Mental Health Maintenance Archives

Efficacy of TMS Therapy

Written by W. Nate Upshaw M.D. on April 14, 2020. Posted in Mental Health Maintenance.

In the world of depression treatment, medications tend to be considered as the “go-to” or first line treatment. Outside of medication, however, there are lots of other options to be considered. One of these options is Transcranial Magnetic Stimulation therapy (TMS), an effective treatment alternative that has proven to be successful among many patients with depression.

What is TMS Therapy?

TMS therapy is a non-invasive, outpatient based, brain stimulation therapy that places magnetic coils on the forehead. These coils send targeted magnetic impulses that stimulate nerve cells in the prefrontal cortex, specifically the left prefrontal cortex, as this area is often responsible for controlling mood. Research and clinical trials show that these impulses have a positive impact on neurotransmitters in the brain that ultimately decrease symptoms of depression and anxiety caused by depression for an extended period of time.

https://www.youtube.com/watch?v=I3nl_ZWSmgs

Effectiveness of TMS

There are numerous clinical studies that show that TMS therapy is a legitimate and effective treatment for Major Depressive Disorder. When compared to antidepressant medications, many people do not find relief or any symptom reduction from medications, or the side effects are simply too much to handle. Therefore, there is a large and immediate need for effective alternative therapies. The term efficacy in efficacy research refers to the ability to produce the intended result, and TMS has proven efficacy and success.

In 2005, The U.S. Food and Drug Administration (FDA) permitted widespread use of TMS for Major Depressive Disorder. It also permitted the marketing of TMS for treating pain from certain migraines in 2013. Even more recently, as recently as August of 2018, a specific device known as the Brainsway Deep Transcranial Magnetic Stimulation System has been approved for the treatment of obsessive-compulsive disorder. While there are exciting treatment options available that have minimal to no side effects, people may wonder about benefits and TMS therapy success rates.

Between 60% and 75% of people who have participated in TMS treatment have shown some signs of improvement in their depression symptoms. Some individuals experience at least a 50% drop in their symptoms. Close to half of all people who have participated in TMS treatment experienced full remission of symptoms. It may be important to note that while results like these are exciting, it does not necessarily indicate permanent remission of symptoms. Harvard Medical School notes that recurrence of symptoms is typical and consistent with other treatments, such as medication and psychotherapy, for mood disorders. However, most patients who have undergone TMS treatment note reduction or elimination of symptoms for many months after treatment ends, with the average length being a little more than a year symptom free.

Multiple studies show that in clinical trials with participants receiving repetitive TMS (rTMS) in comparison to those receiving a sham treatment (sham treatment is a term that has a similar variable in place as a placebo, but referencing a procedure rather than an oral medication) reported significantly greater improvement in their depression symptoms based on a depression index scale.

Overall, it is clear that TMS therapy is an effective treatment for Major Depressive Disorder and has the potential to be a more common, highly useful treatment option for other psychiatric disorders in the future. While there is always room for more studies to improve and refine the use of TMS therapy for Major Depression and other disorders, there doesn’t need to be any hesitation about TMS effectiveness and considering it as a valid treatment today.

If you want to beat anxiety or depression, and you’re concerned about the many side effects of antidepressants, consider TMS therapy. Transcranial Magnetic Stimulation (TMS) is an FDA cleared non-invasive option to treat depression, where targeted magnetic pulses stimulate areas of the brain that affect mood. TMS helps you get back to your best life quickly and with no side effects. Among the many depression treatment options out there, TMS therapy is an excellent, pain-free solution that is covered by most insurance.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

https://youtu.be/vZvbEEDAhCY

Works Cited

Basil, B., Mahmud, J., Mathews, M., Rodriguez, C., & Adetunji, B. (2005). Is there evidence for effectiveness of transcranial magnetic stimulation in the treatment of psychiatric disorders?. Psychiatry (Edgmont (Pa. : Township)), 2(11), 64–69.

Stern, A. P., MD. (2018, February 23). Transcranial magnetic stimulation (TMS): Hope for stubborn depression. Retrieved January 26, 2020, from https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335

U.S. Food & Drug Administration. (2018, August 17). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Retrieved January 26, 2020, from https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder

The Advantages of TMS Therapy as a Treatment for Depression

Written by W. Nate Upshaw M.D. on April 13, 2020. Posted in Depression, Mental Health Maintenance.

Brain stimulation therapies are one way to treat depression. More traditional treatment options include various psychotherapy treatments and techniques, light therapies, and medication intervention. We are likely familiar with numerous depression medication names, but less familiar with brain stimulation treatments. There have been multiple brain stimulation treatments used to treat depression and other psychiatric disorders over time. However, when it comes to choosing between various brain stimulation treatments, there are numerous advantages to TMS over others.

What is TMS Therapy?

Transcranial Magnetic Stimulation (TMS) therapy is a non-invasive brain stimulation treatment option for depression. TMS therapy works by placing magnetic coils onto the forehead. These coils provide magnetic impulses directly to the brain. These impulses stimulate nerve cells in the prefrontal cortex, specifically the left prefrontal cortex, as this area is seen as responsible for controlling mood. Research and clinical trials show that these impulses impact neurotransmitters in the brain and decrease symptoms of depression for an extended period of time.

