Electronic Spring 2023 | Issue 54

A Peek into Psychiatry in the 21st Century: IPS Kicks Off 2023 Virtual Series

By: Jasleen Singh

Celebrating advances in the field of Psychiatry, this year IPS continued its annual virtual series with a four-part lecture series centered around the theme of “Psychiatry in the 21st Century: Where Might the Future Take Us?”.

Attended by about forty people, the first lecture featured Dr. Philip Janicak, MD who discussed Advances in Therapeutic Neuromodulation. Falling under the general umbrella of interventional psychiatry, neuromodulation includes both invasive and non-invasive techniques, with non-invasive methodologies further being broken down into whether seizure activity is involved in the technique, as seen with Electroconvulsive therapy (ECT).

Dr. Janicek focused much of his lecture on FDA-cleared neuromodulation techniques of ECT and TMS. FDA-clearance is a concept used for medical devices and focuses on safety, as opposed to FDA-approval, which applies to medications. Other FDA-cleared neuromodulation techniques include Deep Brain Stimulation (DBS) and Vagal Nerve Stimulation (VNS)

Advantages and disadvantages of ECT were discussed, with note of a recent publication in JAMA Network that supported ECT in its effectiveness for suicidality in depressed patients. As Dr. Janicak discussed, in many areas of the country, including much of the Southwest and West, there are “ECT-deserts” with limited access to ECT. This is further compounded by the stigma associated with ECT as portrayed by the media and in literature. While ECT may be the most widely recognized, other neuromodulation techniques involving seizure activity include Magnetic Seizure Therapy, Focal Electrically Administered Seizure Therapy (FEAST).

One increasingly popular non-seizure neuromodulation technique is Transcranial Magnetic Stimulation, or TMS. First introduced in 2008, it took many years before insurance companies would cover TMS. While all major insurance companies now cover TMS, there are a variety of criteria to receive such coverage, with significant out-of-pocket costs that often remain. Interestingly, TMS is also being studied for its potential beneficial effect on cognitive deficits. Unlike ECT, patients receiving TMS remain independent, and do not require additional monitoring after sessions, as opposed with ECT. However, TMS is more time intensive and also requires a tapering process instead of abruptly discontinuing sessions. Furthermore, as seen with antidepressants, TMS also has a relatively slow onset of efficacy of weeks. Currently, TMS is FDA-cleared for Major Depressive Disorder, Obsessive-Compulsive Disorder, Nicotine Dependence, and Migraines with Aura. However, many studies are ongoing on the potential application of TMS for multiple other disorders including the depressed phase of bipolar disorder, anxiety disorders, neurocognitive disorders, eating disorders, etc. Dr. Janicek reviewed literature relating to TMS, highlighted studies demonstrating the safety of TMS, and also discussed newer techniques including the Stanford accelerated intelligent neuromodulation therapy (SAINT), which involved intermittent theta-burst stimulation (iTBS).

For further details, or to watch recordings of past sessions, click HERE.

To register for upcoming sessions or other IPS events, click HERE.