Adam Hart, MD

Psychiatric illness causes real suffering — and we have better tools than most people realize.

I went into psychiatry because I wanted to help people with the kind of pain that medication cabinets and talk alone don't always reach. Severe depression, treatment-resistant illness, catatonia, post-traumatic stress — these are conditions that can shrink a person's life to almost nothing, and they're conditions where many patients have been told (implicitly or explicitly) that they should expect to just live with it.

I don't accept that framing. Over the course of training and now clinical practice, I've watched neuromodulation treatments — TMS, ECT, ketamine, and others — pull people back from places where nothing else worked. Not always. Not for everyone. But often enough, and dramatically enough, that I think the field deserves to be understood on its own terms, not through decades-old caricatures or marketing copy.

Most people I see in neuromodulation clinic have already been through a lot. They've tried medications that didn't work or caused side effects they couldn't live with. They've done therapy. Some have been hospitalized. They often arrive tired, skeptical, a little defeated — or, on the other end, so optimistic about a particular treatment that they haven't really considered the tradeoffs. My job, as I see it, is to meet people where they are and help them think through the decision in a way that honors both their situation and the actual evidence.

Shared decision-making, taken seriously.

Shared decision-making gets talked about a lot in medicine. In a lot of settings, it means the doctor lists the options and the patient picks one. That's not what I mean by it.

What I mean is a real conversation where I bring the medical knowledge — what the treatments do, what the evidence shows, what the risks are, what the tradeoffs look like — and the patient brings the expertise about themselves that I can't get from a chart: how they tolerate uncertainty, how much cognitive risk they're willing to take on, what their life looks like logistically, what matters to them in recovery, what they've tried before and how it felt. The decision that comes out of that conversation is better than either of us could make alone.

Clinical focus and training.

My clinical practice centers on neuromodulation for psychiatric illness — primarily for severe, treatment-resistant, or urgent presentations where standard approaches haven't been enough. In practice, that means a mix of:

• ECT — for severe depression, psychotic depression, catatonia, and acute high-risk presentations
• TMS — for treatment-resistant depression, OCD, and other FDA-cleared indications
• Ketamine — for severe or treatment-resistant depression requiring rapid response
• VNS management — ongoing care for patients with existing vagus nerve stimulation devices
• Psychotherapy — psychodynamic, CBT, and ERP, often integrated with medication or neuromodulation treatment
• Consultation — for other psychiatrists and primary care clinicians considering neuromodulation for their patients

Why I built this.

Patients and families exploring neuromodulation run into a strange information landscape. There's a lot of marketing, some genuine medical writing, a fair amount of dated stigma, and almost nothing in between that treats the reader as an intelligent adult navigating a serious decision.

The same is true for clinicians outside of dedicated neuromodulation programs. There's textbook-level coverage and there's program-specific protocol manuals, but the in-between — the "I need to know this well enough to have a real conversation with my patient" level — is harder to find than it should be.

I built this site to be that in-between resource. The patient-facing pages are written for someone who is smart and motivated but doesn't have a medical background. The clinician-facing pages are written for another psychiatrist, primary care doctor, or therapist who wants enough working knowledge to refer, co-manage, or just have an informed conversation with a patient.

None of this is a substitute for an actual evaluation. But I hope it's a useful starting point, and I hope it makes the conversations that follow — with me, or with whoever else you end up talking to — clearer and more productive.