Our first-in-human study of low-intensity focused ultrasound targeting the amygdala in MDD is now available on medRxiv. We found convergent evidence of target/circuit engagement across multiple imaging modalities in an active-controlled study. Important caveat: this is a preprint and has not yet undergone peer review. It is also a small early-phase study focused primarily on safety and target engagement—not clinical efficacy. Why post it now? FUS neuromodulation is moving quickly, and we think sharing methods, safety observations, findings, and limitations early is important so others can learn from our work and build on it. Very grateful to our team, our Veteran participants, and funders @NIH_Innovates @VAResearch @BBRFoundation @FUSFoundation medrxiv.org/content/10.64898…

A meaningful milestone today: the first Veteran chose to participate in our new @DeptVetAffairs-funded clinical trial of low-intensity focused ultrasound for PTSD. This study builds directly on our completed first-in-human work targeting the amygdala and moves us into a randomized, sham-controlled dose-finding trial in Veterans with PTSD. Research like this is only possible because Veterans volunteer to participate. We are incredibly grateful to the Veteran who took that first step with us today. Our goal: precise, noninvasive, non-drug treatments for PTSD. clinicaltrials.gov/study/NCT… #PTSD #FocusedUltrasound #Neuromodulation #Veterans

From Author to Editor - the start of a series from the Deputy Editor's Desk at the American Journal of Psychiatry (1/n) I’m going to occasionally share some “Notes from the Editor’s Desk” about what I have learned from the editorial process at the American Journal of Psychiatry. Nothing about individual submissions or confidential editorial decisions will be shared; just observations that may be useful to people deciding what to submit, how to frame their work, and how to make the importance of their science clear. One of the most interesting parts of becoming an editor has been realizing how differently a manuscript can look from the other side of the process. As an author, it is natural to focus on the details: the analyses, the revisions, the reviewer comments, the years of work behind a study. As an editor, the first questions are broader: First, what is the central scientific question? Next... why is it important? What does this study add that we did not know before? And then ... will the answer matter to readers beyond the immediate (sub)specialty? That shift in perspective is changing how I think about scientific communication. I have no doubt it will will change how I think about my own writing but that is a story for another time. Send us your best work (and I'm going to define that, too. Stay tuned).

Pleased to share our new piece in @JAMAPsych: Focused Ultrasound Neuromodulation in Psychiatry—Promises and Challenges. Focused ultrasound is opening a new space in psychiatric neuromodulation: the ability to noninvasively, reversibly, and focally engage deep brain circuits that have largely been beyond the reach of existing noninvasive approaches. This promise comes with challenges. We discuss what the field still needs to resolve around mechanism, dosing, individual acoustic modeling, target engagement, safety, and standardization... and why (IMHO) labeling ultrasound parameters as “excitatory” or “inhibitory” is unlikely to be sufficient. Most exciting is the broader opportunity: FUS may be more than a future treatment. By pairing precise perturbation of deep circuits with imaging and other measures of target engagement, it could become a powerful tool for prospective causal neuroscience in humans, allowing us to creatively test and refine circuit models of psychiatric illness. There is a lot of work ahead, and while I hope this will be a treatment, whether FUS ultimately becomes a clinical treatment is an open question. Getting there requires rigorous mechanistic science, careful safety monitoring, standardized reporting, and thoughtfully designed clinical trials. Very grateful to Drs. van 't Wout-Frank and Arulpragasam for the collaboration, and to the many colleagues helping move this field forward. #ultrasound! Focused Ultrasound Neuromodulation in Psychiatry jamanetwork-com.brown.idm.oc…