to maybe psilocybin? I think it relates, but I would say that more kind of getting back on the right track. Okay. Rather than kind of wiping the slate clean.

Yeah. I think we're trying to get people more on kind of back to more functional circuits. Whereas, you know, psilocybin, I think, works through potentially different mechanisms because it's often combined with therapy and a kind of reinterpretation or kind of kind of rethinking of how one views experiences or themselves. ECT, electric compulsive therapy. I was recently watching Young Sherlock, a great movie, or a great show, I should say, and they show ECT in the most barbaric ways,

but it's still being used and it's still effective. Why is ECD still so effective and is it work in similar ways as TMS, sort of like unsticking people? Yeah, so I think ECT still exists because it's still one of the most effective of treatments for severe depression. I got into this work and became interested in TMS through my experience treating people with ECT. One of the first patients I treated could have been my grandmother.

There was a woman who had a really severe depression that included psychosis. So her depression was so severe that she thought that she'd done something wrong and she hurt her family in some way and and she wasn't able to speak or communicate and the depression was so severe that she was in a catatonic state and and within a matter of three to four treatments she was herself again this very sweet caring woman who you know who could have been my grandmother yeah based on age and how so and that experience really showed the power of of this treatment And still to this day, it has that effect when people have really severe depression. It also works when people have not responded to things like TMS.

Yeah. You know, we have all these new treatments these days, but there's still the need for treatment like ECT. And ECT works as kind of like a reset. So when the tools like TMS, which are kind of gently tapping that big blob, don't work, you need a more powerful tool. And ECT works as kind of like a reset. It kind of is a very strong signal delivered to the brain that reduces a very short seizure under general anesthesia. It's a very quick, safe procedure. And it's effective at really tackling that overactive depression circuitry when all these other treatments don't work. And, you know, there's still a place for it because it can save lives. It can prevent

people from taking their own lives. It's probably one of the only treatments that exists that can actually reduce the risk of someone taking their own life. Yeah. We've used a bunch of analogies, and I think with ECT and psilocybin and now TMS, what's happening in the brain is your, what, inducing greater neuroplasticity? You're kind of warming up the brain. Absolutely. Yes. Like, all of these treatments work on the principle of neuroplasticity. So by stimulating the brain, It caused the brain to take on a different way of operating. So the way describe it is we make the brain stronger and essentially that's what we do when we're doing exercise training. We stress the system and that makes the muscles stronger.

Similarly, in the brain, when you stimulate it, it becomes stronger. And that can get people out of these stuck states. Exactly. So I find these getting out of these stuck states and actually being in the, the world. I feel like most people enjoy those states, whether we know it or not. I play hockey every week. I think I can get into more in the world, more on the ice playing hockey. We ski, we dance, we go mountain biking. You're in the world and your sense of self is a little bit smaller. Like you're not, you're definitely not in those looping thoughts. And I think if you like

turn that up to like a spinal tap 11, you're in like full-blown spiritual practice. You're having a full-blown spiritual experience. And so I guess what I'm curious with, TMS, is it like a nudge or maybe sometimes like a hard bump to help people get not fully into those states, but maybe get them to like a base camp where they can actually find a flow state easier if we want to use that term for it? Yeah, I think absolutely that's what the treatment is about. It's about getting people so that they're not so focused on themselves so that the depression is quieted and they can re-engage in activities that they enjoy or activities that they need to do. What I tell people is that receiving the treatment is one part. It takes time to re-engage 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 and takes time. And often people need the space to think about that and to go through that process of re-engaging.

And where does therapy fit in there, psychotherapy? So you've kind of warmed up the brain. You made it more neuroplastic. It feels like the perfect time to hand the baton off to a therapist. Yeah, you know, that's a really interesting point. And something that we've tried to study at times, whether doing therapy after something like TMS or after ECT can help prolong the response that people have. And I think that that's absolutely a pathway towards staying well. You know, a lot of our work centers on getting people.

better. We need to work harder at kind of keeping people well and resisting and preventing people from entering into recurrence or relapse. So TMS is done, I guess now as of a couple years ago, across quite a large age range. So it's adolescence now and you work with the elderly. Is it more effective in certain age groups, equally effective across those? You know, I think that there's a spectrum. People used to think that TMS didn't work well in older adults. Why? I think the early studies were kind of underdosing the treatment and not giving enough of a stimulation intensity so that people who were older would respond to the treatment. As the field moved to more standard intensity of stimulation, what became clear is that actually older adults

seem to respond better to the treatment. Their brains seem to be more plastic. So this is kind of like a misconception that older people don't have, as plastic brains can't, respond to these newer treatments. But in fact, the opposite is often true. You know, the case is true with things like ECT that older adults seem to respond. Yeah. It's possible to induce neuroplasticity in older brains. Similarly, you know, treatments in younger adults are, you know, we know that young people are really suffering these days. Yes, yeah, yeah, yeah. So there's evidence that TMS works well in adolescence. Is there something with older folks that TMS works, but then there's something to do with the wisdom of old age where they're able to, they don't, maybe they kind of have

their own built-in version of therapy, or they're able to like do something a little bit more with the neuroplasticity because they're old and wise. I think so. That's a possible explanation. Can I pitch you on a whole different type of therapy right now? Let's go for it. So my favorite person, in the entire world was my grandfather. He was 95 years old. And during the pandemic, I would go and visit him for a week or two at a time. I would get tested for COVID before.

