All Posts Tagged: depression

Transcranial Magnetic Stimulation

Transcranial Magnetic Stimulation: High Tech Help For Treatment Resistant Mood Disorders

Despite therapy and the use of medications, we occasionally find that the effects of a mental health disorder persist in some people. For these individuals, brain stimulation therapies like transcranial magnetic stimulation (TMS) may provide relief from their symptoms. TMS may also be an alternative for those who cannot tolerate mood stabilizing medications.

The National Institute of Mental Health (NIMH) reports that TMS and other brain stimulation therapies “involve activating or inhibiting the brain directly with electricity.” TMS is the most noninvasive of these treatments and is given via energy pulses that are generated by an electromagnetic coil held near or against the person’s head.

Because these magnetic pulses are given over and over in a repetitive rhythm, the most technically correct term for TMS is repetitive transcranial magnetic stimulation (rTMS).

What Is Transcranial Magnetic Stimulation Used For?

In 2008, the Food and Drug Administration (FDA) approved repetitive transcranial magnetic stimulation to treat major depressive disorders and their associated cases of severe depression and anxiety. It has also been studied as a therapy for psychosis and researchers are looking into how it may help conditions like post traumatic stress disorder (PTSD). Additionally, another form of rTMS, called deep transcranial magnetic stimulation (dTMS), has been FDA-approved for the treatment of obsessive compulsive disorder (OCD).

In 2010, the NIMH funded a clinical trial on the effectiveness of transcranial magnetic stimulation. Initial results showed that the effectiveness of rTMS was around 14 percent compared with a placebo-type procedure, which was only 5 percent effective. However, when participants were put into a second-phase trial, the remission rate of rTMS increased to 30 percent.

How Does A TMS Work?

When you go through a session of rTMS, you will be fully awake. Each session lasts between 40 and 60 minutes and no anesthesia is required. It is an outpatient procedure so you can drive yourself to the appointment and back home again. Typically, a person is treated four to five times per week for between four and six weeks.

During the rTMS session, an electromagnetic coil, which is about the size of your hand, will be passed over your forehead and scalp along the region of the brain thought to regulate mood. This coil produces short electromagnetic pulses similar in strength to the ones generated by a magnetic resonance imaging (MRI) machine. According to the Anxiety and Depression Association of America (ADAA), “The magnetic pulses cause small electrical currents that stimulate nerve cells in the targeted region of the brain.”

As scientists gain more knowledge about how rTMS can help people, they are developing new treatment methods. In fact, the FDA has sanctioned the use of theta burst stimulation, which is a variation of rTMS. In the theta burst procedure, the person only receives transcranial stimulation for about 10 minutes per session, however they still need to have daily sessions for several weeks.

In addition, another form of rTBS, called iTBS or intermittent theta burst stimulation, is now being given in 3 minute treatments. iTBS (also FDA-approved) gives intensive bursts of high frequency stimulation and has shown results comparable to the customary rTMS therapy.

Does TMS Therapy Hurt?

While rTMS therapy doesn’t hurt, the person may feel some mild sensations as the electromagnetic pulses are administered. These sensations might include:

  • A light knocking or a mild tapping feeling on their skull.
  • The muscles in their face, jaw, or scalp tingling when the magnet is applied.
  • These same muscles contracting while the magnet is in use.

Is Transcranial Magnetic Stimulation Safe?

Although most people do very well with it, rTMS does have some temporary, mild side effects for a small number of people. They can include:

  • Mild headaches
  • Lightheadedness
  • Scalp discomfort

Rare, but possible, is the chance of a seizure, however no seizures were reported during the two large studies that have been done on the safety of rTMS, according to the NIMH.

Additionally, Johns Hopkins reports that people who have non-removable metal objects in their head (for example: stents or aneurysm clips) should not receive rTMS. This is because the magnets can cause these objects to move or heat up, which could produce a serious injury or even death.

It’s worth noting that because transcranial magnetic stimulation is relatively new, we haven’t been able to study its long term effects. That said, treatment data has been compiled and studied since the mid-1990s and there have been no long term complications from its use, to date.

We Can Help

If you are struggling with anxiety, depression, or other mental health concerns, consider speaking with the professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. For more information on how we can help, contact us or call us today at 561-496-1094.

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What Problems Do Adopted Adults Have?

