Sandhya Prashad, MD is the medical director at Houston Ketamine Therapeutics and Houston Deep Transcranial Magnetic Stimulation (TMS) Therapy.
There is no question that the pandemic has shaped myriad aspects of life as we know it, including significantly impacting the mental health care industry. While the unprecedented events have resulted in mental health challenges, it has also delivered growth in the area as well.
“The pandemic has helped break down barriers such as the stigma around treatment, access to care in terms of proximity and available time, and even common misconceptions of what it means to receive treatment for depression.”
In fact, the appetite for treatment has increased so much that providers are finding it challenging to accommodate the surge of requested appointments.1 This newfound openness among patients to explore therapy has served as a means to deliver more care to those who have lived in silence for years due to either apprehension around going into an office or limited understanding around just how far treatment options have come.
Teletherapy has helped shepherd more patients through the door
Leveraging teletherapy has helped providers and patients troubleshoot the common concerns around social distancing and, ultimately, could be credited with getting many first-time patients in the “virtual” door. In fact, the use of teletherapy saw a 154% increase in March 2020 when compared to the same period in 2019.2 The ability to connect with patients in the comfort and privacy of their own homes allowed providers to build rapport over time and helped spark many overdue conversations around tailored options for treatment. While the convenience of teletherapy is likely to foster continued use long after the pandemic subsides, it is important for providers to remind patients that it is not a direct substitute for an in-person visit nor is it the only form of treatment available.
Taking the next step in treatment with the latest technology
Marrying the increased desire to speak with providers and the ability to ease into sessions via virtual visits, providers like myself have a unique opportunity to begin educating patients that mental health treatment is not a one-size-fits-all approach. Studies have shown that depression symptom prevalence is more than 3-fold higher3 during the COVID-19 pandemic, and because more than 40% of people with major depressive disorder (MDD), 4 find they are treatment-resistant, there is a growing need to foster education among patients regarding other available options when there is an unresponsiveness to traditional methods.5 These options include deep transcranial magnetic stimulation (Deep TMS), a non-invasive treatment process that is FDA-cleared for treating depression and obsessive-compulsive disorder (OCD). While well-known within the mental health community, many patients are unaware of this successful treatment option which only takes 20-minutes per session.
In a study published by the Journal of Psychiatric Research, Deep TMS therapy combined with standard medication for MDD was found to be significantly more effective than standard pharmacotherapy alone, reducing the symptoms of close to two-thirds of participants battling depression.6 Deep TMS is a great example of how far we have come in treatment offerings, showing patients that there are treatments that do not require downtime, are noninvasive, and offer virtually no discomfort.
Moving forward in the new normal
While we as a society are working hard to leave the pandemic behind as a footnote in history, we as mental health professionals have been given a catalyst for a mental health movement. The pandemic has helped break down barriers such as the stigma around treatment, access to care in terms of proximity and available time, and even common misconceptions of what it means to receive treatment for depression. It is our responsibility as those committed to improving mental health to look for every opportunity we can to serve and educate, and the pandemic has certainly provided us with a platform.
Sandhya Prashad, MD is a board-certified psychiatrist specializing in interventional modalities for treatment-resistant disorders with a particular interest and expertise in ketamine therapy. She is the founder and medical director of Sandhya J. Prashad, MD, Houston Ketamine Therapeutics, and Houston TMS Therapeutics. Dr. Prashad currently serves as president of The American Society of Ketamine Physicians, Psychotherapists, and Practitioners.
1. Caron C. ‘Nobody Has Openings’: Mental Health Providers Struggle to Meet Demand. The New York Times. https://www.nytimes.com/2021/02/17/well/mind/therapy-appointments-shortages-pandemic.html. Published online February 17, 2021. Accessed February 17, 2021
2. Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic — United States, January–March 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1595–1599. doi:10.15585/mmwr.mm6943a3
3. Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686
4. Major Depressive Disorder and TMS Treatment. Brainsway. https://www.brainsway.com/knowledge-center/major-depressive-disorder-tms-treatment/. Accessed February 9, 2019
5. Jaffe DH, Rive B, Denee TR. The humanistic and economic burden of treatment-resistant depression in Europe: a cross-sectional study. BMC Psychiatry. 19, 247 (2019). doi:10.1186/s12888-019-2222-4
6. Filipčić I, Šimunović Filipčić I, Milovaca Z, et al. Efficacy of repetitive transcranial magnetic stimulation using a figure-8-coil or an H1-Coil in treatment of major depressive disorder; A randomized clinical trial. J. Psychiatr. Res. 2019;114:113-119. doi:10.1016/j.jpsychires.2019.04.020
Original Article: https://www.psychiatryadvisor.com/home/topics/general-psychiatry/teletherapy-helps-shepherd-more-patients-through-the-door/Learn More
American Society of Ketamine Physicians, Psychotherapists and Practitioners Announces Standards of Practice in the Therapeutic Use of Subanesthetic Ketamine
BELLAIRE, Texas, Aug. 11, 2020 /PRNewswire/ — Ketamine, which was originally developed as an anesthetic, has emerged over the last two decades as the biggest breakthrough in 50 years for treatment-resistant depression and suicidality. Despite a growing body of research surrounding its use, guidelines establishing recommendations for best practices have been limited. The American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3) is a group of professionals dedicated to the safe and clinical use of ketamine for mental health disorders and pain conditions that was developed in 2016 and has over 400 members of various specialties. ASKP3 recognizes the lack of formal guidance and seeks to protect and foster the use of subanesthetic ketamine by providing recommendations for standards of practice. (more…)Learn More
This past week the American Journal of Psychiatry published an exciting new study “Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression (SAINT),” which is highlighted in this recent piece in Inverse. We interviewed our Chief Services Officer and co-founder Owen Muir, MD, who was excited to explain how this treatment works, why it’s so important, and how it’s helping to treat depression. (more…)Learn More
A new indication of Janssen’s ketamine based-nasal spray Spravato (intranasal esketamine) has been approved for rapid reduction of depression symptoms in those with major depressive disorder who have imminent risk of suicidal ideation, according to Houston-based psychiatrist Sandhya Prashad.
“The original indication for treatment-resistant depression meant that patients had failed treatments before. This is more for emergency cases” detailed Prashad. “It opens the door to the idea that this is a great treatment for severe depression with suicidal ideation. Traditional antidepressants can take weeks to start working. The availability of a medication that can start to reduce symptoms within one day is very significant.”
Spravato was first approved by the FDA strictly for patients with treatment-resistant depression, requiring at least two medication failures, and insurance often required patients to have three or four medication failures before this treatment was an option. This new approval opens the door for those with the most severe symptoms to be treated even if they have not failed multiple treatments.
Prashad, along with many of her colleagues and contemporaries in the industry, hopes that this will open up more leeway for providers to allow more at-risk individuals to receive this important new treatment.
“Ketamine or esketamine shouldn’t be the last line. It doesn’t have to be a last resort.” Prashad further detailed how ketamine and Spravato are so vital for treatment of depression with suicidal ideation. “This is a unique property of ketamine, this quick reduction in depressive symptoms that translates into reduction in suicidal thoughts. This is potentially life saving for some patients. Many of our patients will say that even if they still feel depressed after a ketamine infusion, they no longer feel like they want to attempt suicide. It’s an effect only seen with ketamine. Other treatments in psychiatry do not have this rapid, robust effect.”
This new treatment could not come at a more pertinent time. In 2017, suicide was the tenth leading cause of death in the United States, claiming the lives of over 47,000 people per the CDC WISQARS Leading Causes of Death Reports. This is more than twice the amount of homicides in the United States in the same year.
Ketamine was first synthesized in the early 1960s and has seen extensive use as an anesthetic and pain reliever since then, but new research in the last two decades has revealed its potential as a treatment for mood and pain disorders. Some doctors and medical professionals such as Thomas Insel, former Director of the National Institute of Mental Health, are saying ketamine may be “the most important breakthrough in antidepressant treatment in decades.”
