How Targeted Magnetic Pulses Help Rewire Depression And Anxiety

We break down TMS in plain language and explain why depression, anxiety, OCD, PTSD, and ADHD are often brain circuit disorders rather than personal failures. We walk through how targeted magnetic stimulation uses neuroplasticity to help the brain rewire, plus what treatment feels like and which newer protocols are changing access. 
• why TMS exists and why many patients never hear about it 
• how the prefrontal cortex regulates mood, motivation, and threat response 
• what underactive left DLPFC looks like in depression 
• what overactive right DLPFC looks like in chronic anxiety 
• how OCD loops get stuck and why meds may not fully break them 
• how PTSD can reflect an overactive amygdala and weak prefrontal brakes 
• why “treatment resistant” often means the circuit has not been targeted 
• what TMS is, how the coil works, and why it is painless and non-invasive 
• neuroplasticity as the core mechanism and why results can last 
• what a session feels like, motor threshold mapping, and common side effects 
• who TMS is for, including people avoiding medication and teens ages 15 to 21 
• real-world response and remission data plus why completion matters 
• protocol options including standard courses, theta burst, SAINTE, and ExoMind 
• expanding indications from smoking cessation to migraines and addiction research 

If anything we talked about today resonates with you, please reach out, start a conversation. 
If you need more information, please reach out to me. 
Please share this episode if you think this would help somebody. 

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Transcript

SPEAKER_01 0:25

Today, I'm really excited to talk to you about TMS. I've mentioned TMS before in previous podcasts, but I want to get a lot more detailed about the why behind TMS and what it's used to treat and talk more specifics about it. So I'm going to keep it simple. I want to keep it clear. Um, because this is one of the most powerful tools

Why TMS Deserves Attention

SPEAKER_01 0:50

in medicine right now that I believe uh can really make a difference in people's lives. And sadly, a lot of people have not heard of it. I sit with patients every single week who have been through the healthcare system. They've tried multiple medications, sometimes two or three different antidepressants. They've done the therapy, they've seen the specialists, and yet nobody has ever really brought up the subject of TMS. They've been told that maybe they're running out of options. And I'm sitting there thinking, nobody's told you about this. TMS has actually been around for well over 40 years. It's been studied extensively, it's actually been FDA approved for certain conditions since 2008. 17 years. And the real world success uh data that is on TMS is absolutely extraordinary. So let's talk about it. Now, before I tell you what TMS is, I really want to talk about why it was created and why it matters so much for the conditions that are affecting more people than any other point in history. Things like depression, anxiety, OCD, PTSD, ADHD. These are not character flaws. They're not weaknesses, they're brain disorders.

Mental Health As Brain Circuits

SPEAKER_01 2:18

And I mean that in the most literal biological sense. And when we image the brains of people living with these conditions, we see measurable, consistent changes in specific brain circuits. Changes that explain exactly what the person is experiencing, and changes that medications, as powerful as it is for many people, does not always reach. So let me explain what is actually happening. At the front of the brain, uh just behind your forehead, sits a region called the prefrontal cortex. And this is the brain's command center. It handles emotional regulation, motivation, decision making, the capacity to feel engaged with life, the ability to feel that things matter. It also serves as the brain's primary regulator,

Depression And Anxiety Circuit Patterns

SPEAKER_01 3:13

keeping the alarm systems in check, moderating emotional swings, and allowing you to respond to the world thoughtfully rather than just react to it. In depression, the left side of the prefrontal cortex, specifically the region we call the left DLPFC, and what that stands for is dorsal lateral prefrontal cortex. So that left area, that dorsal lateral prefrontal cortex in depression becomes underactive. It goes quiet. And when it goes quiet, everything it is responsible for begins to fall apart. Motivation disappears, pleasure disappears, the sense that anything is worth doing, that the future holds anything, that you can access any real hope, all of it dims. And that's not laziness, that's not a lack of gratitude. That is a specific measurable circuit failure that we can now see on brain imaging. The left dorsolateral prefrontal cortex has gone offline, and the rest of the brain is actually paying the price. Now, in anxiety, and what I mean by anxiety is the kind of anxiety that just doesn't stop, that makes it impossible to be in a crowd, uh, the kind that keeps you awake at 3 a.m., that's running the same loop of thoughts over and over. So what we see in anxiety is actually the opposite from depression. There, we oftentimes see the right side of the prefrontal cortex, the right sided dorsolateral prefrontal cortex, it becomes overactive in anxiety. It's running too loud. And when it does, it drives rumination and hypervigilance and catastrophizing and that relentless mental noise that people with anxiety know all too well. Again, not a personality trait, it's basically a circuit that is stuck in overdrive. Let's talk about OCD or obsessive compulsive disorder. In OCD, the circuits connecting the prefrontal cortex to deeper brain structures, particularly the loops involved in checking and repeating and intrusive thought patterns, these circuits get locked and the brain cannot complete the signal. It keeps cycling. Medication helps some people significantly,

OCD And PTSD Stuck Loops

SPEAKER_01 5:42

but for many, those loops remain stuck regardless of what is in the bloodstream. In cases of PTSD or post-traumatic stress disorder, the brain's threat detection center, the amygdala, becomes hyperactive. It fires at triggers that are not real dangers. And the prefrontal cortex, which is supposed to apply the brakes, to tell the amygdala that the threat has passed, that you are safe now, it cannot get loud enough. And so the regulatory voice gets drowned out by the alarm. This is the problem that antidepressants and anti-anxiety medications are trying to solve. And they do help a meaningful number of people, and I want to be clear about that. They work on the chemistry surrounding these circuits. They adjust serotonin and dopamine and norepinephrine, these neurotransmitters. For people, though, whose circuits are responsive to that chemical shift, medication can work well. But for the significant portion of people, roughly 30 to 40 percent with depression alone, the chemistry uh changes and the circuit stays stuck. So the brain doesn't rewire, the pattern does not break. And those people are told, often after trying multiple medications, that they are treatment resistant. We hear that word a lot in healthcare and psychiatry, and that they're oftentimes told, well, this is just how their brain works. It is not. What it means is that they have not yet had access to a tool that works at the level of the circuit itself rather than the chemistry surrounding it. And we're seeing a big shift in psychiatry and neuroscience around this theory of neurotransmitters as being the main issue that drives uh these conditions. So we have a tool that can truly affect the circuitry, and that tool is TMS, transcranial magnetic stimulation. The left dorsal lateral prefrontal cortex, if it's underactive, well, we stimulate it directly with high frequency magnetic pulses that wake it up,

Why Medications Don’t Always Work

SPEAKER_01 8:07

rebuild the connection, restore the regulatory capacity that depression has suppressed. TMS can also be used on the right side. So if the right dorsolateral prefrontal cortex is overactive, like we alluded to in anxiety, we apply low frequency stimulation that actually quiets it. It turns down the volume on the anxiety and rumination loops. OCD circuits stuck? Well, we target the specific prefrontal and deeper brain connections involved in this particular disorder, and we begin to break the pattern. What about PTSD? Well, we strengthen the prefrontal voice so it can finally do its job of telling the amygdala that the threat is over. We're not guessing at the chemistry and hoping it reaches the right place. We're going directly to the circuit in the brain, targeting the specific side of the brain at the specific frequency for that specific condition. And that precision is what makes TMS different from anything else that came before it. And that is why it works when so many other approaches have not. So what is TMS? Let's break it down in plain language. Device itself is small and it actually has a coil inside of it, a magnetic coil, uh shaped like, in some cases, a figure of eight, and other configurations might be shaped like an H for reaching deeper brain structures. And when you hold the device or the coil near someone's head,

How TMS Targets The Circuit

SPEAKER_01 9:46

it actually generates a magnetic field. In fact, it's placed very gently against the head, against the scalp. And what happens is that a magnetic field passes right through the skull completely painlessly, and it creates a gentle electrical pulse in the brain tissue directly beneath it. And that pulse causes the neurons in that specific area to fire. And when you do that repeatedly in a targeted way over a series of sessions, something remarkable happens. The brain starts to change. The circuits that have gone quiet start to wake back up again. And the pathways that have been stuck start to move again. And this is the essence of what we call neuroplasticity. And think about it this way: if you break your leg and stop using those muscles for three months, they weaken. Physical therapy does not give you a pill, it makes you use the muscle again over and over until the strength comes back. TMS, I like to say, is physical therapy for the brain. And we're using a magnetic coil placed gently against the scalp to make specific brain circuits fire until they can do it on their own again. And uh circuits and neurons that fire together actually wire together, and that's the beauty that underlies neuroplasticity. So no surgery, no sedation, no medication. You absolutely just uh sit in a chair, the coil is positioned uh right on your scalp, and the treatment runs, and you drive yourself home. I mean, it's pretty simple. There's no sedation, there's no there's no uh significant side effects. Um but here's something that I want you to

Neuroplasticity And What Treatment Feels Like

SPEAKER_01 11:41

understand, and and I'm gonna keep it simple because it's actually a beautiful concept. The brain has an ability to change. I alluded to it before, and scientists call it neuroplasticity. It means that the brain is not fixed, it's not hardwired forever, it can build new connections, it can strengthen new circuits that have maybe grown weak and rewire patterns that have kept people stuck. TMS accelerates that process deliberately and precisely. And every time a magnetic pulse fires and causes those neurons to activate, it's like sending a signal to your brain that says, This pathway matters. Wake it up, use it. The more that happens, the stronger that pathway becomes. It's the same principle behind uh learning a new skill or forming a new habit. Repetition rebuilds and builds a healthy circuit. And TMS does it directly at the source with a level of precision that really nothing else can match. And that is what makes TMS fundamentally different from medication. Medication adjusts chemistry around the brain's circuits. And while we see that can have its benefits, uh, and for many people it does, but when you stop the medication, the chemistry changes back. On the other hand, TMS actually builds something, it creates structural change in the brain itself, and structural change is what lasts. And let me tell you what the uh experience actually feels like because people always want to know this. Now you can come in and sit in a comfortable chair, and a technician holds the coil. Uh, picture a slightly curved paddle with a handle on it resting on your scalp. And it doesn't press into your head, it just sits on close proximity to it gently against the scalp. And when the treatment runs, most patients feel like a very gentle rhythmic tapping on the scalp. Uh, some people might describe it as a very light knocking sensation, uh, but that's it, it's not painful. And your very first session includes something called motor threshold mapping. And so we gradually increase the stimulation until we see a small involuntary twitch in your hand, which tells us exactly how much magnetic energy your specific brain needs. And um, so it's basically a coil is placed over what we call the motor cortex, which is a little bit further back in the brain, uh, and uh the uh impulse is sent, the magnetic uh impulse is sent, and it sends a signal on the left side of the brain, and so what you'll see is when it's activated in the motor threshold, you'll see a slight movement uh in the right hand or the right fingers of the right hand. And so it tells us really what your threshold is for that specific modality. And so the technology has really made this very fast and more precise than ever. And uh, what we used to take significantly longer amounts of time can now be done in just a few minutes with a level of accuracy that actually personalizes the treatment from the very first session because everybody's different. Everybody's motor threshold is different from one person to the next. Somebody might have a thicker skull, and for that reason, we have to figure out exactly what that threshold is, that minimum amount, minimum amount of impulse that is needed to generate a response. The only side effects that are reported, uh really that are that are most often reported, I should say, are basically a mild uh headache or maybe some scalp sensitivity at the side of where the coil was. That's usually happens maybe in the first few sessions, but both of those symptoms subside very quickly as the body adjusts. And most patients don't even notice them after the first week or two. There are no systemic side effects, nothing in your bloodstream, nothing affecting your whole body, just a targeted magnetic pulse to a specific spot on the brain. Now, let's talk about who TMS is actually for, because I think this surprises people when they hear the full picture. Uh, depression is the primary FDA approved or cleared indication, and really where TMS has its longest and deepest track record, lots of data. The evidence

Who TMS Is For Including Teens

SPEAKER_01 16:30

for this is strongly positive and encouraging for the success of TMS in this specific condition. And again, when we're talking about TMS and depression, it targets the left dorsal lateral prefrontal cortex with very high frequency stimulation, right? We're using higher frequency to create more of a stimulation effect to restore the regulatory function that depression has suppressed. So if you have tried antidepressants and not gotten adequate relief, or if the side effects made it impossible to stay on them, then TMS really belongs in the conversation. You do not need to have failed five medications to qualify. And you really need to deserve, you need to know, and you deserve to know what your options are now. And some people are even gravitating toward this as a first line of treatment rather than even taking antidepressants because it's so effective. Um, the challenges kind of center around what insurance will cover, how they do it, and and uh there's a little bit of a challenge when it comes to sometimes dealing with insurance companies, but there's always uh ways to navigate that. Anxiety is where I see some of the most meaningful responses and protocols that focus on that right-sided dorsolateral prefrontal cortex while also even supporting the left side, uh left dorsolateral prefrontal cortex with certain protocols. What happens is that you can actually recalibrate the balance between the alarm system and the regulatory system. So patients who have been living with anxiety for years, that kind that makes it hard to be, again, in a room full of people, it's hard to sleep, it's hard to turn their thoughts off. These patients are reporting a quieting of that noise after TMS that really nothing else has had uh the same effect on. And so for anyone who's been told that anxiety is just something that they have to manage or live with forever, uh, I would say TMS is definitely worth knowing about and um checking into. OCD, it has its own FDA clearance for TMS. And the circuits involved in OCD, right? The loops between the prefrontal cortex and the deeper brain structures that get locked in patterns that medication often can uh cannot fully break. TMS targets those circuits, right? And it's produced some meaningful reductions in obsessive thoughts and even compulsive behaviors for patients who have really exhausted other options. And PTSD is one of the most compelling applications and is currently being studied. Uh TMS strengthens that prefrontal regulatory uh capacity so patients can finally like put the brakes on overactive thoughts that are coming from that area of the brain that controls that, which is the amygdala. Multiple clinical trials are showing a significant reduction in PTSD symptom severity. So it's very promising. The evidence is real and growing. TMS is, as I mentioned earlier, is maybe indicated for patients who maybe don't want medication at all, patients who maybe don't want the side effects, uh, parents maybe who do not want their teenager on a on a medication, uh, or adults who have had uh difficult experiences with medications in the past, maybe people looking for an approach that works with the brain's own biology rather than altering its chemistry. So TMS is a very legitimate, evidence-based, medication-free option. Which brings me to adolescents, to teenagers, because this is one I feel very strongly about. The mental health crisis among young people right now is real and it's urgent. And one in five teenagers in the United States is experiencing a major depressive episode, and most are not getting the adequate treatment. In 2024, TMS has actually received FDA clearance for adolescents age 15 to 21. Real-world data from over a thousand adolescents showed that nearly 60%, uh 59% of patients experience significant improvement, and 36% actually achieved full remission. That's huge. So for a teenager who's been struggling, whose family has watched them withdraw or stop sleeping or stop engaging with the life they are supposed to be living, those numbers that I mentioned are absolutely profound. And TMS gives young people and their families a real option that does not carry the side effect concerns of psychiatric medicines in a developing brain. And TMS is for people who see their health holistically. It works with the brain's own biology, it stimulates the brain's natural capacity to heal itself. And for patients who are also working on sleep, nutrition, exercise, and stress management, TMS amplifies all of that. The brain being actively rewired through TMS is a brain more receptive to everything else you are doing to take care of yourself. Now let's talk about the results because they are absolutely extraordinary. Real world clinical data, meaning what happens in actual practice, not just controlled research trials. What we see is 83% response rates. That means that 83% Out of a hundred people who go through a full TMS course, see

