PROVIDENCE – In recent weeks, the mysteries and vagaries of the synaptic structure of the human brain have been on full frontal display as part of the messiness of the American electoral political system.

Two aging political leaders, President Joe Biden, who withdrew from the 2024 Presidential election on Sunday, July 21, and former President Donald Trump, who has secured the 2024 Republican nomination, have demonstrated the cognitive limitations of an aging human brain on the political stage.

The large amounts of disinformation and misinformation being spewed out by the political machines, all claiming to possess a kind of pseudo-expertise about the nature of brain science, have made it abundantly clear that, for the most part, the news media just doesn’t know what it is talking about when it comes to health, science, and the way the human brain works.

Call it serendipity then, that ConvergenceRI interviewed Dr. Linda Carpenter, one of the world’s leading neuroscience researchers, earlier this month, following her being awarded the Clinical Transcranial Magnetic Stimulation Society Gold Medal, an honor that has only been given to three other research pioneers in the last decade.

Translated, when it comes to cutting-edge neuroscience research and the development of new devices to aid in the therapeutic interventions for treating depression and other chronic brain conditions, Dr. Carpenter is an expert.

Dr. Carpenter serves as the Director of the Transcranial Magnetic Stimulation Clinic and Neuromodulation Research Facility at Butler Hospital, a division of Care New England.

For the last decade, she has worked as a research collaborator with Dr. Audrey Tyrka, M.D., Ph.D., who was recently named the chair of the Department of Psychiatry and Human Behavior at The Warren Alpert Medical School of Brown University.

The in-person interview with Dr. Carpenter took place on Tuesday afternoon, July 2, at her offices on the Butler Hospital campus, squeezed in between Dr. Carpenter’s hectic schedule of seeing patients and coordinating the work of her team of researchers at the clinic.

The focus of Dr. Carpenter’s research is using an FDA-approved, non-invasive device to record and to monitor brain wave resonance and circuitry in order to treat depression and other chronic mental health conditions.

“As anyone who works in this clinic can tell you,” Dr. Carpenter began, explaining the promising results of the therapeutic approach of the work, “one of the most rewarding things about this treatment, which is very unlike everything else in psychiatry, is that patients come to us who are completely hopeless. They have had decades of medications, but they are not better. They are often fully disabled. And, over the course of a couple of months, we see these transformations. It is unbelievable; you just don’t see this in outpatient practice. You don’t see this in the hospital.”

Dr. Carpenter, holding the gold medal in her hands to pose for a photograph, said that she was “shocked, surprised, and humbled” to receive the award, which was presented at the Society’s annual meeting in London on June 20, recognizing her work as a pioneer.

Here is the ConvergenceRI interview with Dr. Linda Carpenter, a neuroscience researcher who, with her team, is helping to forge a new therapeutic approach to chronic mental health conditions, marrying new kinds of non-invasive devices with state-of-the art, personalized therapies, including the introduction of psychedelics.

CARPENTER: I was super surprised. It’s a huge deal. We were in London for a meeting of the Clinical TMS Society, which is an organization that started up 15 years ago, shortly after we had the first FDA approval for Transcranial Magnetic Stimulation.

Clinicians around the country were starting to adopt this technology and to incorporate it into their practices. I had done and continued to do a lot of research surrounding its efficacy and safety – how to make it better, [identifying] biomarkers. We were [one of] the first clinics [operating] here in New England, that was in 2008.

The organization’s annual meeting took place this year in London. I was absolutely shocked and surprised to get this, in large part because it is not always given out. They had only given the gold medal to a few other people who were pioneers in the field.

ConvergenceRI: You don’t see yourself that way?    
CARPENTER: Well, you know, I am involved in the work day to day…

ConvergenceRI: Impostor’s syndrome? I don’t want to put words in your mouth.    
CARPENTER: [laughing] Maybe that’s it. The people who had received it previously were really extremely fundamental to the field. I was just really honored to be included in that group of people, such as the person who invented the first TMS device.

It was not the case that I’ve done nothing. I’ve published dozens of [research] papers on this topic, as well as actively teaching on this treatment around the country. I do a lot. But, it is really an incredible honor.

ConvergenceRI: As I understand it, this methodology is a treatment for people who have OCD [obsessive compulsive disorder], and PTSD [post traumatic stress disorder].    
CARPENTER: With FDA approvals, it is [a treatment] for depression, for OCD, and for smoking cessation.

Health insurance doesn’t cover smoking cessation yet, even though there are studies, landmark clinical trials that prove that it is efficacious. FDA has approved it, but the insurance companies say, we want to see longer-term data. It is an expensive treatment.

There is a little bit of [insurance] coverage for OCD but not enough. There are a lot of patients whose insurance companies won’t cover it for OCD.

For depression, everyone has been able to get [coverage], at least in Rhode Island. We were the first state to get Blue Cross and Blue Shield to have a Medicare coverage policy; everyone can get [the treatment] covered for depression. Most of the people that we treat [at the clinic] are here with depression.

