Episode 30: TMS, Depression, and Dementia — A Game-Changing Brain Therapy

Transcranial Magnetic Stimulation, or TMS, is one of the most powerful, safe, and underused treatments in modern neuroscience. It requires no anesthesia, no surgery, and no medication, yet has shown remarkable success in patients with severe depression, cognitive decline, OCD, PTSD, addiction, neuropathic pain, migraines, and post-stroke deficits. Despite decades of evidence, most people, including many clinicians, have never been exposed to what TMS can do.

In this episode of *The Dr. Kumar Discovery Podcast*, Dr. Ravi Kumar sits down with neurologist **Dr. Ali Elahi**, founder of NeuroSpa Brain Rejuvenation, to explore how TMS works, why it remains overlooked, and why it may be one of the most transformative tools for brain health today. You’ll learn how electromagnetic pulses can reactivate dormant neural circuits, strengthen connectivity, boost neurotransmitter release, and create durable changes in mood, cognition, and behavior, all without the systemic side effects of medication.

This conversation is essential for anyone navigating depression, dementia, cognitive decline, chronic anxiety, or treatment frustration, or for families seeking new options after exhausting standard approaches.

Episode Highlights

TMS as a noninvasive brain-modulation therapy that stimulates targeted neural circuits
Why TMS is heavily supported by research but rarely discussed in mainstream medicine
How TMS treats depression that has not responded to medication or therapy
Success rates for modern TMS protocols and why remission is possible
How accelerated protocols like SAINT condense 36 days of treatment into one week
Why patients often feel their best several weeks after completing TMS
The limitations of antidepressants and the oversimplified serotonin theory
How TMS improves symptoms in Alzheimer’s and other dementias
What happens to biomarkers like amyloid and tau after TMS
Targeting the prefrontal cortex, parietal regions, and precuneus for cognitive improvement
Why medications have failed in dementia and why TMS offers new hope
The extremely low risk profile of TMS compared to antidepressants and procedures
How neural connectivity, microglial function, and vascular flow improve with stimulation
What a TMS session feels like and what patients can expect
Why TMS is effective across conditions involving disrupted brain networks

Show Notes

What TMS Is and How It Works

TMS uses focused electromagnetic pulses to stimulate specific regions of the brain. This stimulation induces electrical currents in neural tissue, strengthens connectivity, increases neurotransmitter release, and enhances blood flow. Patients sit comfortably in a chair while a figure-eight coil gently taps on the scalp. There is no sedation, no pain, and no systemic side effects. With repeated stimulation, neural circuits begin firing more efficiently, leading to improvements in mood, motivation, cognition, and emotional regulation.

Why TMS Outperforms Medications for Many Patients

Antidepressants help about 30 to 40 percent of patients, and much of that benefit is placebo. TMS has shown 40 to 60 percent success even in people who failed multiple medications. Modern targeted approaches using MRI navigation, EEG biomarkers, and multi-site stimulation can reach 80 to 90 percent success, with remission rates around 40 to 60 percent. These results are rarely seen with medication and do not require lifelong daily pills or management of side effects like weight gain or sexual dysfunction.

Accelerated Treatment Protocols

Newer protocols such as Stanford’s SAINT approach compress 36 traditional sessions into five days by delivering several short sessions throughout the day. These accelerated treatments have demonstrated more than 90 percent success in severe depression. Many patients continue improving for weeks after the final session as neural circuits reorganize and strengthen.

TMS for Dementia and Cognitive Decline

Dementia has resisted decades of pharmaceutical development, but TMS has shown meaningful improvements in memory, attention, mood, agitation, and day-to-day functioning. Families often report improved engagement, calmer behavior, and better communication. Emerging research suggests that biomarkers associated with Alzheimer’s disease, including phosphorylated tau and amyloid ratios, may improve after treatment. Mechanisms may involve enhanced microglial cleanup, improved vascular flow, and strengthened cortical networks responsible for executive function and memory.

Safety Profile and Side Effects

TMS is among the safest treatments in neuropsychiatry. Mild scalp discomfort and occasional headache are the most common issues. Fatigue can occur but is temporary. Seizures are extremely rare, about 1 in 30,000, lower than the risk associated with many antidepressants. TMS does not cause weight gain, emotional flattening, hormonal disruption, or cognitive dulling, and it does not require recovery time.

Why TMS Remains Underrecognized

Despite overwhelming evidence, TMS has not gained mainstream visibility because it is not profitable in the way medications are. There are no large advertising budgets, no recurring prescription refills, and no pharmaceutical marketing campaigns. As a result, a therapy that can safely improve depression, cognition, and neurological function remains unfamiliar to most patients and clinicians.

About the Guest

Dr. Ali Elahi, MD
A board-certified neurologist and director of NeuroSpa Brain Rejuvenation, Dr. Elahi specializes in advanced, personalized TMS treatment for depression, dementia, OCD, PTSD, chronic pain, and post-stroke rehabilitation. His work integrates high-resolution brain mapping, individualized targeting, and cutting-edge stimulation protocols. He is actively advancing research on TMS in memory disorders and is committed to providing safe, effective alternatives for patients who have exhausted conventional options.

Website: https://neurospabrain.com
Clinic Phone: (949) 652-7301
YouTube: https://www.youtube.com/@neurospabrain

Listen on Your Favorite Platform

Apple Podcasts → https://podcasts.apple.com/us/podcast/the-dr-kumar-discovery/id1808415094
Spotify → https://open.spotify.com/show/3UJhg3Y5jjLP8zO6hbpwfT

Explore More Episodes

https://drkumardiscovery.com/podcast/

Transcript

[00:00 –> 00:32] Dr Kumar: On this episode of the doctor Kumar discovery, we’re talking with doctor Ali Alahi, a board certified neurologist who specializes in a remarkable therapy called TMS or transcranial magnetic stimulation. Most of you have probably never heard of TMS. It’s not advertised. It’s not taught in medical school. It’s not taught in residency, and yet, it’s one of the most well studied evidence based noninvasive treatments we have for a whole range of neurological and neuropsychiatric conditions.

[00:33 –> 00:54] Dr Kumar: TMS carries minimal risk. There’s no anesthesia, no surgery, and no medications involved. And the benefits can be profound. It’s been used for depression, OCD, PTSD, addiction, dementia, chronic pain, and even post stroke rehabilitation. The clinical results in many of these areas are frankly extraordinary.

[00:54 –> 01:30] Dr Kumar: So in this episode, we’re gonna explore what TMS is, how it works, what the treatments look like, and what patients actually experience. More importantly, we’ll talk about when TMS might help you or someone you love, especially if you or they feel stuck, you’re suffering, or out of options. For many of you, this may open up a window into a fascinating world of brain health that isn’t dominated by pharmaceutical incentives and yet still offers real life changing potential. So before we dive in, one important reminder. This show cannot be used as medical advice.

[01:30 –> 01:52] Dr Kumar: My goal is to give you the knowledge you need to feel empowered so you can take what you learn here, bring it to your doctor, and have the conversations that help you make the best decisions for your health. Because I believe knowledge is power. And the more knowledge you have, the more power you have. Also, this show is completely separate from my role as assistant professor of neurosurgery at UNC. Okay.

[01:52 –> 01:59] Dr Kumar: So with all that said, let’s get into it. Doctor. Lahi, thanks so much for coming on the show. It’s really I’m really excited to have you here today.

[01:59 –> 02:03] Dr Elahi: Absolutely. It’s also my pleasure, and I’m excited to be here as well.

[02:03 –> 02:36] Dr Kumar: Do you specialize you’re a board certified neurologist who specializes in a procedure, a medical technology that almost no one has heard about, but is surprisingly well researched and very effective at treating problems that have to do with the central nervous system, namely the brain. I mean, I’m a a neurosurgeon, and I hardly know about this. I mean, it’s even though the research is out there, and it’s all had to do with the medical economy and how it works. Yes. And if you can make a ton of money off of drugs, then everyone knows about it.

[02:36 –> 02:37] Dr Kumar: It’s on every commercial. It’s on the Super Bowl.

[02:37 –> 02:38] Dr Elahi: That’s right.

[02:38 –> 02:52] Dr Kumar: But when you have a technology that really, really works, but there’s not a ton of money to be made of off of, you just hardly hear about it. And so that’s what I wanna hear about from you today. So can you just start off by maybe telling us what TMS is?

[02:52 –> 03:26] Dr Elahi: Yes. So you’d be absolutely right, doctor Kumar, in that there’s a lot of technology and a lot of advances in neuroscience that people are not made aware of. And again, this is not uncommon for physicians like yourself, my colleagues who have maybe heard of it, but they don’t really know the whole breadth of its uses. So TMS stands for transcranial magnetic stimulation. So what it is is part of an umbrella of treatments called brain modulation or more specifically noninvasive brain modulation strategies.

[03:26 –> 03:45] Dr Elahi: By noninvasive, it means that we’re not inserting any kind of devices into the brain. We’re not poking the patients with IVs. We’re not introducing any chemicals, and relatively speaking, it’s almost risk free. So that’s where the noninvasive comes from. Brain, obviously, we’re stimulating the brain.

[03:45 –> 04:31] Dr Elahi: We’re modulating brain function. By that, I mean that we’re changing or in some ways optimizing the electrical currents and frequencies of brain cells and thereby changing for the better the chemical and the connectivity of the brain. And that type of paradigm has been in existence for several decades, but it has been now enhanced and there’s now tons more research, clinical trials, also basic science trials that show the exact mechanisms by which it works. So basically, it’s application of of electromagnetic pulses to targeted regions of the brain. So the short answer to your question is electromagnetic stimulation of the brain.

[04:31 –> 04:36] Dr Kumar: Okay. And with, you know, transcranial magnetic stimulation, what kind of problems can you treat?

[04:36 –> 04:56] Dr Elahi: So initially, initially had done a ton of experiments and trials on mood disorders such as depression. And probably that is the most popular use of TMS even at the moment. Even though TMS has now become a viable treatment for many other disorders which I’ll talk about. Depression, I. E.

[04:56 –> 05:36] Dr Elahi: Severe depression, that one that does not respond or has not responded to the standard medication treatments is one that’s a bonafide FDA approved on label treatment. By the way, it’s also to many people’s surprise FDA approved on label for OCD, obsessive compulsive disorder, for smoking cessation of all things. But it has been used and found to be helpful in memory disorders such as even memory disorders such as dementia, Alzheimer’s. And that’s what surprises a lot of patients. Post stroke recovery, those who had paralysis of their arms or legs or speech following a stroke.

[05:36 –> 05:59] Dr Elahi: When applying TMS patients recover faster and more robustly than just with physical therapy or speech therapy alone. So those are some of the most popular uses of TMS. It has been also used for pain management. So patients with chronic neuropathic pain. Are you familiar with trigeminal neuralgia for example with neuropathic pain from spinal disorders?

[05:59 –> 06:17] Dr Elahi: The use of TMS and due to its effect on brain modulation and centers and connections in the brain that are involved in pain has been shown to help reduce neuropathic pain. So there are several uses and those are some of the common ones that we’re excited about and we often see patients for.

[06:17 –> 06:28] Dr Kumar: Yeah. And that’s that’s really cool how broad its indication is in the brain. And just to be clear, this only treats the brain. There’s no other part of the central nervous system or body that it can treat?

[06:28 –> 06:52] Dr Elahi: Well, actually, it can actually be used to treat some musculoskeletal and spinal disorders. For example, you can apply electromagnetic stimulation to nerve injuries in the peripheral nervous system. I’ve seen it used for sciatic nerve injuries. I’ve seen it used for upper shoulder nerve injuries with some success. So this goes back to the issue that this is a tool.

[06:52 –> 07:14] Dr Elahi: Know, for example, you use the scalpel to do many things, right? You have tools to do many things. And so we need to make sure patients and people understand this is a tool. How you use it is very important and can be very much different from clinic to clinic and protocol to protocol. You can excite nerves, meaning increase their activity.

[07:14 –> 07:29] Dr Elahi: You can inhibit nerves through the use of certain frequencies, amplitudes, and rhythms of electromagnetic stimulation. So by the way, I forgot to mention TMS is also FDA approved on label for migraine headaches as well.

[07:29 –> 07:37] Dr Kumar: Yeah. And that’s definitely something I wanna talk about later because that that’s I mean, that’s that is a source of misery for people all around the world.

[07:37 –> 08:12] Dr Elahi: Absolutely. Now the reason I stress FDA approved, not because I have a lot of respect for the FDA, honestly, but because they have been pushed or overwhelmed with so much evidence that they have been compelled to approve it because they’re often accustomed to approving medications. And when the FDA puts their stamp of approval as on label on a product or a service or a treatment it means that there’s no way they could deny it. There’s so much overwhelming evidence. Double blind control trials, the highest levels of class a evidence, there’s no way they can argue against it.

[08:12 –> 08:19] Dr Elahi: And so to get that kind of thing suggests that this thing is very much scientifically proven and legit.

[08:19 –> 08:29] Dr Kumar: Yeah. And if you just, you know, take go through PubMed and search transcranial magnetic stimulation or TMS, I mean, there’s hundreds and hundreds of papers going back decades

[08:30 –> 08:30] Dr Elahi: Yes.

