Theta-burst TMS

Transcranial magnetic stimulation, more commonly known as TMS, is one of the safest, most effective therapies for those suffering from treatment-resistant depression. Since its FDA-approval in 2008, TMS has become a prevalent and respected therapy among mental healthcare providers and it’s easy to see why. On average, 50 to 60% of patients who receive TMS therapy demonstrate a substantial reduction in depression-related symptoms (Stern, 2018). What’s more, by locally stimulating key areas of the brain, TMS avoids the often unpleasant side effects that accompany many medications, which diffuse throughout the bloodstream. Despite achieving this admirable combination of high efficacy and reduced side effects, TMS therapy has one notable drawback: time.

The average TMS session lasts about 37 minutes and this time might extend to an hour if a second protocol is included. With a typical treatment period of 4 to 6 weeks and 5 treatments-per-week, the time adds up quickly. However, a new protocol called theta-burst has the potential to make this time burden a thing of the past.

Theta-burst utilizes the same mechanism as traditional TMS protocols: an MRI-strength magnet positioned over the scalp, which induces a small electrical current in the brain. At certain frequencies this stimulation is able to induce or inhibit activity in a given brain area. Then, after a series of consistent treatments, TMS can change the baseline activity of that brain region; overactive areas can be calmed and underactive areas can be given the boost they need to function properly. However, while the traditional protocols deliver regular or clustered magnetic pulses over a 20-50 minute period, theta-burst delivers much higher frequency pulses, reducing treatment time to just over 3 minutes.

Now you might be thinking, “less time out of my day for treatment sounds great, but is theta-burst as effective as the traditional protocols?” In 2018, a group of physicians and researchers funded by the Canadian Institutes of Health Research came together to answer just this question. The study was comprised of nearly 400 participants all diagnosed with treatment-resistant depression. This population was split into two groups: one would receive the standard TMS protocol and one would receive theta-burst. By the end of the treatments the researchers observed no difference in outcome between groups; 50% of patients receiving theta-burst treatment showed a significant reduction clinical depression measures and 32% achieved remission. For comparison, those patients on their second or third medication trial have a remission rate of around 13% (Blumberger et al., 2018).

So we know theta-burst works, but the protocol is especially exciting for what it’s efficiency means for patients and their providers. For those receiving TMS therapy, the reduced treatment duration can mean an easier time fitting daily sessions into your already busy life. You can pop by the clinic during your lunch break or make it a pit stop on your commute home from work. Shorter sessions also open up the possibility of multiple sessions per day, which may cut a 1-2 month process down to a couple weeks. For providers, 3-minute treatments are an opportunity to take on more patients seeking TMS and potentially decrease costs of operation.

TMS already revolutionized the treatment of depression and theta-burst promises a future in which TMS is more accessible and efficient, making it possible for more people to beat depression, faster.



Blumberger, Daniel M, et al. “Effectiveness of Theta Burst versus High-Frequency Repetitive Transcranial Magnetic Stimulation in Patients with Depression (THREE-D): a Randomised Non-Inferiority Trial.” The Lancet, vol. 391, no. 10131, 28 Apr. 2018, pp. 1683–1692., doi:

Stern, Adam P. “Transcranial Magnetic Stimulation (TMS): Hope for Stubborn Depression.” Harvard Health Publishing, Harvard Medical School, 23 Feb. 2018, .

Crisis Text Line

Adolescence is often considered the pinnacle of emotional turmoil, learning independence, body-image issues, and the emergence of mental illness. According to the National Alliance on Mental Illness, 50% of all lifetime cases of mental illness begin by age 14 and 75% by age 24. This is also the age range where suicide is the 3rd leading cause of death in the US.

So with all these issues affecting teens and young adults, what resources are available for them to seek help? Their parents. But what if their parents aren’t supportive or are part of the problem? Their school counselor. But what if they are scared their peers will see them go to their appointment? Calling a crisis hotline. But what if someone overhears their conversation?


Texting is private.

You don’t have to make an appointment.

No one hears you talking.

In the same age group that risk of suicide is the greatest, texting is collectively used as a primary method of communication. The average Millennial exchanges 67 text messages per day, with 98% of all text messages being opened and viewed. In addition, over 80% of American adults use text messaging, which makes it the most common cell phone activity. To better integrate modern technology and mental health support systems, two women named Stephanie Shih and Nancy Lublin created the organization Crisis Text Line.

