Psychiatry Tomorrow

Dr. Lisa Harding was a teenager when patients burned down the psychiatric hospital her father built in Guyana, and the care that resumed afterward happened in tents. That gap between what gets built and who actually gets treated has followed her from emergency medicine to a Yale chief residency in interventional psychiatry to the insurance-based practice she runs in Connecticut. On this episode of Psychiatry Tomorrow, she tells Will Sauvé and Brittany Albright which cliché she would erase from the field forever, why she thinks new treatments will only ever reach the top two percent of patients, and how becoming a trialist on the EQUIVALENCE comparison of IV ketamine and Spravato made her tighten her own response thresholds. She also explains what worries her about sublingual ketamine arriving at a patient's door in watermelon flavor, and why the field has no warning sign for pushing an NMDA receptor too far. The conversation ends where practices actually break, which is the money. Timestamped show notes Approximate. [00:00] Recording on Juneteenth, and why Harding calls herself a "freedom day baby" [03:02] Training as chief resident of interventional psychiatry at Yale, the field's one open spot [04:57] Two rejections from Yale, and a made-up specialty for people who wanted to do ER psych [05:48] From the ER to psychiatry: "I'll be the most empathetic physician you will ever meet" [07:59] Why she left academia: hospitals are a poor delivery mechanism [09:40] Sauvé on the Bethesda center of excellence that treats ten patients a month [10:30] The psychiatric hospital her father designed in Guyana, and the day patients burned it down [11:56] ECT in a bus, a detox bus, mobile TMS: bringing intervention into communities [13:47] The referral pipeline and the illness-perception threshold [15:52] "I don't think we've been successful." Harding pushes back [17:20] The worry: new treatments that only reach the top two percent [18:06] Set and setting: the broom closet and the sanitized ECT suite [19:11] Sauvé's Frankenstein-basement TMS story [21:02] The effect Harding refuses to call placebo [22:59] Why she does not check in with patients before ketamine [27:12] Building the Mood Institute: insurance-based TMS, Spravato, ketamine, yoga, four retreats a year [31:44] You can take insurance and not see thirty patients a day [32:40] EQUIVALENCE: IV ketamine vs. esketamine, and why she said yes [37:12] How strict the regulatory posture is on lifetime ketamine exposures [38:36] Subscribe-and-save ketamine, and a U-shaped response curve [41:04] Sublingual bioavailability and hitting a moving bullseye [42:16] "We don't have precision psychiatry. I tell patients that it is guesswork" [43:10] NMDA receptor homeostasis, overshoot, and the missing warning sign [46:02] Trial design: randomization, the switch option, and the observational arm [49:12] How becoming a trialist made her question the weighing ritual [50:20] Her thresholds: four weeks, 50 percent, and no dose escalation for partial response [52:28] The number one piece of advice for adding interventions [54:30] Why practices fail on economics, not medicine [58:42] REMS audits you can fail, and the "belly" to carry risk [59:40] The silent survivors of the Spravato launch [01:00:32] Lightning round: the cliché she'd kill ("more is better") [01:01:15] Why depression deserves more aggressive treatment [01:04:27] A pessimist who's still hopeful for science Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Dr. Anita Clayton, chair of psychiatry at UVA and a former Navy physician, built the CSFQ — the validated scale now used across specialties to measure antidepressant sexual dysfunction — after noticing her fluoxetine patients' real rate of side effects was ten times what the drug's label claimed. In this conversation with Dr. Will Sauvé and Dr. Brittany Albright, she breaks down the three sources of sexual dysfunction clinicians routinely conflate: the illness itself, the medication, and the relationship strain that comes with depression. She explains why bupropion doesn't cause sexual dysfunction and can even rescue it from an SSRI, and the case she made to drug companies to stop hiding that fact. The conversation turns to flibanserin (Addyi), the first FDA-approved drug for low sexual desire in women, and the fight over regulators measuring female desire by a standard borrowed from Viagra trials — a saga now documented in the film The Pink Pill. Clayton also previews where she's headed next: zuranolone for postpartum depression, a single-dose psilocybin-analog injectable now being studied in adjustment disorder tied to serious illness, and gepirone ER (Exxua), a new antidepressant with no sexual-dysfunction warning at all. It's a career-spanning episode about what happens when someone refuses to accept "that's just how it's measured" as an answer.   Timestamped show notes Approximate. [00:00] Sauvé on finding psychiatry on an inpatient rotation at Walter Reed [02:30] Welcoming Dr. Anita Clayton and Dr. Brittany Albright [03:00] "Who takes care of all these people?" The nursing-home origin [04:30] One of few women in medical school; choosing OB-GYN and psychiatry [08:00] Wanting to know everyone's story: why psychiatry [12:00] The Navy, HPSP, and becoming a general medical officer at Great Lakes [13:30] Starting an all-women group; treating the whole person [16:30] "I'm examining them": finding what others missed [17:30] The Kmart story and choosing to live your life [18:30] The Pink Pill, and meeting Clayton in it [19:30] Fluoxetine, delayed orgasm, and a label that said 1.9% [21:00] Why you can't trust spontaneous-report side-effect data [21:30] Three kinds of sexual dysfunction: disease, treatment, relationship [24:30] Building the CSFQ scale [25:00] Bupropion, buspirone, and rescuing sexual function [27:00] "Just count the prescriptions": reframing antidepressants for industry [29:30] Should psychiatrists screen for primary sexual disorders? [30:30] Flibanserin, Boehringer Ingelheim, and training actors to model interviews [33:00] The FDA's sedation worries and the fight over approval [35:30] "Successful sexual events" vs. asking women about desire [37:00] Sprout, Cindy Eckert, and patients testifying at the FDA [38:00] Becoming a PI on industry trials since 1991 [40:00] Career and family: a blended family and a summer in Provence [42:30] A father who said "you can do anything" [46:30] Reproductive psychiatry, the midlife clinic, PMDD, postpartum [47:30] Zuranolone and a GABA mechanism that changed the paradigm [48:30] A single-dose psilocybin-analog injectable for postpartum depression [50:30] Adjustment disorder in serious medical illness; an ALS patient at peace [51:30] Gepirone ER (Exxua) and a head-to-head sexual-function design [55:00] What she's proudest of: staying curious [56:30] Mentorship, women in the field, and "I'm still excited" Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

