Tag: treatment

Transcranial Magnetic Stimulation?

You know, you first hear about something like this, and you think it sounds like some sort of witchcraft nonsense. Magnets? To help depression?

Apparently. And it’s scientific based.

I write about this now because I had an appointment last week to explore this as a treatment possibility, and it is likely something I’m going to pursue. Here are the basics, per the Mayo Clinic:

During a TMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. And it may activate regions of the brain that have decreased activity in people with depression.

 Though the biology of why rTMS works isn’t completely understood, the stimulation appears to affect how this part of the brain is working, which in turn seems to ease depression symptoms and improve mood.

The most important question, of course, is this: Does it work? According to the evidence I have seen, yes, and that’s in tests involving a placebo. More research is needed, but this appears to work.

Thankfully, the side effects are very mild, per the Mayo clinic.

Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:

  • Headache

  • Scalp discomfort at the site of stimulation

  • Tingling, spasms or twitching of facial muscles

  • Light headedness

The biggest drawback, as best I can tell? The Doctor I spoke with told me its most effective to do it every single day, for 4-6 weeks. Session, I think, are 30-45 minutes. That’s a heck of a time commitment. That being said, sucks for me. It’s not the Doctor’s fault that this is the way the brain works, but it’s certainly a challenge with my schedule – going to Harrisburg and vacation means I won’t have that kind of time until August.

So, let me conclude by asking you for your experiences. Have any of you out there had TMS? Any experiences to share? I’d love to hear them!

College and mental health

A friend of mine was kind enough to share with me this article in Time, an extremely eye-opening look at the massive spike in college students seeking mental health services – and college’s struggles to keep up with the demand. For those of you who are interested in this topic, I highly recommend that you read the entire article, because its a very comprehensive look at the issue.

The summary is this: More college students are in need of counseling services, but many colleges do not have the capacity to deal with these students mental health challenges. This shouldn’t be surprising: 75% of all mental health issues onset by age 24, and college is a time of transition where young adults are cut loose from all their previous moorings and experiences – thus shaking loose a good deal of mental illness, sadly.

Unfortunately, suicides in the United States have been on the rise since 1999, cutting across all demographics, and college is no exception. Even worse is that, many colleges do not actually track suicides, creating a major problem for dealing with this issue.

I will say that this is a deeply personal one for me. In the course of my mental health journey, I think I always suffered, even from the time that I was a little kid. It was my freshman year, however, when all hell broke loose. It was the first time I was away from home, from my family, my girlfriend and everything that I had previously known. I wasn’t ready for college and the experience of basically restarting my life, and I REALLY wasn’t ready for the “party” culture of college. I didn’t party – just the opposite – I was intimidated by everyone who did and didn’t know how to deal. As a result, my depression and anxiety exploded. Freshman year became the turning point for me – it’s the year I first started to suffer, but thanks to the counseling center at Muhlenberg, I had access to a great therapist who helped save my life by helping me develop strategies to deal with my depression and referring me to a psychiatrist who put me on the medication I still take to this day.

This issue is one of the reasons that, in my legislative career, I introduced legislation which would require colleges to develop and disseminate plans on dealing with mental health and suicide prevention. It’s a small step, but one that I think is desperately necessary to deal with this issue.

This is a major issue from a mental health perspective in this country, and one that we desperately need to deal with. The good news is that people are paying attention – and hopefully will continue to do so.

Coping Strategy: Do Something

I was down a few weeks ago when this particular memory bounced into my head.  I was sitting in my therapists office, discussing something – what, I don’t remember.  I think I mentioned to him how I had gone to the gym (unrelated, but hey, exercise can really help depression), despite the fact that I had been really depressed at that moment and didn’t feel like it at all.  And I remember he said that was good, because that moment when you are most down is exactly when you should get up and do something.

It wasn’t meant to be particularly profound.  But it’s one of those things that REALLY stuck with me.  My wife calls it faking it till you make it.  I referred to it as “pushing through,” but that struck me as simplistic, as if you can just willpower your way through depression (sometimes you can; often you can’t).

Imagine yourself as depressed as you have been.  What do you want to do?  The answer there is obvious: Absolutely, positively nothing, aside from this:

depressed on couch

That, as far as I am concerned, is the worst thing you can do.

Please keep in mind I’m only speaking from my personal experience and this isn’t medical advise, but I’ve always found that lying down and swimming in depression leads to one thing and one thing only: More depression.  And guilt.  “I SHOULD be doing my chores.  I SHOULD be hanging out with my kids.”

Is that guilt warranted?  Of course not.  Everyone deserves time to lounge around and do nothing – yes, you too, depressed person. But – and again, this is just my personal experience talking here – sitting around when depressed just leads to feelings of self-loathing and guilt.

