“The Most Impressive Therapy I’ve Ever Tried” — Tim Ferriss On Transcranial Magnetic Stimulation

Here is a brief summary of the key points in the transcript: - Tim Ferriss is very excited about accelerated transcranial magnetic stimulation (TMS) as a new mental health intervention. He has undergone two rounds of accelerated TMS treatments for conditions like OCD, anxiety, and depression. - Accelerated TMS compresses 50 sessions into just 5 days. The effects have been very noticeable and durable for Tim - improving his sleep, reducing OCD tendencies, and alleviating anxiety and depression. - Tim cautions against DIY TMS at home, as it can be dangerous and make things worse if not done properly. Proper targeting is important. - Tim recommends looking for TMS providers with clinical experience and bonafides. Costs range from $5k-$15k out of pocket currently. - Tim expects TMS will become more widely available and affordable in the next 6-12 months. He plans to do a follow up on his experience and make recommendations once he has more data on durability. - Tim sees great potential for using TMS for performance enhancement in sports and other areas by enhancing traits like reaction speed. But there are risks like over-dampening anxiety. - Tim shares the experience of side effects like temporary inability to orgasm, highlighting the importance of proper targeting.

Speaker A: It has been the most durable noticeable on a day to day, week to week basis change in my state that I have ever experienced. So I want to switch gears a little bit and mention something that I'm incredibly excited about, which is the most impressive, let's call it mental health intervention that I have encountered in the last ten years. So, as some of you may know, I've been very involved with supporting a lot of research, basic science and so on related to psychedelic compounds and psychedelic assisted therapies. That has been because I believe they can really change the lenses through which we look at psychiatry, mental health and so called mental disorders completely due to some of the effect sizes and durability of, say, effects on complex PTSD, treatment resistant depression and so on. But I'm actually tool agnostic. Just like with startup investing, I'm looking for uncrowded bets with super high leverage potential outcomes. I'm quite agnostic about the tools, and I will say, and you and I have talked about this privately a little bit, but in the last, let's call it year, especially the last six months, I've done a very deep dive on a new iteration of an older technology, which is TMSD, transcranial magnetic stimulation. So this is a type of brain stimulation. The technology has existed for a number of decades, but the protocols and the neurotargeting is advanced really quickly.

Speaker B: There was this whole subreddits where you could go and learn how to do it yourself at home.

Speaker A: Don't diy this.

Speaker B: People were literally having burns on their skin doing it.

Speaker A: This is Darwin awards territory. Don't do this, guys, in part because you can make things a lot worse if you don't do it the right way. But to. To jump to the punchline, I have gone through two rounds of something called accelerated tms, and you can learn a lot about this by looking at a number of scientists, including Nolan Williams out of Stanford. I did an interview with Nolan on the podcast for people who want to do a deep dive, and they developed what was previously known. It's gone through some rebranding, the Saint protocol, which is a very condensed protocol for administering tms. So you have these magnets. They elicit, in this case, theta bursts. And typically you might have TMS treatments over the span of many weeks, many months. They're compressing 50 sessions into ten days or actually 50 sessions into five days. Excuse me.

Speaker B: Pause for 1 second, though. For people that don't know, what does this look like for you? Said magnets. I'm thinking like, you know, I don't know what I'm thinking, but, like, what do you. What are you actually doing? Are you hooking shit up to your head? Are you in a lab? Are you doing it at home?

Speaker A: You're not doing it at home. So you are in a clinic or lab, and there are different iterations of this. So my first round was with a company called brain sway, and they use a particular h seven coil. They're developing new technologies that's effectively a helmet that you then attach to your head with a chinstrap. And based on specific targeting, depending on the condition you're trying to address, which could be depression, treatment resistant depression, could be generalized anxiety disorder, could be OCD. Any number Ed, right? Ed.

Speaker B: Sure. Everybody's got their thing.

Speaker A: If there's magnetic Viagra, then there's a whole new business I need to invest in, so. Yeah, sure. And then the second round was with Magnus ventures and a different, slightly different technology, but it effectively looks like a paddle that is placed on the head, and they use computer vision and pretty sophisticated targeting. But the upshot of this is, going into it, no one will be surprised. I remember when I had my first diagnostic interview with one of these psychiatrists, and we went through this long, multi hour process, and they said, you score x, y, and z, and it seems like you have moderate to severe OCD. And they're like, this might take a little while. I know this is heavy news if you need to take a break. And I was like, are you kidding me? This is a surprise to no one. Let's move on. So I went in with pretty high assessment scores, just to simplify the whole thing. OCD, which, looking at my family, you'd be like, yeah, obviously. And then anxiety, and a lot of long term listeners will know bouts of depression. And that also is pretty much kind of genetically hardwired. Did these two sessions, and with three months so far of durability, no longer meet any diagnostic criteria for any of those, it has been the most durable, noticeable on a day to day, week to week basis change in my state, that I've ever experienced.