Real-World Results And Maintenance

SPEAKER_01 22:29

significant improvement. Think about that. So now let's talk about remission rate, or we say complete or near complete resolution of all symptoms. That runs at around 62% in real world settings. So these are the numbers from clinics that are treating real patients, and many of whom had already been through the system and maybe felt like they were out of options. And here's what I want to emphasize these results last because TMS is not just adjusting chemistry that wears off when you stop a pill. It's rebuilding the circuits themselves. And the brain changes structurally. And that kind of change holds over time. And patients who respond to TMS often described it as not just feeling better, but feeling like themselves again, like something that had been dimmed for years finally came back on. And so for a lot of these patients, even though these changes in the brain are long-lasting, we know that the brain is still constantly under the barrage of inflammation and other factors in life, that periodically patients do come back in for follow-up or for maintenance therapy periodically, but that's going to vary from individual to individual. Now, with respect to the results that we're seeing, even insurance companies in the data that they follow backs up these claims that patients who receive TMS actually have significantly fewer psychiatric hospitalizations and emergency room visits in the year following treatment. So this is not symptom management. It's actually a genuine, meaningful recovery. Now let me talk a little bit about protocols because uh TMS has evolved significantly since it was first approved, and the options today are way more advanced than most people realize. So the original FDA approved protocol is five sessions per week for six weeks, and so that's anywhere from 30 to 36 sessions total. And this is typically what the insurance

Protocols From Standard To SAINTE

SPEAKER_01 24:41

uh providers um recommend and will pay for. That's changing. We'll talk a little bit more about that in just a bit. So that might seem like a lot to go through, but again, there's good data to support this, but also um it's worth it. You have to ask yourself going five days a week, 20 minutes at a time, for up to 36 sessions, is it worth the improvement? Is it worth the remission? Is it worth the response rates that we're seeing? And I would submit to you, absolutely. Just ask the people that have had success with this modality and how it's been life-changing for them. So, again, it's each session, as I mentioned, runs anywhere from 20 to 40 minutes, depending on the exact protocol. So patients come in on a Monday through Friday, for example, the treatment runs, and you go on with your day. And for many patients, this protocol's been life-changing, as I mentioned, and it still remains an excellent option. Then came something called theta burst stimulation. And theta burst stimulation is a newer protocol that delivers the same therapeutic effect in a fraction of the time. And we're talking three to five minutes of active stimulation instead of 30 to 40. Same neuros, uh, this causes the same neuroplastic change. And it's same results, just compressed into much shorter sessions. Thetaburst uh have its own FDA clearance and has become increasingly common because it makes the whole process so much more manageable. A working parent, someone running a business, someone who is already exhausted from what they're dealing with and cannot fathom adding five days a week of appointments on top of it, Thetaburst has actually changed that equation. And the treatment fits into uh a life instead of taking over one. I want to talk about something that has been developed at Stanford called the SAINTE protocol. And this is uh an accelerated intelligent neuromodulation protocol. And this particular protocol went even further, and it uses advanced brain imaging to precisely identify each individual patient's dorsolateral prefrontal cortex, target the exact uh spot that's most connected to mood regulation that we've talked about. And um what happens, it delivers this protocol is delivering 10 sessions in a single day over five days. Now that's a lot, it's a big commitment over that five-day time span. You're doing 10 sessions a day for those five days, but this produced remission rates of up to like 79% in patients with severe treatment resistant depression. And so the FDA actually cleared this in uh 2022. Five days. That's how far this technology has come. And that momentum leads me directly to what I am most excited about right now, and it's an emerging technology, and it's called ExoMind. And ExoMind is a next generation TMS platform uh developed by BTL Industries, and that's a company known for some of the most advanced medical devices on the market. Uh, it received FDA clearance in 2024,

