Dr. Husseini K. Manji, a visionary scientist behind esketamine, discusses its groundbreaking development as a treatment for depression. He shares insights into targeting NMDA receptors and the rigorous clinical trials leading to FDA approval. The conversation highlights the challenges of introducing novel psychiatric drugs, including regulatory hurdles and insurance issues. Dr. Manji also addresses the broader implications for mental health treatment and the promising future of psychedelic medicine, emphasizing the need for equality in mental health care.

Charles Miller, a CRNA and founder of Scenic City Neurotherapy, shares insights from his journey in establishing a ketamine infusion therapy clinic. He dives into the challenges of financing, navigating licensing, and the importance of patient education. Charles discusses expanding services and partnerships, particularly with the VA, to improve access for veterans. He emphasizes using technology for practice management and building a compassionate team to enhance patient care. This conversation is a treasure trove of practical advice for aspiring clinic founders.

In this episode of Psychiatry Tomorrow, Dr. Carlene MacMillan hosts a panel of experts to discuss the FDA's pending decision on MDMA-assisted therapy for PTSD. The conversation explores the current landscape of clinical enthusiasm and regulatory caution, key challenges facing approval, and potential regulatory requirements. Panelists Dr. Owen Muir, Dr. Boris Heifets, and Andrew Penn share their insights on functional unblinding in clinical trials, safety monitoring, and provider qualifications. The episode concludes with a look at the future of psychedelic medicine and the potential impact of the FDA's decision on mental health treatment. Brought to you by: Osmind.org, the #1 EHR for the modern private psychiatry practice

In this captivating episode, we explore Dr. David Feifel's unconventional journey from quantum physics to pioneering psychiatrist. Dr. Feifel shares how his fascination with consciousness led him to psychiatry, hoping to witness a "golden era" of breakthrough treatments. However, his early career was marked by disillusionment as the field remained stagnant, prompting him to seek innovative solutions.Dr. Feifel discusses his groundbreaking work with Transcranial Magnetic Stimulation (TMS) and ketamine therapy at UC San Diego. He details the challenges of implementing these treatments in academic settings, including the crucial role of set and setting in ketamine therapy. His persistence led to the creation of the Center for Advanced Treatment of Mood and Anxiety Disorders (CATMAD), where he combined TMS and ketamine treatments with remarkable results.The conversation then turns to Dr. Feifel's decision to leave academia and establish the Kadima Neuropsychiatry Institute, allowing him greater freedom to innovate. He also shares insights on his work expanding ketamine therapy to Rwanda, highlighting the challenges and rewards of adapting treatments to different cultural contexts. The episode concludes with a discussion on the future of psychiatry, including the complex interplay between innovation, regulation, and economics in bringing new treatments to patients.Throughout the episode, Dr. Feifel emphasizes the importance of thinking beyond traditional pharmacological approaches in psychiatry, advocating for a more holistic and innovative approach to mental health treatment. His journey offers valuable lessons for clinicians and researchers looking to push the boundaries of psychiatric care and improve outcomes for patients with treatment-resistant conditions. Brought to you by: Osmind.org, the #1 EHR for the modern private psychiatry practice