[08:30 –> 08:57] Dr Kumar: With many clinical trials, double blinded trials or sham trials. And the fact that we’ve never heard of it, but it’s so heavily researched, it just shows you how, you know, we don’t hear about these technologies that can make a big difference but are economically just not major drivers of of income for companies Exactly. And providers. I hope you’re enjoying this episode so far. Before we go any further, I have a quick favor to ask.

[08:57 –> 09:14] Dr Kumar: Please head over to Apple Podcasts and take a moment to rate and review this show. It makes a massive difference. Your reviews help the algorithm notice this kind of content, and the more people who say it matters, the more the show gets pushed out to others who might truly benefit from it. Alright. Back to the episode.

[09:14 –> 09:29] Dr Kumar: So okay. So let’s just do this, doctor Alahi. You know, because many of us have not heard of TMS, can you just visualize for us what a setup looks like? Because when I bet many people are thinking they’re going into a tube like an MRI scanner, but that’s not it. Right?

[09:29 –> 09:35] Dr Kumar: Tell us what this thing looks like, what a person getting TMS looks like, their whole scenario.

[09:36 –> 09:59] Dr Elahi: Yeah. So, basically, it’s very much noninvasive. It’s not something you go into a tube like an MRI. You’re sitting on a chair, kinda like a dentist chair, and this what looks like a ceramic figure of eight kinda plate sits on a specific region of your scalp. Of course, we can go into details of how we use the coil or this plate looking structure and how we target.

[09:59 –> 10:25] Dr Elahi: But basically, it’s sitting on top of the scalp, and you’re watching TV or sleeping during the entire process. Patients often ask what does it feel like? The most common description that people say is like a what actually a comedian, famous comedian who also did TMS said, it looks like a kind of like a shitty woodpecker who, you know, is hitting your head a few times a second. It doesn’t hurt. It can be somewhat uncomfortable in the beginning.

[10:25 –> 10:54] Dr Elahi: I’ve done it to myself many times. And depending on how how intense we need to apply it, depending on your scalp characteristics, scalp skull thickness, and so on, it’s basically a tapping sensation. And there’s now plenty of YouTube videos and others on social media that you can see exactly what it looks like and people describe it as like a tapping sensation. By the way, the reason I found this to be so fantastic is because I started doing it on my own family members.

[10:54 –> 10:55] Dr Kumar: Were you treating them for?

[10:55 –> 11:16] Dr Elahi: Well, for example, my father had bipolar depression symptoms. My wife had peripartum anxiety. My sister’s daughter had ADD symptoms. My father came back again later for memory issues. And the reason I did that is because I wanted to make sure it’s safe and who else to practice on than your own family members.

[11:16 –> 11:16] Dr Elahi: Right?

[11:16 –> 11:20] Dr Kumar: Right. This was before you started your clinical practice?

[11:21 –> 11:28] Dr Elahi: Yeah. It was just fantastic. My mom said for the first time, your dad is actually waking up motivated to do things rather than just sleeping all day.

[11:28 –> 11:29] Dr Kumar: That’s fantastic.

[11:30 –> 11:55] Dr Elahi: And so, you know, I didn’t trust just the papers themselves. I went out and did it on myself, on many other patients, of my own patients, family members, and the results were fantastic with little to no side effects. And so I started doing it more and more. I tried to figure out how to perfect it. But going back to your question, it’s basically like you’re sitting on a dental chair watching TV, and someone’s massaging your scalp or tapping it.

[11:55 –> 12:00] Dr Kumar: Okay. And so this figure of eight, this is a magnetic coil. Correct?

[12:00 –> 12:22] Dr Elahi: That’s right. So what it is is there’s a is a wire, copper wire Mhmm. That’s circling inside this figure of eight ceramic encasing. And when you pass electricity through a wire, it creates a magnetic field perpendicular to that wire. That magnetic field can trigger a small electric shock, any kind of conductive substance.

[12:22 –> 12:44] Dr Elahi: So the brain, of course, is full of ions, it’s full of salts, and of course, it works through the use of electrical communication. And so it’s a conductive substance. So when you pass electromagnetic field through the scalp, it can create electrical changes in the brain and it bypasses the skull. So it’s not a direct electrical stimulation. Interestingly, there is that too.

[12:44 –> 13:04] Dr Elahi: There’s what’s called TDCS, transient direct cranial stimulation. They actually pass a small electric current through the skull like one time, and it does hurt a little bit because it’s actual electricity. But we use electromagnetic fields so it doesn’t hurt, and it it can bypass the skull easily without hurting the the patient.

[13:04 –> 13:14] Dr Kumar: Right. And from what I understand, you know, that TDCS has been around for a while, and it’s just not it’s just not been as effective as transcranial magnetic stimulation.

[13:14 –> 13:37] Dr Elahi: Yes. Interestingly yes. Exactly. TDCS, interestingly, has good data behind it to to some extent, and it can help but it’s not as easily applied, it’s not as targeted and you can’t keep repeating it over and over again because it hurts. And so there’s a lot more data now, there’s a lot more clinical trials with TMS because it’s so non invasive, so painless, and so risk free.

[13:37 –> 13:42] Dr Elahi: Of course, there are some inherent risks which we can get into, but those are extremely rare.

[13:42 –> 14:10] Dr Kumar: Okay. So just so the audience understands, when you create this magnetic field and it it fluctuates, it has to go on and off, it induces electric current in any type of conductive surface. So if you were driving up to a stoplight, you see that little ring cut in the road? That’s a that’s a wire, a loop of wire, and your car actually creates a magnetic field. And when you drive over that loop, it creates an electric current that sends a signal to the stoplight says, hey.

[14:10 –> 14:19] Dr Kumar: I’m here waiting. Same thing your brain is full of these changing electrical potentials that send signals through neurons, which are Yep. Essentially the body’s wires.

[14:19 –> 14:20] Dr Elahi: Exactly. When you

[14:20 –> 14:31] Dr Kumar: and when you fluctuate this magnetic field through this figure of eight coil you’re talking about, you’re gonna induce electric current through the brain. And that gets down to the basis of what you’re trying to accomplish with TMS. Correct?

[14:31 –> 14:47] Dr Elahi: Correct. Exactly right. So think of, you know, those phone chargers that you just place your phone on top of this little circular surface? That’s using electromagnetic field to charge your phone. So it’s actually inducing electric current through electromagnetic field.

[14:47 –> 15:05] Dr Elahi: When you put your hand on that, it doesn’t hurt. Does it you don’t feel anything because it’s weak electromagnetic fields. If you put your hand on top of a TMS coil, you actually feel it. You feel a little tiny tiny tap or electric shock because again, there are nerves also in your hand and you can feel those. So you hit it on the nail, that’s exactly right.

[15:05 –> 15:42] Dr Elahi: Now if we wanna go into detail how does TMS work, that electrical stimulation then causes electrical release of neurotransmitters. It increases blood flow to that stimulated region. It has been shown to increase certain types of neurotropic factors and proteins which is in large part how it works for post stroke and also Alzheimer’s. There is new synapses that form. It’s just I mean, have all been studied through functional MRI imaging, vascular imaging, and even you know, at the basic science level on animal studies and even basic cell structure evaluations following TMS.

[15:42 –> 15:54] Dr Elahi: So it it’s it’s very interesting how it works. But, yes, the underlying mechanism is is in deduction of electric current in the in the brain through the use of electromagnetic stimulation.

[15:54 –> 16:10] Dr Kumar: Okay. And so by stimulating these areas of the brain, you know, we’ll talk about the targets and the different diseases, but you are essentially stimulating a current there, but you’re also having some kind of network effect throughout the brain. Correct? Because no part of the brain works in isolation. Exactly.

[16:10 –> 16:13] Dr Kumar: We’re just we’re just a bundle of connectivity That’s right. Between our ears.

[16:13 –> 16:39] Dr Elahi: That’s right. So as you know, we now talk about connections in the brain, not so much isolated parts. Any part of the brain is is using connections to perform an operation. When you wanna speak, for example, there’s the prefrontal cortex activation, then there’s involvement of the basal ganglia and other centers in the cerebellum to coordinate the, you know, the palate and speech movements. All of those have to work in coordination.

[16:39 –> 16:56] Dr Elahi: And there’s highway tracks that connect each of these nodes. So when you stimulate this most popular area, the dorsolateral prefrontal cortex, you’re actually stimulating remote areas that are connected to that region. And one of the more popular ones is the anterior cingulate, which is directly connected to the dorsolateral.

[16:56 –> 17:05] Dr Kumar: Very neat. Okay. Let’s talk about depression because I think that’s you know, you mentioned it earlier, that’s the most studied disease that TMS can treat.

[17:05 –> 17:05] Dr Elahi: That’s

[17:05 –> 17:17] Dr Kumar: right. Depression is it affects one in five Americans at some point in their life. And around the world, it is prevalent. And, you know, if you’ve ever been depressed, it is horrible. I mean, you feel like you’re stuck in a hole.

[17:17 –> 17:38] Dr Kumar: You can’t get out. We have medications. We have cognitive behavioral therapies, which are effective. But there is a certain contingent of people who, even with cognitive behavioral therapy and medication and optimal diet and lifestyle, don’t get out of depression. And it’s called treatment resistant depression.

[17:38 –> 17:46] Dr Kumar: And that’s where this TMS possibly could be a lifesaver. So can you talk a little bit about that? Like, who would be a candidate for TMS?

[17:47 –> 18:28] Dr Elahi: Well, that is sort of the lowest hanging fruit, meaning that those are easy peasy patients that can easily be treated with TMS. But the usual candidate is the person who continues to suffer from severe depression despite having tried all of what you mentioned, multiple medications, cognitive behavioral therapy. They may have even tried electroconvulsive therapy, ECT, which is the standard shock treatment that we can go into later, And they continue to have relapses and symptoms. To be honest with you, let’s look at the data. The data shows that medications work between thirty to forty percent of the time.

[18:28 –> 18:48] Dr Elahi: That’s just the honest fact. You can get that through very large randomized trials and even a psychiatrist will tell you that if they’re honest. But even out of the forty percent, only twenty percent of that is actual placebo controlled. There’s a placebo effect that adds another twenty percent. So what about the numbers for TMS?

[18:48 –> 19:21] Dr Elahi: If you take all comers around the world, nothing fancy, they just slap this on the, you know, left side of the brain, they’re not sure where they’re stimulating, they’re not doing EEG biomarkers, no MRI, nothing, you’re you’re gonna get between forty to sixty percent success rate. And these are patients who’ve already failed medications. So these are the patients that couldn’t respond to medications. So the forty to sixty percent is really not comparable, right, because now you’re treating the guys who failed medication. However, you add nuances such as, hey, do I know exactly where I’m stimulating?

[19:21 –> 19:38] Dr Elahi: Am I using the person’s MRI to navigate? Am I using multiple targets? Am I using EEG biomarkers to kinda tell me what protocol to use? That brings it to eighty to ninety percent success rate. And as you know, this is unheard of in anything in medicine, let alone depression.

[19:38 –> 19:46] Dr Kumar: No. So There’s no surgery I do that I can say, hey, eighty to ninety percent chance that this is gonna be successful because it just doesn’t exist.

[19:46 –> 19:59] Dr Elahi: It doesn’t exist. Look at the trial from Stanford that was done. It’s called the SANT trial, the standard accelerated intelligent neurotherapeutic. Eighty to ninety percent, and that’s double blind. So no other there’s just no comparison.

[19:59 –> 20:09] Dr Elahi: Now is it 100% effective? Does it cure everybody? Of course not. But show me anything in the world that is 100%. It just doesn’t exist.

[20:09 –> 20:10] Dr Kumar: Not interested. Because there’s

[20:10 –> 20:28] Dr Elahi: so many external factors and so many things that can cause treatment failures. Regardless, in comparison to standard medications and therapy, it’s by far more effective. And guess what? You’re not taking medications every day. You’re not doing this every day for the rest of your life.

[20:28 –> 20:29] Dr Kumar: Right.

[20:29 –> 20:51] Dr Elahi: Try stopping the medication even when it’s working. There’s a huge relapse. And the relapse rate, by the way, for TMS is less than thirty to forty percent at the end of one to two years. And even then, the severity is far less than the original disease. And if they come back and do a few sessions, like maintenance, they’re back to feeling great again.

[20:52 –> 21:05] Dr Elahi: I’m not I mean, people ask me, come then how come I haven’t heard of this doctor? Why isn’t everybody doing this? And I’m like, I know it sounds too good to be true, and I know it’s frustrating because you haven’t heard about this, but here are the papers.

[21:07 –> 21:10] Dr Kumar: All Yeah. Out there. It’s all out there in the public domain. All that

[21:10 –> 21:13] Dr Elahi: It’s all in there. You can you can chat GPT it.

[21:13 –> 21:27] Dr Kumar: Yeah. Okay. So the I mean, that that’s incredible. And, I mean, the fact that, you know, you can have potentially have an eighty to ninety percent response rate, and I imagine the remission rate, which where depression’s completely gone, is decent as well. Correct?

[21:27 –> 21:28] Dr Elahi: Forty to sixty percent.

[21:28 –> 21:30] Dr Kumar: Forty to sixty percent remission rate. That means you’re cured.

