A Quick Mental Health Treatment Guide for Clinicians: Interventional or Procedural Therapies

The brain is an incredibly complex organ, and even after thousands of years of study, there’s still so much to learn! Clinicians who take the time to understand mental health conditions, evidence-based therapies, and treatment options can play a crucial role in helping their patients heal and improve outcomes by empowering them to make informed decisions about their care.

When traditional psychotherapy or medications are ineffective, interventional or procedural therapies can give patients some alternative treatment options. Interventional psychiatry is an emerging psychiatric subspecialty that targets nerve cells and how they carry information through the brain while incorporating procedural therapies that stimulate the brain to alleviate symptoms.

To better understand these rapidly developing treatment tools, keep reading!

Understanding Mental Health Treatments

A variety of therapeutic tools fall under the expansive umbrella of mental health treatment, including psychotherapies, medications, interventional therapies, and alternative therapies. Interventional therapies, such as psychotherapy and medication, address the needs of patients with treatment-resistant conditions by creating an individualized treatment plan in collaboration with patients to reduce symptoms, improve coping skills, and increase the patient’s overall satisfaction and sense of well-being. Procedural therapies, such as Transcranial Magnetic Stimulation (TMS) or Electroconvulsive Therapy (ECT), are used to manage psychosis, schizophrenia, schizophreniform disorder, brief psychotic disorder, treatment-resistant depression, bipolar disorder, catatonia, PTSD, and obsessive-compulsive disorder. It’s also important to note, in case it seems confusing, that the terms interventional therapy and procedural therapy are often used interchangeably.

Additional alternative techniques recommended for mental health treatment include yoga, animal-assisted therapy, acupuncture, mindfulness, and meditation. Alternative therapies are especially beneficial for patients with anxiety disorders, major depressive disorder, and those dealing with trauma.

More about > Complementary, integrative, and alternative therapies

Understanding Interventional or Procedural Therapies

Interventional mental health therapies offer a multidisciplinary approach, combining neurophysiology, brain stimulation, and neuroimaging to address various mental health conditions using procedural therapies. Which means clinicians need to understand the neural circuits associated with different mental health disorders and the behavioral responses from patients once these circuits are stimulated.

Interventional therapies include Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS), and Ketamine infusions. Not intended as a first-line treatment for mental health disorders, interventional therapies are offered to patients whose conditions are resistant to standard therapies, who’ve experienced side effects from their medication, or who are pregnant, as certain medications can be harmful to a developing fetus. The benefits of procedural therapies are that they’re rapid-acting, long-lasting, and provide symptom relief for patients with challenges in finding effective treatments while also creating the opportunity for personalized mental health treatment.

Electroconvulsive Therapy (ECT)

Despite its overwhelmingly negative portrayal in pop culture, electroconvulsive therapy (ECT) is a humane and effective mental health treatment. It’s performed under anesthesia along with a muscle relaxant, with electrodes carefully placed on the scalp to target specific areas of the brain. A brief electric current is sent through the electrodes, inducing seizure activity for less than ninety seconds, and it’s typically administered for six to twelve treatments until a patient’s symptoms improve.

ECT therapy is beneficial for patients with severe or treatment-resistant depression, catatonia, schizophrenia, schizoaffective disorder, severe suicidality, and bipolar disorder. While it provides relief for patients, it also has side effects to consider (memory loss, confusion, muscle soreness, nausea), and many patients need maintenance therapy (ongoing ECT treatments) or additional psychotherapy with or without the addition of medication to address their symptoms.

Transcranial Magnetic Stimulation (TMS)

Another effective therapeutic procedure is Transcranial Magnetic Stimulation (TMS), a type of noninvasive therapy that stimulates the brain by placing an electromagnetic coil on a patient’s scalp that sends magnetic pulses to the mood-controlling areas of the brain to increase the release of neurotransmitters and activate regions of the brain that have decreased activity due to depression.

