Steve Harvey MD
In this episode Drs Malzberg and Harvey discuss the recent acceleration of progress in psychiatry, and ponder the future. A bright and sunny future? Or, a dystopian hellscape? Could go either way… This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
Dr. Harvey and Dr. Malzberg dive into Part 3 of their guide to running a terrible TMS practice. This episode looks at the major mistakes practices make with referring clinicians, from alienating local colleagues through petty behavior to cutting them completely out of the loop once treatment starts. They also laugh through examples of bad communication, including fake science in update letters, long rambling updates, and basic grammar mistakes like misusing reflexive pronouns. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
In this episode, Dr. Harvey and Dr. Malzberg dive into the key takeaways from the Annual Meeting of the Clinical TMS Society in Boston. While the conference was packed with groundbreaking research—covering new brain targets like the posterior parietal area, accelerated protocols, d-cycloserine, and expanding TMS applications for conditions like Alzheimer's and schizophrenia—the hosts shift their focus to the ultimate test of conference networking: the hors d'oeuvres. Tune in as Dr. Harvey takes a roaming mic around the conference floor to get attendees' unfiltered opinions on the snack budget and puts top TMS experts to the test to see if anyone can actually spell "hors d'oeuvres" (with a special shout-out to Dr. Alvin Lau!). This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
Neuroscientist Dr. Colleen Hanlon joins The TMS Podcast to discuss whether transcranial magnetic stimulation can meaningfully treat addiction…. and what the future of brain stimulation may look like. She explains the emerging evidence for deep TMS in alcohol and nicotine use disorders, how clinicians should think about seizure risk in patients who are actively drinking, and why abrupt alcohol withdrawal is more concerning than stable use. The conversation also explores accelerated TMS, BrainsWay’s ongoing alcohol-use-disorder trial, and rotational field TMS, a next-generation technology designed to stimulate neurons across multiple orientations. It is a practical look at how TMS may expand beyond depression into addiction, PTSD, pain, and other psychiatric conditions. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
Which TMS machine should a psychiatry practice buy? In this episode, Dr. Steve Harvey and Dr. Greg Malzberg walk through the real-world factors clinicians should consider before choosing a TMS device. Rather than naming brands, they focus on the practical questions that matter: upfront cost, rental and per-use fees, coil replacement, service responsiveness, portability, cooling systems, exit options, and the hidden risks of working with a manufacturer. The episode is especially useful for clinicians thinking about starting or expanding a TMS practice who want a more thoughtful checklist than simply comparing the sticker price. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
TMS for OCD is more than just using the same treatment protocol as depression. In this episode, Dr. Harvey and Dr. Malzberg discuss how transcranial magnetic stimulation is used for obsessive-compulsive disorder, including FDA-cleared protocols, the H7 coil, symptom provocation, dorsomedial prefrontal cortex and anterior cingulate targets, and what patients can realistically expect. They also cover why TMS for OCD is less commonly used than TMS for depression, how insurance coverage affects access, and why clinicians need to be careful not to overdiagnose OCD when intrusive thoughts may fit a different formulation. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
TMS gets a historical frame in this episode, using the Chestnut Lodge case and Rafael Osheroff’s lawsuit to explore how psychiatry changes when old assumptions fail patients. Dr. Steve Harvey and Dr. Greg Malzberg discuss psychoanalysis, medication, neuromodulation, and the danger of treating any one approach as the only legitimate answer. The conversation connects a famous psychiatry history case to today’s patients who cycle through depression medications without hearing about TMS, while also warning against turning TMS or any newer treatment into hype. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
TMS safety risks are the focus of this episode, with a balanced look at why transcranial magnetic stimulation is considered very safe while still requiring thoughtful precautions. Psychiatrists explain the rare but serious concerns patients should understand before treatment, including hearing damage without earplugs, seizure risk during stimulation, and metal-related issues near the magnetic field. The discussion also covers practical clinic safety steps, why medication changes can matter during a TMS course, and why “no side effects” is not the right way to describe any treatment. It is a clear, grounded overview for anyone considering TMS or educating patients about it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
How TMS works is the focus of this episode, which moves beyond the idea that depression is simply a chemical imbalance. Dr. Harvey and Dr. Malzberg explain why TMS targets the left dorsolateral prefrontal cortex, how that surface region may influence deeper connected brain networks. They also discuss neuroplasticity with appropriate caution, emphasizing that it is not magical brain fertilizer but one possible part of how treatments for depression create change. The result is a clear, honest psychiatry conversation about TMS, depression, brain networks, and what science still cannot fully explain. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
