TMS for PTSD: Does Protocol Actually Matter? - Dr. Noah Philip

TMS for PTSD: Does Protocol Actually Matter? - Dr. Noah Philip

TMS for PTSD: Does Protocol Actually Matter? | Dr. Noah Philip | The Neurostimulation Podcast In this episode of the Neurostimulation Podcast, Dr. Michael Passmore sits down with Dr. Noah Philip — Professor of Psychiatry at Brown University, Section Chief of Psychiatric Neuromodulation at the VA Providence, and leader at the VA Center for Neurorestoration and Neurotechnology — to explore the cutting edge of brain stimulation for PTSD, depression, and beyond. Dr. Philip shares findings from a landmark multi-site VA study comparing three TMS approaches for PTSD, and what the results mean for clinicians worldwide. He also discusses accelerated TMS, the combination of tDCS with virtual reality exposure therapy, teaching TMS in Ukraine, and the exciting frontier of focused ultrasound as a noninvasive form of deep brain stimulation. In this episode: 🧠 What Dr. Philip's lab at the VA Center for Neurorestoration and Neurotechnology does 📊 Key findings from a propensity-matched cohort study of 756+ veterans comparing 10 Hz rTMS, iTBS, and deep TMS for PTSD — and why the bottom line is: "use whatever device you have" 💡 Why "treatment-resistant" may say more about our limitations than about patients ⚡ How accelerated TMS (5x/day for 5 days) can deliver comparable outcomes in just one week 🎮 Combining tDCS + virtual reality for PTSD — results from a JAMA Psychiatry study 🌍 Teaching TMS in Ukraine and what it means for resource-limited settings 🔬 First-in-human focused ultrasound to the amygdala: safety, early results, and why this technology excites him most 🤖 The role of AI — from facial decoding to personalized treatment prediction — in the future of precision psychiatry Resources & References: 📄 Study: Effectiveness of Transcranial Magnetic Stimulation for Post-Traumatic Stress Disorder: A Multi-Site Propensity-Matched Cohort Study of Treatment Parameters — Brain Stimulation (2025) https://pubmed.ncbi.nlm.nih.gov/41241259/ 🏥 VA Center for Neurorestoration and Neurotechnology https://centerforneuro.org 💻 Unbroken Foundation, Lviv (Ukraine TMS training program) https://unbroken.org.ua/foundation About the Neurostimulation Podcast: Hosted by Dr. Michael Passmore, clinical associate professor in the Department of Psychiatry at UBC, the Neurostimulation Podcast explores the world of neuroscience, clinical neurostimulation, and interventional mental health — making cutting-edge research accessible to clinicians, researchers, students, and curious minds alike. The information in this podcast is for educational purposes only and is not intended as medical advice. Always consult your healthcare provider. Connect & Subscribe: 👍 Like and subscribe to never miss an episode 💬 Share your thoughts in the comments 📲 Share with a colleague who might find this helpful

Signal Over Noise: How Transcutaneous VNS Optimizes Cognition with Dr. Ronan Denyer

