Alternative Prescriptions and Mental Health

I came across this article in Medical News Today, which discusses how exercise can help with depression. None of that is a surprise, of course, and as I type this entry, I’m still gross from having come back from the gym, so yay!

Here’s the interesting part of the study: Individuals who did “prescribed exercise” showed a rise in endocannabinoid levels in their blood – something typically associated with improved mood. This did not occur with people who selected their own exercise.

Wait, what?

Why would that be? Two potential explanations from the article:

One explanation could be the small number of participants and the variation in intensity levels in the preferred-intensity session. Some participants completed the preferred session at a constant, light intensity, while others varied the intensity.

Another explanation for the difference in results between the preferred and prescribed exercise sessions could be that exercising at a level that someone else prescribes has a psychological as well as a biological effect.

It’s that second explanation I want to focus on. We know that anti-depressants often have a powerful placebo effect. Placebos occur, in part, because someone expects a treatment to work. That being said…we know that exercise does, in fact, help with the treatment of depression and other mental health challenges. So that can’t be a complete explanation.

This got me thinking – what if Doctor’s began to “prescribe” other therapies? Go for a damn walk. Meditate. Eat better. And I don’t mean just give it as advice, I mean take out a little prescription pad, write something down and hand it to the patient. Would the patient be more likely to treat that prescription with more care than they would regular advice? Would they actually spend time reducing their stress levels, or just taking ten minutes out of their day to put headphones on and meditate?

I don’t know. But I think that, when you combine aspects of the placebo effect (expecting a therapy to work) with scientifically proven therapy, you’re increasing your chances of success and recovery (again, not a Doctor here, just speculating).

This entire study and line of thought has made me wonder if we shouldn’t try to get Doctors and other health care professionals to look outside of the realm of traditional prescriptions and more into the world of prescribing lifestyle changes.

As you likely know, depression rates are rising across the Western world. We can’t just rely on therapy and medication to get ourselves out of this mess. Something has to change, and I think one aspect of that chance must be revamping the way we look at therapy. Maybe this idea of “alternative prescriptions” can help?

As always, let us know what you think in the comments below!

Does CBD help with depression or anxiety?

In 2018, Donald Trump signed the Farm Bill into law. Among other things, this piece of legislation made legal much of the sale of CBD and hemp, as well as research into this area. – This opens up an array of new potential research, but CBD may have a positive impact on depression and anxiety.

What’s CBD, you ask? First, what it’s not: Marijuana. It is not marijuana. CBD is short for cannabinoid oil, and it became legal to be sold after the 2018 Farm Bill was signed into law.

Specifically, CBD is extracted from hemp plants. It works be manipulating your Endocannibinoid System, a part of your body which regulates a variety of bodily functions, including, potentially, your mood.

Here’s an important point though: While some research has been done, more research is DESPERATELY needed in order to determine CBDs usefulness, effectiveness, proper dosages, long-term impact, etc. At the moment, it is not widely regulated by the FDA, though the FDA has sent out cease and desist letters to some companies which have falsely marketed benefits yet to be proven by research.

Indeed, as of yet, there is no formal regulation when it comes to CBDs marketing or ensuring the quality of ingredients. For example, a 2017 Penn State study surveyed 81 CBD products and found that 70% were mislabeled. As such, if you’re going to purchase CBD, your best bet is to ensure that the label notes it has been independently tested. This means that a product has been evaluated by a 3rd party, and that 3rd party has determined that’s it’s labeling is accurate.

Okay. Enough about the legal disclaimers and warnings. What does the research show?

According to one 2014 study, CBD and Marijuana may show anti-depressant like effects. That finding was replicated in 2018, when a study showed that CBD has “anxiolytic, antipsychotic and neuroprotective properties” and may be useful in fighting a slew of problems, including PTSD and depression.

There’s additional research available, but it does seem clear: There’s opportunity here.

While CBD is not marijuana, and will not get you high like marijuana, some forms of CBD (namely Full Spectrum CBD) do contain trace amounts of marijuana. As such, if you ingest this type of CBD, you may feel some effects. Furthermore, it is possible for Full Spectrum CBD to show up on a drug test – so DON’T TAKE IT if that’s an issue for you.

