Posts Tagged ‘Depression Treatment’

DEALING WITH THE GUILT THAT GOES WITH BEING DEPRESSED

Wednesday, August 18th, 2010

Being depressed is hard enough. You feel sad, inadequate and worthless. You feel as if nothing you’ve ever done, can do or will do matters. You don’t feel like getting up, eating, getting dressed, going outside, working or playing. You just want to stay in bed and sleep. You’re listless, apathetic and de-energized. But, to make matters worse, people who are severely depressed tend to feel a great deal of guilt. I know this only too well. I know it because I’ve been severely depressed and felt this guilt, and I know it because I have sat in groups of depressed adults who speak of feeling this guilt with shame and pain written all over their faces.

What is a severely depressed person guilty over? How about guilt over not being able to work and earn income. Guilt over not taking care of your client’s cases and leaving your partners or associates to pick up your work load. Guilt over not being an active, involved and competent parent to your children who drives them to/from school, coaches their sports and helps them with homework. Guilt over not being a worthy role model for your kids. Guilt over your kids being ashamed of you when their friends find out their lawyer dad or mom is home depressed.

Then there’s guilt over not doing your share of home chores like grocery shopping, cooking, dish washing, house cleaning, weeding the yard or walking the dog. Guilt over not being a good spouse by supporting, encouraging and validating your partner’s efforts in the world – or by not being attractive, sexy and able to engage in passionate lovemaking. Guilt over needing help from others. There’s even guilt over being depressed in the first place.

Psychologists who treat severely depressed people say that guilt is an obstacle to recovery because guilt is a tool of self-punishment. You can’t get well, become functional again and regain your self-respect if you keep bashing yourself for being such a failure as a result of your depression. So what can you tell yourself to lift the burden of guilt?

It’s crucial to take the long view that depression is not a life sentence, that it will eventually pass if you ride it out instead of harming yourself and that you will be functional again one day. It’s crucial to accept the fact you did not desire to be depressed or invite depression in, but that it just happened and that like it or not you’re going to be depressed for a while and there’s simply no getting around it. It’s crucial to have some compassion for yourself in the midst of all that emotional pain.

Rather than denounce yourself as a pathetic failure for being in pain, it’s so much better to love yourself as would love a hurt baby bird which had fallen from the nest. You can actually say to yourself: “I forgive you for hurting like this instead of working and parenting like you usually do. I love you very much even though you are feeling broken right now. I want what is best for you. I’m on your side. I want you to heal and feel better. I want you to be free of suffering. I want to be happy again.”  

You can also help yourself through the guilt phase of depression by remembering certain basic truths about life. No one is always in a position to serve others. Sometimes life forces us to receive, and being depressed is a time when you must receive help from others to survive, heal and recover. This isn’t a bad thing. Other people can find meaning in life by serving you, so your needs enhance their lives. Without someone to receive, nobody can give.

When you always act the part of the tough-as-nails Marine who is completely self-reliant and detests help from anyone, you’re sending out a message that being vulnerable is bad. When you allow others to serve you, you make it okay for the people you care about (your spouse, kids and friends) to be vulnerable too. When they need help one day, it will be easier for them to receive it. If it’s difficult to open yourself to receiving help from your spouse and kids remember all that you have done for them in the past.

Take some time to think about what would not have been if you had not existed. Yes, you may be immobilized by depression right now, but take some comfort and joy in the fact that you’ve added real value to the world by your existence. Perhaps you’ve had a long, happy marriage. Perhaps you and your spouse have raised some wonderful children who care about other people and make the world a better place. Perhaps you’ve built a solid, ethical law practice which has helped many clients over the years. Perhaps you have mentored young lawyers to have integrity, humanity and professionalism as well as keen legal skills.

Meaning doesn’t have to come from what you do. Meaning can come from the way you are. It can come from how you cope with difficulties and how you relate to others during a period of difficulty. If you’re able to release yourself from guilt, overcome your depression and return to health and function, you become a beacon of hope and a model of resilience to others. You become a teacher. No one can help being struck by depression or feeling guilt as a result of depression. But it is possible to release your guilt and this will aid in your healing.