Episode Summary Host Dr. Michael Passmore (Clinical Associate Professor, Department of Psychiatry, University of British Columbia) sits down with Dr. Ronan Denyer, a postdoctoral fellow at the Coactions Lab in Brussels. Dr. Denyer completed his PhD in neuroscience at UBC under Dr. Lara Boyd, and his research sits at the intersection of brain stimulation, neuroimaging, and behavioral neuroscience. In this episode, they take a deep dive into transcutaneous vagus nerve stimulation (tVNS) — what it is, how it works, and what it could mean for the future of cognitive enhancement and neurological treatment. Key Topics Covered * Dr. Denyer's background — From Trinity College Dublin to UBC to Brussels, how a final-year undergraduate project set him on the path of brain stimulation research * The locus coeruleus (LC) — Why this tiny, blue-colored brainstem nucleus with far-reaching noradrenergic projections is one of neuroscience's most intriguing structures * Transcutaneous vagus nerve stimulation (tVNS) — How stimulating specific parts of the outer ear (the cymba conchae and tragus region) can non-invasively activate the vagus nerve → nucleus tractus solitarius → locus coeruleus pathway * tVNS vs. TMS vs. tDCS — Key comparisons between these neuromodulation approaches and why tVNS offers a unique real-time biomarker advantage via pupillometry * Perceptual decision-making study (Brain Stimulation journal) — How tVNS boosted accuracy on a random dot motion task without slowing reaction times, supporting the gain hypothesis over the urgency hypothesis of LC function; the "rescue effect" seen after errors * The drift-diffusion model — How modeling revealed tVNS increases the drift rate (evidence accumulation speed), explaining the accuracy improvement * tVNS + TMS combined study — Evidence that tVNS increases corticospinal excitability during stimulation (online effect), with pupillometry confirming LC engagement; intriguing finding that MEP changes and pupil changes were not correlated, hinting at potential sub-nodes within the LC * Clinical translation potential:Stroke rehabilitation — Pairing tVNS bursts with motor therapy to promote plasticity online * ADHD — The tonic/phasic LC firing model and the explore-vs-exploit hypothesis; why elevated tonic LC firing may underpin attentional difficulties * Parkinson's disease — LC degeneration as an early biomarker; tVNS + pupillometry as a potential low-cost screening tool for preclinical Parkinson's; targeting non-motor symptoms * Anxiety and PTSD — Emerging hypotheses linking LC dysfunction to these conditions * Upcoming research — The KinArm forced-response reaching task: examining how tVNS shifts the speed-accuracy curve and modulates movement vigor, with implications for stroke rehab Key Concepts Explained TermPlain-language meaning tVNS Non-invasive stimulation of the ear to activate the vagus nerve and the brain's noradrenaline system Locus coeruleus Small brainstem nucleus; the brain's primary source of noradrenaline; modulates attention, arousal, and decision-making Gain hypothesis LC noradrenaline boosts signal-to-noise ratio, improving perceptual accuracy without speeding up responses Urgency hypothesis LC increases response speed at the cost of accuracy (not supported by this study) Pupillometry Measuring pupil size as a proxy for LC activity Motor evoked potential (MEP) A muscle twitch elicited by TMS; used to measure corticospinal excitability Drift-diffusion model A mathematical framework for modeling perceptual decision processes Tonic vs. phasic LC firing Tonic = baseline arousal level; phasic = task-triggered bursts that sharpen perception Papers Referenced * Xiang et al. — Transcutaneous Vagus Nerve Stimulation Boosts Accuracy During Perceptual Decision Making, Brain Stimulation https://pubmed.ncbi.nlm.nih.gov/40311845/ * Dr. Denyer's tVNS + TMS corticospinal excitability study (recently published) https://journals.physiology.org/doi/full/10.1152/jn.00008.2026 Connect & Learn More * Host: Dr. Michael Passmore, University of British Columbia, Department of Psychiatry * Guest: Dr. Ronan Denyer, Coactions Lab, Brussels (formerly UBC, Lara Boyd Lab)

Who Heals the Healer? Burnout, Shame & the Psychology of High Achievement: Dr. Stacey Elliott

