Greenbrook Blog

Why Trying More Medications May Not Be the Answer for Your Depression

Thu, 16 Apr 2026 04:00:40 GMT

If antidepressants haven't worked, you may need a different kind of treatment for depression, not another medication.

If you’ve been living with depression and feel like you’ve tried medication after medication without finding real relief, you are not alone. And you are not out of options. Many people assume that if one antidepressant doesn’t work, the solution is to try another, and then another. But what if that cycle isn’t the answer? What if the side effects of the medications are intolerable? What if there were a non-drug treatment option?

At Greenbrook Mental Wellness Centers, we specialize in helping people who have not found success after trying traditional methods like antidepressants or talk therapy. NeuroStar TMS is a non-drug, non-invasive treatment option for people with treatment-resistant depression.

What is Treatment-Resistant Depression?

Depression is one of the most common mental health conditions in the world, affecting more than 21 million adults in the United States.1 For many people, antidepressants combined with therapy provide meaningful relief. But for a significant portion of people living with depression, medications simply don’t deliver the result that they need.

Treatment-resistant depression (TRD) is defined as depression that has not adequately responded to at least two different medications at least two different dosages. TRD is more common than many people realize. Research suggests that roughly 30% of people with major depressive disorder may meet criteria for treatment-resistant depression.2 That means that millions of Americans are caught in a discouraging cycle: try a new medication, wait weeks to see if it works, experience side effects, and then start all over when it doesn’t bring enough relief.

In fact, the largest clinical trial of major depressive disorder showed that a patient’s chance for remission decreases with each subsequent medication attempt, while side effects simultaneously increase.3,4,5,6

Enter NeuroStar TMS

NeuroStar TMS (transcranial magnetic stimulation) is an FDA-cleared, non-drug treatment that targets the underactive areas of the brain by using focused magnetic pulses.7,8 In a real-world study conducted with over 1,200 patients, 83% experienced meaningful symptom improvement, and 62% achieved remission , meaning their depression effectively went away.9

If multiple medications haven’t provided you with adequate relief from your depression, you’ve struggled with medication side effects, or are simply looking for a proven, non-medication path forward, NeuroStar TMS may be right for you.

Finding Hope After Medications Haven't Worked

Depression can feel isolating. Especially when multiple medications or therapies haven’t worked. But you are not alone. There are other options for treating treatment-resistant depression.

At Greenbrook, we offer no-cost consultations where you can speak with a knowledgeable team member, ask questions, and explore our treatment options commitment-free.

Taking the first step toward exploring NeuroStar TMS may open the door to new possibilities for managing depression.

Sources:

NIMH, https://www.nimh.nih.gov/health/statistics/major-depression accessed 4/29/2024.
Zhdanava M, Pilon D, Ghelerter I, et al. "The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States." Journal of Clinical Psychiatry. 2021;82(2):20m13699.
Trivedi MH, et al. (2006). Evaluation of Outcomes with Citalopram for Depression Using Measurement-Based Care in STAR*D Implications for Clinical Practice. Am J Psychiatry, 163(1):28-40
Rush AJ, et. al. (2006) Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry, 163(11):1905-1917.
Fava M, et al. (2006). A Comparison of Mirtazapine and Nortriptyline Following Two Consecutive Failed Medication Treatments for Depressed Outpatients: A Star*D Report. Am J Psychiatry, 163(7):1161-1172.
McGrath PJ, et al. (2006). Tranylcypromine Versus Venlafaxine Plus Mirtazapine Following Three Failed Antidepressant Medication Trials for Depression: A STAR*D Report. Am J Psychiatry, 163(9):1531-1541.
Post A, et al. (2001). J Psychiatric Research, 35:193-215.
Liston C, Chen AC, Zebley BD, et al. (2014). Biol Psychiatry, 75(7);517-526.
Sackeim HA, et al. (2020). Clinical Outcomes in a Large Registry of Patients with Major Depressive Disorder Treated with Transcranial Magnetic Stimulation. J Affective Disorders, 277(12):65-74.

Why Over 2,200 Patients Have Given Greenbrook Mental Wellness Centers a 5-Star Review

Tue, 07 Apr 2026 13:08:47 GMT

How compassionate care, innovative treatments, and personalized support are helping patients find relief from depression.

When you’re considering a new treatment for depression, hearing directly from people who have had similar struggles can make all the difference. Many individuals living with treatment-resistant depression spend years searching and hoping for relief, often trying multiple antidepressants, therapy approaches, or lifestyle changes without experiencing an improvement in their symptoms.

Our patients have given us over 2,200 5-star Google reviews , making Greenbrook a leading provider of advanced mental health treatments like NeuroStar® TMS and SPRAVATO® (esketamine) nasal spray.

Why Our Patients Chose Greenbrook Mental Wellness Centers

While every patient’s journey is unique, common themes appear throughout many of the 5-star reviews: outstanding Care Teams, success with NeuroStar TMS or SPRAVATO® , support with navigating insurance, and flexible appointment scheduling.

⭐Supportive Care Teams

Navigating depression treatment can feel overwhelming. Many patients report that having a dedicated Care Team made the process easier. Greenbrook’s providers and Care Team work closely with patients throughout their treatment journey. From handling the insurance paperwork to answering questions during your consultation to providing treatments every day, the Greenbrook Care Team is dedicated to helping you feel better.

⭐ Innovative Treatment Options for Treatment-Resistant Depression

Many individuals who come to Greenbrook have already tried multiple antidepressants without finding relief and experiencing side effects such as weight gain, hair loss, nausea, insomnia, and more. That is why Greenbrook offers advanced treatments for people who haven’t found success with traditional approaches: NeuroStar® TMS and SPRAVATO®.

NeuroStar TMS – an FDA-cleared, non-drug treatment that uses targeted magnetic pulses to stimulate areas of the brain involved in mood regulation.1,2

Post A, et al. (2001). J Psychiatric Research, 35:193-215.
Liston C, Chen AC, Zebley BD, et al. (2014). Biol Psychiatry, 75(7);517-526.

SPRAVATO® - an FDA-approved treatment for adults who haven’t found relief with traditional antidepressants. It is indicated for 2 conditions: treatment-resistant depression and major depressive disorder with acute suicidal ideation or behavior in conjunction with an oral antidepressant.

⭐Help Navigating Insurance Coverage

Understanding insurance coverage for mental health treatments can be complicated. Many Greenbrook patients note that Care Teams help guide them through the insurance verification process, making it easier to understand potential coverage and out-of-pocket costs.

⭐Flexible Appointment Scheduling

Consistency is an important part of many treatment plans for depression. Many Greenbrook offices offer extended hours for flexible appointment scheduling. This is so that patients can fit appointments easily into their normal routines with work, school, or family.

Hearing From People Who Were Once in Your Shoes

Depression can feel isolating. Especially when multiple medications or therapies haven’t worked. But you are not alone. There are other options for treating treatment-resistant depression.

If you or someone you care about is living with depression that hasn’t improved with traditional treatments, it may be helpful to learn more about NeuroStar® TMS and SPRAVATO®.

At Greenbrook, we offer no-cost consultations where you can speak with a Care Coordinator, ask questions, and explore our treatment options risk-free.

Taking the first step toward exploring new treatment options may open the door to new possibilities for managing depression.

How Greenbrook’s Care Team Helps Patients Find Relief from Their Depression

Tue, 24 Mar 2026 14:01:51 GMT

A look inside Greenbrook Mental Wellness Centers’ commitment to clinical excellence and compassionate care.

When someone is struggling with treatment-resistant depression, finding a treatment that works for them is only part of the journey. Feeling supported and understood throughout the treatment process can make all the difference. Manager of Regional Operations, Kaitlyn, explains how the Care Team at Greenbrook plays a key role in a patient’s treatment journey.

At Greenbrook Mental Wellness Centers, patients receive more than science-backed, effective treatment options. They receive compassionate care from dedicated mental health professionals who are committed to helping them find remission from their depression. If you or someone you know has struggled to find relief from depression with medications or therapy alone, Greenbrook may offer a new path to recovery with NeuroStar® TMS therapy or SPRAVATO® (esketamine) nasal spray.

Does SPRAVATO® Work? A Look at What the Evidence Says

Thu, 12 Mar 2026 14:00:26 GMT

Understanding how SPRAVATO® works, what clinical evidence shows, and whether it can help adults with treatment-resistant depression find relief.

When someone struggles with depression that hasn’t responded to multiple antidepressants, treatment-resistant depression can feel like a dead end. In recent years, SPRAVATO® (esketamine) nasal spray has emerged as an alternative to traditional antidepressants that can provide fast-acting relief of depressive symptoms.* Naturally, the question “Does SPRAVATO® actually work?” arises. Let’s break down the evidence, how it works, and what patients can expect from a SPRAVATO® treatment session at Greenbrook.

* Based on results of SPRAVATO® long-term clinical study; additional details available in the Prescribing Information insert.

What is SPRAVATO®?

SPRAVATO® is the brand name f or esketamine, a nasal spray. It is FDA-approved specifically for adults with:

Treatment-resistant depression
Major depressive disorder with acute suicidal ideation or behavior in conjunction with an oral antidepressant

SPRAVATO® works differently from traditional antidepressants. Instead of primarily targeting serotonin or norepinephrine, it modulates glutamate neurotransmission – a mechanism linked to increased synaptic connectivity and neuroplasticity.

Because SPRAVATO® can cause sedation, dissociation, and other acute effects, it is administered in a clinical setting, with monitored medical professional supervision under a structured program called a REMS (Risk Evaluation and Mitigation Strategy) center.

Effectiveness in Clinical Research

Unlike traditional antidepressants that often take multiple weeks and even months to take effect, many SPRAVATO® patients report changes in as little as 24 hours. *

In a controlled study found that patients receiving SPRAVATO® plus an oral antidepressant had significantly higher remission rates at 4 weeks, compared to those receiving placebo plus an antidepressant.1

So even though the members of the placebo group were on an antidepressant, they still had a considerably lower response rate than the group of patients receiving SPRAVATO®.

* Based on results of SPRAVATO® long-term clinical study; additional details available in the Prescribing Information insert.

Why Choose Greenbrook for Your SPRAVATO® Treatment

Greenbrook is the largest provider of SPRAVATO® in the U.S. and we are the depression experts, but don’t just take our word for it. Hear from some of our SPRAVATO® patients:

“The Spravato treatments I get here are amazing and they keep you wonderfully comfortable during treatment. Low light, comfy cushy chairs, blankets and lollipops (Spravato tastes terrible). Doctor Wu is VERY knowledgeable when it comes to neuroscience and keeps up with all the latest discoveries and breakthroughs, along with her team, they do a phenomenal job making my treatments go super smooth. I've seen such an improvement in my symptoms since starting Spravato.” - 5-Star Google Review

“Spravato is intense and vulnerable work, but the team at Greenbrook has made it feel manageable—even healing. Bri, Devyn, Kelly, and Katelyn show up with consistency, kindness, and presence. They don’t just check boxes—they actually care. I’ve felt safe to unravel when I needed to, and supported through every phase of this process. Dr. Borst has also been attentive, thoughtful, and direct in a way I’ve really appreciated. This isn’t an easy treatment, but being surrounded by this team has made all the difference.” - 5-Star Google Review

“SPRAVATO® isn’t scary, but it's something that opens your eyes to parts of yourself that you couldn’t otherwise see. I feel like my depression has lifted. My wife sees the results. Other people see the results and I certainly have.” - Andrew S., Patient Advocate

In Summary

So, is SPRAVATO® effective? Yes!

Clinical research and patient testimonials show that SPRAVATO® can provide relief to those who have been struggling with treatment-resistant depression or major depressive disorder with acute suicidal thoughts or behaviors.

At Greenbrook, our mission is your remission from depression. You can explore your options for depression treatment risk-free with a no-cost consultation.

Is NeuroStar TMS Effective? An Explanation For Those With Treatment-Resistant Depression

Tue, 24 Feb 2026 17:43:09 GMT

When traditional antidepressants and talk therapy haven't given you the relief you deserve, you may feel hopeless that you will ever find relief from your depression. When multiple medications or talk therapy haven’t worked, it’s called treatment-resistant depression. But there are other treatment options available that are designed to help those with treatment-resistant depression. One of those treatments is Transcranial Magnetic Stimulation (TMS), and NeuroStar TMS is one of the most widely known and studied system used today. But what does the research actually show? And is it truly effective for people with treatment-resistant depression?

Here’s what you need to know.

What is NeuroStar TMS?

NeuroStar TMS is a non-invasive, non-drug therapy that is FDA-cleared for treating depression, anxiety with depression, and as an adjunct to obsessive-compulsive disorder.1 TMS uses focused magnetic pulses to reignite dormant synapses in the brain and help your brain function the way it was meant to.2,3

In a NeuroStar TMS session, a trained mental health provider places an electromagnetic coil against your scalp. The coil emits focused magnetic pulses that stimulate a part of the brain involved in mood regulation, especially the left dorsolateral prefrontal cortex, an area that may be underactive when someone is suffering from depression.

What Does The Evidence Say?

In a real-world study of NeuroStar patient, the data shows that:

83% of patients who completed a full course of NeuroStar TMS experienced a measurable improvement in their depression symptoms.4
62% of patients reached full remission. Meaning their symptoms decreased to the point they likely wouldn’t meet diagnostic criteria for major depression.4

A published study demonstrated that NeuroStar patients could see depression remission lasting up to 12 months after treatment in adults with treatment-resistant depression.5

Why is NeuroStar a Good Option For People With Treatment-Resistant Depression?

If you’ve tried multiple medications without sustained improvement, NeuroStar TMS may be particularly meaningful for several reasons:

1. Works Differently from Medications

NeuroStar TMS is a targeted treatment that treats depression at the source. It is not a drug, which means it does not cause many of the common side effects typically seen with antidepressants, like weight gain, sexual dysfunction, and sleep issues. The most common side effects with TMS are mild scalp discomfort or headaches in early sessions, which usually subside quickly.1

2. Outpatient and Convenient

Treatments are given in a clinic, 5 days a week for 6-7 weeks, and you remain fully alert during sessions. There is no recovery period so you can return to your normal routine and activities. At Greenbrook, we offer flexible scheduling so you can schedule appointments around your day-to-day life.1

3. Supported by Clinical Research

NeuroStar’s outcomes are supported by one of the largest real-world data sets for depression treatment and multiple clinical trials demonstrating NeuroStar’s efficacy and durability for people with treatment-resistant depression.

In Summary

So, is NeuroStar TMS effective? Yes!

Research has indicated that it can provide lasting relief, and even remission, for many individuals with treatment-resistant depression. Since it works differently than other depression treatment options, NeuroStar TMS provides hope for those who typically haven’t felt relief from antidepressants or talk therapy.

Don’t just take our word for it. Hear from Greenbrook patients who have found relief from their depressive symptoms with NeuroStar TMS.

Schedule a no-cost consultation with Greenbrook today to explore whether NeuroStar TMS could be part of your path toward feeling better.

Refer to full indications for use and safety information.
Post A, et al. (2001). J Psychiatric Research, 35:193-215.3.
Liston C, Chen AC, Zebley BD, et al. (2014). Biol Psychiatry, 75(7);517-526
Sackeim HA, et al. (2020). J Affective Disorders, 277(12):65-74.
Dunner DL, et al. (2014). J Clin Psychiatry. 75(12):1394-1401.

Why Patients Choose Greenbrook for Mental Health Care

Tue, 17 Feb 2026 15:00:09 GMT

Dr. Misty Borst answers common questions about care options and what to expect at Greenbrook Mental Wellness Centers

In this video interview, Dr. Misty Borst provides an overview of the mental health treatment offered at Greenbrook, NeuroStar® TMS and SPRAVATO® (esketamine) nasal spray, and how they are giving hope to patients with treatment-resistant depression . She shares how the Greenbrook Care Team makes the biggest difference in providing top-of-the-line patient care.

To see if NeuroStar TMS or SPRAVATO® is right for you, schedule a no-cost consultation with our Care Team today!

How Insurance Verification Works at Greenbrook

Mon, 02 Feb 2026 15:57:11 GMT

By: Chloe Farley

Verification of Benefits Specialist, Greenbrook Mental Wellness Centers

Understanding insurance benefits, in-network coverage, and out-of-pocket costs explained by an expert.

Just like other doctor’s offices, here at Greenbrook we handle all of our insurance billing . You give us your insurance information, we find out your out-of-pocket cost for treatment, then relay that amount back to you. But you may be wondering… How did we get that information? What does that process look like? Well, that’s what I’m here to talk about.

When you talk with our call center to schedule your free consultation , they will ask for your basic information, name, phone #, date of birth, etc. Then you will be asked to provide your insurance information. Now it’s important to remember to give us up-to-date information, as this is what our benefits team will use to obtain your cost. Make sure you’re able to provide the following information: payer name, member ID, and subscriber information (if you are not the policy holder). Once we have that, it will be sent over to our benefits team for further investigation.

Before we get to figuring out your cost, all your demographics (name, gender, DOB, address, etc.) is verified with what insurance has on file, then basic plan information (group #, plan type, claims, term date, deductible and out of pocket etc.) is obtained. After plan verification, we’ll check to see if your provider and center location are in network with your plan. We do this by taking your rendering provider/ treatment location and making sure they are both credentialed with your plan. If we are in network with your plan, then we move onto getting your benefits quote.

For each treatment/visit, there are specific codes that are used when billing your insurance, and each code has a different charge amount. To get your out-of-pocket cost, we take those codes and run them through your plan, which tells us how much you will owe per treatment. Once all information is gathered, it is entered into our system, and the benefits team sends it over to your coordinator. Your coordinator will then calculate your total out-of-pocket cost for all your treatments by adding the amount due for each visit, which is then quoted to you.

Getting insurance benefits may seem like an easy phone call to your insurance, but there is more to it. Here at Greenbrook, we have a dedicated team of individuals who are trained on the process, so that we can get you the most accurate quote possible.

If you have any questions about this process, or on your own benefits, feel free to reach out to our call center and to set up a free consultation !

Find a Greenbrook location near you and schedule a free consultation .

New Year, New Mental Health Journey

Thu, 29 Jan 2026 15:00:24 GMT

How to start 2026 with a healthier mindset

The start of a new year often comes with the pressure to change everything at once. New routines, big goals, and high expectations. But if you are living with depression, simply getting through the day can already feel like a significant accomplishment. A new year doesn’t mean you have to re-invent yourself.

This year, consider making your mental health a priority . This doesn’t have to mean significant life changes, but through small steps that support how you feel right now. If your current treatment plan for your depression has not brought the relief you need, explore new treatment options.

Write an "Ins and Outs" List

An “Ins and outs” list is a simple way to reflect on your habits, mindsets, and priorities. This will help you evaluate what you would like to invite into your life and identify unhealthy habits that are negatively impacting your wellbeing.

Ins : Habits, thoughts, or practices you want to bring into 2026 or continue doing because they support your wellbeing.
Outs : Habits, beliefs, or behaviors that negatively affect your mental health and no longer serve you.

Re-evaluate Your Current Treatment

Mental health care is not one-size-fits-all . What has worked in the past may not be enough now, and that is okay. If antidepressants or talk therapy have not fully helped, or if symptoms or medication side effects continue to interfere with daily life, it may be time to consider additional treatment options.

Build a "Mental Health Menu"

A mental health menu is a short list of healthy ways to support your mood that you can rely on when things feel hard. These options can help you cope without turning to unhealthy behaviors. Even small actions can help regulate our nervous system.

Explore New Treatment Options

Improving mental health is an ongoing journey, not a single resolution . Greenbrook Mental Wellness Centers specializes in treating depression that has not responded to traditional methods. We offer NeuroStar ® TMS and SPRAVATO ® (esketamine) nasal spray in a supportive, outpatient setting.

Find a Greenbrook location near you and schedule a free consultation .

"I Have My Mom Back": A Powerful Story of Healing with NeuroStar TMS at Greenbrook

Mon, 22 Dec 2025 15:15:00 GMT

Helping others can be one of the most fulfilling parts of life—and for Hector, a Behavioral Health Technician at Greenbrook, that purpose is deeply personal.

Hector’s connection to Greenbrook began long before he joined the team. In 2017, his mother underwent NeuroStar® TMS therapy after struggling with severe depression. The results were life-changing.

“I have my mom because of TMS,” he shares. Seeing her transformation inspired him to help others experience the same kind of hope and renewal. “I want to make someone’s life as incredible as my mom’s has now been with this treatment.”

NeuroStar TMS therapy is a non-medication option for depression that can provide meaningful, lasting relief. Hector sees it every day: patients arriving feeling disconnected from themselves, and later leaving treatment saying, “I’m me again.” Sometimes it’s their families who express it most clearly: “I have my loved one again.”

He often reminds patients: “If your depression is hitting you hard and you still make it into the chair, you’ve already won the day.” Showing up for treatment, even on the hardest days, is a powerful step toward healing.

This Year We Are Thankful For

Tue, 02 Dec 2025 01:59:01 GMT

As the season of gratitude arrives, we're taking a moment to reflect on the stories, people, and small but meaningful moments that inspire our work everyday at Greenbrook Mental Wellness Centers.

At our centers across the nation, we are grateful to see individuals that courageous steps toward healing. We are grateful for every member of our Care Team who supports our patients each and every day.

To our community and our Care Team, Thank you for showing up for yourselves and each other.

Here's what our community members are expressing gratitude for this season with the prompt, "Thanks to Greenbrook..."

“I get to work every day with a team who encourages each other and works together to provide the best patient care.” - Kathy S., Greenbrook provider

“I feel like I have a new lease on life.” - Andrew S. | Treated with SPRAVATO®

“I’ve been able to be completely off my medications for the first time since I was 13 years old.” - Abigail F. | Treated with NeuroStar TMS

“I started seeing results and feeling relief that I wasn’t getting on medications.” - Roger E. | Treated with NeuroStar TMS

“I’ve gotten to see people who have failed multiple medications, find their spark again with NeuroStar TMS and SPRAVATO®.” - Savannah H., Consult Coordinator

Finding Relief After 10 Years of Depression: Brittany's Journey with NeuroStar TMS

Tue, 18 Nov 2025 14:24:12 GMT

Brittany lived with depression for more than a decade.

She had begun to lose hope that she would ever feel like herself again. Throughout that time, she tried 15 different medications for her depression, but nothing gave her full relief.

Before treatment, Brittany felt as though her depression controlled every aspect of her life. Motivation was hard to find, and even the simplest tasks felt overwhelming.

“My depression was very controlling, and it limited my ability to get things done around the house, to exercise, and to keep connections with friends,” she said. “I used to have an active social life, and it disappeared when my depression was strong.”

When Brittany first heard about NeuroStar® TMS therapy at Greenbrook Mental Wellness in Fairview Heights , she was uncertain. “I wasn’t sure about starting TMS therapy at first,” she recalled. “But it has been life-altering for me.” From her very first visit, Brittany says the care and compassion of the Greenbrook team made all the difference. “The Care Team at Greenbrook is so kind,” she said. “The initial visit with the doctors was great, and my daily interactions with the staff always made me feel right at home.”

She also rediscovered the desire to be social and active. “I want to get out and have fun,” she said. “One of the biggest changes that I’ve noticed in myself is the motivation to do things outside of the house and check items off of my daily to-do list.”

Looking back, Brittany describes the transformation as both emotional and empowering.
“Before treatment, I felt like a failure,” she said. “When I finished treatment, I knew that not every day would be sunshine and rainbows, but I knew that I was worth it and every single day was worth living.”

After years of feeling disconnected from herself, Brittany says, “Because of NeuroStar TMS, I actually feel alive and vivacious now, and I’m noticing the beautiful things in nature again. NeuroStar TMS treatment has opened my eyes to life’s possibilities. I’ve felt more inspired to put on makeup, get dressed up, and I actually feel confident.”

Abigail's Experience: How NeuroStar TMS Fit into Her OCD Treatment Plan

Tue, 04 Nov 2025 21:58:38 GMT

For more than a decade, Abigail felt like her life was controlled by a cycle of trial and error with medications. Diagnosed with obsessive-compulsive disorder (OCD) at a young age, she had spent years hoping for relief that never fully came.

“I had been on antidepressant medications for over 10 years, and it was exhausting,” Abigail recalls. “I was periodically switching medications because the side effects were unbearable.”

From dry mouth and migraines to hair loss and fatigue, the physical toll of those medications was matched only by the emotional weight of disappointment. “My OCD was so debilitating, and each new failed medication was so demoralizing for me,” she says. “Since I was 13 years old, I’ve been on 8 or 9 different oral medications, each with intolerable side effects.”

But in June 2025, at age 24, Abigail made a life-changing decision—to begin treatment with NeuroStar® Transcranial Magnetic Stimulation (TMS) at Greenbrook. As a Regional Account Manager for Greenbrook, Abigail had already seen firsthand how NeuroStar TMS could transform lives. She realized it was time to take her own advice. “I thought to myself, ‘Why am I not taking advantage of this treatment?’” she says.

Even with a busy 9-to-5 schedule, Abigail found Greenbrook’s Care Team ready to meet her where she was. “Going into treatment every day felt overwhelming at first, but the Care Team worked with me and accommodated my schedule,” she says. “During my treatment plan, I even had to travel for work.”

Before TMS, fatigue often made simple daily activities feel out of reach. Now, she’s rediscovered the joy of movement and connection. “When I was on medication, I didn’t have the motivation to do anything,” she explains. “Now I have so much more energy to go out and enjoy my life.”

For anyone struggling with OCD, depression, anxious depression, and feeling discouraged after trying multiple medications, Abigail wants to offer reassurance and hope.

“Something I really want people to know is that Greenbrook will work with you to make NeuroStar TMS or SPRAVATO® as accessible as possible,” she says. “Whether it’s flexible scheduling, insurance, or simply a smiling face, we’re with you through it all.”

Her message is simple: take the first step. “If you’re thinking about treatment or have any hesitations, just have the conversation with us,” she encourages. “Our Care Team will walk you through every single step. You’re not going to be alone.”

Laura's Battle with Hidden Depression and the Power of SPRAVATO® (esketamine) Nasal Spray

Fri, 03 Oct 2025 16:28:54 GMT

Discover how Laura's experience with SPRAVATO® helped her with her depression and reconnect with her family.

From starting a family to having a successful career, seemingly everything was going really well for Laura, but the reality was that she was really struggling with depression. She opens up about the day-to-day weight of living with treatment-resistant depression and how SPRAVATO® (esketamine) nasal spray has helped her reconnect with herself and with her loved ones.

Re-discovering Self-Love Through SPRAVATO® at Greenbrook

Mon, 29 Sep 2025 15:46:56 GMT

Watch how personalized treatment and support from the Greenbrook Care Team helped Tori overcome depression and reconnect with herself.

Tori felt like she had tried everything from yoga and meditation to antidepressant medications, but wasn’t quite feeling adequate relief from her depression. Then, she started SPRAVATO® (esketamine) nasal spray treatments at Greenbrook and that’s when she noticed a change. “SPRAVATO® helped me lean into acceptance, compassion, and self-love.” Tori discusses her initial hesitations and her favorite activity to do during treatment.

Overcoming Treatment-Resistant Depression

Tue, 23 Sep 2025 14:55:15 GMT

Jackie's Success With NeuroStar® TMS Therapy at Greenbrook

Jackie has always been an advocate for mental wellness—long before she walked through the doors of Greenbrook for her own treatment. As a Behavioral Health Technician working in another mental health practice, Jackie spent her days supporting others. But privately, she was struggling.

“Before treatment, I was struggling with my depression. I was crying daily. I had to fight to get out of bed. I was struggling at work.”

Like many experiencing treatment-resistant depression, Jackie had tried almost everything: 12 different antidepressant medications; all failed to provide lasting relief. The weight of her depression began to affect her relationships, too.

“Prior to starting treatment, my depression was starting to wear on my relationships. I didn’t want to be a burden to others.”

Then came a turning point. Her partner—also navigating their own mental health journey—sought care at Greenbrook and found relief through NeuroStar® TMS (Transcranial Magnetic Stimulation). Seeing his progress and the progress of her patients, she decided to try TMS therapy for herself. Specifically, NeuroStar® TMS.

“I was a Behavioral Health Technician before I ever considered getting treatment and that gave me the confidence to take this step for myself and my mental health.”

“My confidence in pursuing treatment came from knowing that I would be treated using a NeuroStar® TMS system.”

Jackie soon began her own treatment journey—and life began to change.

“After my second round of NeuroStar® TMS , I’ve been able to come down on my medication dosage and this is the best I’ve felt for as long as I can remember.”

With renewed energy and clarity, Jackie didn’t stop at her own healing. She came full circle—applying to join the Greenbrook team as a Behavioral Health Technician. Today, she’s part of the Care Team that helped change her life.

“I was treated at Greenbrook and then applied to be a Behavioral Health Technician here. When I got the job, my partner looked at me and said, ‘You get to make the life-changing impact that someone else made for you.’”

Jackie’s story is more than inspiring—it’s a testament to perseverance, personalized care, and the transformative power of innovative therapies.

Today, Jackie continues to support others through their own breakthroughs—offering not just technical expertise but lived empathy and hope.

Kimberly's Breakthrough: How NeuroStar® Brought Depression Relief

Thu, 04 Sep 2025 17:52:13 GMT

Watch Kimberly's inspiring journey as she shares how Greenbrook's Care Team and NeuroStar TMS helped her reclaim her life.

After the birth of her second daughter, Kimberly faced a deep and overwhelming depression. She felt disconnected from herself, and the hope of feeling better seemed out of reach. Her psychiatrist referred her to Greenbrook to have NeuroStar® TMS therapy and that was when she started seeing a difference in her depression.

Reclaiming Life in Her Twenties: Chloe's Journey with NeuroStar® TMS

Fri, 15 Aug 2025 13:40:14 GMT

At just 20 years old, Chloe found herself struggling with depression—a challenge that made everyday life feel overwhelming and joy hard to find. Working as a Behavioral Health Technician at Greenbrook Mental Wellness Centers, she had witnessed firsthand how NeuroStar® TMS therapy helped patients improve. It was that experience that ultimately led her to seek treatment for herself.

Chloe's decision marked a turning point. She responded remarkably well to NeuroStar® TMS, echoing the very outcomes she used to celebrate in others. What followed was a transformation not only in her mental health but in her overall experience of young adulthood.

The Care Team at Greenbrook played an essential role in her recovery. Chloe described the Care Team as “absolutely amazing,” noting their kindness and commitment to checking in regularly. Their support made the treatment process feel less clinical and more personal—a space of trust and comfort she looked forward to each day.

As treatment progressed, the changes in Chloe’s life began to blossom. She found herself embracing experiences she once would’ve dismissed. One particular moment that stands out is a pottery class she took with a friend—except this wasn’t just any pottery class. It included cuddling baby goats and lambs while painting.

Honestly,” Chloe recalled, “that’s something I never would have thought of doing before. I probably would’ve been like, why would I ever want to go and sit and paint pottery for three hours?” But post-treatment, she found joy in the quirky, simple things—experiences that brought warmth and laughter and reminded her of the beauty in being present.

From dining out with friends to going on dates and reconnecting with her family at gatherings, Chloe’s life became more vibrant. She felt more like herself again. “Going through treatment can be hard, but it is worth it,” she said. “I feel so much more like myself.”

Her message to others is clear: “Give NeuroStar® TMS a try—it could change your life.” For those uncertain, she recommends taking the first step: a free one-hour consultation.

Looking back, Chloe is grateful she chose treatment. “I didn’t want to look back on life and be like, ‘man, I really missed out on being young.’” Now, she’s living it—fully and unapologetically.

She also shares an important reminder about the stigma surrounding depression, especially among young adults: “People might think you’re weird, but it’s nothing to be ashamed of. It’s important to talk about.”

Chloe’s story is more than a recovery journey—it’s a celebration of life, laughter, pottery with goats, and the courage to rediscover joy.

A Passion for Helping People

Fri, 11 Jul 2025 15:57:05 GMT

Kelly’s Journey as a Senior Behavioral Health Technician at Greenbrook Mental Wellness Centers

At Greenbrook Mental Wellness, the commitment to patient care is deeply woven into the fabric of every center. For Kelly, a Senior Behavioral Health Technician at Greenbrook locations in Columbia, Annapolis, and Greenbelt , Greenbrook's mission is more than just a career.

“I care a lot about people, and it comes naturally for me to take care of them,” Kelly shares. “Making sure everything is taken care of, that technicians feel safe and happy, and that patients feel the same way—that puts me at peace.”

Seeing Progress in Mental Health Treatment

Kelly began her career at Greenbrook Mental Wellness Centers as a SPRAVATO® Coordinator, managing initial consultations and navigating insurance processes for patients. While the role was crucial, she soon realized her true passion was in day-to-day patient care.

“Being a Behavioral Health Technician (BHT) means you get to witness a patient’s progress firsthand. You see their growth and help guide them through their journey,” Kelly explains.

One of the most rewarding aspects of Kelly’s work is observing gradual but significant changes in patients undergoing NeuroStar® Transcranial Magnetic Stimulation (TMS) and SPRAVATO® (esketamine) nasal spray treatment.

“TMS patients often don’t notice a difference right away. But then, one day, they mention they washed the dishes last night—after months of struggling to complete even small tasks. That’s when you realize the treatment is working,” she says.

For patients undergoing SPRAVATO®, the change can be more immediate. “I had a patient who, after the very first session, said, ‘I feel better already.’ By the end of her treatment regimen, she went from a PHQ-9 score of 21 or 22 to 0.”

Empowering Patients Through Compassion and Expertise

Greenbrook’s Care Team takes pride in guiding patients through their treatment journey, offering both expertise and emotional support. Kelly assures nervous patients that they are in the best hands.

“All of the technicians and staff here are invested in your journey. We want you to get better. Even if the treatment doesn’t lead to full remission, we’ll create a plan to ensure you continue to improve.”

Specialized Care That Sets Greenbrook Apart

What makes Greenbrook different from other mental health centers? According to Kelly, specialization is the key.

“This is all we do— NeuroStar® TMS and SPRAVATO®. We’re dedicated to helping our patients find relief from their depression with these treatments. Because we focus solely on these therapies, our Care Team is highly skilled, constantly updated on the latest developments, and committed to providing the best care possible.”

Greenbrook Mental Wellness continues to be a place where patients feel seen, supported, and cared for. With professionals like Kelly leading the way, patients at Greenbrook can trust that they are receiving dedicated, compassionate care that prioritizes their mental wellness.

A Patient's Journey Through SPRAVATO® Treatment at Greenbrook

Tue, 24 Jun 2025 20:29:37 GMT

By: Mitchell Whigham, PA-C

Physician Assistant, Greenbrook Mental Wellness Centers

Hello everyone! My name is Mitch, and I am a Physician Associate with Greenbrook. I’ve been providing SPRAVATO® (esketamine) nasal spray treatments for a little over a year now and wanted to share what the journey of going through SPRAVATO® treatment looks like at Greenbrook. I am passionate about these treatments because I have seen them provide relief from depression for many people!

So, what is SPRAVATO® anyway? SPRAVATO® is a derivative of ketamine known as esketamine. It is an important treatment option for people with depression who don’t find relief with typical antidepressants. This condition is called treatment-resistant depression or TRD. This can be a frustrating condition for patients and providers, so knowledge of treatment options like SPRAVATO® is crucial.

The Treatment Journey

Step 1: Initial Evaluation

The first step is to talk to your primary care provider or mental health provider about SPRAVATO®. They can refer you to one of our clinics by filling out a short form on our website. You can also refer yourself by completing a similar form here: https://www.greenbrooktms.com/esketamine-form

Once this is completed, a member of the Greenbrook Care Team will reach out to you to gather preliminary information and schedule a pre-assessment with a Greenbrook medical provider. During this pre-assessment, we will evaluate whether SPRAVATO® is a viable treatment option for you. Certain conditions, such as uncontrolled high blood pressure, may make treatment a risk. We will discuss the risks and benefits of treatment with you, and together, you and your provider will decide whether to move forward.

Step 2: The First Treatment

Once approved for treatment, our Care Team will work with your insurance and pharmacy to ensure your medication is available. When you arrive at your local Greenbrook center, you will meet your Behavioral Health Technician (BHT) who will take you to your treatment room and check your vital signs to ensure safe treatment.

Your first SPRAVATO® treatment (the induction treatment) will be administered nasally at either 56 mg (two sprayers) or 84 mg (three sprayers). Our team will walk you through the procedure, including how to properly use the SPRAVATO® nasal device. We even provide a trainer sprayer with no medication for practice. Any questions or concerns you have will be addressed before starting. When you are ready, we will hand you the SPRAVATO® nasal sprayer to begin your first treatment.

Step 3: The Observation Period

Following your treatment, you will remain under mandatory observation at Greenbrook for two hours. This allows our team to monitor for potential side effects, such as dissociation, sedation, or nausea.

Side effects typically peak around 40 minutes after treatment begins. At that point, we will check your vital signs and ensure you are feeling okay. We will conduct another check at the two-hour mark before you are cleared to leave with your pre-arranged ride. Throughout the observation period, a provider and BHTs will be available to assist you as needed.

Step 4: Ongoing Treatment Plan

The standard regimen for SPRAVATO® starts with twice-weekly treatments for the first month, known as the induction phase. After the first month, you will enter the maintenance phase, where the frequency decreases to once a week. From there, you and your Greenbrook provider will tailor your treatment plan based on your individual needs.

Step 5: Life With SPRAVATO®

It is difficult to predict exactly how SPRAVATO® will affect everyone. Many patients report improved depression symptoms over time. Some find relief within just a few treatments, while others take longer to notice positive effects. Some may experience side effects, while others may not have any. It is important to communicate with your Greenbrook Care Team about any effects, both positive and negative, so they can adjust your treatment plan accordingly.

SPRAVATO® (esketamine) Nasal Spray FAQs

Tue, 24 Jun 2025 20:18:34 GMT

By: Mitchell Whigham, PA-C

Physician Assistant, Greenbrook Mental Wellness Centers

SPRAVATO® FAQs

Q: What should I do to prepare for my first treatment?

A: We recommend refraining from eating anything for two hours prior to your appointment. I would also recommend bringing any comfort items such as a blanket, pillow or headphones to listen to music.

Q: How long to the side effects last?

A: Typically, side effects peak around 40 minutes after dosing with SPRAVATO®. For the majority of people, side effects generally wear off by the end of the two-hour observation period. However, for some, it may be longer or shorter than that.

Q: What do people do during the two-hour observation period?

A: Journaling, sleeping, drawing, painting, watching a movie, listening to music or podcasts are the most common things I see people do during the observation period.

Q: If I don't really get any side effects, do I have to stay the whole two hours for observation?

A: Yes! The two-hour observation period is mandatory regardless of side effects.

Q: Am I able to drive myself home after treatment?

A: No! Do not operate a vehicle or any machinery after treatment with SPRAVATO® for the rest of the day.

Q: What will SPRAVATO® taste like?

A: Most people tell me there is a bitter or metallic taste to SPRAVATO®. Ask your Greenbrook Care Team what amenities they may have to help with the taste, such as ginger ale or mints!

Q: What if I need to go to the bathroom during the observation period?

A: Be sure to let a member of your Greenbrook Care Team that you need to use the restroom. A member of the team will help escort you to and from the restroom.

Q: Does Greenbrook provide IV ketamine treatments?

A: No, Greenbrook does not provide IV ketamine treatments. IV ketamine has not been approved by the FDA for the treatment of depression.

Q: I have a teenager who I think could benefit from SPRAVATO® treatments, do you treat adolescents?

A: SPRAVATO® is approved for and has only been studied in people over the age of 18 at this time.

Depression is already frustrating, even more so after trying multiple medications that don’t help. If you struggle with treatment resistant depression, it may be time to talk to your Doctor about SPRAVATO® or visit GreenbrookTMS.com to learn more.

The Heart of Mental Wellness: A Shoutout to Our Amazing Behavioral Health Technicians

Tue, 03 Jun 2025 14:31:50 GMT

By: Joe Morales

Manager of Regional Operations,

Greenbrook Mental Wellness Centers

At Greenbrook Mental Wellness Center, we talk a lot about cutting-edge treatments like NeuroStar® Transcranial Magnetic Stimulation (TMS) and SPRAVATO® (esketamine) nasal spray . But behind every successful treatment, there’s a dedicated team of people making it all happen—which includes our Behavioral Health Technicians (BHTs). If you've ever walked through our doors, chances are a BHT was there to greet you, guide you and make you feel comfortable. Today, we want to take a moment to shine the spotlight on these incredible individuals who make healing possible every single day.

The Unsung Heroes of Mental Wellness

Our BHTs are the heartbeat of our centers. They’re not just checking boxes or following protocols—they’re the ones holding space for patients on some of their toughest days. They’re the friendly faces who remember your name, the kind voices that reassure you when you're feeling uncertain and the steady hands that make sure each session goes smoothly.

Their role goes far beyond assisting with treatment. They’re the ones who notice when you need a little extra support. They take the time to listen, to offer a comforting word or even just share a small moment of laughter to brighten your day. Their job is part science, part heart, and completely essential to what we do.

The Essential Responsibilities of a BHT

A Behavioral Health Technician wears many hats throughout the day, ensuring that every patient receives the highest level of care. Some of their key responsibilities include:

Guiding Patients Through Treatment : BHTs are there to help patients navigate their TMS and SPRAVATO® treatments, explaining the process, addressing concerns and ensuring safety protocols are followed.
Providing Emotional Support : Mental health treatment can be overwhelming and our BHTs are a reassuring presence, offering empathy and encouragement when patients need it most.
Monitoring Patient Well-Being : They carefully track patient responses, watch for any side effects and communicate observations with the treatment team to ensure personalized and effective care.
Maintaining a Safe and Comfortable Environment : From setting up treatment rooms to ensuring a welcoming atmosphere, BHTs help create a space where healing feels possible.
Coordinating with Clinicians and Staff : They work hand in hand with psychiatrists, coordinator teams and other mental health professionals to provide seamless, patient-centered care.

More Than Just a Job

Mental health care isn’t easy, but our BHTs show up every day with patience, compassion and an unwavering commitment to helping others heal. They understand that behind every patient is a person—someone who may be struggling, hoping or just trying to get through the day. And they do everything in their power to make the journey a little bit lighter, a little less overwhelming and a lot more hopeful.

Whether they’re preparing a patient for a TMS session, sitting with someone through a SPRAVATO® treatment or simply offering a reassuring nod, their presence makes a world of difference. Their kindness doesn’t go unnoticed and their impact is immeasurable.

A Huge Thank You

To our Behavioral Health Technicians: You are the foundation of what makes Greenbrook a place of healing and hope. Your hard work, compassion and dedication change lives every single day. We see you, we appreciate you and we are beyond grateful for everything you do.

And to our patients and community: If a BHT has ever made your experience better, take a moment to say thank you. A kind word, a smile or a simple “I appreciate you” can mean the world to these incredible professionals.

Healing happens together, and our Behavioral Health Technicians are a huge part of that journey. Here’s to them—our everyday heroes!

Behind the Smile: Supporting Patients at Greenbrook

Tue, 27 May 2025 22:20:42 GMT

By: Sonnita "Sunny" Pruitt

Senior Behavioral Health Technician

Greenbrook Mental Wellness Centers

“A new chapter begins, but can someone please write the intro for me” - Unknown

Hello! It’s me, Sonnita Pruitt, but you can call me Sunny. I am a Senior Behavioral Health Technician at Greenbrook Mental Wellness Center’s Orange Park location. I’ve been with Greenbrook since 2019, and I can honestly say I have not only found what I LOVE doing but it has changed my life for the better.

A day in the life of a NeruoStar® TMS technician is all about connection and support. We’re the friendly faces that greet patients every day, guiding them through their treatment journey with empathy and encouragement. Patients commit to daily treatment sessions, five days a week, for about twenty minutes each day. We understand it’s not the easiest commitment, so we work hard to make it a comforting and welcoming space for them. From decorating the treatment center to chatting with patients about their progress, we’re right there alongside them—celebrating victories, offering comfort on tough days, and creating a safe space where they feel supported every step of the way. Sometimes our patients feel so right at home that they don’t want to stop coming in everyday when they have completed their treatment program!

We let them know that they are not on their journey alone and that they have the whole Greenbrook team behind them to support them on the good days and bad days. Empathy goes such a long way with what we do. We make everyone who walks through our doors feel cared for and supported. I make it a point to reassure patients that this is a safe space to vent, to cry, to feel whatever emotions they feel at the time. To see relief on their faces is rewarding. To see them smile is phenomenal.

Every member of the Greenbrook Care Team plays such an essential role in the successful treatment of each individual patient. It’s not just our patients who feel positivity and joy; our Care Team does too. It is such a fulfilling workplace because of what we do for our patients. To be a part of a company/team that understands how challenging depression can be, feels refreshing. We all collectively share the same goal, to help everyone reach remission from depression.

A Day in the Life of a Behavioral Health Technician at Greenbrook Mental Wellness Centers

Cwing@greenbrooktms.com (Caroline Wing) — Fri, 23 May 2025 20:42:39 GMT

By: Katie Osborne

Behavioral Health Technician

Greenbrook Mental Wellness Centers

My name is Katie Osborne and I’m a Behavioral Health Technician (BHT) based in South Florida. Helping other people has always been at the forefront of my mind. Ever since I was a small child, I always knew that I wanted a career that allowed me to engage with and support people. Greenbrook Mental Wellness Centers has given me that opportunity, and so much more.

The Heart of My Work: Patient Care 

While each day brings new challenges and new rewards, one thing stays the same: my love for connecting with others. Patient care should always be a top priority in any healthcare setting, and I’m grateful that my role allows me to engage with patients and witness their progress firsthand. 

On any given day, I am able to interact with between 20-50 patients. Through NeuroStar® TMS Therapy and SPRAVATO ®, I have the privilege of supporting those who are struggling while also building meaningful connections. Patients love learning about me just as much as I love learning about them—whether it’s how many siblings I have, when my wedding is, or fun stories about my two cats. These small moments of togetherness help create a warm and welcoming environment for all who enter our doors.

The Rewarding Moments

The most rewarding part of my job is watching patients who have had such a long history of medication trials and adverse side effects, finally start to find their spark again. They begin to appreciate the small things, like walking, making plans with friends, or opening the windows on a chilly day. Watching the light return to someone’s eyes in real time is invaluable, and I will always cherish those moments. 

A Modern Approach to Mental Wellness

Greenbrook Mental Wellness Centers fosters a diverse, supportive environment where every team member is dedicated to providing a safe and comfortable space for patients to begin their mental health journey. Whether a patient is meeting with a coordinator for their initial consultation, starting their first NeuroStar® TMS session, or relaxing during a SPRAVATO® treatment, one thing remains constant—our unwavering commitment to patient care. 

Being a BHT at Greenbrook has allowed me to combine my passion for helping others with cutting-edge mental health treatments. Every day, I am reminded of the profound impact compassionate care can have on someone’s life, and I wouldn’t trade this experience for anything.  

