On episode 48 of A Chat with Uma, I sit down with psychiatrist–neuroscientist Dr. Martijn Figee, MD., PhD—director of Mount Sinai’s Interventional Psychiatry Program & a groundbreaking pioneer in neurostimulation (e.g. DBS, TMS) for psychiatric disorders, especially OCD & depression—for a clear, grounded tour of circuit‑based psychiatry. This is the science companion to last week’s episode with Jon Nelson (ep. 47): today's episode builds on Jon's lived experience to explain how & why the brain can change (in minutes!) when the right circuit is engaged. We unpack deep brain stimulation (DBS) surgery & transcranial magnetic stimulation (TMS), what “target selection” actually means, & how phenotyping (motor, cognitive, & negative‑affect circuits) guides targeting.

We also get practical: access & eligibility, what insurers & clinicians look for, when to choose TMS first, & how accelerated TMS paired with ERP can fast‑track change. We bust myths (OCD ≠ “just the amygdala”) & look ahead to biotyping work designed to match people to the right target the first time--a real step toward precision psychiatry. If you want a rigorous, hopeful explainer of why electricity can be medicine & what that means for folks suffering, this episode shares everything you need to know from the world's expert!

Topics Discussed (+ Timestamps):

(00:00:00 ) Welcome & introduction to Dr. Martijn Figee!
(00:11:50 ) Who is Martijn beyond titles: psychiatrist–scientist mindset & science as the backbone
(00:17:00 ) From Amsterdam to DBS: imaging arrives, early OCD DBS cases, & changes in minutes
(00:30:00 ) Circuit basics: motor–cognitive–limbic loops across OCD, Tourette, depression
(00:35:52 ) Evidence‑based OCD care: ERP + adequate‑dose meds; why misdiagnosis/mistreatment delays recovery
(00:45:30 ) Comorbidity vs. one driver: how untreated OCD breeds depression—& why it changes the treatment plan
(00:51:00 ) From presentation to target: phenotyping (negative affect vs compulsion/motor vs cognitive) to pick a target
(01:10:00 ) TMS before DBS? Standard vs accelerated TMS & pairing every session with ERP; access & insurance
(01:21:20 ) DBS candidacy & access: OCD is FDA‑approved; depression is trial‑only; what insurers & teams look for
(01:25:40 ) Targeting, not guessing: ALIC/internal capsule, STN, BNST & fiber‑map guidance pushing outcomes toward ~80%
(01:27:40 ) Where to go: Sinai, Baylor, UCSF—why experience & proximity matters
(01:29:50 ) Biotyping with in-scan tasks: motor/cognitive/limbic dominance; what scans can (& can’t) diagnose—yet
(01:33:50 ) Who isn’t a fit & plan B: non‑ambulatory severity, hoarding‑only presentations, & the role of lesions
(01:35:30 ) Myth‑busting: OCD ≠ an “amygdala disorder,” & why the amygdala isn’t a sensible target
(01:38:10 ) Depression biotypes: switching off pathological “grief” loops; interview‑driven med algorithms & next steps

Connect with Dr. Martijn Figee!

• ⁠⁠Email: martijn.figee@mssm.edu⁠⁠
• ⁠⁠TRANSCEND Trial: DBS for treatment-resistant depression⁠⁠
• ⁠⁠DBS for OCD⁠⁠

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