Expert consultation for patients with treatment resistant psychiatric disorders and those who cannot tolerate conventional treatments.
• Evaluation of past treatments and recommendations for appropriate treatment options;
• Information and education about treatment options to help you make informed decisions.
• Providing treatment with approved brain stimulation techniques, with careful follow-up monitoring.
• Where appropriate, referral for experimental treatments.
What is Brain Stimulation?
Brain stimulation represents a new discipline in psychiatry focused on using magnetic or electrical energy to improve brain function. These techniques are used both for research and for treatment in major psychiatric disorders that do not always respond fully to conventional treatments, such as medication or psychotherapy. Stimulation with electrical or magnetic energy interacts with neurons, causing them to release chemicals called neurotransmitters, and possibly also helping form more healthy synapses, or connections, between nerve cells. Repeated stimulation can modulate or “reset” the activity of specific regions of the brain to exert significant changes. Brain stimulation therapy uses both traditional and brand new methods of applying energy, either alone or in concert with medications. As with other treatments, brain stimulation treatments have both risks and benefits that should be discussed thoroughly with your doctor.
Who Can Benefit from Brain Stimulation Treatments?
Our treatments are designed for individuals who are either medication resistant or medication intolerant. While currently available medications and psychotherapies are effective for many people with depression, unfortunately a substantial number of people do not respond. When depression is resistant to medication, it can become chronic, lasting for long periods of time in some cases. Depression can also recur, making long-term maintenance strategies very important.. In addition, side effects of conventional psychotropic medications may limit the effectiveness of treatment. In such instances, the use of Brain Stimulation treatments may allow treatment of a condition that otherwise could not be treated, by replacing medication or by allowing the use of lower doses of medications or medications that are more tolerable to the patient but less effective by themselves.
Approved Brain Stimulation Techniques?
Electroconvulsive Therapy (ECT) has been modernized substantially since it was first introduced over 70 years ago. ECT remains the most effective and rapidly acting treatment for severe treatment-resistant depression and other disorders. Modifications in ECT technique, electrode placement, and dosage can dramatically affect the side effects and tolerability of the treatment. NewYork-Presbyterian Hospital and the New York State Psychiatric Institute have long been recognized as leaders in the field of ECT research and clinical practice. We specialize in individualizing ECT dosage to each patient’s needs, and in selecting treatment parameters that research has shown have the lowest risk of side effects.
Transcranial Magnetic Stimulation (TMS) was approved by the United States Food and Drug Administration in October, 2008, for the treatment of major depression that has not responded to at least one adequate trial of an antidepressant medication in the current episode. Columbia was one of the main research sites that demonstrated the safety and efficacy of TMS prior to its approval, and is the first location in the New York area to offer it now for treatment. TMS is a non-invasive form of brain stimulation that modulates brain activity using focused magnetic pulses. To treat depression, this stimulation is delivered to an area of the brain linked to depression in 30-60 minute sessions administered on an outpatient basis. Treatment typically occurs daily (Monday - Friday) for 4-6 weeks. TMS is not a replacement for antidepressant medications, but may be added onto existing medications.
Vagus Nerve Stimulation (VNS) was approved by the FDA for the long-term treatment of chronic major depression that has not responded to antidepressant treatments. VNS is performed with an electrical device like a pacemaker that is implanted in the chest. Electrical leads are connected to the vagus nerve in the neck. The vagus nerve sends impulses to the brain. VNS is indicated for the adjunctive long-term treatment of chronic (more than 2 years) or recurrent depression for patients 18 years of age or older who are experiencing a major depressive episode and have not had an adequate response to four or more adequate antidepressant treatments. VNS is not a replacement for medications or electroconvulsive therapy (ECT), but it can be added onto other treatments for adjunctive therapy and long-term management. NewYork-Presbyterian Hospital and New York State Psychiatric Institute played a role in the initial clinical trials of VNS for depression. For more information about VNS, click here.
In-depth evaluations are conducted by a team of psychiatrists with expertise in brain stimulation techniques. They are assisted by consultants from our research faculty and other medical and neurological specialists as needed. Integrating this information, we provide a comprehensive assessment, second opinion on prior treatment strategies, and recommendations regarding state-of-the-art clinical care. Where appropriate, FDA-approved brain stimulation treatments may be prescribed and administered and referrals for research based treatments are also available.
We are actively engaged in research with experimental forms of brain stimulation to help identify safe and effective treatments for medication-resistant depression and other disorders such as obsessive-compulsive disorder (OCD), anxiety disorders, and autism spectrum disorders. Areas of research include transcranial magnetic stimulation (rTMS), deep brain transcranial magnetic stimulation (dTMS) magnetic seizure therapy (MST), deep brain stimulation (DBS), and transcranial direct current stimulation (tDCS).
Referrals may be made by treating clinicians or patients themselves.
To receive a clinical evaluation to help you and your doctor determine whether brain stimulation might be right for you, you may contact us by phone at 646-774-8077, via fax at 646-774-5420.
710 W. 168th Street, 12th Floor
New York, NY 10032
New York State Psychiatric Institute, Unit 21
1051 Riverside Drive
New York, NY 10032