June 24, 2021 | Interventional psychiatry is a subspecialty of behavioral health medicine that is becoming more and more recognized throughout the world for using cutting-edge technology to resolve some age-old issues. Depression, for example, is something that affects more than 17 million adults in this country, interfering with their ability to lead healthy, active lives. Major depressive disorder is not a weakness, not something that you can simply “snap out of,” it requires long-term treatment. And thanks to interventional psychiatry, many people who have experienced years and years of depression without any improvement in their symptoms are seeing dramatic results after undergoing therapeutic procedures like electroconvulsive therapy, transcranial magnetic stimulation and ketamine treatments. All of these are currently bringing hope to those dealing with mental-health issues that may have gone unnoticed or been misdiagnosed over the years.

June 24, 2021 | Electroconvulsive therapy, or ECT, is a safe and effective treatment for a variety of mental disorders including depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder. When medication or other typical treatments aren’t working, electroconvulsive therapy may be recommended. Done primarily on an outpatient basis, ECT has been found to be extremely successful in treating patients with suicidal thoughts and those who need to be stabilized quickly. It can also be used for pregnant women who are having significant problems with depression. Patients undergoing ECT receive an electric current that triggers a seizure in the brain. The seizure activity helps the brain essentially rewire itself in an effort to relieve the patient’s symptoms. Administered with an anesthetic, ECT has been shown to produce results after a series of treatments, leading to increased usage of this advanced form of therapy.

June 24, 2021 | Transcranial magnetic stimulation, or TMS, involves the use of a very short pulsed magnetic field to stimulate nerve cells in the brain in an effort to treat major depressive disorder. TMS therapy stimulates areas of the brain that are underactive in depression. Done on an outpatient basis, TMS is performed while the patient sits comfortably in a relaxing chair. Sessions take a little more than 30 minutes and are administered five days a week for 30 to 36 treatments. With TMS, there are none of the side effects commonly associated with antidepressant medication and patients remain awake and alert throughout the treatment. TMS is approved by the U.S. Food and Drug Administration for the treatment of depression, and has shown to be effective in helping those patients who have failed to benefit from antidepressant drugs. Unlike ECT, there is no sedation necessary for TMS and it is not associated with the rare risk of any lasting memory difficulty.

June 24, 2021 | The drug ketamine is approved by the U.S. Food and Drug administration for use as an anesthetic although research has shown that it has antidepressive properties. Because of this, ketamine has been incorporated into the treatment of psychiatric disorders like major depressive disorder, bipolar disorder and post-traumatic stress disorder, or PTSD. The antidepressant properties may stem from its tendency to promote neural plasticity, which is the ability of neurons in the brain to rewire their connections. Because it exerts an antidepressant effect through a new mechanism, ketamine may be able to help people successfully manage depression when other treatments have not worked. Although ketamine infusion therapy is not FDA approved for the treatment of depression, peer-reviewed research studies have been shown to support its effectiveness. Unfortunately, it is not covered by insurance and requires an out of pocket payment.

June 24, 2021 | Esketamine is a nasal spray form of ketamine which is used to manage treatment-resistant depression. UAMS’ Interventional Psychiatry program was among the first in Arkansas to utilize the drug, which changes the activity of certain natural substances within the brain. Esketamine, which is marketed under the name Spravato, was approved for use by the U.S. Food and Drug Administration in 2019. According to UAMS psychiatrist Lou Ann Eads, esketamine can only be used under medical supervision with specific restrictions. Patients receive the drug under the supervision of a physician and are monitored for at least two hours to ensure their safety before being discharged. It is sprayed into the nose twice a week for four weeks, once a week for four weeks and then once every one to two weeks as needed. Esketamine has opened the door for medications currently in development that show great promise for producing a rapid-onset antidepressant effect.