When we think about adopted children, most of us picture a happy family of cooing parents bonding with an adorable infant. For the adult who was adopted as a child, however, this blissful image is often tarnished by issues that carry over from childhood.

What problems do adopted adults have? Among other things, they often suffer from:

  • Feelings of loss and grief
  • Problems with developing an identity
  • Reduced self-esteem and self-confidence
  • Increased risk of substance abuse
  • Higher rates of mental health disorders, such as depression and PTSD.

In fact, Childwelfare.gov reports that, “…most of the literature points to adopted adolescents and adults being more likely to receive counseling than their nonadopted peers (Borders et al., 2000; Miller et al., 2000).”

What Are The Psychological Effects Of Adoption?

Way back in 1982, Silverstein and Kaplan did a study that identified seven core issues in adoption that still hold true today. They are:

  • Loss
  • Rejection
  • Guilt/Shame
  • Grief
  • Identity
  • Intimacy
  • and Mastery/Control

The study reports that, “Many of the issues inherent in the adoption experience converge when the adoptee reaches adolescence. At this time three factors intersect: an acute awareness of the significance of being adopted; a drive toward emancipation; and a biopsychosocial striving toward the development of an integrated identity.”

Loss first comes into the adoptee’s life when they are given up by their birth parents. Although the child is taken into a new family, there is still a sense of loss, even if the child is an infant. We know that it is very beneficial for newborns to bond with their mother – imagine how it can affect a baby who does not make this crucial connection.

Later, as the child matures and finds out they were adopted, that sense of loss becomes a theme running through the person’s subconscious. As such, adopted children typically feel succeeding losses much more deeply than their non-adopted counterparts.

Rejection is part of the initial loss the adoptee experiences. In order to be adopted, they had to be rejected by their birth parents. Later in life, if a birth parent blocks the adoptee’s search for them, the person experiences yet another rejection.

Guilt/shame comes from the adoptee’s feelings of rejection. As we know, children tend to blame themselves when something bad happens, therefore an adopted child naturally questions what they must have done wrong (or what was wrong or “bad” about them) that made their birth parent give them away. Even if the adoptee knows the reason they were placed for adoption, they often still secretly harbor the idea that they were somehow “broken” or could have been a “better” baby, which is why their birth parents rejected them.

Grief is part of adoption because the child lost their birth parents. We see adoption as a joyous occasion for the parents who are adopting the child, therefore the thought is that adopted kids should feel thankful to have a new family. Grieving for what they lost doesn’t usually have a place in the child’s life – it is considered a rejection of the adoptive parents if the child grieves.

Additionally, children sometimes don’t feel the effects of their deep-seated loss until they reach adolescence or adulthood and have developed a high enough cognitive level to understand what the loss means to their life. In many cases, this leads to substance abuse, depression, or aggression.

Identity is another loss the adopted adult must face. While they have been given a new name and identity by their adoptive parents, is it who they truly are? Or are they really the person they were before the adoption?

Even if they fully embrace their new family, the adoptee still suffers a loss of identity because they often know nothing about their birth family. What medical concerns do they need to watch out for (i.e.” does heart disease run in their birth family)? Who are their ancestors? What do they know about inherited genetic ties or family backgrounds?

Intimacy is frequently difficult for the adopted adult because they have such deeply rooted feelings of rejection, guilt or shame, and don’t truly have an identity. Often people who have gone through these negative emotions subconsciously push others away to avoid experiencing another loss.

The Silverstein and Kaplan study notes that, “Many adoptees as teen[s] state that they truly have never felt close to anyone. Some youngsters declare a lifetime emptiness related to a longing for the birth mother they may have never seen.”

Lastly, adoptees often feel little sense of mastery/control over their lives because they had no say in the matter of their adoption. Whether placed with their adoptive family at birth or as an older child, they were not given an option. As they mature, this can result in power struggles with authority figures and a reduced sense of responsibility.

How To Cope With Being Adopted

The first step to coping with being adopted is to recognize that the experience itself leaves residual problems. When the adoptee learns about and acknowledges the core issues inherent to adoption, they can begin to talk about them with someone, such as their adoptive parents, support groups, or a professional.

Accepting and exploring these core issues helps the adoptee work through them. The open adoptions that are the norm nowadays may reduce their sense of loss and guilt, while interacting with other adopted adults can allow the person to feel less alone.