What is ECT Therapy?

Electroconvulsive Therapy (ECT), which is colloquially referred to as “shock therapy”, has a lot of negative connotation and association. It is a more intrusive procedure, impacts the brain as a whole, and has a higher risk of side effects compared to TMS. Some brain stimulation therapies, such as ECT, are more controversial and still being researched before wide-spread use. These treatments include Deep Brain Stimulation (DBS) and Vagus Nerve Stimulation (VNS). Deep Brain Stimulation is currently an approved treatment intervention for Parkinsons and is being trialed for depression treatment.

https://www.youtube.com/watch?v=E_hcITwnvs4

What is the difference between TMS and ECT?

There are a few critical differences between TMS and ECT, that gives TMS a stark advantage. One of the main differences is that with TMS treatments, you are not put under general anesthesia. With ECT, you are put under general anesthesia throughout the duration of the treatment. This may be a concern for people who have a reaction or allergy to anesthesia, or simply do not want to be put under for the treatment of depression. ECT targets the brain as a whole, while TMS specifically targets the left prefrontal cortex to stimulate nerve cells. Duration and recovery periods are different as well. TMS is an outpatient procedure that lasts about 20-40 minutes total, with limited to no recovery time. You are able to go about the rest of your day as usual. With ECT, you may need some extended recovery time to recuperate from more significant side effects.

When it comes to side effects, each treatment varies substantially. TMS addresses the direct source of depression – the brain, and specifically the prefrontal cortex. Therefore, there are little to no side effects with TMS therapy. They are largely limited to application site irritation, headaches, light-headedness, or facial muscle tension. With ECT and medication treatments, side effects can be more significant and systemic. TMS also does not interact with any other medications you may already be taking. You are likely able to continue your current medication and dosage without needing to consider further medication changes. Consider talking with your doctor or TMS provider if you have any concerns.

https://youtu.be/I3nl_ZWSmgs

Getting TMS Treatment

While historically TMS may be recommended only if more conventional or traditional methods of depression treatment are unsuccessful, it would be completely normal to continue to seek psychotherapy in conjunction with TMS treatments. TMS can help to alleviate symptoms of depression, and therapy can help continue social connection, challenge isolation, and promote coping skill use and development. TMS also does not need to be viewed as a last resort treatment option. Talk with your therapist, psychiatrist, or doctor to determine if this therapy is one you want to take earlier on in your treatment.

Fortunately, TMS is also covered by most insurance plans. Insurance providers typically hesitate to cover procedures that are considered risky, still in the stages of clinical trial, or ineffective. Therefore, TMS is a legitimate treatment option that can be considered if you have access to a clinic in your area. The advantages that TMS has over other brain stimulation treatments make it an excellent choice.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

Mayo Clinic. (2018b, November 27). Transcranial magnetic stimulation – Mayo Clinic. Retrieved January 26, 2020, from https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625

National Alliance on Mental Health. (n.d.). ECT, TMS and Other Brain Stimulation Therapies | NAMI: National Alliance on Mental Illness. Retrieved January 26, 2020, from https://www.nami.org/Learn-More/Treatment/ECT,-TMS-and-Other-Brain-Stimulation-Therapies

COVID-19: Increase Physical Resilience by Improving Your Mental Health

Written by W. Nate Upshaw M.D. on March 30, 2020. Posted in Mental Health Maintenance, Step-By-Step Guides.

We are experiencing a time of uncertainty in our world as concerns about COVID-19 are communicated from government health agencies and news sources. People who have never experienced mental health symptoms before are feeling depressed and anxious, and people who have dealt with these issues in the past are experiencing exacerbations. People already suffering with mental health issues may experience a worsening of symptoms. If you are feeling depressed or anxious, it is important to remember you are not alone and there are healthy steps you can take to improve mental health during this challenging time. As an added benefit, improving your mental health can improve your physical health. Reducing the amount of stress you feel can improve your immunity.

A national survey conducted between March 13 and 16, 2020, as the public became more aware of the COVID-19 issue, found that 80 percent of people reported concern about the coronavirus. While only 8% of people reported their physical health had gotten worse, 22% reported their mental health declining and 29% said their emotional well-being was worse.

When facing the unknown, it’s easy to fall prey to what neuroscientists call “negativity bias,” a tendency to focus on threats and contemplate worst-case scenarios. This results in depressed, anxious feelings that begin to manifest themselves physically. Symptoms may include trouble sleeping, inability to focus, increased use of alcohol, tobacco or other substances, and flares of chronic health problems. When we feel depressed or anxious, exercising, interacting with others and making healthy food choices can quickly fall by the wayside. The added recommendations for social distancing or isolating may cause people to feel alone too. There’s nothing strange or unusual about experiencing these feelings, and fortunately, there are things we can do to feel better.

In addition to the physical health tips you’re applying to keep yourself healthy, incorporate these mental health tips to feel better and give your immune system a positive boost.

