A better way to treat psychiatric conditions

imagine for a minute that you’ve had an

accident

and you think you may have broken your

arm so you go to the hospital

and the doctor confirms with an x-ray

that yes it is indeed broken

and you need a cast well you wouldn’t

expect the cast

to look like this sure this may help the

broken bone

but it’s also going to create new

problems like a lack of mobility and

other limbs

you may lose weight because it’s harder

to eat and it’s definitely going to

limit your ability to do any kind of

exercise

so when you break your arm this isn’t

what’s done

instead it looks something like this

where doctors apply casts just to the

broken

bone and don’t cast the other limbs that

aren’t broken

so what about using a similar approach

to treat a psychiatric condition

what if like healing a particular limb

we can treat

particular areas of the brain that are

underlying a particular psychiatric

condition

surely it doesn’t make sense to treat

the whole brain

when only certain brain areas are

functioning differently in someone with

a psychiatric condition

take depression for example now 264

million people worldwide

suffer from clinical depression 264

million

and i’m sure you all know that clinical

depression is associated with

persistent sadness and sometimes even

suicidal thoughts

but what you might not know is

depression can also affect your ability

to sleep

your appetite can affect your

concentration

be associated with physical pain and

digestive problems

but despite how common and debilitating

depression is

most common treatments for depression

still look a bit like the whole body

cast

they affect the whole brain rather than

just the brain areas that are

functioning differently

in someone with depression and this

results in treatments that don’t work

very well and if they’re going to work

at all they take

weeks to get there and they often have

horrible side effects

take for example antidepressant

medications

if you were to take an antidepressant

medication it would change the chemical

balance

across your brain and this could result

in side effects like insomnia

nausea and weight gain this is

essentially

like pouring car oil all over your car’s

engine when the oil needs topping up

now some of the oil is likely going to

land in the right place but it’s also

going to cause other problems with the

engine

when the oil lands in other areas so

this really isn’t a great method

so how can we treat just certain areas

of the brain and not the whole brain

well researchers have developed a tool

that can do this called

transcranial magnetic stimulation tms

and tms can be used to just treat brain

areas

that are functioning differently in

someone with depression and it does this

using a magnetic field

and because it just treats these

particular brain areas

it doesn’t have the side effects

associated with other depression

treatments

so this is great we have a treatment

that can selectively treat these brain

areas and not treat the whole brain but

we have two

problems firstly it takes a long time

the tms treatments we have now take six

weeks of coming to the clinic

every day imagine you’re feeling the

worst you could possibly feel

you’re suffering with severe clinical

depression you can’t work to provide for

your family

you can’t sleep you have this brain fog

that makes it almost

impossible to concentrate on anything

and you find it very difficult to

get out of bed during the day now six

weeks is a long time to be feeling this

way to see if well maybe you might feel

better at the end of it

especially if you consider this could be

the third

fifth or even tenth treatment that

you’re trying for your depression

and the second problem that we have with

tms treatments right now

is after this six weeks of waiting

there’s only about a thirty percent

chance that you will feel better

which isn’t particularly good odds

so my colleagues and i at stanford

university wanted to try and make this

treatment better

we wanted it to work for as many people

as possible

and work as quickly as possible

so how did we try and improve this

treatment well we took into account

differences

in people’s brains now everyone’s brain

is wired differently i don’t think

anyone listening to this

thinks their brain is wired in the same

way as elon musk’s

mind definitely isn’t everyone’s brain

is different

just like everyone’s fingerprints are

different

and that means that the best place to

apply this tms treatment

is slightly different in each person’s

brain

so we took images of people’s brains

using mri scanners

and used this information to find the

best place to apply this treatment

based on each person’s individual brain

and as well as personalizing the

treatment for each person’s

individual brain we use neuroscience

research to decide how much of this

treatment to give

and how often to give this treatment so

that we could fully optimize this

treatment

and the treatment we designed was just

five days long

so that if we were going to see

improvements in people’s depression

we were gonna see them fast

so what happened well after our five day

treatment

ninety percent of people in the clinical

trial felt better

they no longer met clinical criteria for

depression

in fact on average people felt better in

just three days

and we didn’t see the side effects

associated with other depression

treatments

because we weren’t treating the whole

brain we were just

targeting those brain areas associated

with depression

now this is so exciting because it means

it’s possible

to treat clinical depression both

quickly and effectively

without side effects but depression

isn’t special we can use targeted

personalized treatments like this

to treat other psychiatric conditions

if we can identify brain areas that are

underlying a particular condition

or a symptom then we can use treatments

like these

to change those brain areas to provide

quick and effective treatment and

treatments like these could be

particularly important where acting

quickly

is vital imagine a veteran with

post-traumatic stress disorder

that’s so severe that they have a plan

to kill themselves soon

or an individual with an eating disorder

that stopped

eating and is wasting away more and more

every day

fast and effective treatments are vital

to save the lives of individuals with

conditions like these

so just like we apply a cast to a broken

arm

and not the whole body targeted tms

treatments could be used to treat just

the brain

areas that we need to treat rather than

treating the whole brain

to potentially provide fast and

effective treatments without side

effects

i look forward to a future where we have

fast and effective treatments for all

psychiatric conditions

thank you so much for listening

you