The Tim Ferriss Show
#714: A Glimpse of the Future: Electroceuticals for 70%–90% Remission of Depression, Brain Stimulation for Sports Performance, and De-risking Ibogaine for TBI/PTSD
Episode guests
Podcast summary created with Snipd AI
Quick takeaways
- Accelerated transcranial magnetic stimulation (TMS) shows promise as a fast and efficient treatment for severe and treatment-resistant depression.
- Personalized brain imaging could play a crucial role in tailoring treatment for individuals with depression, leading to higher remission rates compared to conventional treatments.
- The field of psychiatry is moving towards personalized interventions targeting specific brain circuitry, which could revolutionize mental health treatments.
- Ibogaine has potential in improving traumatic brain injury (TBI) disability and attenuating physical withdrawal symptoms in opiate addicts, but further research is needed to understand its mechanisms.
- Ibogaine is being explored as a potential treatment for addiction in Kentucky, offering alternative options beyond replacement therapies.
- Psychedelic treatments show promise in rapidly transforming individuals with mental health conditions and may offer new avenues for treatment.
Deep dives
Summary of Podcast Episode
This podcast episode discusses the use of accelerated transcranial magnetic stimulation (TMS) as a treatment for depression. The treatment involves delivering a high-intensity TMS dose over a short period of time, compressing a six-week course into a single day. The results have been promising, with 90% of participants experiencing remission in a pilot study and 79% achieving remission in a randomized control trial. This approach has shown potential for treating severe and treatment-resistant depression, offering a faster and more efficient alternative to conventional treatments. Additionally, there are ongoing trials for other psychiatric disorders like obsessive-compulsive disorder (OCD) and borderline personality disorder. The goal is to personalize treatment based on individual brain anatomy and phenomenology, paving the way for a future of tailored interventions in mental health.
Safety and Side Effects
Accelerated TMS has shown to be safe, with no serious adverse events reported. The most common side effect is temporary headache, often due to coil activation of scalp nerves. Fatigue can also occur, but it is more comparable to mental exertion rather than depression-related fatigue. The treatment does not involve anesthesia and can be done in an outpatient setting.
Patient Population and Results
The patient population for accelerated TMS consists of individuals with severe and treatment-resistant depression, often with multiple failed interventions. In studies, 90% of patients experienced remission in the pilot study and 79% achieved remission in a randomized control trial. The treatment has shown higher remission rates compared to conventional treatments such as oral antidepressants, especially in more severe or treatment-resistant cases. The results suggest that target selection based on personalized brain imaging could play a crucial role in tailoring treatment for individuals.
Future Directions and Opportunities
The field of psychiatry is entering an era of circuit-based treatments, where personalized interventions targeting specific brain circuitry are being explored. The ability to subtype patients based on their brain anatomy and symptomatic presentation could lead to more effective and efficient treatments for various mental health disorders. Ongoing research trials are open for patients with conditions such as anhedonic depression, obsessive-compulsive disorder (OCD), bipolar depression, borderline personality disorder, and addiction. The goal is to revolutionize psychiatric treatments and provide more individualized and rapid solutions for patients seeking relief from their symptoms.
Ibogaine as a potential treatment for TBI
Ibogaine has shown potential in improving traumatic brain injury (TBI) disability, although further research is needed to explore pure TBI populations. The drug's unique mechanism of action, potentially involving multiple neurotransmitter systems, may contribute to its effectiveness. TBI patients could benefit from the interruption and reorganization of brain circuits provided by Ibogaine.
Ibogaine's impact on withdrawal symptoms
Ibogaine has shown promising effects in attenuating physical withdrawal symptoms in opiate addicts. The drug seems to have unique abilities to reduce withdrawal symptoms, potentially by interacting with opioid receptors and the glutamate system. However, more research is needed to fully understand the mechanism behind this phenomenon.
Ibogaine developments in Kentucky
Kentucky is exploring the use of Ibogaine as a potential treatment for addiction as part of the state's efforts to combat opioid abuse. There are ongoing discussions and hearings on the safety and effectiveness of Ibogaine, especially in comparison to other treatments. These efforts aim to address the needs of treatment-resistant patients and provide alternative options beyond replacement therapies.
Implications of Ibogaine's efficacy
Ibogaine's effectiveness in a wide range of psychiatric conditions, including addiction, anxiety, depression, and PTSD, suggests its potential as a valuable therapeutic tool. Further research is needed to better understand the mechanisms of action and optimize its use. The unique properties of Ibogaine warrant further exploration to maximize the benefits and minimize any potential risks associated with its use.
The Potential of Psychedelic Treatments
Psychedelic treatments have shown potential in rapidly transforming individuals with severe mental health conditions. Remission rates are high, and the effects have been durable, with some individuals experiencing lasting benefits for over a year. The use of psychedelic substances in therapy has shown promise in treating conditions such as depression, PTSD, and addiction. Some anecdotal reports suggest that these treatments can enhance perceptual faculties and improve performance in various domains. While more research is needed, the field of psychedelic therapy is expanding and may offer new avenues for treating mental health disorders.
