By Richard Meloff, President of Nushama
Intro
Last week I joined a small roundtable of Canadian and Israeli researchers and clinicians, hosted ahead of a larger evening forum. The goal was simple: put people working on the same hard problems in one room and see where their work overlaps.
There were maybe a dozen of us around the table. Neuroscientists, psychiatrists, an anesthesiologist, a graduate student, and me, representing a ketamine clinic in New York. What struck me most was how quickly the conversation moved past “which treatment is best” to a more useful question: how do these treatments work together?
Here is what stayed with me.
TMS in a day, not six weeks
Dr. Jonathan Downar has spent his career asking a practical question: if we know which brain circuits are involved in depression, how do we reach them more efficiently?
His answer reshaped transcranial magnetic stimulation (TMS). Traditional sessions ran close to 40 minutes, daily, for about six weeks. Using a pattern called theta burst stimulation, his team brought a session down to roughly three minutes. They then showed sessions could be spaced minutes apart instead of a full day apart. Put those together and a full course of treatment can happen in a single day.
That work led to Ampa, the company he co-founded to make TMS simpler and more affordable. It is also the technology behind Nushama ONE, our one-day accelerated TMS program. Hearing Dr. Downar walk through how it came together, step by step, made me even more confident in that choice.
TMS doesn’t change what you think about. It changes how easily you can pull yourself out of a negative loop. Patients describe it as more resilience, more self-control, more room to breathe. Dr. Downar described it as making the brain less likely to get pulled back into the same negative patterns. Patients don’t stop having hard days, but they find it easier to recover from them instead of slipping back into old habits and spirals.
Reset and rewire
The most useful idea of the afternoon was a simple way of describing how different treatments fit together.
Ketamine and psychedelics were described as a kind of reset. They can quiet rumination quickly and open a window, often a few days long, where the brain is more flexible and new patterns are easier to form. TMS, by contrast, builds steadier self-regulation over time, and its effects can last for months.
That framing matches what we see at Nushama. Ketamine can create the opening. What happens in that opening matters just as much, which is why integration is part of every IV ketamine treatment we offer. Several people at the table made the same point from different angles: lasting change depends on the work done after the session, and on the people and environment a patient goes home to.
The group was also candid about barriers. Insurance in the US generally covers only one TMS session per day, which makes accelerated protocols harder to access. Science is moving faster than coverage, and that gap is worth talking about.
A look at what’s coming
Some of the most interesting conversation was about research still in progress.
Targeting the circuits behind ibogaine. Ibogaine has drawn attention for dramatic results in PTSD and addiction, but it is an intense, day-long experience with real cardiac risks. Dr. Downar’s team noticed that stimulating a specific region involved in the brain’s default mode network seemed to produce some similar responses. A study with veterans is now underway to compare the two. The hope is a far safer, more accessible option built on the same biology.
Precision tools for overactive circuits. Prof. Ofer Yizhar of the Weizmann Institute described work using light to quiet specific overactive neurons, rather than stimulating them. Conditions like chronic pain, epilepsy, OCD and Parkinson’s all involve circuits that fire too much. His team’s first clinical target is trigeminal neuralgia, a severe facial pain disorder.
The psychology of healthy aging. Dr. Mario Martinez shared research on centenarians and the emotional patterns, like gratitude and generosity, that seem to travel with longevity. His view: once treatment opens up mental space, it matters what we fill it with.
None of these are ready for the clinic today. But they point in the same direction: more precise, faster and safer care.
What this means for our patients
I left the room thinking less about any single breakthrough and more about combination. The future of mental health care probably isn’t one treatment. It’s the right sequence of treatments, matched to the person, with real support in between.
That’s the approach we’re building at Nushama. Ketamine and Spravato® for rapid relief. Nushama ONE for accelerated TMS. Integration to help the changes last. And a willingness to keep learning from the researchers pushing this field forward.
I’m grateful to our hosts for bringing this group together, and I’m looking forward to where these conversations go next.