Dr. Nolan Williams

you know, the surface of the brain's neurons in this dorsolateral prefrontal.

And if you do that in the actual scanner, which we can do, you can see that that distributes down into the anterior cingulate, in the insula, in the amygdala, and ultimately the tract goes into something called the nucleus tractus solitarius, and ultimately into the vagus nerve, into the heart.

So the heart...

very consistently seems to be the end organ of the dorsolateral prefrontal cortex.

If you do that over visual cortex, you don't get that, or motor cortex, you don't get any of those findings.

It's really specific to this kind of control region of the brain.

Yeah, it seems to, you know, it's our work, other folks work, Martin Arns in Europe, the Netherlands work, showing the same connections.

I think it's been replicated like four or five times.

Where I think TMS is really interesting, actually, we had a lot of patients who've told me, like, my therapist told me that I wasn't trying hard enough in therapy.

These are, you know, moderate to pretty severe depressed patients.

And as soon as we get them well with the TMS approaches, kind of rapid five-day approach, then the next week we come in and see them and they'll say, you know what I did all weekend is I looked at my therapy books and now I can understand it.

And so I actually see TMS as a way of having kind of exogenous sorts of cognitive functions that in milder forms of depression, we can pull off with psychotherapy.

This idea of being able to kind of turn that prefrontal cortex on and have it govern these deeper regions.

In depression, the deeper regions

govern the prefrontal cortex.

You restore order to the game.

And what it looks like is depression is a bunch of kind of spontaneous content that's semi-volitional, that's being kind of generated out of this conflict detection system, the cingulate.

In depression, it looks like the left dorsolateral does not sufficiently clamp down on it.

And what therapy appears to do is to kind of restore that.

What we see with TMS over that region is that we just exogenously do the same sort of thing.