The Psych Commute with Dr. Brown

In this episode I step back from ECT specifically and give a broad, clinician-level overview of interventional psychiatry as a whole: what it is, how it differs from conventional psychiatry, and where the field may be going in the next decade. I start by contrasting conventional psychiatry with what I propose as a working definition of interventional psychiatry: An emerging subfield that encompass...

I cover a significant challenge in clinical psychiatry: distinguishing and treating unipolar vs. bipolar depression. A recent inpatient case prompted me to revisit the question of whether an antidepressant-induced manic episode could have been predicted, and more broadly, whether our traditional diagnostic split makes sense at all. I walk through a real-world clinical scenario: a patient with many...

In this third episode on electroconvulsive therapy, I dive into the details of how ECT is actually delivered at the machine level. I start by breaking down what the ECT device is really doing: delivering bidirectional square-wave pulses defined by four key parameters pulse width , frequency , train duration , and amplitude . I explain how these combine into total charge (in millicoulombs), how tha...

I give a full start-to-finish overview of how electroconvulsive therapy is delivered in real clinical practice. In the prior ECT episode, I focused on key concepts in ECT. Here, I zoom out and walk through the actual workflow: consultation, medical clearance, informed consent, anesthesia, seizure monitoring, and post-procedure recovery. I begin at the referral stage: how an ECT psychiatrist evalua...

In this first installment of the ECT series, I walk through the foundations of electroconvulsive therapy from the perspective of someone who practices it regularly in a busy clinical service. Despite decades of stigma and misunderstanding, ECT remains the most effective treatment in psychiatry for several severe and life-threatening conditions, and modern research has repeatedly demonstrated its s...

I take a closer look at treatment-resistant depression (TRD), what the term actually means, why it’s far less useful than people think, and how I approach severe depressive episodes in real practice. Most definitions of TRD frame it as unipolar major depression without psychotic features that has failed to remit after two adequate trials of first-line antidepressants. But as I discuss in this epis...

In this episode of Dr. Brown’s Psych Commute , I break down one of the most commonly missed syndromes in acute psychiatry: catatonia. Although many clinicians think of it as rare, catatonia occurs in roughly 10–20% of psychiatric inpatients, and in my day-to-day practice, that statistic holds up. I walk through the clinical signs that often get overlooked, how to use the Bush–Francis Catatonia Rat...

In this short introductory episode, I share what this new psychiatry podcast is all about and why I’m starting it. I’m Dr. Brandon Lee Brown, an inpatient psychiatrist in Houston with a background spanning outpatient and inpatient care, interventional psychiatry (TMS, IV ketamine, intranasal esketamine, ECT), and psychotherapy. My goal is simple: to record brief, high-yield reflections during my c...