What is the first word that comes to mind when you hear the word “psychiatry”? If you didn’t say “medication” then either you were born before 1950 or you are among the newest doctors being trained in the field of Interventional Psychiatry. After many decades of trying to lessen devastating mental illness symptoms through pharmacology, newer approaches based on long-standing scientific research are being established and proven to be more effective than daily medication regimens with fewer side effects. These new solutions are being termed interventional psychiatry.
What is interventional psychiatry?
Interventional psychiatry is an approach that specializes in delivering advanced, evidence-based treatments for mental health conditions. These treatments can be especially effective for patients who have not responded to traditional therapies like talk therapy or medication, and are procedural rather than pharmacological. All of these treatments directly target regional brain activity to alleviate symptoms and improve brain function in conditions like depression, anxiety, OCD, ADHD, and PTSD. Some treatments are office-based, while some can be done at home.
How long has interventional psychiatry existed?
- Starting in 1938, ECT (electroconvulsive therapy) was the first effective approach to directly influencing brain function.
- In the 1940s and 1950s, research into transcranial direct current stimulation (tDCS) and vagal nerve stimulation (VNS) began. However, after the first medications were observed to have a beneficial effect for certain mental health symptoms, much of the research focus shifted to psychopharmacology and didn’t return to neurostimulation for decades.
- In 1985, Dr. Anthony Barker developed the first transcranial magnetic stimulation (TMS) device using magnetic pulses to stimulate brain areas.
- In 2008, TMS was approved by the FDA to treat depression. Since then, this technology has continued to develop and has proven effective for treating additional conditions, including OCD and certain addictions.
- In the late 1990s, the first rapid-acting antidepressant effect was noticed as a result of intravenous ketamine infusions. Studies began that showed ketamine’s effectiveness in treating depression at doses far below those used in anesthesia. Many clinics across the U.S. currently offer ketamine treatments.
- Currently, many additional methods of brain stimulation are being investigated as useful treatments for a variety of mental health conditions; these include but are not limited to deep brain stimulation (DBS) for depression and Parkinson’s, psychedelic-assisted therapies such as psilocybin and MDMA for depression and PTSD, and botulinum toxin (botox) injections for depression and headaches.
What are examples of interventional psychiatry?
While the widest definition for interventional psychiatry can include any effort to affect mental health excluding daily medication regimens (and therefore could include talk therapy, exercise, nutrition, or mindfulness meditation), the term interventional psychiatry will typically refer more specifically to devices and office-based procedures that are being performed to modulate brain function in a targeted fashion. Below are some of these specific treatments that are being offered at Interventional Psychiatry of Philadelphia (IPOP).
Transcranial magnetic stimulation (TMS)
Transcranial magnetic stimulation is a noninvasive, painless treatment that sends brief magnetic pulses into the brain to stimulate areas that are known to be involved in the patient’s specific mental health condition. In a way it is like doing physical therapy for the brain to help it build stronger connections that counteract the effects of mental illness.
There are a variety of TMS procedures available. At IPOP, we offer the state-of-the-art technology of deep TMS, which more effectively targets the brain areas affected by the mental health condition, resulting in deeper stimulation and greater positive outcomes.
We also offer an accelerated TMS protocol (based on the SAINT research) that can reduce the treatment time required, and is recommended depending on the patient’s treatment plan. In comparison to the standard TMS treatment, which can take up to two months to complete, the accelerated treatment can be completed within two weeks, with multiple treatments occurring per day.
Ketamine therapy
IV ketamine therapy treatment delivers a low dose of the anesthesia medicine over the course of 40-to-60-minute sessions to achieve rapid improvement in depression and suicidal ideation. Six infusions given between two to six weeks have resulted in 80% effectiveness treatment for depression. All treatments are performed in the office under close medical supervision, adhering to established safety and effectiveness protocols.
At IPOP we understand that both the treatment setting and the mindset are important factors in the effectiveness of ketamine treatments. Therefore, individualized attention is provided throughout the course of treatment to ensure that each patient’s treatment, and measure of success, is optimized to the fullest extent.
Transcranial direct current stimulation (tDCS)
Transcranial Direct Current Stimulation (tDCS) is a non-invasive neurostimulation technology used to modulate neuronal activity and increase synaptic plasticity, which is the brain’s ability to form new connections. It applies a low-intensity current to the scalp through two or more electrodes, creating a positive effect on the activation of neuronal networks. The most common application of tDCS includes using the device daily to stimulate the left frontal cortex, which helps to alleviate symptoms of depression and anxiety. Other uses have also shown benefits for ADHD and addictions.
tDCS is a device patients are able to use in the convenience of their home. At IPOP we provide training on how to use the device properly, ensuring that patients feel confident in their ability to complete the procedure at home for maximum effectiveness. The effectiveness of at-home sessions is monitored for quality and optimal compliance through an app that operates the device.
Botulinum toxin (Botox)
Emerging evidence has shown that there is a feedback relationship between our emotions and our facial expressions. When we are sad, our face often reflects that feeling. But what is also coming to light is the fact that making the facial expression of sadness will actually lead to increased feelings of sadness. Thus a feedback loop occurs between our facial expression and our feelings. Emotions other than sadness also appear to work this way.
Utilizing this knowledge, several studies have shown that injecting botox into particular facial muscles to prevent them from over-expressing sadness can actually improve mood. There are over a dozen research studies showing improvement in depression through botox therapy. Similarly, botox has been shown to help alleviate the pain of headaches by altering the feedback signals given by muscles in the scalp.
IPOP provides botox treatments for both depression and headaches to help lessen the burden of these two kinds of pain. While these same procedures often overlap with the areas targeted in cosmetic applications, the treatment we provide is aimed at improving mental wellbeing.
Psychedelic therapy
Psychedelic therapy is the guided use of psychedelic drugs like psilocybin, MDMA, and ketamine to treat anxiety, PTSD, OCD, and addiction. Although psilocybin and MDMA are currently Schedule I drugs and are not yet approved or legalized, current research efforts are bearing promising results and the safety of potential treatments are being studied. Many, including myself and many other interventional psychiatry providers, are optimistic that these will become legal, available options for medical applications in the near future.
The Future of Interventional Psychiatry
The field of interventional psychiatry is constantly expanding as more evidence-based treatments are being discovered and tested. While medication regimens have provided needed relief for many patients with mental health conditions over the decades, it is encouraging to see more research and effort being put into these more holistic treatments that can not only provide significantly more effective results and symptom relief, but can also drastically reduce the negative side effects patients often experience with medications.