Healthy Thinking

Remind yourself this won’t last forever. While experts say COVID-19 may have an impact in the US longer than we would like, this will not be unending. Think of times past when challenges have successfully been overcome as a country, community, company or family and realize that this too will pass. Think about the future and make plans for something you want to do and take action toward it. Research for a future trip. Work toward steps that could lead to a promotion. If you’d like to run a half marathon, begin training now.
Differentiate between what’s in your control and what’s not. Then, focus on the things that are in your control and steer your thoughts away from things outside of your control.
Be matter of fact. Avoid the tendency to imagine a situation in your mind that is worse than reality. Consider your situation today and the steps you need to take to be safe such as social distancing and proper hand-washing.
Look for opportunities. Rather than focus on the bad, or the things you can’t do, focus on the good and the opportunities you may not see until you take a hard look. What are you grateful for? What can you do with the time you’re saving on your commute.
Focus on the positive. Remind yourself that experts around the world are hard at work containing the virus and developing a vaccine.
Do your part. Staying at home can feel like you’re doing nothing, but experts tell us helping to “flatten the curve” is the most important way we can help at this time. Remind yourself that social distancing or social isolation is a temporary situation and by adhering to the request, you are making a true difference in the trajectory of this virus.
Focus on what is true. Many people who test positive for COVID-19 experience no symptoms or only minor symptoms and most recover well. You can lessen your chances of getting COVID-19 significantly by practicing proper hand washing, avoiding touching your face and practicing social distancing.

Healthy Actions

Commit to a daily routine. Regular schedules add a sense of normalcy and feel comforting, so keep your daily routine to the extent that you can, or create a new routine if needed. Sleep, eat and take your medicines at the same time each day and maintain a healthy balance of work and relaxation. When planning your activities, toss in a little variety each day to prevent boredom. Plan something you enjoy for the evening—a favorite food, game or show—something to look forward to throughout the day.
Exercise. Exercise is always important, but especially so during times of stress. Exercise gives you a boost of serotonin, which helps with healthy mood regulation. If you’re already routinely exercising, keep it up. If not, consider adding an outside walk each day. For added benefit, walk outside in the early morning. It is a scientific fact that early morning sunshine improves mood. Seeing other people as you walk in your neighborhood or park will help negate feelings of isolation as well. On rainy days, Google a yoga class. Yoga is known for reducing stress, doesn’t require much space, can be practiced by any age, and you can find beginner videos online free of charge.
Enjoy nature. Whether it’s walking in the park or working from your balcony, try to incorporate sunshine and nature into every day.
Live in the moment. If your mind starts to race ahead with worry, focus on your senses to bring you back to the present moment. What are you seeing? What are you hearing? What were you doing before the worry distracted you?
Stay informed, but don’t stay tuned in. Seek on the information needed to make good decisions for you and your loved ones and limit the amount of time you spend reading, listening to or watching media that stresses you. Consuming too much media can create anxiety. You may find that reading, is less stress invoking that watching TV because you do not have visuals that linger in your mind.
Mute alarming alerts. You can change the settings on your phone, mute keywords that trigger anxiety on Twitter, and hide Facebook posts or feeds that make you feel overwhelmed. If you leave your TV on for company, tune in to a non-news show.
Connect with others. Don’t equate social distancing or isolation requirements emotional distancing or emotional isolation. Ironically, social isolation may result in improved connection with family members who live in your home, or time home alone may give you the extra time to catch up or reconnect with old friends via phone, email or social media. If you live alone, proactively pursue emotional connection with others and remind yourself that you’re not alone—we’re all in this together. Talk with people you trust about your concerns.
Get creative. Avoiding isolation is important for mental health and with social distancing recommendations, it’s important to think creatively. Here are some tips to help you and your loved ones stay connected in meaningful ways:

- Make a phone call. While text messaging can be convenient, hearing the voice of a friend or family member and having a real conversation is a little closer to being there. This is possible even with elderly relatives who may not be savvy about using FaceTime.
- Plan virtual gatherings. That dinner with friends that was scheduled for next Saturday night? Keep it using a virtual tool like Skype.
- Enjoy dinner together. Make it feel like a real date by enjoying the same entree together virtually over Skype.
- Start a book club. Start a virtual book club with friends. You may want to choose a light subject matter to add levity to your reading time and conversations.
- Take a walk in your neighborhood or a nearby park. Enjoy spending time with others in a public space where it’s easy to practice social distancing. As an added benefit, sunshine, fresh air and exercise are good for your mental health too.
- Get to know your neighbors. Spend time on your balcony, deck or in your yard and chat with neighbors from a safe distance.

Adhere to recommended guidelines. If you struggle with OCD, recommendations to wash your hands or stay indoors and avoid contact may be especially difficult for you and boredom may make your symptoms worse. Remind yourself of recommended guidelines and hold yourself accountable to align your actions with them.
Schedule worry time. If you feel overwhelmed with worry, schedule no more than an hour each day to contemplate your concerns. Do not allow yourself to think about things that concern you outside of that hour.
Accomplish something. Accomplishment feels good, so use the additional time you have to check a task off your list, whether it be reading a book, cleaning your closet or doing a spring deep clean.
Continue treatment to the best of your ability. If you are receiving treatment for a mental health issue, continue your treatment. If you take medications, pick up your refills as soon as they are available. If your prescriptions are for 30 days, ask your doctor if he can provide a prescription for a 90-day supply instead. As about online appointments when in-person meetings are not recommended.
Do a good turn daily. Ask yourself if there is an act of kindness you can do for someone. Picking up supplies for an elderly relative. Calling to check on someone who lives alone. Helping others helps you feel better too.