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THE BEST ANTIDEPRESSANT IS A RESCUE DOG

Monday, August 16th, 2010

While I was recovering from my own severe depression my beloved Bull Mastiff Rosie died. Poor Rosie had been my stalwart companion for nine years. For her first eight years she was a big, playful and bouncy dog covered from black nose to brown wagging tail with powerful muscles. In her ninth year she developed epilepsy which wracked her body in frequent, violent seizures. I had to put her on Dilantin. She lost a lot of weight and looked emaciated (the way I did when I came out of the hospital). Rosie slurped water from the toilets as if her life depended on it, but the poor dog could barely pee. As time passed her eyes looked vacant and she became listless.

Within two days of moving to our new home Rosie became very ill and passed bloody stool. The vet said she must have found some nails in the yard and eaten them, because he could see them on x-ray in her stomach. Given her condition he advised that we euthanize her. With the whole family present our vet said “Good bye old gal.” Rosie wagged her tail feebly. Then he injected her and she went to sleep forever. A wonderful chapter in the book of my life closed forever at that moment. Rosie’s illness and death symbolized the fragility and uncertainty of life. They came at a bad time for me – since I was then pushing myself to disengage from depression and become more hopeful and optimistic.   

After a few months of inner grieving when no one in our family spoke of Rosie, but we all keenly felt her loss in our way, my daughter Simone suggested we adopt a rescue dog. She began searching on her laptop for the perfect pup on www.petfinder.com which displayed thousands of images of abandoned dogs in need of a home, each image accompanied by a cute name and a brief description. We spent many nights crowded around Simone’s computer arguing the merits of different dogs. We visited a number of dog pounds and the homes of rescue angels – the people who acted as temporary caretakers of the abandoned dogs until a new home with a good family could be found for them. Alas, we couldn’t agree on a dog.

One night, Simone excitedly told us she had found the dog we were all looking for – a rescue dog named Coffee with a dark brown head, a light chestnut muzzle, floppy ears, green eyes and a cream colored body splashed with brown specks. We all agreed this dog was incredibly cute. The description said she was an Australian Shepherd pup about two months old that could be picked up in San Francisco, just over the Bay Bridge from our new home. We applied online. A week later a nice Asian lady came to our house, looked it over and asked us plenty of questions about our love of dogs and our past history of caring for dogs. She seemed satisfied and said we would be contacted later.

About a week after that we received a phone call stating that Coffee was in Taiwan and she would be arriving soon in a crate aboard an Air China plane at San Francisco Airport. Apparently Coffee was part of a litter of street dogs that had been found living with their mom in an abandoned taxi cab covered in flees. An Asian-American dog rescue group had found the pups, bathed them and flee dipped them, spayed or neutered them, and given them their shots. The pups had been housed at a rescue angel’s home in Taiwan until they were ready to leave their mom and travel to the U.S. for permanent adoption. I had never heard of this truly remarkable organization called Asians for Humans, Animals & Nature (www.ahan.org). They explained to us that in Taiwan stray dogs are either gassed or killed and eaten, so AHAN volunteers rescue these dogs and get them to America.

We met Coffee one December night in 2008 at the Air China terminal of SFO. When the AHAN volunteer took her out her crate we could see she was unbelievably cute, and to make her still cuter (if it were possible) she was dressed in Chinese silk pajamas! It was love at first sight for us.

Coffee had clearly been traumatized in Taiwan. It took her about three weeks to gain enough trust in us to come near us. Then, gradually, on a day by day basis she came to love us. Coffee became a full member of our household.

Every night before we go to bed, and every morning when we wake up, she makes the rounds and licks all of our faces. Coffee spends the night curled on the bed that I share with my wife. In the morning she nudges me for a belly rub before she yawns, stretches and comes downstairs for breakfast. After her breakfast she poops outside and then nuzzles me while I meditate with eyes closed. After meditation I eat breakfast and then sit down to do my blog. While I’m typing my blog Coffee lays down behind my chair and keeps popping up for head pats and back scratches.

Coffee is a nut, a very lovable nut. Sometimes she will look out the window at absolutely nothing and start to bark. When I pick up her leash or say the word WALK she begins to sing by barking at a very high pitch and to dance by standing on her hind legs and twirling round and round. I usually walk her in a huge cemetery near our house. As my car gets near the front cemetery gate this 50 pound lap dog will jump into my lap and put her paws on the steering wheel of the car while singing in her high pitched voice. In the cemetery I slow to about 5 mph because the road is so rutted. If Coffee sees a flock of birds or a squirrel she will leap out of the open window and chase them even though (thankfully) she never catches them.