Explore the emerging field of metabolic psychiatry and its potential to revolutionize mental health treatment. Discover the inspiring story of the Baszucki family and how a ketogenic diet helped their son overcome severe bipolar disorder. Learn about the science behind the gut-brain connection and the mechanisms by which the ketogenic diet can improve brain health. Gain insights from leading experts Dr. Georgia Ede and Dr. Bret Scher on implementing metabolic psychiatry in clinical practice, including how to assess metabolic health, collaborate with nutrition professionals, and address objections from traditional psychiatry and insurers. Finally, explore practical considerations for patient empowerment and learn how you can get involved in the growing metabolic psychiatry movement to help shape a brighter future for mental health care.Psychiatry Tomorrow Podcast Show Notes00:00:00 - Introduction- Over 50% of U.S. adults have insulin resistance, which affects blood sugar levels and impairs the brain's ability to process glucose- Interview with Dr. Georgia Ede, a psychiatrist specializing in nutritional and metabolic approaches to mental health, and Dr. Bret Scher, a cardiologist and director of Metabolic Mind- Ketogenic diet can fundamentally improve brain health by providing an alternate fuel source 00:02:00 - Introductions and background- Dr. Bret Scher's journey from cardiology to metabolic health and involvement with the Bazouki family and metabolic psychiatry- Dr. Georgia Ede's background and gradual incorporation of nutrition principles into her psychiatric practice 00:05:00 - Defining metabolic psychiatry- Understanding and addressing the metabolic root causes of mental health conditions, often through nutritional strategies 00:06:00 - The Baszucki family story- Matt Bazouki's struggle with bipolar disorder and remarkable improvement on a ketogenic diet under the guidance of Dr. Chris Palmer- The Baszuki family's commitment to advancing metabolic psychiatry research and education 00:10:00 - Research in metabolic psychiatry- Explosion of research in the field across a wide spectrum of psychiatric conditions- Dr. Albert Danan's study on the ketogenic diet in treatment-resistant patients with serious mental illness 00:14:00 - Ongoing and upcoming studies- Completed pilot studies by Dr. Shabani Sethi and Dr. Ian Campbell- New randomized controlled trials at McLean and University of Pittsburgh- Metabolic Mind's role in bringing together the scientific community 00:16:00 - Balancing the need for more research with helping patients today- Relying on clinical experience while working to speed up research and randomized controlled trials 00:17:00 - Metabolic psychiatry in mainstream psychiatric education- Lack of programming in traditional psychiatric training- McLean and Stanford now have formal programs 00:18:00 - Resources for psychiatrists to learn about metabolic psychiatry- Metabolic Mind website, Dr. Ede's book "Change Your Diet, Change Your Mind," clinician training programs, and literature 00:19:00 - Including a simple metabolic evaluation in psychiatric intake- Testing fasting insulin, triglycerides, HDL cholesterol, and waist circumference- Encouraging patients to improve overall metabolic health 00:21:00 - Metabolic assessment details- Problems with relying solely on fasting blood sugar and hemoglobin A1c- Importance of testing fasting insulin levels and other markers of metabolic health 00:24:00 - Scaling the ketogenic diet for the average person- Strategies for making the ketogenic diet affordable and accessible- Adapting the diet to various preferences, including vegetarian and vegan approaches 00:28:00 - GLP-1 agonists and their role in metabolic health- Dr. Ede's preference for food-first, lifestyle approaches- Limitations of medication-based solutions for the metabolic health crisis 00:31:00 - Empowering patients to improve their mental and metabolic health- The role of psychiatrists in supporting and encouraging patients while emphasizing the importance of patient ownership and self-efficacy 00:32:00 - Working with nutritionists and dietitians- Dr. Ede's unique experience incorporating nutrition principles into her practice without a dietitian- The value of collaborating with nutrition professionals for most psychiatrists 00:34:00 - Helping patients get started with metabolic psychiatry- Working with dietitians, therapists, or health coaches when doctors are not available or knowledgeable- Dr. Ede's clinician training course and directory 00:36:00 - Addressing polarization and myths on social media- Countering the perception that metabolic psychiatry is an alternative to conventional care- Emphasizing the importance of combining metabolic interventions with medication, psychotherapy, and other evidence-based treatments 00:38:00 - The role of ketogenic diets in mitigating the adverse effects of psychiatric medications- Metabolic damage caused by antipsychotics and certain anticonvulsants- The ketogenic diet as a powerful add-on treatment to improve metabolic health 00:41:00 - Mechanisms of action: how ketosis helps various psychiatric disorders- Multiple mechanisms, including lowering blood glucose levels, reducing inflammation, oxidative stress, and glutamate excitotoxicity- Providing an alternative fuel source in the form of ketones for those with insulin resistance 00:46:00 - Addressing the drug paradigm and the complexity of metabolic interventions- The ketogenic diet changes whole-body physiology, which may be off-putting to some physicians accustomed to the drug paradigm 00:47:00 - Insurance reimbursement and advocacy- The need for research demonstrating both efficacy and cost savings for insurance coverage- Precedents set by companies like Virta Health for type 2 diabetes treatment- The long-term cost-saving potential of metabolic interventions compared to lifelong medication use 00:50:00 - Getting involved in the metabolic psychiatry movement- Metabolic Mind's advocacy efforts led by Hannah Warren- The growing mainstream media coverage of metabolic psychiatry 00:51:00 - Resources for further learning and support- Metabolic Mind website, podcast, YouTube channel, and social media presence- Dr. Ede's website, DiagnosisDiet.com, offering trainings, a clinician directory, and articles 00:52:00 - Conclusion and final thoughts- The power of dietary interventions for mental health concerns- The potential for metabolic psychiatry to transform clinical practice and improve patient outcomes Brought to you by: Osmind.org, the #1 EHR for the modern private psychiatry practice

