I have some big changes to share!

I have some big changes to share!?After 10 years of psychiatric training and practice, putting my full effort into bringing current neuroscience research to practice, and after 20 years of bringing clinical questions to research because we desperately need new treatments, I have concluded that our current system is broken.?In other words, there is no time to wait for the clinicians to get over their fears of new treatments nor is there time for scientists to stop worrying about sure-bet publications that in no way advance our treatments. Every professional is so overworked that they do not have the bandwidth for an overhaul of the system to meet patient needs.

Let me explain: I am SO excited about the breakthroughs in medication-assisted treatments, direct brain stimulation (TMS, TBS, TDCS) and rapid-acting antidepressants. I thought, particularly with the advent of the pandemic, that the clinicians would welcome these amazing techniques but all I see is desperate clinging our current failed system. I did my PhD while scientists were learning to use medications to disrupt fear storage (literally erasing fear conditioning) and I am thrilled to continue working with Josh Cisler using L-DOPA to enhance safety learning and speed up treatment of PTSD. But the dearth of clinicians who know the science, the culture of medicine treating psychologists as technicians rather than specialists who provide more definitive treatments than our meds, and a research system designed to support only the least clinically-relevant human studies (shout out to BBRF and other foundations that have filled some of this gap), leads me to conclude that this system will not pivot in time to address the incredible emergency of widespread trauma and depression occurring right now.

To expand on that, we have 20-year-old technology that is far more effective than traditional medications but they require a totally different mindset: psychiatrists as acute interventionists.?Right now, we expect psychiatric care to be an indefinite, primary care-like treatment course that starts with SSRIs that have a 1/3 chance of working at all and require 4-6 weeks to even work, while they ruin the sex lives of at least 1/3 of patients.?Then maybe another 4-6 weeks of trying a higher dose or changing to another SSRI (despite evidence that adding an SNRI or bupropion would be far more effective), then try combinations of things, etc until 2-3 years of our very short lives have been lost while patients are left with copays and side effects.?TMS can be administered over a course of a few weeks and provide better antidepressant activity that lasts over a year without any ongoing medications or lasting side effects.?Ketamine can produce antidepressant effects often after the first dose, even in those whose depression resists all other treatments, getting people back on their feet within a month.

I love the personal relationships I have had with patients, and some disorders will always require this (bipolar illness, ADHD, etc) but to handle the immense trauma affecting the world and causing our medical system to crumble, I am determined to help as many people as I can. By chance, I connected with Erick Sheftic, an experienced TMS treater who trained with one of the world experts on rapid acting antidepressant treatments (Steve Garlow).?He was ready to practice 21st century medicine by starting an acute treatment center.?I had been dying to get on the clinical side of TMS after seeing patients have stunning benefits and after doing neurochemical studies in collaboration with Amit Etkin at Stanford.?When Erick asked if I was interested in opening a ketamine treatment center and he agreed we could get a TMS/TBS machine, Accelerated Psychiatry SC was born.

In early 2022, Accelerated Psychiatry will offer IV ketamine infusions (most effective), nasal ketamine (we are an approved Spravato center and will take most insurance including Medicaid) and providing theta-burst (3-minute stimulation) for depression and a dedicated stimulation coil to treat OCD.?As a researcher, I am proud we will use research grade techniques (EMG-based motor threshold determination for brain stimulation) and state-of-the-art continuous vital sign monitoring (https://caretakermedical.net/).?We are thrilled to integrate with Osmind, a Public Benefit Corporation dedicated to advancing ketamine and psychedelic treatments, to provide graphical representation of clinical improvement for patients and providers.?After years of outpatient care, we know what a pain in the ass prior authorizations and referrals can be, and we are leveraging ReferralMD to ease referrals and our experts at Practolytics take the stress out of prior authorizations.

We are so lucky to have Rena Doyle bring her inpatient, outpatient and research nursing experience and Melissa Esperon bring her expertise in TMS and clinical management. With our 38 years+ of experience in psychiatric research and practice, we will be able to adapt emerging, evidence-based techniques safely and effectively.?Our aim is to do 2 things very well: brain stimulation and ketamine treatments.?

But we also hope to partner with trauma-specialists in the community to coordinate ketamine treatments after exposure therapy sessions to accelerate care throughout our mental health system.?While we all have extensive experience with trauma-focused care, we also know that the trust that exists with a current psychologist or psychiatrist is hard to earn, so we want to work with outpatient teams to get people back on their feet now! We are finalizing details of a new location (our original location at 131 W Wilson St was closed by the city engineer for structural reasons), and we will have information for psychologists and psychiatrists and a robust, paperless communication system to coordinate treatments and keep you in the loop on their progress.

I am by no means cutting ties with research.?I am honored to continue working with Vivek Prabhakaran and Nagesh Adluru in the department of Radiology, using high-temporal resolution functional spectroscopy of the medial temporal lobe to understand the emotional impacts of excitatory overload in the human amygdala.?We are about to submit a behavioral paper on the social cognitive impact of COVID, and I think it is going to be a real game-changer with broad implications for emotional flooding and acute fear.?We're also working on our first manuscript using the high temporal resolution fMRS, and keep an eye out for the work of Ted Imhoff-Smith over the coming years. I am truly excited to be reconnected with the neuroimaging community on the main hospital campus!

To all those who are ready to move psychiatry and clinical neuroscience into the 21st century, LFG!!!