For patients who have cycled through therapy and medications without relief, interventional psychiatry has become the next stop, and one of New Hyde Park, N.Y.-based Northwell Health hospitals built its reputation on one of the oldest tools in that kit.
At Phelps Hospital in Sleepy Hollow, N.Y., electroconvulsive therapy has anchored a more than 20-year-old interventional psychiatry program that Craig Rogers, MD, the hospital’s director of interventional psychiatry, leads.
Across the broader system, that arsenal also includes transcranial magnetic stimulation, ketamine infusions and Spravato, the FDA-approved ketamine nasal spray. At Phelps specifically, Dr. Rogers said ECT remains the core offering, at times paired with ketamine as an anesthetic to enhance the treatment’s effect.
“ECT is our most powerful antidepressant by far. It’s been around for decades. It’s safe. It’s effective. It’s got a lot of literature behind it. It’s, in my mind, the gold standard right now for treatment-resistant depression,” Dr. Rogers told Becker’s.
Research shows up to 70% to 80% of patients respond positively to ECT in clinical studies, according to Mayo Clinic’s website. Dr. Rogers, who has administered the treatment for decades, offers a more precise read based on his own experience.
“I would say, having done this for many years… [one] third get a really good response, [one] third a good response, and [one] third wish they had a better response,” he said.
The protocol itself is fairly regimented. Patients are referred for evaluation, medically cleared, and then typically undergo treatment three times a week for a month, as either inpatients or outpatients, he said. The procedure requires brief general anesthesia, but Dr. Rogers said the safety profile has held up over his career, and it’s a track record other hospitals have taken notice of.
“We’ve been doing it here at Phelps for many, many years,” he said. “Over the years, other places are following suit and opening ECT programs in their hospital, and as a freestanding entity.”
Just recently, Sacramento, Calif.-based UC Davis Health expanded interventional psychiatry services, opening an electroconvulsive therapy clinic for patients with serious psychiatric illnesses. The clinic, located on UC Davis Health’s Sacramento campus, provides electroconvulsive therapy for conditions including treatment-resistant depression, bipolar disorder, schizophrenia and catatonia.
That momentum hasn’t translated into uniform insurance coverage across every interventional treatment, though. Coverage varies widely by modality, according to Dr. Rogers. TMS is generally covered by insurers, and Spravato sees close to full coverage as it is FDA-approved, he said.
On the other hand, ketamine infusions are the outlier with patients typically paying out of pocket, at roughly $400 to $800 per session, for a course that usually runs at least six treatments, he said. According to Dr. Rogers, ECT, by contrast, rarely runs into resistance from payers.
Dr. Rogers said these treatments do not work best as standalone interventions. Most patients continue on medication even after starting ECT, though the number of prescriptions often shrinks, and he said psychotherapy paired with interventional treatment tends to outperform either approach used alone. He said the education piece is key to engaging patients.
That same patience-and-buy-in dynamic, Dr. Rogers said, will likely define the next wave of interventional psychiatry: psychedelics. As the federal government continues momentum behind psychedelic-assisted therapy, he pointed to psilocybin as the next major addition to the field. Research from Baltimore-based Johns Hopkins found that the “substantial antidepressant effects of psilocybin-assisted therapy, given with supportive psychotherapy, may last at least a year for some patients.”
Although psychedelics may face early skepticism, he sees this being followed by broader acceptance as evidence and experience accumulate.
“Ketamine might have gone through that kind of phase early on, but then people saw it was effective and safe, so it grew,” he said. “I kind of see psilocybin following the same path, but I think it’s a mindset that’s going to be the biggest obstacle there, from people accepting the treatment and embracing it.”
He added that the shift in mindset applies to providers and health systems as much as patients.
As for what’s next at Phelps, Dr. Rogers said ketamine infusions are the next logical expansion, particularly for the most severe, treatment-resistant cases where he sees TMS as better suited to milder depression. He’s hopeful ketamine infusions will eventually gain FDA approval and insurance reimbursement, broadening access.
For leadership considering establishing and investing in interventional psychiatry, he had a word of advice.
“It’s worth putting the effort into having these programs at your facilities because they are so safe and effective,” Dr. Rogers said. “Logistically it takes a little time to start a program, and it’s very important to have the support of the facility behind you, but it can be done.”
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