In this episode of Psychiatry Tomorrow, Dr. Jake Behrens shares his insights on navigating the complexities of diagnosing and treating adult ADHD. He discusses his comprehensive framework for ADHD assessments, the importance of psychoeducation, and strategies for medication management amidst the stimulant shortage. Dr. Behrens also explores the potential of digital health tools, the power of measurement-based care, and busts common myths about the condition. Throughout the conversation, he emphasizes the underrecognized dangers of ADHD underdiagnosis and undertreatment, and the importance of addressing it as a core issue that can open up profound possibilities for patients' lives.Timestamps and Show Notes:[00:01:00] Introduction: Adult ADHD is the second most prevalent adult psychiatric disorder, yet the U.S. lacks formal diagnostic guidelines, making it challenging for clinicians to properly diagnose and treat.[00:03:00] How Dr. Behrens got into specializing in adult ADHD during his residency working with high-functioning patients who responded robustly to treatment.[00:06:00] Dr. Behrens' framework for thorough ADHD assessments: Gathering detailed patient history, collateral information, using rating scales like the ASRS, and objective measures of executive function.[00:11:00] The importance of devoting significant time in initial evaluations to psychoeducation, explaining ADHD neurobiology and the full range of treatment options.[00:12:00] Navigating stimulant medication options and considering both effectiveness and affordability for patients.[00:18:00] Strategies for dealing with stimulant medication shortages, including working with a virtual assistant to locate medications and establishing relationships with pharmaceutical reps.[00:26:00] The benefits and challenges of working with pharmaceutical reps as a psychiatrist.[00:29:00] The multifaceted reasons behind the current stimulant medication shortage.[00:35:00] The potential impact of the DEA reinstating the Ryan Haight Act's in-person visit requirement for controlled substance prescriptions.[00:36:00] How Dr. Behrens provides patients with blood pressure cuffs for remote monitoring.[00:40:00] The exciting potential of digital health tools and wearables to passively track data that could enhance ADHD assessment and treatment.[00:44:00] The power of measurement-based care and involving patients in tracking their own data.[00:45:00] Busting common myths and misconceptions about adult ADHD, including that it's just about hyperactivity and that stimulant medications work like typical stimulants.[00:47:00] The underrecognized dangers of ADHD underdiagnosis and undertreatment, including increased risk of car accidents, job loss, relationship issues, and other adverse outcomes.[00:50:00] The importance of treating ADHD as a core issue that, when addressed, can remove barriers to other treatments and positive life changes.[00:51:00] Conclusion and sharing of Dr. Behrens' favorite ADHD resources for clinicians and patients. Brought to you by: Osmind.org, the #1 EHR for the modern private psychiatry practice

Dr. Rebecca Allen, a pioneering interventional psychiatrist and president of the Clinical TMS Society, is transforming mental health care delivery through her innovative outpatient clinic in Seattle. By offering a wide range of cutting-edge treatments like ECT, TMS, ketamine, and running COMPASS clinical trials for psilopsybin under one roof, she aims to expand access to life-changing treatments for patients with treatment-resistant conditions. In this interview, Dr. Allen shares her experiences growing a leading interventional psychiatry practice, spearheading groundbreaking research on psychedelic-assisted therapy, and navigating the challenges of insurance reimbursement and unregulated treatment models. She offers candid advice for fellow psychiatrists looking to enhance their practice and make a meaningful impact in the lives of their patients. Through her leadership and unwavering commitment to evidence-based innovation, Dr. Allen is paving the way for a brighter future in mental health care.Timestamps and Shownotes:[00:00:00] Introduction to the Psychiatry Tomorrow podcast and today's guest, Dr. Rebecca Allen[00:01:46] Dr. Allen's background and role as an interventional psychiatrist offering ECT, TMS, VNS, esketamine, IV ketamine, and ketamine-assisted psychotherapy at Seattle NTC[00:03:52] How Dr. Allen got started offering outpatient ECT and the logistics of partnering with Swedish Hospital[00:09:46] Seattle NTC as one of the largest outpatient ECT programs in the U.S., ECT stigma and underutilization[00:13:02] Busting myths about modern ECT and efforts to minimize cognitive side effects[00:16:15] A day in the life at Seattle NTC - ongoing treatments and clinical trials[00:19:45] Seattle NTC's involvement in the COMPASS trial on psilocybin-assisted therapy for treatment-resistant depression[00:20:26] How Dr. Allen's clinic got involved in clinical trials (BEAM study, VNS trial) and became a top enroller for COMPASS[00:27:52] Logistics and challenges of the COMPASS protocol, DEA scrutiny for psychedelic trials[00:29:33] Dr. Allen's concerns about Oregon's unregulated psilocybin program and the importance of robust clinical trials and medical oversight[00:35:17] Psilocybin is powerful but not a panacea - the need for thorough safety monitoring and the dangers of broad unregulated access[00:37:50] The advantages of offering multiple interventional psychiatry modalities to match treatments to patients[00:39:44] Dr. Allen's role as president of the Clinical TMS Society and initiatives to grow the organization[00:45:17] Balancing clinical work, research, and leadership roles[00:47:50] Advice for psychiatrists looking to scale a private practice - seeking expert consultation, reading contracts thoroughly[00:50:47] The importance of negotiating fair insurance reimbursement rates from the start[00:52:12] Conclusion and thanks to Dr. Allen Brought to you by: Osmind.org, the #1 EHR for the modern private psychiatry practice