And there was something about this man's ability to be in the moment. He would putter around his little apartment. He would sing little Italian songs to himself. The way he would do these chores he'd done a million times as if he was doing them for the first time was just amazing. And just watching him like make a risotto, the way he would pour the chicken broth in like so delicate. with his little tongue tucked to the side.

To me that was he was just radiating this joy but also like wisdom. And I found just being in that presence was like very helpful for me. And I think a lot of the things we've been talking about, you're stuck in your head with these looping thoughts and then you get to be out in the world. I feel like, and I've done a little bit of the research on this, but with age comes the opportunity, not always, comes that wisdom to be in the world a little bit more.

And so I feel like we got a lot of elderly folks that are lonely. folks that are lonely. We've got a lot of young folks that are lonely. And it feels like such an obvious thing to create more intergenerational hangouts. Just hanging out with some of the elderly people in your life feels like it could be a larger solution to the problem we're sitting with here where a lot of people are struggling. There's my pitch. I love it. I think it's a great idea. I think it's a, you know, a program that we could implement as a way to help reconnect people and potentially capitalize on that period once people are well to keep them well. So maintaining those connections and building those connections once people have recovered from

episode, I think is really, really important. I saw once a documentary about a daycare and an old age home. So maybe we need to build that in a little bit. Co-location, absolutely. TMS right now feels like it's from the future, but I wanted to talk about the future of TMS. personalization. I think in every healthcare conversation I've been in in different domains, someone needs to talk about personalization. So what does further personalization look like in TMS? I mean, we are, we are, we are, we are, like my brain's going to explode. Okay.

Because we can go in slow here. We can take our time. We got all the time in the world. It's such an exciting time to be working in this area. The speed of change, is remarkable. The tools that we have are you know that they're incredible will show you the tools that we have but but 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. Okay. And so that

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%. And because I think part of the reason that sometimes TMS doesn't work is that we're not at the right frequency. It's not the right tune for that person. Yeah, yeah. And so we're getting a lot better at being precise, both with respect to space and time. So we talk about the space-time continuum. Okay.

Yeah. The brain is not a static organ. It's constantly in motion. So we're moving. We need to catch the area both where it is and when it's actually moving. So you, okay, I'm going to have to explain this to me like I'm five, most likely. but you're matching a wave in time. So you're like trying to find the rhythm of it.

Like you're trying to dance with it almost. Correct. We want to catch it at the right place. And if we have cheap brain scan technology, we can do that. Correct. So there are cheap tools. It's called EEG is or electroencephalography. It's a pretty cheap tool.

Very well done on the pronunciation there. I'm not going to be able to get that. I try. I try. And so we, those tools can be integrated relatively easy in community settings. And as we get better at it, it may be something that is integrated and personalized in a scalable way. But it's too expensive now. I think it's not only that it's too expensive, we don't have the right way of doing it at

scale. We can do it in our very precise way within the clinic, but that's what we're working towards. So depression is obviously not a singular thing, right? So in terms of the neurological imprint of it, it would be very different for different folks. And what you're doing now, this is me, this is a question, not a statement, is, We have a general idea of the circuits for most people and you're hitting those. But you could get very specific of like, what does this person's depression actually look like?

Exactly. And that's the work that we're doing. So we're using kind of more expensive and involved tools like imaging, that in fMRI or functional magnetic resonance imaging is a tool that we use. So I did tell you before you have to say all the acronyms. So thank you. Yeah. So with expensive tools like imaging, we can detect what happens when we deliver that TMS pulse. And yeah, I think that we're kind of in a space that where we can understand the each individual person's depression. Because depression is one thing, but within a person, the circuitry can be different.

Yeah. So you said something to me. when we talked before, and it was, I'm trying to remember it now, it's on another sheet. I have a quote, but I'm just going to remember it. The circuitry of depression is highly connected to the circuitry of pain. How so? Yeah, so pain often causes intense emotions. And so 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. And that's one of the areas that we're really interested in studying, whether we target the pain circuitry. Yeah. And if we target the pain circuitry, can we improve the depression? And if we target the depression circuitry, can we improve the pain? And so this is all about kind of really getting down to the neurobiology of what's happening in each individual person. So we've learned the neuro, the neurology of depression well, the circuits enough to get your little electromagnetic wave in there. But this feels like a multi-purpose technology, right? If we learn the circuitry of OCD or if we learn the circuitry of, can it be used to, I mean, I guess every trial has to, you have to reset and do it for that.

