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In despair from major depression, I turned to a last resort: Magnets

In despair from major depression, I turned to a last resort: Magnets

For most of my 46 years, I have battled mild to severe depression and anxiety. Mood disorders run like a sticky red tape through my family, so it wasn’t a surprise that I needed a psychiatrist’s care starting as a young child. He helped me push on through middle and high school.

But when I went to college – away from my support system – I started thinking about suicide. Hearing this, a campus psychiatrist had me hospitalized, which only increased my despair. I attempted suicide and was institutionalized even longer.

With time and intensive therapy, along with an early form of antidepressant called a tricyclic, I managed to pull myself back into life. I finished college, worked in journalism, got married, had three children.

However, my depression never entirely left me alone. Dysthymia, a persistent, mild depression that insidiously eats away at self esteem, meant I couldn’t feel sustained pleasure or pride in the accomplishments for which I had fought so hard.

But that was nothing compared with what happened a few months ago. Without warning, I slid back down into the dark hole of severe depression, complete with thoughts of suicide.

Major depression strikes both sexes, but is more common in women, in part, it is thought, due to hormonal differences. Its incidence is on the rise, but it already is the leading cause of disease burden – a measure of both health and financial impact — in women worldwide, according to the World Health Organization.

As my case illustrates, major depression affects the entire family. My husband and in-laws took care of the children. Friends brought dinners. And I dragged myself through the days, desperate to stay out of the hospital, leaning on my psychoanalyst and the psychiatrist who prescribed my medications.

It wasn’t enough.

After many grueling weeks, my psychiatrist suggested that I consider transcranial magnetic stimulation (TMS) – a treatment I had never heard of.

‘Like an electronic woodpecker’

TMS is a noninvasive treatment administered by a physician in an outpatient setting daily for approximately six weeks. A magnetic coil that produces pulsing energy is placed on selected parts of the scalp, carefully set to the level of energy needed to stimulate a patient’s brain cells. You remain lying down, wearing earplugs because the machine makes a loud clicking sound like an MRI. In my experience, TMS feels like an electronic woodpecker hammering on my head. But oddly enough, it isn’t painful, and I sometimes even drift off to sleep during treatment.

The magnetic stimulation has been shown to change neuron activity in parts of the brain involved in mood regulation. Estimates for the success of TMS in patients who haven’t been helped by medication or other therapies vary between 50 percent and 75 percent.

It sounded so promising – and I was so desperate – that I quickly scheduled an appointment with John O’Reardon, a Voorhees psychiatrist who has long seen patients close to giving up.

During our 1½-hour consultation, O’Reardon confirmed my severe depression, accompanied by high anxiety levels. He thought I might not be on the right combination of psychiatric medicines but also recognized I was in no condition for the agonizing process of recalibrating them. Since age 18, I’ve tried roughly 15 different drugs, without lasting success.

My experience is not uncommon. Statistics about the efficacy of antidepressants vary and indicate that those with moderate to severe depression benefit the most. Studies of adults with moderate to severe depression showed that about 40 to 60 out of 100 people who took an antidepressant noticed an improvement in their symptoms within six to eight weeks, though research also indicates that some of this gain may be due to a placebo effect.

Putting any major shifts in my medications on hold, O’Reardon recommended a full course of TMS, which the Food and Drug Administration approved in 2008 for the treatment of depression and migraines. I live in Bala Cynwyd but chose to drive every day to see O’Reardon because of his 21 years of experience, first at the University of Pennsylvania in a clinical research setting and now in private practice. I also took heart in his telling me that although I might feel “hopeless,” I was not a “hopeless case.”

“The amount of patients who have severe, what we call treatment-resistant depression, is about four million at any one time in the U.S.,” O’Reardon said later in an interview. “These are patients who do not respond to medications, who may not respond to therapy, and really need something else. And for those patients, in particular, TMS is very useful.”

The treatments stimulate connections of nerves or neurons called circuits to restore their normal activity.

“These circuits are disabled, or if you like, off-line in depression,” O’Reardon said. “And because they’re not working as normal, the patient has many things like depressed mood, low energy, poor sleep, and can, of course, even feel suicidal. By stimulating these circuits with magnetic energy, we can restore them to normal activity.”