Legal experts Daniel Sternthal and Ethan Minkin explore the legal intricacies surrounding ketamine therapy for psychiatric conditions. They delve into the importance of interdisciplinary respect, the legal challenges and malpractice risks associated with off-label ketamine use, and the vital role of informed consent. The discussion also highlights trends in the ketamine space, including the impact of COVID, private equity involvement, and the emergence of home ketamine therapy. With a focus on safeguarding practitioners through meticulous documentation and adherence to evolving legal standards, this episode is a must-listen for clinicians and legal professionals in the psychedelic medicine space. It wraps up with actionable advice on advocacy, education, and maintaining ethical practice standards to mainstream ketamine therapy safely. Brought to you by: Osmind.org, the #1 EHR for the modern private psychiatry practice

Dr. Bergina Isbell, CMO at Led Life Psychiatry, Maryland, combines personal experience and professional innovation to enhance mental health care. Specializing in Ketamine-Assisted Psychotherapy, she offers hope to those with depression, anxiety, and on the Autism spectrum. Dr. Bergina champions restorative justice, seeking healing over punishment and emphasizing mutual understanding and forgiveness. Her practice prioritizes individual sensory needs, creating a therapeutic environment tailored to each patient. Beyond the clinic, her advocacy extends to supporting families with special needs, demonstrating the importance of flexibility, empathy, and finding joy in life's challenges. Timestamps/Shownotes:[00:02:00] Multiple Licenses and Autism: Dr. Brigina discusses her motivation for obtaining multiple state licenses, driven by the need to address her children's requirements due to Autism, and emphasizes the concept of turning lemons into lemonade.[00:07:00] SXSW Talk and Dancing in the Rain: Dr. Brigina shares insights from her SXSW talk titled "Ditch Work Life Balance and Learn to Dance," focusing on juggling life's responsibilities and finding joy in challenges, including her personal connection to dancing as a hobby and metaphor for handling life's difficulties.[00:09:00] Specializing in Special Needs: The conversation shifts to Dr. Brigina's practice specializing in children and adults with special needs, evolving from advocacy at IEP meetings to professional referrals, and supporting neurodiversity through her practice and community engagement.[00:11:00] Boundaries and Self-Disclosure: Dr. Brigina discusses navigating boundaries and self-disclosure in her professional and personal life, especially relating to her experiences as a parent of children with Autism, and shares a story about an airport incident highlighting advocacy for those with special needs.[00:15:00] Tips for Handling Stressful Situations: Dr. Brigina offers advice for families and individuals with special needs on preparing for and navigating high-stress environments like airport security, emphasizing preparation and communication with service providers.[00:18:00] Utilizing Telehealth for Autism Spectrum: Insights on effectively using telehealth for individuals on the Autism spectrum, stressing the importance of initial in-person visits when possible and the use of social stories and personal comfort items during sessions.[00:20:00] Ketamine Therapy and Sensory Considerations: Discussion about the introduction of ketamine therapy in her practice, prompted by a patient's experience, and the importance of sensory inventory to accommodate individuals on the Autism spectrum undergoing ketamine treatment.[00:24:00] Ketamine for Mental Illness in Autism Spectrum: Dr. Brigina reflects on the impact of ketamine and SPRAVATO treatments for individuals on the Autism spectrum with concurrent mental health conditions, based on patient stories and the potential for broader application.[00:27:00] Industry Perspectives and Restorative Justice: Towards the end, Dr. Brigina shares her thoughts on the ketamine treatment industry, emphasizing personalized care over a "puppy mill" approach, and introduces the topic of restorative justice, highlighting her involvement in a TEDx talk on the subject.[00:33:00] Seeking Restorative Justice: Strategies for individuals interested in exploring restorative justice, including community research and professional guidance, and considerations for its appropriate application.[00:37:00] Restorative Justice in Psychiatry: Dr. Brigina advocates for a restorative justice approach within psychiatry, reflecting on the historical context of psychiatric care, the challenges of involuntary commitment, and the potential for innovative treatments like ketamine to transform patient care. Brought to you by: Osmind.org, the #1 EHR for the modern private psychiatry practice