This would be my advice to you, dear reader: Just…try doing something.  Anything that’s actually active and engages your mind, body or both.  It may be reading a book.  It may be going for a walk or heading to the gym.  Write.  Play a game.  Do jumping jacks.  Hell, I really don’t care.

What I do know is that, based on my own experience, is that sitting there, doing nothing, in the long-term, can equal a surrender. As best you are capable, get up, get moving. Will it make you feel better? Hopefully.  Maybe.  But doing nothing will certainly continue to sap your hope away, and anything is better than that.

Any specific strategies you want to share? Leave them below!

Depressed? Try volunteering

I caught this article on Motherboard and it really, really got me thinking.  The article itself is certainly worth the read, but I’ll try to summarize the points and add my own spin on it.

The article notes that volunteering helps with depression.  This happens a few different ways:

  • First, there are mental and physical benefits to volunteering.  Volunteering can lower blood pressure, reduce the risk of hypertension and make you physically feel better.  This happens, in part, by noting that oxytocin (feel good brain chemical) gets released when you regularly volunteer.
  • Volunteering helps you keep things in perspective.  It gets much harder to be depressed when you are working with someone much less fortunate than you.  I’ve always found this to be a helpful strategy, to be honest: On moments when you are depressed, compare yourself to someone who has it worse than you.
  • Volunteering gives you social connections and social interaction, a challenge for people who are depressed.

It’s actually the second point that I want to talk about more than anything else, because that’s something I’ve always found to be powerful: Volunteering gets you out of your own head.  Let me point back to a blog entry I made some time ago about depression and rumination: Thinking obsessively about yourself, and your own problems, can be tied very strongly to depression.

That’s where volunteering can come in.  Not only are you exposed to people in legitimately worse situations than you, but it can help you out of your own head, as it is much harder to think about yourself when you are trying to help others.  Sometimes, your brain needs that extra kick in the butt to stop the thoughts of yourself.  And that’s where volunteering can come in.  According to the article, there is no volunteering that is better than others – doing good means feeling good.

I do want to add one clarification here, however: I’ve made volunteering sound like a selfish exercise designed to the volunteer feel better. That’s not the attitude that you should have when you go to do good. Don’t get me wrong, there is nothing wrong with volunteering because you want to feel better and are hoping to build some social connections and make a difference.  But I would remind you that the only way to truly reap the benefits of volunteering is to do so by approaching it from an ultimately selfless perspective.  Go somewhere with the hope of doing good, and the rest of it will fall into place.

As always, I am curious to hear your perspective.  What good experiences have you had with volunteering in the hopes that it will help control depression?  How about negative ones?  I know I’ve felt both ways when volunteering, and I’m curious to hear other perspectives.  Let us know your thoughts in the comments!

Study: Depression can be treated with…anti-inflammation drugs…??

A friend was kind enough to send me this article, and this one is too strange sounding not to share: According to a new study, depression is “a physical illness caused by a faulty immune system” that can be treated with anti-inflammatory drugs.

From an article on the study:

Current treatment is largely centred around restoring mood-boosting chemicals in the brain, such as serotonin, but experts now think an overactive immune system triggers inflammation throughout the entire body, sparking feelings of hopelessness, unhappiness and fatigue.

It may be a symptom of the immune system failing to switch off after a trauma or illness, and is a similar to the low mood people often experience when they are fighting a virus, like flu.

“In relation to mood, beyond reasonable doubt, there is a very robust association between inflammation and depressive symptoms.  We give people a vaccination and they will become depressed. Vaccine clinics could always predict it, but they could never explain it.

According to the article, more tests will begin next year to see if anti-inflammatory drugs can help alleviate depression.

Obviously, this piqued my curiosity, so I did a little bit more digging.  First, this area of study isn’t new – there are studies dating back at least six years that would support the notion that inflammation and depression are linked.  From that article:

Previous studies have linked depression with higher level of inflammatory markers compared to people who are not depressed. When people are given proinflammatory cytokines, people experience more symptoms of depression and anxiety. Chronically higher levels of inflammation due to medical illnesses are also associated with higherrates of depression. Even brain imaging of people with depression show that their brain scans have increased neuroinflammation.

The article went on to recommend that everyone take anti-inflammatory steps (which are good for you regardless), including better diet, stress reduction, exercise, mind-body exercises and breathing exercises.

This is new to me, and fascinating.  That being said, it makes me nervous.  I’ve always operated under the assumption that depression – and mental illness in general – are not caused by – or treatable with – a single bullet.  They are a combination of things: Genetics, stress levels, thinking patterns, etc., that make someone mentally ill.  As such, the notion that one thing – inflammation – could be the cause of depression – well, it gives me pause.