[21:30 –> 21:35] Dr Elahi: That means you’re cured. That’s a great distinction. Remission rate is unheard of with medications.

[21:36 –> 21:49] Dr Kumar: Yeah. I know. And if you’re taking a medication and you’re getting a response, well then, guess what? You’re probably on that medication for the rest of your life. And it’s important to remember is that with these antidepressant medications, there’s there’s big side effects.

[21:49 –> 22:13] Dr Kumar: I mean, sexual dysfunction, which is devastating for a man or a woman, weight gain, you know, this you can help have all sorts of problems with disequilibrium, flattening of affect, you know, that’s your emotional affect. And these things, people are like, hey. I either take this and suffer, you know, these side effects. I can’t get an erection. I’m overweight now, or I sit in the hole of depression.

[22:13 –> 22:21] Dr Kumar: And those are their two choices. Whereas TMS, it doesn’t have any of those side effects, and it’s potentially more effective, which is incredible to me.

[22:21 –> 22:39] Dr Elahi: Exactly right. You know, I’m glad that you’re in the medical field because those who are not may not realize all these facts. And so and when we talk about dementia, that becomes even more important because to get the needle to move in dementia is unheard of. Right? Yeah.

[22:39 –> 22:41] Dr Elahi: To get Certainly not medication.

[22:41 –> 22:46] Dr Kumar: Oh, yeah. I mean, medications you you take are just to try to basically take a little edge off the symptoms.

[22:47 –> 23:05] Dr Elahi: That’s right. So in the medical field, when we talk about treatments, this is one of the most successful treatment options. You’re talking about a treatment that helps, you know, high cure rate, high response rate with zero I mean, we can talk about potential side effects with almost zero side effects.

[23:05 –> 23:12] Dr Kumar: Yeah. Okay. So, yeah, I do wanna talk about that. What would be the side effects? I mean, you talked about this little tapping, maybe some discomfort on the scalp.

[23:13 –> 23:21] Dr Kumar: You know, there’s some mention of people who have a history of seizure disorder or are on antiepileptics. What do you how do you address those patients?

[23:21 –> 23:49] Dr Elahi: Well, there is, as we say, the common side effects and then the rare but potential side effects. Right? As far as common side effects, yes, there’s maybe mild headaches which usually go away with Tylenol or ibuprofen here and there. Again, we know that there’s FDA approval for treatment of migraine headaches for TMS, so it can’t be like a side effect if it’s also treating it. So there’s some people experience some vibrations of the muscles around the face during the stimulation.

[23:49 –> 24:09] Dr Elahi: Some patients feel fatigue or perhaps mild dizziness. Those are the most common. Then you get it to the very rare. Seizure is listed on there, and the risk is one in thirty thousand. That means that the commonly used prescribed prescription antidepressants have a higher risk of seizures than TMS, just to let you know.

[24:09 –> 24:10] Dr Kumar: Have you ever seen it happen?

[24:11 –> 24:37] Dr Elahi: I’ve seen it in one patient who was abusing substances and on a bunch of other medications and only one time. And guess what? That those parents wanted him to come back even after the seizure because they saw huge changes, and we just modified the protocol and we had him stop all the ugly substances he was using. So out of all the thousands we’ve treated, that’s one. Now the issue is that you can treat epilepsy with TMS.

[24:38 –> 25:03] Dr Elahi: TMS has had trials to help with intractable epilepsy and we’ve actually seen it here in my office. Regardless, that’s one that’s listed. Another one that sometimes we hear about, there’s like three or four handful of cases of retinal tears or vitual humor abnormalities or tears following TMS. But out of the millions of people who’ve done this around the world, there’s like five. So it’s very rare.

[25:03 –> 25:21] Dr Kumar: I don’t think I do any procedure, and I definitely don’t prescribe any medication that has side effects that low. Just to put it out there for reference, I mean, I’ve even seen life ending injuries from aspirin. So, you know, the fact that TMS is so effective with such a low side effect is pretty out of the ordinary for medical treatments, I would say.

[25:21 –> 25:22] Dr Elahi: Exactly right.

[25:22 –> 26:02] Dr Kumar: Back to depression. So you’re stimulating a part of the brain called the dorsolateral prefrontal cortex, which if you’re watching YouTube, you can see where I I’ve got my hand, but it’s kind of right behind the hairline on this left side of the head. And this has some connections to the subgenual cortex and some other parts of the brain that are underactive or overactive in depression. So when you stimulate this left part of the side of the head, the the dorsolateral prefrontal cortex, you’re changing this abnormal circuitry, correct? And basically bringing these patients out of this abnormal rhythm or brain rhythm.

[26:02 –> 26:38] Dr Elahi: That’s right. That’s exactly right. So studies show if you do PET scans for example, if you do functional MRIs, you often find that there is hypometabolic, meaning low metabolic activity in the dorsolateral prefrontal cortex. So the simplest mechanism of action is you’re activating the DLPFC, that area of the brain, and so you’re waking that area up and patients wake up from depression. But when you look at it more carefully, it seems like the connection between that region and remote areas we touched on like the anterior cingulate, which is a deeper structure, How that interaction plays is abnormal in depression patients.

[26:38 –> 26:54] Dr Elahi: So it changes the interaction between the DLPFC and the deeper region of the brain called the anterior cingulate. And it also has been shown to increase neurotransmitters such as glutamate and also dopamine through the release of, you know, those regions of the brain that are being stimulated.

[26:54 –> 27:14] Dr Kumar: Okay. And just to be clear, when you’re stimulating, you’re activating this dorsolateral prefrontal cortex, this part of the brain I just pointed to on YouTube, and it is basically reigniting these neuronal connections and changing the brain chemistry. But you had mentioned this one time before. You don’t just do this once. Correct?

[27:14 –> 27:19] Dr Kumar: You’re doing this you need multiple sessions to reinforce the effect. Right.

[27:19 –> 27:20] Dr Elahi: Exactly. Does what

[27:20 –> 27:22] Dr Kumar: does that look like for a patient?

[27:22 –> 27:44] Dr Elahi: So it used to be thought, and the standard still is, that you have to do this once a day for thirty six times. That’s kind of like the, you know, FDA approved protocol, and that’s what’s most commonly used. So they come in once a day for about thirty minutes. They get stimulation of this region. It’s actually like thirty six minutes.

[27:44 –> 28:09] Dr Elahi: And then they do that, you know, thirty six times. However, there have been a large amount of interest in trials that are trying to make this more easy and feasible for patients because a lot of these patients are coming from out of town. We have patients sometimes coming internationally. So Stanford did a landmark trial where they did 10 sessions per day. Each session is about nine minutes.

[28:09 –> 28:38] Dr Elahi: And then they get a forty five minute break. And there’s actually science behind why forty five minutes. But regardless, they come into the office 8AM, they get this stimulation for ten minutes each, 10 times a day, and then they do that for five days, so Monday through Friday. And they’re done on Friday afternoon. And then the studies show, Stanford showed a greater than ninety percent success with respect to depression after that shortened what they call accelerated treatment.

[28:38 –> 29:06] Dr Elahi: Nowadays there have been a lot more trials showing that, hey, you don’t have to necessarily do 10 a day. Maybe you do five a day on three days of the week. Just get like between 40 or 50 sessions done because not a lot of people have the convenience of spending a whole week doing this. Maybe they want to do two or three sessions a day for five, two or three days of the week. As long as you do between forty and fifty sessions, that’s usually the number.

[29:06 –> 29:32] Dr Elahi: So patients sometimes come in and ask, Doctor, how many sessions do I need? I used to try to figure out like, okay, you need 25 or you need 20 based on history, their brain map or what have you, their EEG. But it’s like, you know, it’s a crapshoot. You can never be exactly right. So if you wanna have the high likelihood of success with a low relapse rate, most patients need forty and fifty.

[29:32 –> 29:54] Dr Elahi: Now I’ve had patients who’ve done more. I’ve had occasionally patients who’ve done over hundreds of sessions, not over a span of a week, but over several weeks or months. And the reason is because they felt that much better each time. And these are patients not necessarily for depression. They have other disorders like OCD, severe panic attacks and anxiety, comorbid with their depression.

[29:54 –> 30:16] Dr Elahi: So it’s a complex set of symptoms and diagnoses and so they need they feel better by doing more. In other words, there’s no harm with doing more but that is kind of those numbers are the standard that has been established. Either 36 or 40 to 50 on a accelerated type of paradigm. So with this Stanford trial,

[30:16 –> 30:22] Dr Kumar: the SANCH trial, guys basically reduced the treatment time from thirty six days down to five days.

[30:22 –> 30:23] Dr Elahi: Correct.

[30:23 –> 30:29] Dr Kumar: And so these depression patients are coming in for five days. They’re giving their basically, week to get treated.

[30:29 –> 30:30] Dr Elahi: That’s right.

[30:30 –> 30:33] Dr Kumar: And at the end of the week, what are they feeling like?

[30:34 –> 30:53] Dr Elahi: Yeah. So what I have been observing is that they do feel better at the end of that week. However, they feel their best several weeks, like two or three weeks after the last session. And there’s many reasons for that. One is there’s actually some reorganization of neurons and connections that occur after the last session.

[30:53 –> 31:33] Dr Elahi: There is of course life factors, meaning they get to experience more of this new brain if you will and understand how it’s different. And so they can report more stories and more circumstances that they are now able to deal with whereas before they could not. But almost always patients come back several weeks saying, I feel even better than I did the last day. And there are patients where they feel like, I feel nothing on Friday evening, and then several weeks later, we look at their scores, we look at their brain map, we talk to them, and their wife, everyone is like, this guy is much better. And he’s no longer complaining about everything.

[31:33 –> 31:48] Dr Elahi: He’s waking up. He’s cleaning his room. He’s actually motivated to have dinner now with people. He’s calling to make appointments. And then so family members and relatives and friends, colleagues see the changes much easier sometimes than the patient him or herself.

[31:48 –> 32:00] Dr Elahi: And then the patients start to realize, hey. I’m not taking this medication anymore. I’m still feeling okay. I’m still functioning. And then we look at I use objective findings with imaging of the brain through EEG.

[32:00 –> 32:14] Dr Elahi: And then so I can see that objectively anyway, but, obviously, we’re not treating EEGs. We’re treating patients. We want them to feel better. So those are the some of the common things that I’ve seen regarding the tempo or course of how they respond.

[32:14 –> 32:35] Dr Kumar: Okay. And this accelerated protocol, is this based on this idea of theta burst? When you’re in a restful calm state and you measure your brain waves with EEG, you’ve got these theta waves that come in around five hertz. And is that what you’re doing here, trying to synchronize the bursts or the pulses of magnetic stimulation with the brain waves?

[32:35 –> 32:37] Dr Elahi: That’s the underlying theory.

[32:37 –> 32:37] Dr Kumar: Yes. Okay.

[32:37 –> 33:15] Dr Elahi: So quickly, theta burst is basically stimulating the brain at a rate of 50 pulses per second in bursts. There’s packets of pulses that run at 50 hertz and each of those packets is delivered at usually five hertz that where hence where the name theta comes in. To To make it very simple for patients and viewers and listeners, basically we’re compressing a lot more pulses in a shorter span of time. The standard is ten sec 10 cycles or 10 pulses per second, but this one is 50. So it allows it to and the machine has to be capable too.

[33:15 –> 34:02] Dr Elahi: There’s some older machines that are not able to do that. Regardless, yes, the theory is that you’re trying to synchronize with the five hertz underlying rhythm or frequency of the brain. However, that still has not been scientifically established as definitive. That’s kind of the model or the theory, but no one really knows exactly why the theta burst works because there have been other experiments where they do 20 hertz instead of 50 hertz, and there’s still some response with that. And it was actually Jonathan Downer and his colleagues from University of Toronto that were able to get this fifth the theta burst three minute three minute trial, not nine minutes, three minutes of ThetaBurst found to be just as good as the thirty minute 10 hertz.

[34:02 –> 34:24] Dr Elahi: And so that was FDA approved as well. That’s why ThetaBurst actually was approved through his work at University of Toronto. But regardless, you know there’s a lot as with anything in medicine, there’s so much we don’t know yet that it could be overwhelming. But we know a fraction of what we should know. The underlying issue is that ask anyone how do medications work?

[34:24 –> 34:32] Dr Elahi: How do antidepressants work? And the answer is even more vague and abstract. Oh we increase serotonin. That has not been established either. No.

[34:32 –> 34:51] Dr Elahi: Actually I looked back when I was med school and undergrad even. I tried to find the papers that showed an increase in serotonin following antidepressants. I couldn’t find any. There was some scant evidence of CSF metabolites of serotonin increasing. So this whole theory that you’re increasing serotonin in the synapse is still theoretical.

[34:51 –> 35:03] Dr Elahi: Right. And that’s mind boggling because the entire industry for the last several decades has been selling you this idea that we’re increasing serotonin and it has not been definitive improvement. I mean, it’s just nonsense.

[35:03 –> 35:36] Dr Kumar: In fact, there’s studies that show that serotonin is lower in patients who are on long term SSRIs, which are selective serotonin reuptake inhibitors. So, you know, this serotonin theory of depression is likely just like what we do in every other disease in medicine. We simplify it so we can understand it because the body’s so complex that if we try to understand and explain and control for every factor, it’s just beyond us to do it. So we have to simplify. We have to reduce and figure it out that way.

[35:36 –> 35:48] Dr Elahi: You know how frustrating that is for patients. Right? They’re asking you, doctor, how does this work? You’re trying to simplify it. And then there is those engineer guys who keep asking those questions, and you’re like, you know, I’m sorry.

[35:48 –> 36:05] Dr Elahi: That’s all we know at the moment. So it’s very frustrating, but such is the state of medicine. But Yeah. I I can almost bet you that we know far more about the mechanism of action of TMS than we know about the mechanism of action of medications in terms of depression.

[36:05 –> 36:35] Dr Kumar: I would I would say that’s pretty accurate. Now, you know, one one thing I would say to the audience is that in medicine, if something works and it’s got low risk, it’s okay to go with it even if you don’t totally understand it. Because, you know, when your your end goal is to fix a problem, and you don’t have to understand every single biochemical interaction to know that I got this treatment and I feel better, or I took this SSRI and I feel better. You know? Maybe it’s not increasing your serotonin levels.

[36:35 –> 37:03] Dr Kumar: But if you feel good on it and it’s not deleterious to the rest of your health, then it’s okay. Now I myself, I’m always for less medication. So that’s why I feel like TMS is so promising is because, you know, you get to reduce the amount of synthetic chemicals you’re putting in your in your body to basically manipulate your biology. And it’s I also like the durability of it too. I mean, that’s the thing is that, you know, you you can get this treatment five days.

[37:03 –> 37:13] Dr Kumar: You could go to doctor Alahi’s clinic, spend five days there, and then essentially potentially go into remission or be greatly improved and not have to take a pill every day.

[37:13 –> 37:28] Dr Elahi: Exactly. So you’ve touched on so many good points, Ravi. I mean, yeah, I mean, you’re you’re speaking my language because you’re in the same field. But yeah, patients get frustrated with they don’t know the exact mechanism of action. Yes, that’s our frustration too.

[37:28 –> 37:52] Dr Elahi: But and I say this to patients who who ask me about supplements. And of course, I don’t prescribe supplements. I don’t sell supplements or any of that. However, I tell patients who ask me, hey, if you feel like it’s helping you and you’re not having any side effects, as far as I know, great, use it. But if you’re using it and it’s not helping and you’re now having all these side effects, then it’s craziness to continue something, right?

[37:52 –> 38:11] Dr Elahi: As Albert Einstein said, it’s madness to repeat something that is not working and keep doing it. So now with respect to, yes, the TMS, I mean that is the best part. It’s very safe, high likelihood of success with durability. Does it mean that every single person that does TMS is cured? Absolutely not.

[38:11 –> 38:16] Dr Elahi: However, in relation to what’s out there, it has a high likelihood of success.

[38:16 –> 38:30] Dr Kumar: Yeah. Well, that’s that’s fantastic. Let’s talk about dementia now because I know this is a area of TMS treatment that’s near and dear to your heart. You’ve published on this topic, and you’ve treated patients for this. And dementia, I mean, it it ruins lives.

[38:30 –> 39:04] Dr Kumar: It not only ruins the patients’ lives, but it it it hurts the lives of the loved ones around them. And you go into this period where you’re losing someone very slowly that you love, and at the same time, the stress to take care of them is so great. And anything that we could do to try to, bring down that the amount of pain around this disease is fantastic. And we have a whole pharmaceutical industry, literally billions of investment, and they’ve come up with basically nothing on this one. So tell us what TMS might be doing in the in this field.

[39:04 –> 39:19] Dr Elahi: Yeah. I almost feel we should have a whole show on just on that. However, briefly, as you mentioned, dementia is extremely prevalent. It’s devastating and debilitating. I’ve had family members, my own maternal grandfather had Alzheimer’s.

[39:19 –> 39:44] Dr Elahi: It’s extremely debilitating. And yes, you’re absolutely right. Currently medications do very little if any for dementia. And it’s very, very upsetting and disappointing that the FDA goes out and approves these newer infusion treatments when even their own neurologist independent panel said it shouldn’t be approved. Regardless, I’m not gonna go into that right now.

[39:44 –> 40:18] Dr Elahi: However, the evidence behind the use of TMS for dementia is very strong. If you do a side by side comparison of trials that have used TMS to treat patients even with mild, moderate, or severe dementia, and put it right next to the trials that were done using medications, TMS is far, far more effective. TMS has shown to be effective in terms of improving your baseline scores, not just slowing down the progression. I’m talking like bedside scores like mini mental status exam, modulo cognitive assessment. These bedside scores improve.

[40:18 –> 40:35] Dr Elahi: Here’s the problem, it is not a cure. TMS is far better. It slows down the progression. Almost invariably every family that I’ve seen, they come back and say he’s much better. He’s much less aggressive, much less agitated, his memory’s better.

[40:35 –> 41:06] Dr Elahi: But six months later he’s kind of deteriorating again. So it pushes back against the disease and delays it and improves the current symptoms but we’re fighting against a neurodegenerative disease, this monster that is chewing away at the brain if you will. So relative to the standard medications, it’s by far more effective with zero side effects. So that I’d say is a big success. And you and I both know these are debilitating conditions that patients have really no other option.

[41:06 –> 41:35] Dr Elahi: And stem cells are still ongoing trials but they don’t do anything as far as I know. I haven’t seen any papers that come even close to the data that we’re seeing with dementia or So with the mechanism, how does it work? So here, I’m gonna share this with you that we’re looking into publishing this. You know how you can now look at biomarkers in the bloodstream for helping with diagnosis? You’re looking at phosphorylated tau, beta amyloid forty two forty ratios.

[41:35 –> 41:49] Dr Elahi: Those are blood tests, right? We have done blood tests before and after TMS, and we have seen invariably every single time those blood biomarkers improve or resolve after TMS.

[41:49 –> 41:49] Dr Kumar: Wow.

[41:49 –> 42:13] Dr Elahi: I looked into the literature to see if anyone’s reported that. I haven’t seen it yet. So that’s why I’m looking into trying to publish that. But every single case of patients, we did their blood test before, we did their blood test after, The biomarkers improved. That means that the metabolites of amyloid and phosphorylated tau have in fact improved down to normal levels in certain cases after TMS.

[42:13 –> 42:50] Dr Elahi: What is the mechanism, doctor? Well, it’s been shown that there is increased vascular outflow and basically the microvascular and the microglial cells that clean up the brain if you will become more active with TMS stimulation. So they’re basically cleaning out the gunk, the amyloid and the tau more effectively. So it just comes out. And so I bet you if someone does a study where they do pet amyloid before, pet amyloid after, which is what all the big pharma and their drugs are based on, you will see just as good, if not better, effects with TMS stimulation.

[42:50 –> 42:51] Dr Elahi: Yeah.

[42:51 –> 43:30] Dr Kumar: Well, just so the for the audience, Alzheimer’s is basically, one of the hallmarks of the disease is this accumulation of these two proteins called beta amyloid and phosphorylated tau. And these are actually proteins that we normally make, even young people are making them. But what happens is they accumulate in abnormal at abnormal levels, and they cause neuronal death. And so you’ll start losing parts of your brain because of the accumulation of these proteins. And what doctor Alahi is saying is that, you know, these proteins are leaking out into the bloodstream, leaking out into the CSF, and he can measure them before a trans cranial magnetic stimulation and say, hey.

[43:30 –> 43:33] Dr Kumar: Look. Are they at higher levels or lower levels before and after?

[43:33 –> 43:40] Dr Elahi: They’re higher. They’re higher. And the forty two forty ratio is reversed. But yeah. They’re generally speaking higher.

[43:40 –> 43:43] Dr Kumar: Higher before, and then after the stimulation, you’re seeing lower levels.

[43:43 –> 43:43] Dr Elahi: That’s

[43:43 –> 44:08] Dr Kumar: right. Meaning, these these proteins have essentially been flushed out and recycled the way they’re supposed to be done. What hap that’s what happens when we sleep, actually, as young people. That’s right. Our glymphatic system is like the lymphatic system in the brain, and these areas between the neurons open up, and these glial cells essentially flush and pulse out a cerebral spinal fluid through your brain, washing these proteins out.

[44:08 –> 44:31] Dr Kumar: And so you’re seeing lower levels after stimulation, which means that these proteins have essentially some of them, at least, have been recycled and and taken away, degraded by proteases, and, basically, you’re you’re restoring some normal neurophysiological process with the so what what part of the brain are you targeting with TMS and dementia?

[44:31 –> 44:54] Dr Elahi: There have been a lot of good landmark trials. Most common, of course, is still the prefrontal cortex, except we’re doing it bilaterally, left and right sublateral prefrontal cortex. After all, that’s where executive function lives in a way. But we’re also stimulating the parietal area, the precuneus, which is a more centralized region. And also sometimes we stimulate the temporal lobe.

[44:55 –> 45:23] Dr Elahi: So there was one study back several years ago where they did multiple target stimulation, and they combined it with some cognitive training, and they showed that you could really help patients with memory loss and even early dementia. They took that data to the FDA and FDA, you can see it, it’s all over the literature, basically knocked them down. Why? Their argument was, well, you combine TMS with cognitive training. How do we know it’s not the cognitive training?

[45:23 –> 45:37] Dr Elahi: Well they actually showed that cognitive training alone doesn’t do much. But when you combine TMS with cognitive training, suddenly there was a change compared to placebo. They didn’t accept that. So it’s mind boggling. There have been double blind control studies with large populations.

[45:37 –> 46:06] Dr Elahi: There has been several Chinese studies, European studies that show clearly that there is an improvement. I’ve seen this argument that what about the cost of TMS? Well, I mean, don’t talk to me about cost when every infusion of these new medications approved for Alzheimer’s costs $50,000. Yeah. Every infusion of these newer monoclonal antibody infusions that have been approved FDA for not just Alzheimer’s, but even just mild cognitive impairment, precursor to Alzheimer’s costs $50,000.

[46:06 –> 46:16] Dr Elahi: And you’re at risk for white matter disease, strokes, and death. You get none of that, none of those side effects with TMS, but suddenly How’s it’s that how how does that make sense?

[46:16 –> 46:30] Dr Kumar: No. It doesn’t. I mean, well, it does make sense because there’s not a lot of money to be made with TMS. There is with a monoclonal antibody that costs $50,000 per infusion. So, I mean, we just have to it it’s not like we’re gonna change our system.

[46:30 –> 46:51] Dr Kumar: Right? Our American system is run on economic incentive. But if we’re aware of it, we can Correct. We can work around it and and try to realize, you know, different avenues for accomplishing our goals like TMS. You know, one thing I think it’s really important to note here is that the prefrontal cortex is where your working memory is.

[46:51 –> 47:10] Dr Kumar: So if you’ve ever known a patient with Alzheimer’s, they remember everything from their childhood perfectly. And those old memories are usually stored in the hippocampus, and they’re they’re recalled to a certain extent when you need them. Your working memory is kinda like your RAM. It’s what you use throughout the day. So where did I put my keys?

[47:10 –> 47:30] Dr Kumar: Well, that goes into your working memory. It’s not necessarily stored as a long term memory. Well, if you’re stimulating the prefrontal cortex and increasing the conductivity there, I could see how that could alleviate a significant amount of symptoms Yeah. Because Alzheimer’s patients can’t remember what what they were doing five minutes ago. They can’t remember the conversation they just had.

[47:30 –> 47:35] Dr Kumar: That’s right. It’s a problem with their short term working memory that’s really causing these problems.

[47:35 –> 48:15] Dr Elahi: By the way, we do cognitive tests done by the computer. So it’s very objective, digitally done before and after for almost even our non Alzheimer’s patients with patients who come in with depression. By and large, they improve cognitively. Now some argue that well, yeah, if you treat someone’s depression they’re gonna do better, which is true, but we’ve seen patients who have no depression also improve cognitively, which is something that has been super interesting because we are now seeing young, healthy, otherwise normal patients do better cognitively after brain stimulation. So it can actually be a way to enhance brain, to optimize brain activity.

[48:15 –> 48:40] Dr Elahi: And there’s been also trials that show that. So it’s just a fascinating field. And yes, with respect to Alzheimer’s, we actually we published a case report of a very early onset dementia patient, young woman, who everyone thought was depressed because who has depression in their I’m sorry, who has Alzheimer’s in their 40s, right? No one thought she had Alzheimer’s. And she would say, doctor, I forgot my password to my phone.

[48:40 –> 48:54] Dr Elahi: And she had young daughters that she was taking care of by herself. And even I was convinced there’s no way she has dementia. She has likely depression causing memory issues. We actually ended up doing biomarker tests. She had florid signs of Alzheimer’s.

[48:54 –> 49:12] Dr Elahi: She has a variant, very rare, called the young onset Alzheimer’s. She had the genetic profile which matched it. And we saw, hey, we were treating her for depression with TMS and her cognitive scores improved. And so we were like, wait, She didn’t have depression so much. She had dementia and she improved cognitively.

[49:12 –> 49:30] Dr Elahi: And so that’s why we published that in Clinical Neurophysiology which was a really interesting case. And how durable was her effect? Well, she ended up actually, she was I had sent her to UCLA. They they actually did an evaluation as well. They said, yes.