The FDA cleared TMS for depression in 2008, yet by one estimate fewer than 1% of the patients who would qualify for it ever get treated. Dr. Will Sauvé sits down with Dr. Scott West, the psychiatrist who brought TMS to Tennessee in 2010, to ask why a treatment that works remains this hard to reach. West argues the real barrier isn't efficacy or even insurance, it's that patients and the clinicians who could refer them don't know the option exists, illustrated by a woman who lived two miles from his clinic her whole life and had never heard of it. Along the way he reframes TMS as a tool that treats brain circuits rather than a single depression treatment, and makes the case for treating depression as an urgent illness instead of something managed in six-week medication trials. The two also get into responsible off-label use, from a fibromyalgia protocol to a nine-year-old with Tourette's, and where the field is heading with QEEG-guided protocols and EEG captured under a live coil. West's advice to clinicians thinking about adding TMS: standard TMS still works, so build a real plan and don't let your machine become a "dead box." Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Ben Leopold spent years on 10 different antidepressants, each one trading his lowest lows for a flatline existence that erased his personality. It wasn't until a psychiatrist stopped prescribing and started digging into the childhood trauma underneath his depression that things began to shift. In late 2020, already armed with years of therapeutic tools he couldn't access through the fog, Ben started Spravato treatment at a clinic in Portland. The dissociative experience let him step outside his anxiety for the first time and see himself the way his family always had. Today, more than two years after his last session, he maintains his recovery through running, surfing, writing horror novels, and showing up for the people he loves. In this episode of Psychiatry Tomorrow, Ben sits down with Osmind's Dr. Will Sauvé and Dr. Brittany Albright to walk through the full journey.Timestamped Show Notes [00:00] Introduction and Ben's opening reflection on where he is today [01:06] Ben begins sharing his story and background [03:09] The morning his father died when he was nine years old [05:58] How early trauma became panic attacks and catastrophic thinking [06:43] Building survival mechanisms and isolation patterns as a child [09:00] The slow decline from 2015 to 2018: getting heavier, losing hobbies, losing himself [10:35] Breaking point: panic attack during a routine work meeting [12:19] Finding his first psychiatrist and starting antidepressants [13:19] How Ben's mother normalized mental health treatment in the late 80s [15:01] Dr. Sauvé on memory loss after 12+ months of depression [16:15] Why supporting someone through depression is a thankless job [16:52] The isolation paradox: pushing people away to "protect" them [22:17] The antidepressant carousel: 10 medications and their side effects [23:44] Emotional blunting: feeling like a shell of yourself [26:18] Ten medications tried over approximately 18 months [27:16] COVID, freefall, and starting fresh with Dr. Combs [28:31] A different approach: addressing root causes instead of just symptoms [32:28] Sister introduces Ben to Spravato [33:47] First impressions of Evolve Health clinic in Portland [35:17] How clinic atmosphere and personalization changed Ben's treatment experience [36:40] Prior psilocybin experience and writing a letter to his mother [37:07] The Spravato experience: the Tasmanian devil tornado metaphor [38:18] Learning to love imperfection [39:07] Why Spravato needed a therapeutic foundation to work [40:11] Integration: zipping up nine-year-old Ben with adult Ben [41:36] Journaling during sessions and learning to express love [42:35] The dissociative sandbox: beta testing yourself [43:38] Off Spravato since 2021 and maintaining recovery through lifestyle [45:37] Taking a year off work to build stability in the boring daily routine [46:26] Current life: running, surfing, writing, family [47:09] Final words: put in the effort, keep pushing Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Most of Brittany Albright's treatment-resistant depression patients test positive for obstructive sleep apnea. Some longstanding ADHD cases turn out to be sleep apnea too—treated, the diagnosis comes off. Dr. Avinesh Bhar, a sleep medicine physician who founded Sliiip, joins Will Sauvé and Brittany Albright to discuss why sleep disorders hide behind psychiatric diagnoses. They cover how sleep apnea now shows up earlier and in different presentations, why women get missed on standard scoring, and what the 2-3am wake-up really means. The conversation also addresses the access crisis—only 150 sleep fellows graduate annually—and how telemedicine and home testing are starting to close the gap.Timestamped Show Notes:[00:00:00] Introduction: Dr. Bhar's path from pulmonology to sleep medicine [02:19] Sleep as a "single-player experience" and why patients normalize dysfunction[06:18] Psychiatry training teaches us to avoid deep sleep conversations[07:09] Only 150 sleep physicians graduate annually; most were grandfathered in[08:08] "The test is negative, now what?" The Seroquel referral loop[09:22] Tardive dyskinesia case from quetiapine prescribed for sleep[11:58] Financial conflicts in sleep medicine: in-lab vs. home testing[14:05] Setting up virtual sleep medicine for accessibility[16:44] Dr. Albright on 9-12 month waitlists and finding Dr. Bhar[19:04] The deprescribing challenge: when patients don't want to stop meds[21:43] Multi-night home testing vs. single-night in-lab studies[22:53] Skulls at smallest size in evolution; REM-dependent sleep apnea in women[24:06] The 2-3 AM wake-up: tracing the third REM cycle[26:15] "Is insomnia a diagnosis or symptom?"[27:01] Teeth grinding as a sign of sleep-disordered breathing[28:13] Sleep apnea and addiction: the stimulant-alcohol cycle[29:02] AI scoring trained on male patients; women get missed[31:32] PTSD, metabolic syndrome, and sleep apnea overlap[32:08] GLP-1s as "cheat code" for insurance approval[34:07] Weight loss doesn't cure sleep apnea permanently[35:38] Patients don't know what "well" feels like[36:20] ADHD diagnosis removal after sleep apnea treatment[38:09] Teenagers on stimulants: changing long-term trajectories[38:54] Magic wand question: insomnia as diagnosis vs. symptom[40:04] CBTI resources: the VA's free app[43:45] Wearables: useful for trends, not diagnosis Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