Show Notes — Neurostimulation Podcast Episode: Who Heals the Healer? Burnout, Shame & the Psychology of High Achievement Guest: Dr. Stacey Elliott, DO In this deeply insightful episode, Dr. Michael Passmore sits down with Dr. Stacey Elliott — board-certified psychiatrist, addiction medicine physician, and founder of CNY Integrative Psychiatry — to explore the hidden psychology behind burnout, high achievement, and the often-overlooked emotional lives of high-functioning professionals. What we cover: * Why burnout is best understood as a loss of connection with the self, not a personal failure * How early attachment patterns and subtle childhood adaptations can drive overachievement in adult life * The surprising overlap between addiction and workaholism — and why both are attempts to manage the same core wound * The concept of therapeutic prescribing: why the relationship around medication matters as much as the medication itself * The nocebo effect in psychiatry and what "difficult" patients are often really communicating * Shame vs. guilt: how shame accumulates in high performers and what it takes to heal it * The importance of peer consultation, supervision, and Balint groups for clinicians and caregivers * What it actually means to be authentically well — not just high-functioning Guest resources: * Dr. Stacey Elliott's website: www.cnyintegrativepsych.com [http://www.cnyintegrativepsych.com/] * Peer consultation services for clinicians: https://www.cnyintegrativepsych.com/peer-consultation [https://www.cnyintegrativepsych.com/peer-consultation] Key concepts mentioned: * Internal Family Systems (IFS) * Balint groups * Vicarious stress and compassion fatigue * Ikigai (the four quadrants of meaningful work) * Nocebo effect in psychiatric medication

Non-Invasive Deep Brain Stimulation: The Promise of Transcranial Focused Ultrasound with Dr. Samuel Pichardo - #46

Non-Invasive Deep Brain Stimulation: The Promise of Transcranial Focused Ultrasound with Dr. Samuel Pichardo In this episode, Dr. Michael Passmore sits down with Dr. Samuel Pichardo, biomedical engineer and researcher at the University of Calgary and the Hotchkiss Brain Institute, to explore one of the most exciting frontiers in neuromodulation: transcranial focused ultrasound stimulation (TUS/tFUS). Dr. Pichardo's lab is at the cutting edge of ultrasound neuromodulation — investigating how low-intensity pulsed ultrasound can precisely target deep brain structures non-invasively, with lasting effects on neural activity. What We Cover: * What is transcranial focused ultrasound (TUS)? How it differs from TMS and tDCS, and why its ability to penetrate to deep brain structures makes it uniquely powerful * The physics of neuromodulation: How pulsed ultrasound bursts at low frequencies (e.g., ~250 kHz) can produce neuromodulatory effects lasting 30–60 minutes after a single session — and why the underlying mechanism is still an active area of research * Pulse repetition frequency (PRF): Key findings from Dr. Pichardo's lab comparing 10 Hz, 100 Hz, and 1000 Hz PRF — and why 100 Hz produced the strongest and most sustained inhibitory effect * The skull barrier: Why lower ultrasound frequencies are used to overcome skull attenuation, and the challenges this creates for precision targeting * Pilot clinical study — essential tremor and Parkinson's disease: Targeting the ventral intermediate nucleus (VIM) of the thalamus non-invasively, and what the results showed: significant tremor reduction in essential tremor patients, and a promising but less robust trend in Parkinson's patients * The multi-focus targeting strategy: How Dr. Pichardo's team addressed the precision-vs.-accuracy tradeoff using phased array transducers to enlarge the treatment envelope * BabelBrain: The open-source, cross-platform (Mac, Windows, Linux) software tool developed by Dr. Pichardo's lab that integrates MRI/CT imaging data to model acoustic intensity, thermal effects, and safety parameters — a turnkey solution for TUS researchers worldwide * The future of the field: Which neuropsychiatric conditions are most likely to benefit first — including refractory depression, OCD, PTSD, and addiction — and why Dr. Pichardo believes depression may become the "poster child" indication for TUS in the next few years * Nomenclature: Why the field still hasn't settled on a consistent acronym (TUS, tFUS, LIFU, FUS) — and why that's okay Key Takeaways: * Focused ultrasound can reach deep brain targets non-invasively with millimeter precision — something no other non-invasive technology can currently match * The neuromodulatory effects are real, reproducible, and growing in clinical promise, but replication studies and sham-controlled trials are still essential * BabelBrain is freely available as an open-source tool for research labs worldwide * The field is at an inflection point, with rapid growth in FDA applications and commercial investment Links & Resources: * Dr. Pichardo's lab at the University of Calgary / Hotchkiss Brain Institute https://www.neurofus.ca/ * BabelBrain (open-source TUS planning software) https://proteusmrighifu.github.io/BabelBrain/ * Pulse repetition frequency study (PRF paper from the Pichardo lab) https://pubmed.ncbi.nlm.nih.gov/38621645/ * VIM thalamic TUS pilot study (essential tremor & Parkinson's) https://pubmed.ncbi.nlm.nih.gov/8109299/ * Focused Ultrasound Neuromodulation Symposium, Paris (July) https://www.itrusst.com/fun26 The Neurostimulation Podcast is hosted by Dr. Michael Passmore, clinical associate professor in the Department of Psychiatry at the University of British Columbia. The content shared is for educational purposes only and is not intended as medical advice. Always consult your healthcare provider regarding your specific health needs. If you enjoyed this episode, please like, subscribe, and share with anyone who might find it valuable. Drop your questions and comments below — and tune in next time for another journey into the cutting edge of neuroscience and clinical neurostimulation.