Furthermore, you should not take any CBD product without consulting with your Doctor or medical professional first. While common side effects of CBD are relatively minor, there can be more problematic impacts for people with Parkinson’s, liver issues, or pregnant/nursing women.

Now that we’ve gotten the warnings out of the way: Is their potential for people with mental illness and CBD? I’d say yes. Anecdotal evidence and some research seems to indicate the potential for relief. Again, more research is needed. Again, don’t do anything without talking to a Doctor or medical professional first. But, yes. More research is now being conducted, this area does prove promising.

 

Teens, marijuana and depression

A friend of mine was kind enough to flag this article for me, and it brings up some points that I really think are worth exploring.

As a debate over legalizing marijuana continues across the country – and in Pennsylvania – a new study draws a connection (not a casualtional one, however) between teen marijuana use and depression.

From the NBC report on the study:

Researchers found that cannabis use during the teenage years was associated with a nearly 40 percent bump in the risk of depression and a 50 percent increase in the risk of suicidal thoughts in adulthood, according to the study, published Wednesday in JAMA Psychiatry.

The report does note that this isn’t to say marijuana causes depression (though that may, in fact, be the case). It’s possible that the depression encourages marijuana use, or that a third factor (such as economics, anxiety, stress, etc) cause both the depression and marijuana use.

Still. The study does show a clear connection between marijuana and depression. There’s an irony to that: Some research shows that medical marijuana may actually help alleviate symptoms of depression. This may be a secondary benefit of medical marijuana, which has been shown to relieve pain and stress – two factors which, of course, may lead to someone becoming depressed.

Can these seemingly contradictory findings be reconciled? Sure. It’s possible that the drugs act in such a way which helps those who are already depressed, but affects other aspects of someone’s brain chemistry in those who are not depressed, thus making them so. It’s also important to note that there are major differences in terms of the chemical composition, and effects, of medical and recreational marijuana, thus potentially resulting in different effects.

The causes and effects of marijuana use are not always clear or linear. More research is needed.

Personally, I believe that marijuana needs to be examined and researched like any other drug. I’ll also note a flaming hypocrisy within our current medical and judicial systems: Numerous legal drugs (such as Oxycontin) are obtainable from reputable medical professionals, despite the fact that Oxycontin is more potent and addictive than marijuana.

Our drug policy in America makes no sense. But – and this is a big “but” – we cannot sit here and pretend that legalizing marijuana is the solution to many of our woes. Legalizing marijuana may be preferable to the alternative of prohibition, but that’s not to say that there won’t be significant negative side effects, and this may very well be depression in young people. Marijuana legalization – it’s pros and cons – need real, comprehensive study and thought. It could have major benefits and harm to the mental illness space.

Using creative arts to combat depression

If you follow my Facebook page, you might have noticed that I posted this article the other day. It’s an NPR story about a photographer named Tara Wray who used photography to combat her depression. Said Wray:

“Just forcing myself to get out of my head and using the camera to do that is, in a way, a therapeutic tool. It’s like exercise: You don’t want to do it, you have to make yourself do it, and you feel better after you do.”

According to the story, this effort resulted in Wray launching the Too Tired Project, which bills itself as, “a photo initiative and traveling slideshow series that aims to help those struggling with depression by offering a platform for collective creative expression and community.”

Creative arts have been used to fight depression throughout history; indeed, creative arts and depression are often linked. Many of history’s greatest artists have struggled with their own demons.

So, why is it that creative arts can help people with depression?

Well, I think the quote above is at least a piece of the answer. Engaging into some other hobby – getting into a sense of flow, if you will – can get you out of your head. I firmly believe that escaping yourself is a key part of beating depression. Even if it’s for a little bit, you can trick your brain into thinking you are somewhere else, and when you “return,” things just don’t seem as bad.

Wray also notes that the arts can provide an incredible sense of relief and accomplishment: “When I’ve made what I think is a good picture, I can feel it, and everything else momentarily falls away.”

I’ll add two personal experiences. Redemption started for me during a very down period. I was struggling at work (for those of you who follow Pennsylvania politics, it was 2015 and we were just starting a rather infamous budget impasse which was very stressful). My wife had just started at a new school and she was struggling as well. As a result, I needed an escape. And thus, Redemption was born.