My TMS Journey: Finding Hope, Healing, and a New Beginning

Tue, 20 May 2025 14:05:21 GMT

Written By: Sean Blackburn

Greenbrook Patient

The Inner Struggle

I am someone who knows the weight of depression and anxiety all too well. I know what it’s like to feel trapped in bed for days, sometimes weeks at a time. I’ve been in that place where every attempt to pull myself up only seemed to drag me deeper into the cold darkness.

For years, I struggled silently like many others who face depression or anxiety, feeling like there was no way out. I eventually found a path forward—something that changed everything for me: NeuroStar® TMS (Transcranial Magnetic Stimulation) therapy at Greenbrook Mental Wellness Centers. Over several weeks, this treatment helped me find the life I so desperately wanted but couldn’t quite grasp.

I first noticed a difference between myself and my peers at a young age. This led to confusion and frustration within myself as I learned to find coping mechanisms for the depression that was creeping into my life day by day.

Those years were hard —really hard. I was sensitive and deeply affected by rejection and criticism. If I didn’t already feel out of place enough, bullying started around that time too, mostly regarding my weight. Each word chipped away at me, adding another layer to the shame and sadness that was already building inside me.

By the time I was 15, my parents saw how much I was struggling. That’s when I began the rollercoaster of trying different antidepressant medications and trying different therapists. The trial-and-error process with medication was grueling. Waiting 4-6 weeks for a new medication to maybe work felt unbearable when I was already feeling miserable. I worried what people would think if they found out I needed medication to regulate the chemicals in my brain or that I would be seen as “weak” for needing help.

Of course, there are always those who don’t understand —people who think depression is a mindset or a problem that is a way to get attention from others. “Why don’t you just be happy instead of sad?” they say. “Exercise! Eat right! You have nothing to be sad about!” or one of my favorites which is “It’s all in your head.” Every time I heard something like that, it stung. It made me feel weak like my struggles were just laziness or a character flaw that could be fixed if I just tried harder.

A Deeper Look into TMS Therapy

I first heard about TMS therapy a few years ago through magazine articles and social media ads. Every now and then, I’d come across something mentioning it as a non - invasive treatment for depression, but at the time, I didn’t think much of it. I filed it away as something interesting but distant —one of those things that might help other people but probably wouldn’t do much for me.

As time when on, my depression became hard to manage. The medications weren’t giving me the relief I needed, and I found myself becoming more desperate to try anything that could help me live the life I always dreamed of —a life where I was happy, confident, and capable. I wanted to advance in my career, take care of my family financially, and be the kind of strong leader my kids could count on. Every time I would try to grasp it though; it would slip through my fingers.

What really drew me to TMS therapy was the fact that it wasn’t medication-based. That appealed to me right away because, after years of adjusting doses and trying new prescriptions, I was ready for a different approach. Then, I saw pictures that visually show the difference in brain activity between a depressed brain and a normal, healthy brain (Fig. 1-1).

In those scans, you can see how much of the brain is dormant when someone has depression. The areas that are supposed to light up with activity are just... dark. When I looked at that depressed brain, I thought, that’s exactly what my brain feels like. Tired. Unmotivated. Negative. Unable to handle all the responsibilities and pressures that life throws at you. It felt like I was looking at the physical representation of everything I’d been experiencing for years. That image stuck with me. The more I learned about NeuroStar® TMS therapy, the more it made sense —stimulating parts of the brain that had essentially gone offline to restore function and lift depression. I also found out that my insurance would cover most of the cost, and since I’d already met my deductible that year, it was a no-brainer —no pun intended.

Beginning Treatment

At first, I wasn’t sure how I’d feel about going into the center five days a week, but it turned out to be something I genuinely looked forward to. Getting NeuroStar® TMS therapy at Greenbrook quickly became a comforting routine for me. Every day felt like another step toward healing, and I was always met by people who truly cared about my well-being. It didn’t feel clinical or rushed — there was a deep sense of compassion.

During the sessions, I felt comfortable, relaxed and cared for. One of my favorite ways to pass the time was talking to my technician about movies. We had a lot of fun swapping show recommendations, and sometimes I’d even pull up relaxing videos on YouTube to watch during the session. It gave me something to look forward to —not just the treatment itself but the simple joy of being able to connect with someone who made the experience enjoyable.

Getting out of the house every day to go to Greenbrook became a bright spot in my routine. It wasn’t about the treatment; it was also about spending time with people who made me feel seen and understood. For someone who’s been through a lot, that kind of connection is something you don’t take for granted. I was even able to bring my 16-month-old daughter with me to most of the appointments, and she would happily watch me and the Greenbrook staff with curiosity as we did the treatments.

How TMS Has Impacted My Life

Around the third or fourth week of treatment, I experienced what I can only describe as an awakening. It felt like I was coming back to life after a long, dark sleep —like the sun was starting to shine through the crack in the curtains. My mood began to improve, and I felt like a heavy burden I had been carrying for decades was finally lifting.

TMS gave me a metaphorical flashlight, illuminating parts of my mind that had been shrouded in darkness for years. It helped me face those thoughts and emotions head-on with confidence and a perspective that continues to evolve and grow every day.

My life is completely different from the day I first walked through Greenbrook’s doors —different in the best ways imaginable. My entire mindset has shifted into a higher gear, one I never thought possible for me. Now, instead of avoiding problems, I confront them head-on. I have an awareness of my thoughts and emotions that I didn’t have before, and this awareness allows me to challenge and defuse negative patterns before they take hold.

Since completing treatment, I got my dream job. I started school to advance my career in IT. Most importantly, I’m able to be the best father to my three amazing children and the kind of husband my wife truly deserves. I’ve become the man I always wanted to be —the kind of man who leads his family with love, strength, and resilience. TMS gave me the tools to unlock that potential within me.

A Brighter Future Awaits

If you’re on the fence about trying TMS, let me tell you this: I was there too. I was skeptical. I didn’t know if it would actually work or if it would be just another trend in mental health treatment. But what I found at Greenbrook wasn’t a fad —it was life-changing.

TMS helped me break free from the chains of depression that held me down for far too long. It gave me a second chance at life. If you’re struggling, you owe it to yourself to explore every option available. TMS might just be the key to the life you’ve been searching for.

I can’t recommend Greenbrook highly enough. The staff there genuinely cares about your healing and success. It’s not just a job to them —they’re invested in your journey. They create an environment that feels safe, supportive, and warm. You’ll be treated with compassion and respect every step of the way. If you’re ready to change your life, Greenbrook Mental Wellness Centers is the place to start.

TMS vs. Medication: TMS wins

Tue, 08 Oct 2024 14:13:36 GMT

*Please note that this blog references real studies around treatment-resistant depression and TMS therapy and is written by a medical professional. Please consult your own care team or contact Greenbrook TMS to discuss options that are best suited for your personal situation.

TMS vs. Medication: TMS wins

If you have tried two or more medicines for depression and still aren’t doing well, then TMS might be your best option. A recent, first-of-its-kind study directly compares the efficacy of TMS to the efficacy of a medication switch in patients who have failed two medications. TMS wins, and it’s not even close.

When antidepressant medications don't seem to work, we call it treatment-resistant depression, or TRD. Individuals with TRD typically try many medications and other treatments, such as talk therapy, without experiencing significant relief from their symptoms. Luckily, medication is not the only option. TMS is a different kind of treatment that often works when medication has failed. Psychiatrists and other mental health providers have long known that TMS often works for patients who don’t get better with medications. But now, there is some fresh evidence of how much better TMS is.

In the past, we had studies of antidepressant medications and other studies of TMS. We never had a good study that directly compared the two head-to-head in the same study . But, now we do.
 

In a recently published study (Dalhuisen et al., Am J Psych, 2024), patients with major depressive disorder and two failed medication trials were randomized to open-label treatment with either TMS or a switch to another antidepressant medication.  HAM-D scores, rates of response, and rates of remission evaluated treatment outcomes. We define response as at least a 50% reduction in depressive symptoms and remission as almost complete relief from depressive symptoms.   

TMS won by a wide margin. The response rate was 37.5% in the TMS group and only 14.6% in the medication group. The remission rate was 27.1% in the TMS group and a dismal 4.9% in the medication group.    

As an important aside, it is interesting that the study’s 37.5% response rate in the TMS group is lower than what we’re accustomed to seeing. This might be because patients in this study had only 25 treatment sessions, instead of the more normal course of 30-36 TMS treatments. In my opinion, it is safe to assume that the advantage of TMS over medication would have been even larger if the TMS subjects had gotten a full course of 36 treatments.  

The bottom line is that this study gives the world a considerably higher quality of evidence for something we already know: for treatment-resistant depression, TMS is a lot more effective than trying another medication.  

** rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches” https://psychiatryonline.org/doi/10.1176/appi.ajp.20230556

3 Ways Depression Affects Your Relationships

Tue, 28 Feb 2023 14:43:16 GMT

You may feel isolated and alone when you have clinical depression, and depression also affects your relationships with family and friends. While the primary focus of your treatment is to improve your mental health, it’s also essential to understand your loved ones may experience their own issues as they try to support you. An understanding of how depression affects relationships can help everyone maintain healthy connections and navigate problems. Here are some of the ways depression may affect the people in your support network.

1. Depression Can Promote Negativity

People with depression may have a sad outlook on life. According to research , this can result in a tendency to express themselves negatively through their words or facial expressions. Also, depression can make people view casual social interactions as negative and attribute these difficulties to their personalities.

This leads to fewer close relationships, a lower level of empathy from others, and a higher incidence of poor social interactions. In response, someone with depression may isolate themselves to avoid rejection. Unfortunately, this can reinforce a negative perception from other people, which further decreases the chances of positive social relationships.

More specifically, research has consistently demonstrated a link between being depressed and experiencing rejection from other people in social settings. Interacting with someone who is depressed may cause otherwise healthy individuals to feel more depressed, hostile, rejecting and anxious. Negative feelings make it harder for the individual who is suffering from depression to display good-natured social behavior and this disrupts relationships.

2. Relationship Conflicts May Occur

Understanding how your depression affects others can strengthen your interpersonal relationships. Caregivers who feel overburdened, such as parents of depressed children, may engage in expressed emotion . This can take the form of hostility, irritability or criticism.

Unsurprisingly, this may lead to arguments and a lack of trust that fractures relationships. Plus, the person who is depressed may see their symptoms increase. The intensified depression may make a person push others away, reinforcing the feelings of depression and deepening the rift in the relationship. If a caregiver can’t lower the level of their expressed emotion, the risk of relapse for the depression sufferer increases and the cycle of negativity continues unbroken. In such cases, psycho-education for family members or loved ones and family-focused therapy can help improve expressed emotion in personal relationships.

3. Depression Impacts Physical

and Mental Health in Others

The effects of depression on family members can take a toll on their health and well-being in the form of stress . Chronic stress often wears on loved ones or caregivers and may manifest in headaches, body aches and pains from muscle tension, acid reflux, heart disease, weakened immune system and other diseases. This stress may also trigger depressive symptoms in other people, especially those who are in a caregiving relationship to the person with depression. It’s helpful for family members or caregivers to join support groups where they can access resources, share their experiences, and learn from the experiences of others.

And everyone—people with depression and members of their support network—should keep up with daily self-care habits that can bolster mental and physical health. Try to eat well, exercise, and get enough sleep each night.

What You and Your Loved Ones Can Do

Treatment takes on new importance once you know how depression affects relationships. You and your loved ones will benefit when you seek proper care for your depression symptoms. It is paramount to seek out professional help. By meeting with a doctor, you can discuss your depression concerns and symptoms with a medical professional. Then, you and your doctor can develop a plan to make things better.

Greenbrook helps you alleviate depression symptoms, especially if you’ve already tried medications or talk therapy with inadequate results. We develop personalized treatment plans for each of our patients to safely and effectively manage their depression through TMS therapy or nasal esketamine .

Explore Depression Treatment with Greenbrook

Depression’s effects are wide-ranging, so it’s important to seek out treatment. Find out if TMS therapy or nasal esketamine is right for you or a loved one. Schedule a free consultation with us today.

5 Common Misconceptions About Depression

Thu, 19 Jan 2023 18:56:00 GMT

We’ve all heard the common health-related misconceptions or myths-- chocolate causes acne, carrots will improve your night vision, and cracking your knuckles gives you arthritis. Subscribing to these particular myths is relatively harmless, but other health-related misconceptions can have far more serious consequences. This is the case for depression—the myths surrounding it can prevent people from getting the help they need.

This is the case for depression—the myths surrounding it can prevent people from getting the help they need. Because untreated depression can have a serious physical and psychological impact, it’s imperative to have the right information in order to make the best decisions for yourself and for your health. Here are 5 common misconceptions about depression, and the facts behind them:

Depression Myth #1: You Can Just "Get Over It"

Depression can make someone feel like they aren’t strong enough, determined enough, or smart enough to just feel better. Dr. William Sauvé , Regional Medical Director for Greenbrook TMS NeuroHealth Centers in Virginia, says that the “pull yourself up by your bootstraps” mentality comes from the misguided feeling of “People believing that they should be able to "make themselves" feel better. People feel ashamed of depression because they can't believe they can't snap themselves out of it — and that's part of the illness. The myth is caused by the illness and perpetuated by those who haven't had depression.”

Depression Myth #2: Sadness & Depression Are The Same Thing

Everyone gets sad sometimes, and life events such as losing a loved one or a job can lead to a period of grief. However, depression isn‘t just sadness. Instead, it’s a number of persistent symptoms, including:

-Fatigue or decreased energy

-Difficulty thinking, concentrating, or making decisions

-Insomnia

-Changes in weight from decreased or increased appetite

-Feelings of worthlessness or guilt

-Loss of interest in activities

One key to differentiating between a natural response to an upsetting event and depression is the severity of symptoms and how long the symptoms have been ongoing. If you have any concerns that you may be experiencing depression, reach out to a medical professional for help.

Depression Myth #3: Antidepressants Work For Everyone

Some people with depression do experience remission with antidepressants, but that isn’t always the case. If you’ve felt that your antidepressants aren’t working as well as you’d like, you’re not alone. Statistically, most people are less likely to get relief from each successive antidepressant that they try. For others, the side effects can be difficult to handle.

Dr. Misty Borst, Medical Director for the Greenbrook TMS NeuroHealth Center in Columbia, says among prescription medications, “A common issue is sexual side effects. If people are having sexual side effects, they generally don’t end up staying on the medication. Another one is weight concerns, which can be difficult to tolerate. Patients also often tell me on antidepressants they feel kind of fuzzy or off—they feel “not right” in a way they’re very aware of.” If your prescription medication isn’t working or is causing you unwanted side effects, Greenbrook TMS therapy is a non-medication option for depression treatment.

Depression Myth #4: Depression Is Only Caused By Traumatic Life Events

For some, depression can be linked to a trauma such as abuse, loss, or hardship. For others, there are risk factors that can increase the likelihood of a person developing depression, including:

-Chronic medical illness, such as cancer, diabetes or heart disease

-Disability

-Social Isolation

-Personal or family history of depression

-Use of certain medications

-Brain disease

-Misuse of alcohol or drugs

-Stressful life events such as loss of a spouse, divorce, or taking care of someone with a chronic illness

But the perception that something bad “must have” happened in order for someone to have depression leads to some people feeling guilty that they’re struggling with their mental health even if nothing is really wrong in their lives. In some cultures, there’s also a stigma that someone with depression must have “done something to deserve it.” The truth is that depression can affect anyone and does not discriminate across gender, racial, or socioeconomic lines.

Depression Myth #5: Depression Is Laying In Bed All Day & Not Functioning

If depression manifested itself exactly how it’s depicted in movies and television shows, no one would ever see people who have depression. They would only stay at home in bed, sleeping all day and unable to accomplish anything.

The truth is that a lot of people –doctors, engineers, retail workers, teachers—have depression and still continue to go to work everyday and function even though they’re finding little joy in it and are lacking the same energy that others have.

So-called “high functioning depression” is a colloquialism for depression that doesn’t preclude a person from being a high achiever. This kind of depression often goes unnoticed and undiagnosed, sometimes leading to tragedy for those who seemingly “have it all.” This is why it’s critical to recognize the signs of depression in ourselves and others.

If you’ve heard any of these depression myths, know that you’re not alone and that it’s possible to get the help that you need. If you’ve been struggling with depression and medication hasn’t helped, we can help. Schedule your free consultation today.

How to Prepare For Your SPRAVATO® Treatment

Tue, 20 Dec 2022 17:54:31 GMT

Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading.

Getting Started with the Nasal Esketamine Treatment

As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS).

At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you.

Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment.

If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment.

There are two important regulations to note when it comes to preparing for treatment:

Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray.
You cannot drive during the rest of the day after treatment and must arrange for transportation.

These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period.

What to Expect During Nasal Esketamine Treatment

On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in.

Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication.

The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments.

You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you.

Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary.

Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate.

After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication.

You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance.

How to Prepare for after your Nasal Esketamine Treatment

Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week.

Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information.

While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment.

Other Tips in Preparing for Your Nasal Esketamine Treatment

At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health.

If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session.

Schedule A Free Consultation

To get started with nasal esketamine, schedule your free consultation today.

How long does it take depression treatments to work: antidepressants, SPRAVATO®, TMS therapy

Mon, 07 Nov 2022 16:45:22 GMT

When can you start feeling better?

When you’re starting a treatment for depression, the biggest question on your mind is bound to be when you can expect to start feeling better. While the end goal of any depression treatment is remission, different treatments can vary considerably in how long it’ll take you to get there. Read on to find how long each treatment takes to start working, and what to do if it doesn’t.

Antidepressant medications

When starting a new antidepressant, adjusting up to a therapeutic dose while keeping an eye on side effects is a process that usually takes a few weeks.

When most people start feeling some improvement

When medicines work, people typically notice improvement after 3 or more weeks of taking their medication daily.

When most people will feel the full effect

Antidepressants typically will have their full effect by 12 weeks, if not sooner.

When to try something different

If it’s been longer than 12 weeks and you aren’t satisfied with your improvement, talk to your doctor.

They might recommend that you increase your current medication’s dosage or try a different medication altogether. If you’ve tried several medications and still have depression symptoms, schedule your no-cost consult for TMS therapy or nasal esketamine with our Care Team- we’ll answer your questions and help you take the next step to feeling better.

TMS therapy

TMS therapy delivers gentle magnetic pulses to stimulate specific targeted areas of the brain, in a way that relieves depression. TMS therapy consists of 30-36 treatment sessions over the course of 6-9 weeks.

When most people start feeling some improvement

When medicines work, people typically notice improvement after 3 or more weeks of taking their medication daily.

When most people will feel the full effect

By the time treatment is over, most people will have gotten most of the benefits of TMS. However, many of our patients do report that they continue to feel improvements in the weeks and months following treatment.

When to try something different

Be open with your treatment team throughout the course of your treatment. At Greenbrook, we measure your symptom progress weekly to make sure you’re on track. If you’ve reached week four with absolutely no reduction in depression symptoms, our Care Team will reevaluate your treatment course and consider what adjustments could be made.

Nasal esketamine

Nasal esketamine primarily targets the glutamate system, which is thought to boost neuroplasticity and provide rapid depression relief. It’s taken alongside an oral antidepressant, typically twice per week for four weeks, then once per week for four weeks. After that, continued treatment depends on how the patient is doing.

When most people start feeling some improvement

Unlike antidepressants or even TMS therapy, nasal esketamine works very quickly against depression symptoms, sometimes within just hours of their first dose.

When most people will feel the full effect

People often feel better within days of starting treatment, but sometimes it takes longer.

When to try something different

If you’ve gone through a full round of treatment and you still haven’t gotten much relief from your depression symptoms, speak with your provider. They may suggest an alternative treatment schedule or a different treatment altogether, such as TMS therapy .

The bottom line

When you’re starting a new depression treatment, remember to set realistic expectations and be honest with your provider about how you’re feeling.

If it’s been several weeks and you still aren’t seeing the improvement you hoped for, don’t give up or settle for just a partial improvement.

Relief from depression is possible, whether you choose an antidepressant, TMS therapy, or nasal esketamine. If you’re interested in learning more about TMS therapy or nasal esketamine, schedule your no-cost consultation today.

Holiday Season Self-Care Tips

Mon, 07 Nov 2022 16:02:55 GMT

Why does self-care feel so hard during the holiday season?

When we practice self-care, what we're really doing is setting boundaries around our mental and physical health to keep ourselves well. The holiday season creates a perfect storm for neglecting self-care practices because of:

Additional emotional stressors and responsibilities , such as navigating difficult family members and managing plans
Extra indulgences like sweets and alcohol during holiday parties
Social media feeds and cultural expectations which pressure us to have the "perfect holiday" and the "most magical" season
Shorter days and lack of sunlight during the fall and winter months can lead to Seasonal Affective Disorder (SAD) , a type of depression which drains your energy and causes feelings of sadness and anxiety

Tips for getting through the holidays

As we're running around trying to accomplish everything we (think we) need to do during the holiday season, the self-care practices that would help lessen our stress fall by the wayside. That's why s elf-care is always important, but it becomes critical during periods of high stress. Here are a few actionable tips:

1. Prioritize, prioritize, prioritize

List everything that needs to be done and be sure to include self-care activities as a non-negotiable. Your therapy session isn't less important than making an extra batch of cookies for the bake sale.

2. If you need to, scale down your self-care (but don't completely abandon it)

You might not have time for four gym sessions, but you can still squeeze in one or two. Even just light stretching each day can benefit you.

3. Plan ahead for difficult situations

If you know you'll regret eating too many sweets at a party, don't arrive hungry! Have some filling, nutritious food before you get there. If you know seeing a difficult relative is going to end with hurt feelings, plan to leave as soon as the situation starts getting tense. Better yet, give yourself permission to just stay home and enjoy your evening!

4. Check in with yourself periodically

This time of year can be especially difficult for those of us who struggle with depression and anxiety. If medications and/or therapy aren't helping your symptoms, it could be time to make some changes (remember to never stop taking any medications without first talking with your provider). If you find yourself shutting down or feeling overwhelmed, reach out for help.

Where is SPRAVATO® Administered?

Wed, 05 Oct 2022 17:09:26 GMT

SPRAVATO® is self-administered at REMS-certified SPRAVATO® treatment centers under the supervision of a health care provider. REMS stands for Risk Evaluation and Mitigation Strategy.

SPRAVATO® is a brand name for esketamine nasal spray , a Schedule III controlled substance derived from ketamine. This medication can cause brief sedation and dissociation in people who take it, and it has the potential to be abused. That’s why the esketamine nasal spray is only distributed to providers under the REMS program.

The FDA requires that all providers, pharmacies, and health care centers that want to provide SPRAVATO® earn REMS certification.

To understand REMS, it’s helpful to know how these providers and health care clinics become certified treatment centers. For either an outpatient or inpatient clinic to gain the status of a REMS-certified treatment center, they must go through many steps before they can begin treating patients with nasal esketamine for depression.

If you’re a patient at a certified inpatient health care setting, you won’t need to enroll in the SPRAVATO® REMS program when your provider prescribes SPRAVATO®. However, if you’re going to an outpatient center, like Greenbrook, you’ll need to enroll.

How to Discuss SPRAVATO® With Your Health Care Provider?

At this point, you might be wondering ‘is Spravato covered by insurance?’ The answer is “probably yes.” At Greenbrook, our care team can help you figure out the insurance side of things. The easiest way to bring nasal esketamine up with your primary care provider is to ask if they believe you’re a candidate for it.

While you can seek out nasal esketamine without a referral, any doctor, therapist, psychologist, or social worker can refer you to a certified nasal esketamine treatment center. The medication is FDA-approved for treatment-resistant depression (TRD) and major depressive disorder with suicidal ideation or behavior (MDSI).

To qualify for treatment, you’ll need to have tried at least two oral antidepressants for six weeks each without significant improvement.

After you’ve talked through your medical history with your PCP and any other health care providers you want to loop in, schedule an nasal esketamine spray consultation with a certified provider. Your treatment provider will conduct an assessment of your symptoms and study your medical history before giving their approval for nasal esketamine treatment. The next step is to enroll you in the REMS program. Your treatment provider will make sure you understand the risks and benefits of treating depression with nasal esketamine spray. They’ll also make sure you agree to these requirements.

Each time you receive treatment, you’ll need to:-Administer the nasal spray yourself—at Greenbrook, we give you the opportunity to practice with trainer sprayers that look and act just like the real thing but do not dispense medication

-Stay at the healthcare setting for at least two hours after treatment, after which your provider will tell you if you’re cleared to go home

-Arrange a ride home, as you will not be able to drive or operate heavy machinery until the following day after treatment

You and your provider will fill out the form and sign it. Your provider will then send the form to SPRAVATO® REMS. Once you’re enrolled, you and your provider can figure out the best treatment plan to fit your needs. A typical round of nasal esketamine spray treatment consists of 24-26 sessions in four phases.

Schedule a Consultation With Greenbrook

At Greenbrook, our Care Team will communicate with your other providers — with your permission — to ensure that they stay up-to-date on your treatment and your progress. If you're struggling with treatment resistant depression and nasal esketamine spray isn’t an option, Greenbrook also provides transcranial magnetic stimulation. Learn more about how TMS works .

Can Psychedelics Replace Antidepressants?

Wed, 05 Oct 2022 16:57:00 GMT

So many of us are used to those familiar names we associate with antidepressants: Zoloft®, Prozac®, Celexa, Paxil. The x’s and z’s roll off our tongues with little effort. These selective serotonin reuptake inhibitors (SSRIs) have been the most popular and commonly prescribed antidepressants since the late 1980s. Along with non-SSRIs like Wellbutrin and Cymbalta, these mostly oral antidepressants have served as the scaffolding for the nation’s mental health treatment for so long that the idea of taking psychedelics for depression and anxiety may feel absurd. But is it?

In 2019, the Food and Drug Administration (FDA) approved nasal esketamine spray SPRAVATO® for treatment-resistant depression and then for major depressive disorder with acute suicidal ideation or behavior in 2020. Derived from ketamine , a dissociative anesthetic drug with hallucinogenic properties, this treatment is the closest the United States has come to implementing psychedelics for depression. Still, ketamine is more of a psychedelic-like medication, not a psychedelic in the same sense as psilocybin or LSD (lysergic acid diethylamide).

Could those psychedelics eventually become the leading antidepressants?

The Scientific Difference Between Psychedelics and Antidepressants

Standard antidepressants, such as SSRIs, tricyclic and tetracyclic antidepressants, and monoamine oxidase inhibitors (MAOIs), all work to elevate the levels of monoamine neurotransmitters in the brain. Serotonin, dopamine, norepinephrine, and epinephrine (adrenaline) are all monoamines. They help regulate mood, emotion, the fight-or-flight response to fear, attention, memory, sleep, and function.

According to the monoamine hypothesis, depression is a result of low monoamine levels in the central nervous system. Because standard antidepressants increase monoamines, they can help treat depression symptoms. Unfortunately, antidepressants can take weeks to kick in, and around one-third of people taking antidepressants will continue to experience symptoms during standard antidepressant treatment.

Put simply, depression is a complex condition, and the monoamine hypothesis can’t explain every case.

This is where psychoactive antidepressants come in. Ketamine and psychedelics for depression and anxiety have been shown to act more quickly to relieve symptoms of depression. Importantly, while ketamine is a dissociative drug, it is not a classic psychedelic like LSD or psilocybin.

How do Psychedelics Work for Depression?

In addition to elevating monoamine levels, ketamine and psychedelics for depression work by acting on amino acid neurotransmitters. They increase neuroplasticity by impacting the most prolific excitatory neurotransmitter, glutamate, which helps us perform cognitive functions pertaining to memory, learning, and thinking.

Ketamine and psychoactive antidepressants also act on gamma-aminobutyric acid (GABA), an amino acid neurotransmitter that regulates brain activity and helps prevent issues with anxiety, depression, sleep, irritability, and concentration. Perhaps because of the way they impact the brain differently than standard antidepressants, psychedelics have been shown to have a more lasting effect.

A study in the February 2022 issue of the Journal of Psychopharmacology reported that after two carefully controlled doses of psilocybin spaced two weeks apart, 75% of participants reported improved symptoms. Even more encouragingly, 58% of participants were still in remission from depression at the 12-month mark.

Psilocybin has yet to gain FDA approval for treating depression, but this study highlights the important relationship between psychedelics and depression treatment. Unlike standard antidepressants, which must be taken every day and can come with side effects, psilocybin appears to relieve symptoms after one or two doses. With psilocybin and other psychedelics, as well as ketamine, side effects tend to last only during the treatment session and end shortly thereafter.

A caveat is that due to the minuscule but worrisome risk of developing psychosis after taking dissociative or psychoactive medications, psychedelics and ketamine may not be appropriate for people with a family history of psychosis.

How Ketamine is Similar to Psychedelics

Like psychedelics, ketamine can cause dissociation and hallucinations, and the two types of medications work similarly to improve symptoms of depression. However, psilocybin, LSD, and other psychoactive antidepressants do this by completely overriding the brain’s inhibitory framework. Ketamine, on the other hand, relaxes it.

The overriding is why classic psychedelics produce a much stronger and less relaxing “trip.” In studies on psychedelics and depression, patients go through much longer treatment sessions with psilocybin than with ketamine. The observation period after psilocybin treatment is six hours, for example, compared to the two-hour waiting period after ketamine treatment.

However, psilocybin’s more intense nature may give it an edge over ketamine. When a patient undergoes FDA-approved nasal esketamine spray treatment, they start out with two treatment sessions a week for four weeks, followed by once-weekly sessions for another four weeks. After this, they may come in for nasal esketamine treatment once every week or two to maintain remission from depression.

Psilocybin can be effective after far fewer doses, and its positive effects may last longer than nasal esketamine spray.

The difficulty, of course, is that psilocybin and LSD are Schedule I controlled substances, meaning that they have a high potential for abuse, and the FDA currently does not recognize any medical benefits they may have. Ketamine, on the other hand, is a Schedule III controlled substance, which means it holds the potential for abuse but has recognized medical benefits.

Psilocybin is also beginning to gain traction as a legitimate psychoactive antidepressant. The state of Oregon decriminalized psilocybin and approved its therapeutic use in 2020. Cities such as Denver, Colorado; Oakland and Santa Cruz, California; Washington, D.C.; and Somerville, Massachusetts have also decriminalized psilocybin.

Psychedelics and Depression: A Promising Future

Because they are fast-acting and long-lasting, psychedelics for depression may be a game-changer for mental health. However, FDA approval may not come until 2025 or later, and even then, the stigma of psychedelics may pose a roadblock to widespread psychoactive antidepressant treatment.

While the future is promising, we are still in the experimental phase for psychedelics and depression. Even now, we lean on standard antidepressants as we explore new options. For example, nasal esketamine spray (SPRAVATO®) must be taken alongside an oral antidepressant.

The good news is that nasal esketamine spray, which works similarly to psychedelics, is FDA approved, covered by insurance, and available at Greenbrook. We offer nasal esketamine spray consultations , along with transcranial magnetic stimulation (TMS) treatment for those who would rather not try nasal esketamine spray. Learn how TMS works here.

To get started with nasal esketamine, schedule a free consultation with Greenbrook. We look forward to helping you find relief from depression.

How Long Does Ketamine Treatment Last?

Wed, 05 Oct 2022 16:56:24 GMT

What will it be like to add SPRAVATO® treatment to your treatment plan? Preparing for SPRAVATO® treatment, also called esketamine nasal spray , can help you feel more at ease and ready for what your first day of treatment will bring.

Getting Started with the SPRAVATO® Treatment

As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether you’re a fit for esketamine nasal spray. Alternatively, you can schedule an esketamine nasal spray consultation with a treatment center that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS) for administering SPRAVATO® treatment. SPRAVATO® is FDA approved for treatment resistant depression (TRD) and major depressive disorder with suicidal ideation or behaviors (MDSI). Note that SPRAVATO® is not a replacement for hospitalization for those currently high at risk.

At Greenbrook’s REMS-certified SPRAVATO® treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine spray treatment is right for you.

Certain conditions, including blood vessel disease and a history of psychosis, may make nasal esketamine spray treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine spray provider before beginning treatment.

If the medication is deemed a good fit, you’ll receive a SPRAVATO® prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard antidepressant along with your SPRAVATO® treatment.

There are two important regulations to note when it comes to preparing for SPRAVATO® treatment:

Each SPRAVATO® treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray.
You cannot drive during the rest of the day after treatment and must arrange for transportation.

These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your nasal esketamine spray treatment schedule. In addition, if you’re wondering what to bring for the nasal esketamine spray treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period.

What to Expect During SPRAVATO® Treatment

On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in.

Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real SPRAVATO® sprayer but does not release any medication.

You’ll complete a depression scale before each nasal esketamine spray treatment. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you.

Each sprayer contained 28mg of esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary.

Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate.

You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook’s Care Team is readily available if you need assistance.

How to Prepare for After your SPRAVATO® Treatment Process

Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after SPRAVATO® treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll be taking nasal esketamine spray treatment twice a week.

While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine spray treatment patients begin feeling relief from depression symptoms within hours of their nasal esketamine spray treatment.

Other Tips in Preparing for Your SPRAVATO® Treatment

At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each nasal esketamine spray treatment session as an opportunity to relax and take care of your mental health.

If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for your nasal esketamine spray treatment.

Schedule A Free Consultation

To get started with nasal esketamine spray treatment, we offer free consultations at Greenbrook . If your doctor thinks you should avoid nasal esketamine spray treatment, transcranial magnetic stimulation (TMS) is a drug-free, FDA-cleared option for you to consider. Learn more about how TMS works .

How Often Will I Take SPRAVATO® For Treatment-Resistant Depression?

Wed, 05 Oct 2022 16:53:27 GMT

If you’re planning to try SPRAVATO® for treatment-resistant depression (TRD), knowing the typical SPRAVATO® treatment schedule can help you figure out how to adjust your daily life to accommodate treatment. SPRAVATO® is the brand name for esketamine nasal spray, and it’s one form of ketamine. Like ketamine, esketamine can cause you to feel dissociated, sleepy, and dizzy in the hours after you receive a dose. You’ll need a ride home–and probably a long nap!–after each visit to your local Greenbrook location .

At Greenbrook, we work with you to map out an esketamine nasal spray treatment schedule that works for you.

Your SPRAVATO® Treatment is Unique to You

SPRAVATO® treatment is usually the most time-intensive during the first four weeks. Whether your provider refers you to Greenbrook or you come to us on your own, your Greenbrook psychiatrist or psychiatric nurse practitioner will review your medical history and evaluate your symptoms. If our provider believes esketamine nasal spray is a good fit, they will build an esketamine nasal spray treatment schedule and dosage plan based on your needs.

If you’re wondering, “How long will I have to take SPRAVATO®?,” the answer is that your treatment duration will depend on how much the symptoms are improving as you progress. After the first month of SPRAVATO® treatment, your Greenbrook provider will evaluate how well it is working and determine if any dosage adjustments are needed.

How Often Can you Expect to Take SPRAVATO®?

During a typical SPRAVATO® treatment schedule, you’ll take two doses a week for four weeks. Before each treatment, your provider will give you a depression scale to fill out. This helps them—and you!—understand how the treatment is working throughout your esketamine nasal spray treatment schedule.

Your provider will then confirm that the dose kit belongs to you and show you how to self-administer the sprayer. Each sprayer contains two sprays for a total of 28 mg of esketamine nasal spray. Your prescription can vary depending on which of the two FDA-approved indications you’re taking it for: treatment-resistant depression (TRD) or major depressive disorder with acute suicidal ideation or behavior (MDD).

If you’re being treated for TRD, you will self-administer medication from two sprayers for a total of 56 mg. After the first treatment, you will take 56 or 84 mg of SPRAVATO®two times per week for the first four weeks of your SPRAVATO® treatment schedule. In weeks five through eight, you’ll take either 56 or 84 mg weekly. By the ninth week and beyond, your Greenbrook provider will evaluate whether you need a 56 or 84 mg dose once a week or once every two weeks. Your total esketamine nasal spray treatment duration after this point will vary based on your symptoms and response to treatment.

Those being treated for MDD will self-administer 84 mg of medication on their first day of treatment. Patients will continue taking an 84 mg dose twice a week for the first four weeks. After this, a Greenbrook provider will work with the patient to determine the next steps. Some people continue taking 84 mg of SPRAVATO® while others go down to 56 mg.

It’s important to note that esketamine nasal spray is not a substitute for hospitalization related to suicide.

How to Speak to Your Doctor About SPRAVATO®

While you don’t need a doctor’s referral to begin a SPRAVATO® treatment schedule, we encourage you to speak with your provider about whether the treatment is right for you. It can feel awkward to bring up medication, but you and your doctor are a team. Together, you’re working to figure out how best to manage symptoms of depression. Ask them if they think esketamine nasal spray could benefit you .

During this conversation, discuss any history of alcohol or substance abuse and tell your provider whether you are pregnant or plan to become pregnant. SPRAVATO® should not be taken if you are pregnant or breastfeeding. Other health conditions, such as blood vessel disease, a ketamine allergy, or a history of psychosis, can make taking SPRAVATO® dangerous for you.

Your doctor will go over your current and past medications and conditions to determine if esketamine nasal spray is right for you. If your doctor doesn’t think esketamine nasal spray is a good idea based on your medical history, FDA-cleared transcranial magnetic stimulation (TMS) may be an option. Learn more about how TMS works .

Questions You Should Ask Your Doctor About SPRAVATO®

At Greenbrook, our providers are always prepared to answer any questions about esketamine nasal spray. We recommend asking the following questions:

How can I know if esketamine nasal spray is working?
What do I do if I don’t feel esketamine nasal spray is working?

If you struggle with side effects or feel that esketamine nasal spray isn’t working, your doctor may adjust your dosage or esketamine nasal spray treatment schedule. Please share your questions and concerns with the provider who cares for you at Greenbrook—they’re here to help.

Schedule A Free Consultation

If you have tried at least two antidepressants without success, you may qualify for esketamine nasal spray. Thanks to its FDA approval, SPRAVATO® treatment at certified centers is covered by insurance. At Greenbrook, we’ll handle the paperwork so that you can focus on your treatment. We offer esketamine nasal spray consultations to help you get started. Schedule your free consultation today.

How Long Does Ketamine Stay in Your System?

Tue, 04 Oct 2022 18:44:04 GMT

Have you ever thought about how long a medication stays in your system after you take it? Most medications must be taken regularly because they don’t last forever in our bodies. Oral antidepressants, for example, must be taken every day.

Ketamine therapy, on the other hand, is given less often than once per day, whether it is ketamine given through an intravenous injection (IV) or in the form of esketamine nasal spray.

The benefits of either ketamine-based treatment usually stick with you in-between doses, even though the medication is no longer in your system for much of that time.

Ketamine is eliminated from your body in two phases. The first phase is called the redistribution phase. During that phase, the amount of ketamine in your bloodstream rapidly decreases over the first 45 minutes or so.

After that, the remaining ketamine in your body is eliminated more slowly, with a half-life of around 2.5 or 3 hours. That means half of it is eliminated in each half-life. After a few half-lives (say, 12 hours) practically all of it is gone.

Does Ketamine Show Up on Drug Test?

Ketamine does show up on drug tests. That said, many standard drug panels do not screen for ketamine. If you’re trying to determine, “How long does ketamine stay in your system?” note that the body metabolizes it within a day or two. It’s the metabolic process that leaves behind metabolites. TTraces of these metabolites can show up on drug tests days and even months after a ketamine dose.

Employers and other organizations who may require a drug test often use five-panel tests that can detect amphetamine, cocaine, opiates, phencyclidine (PCP), and tetrahydrocannabinol (THC).

Others may use seven-panel drug tests that screen for the five previously mentioned drugs with the addition of benzodiazepine and barbiturates. Expanded test panels can detect eight to 12 drugs, including all of the aforementioned substances along with ecstasy (MDMA), hydrocodone (Vicodin), oxycodone (OxyContin), methadone, methaqualone, and propoxyphene.

Ketamine doesn’t show up on this list because it’s not standard practice to test for it, even in a 12-panel drug test. However, a drug test that does detect ketamine can be ordered. Ketamine can show up in saliva samples for up to 24 hours, in blood samples for up to 72 hours, and in urine samples for as many as two weeks. A hair test can detect ketamine for a month or longer.

If you find yourself facing a ketamine drug test and are undergoing ketamine IV therapy or esketamine nasal spray treatment, talk to your provider. They can give you advice on how to handle the situation.

How Long Do Ketamine Effects Last?

Ketamine side effects only last during the time the medication is in your system. The more potent side effects, such as dissociation, sedation, and nausea, usually dissipate within one to four hours.

Drowsiness can persist for around seven to 12 hours, which is why many providers may recommend going home and resting for the remainder of the day following ketamine or esketamine therapy. If you are still feeling side effects the day after treatment, contact your provider for assistance.

Fortunately, the positive effects ketamine and esketamine can have on depression symptoms last longer than any side effects. Ketamine IV therapy patients may receive treatment twice a week for four weeks, with maintenance doses every two to six weeks thereafter.

Patients taking esketamine nasal spray for treatment resistant depression (TRD) or major depressive disorder with suicidal ideation (MDSI) also start out with two treatments a week for four weeks. This is often followed by one treatment a week for four additional weeks and maintenance treatments every week or two after that.

In short, once you enter the maintenance phase of ketamine treatment, you may only have to come in one or two times a month to continue experiencing the positive effects of ketamine .

Is Ketamine Therapy for Everyone?

No. If you have a history of psychosis or have family members with a history of psychosis, ketamine therapy may not be for you. Blood vessel and cardiovascular diseases can make ketamine treatment risky, too.

Anyone who is pregnant or breastfeeding, or is planning to breastfeed or become pregnant, should avoid taking any form of ketamine. Ask your doctor if ketamine IV therapy or esketamine nasal spray may be right for you.

Keep in mind that ketamine IV therapy is not FDA-approved for treating depression or any mental health conditions, which means insurance does not cover it. Esketamine nasal spray, on the other hand, is covered by insurance because it is FDA-approved for hard-to-treat depression, and for depression with suicidal thoughts. .

If you don’t qualify for esketamine nasal spray, transcranial magnetic stimulation (TMS) may be an option. TMS is a medication-free, FDA-cleared depression treatment that uses gentle magnetic pulses to stimulate areas of the brain. Learn more about how long TMS therapy lasts after each treatment and how TMS works .

At Greenbrook TMS, we offer TMS and esketamine nasal spray treatment in a clean, comfortable environment. Schedule a free consultation today to find out if you may benefit from TMS or esketamine nasal spray treatment.

How Does Ketamine Work for Depression?

Tue, 04 Oct 2022 18:34:13 GMT

Deciding to try ketamine treatment for depression can feel promising, especially if you’ve been using antidepressants for years and are ready to explore how an alternative treatment might help you. Excited as you may be, you might also wonder, “How exactly does ketamine work for depression?” It’s perfectly understandable to want more information on how ketamine works compared with standard antidepressants. There’s a reason that the FDA approval of nasal esketamine spray is a groundbreaking step forward for mental health. So, how exactly does ketamine work in the brain?

The Science Behind How Ketamine Works for Depression

Researchers aren’t 100% sure how ketamine works in the brain, but what they do know is fascinating. The answer partly depends on how depression has affected a person’s brain. Depression can cause you to lose synapses, the points of contact that allow nerve cells to communicate with each other. Research has shown that ketamine can help synapses begin to regrow within 24 hours after treatment. The more synapses regrow, the more relief a person feels from symptoms of depression.

Ketamine also acts on the glutamatergic system. Glutamate is an excitatory neurotransmitter that helps nerve cells, particularly those involved in mood regulation, communicate with one another. Ketamine increases glutamate signaling, helping stimulate those weakened connections. It also acts on gamma-aminobutyric acid (GABA), a neurotransmitter thought to help regulate anxiety, fear, and stress.

How Ketamine is Different from other Antidepressants

Unlike antidepressants, ketamine targets amino acid neurotransmitters and monoamine neurotransmitters, whereas standard antidepressants only affect monoamines.

Amino acid neurotransmitters like GABA and glutamate account for roughly 80% of the neurotransmitters in the central nervous system. Monoamines like serotonin, epinephrine, and dopamine—which help regulate mood, pleasure, and learning—make up the other 20%.

Selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and cyclic antidepressants all work to increase monoamine levels in the central nervous system. While they can be effective, they often take anywhere from two to six weeks to work. For some people, these monoamine-targeting antidepressants never work at all.

You may be wondering, “How long does ketamine take to work for depression?” Ketamine acts much more quickly than standard antidepressants, often within just hours or days of starting treatment. While it’s not a quick fix for everyone, many patients report feeling markedly better shortly after they begin ketamine IV therapy or esketamine nasal spray. Researchers believe this is partly because ketamine targets amino acid neurotransmitters and monoamines.

If you’ve tried two or more oral antidepressants with little to no success, you may be a good fit to try ketamine for depression. Keep in mind, however, that the FDA currently requires you to take an oral antidepressant along with SPRAVATO®, the only FDA-approved, ketamine-based depression treatment

How to Speak to Your Doctor about Ketamine

If you feel as though antidepressants aren’t helping, talk to your doctor about esketamine nasal spray. While some doctors may feel reluctant to prescribe ketamine IV therapy since it is not FDA approved for treating depression, they should be willing to explore esketamine nasal spray .

SPRAVATO® is made with a form of ketamine called esketamine. It is FDA-approved for treatment resistant depression (TRD) and major depressive disorder with suicidal ideation (MDSI). Because of this, treatment is covered by insurance.

You don’t need a referral from your primary care provider to begin SPRAVATO®. At Greenbrook, we offer nasal esketamine spray consultations to determine whether SPRAVATO® is right for you. Our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners can recommend and prescribe SPRAVATO® based on their evaluation of your mental and physical health.

We do encourage you to keep your primary care provider and/or psychiatrist in the loop, however, as this gives you the ability to make informed decisions about treatment. Certain conditions, including pregnancy and a history of psychosis, may mean esketamine isn’t a good fit. Esketamine can also come with notable side effects, including dissociation, sedation, nausea, and a temporary spike in blood pressure. At Greenbrook, you’ll be carefully monitored during the mandatory two-hour observation period following each esketamine treatment session.

If your provider does not think esketamine nasal spray is right for you based on your medical history or past reactions to ketamine, transcranial magnetic stimulation (TMS) is an excellent, drug-free option.

Schedule a Consultation at Greenbrook

Our SPRAVATO® REMS-certified clinics are a comfortable and relaxing setting for your ketamine-based treatment for depression. We provide private rooms or bays for your treatment sessions yet can accommodate multiple patients at once, meaning you won’t experience delays in treatment. Your Greenbrook Care Team will attend to your needs from the beginning to the end of each session.

We also provide TMS therapy should you prefer a medication-free option with fewer side effects. Schedule a free consultation with one of our Patient Consultants to learn more about how we can help lift the fog of depression.