Crisis Text Line is a non-profit organization in the U.S. that offers 24/7 free crisis mediation through text messaging. Anyone can text the numbers—741741—and within a matter of minutes, a live trained Crisis Counselor will quickly respond to help you work through your problem, or just to provide emotional support. Crisis Counselors are filtered through an extensive application process and must pass a background check and complete a rigorous training program. All texts are free of charge if you use the providers AT&T, T-Mobile, Sprint, or Verizon.

The texting service uses an algorithm that filters incoming text messages by severity, so that texts containing words such as “kill myself” are brought to the top of the list of counselors’ attention so they can be helped immediately. The texter no longer has to wait for their next therapy appointment to address active suicidal ideations.

This algorithm is also vital for collecting mental health data that can be used for a variety of applications. It has determined that words such as “numb” and “sleeve” in the same message have a 99% match for cutting behaviors, and subsequently sends an automatic message to the Crisis Counselor notifying where appropriate clinics are near the texter in need. The algorithm has indicated the worst day of the week for eating disorders. Monday. It can also pinpoint how the mental health of adolescents and young adults are affected by certain events such as a school assembly, or even the election.

Crisis Text Line is a great example of how integrating modern technology and mental health services can provide a source of support for those who are unable or have trouble speaking out about their issues.




To learn more about Crisis Text Line, crisis trends, and how to get involved, visit the website:

Mental Health Facts: Children & Teens


Genetic Testing

Anyone else tired of playing medication roulette? Or watching a loved one struggle to manage their time and money trying new medication trials without the promise of efficacy? Pop a pill a day, wait a month, endure the side effects and repeat. Only the lucky ones hit the jackpot the first time around.

Fortunately, things have started to change!

By doing a simple cheek swab, you can now find out how your body specifically processes drugs and which types of drugs may benefit you the most.

These genetic tests analyze a panel of key genes that can be useful when determining which medications to take for a wide range of psychiatric disorders, including depression, anxiety, OCD, ADHD, chronic pain, schizophrenia, PTSD and substance abuse. The test results not only indicate which class of medications (i.e., SSRI, SNRI, Atypicals, TCAs) are most appropriate for you, but also which specific medications in each class are clinically indicated with corresponding dosing guidelines.

Let’s say you have moderate to severe depression. You’ve made all the lifestyle changes you can manage and are nearly close enough to your doc to send him a Christmas card this year. But 9 months and 3 medications later you’re still better friends with your couch than other humans and now you’ve somehow gained 15 pounds and no longer get excited when your husband climbs into bed next to you. Instead of rolling the dice and picking the subsequent medication on the list (hoping the next round of side effects don’t include hair loss!) you can now visit your psychiatrist and ask him to order a genetic test. The test results may tell you your genes interact better with a completely different class of antidepressant medications than you’ve been taking. Or, possibly that you have a MTHFR gene deficiency that may benefit from a specialized supplement. The test could also tell you that your body requires a significantly lower or higher dose than is commonly recommend for a certain drug, which may alleviate adverse effects of medications. Or maybe (groan) your body requires greater amounts of physical activity, which benefits the BDNF protein and may contribute to improvements in working memory and cognition.

Genetic testing allows all individuals to gain insight into their genetic makeup and how their body processes medications. Genomind is one genetic testing company whose recent studies report that 91% of patients who have failed at least two medications in the past have experienced improvement with treatment guided by the test.

However, all good things must come with a caveat. While genetic testing can indicate which medications may be clinically preferred over others, patients may still experience unexpected results. You may have taken Prozac for the past 15 years with some benefit only to find the genetic test indicates this is not a viable drug for you.

While the information that we receive from our genes doesn’t always align with clinical experience, utilizing genetic testing as a method of personalizing mental health care is a certainly step in the right direction. Just as our individual brain chemistry and experiences rarely fit into cookie-cutter boxes, neither should our approach to prescribing medications.

To learn more about the genetic testing process, visit the Genomind website:


Autism Spectrum Disorder (ASD): What should future research consist of?

Autism Spectrum Disorder (ASD) is a complex developmental disorder that constitutes both social communication deficits and restricted interests and behaviors (Hollander et al., 2011). Social communication deficits may appear in the form of abnormal eye contact, lack of facial expressions, failure to share their experiences with others or difficulties initiating, sustaining and understanding relationships. A child presenting restricted interests and behaviors may insist on wearing the same superhero costume everyday, have a highly restricted, fixated interest in insects, demonstrate repetitive hand flapping or be highly sensitive to certain senses such as florescent lighting.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) combined the diagnoses of autism, Asperger’s Syndrome, and Pervasive Developmental Disorder (not otherwise specified) under the umbrella diagnosis of Autism Spectrum Disorder. ASD is heterogeneous in its presentation of core deficits, intellectual disability, accompaniment of epilepsy, and in its timing of onset of symptoms. As its name suggests, individuals with ASD fall on a spectrum from having a serious intellectual disability, severe sensitivity to sensory stimuli, and a non-verbal profile to being highly cognitively functional with strong verbal skills and circumscribed interests. According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 68 children in the U.S. are diagnosed with autism, with boys being almost five times more likely to develop the disorder.