Second is the simple fact that it gives you an alternative perspective that is still within you – one that you can still apply to your normal life. Redemption has a few plot threads going on, but it’s core is a twenty year old named Ash, trying to deal with his inner demons, beat his depression and live his life (and save the world but that’s a whole other story!). The book features a cast of characters who help him cope.

This may be an obvious point but for the purposes of this discussion I have to make it: I wrote all of the characters. They are all my voice, my perspective and my experience. But there was something deeply therapeutic about putting that level of advice and support into another character. It reminded me, in a sense, that all the hope, words and inspiration I need are inside of me to begin with.

Creative arts – writing, drawing, photography, whatever – I think they allow you to expunge and make sense of everything ugly inside of you. They force you to think of a perspective outside of yourself. And in that sense, they can help save you.

If you have any other thoughts or experiences, I’d love to hear them.

Your smartphone can tell if you’re depressed

person using phonwYou know how I’ve written about how social media and phones can cause depression? Well, it turns out, your phone can also tell if you are depressed.

The study, from the University of Stanford, shows that face and speech software on your phone can detect depression based on your facial expressions and speech patterns:

The researchers fed video footage of depressed and non-depressed people into a machine-learning model that was trained to learn from a combination of signals: facial expressions, voice tone, and spoken words. The data was collected from interviews in which a patient spoke to an avatar controlled by a physician.

In testing, it was able to detect whether someone was depressed more than 80% of the time. The research was led by Fei-Fei Li, a prominent AI expert who recently returned to Stanford from Google.

The article did caution that, due to the way the study was conducted, the therapeutic applications aren’t clear. According to David Sontag, an assistant professor at MIT:

…that the training data was gathered during an interview with a real clinician, albeit one behind an avatar, so it isn’t clear if the diagnosis could be entirely automated. “The line of work is interesting,” he says,“but it’s not yet clear to me how it’ll be used clinically.”

I have two thoughts about this type of treatment. First, this is fascinating – and this type of technology be helpful in terms of closing the gap between those who have access to treatment and those who don’t. In addition to studies like the one above, Stanford has also developed apps which can be used to treat depression – and which apparently work. I’ve touched on this topic in previous entries as well: Apps which treat depression can work.

In other words, apps and automated programs can help to treat depression. That’s fascinating to me – I never would have believed that depression could be treated without a live, human person, but apparently it can work.

On the other hand, there are some rather frightening potential applications of this sort of treatment. First is privacy: I am sure that any app working right now is operating with the strictest of privacy measures and data safeguards, but as we have seen repeatedly, data hacks and breaches occur with relative consistency. This has some very serious implications for something like text therapy or therapy which occurs over a device, because it begs the question: What data is recorded, and how could it potentially be accessed? I mean, I’m pretty open about the fact that I receive treatment, but even I wouldn’t want the items I discuss with my therapist broadcasted to the whole word. Is that possible with these apps? I don’t know, and it may not be. But there are real privacy and technological concerns which must be addressed when it comes to therapy delivered electronically.

Second: Can someone be diagnosed against their will? I don’t think so. Not yet, anyway. Later down the line, programs like the one discussed above may also have issues with consent. It seems to me that the Stanford program is not yet ready to be used in a public or even therapeutic setting. But, when it is, will people be able to use it on others without their consent? That…that’s kind of a scary thought.

These are questions which are only somewhat hypothetical. Technology is clearly advancing, and I can only hope privacy and ethical safeguards can advance with it.

Let us know your thoughts in the comments below!

Do mental health apps work?

One of the things I have seen a lot of lately is apps that claim to be able to help you improve your mental health and get treatment. There are a bunch out there – this includes apps like What’s Up, Mood Kit and MY3, among many, many others.

Here’s the important question: Do they work?

I bring this up because there’s been a bit of controversy with one app, BetterHelp. The App says that it will hook users up with licensed therapists. The controversy, however, emerged with many YouTubers who had engaged in sponsored ads with BetterHelp.

As long as the sponsorship is transparent, I don’t personally see an issue, but problems emerged with BetterHelp itself. First, it’s terms of services explicitly couldn’t guarantee placement with a qualified, licensed professional:

We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you. The Counselor Services are not a complete substitute for a face-to-face examination and/or session by a licensed qualified professional.