At the cemetery I throw enormous pine cones for Coffee to chase and retrieve. She always comes back with a great Aussie smile. When I come home from anywhere she greets with me with that same smile. At night when all the chores and homework are done and my son Elliott and I lay near each other on our giant mushroom shaped pillows to watch Iron Chef or the Discovery Channel, Coffee will lay down with us, lick us and spoon with us. Her love, her charm and her warm, positive, happy spirit have all helped me to heal from depression. Yes, I’ve taken medication, had psychotherapy and meditated. And yes, I do exercise every day. But without Coffee I wonder if I would have done as well as I have.

Coffee and I have rescued each other. The love of a great rescue dog is truly a great healer for depression, and its power cannot be discounted. Coffee loves me unconditionally. She is always there for me. She makes me laugh and smile. She also gives me someone to love, stroke, pet and care for.

If you’re going through a depression right now or you know someone who is, then please consider a rescue dog. It’s better than antidepressants.

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TRAIN YOUR BRAIN USING OPEN FOCUS EXERCISES TO DIFFUSE STRESS AND RELIEVE ANXIETY OR DEPRESSION

Monday, July 26th, 2010

The human brain is an electro-chemical organ which produces a small but measurable amount of electric current in the form of gamma, beta, alpha, delta and theta waves. Each wave type has a range of frequencies associated with different types of mental activities. The brain does not emit any one wave type in pure form. At any given moment it emits a mix of two or more wave types. The predominant wave type can vary s with the part of the brain being measured. EEG brain wave patterns vary depending on whether a person is awake and actively concentrating, awake and resting, falling asleep, in deep slow wave sleep or dream (REM) sleep; in a fearful, tense and fight-flight state; in a calm, meditative state; or in states of consciousness affected by such things as sexual arousal or consumption of alcohol or drugs. Mental illnesses and alcoholism show distinctive brain wave patterns.

Neuropsychologist Les Fehmi, Ph.D., is an expert in the link between brain waves and stress reduction. After doing his post-doctoral work at the UCLA Brain Research Institute, he became a pioneer in neurofeedback therapy. Neurofeedback is a method of helping individuals reduce stress levels and anxiety symptoms by gaining control over their central nervous system using EEG biofeedback. In 1969 Dr. Fehmi co-founded the Biofeedback Society of America which later became the Association for Applied Physiology and Biofeedback. During the 1970s Dr. Fehmi used neurofeedback on hundreds of patients. He had them sit at a desk wearing a headband with a nest of electrodes attached to their scalp while they watched their EEG displayed in real time on a screen. They were asked to control their brain waves without being told how to do so, since nobody quite knows how this can be done. If they did not make the desired changes they were notified by bleeping noises and flashes of light.

Dr. Fehmi’s approach to neurofeedback was twofold. First he wanted patients to learn to synchronize their brain waves across their entire brains, because the brain operates most efficiently, effectively and under the least stress when brain cells in different brain regions are firing together (synchronously) in the same wave pattern. Second he wanted his patients to reduce beta (the highest frequency, most energetic brain waves in the range of 13-50 hertz) and increase the amount of their alpha waves (in the range of 8-12 hertz). At the higher end of beta frequency people show great mental effort, high mental energy expenditure, anxiety and tensed muscles. A college student taking an important exam who does not know the material and a driver who blares his horn and screams angrily after being cut off are in high beta. In the alpha frequency people are in a relaxed but alert state where they can observe and deal with the world without intense effort. Meditation puts people in an alpha state. You can also move from beta to alpha by closing your eyes.

During the 1970s Dr. Fehmi noticed an interesting phenomenon while treating his patients. All of them went through a difficult break-in period using neurofeedback where no matter how hard they tried they could not get the results they wanted. They couldn’t synchronize their brain waves or reduce beta and increase alpha frequencies. It was only when they gave up and were on the verge of quitting the training that they succeeded. It was only when they concluded that no amount of trying would succeed and they let go of trying, that they effortlessly brought their brain waves under conscious control. Dr. Fehmi concluded that to be successful in neurofeedback his patients had to give up their effortful orientation to the task.