ExoMind And What’s Next

SPEAKER_01 28:07

and it's changing what the TMS experience looks like and feels like in ways that matter directly to patients. Now, the first thing that ExoMind does differently is how it delivers the magnetic pulse. Traditional TMS energy uh has a sharp sudden spike, which creates that tapping sensation and something that uh sometimes uh that that scalp discomfort in the early sessions. ExoMind uses what is called a uh trapezoid stimulation waveform. So it's a it's a little different shape waveform, and the energy builds gradually before firing instead of arriving all at once. And so the neurons are still gonna get the full therapeutic stimulation, but the experience itself is dramatically more comfortable, and patients rate exomind comfort at around half a point out of 10. Uh so traditional TMS averages about two and a half. Um, and most exomind patients describe the sessions as nearly sensationless. And for patients with anxiety or depression who are already carrying a sensitized nervous system, that difference matters enormously. And so the second thing that sets ExoMind apart is a real-time adaptive stimulation. So every conventional TMS device uses a fixed protocol. Your settings are established, and then the machine delivers the same treatment the same way every single session, regardless of how your brain actually is responding that day. So your brain on a Monday after a rough weekend is genuinely different from your brain on a Friday after a good week. So ExoMind responds to the brain it is actually working with. And the treatment is always calibrated to where you actually are. The third thing that I think that sets ExoMind apart and really what surprises people is the protocol length. This is exciting because ExoMind, its recommended treatment course is actually six sessions. That's right, just six sessions. And that's pretty cool. And and what you could do one session per week for six weeks. Some providers are doing anywhere from two sessions a week for three weeks, but each of the sessions lasts just under, probably under 25 minutes. And you know, six sessions instead of 36, that's that's not a shortcut. It's actually the result of more efficient, more precise delivery, improved technology. And this improved technology allows for more energy to reach the target tissue in a shorter amount of time. So it's better calibration, it's real-time adaptation, uh, optimizing each pulse. So the neuroplastis, uh, the neuroplastic change that used to require 36 sessions actually gets there in about six because each one is doing significantly more of the work. Uh completion rates reflect this. ExoMind adherence runs around 72%, 72% compared to about 50 to 60 percent for conventional protocols. So more people finish. And finishing is what produces outcomes. And uh ExoMind also holds uh clearances in Canada and Europe for anxiety, OCD, and binge eating disorder. And the breadth of what this platform is being cleared for tells you exactly where this technology is headed. Um, I also want to take time to make sure that you know the full picture of what TMS is being used for because depression, anxiety, and OCD are just the beginning. TMS is FDA cleared for anxious depression and for smoking cessation. It's being studied extensively and being cleared for migraines and specifically migraines with aura and uh using a hand uh-held single pulse device that interrupts the brain event trigger attack at the onset is also being evaluated. Um cleared in uh 2013, um, that particular device is helping patients who suffer from from migraines. And so uh most people that uh have migraines have really never heard about TMS as an option. Um, beyond the cleared indications, TMS is really showing strong results for addiction and substance use because it targets the prefrontal circuits that regulate craving and compulsive behavior. Uh it can even help with people with wringing of the ears or tinnitus. Uh, some people with early mild cognitive impairment um are benefiting from TMS. Uh, there's emerging um data in the field of Parkinson's research, and certainly with ADHD and autism spectrum disorder, even it's seeing a use in stroke and rehabilitation medicine. So, research exists, um mechanisms are very well understood, and so the application of this technology just keeps growing. So, here's what I want you to take away from this today. And I'm sorry if this has been a little bit more long-winded uh today, but it's it's such an important topic, and I'm so passionate about it. Here's the truth TMS works. The research has shown there's so much data behind it, and it works by going directly to the brain circuits driving the problem. So it stimulates

Key Takeaways And How To Start

SPEAKER_01 33:52

that underactive left dorsolateral prefrontal cortex uh in depression, it quiets the overactive right-sided dorsolateral prefrontal cortex in anxiety, uh, breaking the it breaks the stuck loops in OCD and PTSD and and it rebuilds these circuits through targeted, through precise, repeated stimulation. The real world data is absolutely extraordinary. 62% remission. The protocols keep getting faster, more precise, and more personalized. Um, ExoMind in particular is making TMS way more comfortable and more accessible than ever before. And the range of people it can help keeps expanding. From adults with treatment-resistant depression to teenagers struggling with their mental health, to people looking for a medication-free approach, to anyone who takes their brain health seriously, TMS should be considered. If anything we talked about today resonates with you, please reach out, start a conversation. We're having these conversations in our clinic as well, and we're utilizing TMS to help a lot of people. When you talk about TMS with your provider, it's it's not a commitment, it's just information that you deserve to have. And if you need more information, please reach out to me. Um, and please share this episode if you think this would help somebody. If there are people in your life right now who've been struggling maybe for years and have never heard of those three letters, send this to them. That uh might be the most important thing you do today. Your health, your way, always.

SPEAKER_00 35:44

I'll see you next time. This podcast is for general informational and inspirational purposes and does not constitute the practice of medicine or any healthcare services. No doctor patient relationship is established, and the content in these episodes is not intended to diagnose, treat, or give medical advice, nor is this a substitute for seeking professional medical care. The use of the information discussed is at the user's own risk.