Seeing Psychiatry Through EEG and QEEG Brain Mapping

Psychiatry can do amazing things, but there’s a glaring gap most families never hear about: we often treat brain-based symptoms without ever measuring brain function. We sit down with Cory Williams, Director of Neurodiagnostics and Neurofeedback at the Nashville Child & Family Wellness Center, to unpack how EEG and QEEG brain mapping can change the way clinicians think about diagnosis, medication choice, and outcomes for kids and adults.

We get practical fast. Cory explains a simple but powerful lens for understanding brain data: is it a fast brain, a slow brain, or a sleepy brain? The surprise is that ADHD symptoms can show up in all three, which means the same label can hide very different underlying biology. That difference matters when you’re deciding whether to speed the system up, calm it down, or pause and investigate sleep issues before adding another prescription.

Then we go deeper into a topic that can be missed in standard care: isolated epileptiform discharges on EEG. Even when they don’t equal a seizure disorder, they can track with mood swings, outbursts, focus crashes, and poor stress tolerance. We talk about why brain instability can make certain medications a bad fit, including how some antipsychotics may lower seizure threshold, and why mood stabilizers are sometimes a smarter match when EEG patterns point that way. We also cover what we do when meds help on paper but side effects take over, and how a biopsychosocial approach can guide next steps like therapy, environment changes, neurofeedback, and other neuromodulation options.

If this helps you think differently about mental health treatment and brain health optimization, subscribe, share this with a friend who’s stuck in trial-and-error care, and leave a review with your biggest takeaway.

To learn more about Nashville Child & Family Wellness Center, visit
https://nashvillefamilywellness.com/

To learn more about Transformative Neurotherapy visit:
https://www.TransformativeNeurotherapy.org
Transformative Neurotherapy
570 Lincoln Ave. 
Bellevue, PA 15202 
412-204-7397  

Transcript

SPEAKER_03 0:02

Welcome to the Transformative Neurotherapy Podcast with your host, Dr. Heather Putney, founder and executive director of Transformative Neurotherapy. This is the place where healing happens faster. Because let's face it, your brain doesn't come with an owner's manual until now. Here we take a holistic approach to brain health, bringing together science, mind-body harmony, and the tools you need to optimize your well-being. Whether you're a high performer, executive, athlete, longevity hacker, or just someone tired of your brain working against you, Dr. Putney is here to help you unlock your full potential. From brain fog to chronic stress, we're covering it all. So you can finally experience brain health, mind harmony, and total well-being. Ready to get unstuck? Let's get started.

Why Pair EEG With Psychiatry

SPEAKER_02 0:56

When a child's brain begins to regulate more effectively, the ripple effects can transform their entire world and their families. Welcome everyone. I'm Dr. Heather Putney, founder and executive director of transformative neurotherapy. And I'm in the studio today with Corey Williams, Director of Neurodiagnostics and Neurofeedback at the Nashville Child and Family Wellness Center. We're so excited to hear about Corey's wealth of knowledge of working with both children and psychiatrists and how that helps us um have better outcomes with the clients that we treat. So welcome, Corey.

SPEAKER_00 1:28

Absolutely. Thanks for having me. I'm super excited to be here.

SPEAKER_02 1:32

Yeah, so um Corey, I mean, uh, we know each other from outside of the podcast, and I know that you're doing incredible things in the world. And one of the things in the world of neurotherapy, and one of the things that Corey is so well known for is kind of understanding in a different way the um interplay between EED and um like kind of medications, you know, and and how that informs uh, you know, medication choices or or helps improve outcomes in uh in uh neurotherapy, um, especially with children, because that's the site uh the psychiatry uh group that you work with, correct?

SPEAKER_01 2:07

Correct, yeah, yeah. We uh we see kids and adults, I would say we're primarily pediatric, but probably like a 60-40 split, kids to adults.