The Role of Neuromodulation in Mental Health
Neuromodulation techniques, such as transcranial magnetic stimulation (TMS), are being explored as potential treatments for mental health conditions. TMS has shown promise in aiding the treatment of depression, anxiety, and other psychiatric disorders. By targeting specific brain regions, neuromodulation can potentially enhance brain function and alleviate symptoms. These approaches offer a more targeted and personalized approach to mental health treatment, and ongoing research aims to uncover their full potential. If neuromodulation can be utilized to improve specific cognitive functions or induce a desired state of mind, it could have implications for performance enhancement and various therapeutic applications.
The Future of Psychiatry and Brain Modification
The future of psychiatry may involve a shift towards more precise interventions that target specific brain circuits and functions. Advances in neurostimulation techniques and the ability to manipulate brain activity could lead to innovative treatments for mental health disorders. There is speculation around the possibility of changing specific cognitive or behavioral traits through targeted interventions. However, such developments raise a host of ethical and practical considerations. While the field is still in its infancy, ongoing research and explorations into brain modification hold the potential to revolutionize mental health treatment and open up new possibilities for understanding and shaping the human mind.
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Welcome to a very special episode of The Tim Ferriss Show, an episode that might be an example of peeking around corners and catching a glimpse of the future of mental health treatments in the next five to ten years.
My guest is Nolan Williams, MD (@NolanRyWilliams). Nolan is an associate professor within the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine and director of the Stanford Brain Stimulation Lab. He has a broad background in clinical neuroscience and is triple board certified in general neurology, general psychiatry, and behavioral neurology and neuropsychiatry. Themes of his work include examining spaced learning theory and neurostimulation techniques, development and mechanistic understanding of rapid-acting antidepressants, and identifying objective biomarkers that predict neuromodulation responses in treatment-resistant neuropsychiatric conditions.
Nolan specializes in looking at cutting-edge treatments and new technologies that can be applied to treatment-resistant psychiatric disorders—so, treatment-resistant depression, disorders that are notoriously difficult to address, such as OCD, and many others.
Nolan's work resulted in an FDA clearance for the world's first noninvasive, rapid-acting neuromodulation approach for treatment-resistant depression. And I've tested this myself, and we get into this in the conversation. He has published papers in Brain, American Journal of Psychiatry, and Proceedings of the National Academy of Sciences. Results from his studies have gained attention in Science and NEJM Journal Watch. He has received two NARSAD Young Investigator Awards, the Gerald L. Klerman Award, and the National Institute of Mental Health Biobehavioral Research Award for Innovative New Scientists.
We also discuss things like ibogaine that are seemingly unrelated to neuromodulation, as Nolan is very well-versed in multiple disciplines and in multiple toolkits, both pharmacological and non-invasive neuromodulatory. It's this combination, actually, this rare Venn diagram, that makes him incredibly interesting to me. I really enjoyed this conversation. I think it is very important, highly tactical, and I hope you enjoy it as much as I did.
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[00:00] Start
[07:49] How SAINT helped Deirdre Lehman.
[13:59] Typical vs. atypical sequences of activation.
[21:00] Psychiatry 1.0, 2.0, 3.0.
[26:41] How SAINT (Stanford Accelerated Intelligent Neuromodulation Therapy) came to be.
[34:00] TMS vs. ECT.
[35:26] Rewards and risks of shortening treatment timeframe.
[43:43] Numbers treated and common side-effects.
[46:32] Patient demographics.
[49:51] Where to find current open trials.
[51:01] Observed benefits of SAINT over more conventional treatments.
[52:45] Adapting treatment when symptoms prove misleading.
[58:03] SAINT remission numbers versus those of alternative therapies.
[1:02:50] Delayed remission speculation.
[1:07:06] How Nolan became The Ibogaine Bachelorette.
[1:11:37] The origin of Nolan’s interest in ibogaine.
[1:12:40] Amazing results of the quickest-recruiting study Nolan has ever run.
[1:15:19] Dealing with alexithymia and self-reporting inaccuracies in research.
[1:19:41] Ibogaine research gets federal funding (approved since this conversation took place)!
[1:21:09] Isolating the ibogaine effect.
[1:21:49] The value of life review on ibogaine.
[1:25:56] How ibogaine differs from other psychedelic treatments.
[1:30:05] The challenge behind synthesizing naturally occurring compounds.
[1:31:54] Coping with ibogaine’s cardiac risks.
[1:39:37] Understanding habitual action through ibogaine, Ozempic, caffeine, and alcohol.
[1:45:43] Ibogaine for TBI.
[1:50:08] Ibogaine for alleviating opioid withdrawal symptoms.
[1:51:34] Ibogaine in Kentucky.
[2:00:59] Weighing ethics with potential outcomes in research.
[2:04:31] Can ibogaine be sourced (or synthesized) sustainably?
[2:08:24] Does 5-MeO-DMT complement ibogaine enough to justify its collection?
[2:16:48] What might Psychiatry 4.0 look like?
[2:25:12] Could we develop therapies to change hand dominance?
[2:28:08] Boosting performance.
[2:34:01] Parting thoughts.
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