Many people have depression plus PTSD; depression plus ADHD, depression plus anxiety. There are a lot of co-morbidities.

ConvergenceRI: Do you think that there needs to be more awareness within the medical community about what you are doing?     
CARPENTER: Yes. A lot of the patients find their way to us because they had become aware of the research, and they tell their providers that they would like to try it.

The organization that gave me this award has developed a lot of educational vehicles. I sit on the Education and Training committees. We have a course through which we train doctors around the country. We have slide decks for the residency programs to use.

ConvergenceRI: Are you familiar with the work being done by Dr. Jill Maron at Women and Infants Hospital and her clinical research using saliva swabs and rapid genomic analysis?    
CARPENTER: Yes. It’s important to understand how the brain is functioning before it gets all wired differently. That’s so critical in development; it’s really relevant to the patients that we see here, because many of them have not only had early life stress and neglect, but many of them in their current lives continue to manage a lot of stress, and it’s always working against us.

ConvergenceRI: Is there a lot of ongoing collaboration between you and Dr. Tyrka? Do you meet regularly? How does that collaboration take shape?    
CARPENTER: You may know this, but Dr. Tyrka is the new chair of our Psychiatry Department at Brown.  She and I have been close friends for decades. We’ve been in the same research group. We share research assistants; we are collaborators on numerous projects, more so that she’s moved into the chair position. This facility is supported in part by [the Stress] COBRE. We provide a number of different sets of resources for research for Audrey’s studies, for example, and her studies with children, saliva and biomarkers.

ConvergenceRI: Have you been successful in identifying biomarkers related to stress?    
CARPENTER: Yes, for stress, for sure. The whole cortisol profile is one kind of biomarker. We’re finding other biomarkers, which is sort of the focus of her work, in continuing to look at the shortening of telomeres and mitochondrial dysfunction. That’s really the focus of her work; our job is to support them

We also collect information about our patients going through these treatments in the clinic by collecting information about their early life stress and trauma. And, getting data from them, such as brain wave data.

ConvergenceRI: How has this changed the way that diagnoses are made?    
CARPENTER: I will tell you what’s cool about what we’re doing on that front. There is this company that just got FDA approval last year for a new device. It’s called Prism, and it is a neuro-feedback device.

The way this works is that a patient is sitting in front of a big screen, with headphones. On the monitor it shows an emergency room, and there is a waiting room. All these people are clamoring for attention. And your job, you have this EEG cap on your head, is to develop a thought pattern that makes everyone calm down, to sit down, and be quiet. Your brainwaves offer this path of communicating with the software, and if you get to the right pattern, actually “down regulation” of the amygdala, people gradually sit down in their chairs and are quiet.

This device is now FDA-approved as an adjunct for treatment of PTSD [post-traumatic stress disorder]. What it realty does is “down regulating” the amygdala. The company is already pilot-testing another EEG cap focused on impulse control.

When you asked the question: What are we doing with diagnoses? I think we are at the beginning of bringing out these trans-diagnostic treatments that actually address specific functions.

ConvergenceRI: Are you familiar with the work of Frederike Petzschner and her interactive app with patients regarding pain?    
CARPENTER: Yes. I have her app, SOMA. I wanted to share with you some good news about this new device, Prism.

[The company behind the device, Bespoke  Treatment, describes Prism Neurofeedback as a way “to tune down brain activity associated with PTSD to help you get control of your symptoms. Post-Traumatic Stress Disorder is linked to stuck patterns of brain activity, Neurofeedback is a method of retraining your brain to let go of unhelpful brainwave patterns.”]

Recently, a woman at a Butler fundraiser donated $20,000 so we could buy the device. And we’re going to have it here at the clinic very soon.

ConvergenceRI: It sounds to me that you are continually on the cutting edge, introducing lots of new therapeutic devices. Can you talk about the process of innovation moving forward?    
CARPENTER: With this treatment, we’ve made a lot of people better. Everyday, there is an inspiration that is driving us: How can we make this treatment better? As a field, we are trying to figure out how to personalize and customize treatments, so that each person’s specific brain pathology can be addressed.

I have been working together in collaboration with a psychiatrist at UCLA. For the last eight years, the idea that we’ve had is that there is probably some frequency in your brain, we don’t know what it is, but if we could match it, the frequency that resonates with your own brain waves, in your own circuitry, then when we deliver the stimulation, instead of doing one-size-fits-all, we would get a better outcomes, we would be able to modulate the circuits.

We wrote a grant together, oh my gosh, seven years ago, and it kept getting rejected. But we have been collecting pilot data for seven years. Before a patient gets his or her startup treatment, we put the cap on, and we’d get a data reading. Now, we’ve got this giant databank of recorded brain waves.

About six months ago, we finally got the grant funded, and for the next five years, we are working on testing the method of putting the cap on your head, recording the brain waves, stimulating all the different frequencies and brain waves. The goal is to get the best outcome by modulating the circuit frequency, to identify what is the right area of the brain to modulate, to tap into how to personalize the treatment.