Umm…..that’s a major, major problem. That’s beyond not acceptable. Any app that claims it will provide mental health professionals to users has a moral obligation (and I hope a legal one!) to ensure that the counselors themselves actually are licensed professionals, or at least disclose in a VERY publicly way when they are not.

This entire incident got me wondering about these apps. How good are they? Do they work? Are they substitutes for seeing a counselor in a face to face setting?

First, the obvious: Answers to the questions I posed above will vary widely. It all depends, of course, on the quality of service offered.

The most comprehensive answer I could find was in this paper, published in March 2018. The answer varies, of course, but in sections, it seems to be yes:

  • Depression: ” A meta-analysis of 18 randomized controlled trials (RCTs) covering 22 mobile apps revealed that using apps to alleviate symptoms and self-manage depression significantly reduced patients’ depressive symptoms compared to control conditions (g=0.38, P<0.001).” However, the apps work best when depression is mild to moderate, not severe.
  • Anxiety: “A meta-analysis of nine RCTs that evaluated the effects of smartphone-delivered interventions on symptoms of subclinical and diagnosed anxiety disorders revealed that users experienced reductions in total anxiety after using anxiety treatment apps (g=0.33, P<0.001). Additionally, anxiety-focused mobile apps delivered the greatest reductions in anxiety symptoms when paired with face-to-face or internet-based therapies. In fact, replacing outpatient patient-therapist sessions with a mobile app resulted in no significant loss of treatment efficacy.”
  • Schizophrenia: “Self-reported patient experience survey results revealed high adherence, positive user experience, and broad-ranging clinical benefits.”

Wow. So, yes, theoretically, these can work!

I have two additional thoughts. First, hey, if it works, it works. The mental health practitioner shortage is, in my opinion, the greatest crisis affecting mental health, and if apps can help close that gap at an affordable rate, it’s worth using.

Second. however, is this: It has to be a real app, with high quality and scientifically based therapies and design. In the digital day and age, it can be all too easy to design a subpar treatment program that can scam users out of money and provide no clinical benefit. I hope, in the long run, that the federal government will step in and better regulate these apps in order to protect users from negative experiences that can damage their mental health and sap their limited resources.

Do you have any experiences with mental health apps that you want to share? Please let us know in the comments below!

TMS Update: Is this what feeling better feels like?

So, it’s been about six weeks since I started Transcranial Magnetic Stimulation. As I type this, I’ve had about 26 sessions, with another ten or so to go.

How am I feeling? Is it working? Better. And yes. It is working. And I feel reasonably convinced at this point that it’s not just the placebo effect.

Let me discuss the second part of that question first, because I think it’s almost the most important. Why do I think it’s not a placebo effect? Because life is NOT perfect. I think – I don’t know, but I think – that if this was a mere placebo effect, I’d be sitting here, flying through the sky. Life would feel perfect. There would be birds and sunshine and candy everywhere and all that crap. Then, eventually, the effect would wear away, and I’d crash hard.

Simply put, that isn’t true. Everything doesn’t feel perfect. I’ve still gotten depressed about things, upset. Most of the time, it’s been normal life events. On a couple of days I’ve still woken up really down, but that feeling fades easier than it did before treatment. Simply put, things aren’t magical.

So then, let me tackle the question in the title: Is this what feeling better feels like? Maybe? I can’t answer that question definitively yet, because I don’t know . Look, I’ve been on anti-depressants and in treatment, as needed, since I was 18. I’m 35. Half my life. So I’m not quite sure what “normal” is.

Here’s what I do know. Since I started TMS and began to feel it’s positive impacts:

  • I’ve been enjoying things more. A lot more. A couple of examples:
    • As I’ve long since established I am a big computer game nerd. I play these games more, and I just like them more. I’ve had more fun playing them.
    • I was with my wife and my kids at a local food fair. I’m sitting there, eating this big ole Taco Salad. My son is leaning on me, eating Mac & Cheese. He’s snuggling in. I’ve got my little boy, good food, happy environment, great music. I felt good. I felt lucky. My phone was firmly in my pocket. I felt like I was in the moment. That didn’t happen before.
  • I wake up in the morning without this impending sense of dread. Without feeling like there’s a ceiling over my head, pressing down. It just feels like the world has less pressure. I still feel stressed, still feel overwhelmed. But the world doesn’t feel like it is filled with nearly as much darkness.
  • I’ve been less snappy. Less grouchy.
  • I’ve had an easier time concentrating and getting things done. My motivation is higher.
  • You know that myth about the depressed writer? Bull. Depression does help give you insight and experience for writing, but if it’s too severe, you ain’t writing. And I’ve had a much, much easier time writing lately.

Arguably the most important observation since this started has been from my wife. She was skeptical when TMS first started. She told me last week that she didn’t think it would work, and part of her almost wishes she didn’t know I was doing it so she wouldn’t risk being fooled by a placebo effect as well.

Why? Because she noticed the difference too. She told me the other day, unprompted, that she sees it’s working. She sees that I am happier. And my wife is smarter than me! So if she is noticing this, it makes me more convinced that this thing really is working.

Are things perfect? Hell no. They never will be.

But they are unquestionably better.

DISCLAIMER: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences. However – and again, this is just me writing – I’ve had my TMS from the TMS Center of the Lehigh Valley. I am grateful for their skills, professionalism and willingness to work with my rather insane schedule. I highly, highly recommend them if you are local to the area.

TMS Update

Well, as I type this I am 10 sessions into the 30 session Transcranial Magnetic Stimulation sessions. 1/3 of the way there. Woohoo!

How’s it going so far? Well…maybe better? Honestly, yeah, starting at the beginning of the 2nd week, it did start to feel like I was feeling a bit better, but let me define what I mean. Birds did not start singing. The sky is not the bluest it has ever been. Depression is still there. Life is not perfect.

But, to some extent, I have to say, it does feel like things have gotten a bit better. My life hasn’t dramatically improved, but there does seem to be a bit less…pressure. Like, the ceiling of depression which pressured down on me seems a bit lighter. That’s the best way I think I can put it.

To be clear, this may be placebo. The readings that the Doctor gave me showed that depression probably wouldn’t start to improve until week four. When I mentioned this to him, he said some people did feel better in week two, but for many it was longer, and it is certainly possible that this is just placebo. So I guess we will see!

Some other notes:

  • For me, there are no side effects. Even the slight headaches that during the treatment have become more tolerable. I haven’t taken a Tylenol before a treatment since it started, and my head has not hurt a soon as the treatment has ended.
  • You really do build a resistance to the minor pain caused by the treatment. Of the ten times I’ve had it, I’ve fallen asleep three of them, which is kind of funny.
  • I went through the math in my head the other day. As I said in the last entry on this subject, the magnet taps your head for four seconds, then rests for twelve. During the four seconds in which you get tapped with the magnet, it makes contact 40 times. A session is twenty minutes, so you get tapped 3,200 times a session. Multiply that by the 30 sessions, and congratulations, you’re getting smacked by a magnet 96,000 time over six weeks!

Only 64,000 taps to go!

“A woodpecker on steroids” – My experience, so far, with Transcranial Magnetic Stimulation

So, for the first time in my multi-decade battle with depression, I’m trying a new type of therapy (other than talking and taking pills). It’s Transcranial Magnetic Stimulation (TMS), and I’ve written about it before.

Here’s the basic gist of how it works:

Transcranial magnetic stimulation (TMS) is a method whereby an electromagnet placed on a scalp transmits magnetic pulses or waves to a small portion of the brain. Repetitive transcranial magnetic stimulation (rTMS) delivered at a low frequency (once per second) has been shown to reduce the reactivity or excitability of the part of the brain stimulated and other brain regions functionally connected to the region stimulated.

I started it Monday, and it is time intensive – not so much in how long you have to sit there (my sessions are only twenty minutes), but in terms of how long you have to do it – for me, it’s six weeks, five days a week. I had to wait until vacation was over and for a break in my calendar to make it happen.