But is it multipurpose use for different disorders? Absolutely. Okay. So this treatment's approved for patients who have refractory, who have not responded to medications and therapy for it and they have obsessive compulsive disorder yeah it's approved for patients with substance use disorders there is really 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 so there's tremendous potential for this treatment across disorder

Huh. So that's, so we talked about this, these ruminating loops, the self-reference, the default mode network on fire. And we see that in different disorders, right? From OCD to generalize anxiety disorder, major depressive disorder, da, da, da, da. And so what I'm curious is, is there a common thread here of this? I mean, we already talked about capture, but is there a common thread here, although these are, these are very distinct with separate symptoms. Is there like an underlying? almost similar like neural basis or mechanism for how people get trapped? Yeah, I think so. And I think it kind of goes back to some of that default motor network that you were talking about. A lot of the dysfunction, the disorders that we treat have common circuitry. But the way of treating them may be slightly different with respect to which door you hit. So these circuits have multiple access points. So it might be that there's a different access point for trauma or there's a different access point for treating substance use.

Does this, I know I said it off the top, I feel like you're so used to doing this and it happens incrementally. But does this feel like sci-fi to you? Does this blow your mind to be doing right now? Yeah, I mean, when I go back and think about my training, we had a couple of treatments. And we're living in the world in the Depression where we have a multitude of treatment. treatments that are being developed so rapidly, are demonstrating efficacy. It's, it's an incredible time. But where we struggle is figuring out which treatment works for which individual.

Right. I can't look at one person and say psilocybin is the right treatment for that person or TMS is going to work for that person. But I think we're getting to that point where we'll be able to understand each individual person's depression. and deliver the treatment that's going to work for them. The other end of the spectrum with TMS is that you can actually deliver TMS in a way at a very high intensity and high frequency that is very similar to ECT, but without the memory side of it.

Okay, yeah. So we're at a place potentially where people can get the effect of having a very small seizure-induced, that very powerful effect of when other things haven't worked. without the cost of ECT, which is memory impairment. So if you use TMS, TMS is much more focal and is not carried to the other areas of the brain that are involved in memory. And so you can not impact memory by using TMS to induce a seizure. So that treatment's called magnetic seizure therapy. Okay.

And that's something that's been developed. MST. Exactly. Okay. So we've got to get the acronym. We're not supposed to use acrony. I can get it in there. So we have all these new tools.

in the toolbox. And I remember I had a conversation with a psychiatrist named Roger McIntyre. And he told me when he started his career in the mid-90s, he felt like psychiatry was in a bit of a cul-de-sac. There weren't many new treatments for folks, and a lot of them weren't working. And he says now is not one of,

but the most hopeful times in psychiatry in his 30-plus year career. Do you, how do you see it in this moment? I'm in full agreement. I kind of feel like we're in an era where we have really good options for people. and we need to make them accessible to people. And people need to learn about all these new treatments.

I think a lot of people still don't appreciate what's available and what options there are. We don't really. It's not just people, it's also people who treat, it's not only mental health practitioners that treat people. A lot of primary care physicians aren't aware of all these new options. So it's less about if we know these things work

and it's more about sequencing. Like who, when, and, and, I guess the wear is obvious, but yeah. Yeah, that would be a better mental health system where we have a kind of a stepped care pathway where people start with something that's very accessible at home and potentially access to treatment that's, you know, more intensive, more invasive where they potentially come into the clinic. So what do we have now in Ontario then in terms of a system? We're working on it.

Okay. We're getting there. So there's the Ontario structured psychotherapy program where people can access cognitive behavioral therapy people can access medications. Hopefully people are going to be able to access TMS in a more kind of geographical, geographically equitable way. Do you think people have proper access to all these tools, new tools in the toolbox

right now in Ontario? I think we're working towards it. I think there are one, so some of these newer treatments don't quite yet have the evidence needed to implement them broadly. Some of them do have the evidence. and we need to push people along to say that these are important. We can actually improve the health of our population

if we make these more accessible. I think it's going to be really important to integrate TMS into that kind of step to care pathway. We know that if people have access to TMS earlier in the course of their illness, so if they've not responded to something like therapy or medications, the earlier they access TMS rather than after four

or five different medication failures, there's a better chance that they respond to the treatment. Okay, man, thanks for, thanks for doing this. It's a real joy to hang out here and talk to you. Thank you. Cheers. We do a handshake. If you're enjoying this series, please consider supporting TVO with a donation to make more insightful and thought-provoking podcast possible. TVO is a registered charity, and you will receive a tax receipt for your gift. Visit TVO.org slash give TVO to make your donation today.