Healthy Conversations

Get face-to-face thanks to technology. Research tells us that seven percent of communication comes through our words, 38 percent through our voice and 55 percent through our body language. Use Facetime, Skype, Zoom and similar technologies to make communication more human when being there in person is not possible.
Reassure kids. It is important to communicate with children factually in ways that are appropriate for their age and temperament. Center your conversation around the need for them to be away from their friends for now because of the risk germs spreading pose to our elderly population. Reassure them that children typically do not get very sick from this germ. Explain the steps you are taking to keep your family healthy and allow them to ask questions.
Assist the elderly. We know that COVID -19 has affected the elderly more, and especially those with compromised health. The elderly should follow all recommendations even though things do not look bad yet in this country. Recognize that limited sight or hearing or lack of skills with technology may cause them to miss important information. They may also fall prey to fake news circulating by email. Make sure they are aware of accurate recommendations, listen to their question and concerns and offer to help with errands.
Be helpful, allow for differing opinions and set boundaries. Friends or family members who are not taking recommendations seriously may cause you anxiety. The COVID-19 situation is hard for people to wrap their minds around. In Florida, we have to contend with hurricanes and it’s common for people to become quite anxious in the days leading up to a hurricane. Preparing for a hurricane is a good analogy for preparing for COVID-19. You have to prepare for something that is days in the future, but when you go outside everything looks normal. In the case of a hurricane, the damage we’ve seen from past storms informs us of what to do. If you don’t follow guidelines you put yourself in danger. In the case of COVID-19, the impacts of previous epidemics and the news we’ve seen unfold with COVID-19 in China and Italy help us understand how to prepare. Likening it to a situation they already have familiarity with can make it easier to understand. There are many reliable articles you can share with people who are not taking recommendations seriously, but some people will hold different opinions. If this causes you anxiety, you can set healthy boundaries to keep you and your loved ones safe, like interacting with the person through technology instead of being in close proximity.

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The Side Effects of Anxiety Medications

Written by W. Nate Upshaw M.D. on March 26, 2020. Posted in Anxiety, Mental Health Maintenance.

All anxiety medications come with a long list of potential side effects. The side effects of anxiety medications, also called anxiolytics, include sleepiness, fatigue, and a slowing of mental functioning. Depending on their class, these medications may also be habit-forming or even addictive. They can help level out panic attacks and reduce anxiety attacks to a manageable level. Some can produce lasting relief, while others shouldn’t be used for more than a short-term period.

What Are Common Classes of Anxiety Medications?

If you’re exploring how to find the right anxiety medication, it’s important to learn all you can about them. Physicians prescribe fast-acting anxiety medications to reduce either the immediate effects of an anxiety attack or to work over the long term to reduce day to day anxiety that’s uncomfortable but doesn’t rise to the urgency of a panic attack or anxiety attack. Some of the most common medications include Valium and Xanax.

Four major classes of medications are used in the treatment of anxiety disorders. They include benzodiazepines, Serotonin-Norepinephrine Reuptake Inhibitors, Selective Serotonin Reuptake Inhibitors (SSRIs), and Tricyclic Antidepressants. The side effects of anti-anxiety medications vary from class to class. They also differ from medication to medication within each class.

Benzodiazepines. Most people have heard of at least some of the medications in this class. These anxiety medications became common in the 1960s and are still given today. The difference between benzodiazepines and antidepressant medication for anxiety is that benzos work within minutes to hours. Other classes of medications can take days to several weeks to become effective.

Benzodiazepines are used for the short-term treatment of anxiety. They are not antidepressants and work only to produce relaxation, promote sleep and reduce anxiety. Long-term use causes habituation, in which a person requires ever-increasing dosages of the medication to achieve the same results as a lower dose. Benzodiazepines are habit-forming, may cause physical dependence and have the potential to be addictive. They include :

Restoril, Normison (temazepam). Temazepam is given to treat insomnia and starts working within 30 minutes. Temazepam is also given for the management of panic attacks.
Valium (diazepam). Diazepam is a fast-acting benzodiazepine. Valium is given for sleep and anxiety, and for withdrawal caused by alcohol and other addictive substances. Its effects range from 1 to 3 days.
Xanax (alprazolam). Alprazolam is a fast-acting anxiety medication and lasts from 12 to 20 hours. Alprazolam is given for the immediate relief of panic attacks and anxiety attacks that are underway.
Klonopin (clonazepam). Clonazepam’s effects begin within an hour and can last from 12 hours to a day.
Temesta, Ativan (lorazepam). Ativan begins to work within 1 hour, and lasts as long as 8 hours. It’s given for anxiety disorder and the relief of anxiety symptoms over the short-term. Lorazepam is given for anxiety associated with depression and stress-associated insomnia.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). The SNRI class increases norepinephrine and serotonin, two important neurotransmitters. SNRIs are given for anxiety and depression and may cause side effects. SNRI side effects can include upset stomach, insomnia, sexual dysfunction, headache or a small increase in blood pressure. SNRIs are effective for long-term treatment for anxiety disorders. SNRI brand names include Effexor (venlafaxine), Effexor XR (extended-release), Pristiq (desvenlafaxine), Cymbalta (duloxetine), Savella (milnacipran), and Fetzima (levomilnacipran)

Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs help depression and anxiety by allowing serotonin to remain active longer in the brain. Higher serotonin levels improve mood and reduce anxiety by increasing levels of the brain chemical GABA. GABA (gamma-amino butyric acid) prompts feelings of well-being and calmness. SSRI brand names include Zoloft (sertraline), fluoxetine (Prozac), Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine) and Luvox (fluvoxamine).

