The Brain-Behavior Clinic (BBC) recognizes the challenges of providing safe and effective treatment for mood disorders and is dedicated to the study and provision of innovative treatments for adults with depression and bipolar illness. Located at the New York State Psychiatric Institute at the Columbia Presbyterian Medical Center, it provides treatment to eligible adults by a specialized staff of psychiatrists, social workers and nurses at no cost to the patient.

15% of all adults living in the U.S. suffer from some form of a mood disorder. While antidepressant medications and psychotherapy are frequently effective for depression, some people do not fully respond to these treatments. Recent technological advances have made a variety of new interventions for modulating brain function available. It is these therapies that are being investigated at our Service.

Our staff of specialists is involved in cutting edge research on the brain and its relationship to psychiatric disorders. Using brain imaging, neuropsychological testing and the analysis of endocrine functioning, we hope to understand both the causes and treatments of depression and other psychiatric disorders better.

Frequently Asked Questions:

Who comes to the Brain Behavior Clinic?
Our clinic specializes in treating adults who suffer from various types of psychiatric disorders, including depression, schizophrenia, obsessive-compulsive disorder, depersonalization disorder, and autism. Our patients are diverse, ranging in age from 18-90. Many have been treated in the past either with psychotherapy or with medication, while others are seeking treatment for the first time. We offer new and innovative treatments for all people, even for those whom previous treatments have not been effective.

What can I expect during my first visit to the Clinic?
The first consultation involves a comprehensive interview with an experienced psychiatrist and social worker. During this interview you will be asked questions about your mood, sleep patterns, energy level and appetite. In addition, it may be necessary to perform a simple blood test or physical examination so that we can accurately diagnose your illness and other medical conditions. Upon completing the evaluation, your doctor will discuss with you the diagnosis of your illness, along with recommendations for treatment.

What types of treatment do we offer?
Our Clinic offers numerous innovative treatments for various psychiatric disorders. They include:

Transcranial Magnetic Stimulation (TMS): The BBC is a leader in research on this new treatment for both depression and other psychiatric illnesses. TMS is a non-invasive means of stimulating the brain using magnetic fields. TMS is administered by holding a magnetic coil on the head. The coil is about the size of a ping-pong paddle. This coil generates a strong but brief magnetic field. The field enters the brain, where it stimulates the brain cells, or neurons. If the coil is held over the area of the brain that causes movement, the TMS will elicit a twitch in the muscle whose brain representation we are focusing on.
TMS has proven to be a useful tool in studying brain function. Combined with functional neuroimaging (PET, or fMRI), TMS can map brain circuits underlying complex functions like language, memory, vision, the control of movement, and even emotional processes. Our clinical interest in TMS focuses on its potential utility as a focal treatment for depression and other disorders. Functional neuroimaging studies can teach us about the regions of the brain that are not functioning normally, and TMS can be applied to those regions in an attempt to normalize their function. The idea is to target the intervention to the site of the problem.
Studies to date have suggested that TMS may be of some use in treating depression, but we are still a long way from knowing how best to use it. More studies are needed to teach us the proper dosage and how to select the patients most likely to respond to this form of treatment. TMS remains experimental. It is not currently approved by the Federal Drug Administration and is only available in the context of approved research studies. The BBC has conducted a number of clinical trials with TMS in mood disorders, Parkinson’ disease, and other psychiatric disorders.

Study Information for Protocol #4892 Repetitive Transcranial Magnetic Stimulation (rTMS) In The Treatment Of Negative Symptoms And Social Dysfunction In Schizophrenia Patients.