TMS treats major depressive disorder and OCD with promising results. About 83% of patients had a significant reduction in their depressive symptoms, while 62% of patients reported symptom relief after twelve months. The side effects of TMS are generally mild and include scalp pain or discomfort, headache, twitching of the facial muscles, and lightheadedness.

Ketamine Infusions

Ketamine is a dissociative anesthetic drug with hallucinogenic properties that block the NDMA receptors in the brain and increase the amount of glutamate. Increasing glutamate activates AMPA receptors, allowing neurons to communicate along different pathways while reducing glutamate at other synapses. While researchers are still figuring out how Ketamine infusions produce antidepressant effects and reduce suicidal thoughts so quickly, they show great promise in treating patients with treatment-resistant major depressive disorder.

Ketamine infusions also affect mood and cognition by improving processing speed and memory. Treatment is administered intravenously (IV), and most patients start with one to three infusions. If they see an improvement in symptoms, more infusions are an option. The potential side effects include:

Nausea and vomiting
High blood pressure
Blurry vision
Changes in the perception of colors, noises, time, and textures
Out-of-body experiences (dissociation)

In addition to potential side effects, it’s important to note that ketamine has addictive properties. Patients with a history of substance use disorder should discuss possible complications with their provider.

Comparing First-line Therapies and Procedural Therapies

A wide range of first-line therapies, including cognitive behavioral therapy combined with medication, are commonly employed before considering second-line approaches like procedural therapies. The key differences are that first-line therapies are often administered together for better results and offered to patients when they initiate their treatment journeys.

In contrast, procedural therapies are a complex blend of neuroscience, neurophysiology, and neuroimaging used as interventions for treatment-resistant conditions. So, while clinicians can tailor treatment to a patient’s needs, procedural therapies allow them to see how the therapy affects the brain. A patient’s behavioral responses also enable clinicians to personalize treatment to a greater extent because they’re rapid-acting. In contrast, psychotherapy can take multiple sessions, and certain medications like antidepressants, for example, can take four to eight weeks to reach their full therapeutic effect.

Although each of these interventions has different strengths, it’s important to remember that combining treatments can effectively maintain symptom relief and offer patients additional medical, neurological, or psychiatric conditions additional options for comprehensive care.

Evidence-Based Practices

Evidence-based practices allow clinicians to combine research with clinical knowledge to curate a treatment plan for each patient. It also helps providers avoid ineffective treatments and maximize their time to provide effective treatment options to their patients.

Recent research in interventional mental health shows that procedural therapies can be helpful alternatives for those who’ve struggled with traditional therapies, and because these therapies are more rapid-acting, using them may potentially reduce the overall duration of treatment and decrease the burden on patients and resources.

However, please note that if you’re interested in providing your patient with procedural or interventional therapy, they should:

Have a history of treatment resistance to first-line therapies.
Show severe symptoms of suicidal thinking or behaviors.
Be unable to tolerate medications due to side effects or be unable to take them due to pregnancy.

Practical Considerations for Clinicians

Caring for patients living with mental health conditions requires a collaborative approach between not only clinician and patient but also between multidisciplinary teams because the goal is to provide well-rounded, empathetic, personalized, and effective care. Make sure to discuss your patient’s needs and preferences while working on a treatment plan to ensure they feel heard and respected. Likewise, staying updated on mental health treatment advancements allows you to provide the latest information so you can discuss the most effective treatments with your patients.

On Exploring Evolving Mental Health Treatments

As mental health awareness grows, it’s encouraging to see treatments evolve. There’s a push to make interventional psychiatry an official subspecialty in psychiatry, making it a great time to learn more about how Ketamine Infusions, TMS, and ECT work and how they can be effective treatments. Combining neurophysiology, neuroimaging, and brain stimulation can significantly benefit patients with mental health conditions, particularly those who are treatment-resistant. However, understanding and discussing the potential side effects with your patients is imperative.

Additional Resources

Want to learn more? Feel free to check out these additional resources:

References

Try Osmosis today! Access your free trial and find out why millions of current and future clinicians and caregivers love learning with us.