This led Dr. Fehmi to realize that the how of attention (how we pay attention to something) is much more important than the what (the content of our attention). He began taking physiological measurements of people attending in effortful (beta) and relaxed (alpha) fashion. He found that effortful attention triggers the sympathetic nervous system with the adrenalized fight-flight response and over-reactivity;  whereas relaxed attention triggers the parasympathetic nervous system which keeps people calm and at ease. Dr. Fehmi also found that people learn information more quickly, more accurately and with much less effort in a relaxed mode of attention. People who approach tasks in an effortful way have greater difficulty and progress more slowly.

After years of studying attention Dr. Fehmi came up with different categories of attention. Narrow focus refers involves intense effortful attention associated with high beta waves. A person using narrow focus shrinks the aperture of his attention to one object (be it a person, thing or  idea) while pushing all other objects into the background and excluding them from consciousness insofar as possible. Open focus refers to a diffuse form of attention in which the person’s aperture of attention is wide open. In open focus a person remains aware of the object he’s attending to, but he is  simultaneously aware of his internal sensations, feelings and ideas, the objects in his environment along with their sounds, sights and smells; and the space in, around and between external objects.

Objective focus refers to a state of scientific detachment from the object of attention which is looked at as a wholly separate and distinct entity. It is accompanied by a high degree of self-consciousness, analysis and judgment. Immersed focus refers to a form of attention in which the observer experiences the object of attention from within, yield to it and joins with it. It is accompanied by sensations of union, pleasure and love and marked by a loss of self-consciousness and judgment.

According to Dr. Fehmi the most prevalent form of attentional style in our society is the narrow-objective kind. It can manifest as an obsessive-compulsive focus on a psychological or environmental object or as a denial of and shift of attention away from such an object. This kind of attention limits our awareness and stimulates fear and anxiety by separating us from our inner guidance system (our sensations, feelings, emotions, and intuitions) and from other people. Lawyers engage in the narrow-objective style of attention nearly all the time. They frequently focus on ideas, words and word meanings to the exclusion of their own physical sensations and feelings and their inner sense of what others are feelings. Dr. Fehmi says that people who are stuck in this mode of attention show awkwardness, lack of smoothness and fluidity in dealing with others and a tendency toward anxiety, worry, panic and rigidity.

Narrow-objective attention is a creature of the left brain. Our cave dwelling ancestors used it when they were out hunting or foraging and they had to scan their environment with utmost vigilance and urgency to spot predators like saber tooth tigers. Children in our day learn to use narrow-objective attention when they are told to stop day dreaming, focus on their homework and prove to their parents and teachers that they know their academic material. This amps up their nervous system. As children or as adult lawyers we can get stuck in this amped up state of great cognitive intensity which rigidifies one’s thinking and one’s muscles. Open states of attention act as a gear shifter that can take us out of this mental and physiological state in which we are stuck in over-drive. They allow us to get the best performance out of our brains and feel so much better.
Although narrow-objective attention has its uses, the problem (says Dr. Fehmi) is that we are addicted to it and we use it in many situations where it is more of a hindrance than a help. Narrow-objective focus is useful when learning the parts of the human body, but not when figuring out why a patient is dizzy or depressed. Narrow-objective focus is  useful in learning the notes to a music score but not when playing your part during a symphony orchestra performance. Narrow-objective focus may have some use during  sexual foreplay but not when making love. The key is in developing attentional flexibility so you can make use of all forms of attention at the appropriate time. Developing this flexibility helps release the psycho-physiological stress stored up through habitual use of narrow-objective attention.

When we stop excluding parts of our experience, open up our focus and allow our attention to equally and simultaneously spread out, we experience a softening of goal-directed behavior, a release of energy and a greater sense of wellbeing. The addiction to narrow-objective focus causes us to miss out on many opportunities to use open-diffused and open-immersed attention which are associated with the right brain and which give us a broader big-picture view which sparks creativity, empathy and spirituality. When the right brain is engaged sensory experiences become more fresh, vivid,  captivating, and satisfying. Our brains were designed to be multi-modal, which means they were designed to take in and integrate information from all five senses. We learn best and enjoy life most when we use our minds in a multi-modal fashion. Dr. Fehmi says that a life lived with open focus takes us away from tension, rigidity, anxiety and fatigue to ease, flexibility, efficiency, energy, productivity, spontaneity and creativity.

