Mental health conditions can affect every part of your daily life. While medication and psychotherapy help many people, they don't work well enough for everyone. Interventional psychiatry offers additional treatment options that use specialized medications, medical procedures, or technology to change brain activity and help relieve symptoms.
What Is Interventional Psychiatry?
Interventional psychiatry focuses on people whose symptoms have not improved enough with standard treatments or who cannot safely take certain medications. The right treatment depends on your diagnosis, medical history, previous treatments, personal preferences, and insurance coverage.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression. It may also be used for bipolar disorder, catatonia, and certain other serious conditions.
During treatment, you'll receive anesthesia, so you remain asleep while a controlled electrical stimulus produces a brief therapeutic seizure. ECT is typically given two or three times a week for several weeks. Some people experience temporary confusion or memory problems, but your care team will monitor you closely throughout treatment.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) is a noninvasive outpatient treatment. A magnetic coil placed against the scalp delivers targeted magnetic pulses to areas of the brain involved in mood and behavior.
You'll remain awake during treatment, won't need anesthesia, and can usually return to your normal activities right afterward. Sessions typically last several minutes to about 30 minutes. TMS is FDA cleared for several conditions, including depression and obsessive-compulsive disorder (OCD). Common side effects include temporary headache or scalp discomfort.
Ketamine and Esketamine
Ketamine may be given through an intravenous (IV) infusion or an intramuscular injection to treat depression, although these uses are generally considered off-label. Esketamine (Spravato®) is an FDA-approved nasal spray for adults with treatment-resistant depression.
Spravato is administered in a certified healthcare setting, where you'll be monitored for at least two hours after treatment. Temporary side effects can include sleepiness, dizziness, nausea, increased blood pressure, or feeling disconnected from your surroundings.
Implanted Stimulation Therapies
Vagus nerve stimulation (VNS) uses a small device implanted in the chest to send signals through the vagus nerve. It may be considered for some adults with long-lasting, treatment-resistant depression.
Deep Brain Stimulation (DBS) uses surgically implanted electrodes to stimulate specific brain circuits. It may be considered through a special FDA pathway for carefully selected people with severe obsessive-compulsive disorder.
Because both VNS and DBS involve surgery, your care team will carefully review the potential benefits and risks with you before treatment.
Take-Home Devices and Neurofeedback
ProlivRx is an FDA-approved, prescription-only neuromodulation device for adults with Major Depressive Disorder who have not improved enough after trying at least one antidepressant medication. It provides targeted stimulation to the occipital and trigeminal nerves and can be used at home or in the clinic as an add-on to other treatments. A clinical team prescribes the device, teaches you how to use it, and monitors your progress throughout treatment.
EEG-guided neurofeedback, including PRISM for post-traumatic stress disorder (PTSD), helps people learn to change patterns of brain activity associated with stress responses. Availability and insurance coverage for these treatments vary.
Looking Ahead
Researchers continue to study psychedelic-assisted therapies, focused ultrasound, magnetic seizure therapy, and other forms of noninvasive electrical stimulation. Many of these treatments are still considered investigational and are only available through approved clinical or research programs.
As this field continues to grow, the goal is to offer safer, more precise, and more personalized treatment options for people who need more than medication or psychotherapy alone.
About Butler Hospital
Founded in 1844, Butler Hospital is a nationally recognized leader in psychiatric care and Rhode Island’s only nonprofit, freestanding psychiatric hospital. Butler provides specialized assessment and treatment services for adults, adolescents, and older adults while supporting psychiatric research and education.
About the Authors
Eric Tirrell and Linda Carpenter, MD, lead Butler Hospital’s Brain Research and Interventional Neurotherapeutics (BRaIN) Program. The program brings innovative clinical services and research opportunities together to advance more personalized, brain-based approaches to mental healthcare.
For more information about the BRaIN Program, email BRAIN@CareNE.org or call (401) 455-6632.