Stories from the Field: Moksha Patel, MD

You have a uniquely deep understanding of neuromodulation therapy for psychiatric conditions. Can you tell us more about your experiences as both a patient and a health care provider?

I have dealt with severe and crippling obsessive-compulsive disorder (OCD) ever since I was a child. Throughout medical school and residency, I would routinely work shifts for over 14 hours without using any restrooms due to OCD-related fears of contamination. Despite several forms of medications and psychotherapy, I was unable to manage the disease until I finally received neuromodulation therapy in 2021.

Neuromodulation uses precisely targeted electrical, magnetic, or acoustic energy to change the activity of brain cells and neural circuits. Regulating this activity may, in turn, regulate mental and emotional processes, reducing or even eliminating psychiatric symptoms. The type of neuromodulation that I received was deep brain stimulation (DBS), which uses surgically implanted electrodes to deliver electrical currents directly to specific regions of the brain. Of all of the many treatments I have received, DBS was by far the most impactful on my OCD and quality of life.

What do you wish more people knew about neuromodulation for psychiatric conditions? 

Mental illnesses are often seen as distinct from physical illnesses such as diabetes or hypertension. This often feeds the stigma around psychiatric diseases, which can hinder timely diagnosis and treatment. In reality, psychiatric diseases are matters of brain health with biological, chemical, electrical, and psychosocial factors; no different than any other disease. Perhaps the greatest proof of this is how much my OCD improved after receiving DBS surgery. I hope that people begin to view psychiatric diseases as organic dysfunctions of the brain that can be treated with appropriate medications, therapy, and, if necessary, neuromodulation. 

Additionally, I want people to know that while neuromodulation for psychiatric disease can be life-changing, it isn’t a magic solution. All treatments come with potential complications, harmful effects, and limitations. However, my life has improved dramatically since receiving my DBS, and I am hopeful that other patients who are suffering will see similar relief.

What are some of the biggest challenges facing researchers and clinicians working on neuromodulation in psychiatry? What needs to change (in terms of education, policy, or funding) to move the field forward? 

Two major challenges are the lack of understanding of brain physiology and pathophysiology, and the stigma associated with psychiatric diseases.

 At this time, it is difficult to hone neuromodulation therapies for psychiatric care because experts have an incomplete understanding of the mechanisms behind psychiatric diseases. For instance, we have limited knowledge of the intricacies of neural networks and how they impact thoughts and behaviors. Developing a better understanding of how psychiatric diseases occur and identifying measurable biomarkers associated with these diseases should improve the precision, efficacy, and effectiveness of neuromodulation therapies.

Additionally, the stigma and stereotypes historically associated with psychiatric conditions likely limit how much research funding these disorders receive. Stigma is based on the unknown, and educating the general public on the biochemical and electrical bases of these conditions and the realities of living with them may help bring much-needed attention to the cause.

What needs to change to move this field forward?

My recent experience at the Neuromodulation in Psychiatry Stakeholders’ Roundtable, hosted by the Milken Institute Science Philanthropy Accelerator for Research and Collaboration, truly revealed how siloed this field’s current efforts are with regard to research, funding, and clinical care. I met several world-class researchers, clinicians, entrepreneurs, venture capitalists, and venture philanthropists, many of whom are making amazing individual contributions to the field. However, the event also made it quite apparent that several of our past efforts have gone largely unnoticed by one another.

As the old adage goes, “If you want to go fast, go alone; if you want to go far, go together.” Making real progress in this field will depend on our ability to work across disciplines. Learning from and networking with leaders across industries, academic institutions, and areas of expertise during the Roundtable was an unforgettable experience; our challenge now is to bring that type of collaboration into the real world to make a real difference for patients.