It should be said that, while finding the birth parents can give the adoptee answers and closure, this is a deeply emotional process. Before contacting their birth family, the individual should prepare themselves to experience possible further rejection if a reunion is not what they dreamed it would be (or if the birth parents refuse to meet them once they have been found).

In addition, if an adoptee seeks out a therapist, they should make sure they talk to a professional who has special training in adoption issues.  

We Can Help

If you are an adopted adult and are struggling with your feelings, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida, can help. For more information, contact us or call us today at 561-496-1094.

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Why Words Are so Important in Psychiatry

Why Words Are so Important in Psychiatry

As reviewed in a past article, the field of Psychiatry is unique among medical specialties. At present, medical technology has yet to provide adequate imaging or laboratory testing that would allow for more objective assessment of a patient’s symptoms and concerns. A person with chest pain, fatigue and a racing heartbeat can rest assured that a carefully designed testing protocol will clarify the nature of the problem. Cardiac enzymes, electrocardiogram, chest x-ray and even cardiac catheterization will provide objective evidence to either rule-in or rule-out a cardiac event. Or the severe sore throat that makes swallowing difficult can be objectively clarified by obtaining a throat culture and consequently help the physician chose an antibiotic if indicated.

So how to proceed with such limited biomedical test resources? The art of listening is the answer. Listening will not be successful unless the patient knows that he/she can freely tell their story. First, the patient needs to hear a simple question. “How can I be of help?” After their reply the telling of their story is most important. For this to be successful there needs to be an open and accepting attitude that promotes this storytelling.

Once the story begins to unfold it is often necessary to backtrack and clarify aspects of the story. The words that the patient use become critical. What one individual means by the word “anxiety” may be quite different from that of others. I have discovered that behind the initial complaint of “I am anxious” will often be a core depressive illness that has an anxiety component. It is not uncommon for major depressive illnesses to contain a whole host of anxiety symptoms.

What of the individual with a true primary anxiety disorder. It is not sufficient to accept the word anxiety at face value. That is because anxiety is a more complex disorder and cannot be explained by a single word. Simply speaking, anxiety can be best understood by two of its components. One is best described as “somatic” or physical. Symptoms can include rapid heartbeat, sweating, gurgling stomach, headaches, tight muscles, shortness of breath etc. This individual is persistently or episodically physically uncomfortable and restless. They feel like they do not have control over their bodily sensations.

The other major component of anxiety is more mental or “psychic”. Such individuals spend excessive time with non-stop worrying. They get stuck with “what if this and what if that” thinking. They ruminate. They cannot turn off their brains. Sleep becomes difficult because of a busy head, Their thinking often is catastrophic, taking their worries down a path much farther than would be based on the current situation. Catastrophic thinking fuels the rumination and a vicious cycle ensues.

I am making a big deal of such language because treatment is often influenced by the specific type of anxiety. There are different medications to address somatic anxiety than that of psychic anxiety. Psychotherapies also differ depending upon the clarification of the anxiety explanation. So this is much more than a semantic intellectual exercise.

It is then most important to clarify the context of the individual’s symptoms. The goal is to try to determine how much the person’s difficulties are due to a reaction to a life situation. I have reviewed in past articles the difference between a core biologically-based psychiatric problem that definitely requires medication, a life based problem that would benefit from talking therapy and the hybrid situation in which a life stress induced problem triggers an underlying biological response that would require a combination of both types of treatment. One cannot get answers to such questions unless the dialog between physician and patient allows for a careful analysis of their story.

I have found that there is an added benefit of this approach. When a patient clearly knows that their physician is carefully listening and actively asking questions to clarify the specific aspects of their problem, a stronger therapeutic alliance develops. All too often I hear patients tell me that they were frustrated in the past with their doctor because they felt that he/she was not listening to them. This is so unfortunate because listening is a fundamental and easy process. Teasing apart the meaning of the words used in the story can be more challenging. Once the patient understands the importance of words, they can better appreciate the treatment plan and thus actively participate as a partner in the therapeutic process.

