Real-World Patterns of Interventional Psychiatry Use in a Tertiary Mood Disorders Service

Background: Interventional psychiatry procedures, including electroconvulsive therapy (ECT), intravenous ketamine, intranasal esketamine, and repetitive transcranial magnetic stimulation (rTMS), are increasingly used in patients with severe or difficult-to-treat mood disorders. However, less is known about real-world patterns of use within tertiary care services. Methods: We conducted a retrospective observational study of 1004 patients referred to a tertiary mood disorders service, of whom 894 had sufficient clinical data for analysis. Use of interventional psychiatry procedures and modality-specific patterns were examined using descriptive analyses and multivariable logistic regression models based on baseline clinical variables. Results: Overall, 302 patients (33.8%) received at least one interventional psychiatry treatment. Patients receiving these interventions more frequently presented with treatment resistance, disability, prior psychiatric hospitalization, and lifetime suicide attempts. Major depressive disorder was more common than bipolar disorder among treated patients. rTMS was the most frequently used modality (52.3%), followed by ECT (39.8%), intravenous ketamine (29.3%), and intranasal esketamine (4.3%). Across modalities, partially overlapping clinical profiles were observed, with age, comorbidity, and treatment resistance differing across groups. Conclusions: Interventional psychiatry treatments are commonly used in tertiary mood disorders services and are applied across overlapping clinical contexts shaped by illness burden. These findings describe real-world patterns of care in a specialized clinic and may inform future research on treatment sequencing and service planning.