How Long Will I Stay on SPRAVATO® for Depression?

Tue, 04 Oct 2022 18:24:06 GMT

When you’re just starting out with any new antidepressant or therapy, you may wonder how long you’ll need to stick with it. A couple of months? A year? The rest of your life? If you’ve been approved to begin SPRAVATO® treatments for depression, these questions may be at the front of your mind. After all, the FDA approved SPRAVATO® for treatment-resistant depression (TRD) in 2019, followed by approval for major depressive disorder with suicidal ideation or behavior (MDSI) in 2020. This means that most people haven’t taken SPRAVATO® treatments for much longer than a year or two.

The good news is that long-term studies conducted in the mid-2010s give us clues to help understand the safety and efficacy of SPRAVATO® duration beyond the initial treatment period, which can help us understand how long SPRAVATO® depression treatment can last.

What is SPRAVATO® Treatment and How Did it Start?

SPRAVATO® is the brand name for esketamine nasal spray, a ketamine-derived depression treatment. A dissociative anesthetic, ketamine has been delivered through an IV as an off-label mental health treatment since the early 2000s. The drug is a mixture of (S)-ketamine and (R)-ketamine, which are mirror-image molecules. (S)-ketamine, or esketamine, is more potent at lower doses than ketamine.

Ketamine seemed to help depression patients improve at a much faster rate than oral antidepressants. It prompted researchers at the beginning of the 21st century to study whether esketamine could produce the same benefits as ketamine.

Phase I clinical trials began in 2014, followed quickly by Phase II trials from 2014 to 2016. These trials focused on making sure that esketamine nasal spray was safe for adults to take. Phase III trials began in 2015 and continued for at least one year but usually more. These studies focused on testing both the safety and efficacy of esketamine nasal spray in patients with TRD and MDSI.

Most trials were completed by 2018, paving the way for the 2019 FDA approval, but at least one trial is ongoing. Begun in 2016, A Long-term Safety Study of Esketamine Nasal Spray in Treatment-resistant Depression (SUSTAIN-3) aims to determine the long-term safety and tolerability of nasal esketamine for depression. The study is slated to end in December of 2022, with results available sometime after that. In other words, as of 2022, some patients had been taking SPRAVATO® treatments for about five years.

Researchers believe that esketamine nasal spray acts on two of the most abundant neurotransmitters in the central nervous system: glutamate and gamma-aminobutyric acid (GABA). This helps facilitate rapid neuroplasticity, which is believed to be how the medicine helps depression.

When combined with oral antidepressants that increase the levels of monoamine neurotransmitters like serotonin, dopamine, and norepinephrine, SPRAVATO® treatments may help you feel rapid relief from symptoms and help sustain this remission from depression. Learn more about SPRAVATO® and what your treatments can look like .

How Long Do You Have to Stay on SPRAVATO®?

It depends. At Greenbrook’s SPRAVATO® REMS-certified treatment centers, patients who have found success with SPRAVATO® often choose to take it indefinitely after the initial treatment period. During the first four weeks of treatment, you’ll come in twice a week to self-administer your SPRAVATO® treatment dose and stay for the mandatory two-hour observation period.

During the second four weeks, most patients take SPRAVATO® once a week. After that, treatment can continue for as long as you need it. Some of our patients keep taking SPRAVATO® once weekly. Others come in once every two weeks. Some patients only come in for maintenance doses when they notice that their depression symptoms seem to be returning. Before every single dose, you’ll fill out a depression scale to help your provider monitor how well the medication is working.

Ultimately, the goal is for you to take SPRAVATO® as infrequently as possible while also maintaining remission from depression. You and your Greenbrook provider will communicate often, working together to create a treatment plan that fits your needs. Find out more in a nasal eksetamine spray consultation with Greenbrook.

How Your Health Affects SPRAVATO® Duration?

The amount of time you stay on SPRAVATO® will also depend on your health. If you decide to plan on becoming pregnant, or you become pregnant during SPRAVATO® treatment, tell your provider right away. Like many other antidepressant medications, SPRAVATO® can cause pregnancy complications. However, it’s still important to make sure your mental health needs are taken care of, including during pregnancy. Talk to your primary care provider or OB/GYN for support, and keep in mind that SPRAVATO® should not be taken if you are breastfeeding or planning to breastfeed.

Other medical conditions can also impact SPRAVATO® duration. If you have any major changes in your health, communicate with your provider as soon as possible. They can give you guidance on whether or not you’ll need to discontinue SPRAVATO®.

Schedule a Consultation at Greenbrook

Can You be Treated with SPRAVATO® During pregnancy or While Breastfeeding?

Tue, 04 Oct 2022 18:17:30 GMT

Is SPRAVATO® Recommended During Pregnancy?

SPRAVATO® is not recommended during pregnancy. If you’re trying to become pregnant, your healthcare provider will advise you not to take SPRAVATO®. Anyone with the possibility of becoming pregnant should take precautions to avoid pregnancy while on a SPRAVATO® treatment plan. Should you become pregnant, let your SPRAVATO® provider know immediately.

Studies conducted on pregnant animals treated with ketamine found that the drug did cause fetal harm, which is the driving reason that SPRAVATO® should not be taken during pregnancy. Because of the danger to human fetuses, there isn’t enough data to determine the exact risks of ketamine in human pregnancy. There’s also a lack of data to understand whether ketamine is safe for breastfeeding, so SPRAVATO® is not recommended for breastfeeding mothers.

It can feel disheartening to find out that SPRAVATO® isn’t safe while you’re pregnant or breastfeeding. A dissociative anesthetic, esketamine nasal spray is a major breakthrough as the first such medication to receive FDA approval for treatment-resistant depression (TRD) and major depressive disorder with suicidal ideation (MDSI).

Are Antidepressants Safe for Pregnancy?

Some antidepressants are generally safe for pregnancy. However, doctors may hesitate to prescribe oral antidepressants to pregnant women, including selective serotonin reuptake inhibitors (SSRIs), which are widely known to be the safer options for pregnancy. While they aren’t thought to cause birth defects, SSRIs can cause neonatal adaptation syndrome in newborn babies.

Jitters, irritability, and respiratory distress can all be signs of this syndrome. Researchers think it may occur due to in-utero exposure to the SSRI or withdrawal from the SSRI. Despite being worrisome, this syndrome typically resolves on its own within a month. Still, some mothers may feel nervous about the risk of their baby being born with this syndrome.

Dealing With Depression While Pregnant

Living with depression while trying to keep a fetus healthy is a challenge. The problem with avoiding antidepressants entirely during pregnancy is that mental health conditions like depression can negatively impact a fetus, too. Depression can make it difficult to attend important prenatal appointments, take the recommended vitamins, get adequate rest, and eat a nutritious diet. Severe depression can come with risks to you or your baby’s safety.

Remember that it’s just as important to take care of you while pregnant as it is to care for your fetus. And even though SPRAVATO® is unsafe during pregnancy or breastfeeding, there is another option. Transcranial magnetic stimulation (TMS) is considered safe for pregnant and breastfeeding mothers.

TMS Therapy and Pregnancy

TMS works by delivering gentle magnetic pulses to targeted areas of the brain. These magnetic fields stimulate nerve cells, which can help ease symptoms of depression. Unlike SPRAVATO®, which is taken intranasally, TMS therapy is drug-free and the magnetic fields go nowhere near the uterus. Studies have also found that TMS therapy is safe for lactating women, so you can receive treatment when breastfeeding.

There’s a time commitment to consider when you’re planning for TMS therapy. You’ll need to come to a TMS therapy center, like Greenbrook, five times a week for six to nine weeks. Sessions typically take between 18 and 45 minutes, and there aren’t any restrictions on what you can do afterward. Plus, at Greenbrook, we offer flexible scheduling to help you fit treatments into your daily life.

To find out more about managing depression while pregnant, schedule a no-cost consultation with Greenbrook . We’re here to help you navigate mental health no matter where you are in life.

2022 Suicide Prevention Week

Wed, 07 Sep 2022 14:44:26 GMT

September is National Suicide Prevention Month, with National Suicide Prevention Week taking place from September 4th-10th. Suicide is the 12th leading cause of death in the United States, and is preventable through increased mental health awareness and mental health treatment. How can you help?

Be aware of the risk factors of suicide

Suicide can seem unfathomable to people who have never experienced depression, and it is a common misconception that suicide is the result of any one negative event in a person’s life. In reality, a person may feel that they have no other choice than to commit suicide when they are struggling with multiple risk factors without support. These suicide risk factors include:

Suffering from depression or other mental health conditions
Chronic physical illness
Personal or family history of suicide/suicide attempts
Prolonged exposure to trauma or abuse
Recent loss of employment or family member
Misuse of alcohol and drugs

Recognize the warning signs of suicide

If you or a loved one have been living with depression or any other mental illness, it is important to look for the following warning signs, which may signal that a person is seriously contemplating taking their own life:

Substance abuse or other self-destructive behaviors
Evidence of previous suicide attempt(s)
Talking about death or suicide
Expressing hopelessness when talking about the future
Anger and/or anxiety
Withdrawal from friends, family, and other loved ones
Noticeable mood changes
Giving away possessions
Saying goodbye
Unexplained calmness after displaying the above characteristics

Get involved

Community events are one of the best ways of reducing the stigma behind mental illness and helping create a culture where people won’t be ashamed to seek help for themselves. Here are a few ways you can help:

Local chapters of the National Alliance of Mental Illness (NAMI) hold walks to raise funds for mental illness resources and education. Click here to find a NAMIWalk in your area
The American Foundation for Suicide Prevention (AFSP) holds Out of the Darkness walks for suicide prevention and awareness, along with other events. Click here to find events near you.

If you or a loved one are struggling with depression, any mental illness, or suicidal thoughts, don’t be scared or embarrassed to reach out for support and treatment. Tell someone you trust—your partner, your parent, a friend or sibling—and let them know that you need help. To speak with a trained and confidential crisis counselor about yourself or someone you’re concerned about, contact the Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to 741741. If you are in immediate danger of hurting yourself, call 911.

How Can Ketamine-Based Medications Help Treat Depression?

Thu, 21 Jul 2022 15:11:20 GMT

After decades of limited choices in the treatment of depression, ketamine and other medications related to it have taken off as promising new options for those who still suffer. It just might be the treatment for depression that you’ve been waiting for.

Surprisingly, ketamine was originally used as an anesthetic for surgery. Approved in 1970, it was especially useful in some special situations, including emergency surgery in the battlefield. It is sometimes used for anesthesia even today, and it is also commonly used for anesthesia in veterinary medicine. It’s been called a “horse tranquilizer” because, well, it’s been used to tranquilize horses.

Ketamine has also occasionally been a drug of abuse. The FDA categorizes ketamine as a Schedule III drug, which means it has a low or moderate potential for abuse. Ketamine abuse is rare. But still, ketamine as a drug of abuse has acquired some colorful street names such as “special K” and “blind squid.”

The history of ketamine took a surprising turn around 2009 when there were the first reports of a sudden improvement in depression among some people treated with ketamine. People sometimes improved almost immediately with ketamine, and that was in sharp contrast to the several weeks needed for improvement with antidepressants. This rapid improvement with ketamine contradicted what we thought we knew about medicine for depression, and it sounded too good to be true. But, further research into ketamine and ketamine-like drugs proved that the benefit was real. Finally, one of these drugs, esketamine, gained FDA approval in 2019. Esketamine (pronounced like “s-ketamine”) is just one of many treatments recently approved or on the horizon. Psychedelics such as psilocybin, for example, are a possible treatment in the future. New treatments often work when standard treatments such as antidepressants and therapy have failed – so new options give hope to countless people who still suffer from depression.

Esketamine Nasal Spray Treatment at Greenbrook TMS

Esketamine is given as a nasal spray. And, because it’s already FDA-approved, it is usually covered by insurance. We offer that medication at Greenbrook.

Greenbrook TMS is a certified esketamine nasal spray provider. In a typical esketamine nasal spray treatment schedule, you’ll receive two treatments per week for four weeks, and then one treatment per week for the next four weeks. After that, treatment is typically once every one or two weeks.

You’ll receive your treatment in a relaxing area, in a comfy chair in your own private room or cubicle. Throughout your two-hour session, your care team will monitor you, and will be available if you need anything. In addition, the medical provider will be nearby, and will make rounds during your treatment to assess how you are doing.

Are you ready to take the next step in your journey to relieving symptoms of depression? To learn more about your options, schedule your free consultation with Greenbrook TMS or give us a call at 855-940-4867 today. We offer both esketamine, and TMS (transcranial magnetic stimulation).

Can Psychedelics Treat Depression?

Thu, 21 Jul 2022 15:11:07 GMT

Psychedelics are a promising new category of drug treatment on the horizon. These drugs, which include psilocybin, mescaline, and LSD, are currently experimental and not approved by the FDA. But research shows that these substances – under medical supervision - can be a potential powerful treatment for major depression and other conditions.

Research on the possible therapeutic role of psychedelics actually took off in the late 1950s and early 1960s. Psychedelic research was advancing, and several notable people documented their personal experiments with psychedelics. Joel Elkes, a founding member of the American College of Neuropsychopharmacology (ACNP), openly experimented with LSD in the 1950s. And, famous author Aldous Huxley wrote an entire book, The Doors of Perception, about his use of the psychedelic, mescaline.

This research came to a screeching halt in the late 1960’s, with a growing awareness of the potential downsides of psychedelic use, and a strong political sentiment against psychedelics in the US. Finally, the Controlled Substances Act of 1970 shut down further research for decades. This research has picked up again only in recent years, and the results look promising. But still, for now these medications are not yet approved by the FDA, and are not available for therapeutic use outside of occasional clinical studies. Over the coming years, we’ll learn more about what psychedelics can and cannot do to help people with depression and other conditions.

Although psychedelics are not yet ready as an option, there is another new treatment for major depression that is available today. Esketamine nasal spray is already proven to be effective. It is FDA-approved, and covered by insurance.

Esketamine Nasal Spray Treatment at Greenbrook TMS

Minority Mental Health Awareness Month Resources 2022

Wed, 06 Jul 2022 17:37:00 GMT

Minority Mental Health Awareness Month is recognized nationwide to bring understanding of the mental health needs and experiences within BIPOC (Black, Indigenous, and People of Color) communities, and others who face disproportionate inequities in care, support or mental health services in this country.

Whether you’re interested in learning more about the importance of mental wellness or would like to find treatment for a mental health condition, we’ve compiled a list of resources and information from groups including Mental Health America (MHA), Anxiety and Depression Association of America (ADAA), and the U.S. Department of Health and Human Services Office of Minority Health (OMH) below.

Mental Health Resources for Underrepresented Communities

No matter who you are, we urge you to reach out for help if you’re struggling with your mental health.

For immediate help

If the situation is potentially life-threatening, get immediate emergency assistance by calling 911.

The National Suicide Prevention Lifeline

Accessible through 1‑800‑273‑TALK (8255) or Live Online Chat and features trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals.

The SAMHSA National Helpline

Available at 1‑800‑662-HELP (1‑800‑662‑4357) and is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental health and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

Greenbrook in Your Community: Celebrating Pride 2022

Wed, 15 Jun 2022 17:38:43 GMT

Join Greenbrook for Pride 2022!

Greenbrook is a proud participant and supporter of Pride 2022!

Pride events celebrate diversity among the LGBTQ community, their friends, families, and allies. As a mental health company, we know that depression doesn't discriminate across gender, race, or orientation. Pride parades and festivals are a great opportunity to be part of an important cause for our community, patients, and care team.

Come out and celebrate ! Click on an event below to register and get more details.

Austin Pride Parade & Festival

Saturday, August 13, 2022

Austin, TX

San Diego Pride Parade

Saturday, July 16, 2022 @10am

Hillcrest Pride Flag @ University Ave

San Diego, CA

Capital Pride

Saturday, June 11, 2022

Logan & Dupont Circle Neighborhoods

Washington, DC

Hartford Pride

Saturday, September 10, 2022

Trumbull St.

Hartford, CT

Portland Pride Parade & Festival

Sunday, June 19th, 2022

SW Broadway & SW Couch St

Portland, OR

Annapolis Pride Festival

Saturday, June 4, 2022

Downtown Annapolis

Annapolis, MD

Akron Pride

Saturday, August 27, 2022
Downtown Akron Main Street

Akron, OH

Pride STL

Saturday, June 25 - Sunday, June, 26 2022

Downtown STL

St. Louis, MO

Charlotte Pride Festival & Parade

Saturday, August 20 - Sunday, August 21, 2022

Location TBD

Charlotte, NC

Sarasota Pride

Saturday, October 22, 2022

JD Hamel Park

Sarasota, FL

Resources

We're a proud sponsor of the American Foundation for Suicide Prevention (AFSP), a non-profit advocacy organization whose mission is to save lives and bring hope to those affected by suicide. Below is a list of LGBTQ support resources from the AFSP.

Greenbrook in Your Community: NAMIWalks Your Way 2022

Fri, 29 Apr 2022 14:53:38 GMT

Join Greenbrook for NAMI Walks

2021!

Greenbrook TMS is a proud sponsor of NAMI Walks 2022!

Every year, NAMI Walks take place across the country to raise awareness of and support mental health programs. This year's theme is "A New Day for Mental Heal th" with events taking place in-person.

Come out and join us, we'll be in your community! Click on an event below to register and get more details.

NAMIWalks Your Way St. Louis

Saturday, May 14, 2022

Creve Coeur Park

St. Louis, MO

NAMIWalks Your Way Los Angeles

Saturday, May 21, 2022

Grand Park, Level 4

Los Angeles, CA

NAMIWalks Your Way Raleigh

Saturday, May 21, 2022

Dorothea Dix Park

Raleigh, NC

NAMIWalks Your Way Houston

Saturday, May 21, 2022

Sam Houston Park

Houston, TX

NAMIWalks Your Way Columbia

Saturday, May 21, 2022

Columbia Canal & Riverfront Park

Columbia, SC

NAMIWalks Your Way Northwest

Sunday, May 22, 2022

Peninsula Park

Portland, OR

NAMIWalks Your Way Cleveland

Saturday, September 24, 2022

Edgewater Park - Kite Field

Cleveland, OH

Mental Health Awareness Month 2022

Thu, 28 Apr 2022 15:56:01 GMT

We sponsor the American Foundation for Suicide Prevention (AFSP), a non-profit advocacy organization whose mission is to save lives and bring hope to those affected by suicide, because we know that there are real, tragic consequences to untreated and undertreated depression.

The AFSP has provided an online toolkit for May's Mental Health Awareness month. This year's theme is #MoreForMentalHealth, and as a proud supporter of the AFSP, we hope you'll check out the resources below.

#MoreForMentalHealth

It's time to demand #MoreForMentalHealth . ��

The AFSP explains that the reason for this years campaign is because

"We need improved access to support, services, and understanding. Get involved by encouraging more openness and advocating for the legislation that we know through research – save lives."

"You may not think of yourself as an advocate, but if you care about mental health, the time has come to move things forward, and champion the policies we all need to support our friends, family, community and the rest of the country."

What You Can Do to Help?

For Yourself

Open up to someone close to you about something that you’ve been coping with
Identify three simple self-care activities that work for you, like exercising, meditating, or journaling
Schedule a check-up to talk to a doctor about your mental health, as well as your physical health
Add crisis resource numbers to your phone and encourage a loved one to do the same

For the People in Your Life

Let people in your life know you’re a safe person to talk to about mental health, and actively listen and engage when someone comes to you for help
Connect people in your life who have shared interests, such as music, gaming, sports, art and more!

For Your Community

Advocate for mental health policies that ensure that everyone in your community has access to mental health care, suicide prevention training, and funding for local crisis resources
Get involved with your local AFSP chapter, or join an Out of the Darkness Walk, and help transform your community into one that’s smart about mental health, where everyone has support when they need it
Bring an AFSP mental health education, research or support program to your school, workplace, or community center

Want to learn more?

If you need Immediate help:

National Suicide Prevention Lifeline – 1‑800‑273‑TALK (8255) or Live Online Chat

Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals.

SAMHSA National Helpline – 1‑800‑662-HELP (1‑800‑662‑4357)

A confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental health and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

Depression Resources

Greenbrook in Your Community: Out of the Darkness 2022

Wed, 27 Apr 2022 20:28:02 GMT

Join Greenbrook for Out of the Darkness 2022!

Greenbrook TMS is a proud sponsor of Out of the Darkness 2022!

Out of the Darkness Walks are the American Foundation for Suicide Prevention's (AFSP) signature event, with walks across all 50 states that support suicide prevention programs, bring together those who have been affected by suicide, and create communities.

Come out and join us, we'll be in your community! Click on an event below to register and get more details.

Mat-Su Valley Walk

Saturday, May 7, 2022

Iditapark

Wasilla, AK

Anchorage Walk

Sunday, September 11, 2022

Cuddy Family Midtown Park

Anchorage, AK

Montgomery County Maryland Walk

Sunday, September 18, 2022
Maryland SoccerPlex

Germantown, MD

Wilmington DE Walk

Saturday, September 24, 2022

Glasow Park

Wilmington, DE

Pasadena Texas Walk

Saturday, September 24, 2022

Burke Crenshaw Park

Pasadena, TX

St. Louis Walk

Sunday, September 25, 2022

Creve Coeur Lake Park - Tremayne Pavilion

St. Louis, MO

Portland Oregon Walk

Saturday, October 1, 2022

Daimler Trucks North America

Portland, OR

Lynchburg Walk

Saturday, October 1, 2022

Riverfront Park

Lynchburg, VA

Cleveland Walk

Saturday, October 8, 2022
TBD
Cleveland, OH

San Diego Walk

Saturday, October 22, 2022
NTC Park at Liberty Station
San Diego, CA

Columbia Walk

Sunday, October 23, 2022

Columbia Canal and Riverfront Park

Columbia, SC

Charlotte Metro Walk

Saturday, November 5, 2022

Symphony Park

Charlotte, NC

Anxiety and Depression: Understanding the Overlap

Fri, 22 Apr 2022 19:37:59 GMT

Anxiety and Depression: Understanding the Overlap

When you are dealing with troubling symptoms such as decreased energy, difficulty sleeping, nausea, and agitation, you might feel frustrated and concerned. This is especially true if you seem to be physically healthy otherwise. You probably know that the symptoms you’re dealing with can point to mental health conditions, particularly depression and anxiety. In turn, you may be wondering if it is possible to have both at the same time and, if that’s so, how to seek relief.

Understanding where and how depression and anxiety overlap is an essential step toward seeking treatment for your symptoms.

How do Anxiety and Depression Overlap?

First, note that people can have both anxiety and depression at the same time. The Anxiety & Depression Association of America estimates that nearly half of all people dealing with anxiety also have depression and vice versa. Anxiety can be a symptom of depression , and anxiety disorders like GAD and OCD can trigger depression. Clearly, these two conditions are inextricably linked.

Both depression and anxiety have their own set of symptoms, as set out by the DSM-5. You’ll notice that both conditions list difficulty concentrating, problems sleeping, and fatigue as defining symptoms.

What are the Symptoms of Depression?

From celebrities to athletes to members of the royal family, depression can affect anyone. Some experts estimate that over 260 million people around the world live with depression. Symptoms of this condition can include:

Persistent feelings of sadness, hopelessness, or apathy
A loss of interest in previously pleasurable activities
Difficulty concentrating
Changes in sleep patterns—sleeping more or less than usual, for example
Eating less or more than usual
Lack of energy (fatigue)

Depression can be unpleasant, painful, and frustrating—especially if you also have anxiety.

What are the Symptoms of Anxiety?

When your heart races in certain situations or you feel nauseated for days at a time, you might think it’s normal. Especially if you have experienced symptoms like this all your life. It may not occur to you that this excessive worry is a symptom of anxiety, a highly common mental health condition that can also cause :

Feelings of panic, danger, and doom
Shortness of breath
Hyperventilation
Dizziness
Problems sleeping
Dry mouth
The sensation of having a knot in your throat
Problems concentrating
Fatigue
Obsessively avoiding objects or places that you find fearful

These are just a few of the ways anxiety can manifest.

Overlap Between Anxiety and Depression Symptoms

As with depression, the causes of anxiety are complex. And while the causes are not fully understood, experts believe that traumatic life events and high-stress levels are some of the contributing factors. Further, researchers have found that generalized anxiety disorder and major depressive disorder have a level of shared genetic risk . The silver lining is that both anxiety and depression can be treated similarly.

Can You Treat Anxiety and Depression at the Same Time?

Yes. If you feel that any of the depression or anxiety symptoms sound all too familiar, know that treatment is available for both ‌conditions. In some cases, you may be able to undergo therapy that reaches beyond traditional antidepressants. Reach out to your doctor to find out what you can do to treat your symptoms, whether that’s antidepressant medication, talk therapy, or TMS therapy.

TMS therapy is an FDA-cleared treatment for OCD and depression that uses gentle magnetic pulses to stimulate targeted areas of the brain. In August of 2021, TMS was FDA cleared to treat anxious depression, too, which means that if you suffer from anxious depression, TMS can treat symptoms of both anxiety and depression simultaneously. Learn how TMS works and schedule your free consultation today. Or, enter your zip code in our center locator to find a TMS center near you .

How TMS Helps Military Families

Wed, 23 Mar 2022 15:52:33 GMT

How TMS Helps Military Families

Trauma, separation from loved ones, injury, extreme stress, and death are all potential hazards faced by military families. These pressures can lead to major depressive disorder for service men and women, as well as their loved ones. TMS can be an effective depression treatment for military families.

Depression and the Military

Depression can linger for members of the military long after their tours of duty are over. The U.S. Department of Veterans Affairs (VA) estimates that:

Roughly 1 in 3 veterans showed signs of depression during their doctor’s appointments.
Another 1 in 5 have symptoms serious enough to warrant a diagnostic evaluation.
And about 1 in 8 to 10 veterans has major depressive disorder that calls for treatment such as antidepressants or talk therapy. If those first-line treatments don’t work, TMS for veterans may be an option.

Many factors can increase the risk of depression for service men and women. These include:

Traumatic brain injury suffered during combat
Substance abuse
Attacks that are physical or sexual in nature
Combat stress
Separation from their support network back home

The risk of depression also may increase for people with post-traumatic stress disorder (PTSD). The trauma they’ve experienced can trigger symptoms of depression, such as sadness, guilt, hopelessness, or insomnia. Some of the VA’s sobering statistics on PTSD and members of the military :

About 30% of Vietnam veterans experienced PTSD at some point in their lives.
Roughly 12% of Gulf War vets have reported PTSD.
And 11% to 20% of people who served in Operation Iraqi Freedom and Operation Enduring Freedom have PTSD in any given year.

These issues aren’t limited to those who served. Loved ones and close relatives can also suffer from depression, especially during deployment. They may also struggle with PTSD if the enlisted member of the family experienced trauma or injury during military service.

How to Tell If You or a Loved One Has Depression

Has your loved one acted differently since separating from active duty? Or are you feeling a gnawing anxiety with your partner on tour of duty? It’s helpful to know if depression is the cause. Watch for these signs:

Persistent sadness or hopelessness
Lethargy
Insomnia
Feelings of guilt or worthlessness
Changes in weight or appetite
A brain fog that inhibits concentration or clear thinking

Depression treatment for military families usually entails talk therapy (perhaps with a counselor who is also trained in treating PTSD) and/or antidepressant medications. Sometimes, it is also beneficial for military members to join a support group of fellow veterans where they can share their stories with others who have similar experiences.

TMS For Military Members: How It Can Help

TMS therapy for PTSD isn’t cleared by the U.S. Food and Drug Administration. However, TMS can be used to treat symptoms of major depressive disorder.

This can be an effective treatment method for members of the military and their families who haven’t gotten the results they want from medication or talk therapy. TMS can be used on its own or in conjunction with other treatment modalities.

The science behind how TMS works : An electromagnetic coil is placed on the patient’s scalp. It emits magnetic pulses, which turn into gentle electrical currents that stimulate targeted areas of the brain. Treatment sessions last about 18 to 40 minutes and take place over several weeks. Sessions take place every weekday for the first several weeks before tapering in frequency.

TMS for military members offers several benefits, including:

It’s non-invasive.
It doesn’t require sedation, so you can drive yourself to and from treatment.
Side effects are minimal.
TMS can have a long-term benefit. One study found that among those who improved, 62% were still improved or in remission a year after treatment.

Plus, TMS for military members is covered by TriCare. This is the health insurance carrier for active duty service men and women, as well as family members, retirees, and members of the Reserve and National Guard.

Greenbrook TMS is honored to help military families find solutions for depression with TMS treatment. We understand the importance of supporting members of the military in their quest to improve their mental health. Our chief medical officer, Dr. Geoffrey Grammer , is a decorated Army colonel who served two tours of duty in Iraq. He also developed the Transcranial Magnetic Stimulation Program at Walter Reed National Military Medical Center as its chief of Inpatient Psychiatric Services. Contact us today to learn how we can help you and schedule your free consultation .

3 Tips on How to Protect your Mental Health during the Winter Months

Wed, 23 Mar 2022 15:51:39 GMT

3 Tips on How to Protect your Mental Health during the Winter Months

If the shorter days and gloomy weather have you feeling down, you may not be sad, but SAD. Seasonal affective disorder is a type of depression that occurs during the dark days of winter when the lack of bright light induces a profound sadness. Add in another season shadowed by the gloomy specter of COVID-19, and you can understand why it’s important to protect your mental health right now and address depression during winter.

Recognizing SAD Signs

About 0.5% to 3% of Americans are affected by SAD . However, that figure jumps to 10% to 20% for people with major depressive disorder.

And while SAD is typically a temporary condition that ends when the sun starts shining again, about 40% of people with SAD experience lingering symptoms past the change of seasons. That can lead to a diagnosis of major depression.

It’s not surprising, then, that SAD and depression share many of the same characteristics, such as:

Fatigue or extreme inertia
Sadness or hopelessness
Weight gain from overeating and food cravings
Irregular sleep patterns, especially a tendency to oversleep
A desire to stay indoors and isolate, avoiding social interactions

There are ways to protect your mental health if you’re suffering from SAD symptoms. Be proactive about caring for yourself, especially if you’ve noticed pervasive signs of depression or SAD occurring almost every day for two weeks or longer.

Winter and Mental Health: Some Simple Ways to Take Care of Yourself This Season

Review your Mental Health Treatment Plan

If you suspect that you suffer from SAD, it may be helpful to meet with your healthcare provider for evaluation. This can include physical and psychological evaluations. If you are diagnosed with SAD, your physician may recommend light therapy as well as talk therapy. Antidepressants may be prescribed if your symptoms are serious.

Light up Your Life

Light therapy brightens your day with a lighted box that captures the essence of sunlight, filling in for Mother Nature. Also called phototherapy, light therapy is a proven approach that helps with SAD. Try to start each day with this extra dose of light. It will lift your mood and ensure that your sleep/wake rhythms stay on track for high-quality sleep, which can support your mental health. As an alternative, you can put high-wattage bulbs in your light fixtures, especially in areas where you spend a lot of time during the day. Here are some ways to incorporate light therapy into your daily routine.

Swap Facebook for Face-to-Face

Spend in-person time with friends and family. Too much time online can be detrimental to your mental health during winter months or anytime. Recent research indicates there may be an association between frequent social media use and an increase in depression symptoms. If you need to build up your social network—the real-life one, not the digital one—consider volunteering for a cause you believe in. You’ll meet new people and feel good about helping others, too.

Can TMS Help with SAD?

SAD sufferers may also have a history or diagnosis of major depressive disorder. In those cases, medications alone may not be enough to help.

TMS may be beneficial when first-line treatments aren’t bringing the desired results. However, it should be noted that TMS is cleared for use with depression, not SAD specifically. You can talk with your mental health care professional or a TMS provider to see what the best options are for you.

Don’t let doom and gloom define your mental health during the winter months. Take the necessary steps to care for yourself, and look forward to the possibility of brighter days ahead with TMS. Contact us to learn more about how TMS works and schedule your free consultation .

Understanding the Benefits of Esketamine Nasal Spray

Thu, 24 Feb 2022 17:21:10 GMT

Understanding the Benefits of Esketamine Nasal Spray

Several medications can help people with depression find relief from their symptoms. Sometimes, however, first-line treatments don’t work, and patients may need to seek out additional strategies to help reduce symptoms. This scenario—where adults who have tried at least two medications don’t find any relief from their symptoms—is called treatment-resistant depression (TRD). One option for those with TRD is esketamine nasal spray for depression. Here’s what you should know about the benefits of this ketamine-based depression treatment.

What is Esketamine Nasal Spray?

Esketamine is a form of ketamine, a medication that has been around for decades. Ketamine is given as an anesthetic and pain reliever, but it’s been used as an off-label treatment for depression for years. Unlike traditional antidepressants, ketamine works within hours or days, making it a promising short-term treatment for patients who find no relief from other forms of antidepressants. In March of 2019, the FDA approved SPRAVATO® as the first esketamine nasal spray for resistant depression.

While esketamine nasal spray works similarly to ketamine, there’s a key difference between the two medications. Ketamine is a racemic mixture of “S” and “R” mirror-image molecules, whereas esketamine consists only of the “S” molecule. This difference means that esketamine is more potent than ketamine but with fewer side effects. In addition, esketamine for depression is thought to work more quickly than ketamine to relieve symptoms of depression.

Because it is a Schedule III Controlled Substance, esketamine nasal spray can only be given to patients at certified clinics under the supervision of a medical professional. The provider will tell patients how much esketamine to use and instruct them on how to spray it up their own nostrils. After self-administering the prescribed number of sprays, patients will remain under observation for two hours.

How Does Esketamine Nasal Spray Work?

Esketamine for depression works by initiating activity in the glutamatergic system of the brain. This activity then helps to quickly restore neural pathways that had previously been lost as a result of treatment-resistant depression.

The results of depression treatment nasal spray typically become apparent within hours. Patients may notice a renewed sense of hopefulness, along with a decrease in anxiety and depressive symptoms. The results can last from one to two weeks, depending on the patient and the situation. The provider will know how much esketamine nasal spray to prescribe and how often it should be administered.

Patients return to the clinic twice per week for their treatment during the first four weeks. After that, they typically continue treatment once per week for a while, and then, depending on how they’re doing, less often after that.

It’s important to note that esketamine for depression should be taken along with an antidepressant. Side effects typically last less than two hours after the dose of esketamine is given and may include drowsiness, dissociation, dizziness, nausea, and lightheadedness.

Who is Esketamine Meant For?

Depression treatment nasal spray is meant for people who struggle with treatment-resistant depression. In order to qualify for SPRAVATO®, patients with TMD must have tried two previous oral antidepressants with unsatisfactory results.

Esketamine nasal spray is also approved to treat people who have major depressive disorder with acute harmful behaviors. One of the major benefits of using esketamine nasal spray is that it works rapidly to treat symptoms. Many patients feel substantial relief within hours.

Ketamine IV treatment can also provide rapid relief, but in many patients, it takes at least three separate IV infusions before symptoms begin to improve. Unlike SPRAVATO® nasal spray, ketamine IV treatment is not approved by the FDA for treatment of depression. Because of this, insurance does not cover the cost of ketamine IV treatment.

Is Esketamine FDA Approved?

Esketamine is FDA approved for two indications: treatment-resistant depression and major depressive disorder with acute harmful behaviors. SPRAVATO® is monitored as a Schedule III drug. This means that in order to receive treatment, you will need to visit a certified clinic and administer the medication to yourself under the supervision of a medical provider. Because it is FDA approved, esketamine is covered by insurance.

Schedule Your No-Cost Consult with Greenbrook Centers

If you have TRD or MDD with acute harmful behaviors, schedule your no-cost consult with Greenbrook TMS NeuroHealth Centers. We are a certified SPRAVATO® treatment center, and we are also FDA-cleared to provide transcranial magnetic stimulation (TMS) therapy. Our care team can help you discover which treatment is right for your situation.

The Difference between Ketamine IV vs. SPRAVATO® Nasal Spray

Thu, 24 Feb 2022 17:19:57 GMT

For patients who require a fast-acting treatment for depression, ketamine-derived medications can provide immediate relief from symptoms. While Esketamine nasal spray was FDA-approved for the treatment of depression symptoms in 2019 under the name SPRAVATO®, patients have been receiving intravenous (IV) ketamine treatment for years. If you have treatment-resistant depression (TRD) or major depressive disorder (MDD), receiving ketamine treatment can have significant benefits. You may be wondering, what is the difference between SPRAVATO® nasal spray vs. ketamine IV for depression?

How do Ketamine and SPRAVATO® work?

First developed in the mid-20th century as an anesthetic and pain reliever, ketamine is widely used to provide rapid relief from symptoms of depression. There are two types of ketamine:

Racemic: A mixture of both “R” and “S” mirror-image ketamine molecules, racemic ketamine is FDA approved as an anesthetic. A low dose is delivered via IV infusion as an off-label treatment for depression patients.
Esketamine: This form of ketamine uses only the “S” molecule of ketamine and is delivered at certified treatment centers in the form of a nasal spray. SPRAVATO® esketamine spray is FDA approved to treat depression.

Ketamine IV treatment typically involves visiting a provider, getting an intravenous line (IV), and having a medical professional administer a dose of ketamine that is about one-tenth the strength of the dose used for anesthesia. The procedure takes about 40 minutes. Some patients may notice improvement right away, while others won’t notice an improvement in symptoms until they have received two additional infusions. Many recipients of ketamine IV treatment will need to return weekly, or up to three times a week, for continued results.

Esketamine nasal spray is a more potent form of ketamine that works much in the same way as IV ketamine for depression. Instead of receiving the medication from an IV line, however, you’ll spray it up your nose under the supervision of a healthcare provider. Esketamine nasal spray often begins working within hours.

If you have tried at least two antidepressants and have failed to find relief from your depression symptoms, one of these two different forms of ketamine may be right for you.

What is the Difference Between Ketamine IV and SPRAVATO® Nasal Spray?

One major difference between SPRAVATO® nasal spray vs. Ketamine IV is that while Ketamine IV treatments are used for depression, they are not FDA approved for treatment-resistant depression . Ketamine nasal spray, on the other hand, has FDA approval as a depression treatment.

Additionally, patients who are wary of needles may feel hesitant to receive a new intravenous line during each infusion. A nasal spray is a much less invasive method of receiving ketamine treatment.

Effects of Ketamine and SPRAVATO®

Traditional antidepressants are thought to work by boosting serotonin and other neurotransmitters. Those neurotransmitters then affect glutamate, which is also a key neurotransmitter. Ketamine is thought to skip ahead to directly affect the glutamate system. This leads to the activation of receptors that help build new pathways in the brain. Ketamine most likely affects the brain in additional, helpful ways. Researchers are actively studying its effect on treatment-resistant depression to better understand the role ketamine can play.

As with any medication, side effects are possible. The most common side effects of SPRAVATO® are sleepiness, dizziness, a feeling of dissociation, and anxiety. With IV ketamine for depression, side effects can include sleepiness, dissociation, dizziness, and nausea. Both medications should only be given in trusted medical clinics, where medical providers will observe patients for two hours after treatment to monitor for negative side effects.

Both treatments work quickly, but with IV ketamine for depression, it can take three infusions before a patient notices a change in mood. Esketamine nasal spray, on the other hand, often works within hours after treatment.

Another benefit of esketamine is that it may reverse stress-related changes in the brain. In addition, animal studies have indicated that esketamine is beneficial to the hippocampus , which is essential to learning and memory. In the long run, suffering from depression can shrink the hippocampus by up to 20%, making this a notable finding. It means that esketamine may aid in reducing the risk of depression-related dementia.

Which is More Effective?

Whether you choose SPRAVATO® nasal spray vs. ketamine IV treatment, both medications can be beneficial to you. However, because it is not FDA-approved, insurance does not cover IV ketamine for depression. Esketamine nasal spray, on the other hand, is likely to be a treatment covered by insurance. Therefore, the cost of this option will normally be much less. It should also be noted that ketamine or esketamine should be used in conjunction with antidepressants.

Typically, after a small number of infusions of ketamine IV treatment, patients may experience reduced acute thoughts of self-harm, decreased symptoms of depression, and decreased anxiety. The beneficial effects of each IV ketamine infusion can last for up to one week.

In the hours after esketamine nasal spray treatment, patients may experience reduced acute thoughts or actions of self-harm, decreased symptoms of depression, and decreased anxiety. The beneficial effects of esketamine nasal spray can last for up to two weeks.

Schedule Your No-Cost Consultation Today

SPRAVATO® can only be provided at certified clinics, such as Greenbrook Neurohealth Centers. If you believe you might benefit from esketamine nasal spray, schedule a no-cost consultation with the Care Team at Greenbrook Centers today and find out if SPRAVATO® could be right for you.

The Connection Between Social Anxiety and Depression

Thu, 24 Feb 2022 17:16:26 GMT

The Connection Between Social Anxiety and Depression

You were invited to a big party tonight, but the thought of going fills you with dread. There will be new people to meet, which means they’ll be judging you—your appearance, your personality, your conversational skills. You just know they’ll think poorly of you, so you wonder why you should even bother going. You text the party host that you can’t make it and stay home alone again, a result of your social anxiety.

A form of generalized anxiety, social anxiety disorder is a deep-seated, unfounded fear of negative social interactions. Typically, someone with social anxiety knows that their feelings of dread make no sense, but they can’t help it. If you don’t explore treatment options for social anxiety disorder, it can cripple your sense of normal life and leave you feeling isolated.

But while you may be lonely, you aren’t alone in coping with this anxiety disorder: 15 million American adults have social anxiety . And for many of them, social anxiety disorder can lead to depression.

Social Anxiety and Depression

Work meetings, first dates, public speaking, talking to strangers—these situations all pose potential pitfalls for someone with social anxiety disorder. Exposure to others in a public setting triggers an irrational worry about being perceived negatively and that this harsh judgment will result in humiliation or embarrassment.

This type of anxiety and social withdrawal go hand in hand. If you have social anxiety disorder, you may become fearful before social events, to the point that you’ll avoid them whenever possible. And social anxiety doesn’t disrupt big events, but your normal everyday routine, too—for instance, you may walk an extra 10 blocks to work to avoid being around others on the subway.

And if you can’t avoid these situations, you may experience symptoms that include:

A feeling of dread
Feeling self-conscious or nervous
Elevated heart rate
Inability to speak clearly (mumbling, stuttering)
Sweating
Shakiness or trembling
Shortness of breath
Nausea
Muscle pain
Feeling dizzy or faint

Can Anxiety Lead to Depression?

There is a difference between anxiety and depression ; some symptoms are also different, while others overlap. However, it’s possible to have both social anxiety and depression at the same time, which can be referred to as comorbidity. For people with social anxiety, the prevalence of comorbid depression ranges anywhere between 20% to 70% .

Without a strong support network and treatment options for social anxiety disorder, you may feel loneliness, hopelessness, and isolation. Those are also hallmarks of major depressive disorder . The sadness that can result from social anxiety can lead to depression.

Additionally, social anxiety and depression both carry a risk of social withdrawal, although for different reasons. Someone with social anxiety will withdraw from situations because of their fears. Someone with depression, however, will isolate themselves because they don’t get pleasure from being in social situations. This withdrawal may also make it hard to seek help, but there are treatment options for social anxiety disorder that can help manage symptoms of both social anxiety and depression.

Treatment Options for Social Anxiety Disorder

Social anxiety is typically treated with medication and talk therapy, either on its own or in combination.

Medications usually include selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines. SSRIs are a class of antidepressants that can be used for anxiety as well as depression. They include fluoxetine, sertraline, and citalopram. Benzodiazepines can be prescribed also but are sometimes avoided because there is a risk of drug tolerance and dependency with prolonged use. Typical benzodiazepines include clonazepam, lorazepam, and alprazolam. These are often prescribed as a short-term solution.

With psychotherapy, exposure-based cognitive behavioral therapy helps patients face their fears in social interactions. This type of exposure therapy is much like the name implies: Over time, patients are exposed to a situation that triggers their social anxiety. The goal is to show patients that their fear of the particular situation is unfounded, leading to a decrease in their anxiety. The patient also grows in self-confidence as they learn to successfully navigate these social interactions and replace the anxiety with realistic thoughts and expectations.

TMS for Social Anxiety

Transcranial magnetic stimulation (TMS) is an option if those first-line treatments of talk therapy and medication aren’t reducing social anxiety. TMS therapy for depression and anxiety alleviates the depression symptoms caused by social anxiety. Although TMS is not approved for anxiety disorders, it can still be very helpful for anxiety sufferers because of the large overlap between depression and anxiety.

During TMS treatment sessions , an electromagnetic coil placed on the scalp sends magnetic pulses to specific areas of the brain. The pulses turn into gentle electrical currents that stimulate the brain to alleviate depression symptoms.

In addition to targeted treatment, TMS provides patients with an FDA-cleared method for reducing symptoms of depression. It is also non-invasive and doesn’t require a sedative, so there is no down time, and you can drive yourself to and from treatment sessions. TMS therapy for depression and anxiety takes place every weekday over the course of several weeks, then tapers off in frequency over the following weeks.

If you have social anxiety, it’s common to have depression also. If that’s the case for you, then TMS can help. To live a fuller life that’s not constricted by social anxiety disorder, contact us to schedule a free consultation and talk about your options.

What Is Ketamine? How It Can Help with Severe Depression

Thu, 24 Feb 2022 17:12:55 GMT

What Is Ketamine? How It Can Help with Severe Depression?

Ketamine isn’t a new medication—it’s been used as an anesthetic and recreational drug—and has gained attention recently as a potent, rapid treatment for depression .

On its face, this is welcome news for the 19.4 million adults in America who have had a major depressive episode . However, it’s critical to understand what ketamine treatment is and its potential effects before deciding if this therapy is right for you. Learn more about what ketamine is used for, how it works, and potential side effects.

What Is Ketamine?

Ketamine is a medication classified as a “ dissociative anesthetic .” It sedates and calms users, and it also separates them (or dissociates them) from feelings of pain. That’s why it’s been employed for short-term anesthesia. Further, it’s also known as a potent club drug with street names such as Special K or Cat Valium.

There are two types of ketamine mental health treatments: racemic ketamine IV infusions and esketamine nasal sprays.

Racemic Ketamine

As an anesthetic, racemic ketamine is approved by the U.S. Food and Drug Administration, but its use as a depression treatment is off-label. This version of ketamine is administered with an intravenous (IV) infusion.

How Does a Ketamine Infusion Work?

IV treatments infuse the fluid in the IV drip bag through a tube inserted into the patient’s arm. The ketamine goes into the bloodstream, which allows for maximum absorption and effects that can occur almost immediately . Infusions are usually administered over a period of several weeks.

Esketamine

This form of ketamine is taken via nasal spray under the direction and supervision of a medical professional. It was approved by the FDA for depression treatment in 2019 and is manufactured under the brand name Spravato®. Because it is inhaled, esketamine takes effect differently than racemic ketamine that enters the body via the bloodstream. Esketamine can take effect fairly quickly where dosage can be individualized according to a patient’s needs.