Tricyclic Antidepressants. Tricyclic antidepressants include amitriptyline, imipramine, and nortriptyline. They’re effective for some anxiety disorders, like Generalized Anxiety Disorder, but not others. They can cause serious side effects, including dry mouth, blurry vision, urinary retention, constipation and orthostatic hypotension (low blood pressure on rising).

Common Anti-Anxiety Medication Side Effects

All anti-anxiety medications have side effects. Of the classes of anti-anxiety medications, only benzodiazepines are fast-acting. However, benzodiazepines also carry a serious risk for addiction. Benzodiazepines are effective over a short term period, typically less than 4 weeks. All classes of anti-anxiety medications require a doctor’s guidance to stop, as abruptly quitting these medications after taking them for a week or longer can cause severe, even temporarily debilitating side effects.

Benzodiazepine side effects

Restoril (temazepam, Normison) side effects. Temazepam side effects include dry mouth, nausea, muscle weakness, confusion and irritability. Restoril is powerful and has a high potential of abuse.

Valium (diazepam) side effects. Some of the most common side effects after taking diazepam include drowsiness, dizziness, fatigue, memory problems, nausea, dry mouth, slurred speech and blurred vision.

Xanax (alprazolam) side effects. Similarly, taking alprazolam can cause drowsiness, dizziness, insomnia, memory problems, poor balance, difficulty concentrating, and slurred speech among others.

Klonopin (clonazepam) side effects. Clonazepam’s effects include dizziness, muscle aches, blurred vision, fatigue, depression, nervousness, and confusion. Additionally it can increase suicidal thoughts and behavior.

Temesta. Temesta’s side-effects include drowsiness, hyperactivity, nausea, fainting and skin rashes. Temesta can cause memory impairment.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) Side Effects

SNRI side effects can include upset stomach, insomnia, sexual dysfunction, headache or a small increase in blood pressure. SNRIs can take days to weeks to start working, so they are not effective for a panic attack or anxiety attack that is underway. They work to prevent anxiety attacks from happening at all.

Selective Serotonin Reuptake Inhibitors (SSRI) Side Effects

SSRI side effects include nausea, sleep problems, problems having sex, tremors and in some cases nervousness. Like SNRIs, SSRIs do not work instantly. Once they have reached a therapeutic level in a person’s body, they can prevent uncomfortable levels of anxiety arising.

Tricyclic Antidepressant Side Effects

Tricyclic antidepressants may cause serious side effects, including dry mouth, blurry vision, urinary retention, constipation and orthostatic hypotension (low blood pressure on rising).

Treating Depression-Related Anxiety With No Side Effects

If you want to beat anxiety that stems from depression and you’re concerned about the many side effects of medication, consider treatment via Transcranial Magnetic Stimulation (TMS). This is an FDA cleared non-invasive treatment for depression and OCD, as well as any anxiety related to depression. TMS therapy uses targeted magnetic pulses to stimulate areas of the brain that affect mood, which helps you get back to your best life quickly and with no side effects. Among the many treatment options out there, TMS therapy is an excellent, pain-free solution that is covered by most major insurance companies. The best part is there are no side effects from TMS therapy, making it an excellent solution for those who fear the side effects of certain medication.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

Benzodiazepines: Uses, Side Effects, Interactions & Warnings. (n.d.). Retrieved from https://www.drugs.com/article/benzodiazepines.html#side-effects

Dellosso, B., Buoli, M., Baldwin, D. S., & Altamura, A. C. (2010). Serotonin norepinephrine reuptake inhibitors (SNRIs) in anxiety disorders: a comprehensive review of their clinical efficacy. Human Psychopharmacology: Clinical and Experimental, 25(1), 17–29. doi: 10.1002/hup.1074

Harvard Health Publishing. (n.d.). What are the real risks of antidepressants? Retrieved from https://www.health.harvard.edu/mind-and-mood/what-are-the-real-risks-of-antidepressants

Papakostas, G. I., Thase, M. E., Fava, M., Nelson, J. C., & Shelton, R. C. (2007, December 1). Are antidepressant drugs that combine serotonergic and noradrenergic mechanisms of action more effective than the selective serotonin reuptake inhibitors in treating major depressive disorder? A meta-analysis of studies of newer agents. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17588546

Thase, M. E., Entsuah, A. R., & Rudolph, R. L. (2001). Remission rates during treatment with venlafaxine or selective serotonin reuptake inhibitors. British Journal of Psychiatry, 178(3), 234–241. doi: 10.1192/bjp.178.3.234

The most commonly prescribed type of antidepressant. (2019, September 17). Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

What Are the Best Medications for Anxiety. Everyday Health. (2018, January 31). Retrieved from https://www.everydayhealth.com/anxiety/guide/medications/

Food and Depression: The Best Diet to Manage Depression

Written by W. Nate Upshaw M.D. on March 25, 2020. Posted in Depression, Mental Health Maintenance.

