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