Both types of ketamine are used in lower doses than the anesthetic version of the medication. Because they work differently inside the body, and because esketamine is a relatively new treatment, it is difficult to compare the two.

How Does Ketamine Work for Depression?

Scientific research hasn’t narrowed down a particular reason why ketamine works for depression. It’s thought that the medication acts on the glutamate system, which is a widespread neurotransmitter system that affects mood. It’s thought that the medication increases the amount of glutamate, a neurotransmitter in the brain that influences mood.

Ketamine may also improve communication between neurotransmitters in the brain and lower inflammation, which can also impact mood. Because esketamine was only recently approved for use with depression , it's an area that's still being researched.

What is Ketamine for Depression Used For?

Ketamine is noted for the quick effect it can have on symptoms of major depression. Patients may experience rapid reduction of depression symptoms , including suicidal thoughts.

Both types of ketamine for depression should be used for people who haven’t responded to other first-line antidepressant medications and have treatment-resistant depression. While some clinics may advertise that they use ketamine for other mental health conditions, such as bipolar disorder, obsessive compulsive disorder (OCD), and co-occurring depression and anxiety. However, these uses are off-label and haven’t been cleared by the FDA.

While it will be interesting to see how ketamine works over the long term, it’s crucial to note that it isn’t a wonder drug. It’s thought that a patient also needs talk therapy in conjunction with ketamine treatment to be most effective. Some potential side effects are associated with ketamine treatment. The short-term effects include:

High blood pressure
Nausea
Vomiting

Not everyone who uses esketamine will experience these side effects, and in affected individuals, these issues tend to resolve within an hour or so.

Other points to remember:

Ketamine’s dissociative properties can result in temporary euphoria, altered mood, and an out-of-body sensation.
Ketamine can be addictive, which can pose a potential risk for patients who have depression and a co-occurring substance use disorder, which is why it’s well-regulated by the FDA and is offered only in an outpatient setting.
Because ketamine is a newer depression treatment, its long-term effects aren't known.

If you are concerned about the potential side effects and risks of ketamine, you may also want to consider TMS for depression treatment if your first line treatment options, including antidepressants and talk therapy, haven’t delivered the desired results.

TMS has proven effectiveness at alleviating depression symptoms —without the use of sedatives or invasive therapies and with minimal side effects. And unlike ketamine, TMS is cleared for OCD and anxiety symptoms related to depression. With TMS, an electromagnetic coil placed on the scalp sends magnetic pulses to stimulate targeted areas of the brain. TMS is designed to alleviate symptoms over the course of several weeks of treatment.

How Long Will I Stay Better After TMS?

dhageman@innovasium.com (Daniel Hageman) — Mon, 07 Feb 2022 20:07:12 GMT

How Long Will I Stay Better After TMS?

Therapies for depression such as transcranial magnetic stimulation (TMS) often work well even after conventional treatments fail. Prospective patients are often curious about TMS and want to know all about it, particularly how long TMS therapy lasts. Results vary from patient to patient, which is why we encourage anyone considering TMS for major depressive disorder to schedule a consultation to discuss their specific circumstances.

TMS can be an effective treatment method for depression, particularly for people who haven’t gotten the results they want from first-line treatments such as talk therapy and antidepressants.

With TMS, magnetic pulses are transmitted into the brain from an electromagnetic coil placed on the patient’s scalp. These pulses become gentle electrical currents that stimulate specific areas of the brain in order to alleviate depression symptoms.

TMS treatment typically takes place every weekday for several weeks, then less frequently towards the end of treatment. Most people don’t have to wait until after the treatment period ends to see the difference TMS makes.

How Long Does It Take TMS to Start Working?

During the weeks of TMS treatment, the first positive effects may become noticeable. Again, when those signs first occur can be different for everyone—someone may feel a change after the first couple of weeks, while another patient may begin seeing those changes towards the end of the first phase of treatment.

Ultimately, how long the effects of TMS treatment last depends on the individual patient. Some people may need TMS maintenance treatments again, particularly if they have another major depressive episode. The good news is that if TMS works well for somebody during their initial treatment, it almost always achieves good results if they need TMS again. TMS offers the potential for sustainable, long-term mental health benefits. One study found that among those who improved, 62% were still improved or in remission at the end of a year.

We also encourage all of our patients to build a lifestyle of positive habits that support their mental health. These include eating well, exercising, getting enough sleep, and engaging in talk therapy. Along with TMS, these tools will equip you to create sustainable change for the better in your mental health.

Want to know more about how long TMS therapy lasts? Our patient consultants can explain the TMS process in detail, as well as what you can expect to happen over the ensuing weeks of treatment. They can also tell you about the many benefits of TMS therapy. In addition to its effectiveness, TMS is also non-invasive, doesn’t require sedation, has minimal side effects, and is a targeted treatment modality, unlike antidepressants that affect the entire body. Contact us today to learn more about TMS and how it can help you.

How to Help an Elderly Person with Depression

dhageman@innovasium.com (Daniel Hageman) — Mon, 07 Feb 2022 20:07:10 GMT

How to Help an Elderly Person with Depression

Older adults are typically portrayed as living their golden years, filling their retirement with hobbies, travel, and time spent with grandchildren. But life can lose its luster if a senior adult struggles with depression.

Many contributing factors may trigger depression in older adults, ranging from illness to isolation. Whatever the cause, if you or someone you love is dealing with depression in the later years of life, it’s critical to get treatment to alleviate symptoms. Learn more about the common signs of depression in older adults and what can be done to help.

Depression and Older Adults

Aging and depression are heavily influenced by a senior adult’s overall health. The U.S. Centers for Disease Control and Prevention states that the risk of depression is lower for seniors in relatively good health. However, health issues are common as we age, and they can increase the risk of major depressive disorder. The CDC estimates that 80% of older adults live with one health issue, making depression more likely. Also, depression rates are higher for people whose medical conditions require home health care or hospitalization.

Chronic, debilitating health conditions that limit mobility or impair brain function can be a significant cause of old-age suffering that leads to depression. But there are other possible reasons for major depressive disorder that occurs during the senior years:

A history of depression earlier in life
Medication that affects mood
Substance abuse
Seasonal affective disorder (SAD), which occurs during winter months when sunlight is low
Loneliness for older adults who live in isolation or who have lost many of their peers in their social network

Much like senior adults would seek treatment for a medical condition such as osteoporosis, heart disease, hearing loss, or arthritis, they should also seek out depression treatment. Major depressive disorder can be managed to avoid the consequences of depression in the elderly.

Signs of Depression to Watch For

Perhaps you’ve noticed a change in your behavior or that of a loved one. Major depressive disorder may be responsible, especially if the symptoms have persisted almost every day for at least two weeks. Here are some of the main signs of depression in older adults :

Empty or numb feelings
Deep-seated sadness
Irritability or mood swings
An intense sense of guilt or worthlessness
Low energy or lethargy not caused by a medical issue
Trouble thinking that is not due to normal aging or a neurological condition
Insomnia
Changes in appetite
Suicidal thoughts

The good news is that there are interventions for depression in older adults that may improve their outlook.

What to Do for Elderly Depression

Addressing depression directly can help relieve the suffering with aging that some people experience. It’s also important because the consequences of depression in the elderly can hasten physical and mental deterioration.

Here are some helpful strategies to use if you spot the common signs of depression in older adults:

If the older adult in your life shows signs of depression, it’s crucial to see a doctor to rule out any potential medical causes.
If there’s a depression diagnosis, you’ll want to get a treatment plan in place and make sure it’s being followed, whether the adult lives on their own or in a care facility. You may need to seek out extra care for your loved one if they are on their own without family nearby.
Seek out support groups for older adults with depression. (You may find resources for yourself by joining support groups aimed at caregivers.)
Ensure your loved one is eating a healthy diet and getting some sort of exercise if possible, such as walking, yoga, or swimming.
Find a therapist who specializes in depression in the senior community. This professional can address specific issues your loved one may be facing, such as grief over the deaths of friends or frustration over a medical condition that limits their activity.
A psychiatrist should also be consulted about potential antidepressant medications, especially if your loved one is on medication for other health conditions.

Many older adults don't improve with first-line treatments such as antidepressants and sometimes they can’t tolerate medications. When that happens, transcranial magnetic stimulation (TMS) may be a helpful treatment modality that can have a powerful effect. It’s non-invasive and non-sedative, so there’s less impact and risk for senior adults’ mental and physical health.

TMS can be an effective, beneficial treatment for older adults with depression, as well as OCD or depression-related anxiety. Contact us today to set up a free consultation.

Will Your Insurance Cover TMS?

dhageman@innovasium.com (Daniel Hageman) — Mon, 07 Feb 2022 20:07:08 GMT

Will Your Insurance Cover TMS?

When prospective patients contact us about Transcranial Magnetic Stimulation (TMS), they often ask, “Is TMS therapy covered by insurance?” The good news is that most insurance companies now cover TMS treatment, as long as certain guidelines are met.

What to Know about TMS and Insurance Coverage

The final approval of TMS insurance coverage will depend on your particular plan and the benefits it includes. However, there are some general criteria to keep in mind:

You must be treated for an applicable mental health condition.

TMS is generally covered for major depression treatment. It also may be covered for use in treating obsessive compulsive disorder (OCD) and smoking cessation. Insurance does not cover TMS for treatment of other conditions such as post-traumatic stress disorder (PTSD) and bipolar disorder.

TMS should not be your first line of treatment.

Insurance companies will want to see that you’ve tried some medications before approving TMS treatment. Sometimes, insurers will require that you’ve tried talk therapy.

Certain health conditions may disqualify you from coverage.

Substance abuse, neurological conditions such as epilepsy, and medical devices such as cochlear implants are all potential obstacles to insurance approval.

Even if your insurance company approves TMS treatment, there will still be some costs depending on your deductible, copayments, and annual out-of-pocket maximum. Our patient counselors can help you determine what that cost will be.

What About Medicaid and Medicare?

Does Medicaid cover TMS therapy? Can Medicare benefits help defray treatment costs? Our patient counselors frequently hear these questions when people are inquiring about TMS.

As with standard health plans, TMS coverage under Medicare and Medicaid is plan dependent. For instance, once you’ve met the deductible, Medicare may pay up to 80% of costs. We accept Medicare and Medicaid at certain locations; our patient consultants can help you find the most convenient location near you.

You don’t have to worry about your TMS insurance coverage. We can help you get the TMS treatment you need and eliminate the guesswork involved in determining insurance benefits. Contact us today for a consultation.

Depression Treatments That Are Safe for Pregnant Women

Mon, 07 Feb 2022 20:07:03 GMT

Depression Treatments That Are Safe for Pregnant Women

Pregnancy means you’re living healthy for two. That includes eating a nutritious diet, exercising regularly, getting enough sleep—and, if you have depression, finding a treatment that’s safe for you and for your baby.

Mental health is just as important as physical health for expectant moms. Much attention has been paid to postpartum depression, but many people may not realize that depression during pregnancy—called antepartum depression —is a real concern for many women.

About 14% to 23% of women experience symptoms of major depressive disorder during their pregnancies. It’s important for these women to seek treatment to avoid the side effects of depression during pregnancy. If you’re concerned about the use of antidepressant medications while pregnant, it’s helpful to know that there are other alternatives available, such as TMS.

Risk Factors for Antepartum Depression

The surging hormones that ensure your baby develops properly in utero are also a key contributing factor to depression during and after pregnancy . Other risk factors include:

High stress levels
A history of depressive episodes
Anxiety, whether it’s generalized anxiety disorder or something more specific such as miscarriage anxiety
Little to no support inside or outside the home
An abusive relationship
Unexpected pregnancy

Signs of Pregnancy Depression

Women and their partners need to be aware of the signs of depression. These can include:

Profound sadness
Changes in appetite or sleep habits
Feelings of guilt or hopelessness
Heightened feelings of anxiety
Brain fog that makes it hard to focus mentally

It may seem confusing to determine if a symptom is caused by pregnancy or depression. For instance, have you lost your appetite because you’re depressed, or is it morning sickness? Also, it’s very common for women to be concerned about how to deal with anxiety while pregnant. And it may be hard to sleep well with your body expanding or baby kicking. You should talk to your doctor if you have any concerns and ask for a mental health screening at your next appointment.

Why Antepartum Depression Shouldn’t Be Ignored

Treating depression while pregnant is vital for you and your baby. Untreated depression can take its toll on your mind and body, which are already in overdrive to meet the demands of carrying a baby. You may feel too exhausted or unmotivated to take care of yourself. As a result, you could stop eating a well-balanced diet, start skipping your doctor’s appointments or even turn to alcohol or drugs to try to cope.

All of these decisions can potentially harm your baby. For instance, low birth weight and preterm birth have been linked to maternal depression during pregnancy, and those two conditions raise the risk of infant hospitalization or death.

Depression is treatable, and it’s essential for expecting mothers to get help. Talk therapy can be beneficial . Cognitive behavioral therapy helps women change their negative thoughts or behavior patterns to help ease depression symptoms. With interpersonal therapy, women examine their relationships and support networks to see how they influence mood.

There are some safety concerns when it comes to another first-line depression treatment. Antidepressants may not be advisable in some cases. Conventional wisdom on the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has fluctuated, based on limited or conflicting data.

For instance, a recent CDC study was unable to confirm previous associations between certain medications and birth defects, but it also found new ones, such as the increased risk of birth defects with paroxetine or fluoxetine use in early pregnancy.

While these defects are rare, you’ll want to discuss your antidepressant use with your doctor to decide what’s best for you. That choice should be based on what’s best for you as well as for the baby. If you want to explore another route, TMS may be beneficial for you.

How TMS Can Help Pregnant Women Manage Depression Symptoms

TMS is believed to have a favorable safety profile in pregnancy. With TMS, there is no magnetic field near the uterus, and there are no known adverse effects in pregnancy.

Treatment takes place over the course of several weeks, starting with sessions every weekday then tapering down in the final weeks. An electromagnetic coil placed on the scalp emits magnetic pulses, which turn into gentle electric currents stimulating targeted areas of the brain.

Since treatment is non-invasive and drug free, TMS is beneficial for pregnant women. Side effects are minimal, and the magnetic pulses don’t pose harm to the mother or the baby. TMS is also cleared by the U.S. Food and Drug Administration to treat depression.

One of the best things you can do as a mother is to take care of yourself so that you can be there for your baby. Depression treatment is essential during pregnancy. Contact us to get started on safe, effective TMS treatment.

Who is a Good Candidate for TMS?

Mon, 10 Jan 2022 20:49:52 GMT

Who is a Good Candidate for TMS?

Transcranial magnetic stimulation (TMS) can be very beneficial for people with certain mental health conditions such as major depressive disorder. Many people are eager to try TMS once they hear about the treatment and how it can help alleviate symptoms. Ultimately, however, determining who is a good candidate for TMS is done on a case-by-case basis. This is an individualized treatment. To be considered for it, patients must first meet TMS criteria. Here’s what you should know about TMS and whether it may work for you.

Understanding the TMS Treatment Process

It’s helpful to understand how TMS works to see if it will be a good fit for you. There are some key characteristics worth noting:

Side effects are minimal. The main one is a tapping sensation on the scalp during treatment. Also, patients sometimes have a mild headache after treatment. These headaches can be treated with an over-the-counter pain reliever.
TMS is non-invasive and doesn’t require a sedative, so you can drive yourself to and from treatment without any downtime.
During treatment, an electromagnetic coil is placed on the scalp. Magnetic pulses are emitted from the coil that turn into gentle electrical currents in the brain. These currents stimulate targeted areas of the brain.
Treatment sessions last between 18 and 40 minutes. A typical course of TMS takes place every weekday over several weeks, then less frequently towards the end of treatment.

TMS is a personalized treatment customized to each patient. Before getting started, however, potential candidates for treatment need to meet certain TMS requirements.

Important TMS Criteria

You must meet the following TMS qualifications to be approved for treatment:

Mental Health Condition : TMS is cleared by the U.S. Food and Drug Administration to treat major depressive disorder, obsessive compulsive disorder (OCD), smoking cessation, and anxiety symptoms related to depression (also called depressive anxiety). It is currently not cleared for the treatment of other mental health conditions.
Treatment History : TMS is generally used for people who are still not doing well in spite of trying medications and/or talk therapy. However, people often continue their medications and/or therapy while they’re getting TMS.
Age : TMS is normally for people 15 years old and up, and for now, it is not approved for children or adolescents. Patients who are almost 15 are in a “grey area” and might be appropriate for TMS - and that can be determined by the TMS provider.
Health History : Due to the nature of TMS treatment, people might not qualify if they have implanted metal objects in the head (except for dental fillings—those are fine) or implants such as pacemakers or vagus nerve stimulators. Neurological complications, such as epilepsy risk or head injury, might also disqualify someone from treatment. If you have any of these conditions, it doesn’t necessarily disqualify you from treatment; our Care Team will be able to give you guidance based on your specific situation.

How Greenbrook TMS Can Help You

Still want to know if you meet the basic TMS requirements for treatment? Take our qu iz to see if TMS could help you. Our staff can also answer any questions and review your history. Plus, they can check your insurance coverage for TMS and coordinate your payment options. We understand how important it is to give all of our patients a clear and accurate picture of the financial costs of TMS. We can also help you find third-party financing if you don’t have insurance coverage for TMS.

After that, you’ll meet with one of our affiliated psychiatrists, whose evaluation will determine if TMS is a good fit for you. You also have ample opportunities to ask questions about your treatment. We encourage you to talk with our providers about their experience delivering TMS, what type of outcomes they’ve seen in other patients, and details about what an individualized TMS plan may look like for your particular case. You can also clarify the potential pros and cons of TMS and take time to research the treatment on your own so that you have confidence in your mental health treatment.

Once you’re approved and ready to proceed, the psychiatrist develops your personalized plan, and treatment can begin. Results vary from patient to patient. Our care team will carefully monitor your progress over the ensuing weeks. We’re here to help you discover the potential benefits of TMS. Contact us to schedule your free consultation .

Tips for Dealing with Depression in College

Mon, 10 Jan 2022 20:38:24 GMT

Tips for Dealing with Depression In College

College can be an exciting time of independence and change. But for some young people, these new experiences may seem daunting, which can trigger anxiety or depression. This problem is compounded now that students have returned to campus in the wake of the COVID-19 pandemic, which presents new challenges and uncertainty. School depression is on the rise for America’s college students in 2021.

A recent Harvard poll found that 51% of young adults said they were depressed or hopeless in the weeks leading up to the survey. And in a survey from the Centers for Disease Control and Prevention , more than 25% of participants ages 18 to 24 said they had contemplated suicide within the past month.

Mental health is a major issue at U.S. colleges and universities—and it won’t be going away anytime soon. Today’s high schoolers—tomorrow’s college students—are also grappling with their mental health. According to the new State of Mental Health in America report commissioned by the nonprofit Mental Health in America, one in seven U.S. children ages 12 to 17 had at least one major depressive episode in the last year.

It’s more vital than ever to help older teenagers and young adults take care of their mental health. College students face many high-pressure demands that cause stress. Getting good grades or a job after graduation, social stress, financial burdens, and homesickness can all take a toll.

Students may also experience depression due to factors not associated solely with school, such as substance abuse or low self esteem triggered by social media.

Parents should also know these warning signs so that they can check in on their children whether they live at home or on campus. The symptoms include:

A drop in grades or unexplained absences at classes, especially for formerly good students.
Withdrawal from social events or activities they used to enjoy.
Fatigue (difficulty getting out of bed in the morning or keeping up with school and work).
Lack of motivation in school.
Physical symptoms such as headaches or stomach problems.
Inability to concentrate on coursework.
Insomnia or other sleep issues.
Changes in appetite and weight.
Talk of feeling guilty, sad, or hopeless.
Suicidal ideation.

Tips for Coping with School Depression

College is an ideal time to learn self-care strategies for coping with depression symptoms. These are valuable skills that will serve students well through all their adult lives.

Establish a routine that isn’t overscheduled but allows time for classes and coursework, a job, exercise, or time outdoors and a hobby or sport.
Plan healthy meals. Dorm life can seem like an endless stretch of midnight pizza runs and instant ramen between classes. College students should try to make smart choices at the dorm cafeteria and limit late-night snacking.
Exercise every day. Physical activity can re-energize and boost mood, which helps fight fatigue and a lack of motivation.
Minimize alcohol consumption. Liquor is a mainstay at most college parties, and it’s tempting to hang out with friends at off-campus bars. However, alcohol can intensify depression symptoms.
Develop coping tools. Deep breathing, self-soothing items, or meditation can help students pause and settle themselves. Also, some campuses have a safe space where students can go and talk to counselors or trained peers.
Try to get seven to nine hours of sleep most nights. Late-night studying (and partying) keep students from getting restorative rest that can mitigate depression symptoms such as fatigue, restlessness, or lack of mental focus.
Bring in professional help. If you’re struggling, talk to a therapist or a psychiatrist. Or, you could even start with your primary care provider. They can direct you to some options for medication and/or therapy for your depression.
Consider TMS. If medications or talk therapy aren’t working for depression, then transcranial magnetic stimulation (TMS) might be a good option. This effective, non-invasive treatment easily adapts to a college student’s busy schedule. Sessions only take 18 to 40 minutes so that they can be completed between classes, and TMS is non-sedating, allowing students to drive themselves to and from treatment. Plus, TMS doesn’t have medication-related side effects such as weight gain or fatigue.

If you’re a college student, or the parent of one, talk to us to learn more about how TMS works . Call us today to schedule a free consultation .

The Connection Between Depression and Motivation

Tue, 28 Dec 2021 14:59:21 GMT

The Connection Between Depression and Motivation

You wake up in the morning already exhausted, thinking of the many tasks you have to accomplish that day. It’s so overwhelming, in fact, that you can’t seem to do anything at all but crawl back into bed. What you need is motivation, and that’s in short supply when you’re struggling with depression.

The relationship between depression and motivation is a vicious circle. When you’re depressed, it’s often difficult to fulfill your normal obligations. Then, falling behind on your obligations can make you feel even worse. It can be particularly frustrating to feel unmotivated when treating your depression with medication and talk therapy. That’s when TMS can be helpful in alleviating depression symptoms so that you can regain your motivation and momentum again.

Lack of Motivation and Depression: How They’re Linked

All areas of your life are affected when you’re not feeling motivated or driven. A straight-A student or productive employee may see their performance suffer because they can’t accomplish the simplest tasks. And it can be hard to communicate to coworkers or teachers the reason why you’re having a hard time. This may make you feel even more depressed.

Low motivation is detrimental personally as well as professionally. Relationships may deteriorate because you don’t have the energy to connect with others. That same low energy makes it hard to do basic self care, such as exercising, eating well, and getting enough sleep, which can lead to mental and physical health issues.

Finally, too much stress can also wear you down. When the body produces excessive amounts of the cortisol hormone in response to stress, it can cause exhaustion. In turn, it can lower levels of dopamine and serotonin. And when you’re already feeling unmotivated, the stress from falling behind on tasks may intensify the lack of motivation. You simply lack the will to function. It’s easy to fall into the trap of feeling worthless or hopeless when you lose motivation. These feelings of failure may spiral, which is why it is critical to speak with your support team and seek professional treatment to help with your depression symptoms. There are also some things you can do to help boost your motivation that don’t require too much effort. Even a small step towards positive change can make a big difference.

How to Find Motivation When You’re Depressed

Increasing your motivation is like building muscle—you need to exercise it regularly to make it stronger. Here are some simple things to try:

Interrupt negative thought patterns: Negative thoughts and self-talk are defeating. Beating yourself up about missing a deadline will only make you feel worse. Cognitive behavioral therapy (CBT) allows you to examine the negative emotions and thoughts and replace them with more positive patterns. A therapist trained in CBT can teach you coping strategies and tools you can use when you find your thoughts turning towards a dark place.
Make a routine: Keep it simple at first so that you aren’t overwhelmed—it’s daunting when there’s too much on your to-do list. Plus, when you’re too busy, you run the risk of toxic productivity, a byproduct of high-functioning depression that can keep you from focusing on your mental health.
Invest in supportive relationships: Social contact with close friends or family may increase your motivation with their support and encouragement. They can also help hold you accountable if you need a gentle, loving push to get motivated.
Take care of your physical needs : A massage or a day soaking up the beauty of the outdoors may be great, but if you can’t manage that, simplicity is key. Healthy food, a walk around the block, and seven to nine hours of sleep are great self-care habits to follow. They’ll provide an energy boost that may jump-start your motivation.
Look for small pleasures: Do something that gives you pleasure, even if it’s just once a week for a short period of time. This can be a hobby, a sport, or socializing with friends. The good feelings this generates can ease symptoms of depression and lack of motivation.
Create a reward system: When you find the motivation to accomplish a task or take care of yourself, reward yourself with a movie, a new outfit, or something else you’d like. This will reinforce your motivation to keep up with positive habits. You’ll also gain self-confidence as you dig deep to get motivated and achieve your goals.

Even though these strategies may sound easy, they can be daunting for someone in the midst of a depressive episode. Feelings of failure, hopelessness, or fatigue can seem insurmountable. That’s why it’s vital to find depression treatment that works for you, making symptoms more manageable so that you can work on regaining your motivation.

Medication and talk therapy such as CBT are first line treatments. TMS can be effective when you find those methods aren’t giving you the results you want. TMS is a non-invasive outpatient treatment for depression that can help alleviate symptoms, including lack of motivation. This is how TMS works: An electromagnetic coil is placed on the scalp, near the left temple. Gentle magnetic pulses are sent through the coil to the targeted areas of the brain. The pulses become electrical currents that activate the brain’s nerve cells to restore brain function and ease symptoms.

Treatment sessions are brief, between 18 and 45 minutes long, and you’ll remain comfortably seated the whole time. There are minimal side effects—mild headaches or scalp discomfort are the most common—and no downtime so you can drive yourself to and from treatment. A course of treatment usually includes TMS every weekday for four to six weeks, followed by some less-frequent treatments for a while. If you’re feeling motivated to make meaningful change in your life, schedule your free consultation to see if TMS is right for you.

Can TMS Help with Bipolar Depression?

Tue, 28 Dec 2021 14:57:47 GMT

Can TMS Help with Bipolar Depression?

Transcranial magnetic stimulation (TMS) isn’t cleared—either by the U.S. Food and Drug administration or health insurance carriers—to treat bipolar disorder. However, research shows promise for the use of TMS to address the depressive symptoms associated with bipolar depression.

Bipolar depression is a complex diagnosis, which is why it’s important to use a trusted, experienced TMS provider who can determine which treatment is appropriate for you.

What is Bipolar Disorder?

Bipolar disorder is a mental health condition that used to be known as manic-depressive disorder. It’s not as common as major depressive disorder. About 2.8% of American adults have a bipolar diagnosis , compared to 7.1% of adults with depression .

As the name implies, bipolar disorder is typified by drastic shifts in mood and energy—they’re so extreme, in fact, that these mood swings disrupt normal life. Highs, referred to as hypomania or mania, are periods of excessive euphoria. The lows, or depression, are similar to what you’d experience with major depressive disorder: intense sadness, lack of motivation, hopelessness, isolation, and, in serious cases, thoughts of self-harm or suicide.

Trauma or stress, brain function, or family history may all play a role in whether someone has bipolar disorder, although there isn’t one known cause at this time. Manic or depressive episodes can last at least a week or more, but symptoms and frequency of mood swings may be less for one person than another.

There are three main types of bipolar disorder:

Bipolar I is marked by a manic episode, in which an uncontrollable high lasts for at least a week. It alternates with either depression or hypomania, a milder form of mania that is more subdued and lasts only a few days.
Bipolar II alternates between depression and hypomania, without a more intense manic episode.
Cyclothymia characterized by spells of milder depression and manic-like symptoms.

Signs of Bipolar Disorder

Given the marked contrasts between depressive and manic episodes, it’s understandable that they have very distinct symptoms. During depressive states, people may experience:

Weight gain from overeating. Or, sometimes weight loss from loss of appetite.
Exhaustion from too much or too little sleep.
An inability to mentally focus or accomplish simple tasks.
A loss of interest in hobbies, relationships, and normal activities that they used to find pleasurable.
Feelings of worthlessness or self-loathing.
Suicidal ideation.

During manic states, patients may experience:

Decreased need for sleep.
Excessive talkativeness.
High energy.
Euphoria, or an unusual level of happiness.
Irritability.
Racing thoughts and speech.
Trying to accomplish several tasks at once.
Risky behavior that could harm themselves and/or others.
An elevated sense of self.

What is the Difference Between Bipolar Disorder and Depression?

The most important difference is that depression is considered a unipolar condition. Instead of cycling between high and low states as people do with bipolar disorder, a major depressive disorder only triggers the lows. Treatment plans will differ depending on whether someone is diagnosed with bipolar disorder or major depressive disorder. It’s important to have a qualified professional make the correct diagnoses to ensure your treatment plan will be effective. TMS can be a valuable treatment option for someone suffering from the symptoms of bipolar depression.

Is TMS Approved for Bipolar Disorder?

As of now, there is not enough research data to recommend TMS therapy for bipolar disorder, according to the FDA. For now, using TMS to treat bipolar disorder is “off-label” because it is not approved by the FDA.

What Are the Treatment Options for Bipolar Depression?

Bipolar depression, like unipolar depression, can be treated with medications and psychotherapy. Medications can include antidepressants, mood stabilizers, or antipsychotic drugs, depending on the patient’s condition. Psychotherapy modalities include cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT).

TMS therapy for bipolar depression is another option. This is an effective, FDA-cleared treatment for major depressive disorder, as well as obsessive compulsive disorder, smoking cessation, and anxiety symptoms related to depression.

Magnetic technology is the foundation for how TMS works . An electromagnetic coil is placed on a patient’s scalp near the left temple. This allows targeted areas of the brain to be stimulated with magnetic pulses. These pulses become electrical currents that activate the brain’s nerve cells to restore proper function and alleviate depression symptoms.

TMS is non-invasive and doesn’t require sedation. In other words, there’s no downtime or recovery period. A course of treatment usually lasts six or more weeks, starting at five sessions per week, with five sessions per week. Each session lasts 18 to 40 minutes, so there’s minimal disruption to your daily schedule.

More than 62% of TMS patients experience significant reduction in symptoms, with 42% of those patients achieving complete remission, according to the Journal of Clinical Psychiatry . Preliminary studies indicate TMS treatment for bipolar depression can be helpful.

Greenbrook TMS does not treat patients specifically for bipolar disorder, but rather for symptoms associated with bipolar depression. Find out if TMS therapy is right for you or a loved one. Schedule your free consultation .

FDA Clears TMS System for Anxiety Symptom Relief

dhageman@innovasium.com (Daniel Hageman) — Tue, 28 Dec 2021 14:54:12 GMT

FDA Clears TMS System for Anxiety Symptom Relief

Prospective patients often ask us, “Is TMS FDA approved for anxiety?” Until recently, the answer was a straightforward no. But in an exciting development, the U.S. Food and Drug Administration (FDA) cleared the use of BrainsWay’s deep Transcranial Magnetic Stimulation™ (TMS) system to help alleviate symptoms of anxiety in people with major depressive disorder.

This is welcome news for the millions of people who have struggled with the common co-occurrence of depression and anxiety, especially for those who haven’t found relief with other treatment methods, such as medication or talk therapy.

Distinctions Between Depression and Anxiety

TMS has been FDA-cleared for treatment of major depressive disorder since 2008. It’s important to note that this new ruling approves the use of BrainsWay deep TMS to treat anxiety in people with depression, not an anxiety disorder itself. As far as we know, TMS is not effective for anxiety disorders by themselves.

Anxiety and depression can be interlinked, possibly because both conditions are impacted by low levels of the brain neurotransmitter serotonin. Anxiety is very common in depressed patients. For those suffering from depression, more than half have at least moderate anxiety, and many have severe anxiety. Similarly, patients with anxiety disorders often also have depression.

If you’re someone who is experiencing symptoms in both categories, it’s critical to get a diagnosis to ensure the proper treatment plan is put in place to address anxiety and depression.

Depression and Anxiety Treatment Cases of co-occurring depression and anxiety can be treated with medications and therapeutic intervention as a starting point. Either modality can be used on its own, or in combination with each other.

Cognitive behavioral therapy (CBT) is perhaps the most common form of talk therapy used for anxiety and depression treatment. A CBT therapist helps patients examine their negative beliefs and thought patterns, giving them the necessary tools to replace those feelings with more positive behaviors. Dialectical behavioral therapy (DBT) may also be recommended for people with co-occurring anxiety and depression. This is an offshoot of CBT that believes patients must accept their negative patterns as part of life, and by accepting those challenges they can move towards change. Also, DBT coping mechanisms can be used when a patient is in emotional or physical distress.

Medications are the other common component of a treatment plan. Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that can also be used to manage anxiety symptoms. Typical SSRIs include sertraline (Zoloft®), fluoxetine (Prozac®), and paroxetine (Paxil®).

Other antidepressants used for depression and anxiety include serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclics. Duloxetine (Cymbalta®) is an example of an SNRI, while amitriptyline (Elavil®) is a type of tricyclic. Anxiety medications also include buspirone or benzodiazepines such as Xanax®. Prescription medications for depression include monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil®).

Sometimes, however, medication and talk therapy don’t deliver the desired results. The new FDA clearance for the BrainSway TMS system indicates the promise TMS holds for people with depression who are seeking relief from anxiety symptoms. The data submitted to the FDA analyzed the results of 573 people across three randomized controlled trials and 11 studies where people had undergone deep TMS. According to the FDA report granting the clearance, BrainsWay’s deep TMS system produced “consistent, robust and clinically meaningful” results when compared to medication or placebo treatment.

Contact Us for TMS Treatment Today

TMS is an effective treatment option for depression, as well as for obsessive compulsive disorder (OCD) and smoking cessation. Magnetic technology is the foundation for how TMS works . With an electromagnetic coil placed precisely on the scalp, near the left temple, magnetic pulses turn into gentle electrical currents that stimulate targeted areas of the brain.

Proper brain function is restored and symptoms are alleviated during a course of treatment, which is typically every weekday for several weeks, and then less frequent toward the end of treatment. Each session lasts from 18 to 40 minutes. TMS is non-invasive, no drugs are involved and side effects are minimal, so you can drive yourself to and from treatment and keep up with your normal schedule. Talk with us to find out if TMS is right for you or a loved one. Schedule your free consultation today.

Signs of Holiday Depression

Tue, 28 Dec 2021 14:51:29 GMT

Signs of Holiday Depression

Contrary to what the song tells us, the holidays aren’t the most wonderful time of the year for everyone. It can be a difficult season for many people, and that’s especially true this year as people are likely dealing with added frustrations or pressures in the wake of COVID-19. There may be unrealistic expectations for a “perfect” holiday after pandemic-related isolation and lockdowns, and that can add even more stress to an already stressful time.

There’s even a name for this seasonal effect: “holiday blues.” On its own, the holiday blues is a temporary condition, but it can intensify symptoms for people with depression. You’re not alone if you experience this: One survey found that 64% of people with a mental health issue said the holidays made them feel worse. Holiday depression of this kind isn’t an official diagnosis but an accurate description of the sadness and stress that can be overwhelming during this season.

That’s why it’s important to recognize the signs of holiday depression and know what helpful steps you can take for your mental health.

‘Tis the Season to be Stressed: It’s not surprising that so many people experience intensified depression during the holidays. There’s a lot of stress beneath the season’s shiny tinsel veneer. One survey found that 77% of people indicated they felt more pressure during this time of year than any other. Extra stress can intensify depressive symptoms such as sadness, hopelessness, or fatigue. There are many reasons for this.
Hectic Schedules: Life may be busy year-round, but it feels even more frantic now. There are final exams if you’re in school or end-of-the-year deadlines at work. And, of course, the holidays bring extra demands on your time with family obligations, parties, gift shopping, and other tasks on your to-do list.
Financial Concerns: You may feel pressure to buy lots of expensive presents to make up for last year’s pandemic holiday. This can strain your budget and, in turn, your sense of well-being.
Family Relationships: Spending time with relatives can be tough if you have dysfunctional or fractured relationships. Unhealthy family dynamics cause stress anytime, but especially during the holidays when you may be spending more time together than usual.
Loneliness: On the other hand, you may not have family nearby. Or you may rely on friends who serve as your “chosen family” but aren’t available during the holidays because they are with their own families. This can make you feel isolated, contributing to holiday depression symptoms.
Seasonal Affective Disorder (SAD): Wintry days and long nights can trigger this seasonal form of depression around the holidays. For people without depression, SAD symptoms can be milder and temporary, ending when the seasons change. For people with depression, however, the gloomy days can exacerbate symptoms.
Lack of a Normal Routine: Something’s got to give in your jam-packed schedule, and it may be the self-care habits that help you manage depression symptoms. You may develop holiday depression if you don’t make time to eat well, exercise regularly, and get enough sleep.
High Expectations: It’s frustrating when you think you have to be happy during the holidays, but your depression symptoms make that difficult. You may feel like a failure because you have unrealistic expectations for how you “should” think and feel during a season typically marked by joy and celebration.
Signs of Holiday Depression to Watch For: So what is holiday depression, and how do you know if you are struggling with it? You may be diagnosed with depression if you have persistent feelings of sadness almost every day for at least two weeks.

That sadness may also be accompanied by risky or erratic behavior, mood swings, fatigue, and feelings of hopelessness or guilt. If you have holiday depression, you may also find it hard to concentrate or think clearly, experience fluctuations in appetite or weight, and feel the need to isolate yourself from others.

It’s critical to get professional help if you recognize these signs in yourself or in a loved one, especially if there is also talk of self harm or suicide.

Tips to Ease Holiday Depression

There are some smart strategies to use this holiday season:

Keep up with self care: Eat well, exercise, and get enough sleep. These habits support your mental and physical health. Additionally, they contribute to a positive outlook.
Say no to overscheduling : Don’t commit to every holiday invitation. Look at your schedule and be honest with yourself about how much bandwidth you have. Say yes to events you absolutely have to attend or those that bring you joy, and decline the rest.
Have a support network in place, whether you’re meeting virtually or in person: Spend time with friends you trust. If friends aren’t around for the holidays, meet new people while volunteering for one of the many charitable events held during this season. (Plus, you’ll be helping others, which is a stress-buster and mood-booster .). If you don’t have these close relationships right now, it may help to see a therapist or join a support group during the holidays.
Limit your alcohol intake: Champagne, spiked punch, wine—drinks flow freely during the holidays. Remember to imbibe in moderation as alcohol can influence depressive symptoms and detract from your physical well-being.
Set a budget: Map out how much you can spend on gifts during the holidays to avoid the stress of high credit card bills in the new year.
Take time to breathe—literally: Deep breathing, mindful meditation, and tai chi are all great for alleviating stress and promoting relaxation. Carve time out every day to get calm and centered. Remember that mere five minutes a day is all you need to get started.
Don’t put pressure on yourself : Holiday cheer isn’t cheery if it’s false or forced. Give up expectations for the “perfect” holiday and focus on taking care of yourself.

Get Help for the Holidays with TMS

You may be afraid to face the holidays if you haven’t found effective depression treatment with medication or talk therapy. This is a good time to pursue TMS treatment. Our Patient Consultants can tell you how TMS works and answer all of your questions. This effective, non-invasive treatment may be just the gift you need to give yourself this holiday. Contact us to schedule your free consultation .

The Importance of Managing Behavioral Health Disorders in the COVID Era

dhageman@innovasium.com (Daniel Hageman) — Mon, 27 Sep 2021 19:01:21 GMT

The Importance of Managing Behavioral Health Disorders in the COVID Era

Taking care of your mental health is important under the best of circumstances, but it’s especially important during the COVID-19 pandemic.

In a survey conducted by the Centers for Disease Control and Prevention, more than 40% of respondents age 18 and older said they experienced depression, anxiety, or other mental health symptoms between April and June 2020.

As a result, there has been a corresponding increase in detrimental health effects. American adults responded in a Kaiser Family Foundation poll that they had problems sleeping (36% of participants), ate poorly (32%), turned to drugs or alcohol to cope (12%) and experienced a downturn in chronic health conditions (12%). These effects, and the toll they take, make it harder to stay healthy mentally and physically.

Additionally, a new meta-analysis published in JAMA Psychiatry reinforces the importance of taking care of your mental health. Not only does the stress of the pandemic take a toll on us, but the study found that there is also an increased risk of death among those with more serious mental health conditions. In essence, people with a mental health condition may be at higher risk of dying from COVID compared to people without those struggles. TMS can be a useful tool for supporting your mental health during COVID and enhancing your overall well-being.

Are People with a Mental Health Condition at Greater Risk of Contracting COVID-19?

The JAMA Psychiatry study analyzed data from seven countries on three continents: Denmark, France, Israel, South Korea, Spain, the United Kingdom and the United States. The main conclusion of the meta-analysis stresses the relationship between severe cases of COVID and mental health: People with mental health conditions should be considered a high-risk group, with extra attention paid to disease prevention and management.

The review, published in July 2021, does have some limitations because there aren’t specific demographic breakdowns across the data gleaned from all seven countries, and there were differing definitions of mental health issues. However, it appears that the risk for poor COVID-19 outcomes increases for more severe mental health issues such as schizophrenia and bipolar disorder.

One factor that may play a role in these findings is that many people with mental health conditions also have medical conditions that elevate their COVID-19 risk. These include diabetes, chronic obstructive respiratory disease (COPD), hypertension, and weight problems.

In addition, people with mental health conditions may not have the socioeconomic resources or access to care within their communities, which also increases their risk. These barriers to care can also increase their risk for contracting COVID-19 and suffering intense symptoms.

The study has its limitations, but still, it is another reminder that taking care of your mental health is especially important during the COVID-19 pandemic.

People with recurrent major depressive episodes may be more vulnerable to severe COVID-19, but study results aren’t clear on the relationship between the two. In fact, the researchers behind this review stated that more research is needed on this topic. The data reviewed in this analysis is from the pandemic’s first wave and doesn’t reflect current numbers. Studies also need to be conducted to clarify the association between high COVID risk and other conditions such as depression, anxiety and personality disorders. Finally, study parameters were different in each country, so it’s difficult to make clear-cut extrapolations.

What the data does make clear is that it’s imperative to care for your mental health during the COVID-19 pandemic.

Staying Proactive about Your Health during COVID-19

Depression is a risk factor for anxiety and panic attacks, especially during times of stress such as the pandemic. It's a normal, understandable response, and one that calls for immediate treatment as soon as possible.

With the COVID-19 pandemic, depression and anxiety are on the rise. First line treatments include medications and/or talk therapy. If those options don’t work, consider TMS treatment.

TMS works for major depressive disorder. This non-invasive treatment targets the areas of the brain that regulate mood. With a coil placed on the head near the left temple, gentle magnetic pulses stimulate the brain’s nerve cells to ease symptoms and restore normal brain function. TMS doesn’t pose the side effect risks associated with antidepressants, and patients typically only feel a slight tapping on the scalp during treatments. Patients can resume their normal schedule once treatment is over, without any downtime.

And don’t forget to take care of your physical health. Acute or chronic illnesses can raise the risk of contracting COVID-19. Keep up with regular doctor appointments, adhere to healthy lifestyle habits such as regular exercise and a nutritious diet and don’t skip screenings that may provide early detection for diseases such as colon or breast cancer.

Do you need to explore the relationship between TMS and mental health as a way to get through the COVID-19 pandemic? TMS treatment helps with major depressive disorder as well as obsessive compulsive disorder and depression-related anxiety. Our clinic is committed to providing a safe environment for TMS treatment, which includes enhanced cleaning and safety protocols and virtual care options. Take the time to take care of yourself, and schedule your free consultation today.

Which Type of TMS Therapy is Best?

dhageman@innovasium.com (Daniel Hageman) — Mon, 27 Sep 2021 19:00:09 GMT

Which Type of TMS Therapy Is Best?

Different treatment variations have developed over the decades since transcranial magnetic stimulation (TMS) was proven effective at treating major depressive disorder in the 1980s. It’s critical for patients to understand these distinctions to have a clear picture of their treatment options. Patients should discuss the various types of TMS with their primary provider as well as the team at their prospective TMS clinic to find the best solution for their needs.

How TMS Works

First, it’s helpful to know how TMS works to understand its effectiveness. TMS is an FDA-cleared treatment that uses magnetic technology to produce painless electrical currents in the brain. These currents stimulate brain tissue and nerve cells to restore proper brain function and alleviate symptoms associated with depression. TMS can also be used to treat obsessive compulsive disorder (OCD).

The process itself is simple. While a patient sits in a comfortable chair, an electromagnetic coil is placed on the scalp near the left temple. This placement targets the areas of the brain that govern mood and are associated with depression. Patients only feel a slight tapping on their scalp during treatment.

There are several benefits to TMS. This treatment is non-invasive, performed on an outpatient basis, and does not require medication or anesthesia. Unlike medication, TMS doesn’t have taxing drug-related side effects such as weight gain or insomnia. TMS side effects are limited to mild headaches and scalp discomfort. And once the treatment session is finished, there’s no downtime or need to have someone drive the patient home. TMS is easily scheduled even during a busy day because patients can resume normal activities post-treatment.

Standard TMS treatments sessions take anywhere from 18 to 45 minutes. A course of treatment lasts between four and six weeks, with five sessions per week.

Are All TMS Treatments the Same?

The difference between the assorted types of TMS may involve the magnetic pulse rate or the type of equipment used. A TMS provider should be able to explain which type of treatment is used and how it may help you.

The first category of TMS treatments varies in terms of pulse rate:

Single-pulse TMS

One pulse is administered at a steady rate every few seconds.

Paired-pulse TMS: Two pulses are applied at the same time. These pulses can either target the same brain hemisphere or both of them, depending on the desired results for each individual patient.
Repetitive TMS (rTMS): This is probably the most common type of TMS treatment. A series of pulses are delivered at once with different frequencies achieving different objectives. Fewer pulses have a suppressive or inhibiting effect on the brain, while more pulses have an excitatory effect. The pulse rate is based on each patient’s particular circumstances. The patient’s motor threshold is measured to determine this optimal rate, using the lowest amount of magnetic energy required to activate muscle fibers and cause the thumb to twitch. There is no difference between TMS vs. rTMS; the terms are generally interchangeable.
Theta-burst stimulation TMS (TBS): Time is the biggest differentiator when it comes to TMS vs. TBS. Unlike a typical course of TMS treatment, which can last up to 45 minutes, TBS takes only one to three minutes. That’s because TBS delivers its magnetic pulses at a much quicker rate, one that’s similar in frequency to brainwaves. Cleared by the FDA in 2018, this version of TMS is often referred to as express or accelerated TMS.

Then there are two other forms of TMS, which use different equipment compared to standard TMS.