It would be so, so wonderful to be wrong!

Two points about this research, and understand, please, that they are coming from a layman, not a doctor!:

First, more tests are required, so don’t run out and buy an anti-inflammatory today.  More information, specifics and treatment options are still needed.  For now, keep going to therapy and taking your medication, darn it!

Second, let’s say, for a moment, that future studies confirm a connection between inflammation and depression.  That does not (necessarily) mean that you should stop taking your medication or going to therapy.  Remember, all body-mind reactions are a two way street.  Yes, your body can affect your mind, of course, but the way you think can affect your body.  When you are scared, your heart rate accelerates, your breathing speeds up and you get sweaty.  Don’t think that being depressed, having negative emotions or damaging thought processes can’t potentially cause the inflammation that causes depression.  I’ve always believed – at least for me – that a combination of medication and therapy are the best way to deal with depression.  If you believe that too, don’t think that therapy will no longer be necessary just because you take some pills that can make the swelling go down.

This is fascinating.  And potentially hugely promising.  I can’t wait to track more information about this, and I really hope that this can provide people with real relief in the future.

Physician shortages: The biggest challenge facing mental health in America

I often write about stigma and the devastating role it can play in terms of keeping people out of treatment.  I think a big part of the reason I discuss it so frequently is that it’s the one area that people can actually get involved in and feel like they are making a difference.

That being said, I need to be clear about this one: Stigma reduction, though important, is not the most critical issue facing mental health.  That, I would argue, is a lack of capacity, largely in terms of mental health practitioners.

The facts on our ongoing physician shortage crisis are staggering:

  • According to a report by the Association of American Medical Colleges, over the next eight years, the United States will experience a doctor shortage of between 61,700 – 94,700.
  • That problem is much more acute in the area of mental health.  According to one report, in order to meet demand, the United States needs to add 70,000 providers over the next eight years if we are going to meet a growing demand.  The problem is even worse for people who live in rural areas; 60% of all people in rural areas live in a mental health professional shortage area.  In general, according to NAMI, only 41% of all people with mental illness are treated, while that number increases to 63% of all people with a serious mental illness.
  • The shortage doesn’t just affect personnel, but facilities.  It can be extremely difficult for the mentally ill who need inpatient care to have access to it, with some surveys estimating that the United States needs a whopping 123,000 psychiatric beds.

How did we get here?
As you can imagine, there are a variety of culprits, including:

  • Incredibly high standards to get into medical school and a long length of time for training.
  • Crushing medical student loan debt (averaging $207,000).
  • A shortage of residency slots for hospitals.  These slots are almost entirely funded by Medicaid, and that funding has not increased since 1997.
  • High cost of malpractice insurance.
  • Varying reimbursement rates for different specialties (more on this later).

Why is this problem so much worse in mental health?
This problem is even more acute in the mental health universe, where amount of psychiatrists declined 10% from 2003-2013.  The shortage gets even more severe as you go into mental health specialties, such as pediatric and geriatric care.

Again, there are many reasons that this issue is so problematic for mental health.  For one thing, hospitals and insurance companies pay doctors more if they are involved in specialties that turn a profit, like orthopedic surgery and urology…not psychology or psychiatry.  Additional public cuts to human services and mental health further exacerbate the problem. As a result, there is less staff in this area, regardless of it’s importance.

Physician burnout is also a problem, with one study noting that “86 percent reporting high exhaustion and 90 percent reporting high cynicism.”

Another problematic area is physician training, where there are concerns that training models have not evolved enough to introduce more medical students to mental health areas.

There’s more – much more than a simple blog entry can handle.  For a more in-depth look, I highly recommend that you review this report by the National Council for Behavioral Health.

What can we do about it?

  • Increasingly utilize technology and telehealth, which some studies have shown to be promising in the area of mental health.  With additional capacity, telehealth can help overcome geographic shortfalls that occur.  Other systems, such as bed and doctor registries, can help patients in need of treatment find appropriate resources.
  • Expanded number of residency slots.
  • Adjustment to reimbursement rates to ensure that mental health services achieve parity with other areas.
  • Adjustment to licensure laws in order to allow for other certified professionals – with appropriate training – to treat patients.

It is important to not lose sight of this simple truth: The mental health practitioner shortage can devastate the quality of life of the mentally ill.  It can kill people, frankly.  In my government job, my office regularly fields calls from constituents who need help but can’t find it.  Mental health is an issue that society is only truly starting to understand and deal with.  We must ensure that the mentally ill have the access to the resources that they need.