When five antidepressants have failed to work, how hopeful are you for number six?

If the next one is Saint TMS, there's a good chance, an 80% chance, it will bring full recovery

within a week. Stay tuned for a practical guide.

Welcome to the Carlisat Psychiatry podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlatte Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

In March of 2017, a group of researchers at Stanford University launched a new clinical trial.

The trial did not go as expected, but it has changed the way we approach treatment-resistant depression.

Today, we're going to look at this study and what it means for your patients who haven't recovered after three to seven antidepressant failures, the typical range in this study.

The treatment they were testing was a new form of transcranial magnetic stimulation, or TMS.

At first, they called it spaced TMS, but as the lead author, Nolan Williams, saw how powerful

it was, he changed the name to the more angelic, St. TMS, an acronym for Stanford accelerated,

intelligent neuromodulation therapy. Then he had to change it again. After a journal reviewer complained that we shouldn't mix

religious language with medical treatment so saint became s nt Stanford neuromodulation therapy

midway through the trial williams and his team were forced to make a different kind of pivot

it was three years into the study, and they had treated 30 patients.

But before enrolling anymore, the team peaked at the data to see how things were progressing.

This is standard research protocol.

If you're testing a new treatment, you need to know if it's causing problems before you put

more subjects through the test.

What they found was not a problem. S&T was well tolerated. Instead, they became alarmed at how

powerful it was. It had already achieved a clear statistical difference from placebo at the midway point, with an effect

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