SPEAKER_02 2:16

Can you tell me a little bit more about how you uh incorporate uh EEG and neurotherapy with the psychiatry side of in your practice, which is kind of unique to be able to have them both, you know, both in the same place?

Fast Brain Versus Slow Brain

SPEAKER_01 2:31

Oh, very unique. I I mean I think I've probably met uh maybe five psychiatrists, and I've been doing this for almost 12 years now, and I think I've met maybe five psychiatrists who do this. So it's it's not the most common. So I feel very, very honored to be able to work here and to be able to do the work that we do. It's super cool. Um yeah, so uh, you know, in in most of modern medicine, the doctor has the ability or the potential to look at the organ that they are treating, right? A cardiologist will listen to your heart or will do an EKG. Uh, a gastroenterologist will do imaging of your stomach. Um, you go to your general practitioner and say, I think I broke my arm, they do an x-ray. And psychiatry is one of the few, maybe the only field of medicine where the doctor does not get to look at the organ that they are trying to treat. And that's for me at least, um, slightly problematic, right? Because it's really important to know what's going on in there before we try to medicate it. And so uh by doing EEG and QEEG, and by making brain maps and writing these reports for clients, we're able to provide the doctor. And I say the doctor, there's two psychiatrists and I think seven nurse practitioners. So it's really the medical staff, right? But we get to provide the medical staff with um some insight into what's going on in this brain. And we could get into like real hyper-specific stuff about neurotransmitters and frequencies and individual bins. But the easiest way for me to explain it, uh even to the staff here who have, you know, we've been working together for in this location almost nine years, 10 years, is this a fast brain or a slow brain? Or is it a little bit of both? And what's crazy about this, and I know it's really counterintuitive, um, especially for folks who don't study EEG, but you can you can show up to our clinic with ADHD symptoms and have a really slow brain or a really fast brain or a really sleepy brain. And all three of those things will get you diagnosed with ADHD. But obviously, all three of those things are very, very different. And we want to go about treating them very, very differently, right? And so when somebody, when we know, oh, this client's brain is especially slow, we might say, okay, let's give them a stimulant to speed things up, to wake them up a little bit. When we know that a client's brain is especially fast, we might go more the sort of like traditional anxiolytic route to try and slow things down. And if we know that it's a sleep disorder, we might hold off on medication altogether until we do a sleep study or get tonsils removed if it's an apnea thing, or you know, there's lots of different things that we do for sleep. Sometimes it's just therapy. So uh having that information is just absolutely crucial. And that's even before we get into like the the nitty-gritty specifics of these meds respond best to these phenotypes or these types of brains, and because there's a whole world of that. And I'm happy to talk about that. But just on the most rudimentary level, uh knowing is this brain fast or slow or sleepy ends up being super valuable to the medication team here.

SPEAKER_02 6:03

I'm imagining that this has really revolutionized how you guys work and also improved outcomes immensely. Have you been able to see like the before and after changes of implementing this strategy?

SPEAKER_01 6:14

Yeah, absolutely. And you know, I would love more than anything, I would love to tell you that we do this for every client that walks through the door. And unfortunately, we don't. Um it's a lot of work and we see a lot of people, you know. I I'm one person doing EEGs and EEG analysis. Well, there's nine medication providers, right? Seven nurse practitioners and two psychiatrists. Uh that would mean I was working like 90 hours a week to cover all the new patients. I just can't do it. Um, so what we end up doing is all of the all of that staff I have the utmost confidence in, they're all super well trained. They know their stuff. And usually with a few questions, a little bit of a kind of um feeling out process, they can get a feel for where the client is and what type of medication they need. But if that feeling out process is um misleading or wrong, or they try meds and they don't work, that's when kids get and adults get sent to me, right? So I'm not the first person that everybody sees, although that would be super cool. But we end up seeing the really, really tricky ones. And that ends up being um beneficial for a lot of reasons. Uh can we can we go on the antipsychotic tangents and epileptiform discharges?