What if one of psychiatry's most effective treatments for treatment-resistant depression emerged from watching childbirth breathing techniques?Around 30-48% of depression patients become treatment-resistant after failing two or more antidepressants. For those who've exhausted every option—medication after medication, therapy combinations, even ECT—psychiatrists face a clinical impasse. But vagal nerve stimulation (VNS) offers something unprecedented: patients don't just maintain improvement—they keep getting better, month after month, year after year.At Stony Brook University, Dr. Lucian Manu has helped over 20 patients access VNS, many of whom have reduced their reliance on weekly ketamine infusions to monthly or less while maintaining stability.What You'll LearnWhy VNS emerged from an accidental observation during Lamaze classes and what that tells us about vagal modulationHow VNS creates a clinical "floor" that prevents patients from reaching their lowest depressive episodesThe Medicare coverage breakthrough after 15 years of insurance denials—and the cost-effectiveness argument that workedPatient selection criteria, practical implementation details, and managing the insurance appeals processWhy functional improvements often precede symptom score changes Timestamped Show Notes[00:00:00] Introduction: VNS as a treatment discovered by accident[00:01:00] Dr. Will Sauvé joins as new co-host[00:02:00] Why VNS is gaining momentum now[00:03:00] Dr. Manu's journey into VNS starting in 2016[00:05:00] The vagus nerve: anatomy and function—80% afferent, pathway to locus coeruleus[00:08:00] Jake Zabara's serendipitous discovery at Lamaze class[00:11:00] From stopping dog seizures to human epilepsy treatment[00:13:00] PET scans reveal VNS targets same brain regions as TMS; patients report feeling better than ever[00:16:00] The two unique features that convinced the FDA: improvement over time, low relapse[00:19:00] Why insurance companies refused coverage 2005-2020: not "class one evidence"[00:22:00] The RECOVER trial and Medicare breakthrough—cost-effectiveness argument[00:27:00] Getting single-case agreements through appeals: "war of attrition"[00:31:00] Patient selection criteria: 4+ failed treatments, bell curve age distribution, no ceiling on failures[00:34:00] Comparing VNS to ECT: "less extreme, more natural—dialing up existing function"[00:35:00] Bipolar depression often underdiagnosed in "treatment-resistant" populations[00:38:00] How VNS reduces ketamine treatment frequency: creating the floor while ketamine provides acute relief[00:42:00] The surgical procedure: outpatient, comparable to pacemaker, 21 patients with zero explantation requests[00:46:00] Quality of life improvements precede symptom scores; using MADRS and CGI to counter self-report bias[00:50:00] Transcutaneous auricular VNS: the non-invasive future, respiratory-gated stimulation research[00:53:00] VNS-assisted psychotherapy: priming the brain to learn by activating locus coeruleus attention systems[00:56:00] Trauma surgery ICU delirium study with ta-VNS—cross-disciplinary collaboration Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Nine out of twenty patients in Dr. Brittany Albright's psychiatry practice were taking GLP-1 medications—not for weight loss, but because metabolic and psychiatric disease share the same pathophysiology. About 43% of patients with major depression have obesity, and GLP-1 receptors throughout the brain's mesolimbic reward system explain why these medications reduce alcohol cravings, tobacco cravings, and compulsive eating. A February 2024 JAMA Psychiatry study showed semaglutide significantly reduced drinking episodes in alcohol use disorder at relatively low doses. Dr. Will Sauvé and Dr. Brittany Albright discuss the neurobiological mechanisms, evidence-based patient selection beyond BMI, and why psychiatrists need to stop asking whether they're "allowed" to treat their patients' metabolic dysfunction. By 2030, over 50% of US adults will have obesity—the question isn't whether psychiatrists should prescribe GLP-1s, it's how we've gotten away with ignoring metabolic health for so long. Timestamped Show Notes[00:00:00] Introduction - Brittany's home office with plants and dogs[02:02] The "holistic" medicine debate[04:02] Why Brittany opened Sweetgrass Psychiatry[07:00] Bringing family medicine in-house[10:01] The economics of integrating primary care[11:08] Scaling to 30 clinicians[13:41] Full suite of interventional services offered[15:08] Nine out of twenty patients on GLP-1s[16:15] Depression and metabolic syndrome: 50/50 overlap[19:03] GLP-1s and the mesolimbic system[20:24] JAMA Psychiatry study on semaglutide for alcohol use disorder[21:17] Dr. Stahl quote: "Follow the FDA label and never get anybody better"[22:10] When GLP-1s aren't appropriate[24:01] Case study: patient on paliperidone gaining weight despite tirzepatide[25:52] Discovery of nucleus tractus solitaris[28:26] The "are we allowed to prescribe this?" debate[29:10] Valproic acid, propranolol, and scope of practice[30:01] Bipolar disorder, obesity, and mood episode frequency[30:49] Moving beyond the monoamine hypothesis[31:19] UK paper: no proof depression is serotonin deficiency[33:23] Alternative treatments: TMS, ketamine, GLP-1s[34:03] Dr. Stahl's prediction: MDD is five different illnesses[36:11] 2030 projection: over 50% of adults with obesity[37:27] Starting with clinicians practicing what they preach[38:44] Wild 5 Wellness program[40:34] Force multipliers: treating populations, not just individuals[43:06] Equipping other clinicians rather than scaling[43:48] Private practice summit planned for Vegas 2026 Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Dr. Martha Koo bought her first TMS machine in 2009 when colleagues thought she was "crazy"—now she runs 11 centers across California as immediate past president of the Clinical TMS Society. Her biggest revelation came when longtime therapy patients said "I'm good, but I'm not my true full self," showing how psychiatrists often settle for partial recovery. Unlike medications, TMS doesn't require patient belief to work—as one skeptical patient discovered when he achieved complete remission despite thinking the treatment was "silly." Early billing operated in a regulatory gray zone where insurers accidentally processed TMS sessions like MRIs, inadvertently funding the field's growth. She envisions a future with accelerated one-day protocols, mobile devices in oncology and OB-GYN settings, and implantable brain stimulators. Her blunt advice to hesitant colleagues: "The cat's out of the bag—I don't see a world in future psychiatry that's just medicine and therapy."Timestamped Show Notes:‍[08:09] The $100K gamble and early TMS adoption[13:25] Insurance loopholes and money-back guarantees[15:57] "Not my true full self": what patients really want[19:44] Santa's sleigh and the belief problem[22:50] Military medicine and the polypharmacy solution[25:05] Why TMS is five days a week (blame Dr. George's wife)[28:33] Accelerated, mobile, implantable: what's next[34:05] VNS comeback and combination approaches[37:21] Interventional psychiatry as evolution, not revolution[48:09] Advice for hesitant psychiatrists Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