Further information about TMS may be found at the following websites:

Please click here for a video clip about RTMS study.

http://www.elsevier.com/homepage/sah/ifcn/doc/rtms-inf.htm
http://news.bmn.com/hmsbeagle/110/notes/feature2
http://cnn.com/HEALTH/9803/20/magnets.depression/index.html
http://www.msnbc.com/modules/exports/ct_email.asp?/news/767738.asp
http://www.salon.com/health/feature/2000/10/03/tms/index.html
http://www.sciencemag.org/cgi/content/full/292/5520/1284
http://www.sciencenews.org/20000923/bob2.asp

Information about some of our own basic research using TMS to map brain function can be found at the following website
(http://cpmcnet.columbia.edu/news/in-vivo/Vol1_Iss11_june26_02/overcoming.html)

Magnetic Seizure Therapy (MST): MST refers to the use of magnetic stimulation as a new way to perform convulsive therapy that may have fewer side effects than conventional electroconvulsive therapy (ECT).
ECT is highly effective for severe depression, but it also can cause significant side effects like memory loss. ECT works by sending electric currents through the brain to induce a seizure. The skull’s resistance to electrical current limits our ability to refine the treatment and reduce its side effects.
Magnetic stimulation may offer a better way to perform convulsive therapy because magnetic fields enter the brain more easily than the electricity used with ECT. This means that the magnetic fields can be focused more precisely on specific regions of the brain important to depression, allowing us to avoid the regions of the brain that control memory.
MST was developed here at Psychiatric Institute. After extensive pre-clinical testing, we started trials with MST in patients with depression in May of 2000. To date, our preliminary data suggest that MST has fewer side effects than ECT, and is more easily tolerated. Patients generally report that MST does not significantly affect their memory. We are testing the efficacy and side effects of MST in an ongoing clinical trial. In this study, there is no placebo (i.e. all patients receive real MST). Patients are admitted free of charge to the inpatient unit at NYSPI to receive the MST treatments three times a week. If MST is not fully effective, patients have the option of staying on to receive conventional treatment (including medications and/or ECT).

Electroconvulsive Therapy (ECT): ECT is the most effective antidepressant treatment available. Specialists at the Brain and Behavior Clinic are recognized for their expertise and contributions to the refinement of this treatment modality for patients world-wide.

What does treatment entail? What is the level of commitment required?
If eligible for one of our studies, you will have a physical exam, a routine blood work-up and an electrocardiogram prior to beginning treatment. Routine visits to the clinic allow us to closely monitor you, providing optimal clinical care. During each visit you will meet with your doctor and social worker to discuss your progress and the effectiveness of the treatment. Our treatment programs vary in length, generally requiring the patient to come to the clinic weekly for about 6-8 weeks. In some cases, patients come daily for treatment or may be admitted to our inpatient unit. Following this acute period, we continue to treat patients on a less frequent basis.

What is the cost of treatment?
There is none. The Brain Behavior Clinic is supported by private and public funding, and all evaluation services are provided at no cost to the patient. In addition, for those patients who are eligible for our studies, treatment is available at no cost. This includes all doctor’s visits, routine lab work, any research treatment administered, and inpatient stay if required as part of the protocol.

Federal Drug Administration (FDA) approval?
Since we specialize in innovative treatments, many of the treatments that we study are not yet FDA approved. All of our research studies, however, are conducted with approval of the NYSPI Investigational Review Board (research ethics committee). Since some of our studies involve investigational devices, (Transcranial Magnetic Stimulation and Magnetic Seizure Therapy), our therapeutic research trials involving TMS and MST are being conducted under the auspices of an Investigational Device Exemption from the FDA.

For more information: To learn more about our free treatment programs for depression and bipolar illness, or to schedule an evaluation appointment, please call our clinic coordinator at (212) 543-5767.

Basic Information:

Director: Sarah H. Lisanby, M.D.
Associate Professor of Clinical Psychiatry, Columbia College of Physicians and Surgeons,
Director, Columbia University Division of Brain Stimulation and Therapeutic Modulation
(http://www.dr_lisanby.yourmd.com )

Address: Brain Behavior Clinic
New York State Psychiatric Institute (NYSPI)
1051 Riverside Drive, Room 1501
New York, NY 10032

Clinic Hours: Tuesdays, 1-5 pm; Thursdays, 9-12pm; by appointment only

Phone: For appointments, call (212) 543-5767.