Explore the dynamic landscape of psychiatric clinical trials through the expert lens of Dr. Michael Banov, a renowned figure with a wealth of experience in over 150 trials. This in-depth blog post delves into his groundbreaking journey, starting with the revolutionary Clozapine trial for depression and extending to the recent developments in Vagus Nerve Stimulators (VNS). Gain an unparalleled understanding of the challenges and advancements in clinical trials, including the transition from traditional methods to innovative approaches. Dr. Banov shares his valuable insights on patient recruitment complexities, the importance of real-world scenarios in trials, and the critical role of ethical oversight. Discover the impact of technology on patient engagement and the intricacies of conducting trials in a modern, regulated environment. This comprehensive guide is an essential read for clinicians and professionals interested in the evolving world of psychiatric research and its profound implications for the future of mental health care.Timestamps:[00:00:00] Introduction to the podcast and mention of ketamine treatments and vagus nerve stimulators.[00:01:00] Introduction of Dr. Michael Banov and his background in clinical trials.[00:02:00] Discussion on the challenges of recruiting for psychiatric clinical trials.[00:03:00] Insights into the evolution of clinical trial landscapes and the role of social media in recruitment.[00:04:00] Introduction to the trial of vagal nerve stimulation for depression.[00:05:00] Discussion on the potential of vagal nerve stimulator trials for treatment-resistant depression.[00:06:00] Dr. Banov's career highlights and how to get involved in clinical trials.[00:07:00] Dr. Banov's first clinical trial experience and the use of Clozapine.[00:08:00] The transition from academic research to industry and the ethical considerations.[00:09:00] Challenges faced in starting clinical research and the importance of experience.[00:10:00] The shift in psychiatric treatment approaches and the role of industry professionals.[00:11:00] Insights into the pharmaceutical industry and the development of medications.[00:12:00] The process of recruiting for a Clozapine trial and the challenges involved.[00:13:00] The key role of recruitment in clinical research and the evolution of patient protection.[00:14:00] The increasing challenges in recruiting for clinical trials.[00:15:00] The impact of clinical trials on real-world treatment scenarios.[00:16:00] The unique aspects of running psilocybin clinical trials.[00:17:00] Challenges in placebo control and patient interaction in psilocybin trials.[00:18:00] The necessity of a placebo script in clinical trials.[00:19:00] The regulatory aspects of clinical trials and the importance of consent forms.[00:20:00] Reflections on the changing landscape of psychiatric clinical trials.[00:21:00] The shift towards more regulated clinical trials and the loss of nuanced patient interaction.[00:22:00] The impact of private equity on research organizations and clinical trials.[00:23:00] The role of technology in modern clinical trials.[00:24:00] The challenges introduced by technology in clinical trials.[00:25:00] The use of technology for monitoring patient compliance in trials.[00:26:00] The importance of oversight in clinical trials.[00:27:00] The process of being monitored and audited in clinical trials.[00:28:00] The role of Contract Research Organizations (CROs) in clinical trials.[00:29:00] The process of site initiation and monitoring in clinical trials.[00:30:00] The reasons for FDA audits in clinical trials.[00:31:00] The consequences of FDA audits and the importance of ethical conduct.[00:32:00] The challenges of being a high enroller in clinical trials.[00:33:00] The role of technology in patient recruitment and enrollment.[00:34:00] The challenges of recruiting patients in active clinical practice.[00:35:00] The implementation and mechanism of vagal nerve stimulators.[00:36:00] The contrast between VNS and other treatments like ketamine.[00:37:00] The design of the VNS trial and its benefits.[00:38:00] The steps to become a site researcher in clinical trials.[00:39:00] The importance of experience and connections in starting clinical research.[00:40:00] The necessity of oversight in clinical trials for patient safety.[00:41:00] The role of technology in facilitating patient identification and enrollment.[00:42:00] The challenges of using social media for recruitment in clinical trials.[00:43:00] The practical aspects of running a VNS study in a clinical practice.[00:44:00] The process and placement of the VNS unit.[00:45:00] The sustained response of VNS compared to other treatments.[00:46:00] The sponsor of the VNS study and the cost considerations.[00:47:00] The trial design of VNS and its real-world applicability.[00:48:00] Advice for clinicians interested in becoming involved in clinical trials.[00:49:00] The importance of gaining experience and certifications in clinical research. Brought to you by: Osmind.org, the #1 EHR for the modern private psychiatry practice