SummaryDr. Nicholas Fabiano, a third-year psychiatry resident at the University of Ottawa with 70,000+ X followers, explains how exercise can match antidepressants for mild-to-moderate depression through muscle-released proteins called myokines that act like "miracle grow for the brain." He introduces the FIT framework (Frequency, Intensity, Type, Time) for systematically discussing exercise with patients, similar to prescribing medication. Creatine supplementation, typically used by athletes, shows promise for mental health when used alongside traditional treatments, but brain benefits may require higher doses (10g+) than the standard 5g used in fitness. Fabiano warns that excessive exercise can become a form of self-harm when used to transfer emotional pain, with red flags including 6+ hours daily and frequent injuries. His vision for psychiatry's future centers on removing the artificial divide between mental and physical health, enabling better collaboration across medical specialties.Key takeaways:• Exercise intensity matters more than type for antidepressant effects • Creatine costs ~$35 for 90 servings and has favorable risk-benefit ratio • Supervised exercise interventions outperform unsupervised due to adherence • Future psychiatry requires integrated mind-body treatment approaches Timestamps / Shownotes[00:00:00] Introduction - Dr. Fabiano's background and training structure in Canada [00:04:30] Defining lifestyle psychiatry and the mind-body connection[00:06:00] Exercise for depression - research evidence and meta-analyses [00:09:00] Exercise study design challenges and placebo controls [00:11:30] Exercise intensity vs. type - what matters for antidepressant effects [00:15:00] The muscle-brain connection - myokines and BDNF explanation [00:20:00] Creatine for mental health - from gym supplement to brain fuel [00:26:00] Clinical implementation - the FIT framework for prescribing exercise [00:33:00] Exercise as self-harm - warning signs and red flags [00:40:00] Balancing productivity with self-care during medical training [00:42:00] Future of psychiatry - removing mental-physical health divide Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

After a young patient died by suicide, many psychiatrists might retreat to safer cases—Dr. Matt Bernstein took a different path, choosing to treat our field's highest-risk patients in their communities rather than behind hospital walls. Drawing from his experience at McLean Hospital's acute unit and now at Ellenhorn's community-based program, he shares practical insights on balancing clinical risk with recovery potential. Through the groundbreaking Accord Metabolic Psychiatry Program, Bernstein demonstrates how integrating metabolic approaches with psychosocial rehabilitation can reduce symptoms and medication needs. His team's comprehensive approach combines measurement-based care, metabolic interventions, and meaningful social engagement to help patients rebuild their lives. Perhaps most importantly, Bernstein challenges our field's approach to risk, arguing that acknowledging psychiatry's mortality rate—while maintaining hope for recovery—opens new possibilities for treatment. His work offers a compelling model for moving beyond crisis management to create sustainable paths for recovery, even in our most complex cases.Episode Show Notes and Timestamps:[00:00:00] - Introduction: After a young patient's death by suicide, Dr. Bernstein chose to focus on high-risk psychiatric care in community settings.[00:01:00] - Host Dr. Will Sauvé introduces his background in military psychiatry and interventional approaches.[00:02:00] - Overview of Dr. Bernstein's career trajectory from McLean Hospital to pioneering community-based care.[00:03:00] - Early career at McLean Hospital- 8.5 years on Schizophrenia and Bipolar Inpatient Unit- Experience teaching residents- Transition to longitudinal care focus[00:05:00] - The PACT Model and Ellenhorn's Evolution- Origins in 1970s Wisconsin- Design as "hospital without walls"- Transition from public to private sector implementation[00:08:00] - Ellenhorn's Comprehensive Approach- Holistic treatment model- Integration of psychosocial rehabilitation- Focus on real-world functioning[00:11:00] - Discussion of Risk Management in Psychiatry- Comparison with other medical specialties- Role of clinical judgment- Impact on treatment decisions[00:13:00] - Development of Metabolic Psychiatry Program- Introduction to ketogenic approaches- Implementation of fasting protocols- Creation of Accord program[00:16:00] - Measurement-Based Care Strategies- Standard clinical measures- Functional outcome assessments- Digital phenotyping implementation[00:20:00] - Family Engagement and Risk Assessment- Shared decision-making approach- Balance of clinical liability and treatment access- Case example of successful risk management[00:28:00] - Future Directions- Integration of innovative treatments- Expansion of metabolic approaches- Vision for community-based careKey Quotes:- "What we find is that when we can get people connected psychosocially out there in real jobs or school or relationships, those experiences can reduce symptoms and take the place of medications."- "These are illnesses that have a mortality rate... sometimes someone dies and everyone did everything exactly right."- "It's a great time to be working in psychiatry because of these options that we didn't have even ten years ago."Resources Mentioned:- Program of Assertive Community Treatment (PACT)- Ellenhorn Community Treatment Program- Accord Metabolic Psychiatry Program‍ Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Dr. Husseini K. Manji takes us behind the scenes of esketamine's development, from basic neuroscience research to FDA approval. Learn about the science of targeting NMDA receptors, the rigorous clinical trial process, and the potential of esketamine as a first-line treatment for depression. Dr. Manji discusses the challenges of bringing a novel psychiatric drug to market, including regulatory hurdles and insurance coverage issues. He also explores the broader implications of esketamine's success for mental health treatment, including the fight for parity and the future of psychedelic medicine development. This episode offers invaluable insights for clinicians, researchers, and anyone interested in the future of psychiatry and drug innovation. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Charles Miller, CRNA, founder of Scenic City Neurotherapy, takes us through his journey of starting a ketamine infusion therapy clinic from scratch. From cashing out his 401k to navigating complex licensing requirements, Charles shares the ups and downs of building a successful practice. He discusses the importance of patient education, the challenges of insurance reimbursement, and the role of technology in streamlining operations. Charles also offers insights on expanding services, managing supply chains, and building a strong team. This episode is packed with practical advice for clinicians considering opening their own breakthrough treatment clinic or expanding their existing services.Timestamps with show notes:[00:00:00] Introduction to Charles Miller and Scenic City Neurotherapy [00:01:00] Charles' background in anesthesiology and interest in ketamine therapy [00:02:00] The decision to start a ketamine clinic and initial research [00:05:00] Starting small: Initial funding and facility setup [00:08:00] Navigating business challenges: Licensing and financial management [00:11:00] Collaborating with psychiatrists and expanding services to include TMS [00:15:00] The importance of patient education in ketamine therapy [00:18:00] Securing VA contracts and navigating insurance reimbursement [00:22:00] Using Osmind platform for practice management [00:24:00] Building a strong team and hiring process [00:28:00] Community education and advertising strategies [00:31:00] Measuring success and patient outcomes [00:35:00] Managing supply chain challenges and diversifying suppliers [00:38:00] Proactive approach to regulatory compliance [00:41:00] Advice for aspiring clinic owners [00:45:00] Concluding thoughts on the rewards of running a breakthrough treatment clinic Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