Speaker B: Can you give me, or if you care to share, can you give me something like, let's just say on the OCD side, where you were doing it previously, you had the treatments, and now it's.

Speaker A: Yeah, yeah, I can give examples. And I should say your mileage will vary, and the sample sizes are still very, very small for accelerated TMS, which is. I'm an early stage guy too. Right? Like, I like to get involved, but there are many unknowns many open questions. They're still in, I want to say sub thousands in terms of subjects. In some cases for, say, OCD, it's probably fewer than 200 would be my guess. I'm making up some of these numbers, but I don't think they're very far off. So there's still a lot to figure out. But as an example, I've had lifelong onset insomnia where my brain will just not quiet down. You know, my mind is like, I've been waiting all day to talk to you, and it can take me an hour, 2 hours to fall asleep. In three months, that's effectively gone to zero. None of that.

Speaker B: That's crazy.

Speaker A: Like the best sleep I've had in decades.

Speaker B: Do you look at aura data as well to see like, hey, am I getting the proper deep sleep?

Speaker A: Am I getting, you know, I haven't gone super granular? I recognize how that could be helpful in a sense, but I really feel like we can outsource our awareness to devices and metrics where it's pretty small.

Speaker B: Well, you know, when you wake up.

Speaker A: If the effect size is large enough, it should be pretty obvious to. And I will say just there are some people who respond inversely to this, it can worsen some people's conditions. I've seen a number of lives transformed. We have the most data for depression by far. And if you talk to really competent, sophisticated psychiatrists who have looked keep abreast of the latest technology, they will say, finally, TMS is delivering on what we hoped it would deliver. Like the promise is. Finally we're seeing some of the results we're hoping to see.

Speaker B: So there's been so many devices, even at home, devices that claim to do, you know, TMS that you can, you can literally, I've seen them on Amazon. Yeah, but here's the real question is like, okay, obviously you did all the proper due diligence around figuring out who's the best. The best in this business is actually doing the real science. How soon until that actually propagates out to clinics where you would feel comfortable saying, okay, nows the time when the average person can go and do this?

Speaker A: Its hard to say. I will say on a widely distributed basis, but thats also like Uber black got all this criticism early on, and then those people subsidized the development of UberX and over time, cost went down.

Speaker B: Hows the price?

Speaker A: I would say it ranges at this point because insurance will not cover accelerated TMS, at least as far as I'm aware from. Let's call it if we're looking at competent, well trained outfits who are vetted five to 15k for that five day period. But here's the thing. Depending on your conditions, depending on your resources, if you were to ask me how much would you pay to go back 20 years and have this treatment, I'd be like, take half my net worth, it's fine. Like, the payoff is so noticeable now. It's not a silver bullet. Nor are psychedelic assisted therapies, by the way. It's not one shot, one kill with conditions. So most people will go back for boosters every three to six months for say a single day of treatment. Not necessarily five days, but the, when I say effect size, people can look this up. But the magnitude of change and durability is so far beyond pretty much any conventional treatment that I can think of. Especially if you exclude maintenance therapies that are really just covering symptoms or suppressing symptoms. I'm very, very excited about this. In terms of time, I couldn't tell you. I think that it will be more widely available at retail, where people pay out of pocket in the next six months to twelve months.

Speaker B: How will someone know if that has been the same thing that you're doing? Is there like a, is there some type of like certification or what do you look for? Because I've seen these types of clinics, I've seen it being offered in various places.

Speaker A: Yeah, I would look for people who have real clinical experience, who are working with established hospitals and have some bonafides. There's a lot of fly by night TMS operations. Just like there are lots of rent a shamans on Craigslist and Facebook who did some weekend yoga course in Costa Rica, and suddenly theyre going to save your soul. Probably not a great idea. Similarly, if its like, yeah, we run a dentist office and we offer tms, maybe you dont do that. Or the people are like, yeah, we will fix your nails and give you semaglutide. Like meh, you mix in the bathroom. Like maybe you dont do that. So I think common sense applies. But it has been really fascinating. And the reason you don't want to diy it, or one of the many, many reasons you don't want to diy it, is that you're dealing with very sensitive circuitry. This whole thing in our heads, as far as I know, is powered on roughly the electricity of a light bulb. We really don't know how it works, how we're able to function at such a high level. I suspect there are all sorts of. And this is true for all factions, like quantum effects and many, many complicated mechanisms that we just do not understand. And when you're applying a magnetic pulse to your brain, you are. And this is simplified, but you're either activating or deactivating, right, enhancing or suppressing some degree of activity or a network of activity. And if you screw that up, you can get the opposite of what you're looking for.

