Publications

As we find ways to treat the toughest cases of treatment-resistant mental illness, we have published numerous articles about our approach and methods in both scholarly and popular journals.

Here are some worth noting:

    • author: Steven R. D. Best, Dan Pavel

    • publication: Psychiatric Times, May 2025

    • abstract: The article explores the challenge of treating refractory (treatment-resistant) bipolar depression when traditional approaches—such as medications, counseling, and lifestyle changes—fail. In a case study, Brain SPECT imaging revealed significant cerebral perfusion abnormalities, guiding clinicians away from further oral medications and toward brain stimulation therapies. The team chose a novel combination therapy: high-intensity, low-frequency transcranial magnetic stimulation (TMS) at 1 Hz, administered with procedural sedation using moderate doses of ketamine to ensure patient comfort. This combination not only increased brain perfusion and neuroplasticity but also led to dramatic clinical improvement, with sustained remission in over 85% of similar cases. The article highlights the value of perfusion imaging and the synergistic effects of TMS and ketamine in addressing the underlying neurophysiology of treatment-resistant depression

    • link to the article on psychiatrictimes.com

    • authors: Steven R. D. Best, Dan G. Pavel, and Natalie Haustrup

    • publication: Heliyon, 2019

    • abstract: This retrospective clinical review examined the safety and effectiveness of a novel combination therapy—transcranial magnetic stimulation (TMS) with ketamine analgesia (CTK)—for patients with treatment-resistant depression (TRD). Twenty-eight patients who had not responded to other treatments received high-output TMS and biomarker-guided ketamine infusions. The study found a significant reduction in depression severity, as measured by the Clinical Global Impression (CGI) scale, which was sustained for two years after treatment. The combination allowed for higher TMS intensities than usual, with no major adverse effects. The authors conclude that CTK can be a promising long-term therapy for TRD.

    • PDF Article

    • authors: Steven R. D. Best, Natalie Haustrup and Dan G. Pavel

    • publication: frontiers in Psychiatry, 2022

    • doi: 10.3389/fpsyt.2021.713141

    • abstract: The article explores the use of Single Photon Emission Computed Tomography (SPECT) as a functional brain imaging tool to assess and monitor the effects of novel treatments in patients with complex neuropsychiatric conditions. The study presents six case studies where SPECT imaging was used to evaluate the efficacy of treatments such as combination transcranial magnetic stimulation with ketamine infusions (CTK), hyperbaric oxygen therapy (HBOT), and perispinal administration of etanercept (PSE). The findings suggest that SPECT imaging can serve as a valuable biomarker for monitoring clinical changes and guiding treatment decisions in psychiatry.

    • PDF Article

  • author: Steven R. D. Best

    • publication: Psychiatric Times, January 2026

    • abstract: Evidence suggests that treatment-resistant depression (TRD), neuropathic pain, and substance use disorders (SUDs) share a common "triple network" dysfunction characterized by overactivity in the Default Mode Network (DMN) and Salience Network (SN), alongside hypoactivity in the Central Executive Network (CEN). Ketamine facilitates rapid, systemic neuroplasticity and acute suppression of the DMN, while transcranial magnetic stimulation (TMS) provides targeted, circuit-specific modulation to restore CEN-mediated top-down regulation. Their combined use appears to enhance treatment durability and clinical efficacy compared to monotherapy, while potentially mitigating the discomfort associated with high-intensity TMS.

    • link to the article on psychiatrictimes.com