The Frontier Psychiatrists

I’m a fan of a good interview, especially when there is breaking news to discuss. Ways to measure the brain, including EEG, have been news on this newsletter for some time. We’ve had Universal Brain at our RAMHT events. I gave 256 lead EEG from EGI (part of Magstim) on my head just the other week in the office. I’ve written about our work with PRISM EEG-fMRI neurofeedback before. Heck, I’ve even published a little on novel cases myself.I’ve interviewed Dave DeCaprio, president of Firefly Neuroscience, right here on The Frontier Psychiatrists:Today’s video is the podcast version of the column from Friday…for those who enjoy a watch or a listen, I present…this podcast! This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

Dear readers, I’ve been a sceptic for too long. It’s easy to be sceptical as a psychiatrist—the flowers will be lour’d upon you! I’ve been using Graymatter’s Health PRISM EEG-fMRI neurofeedback system for a few years, it’s true. There are EEG leads on there. I saw a lot of EEG-related technology in Beijing. It’s possible I’m looking at an EEG in this very photo from my hotel room in China, below:But have I been measuring the brain with EEG regularly? Well, no, again! I’ve been content with my fancy fMRI scans alone, for SAINT, and giant brain healing magnets at set frequencies, like deep TMS with SWIFT.There are even videos of me talking about TMS, like this one below, with friends like Colleen Hanlon from BrainsWay, and heroic patients who chose to speak publicly, too.But one thing I haven’t routinely done is measure the brain itself as part of clinical care, as companies like Firefly Neuroscience are making possible. That may need to change, is the outcome in my personal brain as a result of this interview. I speak, at length, with Dave Decaprio, their president and COO.The EVOKE system provides multimodal analysis of brain function, including Quantitative EEG and Event-Related Potentials. From the Firefly website:At Firefly Neuroscience, our technology is built to measure and interpret brain function in a clinically meaningful way. The Evoke™ system combines quantitative EEG (qEEG) and event-related potentials (ERP) to capture both baseline brain activity and cognitive response during structured tasks.This data is analyzed against a proprietary normative database of over 191,000 EEG and ERP sessions, allowing clinicians to evaluate patterns relative to age-matched expectations and track changes over time. The result is a structured, interpretable view of brain function that can be used alongside clinical evaluation to support earlier insight, more informed treatment decisions, and a clearer understanding of patient progress.I haven’t used it in clinical practice yet, but Dave makes a compelling case, and at this point I think it’s only a matter of time. Brain Medicine, as an emerging specialty, brings change. That change needs to be measured. EEG might be one such tool.I hope you enjoy today’s podcast! And thanks to Sharena Rice, PhD, William M. Sauve, MD, along with Dave, for their guest spots.—OwenAnnouncements: * You can Join The Frontier Psychiatrists LIVE at Psych Congress 2026. Get your tickets now!* You can buy a copy of my IRL in print book on Amazon, Inessential Pharmacology. It’s got a lot of good reviews, and one “one star” review, which, in the spirit of transparency, I will excerpt for you:The author has taken a collection of drug leaflets from pharmaceutical companies and woven them together with underwhelming lackluster commentary and memes. He intended to create an engaging reading experience, however, this aim should have been clearly stated, should have been made explicitly clear in the book description. He wanted to have fun writing it and wanted readers to have fun reading it. Now, having missed the return window, I find myself stuck with a book that feels more tedious than enjoyable.Don’t miss the return window if you hate my work! Good advice for us all. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

Thank you to everyone who tuned into our live video! Join Jeremy the therapist and I for our next live video in the app.As a brief aside, I have found that social media, when actually used to be Social, used to be a wonderful tool. I met Jeremy on Clubhouse, and we've never actually gotten to spend time together in person. I do think the synchronous communication allowed by Clubhouse, and by Substack Live, and others, in which you actually get to have a conversation, is as good as a phone call. My relationship with Jeremy has been fruitful, help change the way I think, and has led to a lot of great collaborations. I could say similar things about a number of other people, such as my friend and collaborator Burton Tabaac—we met on Twitter spaces, talking about NFTs, and have gone on write almost a dozen scientific papers together. I think the trick to being social is to actually be social. And one of the best ways to genuinely socialize is to work on something together. This newsletter is one example of a giant excuse to be social and connect with other people. I'm a writer, and I get to collaborate with other writers. I get to create something out of thin air with colleagues like Jeremy, Rob Glatter, Awais Aftab, Lila , Michelle Bernabe, RN , David Carreon, MD, and many more. Do something together, it's a great way to keep a friendship going. These kinds of friendships are more important and more nourishing than you can imagine over time, and doing something together—separated by space and even time— is still better than not doing that. When we get older, we get kids, we get a family, we get a house, we get a car accident to deal with, we have physical disabilities, we gain all sorts of problems that make it a lot harder than just playing with Legos together in person. But I think it makes a lot of sense to do things together. This video is one example of me doing something with a friend that we hope the rest of the world will get something out of. But I can't recommend it strongly enough as a component of a full, healthy life.But you know what, hanging out in person is cool too. Please join us for a live in-person event for readers of this newsletter and all of our friends in San Francisco on May 16. I think I'm going to do more of these, because I need more excuses to spend time with people in real life. The Live-Action Version of this Newsletter, RAMHT 2026 SF, is coming up on May 16th, 2026!Get a ticket now—it’s free if you ask. Just email us at [email protected] for your free code. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