Speaker B: Is there any real time, like, feeling, like when you're sitting there, are you, like, seeing shit?

Speaker A: Feels like someone flicking the side of your head. There are no visuals or anything, but you feel like someone's flicking the side of your head. And each day you feel like you ran a mental ultramarathon, like if you were cramming for the LSATs every day for 15 hours straight. That is the degree of mental exhaustion. It's very tiring.

Speaker B: Do you find that it's improved your cognitive tasks? Like, are you, like, able to. Is there any performance enhancing benefits to this as well?

Speaker A: Well, I do think TMS is going to be used for performance enhancement. I think it could be used for sports enhancement and many things. So I do think, especially in the world of anti doping and so on, that athletes are going to start to use TMS pre competition for enhancing, who knows, visual acuity, reaction speed. That's going to happen for sure, because you can already use TMS to change trait hypnotizability. If you want to make people more susceptible to being hypnotized, you can use this. It's going to get super wild really quickly. I will say that one thing I have noticed on the plus or negative side, depending on how you look at it, is that I've been so much less productive in the last few months.

Speaker B: You seem really chill right now.

Speaker A: Yeah, super chill. Here's what I would say. I wouldn't trade the productivity for my current sense of calmness. And I was chatting with a therapist about this and they said, well, I think for a lot of people that anxiety is used as a fuel to work, to basically run away from things, not run towards things. And I was like, yeah, I could see that. That doesn't seem shocking to me. So a question I've tried to ask myself with a lot of different projects is, am I running away from something or am I running towards something? That seems a very important distinction to make and also another reason not to diy this is in a lot of cases, youre a, let's just say in the case of anxiety. So you have too much like fight or flight or freeze let's just say. So you want to dampen that a little bit so you can move around without being a head case. Okay, great. You still need some of that fight or flight in your life so you can over dampen that. Or maybe you want to increase your parasympathetic response. This is going to be very personal. I didn't really think I would talk about this publicly, but. So there's. There's a shorthand in medical school, they say point and shoot, in other words, parasympathetic to get an erection sympathetic to orgasm. Both of those are really important. So after I got my sympathetic smashed, I couldn't orgasm for like two weeks and I was freaking the fuck out. I was like, did I just completely screw up my hardwiring? Like, I'm never going to orgasm again. That seems like a high tax to pay fuck.

Speaker B: Was the engine there scary, momentous? Like, you didn't have a problem with the point?

Speaker A: No.

Speaker B: No. Okay. It was just the finish the shoot.

Speaker A: That was the problem. Yeah.

Speaker B: Jesus, man.

Speaker A: So, like, that could freak you out.

Speaker B: Or let's say like classic Tim Ferriss, like early, like, trying the craziest shit.

Speaker A: You know, I'm taking the bullet so that people don't necessarily have to. But these are all reasons why you don't want to buy a kit on Amazon and just start zapping your brand while you're watching Netflix. Yeah. All right.

Speaker B: Unless you're fast and you need to.

Speaker A: Slow down, you know, if somebody else wants to run that n zero one, like, knock yourself out, but I'm not going to do that. All right, moving on.

Speaker B: So last question and then we can move on. Is there a website or anything where you went? Like, where did you go? If someone's listening to this and they're like, I want to go where Tim went.

Speaker A: Yeah, I mean, this is where I would like to have, and this is not for any reason other than I'm going to. I'm going to defer on that just because I want to have some more experience. Also, I want to do a follow up. I want to see what the durability looks like before I start recommending outfits.

Speaker B: I appreciate that.

Speaker A: So I will do that. I'll have more to say about this, but for people who want to do a deep dive, Doctor Nolan Williams and the podcast that I did with him touches a lot of this. I will also say, just a quick note, which is there are some theories around, say, depression, which are not chemically focused. So instead of like, oh, serotonin imbalance, this imbalance, which is a little antiquated in a bunch of senses. It's not that it isn't a non variable, but it doesn't seem to be the primary determinant. It could be that different structures in the brain are firing out of sequence and you can use the TMS to correct that sequence instead of firing BAC. It's like, oh, well, let's slightly tweak that system so it's firing in what we see in normal healthies, which is ABC. Pretty interesting to be able to basically just reset the tripwire sequence. Yeah, so something I think we'll be hearing a lot more about in the next handful of years. And it is better tolerated than most medications, like from a risk profile perspective for most people, in very rare cases it can trigger seizures. Like there are adverse side effect potentials, but for the vast majority very well tolerated. So I'm excited about it because, for instance, psychedelic assisted therapy is contraindicated for lots of people. There are many people who should not take this or engage in that type of therapy. Too many risks involved, people with, say, borderline personality disorder, with family history of schizophrenia, et cetera. But they wouldn't necessarily be automatically excluded from doing something like accelerated TMS. So that's exciting to me. It.