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Lasting Benefit Seen for TMS as an Alternative Treatment in Depression at South Florida Psychiatrist, Dr.
NEW ORLEANS -- Relapse rates for patients with treatment-resistant major depression were much lower following transcranial magnetic stimulation (TMS) and rTMS than is normally seen with drugs or electroconvulsive treatment, researchers said here. Six-month results from two separate studies presented at the American Psychiatric Association meeting showed that only about 10% to 12% of patients achieving an initial remission suffered relapses after TMS treatment. That compares with a relapse rate of about 40% over 12 months in the STAR*D study of antidepressant treatment among participants who achieved remission on a second-line drug regimen after failing citalopram (Celexa). These were the first long-term results to be reported for patients participating in randomized trials of TMS.
The findings "suggest that the durability of effect for TMS is good," according to Philip G. Janicak reported results in patients with treatment-resistant depression who had achieved remission in a placebo-controlled trial of TMS. That trial, which enrolled 301 patients initially, ran for six weeks with the placebo control. Janicak and colleagues analyzed six-month results for 21 patients who achieved remission with placebo treatment and in 99 who remitted with TMS -- 61 in the blinded phase and 38 with open-label treatment. Patients showing remission during the study were switched to maintenance treatment with an unspecified antidepressant drug. Some 12% of patients who received TMS had another episode of depression during follow-up, compared with 22% of those showing remission with the placebo treatment (P not reported). The study protocol also allowed patients, including those remitting with placebo treatment, to receive booster TMS and rTMS treatments during the follow-up if they experienced a one-point change in the Clinical Global Impression-Severity scale for two consecutive weeks. By the end of the follow-up period, about 38% of patients remitting with TMS treatment had received a booster, compared with some 66% of those initially benefiting from the placebo treatment (P not reported). The vast majority of patients receiving the booster treatments -- 84% -- showed at least some improvement in depressive symptoms, according to Janicak and colleagues. Similar findings were reported by Antonio Mantovani, MD, PhD, of Columbia University in New York City, in a platform presentation on long-term follow-up in the so-called OPT-TMS trial. The 190-patient trial was also placebo-controlled initially, with results reported earlier this month in Archives of General Psychiatry. The findings from that trial were somewhat disappointing, in that only 14% of patients receiving TMS had complete responses during the blinded treatment, although 30% of nonresponders from both groups achieved remission during subsequent open-label treatment with TMS.
Among 61 patients who achieved remission in the study with TMS, either blinded or open-label, seven relapsed during a six-month follow-up period, for an overall relapse rate of 11.5%. Mantovani said the relapses mainly occurred early in follow-up, although a substantial number of patients were lost to follow-up between two and four months. Patients with relatively severe depression at study entry tended to be at greater risk for relapse, he said. Participants in both studies had failed at least one previous antidepressant treatment and most had failed two or more. Another unanswered question about TMS -- whether adding it to existing antidepressant drug treatment is effective -- was addressed in a third study presented here. Scott Aaronson, MD, of Sheppard Pratt Health System in Baltimore, reported on 21 patients who had persistent major depression despite at least two courses of antidepressant drug treatment, and who then received TMS while remaining on the most recent drug regimen. About 57% of patients showed at least 50% improvement in Montgomery Asberg Depression Rating Scale scores relative to pre-TMS baseline, and 24% had remission, he said.