So how do we get there? You can either seek a solution to your problems in the content of your lived experience (memories of the past), which Dr. Fehmi says won’t work, or you can change your style of attention to open focus. When patients come to Dr. Fehmi for help he can give them neurofeedback, open focus exercises or both. The neurofeedback route is more expensive and requires multiple visits to his office in Princeton, New Jersey, to use the EEG machine.

Patients using neurofeedback benefit by producing more alpha than beta all over the brain and by harmonizing their production of alpha so the various parts of their brain emit alpha in unison like a choir. This allows information to pass through the brain more rapidly, fluidly and completely and allows for the greatest possible integration of information. It enables thinkers, artists, musicians and athletes to reach their peak performance. If you want to try this therapy your insurance might cover it, for instance if the presenting complaint was headache or insomnia. If you can’t make it to Princeton where Dr. Fehmi’s Princeton Biofeedback Center is located, you can go to his website at www.openfocus.com to find links to people he has trained in various parts of the country.

Open focus exercise therapy is inexpensive and can be done at home or at the office behind closed doors. You can do it with a CD. In 2007 Dr. Fehmi came out with The Open Focus Brain published by Trumpeter Books. It contains a companion CD with open focus exercises as well as written exercises after each chapter. I have tried the open focus exercises on CD and found them quite helpful. They put me in the same relaxed, tranquil and mildly euphoric state of mind that meditation does. Like meditation these exercises give me renewed mental clarity and extra energy. Open focus exercises and meditation both involve learning to accept rather than fight one’s sensations, feelings and ideas. In his book Dr. Fehmi talks about curing pain by turning into it, rather than running from it and trying to push it away. Whether you allow the imagined physical space around your pain or the space of your awareness to enter it and fuse with it, either way it will dissolve. The same holds true for negative thoughts and fears.

Based on his work with many thousands of patients Dr. Fehmi says that open focus work can become second nature after you do the exercises enough, and it can not only reduce your stress and anxiety, but help you with self-realization. Chronic stress breeds depression, substance abuse, insomnia, fatigue and stress-related disorders like asthma, allergies, rashes and psycho-somatic pain syndromes. When these have been cleared up, and your brain is working in alpha and firing synchronously, you can expect to experience renewed energy, productivity, enhanced relationships and improved performance in your work, sports, leisure and artistic activities.

Although open focus work is compatible with, and can be done simultaneously with, meditation, I know from experience that some people who could benefit from both modalities are not going to become long term meditators. Why? Some people don’t like sitting for prolonged periods of time in silence in the hope of reducing stress, improving mental clarity and gaining wisdom and compassion. They find listening to their own interior mental chatter intolerable – or they complain of distracting noises, physical pain or discomfort, boredom, restlessness, frustration, lack of progress and a host of other problems. Meditation isn’t for everyone. For these people open focus could be a safe, drug-free method of reducing stress, anxiety and depression while enhancing their performance of and enjoyment of their work and other activities.