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 All-in-one Billing Solution + 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 All-in-one Billing Solution + 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 All-in-one Billing Solution + 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 All-in-one Billing Solution + 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 All-in-one Billing Solution + 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 All-in-one Billing Solution + 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 All-in-one Billing Solution + 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 All-in-one Billing Solution + EHR for the modern private psychiatry practice

The power of community and networking in private practice psychiatry cannot be overstated.‍Clinicians often grapple with isolation while staying up-to-date on research, best practices, finding mentors, and collaborative care. Addressing this, a panel of experts from the Osmind Community Advisory Board.The forum, centered on overcoming the challenges of solo practice through community engagement featured insights from:Andrew Penn, MS, PMHNP, Clinical Professor at UC San Francisco, School of NursingDr. Michael Banov, Medical Director at Psych AtlantaDr. Awais Aftab, Clinical Assistant Professor of Psychiatry at Case Western Reserve UniversityDr. Charles Miller, Founder and CMO at Scenic City NeurotherapyModerated by: Dr. Alison McInnes, VP of Scientific Affairs at Osmind, and Dr. Carlene MacMillan, Chief Medical Officer at Osmind.Listen to learn why community is not just a support system, but the very foundation of a successful psychiatry private practice. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Delve into the complexities of starting and thriving in a private mental health practice. Listen to Dr. Kristin Budde, Dr. Erick Sheftic, and Dr. Raghu Appasani share their experiences and insights on integrating the latest treatments into standard practice, the importance of continuous learning, finding your niche, and the power of interdisciplinary collaboration in overcoming access barriers. They also tackle the crucial issue of professional burnout, offering strategies to carve out a unique niche that resonates with both their values and the needs of their patients. This episode is an invaluable resource for mental health professionals seeking to navigate the ever-evolving landscape of private practice, providing practical advice and inspirational examples from those at the forefront of the field. Tune in to gain a comprehensive understanding of how to build a successful, sustainable, and fulfilling mental health practice in today's dynamic healthcare environment. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Join a panel of renowned experts from Osmind's Community Advisory Board, including Dr. David Feifel, Dr. Tobias Marton, and Dr. Christy Duan, moderated by Dr. Carlene MacMillan and Dr. Alison McInnes. They unveil the future of psychiatry at the intersection of tradition and cutting-edge innovation. Listen to in-depth discussions on harnessing big data and real-world evidence to revolutionize personalized care, moving beyond conventional treatments to embrace complementary novel therapies such as TMS and psychedelic interventions. Learn why "Interventional Psychiatry" will just be called "Psychiatry" in the future.This episode also examines the delicate balance between patient autonomy and expert-guided care, reflecting on how these changes redefine the psychiatrist-patient relationship. Glimpse into a future where psychiatry not only adapts to but proactively shapes mental health care. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Dive into the world of psychiatric care for PTSD with General Stephen Xenakis, M.D., a renowned expert who uniquely combines his extensive military and medical experience. As the Executive Director of the American Psychedelic Practitioners Association (APPA), General Xenakis is pioneering the integration of advanced psychedelic therapies into mainstream mental health treatment, particularly focusing on the complexities of Post-Traumatic Stress Disorder (PTSD) among veterans.General Xenakis shares his personal journey from his medical training at the University of California, San Francisco (UCSF) to his impactful military service, treating soldiers returning from Vietnam. He offers a candid critique of the historical shift in psychiatry from holistic approaches to a more reductionist, biological focus, and advocates for a return to comprehensive, patient-centered care. His insights reveal the limitations of traditional models like the DSM and underscore the need for a more nuanced understanding of mental health disorders.A significant portion of the discussion is dedicated to exploring the potential of psychedelic treatments in psychiatry. General Xenakis highlights the importance of professional practice guidelines and accredited training in this emerging field. He also discusses the challenges in integrating these therapies into mainstream healthcare, emphasizing the need for an ethical framework to avoid past mistakes with psychedelic use.General Xenakis’s vision extends to the educational front, where he envisions psychedelic medicine becoming a vital part of psychiatric education in medical schools and residency programs. He also touches on the critical role of collaboration with institutions like the VA and DoD in advancing research and treatment options for veterans.The episode also delves into the specifics of alternative therapies such as Ibogaine and MDMA-assisted therapy, discussing their potential benefits and challenges in treating PTSD. General Xenakis passionately advocates for a diverse and integrative approach to therapy, stressing the importance of therapeutic alliance, trust, rapport, and the inclusion of family support in the treatment process.Timestamps and Show Notes for General Stephen Xenakis Interview[00:01:00] Introduction: Introduction of General Stephen Xenakis and his role as the Executive Director of the American Psychedelic Practitioners Association.[00:05:00] Career Trajectory: Discussion on General Xenakis's journey into the military and psychiatry, including his experiences treating soldiers returning from Vietnam and his time as a patient at Walter Reed.[00:09:00] Changes in Psychiatry Over the Years: General Xenakis reflects on the shift in psychiatry from a holistic approach in the 70s to a more reductionist, biological approach in the 80s and 90s.[00:12:00] Beyond the DSM and Patient-Centered Models: Exploration of moving beyond DSM to patient-centered models in psychiatry, integrating genetics, AI, and large language models for personalized treatment.