interventional psychiatry

Robert Ostroff, MD, (left) and Gerard Sanacora, MD PhD, of Yale New Haven Psychiatric Hospital's Interventional Psychiatry Services, which specializes in treating patients with serious mental illness that doesn't respond well to traditional treatments.

According to the National Alliance on Mental Illness, 16 million American adults – 6.9 percent – live with major depression. It is a leading cause of disability and one of the top 10 causes of death.

"People use the word 'depression' a lot," said Gerard Sanacora, MD, PhD, director, Yale Depression Research Program. "But clinical depression involves much more than feeling down on occasion. It is a very serious illness." Clinical depression, also called major depressive disorder, causes severe symptoms that can derail a person's daily life. While medication and psychotherapy can help, about one-third of sufferers don't respond well to these treatments.

Yale New Haven Psychiatric Hospital's Interventional Psychiatry Services (IPS) specializes in treating these types of patients, as well as those with schizophrenia, bipolar disorder and other complex psychiatric illnesses that don't respond to traditional treatments.

Interventional psychiatry uses advanced methods and technologies, including electroconvulsive therapy (ECT). Developed in the late 1930s, ECT has significantly evolved over the years to become the "gold standard" for patients for whom traditional treatments don't work, said Robert Ostroff, MD, medical director of the YNHPH Adult Inpatient Service and ECT Service. Patients are placed under general anesthesia and receive, via electrodes, carefully calculated doses of electrical current. The current triggers a brief seizure that causes changes in brain function.

As part of the IPS' emphasis on research, clinicians are evaluating the effectiveness of combining ECT with other therapies, including novel psychosocial interventions, to improve outcomes.

The IPS is also developing innovative treatment strategies using medications that have been reported to produce rapid antidepressant effects in patients that had not previously responded to standard antidepressants. The service is continuing longstanding work by Yale physicians and scientists on the use of ketamine to treat severe, treatment-resistant depression. Ketamine's antidepressant properties were discovered at Yale nearly two decades ago, but the medication is only now being used in clinical practice. The IPS offers the treatment to appropriate patients and is a major participant in several large, multi-facility clinical trials.

The IPS is also introducing transcranial magnetic stimulation, a relatively new, non-invasive technique that can stimulate neurons in regions deep in the brain that are responsible for depression.

"Our department is at the forefront of developing novel treatments," Dr. Ostroff said. "We have a unique partnership between researchers and clinicians that allows us to provide outstanding care and advance knowledge in the field, all in the same setting."