Dr. Rebecca Allen, a pioneering interventional psychiatrist and president of the Clinical TMS Society, is transforming mental health care delivery through her innovative outpatient clinic in Seattle. By offering a wide range of cutting-edge treatments like ECT, TMS, ketamine, and running COMPASS clinical trials for psilopsybin under one roof, she aims to expand access to life-changing treatments for patients with treatment-resistant conditions. In this interview, Dr. Allen shares her experiences growing a leading interventional psychiatry practice, spearheading groundbreaking research on psychedelic-assisted therapy, and navigating the challenges of insurance reimbursement and unregulated treatment models. She offers candid advice for fellow psychiatrists looking to enhance their practice and make a meaningful impact in the lives of their patients. Through her leadership and unwavering commitment to evidence-based innovation, Dr. Allen is paving the way for a brighter future in mental health care.

Timestamps and Shownotes:

[00:00:00] Introduction to the Psychiatry Tomorrow podcast and today's guest, Dr. Rebecca Allen

[00:01:46] Dr. Allen's background and role as an interventional psychiatrist offering ECT, TMS, VNS, esketamine, IV ketamine, and ketamine-assisted psychotherapy at Seattle NTC

[00:03:52] How Dr. Allen got started offering outpatient ECT and the logistics of partnering with Swedish Hospital

[00:09:46] Seattle NTC as one of the largest outpatient ECT programs in the U.S., ECT stigma and underutilization

[00:13:02] Busting myths about modern ECT and efforts to minimize cognitive side effects

[00:16:15] A day in the life at Seattle NTC - ongoing treatments and clinical trials

[00:19:45] Seattle NTC's involvement in the COMPASS trial on psilocybin-assisted therapy for treatment-resistant depression

[00:20:26] How Dr. Allen's clinic got involved in clinical trials (BEAM study, VNS trial) and became a top enroller for COMPASS

[00:27:52] Logistics and challenges of the COMPASS protocol, DEA scrutiny for psychedelic trials

[00:29:33] Dr. Allen's concerns about Oregon's unregulated psilocybin program and the importance of robust clinical trials and medical oversight

[00:35:17] Psilocybin is powerful but not a panacea - the need for thorough safety monitoring and the dangers of broad unregulated access

[00:37:50] The advantages of offering multiple interventional psychiatry modalities to match treatments to patients

[00:39:44] Dr. Allen's role as president of the Clinical TMS Society and initiatives to grow the organization

[00:45:17] Balancing clinical work, research, and leadership roles

[00:47:50] Advice for psychiatrists looking to scale a private practice - seeking expert consultation, reading contracts thoroughly

[00:50:47] The importance of negotiating fair insurance reimbursement rates from the start

[00:52:12] Conclusion and thanks to Dr. Allen

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Legal experts Daniel Sternthal and Ethan Minkin explore the legal intricacies surrounding ketamine therapy for psychiatric conditions. They delve into the importance of interdisciplinary respect, the legal challenges and malpractice risks associated with off-label ketamine use, and the vital role of informed consent. The discussion also highlights trends in the ketamine space, including the impact of COVID, private equity involvement, and the emergence of home ketamine therapy. With a focus on safeguarding practitioners through meticulous documentation and adherence to evolving legal standards, this episode is a must-listen for clinicians and legal professionals in the psychedelic medicine space. It wraps up with actionable advice on advocacy, education, and maintaining ethical practice standards to mainstream ketamine therapy safely.

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Dr. Bergina Isbell, CMO at Led Life Psychiatry, Maryland, combines personal experience and professional innovation to enhance mental health care. Specializing in Ketamine-Assisted Psychotherapy, she offers hope to those with depression, anxiety, and on the Autism spectrum. Dr. Bergina champions restorative justice, seeking healing over punishment and emphasizing mutual understanding and forgiveness. Her practice prioritizes individual sensory needs, creating a therapeutic environment tailored to each patient. Beyond the clinic, her advocacy extends to supporting families with special needs, demonstrating the importance of flexibility, empathy, and finding joy in life's challenges.

Timestamps/Shownotes:

[00:02:00] Multiple Licenses and Autism: Dr. Brigina discusses her motivation for obtaining multiple state licenses, driven by the need to address her children's requirements due to Autism, and emphasizes the concept of turning lemons into lemonade.