[00:19:00] Role as Executive Director of the American Psychedelic Practitioners Association: General Xenakis discusses his involvement and vision for the association, emphasizing the importance of practitioner-led changes in mental healthcare.[00:25:00] Integration of Psychedelic Medicine in Mainstream Healthcare: Challenges in integrating psychedelic medicine into mainstream healthcare, including the shift from a disease-based model to a more holistic approach.[00:31:00] Alternative Therapies for PTSD: Discussion on the utility and challenges of treatments like Ibogaine, ketamine, MDMA, and psilocybin in treating PTSD.[00:38:00] Human Rights Advocacy: General Xenakis talks about his advocacy against torture and mistreatment, reflecting on his experiences with Human Rights First and Physicians for Human Rights.[00:42:00] Home Ketamine Businesses and Clinical Model: Views on home ketamine businesses and the importance of maintaining the clinical model for delivering treatments like ketamine and MDMA.[00:45:00] Mental Health in the Wake of COVID-19: Reflections on the increased awareness of mental health issues following the COVID-19 pandemic and addressing the broader mental health crisis. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Stella's acquisition of Field Trip Health's U.S. assets takes center stage, revealing a strategic merger that combines Stella's innovative Stellate Ganglion Block technique and physical treatement centers with Field Trip Health's experience  and infrastructure for deliverying in psychedelic-enhanced psychotherapy. Dr. Eugene Lipov and Mujeeb Jafferi delve into the nuances and power of combining treatments, the potential of telepsychiatry, and the future trajectory of mental health care, emphasizing the critical role of data-driven approaches and the need for broadened accessibility in the realm of psychiatric treatments.Timestamps and Show-notes From the Episode:‍3:33: Dr. Eugene Lipov discusses the invention of the Stella Ganglion block.‍5:33: Mujeeb Jafferi shares the founding story of Field Trip Health.‍8:53: The origin story of how Field Trip and Stella met and how their partnership evolved.‍10:03: Discussion about Field Trip's rapid expansion and subsequent challenges. Transition from a B2B to a B2C model during the pandemic.‍16:03: Challenges faced while opening the first Stella center, especially right before the pandemic.‍18:13: Comparison of various treatments, with a focus on the Stella Ganglion block vs. TMS and ketamine. The increasing cultural awareness of ketamine.‍19:53: Introduction of at-home ketamine services due to new telehealth laws. The partnership with NeuLife and the effectiveness of ketamine in different settings.‍24:55: Dr. Lipov talks about the merger of Stella and Field Trip Health. He discusses the benefits of integration and the combination of treatments.‍29:53: Mujeeb Jafferi's concerns about the merger, especially regarding the preservation of treatment protocols and quality of care.‍32:18: Introduction of a new CTO and the technological innovations in place, including a custom patient portal.‍35:43: A deep dive into the design and user experience of the Field Trip app.‍38:23: Discussion about insurance coverage for different treatments, with a focus on Stella Ganglion blocks and ketamine.‍45:03: The importance of data collection through measurement-based care and related research.‍46:53: Dr. Eugene Lipov shares insights on epigenetics and its potential to reverse aging.‍47:33: Discussion on self-funded employer plans, with a focus on advocating for covering novel treatments.‍53:23: Speculation on the evolution of the Field Trip brand after the merger, emphasizing company name, people, and products. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Navigating the challenging terrains of psychiatry requires a blend of expertise, vision, and ethical grounding. Dr. Rebecca Brendel, MD, JD, exemplifies these qualities. As the immediate past president of the APA and a luminary at Harvard's Center for Bioethics, she has consistently showcased her commitment to upholding ethics in the ever-evolving field of psychiatry. In this episode, she offers a panoramic view of her journey, the APA's strides under her leadership, and the directions in which psychiatry is headed, especially in the realms of technology, diversity, and medical ethics.Timestamped Shownotes:2:00 - The intricate challenges and accomplishments of leading the APA during and post-pandemic.3:25 - Revelations and historical nuances encountered during her presidency at the APA.5:40 - Dr. Brendel's awe-inspiring journey within the APA: tracing her path from a research fellow to the apex of leadership.10:20 - The inherent attributes and challenges associated with being an ethical spokesperson in today's world.13:20 - The tangible impact of Dr. Brendel's ethics-centered approach at the APA, with a focus on the Goldwater Rule.15:05 - Demystifying the misconceptions around the Goldwater Rule.17:40 - The APA's forward-thinking initiatives in promoting diversity, equity, inclusion, and addressing structural racism.21:10 - The myriad opportunities presented by APA’s 501c foundation, extending its benevolence beyond the clinical realm.22:30 - A deep dive into the PsychPRO Registry: understanding its mechanics and its ambitious vision for the future of psychiatry.26:10 - An overview of the collaborative care model and its relevance.27:00 - Measurement-based care: striking a balance with clinical judgment.32:00 - A spotlight on Dr. Brendel's leadership role at the Center for Bioethics at Harvard University.33:50 - The unwavering significance of hands-on clinical work in Dr. Brendel's illustrious journey.36:20 - Guiding young enthusiasts on how to actively engage with professional psychiatric organizations.38:40 - Dr. Brendel's aspirations and hopes for the future of psychiatry, with a special emphasis on the burgeoning role of technology.41:00 - Exploring the ethical implications of partnerships between psychiatrists and the expansive tech industry.43:05 - The contemporary framework of ethics training tailored for the next generation of medical practitioners.45:00 - Dr. Brendel's reflective words, drawing from her tenure as the president of the APA.Links and Resources Mentioned:Center for Bioethics at Harvard UniversityAPA's Official Website Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

