In this episode I step back from ECT specifically and give a broad, clinician-level overview of interventional psychiatry as a whole: what it is, how it differs from conventional psychiatry, and where the field may be going in the next decade.

I start by contrasting conventional psychiatry with what I propose as a working definition of interventional psychiatry:

An emerging subfield that encompasses invasive or non-standard medication delivery routes (like IV ketamine) and medical procedures designed to directly modulate neural circuits implicated in psychiatric disorders.

We then discuss the established interventional psychiatry treatment modalities.

Neuromodulation: TMS and ECTI start with the history of neuromodulation.I outline several leading hypotheses for how ECT works.We have evidence for all of these, but no single definitive causal mechanism.Ketamine & Esketamine (Spravato)

I then move into interventions that are FDA-cleared but rarely used, or still investigational:

* Vagus Nerve Stimulation (VNS)

* External trigeminal nerve stimulation (FDA-cleared for ADHD)

* Low-Intensity Focused Ultrasound (LIFU)

* tDCS and Cranial Electrical Stimulation

* Magnetic Seizure Therapy (MST)

* Stellate Ganglion Block

* Deep Brain Stimulation (DBS)

* Ablative Psychiatric Neurosurgery

Please email me with questions or comments or suggestions at [email protected]

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