A typical course of TMS is five days a week for a total of 30 to 36 sessions. The treatment is very safe and, unlike psychiatric medications, has few side effects. The most serious issue is a risk of seizure in about one out of every 1,000 patients. People can drive themselves to and from appointments and conduct normal conversation during treatments.

Expanding TMS’s reach

Approximately 1,000 TMS centers have popped up across the country since 2008. Clinicians around the world are studying TMS to treat conditions from post-traumatic stress disorder to autism spectrum disorder.

Deborah Kim and Susan Rushing, psychiatrists who jointly run TMS Associates of Pennsylvania in Haverford, do what is known as deep TMS.

“Really, the main difference is that it works on a larger part of the brain so it gets more of the circuit that we think is involved in depression,” said Kim, who is also an associate clinical professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania. “This is as close as we can get without doing deep brain stimulation,” she said of the surgical procedure used most often to help address some symptoms of Parkinson’s disease.

She notes that TMS is especially useful for treating depression in women who don’t want to use medication while pregnant or nursing.

Yvette Sheline, director of the Center for Neuromodulation in Depression and Stress at Perelman, and her colleague Desmond Oathes are researching using MRIs of people’s brains to better pinpoint where the magnetic energy should be applied to maximize benefits. Showing brain activity on an MRI while the device is in use enables “the correct target to be identified at the outset and keeps the stimulation on target during treatment,” Sheline said.

Roy Hamilton, a Penn neurologist, is looking at TMS for improving language development and motor skills after brain injuries such as stroke. “Plenty of patients who’ve been through physical therapy still have pretty dense motor deficits,” Hamilton said, adding that a goal of his research is to “accelerate the course of recovery and to extend the overall level of recovery.”

O’Reardon has used TMS “off-label” to help people with obsessive-compulsive disorder, post-traumatic stress disorder, auditory hallucinations caused by schizophrenia, and chronic pain.

Up out of the hole

I had 30 sessions at $300 a pop, which I paid for out-of-pocket and then submitted to my insurance company – after receiving prior authorization – for out-of-network reimbursement.

The sensation over time was like climbing up a staircase out of the hole, back into my daily life. I began working and parenting again and ultimately feeling brighter, more hopeful, and more resilient than I had in as long as I could remember.

“Some people really just feel like a light is turned on in a way that it never felt like when they were on medications,” Kim said. “The world looks colorful again.”

O’Reardon and I are now discussing how to maintain my gains, most likely through once or twice monthly session of TMS for the indefinite future. He will also continue to manage my medications.

As remarkable as my recovery feels, what may be more astonishing to me is discovering that depression may no longer be a life sentence for me.

“I had never had somebody tell me before that I could get fully well,” I recently told O’Reardon. “That was really an eye-opener when I came in here, and you talked about remission.”

“I think it speaks to some degree to under-treatment in the community – that [depression is] not always treated intensely enough, and then I guess maybe people don’t think about it the way we should think about it: as a reversible illness,” O’Reardon said.

“We should be treating depression more like treating hypertension or diabetes. If you had the right tools, you should be able to reverse things fully and get back to a normal balance. Now we don’t always achieve that, but you’ve got to start with that goal in mind.”

Source For The Inquirer

Postural exercises improve depression

Postural exercises improve depression

At the American Psychiatric Association meeting in May,2018 Dr. Martin Furman from the University of Maimonides, Buenos Aires, Argentina, presented a randomized study showing marked improvements in depressive symptoms after a series of postural exercises.Two set of exercises, one minute each were repeated 4 times a day every day for 12 weeks. One type was “equilibrium exercise”, raising both arms and flexing one lower limb and then the other. Each flex was maintained for 15 seconds. In the other type of exercise the patient was asked to hold a pencil between the teeth and “smile” for 1 minute. The results were impressive, Reductions in the Ham-D 17 and the Beck Depression inventory scales were significant. Tai Chi exercises emphasize equilibrium and are known to help with depression and significantly reduce anxiety. Yoga posturing combined with verbal expressions of gratitude also have shown benefits for stress, anxiety and depression.Exercise in general improve mood in a variety of circumstances. Dr. Furman has been working with Dr. Tomas Ortiz-Alonzo a psychiatrist from the University Complutense of Madrid. Dr. Ortiz-Alonzo has pioneered this type of investigation for the past several years. According to Dr. Furman, “feedback of the muscular and facial skin afferents has been associated with modulation of neural activity within the central circuit of emotions”