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DETECTING AND TREATING DEPRESSION IN OLDER LAWYERS

Thursday, July 8th, 2010
Life doesn’t always get easier for lawyers who make it through middle age into their sixties and seventies. Geriatric psychiatrists Mark D. Miller, M.D. and Charles F. Reynolds III, M.D., have written extensively about the unique challenges facing people in later life (people over 60) which can precipitate depression while making it hard to get treatment. According to these physicians if you become depressed for the first time after age 60, the odds are that your depression is not the result of genetic influences but came from something else.
What else might cause a first time depression in someone older than sixty? Their list includes the following: a series of mini-strokes which went undetected but caused cognitive impairment; experiencing the death of one’s parent, spouse, siblings or close friends; living with disability due to chronic pain or other causes which forces one to stop playing sports or engaging in hobbies; thyroid malfunction (either too much or too little output of thyroid hormone); Vitamin B12 deficiency; neuro-degenerative diseases such as Alzheimer’s or Parkinson’s; sleep apnea; liver or kidney disease allowing toxic substances to build up in the blood that goes to the brain; and the use of a beta blocker to lower blood pressure, which can cause depression as a side effect. Current research by other physicians indicates that statin drugs used to lower cholesterol can impair serotonin reception and cause depression, and that Vitamin D deficiency can be source of parathyroid hormone disruption and depression in older people.
Whatever the cause of the depression, Drs. Miller and Reynolds say it is a disease which can and should be treated rather than a natural part of aging. In their practice they have found that the vast majority of older patients who are treated for depression experience significant improvement in mood and increase in daily functioning. According to these physicians whatever the cause of the depression, the existence of depression may be missed in older people or not taken seriously for several different reasons.
First, there is a general assumption that when you’re old you slow down and begin to tune out. Second, there is an assumption that anyone who faces the circumstances of aging (illness, disability and loss of loved ones) is justified in feeling down. Third, older people don’t say they’re feeling “sad,” “blue,” or “depressed,” but talk about feeling “lousy” which can mislead others into thinking they have purely physical problems. These doctors assert the myth that depression is an inevitable part of later life is the biggest obstacle to treatment.
A fourth reason family and friends may fail to detect depression in an older member was recently discovered by Linda Mah, M.D. who works with older adults with depression at the Mood Clinic at Baycrest in Toronto, Canada. Her study appeared in the May 2010 online version of the American Journal of Geriatric Psychiatry. Dr. Mah was aware that in older patients the diagnosis of depression is typically made on the basis of cognitive impairment, whereas in middle aged patients the focus is on poor mood. She explored the possibility that studying emotion could help us better understand depression in older people.
Dr. Mah recruited 22 people age 60-87 consisting of a group of 11 un-medicated outpatients with major depression and another 11 healthy controls. She showed them photographs of faces with happy, sad, fearful or neutral expressions. The depressed patients showed a relative lack of sensitivity to the effects of positive or negative emotional expression, and they had 60% greater difficulty with correctly labeling neutral faces compared to the healthy subjects. Dr. Mah concluded that older depressed patients have an impaired ability to read other people’s emotional expressions (something that would likely damage their social connectivity); and that unlike younger depressed patients, who tend to respond negatively to all emotional stimuli compared with healthy controls, older depressed patients respond in a baffled or confused way to the emotional displays of others.
If you’re concerned that an older colleague might be depressed what symptoms should you be looking for? The chief symptoms are insomnia, loss of appetite with weight loss, low energy or fatigue, difficulty concentrating, feeling worthless or excessively guilty (often expressed by describing oneself as a “burden” to others), slowing of movements (often accompanied by a long face and stooped posture) and suicidal thoughts.
If you see these symptoms in an older colleague, do your best to get him seen by a geriatric psychiatrist. Drs. Miller and Reynolds say that the rate of suicide is five times higher in later life than at other times. This may have something to do with the perception of older people that their time is running out coupled with the depressive thought that things will only get worse and cannot get better. These perceptions are distortions. In a previous blog I detailed the insights of Harvard psychiatrist George Vaillant, M.D. in his book Aging Well on how to make later life the crown and the happiest time of a well lived life.
In their book Living Longer Depression Free: A Family Guide to Recognizing, Treating, and Preventing Depression in Later Life, Drs. Miller and Reynolds cover all the different forms of conventional and alternative treatments now available to help older people with depression. I recommend this book to anyone trying to understand how to deal with issues posed by depression in later life. It has an excellent chapter on how to grieve in a full, expressive, and healthy manner, as well as much useful information on the practicalities of how to access proper care for depression.