His experience with boosters has been similar to that in the study by Janicak and colleagues, he said. Aaronson added that TMS is a relatively young technology and has probably not been fully optimized. Numerous parameters can be adjusted in TMS, including pulse duration, pulse frequency, total pulses per session, and the number and frequency of sessions. Mark Demitrack, MD, chief medical officer of Neuronetics, which sells the only FDA-approved TMS device, said the technology had been in development for about 10 years prior to its 2008 approval. Aaronson said those settings were the obvious starting point since they were used in the registration trials. At the moment, he said, one of the major barriers to TMS is that, despite the FDA approval, most insurers won't pay for it. TMS may appear high-priced, but it may save money in the long run when compared with the long-term cost of ECT or repeated attempts at drug treatment in patients with poor past responses to antidepressant medications, it appears to be a successful alternative treatment for depression. At South Florida's premier TMS center, Chrysalis TMS Institute, we can help free your mind from Depression using the NeuroStar Transcranial Magnetic Stimulation system. Having been through years of very TRD, I spent months taking the "brain-available" B vitamins and folate he is touting. I have to wonder why the "chemical imbalance" theory was pushed by drug companies and doctors for so many years, even though the evidence of its failure was mounting. Now there are inexpensive options like ketamine that appear to hold great promise for TRD patients, but little interest in obtaining FDA approval for the treatment. The doctor is being funded by Accera, a maker of supplements to treat neurological disease. Also, the adverse effects of prior drugs must be taking into account in "treatment-resistant" cases.
Patients may also have become hypersensitive to all neuroactive drugs, supplements, even foods. This seems to be a highly biased talk, as the speaker only mentioned one brand name product for B vitamin supplementation. The role of alternative medicine in treating postnatal depression.The role of alternative medicine in treating postnatal depression.
Marijuana is a valid medicine, and like many other medicines, it has a potential for abuse. Prescribed use of medicinal marijuana is currently legal in twenty states and the District of Columbia. The use of medical marijuana is intended to improve onea€™s quality of life by reducing or eliminating negative symptoms of a disorder.
If we have a clear understanding of a persona€™s quality of life prior to beginning medicinal use, we can measure the frequency and intensity of the symptoms that marijuana is used to relieve.
Ita€™s unlikely that our use will be scrutinized as it would be if we were being prescribed pain killers or benzodiazepines. Medical marijuana is most often prescribed not with treatment parameters (dosage amount, frequency of use, route of ingestion) but rather with little more than governmental limits as to the amount a person can have in their possession. Self surveys provide objective information to help you make sound decisions, over the short and long-term. Short term results are likely influenced by a persona€™s past experience with marijuana use.
Consider modifications to frequency and dosage to be made if your findings show even minor cause for concern or ineffectiveness of the medication.Gather impressions from friends and family. The biggest potential pitfall of marijuana use is that long term and heavy use tends to be associated with lower levels of productivity. In the case of medically prescribed drugs, there is a significant gray area as side effects are often inevitable and can easily be viewed as a€?problems.a€? In this light, the only objective measurement would be to contrast the side effects of marijuana use to those of alternative medications and forms of treatment. Perhaps our best determining factor in weighing continued use is to consider that as a person develops a substance abuse problem and moves toward addiction (whether psychological or physical dependence) the use of the substance gradually becomes a focal point in their life. Learn more about this herbal medicine thata€™s research-proven to reduce the agitation, irritability, insomnia and anxiety of an opiate withdrawal.
Used for thousands of years as a traditional medicine, nigella sativa is a safe and effective complementary medicine that treats everything from cancer, to arthritis - and possibly opiate withdrawal. Whether taken as a supplement or in cups of tea, l-theanine is safe and helps many people reduce stress and anxiety.
However, aromatherapy provides only modest benefits and no one suggests that it be used as a stand-alone treatment for any type of clinical anxiety condition.
Kava is a traditional intoxicant and ceremonial substance which has been used by South Pacific islanders for generations. Beyond traditional uses, Kava extract or kava powder capsules can now be purchased legally as an herbal supplement in most countries. Kava sounds like a perfect antidote to anxiety a€“ a natural substance with a centuries long history of safe use that provides mild but effective anxiety relief without impairing cognitive abilities - and reflecting these positive qualities sales of the supplement reached $50 million in the US in 1998 alone. A Cochrane Reviews literature review study on 12 clinical studies of Kava as a treatment for anxiety found that Kava was worked well as a treatment for anxiety and that people taking kava enjoyed significantly greater reductions in anxiety symptoms than people taking placebo. No subjects in any of the studies experienced any significant adverse effects and any minor adverse side effects experienced were minor and short lasting.