SPEAKER_02 7:37

Go ahead.

SPEAKER_01 7:38

Oh, fantastic. So yeah, thanks.

SPEAKER_02 7:40

Um so that's what it's forward.

SPEAKER_01 7:43

Yeah, so so um there are uh within the brain, right? Sometimes these things that we see in an EEG, uh, it looks like a spike followed by a really big slow wave. And we call that an isolated epileptiform discharge. Now, sometimes those can build up into a seizure, right? Um, and sometimes not. And that's not really our decision to make if it's a seizure or not. When we see those cases, we refer them to neurology if there's a suspicion of seizures. But from a medication perspective, this ends up being crucially important. So the literature that we have suggests that uh, one, if you have these discharges, you are more likely to experience mood swings, outbursts, uh, lapses in focus, lapses in executive function, and then also poor stress tolerance. So we know that it might not be a seizure and a neurologist might call it benign, but it is not benign from a mental health perspective, right? Nobody wants to have lapses in focus and wild mood swings. So we know that it's important. We know that these things occur in about, I believe the number is around 7% of the population just at large. However, it happens in about 30% of the population with ADHD or that's diagnosed with ADHD. And it happens, now this part's really interesting, in about 65% of the population that's diagnosed with autism spectrum disorder. And if you look at all of the studies in which they look for these things in ASD populations, most of them find these discharges, right? These IEDs, in about 60 to 70%. One of those studies did a sleep study on people with autism, and they found uh 90% of their patients or their clients in that study had isolated epileptiform discharges. So the prevalence of these is much, much higher in autism populations. It's actually much, much higher in anxiety populations and ADHD populations too, compared to the NOR. Now, why is this so important? Why did I why did I want to go down this rabbit hole? Well, when you have these IEDs in an EEG, it means that there is a functional instability. The brain is not working the way we expect it to work. And this becomes really important with medication because if you give these brains antipsychotic medication like Abilify or uh Risperdol, those drugs lower seizure threshold. They make the brain less stable overall. Sometimes that's what you want if a brain is really locked in, right? You need to, you need to like decrease some of that fat, like locked up stability. But these brains are already unstable. So when you give them antipsychotic medications, these people get worse. And sometimes they develop seizures or seizure disorders that they didn't have beforehand. So by by looking at the EEG prior to starting medication, we can see these uh epileptiform discharges, and it helps us to say, oh, actually, abilify is gonna not not only not help, but make things worse. Instead, let's try an anti-seizure medication, like lamyctol or depicote, which, you know, when given by a neurologist, is anti-seizures. But in our world in mental health, it's used as a mood stabilizer. And those stabilize the EEG. And so what we end up with then is uh correctly medicating these kids for what's really going on. So much of mental health and psychiatry, you are basing your decisions on what medication to use based off of symptoms and presentation, right? How does this person appear in my office? What are they complaining about? But by adding the EEG, we're able to then base our medication decisions on what does your brain look like it needs? And sometimes that's something that we wouldn't think of at first, but actually ends up being a really important distinction. Um, and so just within that population, if we only looked at ADHD and autism cases, all of the people who do EEGs are more likely to have better outcomes. I don't want to make this sound like we always get it right and it's perfect every time because it isn't, but uh the outcomes are are greatly improved. I mean, I can think of dozens of cases off the top of my head where just by identifying, hey, this brain is unstable, let's switch to a mood stabilizer, we have had uh tremendous success or far more success than we had up to that point. So what I don't have for you is hard data. Um, so I would love for us to be able to publish some of this data to show, right, like how much better it is improved. But you know, when you work in a clinic, uh publishing research papers is like the push to the back, back, back, back returner, right? Because you're seeing clients all day, you're you're processing EEGs all day, you're meeting with therapists and psychiatrists all day. And so uh the goal is for us to eventually start to publish some of this data, but we're just not quite there yet.