Understanding Nervous System Dysregulation: CES Therapy for Anxiety and Trauma with Tauna Young & Cara Maxfield - #45

Episode Summary In this episode, Dr. Michael Passmore is joined by two guests who bring both clinical expertise and lived experience to the topic of nervous system dysregulation. Together, they explore why anxiety is far more body-based than most people realize, and how a lesser-known technology called Cranial Electrotherapy Stimulation (CES) may offer real relief for anxiety, insomnia, trauma, and chronic pain. Guests Tauna Young, Psychiatric Nurse Practitioner and founder of NeuroVana Calm — a company focused on expanding access to CES therapy. Tauna has years of clinical experience helping patients struggling with anxiety, insomnia, PTSD, and nervous system dysregulation. Cara Maxfield, entrepreneur and content creator who speaks openly about navigating trauma recovery, anxiety, panic attacks, chronic pain, and the real-world challenges of managing mental health while parenting and running a business. Topics Covered What nervous system dysregulation actually is and how it shows up in the body Why anxiety is a physical, physiological experience — not a character flaw or weakness The fight-or-flight response: when a protective mechanism becomes miscalibrated The connection between trauma, body memory, and emotional triggers What Cranial Electrotherapy Stimulation (CES) is and how it works How CES stimulates the thalamus and vagus nerve to induce a calm brain state Research comparing CES to experienced meditators' brainwave states CES FDA clearance (since 1979) and its safety profile vs. medications Clinical applications: anxiety, insomnia, PTSD, chronic pain, fibromyalgia Why CES remains largely unknown in mainstream medicine How to use CES: loading phase, daily use, and situational use Combining CES with CBT, psychotherapy, exposure therapy, and medication Cara's first-hand account of using CES during a panic attack Practical tips for regulating your nervous system Key Takeaways Anxiety is a nervous system state, not a personal weakness The body and brain are deeply interconnected — what affects one affects the other CES is portable, discreet, safe, and can be used anywhere — even the dentist CES has a 67% success rate (≥50% improvement) vs. ~45–55% for SSRIs, with far fewer side effects Tools like CES work best as part of a broader toolkit alongside therapy and lifestyle strategies Everyone has trauma to some extent — normalizing that conversation is key to healing Resources & Links 🌐 NeuroVana Calm: NeuroVanaCalm.com 📖 Free eBook from Tauna Young: A deeper dive into the science of CES — available at NeuroVanaCalm.com 📚 The Body Keeps the Score by Bessel van der Kolk (referenced in episode) https://a.co/d/0bkbVqsp Connect & Subscribe If you enjoyed this episode, please share it with someone who might benefit, leave a review, and subscribe so you never miss an episode. Drop your questions and topic ideas in the comments — your feedback shapes future episodes. The Neurostimulation Podcast is an independent educational project by Dr. Michael Passmore. All content is for educational purposes only and is not medical advice. Always consult your healthcare provider.