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LGBTQ Mental Health

Studies have shown that people who identify as lesbian, gay, bisexual, transgender, or questioning (LGBTQ) suffer from higher levels of anxiety and depression than the general public. In fact, approximately 30 – 60 % of the LGBTQ population have anxiety and depression and, as a whole, the LGBTQ community faces disproportionately high rates of suicide, self-harm, substance abuse and addiction. While there are many things that can influence a person’s mental and emotional wellbeing, prejudice and discrimination add additional trauma to LGBTQ mental health concerns.

Factors that Affect LGBTQ Mental Health

In and of itself, simply being LGBTQ does not affect a person’s mental health condition. Identifying against a cultural norm, however, exposes an LGBTQ person to prejudice and discrimination that their heterosexual counterparts don’t generally face. Some factors that affect LGBTQ mental health are:

  • Bullying
  • Homophobic societal attitudes
  • Hate crimes against LGBTQ people
  • Minority stress, which is a constant need to be “on guard” and to watch out for potential threats
  • Negative self-image and self-loathing due to societal attitudes
  • Lack of awareness of where to find positive role models
  • Media coverage that is beginning to embrace the LGBTQ culture on one hand, but shows detrimental news stories about the treatment of the community on the other
  • Worry about showing their true selves at work for fear of losing clients or promotions
  • Fear of being denied housing
  • Discrimination against transgender people within the LGBTQ community

Despite the fact that society is slowly becoming more accepting of the LGBT community, an uphill battle still remains. LGBTQ people have heard from birth that being something other than heterosexual or identifying with the gender you were born into is wrong. For example, although gay marriage was recently legalized, federal law still allows for legal discrimination in the workplace because it doesn’t protect people based on sexual orientation or gender identity. People can still legally be evicted from housing, fired from their job, or refused public or private services because of their LGBTQ status. Additionally, it is all too common for family members to reject someone who comes out to them.

Up to 65% of LGBT people suffer from some level of homophobia themselves (the belief that being LGBTQ is wrong). Hearing throughout their lives that they are somehow flawed causes many people to internalize those negative thoughts. Those who don’t have family or peer support have a harder time, as do those individuals who tend toward more negative personalities or have gone through adverse experiences, such as rejection or bullying.

On the other hand, even LGBTQ people who have supportive family and friends can end up feeling that their sexual or gender identity is somehow wrong. Often, people who love them want to help, but have no idea how to do so, and end up suggesting “cures” or a laundry list of worries (“you’re going to get AIDS”). These things contribute to the person’s feeling of being unworthy or hopeless. When the individual internalizes this shame from a young age, it often leads to long-term mental and emotional consequences.

Compassionate Care is Needed

For LGBTQ people, talking about their problems can feel like they are reinforcing the damaging stereotype against the gay and transgender community. Many individuals have been kicked out of their homes or shunned by family members and friends after they’ve come out. As an example, it’s estimated that about 40% of the homeless population in Southern California consists of homeless LGBT youth.

Compassionate care is needed to help the LGBTQ community recover from its serious mental health issues. Obviously, mental health providers should approach and treat their LGBT patients in the same manner as they would any other patient. However, they also need to understand how oppression and other factors contribute to anxiety and depression in these patients.

We Can Help

Our mental health professionals provide caring, compassionate LGBTQ mental health services. For more information, contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. Call us today at 561-496-1094.

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Can Using Medical Marijuana Increase Anxiety and Depression?

As of this writing, 30 states, Guam, the District of Columbia, and Puerto Rico all have approved the broad use of medical marijuana. Additionally, other states allow limited medical use and 8 states (and the District of Columbia) allow recreational use of the drug. Even though the use of pot and weed is becoming more acceptable, the Drug Enforcement Administration (DEA) still considers marijuana to be a Schedule I substance, meaning it is likely to be abused and it completely lacks medical value. This classification also means there hasn’t been much research into the efficacy of the drug for medical conditions and, in particular, we lack long-term studies that would tell us whether it is safe and/or effective when used over a long period of time.

What we do know is that, in clinical practice – both in our practice and in discussions with colleagues in other practices – mental health professionals are seeing an increase in the number of incidents of anxiety, panic attacks, depression, and even psychotic reactions now that marijuana use has become more mainstream.

