About the Talk: With recent advances on both the mechanistic and practical fronts, non-invasive brain stimulation technologies such as TMS are now achieving ever-greater efficacy on ever-shorter timescales. Yet to meaningfully address the high prevalence of depression and other common psychiatric and neurological conditions, TMS must still achieve additional order-of-magnitude improvements in cost, convenience, technical simplicity, and scalability. There is indeed a pathway by which TMS can match the cost and convenience of medications, but the critical optimizations involved are quite non-intuitive, and largely neglected in the research literature to date. Here we will review recent progress in optimizing TMS for cost, simplicity, and scalability, as well as a set of key questions for future work. If these issues can be solved, TMS may indeed prove competitive with medications on cost, convenience, efficacy, accessibility, and scalability. A billion patients stand to benefit from such work, within our practice lifetimes.

About the Speaker: Dr Jonathan Downar is an Adjunct Professor in the Department of Psychiatry and Institute of Medical Science at the University of Toronto. He holds a clinical appointment at the Centre for Addiction and Mental Health in Toronto. He holds a PhD in functional neuroimaging from the University of Toronto, trained in medicine at the University of Calgary, and completed his psychiatry residency at the University of Toronto.

Dr Downar has been working as a clinician and researcher in the field of TMS since 2010. He has published over 180 peer-reviewed articles on TMS and brain imaging, in journals including Lancet, Nature Medicine, Nature Neuroscience, JAMA Psychiatry, and The American Journal of Psychiatry. He is the senior author of the THREE-D study, a major Canadian TMS study published in Lancet in 2018 that demonstrated that TMS treatments could be reduced from 38 min sessions to 3 minute sessions with no loss of efficacy. He has also pioneered the use of novel TMS protocols including dorsomedial TMS and orbitofrontal TMS in depression and in other clinical disorders.

His current focus is on developing a new generation of TMS techniques involving highly accelerated, pharmacologically enhanced treatment protocols as well as simple, scalable TMS hardware that is telemedicine-capable. The goal is to make TMS effective and readily accessible for any patient, at a cost comparable to medication. At the same time, he continues to work on clinical TMS delivery, research and teaching with practitioners and collaborators around the world.