Serotonin Hypothesis of Depression: Why Low Serotonin Is Too Simple

What Are the Safety Risks of TMS? (Seizures, Hearing Loss, and Metal)

TMS safety risks are the focus of this episode, with a balanced look at why transcranial magnetic stimulation is considered very safe while still requiring thoughtful precautions. Psychiatrists explain the rare but serious concerns patients should understand before treatment, including hearing damage without earplugs, seizure risk during stimulation, and metal-related issues near the magnetic field. The discussion also covers practical clinic safety steps, why medication changes can matter during a TMS course, and why “no side effects” is not the right way to describe any treatment. It is a clear, grounded overview for anyone considering TMS or educating patients about it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

How TMS Works for Depression: Brain Networks, Neuroplasticity, and the Left DLPFC

How TMS works is the focus of this episode, which moves beyond the idea that depression is simply a chemical imbalance. Dr. Harvey and Dr. Malzberg explain why TMS targets the left dorsolateral prefrontal cortex, how that surface region may influence deeper connected brain networks. They also discuss neuroplasticity with appropriate caution, emphasizing that it is not magical brain fertilizer but one possible part of how treatments for depression create change. The result is a clear, honest psychiatry conversation about TMS, depression, brain networks, and what science still cannot fully explain. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Serotonin Hypothesis of Depression: Why Low Serotonin Is Too Simple

Serotonin hypothesis of depression is the center of this episode, as two psychiatrists unpack why the low serotonin “chemical imbalance” story became so popular and why it falls short. They trace the monoamine hypothesis, discuss serotonin, norepinephrine, and dopamine, and review evidence that challenges a simple serotonin deficiency model. The conversation also explains why this does not mean SSRIs or antidepressants stop working, using clear analogies and clinical examples like delayed medication response, serotonin syndrome, tryptophan depletion, TMS, and depression research. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

How to Fail in a TMS Practice (Part 2): When Business Decisions Undermine Patient Care

TMS practice management is the focus of this episode on how clinics fail when business decisions start overriding clinical judgment. The conversation explores patient care vs profit, physician leadership, non-medical managers, clinician autonomy, Spravato pressure, and why treatment quality is also a business strategy. For psychiatrists, TMS providers, and private practice owners, this is a practical discussion of TMS clinic operations and healthcare management grounded in the realities of psychiatry. It is especially relevant for anyone trying to build a physician-led TMS clinic without letting quotas, sterile workflows, or non-clinical control erode patient care. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

How to Fail in a TMS Practice: The Biggest Mistakes Clinics Make

TMS practice mistakes are at the center of this episode on why TMS clinics fail and what those failures reveal about better care. The conversation covers timid rollout, underestimated demand, remote management, referral boundaries, physician leadership, and the damage that happens when business pressure starts to shape clinical decisions. For psychiatrists, practice owners, and clinicians interested in transcranial magnetic stimulation, this is a practical discussion of TMS clinic management rooted in real-world patterns rather than abstract theory. It is especially useful for anyone starting a TMS practice or trying to understand why a service is underperforming. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com [https://psychofarm.substack.com?utm_medium=podcast&utm_campaign=CTA_1]