Did you know that:

  • THC, the primary chemical in marijuana, is believed to stimulate areas of the brain responsible for feelings of fear.
  • According to available scientific literature, people who use weed have higher levels of depression and depressive symptoms than those who do not use cannabis.
  • Frequent or heavy use in adolescence can be a predictor of depression or anxiety later on in life – especially for girls.
  • Even if using cannabis seems to alleviate symptoms in the short-term for some users, it can lead to delay in getting appropriate treatment.
  • Scientific evidence suggests cannabis use can trigger the onset of schizophrenia and other psychoses in those already at risk of developing it.
  • A 2015 study found that university-aged young adults are more likely to have a higher risk of developing depression from heavy marijuana use.
  • Numerous research studies show that marijuana is an addictive substance. The more you use it, the more you need to use in order to get the same “high.”

Medical Marijuana vs. Recreational Marijuana

Whether it’s used recreationally or medicinally, both forms of pot are the same product. The medical version contains cannabinoids just like recreational marijuana. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main chemicals found in the medical form.

Although medical marijuana is used for many conditions (among them: multiple sclerosis (MS), cancer, seizure disorders, and glaucoma), its efficacy hasn’t been proven. “The greatest amount of evidence for the therapeutic effects of cannabis relate to its ability to reduce chronic pain, nausea and vomiting due to chemotherapy, and spasticity [tight or stiff muscles] from MS,” says Marcel Bonn-Miller, PhD, a substance abuse specialist at the University of Pennsylvania Perelman School of Medicine.

Mental Illness and Psychoactive Substances

As noted above, there aren’t many studies on the relationship between marijuana use and mental illnesses, such as anxiety, depression and bipolar disorder yet. However, research done in 2017, examined marijuana use in conjunction with the depression and anxiety symptoms of 307 psychiatry outpatients who had depression (Bahorik et al., 2017). This study found that “marijuana use worsened depression and anxiety symptoms; marijuana use led to poorer mental health functioning.” In addition, the study determined that medical marijuana was associated with reduced physical health functioning.

Part of the problem with using marijuana either recreationally or medically is that there is no way to regulate the amount of THC you’re getting, because the Food and Drug Administration (FDA) doesn’t oversee the product. This means not only the ingredients, but the strength of them can differ quite a lot. “We did a study last year [2016] in which we purchased labeled edible products, like brownies and lollipops, in California and Washington. Then we sent them to the lab,” Bonn-Miller says. “Few of the products contained anywhere near what they said they did. That’s a problem.”

Another area of concern is that, as we know from regulated psychiatric medications, one dose may affect you differently than it affects your sibling or a friend. People are unique – each person’s reaction to a medication will vary, which is why psychiatric medications are monitored by the prescribing doctor so that the dosage can be adjusted for your specific needs.

Be Careful with Marijuana Use

In summary, if you choose to use marijuana either medically or recreationally, be careful. Talk to the doctor who authorized it, or speak with a mental health professional if you find yourself experiencing the symptoms of depression or anxiety, or if you have panic attacks that begin or worsen while you are using pot. Additionally, be sure your doctor knows your psychiatric history before they authorize medical marijuana for you, especially if you have been diagnosed with anxiety, depression, panic attacks, bipolar disorder, or psychosis.

Do You Have Questions?

We can help! The mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida can answer your questions about how medical or recreational marijuana use can affect your anxiety, depression, or other condition. For more information, contact us or call us today at 561-496-1094.

Resource:  Bahorik, Amber L.; Leibowitz, Amy; Sterling, Stacy A.; Travis, Adam; Weisner, Constance; Satre, Derek D. (2017). Patterns of marijuana use among psychiatry patients with depression and its impact on recovery. Journal of Affective Disorders, 213, 168-171.

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For My Anxiety or Depression: Should I Use Medication or Therapy? (Webinar)

About the Webinar:

Dr. Andrew Rosen, Board Certified Psychologist, founder and director of the Center for Treatment of Anxiety and Mood Disorders and Dr. David Gross, Board Certified Psychiatrist, and medical director of the Center recently held a webinar on using medication versus therapy for anxiety and depression with The Anxiety and Depression Association of America. Some of the topics covered in the webinar include: What are the roles of medication and therapy? How can my psychiatrist (or primary care doctor) and my therapist work together as a team? How soon can I expect to see results from medication? How soon can I expect to see results from cognitive-behavioral therapy (CBT)? Are there situations where medication and CBT can work great together?

 

Watch the webinar here:

Recorded on April 21, 2017 for the Anxiety and Depression Association of America (www.adaa.org) © ADAA 2017

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