In this insightful episode, Dr. Toby Marton, Chief Medical Officer of Mindful Health Solutions, takes us on a journey through his impactful career in the mental health space and his predictions for the future of mental health treatments. Toby, an expert in brain stimulation techniques for treatment resistant depression, shares his experiences of working with veterans and the efficacy of Ketamine Infusion Therapy (KIT) for PTSD. The conversation dives into the evolution of his passion for rapid acting treatment and the role of treatments like TMS, ECT, and esketamine in the long-term management of treatment-resistant depression (TRD). Toby discusses the challenges of scaling treatments like MDMA and offers valuable insights on the future of psychiatry, the role of AI, and the integration of psychiatric care into general healthcare systems. This episode promises a comprehensive exploration of the cutting-edge frontiers of mental healthcare, from the perspective of a leader in the field.Shownotes/Timestamps: 3:00: Toby’s inspiration for pursuing Psychiatry and his choice for an MD in Psychiatry and a PHD in Neuroscience over neurology. His interest in consciousness as a complex subject. 6:45: Toby discusses the prevalence of learned helplessness and nihilism in Psychiatry. 7:40: Insights Toby gathered about the brain from Electroconvulsive Therapy (ECT). 9:00: The motivations behind Toby's shift from bench research to clinical work. 12:30: Exploration of Toby’s research on rapid-acting antidepressants and testing new treatments at the VA. 14:16: Delving into the misleading interpretations of a Naltrexin paper which suggested that ketamine's action was akin to that of an opioid. This conclusion was drawn from a single study with a small sample size.18:31: Characteristics of patients who didn’t respond as quickly to ketamine treatments for Depression29:14: The payer/operational decisions on which treatment to try first between ketamine, TMS, and esketamine‍37:57: Cosmetic psychiatry and discussion on if the dissociative experience is paramount to the antidepressant effects of ketamine‍42:40: Preparing for MDMA-assisted therapy45:02: Challenges of scaling psychedelic-assisted therapies and how tech can help. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Delve into the evolving legal landscape of MDMA-assisted psychotherapy. This episode features Kimberly Chew and Karen Luong, co-leaders of the Psychedelic and Emerging Therapies group at Husch Blackwell. In this enlightening conversation, they decode the legal steps required to offer MDMA treatment for PTSD, a topic of interest for 60% of our surveyed clinicians. They discuss the certification requirements for practitioners, liability concerns, state and federal regulations, and risk reduction strategies. They also talk about the potential of insurance coverage for MDMA therapy, informed by their insights into ketamine clinics and the regulations that surround them. Finally, they reflect on the exciting advancements in the field of psychedelic research and therapy, offering their perspective on the future trajectory of this promising therapeutic realm. Shownotes and Timestamps:3:00: MDMA for PTSD certification requirements for practitioners5:20: REMS program explanation and how they’re collecting post-marketing data.6:30: Liability concerns practitioners should be aware of with MDMA and current lawsuit types they’re currently seeing, and how to avoid them.8:45: Any litigation concerns we can learn from ketamine as an example (different types of insurance practioners should get to avoid a lawsuit or claim)11:40: Other training considerations to avoid legal issues to be prepared12:30: state and federal regulations that govern MDMA therapy (false start) - start over at 11:4515:30:How state and federal laws intersect, and the significance of trigger laws16:25: How friendly is California to these MDMA developments?16:55: How can practioners make sure they’re within compliance with MDMA laws?18:11: Will the public have an opportunity to chime in with commentary and support for MDMA’s legal status/rescheduling? How to use the public comment system to advocate.19:20: Once rescheduled, what are the rules for purchasing and storing MDMA?21:10: Security concerns21:40: Legal considerations for MDMA therapy compared to other substances - how intense will the regulations be?23:40: Will there be standard operating procedures (SOPs) for uniform standards for psychedelics?25:05: Insurance coverage for psychedelics and CPT codes27:00: Why approving psychedelics for insurance reimbursment saves insurance companies money? The case for covering psychedelics.28:18: What’s the best way to reduce risk and reduce malpractice claims heading into this decade? Details about transporting patients.‍ Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Join us in this captivating episode as we explore the transformative potential of psychedelics with our guest, Andrew Penn, a registered Psychiatric Mental Health Nurse Practitioner (NP) and expert in the therapeutic use of psychedelics. We delve into the concept of small psycholytic changes versus monumental breakthrough experiences and the need for further research in this area. Andrew emphasizes the crucial role of set and setting in creating a safe and supportive environment for psychedelic experiences, and discusses the importance of cultivating a sense of safety. We also delve into the impact of psychedelics on changing our relationship to illness, particularly depression, and how they can provide a profound sense of interconnectedness. Throughout the episode, Andrew shares practical tips for individuals considering psychedelic therapy, highlights the role of mindset and placebo effects, addresses healthcare inequities, and recommends resources and training programs. Tune in for an enlightening conversation on the transformative power of psychedelics with with Andrew Penn, MS, PMHNP.Get the full digest of insights here! Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

Join us in this riveting podcast as Ben McCauley, the founder of Denovo Therapy, sheds light on the evolution of his Lubbock-based clinic from a single provider to a beacon of hope for the broader community. The episode explores Denovo's commitment to meeting patients where they are and their innovative use of ketamine-assisted therapy, particularly in a conservative community often wary of such treatments. McCauley reveals how the clinic navigates these challenges, maintaining high clinical standards and a cross-disciplinary approach.Learn about a unique patient's journey and how the innovative use of journaling during treatment sessions contributed to their recovery. Listen as McCauley stresses the importance of patient-directed treatment guided by inner wisdom, safety, and curiosity.Ben discusses the pivotal role of Osmind's user-friendly Electronic Health Records (EHR) in delivering patient-centered care at Denovo. McCauley shares the process of transitioning from paper to digital records, emphasizing the advantages of home access and easy consent form delivery that Osmind provides.Glean valuable insights into the future of mental health care, patient-centric approaches, and the unique power of journaling in therapy sessions.Timestamps from the episode:[00:15:00] Introduction of external therapists and Texas Tech students for ketamine-assisted psychotherapy best practice sharing and learning.[00:16:00] Discussion on training and consulting, merging therapy and medical model into a psychedelic model, especially in a small conservative town that might not be receptive to ketamine treatments initially.[00:22:00] Conversation on the benefits of patients live-journaling during treatment sessions.[00:23:00] Follow-up on a patient's journey resolving suicidality, PTSD within a month, and most symptoms in eight months.[00:24:00] Emphasis on patient-directed treatment guided by inner wisdom, safety, and curiosity.[00:25:00] Highlighting Osmind's role as an easy-to-use electronic health record in care delivery.[00:32:00] Encouragement for patients to use the Osmind app for journaling while adjusting to their needs.[00:33:00] Dialogue about transitioning from paper to Osmind's electronic health records, including home access and consent form delivery.[00:34:00] Further talk on electronic health records transition, consent form reformatting for mobile, and the advantages of letting patients fill forms from home.[00:35:00] Process of moving existing patients to an electronic system, including writing summary notes and archiving old records. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

