- Noah Philip, MD, is an Associate Professor of Psychiatry and Human Behavior at the Alpert Medical School of Brown University.
- He is researching focused ultrasound–based neuromodulation for depression, anxiety, and PTSD.
- Dr. Philip participated in the Foundation’s recent congressional briefing to help educate and garner support for focused ultrasound research.
Noah Philip, MD, is an Associate Professor of Psychiatry and Human Behavior at the Alpert Medical School of Brown University. He is the founding Director of Psychiatric Neuromodulation at the US Department of Veterans Affairs (VA) Providence VA Health System in Providence, RI, and leads innovative mental health research at the VA’s RR&D Center for Neurorestoration and Neurotechnology. His Twitter handle is @NoahSPhilipMD.
Dr. Philip also participated in the Foundation’s congressional briefing this month, helping to educate and urge policymakers to support further focused ultrasound research funding.
Focused Ultrasound Work
When and how did you become interested in focused ultrasound?
I am a recent entrant into the field. When I went to medical school at Albany Medical College, my original plan was to go into critical care medicine; but I soon realized that where people were critically ill was in psychiatry. During my psychiatry residency at Brown University, it became apparent that the available treatments were not meeting the needs of the patients, so I made the transition into a research career during residency and have been in an integrated clinical and research position since then.
Over the past decade, I have been using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) to develop new and noninvasive ways to therapeutically change the brain. Our research has been quite successful, and we have gained many new insights and understandings about how these interventions work. I run a TMS clinic here at the Providence VA Medical Center, where we are truly translating our research technology into day-to-day clinical care.
The available technologies that we have right now – primarily TMS – stimulate only the outside surface of the brain. But the neurons involved in depression, anxiety, and posttraumatic stress disorder (PTSD) are in the deep, core regions of the brain. The available technologies cannot reach these areas, so that is where focused ultrasound comes into play. I first heard about focused ultrasound broadly in the field and became excited about a technology that showed promise for reaching deep brain regions, specifically the amygdala and thalamus. I’m a noninvasive researcher in my heart and to my core, and I want something I can use in my clinic on every patient who walks through the door.
With focused ultrasound, I first read a report in the literature from Martin Monti’s group at the University of California Los Angeles (UCLA) on using it to wake someone suffering from a disorder of consciousness, and I thought that was exciting. Then, about 5 years ago, I saw a poster presentation at a brain stimulation meeting in Vancouver. The topic was using a focus ultrasound device to change how the thalamus was functionally connected with the rest of the brain — focused ultrasound could safely modulate the brain in healthy individuals. That presentation inspired me to see that this technology had legs, and that it could be done without a multimillion-dollar setup.
Do transcranial stimulation therapies help all patients?
With TMS therapy, two out of three patients get better but one in three does not respond. However, in the group that does respond, many patients (about a third of all patients) have positively life-changing results. We are still trying to figure out which patients will respond to these therapies. Our current research questions are “How does the brain change when patients respond to treatment and get better?” and “What tools do we have to make positive changes?”
What are your areas of interest in focused ultrasound?
I use focused ultrasound for neuromodulation; specifically, to suppress brain regions of interest. I am interested in using it for noninvasive and non-ablative treatments that can be done in a clinic setting.
What clinical indications do you study?
We are actively working on depression, anxiety, and PTSD. There are several other exciting indications in this field, but those are our primary focus right now. Because the neural target is different for obsessive-compulsive disorder (OCD) and it has an ablation solution, we are not researching it right now
What is the goal of your work?
Our goal is to develop noninvasive treatments for depression, anxiety, and PTSD.
What are your funding sources?
Our research began in 2019 with a VA novel equipment development grant that we used to buy a BrainSonix focused ultrasound system. Then, last year, we received a $2.3 million, 4-year grant from the National Institute of Mental Health (NIMH) for a first-in-human clinical trial in its experimental therapeutics program. We had conducted several pilot studies that led to the NIMH grant. NIMH is funding safety validation studies that will generate core scientific advances necessary to move the field forward.
Who are your team members?
We have a reasonably large research laboratory at the Providence VA Medical Center. I am the principle investigator of my group, and we have a good mix of senior faculty, junior faculty, research assistants, psychiatry residents, and post-doctoral research fellows. We also host undergraduate and medical students from Brown University.
Who are your internal and external collaborators?
For our low intensity focused ultrasound research, our internal collaborators in the Brown University Department of Psychiatry and Human Behavior are:
- Benjamin Greenberg, MD, PhD
- Mascha van’t Wout-Frank, PhD
- Jennifer Barredo, PhD
- Amanda Arulpragasam, PhD
We are incredibly grateful for support from Emily Aiken, MA and Christiana Faucher, BS, who assist with day-to-day implementation.
Our internal and external collaborators for the NIMH grant include:
- Taylor Kuhn, PhD, clinical neuropsychologist (University of California Los Angeles)
- Nathan McDannold, PhD, MR physicist (Harvard University/Brigham and Women’s Hospital)
- Edward Walsh, PhD, MR physicist (Brown University)
- Israel Liberzon, MD, psychiatrist and behavioral scientist (Texas A&M College of Medicine)
- Stephen Correia, PhD, neuropsychologist at Butler Hospital (Brown University)
How many patients have you treated?
The NIMH clinical study grant has provided our first patient treatments. The treatment parameters were determined by a series of published settings that have a suppressive affect. We are using the BrainSonix single element pulsed system with MR guidance for neuromodulation. We have completed the first three patients as of February 2022, and the work is ongoing.
Do you have any preliminary clinical research highlights that you can share?
Our participants have been very generous with their time and thoughts. While it is too early to discuss preliminary data, we will let everyone know our results as they emerge.
What are your greatest achievements?
My greatest personal achievement is coparenting two young children with a professional woman during a pandemic. Professionally, my largest contribution is identifying how the brain changes biologically when patients move from illness to health.
Do you have any major disappointments?
I wish that mental health research was funded like cancer research. We are incredibly far behind other areas of medicine. Although depression is the number one cause of disability across the globe, it is not funded for research. Many people are suffering, and we could be moving so much faster.
What do you see as impediments to your success?
In psychiatric research, there is no shortage of ideas but there is a shortage of funding. The best and brightest in our field are competing for the same limited resources. We ALL need to be funded.
What is your research wish list?
I’ve never been asked that before. I wish our field could collaborate more and work together toward common goals in a way that is not competitive. The pandemic has reminded us that the word impossible just isn’t so. Take a step back and ask if how we have been doing things is the best way to do it.
Has the Foundation played a role in your work?
Not yet, but the Foundation will be supporting psychiatric research and its support comes in many ways. As a newcomer to the field, the Foundation has been the central way to learn more about what else is going on out there. We have been talking about ways to collaborate, and I have been happy to help with the February 2022 Congressional briefing.
What comes next?
If we can successfully suppress the amygdala, it will be the first time that anyone has been able to modulate a core part of the brain in patients. Ten years ago, I would have not thought this was possible. We have been able to translate this in psychiatry.
Will you have any follow-up funding opportunities after the NIMH grant has been completed?
It depends upon what we find! It is my hope that, at the very least, we will definitively show that low intensity focused ultrasound is safe in patients with depression, anxiety, and PTSD. This will let the entire field move forward with this line of inquiry.
Virtual Congressional Briefing on Focused Ultrasound February 2022