Reports from health authorities in the UK, Canada and in various European countries have linked the use of Kava to liver damage; with hepatic toxicity severe enough in some cases to require liver transplant, and in some cases proving fatal.

In 2007, a World Health organization safety panel concluded that kava use had been associated with a number of deaths and cases of liver failure, but noted that in most cases damage occurred after the use of preparations which were based on the whole kava plant. Unfortunately, since the FDA does not regulate or inspect kava as a herbal product there is no way to know for sure if products labeled as derived from the root only are adulterated with leaves and stems. Kava works but ita€™s not without risks, and unfortunately, the experts dona€™t yet agree on whether those risks are worth taking.
While most therapists believe that the treatment of phobia or trauma is a long and difficult process and that it is important to unburden yourself of the stories of trauma and abuse in a safe setting with a trusted and experienced professional therapist, there seems to be the possibility of an alternative route. But then I heard that the American Psychological Association had distanced itself from Thought Field Therapy.
About three months ago, however, I heard from a friend of mine that TFT was extremely popular in Europe and was beginning to be researched more extensively here in America.
What's important here is that the Review of General Psychology is published by the American Psychological Association. The real question is: can this deceptively simple and amazingly rapid treatment modality provide relief for millions of people suffering from phobias, anxiety, trauma and other problems?
For anybody who's ever been in psychotherapy this certainly seems like a really strange way of dealing with anxiety, fears or trauma.
Traditionally used in shamanistic ceremonies in the Amazon basin, ayahuasca is now also used to help people overcome addictions to drugs and alcohol. Ayahuasca is concocted from a mixture of boiled banisteriopsis caapi vine and leaves from the chacruna or chaliponga shrubs. Ayahuasca deadens sensations in the body and some people find it brings a heaviness to their movements. Because of the intensity of the experience and the physical side effects, ayahuasca is not something that is likely to be abused for recreational purposes. Although traditional cultures had used ayahuasca as a healing agent for thousands of years and had been using it to treat cocaine and alcohol addictions long before the modern world took notice, it wasna€™t until a French doctor, Dr. Dr Mabit is the founder of the Takiwasi addiction treatment center in Peru and a trained ayahuasca healer who has participated in the treatment of literally thousands of patients with debilitating addictions to drugs and alcohol. Traditional people will often use psychoactive substances like ayahuasca as tools to gain access to the spiritual realm. In modern society, most of us lack this cultural framework that would help us to understand and integrate transcendent experiences of altered consciousness. But the answer cannot be total sobriety or abstinence from all psychoactive substances as this closes an avenue of access to a€?the otherworlda€™ or the spiritual plane. Ayahuasca opens the door to the vast unconscious experience, inducing rapidly transforming visions and repressed memories that are experienced, not solely as visual hallucinations, but as experiences that integrate all 5 senses and which are processed at the cortical level of the brain as well as in deeper parts of the ancient mind.With the synthesization of your physical being, your perceptions and your thoughts comes a very novel way of experiencing your reality. The psychoactive chemical DMT in ayahuasca is considered to be a schedule 1 controlled substance by the United Nations. In some countries, religious groups have fought and won for the right to use ayahuasca as a ritual aid on the grounds of religious freedom.
While ayahuasca proponents have long pointed to the thousands of years of continuous safe human use as validation enough of the safety of the herbal medicine, a literature review study appearing in the journal a€?Addictiona€™ in 2006 took a more clinical approach to develop risk and safety conclusions that are based on established scientific criteria.
The ayahuasca LD50 (the dose it would take to kill 50% of the people who ingested it) was approximately 20 times greater than the average dose given in ceremonial preparations.