Suicidio, mitos y realidades

Suicidio, mitos y realidades

El Suicidio, mitos y realidades

  1. “El Suicidio es un acto egoísta”: Los psicópatas y los sociópatas son egoístas pero muy raras veces se suicidan. La persona deprimida razona que ella con su depresión representa un problema serio para su familia y para sus seres queridos. Por lo tanto, el suicidio es una alternativa para que su familia se libere de una carga emocional, física y financiera. En realidad el suicidio, en la opinión del suicida es un acto final de ayuda para liberar a su familia de una carga de la que él se siente responsable. La idea principal de “quiero suicidarme” puede ser una constante en una vida que maneja en muchos casos una ansiedad y depresión concomitantes.
  2. “El Suicidio es un camino fácil”: Por cada muerte por suicidio, hay un promedio de 25 intentos fallidos. La persona que se suicida, generalmente lo ha pensado durante mucho tiempo y ha batallado con sentimientos contrarios a sus creencias, ha luchado con sentimientos de culpa, con baja autoestima, llanto, desesperanza y vergüenza. El suicidio con la finalidad y la letalidad que representa es una decisión ardua y difícil de llevar a cabo. En muchas ocasiones la ayuda psicológica no llega de primera línea y las consecuencias pueden ser más fuertes.
  3. “El que se quiere suicidar, lo va a hacer de todos modos”: Los programas de prevención de suicidio ha tenido mucho éxito en disminuir las tasas de suicidio y proveen una ayuda invaluable para las personas que sienten que ya han llegado al final de su jornada. Las líneas telefónicas “calientes” han salvado innumerables vidas en varios países y han ayudado a hacer conciencia y a educar al público acerca de la necesidad de ayudar al enfermo suicida. La salud mental en Guatemala debe tomar como ejemplo estas alternativas para disminuir esta problemática.

    Existe una depresión resistente a tratamiento farmacológico y los hallazgos de la investigación STAR*D, (Sequenced Treatment Alternatives for the Relief of Depression) que se llevó a cabo en varios centros clínicos en los EEUU hay un 60 % de pacientes que no responden al tratamiento medicamentoso inicial y que cerca del 30% no encuentra mejoría cuando usan dos o más agentes farmacológicos. La “depresión resistente” se ha definido como aquella que no responde al curso de tratamiento con por lo menos dos antidepresivos. Tradicionalmente, para tratar este tipo de depresión se han empleado varias formas de psicoterapia, múltiples fármacos combinados, hospitalización y tratamiento electroconvulsivo. Estos tratamientos no son del todo efectivos y algunos tienen riesgos físicos bastante graves. Existen alternativas para tratar la depresión sin medicamentos, como las que cuenta nuestra clínica.

Una realidad más allá de la fama

Una realidad más allá de la fama

Una realidad más allá de la fama…

Robin Williams, el talentoso actor y comediante estadounidense murió el 11 de agosto de 2014 a consecuencia de asfixia por ahorcamiento, completando con éxito un final intento suicida. En una de sus actuaciones estelares en la película “La sociedad de los poetas muertos”, Williams hace el papel de un profesor idealista que va a enseñar a estudiantes, una de sus películas más gustadas por el público, Williams llega a ser un doctor que utiliza intervenciones médicas no convencionales para recordarle a sus colegas las virtudes del juramento hipocrático y para ayudar a sus pacientes a encontrar fe y esperanza cuando la muerte acecha. Pero la vida tiene sus indescifrables designios y el propio Williams, en su papel de la vida real, como paciente atrapado por una enfermedad debilitante, asociada a un estrés y ansiedad constantes lo llevó a un desenlace en donde finalmente no pudo como vencer la depresión.

