Interventional Psychiatry Clinic

Electroconvulsive therapy (ECT) is a medical treatment most commonly used in patients with severe depression or bipolar disorder who have not responded to other treatments. ECT involves a brief electrical stimulation of the brain while the patient is under anesthesia.

General Considerations

ECT usually involves 6 to12 treatments over 2 to 3 weeks. It is a form of seizure therapy and does involve general anesthesia. Patients will need to arrange for transportation and have someone who can stay with them for monitoring at home.

Candidates for Treatment

• Treatment-refractory depression
• Schizophrenia
• Bipolar depression, mania or mixed disorder
• Catatonia

Risks and Potential Side Effects

• Confusion and memory problems
• Headaches and muscle aches
• Nausea and vomiting

Benefits

• Quick response
• Offers relief to symptoms in severely depressed or suicidal patients
• Highly effective (60 to 70% response rate in treatment-refractory depression)

Relative Contraindications to ECT

• Active substance use disorder, including alcohol and illicit drugs
• Unstable cardiovascular and lung problems
• Severe uncontrolled hypertension
• Bad reactions in the past to anesthesia

Cost

• ECT is usually covered by most insurance policies. Even with insurance coverage, there may be a bill to the patient.

If you are interested in starting ECT therapy, please print off the following questionnaire, fill in the requested information and bring this completed form to your first appointment.

Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven't been effective.

General Considerations

TMS usually involves 36 treatments over 4 to 6 weeks. Each treatment is 3 to 4 minutes in duration.  

Candidates for Treatment

Patients have severe symptoms or a diagnosis including:

• Treatment refractory depression

Risks and Potential Side Effects

• Headaches
• Burning sensation during treatments
• Other possible side effects exist

Benefits

• Low risk for side effects
• Highly effective (50 to 60% have an improvement in symptoms in FDA trials)
• Safe in many patients with a complicated history of medical problems

Relative Contraindications to TMS

• Active Substance use disorder including alcohol and illicit drugs
• Patients with seizure disorder (epilepsy)
• Patients with ferromagnetic implants such as aneurysm clips and cochlear implants

Cost

• TMS is covered by most insurance policies. Insurance coverage usually requires that a patient have some form of psychotherapy and try 2 to 4 different FDA approved medications in the current episode of depression.

If you are interested in starting TMS therapy, please print off the following questionnaire, fill in the requested information, and bring this completed form to your first appointment. 

Ketamine is a dissociative anesthetic (blocks sensory perception) also known as Ketalar and Ketaset. Under medical supervision, it can relieve serious symptoms of depression and depression combined with anxiety.

General Considerations

Ketamine is a treatment adjunct and should be used in combination with psychotherapy and psychotropic medication management in the treatment of depression. Ketamine Therapy usually involves 6 to 10 treatments over 3 to 6 weeks. Each treatment involves 90 minutes of monitoring for IM Ketamine and two hours of monitoring for esketamine.

Treatment Options

• Intramuscular Ketamine
• Intranasal Esketamine (Spravato)

Candidates for Treatment

Patients have severe symptoms or a diagnosis including:

• Treatment refractory depression
• Post-Traumatic Stress Disorder

Risks and Potential Side Effects

• Panic attacks and dissociative episodes
• Hypertension
• Nausea and vomiting
• Confusion
• Laryngospasm
• Other possible side effects exist

Benefits

• Quick response (usually within in 1-2 weeks)
• Effective in up to 60% of patients with severe treatment refractory depression

Relative Contraindications to Ketamine

• Active substance use disorder including alcohol and illicit drugs
• Unstable cardiac and pulmonary conditions
• Severe hypertension
• Prior significant adverse events with anesthesia medicines
• Active Pregnancy
• Frequent or intense dissociate episodes
• Concurrent treatment with Suboxone or another opioid medicine

Cost

Ketamine may not be covered by many insurance policies.


If you are interested in starting Ketamine therapy, please print off the following questionnaire, fill in the requested information, and bring this completed form to your first appointment.
 

Vagal Nerve Stimulation (VNS) is another procedure that professional psychiatry may utilize when psychiatric symptoms are severe and have not responded appropriately to counseling and medication management. You may be referred to this clinic for the treatment of severe and chronic depression.

General Considerations

Insurance coverage usually requires that a patient be greater than 18 years of age and have had a trial of at least four different FDA approved medications without success. 

Candidates for Treatment

Patients have severe symptoms or a diagnosis including:

• Chronic or Recurrent Depression

Risks and Potential Side Effects

• Hoarseness and change in voice
• Abnormal sensation in the throat
• Shortness of breath and dry cough
• Other possible side effects exist

Benefits

• Highly effective (70% have significant improvement)
• Improved quality of life in greater than 50% of patients for 5 years

Relative Contraindications to VNS

• History of left Vagus nerve cut (vagotomy)

Cost

VNS for depression is FDA approved and is usually covered by Medicare. Even with insurance coverage there may be a bill to the patient.

If you are interested in starting VNS therapy, please print the following questionnaire, fill in the requested information, and bring this completed form to your first appointment. 

Interventional Psychiatry

Carilion Clinic Psychiatry and Behavioral Medicine
4434 Electric Road
Roanoke, VA 24018
Phone: 540-527-4900

Dora Wygal, LPN, Interventional Psychiatry Clinic nurse coordinator

Justin White, MD, Psychiatry
Interventional psychiatry training at UPMC and Berenson-Allen Center

Tracey Criss, MD, Psychiatry
Interventional psychiatry training at Long Island Jewish Hospital

Azziza Bankole, MD, Psychiatry
Interventional psychiatry training at long Island Jewish Hospital

 

Additional Expertise

Ketamine Treatment

• Psychiatry nurses and psychiatric technicians

ECT Treatment

• Anesthesiologists
• Certified registered nurse anesthetists
• Registered nurses in the post anesthesia care unit

 

• To schedule an appointment, contact our nurse coordinator at 540-527-4900.
• Please fill out the Screening Questions Form found under the tab of the treatment you are interested in talking about and bring it filled out to your first appointment.
   

What To Expect on Your First Visit

During the initial visit you will meet with a psychiatrist to discuss possible treatment options offered in this clinic. This usually involves a review of the clinical history including psychiatric symptoms and diagnosis. 

Patients will fill out clinical assessment information forms. Most of the first visit will be centered on a discussion of the treatments. We will also speak about the consent process and determine if there is a need for lab work or medicine changes, which may be needed depending on the type of interventional treatment. 

If you are a candidate for interventional treatment, you will NOT receive a Ketamine, TMS, VNS or ECT treatment on your first outpatient visit. The nurse coordinator will contact the patient within a week of the first visit to discuss scheduling the treatment.

If you have a patient whom you feel would benefit from Ketamine, TMS, VNS or ECT, we would greatly appreciate the opportunity to meet with and evaluate this person at the Carilion Clinic Interventional Psychiatry Clinic. Please send your referral with a brief summary of the desired treatment and the last progress note including current medicines.

Thank you for the referrals and your commitment to treating psychiatric illness in our community.

Please see the attached document for more information about referral criteria.
 

Contact Us

Carilion Mental Health
Interventional Psychiatry Clinic
4434 Electric Road
Roanoke, VA 24018

Dora Wygal, Interventional Psychiatry Clinic Nurse Coordinator
Phone: 540-527-4900
Fax: 540-772-3913