When pills and talk therapy aren’t enough, these options may help

From tried-and-true ECT to newcomers like ketamine, TMS and tDCS, treatments offer hope for depression, bipolar disorder, dementia-related behaviors and more

10:22 AM

Author | Kara Gavin

This recording of a livestream from the Department of Psychiatry covers the four approaches to interventional psychiatry described below. Credit: Michigan Medicine

If you or someone you know is experiencing a mental health crisis, or at risk of self-harm or suicide, call or text the number 988 from any cell phone, or visit 988lifeline.org and use the chat function on the web. This is a national, free, 24/7 service that can help with an immediate crisis, and connect you to resources near you.

With Americans paying more attention to their mental health than ever before, more people are getting treatment through talk therapy and medication for issues such as depression, anxiety and bipolar disorder.

Meanwhile, new drugs for people who have started to lose memory or behave differently due to the early stages of dementia have gotten a lot of attention.

But some people find that their mental health symptoms don’t ease even after trying several medications – and dementia-related drugs have not helped as much as hoped, while costing a lot.

That’s why Michigan Medicine Department of Psychiatry teams are working to develop and deliver options that could help those who need advanced care. Called interventional psychiatry, these approaches involve electrical or magnetic impulses delivered from outside the brain, or drugs that are delivered by intravenous infusion or nasal spray.

One of the options is available only through clinical trials at U-M, but the other three are available at Michigan Medicine and at other locations including major teaching hospitals and freestanding clinics.

In the video above, the four experts also include information about insurance coverage, how to choose a treatment location and information on the current state of evidence for use of these options in people with other mental health and behavioral health conditions.

4 types of interventional psychiatry approaches

Transcranial direct current stimulation

As neuropsychologist Benjamin Hampstead, Ph.D., explains, tDCS is a form of low-energy electrical impulse that’s delivered to the brain through dime-sized transmitters and receivers that are temporarily attached to the head at carefully chosen sites.

He and his team at the Research Program on Cognition- and Neuromodulation Based Interventions have clinical trials under way now to test this option. Early results are encouraging, but they’re seeking even more people to take part in their studies, especially people in the early stages of memory loss but also those without.

SEE ALSO: A prescription to ward off cognitive decline – without medication

Transcranial Magnetic Stimulation

Stimulating key regions of the brain to try to address depression is the goal of TMS, which is a non-invasive option and has been cleared by the United States Food and Drug Administration.

Stephan Taylor, M.D., a psychiatrist who has studied the use of TMS through clinical trials, and helps run the clinical TMS program at Michigan Medicine, says the evidence behind TMS makes it a good option for patients who have not responded to several different depression medications.

He notes that TMS providers can be found across the country, but that insurance coverage can vary. Learn more about the TMS program at Michigan Medicine here.


This medication-based treatment for depression actually has its roots in Michigan Sagar Parikh, M.D., points out. Developed decades ago by a Detroit-based drug company as an anesthetic, it was tested and characterized by legendary U-M pharmacologist Edward Domino, Ph.D.

Still used as an anesthetic, and subject to careful controls to avoid illicit use, ketamine’s off-label use in treatment-resistant major depression and bipolar disorder began to grow in the mid-2000s. It is now offered by clinics across the country that have the capacity to provide it as an intravenous infusion delivered in several multi-hour sessions.

A nasal spray form of one subtype of ketamine, called esketamine, received FDA approval recently and is growing more widely available but has barriers to its use, Parikh says.

The Michigan Medicine ketamine clinic, and the VA Ann Arbor Healthcare System ketamine clinic, are both run by expert teams led by U-M psychiatrists. Parikh advises anyone seeking either form of ketamine treatment to make sure the clinic is experienced and well-run.

Electroconvulsive therapy

While ECT has been around for decades, the refinement of its use and the evidence for its effect on people with a range of severe mental health conditions has grown tremendously in recent years, says Shami Entenman, M.D., a psychiatrist who cares for adult and pediatric patients at the Michigan Medicine ECT Program.

ECT involves electrical pulses that are delivered from outside the head to targeted areas of the brains of people while they are under general anesthesia. It causes a short seizure which can be seen on an EEG monitor, but due to the anesthesia, there is no pain and very little movement, shaking, or “convulsing”. It has helped a high percentage of individuals with different conditions achieve short-term relief and long-term remission.

One of those patients is Heather Stein, an Ann Arbor-area mom and former teacher who describes her own experience with severe depression and the help she has gotten from ECT. She now volunteers with the Patient Family Advisory Council at Michigan Medicine, speaking to patients and their loved ones about ECT.

In addition to the information shared in the video above, the Department of Psychiatry has created a video giving an in-depth look at the ECT experience.

SEE ALSO: Electroconvulsive therapy: Peeling back the mystery

For more on this topic, watch the full livestream event featured in the video above.

More Articles About: Mental Health Mental Health Assessment Community Health Hospitals & Centers Depression Alzheimer's Disease bipolar disorder Adult Psychiatric Treatment
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