Como dijera Peza en dicho poema: “…Cuantos hay que, cansados de la vida, enfermos de pesar, muertos de tedio, hacen reír como el actor suicida, sin encontrar para su mal remedio…”

Robin Williams murió después de luchar por largos años contra una enfermedad depresiva severa, drogadicción y el abuso de alcohol, dichos trastornos llevados sin buscar una ayuda psicológica adecuada durante prolongados períodos de tiempo. Esta nefasta combinación, a través de los años menguó gradualmente su fuerza emocional y contribuyó al deterioro de su salud física. Rico, inteligente, famoso y extremadamente talentoso, Williams parecía tenerlo todo. La pregunta inevitable es: Como es posible que Robin Williams con todo lo que poseía, tangible e intangible, escogiera descender a los lugares más recónditos de la mente para buscar solución a sus problemas y al final tomara la decisión de suicidarse? Robin Williams era único como actor y comediante pero como ser humano era como el resto de nosotros, vulnerable y frágil ante la enfermedad mental. El llena casi perfectamente el perfil de alguien con alto riesgo de suicidio. Hombre de raza blanca, pasado de la mediana edad, casi al final de una exitosa carrera, con problemas de salud (Parkinson, 2014 y S/P Cirugía de la válvula aortica, 2009), con depresión crónica severa, con historia de abuso de drogas y alcohol, recién egresado de un programa de rehabilitación, y atravesando por un periodo profesional difícil. El suicidio de Williams ha iluminado de cierta forma los escondrijos y los recovecos más profundos y obscuros de la mente afligida por la depresión y carcomida por las drogas y el alcohol. Con respecto al suicidio, en los EEUU en el 2011, 39,518 personas se quitaron la vida. El 60% de los que se suicidan sufren de depresión. Suicidio es la cuarta (4ta) causa de muerte en los EEUU. El 90 % de la gente que se suicida lleva asociado un diagnóstico de enfermedad psiquiátrica.

La importancia de la psicoterapia en salud mental

La importancia de la psicoterapia en salud mental

Históricamente, la relación entre psicoterapia y psiquiatría no ha tenido siempre una convivencia positiva en lo que es el acompañamiento y tratamiento en problemas de salud mental, aunque en los últimos años dicha dificultad ha disminuido. Hoy en día se considera como un abordaje integral el acompañamiento de ambas profesiones en un proceso que implica tanto un desbalance neuroquímico y una dificultad cognitiva en ámbitos emocionales y de dinámicas humanas.
El tratamiento de los trastornos mentales ha evolucionado considerablemente en los últimos años con la venida de los fármacos y ahora nuevas opciones en neuromodulación, como lo es la Estimulación Magnética Transcraneal Repetitiva. A pesar de esto, la psicoterapia siempre ha tenido un rol muy importante en el acompañamiento del paciente con distintos cuadros emocionales o adaptativos y de igual forma ha ido creciendo hacia nuevas técnicas y formas de acompañamiento tanto para la persona que consulta o sus familiares.
De acuerdo a la Asociación Americana de Psicología (APA) la psicoterapia es “un tratamiento colaborativo basado en la relación entre un individuo y un psicólogo. El Psicólogo provee un apoyo que permite a la persona hablar abiertamente con alguien que es objetivo, neutral y sin juicios de valor. La mayoría de las terapias son individuales, aunque algunos psicoterapeutas también trabajan con parejas, familias y grupos”
Glen O. Gabbard es un psiquiatra y psicoanalista muy conocido en la comunidad tanto médica como psicoanalítica, con múltiples publicaciones a lo largo de su carrera y autor de varias obras enfocadas hacia el abordaje psicoterapéutico y psiquiátrico desde una práctica clínica. En un estudio publicado por la revista Internacional de Psiquiatría en 2007, expuso que el cambio del péndulo hacia una dirección más biológica de la psiquiatría ha llevado a la marginalización de la psicoterapia como una dentro de la disciplina de la psiquiatría como un todo. Sin embargo, la psicoterapia es una ciencia básica muy importante con aplicación en muchos escenarios clínicos, ejerciendo un rol fundamental en el valor pronóstico del paciente.
Tanto la psiquiatría, como la psicoterapia tienen un contexto biológico que produce cambios en el cerebro, y es, por lo tanto un acompañante tan importante como la farmacoterapia en la planeación de un tratamiento integral.
De hecho, la combinación en medicación, neuromodulación y psicoterapia se han convertido en un método común para tratamiento psiquiátrico de la práctica clínica actual.
La psicoterapia por lo tanto tiene un rol esencial en el contexto de la práctica clínica, por lo cual una ayuda psicológica y un acompañamiento psiquiátrico pueden representar un mejor valor pronóstico a la hora del tratamiento y acompañamiento de padecimientos asociados a la salud mental.