Interventional Psychiatry - Breakthrough Treatments for Depression and More
Interventional psychiatry is a branch of psychiatry that focuses on using procedures and technologies, in addition to traditional therapy and medications, to treat mental health conditions. It sits at the intersection of psychiatry, neurology, and, at times, anesthesiology.
Interventional psychiatry offers advanced treatment options for people with mental health conditions that haven’t improved with traditional therapy or medications, including treatment-resistant depression, obsessive-compulsive disorder, PTSD, or other severe psychiatric conditions. Using safe, evidence-based procedures like brain stimulation (TMS or ECT) or fast-acting medications such as ketamine, interventional psychiatry works directly with the brain to help relieve symptoms of depression, anxiety, PTSD, and other challenging conditions. These treatments are carefully monitored by specialists and can provide faster, targeted relief when standard approaches haven’t been enough.
In short, interventional psychiatry is like psychiatry that uses specialized “procedure-based” tools to intervene directly in the brain’s functioning, rather than relying solely on talk therapy or medications.
What Types of Interventional Psychiatry are used at RCBM?
At RCBM, we offer SPRAVATO® (esketamine nasal spray), a new depression medication and an innovative nasal spray treatment for depression that hasn’t improved with other medications. We also offer Transcranial Magnetic Stimulation (rTMS), a non-invasive treatment that uses magnetic pulses to stimulate brain regions.
What They Are
SPRAVATO®
- A prescription medication containing esketamine, a derivative of ketamine.
- Delivered as a nasal spray in a certified medical setting.
- FDA-approved for adults with treatment-resistant depression and, in certain cases, major depressive disorder with suicidal ideation.
rTMS (Repetitive Transcranial Magnetic Stimulation)
- A non-medication procedure that uses magnetic pulses to stimulate specific parts of the brain involved in mood regulation.
- Done in an outpatient clinic; no drugs or sedation required.
How They Work
SPRAVATO®
- Works chemically by affecting glutamate neurotransmission via NMDA receptor modulation.
- Can promote rapid changes in brain chemistry and neuroplasticity.
- Often has a rapid effect—many people notice improvements within hours or a few days after dosing.
rTMS
- Uses magnetic fields to induce electrical activity in brain regions (often the prefrontal cortex) tied to mood regulation.
- Aims to “retrain” brain circuits over time.
- Effects develop gradually over the course of treatment—typically 6 weeks of 5-day-per-week sessions.
Treatment Schedule
SPRAVATO®
- Administered under medical supervision (usually in a clinic).
- Typical protocols start with twice-weekly dosing, followed by maintenance over several weeks based on the individual treatment plan.
- Each session lasts about 2 hours, including post-dose monitoring.
rTMS
- The standard course consists of daily sessions (often 5 times/week) for 6 weeks.
- Each session lasts ~20–30 minutes.
- No sedation or recovery period needed.
Mechanism Differences Summary
| Feature | SPRAVATO® | rTMS |
|---|---|---|
| Type | Medication (nasal esketamine) | Device-based brain stimulation |
| Mechanism | Chemical modulation of neurotransmitters | Magnetic stimulation to influence brain circuits |
| Onset | Rapid (hours to days) | Slower (weeks) |
| Consciousness Altered? | Yes (dissociation possible) | No |
| Monitoring Required | Yes, due to side effects | Only during the session |
| Sedation | Possible | Not required |
Side Effects of SPRAVATO® Compared with rTMS
SPRAVATO®
- Common side effects: dissociation (psychedelic-like sensations), dizziness, nausea, sedation, and increased blood pressure.
- Patients are monitored for side effects during and after treatment.
TMS
- Generally well-tolerated.
- Most common: mild headache, scalp discomfort, or tingling during stimulation.
- No systemic drug effects, sedation, or altered consciousness.
Should You Have Treatment with SPRAVATO® or rTMS?
SPRAVATO® might be preferred if:
- Faster relief of depressive symptoms is desired.
- Conventional antidepressants have not worked, and you qualify under approved indications.
- You and your provider are comfortable with monitoring and possible dissociative effects.
rTMS might be preferred if:
- A non-drug option is preferred.
- You prefer to avoid altered states of consciousness.
- You’re okay with a longer treatment course to see gradual improvement.
Are Both SPRAVATO® and rTMS Covered by Insurance?
Both treatments are typically covered for major depressive disorder when medical criteria are met, but specific coverage, eligibility, and out-of-pocket costs can vary by plan.
In summary, SPRAVATO® is a rapid-acting, medication-based therapy with potential psychoactive effects that require monitoring, while rTMS is a non-invasive, device-based treatment that works gradually by stimulating brain regions without drugs. Discussing both options with your psychiatrist or mental health provider is essential to determine the best fit based on your symptoms, treatment history, health profile, and preference