In Psychiatry Tomorrow, we'll delve into the challenges and opportunities that lie ahead. We'll explore the delicate balance between new evidence-generating practices and timeless therapeutic wisdom. Our podcast is not intended to be individual medical advice. Rather, our goal is to create a space for critical and in-depth conversations about where the field has been, and make predictions on where it's going. ‍ As we navigate the complexities of this new era for psychiatry, we strive to be a reliable beacon amidst uncertainty—a compass directing you toward the forefront of mental health innovation. We'll bring together thought leaders and mental health professionals advancing the field in groundbreaking ways, from neuromodulation and rapid-acting antidepressants to metabolic psychiatry and psychedelic medicine. We’ll also share practical advice on starting and growing your professional practice to thrive amidst these changes. ‍ As you know, mental health takes a village, and clinical practice doesn’t exist in a vacuum. That’s why we’ll bring panelists together to discuss the broader issues that interact with mental health, from Ai and software applications to cultural policy shifts transforming how we practice. ‍ Together, let's transform mental health care by staying ahead of the curve and engaging in these vital conversations. Follow the Psychiatry Tomorrow podcast on your favorite podcast platform, and join us on this thrilling journey through psychiatry’s next frontier. See you in you the future! ‍ Ready to dive in?Find your favorite episode, and subscribe to Psychiatry Tomorrow on your favorite podcast platform. That way, you won't miss a new episode!Behind the Cover: In ancient Greek, the word for butterfly was "psyche," which means the "mind" or "soul."Just as a butterfly emerges from its cocoon, the state of the butterflies being set free mirrors the journey of withdrawal and depression often experienced by those impacted by mental illness—to emerging anew with potential for change and growth.In "Psychiatry Tomorrow," we navigate the challenges and opportunities of the future. Our cover art features a statue's head that opens to reveal a renaissance of new perspectives, breaking away from entrenched ways of thinking.Join us as we explore the ongoing metamorphosis of psychiatric care. Together, we’ll chart psychiatry’s next frontier. Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

In this episode, we engage in a nuanced discussion with Dr. Awais Aftab, a leading figure in critical psychiatry, exploring key issues in the field. We distinguish critical psychiatry from "anti-psychiatry," explore the influence of cultural movements on mental health discourse, and discuss the role of service users in advocating for better care. Dr. Aftab shares insights on the role and challenges of crisis hotlines, advocates for a shift in focus of inpatient psychiatric care from risk management to therapeutic outcomes, and discusses the potential and pitfalls of telepsychiatry. Join us as we aim for a more patient-centered approach in mental health care.What you'll learn in this episode:Understanding the landscape of critical psychiatry and contrasting it with the divisive term "anti-psychiatry"The role of cultural movements and groups like mad pride, service users, psychiatric survivors—in shaping language around how we conceptualize mental illnessThe role of service users in advocating for better care, especially regarding involuntary hospitalizations and crisis hotlinesHow practicing psychiatrists can move the field forward in a meaningful way Dive deeper into these insights in the full blog post (coming soon) Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

The "placebo effect" gets a bad rap. The human mind is a powerful thing, capable of incredible feats of healing and transformation. Nowhere is this more evident than in the world of psychedelic research. Dr. Boris Heifets has spent years studying the neurobiological underpinnings of these compounds, but he knows that their true power lies in something much deeper. In this interview, Dr. Boris Heifets discusses:•His efforts to understand the neurobiological underpinnings of psychedelics, and how that translates to the future of psychiatry•The healing power of suggestion (and an amazing first-person account)•How he uses his knowledge to turn ideas into real-world applications Read the summarized blog post of this interview (originally published in Northern California Psychiatric Society Magazine). Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice

In this enlightening episode, host Carlene MacMillan, M.D., and guest Brittainy Wagner, LPC, delve into the potential of Esketamine (SPRAVATO®) as a breakthrough solution for treatment-resistant depression and acute suicidality. They explore how to successfully incorporate this novel treatment into your psychiatric practice, despite challenges like navigating the REMS program and understanding complex billing procedures.Listen in as they provide a deep dive into the essential facets of SPRAVATO®: its function, typical treatment protocol, potential side effects, and the crucial SPRAVATO® REMS program. The episode also covers patient eligibility, crafting a comfortable treatment space, and tips on streamlining REMS administration for your practice.The conversation doesn't stop there. Carlene and Brittainy also tackle the often perplexing topic of reimbursement, offering insights into the cost of SPRAVATO®, understanding billing codes, and how to navigate Medicaid reimbursement. They also discuss potential financial assistance through the Janssen Carepath program and strategies for dealing with common payer issues.Finally, they highlight how Osmind EHR's integration with SPRAVATO® REMS program can save hours of administrative work, allowing you to focus on patient care. Tune in to learn how to make offering SPRAVATO® simpler and more profitable.Read the quick and comprehensive guide to adding SPRAVATO® to your practice here. You'll learn:What is SPRAVATO® (esketamine)?What is the typical treatment protocol for SPRAVATO?What are the Potential Side Effects of SPRAVATO®?What is the SPRAVATO® REMS program?How can you set up a comfortable treatment space?How can you streamline REMS administration and protect yourself?How do you navigate reimbursement challenges? Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice