What Does Interventional Psychiatry Actually Mean? Reframing Non-Standard Treatments for Depression

Lara Shirikjian, MD, discussed practical approaches to treatment sequencing in major depressive disorder, the clinical utility of early antidepressant response in decision-making, and the evolving application of interventional psychiatry at the Southern California Psychiatry Conference.

Shirikjian addressed the limitations of conventional antidepressant sequencing, in which patients cycle through multiple selective serotonin reuptake inhibitors before alternative treatment modalities are considered. She argued that this approach prolongs unnecessary suffering and that the field is moving toward earlier consideration of non-standard treatments. She acknowledged the real-world constraints of insurance-based practice—including prior authorization requirements and step therapy mandates—but noted that clinicians retain the ability to advocate for patients through formal documentation of clinical necessity.

On early treatment response, Shirikjian cited the established evidence base indicating that symptom movement within the first 2 weeks of antidepressant therapy is a meaningful predictor of longer-term remission, and that absence of early improvement is associated with substantially lower likelihood of eventual response.¹ She emphasized that this signal should be used to guide earlier treatment modifications, while still allowing an adequate therapeutic trial at a sufficient dose. She also noted that early symptomatic improvement supports patient engagement and behavioral activation, without which patients may disengage from other health-promoting behaviors that contribute to recovery.

Shirikjian reframed the concept of interventional psychiatry as broader than its name implies, encompassing any FDA-indicated treatment that departs from conventional oral antidepressant monotherapy—including esketamine, electroconvulsive therapy, and transcranial magnetic stimulation—rather than implying invasiveness or high risk.² She encouraged clinicians to expand their practice through education and referral partnerships rather than feeling compelled to offer all modalities personally, noting that collaborative care models allow psychiatrists to maintain their primary therapeutic relationship while patients access specialized interventional services elsewhere.

Dr Shirikjian is a psychiatrist and medical director and principal investigator at CenExcel clinical research.

References

1. Belanger HG, Lee C, Poliacoff Z, et al. Early response to antidepressant medications in adults with major depressive disorder: a naturalistic study and odds of remission at 14 weeks. J Clin Psychopharmacol. 2023;43(1):46–54.

2. Idlett-Ali SL, Salazar CA, Bell MS, et al. Neuromodulation for treatment-resistant depression: functional network targets contributing to antidepressive outcomes. Front Hum Neurosci. 2023;17:1125074.