Can you eat to beat depression? That’s a common question with a complex answer. To cut right to it, no, there’s no type of food or combination of foods that can cure depression permanently. However, there is without a doubt a significant link between diet and depression.

There’s truly not one specific best diet plan for depression that’s perfect for everyone. The best thing patients with depression can do is to follow a healthy diet that suits each individual in their own way. What is known, however, is that a diet high in processed foods and refined sugars is hard on the body and contributes to many illnesses. On the other side of things, foods high in protein, fiber and complex carbohydrates have the best nutrients for fighting depression.

It’s a fact that many people who suffer from depression feel cravings for foods high in carbohydrates. “Carb craving” is particularly intense in Season Affective Disorder, but it’s a symptom of other forms of depression as well.
However, there are foods that support the good health of the nervous system. Some of the best foods to help fight depression include:

Fish. Cold-water ocean fish like sardines, salmon, trout, mackerel and trout are good sources of omega-3 fatty acids. Omega-3 fatty acids boost brain health by strengthening the connections between brain cells. Omega-3 fats also decrease inflammation in the tiny blood vessels that supply nerve cells with vital nutrients. Ocean fish are also rich sources of vitamin B12, which is necessary for healthy nerve tissue.

Seeds. Pumpkin and squash seeds increase tryptophan, an amino acid that’s essential for the production of serotonin. Serotonin is a critical brain chemical that’s responsible for mood and the regulation of our mood. Chia seeds along with flaxseed are exceptionally good sources of omega-3 fats and are a good replacement for fish oil for those who prefer a vegetarian or vegan diet.

Whole Foods. Heavily processed foods aren’t good for mental health or health in general. They have few nutrients but are high in fat and calories. They’re loaded with simple carbohydrates, which break down into sugars that play havoc with blood sugar and insulin levels. Spikes and troughs in blood sugar contribute to high fatigue and poor mood. Whole foods are full of nutrients and digest more slowly than processed foods.

Protein and Meat. Red meat does not cure depression, but the plentiful B vitamins in lean meat are essential for the health of the nervous system. Servings of lean meat provide a rich source of B12, a vital nutrient for good brain health. Meat also provides plenty of protein. Proteins provide the body with essential amino acids that are then used by the nervous system to build neurotransmitters. Healthy levels of neurotransmitters are absolutely vital for a good mood. Proteins also balance blood sugar levels.

Vegans and vegetarians aren’t exempt from needing protein, but our next two categories have them covered.

Nuts. Walnuts support good brain health as they’re rich in omega-3 fatty acids. Nuts like brazil nuts, hazelnuts and cashews are also good sources of protein and omega-3 fats.

Beans. Beans are loaded with fiber and protein. They’re also full of folate, a B vitamin our bodies require to process and use vitamin B12. B12 helps the brain manufacture chemicals that regulate mood. Chickpeas are high in folate, as are pinto beans.

There are good foods for depression all around. It just takes a little research to identify the best diet for depression that works for you. A healthy diet filled with nutrient-dense foods will help you manage depression and its ugly fellow-travelers, like anxiety and mood swings.

We tend to crave foods high in starches and simple carbohydrates when we’re stressed out. Even the best of intentions can go bad when we try to eat healthily but feel worse. Consider that sometimes a crash diet robs us of the nutrients we need to stay healthy. All of the following foods worsen depression when eaten in excess.

Foods That Worsen Depression

Simple Carbohydrates and Sugar. Sugar is added to so many foods it doesn’t bear repeating. Processed and refined sugars have a serious, negative impact on mood. Sugars include things like:

High fructose corn syrup (HFCS)
Dextrose
Sucrose
Maltose
Corn syrup

Some foods have sugar in them as an essential aspect of that food. Fruits are one example. Other foods have sugar added to them. No matter its source, limit your intake of sugar to better manage your mood.

Starches and Processed Grains. Refined grains and starches don’t occur in nature. They cause wild swings in blood sugar levels which prompts a low mood, mood swings throughout the day, and fatigue.

Fried foods. Fried foods are loaded in grease and salt. They’re often breaded, which loads you up on processed grains and fat.

Alcohol. Limiting one’s intake of alcohol is always a good idea, but it’s necessary if you have problems with depression or anxiety. Alcohol acts as a depressant in the central nervous system and slows down many important brain functions, including the brain’s ability to purge toxins from its tissues. Alcohol is loaded with sugar, which as we noted above, causes excessive peaks and troughs in blood sugar levels. Large fluctuations in blood sugar and insulin are tied to a depressed, anxious mood.