Hi. I haven’t done a podcast in too long, so here is one!I’m introducing Brain Medicine. I’ve written about its ascendancy in the news this week.For those who’d like to read something today, I suggest this article about understanding Narcissistic Personality Disorder, in Prevention magazine, also published this week.For those about to listen to a quick podcast to start out their run, I offer the above. Also, I went to a flower show:Something for everyone!Advertising Moments: Inessential PharmacologyI have a new, PHYSICAL, IN-PRINT book available for purchase. Inessential Pharmacology is available from Amazon (affiliate link), in both hardback and paperback. Kindle ebook version is also available.RAMHT 2026 SF is coming up on May 16th, 2026!Get a ticket now—also, it’s free if you’re an APA (the psychiatric one) member. Just email us at [email protected] for your free code. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

One of the things I like about being on the Internet is that I get to meet the actual humans! There are people I've had real relationships with over many years, and some of them I've just never gotten to see in person yet. Making content on the Internet helps connect you to other people making content on the Internet, and if you're good at making friends, sometimes you can make a new friend. One such friend is featured in this podcast, and it's Annalisa Hanson—she is a therapist, who made some great content on TikTok, and then we hopped on the phone because we were such mutual fans, and then she joined me here on the podcast. Another guest on this episode is Dr. Mason Hargrave, we are also Clubhouse, and then he invited me to record a podcast in what was his apartment at the time. It's a classic.Today’s conversation grew out of a phone call with Annalisa and subsequent calls with Brandon In, Mason, Ahmed Tahseen, and my daughter Quinn.We “delve” into AI chatbots as a source of relationship advice. It’s quite the cautionary tale.The music is by Owen Muir, with some tunes a gift from my friend John Vanderslice. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

Schizophrenia is a really challenging illness. There's been a lot of progress made recently, I will note. I've already written about novel treatments like Cobenfy, and using accelerated transcranial magnetic stimulation for negative symptoms and positive symptoms in schizophrenia. One of the most bothersome of those “positive symptoms”—things that shouldn't be there, in someone's mind, but are—are auditory hallucinations. If you imagine having invisible AirPods that are playing a terrible podcast that you'd rather not be listening to, and that everyone else can't hear, you get a sense of how distracting it might be to have auditory hallucinations.In my previous article about the treatment of auditory hallucinations with transcranial magnetic stimulation (TMS), one of my favorite forms of brain stimulation, I highlighted promising results from early studies. Now we have a much larger Study, phase 3 trial, conducted over many years in Germany. We are even at the level of meta-analysis at this point!It’s a considerable study:138 adults with treatment-persistent auditory verbal hallucinations and schizophrenia spectrum disorder were randomly assigned (1:1) to receive 15 sessions of active (n=70) or sham cTBS (n=68) administered sequentially as 600 pulses to the left and 600 pulses to the right temporo-parietal cortex over a 3-week period.I called friends of the podcast—Dr. David Garrison, Dr. Will Sauve, and my mom, Vita Muir, to talk through this paper together, and what it might mean for individuals suffering from psychotic disorders. In the meantime, the team at Radial, where we provide such treatment, does some funny, tough-guy faces with our Ampa One system:Thanks for reading! A live-action newsletter event coming up on January 11th in San Francisco: RAMHT 2026 SF. Join us! This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