As for how it works: Honestly, it’s not hard. You sit there. You get yourself into a nice and comfy chair and they adjust a couple of things by your head. The right side of your head is lined up with a pad to keep your head still. The left side of your head is where the action is at – a magnet, enclosed in some equipment, is aligned in the right spot. It’s desired location is your frontal cortex, which is the area of your brain where depression apparently can be adjusted. They send one magnetic pulse into your head, and if your hand twitches, they have the right spot.

Once they have the right spot, they save the settings and that’s where you sit. If it’s aligned right, you may feel a little discomfort or pressure during the actual treatment. The actual treatment consists of your head being tapped with a magnet (not directly, but through padding) for four seconds, followed by a rest of twelve seconds. That continues for twenty minutes.

Is it painful? No. The first alignment can be – if it’s misaligned, it hits a nerve and OUCH. It just stings for a few seconds. They readjust, and then it’s fine. Now, is it comfortable? Nah. But you do build a resistance to it. I had a headache and took Tylenol the first three days. By days four and five I barely noticed. They also give you earplugs. Those are optional, but if a Doctor gives you ear plugs, use them, okay?

It’s a strange experience, described to me by the nurse as being hit by a woodpecker on steroids. I love that description, and it’s accurate. I mean, you’re basically getting tapped by a magnet or roughly 30 times over four seconds. It’s weird, but not painful. I’ll putz on my phone, close my eyes and chill, whatever. Honestly, its not that bad. The session ends and you go back to work. There are no after effects, except for maybe a slight headache that Tylenol can bop right out. You can drive, think, function, etc. I’ve left therapy sessions where I’ve been more disoriented.

When am I supposed to see results? The literature I read said week four. They said they thought they had seen some people get more depressed as the placebo effect wore away in week two. I’m hoping I don’t go through that, because I have no illusions that this will work until at least week four.

So, one week down, five to go. Here’s to hoping.

As always, I’d love to hear your thoughts and experiences, and as the process goes on I’ll share more, including some pics. Let us know about your TMS experiences below!

SIDE NOTE: First, again, I’m not a doctor or medical professional – I’m a damn politician and writer. I’m certainly doing my best to write an accurate description, but if you have any questions or concerns, please contact a medical professional. Second, this probably goes without saying, but I’m going through this treatment like any other normal person and paying with my insurance. I am not receiving any compensation or consideration whatsoever for sharing my experiences.

Depression and meditation

Ugh, just writing this article makes me a little depressed. Why? Well, cause I can’t stick with this. No matter how hard I try, I absolutely, positively cannot stick with meditation – and that’s despite the evidence I’m about to write about below.

The studies are clear and I have written about the subject before: Meditation helps with depression. According to one study published in The Lancet, meditation may be as useful as anti-depressants at keeping depression at bay (side note: Damnit! I really need to look at this again!). This study noted the benefit of mindfulness meditation, which is a specific type of meditation.

What is mindfulness meditation? Mindful.org describes it simply: “Take a good seat, pay attention to the breath, and when your attention wanders, return. By following these simple steps, you can get to know yourself up close and personal.”

Want to know more? I found a few interesting resources on the subject. First, there’s this, from Headpsace, a meditation app I’ve used before. The article details the struggles of a very depressed man who tries meditation in a desperate attempt to get some relief and how meditation changes the way he thinks. The Washington Post ran a similar story earlier in the year, in which the author discusses how the Headspace app (this isn’t a sponsored post, I swear) helped them relearn their thinking.

Want more info on the research behind meditation? Check out this article on Mindfulness-Based Cognitive Therapy, which is a specific type of meditation designed to help those with depression.

If you’re interested in more information on how meditation may help people with anxiety and depression, look at this pretty fascinating article from Harvard, which details specifically how depression can physically change your brain.

I will say this: As I’ve bitterly noted repeatedly, there have been many instances where I have actually meditated with some regularity, only to stop after some period of time. But, during those times, I did notice some changes about the way I was thinking. Specifically, I found myself focusing less often on anger, frustration and bitterness. I found myself better able to let things go, and it felt great. Sadly, inevitably, a busy life caught up with me, and I let the practice fall away.

Time to try again!

As always, I conclude with a question: What has been your experience with meditation? Have you practiced it – or do you practice it – on a regular basis? Notice any changes that you want to share with us? Please tell us your story in the comments below!