[49:30 –> 49:42] Dr Elahi: We agree she has Alzheimer’s. And I called her husband, like, two years later, and he said that she’s still better than she was before, but you know, she continues to deteriorate because of the neurodegenerative process.

[49:43 –> 50:04] Dr Kumar: But you gave her a significant improvement in her quality of life Right. Through the stimulation. You know, there is in depression, there’s something called pseudodementia. And a lot of times people are who are depressed, they’re like, I I think I’m in early dementia because they can’t remember anything, and that’s a symptom of depression. But you won’t have these biomarkers for Alzheimer’s when you have pseudodementia.

[50:04 –> 50:23] Dr Kumar: So and that kind of differentiates it. And this early onset dementia is a very rare thing. Not many people get it. And it’s really great that you caught it, treated it, published it so people can understand that, hey. There is another potential avenue here because the treatments still, even in early onset dementia, are not good.

[50:23 –> 50:37] Dr Elahi: The reason I thought it was publishable wasn’t just because she improved with TMS because that’s our that was already established. But this was a young onset dementia. It wasn’t your typical run of the mill dementia. So that’s why I thought this was really unique.

[50:37 –> 50:58] Dr Kumar: Very cool. So okay. Let’s go into some of the other indications. I know we spend a lot of time on depression and dementia, which I think are very two of the things that I I really wanna talk about the most. But let’s talk about addiction, because it is FDA approved for getting off of cigarettes, which nicotine, if anyone’s been ever addicted to it, it’s the third most addictive drug in the world.

[50:58 –> 51:17] Dr Kumar: Very hard to get off of. And nicotine, honestly, there’s a lot of stuff that goes around social media about, hey. Nicotine’s a smart drug. It’s not, guys. It might have some acute increase in attention, but overall, nicotine and smoking and vaping and all these other forms of nicotine generally destroy your body.

[51:17 –> 51:38] Dr Kumar: It’s this powerful vasoconstrictor that basically I’d see spine issues all the time from nicotine abuse. Wounds don’t heal. I won’t even operate on a person who’s on who’s using nicotine because their wound doesn’t heal. So overall, it’s not good for you, and I think I just wanted to put it out out there because health gurus out there who are pushing, hey. Nicotine’s good for you.

[51:38 –> 51:50] Dr Kumar: Very few situations where it is, and it’s very hard to get off of. Because once it takes a hold of your reward circuits in your brain, you’re essentially beholden to it. So how does TMS come into something like this?

[51:50 –> 52:10] Dr Elahi: Yes. Excellent. Excellent question. So TMS has not only been shown to be effective, by the way, for smoking or nicotine cessation. We have now very strong trials from University of Utah, University of Kentucky, who has shown, and I’ve seen it here in my office, with respect to alcohol craving or alcohol addiction.

[52:10 –> 52:31] Dr Elahi: So the way the mechanism is not the same as with other disorders we’ve mentioned. We actually stimulate a different region. We stimulate the medial prefrontal cortex rather than the dorsolateral prefrontal cortex. We actually have patients get into a craving mode. We show them pictures of smoking or alcohol, their favorite drinks.

[52:31 –> 52:57] Dr Elahi: And then after a few minutes, or usually a couple minutes or so, we use an inhibitory protocol to stimulate the medial cortex. So we actually put the coil here, and then we stimulate to inhibit, not to excite, the medial prefrontal cortex. And after doing that several times, patients report less craving. Less craving for nicotine, less craving for alcohol. I had one young man who basically his work revolved around alcohol.

[52:57 –> 53:21] Dr Elahi: Every meeting, you know, whether it be sales meetings or or whatever it was, revolved around drinking. And he found himself drinking a lot, and he began craving it. So he wanted to see if we can reduce his craving. He also had trouble with attention deficit disorder, so we treated that as well. But we applied this paradigm for the first time in my office and we weren’t sure if it was gonna work.

[53:21 –> 53:44] Dr Elahi: And he reported back saying he no longer even craves alcohol. He uses mocktails instead and he feels just as good. And it was amazing for me because that was my first real patient with these kinds of symptoms who responded and it was just amazing. So again, people are gonna probably think, oh, you’re saying this is good for this, good for that, this for, you know, x, y, and z. How could that be?

[53:44 –> 53:57] Dr Elahi: That’s why I emphasize this is a tool. You can inhibit certain regions. You can excite certain regions. How you use it is important. So yes, it has been proven to be helpful for cravings, for nicotine, for addiction.

[53:57 –> 54:20] Dr Elahi: We actually used it on a patient who had an eating disorder and had trouble with craving fatty foods. We actually showed images of french fries and chicken, whatever she liked, and we tried to inhibit that region with inhibitory protocols. So it’s very fascinating when it comes to addiction. There’s a lot of work still being done in that field, but it’s showing a lot of good promising results.

[54:20 –> 54:25] Dr Kumar: And how many sessions would a patient who’s trying to be treated for addiction have to go through?

[54:25 –> 54:38] Dr Elahi: Well we saw an effect within 10 to 20 sessions. So now this patient I’ve mentioned with respect to the alcohol came back and did like additional ones because he felt it was so effective he wanted to continue. But usually within ten to twenty, we see an effect.

[54:38 –> 54:42] Dr Kumar: And are these the rapid sessions or these are full days?

[54:42 –> 54:44] Dr Elahi: No. These are rapid sessions.

[54:44 –> 55:05] Dr Kumar: So they come in for 10 to 20 short sessions and Okay. See So let’s talk about chronic pain because that’s another thing. Oh, if you if you’ve ever had chronic pain, it totally destroys your life. In fact, there’s people people commit suicide over chronic neuropathic pain because it’s so bad. Classic examples are trigeminal neuralgia or tic de la roe.

[55:05 –> 55:09] Dr Kumar: You can get chronic pain in anywhere where there’s a nerve that’s injured, essentially.

[55:10 –> 55:11] Dr Elahi: That’s right.

[55:11 –> 55:13] Dr Kumar: What role does TMS play in chronic pain?

[55:13 –> 55:30] Dr Elahi: Well, I mean, you can pull up the papers. It’s very clear. They stimulate the motor cortex. So they stimulate the motor cortex here in the, you know, vertex of the brain. And if you actually stimulate it at 10 hertz, patients with neuropathic pain after a few sessions report less pain.

[55:30 –> 55:58] Dr Elahi: So the mechanism is thought that, as you may know Ravi, the motor cortex plays a big role in pain perception. And by the way, this is the same mechanism by which migraines are treated. We stimulate the motor cortex at 10 hertz and we see a reduction in migraine frequency as well. With migraines we also stimulate the occipital region as well. But regardless, we see there has been large trials for neuropathic pain specifically.

[55:58 –> 56:27] Dr Elahi: For example, phantom limb pain, neuropathic pain such as trigeminal neuralgia, post stroke neuropathic pain. As you know, a lot of patients after stroke develop neuropathic pain in the area that was injured and we see significant improvements. Now I’ll be honest, they’re not zero. The pain doesn’t come back to zero, but it goes down by like several notches. Just to do that and to reduce their overall opioid or narcotic or other harmful medication use is a big win.

[56:27 –> 56:34] Dr Elahi: So from what I’ve seen, while it doesn’t extinguish the pain completely, it does reduce it by a good factor.

[56:34 –> 57:02] Dr Kumar: Yeah. And, you know, I’ve done a few of these procedures where I’ve actually cut open a person’s scalp, taken off their skull, and implanted a grid, a stimulating grid, over the motor strip to help with neuropathic pain. And, you know, to get to that point where you’re going to implant a device in someone’s brain, they have to be in a lot of pain. And you can imagine these people are miserable. And this phantom limb pain you’re talking about, they’ve had an amputation, and they feel pain in a limb that doesn’t exist.

[57:02 –> 57:23] Dr Kumar: Now you can imagine how that could just totally destroy someone. That and that’s why they called this phantom limb pain because there’s a phantom limb that is hurting you. Well, stimulating the motor cortex somehow improves that pain. And to not have to open someone’s head and implant a device and instead do it with TMS is pretty extraordinary in my opinion.

[57:23 –> 57:45] Dr Elahi: Yeah. So, doctor Kumar, I mean, patients often don’t realize opening someone’s skull is a not just like a simple intervention. You’re risking blood, you know, issues, infection, and you know better than I. And so and then recovery time. I mean, to be able to do this non invasively is just huge, huge advance.

[57:45 –> 57:55] Dr Kumar: Yeah. It’s huge. I mean, that that that’s that’s where the future is, honestly. Because someday we’ll look back on what the kind of procedures I do right now. We’ll think, gosh.

[57:55 –> 58:27] Dr Kumar: That was barbaric. They cut open people’s skull and put, you know, electrical wires in there. I mean, just this week alone, I it was deep into the center of a poor man’s brain because he had a big old tumor there that I had to remove, and that’s the technology we have. But there’s emerging stuff coming out. Mean, there are implantable lasers that we can ablate tumors with now, and now we have this you know, we have transcranial magnetic stimulation, which can accomplish things that we still have, for the last many decades, been opening the head to do.

[58:27 –> 58:28] Dr Kumar: Yeah.

[58:28 –> 58:46] Dr Elahi: Yeah. So Ravi, you know, for example, by the same token, or treating Parkinson’s now more and more commonly with deep brain stimulators. Right? You’re implanting like inside the brain, which I think is fantastic, and I think it works great. However, we can come close to that, believe it or not, with TMS for Parkinson’s.

[58:46 –> 58:51] Dr Kumar: How are you doing that? We’re because, you know, we we implant these electrodes deep in the brain, in the thalamus.

[58:51 –> 59:09] Dr Elahi: That’s right. Well, I’ll be honest. It probably doesn’t work as robustly as the deep brain stimulation. However, we’ve seen clinical trials, and I’ve seen it again clinically in my patient population here, where we can reduce the tremors by stimulating again the there are several targets. One is the motor cortex.

[59:09 –> 59:49] Dr Elahi: One is the supplementary motor area in front. And another is the premotor cortex. Those are the three common targets and usually it’s inhibitory but can also sometimes stimulate the cerebellum as well although that’s less likely helpful in terms of Parkinson’s. So we’ve had patients with Parkinson’s who actually did improve, I would say probably not as robustly as placing electrodes inside the thalamus or the subthalamic nucleus as you do. However, you’re talking nonsurgical versus surgical and having to replace the batteries and deal with all the potential complications of insertion of a a material into the brain.

[59:49 –> 60:14] Dr Kumar: And those, you know, there’s hemorrhages, there’s infections, the DBS, these deep brain stimulating systems get infected frequently. And then there’s sometimes it stops working. You know? You go through all this and then it just doesn’t work anymore. On top of that, it’s over it costs over a $100,000 to have this system installed and in a in a significant amount of suffering because it’s not it’s not painless.

[60:14 –> 60:28] Dr Kumar: You know? We have to implant battery packs in the over the chest and run wires under the skin all the way up to the top of the head. We have to drill holes through the head. It is a big ordeal. Tons of money, tons of suffering, and it’s effective.

[60:28 –> 60:50] Dr Kumar: There’s no doubt that it’s effective. But if you can do all that with a visit to your outpatient neurologist or psychiatrist’s office and I’m I know we’re at the beginning of this therapy. And as our knowledge improves, man, what could we do? Could we get rid of DBS altogether by modulating through magnetic fields or ultrasound or, you know, what other noninvasive technique we have?

[60:50 –> 60:52] Dr Elahi: Medtronic is not gonna like what you’re saying.

[60:52 –> 60:57] Dr Kumar: I know. Shareholders don’t either because, you know, that’s a lot of what drives this stuff.

[60:57 –> 61:17] Dr Elahi: But as I always say, Ravi, there’s always a role for medications. There’s a role for these surgical procedures as well. However, we should not be ignorant of these other options. And so patients should be informed of, yes, you do have these options and this is the risk and benefit for this. These are the risk for benefits of that.

[61:18 –> 61:41] Dr Elahi: And they should be well informed. I have seen patients with DBS do well, but also there’s risks with that as you just clearly pointed out. Not to mention that a lot of patients with underlying memory issues are not even candidates for DBS. They you know, that’s one of the contraindications. And so a well informed patient should have the option of choosing between all the different invasive and noninvasive option.

[61:42 –> 61:47] Dr Kumar: Yeah. Absolutely. I totally agree with that. Let’s talk about migraines. You mentioned it earlier.

[61:47 –> 62:01] Dr Kumar: You know, migraines are very common, obviously, and we do have good medications for migraines, and we have even some newer injections that are fantastic. Yes. What role can TMS play in in managing migraines?

[62:01 –> 62:20] Dr Elahi: Yeah. Well, as you as you say, migraines are extremely debilitating and prevalent. As neurologists, it’s like we see migraines all the time, and there are a growing number of very good treatment options from a medication perspective. I think Botox is also very effective. Botox is FDA approved for migraine prevention as well.

[62:20 –> 62:52] Dr Elahi: With respect to TMS, TMS has shown to treat both acute and prevent migraines. So it can be used for both acute and prevention. For the acute treatment, meaning you just had a migraine and you need something now, there was a company that made a very simplified TMS device that basically triggered a single transcranial magnetic pulse delivered over the occiput. So patients would place this over the back of their head, push the button, and it would deliver that pulse. And it did cut down the migraine severity.

[62:52 –> 63:41] Dr Elahi: However, apparently the company went out of business for whatever reason, probably because not a lot of people knew about it and insurance wouldn’t cover it for whatever reason. And we actually do that except with the kind of the industrial size TMS where we stimulate both here and the motor cortex again to help both prevent and treat acute migraines. And for the most part, it’s just as good as many of the medications out there, meaning it cuts down the acute migraine, it does help prevent migraines. On the prevention side, it’s probably more effective in my view because I’ve had patients who came in saying they didn’t come in for migraines, came in for depression or something else but they also said they have migraines. I try to treat everything as much as I can so I also add in the protocols for migraines with their TMS.

[63:41 –> 64:13] Dr Elahi: And when I call them again or when I talk to them again afterwards, they’re like, yeah. I haven’t had any migraines since I’ve been here. So and they were having it like every week or every day. So it is very effective, but it may not be cost effective because you can’t do, you know, TMS every day or every week. However, I do think it’s a viable option and it just speaks to the fact that these mechanisms of action are very much effective and they do have profound positive impacts on brain circuitry.

[64:13 –> 64:30] Dr Elahi: And we know migraine definitely involves abnormal circuits in the brain. So yes, it is FDA approved. It is a definite viable treatment. However, nowadays I just do it as a comorbid bonus, if you will, for patients who come in for other disorders. We’re not just treating migraines.

[64:30 –> 64:41] Dr Kumar: You wanna kinda go over the other indications for t for TMS like OCD, PTSD, even post stroke rehabilitation, which I think you talked to her a little bit about already.

[64:42 –> 65:08] Dr Elahi: So post stroke, let’s jump into that real quick. Patients are debilitated. Imagine having half your body paralyzed and there has been an intense amount of research, tons of money trying to find that compound, that medication that is going to help increase the rate of recovery. And none of those trials have ever been successful. What has been successful is the use of TMS.

[65:08 –> 65:48] Dr Elahi: The way it works is when you have a stroke, when one part of the brain is injured or dead, let’s say the left or in this case the right side of the motor cortex. Well the left side is overcoming the left side through cross inhibition. And so what happens is the other side doesn’t allow for the injured side to recover well. So we apply TMS to basically quiet down the overactive side or the healthy side so that the injured side can actually recover faster. Put it simply, we actually help the brain recover faster by stopping itself from injuring itself further.

[65:48 –> 66:11] Dr Elahi: Having said that, the actual clinical trials show that patients recover faster, meaning especially with hand paralysis or arm or limb strokes, they are far more able to do things with their hand and arm at a faster rate than without TMS. So for example, if it took a year for the patient to recover, it now takes six months to recover. And so we’ve You’re seen that

[66:11 –> 66:15] Dr Kumar: the non stroke side of the brain.

[66:15 –> 66:42] Dr Elahi: Stimulating non because although there’s been trials where you stimulate the injured side as well, and so I’ve done it both. I’ve done both inhibitory to the healthy side and stimulation to the injured side. But also remember that these patients also suffer from immense amount of depression because they sometimes are otherwise healthy people. By healthy, I mean they were moving and no problems with their movements, and now they’re paralyzed. So they become extremely depressed.

[66:42 –> 67:00] Dr Elahi: So we actually stimulate the prefrontal cortex as well and try to recover from their depression. So it has become so good in terms of its evidence that many countries in Europe use it as standard of care. For example, I know in Russia, it’s just like, yeah, everyone after stroke does TMS. It’s like normal. Yeah.

[67:00 –> 67:03] Dr Elahi: And many parts of Europe are doing it post stroke as well.

[67:03 –> 67:07] Dr Kumar: And what kind of results have you seen personally with treating post stroke patients?

[67:07 –> 67:39] Dr Elahi: I’ve seen I’ve seen basically patients have increased in their what what we call Fugle Meyer scores, which is a way to measure hand movements and strength. And I had one patient with a huge, huge hemispheric stroke, chronic stroke, who after we did TMS and she had been through everywhere. She was from a wealthy family. She had gone through the entire world, Mayo Clinic, everywhere, everywhere you could think of. For the first time, her family and friends told me this person is a whole new person.

[67:39 –> 67:49] Dr Elahi: She speaks better. She’s much more alert. She does move better. So that’s kinda what I’ve seen. In terms of the actual movement itself, there’s some improvement.

[67:49 –> 67:55] Dr Elahi: I can’t I won’t I’ll be honest. It’s not like a night and day difference, but there is some improvement. And again

[67:55 –> 68:05] Dr Kumar: So what what’s the thought there? I mean, if that part of the brain is dead, is it the is it the thought that maybe there are some surviving part portions of the brain that are just not allowed to come in and recover?

[68:05 –> 68:25] Dr Elahi: That’s it. The penumbra, the surrounding areas that are still able to fire are invade out to fire more effectively. So the few cells that are still healthy around the injury, as we call it the penumbra, are still able to take over the injured side, the injured cells.

[68:26 –> 68:44] Dr Kumar: So you’re basically allowing that patient to realize the potential of what they have left. Whereas without it, it’s it’s very difficult to do it because of this theory of cross inhibition where the healthy side of the brain is basically overriding the motor input outputs of the other of the injured side.

[68:44 –> 69:13] Dr Elahi: But you have to kinda block the healthy side from the overwhelming towards the injured side. I I think there’s more to it because studies show there’s increased blood flow and that by itself helps increase protein synthesis and synapse synthesis and that’s been shown. So the mechanisms have not been fully clear but those are some of the bonafide proven methods. The cross inhibition, the increase in blood flow and synapses. So yeah, I mean, we see we see improvements.

[69:13 –> 69:36] Dr Elahi: In the research trials, they have seen improvements in their physical therapy measurements. Like I mentioned, the Fugal Meyer score, and other objective ways to measure strength and mobility. We’re also talking about pain. A lot of patients, as you mentioned earlier, have post stroke neuropathic pain and that also improves as well with Okay. These types of treatments.

[69:36 –> 69:55] Dr Kumar: So at what point after a stroke would a patient wanna start with this? Because, you know, there’s there is this period where you have the most plasticity because there’s there’s this potential for recovery, and then you start forming glial scars and your potential goes down. So when do they should they start TMS after a stroke?

[69:55 –> 70:09] Dr Elahi: As soon as possible. Like, within no later than three to six months. The earlier, the better. Now, unfortunately, the the patients, a lot of them, because they didn’t know one that I existed, they didn’t know that there was this. So it was like several years.

[70:09 –> 70:32] Dr Elahi: But if we can get those patients right after the stroke, it’s gonna do far more help for them. It’s gonna do far more than if we get them a year. This patient that I was telling you about was several years, like five years, ten years later. Even She’s a permanent. If we can get them right after a stroke, is what a lot of the vast majority of papers show, that’s the key.

[70:32 –> 70:40] Dr Elahi: We really can as you mentioned, there’s a higher level of plasticity at that moment, at that period of time and stage than the chronic stage.

[70:40 –> 70:49] Dr Kumar: Now let’s move over to PTSD. Do you treat patients with PTSD? Because this is an extraordinarily difficult neuropsychiatric syndrome to treat.

[70:49 –> 71:08] Dr Elahi: Yeah, PTSD is very much a bread and butter for TMS as well. There is large trials, especially in the veteran population. There is VA trials and many other trials. And yes, it’s been proven to be very helpful. Again, we stimulate usually the right DLPFC, not so much the left DLPFC.

[71:08 –> 71:31] Dr Elahi: And sometimes we stimulate also the visual cortex as well. By far and away, these medicines, these patients are placed on antidepressants and they go through therapy. Not to downplay those, I think they do help of course, but more often than not, they end up continuing to have symptoms. When you add something like TMS to the rest of their treatment, it’s a big game changer. So PTSD is a big one.

[71:31 –> 71:39] Dr Elahi: And again, there’s certain protocols. It’s more effective than the standard one size fits all that you use for depression. So PTSD is a big one.

[71:39 –> 71:46] Dr Kumar: You’re not having these patients come off their meds. Right? You’re treating them at the same time as they take so they stay on their PTSD They have.

[71:47 –> 72:18] Dr Elahi: Exactly. We never take patients off medications right away. We do help them come off slowly or taper them in a structured manner after they’ve improved because some of these medicines were either ineffective or causing side effects. In some cases, in the toughest cases, the medicine wasn’t really working before but after TMS the medicine seems to be working far better so we keep them on it. Yeah, it’s case by case basis but in some patients, I mean there are a ton of medicines, none of which were working causing side effects.

[72:19 –> 72:24] Dr Elahi: So we almost always reduce their medication load if not eliminate it. But afterwards, not before.

[72:24 –> 72:40] Dr Kumar: One thing I’ve definitely in social media, but the literature supports it, is this use of psychedelics for PTSD with a guided therapist can help make significant improvements in PTSD. Are we seeing like similar efficacy with TMS?

[72:40 –> 73:03] Dr Elahi: Yeah. So first off, psychedelics do work. However, you can’t take them all the time because they you develop tolerance, you develop hallucinations, and many other side effects. A lot of people have GI disturbances. There was a large study in the New England Journal of Medicine, you know, a very respectful internationally known journal which compared mushrooms with Lexapro for depression.

[73:03 –> 73:17] Dr Elahi: And Lexapro, our mushrooms did well, but they had all these side effects. So with respect to PTSD, yes, it works just as well, if not better, without those side effects as far as TMS goes. So, I mean, it’s that one is also a low hanging fruit. It’s a no brainer.

[73:17 –> 73:26] Dr Kumar: Yeah. That’s that’s remarkable, honestly. So if you did get hallucinations from TMS, then it would be much sexier though, and people would wanna do it. You’d hear all about it all the time.

[73:27 –> 73:46] Dr Elahi: I I I almost wish that it it did that but it doesn’t. This is what I tell patients which is very important because some of the younger patients especially are like, I don’t want my personality to change. We’re not changing your personality. This this type of treatment is not so powerful to change your entire brain. We’re using small electromagnetic pulses to tweak small areas of the brain.

[73:46 –> 74:01] Dr Elahi: And it’s not gonna make you all of a sudden super happy or hallucinate. It’s not a hallucinogen. It’s not a drug. It’s not a substance. It basically reestablishes normalcy to brain structure and brain chemistry.

[74:02 –> 74:09] Dr Elahi: Not going to suddenly make you this super happy human who’s always happy no matter what happens. You can have normal emotions, which you’re supposed to.

[74:09 –> 74:33] Dr Kumar: Right. And, you know, I would just mention that one of the treatments for treatment resistant depression is ECT, which stands for electroconvulsive therapy. And if you I’ve seen it, and it is crazy the craziest thing to see. You basically take a a patient, you you put them in a sedated state, and then you take two electrodes, you know, on both sides of the brain. Back when I watched it, it was on both sides.

[74:33 –> 74:52] Dr Kumar: Now I heard they’re just doing right side. And you shock the brain and send the person into a tonic clonic seizure where their whole body is convulsing. And you let that go for, you know, thirty seconds to a minute, and then you give them a medication to stop it. And you do that a couple times, and then you wake them up. And, basically, depression gets better.

[74:52 –> 75:10] Dr Kumar: They stop wanting to commit suicide because oftentimes it’s used for suicidal depression. But there’s cognitive consequences to this. You know? So you’re you’re basically shocking these people’s brains, trying to create some rewiring, and they can they start having memory issues. They can have flattening of their personality.

[75:10 –> 75:21] Dr Kumar: That’s a big one. And that’s all to try to treat depression, and TMS doesn’t have any of that. We weren’t doing it in the psych ward when I was in medical school. You know?

[75:21 –> 75:43] Dr Elahi: That’s right. So, actually, TMS has been compared to ECT. It’s just as effective, if not more effective in certain cases. And without all the invasive procedures and side effects that you’re exposed to. However, I will say this Ravi, that in the occasional patient that is not responding to TMS, I’m left with no choice but say maybe you should try ECT.

[75:43 –> 75:44] Dr Kumar: Yeah.

[75:44 –> 75:48] Dr Elahi: However, the vast majority do respond well to TMS.

[75:48 –> 75:56] Dr Kumar: Okay. So the last thing I wanna mention before we start to wrap up is OCD. Is there an indication for TMS and OCD?

[75:56 –> 76:16] Dr Elahi: Absolutely. It’s on label, FDA approved. But I will tell you, it’s one of the toughest things to treat. One of my first patients and this patient, it was kinda like I will either continue doing TMS or I will stop depending on how this patient does. This guy had gone to everywhere, UCLA, the best of the best for his OCD.

[76:16 –> 76:20] Dr Elahi: And it was severe. He would wash his face with bleach because he had germ obsessions.

[76:20 –> 76:21] Dr Kumar: Oh, wow.

[76:21 –> 76:36] Dr Elahi: He couldn’t go to an interview because he couldn’t park the car the exact right way and he had compulsions. He also had comorbid bipolar depression as well. So it was one of my first patients. We did multiple targets. We did I think 41 sessions.

[76:36 –> 76:57] Dr Elahi: In that time we actually used functional MRI also along with EEG to guide the treatment. For the first time he actually became functional. He was so happy. His father gave us a testimonial. Several years later, I’m talking like seven, six years later now, he still calls me and says, Whoever you want to treat, tell him to call me.

[76:57 –> 77:10] Dr Elahi: He has been our poster child. And he invited me to his wedding, to his he’s married now with two kids. He wasn’t able to work. He’s fully functional. His father was like, you saved my son’s life.

[77:10 –> 77:38] Dr Elahi: It was one of the things that stuck in my mind and to this day I think he was one of the reasons I continued to pursue TMS because it changed his life so much. That’s incredible. Obsessive compulsive disorder is extremely debilitating. Yeah, we all have OCD traits but those who have the disorder are so dysfunctional that, and the medications do nothing by the way. The relapse or the response rate with medications is twenty percent.

[77:38 –> 77:58] Dr Elahi: And so those patients are desperate. And TMS does provide an answer. It’s one of the toughest things to treat. You have to do it over and over again, do it right for it to work, but it’s far better than the vast majority of medications. Some of them do need a combination of meds with TMS for it to work well, but it is a big breakthrough for those patients.

[77:58 –> 78:00] Dr Kumar: And what kind of response rates are you getting?

[78:00 –> 78:03] Dr Elahi: So we’re getting between sixty to eighty percent response rates.

[78:03 –> 78:04] Dr Kumar: Oh, that’s incredible.

[78:05 –> 78:07] Dr Elahi: Not as high as depression, but

[78:07 –> 78:07] Dr Kumar: Still.

[78:08 –> 78:34] Dr Elahi: The vast majority of people respond. And for those that don’t respond, by the way, at my clinic we never give up on patients. We talk about other methods, neurofeedback, combining it with maybe other medicines they haven’t tried, maybe even deep brain stimulation or ECT, but that’s rare. We almost never have treatment failures to that extent. Sometimes we do a functional MRI to find out where else we can stimulate, but those are challenging patients.

[78:34 –> 78:46] Dr Kumar: Okay. Yeah. That’s but that’s incredible, the sixty to eighty percent response rate in OCD. I mean, you’re beating any other treatment on the market by far. And, you know, a lot of people have mild OCD.

[78:46 –> 78:58] Dr Kumar: The ones with severe OCD, they’re, like you said, completely nonfunctional. Like, they can’t function in the in the world. To give someone back even a little bit of benefit is is incredible, honestly.

[78:58 –> 79:01] Dr Elahi: Yeah. We haven’t even touched on tinnitus. Tinnitus

[79:02 –> 79:02] Dr Kumar: Oh, yeah.

[79:03 –> 79:17] Dr Elahi: Has actually a lot of good data behind it. I will be honest. It doesn’t cure it, so patients still have tinnitus, but it’s far better. And nothing else was touching the tinnitus. That’s ringing in the ears for people who don’t recognize that word also.

[79:17 –> 79:25] Dr Elahi: Yeah. We stimulate the auditory cortex, inhibitory, and it’s definitely better than nothing, but those patients are thankful.

[79:25 –> 79:29] Dr Kumar: So is this for patients with sensorineural hearing loss?

[79:29 –> 79:33] Dr Elahi: No. I mean, they could have tinnitus too, but any tinnitus. It doesn’t have to Any

[79:33 –> 79:33] Dr Kumar: tinnitus. Okay.

[79:33 –> 79:34] Dr Elahi: Sensory hearing loss.

[79:34 –> 79:55] Dr Kumar: So so for the the listeners, tinnitus, you might have heard it pronounced tinnitus too. You know, people get to pronounce it however they want, really, but it is ringing in your ears. And that sounds like not a big deal. Right? Well, when it when you have a patient, and I I know this because I’ve had a lot of patients with with tinnitus, they come in and they are miserable.

[79:55 –> 80:31] Dr Kumar: And they are like just anything you can do to make this stop because they’ve got this ringing. Sometimes they call it roaring or, you know, they feel like there’s the wind is just blowing in their ears constantly, and it drives them literally crazy. And, you know, there’s there’s medications we can try, but, really, you know, unless you can find, for me, a structural reason why it’s happening, there’s not a good treatment for it. And oftentimes as patients age, they start to lose some of the function in the in the auditory nerve, and the brain’s like, it’s not picking up the signal, and it says, hey. What do we do?

[80:32 –> 80:47] Dr Kumar: There must be some background noise. So it creates this auditory signal that really drives people crazy. So Exactly. You’re able to basically quiet that part of the brain that’s picking up this lack of signal and and basically creating white noise.

[80:47 –> 81:05] Dr Elahi: That’s right. So, basically, the response rates that I’ve we’ve been able to achieve is between twenty to fifty percent. Wow. So when we look at we use a tinnitus handicap inventory, DHI. When you look at their post treatment scores, it’s about 20 at the lowest to highest fifty percent reduction.

[81:05 –> 81:17] Dr Elahi: However, it’s not completely cured. You know, patients sometimes, when we talk about these treatments, they’re like, but I’m not cured. And that we have to say, just to get this is is just nothing short of a miracle. Yeah.

[81:17 –> 81:24] Dr Kumar: Yeah. And oftentimes, there’s other treatments that you can do too. You know, sometimes a hearing aid by itself will will help. Yeah.

[81:24 –> 81:32] Dr Elahi: Voice canceling hardware. I heard one. I forgot the name of it. It’s it’s quite effective. Again, they’re getting the same kind of rates, twenty to fifty percent.

[81:32 –> 81:42] Dr Kumar: Yeah. Okay. Very good. Okay. Let’s before we kinda wrap everything up, can you walk us through, like, a case study of a patient?

[81:42 –> 81:49] Dr Kumar: Let’s go with depression, if you wouldn’t mind, because I think that’s the most salient issue. Let’s do this. Let me give you a fake patient, basically.

[81:49 –> 81:49] Dr Elahi: Yeah.

[81:49 –> 82:03] Dr Kumar: And and you tell me what you’re gonna do. So it’s a 42 year old female. She’s had three children. And after every child, she became a little depressed, but she got over it. But now for the last two years, she’s been so morbidly depressed.

[82:03 –> 82:18] Dr Kumar: She’s had several medications she’s tried. She sees a psychiatrist. She sees a psychologist and has done cognitive behavioral therapy. She has become suicidal in fact, and she’s thought about taking her life. But you know, she has little children.

[82:18 –> 82:26] Dr Kumar: What would you do with this patient? How would you what imaging studies would you get? How would you plan her treatment? What kind of expectations would you give her?

[82:26 –> 82:45] Dr Elahi: Yeah. Well, actually I’ve had a patient very similar to that exact scenario. I always tell people, and actually I’m putting a YouTube video on this, we do a comprehensive consultation. So I sit down and I go through the symptoms in detail. And then we go through what medications have you tried and felt.

[82:45 –> 82:56] Dr Elahi: I look for comorbidities. Is she having cognitive issues? Is she having hormonal disturbances? Has she had an endocrine evaluation? Once all that is kind of done, I ask, for example, is she drinking alcohol?

[82:56 –> 83:13] Dr Elahi: We didn’t even go into this, but alcohol reduces neuroplasticity, causes depression, and can be heavily negatively impact everything. So let’s say she’s not drinking much alcohol. How’s your sleep? We talk about sleep and those kinds of things. And then we say, okay, you’ve tried these different medications.

[83:14 –> 83:33] Dr Elahi: Let’s consider TMS, transcranial magnetic stimulation. We talk about the risks and benefits and we went through that in detail here in this conversation with you of course. And then we actually do a couple things. We do an MRI of the brain and we also do what’s called a quantitative EEG. It’s not absolutely necessary that you do those things but I like to do them.

[83:33 –> 83:49] Dr Elahi: One, MRI of the brain does two things. One, I make sure there’s nothing else contributing to her symptoms. A rare case, maybe she has vasculitis. Maybe she has a brain tumor. Maybe she has something that is rare but we look for it.

[83:49 –> 84:10] Dr Elahi: And then more importantly I use that data to actually navigate to specific locations of the brain. So typically most offices just use scalp measurements to identify the left dorsolateral prefrontal cortex which is okay. But I actually, as you know, everyone’s brain is like a fingerprint. The sulci, foals, gyri are slightly different. The head size is different.

[84:10 –> 84:31] Dr Elahi: So I get an MRI. We have basically kind of like ear field. We actually see the MRI, see their brain in real time. And then we do the EEG because the EEG helps me establish a baseline. Usually it shows, for example, abnormalities either in the prefrontal cortex or sometimes in deeper regions of the brain like the cingulate.

[84:31 –> 84:44] Dr Elahi: And then we talk about that. And then we start a treatment design for her. So for example if she has comorbidities with headaches, I designed a protocol to address that. But we talk about different options. We have the accelerated option, five day protocol.

[84:44 –> 85:05] Dr Elahi: Maybe she’s coming from out of town. Maybe she’s come from the East Coast or wherever and she can’t spend thirty days here, right? We offer her this five day treatment which has greater than ninety percent success for depression. And we talk about the risks and benefits. We have our MRI, we have our EEG and then we have her sit down in the chair.

[85:05 –> 85:32] Dr Elahi: We use these fiduciary markers to tell the system where her brain is. We find the dorsolateral prefrontal cortex, we place the coil and we run a usually theta burst protocol as you mentioned plus maybe another protocol to help with her anxiety and one for her migraines. And then she’s there for about ten or fifteen minutes of 10 times a day. And after the fifth or the second day we remeasure what’s called the motor threshold. This is to ensure we’re stimulating the brain.

[85:32 –> 85:49] Dr Elahi: So we measure how intense we need to stimulate to move our hand and then we use that to basically stimulate the brain. And then we constantly, every time the staff and I ask her, are you doing? Are you having any headaches? Are you having any, did you have a bad night of sleep? Are you feeling any changes?

[85:49 –> 86:08] Dr Elahi: I modify the protocol accordingly. And then after she’s done, if she’s from out of town, we repeat the brain map, the EEG we call it, after the last session. If she’s available in town, we have her come back in two weeks and do it. We have her do the rating scales. So I forgot to mention that before we start, we have her do standardized rating scales.

[86:09 –> 86:27] Dr Elahi: For example, we use the Burns Depression Scale. We use the PHQ-nine. We use the Montgomery Asperger Depression Scale, which is what was used in Stanford’s trials. And then we kinda gauge the severity. We have her repeat those same scales twenty four hours after the last session and then come back and repeat them again in two weeks.

[86:27 –> 86:35] Dr Elahi: And then we have a follow-up either via Zoom or in person in two weeks. So that’s kind of the entire process in a nutshell.

[86:35 –> 86:40] Dr Kumar: Okay, very cool. So you’re using, you’re getting an MRI. Is it a functional MRI or just a standard MRI?

[86:40 –> 86:57] Dr Elahi: Right now we’re just doing a specific standard MRI. We have very thin cuts. We actually have a protocol we send to the MRI center. Basically, functional MRI, we have the capability of doing so, but it’s added costs. So unless it’s absolutely necessary, I don’t really do it.

[86:57 –> 87:27] Dr Kumar: So for the listeners, doctor Allahi’s using something called stereotaxis, and we’ve used this all the time in in the OR. In fact, no neurosurgeon will operate in the brain essentially without stereotaxis. And that’s this concept that three points in space can tell you three points can give you any point in space. So he’s talking about these fiducials. They’re these little buttons that you stick on the skin and you do the MRI, and those three points will tell you where in the brain you are targeting essentially.

[87:28 –> 87:50] Dr Kumar: And in this setting, you’re targeting targeting the dorsolateral prefrontal cortex. So doctor Alahi actually knows exactly where it is. He’s not just measuring five centimeters up from in the motor cortex or whatnot. He’s actually he knows the exact gyri of the brain that he’s hitting, and that leads to better accuracy and presumed better outcomes.

[87:50 –> 88:29] Dr Elahi: That’s right. You mentioned functional MRI, so I should distinguish. The Stanford trial prides itself in doing the functional MRI to identify the exact location within the dorsolateral prefrontal cortex using what they call the activation deactivation area between the dorsolateral prefrontal cortex and the anterior cingulate. However, they’ve never shown, there’s been no study to compare as a head to head trial whether to do that is actually the key component of the accelerated outcomes. In other words, there wasn’t a trial showing, okay, let’s do it without the functional MRI as compared with this and see if there’s a difference.

[88:29 –> 88:44] Dr Elahi: So a lot of us in this field argue that we don’t know if that was a key component. Why not just reduce the cost for the patient? And yes, you can do an anatomical MRI and we use EEG as a baseline as well. Target the dorsolateral prefrontal cortex. And there are some nuances.

[88:44 –> 88:56] Dr Elahi: If you go more midline, it’s more there’s some anxiety related to it. If you go more lateral and inferior, it’s more anhedonia and depression. And some of that is research based. And we get the similar outcomes. So I.

[88:56 –> 89:04] Dr Elahi: E. Eighty to ninety percent or better. So I spare the patient as much as I can in terms of logistics, costs, and going back and forth.

[89:04 –> 89:16] Dr Kumar: So what can you give me a range? If someone’s depressed and they want the full five day theta burst treatment, will their insurance pay for it? And if not, how much will it cost them out of pocket?

[89:16 –> 89:22] Dr Elahi: Well, good question. Well, first off, 90% of insurance policies cover the standard thirty day treatment.