Treating Depression With TMS Therapy

Although eating the right kinds of food can help fight depression, it’s still important to get treatment with a professional. If you’re seeking treatment for depression and you’re concerned about the many side effects of antidepressants, consider Transcranial Magnetic Stimulation (TMS) therapy. This is an FDA cleared non-invasive treatment for multiple mental health disorders. TMS therapy uses targeted magnetic pulses to stimulate areas of the brain that affect mood, which helps you get back to your best life quickly and with no side effects. Among the many depression treatment options out there, TMS therapy is an excellent, pain-free solution that is covered by most major insurance companies. The best part is there are no side effects from TMS therapy, making it an excellent solution for those who fear the side effects of medications.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

Crichton-Stuart, C. (2018, August 1). 9 foods that help reduce anxiety. Retrieved from https://www.medicalnewstoday.com/articles/322652

Daniel K. Hall-Flavin, M. D. (2018, June 1). Vitamin B-12 and depression: Are they related? Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/vitamin-b12-and-depression/faq-20058077

Keeso, A. (2017, February 16). 5 Foods That Fight Symptoms Of Depression. Retrieved from https://www.huffingtonpost.ca/abigail-keeso/5-foods-that-fight-symptoms-of-depression_b_9190300.html

L., Kate, et al. “Intake of Raw Fruits and Vegetables Is Associated With Better Mental Health Than Intake of Processed Fruits and Vegetables.” Frontiers, Frontiers, 23 Mar. 2018, www.frontiersin.org/articles/10.3389/fpsyg.2018.00487/full.

Serefko, A., Szopa, A., Wlaź, P., Nowak, G., Radziwoń-Zaleska, M., Skalski, M., & Poleszak, E. (2013). Magnesium in depression. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23950577

Wani, A. L., Bhat, S. A., & Ara, A. (2015). Omega-3 fatty acids and the treatment of depression: a review of scientific evidence. Integrative medicine research, 4(3), 132–141. https://doi.org/10.1016/j.imr.2015.07.003

WebMD. Foods to Avoid If You Have Anxiety or Depression. (n.d.). Retrieved from https://www.webmd.com/depression/ss/slideshow-avoid-foods-anxiety-depression

COVID-19: How To Cope With Your Mental Health During Uncertain Times

Written by W. Nate Upshaw M.D. on March 23, 2020. Posted in Mental Health Maintenance.

During this new normal we’re collectively experiencing amidst the Coronavirus pandemic and social distancing mandates, our own Dr. Upshaw will be providing free resources, tips and advice to stay on top of your mental health with daily updates, videos, and YouTube Lives to shed light, inspiration and information for those in need or seeking guidance.

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What is Depression? Causes and Other Major Depression Facts

Written by W. Nate Upshaw M.D. on March 5, 2020. Posted in Depression, Mental Health Maintenance.

Depression is classified as a mood disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) used by clinicians and medical professionals. Its clinical title is Major Depressive Disorder, or sometimes more casually called Major Depression. It is defined by the American Psychiatric Association as a medical illness that predominantly causes feelings of sadness and/or a loss of interest in activities you once enjoyed. When it comes to mental health in general, there tends to be stigma around illnesses and disorders such as depression. For example, people often wonder if depression is a disease. It’s complicated. It is classified as a disorder, which, by definition, is a disturbance of regular functioning. Technically, depression is not a disease, but some may argue against that.

https://www.youtube.com/watch?v=2DgTIhXFoxo

Symptoms of Major Depressive Disorder

What does Major Depressive Disorder look like? These are the criteria listed in the DSM to describe what are common depressive symptoms:

Feeling sad or having a depressed mood.
Loss of interest or pleasure in activities once enjoyed.
Changes in appetite — weight loss or gain unrelated to dieting.
Trouble sleeping or sleeping too much.
Loss of energy or increased fatigue.
Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others).
Feeling worthless or guilty.
Difficulty thinking, concentrating or making decisions.
Thoughts of death or suicide.

In order to be diagnosed with Major Depressive Disorder, you must meet five (or more) of these criteria in the same two-week span, with one of them being depressed mood or loss of interest/pleasure. Depending upon the number of symptoms experienced from the list above, the diagnosis can have a specifier of mild, moderate, or severe. These symptoms must also cause significant clinical distress (which means having a negative impact on areas of your life such as work, school, relationships, etc.), as well as cannot be explained by substance use or a medical condition.

Causes of Major Depressive Disorder

People often ask, “what are the causes of Major Depressive Disorder?” The answer to this varies greatly. There are multiple causes or risk factors for depression. Those who have experienced generational, systemic, or situational trauma are at risk, as well as those who have a genetic predisposition. That means having family members that have also experienced depression puts an individual at higher risk of also having depression. People with certain personality traits, such as lower self-esteem or those who are easily overwhelmed, may be more susceptible to depression. Certain physical illnesses, such as Parkinson’s, diabetes, or cancer, may also trigger depressive episodes. Physiologically, depression is thought to be chemical imbalances in the brain, however that tends to be a highly simplified way of describing it. Different brain structures also play a role. One particular study finds that the hippocampus is smaller in people with depression. While there are certain factors that put some at risk over others, it is important to note that depression can occur in anyone.

Who is affected by Depression?

Depression is one of the most common mental illnesses. It impacts an estimated 1 in 15 adults each year, or approximately 6.7% of the population according to the American Psychiatric Association. One in six people will experience depression at some point during their lifetime. While depression can occur at any point during the life span, it most commonly appears during the late teens to mid-twenties for the average person. Women are at a higher risk of depression over men, some studies showing up to twice as likely. Considering the risk factors, it is not uncommon for marginalized communities to be at a higher risk of depression due to oppression and lack of resources for mental health care.