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TRANSCRANIAL MAGNETIC STIMULATION THERAPY FOR DEPRESSION

Wednesday, June 30th, 2010
The NeuroStar device for transcranial magnetic stimulation (TMS) of the brain was approved for treatment of major depression in certain patients by the FDA on October 9, 2008. TMS is not a front-line treatment. The patient group for whom TMS was approved consists of those depressed patients who have failed to respond to at least one drug. In clinical parlance “respond” means showing an improvement in symptoms of at least 50%. The typical patient who is referred for TMS has what is called treatment-resistant depression and has failed to benefit from trials of many different anti-depressant drugs.
TMS is safer than electroconvulsive therapy (ECT), because it treats depression without inducing loss of consciousness, seizures or memory impairment. In order to understand how the NeuroStar works I went today (6/30/10) to a facility in Berkeley, California, called Bay TMS (www.baytms.com). Claudia, the technician who operates the machine, was kind enough to show me the machine and explain how it works.
The TMS machine is premised on the idea that depressed patients have  underactive prefrontal lobes and an overactive amygdala (the part of the brain that triggers a neuro-hormonal cascade involving fight-flight, cortisol release and anxiety). The machine has a coil which generates a magnetic pulse. The coil is housed in a plastic unit that can be placed on the patient’s head and directed by the technician to send harmless magnetic energy through the prefrontal lobes. The magnetic energy is believed to wake up (increase the activity of) the prefrontal lobes and to quiet or dampen the activity of the amygdala.
The first session is conducted by a psychiatrist who reviews the patient’s history of depression and determines that he has major depression which has not responded to anti-depressant medication. The patient sits in a comfortable, reclining chair with his head tilted on a headrest so that the lateral corner of his left eye is aligned with a laser beam. The psychiatrist makes measurements so the magnetic pulse is most likely to pass through the patient’s prefrontal lobes. These measurements are recorded in the computer for later use by the technician. Before the coil is activated the technician applies a sticky white strip over the top and around the sides of the patient’s head so it won’t move during  treatment. The strength of the magnetic pulse is set at the lowest strength consistent with a good clinical effect which is equal to 120% of the amount of magnetism needed to cause a slight twitch in the patient’s thumb when he holds his thumb up like a hitchhiker.
Before lowering the unit to the side of the patient’s head, the technician applies a strip containing two sensors to the plastic unit housing the coil. These transmit data wirelessly to a computer in the room regarding the flow of magnetic energy through the patient’s brain. There are 10 pulses of magnetic energy per second pulsed for 4 seconds with a rest interval of 26 seconds. The average duration of one treatment session is 37-50 minutes. Patients experience the flow of magnetic energy similar to how a person would feel a very mild discharge of static electricity. Over time most patients either stop noticing the discharge or hardly notice it.
Typically a patient is treated five days per week for the first 4 weeks, and then over the last two weeks treatments are tapered down to zero. However, sometimes a patient responds much more quickly. Claudia said she has treated approximately 20 patients including some patients with suicidal ideation and one who made a suicide attempt. All of the patients showed good clinical benefits with some of them experiencing complete remissions of symptoms. Claudia noted that the TMS treatment not only helps with major depression but has helped their patients with co-morbid conditions such as PTSD and OCD. She anticipates the FDA will approve the NeuroStar for treatment of PTSD in the future.

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FOLLOW UP COMMUNICATION CRUCIAL TO EFFECTIVE TREATMENT OF DEPRESSION

Sunday, June 27th, 2010
Less than half of all people with depression get treated because of obstacles like  denial, fear of stigma or pessimism about being helped. Sadly, many of the people who do get treated remain symptomatic because they stop taking their medication due to side effects or they encounter stressors that flare up their smoldering depression. Instead of   re-connecting with their doctor for help they just give up.
A health care quality group called MN Community Measurement ascertained that historically only 5.8% of Minnesotans treated at primary care clinics for depression reported being free of symptoms within six months. In 2008 ten clinics in Minnesota got together to create a new treatment program for depression called the Diamond Project. Participating clinics trained their employees to act as “care managers.” They checked on patients by phone to see if they were still taking their meds or experiencing side effects. They provided coaching by phone with regard to medication and stress issues. The program was so successful it spread to 83 clinics statewide. On June 25, 2010, MN Community Measurement reported that an average of 26% of patients seen at Diamond Project clinics were symptom free six months after being seen. The best result was reached at the Mayo Northwest Clinic in Rochester which had a six month success rate of 36%.
Psychiatrist Mark Williams at Mayo’s Northwest Clinic said that depressed people can give up on treatment easily if left to their own initiative. His clinic’s high success rate in treating depression came from tracking patients down after they were seen to find out how they’re doing. When people are called after being seen, they are much more likely to make a return visit to the clinic if they are having difficulties with medication or with life.
What happened in Minnesota can happen elsewhere in the country. If more states adopted programs like the Diamond Project more people with depression would maintain clinical improvement after being treated.
If you live in a state or county which does not have a clinic with good follow up for depression treatment, please alert your physician to the Diamond Project and suggest that he study their results. Meanwhile, make a pact with your physician, your spouse or a good friend to keep track of your medication compliance and your mood, and to prod you to return to your doctor if you’re experiencing difficulty. By staying in touch with your treating physician when you hit a rough patch, your odds of remaining free of depression or of avoiding the most severe symptoms are much better.

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