Marlene Dobkin de Rios and Roger Rumrrill in their book 'A Hallucinogenic Tea, Laced with Controversy' take a broader look at the practice of westerners traveling to economically deprived parts of South America for spiritual journeys and point to risks that go beyond the strictly medical. Other ayahuasca researchers, such as psychologist Stephen Trichter, acknowledge the power and potential of the ayahuasca experience for spiritual and psychological growth, but say that caution must be used when transferring an intense hallucinogenic experience from one culture onto an audience for that experience from a vastly different social and cultural framework. Trichter says that some people, such as those with certain mental health disorders or those at risk for certain mental health disorders should be very wary of using this a€?potent hallucinogenic.a€™ He says the ayahuasca experience can bring to immediate consciousness past traumas that can cause overwhelming mental and emotional stress, especially to already emotionally vulnerable people a€“ in some cases, doing more harm than good. Become very knowledgeable about the hallucinogen, specifically: its traditional uses, its effects, risks to health and safety, legal issues and its possible benefits Comply with recommended dietary and medication restrictions for a period prior to using the drug. Janicak, MD, of Rush University Medical Center in Chicago, who presented one of the studies during a poster session. He said the parameters used in most recent studies -- 10 pulses per second for four seconds, twice a minute, for a total of 3,000 pulses in each daily session -- appeared to maximize the benefit. 561-394-2532 The success of Transcranial Magnetic Stimulation (TMS and rTMS) as an alternative treatment for depression depends heavily on the skills and techniques practiced by the medical doctor handling your care. What are the statistics on response and remission to special-vitamin-product alone and with added AD? I have learned to keep an open mind and if a patient has failed conventional therapy and needs relief quickly i am willing to try anything as long as it doesnt put the patient at risk. All the businesses want to patent some ketamin-analog or business method for treatment so they can continue to gouge patients and their insurance for a low-cost procedure. Check out their web site, and you will learn of a study using peanut butter to diagnose Alzheimer's- according to their information, the decreased ability to detect the smell of peanut butter from the LEFT nostril is associated with the disease. Long-term post-discontinuation effects can be emotional anesthesia, sleeplessness, surges of anxiety, and post-SSRI sexual disorder, among others.
For such people, simply stopping attempts at drug treatment might allow their nervous systems to recover. Poor family and social support and high stress raise the risk of postpartum depression (PPD).
However, with medical marijuana, you're usually left to decide how much and how often to use on your own. There is growing research demonstrating effectiveness of marijuana in treating Attention Deficit Disorder and anxiety disorders (especially Post Traumatic Stress Disorder).
If we are to judge its effectiveness to the individual, we must establish what a persona€™s baseline is prior to use, after short term use, and monitor effects of long term use.
We can assess mental health and cognitive functioning, productivity, and investment in improved health. It is highly recommended that we check with our local dispensary or other provider as there are a plethora of marijuana strains that can be matched to our specific needs. Those who have had positive experiences in the past may be predisposed to consider their experience of using marijuana medicinally to be beneficial. In assessing and monitoring continued use, what wea€™re really doing is weighing the pros and cons of life with and without this form of treatment. The amount of marijuana required to relieve symptoms will increase over time for most users. If we consider how much of our life is centered around using marijuana, we can spot a problem developing. Learn more about the benefits (and risks) of this affordable and natural home-remedy for opiate withdrawal.
L-theanine may not replace your need for therapy or medication, but if you struggle with stress or anxiety, or even if you dona€™t, the soothing and cognition enhancing effects of this tea amino acid may be just what you need. Most people can use this affordable therapy without experiencing negative side effects, so if you struggle with stress or anxiety, maybe you should add a little lavender or citrus to your daily routine!
The research evidence is inconclusive, but a number of studies show real benefits and no studies show significant harms. A brief summary of some studies on its effectiveness and a discussion about the potential liver damage risks of consumption.
In its traditional form, roots of the kava plant are ground and mixed with water to form a thick drink that when consumed, produces mild euphoria, improved well being and slight intoxication.
In addition to producing pleasurable effects, research demonstrates that kava is an effective treatment for anxiety, depression and insomnia. Traditionally, South Pacific islanders would grind only the peeled root for use and some experts believe that by using other parts of the pant, and by extracting compounds with more than just cold water, health risks are amplified. There seems to be a possibility of a new direction in psychotherapy coming from the field of energy psychology. This actually made sense to me because the practitioners who promoted Thought Field Therapy talked about moving subtle energies with properties that were so ethereal they could not possibly have been defined. Which means that the American Psychological Association is no longer actually distancing itself from these therapies. Read on to learn more about how Ayahuasca works and to find out where you can get treatment with this traditional shamanic medicine if you so desire. For a few hours after you take ayahuasca you experience rapid thinking and hallucinations which are multi sensory in nature (not just visual). Although the drug induces very potent hallucinations, it does not impair cognition and you are fully alert in the moment.
Jacques Mabit, spent years in Peru the early 80s studying plant medicines as an apprentice shaman that the outside world really became aware of this hallucinogena€™s potential. The philosophy of his treatment is based on a study of the traditional uses of ayahuasca, his personal experiences with the drug as a consumer and as a shaman healer and his decades of experience working with addicts at his treatment center in the jungles of Peru.

Mabit believes that addiction arises as people search for meaning in a modern world that has been stripped of meaningful ritual and sacredness; where many no longer feel a sense of belonging or participation in the spiritual or transcendent realm of life. What they find there during periods of altered consciousness makes sense through the lenses of a shared cultural framework and so what they take away from such experiences is recognized as real and important and lessons learned there can be integrated to good effect in ongoing life.
However, it is part of the human condition for all of us to seek out this transcendence and so we try, through various ways, to achieve states of altered consciousness that will bring us what we want. Mabit, it is not the seeking of altered consciousness that is the problem - since this is something all humans are want to do as they explore the spiritual realm - it is that we use the altered consciousness we create for ourselves so poorly that it offers us nothing lasting, and so the only thing we can do is strive to repeat and repeat and repeat again what we hope will bring us happiness.
Mabit, it is not only the drugs within the brew which are curative -  the rituals, honed on 1000a€™s of years of traditional practice, also exert enormous influence over outcomes. Once this door opens, information from this other world becomes available through dream-like visions. The ayahuasca LD50 is similar to the LD50 of other hallucinogens, such as psilocybin (magic mushrooms). They say that an increasing number of American drug tourists and spiritual seekers are visiting countries like Peru to try ayahuasca and are being tricked or even abused by those only pretending to be shamans and experts.
There are a number of foods, prescription and even over the counter medications that must be avoided for some time before using ayahuasca.
Under normal circumstances, orally consuming a DMT containing solution would produce no effects, as the DMT would be destroyed in the stomach and intestines, but ayahuasca contains other compounds called monoamine oxidase inhibitors (MAOIs) which protect the DMT and allow its absorption into the brain. The good news is that, once you've responded, if we can catch it before the depression gets severe, we can usually shorten the number of treatments" necessary to restore the response. Whether you have a psychiatric or neurological condition, we may be able to help you reach your goals. What are the rates of response and remission in patients of the same population who are given traditional ADs only? Here's a guide to making sure your medicine doesn't start causing more problems than it solves.
Baselines can be conceptualized as a normative range of functioning and quality of life of an individual over time. Ideally, these assessments would be made in conjunction with a clinician or medically trained professional who is able to maintain objectivity and is not biased against the use of marijuana. Ita€™s common that the first time a person uses marijuana that they not experience significant effects. If the amount of marijuana being used increases, we must again consider a highly subjective assessment a€“ are we relieving symptoms or are we simply getting high? Ultimately, whether marijuana causes us benefit or harm overall, it remains only one form of treating a condition. It consisted of thinking about a trauma or phobia, rolling your eyes and tapping on different parts of the body. Although I was seeing some success with this technique I was not convinced that that success was not also caused by all the rest of the therapy that I used with these particular patients. In addition, with some major insurance companies researching energy psychotherapies, like Kaiser Permanente, there is a real possibility that TFT and EFT will become mainstream. Even in the hands of the most experienced practitioner it is purported to have an 80% success rate. It might be that you have a simple phobia, in which case treatment should be very quick and simple. We search for happiness from without, rather than from within, and hoping to find it we take drugs and alcohol, gamble, have too much sex and eat very poorly among other things. Unfortunately however, in doing so, we most often bring ourselves pain - such as drug or alcohol addiction. Taking the drug in a different or falsified environment would not result in the same positive results. The drug provides a non verbal experience, where information in transferred through all senses. After draining my wallet on several bottles of this stuff, I realized it made no difference. We have good days and bad days, but overall there is a range within which we holistically function (physically, mentally, emotionally, spiritually and in more quantifiable ways like productivity). The success of self assessment is best ensured when we externalize our insights in writing (ita€™s harder to rationalize or minimize in black and white). In a percentage of users a heightened amount of anxiety follows and for these folks continued marijuana use is likely counter indicated. I rented an office and hung up my shingle and I would love to say that I had a thriving practice, but that didn't happen so quickly.
On the other hand most people have developed much more complex feelings and behaviors around the issues that bother them. And it takes an experienced clinician to break down a persona€™s issues and problems into manageable a€?chunksa€? that can be easily treated with TFT. Ayahuasca unlocks the experience of all emotions, both those we consider to be positive and negative - although in an ayahuasca experience, no emotional experience is value-judged, as they are all teachable and important parts of the experience.
This can help those who are not strong in verbal communication or language come to a strong awareness of their own mind.
Since NeuroStar-TMS has been available to the public, numerous additional rTMS and TMS applications have been investigated by researchers and clinicians. I have had a few patients fit into this subset of patients and do very well with therapy with L methylfolate (deplin). Andrew Farah, MD, Chief of Psychiatry at the High Point Division at University of North Carolina Health Care system nattering on about "chemical imbalance" being responsible for "treatment-resistant depression" (via poor absorption of B vitamins!). To further ensure success we can add journaling as a daily form of processing and building holistic awareness. Although I had a pretty good reputation back in Brooklyn, my refusal to become a registered provider for an insurance company was hindering my progress. Over the next few years they used it as a supplement for therapy dealing with depression, anxiety and trauma.
The clinician will try to determine which particular aspect might be good for you to start to work on. There are other aspects of this method which are based on modern neuroscience and relatively new understanding of how the brain works. This is a very difficult process, and often it is here that the treatment become difficult even for the experienced clinician. The more complex an issue is the more work and time might be involved, but it is still faster and seemingly more efficient than many other options. I've always been interested in any method or technique that shows promise to help my clients.
That he or she will tell you to think about that specific aspect of your problem and ask you to rate, on a scale of 0 to 10, how much discomfort you have while thinking of that.
Looking at problems from this new perspective often results in the finding of novel solutions or alternatives. It so happened that I was sharing an office with a psychologist by the name of Sheila Bender. I have seen and heard of a lot of new fads in the psychotherapy world, so I was very skeptical.
After recording your rating he or she will ask you to do a series of tapping on particular parts of your body and ask you again to rate your discomfort while thinking of the problem.
The drug affects our deep selves, and is equally relevant to anyone, no matter what cultural or religious framework they choose to interpret it through. Good TMS practitioners also evaluate your progress while you are receiving therapy so that appropriate real-time alterations can be made in the specific TMS protocol being applied. She told me of a new and innovative technique that was, according to her, pretty darn amazing. There are particular patterns of tapping on specific places in the body in order to reduce the discomfort. Ayahuasca visions can reduce the power and influence of some traumatic memories which lie buried and hidden in our unconscious but nevertheless affect our day-to-day lives. Once you feel completely rid of the discomfort you she will tell you to do another sequence of behaviors which includes tapping, rolling your eyes in a particular pattern, and humming.
It increases intelligence and concentration, decreases anxiety, improves self esteem and helps us to resolve and relinquish past conflicts.

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