UT Southwestern Medical Center specializes in interventional psychiatry, an advanced approach for people with treatment-resistant mental health disorders. Our psychiatrists combine expertise, research, and compassionate care to help restore stability and improve quality of life.

What Is Interventional Psychiatry?

Interventional psychiatry is a group of noninvasive treatments that include transcranial magnetic stimulation (TMS), ketamine, esketamine (Spravato®), and electroconvulsive therapy (ECT). These treatments can help patients with severe depression, obsessive-compulsive disorder (OCD), and other serious mental health conditions that haven’t improved with medication or talk therapy.

How Does Interventional Psychiatry Differ from Traditional Psychiatric Treatments?

Traditional psychiatry relies primarily on medication and psychotherapy to relieve symptoms. Interventional psychiatry expands this approach with neuromodulation and fast-acting medications that target brain activity directly.

Key differences include:

• Mechanism of action: Conventional antidepressants adjust neurotransmitters such as serotonin or norepinephrine, while interventional treatments influence broader brain pathways.
• Speed of response: Techniques such as ECT and ketamine often act within days rather than weeks.
• Method of delivery: Interventional treatments use device-based procedures or fast-acting medications rather than pills or talk therapy.

How Does Interventional Psychiatry Work?

Noninvasive neuromodulation therapies, such as TMS, accelerated TMS, and TBS, deliver electromagnetic pulses to stimulate nerve cells in areas of the brain involved in depression, OCD, and other treatment-resistant mental health disorders.

Traditional treatment for mental health disorders usually begins with psychotherapy (counseling) and medications. In most cases, these therapies provide relief, but up to 50% of people still experience severe symptoms. These people might not be able to take certain medications due to intolerance or severe side effects, or they might not be able to take certain medications safely.

Our interventional psychiatry therapies provide safe, effective options for them through noninvasive brain stimulation and advanced medications, such as esketamine, to address hard-to-treat symptoms. We work closely with each patient to create a personalized treatment plan.

What Conditions Does Interventional Psychiatry Treat?

Interventional psychiatry offers safe, noninvasive, effective brain stimulation therapies and advanced medications that can help people who haven’t found relief with traditional treatments. The conditions we treat with interventional psychiatry include:

• Major depressive disorder
• Severe treatment-resistant depression
• OCD
• Catatonia (unusual movements, rigidity, self-injurious behaviors, and lack of response) related to autism or other neurological or psychiatric conditions
• Severe mental health disorders involving psychosis (psychotic disorders), such as schizophrenia, brief psychotic disorder, and schizophreniform disorder
• Severe mania related to bipolar disorder

Who Can Benefit from Interventional Psychiatry?

Interventional psychiatry treatments can help people who:

• Have tried at least two types of medications for a mental health disorder, but the symptoms didn’t go away or got worse
• Can’t be safely or effectively treated with standard medication therapies
• Have had previous successful treatment with brain stimulation
• Are experiencing severe symptoms, such as persistent suicidal thoughts

People should seek immediate emergency care if they have current plans or thoughts of suicide or self-harm and do not feel safe.

What Are the Benefits of Interventional Psychiatry?

Interventional psychiatry offers new hope for people whose symptoms have not improved with traditional treatment.

• Beyond standard care: Provides effective alternatives when medications and therapy haven’t delivered adequate relief
• Circuit-targeted treatments: Acts directly on brain networks driving symptoms, offering faster relief for some
• Modern outpatient options: Noninvasive or brief procedures, such as TMS/iTBS, esketamine, or ECT, that complement ongoing care
• Individualized, not one-size-fits-all: Plans are tailored to a patient’s history, goals, and medical needs
• Safety first: Physician-led evaluation and monitoring to maximize benefit and minimize side effects

During Interventional Psychiatry

At each visit, patients complete check-in, have their vitals checked, discuss any symptoms and side effects, and ask questions they may have.

What to expect by treatment type:

• TMS/iTBS: The patient sits awake in a chair. A coil rests on their scalp and delivers brief pulses (a tapping sensation). Treatment itself lasts 20 minutes (visit time is a bit longer). No anesthesia is necessary, and the patient can resume normal activities afterward.
• Esketamine (Spravato®): Nasal spray is given in a clinic after a safety screen. The patient rests in a quiet room while we monitor them for about 2 hours. Temporary effects, such as dissociation and dizziness, are common, and they fade the same day. Patients need to arrange for a ride home.
• ECT: This is an outpatient procedure under short-acting anesthesia with a muscle relaxant. The patient is asleep for the treatment, which takes a few minutes. Recovery room monitoring follows (typically 30 to 60 minutes). Patients may experience a headache or temporary memory issues. Patients need to arrange for a ride home.

After the session, we schedule the next visit, track the patient’s progress, and adjust the plan as needed. Patients receive specific instructions – such as fasting or arranging transportation – specific to their treatment.