Serotonin hypothesis of depression is the center of this episode, as two psychiatrists unpack why the low serotonin “chemical imbalance” story became so popular and why it falls short. They trace the monoamine hypothesis, discuss serotonin, norepinephrine, and dopamine, and review evidence that challenges a simple serotonin deficiency model. The conversation also explains why this does not mean SSRIs or antidepressants stop working, using clear analogies and clinical examples like delayed medication response, serotonin syndrome, tryptophan depletion, TMS, and depression research. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
TMS practice management is the focus of this episode on how clinics fail when business decisions start overriding clinical judgment. The conversation explores patient care vs profit, physician leadership, non-medical managers, clinician autonomy, Spravato pressure, and why treatment quality is also a business strategy. For psychiatrists, TMS providers, and private practice owners, this is a practical discussion of TMS clinic operations and healthcare management grounded in the realities of psychiatry. It is especially relevant for anyone trying to build a physician-led TMS clinic without letting quotas, sterile workflows, or non-clinical control erode patient care. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
TMS practice mistakes are at the center of this episode on why TMS clinics fail and what those failures reveal about better care. The conversation covers timid rollout, underestimated demand, remote management, referral boundaries, physician leadership, and the damage that happens when business pressure starts to shape clinical decisions. For psychiatrists, practice owners, and clinicians interested in transcranial magnetic stimulation, this is a practical discussion of TMS clinic management rooted in real-world patterns rather than abstract theory. It is especially useful for anyone starting a TMS practice or trying to understand why a service is underperforming. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
TMS research has reached a tipping point, and in this episode Dr. Harvey walks through the five studies he believes have most dramatically reshaped the field. From a Dutch randomized trial showing TMS outperforms a third antidepressant by a factor of five, to the theta burst 3D trial that compressed treatment into three minutes, to Stanford’s headline-grabbing SAINT protocol and its 90% remission claim — each study adds a new layer to how clinicians can approach treatment-resistant depression. The episode also covers a promising single-day TMS trial and emerging data on TMS plus neuroplastogens for OCD, making this a must-listen for psychiatrists and patients alike. Study 1 — TMS vs. Antidepressants (Netherlands RCT) Dalhuisen et al., American Journal of Psychiatry, 2024 → https://pubmed.ncbi.nlm.nih.gov/39108161/ Study 2 — The THREE-D Trial (Theta Burst vs. 10 Hz rTMS) Blumberger et al., The Lancet, 2018 → https://pubmed.ncbi.nlm.nih.gov/29726344/ (Full Lancet abstract also available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30295-2/abstract) Study 3 — The SAINT Trial There are two key papers here — the original open-label study and the follow-up double-blind RCT: * Original SAINT (Cole et al., Am J Psychiatry, 2020): https://pubmed.ncbi.nlm.nih.gov/32252538/ * Double-blind SNT trial (Cole et al., Am J Psychiatry, 2022): https://pubmed.ncbi.nlm.nih.gov/34711062/ Study 4 — Single-Day TMS (ONE-D Protocol) Vaughn & Downar et al., Transcranial Magnetic Stimulation journal, 2025 → https://www.sciencedirect.com/science/article/pii/S3050529125001163 Study 5 — TMS + D-Cycloserine for OCD McGirr et al., American Journal of Psychiatry, 2025 → https://pubmed.ncbi.nlm.nih.gov/39967412/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
In this episode, Dr. Harvey and Dr. Malzberg walk through the full history of transcranial magnetic stimulation, from Dr. Tony Barker’s 1985 discovery in a UK engineering lab to the 2008 FDA clearance of the Neurostar system for treatment-resistant depression. They explain how a magnetic field bypasses the skull to induce electrical current in the brain, why early TMS likely underdosed patients, and how new coil designs, expanded indications, and accelerated protocols have transformed the field into one of psychiatry’s fastest-moving areas. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com
In this foundational episode on transcranial magnetic stimulation, Dr. Malzberg is joined by Dr. Steve Harvey… a TMS specialist and early adopter since 2013… for a clear, hype-free introduction to how TMS works and why it matters. They cover the basic physics of using magnetic pulses to create electrical stimulation in the brain, the evidence behind targeting the prefrontal cortex in depression, and how TMS differs fundamentally from ECT. They also take an honest look at where the field oversells itself, and why intellectual humility should guide how clinicians and patients think about brain stimulation therapy going forward. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit thetmspodcast.substack.com