How to treat depression

Although these statistics sound concerning, depression is one of the most treatable mental illnesses. There are numerous treatments available to consider when treating depression. Treatment for Major Depressive Disorder can involve medication, psychotherapy, light therapy, or brain stimulation therapies. The biological changes in the brain should get better with any type of treatment and the brain should return to healthy, normal functioning. Multiple therapies may need to be tested to treat your depression as what works for one person, may not be best for the next. It is best to consult with your doctor or therapist to determine what works best for you.

One specific treatment for depression that is highly effective and produces limited to no side effects is Transcranial Magnetic Stimulation or TMS therapy. This is a non-invasive brain stimulation therapy that targets the prefrontal cortex with magnetic pulses. These impulses stimulate nerve cells in the prefrontal cortex, as this area is often responsible for controlling mood. Research and clinical trials show that these impulses impact neurotransmitters in the brain and decrease symptoms of depression for an extended period of time. This is an FDA cleared, non-invasive pain-free solution that is covered by most major insurance companies.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

https://www.youtube.com/watch?v=E_hcITwnvs4

Works Cited

American Psychiatric Association. (n.d.). What Is Depression. Retrieved January 26, 2020, from https://www.psychiatry.org/patients-families/depression/what-is-depression

Harvard Health Publishing. (2019, June 24). What causes depression? Retrieved January 26, 2020, from https://www.health.harvard.edu/mind-and-mood/what-causes-depression

The National Institute of Mental Health. (n.d.). NIMH » Depression. Retrieved January 26, 2020, from https://www.nimh.nih.gov/health/topics/depression/index.shtml#part_145397

How To Treat Depression Without Medication

Written by W. Nate Upshaw M.D. on February 12, 2020. Posted in Depression, Mental Health Maintenance, Step-By-Step Guides.

When it comes to depression treatment, individuals have a variety of options to choose from depending on what will best suit their personal needs. Oftentimes, medication is the first treatment type that comes to mind. But can depression be treated without medication? While traditional medications are a common and beneficial form of treatment for depression for many people, there are multiple ways to treat depression without drugs.

https://www.youtube.com/watch?v=y7HObGhxZ64

What are the symptoms of depression?

Depression manifests itself as low moods, feelings of sadness, hopelessness, sometimes thoughts of suicide, and social isolation among other symptoms. Depression can also be present in physical symptoms. You or someone you love who experiences depression may feel exhaustion, sleep for excessive amounts of time, or struggle to sleep at all. While serotonin does play a large role in our mood, sex drive, and social connections to name a few, there are other aspects of one’s life that can lead to the development of depression such as trauma, environmental circumstances, and genetic predisposition. Medications such as SSRIs (Selective Serotonin Reuptake Inhibitors) can help with treating depression, but there are other methods of treatment for depression. For some individuals suffering from depression, medication can be ineffective, with many drugs for depression also causing harsh side effects. Non-drug treatment for depression exists, and is possible.

Treating depression with traditional psychotherapy

Psychotherapy is one effective form of treatment for depression. Research shows that the learning and practicing of Cognitive Behavioral Therapy techniques can help challenge the negative thoughts that depression is notorious for, improve motivation, and improve social skills. The creation and consistency of a relationship with an effective therapist or counselor, the coping skills learned, and the safe space to feel uncomfortable feelings are all great benefits in treating depression without drugs.

TMS therapy: remission is only a step away!

Another highly effective treatment option is Transcranial Magnetic Stimulation (TMS). TMS is a non-invasive procedure that stimulates nerve cells in the brain to improve depressive symptoms. The 20-minute therapy sessions are pain free, and provide patients with the opportunity to treat even severe depression without medication. This non drug therapy for depression is an option that should be considered. early on in your treatment journey. Always know that there are options for treating depression without drugs.

https://www.youtube.com/watch?v=vZvbEEDAhCY

Everyday habits to improve your mental health

Physical movement, social interaction, and taking care of our basic needs are other ways in which we can treat depression without drugs. Physical movement doesn’t only impact our bodies, but has a great impact on our mental health as well. Physical movement doesn’t have to be a rigorous, sweaty workout, necessarily. Taking a walk outside, a short hike, or taking your dog out for a walk can often be sufficient. Social interaction, despite the desire to isolate that usually comes along with depression, can remind us and challenge the various negative personal beliefs often associated with depression. Ensuring that we are taking care of our basic needs such as eating regularly, staying hydrated, and keeping tabs on our hygiene are important, particularly if experiencing a depressive episode. Keeping a routine can help you to stay present and be a good reminder that you are worthy of having your basic needs met.

This blog post is meant to be educational in nature and does not replace the advice of a medical professional. See full disclaimer.

Works Cited

Depression (major depressive disorder). (2018, February 03). Retrieved from https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

Treatment of Depression. (n.d.). Retrieved from https://www.psychologytoday.com/us/basics/depression/treatment-depression#what-does-psychotherapy-do

Efficacy of TMS Therapy

The Advantages of TMS Therapy as a Treatment for Depression