I wrote an article about this research before, available here. However, I also made a podcast for my audience about the topic! Antisocial Personality Disorder is usually considered untreatable. A new study from the Anna Freud Centre’s MBT program demonstrates a remarkably effective treatment.At Radial, this is the modality of therapy we specialize in providing. It is also effective in borderline personality disorder and in suicidal adolescents. However, with some riffs, it turns out, it also helps ASPD. I even wrote a book on this a while back, published by Springer Nature (Amazon affiliate link).This conversation features my mom, Lila , and David Carreon, M.D..If you enjoy it, please share it with others! This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

This is the podcast version of yesterday’s article. Yes, I Know It Has A Different Title.Thanks for listening.And if you are looking for care for yourself or a loved one…join us at Radial—where I work—we focus on next-generation treatments.They include Spravato, Nightware, eTNS, PRISM Neurofeedback, soon, eCOT-AS by Neurolief, TMS, Accelerated TMS, and fMRI-guided SAINT TMS.Radial offers the most advanced mental health care, anywhere. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

I was invited, thanks to the magnificent and only-ever-positive internet, to give a lecture to colleagues in Nigeria. I’m kidding, a little—the internet can be rough. Ask a comment section of a YouTube video! However, it is also a technology that has brought the world closer together. One of those less absurd corners of the internet is LinkedIn—it’s like the world’s most boring dad and his boss decided to invite you to a global-scale compliance educational module. “So exciting, it’s mandatory!”I am giving the internet a hard time. Sometimes it’s a special kind of magic. Like, for example, today. Imagine you are a progressive hospital system in Lagos, such as Gracehill Hospital. Yes, that is in Nigeria. It’s a progressive country, compared to the rest of the continent, but some of that progress is recent, as in 2023.A new Mental Health law was recently enacted in Nigeria to replace the Lunacy Ordinance of 1958. The passage of the new law was a major leap from the old. It was received with excitement because the former law was not only outdated but failed to address core issues such as the promotion of mental health and the protection of the rights of the mentally ill.If you're looking to move your healthcare system into the future, you might want to consider finding speakers for your grand rounds. With Zoom, it’s easy to host hundreds of people. On LinkedIn, you can see professionals posting about what they are up to. And, if you're bold, you can simply ask one of those folks to speak. Which is what happened to me, and how I found myself drafting a lecture on Bipolar Disorder for an audience of Nigerian (and global—many people, both professionals, patients, and family members attend these seminars!).Nigeria has an estimated 250 practicing psychiatrists for a population of over 220 million (WHO, 2023), amounting to roughly one psychiatrist per 880,000 people. I probably spoke to 1/4 of them yesterday.There are substantial barriers to mental health care in Nigeria—much if it financial. According to the World Bank, Nigeria’s Gross National Income (GNI) per capita in 2023 was $2,460 USD. Fewer than 10% of Nigerians have health insurance. Those plans cost $250+ a year, but mental health parity doesn’t exist, and thus those services are only covered under yet more expensive plans.To draw a direct comparison, Nigeria has 0.11 psychiatrists /100,000 population. This is similar to Kenya (0.2/100,000) but with 400% more money budgeted to address the care of the population. The US has 13/100,000 and spends about 6.2% of its health budget on mental health care.The question, globally, is how to do more for our patients with less harm and at lower cost. One interventional treatment is considered essential—and its ECT. The WHO's keep an “essential medicines” list! Nigeria has access to ECT. Lithium is also an essential medicine. TMS is not on that list, yet. Maybe, I posit, it should be?What follows in this podcast is the talk I gave. Thanks for reading— and listening. A huge shout out to my gracious hosts at GraceHill, and their Partners, who make this series possible!The Frontier Psychiatrists is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.If you are interested in the Validation Institute’s award for Best Mental Health Treatment in 2024, consider Radial. It’s where I work, and with locations across the US already, we are working to bring the most advanced mental health care to everyone and make it accessible. If you are looking for help, Radial offers the most advanced mental health care. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe

One of my great joys as a psychiatrist is the ability to collaborate with excellent colleagues. Irfan Handoo, M.D., of Kansas City Psychiatric Partners, is one such human. In this interview, we learn about how Dr. Handoo went from psychopharmacologist to interventional psychiatrist, why Kansas City is the best city in the world, and why being South Asian is the ultimate hack to get your patients the best care. It's really easy to think of doctors being completely burned out, and not caring about their patients. Being a physician is a tremendously challenging thing to do with one’s time, and many doctors have their compassion wear thin. This interview with Dr Handoo reminded me how much some of us care, all day, every day. He's an inspiration to me, and I hope, to my listeners also.I am delighted to bring you this interview! Prior articles featuring the work of Dr. Handoo include:Thanks for reading and listening!The Frontier Psychiatrists is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe