The Future of Psychiatry with Dr. Muir: VNS, eTNS, PRISM, TMS, Spravato, & More | Psychofarm Podcast

This podcast explores the cutting-edge future of interventional psychiatry, focusing on neuromodulation treatments like transcranial magnetic stimulation (TMS), non-invasive vagus nerve stimulation (GammaCore NVNS), external trigeminal nerve stimulation (Monarch ETNS), Prism neurofeedback, and esketamine (Spravato). Dr. Owen Muir discusses how these innovations are transforming the field.
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Psychiatry is evolving beyond traditional medication-based treatments, and this podcast dives deep into the latest advancements in neuromodulation and interventional psychiatry. Dr. Owen Muir, a leader in the field, breaks down transcranial magnetic stimulation (TMS), advanced TMS protocols, Prism neurofeedback, non-invasive vagus nerve stimulation (NVNS) using GammaCore, external trigeminal nerve stimulation (ETNS) with the Monarch device, and esketamine (Spravato). These FDA-cleared and emerging treatments are transforming care for treatment-resistant depression, PTSD, ADHD, and migraine disorders, offering hope to patients who have not responded to conventional therapies.

One of the most promising treatments discussed is non-invasive vagus nerve stimulation (GammaCore NVNS), a handheld device that delivers electrical stimulation to cranial nerve 10. Originally FDA-cleared for migraine and cluster headaches, it is now being investigated for depression and PTSD. Dr. Muir shares a case study of a patient with severe, treatment-resistant depression who achieved remission after three weeks of GammaCore use, highlighting the potential of neuromodulation beyond its current indications. Unlike older implantable vagus nerve stimulators, this device is completely non-invasive and avoids the risks of surgery.

For ADHD, external trigeminal nerve stimulation (ETNS) with the Monarch device is a game-changer. This FDA-approved device for pediatric ADHD and epilepsy stimulates the trigeminal nerve while patients sleep. Clinical trials show that in 50% of children, Monarch ETNS is twice as effective as stimulant medications, making it a powerful non-pharmacologic alternative for ADHD treatment. Unlike stimulants, ETNS does not cause appetite suppression, insomnia, or increased heart rate, making it a preferred choice for some patients, particularly those with emotional dysregulation who do not respond well to stimulants. Dr. Muir personally uses Monarch ETNS instead of stimulant medications, reporting improved focus, attention, and sleep quality.

The podcast also explores Prism neurofeedback, an AI-driven brain-training system that uses EEG and fMRI synchronization to help patients with PTSD regulate their amygdala response. Unlike traditional biofeedback therapies, this approach does not require a psychologist to guide the process. Instead, patients use a video game interface that trains their brain to reduce hyperactive fear responses, providing a non-invasive, non-medication treatment for PTSD. This technique allows for trauma therapy without requiring patients to relive traumatic experiences, making it a revolutionary approach for individuals struggling with severe PTSD.

Beyond the treatments themselves, this podcast highlights the systemic challenges facing neuromodulation and psychiatric innovation. Insurance companies often lag behind scientific research, limiting access to new treatments. TMS, for example, is only covered under rigid guidelines that do not yet reflect the benefits of accelerated TMS protocols. Dr. Muir discusses potential policy solutions such as the Breakthrough Treatments Act, which could force Medicare and commercial insurers to cover FDA breakthrough-designated treatments within three months, increasing access for patients.

Artificial intelligence (AI) is also shaping the future of psychiatry. AI-assisted diagnostic tools can already detect tardive dyskinesia (TD) more accurately than human raters, eliminating racial bias in assessments. Future AI applications could help identify which neuromodulation treatment will work best for an individual patient, reducing trial-and-error prescribing and personalizing mental health treatment like never before.

Tune in to this fascinating conversation on how psychiatry is changing, why neuromodulation is the future, and how policy, payment models, and education must evolve to ensure these treatments reach those who need them most.