[89:23 –> 89:24] Dr Kumar: The thirty day treatment, okay.

[89:25 –> 89:47] Dr Elahi: If they show that they’ve tried and failed medications, they’ve tried and failed therapy, and they have severe depression. That’s a no brainer if you will. I think maybe one or two actually are approving the accelerator protocol at this moment. However, I’ve heard that more and more insurance companies are covering the accelerator now. I asked a couple of them, Why don’t you?

[89:47 –> 89:54] Dr Elahi: It’s FDA approved. It’s on label. And they couldn’t give me an answer. They said, we just don’t. And so that’s that.

[89:54 –> 90:10] Dr Elahi: Now as far as patients coming in, maybe they don’t meet the qualifications from insurance. Maybe they wanna do the accelerated and their insurance doesn’t cover it. The cost is basically between 3 to $400 per session. If you do 50 sessions, that’s between 15 to $20,000.

[90:10 –> 90:27] Dr Kumar: Okay. Yeah. I mean, 15 to $20,000, it definitely would be worth it if you’re stuck in a hole, honestly. But for many people, that might be out of reach. So if they can get their insurance to approve it, just to be clear, the thirty six day protocol is not less efficacious than the five day protocol.

[90:27 –> 90:27] Dr Kumar: Correct?

[90:27 –> 90:31] Dr Elahi: It is not. Yeah. It is not is not less efficacious. It’s just as good.

[90:31 –> 90:36] Dr Kumar: Just as good. It just takes longer. And that’s the one that most insurance programs will approve.

[90:36 –> 90:36] Dr Elahi: Correct.

[90:36 –> 90:47] Dr Kumar: Yeah. For most people, I think the insurance approval is probably gonna gonna be the way to go. To get approved by insurance, do they have to have have they had to have failed at least one or two medications?

[90:47 –> 91:00] Dr Elahi: Yes. They do. Unfortunately. Even though there’s no reason scientifically, it will work whether you’ve ever tried medications or not. But for insurance purposes, they have to have tried and failed medications.

[91:00 –> 91:17] Dr Elahi: Now some insurance say two, some insurances say three. I think one says one. The FDA protocol, the FDA label is only one failed medication. And then some insurance make a fuss about it. You have to have tried different meds from different categories for some period of time.

[91:17 –> 91:27] Dr Elahi: But it’s becoming more and more clear to insurance companies that, hey, we’re gonna save money by approving these treatments. So they’re becoming much more flexible than they were before.

[91:27 –> 91:53] Dr Kumar: You have to have a long view. You have to be forward thinking, honestly. I mean, put a patient on antidepressant for the next two decades, three decades with, you know, erectile dysfunction, weight gain, metabolic syndrome, you know, apathy and poor productivity in the in the world. And you think about that versus one, maybe two, a couple backup treatments of TMS. It just makes sense from a financial standpoint.

[91:53 –> 92:25] Dr Elahi: Oh, yeah. And so as one of my patients said, Ola Gentleman brought his wife who had suffered from PTSD and depression for decades, ever since she was in her twenties, and nothing worked. And for the first time she saw significant relief. And her husband was so reluctant at first, was so dismissive, he was convinced afterwards to a point where he came on and gave us a testimonial. And he said, tell your patients you can’t afford not to do it because he came from a wealthy background.

[92:25 –> 92:30] Dr Elahi: He had spent thousands of dollars on so many other treatments. This was the only thing that worked for her.

[92:30 –> 93:09] Dr Kumar: Well, I’m I’m excited to see more about TMS, and I’m really appreciative that you’re out there getting information out about it because, you know, we won’t know about it unless doctors like you come out and talk about talk about your experience, talk about the literature. Because right now, billions is being made on pharmaceuticals. There’s no doubt about it. And there’s a whole industry built around depression and dementia and, you know, PTSD, making medications that oftentimes just don’t work. And here you are, you have a noninvasive magnetic therapy that creates real changes in the brain that lead to improvement in these debilitating symptoms.

[93:09 –> 93:12] Dr Kumar: So I’m very appreciative to you Yeah. For that.

[93:12 –> 93:39] Dr Elahi: I’m I’m very appreciative of guys like you who are putting time in. I know your time is is not, like, you know, super available, and you’re doing this. This is incredible. And I’ve done some podcasts. This is the first one with an actual neurosurgeon who knows what I’m talking about, who recognizes the field, is very familiar with the field, and recognizes some of these risks and benefits very well.

[93:39 –> 93:41] Dr Elahi: So I thank you for for being available.

[93:41 –> 94:00] Dr Kumar: And I would just one thing I wanna add on the cost again. Guys, I don’t do a single surgery that costs less than 15,000. I don’t think I do a single surgery that costs less 20,000. Insurance pays for it most of the time, and, you know, if insurance will pay for the thirty six day protocol on the TMS. So but that’s just to put things in perspective.

[94:00 –> 94:36] Dr Kumar: And when I do, you know, I do a lot of spine surgeries for degenerative spine disease. It’s usually the first of many, or it’s the second or the third of many because you get this continued domino effect of degeneration throughout the spine. And, unfortunately, we’re not curing degenerative spine disease with spine surgery. We’re just stabilizing and hopefully creating more quality of life before the next degenerative event comes. With TMS, you’re actually fixing broken neurological patterns, And it costs less than any surgery can do with less suffering.

[94:36 –> 95:03] Dr Kumar: I mean, just think about that. There’s no suffering. When I do a spine surgery or a brain surgery, people are in the hospital for a day or more or many more suffering, taking narcotics, stool softeners, muscle relaxers. And, yeah, the their neuropathic pain gets better, and that that’s very rewarding to see. But they have to go I mean, they’re off work for six weeks to three months after these surgeries I do that I’m doing multiple times per week every week.

[95:03 –> 95:18] Dr Elahi: Well said, Robbie. My my own father had multiple levels of fusion. This is before I even went into this field, and he’s still suffering. He actually you asked about my dad. I actually did TMS for his chronic pain as well, and he did see improvement.

[95:18 –> 95:33] Dr Elahi: My mother just had a spinal fracture two weeks ago, and she had a one level fusion a year ago, facing another one now. So, yeah, it’s very, very debilitating and very very hard to see.

[95:33 –> 95:51] Dr Kumar: Yeah. And I’m not arguing against doing invasive therapies. That’s what I do for a living. But when you find something that’s less invasive with equal or more benefit, pay attention because that’s what TMS is, essentially. We’re not learning about this in medical school, by the way, too.

[95:51 –> 96:05] Dr Kumar: And no one’s teaching them this in medical school. I saw it during residency. A PhD researcher was doing it, and he put it up against my head. My hands started twitching, and I was like, well, that’s pretty cool. But I thought this guy’s just dabbling in a curiosity.

[96:05 –> 96:23] Dr Kumar: That was a long time ago. But, yeah, I mean, this is not being taught in medical school because there’s no there there’s really no money for large businesses behind it. You know? And doctors can make a living off of it, and patients can get tremendous benefit off of it, and that’s kinda where it stands. How can patients get ahold of you, doctor Elihi?

[96:23 –> 96:33] Dr Elahi: Many ways. So we can they can directly call us. The office number is, (949) 652-7301. They can go on our website. The website is pretty easy.

[96:33 –> 96:45] Dr Elahi: It’s neurospabrain.com. By the way, the word neuro spa was my wife’s suggestion. Unfortunately, some patients think it’s a good idea. Some patients think it’s not a good idea. We don’t do any spa treatments.

[96:45 –> 96:55] Dr Elahi: It’s not a spa, it’s a medical office. But anyway, neurospabrain.com. You can go to our YouTube page. It’s basically Neurospa Brain. If you search that on YouTube, it’ll be there.

[96:55 –> 97:11] Dr Elahi: We have like 76,000 subscribers. People I post educational things on there, similar kinds of things we just talked about, and also patient testimonials so you can see for yourself what patients have to say. And, of course, they can always email us [email protected].

[97:11 –> 97:28] Dr Kumar: Okay. And I’ll put all those in the show notes, all that information in the show notes. But, yeah, this has been tremendous. And if you are listening to this, it might be worthwhile to come back and watch it on YouTube because doctor Alahi’s been had a brain model out. He’s been showing us anatomy on the brain throughout this whole talk.

[97:28 –> 97:38] Dr Kumar: So, yeah, it’s it’s fantastic, this field, and I’m really excited about learning more about it. And thank you so much for coming on the show, doctor Alahi.

[97:38 –> 97:44] Dr Elahi: So it’s really my pleasure, and thank you so much for allowing this platform for viewers and listeners to listen to.

[97:44 –> 97:46] Dr Kumar: Great. Cheers. Thank you.

[97:46 –> 97:47] Dr Elahi: Thank you so much.

[97:47 –> 98:20] Dr Kumar: So I hope you enjoyed this conversation with doctor Elahi and now have a solid foundation for understanding TMS. What it is, how it works, and why it can be such a powerful, sometimes even life changing option for conditions that are notoriously difficult to treat with medications alone. These are the illnesses where drugs often bring major side effects, inconsistent results, or simply don’t work at all. TMS offers something different, and my hope is that this episode gave you a clear window into that world. If you enjoyed the show, please let me know.

[98:20 –> 98:48] Dr Kumar: I genuinely love hearing from listeners. In our next episode, we’re finally getting into that deep dive on depression that I’ve been promising you guys. This is gonna be a full exploration of the biology and the mechanisms behind depression. And because the topic is so important and so huge, I’ll likely split it into two episodes. Episode one will walk you through the biological basis, what’s happening in the brain, the networks, the neurochemistry, and the full landscape of available treatments.

[98:48 –> 99:14] Dr Kumar: Episode two will be a practical structured roadmap for recovery. Evidence based tools, lifestyle strategies, supplements, therapies, and how they all fit together. And yes, TMS that we learned about in this episode is part of the depression treatment algorithm. I’ve basically written this series on depression to empower you with clarity and real actionable knowledge. So until then, stay curious, stay skeptical, and stay healthy.

[99:14 –> 99:14] Dr Kumar: Cheers.

References & Resources

Daily Left Prefrontal Transcranial Magnetic Stimulation Therapy for Major Depressive Disorder A Sham-Controlled Randomized Trial

Psychiatric Applications of Repetitive Transcranial Magnetic Stimulation

Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology

A Systematic Review and Meta-Analysis of rTMS Effects on Cognitive Enhancement in Mild Cognitive Impairment and Alzheimer’s Disease

Repetitive transcranial magnetic stimulation for early-onset Alzheimer’s disease – A case report

Beyond the Surface: Deep Transcranial Magnetic Stimulation Efficacy in Reducing Craving in Addictive Disorders: A Systematic Review and Meta-Analysis

Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta-analysis

Episode 30: TMS, Depression, and Dementia — A Game-Changing Brain Therapy

Episode Highlights

Show Notes

What TMS Is and How It Works

Why TMS Outperforms Medications for Many Patients

Accelerated Treatment Protocols

TMS for Dementia and Cognitive Decline

Safety Profile and Side Effects

Why TMS Remains Underrecognized

About the Guest

Listen on Your Favorite Platform

Explore More Episodes

Transcript

References & Resources

Daily Left Prefrontal Transcranial Magnetic Stimulation Therapy for Major Depressive Disorder A Sham-Controlled Randomized Trial

Psychiatric Applications of Repetitive Transcranial Magnetic Stimulation

Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology

Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression

Durability of clinical benefit with Stanford Neuromodulation Therapy (SNT) in treatment-resistant depression

Accelerated TMS - moving quickly into the future of depression treatment

A Systematic Review and Meta-Analysis of rTMS Effects on Cognitive Enhancement in Mild Cognitive Impairment and Alzheimer’s Disease

Repetitive transcranial magnetic stimulation for early-onset Alzheimer’s disease – A case report

Beyond the Surface: Deep Transcranial Magnetic Stimulation Efficacy in Reducing Craving in Addictive Disorders: A Systematic Review and Meta-Analysis

Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta-analysis

Effectiveness of Repetitive Transcranial Magnetic Stimulation on Managing Fibromyalgia: A Systematic Meta-Analysis

The efficacy of transcranial magnetic stimulation on migraine: a meta-analysis of randomized controlled trails

Default Mode Network Mechanisms of Transcranial Magnetic Stimulation in Depression

Network Mechanisms of Clinical Response to Transcranial Magnetic Stimulation in Posttraumatic Stress Disorder and Major Depressive Disorder

Evidence of rTMS for Motor or Cognitive Stroke Recovery: Hype or Hope?

Efficacy and Safety of Transcranial Magnetic Stimulation for Attention-Deficit Hyperactivity Disorder: A Systematic Review and Meta-Analysis

Disclaimer

Episode 30: TMS, Depression, and Dementia — A Game-Changing Brain Therapy

Episode 30: TMS, Depression, and Dementia — A Game-Changing Brain Therapy

Subscribe to the Podcast:

Episode Highlights

Show Notes

What TMS Is and How It Works

Why TMS Outperforms Medications for Many Patients

Accelerated Treatment Protocols

TMS for Dementia and Cognitive Decline

Safety Profile and Side Effects

Why TMS Remains Underrecognized

About the Guest

Listen on Your Favorite Platform

Explore More Episodes

Transcript

References & Resources

Share this article

Join The Discovery

Disclaimer