Scientists and researchers have come a long way in discovering new risk factors, early childhood screening tools, and characteristics of ASD, yet the etiology of the disorder is still largely unknown. In the meantime, it is crucial that we increase our research funding to areas of autism research that need it the most.

According to the 2010 Autism Spectrum Disorder Research Portfolio Analysis Report conducted by the Interagency Autism Coordinating Committee [IACC](2012), there was a fund of over 400 million dollars designated to seven areas of ASD research, with only 2% of the money utilized for research related to autism lifespan issues. Lifespan issues can include adult interventions and service needs, transition and vocational programs, social skills training, and other services related to improving the quality of life of individuals with ASD as they enter into adulthood (IACC, 2012). Results from a UK study reported that parents of autistic children felt that once their child was given an autism diagnosis, they were given little to no assistance for how to move forward (Pellicano, Dinsmore & Charman, 2014).

Overall, it appears that it is widely agreed upon by the autism community that the main concern of future autism research should be to improve the day-to-day lives and future of those currently affected by the disorder.

In recent years, a new therapeutic method has emerged that has shown evidence for helping to improve certain traits associated with ASD that would help young adults with this transition. Transcranial magnetic stimulation (TMS) Therapy is a non-invasive procedure that uses electromagnetic pulses to stimulate neurons in the brain. Studies indicate that TMS may improve certain aspects of daily functioning that are reported as difficult for those diagnosed with ASD. These include being better able to read social cues and complete cognitive tasks. TMS Therapy also provides the added benefit of demonstrating durability over time, which would support those with ASD throughout their future endeavors. While TMS Therapy for ASD is still in the very early stages of research, it will be an interesting avenue to explore, as it does not act as a medication which can inhibit the wonderful, unique aspects of those with ASD but may improve their social functioning enough to better show them to the world.




Hollander, E., Kolevzon, A., & Coyle, J. T. (Eds.). (2011). Textbook of autism spectrum disorders. Arlington, VA: American Psychiatric Publishing, Inc.

U.S. Department of Health & Human Services, Interagency Autism Coordinating Committee. (2012). 2010 IACC autism spectrum disorder research portfolio analysis report. Retrieved from

Pellicano, E., Dinsmore, A., & Charman, T. (2014). What should autism research focus upon? Community views and priorities from the United Kingdom. Autism, 18(7), 756-770.


Dear Readers,



  1. : a group, individual, or structure that is not normal or typical
  2. : a person whose behavior departs substantially from the standard

This blog is for us aberrants. The dopamine deficient introverts, the sleep-wake cycle jugglers, the thrill-seeking daydreamers, and the pill with your morning coffee takers. I am writing to those of us stuck along the synapse-dense spectrum, to those who walk the tightrope between euphoria and despondency, and to those whose list of worries far surpass the dread that there’s a monster in their closet.

We are all aberrants, deviations from the idealized, ever-changing norm. I may be struggling to sit still through a conference while my co-worker is struggling to ignore the imaginary twin telling him jokes in his head, but hey, we’re both different. We all are.

Through these posts, I hope to provide some insight and perspective into new therapeutic treatment methods, significant research findings, current topics in the news and simply fun facts as we delve into the brain and the mental health industry. You may be wondering, why do there seem to be a lot more kids these days with anxiety and ADHD? Are we to blame the student taking a cocktail of antidepressants for their problems, or do we blame the parents? The teachers? The system? Those of us who spent Freshman Year Psychology 101 experimenting with everything but paying attention may be wondering, what exactly is the function of the amygdala? The thalamus? If I have tried everything for my mental health, are there more options?

Navigating the system surrounding mental health entails a constant tangled web of questions, which I will utilize this blog to ask, research and convey. As they say, the only thing we know for certain is that nothing is certain. Research is ever expanding to uncover new theories, new connections and new possibilities. And in the meantime, you can find comfort in the fact that we are all aberrant, struggling to find balance in our interweaving pursuits of normalcy and happiness.