Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.

This episode covers interventional psychiatry with Dr. Sean Nestor, an interventional psychiatrist and clinician-scientist at the University of Toronto, where he serves as Assistant Director of the Psychiatry Program and oversees the Clinician Researcher Track (CResT) residency within the Department of Psychiatry. His research program at Sunnybrook Health Sciences Centre focuses on advancing the clinical application of neuromodulation therapies to improve outcomes across a wide range of psychiatric disorders.

The learning objectives for this episode are as follows

1. Define interventional psychiatry and distinguish it from traditional pharmacologic and psychotherapy-based approaches
2. Describe the role of interventional psychiatry in clinical practice, including identifying patient populations most likely to benefit from neuromodulation treatment
3. Identify pathways to become involved in research and scholarly work within the field of interventional psychiatry

Guest: Dr. Sean Nestor

Hosts: Dr. Pooja Sankar (PGY1), Michael Wang (MS4), Dr. Kate Braithwaite

Audio editing: Dr. Kate Braithwaite

Time Stamps:

(2:25) - Defining Interventional Psychiatry (IP) and its role in Psychiatric practice

(4:20) - Evolution of Interventional Psychiatry (IP)

(8:40) - Patients who will benefit from IP modalities

(12:35) - Other factors to consider when assessing a patient for IP 

(15:30) - rTMS

(19:15) - Description of a typical rTMS session

(23:50) - ECT

(26:45) - Ketamine

(29:05) - Other Investigational Modalities

(30:45) - Maintenance treatment

(35:30) - Medication and IP

(37:55) - Addressing stigma of ECT

(43:15) - Discussion on place of IP in Depression management decision tree

(47:00) - How to get involved in IP

(50:10) - Rewarding aspects of working in IP

(52:25) - Challenges of working in IP

(53:40) - Future of the field 

Resources:

⁠Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) | Stanford Health Care⁠

⁠CTMSS | International medical society dedicated to optimizing clinical practice, supporting research, and increasing access to high quality, evidence-based Transcranial Magnetic Stimulation

⁠The Interventional Psychiatry Consortium⁠

References:

Andrade, J. & Brito, M.. (2023). When the SAINT goes marching in – A novel transcranial magnetic stimulation protocol shows miraculous promise. European Psychiatry. 66. S835-S835. 10.1192/j.eurpsy.2023.1768. 

⁠Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults | CANMAT⁠

Conway, C. R., & Sackeim, H. A. (2022). Interventional Psychiatry: The revolution has arrived. Brazilian Journal of Psychiatry. ⁠https://doi.org/10.47626/1516-4446-2022-0046⁠ 

Rakesh, G., Cordero, P., Khanal, R., Himelhoch, S. S., & Rush, C. R. (2024). Optimally combining transcranial magnetic stimulation with antidepressants in major depressive disorder: A systematic review and Meta-analysis. Journal of affective disorders, 358, 432–439. https://doi.org/10.1016/j.jad.2024.05.037

Yavi, M., Lee, H., Henter, I. D., Park, L. T., & Zarate, C. A., Jr (2022). Ketamine treatment for depression: a review. Discover mental health, 2(1), 9. ⁠https://doi.org/10.1007/s44192-022-00012-3⁠

Zaidi, A., Shami, R., Sewell, I. J., Cao, X., Giacobbe, P., Rabin, J. S., Goubran, M., Hamani, C., Swardfager, W., Davidson, B., Lipsman, N., & Nestor, S. M. (2024). Antidepressant class and concurrent rTMS outcomes in major depressive disorder: a systematic review and meta-analysis. EClinicalMedicine, 75, 102760. https://doi.org/10.1016/j.eclinm.2024.102760 

For more PsychEd, follow us on Instagram (⁠⁠⁠@psyched.podcast⁠⁠⁠), Facebook (⁠⁠⁠PsychEd Podcast⁠⁠⁠), X (⁠⁠⁠@psychedpodcast⁠⁠⁠), and Bluesky (⁠⁠⁠@psychedpodcast.bsky.social⁠⁠⁠). You can email us at ⁠⁠⁠[email protected]⁠⁠⁠ and visit our website at⁠⁠⁠ psychedpodcast.org⁠⁠⁠