SPEAKER_02 13:03

Yeah. And I mean, uh I I work in a mental health agency. You know, I don't have the luxury of having a psychiatrist, you know, in the office. But the types of clients that I get, you know, um quite uh like kind of like you mentioned, a lot of the EEG cases you get are the more complex clients, even from your own clinic, you know, and a lot of the clients that I'll get are those that have maybe done psychiatry and it hasn't really worked very well. The ones that tend to be a little bit more medication resistant. And of course, some of that background might be because they're getting they're the they're not looking, you know, under the lid or whatnot, you know, to to kind of know what um what their brain needs. Or sometimes they've tried a variety of things and it's just not working. So I I'm curious as as you as you've done this, I mean you have the ability to match the medication with the EEG and your practice really well. But I'm also wondering um that you probably have this subset that maybe medication that isn't, you know, doesn't work as well for them. And what do you do for those clients? Or or do you see that? Maybe that's different for you than for me.

When Meds Fail Or Side Effects Win

SPEAKER_01 14:01

Oh no, uh absolutely. And um it's I would say a lot of times what we run into is either medication doesn't work super well, or the medication works, but the side effect profile is so robust that the plusminus of the medication ends up being a net negative, right? Like, yeah, my focus got better, but I started chewing on my fingernails so much they were bleeding. It's like, well, that doesn't sound good either, right? So, okay, so what do we do then? Um, you know, in our practice, we always try to frame things through that bio-psychosocial model, right? So the biology here is the brain, the psychology is the mind, how you think to yourself, what what skills you have, what strategies. And then the social is the kind of the environment around you, right? And so one of the cool things about um doing EEG is we get to rule out one of those pieces. So if somebody comes in, for example, and they say, I'm depressed, and you go through all your questions with them, mood is low, sleeping too much, not eating or eating too much, right? And you you decide, I agree, this person is clinically depressed. And then you look at their EEG, and their EEG looks totally normal. It looks like just a regular average run-of-the-mill EEG. Well, what that lets you do then is rule out the brain side of this, right? The biology side of this. So then we can say, okay, look, your brain looks healthy. That's a great thing. I'm not saying you're not depressed, you are, but it means we can look at these other places to try to pinpoint why. Maybe it's because you don't have any coping skills and you just need to, you just need to learn some stuff, right? Maybe it's because you hate your job and every day you go there and you're miserable. Okay, let's talk about like how do we make a change, right? So uh it helps us to kind of narrow in the treatment focus. And then um, we do have some folks for whom it is a biology issue, their brain is dysregulated, and for whatever reason they're not responding well to medication, then we get into the world of neurofeedback and neuromodulation. Um, and that's that's a whole universe that is uh incredibly fascinating and incredibly rewarding to be in. Um, we get to retrain the brain, right? We train the brain to work differently. Um and we do that with either behavioral, subtle behavioral changes like neurofeedback, or we do it with more um I don't want to say invasive, that's not the right word, but maybe more direct communication to the brain with things like transcranial uh stimulation.

Next Steps And Free Consultation

SPEAKER_02 16:43

Very good. Well, fortunately, we are gonna get to uh hear from you in another episode where we can learn a little bit more about these other ways that you help clients. But this has been absolutely fascinating to learn how you bridge EEG with psychiatry and matching the brain to the medications for better outcomes. And so we're really uh excited about the work that you do and all the people that you help there down in Nashville. So thank you so much for joining us today. Um, and have a wonderful day.

SPEAKER_01 17:11

Thanks. Yeah, thanks for having me. It's super fun to be here.

SPEAKER_03 17:17

You've been listening to the Transformative Neurotherapy Podcast with Dr. Heather Putney. Remember, your brain isn't supposed to hold you back, it's supposed to power you forward. So stop letting it crash your party and start letting it do its job. If you're ready to optimize brain health, sharpen your focus, and age like a fine wine, schedule your free consultation today at Transformative Neurotherapy.org. Or call us at 412-204-7397. Because here, healing happens faster. See you next time.