Sandhya Prashad, MD – Dr. Sandhya Prashad, board-certified Psychiatrist based in Houston, has specialized in treatment-resistant depression and has been using ketamine in her practice since 2016. She is the founder and medical director of Houston Ketamine Therapeutics and Houston Deep TMS Therapy (www.sprashadmd.com) A graduate of Baylor College of Medicine for both Medical School and Psychiatry Residency, she has presented on the national level at conferences regarding the use of ketamine. She is a founding member and the President of the American Society of Ketamine Physicians, Psychotherapists, & Practitioners (www.askp.org), which is a non-profit organization created to advocate for the safe use of ketamine for mental illness and pain disorders and to expand access to ketamine therapy. Dr. Prashad was also named one of Houston’s Top Doctors by H Texas Magazine for 2017, 2018 and 2019.
The Janssen Pharmaceutical Companies of Johnson & Johnson released more information found in this press release.
About SPRAVATO® – SPRAVATO® (esketamine) CIII nasal spray is a non-selective, non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor – an ionotropic glutamate receptor. It has a novel mechanism of action, meaning it works differently than currently available therapies for major depressive disorder (MDD).
SPRAVATO® is approved in the United States, in conjunction with an oral antidepressant, to treat adults with treatment-resistant depression (TRD) and depressive symptoms in adults with MDD with acute suicidal ideation or behavior. SPRAVATO® has been submitted for health authorities’ review for TRD and adults with MDD who have current suicidal ideation with intent in other markets around the world, including Europe. The FDA granted Breakthrough Therapy Designation to esketamine nasal spray for TRD in November 2013 and for MDD with imminent risk for suicide in August 2016.
About the Phase 3 Studies – ASPIRE I and ASPIRE II evaluated the efficacy and safety of SPRAVATO® in addition to a comprehensive standard of care in adult patients with major depressive disorder who had active suicidal ideation with intent. This is the first global clinical program to study this severely ill patient population, who have been typically excluded from antidepressant clinical trials, addressing a great unmet need. Patients were defined as those with major depression and active suicidal thoughts with intent. Every patient was treated with a comprehensive standard of care in both trials to safely and ethically conduct the studies. The comprehensive standard of care included initial hospitalization, a newly initiated or optimized oral antidepressant and twice-weekly treatment visits for four weeks.
The primary efficacy endpoint of the double-blind, randomized, placebo-controlled, multicenter studies was a reduction in depressive symptoms at 24 hours after the first dose, as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). The MADRS scale is a tool used to assess severity of depressive symptoms, allowing clinicians to evaluate 10 symptoms on a six-point scale to produce a total score of up to 60 points. A secondary efficacy endpoint measured improvement in severity of suicidality as measured by the revised Clinical Global Impression of Severity of Suicidality (CGI-SS-r), a seven-point scale developed by clinical experts that is a measure of the severity of suicidality as judged by the clinician’s global impression.
Originally posted on KetamineNews.Learn More
An option for people who don’t see successful results from standard depression treatments like talk therapy or antidepressants is transcranial magnetic stimulation (TMS). Research shows that this non-invasive technique, which uses electromagnetic fields to stimulate nerve cells in the brain, can fill the therapeutic void left when other treatments fail.Learn More
In March 2019, intranasal esketamine—a form of ketamine marketed as SPRAVATO™ CIII Nasal Spray*—was approved by the U.S. Food and Drug Administration (FDA) to treat patients with treatment-resistant depression (TRD). James Murrough, MD, PhD, Director of Mount Sinai’s Depression and Anxiety Center for Discovery and Treatment, was deeply involved in the research that led to esketamine’s FDA approval. In November 2019, he launched a TRD Program at the Icahn School of Medicine at Mount Sinai, featuring esketamine as a treatment option. Below, Dr. Murrough breaks down the top five things to know about esketamine based on his experience over the past decade.Learn More
For many people coping with major depressive disorder—which includes different types of depression that persist for at least two weeks—antidepressants can play an invaluable role in helping relieve symptoms, enabling them to resume the life they once enjoyed. But for those who experience a form known as treatment-resistant depression (TRD), standard medications tend to provide little to no relief.Learn More
It goes without saying that COVID-19 is on the minds of nearly every American. The societal and economic disruption is almost without precedent. As government officials and clinicians wrestle with issues of how to protect the public, there seem to be more questions than answers. The mental health effects of COVID-19 are as important to address as are the physical health effects. Social isolation, school closures, lack of structure, financial difficulties, and unemployment are among the many stressors related to COVID-19 that have significant impacts on mental well-being.Learn More