[00:07:00] SXSW Talk and Dancing in the Rain: Dr. Brigina shares insights from her SXSW talk titled "Ditch Work Life Balance and Learn to Dance," focusing on juggling life's responsibilities and finding joy in challenges, including her personal connection to dancing as a hobby and metaphor for handling life's difficulties.

[00:09:00] Specializing in Special Needs: The conversation shifts to Dr. Brigina's practice specializing in children and adults with special needs, evolving from advocacy at IEP meetings to professional referrals, and supporting neurodiversity through her practice and community engagement.

[00:11:00] Boundaries and Self-Disclosure: Dr. Brigina discusses navigating boundaries and self-disclosure in her professional and personal life, especially relating to her experiences as a parent of children with Autism, and shares a story about an airport incident highlighting advocacy for those with special needs.

[00:15:00] Tips for Handling Stressful Situations: Dr. Brigina offers advice for families and individuals with special needs on preparing for and navigating high-stress environments like airport security, emphasizing preparation and communication with service providers.

[00:18:00] Utilizing Telehealth for Autism Spectrum: Insights on effectively using telehealth for individuals on the Autism spectrum, stressing the importance of initial in-person visits when possible and the use of social stories and personal comfort items during sessions.

[00:20:00] Ketamine Therapy and Sensory Considerations: Discussion about the introduction of ketamine therapy in her practice, prompted by a patient's experience, and the importance of sensory inventory to accommodate individuals on the Autism spectrum undergoing ketamine treatment.

[00:24:00] Ketamine for Mental Illness in Autism Spectrum: Dr. Brigina reflects on the impact of ketamine and SPRAVATO treatments for individuals on the Autism spectrum with concurrent mental health conditions, based on patient stories and the potential for broader application.

[00:27:00] Industry Perspectives and Restorative Justice: Towards the end, Dr. Brigina shares her thoughts on the ketamine treatment industry, emphasizing personalized care over a "puppy mill" approach, and introduces the topic of restorative justice, highlighting her involvement in a TEDx talk on the subject.

[00:33:00] Seeking Restorative Justice: Strategies for individuals interested in exploring restorative justice, including community research and professional guidance, and considerations for its appropriate application.

[00:37:00] Restorative Justice in Psychiatry: Dr. Brigina advocates for a restorative justice approach within psychiatry, reflecting on the historical context of psychiatric care, the challenges of involuntary commitment, and the potential for innovative treatments like ketamine to transform patient care.

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Explore the dynamic landscape of psychiatric clinical trials through the expert lens of Dr. Michael Banov, a renowned figure with a wealth of experience in over 150 trials. This in-depth blog post delves into his groundbreaking journey, starting with the revolutionary Clozapine trial for depression and extending to the recent developments in Vagus Nerve Stimulators (VNS). Gain an unparalleled understanding of the challenges and advancements in clinical trials, including the transition from traditional methods to innovative approaches. Dr. Banov shares his valuable insights on patient recruitment complexities, the importance of real-world scenarios in trials, and the critical role of ethical oversight. Discover the impact of technology on patient engagement and the intricacies of conducting trials in a modern, regulated environment. This comprehensive guide is an essential read for clinicians and professionals interested in the evolving world of psychiatric research and its profound implications for the future of mental health care.

Timestamps:

• [00:00:00] Introduction to the podcast and mention of ketamine treatments and vagus nerve stimulators.
• [00:01:00] Introduction of Dr. Michael Banov and his background in clinical trials.
• [00:02:00] Discussion on the challenges of recruiting for psychiatric clinical trials.
• [00:03:00] Insights into the evolution of clinical trial landscapes and the role of social media in recruitment.
• [00:04:00] Introduction to the trial of vagal nerve stimulation for depression.
• [00:05:00] Discussion on the potential of vagal nerve stimulator trials for treatment-resistant depression.
• [00:06:00] Dr. Banov's career highlights and how to get involved in clinical trials.
• [00:07:00] Dr. Banov's first clinical trial experience and the use of Clozapine.
• [00:08:00] The transition from academic research to industry and the ethical considerations.
• [00:09:00] Challenges faced in starting clinical research and the importance of experience.
• [00:10:00] The shift in psychiatric treatment approaches and the role of industry professionals.
• [00:11:00] Insights into the pharmaceutical industry and the development of medications.
• [00:12:00] The process of recruiting for a Clozapine trial and the challenges involved.
• [00:13:00] The key role of recruitment in clinical research and the evolution of patient protection.
• [00:14:00] The increasing challenges in recruiting for clinical trials.
• [00:15:00] The impact of clinical trials on real-world treatment scenarios.
• [00:16:00] The unique aspects of running psilocybin clinical trials.
• [00:17:00] Challenges in placebo control and patient interaction in psilocybin trials.
• [00:18:00] The necessity of a placebo script in clinical trials.
• [00:19:00] The regulatory aspects of clinical trials and the importance of consent forms.
• [00:20:00] Reflections on the changing landscape of psychiatric clinical trials.
• [00:21:00] The shift towards more regulated clinical trials and the loss of nuanced patient interaction.
• [00:22:00] The impact of private equity on research organizations and clinical trials.
• [00:23:00] The role of technology in modern clinical trials.
• [00:24:00] The challenges introduced by technology in clinical trials.
• [00:25:00] The use of technology for monitoring patient compliance in trials.
• [00:26:00] The importance of oversight in clinical trials.
• [00:27:00] The process of being monitored and audited in clinical trials.
• [00:28:00] The role of Contract Research Organizations (CROs) in clinical trials.
• [00:29:00] The process of site initiation and monitoring in clinical trials.
• [00:30:00] The reasons for FDA audits in clinical trials.
• [00:31:00] The consequences of FDA audits and the importance of ethical conduct.
• [00:32:00] The challenges of being a high enroller in clinical trials.
• [00:33:00] The role of technology in patient recruitment and enrollment.
• [00:34:00] The challenges of recruiting patients in active clinical practice.
• [00:35:00] The implementation and mechanism of vagal nerve stimulators.
• [00:36:00] The contrast between VNS and other treatments like ketamine.
• [00:37:00] The design of the VNS trial and its benefits.
• [00:38:00] The steps to become a site researcher in clinical trials.
• [00:39:00] The importance of experience and connections in starting clinical research.
• [00:40:00] The necessity of oversight in clinical trials for patient safety.
• [00:41:00] The role of technology in facilitating patient identification and enrollment.
• [00:42:00] The challenges of using social media for recruitment in clinical trials.
• [00:43:00] The practical aspects of running a VNS study in a clinical practice.
• [00:44:00] The process and placement of the VNS unit.
• [00:45:00] The sustained response of VNS compared to other treatments.
• [00:46:00] The sponsor of the VNS study and the cost considerations.
• [00:47:00] The trial design of VNS and its real-world applicability.
• [00:48:00] Advice for clinicians interested in becoming involved in clinical trials.
• [00:49:00] The importance of gaining experience and certifications in clinical research.

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The power of community and networking in private practice psychiatry cannot be overstated.

‍Clinicians often grapple with isolation while staying up-to-date on research, best practices, finding mentors, and collaborative care. Addressing this, a panel of experts from the Osmind Community Advisory Board.

The forum, centered on overcoming the challenges of solo practice through community engagement featured insights from:

• Andrew Penn, MS, PMHNP, Clinical Professor at UC San Francisco, School of Nursing
• Dr. Michael Banov, Medical Director at Psych Atlanta
• Dr. Awais Aftab, Clinical Assistant Professor of Psychiatry at Case Western Reserve University
• Dr. Charles Miller, Founder and CMO at Scenic City Neurotherapy
• Moderated by: Dr. Alison McInnes, VP of Scientific Affairs at Osmind, and Dr. Carlene MacMillan, Chief Medical Officer at Osmind.

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Delve into the complexities of starting and thriving in a private mental health practice. Listen to Dr. Kristin Budde, Dr. Erick Sheftic, and Dr. Raghu Appasani share their experiences and insights on integrating the latest treatments into standard practice, the importance of continuous learning, finding your niche, and the power of interdisciplinary collaboration in overcoming access barriers. They also tackle the crucial issue of professional burnout, offering strategies to carve out a unique niche that resonates with both their values and the needs of their patients. This episode is an invaluable resource for mental health professionals seeking to navigate the ever-evolving landscape of private practice, providing practical advice and inspirational examples from those at the forefront of the field. Tune in to gain a comprehensive understanding of how to build a successful, sustainable, and fulfilling mental health practice in today's dynamic healthcare environment.

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Join a panel of renowned experts from Osmind's Community Advisory Board, including Dr. David Feifel, Dr. Tobias Marton, and Dr. Christy Duan, moderated by Dr. Carlene MacMillan and Dr. Alison McInnes. They unveil the future of psychiatry at the intersection of tradition and cutting-edge innovation. 

Listen to in-depth discussions on harnessing big data and real-world evidence to revolutionize personalized care, moving beyond conventional treatments to embrace complementary novel therapies such as TMS and psychedelic interventions. 

Learn why "Interventional Psychiatry" will just be called "Psychiatry" in the future.

This episode also examines the delicate balance between patient autonomy and expert-guided care, reflecting on how these changes redefine the psychiatrist-patient relationship. Glimpse into a future where psychiatry not only adapts to but proactively shapes mental health care.

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Dive into the world of psychiatric care for PTSD with General Stephen Xenakis, M.D., a renowned expert who uniquely combines his extensive military and medical experience. As the Executive Director of the American Psychedelic Practitioners Association (APPA), General Xenakis is pioneering the integration of advanced psychedelic therapies into mainstream mental health treatment, particularly focusing on the complexities of Post-Traumatic Stress Disorder (PTSD) among veterans.

General Xenakis shares his personal journey from his medical training at the University of California, San Francisco (UCSF) to his impactful military service, treating soldiers returning from Vietnam. He offers a candid critique of the historical shift in psychiatry from holistic approaches to a more reductionist, biological focus, and advocates for a return to comprehensive, patient-centered care. His insights reveal the limitations of traditional models like the DSM and underscore the need for a more nuanced understanding of mental health disorders.

A significant portion of the discussion is dedicated to exploring the potential of psychedelic treatments in psychiatry. General Xenakis highlights the importance of professional practice guidelines and accredited training in this emerging field. He also discusses the challenges in integrating these therapies into mainstream healthcare, emphasizing the need for an ethical framework to avoid past mistakes with psychedelic use.

General Xenakis’s vision extends to the educational front, where he envisions psychedelic medicine becoming a vital part of psychiatric education in medical schools and residency programs. He also touches on the critical role of collaboration with institutions like the VA and DoD in advancing research and treatment options for veterans.

The episode also delves into the specifics of alternative therapies such as Ibogaine and MDMA-assisted therapy, discussing their potential benefits and challenges in treating PTSD. General Xenakis passionately advocates for a diverse and integrative approach to therapy, stressing the importance of therapeutic alliance, trust, rapport, and the inclusion of family support in the treatment process.

Timestamps and Show Notes for General Stephen Xenakis Interview

• [00:01:00] Introduction: Introduction of General Stephen Xenakis and his role as the Executive Director of the American Psychedelic Practitioners Association.
• [00:05:00] Career Trajectory: Discussion on General Xenakis's journey into the military and psychiatry, including his experiences treating soldiers returning from Vietnam and his time as a patient at Walter Reed.
• [00:09:00] Changes in Psychiatry Over the Years: General Xenakis reflects on the shift in psychiatry from a holistic approach in the 70s to a more reductionist, biological approach in the 80s and 90s.
• [00:12:00] Beyond the DSM and Patient-Centered Models: Exploration of moving beyond DSM to patient-centered models in psychiatry, integrating genetics, AI, and large language models for personalized treatment.
• [00:19:00] Role as Executive Director of the American Psychedelic Practitioners Association: General Xenakis discusses his involvement and vision for the association, emphasizing the importance of practitioner-led changes in mental healthcare.
• [00:25:00] Integration of Psychedelic Medicine in Mainstream Healthcare: Challenges in integrating psychedelic medicine into mainstream healthcare, including the shift from a disease-based model to a more holistic approach.
• [00:31:00] Alternative Therapies for PTSD: Discussion on the utility and challenges of treatments like Ibogaine, ketamine, MDMA, and psilocybin in treating PTSD.
• [00:38:00] Human Rights Advocacy: General Xenakis talks about his advocacy against torture and mistreatment, reflecting on his experiences with Human Rights First and Physicians for Human Rights.
• [00:42:00] Home Ketamine Businesses and Clinical Model: Views on home ketamine businesses and the importance of maintaining the clinical model for delivering treatments like ketamine and MDMA.
• [00:45:00] Mental Health in the Wake of COVID-19: Reflections on the increased awareness of mental health issues following the COVID-19 pandemic and addressing the broader mental health crisis.

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Stella's acquisition of Field Trip Health's U.S. assets takes center stage, revealing a strategic merger that combines Stella's innovative Stellate Ganglion Block technique and physical treatement centers with Field Trip Health's experience  and infrastructure for deliverying in psychedelic-enhanced psychotherapy. 

Dr. Eugene Lipov and Mujeeb Jafferi delve into the nuances and power of combining treatments, the potential of telepsychiatry, and the future trajectory of mental health care, emphasizing the critical role of data-driven approaches and the need for broadened accessibility in the realm of psychiatric treatments.

Timestamps and Show-notes From the Episode:
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3:33: Dr. Eugene Lipov discusses the invention of the Stella Ganglion block.

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5:33: Mujeeb Jafferi shares the founding story of Field Trip Health.

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8:53: The origin story of how Field Trip and Stella met and how their partnership evolved.

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10:03: Discussion about Field Trip's rapid expansion and subsequent challenges. Transition from a B2B to a B2C model during the pandemic.

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16:03: Challenges faced while opening the first Stella center, especially right before the pandemic.

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18:13: Comparison of various treatments, with a focus on the Stella Ganglion block vs. TMS and ketamine. The increasing cultural awareness of ketamine.

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19:53: Introduction of at-home ketamine services due to new telehealth laws. The partnership with NeuLife and the effectiveness of ketamine in different settings.

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24:55: Dr. Lipov talks about the merger of Stella and Field Trip Health. He discusses the benefits of integration and the combination of treatments.

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29:53: Mujeeb Jafferi's concerns about the merger, especially regarding the preservation of treatment protocols and quality of care.

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32:18: Introduction of a new CTO and the technological innovations in place, including a custom patient portal.

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35:43: A deep dive into the design and user experience of the Field Trip app.

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38:23: Discussion about insurance coverage for different treatments, with a focus on Stella Ganglion blocks and ketamine.

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45:03: The importance of data collection through measurement-based care and related research.

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46:53: Dr. Eugene Lipov shares insights on epigenetics and its potential to reverse aging.

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47:33: Discussion on self-funded employer plans, with a focus on advocating for covering novel treatments.

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53:23: Speculation on the evolution of the Field Trip brand after the merger, emphasizing company name, people, and products.

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Navigating the challenging terrains of psychiatry requires a blend of expertise, vision, and ethical grounding. Dr. Rebecca Brendel, MD, JD, exemplifies these qualities. As the immediate past president of the APA and a luminary at Harvard's Center for Bioethics, she has consistently showcased her commitment to upholding ethics in the ever-evolving field of psychiatry. In this episode, she offers a panoramic view of her journey, the APA's strides under her leadership, and the directions in which psychiatry is headed, especially in the realms of technology, diversity, and medical ethics.

Timestamped Shownotes:

• 2:00 - The intricate challenges and accomplishments of leading the APA during and post-pandemic.
• 3:25 - Revelations and historical nuances encountered during her presidency at the APA.
• 5:40 - Dr. Brendel's awe-inspiring journey within the APA: tracing her path from a research fellow to the apex of leadership.
• 10:20 - The inherent attributes and challenges associated with being an ethical spokesperson in today's world.
• 13:20 - The tangible impact of Dr. Brendel's ethics-centered approach at the APA, with a focus on the Goldwater Rule.
• 15:05 - Demystifying the misconceptions around the Goldwater Rule.
• 17:40 - The APA's forward-thinking initiatives in promoting diversity, equity, inclusion, and addressing structural racism.
• 21:10 - The myriad opportunities presented by APA’s 501c foundation, extending its benevolence beyond the clinical realm.
• 22:30 - A deep dive into the PsychPRO Registry: understanding its mechanics and its ambitious vision for the future of psychiatry.
• 26:10 - An overview of the collaborative care model and its relevance.
• 27:00 - Measurement-based care: striking a balance with clinical judgment.
• 32:00 - A spotlight on Dr. Brendel's leadership role at the Center for Bioethics at Harvard University.
• 33:50 - The unwavering significance of hands-on clinical work in Dr. Brendel's illustrious journey.
• 36:20 - Guiding young enthusiasts on how to actively engage with professional psychiatric organizations.
• 38:40 - Dr. Brendel's aspirations and hopes for the future of psychiatry, with a special emphasis on the burgeoning role of technology.
• 41:00 - Exploring the ethical implications of partnerships between psychiatrists and the expansive tech industry.
• 43:05 - The contemporary framework of ethics training tailored for the next generation of medical practitioners.
• 45:00 - Dr. Brendel's reflective words, drawing from her tenure as the president of the APA.

Links and Resources Mentioned:

• Center for Bioethics at Harvard University
• APA's Official Website

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