Deep TMS (dTMS) : Deep TMS treatment gets its name because it uses a specific type of machine with a different coil than rTMS. The manufacturer of dTMS machines claims the coil allows the magnetic pulses to travel deeper into the brain (about 4 cm in, compared to about 1.5 with rTMS). But when it comes to pulse rate for dTMS vs. rTMS, they’re similar in delivering several pulses at once.
Functional MRI or Neuro-navigated TMS (fMRI TMS) : During treatment, a neuroimaging device such as MRI measures brain activity for real-time assessment of brain function while TMS is administered. The MRI can also be used for placing the coils on the brain to best effect.

Find the Best TMS Treatment for You

Still wondering about the benefits of deep TMS vs. TMS vs. express TMS? This is when it’s advantageous to work with an experienced TMS provider. A clinic with in-depth expertise in TMS can help you settle on the best option for your specific needs. Talk with our patient consultants to find out if TMS therapy is right for you or a loved one or schedule your free consultation .

How does TMS Therapy help with OCD?

dhageman@innovasium.com (Daniel Hageman) — Mon, 27 Sep 2021 18:57:53 GMT

How Does TMS Therapy Help with OCD

If you haven’t explored TMS for obsessive compulsive disorder (OCD), this is an ideal time to see if it’s right for you. It holds especially true if aspects of your life seem out of your control and other therapies haven’t worked for you.

OCD can lead to feelings of helplessness, with symptoms that disrupt daily life. This lack of control over certain thoughts and behaviors can be disheartening when standard treatments such as therapy and medication aren’t producing effective results. TMS (which stands for transcranial magnetic stimulation) is a promising treatment that can help people with OCD regain some control in their lives.

What is OCD?

More than 2 million Americans are diagnosed with OCD each year. This mental health condition triggers obsessions, which are irrational fears or thoughts. As the obsessions take hold in the mind, they can lead to compulsive, repetitive behaviors that are employed in an effort to reduce the anxiety behind the troubling thoughts.

The obsessions and compulsions may manifest in several different ways. These can include:

Obsession: A need for order

Compulsion: A constant drive to reorganize objects or place them “just so”

Obsession: Anxious thoughts of danger or harm to self or others

Compulsion: Avoiding situations that may pose a threat, even if the threat is irrational

Obsession: Fear of contamination by dirt, germs, blood or other foreign substance

Compulsion: Excessive hand washing or house cleaning

Scientific research hasn’t pinpointed a particular cause of OCD. It’s thought that certain risk factors contribute to OCD, such as traumatic events or associated mental health issues, including anxiety or depression. But one thing that is known is that the brain plays a significant role.

The brain has an intricate neural network that allows different parts of the brain to communicate with each other. With OCD, particular areas of the brain experience a marked increase in neural activity, which is called hyperconnectivity. This intense, elevated state of communication can trigger the fear and anxiety that lead to obsessions and compulsions.

Standard OCD treatments address the brain’s role in this mental health condition. They include a form of therapy called exposure and response prevention (ERP). In ERP, a therapist guides a patient through systematic exposure to situations involving the obsessions, so the patient gradually learns how to cope and lessen their fears. Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are another type of standard OCD treatment. Examples of SSRI medications for OCD include sertraline (Zoloft) and fluoxetine (Prozac).

The value of TMS treatment for OCD is that it focuses on those areas of hyperconnectivity in the brain. Plus, it doesn’t carry the risk of side effects that come with medications. Many people turn to TMS for OCD treatment as a next step after medication or cognitive behavioral therapy.

How Effective is TMS in Treating OCD?

TMS was FDA cleared to treat depression in 2008. However, it wasn’t until 2018 that the FDA cleared it for use in OCD treatment.

TMS uses gentle magnetic pulses that target specific areas of the brain through a coil placed near the patient’s left temple. These pulses form painless electrical currents, which affect the brain’s nerve cells. These magnetic pulses can alleviate the hyperconnectivity that leads to OCD symptoms.

TMS is a non-invasive treatment, and it’s tailored to each patient’s unique anatomical brain structure. Patients are comfortably seated throughout a treatment session and can relax and watch TV, read or listen to music. The pulses typically aren’t painful; patients may feel a tapping sensation on their scalp during treatment. There’s no anesthesia required for TMS treatment, which means there’s no downtime—patients can drive themselves home after treatment and they can resume their normal schedule. This makes it easy to fit TMS treatment for OCD into anyone’s schedule.

Results are different for everyone, depending on their symptoms and the severity of the OCD. TMS may be especially effective for people who haven’t found the success they want with standard treatments.

Using TMS treatment for OCD is still relatively new but shows promising results. It’s an exciting field ripe for more research. Greenbrook TMS offers patients expertise in TMS treatment for OCD as well as depression. Our team of Patient Consultants and psychiatrists can develop a treatment plan to help you. Schedule your free consultation with us today.

TMS Therapy vs Electroconvulsive (ECT) Therapy: What's the Difference?

Mon, 27 Sep 2021 18:51:46 GMT

What Is the Difference between TMS and ECT?

Finding the best depression treatment for you requires a clear understanding of your options. At first glance, electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) may seem similar because they both target areas of the brain. However, there are notable differences between the two treatments you should know about, which will allow you to make more informed choices for your mental health and overall well-being.

TMS Therapy vs. ECT

Depression occurs when there are chemical or structural changes to the brain. The brain contains neurotransmitters, which are the chemical messengers that form a communication network between brain cells. If that system isn’t functioning properly, it can contribute to depression. While there are many different types of neurotransmitters, there are some specific ones that are thought to be linked to depression, such as serotonin, dopamine, glutamate and norepinephrine.

Structural variations in the brain may also play a role in depression, though scientists are uncertain if these alterations are the cause of depression or an effect. These changes to the brain’s structure and chemistry are particularly crucial in the limbic system, which governs mood and behavior, among other functions. Parts of the brain that make up the limbic system include the hippocampus and the amygdala.

Both TMS and ECT treat depression by stimulating areas of the brain. The main difference between TMS therapy vs. ECT is the methodology used in these treatments.

What Is TMS?

This treatment uses gentle magnetic pulses to stimulate targeted areas of the brain. The pulses create painless electrical currents that activate nerves in the brain. As a result, new connections between nerve cells are formed to restore brain function and ease depression symptoms.

Many people find TMS easy to integrate into their schedules. This is a non-invasive, outpatient treatment, and it is performed without the use of medication or anesthesia.

A typical treatment session lasts between 18 and 45 minutes. An electromagnetic coil is placed on the patient’s scalp, near the left temple. The placement is determined by mapping the patient’s brain, which is done prior to the start of treatment. This ensures that the magnetic pulses hit their target areas in the brain for the greatest effectiveness. Patients stay seated and comfortable during the TMS session, only feeling a slight tapping on their scalp. Patients can return to their normal routines after the session is over.

There are minimal side effects associated with TMS. The most common are mild headaches or some discomfort at the stimulation site on the scalp. These issues can be resolved with over-the-counter pain relievers, which can be taken as needed.

TMS treatments are typically every weekday for a few weeks, and then roughly twice per week near the end of the treatment course. More than 62% of TMS patients experience a significant reduction in symptoms, with 42% of those patients achieving complete remission, according to a study in the Journal of Clinical Psychiatry . Treatment can be repeated if symptoms recur at a later date. TMS can be used on its own or in tandem with an existing medication plan. This decision is made by each individual patient and is based on the recommendations of their primary health care professional and the TMS provider.

What Is ECT?

There are key differences between TMS treatment vs. ECT. ECT sends low-level electrical currents to the brain that cause a grand mal seizure that typically lasts around 20 to 60 seconds. This seizure is purposely induced because it is thought to improve depression. Patients must go under general anesthesia for ECT treatment and also receive a muscle relaxant to prevent injury from the induced seizure. Unlike TMS, which targets specific areas of the brain involved with depression, ECT seizures affect the entire brain. TMS also doesn’t trigger seizures.

To begin ECT treatment, electrodes are placed on the patient’s head to transmit the electrical current to the brain. Patients are also attached to monitors to check their vital signs during the treatment session. Plus, an electroencephalogram (EEG) tracks brain activity during ECT. The treatment itself takes five to 10 minutes to complete, not including the prep work that must be done before the procedure.

ECT also takes more time post-treatment. Patients must stay for an observation period after ECT, and it can take a few hours (or longer, for some patients) before normal activities are resumed. Patients cannot drive themselves to treatment; with TMS, however, patients aren’t sedated and therefore don’t need to rely on someone else for transportation.

A typical course of ECT treatment includes two to three sessions per week, over three to four weeks. Once completed, ECT can be used with reduced frequency, or patients can employ standard forms of treatment, such as medication or talk therapy, to prevent symptom recurrence.

There are several potential side effects of ECT. These include temporary memory impairment, confusion, headache or muscle pain, and nausea. Physical symptoms can be alleviated with medication. But ECT side effects related to brain function may persist, in some cases for weeks or even months. Memory loss, in particular, can take the form of a temporary amnesia, where patients draw a blank on events before or during treatment. In addition, ECT may not be recommended for people with cardiac conditions because the treatment raises blood pressure and heart rate. The general anesthesia used during ECT can also increase the risk of complications during treatment.

Learn More about How TMS Therapy Can Help You

Now that you know how TMS is different from ECT, you can make a more informed choice. Depression treatment is a personal decision influenced by several factors, such as your age, current health condition, and scheduling availability, as well as the severity of the depression you’re experiencing. We can help you determine if TMS will be the best fit for you. Our patient consultants will discuss each step of TMS therapy with you, as well as insurance coverage, and you’ll get a treatment plan after meeting with our team of experts.

Find out if TMS therapy is right for you or a loved one. Schedule your free consultation with us today.

Understanding The Pros and Cons of TMS Therapy

dhageman@innovasium.com (Daniel Hageman) — Tue, 27 Jul 2021 17:33:23 GMT

Medically Reviewed on 5/11/2021 by

Dr. Kimberly Cress

Regional Medical Director Texas

You've been dealing with a mental health issue for a while. You've tried a few therapies and medications, but nothing seems to be working. Now, you're weighing the advantages and disadvantages of transcranial magnetic stimulation (TMS), and, like many others, aren't sure if you have all the information you need to make a confident decision. Here's a look at the pros and cons of TMS therapy to help you decide how to move forward on your journey to wellness.

The Pros of TMS Therapy

The most common use for TMS is to treat depression symptoms, but TMS can be used to treat other conditions, including obsessive-compulsive disorder (OCD) and smoking cessation. TMS is a rapidly evolving medical field that will likely be used to treat many other conditions in the future, but more research needs to be done to gain further understanding, FDA clearance, and insurance coverage.

TMS Works When Other Treatments Don't

TMS therapy is FDA-cleared to treat major depressive disorder (MDD) in patients who have failed to respond to one antidepressant (though insurance companies generally cover TMS only after a patient hasn't responded to at least two antidepressants). The TMS success rate is promising; one prominent multicenter study found that 70 percent of TMS patients experienced reduced symptoms, and 40 percent experienced full remission. These numbers reflect results solely among people who found medication ineffective, meaning TMS has proven successful among the majority of people with treatment-resistant depression (TRD).

For many people with TRD, TMS therapy succeeds where medication has failed. Among patients with MDD who have received TMS, three out of four have reported a reduction in depression symptoms after completing the acute phase of the procedure. Others may find the side effects of antidepressants intolerable, making TMS therapy a desirable option.

TMS Side Effects Are Minimal

TMS is generally well tolerated with few adverse consequences. The only side effect that is greater than a 5% risk is transient headache or site pain with initiating treatment. On the other hand, medications travel thru the body thus individuals are vulnerable to systemic side effects. For example, some antidepressants are known to cause weight gain, constipation, anxiety, blurred vision, nausea, sedation or insomnia and sexual dysfunction making compliance with antidepressant medication a challenge.

TMS Is an Opportunity for Self-Care

Some patients balk at the time commitment for TMS therapy—patients will have 30-36 sessions over six to nine weeks. However, many patients find the appointments to be relaxing, a scheduled time dedicated to attending to their own needs. When coming in for a treatment, you'll sit in a comfortable chair while the TMS therapy device is situated on your head. The device, which can be adjusted to your comfort, will deliver gentle magnetic pulses to the brain regions known to be directly associated with mood regulation. After a 20-minute treatment session, you can immediately return to your normal routine.

The technicians do everything they can to ensure you have a comfortable and relaxing experience. "I had wonderful technicians who were so good at explaining everything to me," says Josie, a Greenbrook TMS patient. "They were kind and entertaining, making every 20-minute session go by quickly. I felt like we were a team."

The Cons of TMS Therapy:

TMS is a lifeline to many people who feel like they are out of options, but not everyone has an easy time with TMS therapy. Hurdles like insurance, contraindications, and barriers to access can be frustrating for patients who might otherwise enjoy the benefits of TMS.

Insurance Can Be Tricky

TMS therapy is covered by most major insurance companies for MDD if you have tried and failed at least two antidepressants. Because TMS is more expensive than most antidepressants, insurance companies typically won't authorize payment if TMS is the first-line therapy.

That being said, Greenbrook helps manage the insurance process for you. Throughout the process, you'll work with a patient consultant to find the status of your insurance requests. You'll know what your benefits inquiry is when you start so your payments are predictable, and this allows you to make an informed choice about what's best for you. If your insurance does not cover TMS, Greenbrook can help you find third-party financing.

TMS Isn't Recommended For Everyone

TMS may be complicated or contraindicated for people with certain conditions. TMS's use of magnetic fields can have negative consequences for people with metal implanted above their neckline. The magnetic field won't pass through metal, and it can also cause the metal to get hot. Other things that could complicate TMS include brain tumors, implanted devices, and a history of seizures. Many of these issues can be accommodated, so be sure to see an experienced TMS provider who may be able to work around your specific case before you decide that TMS won't work for you.

Some Face Accessibility Issues

Behavioral health care in rural areas remains a problem in the United States. Because TMS is a relatively new treatment, even if you are not in a rural area, you may have trouble finding a treatment center near you.

Greenbrook providers recognize that TMS therapy needs to be convenient, so they've established centers where it's easier for people to visit. The goal is to avoid causing someone to drive hours to receive TMS therapy for depression. Greenbrook is constantly expanding to bring TMS therapy to those who need it. Patients can go to the website, which has a location finder, to can find the center nearest to your home.

Learn More about TMS Therapy

No matter your situation, it's a smart idea to weigh the pros and cons of TMS therapy and seek the treatment that works best for you. If you're interested in learning more about the advantages and disadvantages of TMS for your specific situation, you can set up a free consultation , and a patient consultant will discuss any questions you may have.

Understanding the Link between Depression and the Menstrual Cycle

Tue, 27 Jul 2021 17:32:53 GMT

Medically Reviewed on 6/10/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

The relationship between depression and the menstrual cycle is complex and may affect different people in different ways. And while both depression and its treatments can affect your monthly cycle, there are also ways to mitigate these effects.

The effects of both depression and menstruation have a significant bearing on your daily life, so it's natural to have questions. You might wonder, can depression delay my period? Will antidepressants affect my menstrual cycle? To answer these and more, here's a look at the evidence.

Breaking Down the Menstrual Cycle

Firstly, how does a "normal" menstrual cycle work? Roughly once a month (every 24 to 38 days ), the ovaries release an egg, and the uterus thickens its lining (endometrium) in preparation for pregnancy. If the egg is not fertilized, the endometrium sheds as a period—a mixture of blood, mucus, and tissue. Remember: your cycle is more than just your period, and everyone's experience may differ.

Can Depression Delay My Period?

Yes, it can. There is research that shows that people with anxiety typically have shorter periods, and people with depression are more likely to have irregular cycles. One of the most common causes of delayed or missed periods is functional hypothalamic amenorrhea , or stress-induced anovulation. This is essentially a survival mechanism: your body decides it isn't a good time to be worrying about reproduction and presses pause on ovulation. Not ovulating disrupts the cycle; your periods may stop, or they may become more irregular. This can be triggered simply by the emotional stress of depression or by changes to your appetite and diet if you undereat when you feel depressed.

Can Antidepressants Affect My Menstrual Cycle?

Besides the link between depression and the menstrual cycle, there's also evidence that antidepressant medication can affect your periods. For some people, this may mean an increase in symptoms, such as painful, heavy, or irregular periods. Research found that women who were taking antidepressants had "significantly higher" rates of menstrual disorders than those who weren't. Researchers concluded that these symptoms "appear to be associated with antidepressant use at least in some women."

Antidepressants affect the chemical serotonin, a neurotransmitter associated with depression and anxiety. However, serotonin also plays a role in blood clotting . This could explain why antidepressants seem to increase the risk of heavy bleeding. Some antidepressants have also been linked to high levels of the hormone prolactin , which can prevent ovulation. This may result in disruption to your cycle, such as missing or irregular periods or changes to your menstrual flow.

Can Periods Make Depression Worse?

It's also worth noting that the connection between depression and the menstrual cycle works both ways. A study published in 2005 found that 64 percent of women with depression experience "premenstrual exacerbation." In other words, the depression symptoms get worse for most women during the five to 10 days before their periods. For women with premenstrual dysphoric disorder , premenstrual symptoms of depression can be particularly severe and may even lead to suicidal thoughts.

How Can I Mitigate the Effects of Depression on My Period?

If depression or antidepressants are disrupting your menstrual cycle, talk with your doctor. There's no one-size-fits-all solution, but lifestyle changes may help you lessen the stress-induced effects. As much as possible, try to make sure that you're eating enough to fuel your body, sleeping enough to rest, and exercising moderately. Gentle movement, such as walking and yoga, can help ease stress, as can breathing or mindfulness exercises and journaling.

If antidepressant medication seems to make your symptoms worse, speak to your doctor about non-pharmaceutical treatments for depression. These could include talking therapies, such as counseling or cognitive behavioral therapy, or transcranial magnetic stimulation therapy.

TMS vs. Antidepressants

Tue, 27 Jul 2021 17:32:49 GMT

Medically Reviewed on 6/10/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Exploring different treatment options for depression is often an essential step in finding the right treatment for you. Antidepressants and TMS therapy are two treatments you're likely to come across in your search, but which should you try first? Are they effective? How long do both treatments last? This guide will answer these questions and more to help you determine which treatment option may be the best fit for you.

TMS vs. Antidepressants

TMS therapy and antidepressants are both effective treatments for depression. However, one of the benefits of TMS therapy is that it can provide relief for people who either haven't had much success with antidepressants or cannot tolerate them. To compare TMS therapy and antidepressants effectively, it's necessary to examine the particulars of both. Knowing how they work, their side effects and success rates can help inform your treatment choices.

How They Work

TMS Therapy:

TMS therapy uses magnetic pulses to stimulate specific areas in the brain responsible for regulating mood and emotion. The stimulation of nerves in these brain regions can improve the brain's ability to regulate mood.

Antidepressants:

Chemical messengers called neurotransmitters allow the brain to receive signals from the nervous system. Antidepressants generally work by increasing the levels of specific neurotransmitters that affect mood and emotion. Different types of antidepressants achieve this result by interacting with certain neurotransmitters.

Success Rates

TMS Therapy:

Data shows that about two-thirds of people who haven’t benefitted from antidepressants see good results from TMS therapy. Some even go into full remission and don't experience depressive episodes or symptoms again. Others may need maintenance sessions down the line if their symptoms resurface. TMS therapy remains effective after initial treatments, so maintenance sessions are usually helpful.

Antidepressants:

Antidepressants provide symptom relief for about two out of three people who use them to treat depression. However, they often involve some trial and error. Sometimes, people need to try two or three antidepressants before finding an effective one. And one-third of people do not find relief from antidepressants.

Side Effects

TMS Therapy

One of the benefits of TMS therapy is that it has minimal side effects. About 42% of people experience mild to moderate headaches and/or discomfort during or after the treatment session, but for most people, these side effects subside and eventually cease as they become acclimated to the treatment. An extremely rare side effect of TMS therapy is seizures, which happen in fewer than one out of every 60,000 TMS sessions.

Antidepressants

More than half of all individuals who take antidepressants experience side effects. The particular side effects a person experiences are somewhat dependent on the type of antidepressant they are taking. Common side effects of SSRI and SNRI antidepressant medication are nausea, diarrhea, headaches, sleep problems, and sexual problems. Tricyclic antidepressants are more likely to cause side effects such as blurred vision, constipation, dizziness, dry mouth, trembling, and difficulty urinating. Rare side effects of antidepressants include heart problems and liver damage.

For the most part, side effects are less common after the first few weeks of using antidepressants. However, for some people the side effects are intolerable, which can lead to them discontinuing their treatment.

Depression in New Fathers

Mon, 26 Jul 2021 14:55:49 GMT

An open letter from new father Ross Hunt to his baby has sparked a conversation about depression in fathers. He wrote to his 11 month-old daughter that "I regretted having you, and thought that my life had been ruined by you being born. I know that’s hard to read, but trust me, it’s incredibly hard to write too." Hunt is not alone; an estimated 7-10% of new fathers will experience depression after having a child. This condition is especially hard-hitting for younger fathers (~25 years old) and those who live with their newborn.

Although lack of sleep and high stress levels in the first few months of a child's life can cause any parent to feel overwhelmed and anxious at times, these feelings usually fade as caretakers settle into a routine and learn how to care for their child. Conversely, PND is a persistent condition, and includes the following symptoms:

Irritability
Problem behaviors such has overworking, self-medication with alcohol/drugs, or gambling
Feelings of despondency
Difficulty concentrating
Obsessive/anxious thoughts about the health and wellbeing of the baby or partner
Thoughts of harming themselves or the baby

In the New York Times Article " I Gave Birth, but My Husband Developed Postpartum Depression " Kim Hooper explains the effect child birth can have on men's mental health. When discussing maternal postpartum depression, it's often hard for people to take seriously the idea of a man having similar issues.

Because men are less likely to acknowledge that they are struggling with their mental health and the focus of depression after having a child has largely been on mothers (although even for women, the topic remains taboo and very stigmatized), men often do not ask for help or support for fear of seeming weak or unable to cope . They also have to consider the logistical complications of seeking treatment with a new baby in the household.

Men seeking help may find relief from medication and/or talk therapy. Transcranial Magnetic Stimulation (TMS) Therapy is another option for those seeking an FDA-cleared, non-drug, non-systemic treatment. If you or a loved one are struggling, reach out to us to schedule your free consultation .

Does TMS Work Long Term?

Sat, 17 Jul 2021 16:45:02 GMT

Medically Reviewed on 6/10/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

For those who have struggled to find relief from depression symptoms, transcranial magnetic stimulation (TMS) therapy is an appealing option. FDA-cleared for major depressive disorder (MDD), obsessive-compulsive disorder, and smoking cessation, TMS is a non-invasive treatment with minimal side effects and a high response rate in patients with treatment-resistant depression.

"Before TMS therapy, I was moody, mercurial, sad, and crying most of the day," says Emily , a Greenbrook TMS patient. "I felt relief from my overbearing, all-consuming depression after my first 20-minute session."

So, does TMS work? With most patients, like Emily, yes. TMS therapy is changing the lives of people with depression symptoms every day. With many patients seeing results immediately or within a few treatments, the question remains: does TMS work long term, and will patients need to return after some time? That answer is a bit more complicated.

What the Research Shows

Looking at three major TMS studies may be helpful in understanding how we measure success, in both the short and long term.

One of the original studies of TMS, which examined TMS's efficacy and safety in the acute treatment of MDD, was conducted with randomized, double-blinded, sham-controlled trials. In other words, study subjects didn't know if they were getting a real or a fake TMS treatment. All study participants discontinued their antidepressants before beginning the trial, and the technicians administering TMS were told to be emotionally neutral, making the trial sterile and, subsequently, not terribly impressive. Researchers concluded TMS was effective in treating MDD with minimal side effects, and the FDA gave its approval—but many participants who were given the placebo, or fake treatment, were left without any improvement.

Neuronetics , a company that makes one of the TMS chairs that Greenbrook TMS uses, saw an opportunity for a continuation study . They invited participants from the first study to participate in an open-label phase where participants knew they were receiving a real TMS treatment. Study participants were treated with TMS in a real-world setting, not a sterile, emotionless one. Many patients find the very process of TMS therapy to be therapeutic, setting aside time for themselves each day to be greeted by friendly people who are interested in their well-being. Plus, patients were allowed to go back on their antidepressants, suggesting that TMS may provide even better outcomes when used in conjunction with other things that work.

A similar, second continuation study was conducted two years later that followed participants for a year. By this time, results were looking good: After six weeks of TMS therapy, patients had a 62.3% response rate to TMS, and 41.2% of patients experienced remission. A year later, 62.5% of the patients who responded were still better, and 45.1% of those patients in remission were still in remission. Furthermore, 84.2% of patients who benefited from TMS during their first course of treatment but did not achieve remission were found to benefit from TMS during a second course of treatment.

So, does TMS work long term ? For many, the answer is yes. And for others who experience symptoms at some point after receiving TMS therapy, another round of TMS will successfully set them back on track.

Staying Well After TMS

More research is needed to understand how to get the full range of benefits from TMS therapy, but based on studies about depression, as well as doctors' and patients' experiences, other therapeutic modalities can encourage and prolong the positive effects of TMS therapy.

1. Antidepressants

Even if antidepressants didn't work for you before TMS, a singular antidepressant can hold your state constant afterward, reducing your risk of depression symptoms returning. Staying on an antidepressant for a year after your course of TMS can be a safe, precautionary way to support your positive response to TMS.

"TMS and medications work best together ," says Dr. Don DuBose , Greenbrook TMS's South Carolina Medical Director. "The goal is getting you better, so whatever we need to do to get you there, that's what we do."

2. Talk Therapy

Talk therapy is exceedingly useful in sustaining wellness, even if therapy didn’t seem to help before TMS. Cognitive behavioral therapy (CBT) is one particularly well-supported type of therapy. CBT helps you avoid the pitfalls of cognitive loops that can lead to a circular decline in mood.

3. Lifestyle Changes

If you responded to TMS therapy, then maintaining a normal sleep-wake cycle, getting adequate nutrition, and exercising regularly can aid in keeping you well. Overdoing any of these, particularly exercise, is not the goal; the medical benefits of exercise can happen at modest levels. If your doctor clears you to exercise, you do not need to engage in an extreme regimen. A walk around the block, gardening, or walking your pets all have tremendous health benefits and can help sustain the benefits of TMS.

What to Do If Depression Comes Back

You can do everything right and your symptoms may still return—that's simply the way depression is. It's important to remember that having depression is not your fault. Still, the more you stay well, the more the wellness pathways in your brain will be strengthened to keep you feeling well.

If you do find that your depressive symptoms are returning after TMS therapy, get back into treatment quickly. Don't let those depression symptoms fester for more than a couple of weeks before you reach out to a TMS center. The Care Team at Greenbrook TMS is ready to hear your concerns and work out a plan to get you feeling better, faster

History of TMS Therapy: How Long Has TMS Been Around?

Thu, 15 Jul 2021 21:00:03 GMT

Medically Reviewed on 6/10/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

As a condition with a variety of symptoms and causes, depression affects different people in different ways. This also means that health care providers can offer a variety of treatments, to differing degrees of success. Most people have heard about traditional talk therapies, antidepressant medications, or recommended changes in diet, exercise, and other lifestyle habits. But there's another treatment that isn't as well-known: transcranial magnetic stimulation , or TMS. You might be surprised to learn just how much research has gone into TMS over the years. So, what is TMS therapy exactly, and how long has TMS been around?

The Connection: Electricity and the Brain

Physicians have long been intrigued by the effects of electricity on the brain. As far back as 46 A.D., Scribonius Largus, the court physician to the Roman emperor Claudius, compiled a book of medical treatments known as Compositiones. It included a recommendation for applying live electric torpedo fish onto patients' scalps to cure headaches . A thousand years later, the physician Ibn-Sidah prescribed using live electric catfish to treat epilepsy .

In the mid-20th century, scientists began applying electrodes to the brain in electroconvulsive therapy (ECT). While ECT is still used successfully , it requires patients to go under general anesthesia and is reserved for those with severe mental illnesses who have not responded to other therapies. It is understood that nerve cells operate by generating electric signals that trigger muscles, for example, or activate chemicals in the brain. To investigate how these processes work and better develop treatments, researchers sought safer ways to introduce electricity to the body.

How Long Has TMS Been Around

In 1985, Anthony Barker and his colleagues were the first to use a magnetic stimulator to activate the brain. This development took advantage of a basic discovery made by physicist Michael Faraday made back in 1831. Barker's device, placed on a patient's head, generated a magnetic pulse that passed painlessly through the scalp and induced an electric current in the underlying brain tissue. Within a few years, scientists engineered improvements to allow TMS devices to deliver repeated magnetic pulses.

Although the new TMS device was originally meant to be a research tool, Hans Martin Kolbinger and his colleagues published a pilot study in 1995 showing evidence that TMS helped patients with major depressive disorder (MDD). The next year, leading TMS researchers convened to set detailed guidelines on how TMS should be used safely and ethically in laboratory research and clinical settings. With these guidelines in place, scientists expanded tests using TMS, initially involving patients with depression who did not find relief from existing treatments.

In 2007, results were published of a major clinical trial that conducted TMS treatments on 301 patients with MDD who had not benefited from other therapies. It found that TMS was safe and could alleviate symptoms of MDD. By then, more than a decade of studies had shown that TMS therapy produced few and minor side effects . In 2008, the U.S. Food and Drug Administration cleared TMS therapy as an accepted depression treatment.

Breaking New Ground with TMS

Since 2008, numerous studies have demonstrated that TMS therapy can provide relief for those whose depression symptoms haven't improved after medications and/or talk therapy. Further, TMS has often provided more relief when used in conjunction with other therapies.

Antidepressant medications, for example, have been shown to help relieve symptoms in 40% to 60% of patients. Some people don't like to take antidepressants, even if they are effective, because they sometimes come with side effects such as insomnia, weight gain, headaches, blurred vision, rashes, high blood pressure, and gastrointestinal and sexual problems. TMS is a non-drug, non-invasive therapy with a long history of producing few side effects. Patients sit in a comfortable chair with a TMS device near their scalp. The magnetic pulses are not painful, but rather feel like a gentle tapping, as they stimulate areas of the brain that are known to regulate moods.

When it comes to just how exactly TMS works, scientists have many theories . TMS may increase electrical activity and/or blood flow to brain regions that may be slowed down because these were lacking. Magnetic fields from TMS may help growing brain cells align into more efficient circuits to convey brain signals. Or, TMS could help trigger the release of chemicals that speed brain signaling.

Because these mechanisms logically could also aid in other brain conditions, researchers have explored using TMS to treat other conditions. In 2018, the FDA approved TMS as a treatment for obsessive-compulsive disorder . What's more, TMS is also being tested and used to help patients with Parkinson's disease, migraines, strokes , head traumas , and multiple sclerosis . Talk with your doctor to see if TMS therapy might be a beneficial option for you.

Infertility and Depression: The Importance of Finding Treatment

Tue, 13 Jul 2021 20:45:02 GMT

Medically Reviewed on 6/29/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

A couple’s infertility journey can be a long and hard road: the perceived shame surrounding infertility can be very isolating, biological limitations can present a shrinking, anxiety-inducing window of opportunity, treatment itself is expensive, and hormone manipulation can hugely impact mood. It may come as no surprise, then, that experiencing depression while undergoing infertility treatment is common: about 39% of women and 15% of men develop depression during infertility treatment.

Depression is a mental health condition that should be treated, and leaving it untreated can lead to other health problems. However, many patients are concerned with the impact that depression treatments might have on conception and fetal development. Fortunately , [SHM1] there are options available. Read on to learn how infertility and depression are linked, and why you should seek treatment if you're feeling depressed during infertility treatment.

The Risks of Leaving Depression Untreated

Many people opt to leave depression untreated when they undergo infertility treatment because they are fearful of doing anything that could reduce their chances of getting pregnant or impact the health of their fetus. This worry is understandable, as fertility treatments are a substantial financial investment. The possibility of dealing with the combined side effects of antidepressants and fertility treatment can often be a source of anxiety, too.

Nevertheless, leaving depression untreated is not advisable. Going without treatment can cause the distressing feelings you have to become more intense, and it could even cause persistent physical symptoms, such as nausea, chronic pain, and headaches. In addition to negatively affecting your overall health, depression may even impact your ability to get pregnant. Research has shown that once pregnant, mothers who experience major depression have an increased risk of premature birth, low birth weight, and decreased fetal growth. After labor , depression can also make it difficult to bond with the baby.

The Relationship Between Infertility and Depression

Infertility and depression are intertwined, and depression can indirectly affect your ability to become pregnant by influencing your overall physical health. For instance, depression sometimes causes a significant increase or decrease in appetite, which could lead to being overweight or underweight. Both states are known to cause or play a part in infertility . Conversely, infertility can cause depression or worsen existing depression. A Harvard study showed that women with infertility feel just as anxious and depressed as people diagnosed with cancer or hypertension. The study also notes that men who are infertile experience similar levels of depression and low self-esteem as infertile women.

As a matter separate from infertility depression, fertility treatment itself can sometimes cause a person to become depressed. For instance, side effects from some of the drugs involved in fertility treatment are depression or other mental health conditions. The financial cost and strain of undergoing fertility treatment can contribute as well, as treatment is not always covered by insurance. The stress of the treatment process itself, which often involves multiple appointments and taking many medications, can also heighten the emotional impact of infertility and contribute to depression.

Depression Treatment Options During Infertility

Antidepressants are typically the standard treatment for depression. However, some studies suggest that antidepressant use may have a negative impact on fertility , though more research is needed to fully understand their effects. Many people aren't comfortable taking them because they're concerned about either the potential impact on their chances of conceiving or the risk of side effects. In these cases, TMS therapy is a potential non-medication treatment to consider.

Transcranial magnetic stimulation (TMS) therapy delivers gentle magnetic pulses to stimulate the regions of the brain that regulate mood and emotion. The stimulation of nerves in these areas can improve the brain's ability to regulate mood, treating depression. Though TMS has not been studied in large groups of pregnant women, there is no associated impact on hormone levels and the range of the magnetic pulses does not extend to the reproductive system. In addition, TMS therapy has no drug-related side effects and is well-tolerated, so you don't have to worry about extra effects on top of those that may accompany fertility treatments.

There is no need to choose between treating depression and becoming pregnant. There are options, including TMS, that will allow you to do both. If you're interested in learning more, you can continue browsing resources on TMS , or reach out to Greenbrook for a consultation. You deserve to feel your best as you work to build a family.

Navigating Apathy and Depression

Mon, 12 Jul 2021 20:01:35 GMT

Medically Reviewed on 5/11/2021

Dr. Kimberly Cress

Regional Medical Director Texas

When you sit down to video chat with your friends, you might expect to feel happy and excited. When your partner needs help making a tough decision at work, you want to feel sympathetic and supportive. But instead, you might not feel anything. Apathy can come in related but distinct forms, from disinterest to lack of motivation. It can make it difficult to perform daily activities, complete projects at work or school, and keep up social relationships.

These are some of the same issues that characterize depression, but are apathy and depression the same thing? No, though apathy can be a sign that you're experiencing depression. If apathy has become a persistent challenge in your life, read on to learn how it relates to depression and other conditions and how to find effective treatment.

What Is Apathy?

We have a natural inclination to seek out stimuli—new challenges, hobbies, and relationships that satisfy our curiosity. If you feel no desire to partake in these experiences or you suddenly lose interest in activities you previously enjoyed, it may be a sign of apathy.

Apathy is a lack of emotion, interest or concern for daily activities or events going on around you. Apathy may be situational and temporary, or it may be persistent and ongoing. It is normal to go through moments where you lose interest in things due to acute stress, but if this happens more frequently or at atypical times, it can prevent you from enjoying life, impede your work, or challenge your connections with other people.

While apathy on its own is not a clinical condition, one psychologist characterized it as an "attitude" that can indicate an underlying condition. For example, apathy may be a sign of a neurodegenerative condition, as persistent apathy can be caused by issues with the region of the brain that regulates emotion and behavior. In one study, 45 percent of people with dementia experienced a lack of interest amounting to apathy. Apathy, in addition to memory loss, is also a primary symptom of Alzheimer's disease .

Apathy can be a sign of other conditions, such as Parkinson's disease , schizophrenia , post-traumatic stress disorder , and Huntington's disease —as well as depression. Doctors who note apathy in their patients will often take steps to determine whether an underlying medical condition can be treated to improve symptoms. Experiencing disinterest in daily activities is also a sign of anhedonia, which makes it easy to confuse it with apathy. However, they are distinct. A person with anhedonia mainly experiences a lack of pleasure in their daily activities, without the lack of motivation that is common in apathy. That said, in some cases you may experience apathy and anhedonia at the same time.

Does Depression Cause Apathy?

It can be easy to confuse depression with apathy, as both can cause you to experience disinterest in daily activities . Feeling unexcited about life in general is a common occurrence with both, as is a lack of motivation to achieve your goals.

Just as apathy can indicate the neurodegenerative and other disorders described above, it can also be a symptom of depression. According to one study that aimed to define diagnostic criteria for apathy , apathy was a characteristic in 94 percent of depressive episodes. Based on those criteria, these symptoms must last for four weeks or longer to qualify as apathy.

Apathy may be diagnosed as a symptom of depression if you experience it alongside other symptoms of depression, including physical indicators like pain and fatigue and emotional indicators like sadness, hopelessness, or guilt. To understand whether the apathy you are experiencing is tied to depression or to a different underlying condition—and how best to treat it—talk to your doctor about any other symptoms you may be feeling.

Seeking Treatment

If you persistently feel apathetic and unhappy, it's important to consult a doctor or mental health professional for diagnosis and treatment, even if you do not think you have depression. You may be able to address apathy with psychotherapy such as cognitive behavioral therapy (CBT), individual therapy, or prescribed medication. These methods are also frequently recommended for treating depression. However, because everyone with depression experiences the condition differently, certain treatments may be more effective for some people than for others. In fact, one in three people still experience depression symptoms after trying two medications.

Transcranial Magnetic Stimulation (TMS) therapy is another option when first-line treatments have not worked. TMS is FDA-cleared for the treatment of Major Depressive Disorder when medications have not been effective, TMS is a non-invasive, non-drug treatment that uses gentle magnetic pulses to stimulate specific areas of the brain to improve symptoms of depression and help you regain the motivation and emotional response you have been missing. To learn more about whether TMS is right for you, schedule a no-cost consultation .

Is Depression a Chronic Illness?

dhageman@innovasium.com (Daniel Hageman) — Mon, 12 Jul 2021 16:53:28 GMT

Medically Reviewed on 5/13/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Some people with depression may be reluctant to pursue new treatment options because they believe that nothing will work for them or that their persistent low mood is just part of who they are. But it is possible to find relief from depression symptoms, even if first-line therapies have been ineffective. Is depression treatable? Yes. However, persistent or "chronic" depression is a distinct form of depression that often requires specific treatment. The key is finding a treatment option that works for you.

Is Depression a Chronic Illness?

Though definitions vary , the Centers for Disease Control and Prevention characterizes chronic illness as a condition that lasts at least one year and demands ongoing medical attention or restricts activities of daily living. Examples of common chronic conditions include asthma, heart disease, and diabetes. Treatment options for chronic diseases tend to involve lifelong symptom management rather than curative courses of treatment.

In most cases, major depressive disorder will not meet this definition of "chronic," as the average length of an episode of depression is three months. However, many people experience chronic symptoms because they have not received the right treatment. For instance, about two-thirds of patients with chronic depression do not receive a medication of adequate dose and duration.

For people who experience depression that lasts longer than the average episode, depression can have a greater impact on daily life than other chronic conditions—whether at work, at home or socially. In a national depression survey, 96.9% of respondents reported at least some form of impairment in their day-to-day lives, most commonly in their social life. They had 35 days "out of role" in total, which means they were unable to perform their normal activities for over a month. This contrasts with most other chronic conditions, such as heart disease and high blood pressure, for which patients reported 15 days "out of role" on average.

What about Persistent Depressive Disorder?

Also known as dysthymia, persistent depressive disorder (PDD) is a specific form of chronic depression that causes people to experience symptoms for at least two years. Of individuals diagnosed with depression, around 30% report PDD , and the National Institute of Mental Health estimated that 1.3% of all US adults had experienced persistent depressive disorder at some point in their lives.

If you have PDD, you may feel depressed more days than not. You might also experience other symptoms of depression, such as a change in your appetite, disrupted sleep, or diminished energy levels. You are more likely to develop PDD if you experienced early life adversity, such as childhood neglect or emotional trauma, or if you have a family history of mood disorders.

Is Chronic Depression Treatable?

It is possible to find relief from long-lasting depression. A major 2019 review found that chronic depression responds well to several treatments, including psychological therapy and medications. Here are some options you may wish to explore:

Changing medications: If you are already on medications, you could speak to your doctor about optimizing the dose of your current medication or trying a different one.
Targeted therapy: Since PDD is more associated with childhood adversity than non-chronic depression, attending therapy sessions can be an important part of addressing the condition. Specific therapy techniques that address childhood maltreatment have been shown to be more effective in treating chronic depression than standard (non-specific) psychotherapy.
Transcranial magnetic stimulation: If you are still experiencing symptoms after trying medications and therapy, there are other options available. Transcranial magnetic stimulation (TMS) is a non-invasive and non-drug treatment that has been cleared by the FDA when at least two medications have not been effective for depression. TMS uses gentle magnetic pulses to stimulate brain regions involved in mood regulation; these regions are underactive in people diagnosed with depression. TMS can help to relieve some, or even all, symptoms of depression in many patients. Sixty-two percent of patients report a reduction in depression symptoms at the completion of the acute phase of TMS therapy, which lasts six to nine weeks.

What If I Experience a Recurrence of Depression?

If your symptoms have improved, could they return? Yes, but recurrences generally respond to treatment.

Taking antidepressants over an extended period of time may reduce the severity of your symptoms. Continuing psychological therapy may also decrease the chance of depression returning , and TMS in particular may help patients who have not found relief from medications. To learn more about whether TMS might be right for you, consider scheduling a no-cost consultation .

Reaching out for treatment is a meaningful and empowering step toward improving your long-term well-being. Remain hopeful as you pursue a treatment option that works for you. You don't need to settle for anything less.

Sign That Your Major Depressive Disorder Treatment Plan Isn't Working

dhageman@innovasium.com (Daniel Hageman) — Mon, 12 Jul 2021 16:53:25 GMT

Medically Reviewed on 5/13/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Getting on a major depressive disorder treatment plan is a great step forward, but it can be hard to know if it's working—or if it should be working better.

While the right boxes may be checked on your plan, it can still feel like the journey is far from over. Maybe you're seeing some progress, but you'd hoped to see more. You may not know if you should expect things to continue improving or if this in-between state is the best you can hope for. No matter how long your treatment journey has been, it's important to not settle for "better." You have every right to seek new treatments until you truly feel that your depression is resolved. Here's a look at some signs that your major depressive disorder (MDD) treatment plan might not be working.

1. Only Some of Your Symptoms Have Been Resolved

If your MDD treatment plan is successfully taking the edge off your worst depression symptoms, you might be tempted to count your blessings, even if other symptoms continue to bother you. The reality is that a depression treatment plan that is only partially successful isn't a successful depression treatment.

The problem is two-fold. On the one hand, you deserve complete relief, and lingering symptoms can keep you from enjoying full quality of life. On the other hand, research has found that residual symptoms of depressive disorder are major predictors of relapse of depression.

In some studies , residual symptoms in patients with depression are associated with social functional impairment. This can lead to sustained feelings of isolation and loneliness that continue to contribute to depression. It's important to know that if only some of your symptoms have resolved, much more can be done to help you experience a fuller, more satisfying breakthrough for restoring quality of life.

2. You're Experiencing Reduced Versions of the Same Symptoms

It's also possible to see mixed results when it comes to symptom severity. Many people experiencing depression decide to simply settle for reduced—but not eliminated—symptoms because they are happy to get any kind of relief. Similarly, many who find early success with a treatment option feel excited because they assume that the results will continue to get better and better.

Sometimes, though, an initial reduction in the severity of depression symptoms represents the "peak" level of relief that you'll experience on a given course of treatment. While we can't underestimate how good it is to see a reduction in depression symptoms, staying with a plan just because it worked "a little" is really just settling for less than a resolution to MDD.

3. The Side Effects Are a Burden

Unfortunately, a major depressive disorder treatment plan that includes medications can put you in a position of trading some of your unwanted symptoms for other unrelated symptoms. Some antidepressant medications cause side effects , such as diarrhea, nausea, headaches, and joint pain, that make it hard to get on with daily life. Other side effects are subtler but can detract from the quality of life in big ways. For instance, some medications may contribute to sleepiness that saps your energy and enthusiasm, while others can cause weight gain .

Unfortunately, these side effects can make you feel hopeless or out of control just when you were hoping to turn a corner. If side effects are creating new problems in your life, you might want to talk to your provider about different medications or treatments for major depressive disorder that won't alter you on the physiological level.

4. Your Depression Has Morphed to a State of High Excitement

Some people feel relief from anxiety that is replaced by feelings of overexcitement when taking medications for depression. Some might describe this experience as feeling "high." There's even a chance that you may have feelings of euphoria, invincibility, or mania. "During a manic episode, continuing antidepressant medication serves no purpose other than to contribute to or exacerbate mania symptoms," according to research published in Federal Practitioner .

While some people may confuse feelings of agitation and restlessness as signs that the fog of depression is lifting, it's actually possible that something called serotonin syndrome is occurring as a result of a new medication. It's important to let your care provider know if you're feeling overly excited in a way that doesn't match your personality. This could be a sign that your medication is not working as intended.

Rethinking Your Major Depressive Disorder Treatment Plan: Consider TMS

Living with reduced severity of depression symptoms is still living with depression. If you're left unsatisfied with talk therapy or antidepressants, it may be time to explore new treatments for major depressive disorder.

One option to consider is transcranial magnetic stimulation (TMS) therapy. This therapy is FDA-cleared for major depressive disorder and uses non-invasive devices that deliver gentle magnetic pulses to stimulate areas of the brain tied to mood.

Because it's not considered a "front-line" treatment like therapy or medications, TMS can be a great fit for those who haven't seen satisfying results from those other approaches. "The goal here is complete remission of your symptoms," says Dr. Geoffrey Grammer , chief medical officer at Greenbrook TMS. "And a lot of times, if we add TMS therapy to the medication that's had a partial effect, then the combination of the two is enough to completely relieve someone's symptoms." To learn more about whether TMS therapy can help you find true relief from depression, reach out for a no-cost consultation .

Coping with Depression after COVID-19

Mon, 12 Jul 2021 16:52:17 GMT

Medically Reviewed on 6/10/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

For many people around the world, the coronavirus pandemic has created mental health problems or exacerbated issues that previously existed. With tremendous amounts of stress and uncertainty surrounding our current situation, 2020 saw a significant rise in mental illness—particularly depression and anxiety—among people of all ages. With much of the United States vaccinated, you might be wondering why people are still struggling with depression even after the worst of the COVID-19 pandemic seems to be over. Let’s take a look at the strong link between COVID-19 and depression, and why people are struggling.

How COVID-19 Led to an Increase in Mental Health Issues

The exact causes of this trend have yet to be determined definitively, but there are many potential contributing factors.

Social Isolation

Social distancing and self-isolation left many people feeling more lonely. Being stuck indoors and away from others could magnify preexisting conditions, such as anxiety and depression. Survey data shows that this risk was elevated in young people between the ages of 18 and 24. In the time since lockdowns began in April 2020, participants in this age range were far more likely to experience loneliness than other control groups, suggesting a connection between inactivity due to COVID-19 restrictions and loneliness, which can contribute to depression.

This might be the case because, under normal circumstances, younger people tend to be more engaged in an array of social activities than people in other age ranges. With the closure of schools and universities, adolescents and young adults in particular were forced to miss out on key developmental milestones in their lives, losing valuable social and educational experiences. This could result in fear of missing out and anxiety about the future, as well as loneliness and depression.

Feelings of loneliness aren't limited to younger populations, however. Thirty-nine percent of people who were married or in a civil partnership reported high levels of anxiety when surveyed, compared to 19 percent before the pandemic began. As more data emerges, it's becoming clear that symptoms of anxiety and depression in the COVID-19 setting aren't limited to any specific subgroup, but can affect us all in different ways.

Fear and Uncertainty

With official guidance on preventing COVID-19 infection evolving continuously over the course of spring 2020, it was difficult to gauge the level of risk involved in typically harmless activities like seeing friends and family, going to the grocery store, and taking public transportation. That uncertainty has only been compounded by variations in guidelines across the country and the world, as well as the often politicized nature of the debate around the virus.

In addition to being afraid of contracting COVID-19 themselves, many people are concerned about the health and well-being of their aging parents or relatives, the possibility of being laid off at work, and having to help their children continue learning remotely. These factors could be contributing to the development of depression for many people and making existing depression more difficult to address for others.

The Virus Itself

While the general stress and loneliness instigated by the pandemic are likely causing increases in anxiety and depression for many, emerging studies show that there may also be a direct connection between COVID-19 diagnoses and the rise of depression during the pandemic. In other words, it could be that the infection itself plays a role in the onset of mental health issues.

Research published in The Lancet shows that a striking 18 percent of COVID-19 patients developed mental health issues, including depression, anxiety, and even dementia, within three months of diagnosis. Such studies support the notion that COVID-19 may be responsible not just for physical symptoms, but for mental side effects too.

Managing Depression After COVID-19

Thankfully, there are a number of steps you can take to mitigate symptoms of loneliness and depression and improve your mental health if you’re struggling with depression even after the factors above have resolved.

Helping Others to Help Ourselves

Taking care of your friends and family can be a tremendous stress reliever. Studies have shown that simply being kind and compassionate toward others is directly linked to feelings of happiness and positivity for people of all ages. Moreover, strengthening connections with others can remind us that, despite how we might feel, we are not alone.

Seeking Professional Support

In addition to interpersonal support, we should also seek professional support when necessary. Both mental and physical support options are available to most people and can boost mental health and alleviate symptoms of depression, anxiety, and other mental health conditions. Because stress has been known to weaken the immune system , seeking support to reduce stress levels could also help bolster your defenses against future infections.

There are many depression treatment options to choose from. Understanding what options are available can enable you to select the best course of action for your unique situation. Reaching out to a licensed therapist is one option, as is seeking treatment in the form of transcranial magnetic stimulation (TMS). TMS therapy involves the use of non-invasive, FDA-cleared devices to stimulate areas of the brain connected to mood regulation. When other treatment options have failed to have a positive impact on alleviating depressive symptoms, TMS may boost a patient's mental health, and the treatment has proven to be a strong contender in the fight against depression.

Hope for the Future

There is hope on the horizon for the end of the COVID-19 pandemic, but the symptoms of depression amid COVID-19 are becoming increasingly prominent. Fortunately, we can all take proactive steps now to boost our mental health and navigate the current climate.

When Depression is Affecting Your Work: Signs to Recognize

dhageman@innovasium.com (Daniel Hageman) — Mon, 12 Jul 2021 16:48:47 GMT

Medically Reviewed on 5/13/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

When it feels difficult to just get through the day, facing challenging tasks at work can be overwhelming. And the feeling that you're not doing your best on the job may exacerbate your symptoms, especially if you tie your identity to your work.

If depression is affecting your work, it can feel isolating—but it's actually more common than you'd think. According to the Centers for Disease Control and Prevention, in any given year, roughly 10 percent of American adults will experience depression, translating into nearly 200 million days of missed work due to mental health sick days.

However, there is hope. First, it's important to understand how depression is affecting your work specifically, since there's a range of factors with both short- and long-term effects. There are also a number of support and treatment resources you may have access to through your job that can help.

Navigating Depression at Work

Most people are familiar with the emotional symptoms of depression, and it's not difficult to see how they might affect your work performance. Especially in a culture that rewards keeping emotions out of the workplace, putting your head down, and getting things done, emotional symptoms can be challenging to navigate at work.

You may feel sad, empty, or hopeless, wondering what the point of anything is, especially work. Feelings of worthlessness and a lack of confidence may hold you back from accomplishing tasks and projects because you feel like your contributions don't matter. And even if you are typically a self-starting high performer, finding the motivation to get started on a project may feel impossible.

The emotional effects of depression can also impact your relationships with those you work with, from colleagues to clients. You might withdraw from or be short with others, and if you interact with other people frequently, this may start to affect your reputation around the workplace.

Understanding the Physical Symptoms

Physical symptoms of depression sometimes go overlooked, but they're equally liable to present challenges at work.

Depression symptoms can sometimes cause you to feel as though you're trudging through molasses to get the most basic of tasks done. Fatigue is a common symptom, often going hand in hand with either insomnia or hypersomnia (sleeping too little or too much). You may just feel like you want to nap all the time, making it hard to get work done. Frequent dull tension headaches are possible as well and can lead to difficulty concentrating.

You may also experience psychomotor agitation or psychomotor retardation at work. Psychomotor agitation might look like endlessly pacing the room or fidgeting externally; internally, you may be experiencing racing thoughts. Frequent staring off into space, slow walking, and decreased cognitive ability and focus are all signs of psychomotor retardation. Both of these symptoms can make it hard to get work done, either because you are too fidgety to sit down and focus or because your brain is too sluggish to find motivation.

Identifying Stress at Work

As you might expect, sometimes work itself can cause or contribute to depression. You may be feeling spread too thin by an overload of responsibilities and duties, or the sheer pressure of your work may be taking a toll. On the other hand, you may not be feeling challenged enough, and you're bored without a clear path of career advancement.

With many people spending 40 hours a week or more at their jobs, tension and disputes with coworkers can worsen depression and undermine your quality of life. Not only can work thoughts take up mental space after hours, but smartphones and an always-on culture—not to mention the remote work trend brought on by the COVID-19 pandemic—mean there's a good chance that your work stress is persistent and pervasive. Compensation might also be a point of contention if you feel you're being undervalued or struggling to make ends meet.

Looking to the Future

Depression can mean seeing the future through a gray, foggy filter. You may believe things will never get better, and so your only focus is making it to the weekend so you can have a break. But while depression can make each workday a challenge, it can also take a toll in the longer term.

It can be difficult to set the career goals you're truly capable of when you're struggling with forward thinking and making an accurate assessment of your skills. A lack of faith in yourself may prevent you from engaging in self-advocacy or lobbying for a deserved promotion—and then you may feel guilt because you didn't speak up for yourself when you know you should have. With your confidence rattled, these may be bigger risks than you are ready to take, even though you have the skills and ability.

Finding Treatment—and Hope

The good news is that depression is highly treatable and, more than ever, workplaces recognize the need to focus on their employees' mental health. Many large corporations even offer free or low-cost mental health resources, in addition to health insurance coverage.

If you're navigating depression at work, consider talking to your manager. Certain accommodations, such as a more flexible work schedule or extended deadlines, where feasible, might be a good place to start. Additionally, they may be able to point you to how or where to get help within the company. They can vouch for you and your performance to their higher-ups, if necessary. Or, if your performance has only been minimally affected, perhaps you are just looking for a little empathy and understanding so that you feel less alone.

If your company has a human resources representative, they can also help you navigate your options. Many companies have Employee Assistance Programs that offer short-term counseling, as well as referrals to mental health professionals, such as therapists or psychiatrists. Further, HR can help you demystify your mental health benefits by highlighting what is covered. Your health insurance may cover more of your mental health treatment than you think, thanks to the Mental Health Parity and Addiction Equity Act that requires insurers to provide mental health benefits with equivalent limits and coverage to physical benefits. If you've already tried talk therapy and medications, treatments like transcranial magnetic stimulation may even be covered in full.

Even if depression isn't holding you back from performing at work and advancing your career, you deserve to feel your best. Getting help isn't about getting by—it's about getting the most out of life.

Migraines and Depression: Can Treating One Help the Other?

Sun, 11 Jul 2021 20:45:02 GMT

Medically Reviewed on 6/29/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

One of the worst aspects of migraines is that they can strike at any time. Whether you're heading to the beach with your family, taking an important test, or trying to get through a shift at work, a migraine is a sure way to derail your plans. If you experience debilitating migraine headaches, you are certainly not alone. Migraines are among the most common health conditions, and affect around 1 out of 7 adults, according to Migraine Trust .

Migraines and Depression: Is There a Link?

One highly researched aspect of migraine is its relationship to depression. According to the Anxiety and Depression Association of America , roughly 40 percent of people with anxiety and depression also experience migraines. This suggests that if depression is effectively treated, migraines may also subside or become less frequent.

The causal relationship between these conditions is not entirely clear, but it may be due to a shared genetic cause, environmental exposure, neurochemical activity within the brain, or a combination of these factors. According to Psychiatry Advisor , imaging studies have demonstrated that the same structures in the brain, specifically the structures responsible for mood, motivation, and affect, are affected in both depression and migraine.

Aggravating Factors

Migraines and depression in combination can cause a variety of negative effects. For people who have several debilitating migraines each month, not knowing when they will suddenly have to take a day off from work or be unable to participate in a family event can cause sadness, anxiety, and a feeling of lack of control.

A well-known migraine prevention strategy is to follow a routine of good migraine hygiene every day. Going to bed at the same time each day, taking medications at set intervals, and managing stress are all components of good migraine hygiene. If you have depression, however, you might not feel motivated to get up and cook a healthy breakfast for yourself regularly, or you might forget to take your medications or suffer from a bout of insomnia, which could trigger migraines.

We know that treating depression is important for migraine sufferers. Antidepressants and talk therapy are usually the first line of treatment for depression. That said, they don't work for everyone. In fact, roughly one-third of people with depression don't find relief even after trying two medications. If you fall into this category, consider Transcranial Magnetic Stimulation (TMS) therapy. TMS uses gentle magnetic pulses to activate specific brain regions involved in mood and emotion regulation

Is TMS a Good Option for Migraine Sufferers?

Headaches (not migraines) can be a side effect of the TMS therapy, which can make people with frequent migraines worry about getting TMS. An experienced TMS provider can change the sequence and treatment plan to prevent TMS from causing undue pain or discomfort. If your migraines cause you to frequently miss school or work, it can also seem like TMS therapy isn’t an option because it requires coming into the office five days a week for six to nine weeks. Rest assured that it’s fine if you need to skip a day or two of TMS treatment here or there to accommodate your migraine days. We’ll work with you.

Danielle, a patient at Greenbrook TMS, shared details about her treatment experience and the responsiveness of Greenbrook staff in adapting her sequence to prevent migraines: "For my first session at Greenbrook TMS, I wasn't nervous. . . . The only thing I was taken aback by is that I have chronic migraines and the intensity of the pulses was a little too high. The staff immediately noticed I flinched, so the doctor and techs went down on the intensity, and we went more slowly building up, so it wasn't scary. Within two or three sessions, I was relaxed during the whole procedure, no problem at all. I felt like, I'm doing this and it's going to get better."

If you are one of the millions of Americans who experience depression and migraines, consider scheduling a no-cost consultation to learn whether TMS might be right for you.

TMS FAQs: What Are the Side Effects of TMS?

Sat, 10 Jul 2021 20:45:02 GMT

Medically Reviewed on 6/10/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

When considering any kind of mental health treatment, you'll want to ensure that you have as much information as possible to inform your decision. If you're interested in trying transcranial magnetic stimulation (TMS), you may be wondering, what are the side effects of TMS?

One of the major advantages of TMS is that it's non-systemic, meaning that any side effects of TMS for depression tend to only impact the treatment site—not the rest of your body. Any potential reactions should only occur within the few hours following your treatment, and they tend to dissipate quickly. TMS is often better tolerated than other depression treatments, such as antidepressants, due to this low side effect profile. Read on to understand what the possible side effects are and how common each one is.

Most Common Side Effects of TMS

Headaches are the most common side effect you might face during TMS treatment—up to 50 percent of people may experience them. However, they are typically mild and decrease over your treatment cycle. Your doctor may adjust the level of stimulation you receive or recommend an over-the-counter pain medication before your session, if necessary.

Some tingling or discomfort on your scalp or face is another common—but mild—side effect seen during TMS treatment. Approximately one-third of people trying TMS report feeling this sensation. The stimulation from TMS can also make the muscles around your eyebrow or other parts of your face twitch during stimulation. This might feel odd, but people get used to it quickly. The good news is that if you experience this during treatment, your technician can usually adjust the coil positions and stimulation settings to ease the discomfort.

Less Common Side Effects

There are a few less common side effects to be aware of. One is lightheadedness or dizziness. There are a few less common side effect to be aware of. One is a feeling of lightheadedness or dizziness during treatment. This is temporary, and usually mild. Normally, this improves with simple measures, such as a brief break during treatment..

People undergoing TMS therapy occasionally experience mild nausea. This is typically brief, and seldom requires anti-nausea medicine.

Seizures are the most serious—but also most rare—side effect. For those without risk factors, studies found that TMS caused fewer than 1 seizure per 60,000 sessions . Several risk factors to be aware of are sleep deprivation, family history of seizures, alcohol use, previous neurological conditions, or medications known to lower the seizure threshold. Also of note, a recent Clinical Neurophysiology study showed that the chances of seizure decreased over the course of treatment.

All in all, many people won't experience any reactions, and those who do typically experience mild reactions that resolve quickly. Any treatment comes with potential side effects, but when compared with other available options, the side effects of TMS for depression are very few.

How Does This Compare to Other Depression Treatments?

Compared to those associated with antidepressants, the side effects of TMS are minimal. Antidepressants can be difficult on your body, and sometimes on your mind, with a range of side effects throughout many different systems. Common antidepressant side effects include weight gain, sexual issues, fatigue, nausea, and insomnia, all of which may impact your mood further. Antidepressants may also negatively affect your emotional well-being directly, potentially causing agitation and anxiety. These antidepressant side effects may linger, while most TMS side effects are short-lived.

To learn more about whether TMS might be right for you, schedule a no-cost consultation today.

What is Agitated Depression? Dealing with Restlessness and Depression

Fri, 09 Jul 2021 20:45:02 GMT

Medically Reviewed on 6/29/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Typical media depictions of depression might lead you to believe that depression only presents as total apathy, sadness, and a lethargy that causes you to want to stay in bed all day. Yet up to 25 percent of people with depression actually experience agitated depression symptoms, which can be quite the opposite.

What is agitated depression, and how do its symptoms differ from other symptoms of depression? Agitated depression occurs most often in people with major depressive disorder, when they are having a major depressive episode. In many ways, these episodes may be similar to a typical major depressive episode, but if you're feeling particularly agitated, it's worth recognizing how that agitation relates to depression and how the right treatment could provide relief from your symptoms.

What Is Agitated Depression?

Agitated depression isn't an official diagnosis; it's simply a way of referring to a major depressive episode with symptoms that relate to agitation. Potential causes of agitated depression generally overlap with those of depression, which may include trauma, recurring stressors, genetic predisposition, or hormonal imbalances such as those caused by thyroid problems.

With agitated depression symptoms, you might find yourself snapping at your partner or feeling restless and frustrated regardless of the circumstances. For instance, a seemingly small stressor, like your roommate not doing the dishes, could cause you to become more upset than the situation warrants. You might feel too depressed to leave your house but also feel anxious and trapped while you are at home. These seemingly conflicting feelings may feel difficult and uncomfortable to reconcile. Other symptoms of agitated depression include irritability (especially over small things), anger, fidgeting, restlessness, pacing, and incessant talking.

Treatment for Agitated Depression

If the above symptoms seem like they apply to your situation, you may want to consult a doctor, especially if the symptoms are affecting your life significantly. Agitated depression symptoms can be associated with depressive episodes in both unipolar depression (depression without mania, also known as major depressive disorder) and bipolar disorder (characterized by depression and mania), so you will want to consult with a doctor to investigate whether you are experiencing one condition or the other to get a proper medical diagnosis. Agitated depression may also be called depression with mixed features , or a major depressive episode in which both manic symptoms and depressive symptoms occur.

Treatment for agitated depression usually includes medication, talk therapy, or some combination thereof. While a major depressive disorder diagnosis is generally treated with antidepressants, agitated depression—especially if it accompanies a bipolar diagnosis—may be treated with mood stabilizers, antipsychotics or anti-anxiety medications. A mood stabilizer can help to reduce the drastic swings between lethargy and agitation, while an anti-anxiety medication can provide some relief from the physical symptoms of anxiety or agitation, such as tense muscles or a racing heartbeat. Cognitive behavioral therapy (CBT) may also be used to find healthier ways of coping with irritation.

Other Options for Treatment

If you have tried one or several medications and haven't found relief yet, there is good reason to remain hopeful and persist in your search for a working treatment. In fact, only about 30% of people find the right medication for them on the first try. In some cases, your current medication might even be causing your agitation , which could mean that a different treatment may be better for you.

There are also options you could consider beyond medication. For example, transcranial magnetic stimulation , or TMS, is a treatment that has proven effective for many people who still experience depression symptoms after trying medication and talk therapy treatments. With TMS, magnetic pulses gently stimulate regions of the brain responsible for regulating mood. Unlike other non-medication treatment options, TMS is non-invasive, and the sessions tend to be short, with each one lasting only 30 minutes or less. Another bonus of TMS is that the side effects are minimal and usually dissipate quickly after the session. Agitated depression can feel like an inner tug-of-war, but the condition is treatable. With the right treatment, you can find relief from your depression symptoms and enjoy a more peaceful life.

Minority Mental Health Awareness Month Resources 2021

dhageman@innovasium.com (Daniel Hageman) — Fri, 09 Jul 2021 18:01:57 GMT

Whether you’re interested in learning more about the importance of mental wellness or would like to find treatment for a mental health condition, we’ve compiled a list of resources and information from groups including Mental Health America (MHA), National Alliance on Mental Illness (NAMI), Anxiety and Depression Association of America (ADAA), and the U.S. Department of Health and Human Services Office of Minority Health (OMH) below.

No matter who you are, we urge you to reach out for help if you’re struggling with your mental health.

For immediate help

If the situation is potentially life-threatening, get immediate emergency assistance by calling 911.

The National Suicide Prevention Lifeline

The SAMHSA National Helpline

Mood Swings: Mental Health Issue or Something Else?

Thu, 08 Jul 2021 20:42:13 GMT

Medically Reviewed on 6/29/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Mood swings, mood instability, mood lability; whatever you want to call it, can be frustrating and difficult. When your mood is unpredictable, it can interfere with relationships, work, school, and your leisure activities. Situations you normally handle with ease can feel exhausting and overwhelming. Further, the causes of mood swings can seem like a mystery, and that uncertainty can be discouraging. That said, don't lose hope: it's usually possible to find the underlying causes of mood swings, and those underlying causes can usually be treated.

Understanding Mood Swings

It's important to recognize that mood swings are much more than just your being sensitive. They're significant, uncontrollable changes in mood that can impact your day-to-day life and are often signs of a larger issue. There's a harmful stereotype that mood swings only affect women, but the truth is they can happen to anyone. There are many causes of mood swings, including medical conditions, life circumstances, sleep problems, and psychiatric conditions. If your mood has been unpredictable recently, take the time to learn more about the medical and mental health conditions that can be causes of mood swings. This way, you can better understand your symptoms and find a treatment that helps you feel more balanced.

Identifying Common Causes of Mood

Mood swings can be an important sign of a possible medical or mental health condition. While it is normal to have some good and bad days or some degree of mood variation, if the frequency and severity are creating problems for you, it is important to receive an evaluation from a medical provider. Your mind and body may be trying to tell you something about your health.

The following are some of the most common underlying causes of mood swings:

Medical Conditions

There are several medical conditions than may be causes of mood swings. Patients with thyroid disease, particularly overactive thyroid (hyperthyroidism) may find themselves having periods of anxiety or rage that can seem unpredictable and not related to the environment. Alterations in blood sugar levels, particularly lower blood sugar, can cause anxiety and irritability. Alterations in your body's hormone levels can also be associated with causes of mood swings. In fact, the list of conditions associated with mood swings, including dementia, is very extensive and a good place to start for help is with your primary care provider, especially if these symptoms are relatively new.

Head Injury

Head injuries, even minor concussions, can another of the causes of mood swings. We know that even though a brain MRI might be normal, head injury can be associated with disruption in the architecture of nerves, which interferes with their function and changes the way nerves communicate with each other in the brain. This can lead to a loss of mood control and unpredictable mood changes. There are treatments available so if you have noticed mood problems after a head injury, it is important to seek medical help.

Stress

Worries, frustrations, an unhappiness can strain our reserves. As we become overwhelmed, we may find our tolerance starts to decline and those emotions can start to leak into other situations as mood swings. Managing stress can be key to keeping this under control. While these kinds of reactions can be normal, if the severity and frequency of mood swings becomes problematic, a therapist may be able to help you with sustaining perspective and incorporating strategies for managing stress.

Sleep Deprivation and Sleep Disorders

Our brains are very active during sleep, consolidating memories and resetting metabolic states during different stages of sleep. When we can't complete all the stages of sleep because of frequent awakenings, a sleep disorder disrupting your natural sleep stages, or inadequate sleep preventing all stages of sleep from completing, then our brains function less efficiently and this can cause mood swings. Sometimes sleep apnea or another sleep disorder can only be confirmed with a formal sleep study. If you find you have persistent difficulty with sleep or if you feel your sleep is not restful, consider reaching out to your physician for evaluation.

Substance Use

Alcohol or illicit drug use can cause mood swings through various mechanisms. Intoxication can alter brain function and decrease the efficiency of thinking, resulting in uncontrolled moods. Withdrawal can also cause abnormalities in brain function and physical discomfort. Addiction and drug seeking behaviors may impair being mentally present and result in moods that are not reflective of life events. Long standing substance use can damage areas of the brain leading to emotional leakage. All of these can be causes of mood swings.

Personality

Some people have more dynamic personalities and shift moods more easily or quickly than others. For some people, this is a harmless personality quirk. For others, it can be problematic and interfere with work, school, or relationships. If that’s the case, therapy may be useful.

Psychiatric Conditions

Some psychiatric conditions can have mood swings as a component. These can include anxiety (catastrophic thinking leading to distress and irritability) and PTSD (hypervigilance causing unpredictable anxiety and irritability). Note that while it’s common to refer to the cycling of moods in bipolar disorder as “mood swings,” rapid cycling bipolar patients have at least four mood episodes in a year, each lasting days to weeks on end. This is different than the typical hour-by-hour mood fluctuation of the mood swings outlined in this article. If you think your mood swings may be caused by a psychiatric condition, a mental health provider can help you with diagnosis and treatment suggestions.

Getting Treatment for Mood Swings

If mood swings are taking you for a bumpy ride, remember you have options. Contact your doctor to discuss your symptoms and keep searching for a treatment that helps. If past treatments for mental health conditions such as depression haven't worked, consider looking into transcranial magnetic stimulation (TMS) therapy . TMS stimulates areas of the brain involved in mood regulation—the same areas known to be underactive in those with depression. No matter what causes your mood swings, you deserve to find a treatment that works for you.

Don't Avoid Medical Care Because of COVID-19

Thu, 08 Jul 2021 20:42:03 GMT

Medically Reviewed on 6/10/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

COVID-19 has consumed our thoughts and kept us quarantined, triggering another medical crisis. Many people are avoiding medical care because they fear leaving the safety of their homes and getting COVID-19. Some might wait too long before seeking urgent lifesaving treatments for heart attack, stroke, or appendicitis, or they might postpone regular vaccinations or cancer screening.

Others might put off getting essential therapies and medications for chronic conditions, such as heart disease, diabetes, and asthma, causing their health to deteriorate. Many people aren't seeking therapy for mental health problems as well, even though the rates of COVID-19 and depression have both been rising.

A study from the U.S. Centers for Disease Control (CDC) showed that an estimated 41 percent of adults in the United States had delayed or avoided emergency or routine medical care because of concerns about COVID-19. According to a study in the Journal of the American Medical Association , avoiding medical care because of COVID-19 could claim tens of thousands of lives indirectly "through delayed care for acute emergencies, exacerbations of chronic diseases, and psychological distress (e.g, drug overdoses)."

Don't Stay Home If You Require Health Care

Early in the pandemic, visits to hospital emergency rooms across the country declined 23 percent for heart attacks and 20 percent for strokes, according to a CDC study . For potentially life-threatening conditions such as these, "the sooner emergency care begins, the better are the chances for survival," the CDC report said. Fearing exposure to COVID-19, some parents have put off measles, polio, and other routine vaccinations for their children. Doctors say that these delays put families and their neighbors at risk of contracting other debilitating and deadly diseases.

A study of 20 institutions found that in the first four months of last year, screenings for breast cancer and colon cancer both fell by more than 85 percent . As another study put it, "While residents have taken to social distancing, cancer does not pause." Patients whose cancers aren't caught early usually need more intensive treatment and are more likely to die of the condition.

Heart disease, cancer, and stroke are on the long list of chronic diseases that six of 10 Americans suffer from. Other conditions on the list include hypertension, diabetes, Alzheimer's, chronic lung disease, obesity, and cerebral palsy. Without consistent care, treatment, and medications, all of these chronic illnesses can quickly worsen, which might also cause or increase symptoms of depression .

Not seeking treatment for an underlying condition is just one factor linking COVID-19 and depression. The stress and social isolation caused by the pandemic can also have a considerable impact on a person's mental health. In fact, more than 40 percent of people surveyed by the CDC reported struggling with mental health between April and June 2020. Additionally, the annual Gallup Poll assessing Americans' mental health showed that Americans believe their mental health is at the lowest point since the survey began in 2001.

Avoiding Health Care Could Increase Your Risk of Contracting COVID-19

Having an acute or chronic illness, such as depression , can increase a person's risk of contracting a worse—and perhaps fatal—case of COVID-19. If you are sick, you can't afford to sit back and wait for the condition to subside on its own. You need to act now and seek the medical treatment you require to remain well and spare yourself from additional suffering or death.

Health care providers are intensely aware of how important it is to take care of their patients . Despite the challenges caused by COVID-19, hospitals and health clinics have implemented safeguards to minimize their patients' risk of exposure to the virus. These precautions include stringent disinfecting protocols, procedures to maintain physical distancing, and telehealth services.

In this time when mental health treatment is so urgently needed, Greenbrook TMS NeuroHealth Centers offers another option for relieving symptoms of depression: transcranial magnetic stimulation (TMS) . This non-invasive, non-drug treatment uses gentle magnetic pulses to improve brain signaling and support better mood regulation. Greenbrook strives to make it as easy as possible for you to schedule appointments in our private centers, providing face-to-face and telehealth consultations. To discuss whether transcranial magnetic stimulation (TMS) therapy may be right for you, consider scheduling a no-cost consultation .

4 Questions to ask your TMS Provider Before Treatment

Thu, 08 Jul 2021 20:40:40 GMT

Medically Reviewed on 6/29/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Like many people, you may have sought information online before deciding to get a TMS consultation. You may also be nervous about whether you know exactly what to ask your doctor about this treatment option. We at Greenbrook TMS applaud patients who want to be informed and advocate for their health, and we firmly believe that you have a right to know about your doctor's background and the treatment at hand. No provider should be offended by your questions, and you should find a TMS doctor who is willing to answer any questions you might have.

An outdated view of the doctor-patient relationship is that the patient should do whatever their doctor tells them to, rather than the patient being informed and then agreeing with their doctor's assessment and treatment plan. In a modern doctor-patient relationship, you can participate in your health care by researching beforehand and advocating for yourself.

If you're feeling nervous about questioning your doctor, adopting this view of the doctor-patient relationship may help. After all, you are a consumer of health care, and that means you're paying money for a service. Think of choosing health care the same way you might choose a dish at a restaurant. The staff is there to guide your choice, but the decision ultimately is yours. If you're not sure what to ask your doctor, here are five questions to start the conversation.

1. Who Will Perform My Treatments?

You have a right to know who is treating you, first and foremost. You can ask where your provider went to medical school, what their specialty is, and whether they are board-certified. You can also ask how they maintain their certification for TMS and whom they go to for consultation for a question they have. You deserve to know the circumstances of your care.

At Greenbrook your doctor will perform a test to identify your motor threshold, which is how we determine your treatment intensity and location. After your first treatment, a TMS technician will treat you based on the motor threshold sequence your doctor previously determined.

2. How Long Have You Been Doing TMS?

TMS has only been more common for the last several years, so your care provider might not have been trained in TMS in medical school or residency. That’s okay, so long as they’ve had training and experience in the field. Other questions you might ask with respect to training include, "How did you train?" and "How many cases do you treat a year?" With all medical treatments, provider experience is important, and if you are only a doctor's third case, you have a right to know that.

3. What Are Your Outcomes?

You should feel comfortable asking how many of your provider's patients see improvements, face setbacks, or experience side effects, as well as how those outcomes are determined. If your provider's outcomes are generally not favorable, you should be aware of that. While unfavorable outcomes may be the result of particularly difficult cases, it could also be a red flag that prompts you to seek a second opinion.

4. Will TMS Work for Me?

You want to make sure TMS therapy is clinically appropriate for you and that you understand why your doctor is recommending TMS therapy. You can also ask how many sessions you will have, what the schedule will be, how long the treatments will last, and whether you will need to return for more treatments.

In addition to asking the questions suggested here, you may want to do your own research on TMS therapy once you find a suitable doctor so you can decide what to ask them. Apart from Greenbrook's website , you can see videos of TMS on our YouTube channel to aid in forming your own questions.

You are always welcome to bring someone with you to an appointment to advocate for you, though the pandemic may pose some restrictions, so check with your provider before you bring someone into the clinic. We at Greenbrook TMS are committed to answering your questions and supporting you on your journey to find a TMS doctor.

Greenbrook in Your Community: NAMI Walks 2021

dhageman@innovasium.com (Daniel Hageman) — Thu, 08 Jul 2021 20:34:15 GMT

Join Greenbrook for NAMI Walks

2021!

Greenbrook TMS is a proud sponsor of NAMI Walks 2021!

Every year, NAMI Walks take place across the country to raise awareness of and support mental health programs. This year's theme is "A United Day of Hope" and events are taking place both virtually and in-person.

Come out and join us, we'll be in your community! Click on an event below to register and get more details.

NAMIWalks Your Way Greater Cleveland

Saturday, September 11, 2021

In person: Edgewater Park's Kite Field

virtually through social media and NAMI Live feeds

Greenbrook in Your Community: Celebrating Pride 2021

dhageman@innovasium.com (Daniel Hageman) — Thu, 08 Jul 2021 20:29:03 GMT

Join Greenbrook for Pride 2021!

Greenbrook TMS is a proud sponsor of Pride 2021!

Come out and join us, we'll be in your community! Click on an event below to register and get more details.

San Diego Pride Fest

Saturday, July 17, 2021 @ 9am - Sunday, July 18, 2021 @ 10pm
Multiple Locations

San Diego, California

Austin Pride Parade

Saturday, August 14, 2021

Congress Avenue

Austin, TX

Akron Pride

Saturday, August 28, 2021 @ 11am - 10pm
Downtown Akron

Akron, OH

Mid Missouri Pride Fest

Saturday, August 28, 2021 - August 29, 2021
Rose Music Hall

Columbia, MO

Hartford Pride

Saturday, September 11, 2021 @ 10am
Bushnell Park

Hartford, CT

Charlotte Pop-Up Pride

Saturday, September 18, 2021
Location (TBD)

Charlotte, NC

Blue Ridge Pride

Saturday, September 25, 2021 @ 10am-7pm
Pack Square Park
Asheville, NC

Pride in the Park Sarasota

Saturday, October 23, 2021 @ 12 - 5pm

J.D Hamel Park

Sarasota, FL

Annapolis Pride Festival

Postpon ed

June 2022

Greenbrook in Your Community: Out of the Darkness 2021

dhageman@innovasium.com (Daniel Hageman) — Thu, 08 Jul 2021 20:11:06 GMT

Join Greenbrook for Out of the Darkness 2021!

Greenbrook TMS is a proud sponsor of Out of the Darkness 2021!

Out of the Darkness Wa lks are the American Foundation for Suicide Prevention's (AFSP) signature event, with walks across all 50 states that support suicide prevention programs, bring together those who have been affected by suicide, and create communities.

Come out and join us, we'll be in your community! Click on an event below to register and get more details.

Anchorage Walk

Saturday, September 11, 2021

Chuck Albrecht Softball Complex

Anchorage, AK

Ventura County Walk

Saturday, September 18, 2021

Constitution Park

Camarillo, CA

St. Louis Walk

Sunday, September 26, 2021
Creve Coeur Lake Park

St. Louis, MO

Loudoun Walk

Sunday, September 26, 2021
Ida Lee Park

Le esburg, VA

Kalamazoo/Southwest Michigan Walk

Sunday, September 26, 2021

Celery Flats

Portage, MI

Salem-Roanoke Walk

Saturday, October 2, 2021

Venue TBD

Salem, VA

Portland Oregon Walk

Saturday, October 2, 2021

Veterans Memorial Coliseum

Portland, OR

Hamden/New Haven Walk

Sunday, October 3, 2021

Venue TBD

Hamden, CT

Cleveland Walk

Saturday, August 1, 2020
Location to be announced
Charlotte, NC

San Diego Walk

Saturday, October 16, 2021
NTC Park at Liberty Station
San Diego, CA

Austin Walk

Saturday, October 23, 2021

Texas State Capitol (Pending Guidelines)

Austin, TX

Baltimore Walk

Date/Venue TBD

Baltimore, MD

Greater Houston Area Walk

Saturday, November 6, 2021

Town Green Park

The Woodlands, TX

Charlotte Metro Walk

Saturday, November 6, 2021

Symphony Park

Charlotte, NC

Tampa Walk

Saturday, December 4, 2021

Al Lopez Park

Tampa, FL

What to Do If Your Antidepressants Stopped Working

Thu, 08 Jul 2021 20:00:02 GMT

Medically Reviewed on 5/18/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

You can feel them creeping back into your life: sadness, negative thoughts, sleepless nights, and other familiar depression symptoms. You're worried your antidepressants stopped working, even though you've been feeling better for a while. Now what?

Finding an effective antidepressant can be a challenge, so this situation can be frustrating and disheartening. But there could be more to the story—your old symptoms may be more noticeable again for many reasons, and not all of them are directly related to your medication. So if you think the effects of your antidepressants are wearing off, your next step is to gain a better understanding of your overall health. Here's what you need to know.

Assessing If—and Why—Your Antidepressants Stopped Working

Before your doctor can make any changes to your treatment plan, be sure to do the following. First, keep taking your medication exactly as it was prescribed. Second, observe your symptoms for about a week to see how things develop. Describe what they were like when your medication was working and how things have changed recently.

Having more noticeable symptoms once in a while doesn't mean your medication is failing you. However, feeling worse for several days in a row could be meaningful. Consider how the following three factors can help you determine your next step.

1. Your Diagnosis and Other Conditions

Your doctor makes your depression diagnosis with the best information they have at the time. At some point, you may need to revisit your diagnosis and examine how other issues could be part of the picture.

Start by reviewing the original diagnosis. You may have bipolar depression instead of major depressive disorder, for example, or perhaps a new mental health issue is developing. You may also have a new or undiagnosed medical condition that's interfering with your ability to navigate your symptoms. Sometimes issues like thyroid disease or diabetes cause imbalances in your body that can affect your mood.

At the same time, if you've gone through a period of significant weight loss or have a medical condition affecting your digestive system , your body may not be able to absorb medication as well as it did previously. Inflammatory bowel disease, Crohn's disease, or gastric bypass surgery could have this effect on antidepressants.

Finally, simple aging can affect the way your body responds to medications. Changes to your blood-brain barrier, the density of your nerve cell receptors, and a slower response to medication can all make a difference. What worked for you at age 25 may not work the same way at 55 or 60.

2. The Medication Itself

Do the effects of antidepressants wear off? Your medication can become less effective for several reasons, even if it's helped for a while. Talk with your doctor about whether your medication is being absorbed into your body correctly. Again, absorption can be impacted by medical issues and the effects of aging, and another medication may work better for your body now.

Next, look closely at how you're using your medication. Has anything changed your ability to take it as prescribed, even just a few times? This could explain why its effectiveness has changed, and your doctor can help you find a regimen that fits with your current schedule.

Finally, check to see if your pharmacy switched to a generic version of your medication. Even when the active ingredient is the same, some variations in generic medications can change how they work in your body.

3. Your Life Circumstances

If you've recently gone through a life transition or a period of grief, your symptoms may be part of a normal but temporary reaction. You may feel better with more emotional support from others or lifestyle changes. A short-term adjustment to your treatment may be appropriate if you're not functioning well.

What If You Need to Change Your Depression Treatment?

Depending on what you discover by exploring these factors, it may be time to change your depression treatment plan. Consider these possibilities to get your journey back on track.

Try a Different Antidepressant

Less than half of all adults using antidepressants find success on the first try. So, if you need to choose something different, it may take some trial and error. The good news is that you have many safe and effective choices to work with.

Add Another Medication

If your antidepressant relieves most of your symptoms, your doctor might add a second medication to fill in the gap. Called augmentation, this strategy can improve your symptoms without switching medications. While you may have more potential side effects to consider, a combination approach may give you the best relief.

Seek Counseling

Medication and counseling (also called therapy, or psychotherapy) can be an effective combination for depression symptom relief, often better than either treatment alone. If you're currently in therapy, talk to your therapist about improving your symptoms. You may consider a different approach or more frequent sessions. And if you're not in counseling right now, then this may be a good time to start.

Look into TMS

Even after trying two antidepressants, one-third of people don't find relief from depression. If you find yourself in this situation, it may be wise to consider transcranial magnetic stimulation (TMS) therapy. FDA-cleared for treatment-resistant depression, TMS is a non-invasive treatment that could help you start feeling better within a few weeks. With TMS, a handheld device delivers magnetic pulses to specific areas of the brain that regulate emotion and mood. Treatment sessions are short and can be safely scheduled into your regular routine. In some cases, the combination of partially effective medications and TMS is enough to bring complete relief.

It's important to take the time to observe and understand how helpful your current antidepressant treatment is before making a change, but it's possible that TMS is an effective way to treat your symptoms. To learn more about whether TMS is right for you , schedule a no-cost consultation .

Is TMS Right For Me? 4 Questions to Ask Yourself

Mon, 05 Jul 2021 19:45:02 GMT

Medically Reviewed on 5/18/2021 by

Dr. Steven Harvey

Regional Med ical Director Greater St. Louis

Depression can be challenging to treat. Many people eventually find relief, but it can take trying talk therapy, medications, and more to get there. If you've already tried therapy and antidepressants without finding relief, you may have talked to your provider about transcranial magnetic stimulation (TMS). Since TMS is a treatment some providers are still gaining familiarity with, even after discussing it, you may be left wondering if TMS is right for you.

What Is TMS Therapy?

TMS therapy is an FDA-cleared method for treating major depressive disorder (MDD) and other conditions. It works by using a non-invasive handheld device to deliver soft magnetic pulses that stimulate areas of the brain associated with mood regulation. TMS treatment typically takes place five days a week over the course of six to nine weeks, with each session lasting about 30 minutes. Side effects are minimal and typically subside quickly. Some mild reactions include headache, scalp discomfort, and slight tingling in facial muscles.

Is TMS Therapy Right for Me? 4 Questions to Ask Yourself

To help you determine whether TMS therapy is right for you, consider the following four questions.

1. Have You Been Diagnosed with Depression?

To receive TMS therapy for depression and have it covered by your insurance, you will need a diagnosis of MDD, also known as clinical depression. A therapist or psychiatrist can evaluate you by asking you a series of questions, including how long you have been feeling depressed, how your appetite and sleep are, if you are experiencing fatigue or a lack of focus, and how these symptoms are affecting your life.

While TMS is also FDA-cleared for other conditions also, it has been used mostly in patients with major depressive disorder, with more than 50 percent of individuals studied responding that their symptoms were reduced in intensity by half. Nearly 40 percent enjoyed remission or a complete absence of symptoms.

2. Have You Tried Other, First-Line Treatments?

TMS is not considered a first-line treatment, so your insurer will typically want to see at least two ineffective medication attempts before it will pay for your TMS treatment. Your insurer may also want to see that you have tried evidence-based psychotherapy, such as cognitive behavioral therapy (CBT). However, given that one-third of people continue experiencing depression symptoms even after trying two medications, you may be among those who qualify for TMS and have their treatment covered by insurance.

3. Do You Have Any Other Conditions?

While TMS is generally associated with a low side effect profile, there are conditions that can make TMS treatment impossible. For example, if you have non-removable metal in your head, you are not a candidate for TMS. This includes aneurysm clips or coils, stents in the neck or brain, and deep brain stimulators. However, cavity fillings and braces are no problem. You will also want to inform your provider if you have epilepsy, bipolar disorder, or a substance use disorder. Also, your doctor might ask you about your alcohol use. These are not necessarily impediments to treatment, but letting your doctor know that you have one of these conditions can help them identify slightly different side effects. Since mild headaches are one of the few side effects of TMS, be sure to let your technician know if you experience frequent headaches so they can adjust your treatment accordingly.

4. Are You Ready To Make Time for Self-Care?

While individual sessions are brief and allow you to continue with your day afterward, the total time for a TMS course of treatment is not insignificant. But as time for self-care, it is time well spent. In fact, many patients say that stepping outside their normal routine to take this time for themselves was an unexpectedly rewarding part of their TMS treatment. At the same time, no treatment works in isolation, so you should also aim to maintain other self-care habits, such as exercise, meditation, and journaling.

Is TMS Therapy Right for Me? Learn More

If you've tried several treatment strategies and are still experiencing depression, know that you are not alone and that there is hope for relief. Taking time to consider the questions posed above will help you feel more confident about your path forward, but don't hesitate to schedule a no-cost consultation to have more of your questions answered.

Is TMS Therapy Right for Me? Learn More

What is the Difference Between Anxiety and Depression?

Fri, 02 Jul 2021 19:45:02 GMT

Medically Reviewed on 5/18/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Despite being clinically different disorders, anxiety and depression can appear quite similar in their symptoms. Naturally, this can lead to confusion about how to tell them apart and if a person can have both at the same time. So, what is the difference between anxiety and depression? And is it possible to have both at the same time? To help you answer these questions, here's an overview of the two conditions and what each one's symptoms are.

What is Anxiety?

Most people experience feelings of anxiety at some point in their lives. The occasional panicked breathing, chest-thumping, or feelings of worry are natural. But when they last for extended periods or happen consistently, it may signal an anxiety disorder.

Essentially, a person with an anxiety disorder experiences a pattern of constant and excessive worry that's hard to control and often affects their daily lives. There are many types of anxiety disorders, but the most common is generalized anxiety disorder (GAD). Others include social anxiety disorder, panic disorder, phobias such as claustrophobia and agoraphobia, and separation anxiety.

What is Depression?

Depression is a complex mood disorder that affects more than 264 million people in the world. Depression causes a person to feel persistently sad, hopeless, or unmotivated for weeks or months. Depression is different from normal mood swings, occasional feelings of sadness, or responses to loss or trauma. Its symptoms are lasting and can be severe enough to affect your personal, work, and family life. There are many different types of depression, with the most common being major depressive disorder (MDD).

What Do Anxiety and Depression Look Like?

What is the difference between anxiety and depression, exactly? Identifying the psychological and physical symptoms of the two conditions can help answer this.

Phycological Symptoms

Anxiety: The psychological symptoms of anxiety are constant worrying, feelings of extreme anxiousness, feelings of helplessness, irritability, restlessness, difficulty concentrating, and feeling on edge.
Depression: With depression, psychological symptoms include continuous sadness, loss of motivation, loss of interest in hobbies/activities, thoughts of self-harm, irritability, feelings of anxiousness or helplessness, feelings of guilt or worthlessness, difficulty concentrating or making decisions, and continuous empty moods.

Physical Symptoms

Anxiety: The physical symptoms of anxiety include fatigue, insomnia, muscle aches and tension, heart palpitations, dizziness, shortness of breath, excessive sweating, stomach aches, dry mouth, and headaches.
Depression: Some of the physical symptoms of depression are fatigue, insomnia, oversleeping, unexplained pains, constipation, changes in appetite, changes in weight, and speaking or moving slower than usual.

Do I Have Anxiety and Depression?

It is possible to have both of these conditions. Although anxiety and depression are distinct from one another, they are often co-morbid. This means that many people with anxiety also have depression (and vice versa).

In fact, studies reveal that approximately 67 percent of people with lifetime GAD also report having MDD. And 20 percent of people with MDD report having GAD. Sometimes, when a person has both anxiety and depression, they co-occur simultaneously. In other cases, one is caused or triggered by the other. It's important to remember, though, that only a trained mental health professional can diagnose you with any (or both) of these conditions.

What's Next?

Anxiety and depression symptoms can interfere with your routine and negatively impact your life. Fortunately, they are very treatable. If you suspect you have depression and/or anxiety (or you already have a diagnosis), you should seek appropriate treatment. A mental health professional can give you an accurate diagnosis and help you decide which available treatment option is best for you.

If you have tried medication and talk therapy and found limited success, you can consider non-drug treatments, such as transcranial magnetic stimulation (TMS). TMS is a proven treatment for people with MDD that does not respond to medication. And if you have co-morbid anxiety symptoms, treating MDD can sometimes help you manage those symptom s as well.

How Long Do Antidepressants Take to Work? Improve the Wait by Setting Accurate Expectations

dhageman@innovasium.com (Daniel Hageman) — Thu, 01 Jul 2021 19:37:35 GMT

Medically Reviewed on 5/18/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Antidepressants are often a vital part of the strategy for treating depression. They can be helpful and even life-changing, but the antidepressant process can also be frustratingly slow. Knowing the potential side effects of antidepressants is essential to remaining informed about your condition, but so is understanding how these medications could help you. How will antidepressants make you feel? How long do antidepressants take to work? Why does it take so long for antidepressants to work?

Knowing how antidepressants work and how long they take can help you gauge your expectations if depression is reducing your motivation or causing you to doubt the effectiveness of your treatment. While the wait for symptom relief might feel lengthy, knowing the details of the antidepressant treatment process can help you assess its benefits and drawbacks, which may make the process smoother and more tolerable.

How Will Antidepressants Make Me Feel?

Antidepressants are meant to help you get back to your non-depressed baseline. For some people, it can be hard to remember what this feels like or to imagine feeling anything other than depression, but many people do find relief from their symptoms through antidepressants. However, antidepressants are not "happy pills," as they are sometimes called, and they won't make a person immune to emotional discomfort.

Because the benefits can take time to appear, it isn't always immediately obvious what is changing. It is common for people with depression to notice improvements in retrospect or for loved ones to see a shift first. You might, for instance, be surprised to realize that you have gone three days without showing signs of emotional exhaustion, or you may find yourself genuinely laughing at a coworker's joke. It might feel natural to resume an activity that you once enjoyed, such as reading for pleasure. When antidepressants are working as intended, improvements often do feel natural.

How Long Do Antidepressants Take to Work?

Antidepressants don't result in immediate relief of symptoms. Some individuals experience initial improvement in 1-2 weeks, while others notice smaller, more gradual changes accumulating over the ensuing weeks of treatment. It typically takes 4-6 weeks or more to see the full effect of medication at any particular dose. Dose adjustment is often needed, and different doses are needed by different people.

With that said, medications usually have a “starting dose” which is smaller and an average or “typical” dose, which is higher. Some people improve with a smaller dose, and some need higher doses. Some people see benefits with smaller doses, but if these don't produce the desired effect, it can take time to increase to an adequate amount of the medication. Because incrementally raising the dose requires additional time, the full benefits of antidepressants may take longer than 4-6 weeks to become apparent if the dose needs to be increased.

Why Does It Take So Long for Antidepressants to Work?

Several factors can contribute to how long antidepressants take to work, but the exact ways that antidepressants relieve depression are not yet fully understood.

The most commonly used antidepressants increase serotonin signaling in the brain. Serotonin is a messenger hormone (or neurotransmitter) that is thought to contribute to positive emotions by supporting communication between the brain and other parts of the nervous system. The increase in signaling happens relatively quickly when a person starts using antidepressants, but depressive symptoms typically aren't alleviated at the same pace. Other downstream changes occur as a result of the increased serotonin signaling, and these modifications take time to manifest and influence depression symptoms. Which process is the primary source of antidepressant response has yet to be determined, so treating depression with antidepressants isn't as simple as just increasing brain serotonin.

Another factor that may contribute to the time needed for a clinical response is the medicine's therapeutic dose, described above. Because the starting dose of the medication often isn't the therapeutic dose, antidepressant medications are started at smaller amounts to allow the body time to adjust and avoid side effects. The pace of dosage adjustment may be influenced by how a person tolerates the medicine. If there are side effects, a slower adjustment (or titration) rate may be necessary, which would result in additional time before a therapeutic dose is reached.

At the beginning of treatment, you and your provider will decide whether to stay at the initial antidepressant strength long enough to assess for clinical response, or to titrate up to the average therapeutic dose steadily. Because it can take a long time for antidepressants to produce an effect, some individuals with depression opt to raise the medicine past the initial dose before waiting for a response. If a person will ultimately require a higher dose, the decision to increase sooner may cut down the time it takes to see benefits. This decision is a matter of personal preference and should come after discussing and weighing the pros and cons of both approaches with your provider.

Knowing What to Expect Can Reduce Frustration

Despite producing effects at slow rates, antidepressants remain a fundamental part of the treatment strategy for depression. Confusion about what to expect when you start taking an antidepressant can add frustration to an already difficult situation, but by taking time to learn more about how antidepressants work, you can properly evaluate their benefits and advocate for treatment changes if necessary. If you've tried several treatment strategies and are still experiencing depression, know that you are not alone and that there is hope for relief. Taking time to consider the questions posed above will help you feel more confident about your path forward, but don't hesitate to schedule a no-cost consultation for TMS to have more of your questions answered.

Dealing With Depression During or After Divorce or a Breakup

Wed, 30 Jun 2021 19:35:18 GMT

Medically Reviewed on 5/18/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Other than the death of a loved one or a major illness, divorce is one of the biggest life stressors you may face. It's a complicated decision, both legally and emotionally, and it's not uncommon for depression and divorce to occur together .

Depression after divorce is common because it's a major loss that can bring with it immense grief. Sometimes, a traumatic event like divorce may exacerbate a preexisting mental health condition or lead to the development of a new one. What are the signs you should look out for, and how can you prepare for them as you navigate this difficult time?

Common Stressors from Divorce

During a divorce, you're attempting to live your everyday life on top of juggling all of the divorce-related stressors. It can be emotionally and mentally draining for anyone, so it's not surprising if you're wondering whether what you're feeling right now is from divorce, depression, or both.

Common stressors during this time can include needing to start over, deciding whether to keep your marital home or move, losing the life and lifestyle you know, paying high lawyer fees, and managing your children's reactions if you're a parent. And then, of course, there's the stress of the unknown. You may wonder if the divorce settlement agreement will be just, if you'll get the assets you want and need, and if your employment status will need to change (e.g., if you need to go back to work after you've been a stay-at-home parent). You may also wonder how divorce will affect your kids and other relationships in your life, like mutual friends.

Recognizing Symptoms of Depression during or after Divorce

If you're also managing symptoms of depression, these stressors can be even more difficult to manage. It can be hard to distinguish whether you're experiencing expected stress and/or depression, especially since the two often coexist. However, there are some specific symptoms of depression that aren't caused by everyday stress. These symptoms can include fatigue, feelings of worthlessness or hopelessness, weight loss or gain, and thoughts of death or suicide.

While you might feel that this isn't the right time to seek treatment, remember that depression can also impact decision-making capacity , and it's critical to be able to think clearly and advocate for yourself while you're dealing with a life decision as complicated as divorce. When symptoms from depression and divorce start impacting your life—if you have trouble making it to work or keeping up with your responsibilities, for example—it may be time to seek treatment.

Treatment Options

One of the best ways you can advocate for yourself if you're experiencing depression during your divorce is to seek care. Your first line of treatment will likely be either talk therapy or medication . You may want to talk to your primary care provider and see if they have a referral to a therapist. If you're prescribed medication, don't be discouraged if the first pharmacological treatment you try isn't the one for you— less than 30% of people find the right one on the first try.

However, if you've tried two or more medications and are still experiencing symptoms of depression, you're not out of solutions. Another option to consider is transcranial magnetic stimulation (TMS), a treatment that uses magnetic pulses to gently stimulate areas of the brain. TMS is non-invasive, and its treatments are short (about 20 minutes), creating minimal disruption to your already full routine.

It's common to experience depression during or after divorce, but you don't have to feel this way. If you're not feeling better after medication and therapy, then consider looking into other treatments, such as TMS. But above all, be sure to give yourself grace while going through this hard time, and as much time as you can when making a big decision.

The Relationship Between Anxiety and Depression

Tue, 29 Jun 2021 19:34:00 GMT

Medically Reviewed on 5/18/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

If you are dealing with both depression and anxiety, it can feel like you're being pulled in opposite emotional directions. But you are far from alone. In the United States, an estimated 48 million people deal with anxiety, and research has found that about 59 percent of those with anxiety also show symptoms of depression.

Does anxiety cause depression, given that high correlation? Theories suggest it might, but a causal relationship hasn't been proven. All we know for certain is that depression and anxiety frequently appear in tandem. Both are highly treatable, though, and helping one has the potential to help the other.

What Are Depression and Anxiety?

It's likely you've experienced anxiety at some point in your life. If you've felt overwhelmed by your thoughts before a work interview or asking someone on a date, that's a normal expression of anxiety. However, if you're frequently experiencing anxiety that's disproportionate to a situation or unrelated to any specific event, you may have an anxiety disorder. As with any medical condition, it's important to see a mental health professional for diagnosis and treatment if you think you may have anxiety. Anxiety disorders can also cause physical symptoms, which could include insomnia, fatigue, muscle tension, or digestive troubles.

Similarly, you've probably experienced feelings of depression—trouble concentrating, sleep issues, lethargy, or not wanting to socialize. But major depressive disorder, , according to the DSM-V , occurs when these feelings last for longer than two weeks. It also includes feelings of worthlessness, sleep disturbances (sleeping too much or too little), weight loss or weight gain, and difficulty concentrating.

The Relationship between Anxiety and Depression

Fifty-nine percent of those w ith g eneralized anxiety disorder also show symptoms of m ajor depressive disorder . The reason for this overlap has not been proven conclusively, but several theories exist. One is that the relationship between anxiety and depression is related to a biological link in the brain that contributes to these comorbidities. Another theory suggests that both anxiety and depression can be triggered by stressful events—such as loss (of a relationship, job, or person) or interpersonal conflict—so symptoms of both may emerge and overlap.

Does anxiety cause depression? Sometimes anxiety can contribute to depression's development because it's taxing on the body or because it can lead to a habit of negative thinking. However, it's only one of many possible contributing factors. By contrast, depression doesn't typically trigger anxiety.

Treating Depression

Unfortunately, there is no one-size-fits-all treatment for depression, so it may take you a few tries to find something that works. Antidepressant medication, talk therapy, or a combination of the two are common treatments. Self-care strategies like exercise or meditation can help by producing feel-good chemicals in the brain, but they're not a substitute for professional help.

If depression doesn't respond to talk therapy or medication, you may also want to consider non-drug treatments like transcranial magnetic stimulation (TMS) therapy. TMS therapy uses gentle magnetic pulses to target the areas of the brain that contribute to depression. It's non-invasive and has proven to be effective for people who don't respond well to other depression treatments.

Treating Anxiety

Anxiety disorders may also be treated with medication, talk therapy, or a combination of the two. Cognitive Behavioral Therapy is a popular type of therapy because it gives you the tools to directly change the thoughts causing your anxiety, leading to relief. Several antidepressants are also recommended for anxiety. Benzodiazepines, or sedatives, may be used as a fast-acting rescue medicine for anxiety or panic attacks. Relaxation techniques are also recommended, such as yoga or meditation.

Treating One May Help the Other

The good news is that, since many of the symptoms of depression and anxiety overlap, treating one may help with the other —especially if the anxiety presents first. Managing anxiety by working on healthy coping skills may also help depression symptoms down the line. The reverse is sometimes true as well—treating depressive symptoms can reduce the number anxiety symptoms you need to address. It can also give you the energy and focus needed to find the appropriate anxiety treatment.

It may take several tries to find what works for you, but don't be discouraged—relief is out there, and you can find the unique combination of approaches that works best for you.

Dwyane "The Rock" Johnson Shares His Depression Story

Mon, 28 Jun 2021 16:58:42 GMT

Dwayne "The Rock" Johnson recently shared his struggle with depression in a People interview . Johnson says that "I was an only child, and I was always a better listener than I was a communicator in terms of sharing my feelings," he said. "And I feel like the most important thing, obviously, is communicating and realizing that asking for help when you're down and you're feeling wobbly or when you're depressed is actually the most powerful thing you can do. Asking for help is not a weakness."

"As a matter of fact, asking for help is our superpower, and men, especially us, we fall into this trap of being really adverse to vulnerability, because we always want to be strong and feel like we can take on the world."

His words touch on a deeper, overlooked point-- although mental illness stigma affects everyone, men are critically underserved in regards to mental health, both in terms of admitting that they need help and need to seek out treatment . "Asking for help is not a weakness. As a matter of fact, asking for help is our superpower, and men, especially us, we fall into this trap of being really adverse to vulnerability, because we always want to be strong and feel like we can take on the world." Johnson says.

Many men often experience depression differently than women.

They may not necessarily know that their symptoms are indicative of depression because they may not be the "classic" symptoms depicted in popular media.

There are lesser-known physical symptoms such as, backaches or headaches as well as dangerous/maladaptive behavior such as excessive drinking, overworking or aggression. Other symptoms include:

Fatigue or decreased energy
Difficulty sleeping
Weight gain or loss
Bogy aches, headaches, or digestive issues
Trouble concentrating
Agitation
Reckless behavior
Self-medication with drugs

This interview is not the first time that Johnson has opened up about his struggles with mental health. Johnson stated that he experienced depression after hitting a critical career setback in his early 20s. He also saw his mother attempt to commit suicide in front of him, an experience that impacted him deeply. After these troubling episodes, Johnson was left struggling and contemplating how he might continue living. And during an intimate interview in 2015 for the Oprah network, he also spoke openly about the loneliness of a depressive episode. He said that "with depression, one of the most important things to realize is that you're not alone."

As Johnson said, "With depression, an important thing to realize is, you're not the first to go through it, and you won't be the last to go through it." If you or a loved one are experiencing depressive symptoms and medication does not seem to be enough, reach out to schedule a free consultatio n to see if TMS is right for you.

Depression and Relationships: 3 Ways Treating Depression Will Improve Your Relationship

Sun, 27 Jun 2021 19:40:27 GMT

Medically Reviewed on 5/18/2021 by

Dr. Steven Harvey

Regional Medical Director Greater St. Louis

Depression is a thief that will try to rob you of self-esteem, pleasure, and energy. In return, it will give you a lens of negativity to view the world through. This depressive filter leads to distorted perceptions of self and others and has the ability to magnify everything that isn't positive, getting in the way of the connections you might want to make with others. But depression and relationships don't have to be mutually exclusive. While it's harder to nurture a romantic relationship when feeling down, finding the right treatment will benefit your relationships, and feeling better helps you gain the ability to build the intimacy and natural connections that can make your life better.

Major Depressive Disorder and Relationships: How Treatment Can Help

When you can remove the tainted lens of depression, things are naturally brighter, and your energy isn't in such short supply. Here's a closer look at three ways treating depression will benefit your relationship

1. Improve Your Ability to Connect with Others

Withdrawal and avoidance are frequent byproducts of depression. At times, the effort it takes to interact with others feels insurmountable. Reduced energy, sadness, self-doubt, and skewed perceptions get in the way. Depressive thoughts play on repeat, clouding the ability to engage with others. This withdrawal can lead to a growing distance in your relationships, and each person involved can feel more isolated.

But with treatment, spending time with others begins to feel more comfortable. As the volume of the negative tapes is reduced, there's more room to hear other thoughts. It becomes easier to be present and engaged in the relationship.

2. Reduce Irritability and Conflict

When the negatives in life become magnified and the positive parts minimized, people are naturally less easy-going. In this state, it can be hard to let annoyances go. Something that wouldn't have been a big deal before depression can now feel intolerable.

As depression fades, this heightened level of irritability and sense of conflict should go away. When feeling well, it's easier to see people in a balanced, nuanced light and hold the good with the bad. Pleasure and enjoyment can return to the relationship.

3. Rediscover the Satisfaction of Mutually Enjoyed Activities

Prior to depression, you and your partner may have had an active social life, relished traveling together, and cooked fancy meals. But now, negative thoughts and feelings are all-consuming, so ordering takeout and watching a movie on the couch is the most you can muster.

With treatment, activities that used to be pleasurable begin to feel rewarding again, and previous levels of energy and enthusiasm return. Joining together to participate in mutually enjoyed activities strengthens the connection and reminds you both why you chose the relationship in the first place.

Depression and Relationships: A Time for Support

Because depression causes difficulties connecting and communicating, outside support for both partners can help mitigate the effects of depression on the relationship. It's exhausting to navigate depression symptoms, and it's also hard to worry about the mental health of the person you love. Individual and couples therapy can speed up recovery and help identify patterns that get in the way of moving forward.

What Changes after Starting TMS Therapy?

dhageman@innovasium.com (Daniel Hageman) — Fri, 25 Jun 2021 17:47:58 GMT

At a basic level, depression causes changes in a person's mood and behavior. But if you've experienced it, you know that depression isn't simply about feeling "sad"-- all facets of a person's life are impacted. People struggling with treatment-resistant depression who haven't responded to medications or talk therapy over the course of months and years can encounter great difficulty with their career, personal goals, and relationships. That's why when depression lifts, a person may experience improvements in their life outside of just their mood. We asked some of our patients what’s changed for them since starting Greenbrook TMS therapy. Here are their answers:

For Josie, 67, TMS therapy helped her rediscover her hobbies and opened her up to a livelier social life. She says “I used to get tremendous pleasure out of reading, but I’d given that up. Now I’m back to reading again. I enjoy those simple pleasures. It’s not like I have to win the lottery to be happy. I just became more active, I went back to my fitness habits.

I remember that I wanted to be with people. By nature I’m an introvert but that sort of changed. I talk to people more often, even strangers. And it was fun! It gave me more fun in my life.”

For Dereck, 51, depression had impacted his sense of self-worth and kept him from seeking out the physical care and mental health support he needed. Since Greenbrook TMS therapy, Dereck says "I’m going to see my doctor about some health issues that I’m having, which normally I wouldn’t care enough about myself to do that. I’m going to depression support groups.

I used to just lie in bed and think about how bad I felt— now on my bad days, I’m able to at least watch TV or go for a walk. That’s something I never used to do before."

Michaela, 30, had been experiencing treatment-resistant depression since she was a young teenager. She felt stalled in her life's trajectory and was having trouble at work. Michaela says that “Since Greenbrook TMS I have gotten a promotion. Pretty much every aspect of my life has gotten better.

My family noticed and especially at work they noticed. Right before I went for TMS, my manager talked to me a few times about my attitude because I was very depressed. I think things would have been a lot harder if I hadn’t gotten TMS.”

Wanda, 47, was able to find things to look forward to, after years of feeling like she was simply existing rather than really living. Wanda says “I’m thinking of the future.

Before TMS, everytime I’d go to see my doctor for a physical I’d feel like, wow, we’re here again because I was surprised that I made it another year. I notice I don’t talk like that anymore.”

Joseph, 81, had been experiencing treatment-resistant depression with insomnia that took a great toll on him, both mentally and physically. Joseph says that "By the time I finished treatment, my sleep had increased to six or seven hours. It was just wonderful. Within a week of completing treatment, I was up to eight hours. The headaches are gone, the result of fatigue has greatly been reduced.

I’m back to almost a completely normal life. To me, Greenbrook TMS is a miracle."

Samantha, 20, juggles a busy schedule and had difficulty managing her emotions. Since TMS therapy, she's able to better handle school and her job in a stressful environment. Samantha says “I’m in college and I work as a server, and I noticed that at work I still get frustrated but now I handle it better. I used to get frustrated and just walk away, or react badly faster than I should.

My eating habits are better and I don’t have to force myself to eat. I’m motivated to do homework, which I used to never do. I just didn’t care enough and it wasn’t a priority. My anxiety has always been rooted in my depression but I’m able to control it more and it’s not as bad as it used to be. Since TMS, I have more control over how I react to things and my emotions. I used to not care and just react however my depression wanted me to, but now I’m able to control it more.”

Tessa, 23, was finding it difficult to engage in her passions and feel motivated. She says that "A few days into treatment at Greenbrook TMS, I was waking up at six to go to the gym.

I was walking dogs to make extra money. I wanted to do things. Something as simple as running an errand or making dinner for myself and my family. People were even telling me I seemed a lot happier and a lot different, which is when it really hit me that I was getting better."

Midlife Crisis or Midlife Depression: Knowing When to Seek Help

Wed, 19 May 2021 13:57:02 GMT

You've hit middle age and feel like you're in a rut. Maybe some setbacks have piled up and chronic aches are slowing you down. The hope, excitement, and drive of your youth have faded, and you're in a consistent state of disappointment. This may sound like a midlife crisis—just another stage of life, like adolescence or old age. But it could be more than that. You may be experiencing depression, which is a medical condition that needs to be treated.

Is It a Midlife Crisis or Depression?

Descriptions of the existential challenges of mid life have existed for centuries, but the phenomenon of the mid life crisis was academically introduced as recently as 1957 . Then popular books such as Gail Sheehy's Passages: Predictable Crises of Adult Life made it a household phrase in the 1970s. The midlife crisis has become part of our cultural consciousness because "middle age" is often a period in people's lives when they are likely to face stressful changes in their relationships and other major life events. Their children, the focus of their love and attention for so many years, have grown up and left. Their parents have aged, and they may need to take care of them. Their work demands have hovered near the red zone for years. Their stamina isn't what it used to be, and once-easy tasks have become more burdensome.

Any of these circumstances can make it harder to feel happy, but they could also trigger depression. While a mid life crisis can be a normal state of development, depression is not. It's important to remember that depression is not simply a catch-all term for feeling sad. Depression is associated with changes in chemicals in the brain that regulate signaling and moods—and it's a medically recognized condition that requires treatment.

Understanding Midlife Depression

As the term "midlife crisis" gained notoriety, scientists began to investigate whether depression might be caused by middle-age physiological changes in the body that show up in different ways in women and men. Ever hear the term " male menopause "? But research has not shown that these biological changes are a cause of depression (though some of them can contribute to depression). More likely, a variety or combination of factors in midlife, both emotional and physiological, may cause depression. Still, it's necessary to acknowledge that midlife depression is not a universal experience, and it should not be considered normal or expected. Therefore, it's important to recognize the symptoms of midlife depression—especially because different symptoms can appear in different people. Here's a list to keep an eye on:

You often feel overwhelmed with feelings of helplessness, hopelessness, worthlessness, or guilt.
You experience big mood shifts, becoming much more angry, irritable, anxious, sad, or hopeless.
You've lost interest in activities, hobbies, and people you once enjoyed, and you've withdrawn from family, friends, and colleagues.
You've lost interest in your work, or just the opposite—lost yourself in work and become a workaholic.
Your eating and sleeping habits have also been affected—whether eating too much or too little, or having trouble sleeping or trouble getting out of bed.

These unhealthy changes, along with stress, can cause a wide range of physical ailments, including backaches, headaches, fatigue, stomach problems, and sexual dysfunction. Mentally, those with depression can have difficulty focusing, remembering things, and making decisions. Some of those clichéd midlife crisis behaviors—buying a flashy sports car or having an affair—may be the result of feeling worthless or withdrawn from relationships, among other symptoms of depression.

Moving forward and Seeking Treatment

If you are between your late 30s and early 50s and experiencing any of the symptoms above, don't shrug it off as "just a midlife crisis." Depression is not an inevitable part of middle age; many in their 40s, 50s, and beyond acclimate to life changes and continue to enjoy good physical and mental health. Depression is a condition, like any condition at any age, that can detract from quality of life for you and your loved ones. According to current research , two-thirds of people with depression don't seek or get treatment. Many people have effectively treated depression with therapy and medications. If those haven't worked for you, though, there are other options to try, such as Transcranial Magnetic Stimulation (TMS). TMS is an FDA-cleared non-invasive and drug-free treatment. In a private treatment room, you sit in a comfortable chair, awake and alert, while a device near your scalp delivers gentle magnetic pulses, similar to those in an MRI scan. These pulses stimulate changes in brain chemical signaling that can alleviate symptoms of Major Depressive Disorder . You can drive yourself home or back to work afterward. Whatever path you choose, make sure to consult your doctor and get the help you deserve. Your life isn't half over when you reach middle age. You have plenty ahead of you, and with treatment for depression, you can find relief from your symptoms and make your best memories yet.

Mental Health Awareness Month 2021

dhageman@innovasium.com (Daniel Hageman) — Tue, 11 May 2021 14:12:13 GMT

The AFSP has provided an online toolkit for May's Mental Health Awareness month. This year's theme is #MentalHealth4All, and as a proud supporter of the AFSP, we hope you'll check out the resources below.

#MentalHealth4All

This May for Mental Health Awareness Month, we’re sending the message that no one’s mental health is fully supported until everyone’s mental health is fully supported. That’s why for our #MentalHealth4All campaign, we’re encouraging everyone to get involved by taking one simple action to encourage their friends, family, and community to take their own and others’ mental health seriously.

Your one #MentalHealth4All action could be as simple as reaching out to someone in your life to see how they’re doing; starting a conversation with someone close to you about a topic you have difficult feelings about; or letting your group of friends know you’re comfortable talking to them about anything they’re going through. You can support #MentalHealth4All by advocating for legislation that addresses the disparity in mental healthcare access for underrepresented communities; joining a walk; bringing suicide prevention education, research or support programs to your school or workplace to ensure that more people around you know that mental health is a vital part of everyone’s life; or spreading the word about your local AFSP chapter to ensure that every member of your community has the support they and their loved ones need during a difficult time.

Everyone has different experiences with their own mental health, and their own preferred methods of care and support. It’s important that we all remain open and ready to listen to others’ points of view and perspectives, especially during this challenging time in our history. We all have mental health, and by taking one simple action, we can each help influence massive collective change to support #MentalHealth4All.

What You Can Do to Help?

For Yourself

Open up to someone close to you about something that you’ve been coping with
Identify three simple self-care activities that work for you, like exercising, meditating, or journaling
Schedule a check-up to talk to a doctor about your mental health, as well as your physical health
Add crisis resource numbers to your phone and encourage a loved one to do the same

For the People in Your Life

Let people in your life know you’re a safe person to talk to about mental health, and actively listen and engage when someone comes to you for help
Connect people in your life who have shared interests, such as music, gaming, sports, art and more!

For Your Community

Advocate for mental health policies that ensure that everyone in your community has access to mental health care, suicide prevention training, and funding for local crisis resources
Get involved with your local AFSP chapter, or join an Out of the Darkness Walk, and help transform your community into one that’s smart about mental health, where everyone has support when they need it
Bring an AFSP mental health education, research or support program to your school, workplace, or community center

Want to learn more?

If you need Immediate help:

National Suicide Prevention Lifeline – 1‑800‑273‑TALK (8255) or Live Online Chat

SAMHSA National Helpline – 1‑800‑662-HELP (1‑800‑662‑4357)

Depression Resources

Interview with Maggie Mortali for AFSP’s Interactive Screening Program

dhageman@innovasium.com (Daniel Hageman) — Tue, 30 Mar 2021 14:48:25 GMT

What is the AFSP?

AFSP stands for the American Foundation for Suicide Prevention. We’re a non-profit organization headquartered in New York City with local chapters in all 50 states and founded in 1987. Our mission is to save lives and bring hope to those affected by suicide. We also support survivors of suicide loss and those who have lived through suicide ideation and attempts. We use an upstream approach to preventing suicide through research, education, and advocacy. One of our programs is the Interactive Screening Program.

How did the Interactive Screening Program (ISP) come about?

AFSP was approached by two families with college-aged children who had died by suicide. Though the two students both attended colleges that offered counseling services, neither of them had reached out to a counselor. They wanted to gain a better understanding of college student suicide risk, and especially wanted to know what could be done to improve help-seeking for mental health distress. We connected researchers and scientists to figure out a systematic, routine method of reaching out to at-risk students and connecting them to available campus mental health support. This became the Interactive Screening Program. That was just the beginning. Since its inception as a research project, the ISP has grown to become a resource for those seeking mental healthcare at colleges and universities and workplaces nationwide.

What’s been the impact of the ISP?

To date, we’ve connected 180,000 people to mental health resources with the use of the ISP. Beyond college campuses, this tool has been implemented by first responders, healthcare systems, and other workplaces. The ISP starts with a screening for stress, depression, and other mental health concerns, and provides participants to connect with a counselor who can provide information on clinical services, offerings, and options.

I mplementing ISP, has helped build out mental health resources and networks, so that students and others have more options in their own community. The community partnerships are important in the event the college does not have the resources that someone needs. For example, a student may want longer term counseling, or students may want to know about non-medication depression treatments that aren’t typically available on a college campus, such as TMS therapy. Overall, we really strive to make everyone aware of all services and treatments that are benefitting others and how to access that care.

Have you seen increased demand from COVID-19?

During the first few months of COVID-19, we were receiving the highest number of inquiries from institutions and organizations wanting to implement the program than we’ve ever had. COVID-19 created a shift where other care options were needed when some services were closed for public safety. We all needed a way to reach people when communities were no longer on campus or in the work setting. ISP is a way to engage people directly into virtual counseling and other treatments.

Greenbrook TMS is a proud sponsor of the AFSP. Learn more about AFSP here.

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741

An Interview with Jennifer Marshall, founder of This Is My Brave

dhageman@innovasium.com (Daniel Hageman) — Thu, 25 Mar 2021 13:57:33 GMT

What does This Is My Brave do?

This Is My Brave – The Show is a live presentation of touching essays, original music, poetry and comedy performed by a dozen individuals living with – or loving someone with – a mental illness. Shows are held in cities and towns across the United States, as well as in Australia. Auditions are held in each city in advance of the show, creating a cast made up of members of the local community. They rehearse together with a local producer before presenting their stories live on stage in front of an audience. Since 2013, This Is My Brave (TIMB) has successfully produced 77 shows in seven years throughout the country.

What is involved in bringing a TIMB show to life?

Each TIMB show takes a lot of work and dedication. You need to build a well-rounded team that includes marketing, connection to the venue, ability to raise funds, picking a mental health beneficiary in the area that will receive proceeds from the show, etc. The production takes roughly six months. Beyond the administrative and technical set-up, the team surrounding each show helps lead the transformation and change that we so often see in our producers, speakers, and the audience.

As shows have continued to grow in popularity, demand has increased. Because TIMB is currently a small team of three, we were struggling with being able to keep up with spreading the TIMB experience while still maintaining enough bandwidth for everything else we still have to do as an organization day-to-day. That’s why we’ve developed a new production model to help bring more shows to more areas.

What are your future plans for TIMB?

The new production model includes an online training component that enables communities to get a TIMB show up and running. We take a production team through 10 hours of training to plan, prepare, and run a show in their area. TIMB provides assistance every step of the way to make sure things run smoothly.

TIMB brings a sense of community, not just as a speaker but also as an audience member or as part of the production team. The entire experience creates an amazing support system within your community with those who are navigating through their mental health. You can leave a TIMB show feeling valued, self-confident, a strong sense of purpose, a sense of community, and reducing the self-stigma and shame surrounding mental health.

Greenbrook TMS is a proud sponsor of TIMB. Learn more about TIMB here.

TMS for Anxiety: Can It Help?

Tue, 02 Mar 2021 14:34:52 GMT

Medically reviewed on 12/21/2020 by
Dr. Steven Harvey
St. Louis Regional Medical Director

Depression can leave you feeling empty and drained, and anxiety can overwhelm you with tension and worry. When you live with both conditions, you may feel like you're being pulled in opposite directions. But depression and anxiety have much in common, and having one condition means you're likely to have some symptoms of the other. You may find relief with TMS therapy for depression , and anxiety symptoms may improve some as well after receiving treatment. However, while TMS for anxiety may be on the horizon , TMS is not currently approved to treat anxiety. Instead, anxiety is treated with talk therapy and medication. Treating depression and anxiety together can feel frustrating, but it's important to keep trying. With a better understanding of how both conditions are related, you can find treatment options that work for you.

How Depression and Anxiety Are Related

Experts continue to study the relationship between these two conditions and have a few theories about how they're connected. Some of their findings include the following:

Many of the same mental and physical functions may be involved with both depression and anxiety.
Some of the same neurotransmitters may be involved in both conditions.
You may be more genetically vulnerable to developing one or both conditions.
Chronic illness or serious health events can put you at greater risk of developing both conditions.

Depression and anxiety disorders often occur together. Researchers have found that as many as 60 percent of people with depression may also have anxiety symptoms. The rate is similar for people with anxiety disorders who have some depression symptoms. One disorder may be more prominent, but symptoms of both can appear at the same time. And when you have both depression and anxiety, you may struggle more with daily activities or have a lower overall quality of life than if you experienced only one condition.

So, how effective is TMS for anxiety symptoms? They may improve with TMS therapy, but not for the reason you may think. TMS currently only targets depression symptoms and is not approved as a treatment for anxiety disorders. But when you effectively treat depression, you may find that some anxiety symptoms can improve as well. To understand how this works, it helps to look more closely at the connections between both conditions.

Treat Depression, Help Your Anxiety

Many physical and emotional symptoms of depression and anxiety overlap. And some symptoms can be a trigger for other issues, such as sleep problems leading to more irritability, or a poor appetite leading to fatigue. When at least one or two main symptoms can be improved, you're more likely to feel better overall. When your depression improves, your outlook on life can seem brighter. This mindset shift slows the flow of negative thoughts, giving you less to ruminate on and worry about. Even though you aren't directly treating anxiety, improvement of any of the following shared symptoms can lessen anxiety's impact:

Sleeping too much
Not sleeping enough
Fatigue
Aches and sore muscles
Change of appetite and eating patterns
Difficulty concentrating
Irritability

Keep Seeking Treatment for Anxiety

However, this doesn't mean that you'll automatically feel better after treating only one condition. Depression treatment can help with some anxiety symptoms, but this may not be enough. You'll likely receive the best results if you treat both depression and anxiety. To get relief from anxiety, consider talk therapy or medication. For the best results, keep pursuing these options even if depression treatment helps you feel better. TMS therapy for depression can be very effective, but it's still not a treatment for anxiety and therefore isn't a panacea.

TMS Therapy for Depression and Anxiety

Depression and anxiety can make every day feel overwhelming, especially if you live with both conditions. It may take some patience to work through different treatment options, but stay encouraged and don't give up your search. Once you find the combination that works, you'll be able to start feeling better and get back to enjoying your life.

How Many TMS Treatments Are Needed?

Mon, 22 Feb 2021 15:33:26 GMT

Medically reviewed on 9/29/2020 by
Dr. Geoffrey Grammer
Chief Medical Officer

If you're interested in Transcranial Magnetic Stimulation (TMS) therapy, you'll likely want to know what kind of commitment it requires. Will you be able to slot it into your schedule and manage it within your lifestyle? There's a good chance the answer is "yes." There are several factors that make TMS therapy very convenient relative to other treatments.

Read on to get the answers to:

1. How many TMS treatments are needed?

2. How long does TMS treatment last?

What Is TMS?

TMS is a non-invasive treatment in which magnetic pulses are used to activate specific brain regions that are involved in regulating moods. If you've been diagnosed with Major Depressive Disorder (MDD) or Obsessive-Compulsive Disorder (OCD) and haven't had much success with talk therapy or medication, TMS therapy is a safe and effective treatment option you should consider.

How Many TMS Treatments Are Needed?

During a typical course , you'll receive around 36 treatments over a nine week period. You'll undergo five treatment sessions per week for the first six weeks, and then taper down the remaining six sessions over the following three weeks. However, your provider may recommend a shorter or longer course of TMS depending up your unique clinical circumstances. How long does TMS treatment last? Each individual TMS treatment session is fairly brief. Your first session may last a little longer while a Greenbrook TMS psychiatrist determines how to best deliver your treatments. Each subsequent session typically only takes approximately 20 to 30 minutes, though your doctor may prescribe a slightly different sequence depending on your clinical presentation. Some people are able to fit it in during their lunch break, or receive treatments on their way to or from work or school. Every patient is different, and there might be some variation to these timelines depending on your individual needs. You may start to feel better and notice changes before your course of treatment is over, but it's essential you complete it to get the full benefits of TMS.

Are Additional TMS Treatments Needed?

After the initial round of treatment, your Greenbrook physician may recommend additional sessions. This is because depression treatments don't work the same way for everyone, and there's a chance depression symptoms could come back after the first set of treatments. So, although many people won't need follow-up maintenance sessions —one treatment a week after the initial round, for example—it's helpful to recognize that you might. (Note, however, that insurance many not cover maintenance sessions.) It's also possible that depression symptoms may return after a period of remission, requiring another full course of TMS therapy. There's no way to scientifically predict if or when this will happen. It's important to regularly check in with your mood and emotions after the initial treatment round. You could also ask your loved ones or your behavioral health providers to help keep an eye out. This way, if the depression does return, you can take steps to get treatment right away.

The good news is that unlike other depression treatments, TMS usually does not become less effective after the initial treatment course. If you achieved remission before with TMS, there's a high probability that you'll achieve it again . It's important to remember that you deserve to achieve relief.

The Bottom Line

TMS therapy does require some investment of time, but if you're seeking to reduce your symptoms and improve your quality of life, TMS has been proven to be effective. TMS therapy holds a response rate of 62 percent , and it has very few side effects, the most common being scalp discomfort. Many people find this much easier to tolerate than common antidepressant side effects, which can include weight gain, poor sleep, low libido, and more. Further, when you compare TMS therapy to other treatments, it's quite convenient. It's non-invasive, and you can stay awake through it all. Plus, anesthetics or sedatives are not needed, so you can resume your daily activities right after a session.

A t Greenbrook, your comfort is prioritized, and you will be closely monitoring by an experienced TMS technician throughout your treatment. Many patients ultimately find the entire treatment experience quite pleasant. You can learn more about TMS therapy from Greenbrook resources , including patient stories detailing the different positive experiences they've had. Whenever you feel ready to take the next step, you can set up a free consultation .

Achieve TMS joins Greenbrook TMS

dhageman@innovasium.com (Daniel Hageman) — Thu, 18 Feb 2021 20:59:44 GMT

Greenbrook will have a national footprint of over 125 TMS Centers from coast-to-coast, enabling us to continue to increase awareness of TMS and to provide more individuals suffering with depression and other mental health disorders with access to this potentially life changing therapy. We are excited to collaborate and expand with the Achieve TMS team who shares our passion for TMS therapy and delivering exceptional patient care.

Bill Leonard,

President and CEO, Greenbrook TMS

Menopause and Depression: The Importance of Finding Relief

Wed, 17 Feb 2021 15:17:57 GMT

Medically reviewed on 11/16/2020 by
Dr. Geoffrey Grammer
Chief Medical Officer

Most people know that menopause is associated with physical symptoms like hot flashes, but there's a link between menopause and depression, too—one that's often under-recognized. During perimenopause—the years leading up to menopause—estrogen levels decrease. One study found that depression is 2.5 times more likely at this time of life than in the years before or after. However, perimenopausal depression is frequently missed, partly because physical symptoms receive more attention and partly because many depression symptoms overlap with those of menopause. Symptoms shared by both depression and menopause include low energy, changes in libido, trouble concentrating, sleep disturbances, and weight changes. The reassuring news is that treating the mental health symptoms of menopause can help with the physical ones, too. Taking a little time to understand the link between menopause and depression can be a meaningful first step along the road to better health.

Why Does Perimenopausal Depression Occur?

Three broad factors link menopause and depression: hormones, sleep disturbances, and life stressors.

Hormone Changes. Hormonal fluctuations are an integral feature of perimenopause. During these years, people experience fluctuating and decreasing levels of estrogen. Estrogen plays a key role in the manufacture, efficiency, breakdown, and regulation of chemical messengers such as serotonin and norepinephrine. These chemical messengers (neurotransmitters) influence mood and behavior: Normal levels contribute to feelings of wellness, calm, happiness, and contentment. Decreased or fluctuating estrogen levels in perimenopause can disrupt the normal functioning of serotonin and norepinephrine in some women, which in turn can lead to depression.

Sleep Disturbances. Sleep disturbances are a notable symptom of depression, and perimenopause is similarly associated with sleep-related issues. A third of perimenopausal people report sleep difficulties, often related to uncomfortable night sweats, and those transitioning to menopause are up to 3.5 times more likely to report severe sleep difficulties than their premenopausal counterparts. This is likely related to a perimenopausal decline in certain hormones that influence sleep patterns—estrogen, progesterone, melatonin, and growth hormone. Other non-menopausal factors can also affect sleep in midlife, including chronic illness and a natural age-related change in our sleep patterns.

Life Stressors. Menopause frequently arrives at a time when people are already experiencing significant shifts in their lives (95 percent of people have their last period between the ages of 45 and 55). The following factors, often associated with midlife, are also associated with an increased risk of depression:

Caregiver stress: Those in midlife often must act as caregivers for their own aging parents. This can be stressful, and stress can contribute to depression. Being a caregiver also limits the amount of time you have to connect with friends, and low social support is a risk factor for perimenopausal depression.
Career changes: For many, midlife is a time for career changes, the stress of which can contribute to depression.
Personal aging: Shifts in familial dynamics, poorer overall health, and coming to terms with a loss in fertility are stressors that naturally come with aging. The stress of coping with such drastic changes may contribute to depression in some. (Older studies suggested that depression arose from children leaving home—known as "empty-nest syndrome"—but this has been disproven.)

Although midlife can be a time of seismic change, it's also a time where some feel especially empowered to reach out for the treatment they deserve. Finding the right treatment choice for you is the next step.

Perimenopausal Depression Treatment

Depression isn't something you simply have to accept in your perimenopausal years. Untreated perimenopausal depression exacerbates heart disease, diabetes, and osteoporosis, so it's important to seek depression treatment early. Talk therapy and medications help many people with depression. Selective serotonin reuptake inhibitors (SSRIs) can also relieve some of the physical symptoms of menopause, such as hot flashes and insomnia.

Menopausal hormone therapy can also soothe the physical symptoms of menopause (hot flashes, night sweats, and sleep disturbances). Some studies suggest that estrogen replacement therapy can help mood and enhance the effects of antidepressants. There are two caveats about the above drug-based treatments. First, hormone therapy may not be suitable for you if you are a smoker, have high blood pressure, or have a history of breast cancer, blood clots, or active liver disease due to increased risk of adverse effects. Second, up to a third of people with depression don't respond to antidepressants.

If you don't respond to antidepressant medications, there are non-drug options you can try, including Transcranial Magnetic Stimulation (TMS). TMS applies highly focused magnetic pulses to brain regions that are crucial in the regulation of mood. TMS is a non-invasive treatment that has been cleared by the FDA for the management of Major Depressive Disorder when one medication hasn't been effective (though typically covered by insurance after two). TMS can help to relieve some or even all of the symptoms of depression in many patients and is suitable for people with depression related to perimenopause. The symptoms of menopause have long been viewed as inevitable or inescapable. Thankfully, times have changed, and effective treatments are helping people with perimenopausal depression live the lives they deserve.

Depression Treatment Options: Beyond Medication and Therapy

Tue, 16 Feb 2021 15:18:20 GMT

Medically reviewed on 12/28/2020 by
Dr. Darlene Ifill-Taylor
Charlotte Regional Medical Director

Trying different depression treatment options can sometimes be a lengthy process. Once you've been through a few that haven't been right for you, it's natural to feel frustrated. You may know someone who found one medication helpful or made great progress with their once-a-week therapy sessions, but for many people those treatments can prove ineffective.

H owever, that doesn't mean you have to continue experiencing depression symptoms indefinitely. Your choices for MDD treatment aren't limited to traditional therapy and medications—and in fact, there are more treatment options now than ever before. As you learn more about these treatment options, remember that your search for an effective depression treatment can have a positive ending.

Medical Treatments for Depression

Antidepressant medication is the most commonly used medical treatment for depression, but it's far from the only effective method. Several medical treatments beyond medications have been developed and modernized in recent years, providing more hope for people seeking MDD treatment. The following are evidence-based treatment methods, and most people try them in approximately this order:

1. TMS Therapy

Transcranial Magnetic Stimulation (TMS) therapy is an FDA-cleared, non-invasive method of brain stimulation that uses gentle magnetic pulses. A magnetic coil placed close to the skull delivers the magnetic pulses to specific areas of the brain that regulate mood and emotion. Experts believe this stimulation helps brain cells in these areas communicate better, causing symptoms to improve. A typical TMS session lasts 20 to 30 minutes and takes place in a private treatment room. It has minimal side effects, and you can drive yourself home afterward. A course of treatment typically runs six to nine weeks.

2. Spravato

Spravato is an FDA-approved form of a substance called esketamine that is delivered as a nasal spray. Because it is a controlled substance that can cause disorientation or confusion, Spravato can only be administered by a doctor in a medical clinic or hospital. While there is still more to learn about how Spravato can help people, it stands out as a fast-acting, effective medication for short-term use. It can provide quick relief, and it holds promise for people with a high risk of suicide .

3. ECT (Electroconvulsive Therapy)

Electroconvulsive therapy (ECT) delivers brief electrical currents through the brain while a person is under anesthesia. These currents intentionally create a mild seizure, which is believed to affect the chemistry in a person's brain. For some people, this treatment can reverse the effects of severe depression when other methods have failed. It is much safer than in years past, but ECT can cause some side effects and isn't right for everyone.

4. VNS (Vagus Nerve Stimulation)

Vagus nerve stimulation (VNS) treatment begins with surgically implanting a small device in the chest. This device is programmed to deliver cycles of stimulating pulses to the vagus nerve, which runs down the left side of the body. Experts don't completely understand how VNS helps depression symptoms, but they believe the stimulation may change the way that nerve cells communicate to regulate mood. For some people, vagus nerve stimulation can provide depression relief. While it's rarely used, experts are encouraged by its potential benefits and safety for long-term use.

Alternatives to Traditional Talk Therapy Settings

Traditional talk therapy generally consists of weekly appointments at an office with a therapist, or counselor. This person may be a Psychiatrist, Psychologist, LCSW, or other Mental Health therapy specialist. While this approach helps many people through depression, some people respond better to a different approach. Effective talk therapy can take place in a variety of settings that offer more flexibility and support:

Non-Residential Therapy
Intensive Outpatient Therapy (IOP). IOP programs, usually include individual therapy sessions and group or family sessions a few times a week. Most sessions are offered during evening hours or weekends for IOPs to fit around work and school schedules.
Home-Based Therapy. For some, getting to an office every week for therapy can be tough. Home-based therapy brings treatment to a person in the comfort of their home. These sessions can be individual, or they can include family members, if appropriate. This can allow people with mobility issues, severe symptoms, or difficulties regarding transportation to receive depression treatment with fewer barriers.
Partial Hospitalization/Day Treatment. Partial hospitalization can help a person transition from 24-hour care to a less intense level of care. Alternatively, a day treatment program could serve as a stand-alone treatment. Partial hospitalization offers intensive therapy in a structured setting while allowing for independent living on evenings and weekends. Treatment can include medication management, group or family therapy, yoga, art therapy, and social interaction. For children and adolescents, there is usually a classroom setting each day so that children can complete their schoolwork.
Residential Therapy. Residential therapy can be beneficial for a person with multiple mental health needs or strong, persistent symptoms. Residential treatment can last for a few weeks or several months, depending on a person's needs. With 24-hour access to support and medical care, the patient can take the time they need to try medications or other treatments until their symptoms improve. Additional therapeutic techniques, such as outdoor exercise, music therapy, meditation, or nutritional support may also be included.

Depression Treatment Options to Consider

If the depression treatments you've tried don't seem to help, take a closer look at TMS therapy and other treatments to see if they might work for you. The path to recovery may have bends, but don't lose hope. If you persist in your search, you will likely find a treatment that gives you relief.

What's the Relationship between Depression and Appetite?

Fri, 12 Feb 2021 19:02:33 GMT

Medically reviewed on 11/17/2020 by
Dr. Geoffrey Grammer
Chief Medical Officer

If you've noticed yourself losing or gaining weight while experiencing depression, you're not alone. It's not uncommon for depression to cause changes to appetite, along with a host of other physical symptoms like fatigue and digestive problems. In fact, nearly half of adults with depression experience the combined effects of depression and loss of appetite . Meanwhile, roughly 35 percent see an increased appetite related to depression and may find themselves eating more than normal.

This divergence means that the relationship between depression and appetite is a complex one. Here's a closer look at why depression might change how hungry you feel and where to look for support and treatment.

How Depression May Affect Your Eating Habits

There's limited research into exactly why depression leads to appetite changes. However, one study using functional magnetic resonance imaging showed that similar parts of the brain are implicated in both depression and appetite cues. Different brain responses are associated with different changes in appetite, which could indicate that there are different subgroups of depression.

Beyond affecting your hunger levels, depression can influence the types of food you eat. It's common for people who are experiencing depression and feeling unmotivated to opt for quick and convenient meals or snacks. Similarly, the fatigue and lack of energy that often come with depression can make it difficult to feel like preparing and cooking healthy meals from scratch. If you have an increased appetite, you may crave comforting prepared foods. These are often high in sugar and addictive. As well as being an easy option, these foods may give you an initial feel-good buzz, boosting your mood and energy in the short term. However, they can also lead to energy slumps later, making you feel worse in the long run.

Healthy Eating and Depression

It's easy to see how depression and appetite changes can lead to a cycle of under- or overeating and reliance on convenient foods. We all know about the importance of eating a healthy, balanced diet to maintain your overall health and well-being. This is equally true when it comes to depression. Research shows a link between high-sugar diets and reduced mood . In fact, 95 percent of the mood-boosting chemical serotonin is produced in your gastrointestinal tract. What you put into your stomach really can make a difference to what happens inside your brain.

However, when you're experiencing depression, it can be difficult to muster the energy required to take control of your eating habits. This isn't your fault; remember that appetite changes are common with depression. But that doesn't mean you have to put up with them. Even if you're able to make some adjustments on your own, it's important to seek professional treatment for depression. This can set you on the path toward getting your appetite and diet back in balance as well as improving your mental health.

Seeking Treatment

Your first port of call will often be your doctor or health care team. They can listen to your concerns and recommend common first-line treatments such as antidepressant medications or talk therapy, which may help ease your symptoms. But we know that for some people, depression can be more persistent, and certain treatments may not be as effective for everyone. One study showed that even after trying two different medications, a third of people weren't free of depression symptoms . If previous treatments haven't helped you, Transcranial Magnetic Stimulation (TMS) therapy is a non-drug, non-invasive option to consider.

TMS is an FDA-cleared treatment for Major Depressive Disorder (MDD). It works by stimulating areas of the brain involved in mood regulation, so it could help to get both your mental health and your appetite back on track. To learn more about TMS and whether it might be right for you, schedule a no-cost consultation .

How does Depression Feel

Mon, 08 Feb 2021 15:27:21 GMT

Medically reviewed on 11/23/2020 by
Dr. Steven Harvey
St. Louis Regional Medical Director

We've all had bad days—days when we feel like we don't have enough energy or confidence to get through the workday and would rather stay in bed. But does that mean you're suffering from depression? What does depression feel like, exactly? There's no one-size-fits-all list of symptoms for depression, but rather a complex range of symptoms that can be hard to recognize and perhaps different from what you might expect. People often equate depression with sadness, but you can be depressed without necessarily feeling sad, and vice versa.

S o how does depression feel? The answer is that it's different for different people. An estimated 264 million people of all ages suffer from depression worldwide, and each of those people experiences depression in their own unique way. However, there are some symptoms to be aware of that can help you determine whether you might be experiencing depression.

Depression: Not Just Emotional Symptoms

It's an old cliché that life's a roller coaster. You expect that your moods will take downward dips occasionally: normal daily life comes with a range of stressors, and you are bound to encounter people, situations, and events that trigger anger, sadness, or other negative emotions. With time, though, the car keeps rolling and ascends again. But if the roller coaster of life doesn't seem to be turning back upward again, that may be a signal to give yourself a mental checkup. If you're feeling sad or anxious for a prolonged period—two weeks or more—and you find yourself not wanting to do some of the things you always liked to do, these may be signs of depression.

In addition, if you are constantly burdened with thoughts and feelings of guilt, helplessness, worthlessness, or suicide; or you often feel restless, easily irritated, or frustrated, these too should spur you to consult your doctor. But depression isn't only tied to mental and emotional distress. It can spark a host of physical symptoms that you should keep an eye on as well. Anxiety can interfere with sleep and eating patterns—sometimes in opposite ways. Some people with depression eat a lot to soothe themselves and gain weight, while others lose their appetites. Many people with depression get insomnia and have trouble falling asleep, or they wake up in the middle of the night and cannot help but ruminate on stressful thoughts, which can make it difficult to go back to sleep.

For others, the opposite happens: they can't wake up, and they sleep far longer than usual. Other physical ailments that can arise alongside depression can include muscle tension, headaches, or stomach problems. If you are feeling tired and stressed, you may also have trouble focusing, recalling details, or making decisions

Potential Treatment Options

If you are experiencing any of the symptoms above, it's possible you may be suffering from depression. While depression can often be successfully treated with therapy and medications, one in three people continue experiencing symptoms of depression even after trying two medications.

If these methods have not been effective for you, another option is transcranial magnetic stimulation (TMS). TMS is a non-invasive, drug-free treatment in which patients sit comfortably in a chair, awake and alert, as a device near their scalp delivers gentle magnetic pulses similar to those of a magnetic resonance imaging (MRI) scan. These pulses stimulate changes in brain chemical signaling that can alleviate symptoms of major depressive disorder (MDD).

D epression doesn't always feel how you may expect it to. It's important to understand and recognize the symptoms of depression so they can be treated and life can turn upward again. Remember, you're not alone in facing depression, and even if you haven't seen success with medication treatments, there are other options that may work for you.

Exploring the Relationship between Chronic Illness and Depression

Fri, 05 Feb 2021 15:27:27 GMT

Medically reviewed on 11/16/2020 by
Dr. Geoffrey Grammer

Chief Medical Officer

If you've been negotiating a chronic illness day after day, you're bound to feel run down at times. Long-lasting illnesses such as diabetes or Parkinson's disease can cause incessant pain and stress. They can also make it difficult or sometimes impossible to function at your best at work and in your relationships. But those illnesses can also trigger another condition: depression. Chronic illness and depression often go hand in hand, each making the other worse. So, managing your chronic illness and taking care of your mental health is ultimately a double-duty job. According to the Cleveland Clinic, one-third of people with chronic illnesses also experience depression . There's a medical term for this: "comorbidity," the simultaneous presence of two or more distinct conditions in a patient. The symptoms of one condition can often overlap with and mask another. This can make it difficult for people with depression (and sometimes even their doctors) to recognize that two separate ailments—each requiring its own treatment—are occurring at the same time. The list of illnesses that persist or can't be fully cured is unfortunately long. Along with physical pains, chronic conditions like cancer, AIDS/HIV, and multiple sclerosis can bring emotional ones, too, from fear to frustration and loneliness. It's no wonder that the continuous stress of a chronic illness can affect your mental health. Still, it's important to recognize that you are not alone, and that there is hope.

The Connection between Chronic Illness and Depression

A problem can arise when patients and physicians fail to recognize that certain normal and expected feelings have reached the threshold of triggering medical depression. Treating the chronic illness can take so much attention and energy that it's easy to overlook another condition in the midst. To complicate matters, many of the telltale symptoms of depression are the same ones that people with chronic illnesses experience: fatigue, insomnia, stomach troubles, backaches and headaches, weight gain or loss, sexual dysfunction, problems concentrating, and feelings of helplessness, worthlessness, or hopelessness. It can be hard to distinguish whether these symptoms are caused by chronic illness or by depression. The cause could, in fact, be both. Many of the physical symptoms brought about by depression are associated with inflammation in the body, potentially leading to aches and pains, a weakened immune system, and increased stress. All of these can worsen chronic illness, which in turn can heighten depression. Research has shown, for example, that depression is associated with poorer prognoses and faster development of chronic illnesses , such as heart disease and diabetes. Chronic illness and depression have a cyclical, mutually harmful relationship, each one exacerbating the other.

Seeking Treatment for Depression Can Lighten the

Depression is associated with changes in the brain chemicals that regulate signaling and moods. For some people, it can be effectively treated with talk therapy and/or antidepressants and other medications. Yet roughly one in three people don't find relief even after trying two medications. And if you have a chronic condition that already requires medications, you simply may not want to add another pill for depression. You might also be concerned about potential drug interactions between a chronic illness medication and depression medications—or that your chronic illness medication may actually be increasing your risk for or contributing to depression. Especially if you fall into these categories, Transcranial Magnetic Stimulation (TMS) is a depression treatment worth considering. TMS is a non-invasive, drug-free, outpatient treatment in which you sit in a comfortable chair, awake and alert, while a device near your scalp delivers gentle magnetic pulses. These pulses, similar to those in an MRI scan, stimulate changes in brain chemical signaling that can alleviate symptoms of Major Depressive Disorder . To learn more about whether TMS therapy is right for you, schedule a no-cost consultation . If you have a chronic illness, keep in mind that you also have a higher risk of depression. While it can be tough to do, it's important to take care of both your chronic illness and your mental health. You deserve to feel your best, and treatment can help get you there.

If Depression Goes Untreated, What Happens?

Tue, 26 Jan 2021 17:49:24 GMT

Medically reviewed on 11/13/2020 by
Dr. Steven Harvey
St. Louis Regional Medical Director

For some people, finding the right treatment for depression can be challenging. Although antidepressants and talk therapy work for many, they provide little to no relief for others. If you fall into the latter category, it's possible that you've wondered what happens if depression goes untreated. Will it go away, or will it get worse?

I f you've found your antidepressants to be ineffective or produce too many unpleasant side effects, you may also be wondering what happens if you stop taking your antidepressants. Plus, you may be feeling discouraged with depression treatments in general and wonder if there's any point continuing the search. Is there any depression treatment out there that could be effective for you? The answer to that final question is a resounding "yes." There is always another option to try, even if medication and talk therapy haven't worked for you in the past. Let's take a look at why it's so important to treat depression, and what you can do if past treatments haven't been successful.

Progression of Untreated Depression

Depression (and the distressing feelings it can cause) often becomes more intense when it's left untreated. It can even become chronic and last for years or a lifetime. Depression doesn't only affect mood and emotions, either. Depression also causes physical symptoms such as nausea, chronic pain, fatigue, and headaches. And when it isn't treated, these symptoms persist. Sleep is affected, as well. Many people with untreated depression suffer insomnia and find it difficult to sleep. Others feel excessively tired and find it necessary to sleep more.

Some researchers believe that depression is connected to the immune system , so untreated depression may also impact your overall health or ability to recover from illnesses. Your personal, family, and work life could be impacted, too. For instance, if depression goes untreated, there's an increased likelihood of work performance decline and absenteeism.

F urther, untreated depression has been found to increase a person's risk of developing drug or alcohol addiction. So, although it may be tempting to stop the search for treatment altogether, the negative consequences aren't worth it. In the long run, continuing to seek treatment will have the most positive results, even if it seems like a difficult road.

Stopping Antidepressants

If you've found no relief from antidepressants, or if your antidepressants have had unpleasant side effects, you may be wondering, what happens if I stop taking my antidepressants? You may think it makes sense to stop taking something that just isn't working, but suddenly going off an antidepressant can have adverse outcomes. How? Put simply, antidepressants impact your brain chemistry. They work by changing the way certain brain chemicals, called neurotransmitters, affect your mood and emotion. Eventually, messenger cells in your brain get accustomed to receiving increased levels of neurotransmitters.

If you abruptly stop taking your antidepressants, you could experience serious symptoms of withdrawal—especially if you've taken the medication(s) for more than a month. Some of the withdrawal symptoms include nausea, anxiety, restlessness, trouble sleeping, nightmares, sweating, and electric shock-like feelings in your head. Altogether, these symptoms are also known as antidepressant discontinuation syndrome. Antidepressant withdrawal symptoms typically occur within a few days of stopping antidepressant medication. Generally, they can last for up to six weeks. In some cases, however, the withdrawal symptoms are more severe and can last for many months.

I f you want to stop taking your antidepressant medication, you should speak to your physician first. Any reduction of your antidepressants will probably be gradual—over several weeks. This way, your body can adapt better to the changes in your neurotransmitter levels.

A Different Kind of Treatment

If you've tried multiple antidepressant medications and feel like they aren't working, there's a chance you might have treatment-resistant depression . You're not alone, though: about one-third of people with depression still have symptoms even after trying two medications. It's also possible that the antidepressant you're on works well but has intolerable side effects. The search for the right treatment can take some time, but there are other options out there that have worked for many people.

T ranscranial magnetic stimulation (TMS) therapy is one such option you may want to consider. It's a safe, non-invasive treatment that is used to effectively treat major depressive disorder. TMS therapy uses magnetic pulses to stimulate specific brain regions involved in mood regulation. It has successfully treated depression for many people who did not have much success with antidepressants and talk therapy. You can learn more about TMS therapy from patients reporting their positive outcomes. Whatever path you choose, remember to stay hopeful on your journey. You deserve to feel like yourself again.

When to Get Help for Caregiver Burnout and Depression

Sun, 24 Jan 2021 17:37:15 GMT

Medically reviewed on 11/11/2020 by
Dr. Darlene Ifill-Taylor
Charlotte Regional Medical Director

Most people would drop anything to help out a loved one in need, but acting as a long-term caregiver can come at a cost they may not predict. Burnout is a very real concern for many caregivers and can eventually lead to depression. Caregiver burnout and depression can affect all areas of your life, including your ability to care for your loved one. According to one recent AARP study, 47.9 million caregivers provided an average of roughly 24 hours of care each week in 2019. Of those caregivers, 70 percent reported high emotional stress, 55 percent reported feeling alone, and 36 percent reported financial strain. It's not surprising that you would feel overwhelmed, nor is it your fault.

While caring for a family member is a labor of love—it's still labor, and emotionally taxing labor at that. If someone asked you to take on a 24/7 job—that you have to pay to do, on top of everything else in your life, you'd call them crazy. Yet, that's what being a caregiver entails, so it is natural if you are feeling burnt out. Caregivers may not have been given a choice or received training, and it is work that can feel intensely underappreciated at times. Ultimately, finding the time or emotional resources for self-care can become a challenge. So, as a caregiver, what should you do if you find yourself experiencing burnout or depression?

Recognizing Caregiver Burnout and Depression

Caregiver burnout is a common phenomenon. In fact, the American Medical Association has an assessment tool that specifically measures caregivers' physical and mental health. You may be experiencing caregiver burnout if you're often feeling overwhelmed or exhausted, you're becoming easily irritable, or you're losing interest in activities you used to enjoy. These symptoms can overlap with those of depression. For example, if you're experiencing depression, you might have diminished interest in hobbies, struggle with insomnia, or feel overwhelming guilt or worthlessness.

There are some key differences, though. With burnout, you may feel like all of your energy has been depleted because you've already given so much, whereas with depression, you may feel like you can no longer experience joy. Burnout is a response to a stressor; depression is a mood disorder.

One key factor that differentiates burnout from depression is that burnout usually stems from an ongoing, unresolvable, easily identified issue; depression is a bit more general, and it may be more difficult to pinpoint the cause. Left untreated, however, burnout can lead to depression. And if you have a history of depression, a stressful situation like caregiving may be more likely to exacerbate depression or cause a depressive episode.

If you're feeling burned out, caring for your loved one can be challenging. You might even feel frustrated with yourself and think you shouldn't feel this way. But these feelings are natural, and you are far from alone. In a recent study, up to 80 percent of caregivers reported feeling symptoms of stress. Plus, caregiving is often for the long haul. In the AARP study, the average length of caregiving was 4.5 years, with 30 percent of caregivers providing care for at least five years. If you are in a long-term caregiving situation, it may feel difficult to make the time to care for yourself, but your health is still paramount and worth protecting.

Seeking Treatment

Whether what you're experiencing is depression or caregiver burnout, if you believe that caregiving is impacting your mental health, it's time to get help. It's not just for you—it's for the benefit of your loved one, too. You can't be an effective caregiver if you're not also caring for yourself.

Seeking treatment is a sign of strength. It shows that you care enough about yourself and your loved one to take action, and it's one of the best ways you can care for both of you. Your first line of treatment will likely be talk therapy or medication. But don't be discouraged if the first medication you try isn't the right one for you—only about 1 in 3 people find the one for them on the first try.

But if you've tried one or more medications and you're still not feeling relief, you have plenty of other options. You may want to look into Transcranial Magnetic Stimulation (TMS), for instance. TMS therapy is a depression treatment that uses mild magnetic pulses to gently stimulate the brain and regulate mood.

Caregiver depression is common, but that doesn't mean you need to resign yourself to feeling low. There are plenty of treatment avenues to consider so you can feel better faster. Be sure to reach out to your doctor if you're experiencing signs of caregiver burnout or caregiver depression. But above all, remember that your health matters just as much as your loved one's.

Men's Mental Health: Moving Past the Stigma

Fri, 22 Jan 2021 17:37:12 GMT

Medically reviewed on 11/13/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director

You might have heard that old gag line: "Real men don't eat quiche." It's the title of a book that pokes fun at age-old stereotypes of men. Tough guys are supposed to man the grill and scarf down no-nonsense hamburgers instead. Here's another similar, stubbornly held stereotype, but it's no laughing matter: Too many men think only women experience depression . For them, men's mental health is a taboo topic. They avoid treatment for mental illness in men—with dire impacts on their health that can shorten their life expectancy . More women than men are treated for depression, but the statistics are skewed because men are less comfortable with seeking treatment. Additionally, men often don't recognize the symptoms of depression, or they may deny or ignore their symptoms. Fortunately, as stigma fades, men have a range of support resources and treatment options available to them.

Symptoms of Depression in Men

Our culture puts a lot of pressure on men to always be strong, reliable, and competent. Depression makes it hard to meet these lofty expectations. Sometimes, just the stress of failing to always live up to unrealistic goals can erode self-esteem. Men of all ages get depression—as many as one-third of men in the United States may experience depression at some time in their lives. But male adolescents—on the cusp of manhood and wrestling with those expectations—face particular risks. So do older men who retire and may suddenly feel they have lost their routines, prestige, and purpose in life. Depression affects your ability to sleep and eat well; makes you tired; impairs your ability to focus; and causes physical ailments such as backaches, headaches, stomach troubles, chest tightness, and sexual problems. A lot of men don't realize that the root of these symptoms is depression . The symptoms of depression in men and women can be different . Thinking they need to be the strong and silent types, men may bottle up their feelings. Not wanting to appear weak in the eyes of their family, friends, and colleagues, they may deny their symptoms or try to cover them up—often by doubling down on macho behavior. For example, they may dive more compulsively into their work. Or they may get angry easily and sometimes become abusive. They may also drink too much, use drugs, or engage in risky behaviors like driving recklessly or cheating on their spouses. Our culture often defines these behaviors as just "boys being boys," but they can be real signs of depression. And they can cause profound harm to men's families, friends, and co-workers—and to themselves.

Seeking Treatment for Depression

If you've experienced some of the above symptoms, know that depression isn't a sign of weakness. It's a medical condition that needs to be treated. If you had a heart condition, you wouldn't ignore it; you would go to the doctor. Depression should be viewed the same way. Though you may feel uncomfortable asking for help at first, remember that seeking treatment for depression is a sign of strength. It takes courage to confront your illness and do what needs to be done to get better. Talk and behavioral therapies and medications have proved effective for mental illness in men. If these don't provide relief, another option is Transcranial Magnetic Stimulation (TMS). This non-invasive, non-drug treatment uses magnetic pulses to improve brain signaling that regulates mood. If frontline depression treatments haven't had an effect, TMS may be right for you . Men's mental health shouldn't be ignored. If you're experiencing depression, don't be afraid to ask for help.

What to Look for in a TMS Provider

Mon, 11 Jan 2021 16:36:22 GMT

Acknowledging you need mental health care isn't easy, and finding the right provider can be downright daunting. We applaud you for conducting research to find a transcranial magnetic stimulation provider, because that means you are invested in feeling better and restoring a good quality of life. While we want to be your TMS provider, our biggest hope is that you find the provider that's right for you. To aid you in your search, we'd like to offer some things to think about when choosing your TMS provider.

Do They Help You with Insurance?

The World Health Organization attributes 14 percent of the global disease burden to mental health disorders, with depression being a main cause of disability. In spite of that, insurance companies remain a burdensome hurdle to receiving quality care. The American Psychological Association recommends calling your insurance company or visiting the company's website for a list of in-network providers, asking about co-payments and your deductible upfront, and talking to your provider about whether they accept your insurance. These are all important points to determine, but struggling with insurance and wondering if you can afford good care shouldn't be obstacles between you and relief from your depression. Besides, sometimes the insurance company website won't even have up-to-date information. At Greenbrook TMS, we have a billing department to do all that research for you.

We work with major insurance providers , which means all you need is an insurance card to get coverage. A patient consultant will work with you on the status of your insurance requests, and our team will file and process claims, as well as help with appeals. We make sure payment is predictable for you, with no hidden fees, helping you to make an informed choice about whether being treated by us is best for your.

Are the Providers Experienced?

Any time you get a procedure, you should consider the experience of the physician performing the procedure. You have a right to know if you're the third case or the 100th case. Since TMS has been around for just over a decade, you may find providers who are new to it. If this is the case, you can ask how the physician was trained to perform TMS and which devices they use, as not all devices are equal in efficacy .

At Greenbrook TMS, we use a variety of devices that are all cleared by the FDA, enabling us to offer several treatment options to our patients. We have more than 100 physicians in our company, including some of the nation's most experienced TMS providers, who undergo extensive TMS training. The most experienced physicians belong to our Clinical Advisory Committee to provide on-demand advice and resources to any of the physicians at Greenbrook TMS. No matter which Greenbrook TMS center you visit, you will receive the same standard of treatment with all the benefits of our best providers.

What about Location, Convenience, and Atmosphere?

Because TMS is not as commonly employed as other mental health treatments like antidepressants and talk therapy, finding a TMS center can be challenging. Availability is certainly better now than it was 10 years ago, and the Clinical TMS Society has an interactive map to help you find a nearby provider. Unfortunately, there are some providers who aren't as focused on the patient experience and may cut corners on their overhead by neglecting things like conveniently located centers, modern offices, or comfortable TMS chairs. First and foremost, Greenbrook TMS chooses centers based on geographic proximity to people's homes and workplaces. Next, we make sure our centers are appealing, soothing, and safe for our patients, making them feel more like spas than doctors' offices. We want to be sure that when you come into our centers, you're able to relax and focus on getting better.

How Friendly and Competent Is the Care Team?

When you decide to get TMS treatments, you will have 30 to 36 sessions over six to nine weeks . After your physician determines your device's settings, most of these treatments will be administered by a TMS technician. While you may have found a provider you are comfortable with, the physicians are just one part of the care team that's working with you throughout your treatment. Your TMS experience could be an unpleasant one if the technicians don't treat you the same way your physician does or, worse, aren't trained well and therefore mishandle your treatments.

Greenbrook TMS technicians are not administrative staff who also work as technicians—their full-time job is in the administration of the TMS therapy. Our technicians undergo training that far exceeds the industry standard, and we have a formalized internal training program and continuing education training opportunities to make sure they stay up to date. Besides their competency, our technicians are always pleasant and friendly. In fact, many of our patients that one of their very favorite parts of treatment is getting to see their techs every single day and talk with them.

Choosing a TMS Provider

No matter where you choose to receive TMS therapy, we want you to feel safe, well cared for, and, ultimately, better. Because Greenbrook TMS is the largest provider of TMS in the United States, we have internal quality assurance initiatives to keep track of our clinics' and providers' performance, so we know that our patients are receiving the same standard of care across the company. Between physician peer review, technician training, and quality assurance data analysis, you can rest assured that no matter where you get your Greenbrook TMS treatment, it's going to be the best that TMS has to offer. If you're ready to take the next step in choosing a provider, we would love to hear from you .

The Safety of Antipsychotics for Depression

Mon, 11 Jan 2021 16:32:50 GMT

Medically reviewed on 11/23/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director

Using antipsychotics for depression is one of the most common augmentation strategies for patients with treatment-resistant depression . Drugs such as Seroquel, Abilify, Rexulti, and Zyprexa are often prescribed when antidepressants don't work on their own, especially if a patient doesn't see relief from symptoms after two classes of medications. While these medications can be helpful, doctors and patients alike often underestimate the risks with this augmentation strategy. Atypical antipsychotics can be associated with problematic side effects and shrinking areas of the brain that house our neurons and neuron cell bodies. Is Transcranial Magnetic Stimulation (TMS) safe as an alternative to antipsychotics for depression?

Atypical Antipsychotic Risks and Benefits

One potential consequence of taking atypical antipsychotic medications is their metabolic effects. These drugs appear to increase insulin resistance, which can cause elevations in blood sugar and fat deposition, leading to weight gain . The weight gain can be quite substantial and can happen quickly, raising your risk of diabetes and high cholesterol. These medications can also contribute to motor problems like muscle stiffness, tremors, and even a permanent neurologic condition called tardive dyskinesia, which causes involuntary movements of the lips, mouth, and limbs.

What may be more alarming to some is the finding from a recent study that antipsychotics are associated with brain shrinkage, or what physicians call cortical atrophy, which can lead to cognitive deficiencies in memory and thinking. Brain shrinkage affects not just how you think through problems but also how you think about the world, limiting your ability to compose thoughtful observations, ideas, and arguments, thus potentially affecting your career, your relationships, or your parenting. Because of this, antipsychotics may be dangerous to take over the long term. While the potential side effects could deter you from trying atypical antipsychotics for depression, keep in mind that they have been proven to be beneficial over the short term and can be better than the consequences of untreated depression. Before you take an atypical antipsychotic, you should ask your doctor the following questions:

Why are you choosing this particular atypical antipsychotic as opposed to another?
What are the anticipated risks?
What other treatment options are available to me?

Atypical antipsychotics are meant to help patients get better from treatment-resistant depression. But once you're in a state of recovery, you may be able to lower your dose and keep a close eye on your side effects, or come off of atypical antipsychotics altogether. If you're getting better with these medications, talk to your doctor about transitioning to other options for the treatment of major depression.

Beyond Atypical Antipsychotics: TMS and Other Options

If atypical antipsychotics aren't working for you as an augmentation strategy or if the side effects from these medications are causing too many health problems, you have many other options. For example, you can ask your doctor for a different atypical antipsychotic with fewer metabolic consequences. You can ask to try another augmentation strategy, like using Lithium, which doesn't have the same side effects. Evidence-based psychotherapy can help. Spravato, a nasal spray the Food and Drug Administration approved last year, is another effective treatment. Electroconvulsive therapy and vagus nerve stimulation are other options, but they're often reserved for patients who have tried many other therapies or those who are very ill.

I s TMS safe as another option? The answer might surprise you. A non-drug alternative for treatment-resistant depression that neither results in the side effects associated with atypical antipsychotics nor damages the brain, TMS may actually be associated with better brain health. Think of TMS like physical therapy for the brain—it enhances chemicals associated with increased brain complexity, and it may improve neuronal function over time. In observational trials, the response rate of TMS is upwards of 62 percent, which weighs favorably against any other strategy for treatment-resistant depression. The most important point here is to talk to your doctor about augmentation strategy options beyond atypical antipsychotics and the side effects that go hand in hand with them. If you would like to learn more about TMS therapy, you can set up a free consultation . Treatments are non-invasive, our centers are conveniently located, and we are providers on most insurance plans.

Breaking the Cycle: Depression and Genetics

Mon, 11 Jan 2021 16:27:17 GMT

Medically reviewed on 11/16/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director

Do you have your father's nose or your mother's eyes? Perhaps stubbornness is a common family trait, or you all have a similar sense of humor. Many traits run in families, so it's natural to wonder, is depression genetic, too? Depression and genetics are correlated in some ways, but you are much more than your DNA. If you have a parent or sibling with depression, that doesn't mean you'll inevitably develop depression, too. In fact, recent research suggests you could even positively influence the genetic legacy you pass onto future generations.

The Relationship between Depression and Genetics

Depression can sometimes arise in response to events in our lives: the COVID-19 pandemic, stress, chronic pain, or bereavement, for example. So, to what extent is depression genetic? Only 40 percent of the population's tendency toward depression can be explained by genes. There is no single gene for depression. At least 44 gene variants contribute to the risk of depression from one generation to the next, and research is ongoing to better understand. Even if you were to inherit many of these, you still might not develop depression. Instead, the chance depends on:

How many of these genes you inherit (each one makes a tiny contribution to the risk of depression)
Which specific genes you inherit (some matter more than others)
How this genetic blueprint interacts with other personal factors (such as stress, chronic pain, or illness)

As a result, even if your child were to inherit all these genetic variants from you, he or she would not necessarily develop depression.

How Genes Can Contribute

The genes identified in depression studies are integral parts of the nervous system. They influence how nerve cells grow and send signals to brain regions that influence mood. They control the function of chemical messengers called neurotransmitters (such as serotonin), which are altered in depression. Some genes influence the immune system, which is also linked to our mood . So, could you change the genetic code you pass onto future generations? Possibly. A relatively new scientific field called epigenetics explores how the events in our lives switch the expression—or readability—of our genes without changing the DNA code itself. These life events include early adversity in childhood, trauma, or prolonged stress. Tiny chemical tags are added to or removed from our DNA in response to these events. The chemical tags turn depression genes on or off.

Subsequently, epigenetic changes can be passed down to the next generation. That means it may be possible to pass on positive epigenetic changes by taking positive steps that actively support your health. These include surrounding yourself with strong social support, engaging in physical activity where possible, and treating symptoms of depression.

Why Depression Seems to Run in Families

If you have a sibling or parent with depression, you have two to three times the chance of developing depression yourself. However, this isn't solely related to the DNA you share. We know this partly due to studies of identical twins. Even though they have almost no difference in their DNA, if one twin develops depression, the other twin frequently doesn't. Instead, it's our experience and environment that matter. Shared life experiences within families can often place closely related people at higher risk for depression. These shared experiences could include early adversity or neglect in childhood , trauma, family pressures, or addiction.

I f you have depression just as another member of your family does, your shared experiences could also explain this, rather than your shared DNA. Further, depression often affects not only the person with depression, but their family, too. Family life can feel unsettled, compounded by the financial, social, and physical issues that accompany depression. Finding the right treatment could restore balance to your own life as well as the lives of your loved ones.

Breaking the Cycle of Familial Depression

If you're ready to begin your treatment journey, empower yourself to take the next steps. Imagine waking up refreshed each morning with hope for the day ahead, passion for the interests you hold, and positive energy to see you through time spent with family and friends. If you have persistent stress, counseling might help you and your family. Consider speaking to your doctor about treating any underlying medical conditions, such as chronic pain or sleep apnea, that exacerbate depression. Or perhaps you'd benefit from an antidepressant medication. If those common approaches don't work, another way to break the cycle of depression and genetics is transcranial magnetic stimulation (TMS).

T MS therapy is a non-invasive and non-drug depression treatment that applies highly focused magnetic pulses to brain regions that are crucial in the regulation of mood. It's been cleared by the FDA for the treatment of Major Depressive Disorder and Obsessive Compulsive Disorder. TMS can help to relieve some, or even all , of the symptoms of depression in many patients. Whichever treatment path you choose, remember: even if depression has been part of your family's history, it doesn't need to be part of your future.

Can Exercise Help with Depression?

Sun, 10 Jan 2021 16:25:40 GMT

Medically reviewed on 12/13/2020 by
Dr. Darlene Ifill-Taylor
Charlotte Regional Medical Director

Say you have a boss who puts you down so constantly that your emotional health starts to suffer. After one particularly tough exchange, you close your laptop and set off for a 10-mile run. Back home, your feelings have lost their edge and you spend the afternoon productively. In this case, exercise had a clear effect on your mood—but what if your sadness and difficulty making decisions persist for weeks or months? Can exercise help with depression? The simple answer is yes . Research has shown the positive effects of exercise on depression . For some people, exercise can complement other therapies and help improve symptoms of depression. But like many other strategies for alleviating depression, exercise doesn't help everyone, and it isn't a one-stop cure or a replacement for professional treatment.

How Does Exercise Help Relieve Depression?

There are many theories about the benefits of exercise for depression. Some effects of exercise on depression are psychological and emotional: Exercise can distract you from your worries. It can give you a sense of control and boost your self-confidence and self-esteem. Studies have also demonstrated that exercise has beneficial physiological effects. It can increase levels of certain chemicals in the brain, including endorphins , which reduce pain, and neurotransmitters, which enhance signaling between brain cells.

Exercise also stimulates muscles to secrete chemicals that increase levels of a protein called brain-derived neurotrophic factor , or BDNF, which is essential for growing and maintaining healthy brain cells. Increasing the levels of these chemicals counteracts the impacts of depression, which is associated with impeded signaling in areas of the brain that regulate mood. To benefit from exercise, you don't have to go all out running, swimming, biking, or lifting weights. Low-intensity exercises such as yoga and stretching can be effective, too. Even minor exercise can help. Try something more manageable for you, such as gardening, housework, taking a walk, or using the stairs instead of the elevator.

But if exercise feels like too much for you, don't worry. It doesn't mean you're lazy. Remember that depression is a medical condition that saps your energy and impairs your ability to focus, feel motivated, and act on plans. After you get treatment for depression, you can identify the best way to slowly add exercise into your tool kit of strategies to maintain your overall well-being.

Exercise Your Options to Seek Treatment

The most important step is to seek treatment from mental health professionals. They can offer a variety of therapies that successfully relieve the symptoms of depression. Most frequent among first-line treatment strategies are talk therapy (Interpersonal, Psychodynamic or cognitive behavioral therapy) and antidepressant medications. But just as exercise itself isn't a silver bullet for depression, roughly 1 in 3 people don't experience relief even after trying two medications. If you've struggled to find an effective depression treatment, consider Transcranial Magnetic Stimulation (TMS) therapy.

TMS is a non-invasive, drug-free treatment in which a device near your scalp delivers gentle magnetic pulses, similar to those in an MRI scan. You sit comfortably during the session, remaining awake and alert. The pulses stimulate changes in brain chemical signaling that can alleviate symptoms of Major Depressive Disorder . TMS is FDA-cleared for those who have tried one medication without success (and covered by most insurance policies after two medications). Depression affects different people in different ways. Some treatments work for some individuals, but not for others. Finding the right option for you is critical for both your mental and your physical health, especially if it helps you enjoy and engage in regular exercise. To learn more about whether TMS is right for you, schedule a no-cost consultation .

Why Am I So Tired? The Thyroid and Depression

Sat, 09 Jan 2021 16:23:12 GMT

If you find yourself reaching for an extra cup of coffee or pining for a nap between Zoom calls, you can often point to the reason: an early wake-up time, a series of especially busy days, or maybe even a late-night Netflix binge. But if you're not feeling refreshed after a good night's sleep, there may be something else causing your tiredness and lack of energy. If your fatigue is paired with a persistent low mood, depression is one possible explanation, but it's not the only one. Issues with the thyroid gland can also cause tiredness and low mood. Hypothyroidism is a common contributing factor in mood changes, especially among women and older adults. Hypothyroidism and depression can also have a significant overlap in symptoms , and both require medical attention, so it's important to see a doctor for an evaluation if you're experiencing symptoms of one or both.

What Is the Thyroid?

The thyroid is a shield-shaped gland in the front of the neck, just behind the Adam's apple. It releases hormones that affect every cell of the body. The thyroid contributes to several bodily functions, including telling the body how to use calories, regulating body temperature, speeding up and slowing down heart rate, helping muscles contract, regulating how fast food moves through the digestive system, and managing how quickly cells regenerate. When the thyroid stops working as it should, typically due to factors such as medications, age, genetics, or autoimmune disease, it can cause a host of problems related to body functions and sense of well-being, including mental healt h.

The Thyroid and Depression

Hypothyroidism occurs when the thyroid is not secreting enough hormones, which can result in a number of symptoms that overlap with those of depression, including:

Fatigue
Weight gain
Low mood
Difficulty concentrating

These symptoms are so similar to those of depression that they often lead people to believe they have Major Depressive Disorder (MDD) instead. But while the presentation of a depressive episode caused by hypothyroidism and one cased by MDD may be the same, the diagnoses are different; with hypothyroidism, the depressive episode is related to low serum thyroid hormone levels, but with MDD, the direct cause is unknown. In addition, the effects of hypothyroidism can worsen pre-existing depression. There are other symptoms of hypothyroidism that don't overlap with depression, such as constipation, feeling cold all the time, stiff muscles, cramping, and hair loss. Being aware of the symptoms of hypothyroidism and depression can enable you to paint a more complete picture of your condition for your doctor so they can help you get the treatment and care you need.

The Impact of Hyperthyroidism

Hyperthyroidism , on the other hand, is when the thyroid produces too much thyroid hormone. In a lot of ways, it's the opposite of hypothyroidism. Instead of causing a slow metabolism, hyperthyroidism can cause the metabolism to operate too quickly, making it difficult to gain and retain weight. Instead of feeling depressed, you may feel anxious or nervous with hyperthyroidism. You might also experience heart palpitations, difficulties with sleeping or tolerating heat, and muscle weakness. Anxiety is the most common mental health concern caused by hyperthyroidism, with 60% of hyperthyroidism patients reporting it. However, hyperthyroidism can also occasionally cause depressive symptoms , especially among elderly people. People with hyperthyroidism can also develop a large thyroid, or goiter, in the neck. It may also lead to Grave's ophthalmopathy, which causes the eyes to bulge out of their sockets. If you notice any of these symptoms, it's important to contact your doctor for further evaluation.

Diagnosis and Treatment

The good news is that the diagnosis of thyroid conditions is relatively simple, typically consisting of a blood test. From there, treatment is also fairly straightfoward, though it is usually life-long and may require regular checkups to ensure that the dosage is appropriate. Treating thyroid conditions can effectively moderate depressive symptoms caused by the thyroid and prevent other health problems associated with thyroid issues. In addition, thyroid disease treatments are sometimes used alongside antidepressant medications as mood boosters, even when a blood test shows normal thyroid function, according to Harvard Medical School . The potential relationship between the thyroid and depression underlines the importance of a comprehensive physical exam for fully addressing your symptoms. It's a classic case of a sound body contributing to a sound mind.

I f you are seeking relief from depression symptoms, remain persistent in your search. Thyroid medications, antidepressants, and non-drug treatments like Transcranial Magnetic Stimulation (TMS) have all been shown to improve quality of life for people with depression . Talk to your doctor about which treatment option may be the best fit for you.

Does Depression Go Away with Time?

Fri, 08 Jan 2021 21:09:37 GMT

Medically reviewed on 12/10/2020 by
Dr. Darlene Ifill-Taylor
Charlotte Regional Medical Director

If you fell off your bike and broke your leg, what would you do? You'd go to the hospital to have an orthopedic specialist assess the injury, treat the damage, and recommend a course of recovery. What you wouldn't do is go home and wait for your leg to get better on its own. Yet when it comes to depression, many people do just that. Instead of getting the help they need, they hope depression will go away with time. It's understandable—seeking treatment for a broken leg doesn't carry the societal stigma that finding support for depression does. But depression needs to be treated as much as any other medical condition, so it's critical to take steps to find one that works for you. Here's why you shouldn't wait longer than you have to when it comes to feeling better.

Do Depressive Episodes Go Away?

When seeking treatment for depression, it's helpful to understand what a depressive episode is and how it relates to MDD. A depressive episode involves experiencing the symptoms of depression for two weeks or more. If you're going through a depressive episode, you may feel particularly unhappy, tired, or worthless. You may also lose interest in most activities and experience physical symptoms like appetite changes or sleep disruption. Depressive episodes can be caused by stressful events, psychological trauma, substance abuse, health conditions like chronic pain or thyroid disease, and several other factors.

If you're experiencing a depressive episode, it's important to talk to your doctor and work with them to rule out any underlying medical conditions. Sometimes depression symptoms can go away if underlying health conditions are treated. If you're experiencing recurrent depressive episodes and other causes have been ruled out, Major Depressive Disorder (MDD) may be diagnosed. MDD is a medical condition characterized by recurring depressive episodes with no other underlying physical cause. A depressive episode can sometimes go away on its own, but even if it does, it can take months or years to do so and may return in the future. In the meantime, you're left stuck with the symptoms. The best way to ensure that it ultimately remains gone is to make sure the root cause, whether MDD or something else, has been treated.

Why It's Important to Seek Treatment

Depression is usually a long-term condition, and it likely won't go away without proper treatment. Moreover, depression has been linked to a number of physical conditions such as heart disease, inflammation, gastrointestinal problems, sleeping difficulties, and a variety of chronic diseases. Seeking treatment to manage your symptoms can help prevent these long-term conditions from manifesting or becoming worse. Depression can also affect your work, relationships, and ability to meet personal goals, but effective treatment can help prevent these consequences. There's also the matter of recurrence to consider. When you're in remission and no longer feeling your symptoms, it can seem like the depression has gone away, but research has shown that individuals who have dealt with one depressive episode have a 50% risk of experiencing another episode, and that risk increases with each new episode. Maintenance talk therapy can be a useful tool to understand the risk of recurrence and get you into effective treatment before your symptoms become overwhelming.

Treatment Options

Treatment for depression can involve medication, talk therapy, or lifestyle changes—or in many cases, a combination of all three. However, some people's symptoms don't respond to these frontline treatments. This isn't uncommon. In fact, one in three people seeking treatment for depression do not respond well to antidepressants. If this is the case for you, you may have treatment-resistant depression . Fortunately, despite the condition's name, treatment-resistant depression is treatable. If treatments like talk therapy and medication haven't worked for you, there are other options you can explore, such as Transcranial Magnetic Stimulation (TMS). TMS is a non-invasive therapy that uses gentle electromagnetic pulses to stimulate nerve cells in the brain and improve depression symptoms. TMS has few side effects, and it's an option worth considering when other depression treatments haven't been effective. To learn more about TMS, schedule your no-cost consultation . With the right treatment and support, you can manage both the physical and mental effects of depression and work toward a symptom-free life.

Treating Depression during Pregnancy: Safe Options for You and Your Baby

Fri, 08 Jan 2021 20:53:41 GMT

Medically reviewed on 12/4/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director

Pregnancy is supposed to be a happy time, so why do some expecting mothers have feelings of overwhelming doubt and anxiety? If you're feeling unsettled or sad, you may think there's something wrong with you as a parent—but these feelings are actually common. You may be one of the many mothers quietly struggling with depression during pregnancy. If so, you may feel hesitant to speak up about it, but getting treatment for depression is essential. You deserve to feel healthy and well as you prepare for childbirth. Prenatal depression can be challenging, but it is treatable—and getting better starts with understanding your treatment options. If you're concerned about taking antidepressants while pregnant and want to learn about other treatment methods, Transcranial Magnetic Stimulation (TMS) could be worth considering.

When Prenatal Depression Develops

Depression during pregnancy is more common than most people believe. Still, it can be difficult to recognize and can cause expecting mothers to doubt themselves. Experts estimate that between 14 and 23 percent of expecting mothers have depression symptoms during their pregnancy. Some women feel ashamed to admit they're struggling. Despite improved openness about depression, the stigma still exists. This can be especially challenging when pregnancy and motherhood are portrayed as only positive experiences. Further, emotional depression symptoms can be easy to write off as an overreaction to pregnancy hormones. Physical symptoms such as fatigue and appetite changes can also mimic typical aspects of pregnancy. Pregnant women most at risk for developing depression typically have experienced one or more of these issues:

High levels of stress in daily life
One or more current or previous mental health conditions, especially anxiety or depression
Low levels of social support
Involvement in an abusive or violent relationship

Emotional ups and downs can be common in pregnancy and after childbirth, as well. Each time a baby is born into a family, everyone goes through an adjustment. And the stronger presence of hormones, stress, and fatigue can all play a part. The difference between typical emotion swings and prenatal depression is that these symptoms persist and become worse, causing dysfunction. Ongoing sadness, constant crying, or feelings of disconnection are signs of something more serious. Talking with your doctor can help you understand if you may be experiencing depression.

Impacts of Delaying Treatment

Expecting mothers with depression often feel frustrated when pursuing depression treatment. They want to feel better, but in many cases, they're concerned about potentially exposing their babies to an increased risk of adverse impacts from starting antidepressant medication. Some expecting mothers delay medical treatment and endure their depression symptoms for weeks or months. Counseling therapy is a safe choice, but it may not be enough to help them feel like they can perform daily activities again. While some may be hesitant to seek treatment initially, untreated depression can ultimately cause more harm to mother and baby. Without effective depression treatment, an expecting mother may be less likely to take care of herself. Depression during pregnancy can lead to physical, mental, and emotional symptoms that interfere with healthy self-care habits. This may eventually lead to:

Eating a diet lacking in nutritious food
Inconsistent eating patterns
Not drinking enough water
Skipping prenatal medical appointments
Engaging in risky behaviors like smoking or using substances

When a pregnant woman neglects her needs, she's not the only one at risk for consequences. Untreated depression during pregnancy is linked with low birth weight and preterm birth , both of which can cause long-lasting health issues for babies. Prenatal depression also increases the risk of developing a form of postpartum depression. "Baby blues" are a common period right after birth when a mother can feel more emotional or sad than normal. While the baby blues are mild and usually resolve on their own after a few weeks, postpartum depression is the presence of stronger, more persistent symptoms and requires treatment.

TMS as a Safe, Non-Medication Option

While all medications carry some risk, there are effective antidepressants used during pregnancy. However, if you don't feel comfortable taking antidepressants to treat your symptoms, don't avoid getting help altogether. Instead, consider a non-drug option like TMS. TMS treatment involves gentle magnetic pulses directed at specific areas of the brain that regulate emotion. A TMS device is placed close to your scalp to deliver these pulses for approximately 20 minutes. The average treatment course consists of 30 to 36 sessions spanning six to nine weeks. Experts think that TMS relieves depression symptoms by improving the way neurons communicate with each other. This positive effect has been shown to reduce symptoms as soon as the fourth week of treatment.

S o, what makes TMS a safe option for you as an expecting mother? TMS is non-invasive and involves no medications. Some people experience mild discomfort, such as a brief headache. But these effects are typically short-lived, and most people feel comfortable going about their normal activities immediately after a treatment session. Nothing enters the bloodstream, and the magnetic pulses are not harmful to you or your unborn baby.

Prioritizing Treatment for Prenatal Depression

During pregnancy, you're more watchful than ever about what you put into your body. If you're experiencing depression, you may be weighing the pros and cons of antidepressant medication. Instead of putting off essential depression treatment, consider TMS therapy as a safe option. Keep both you and your baby healthy by getting the depression treatment you need.

What Not to Say to Someone with Depression

Wed, 06 Jan 2021 20:46:36 GMT

Medically reviewed on 11/13/2020 by
Dr. Darlene Ifill-Taylor
Charlotte Regional Medical Director

Understanding how to help a loved one with depression—and learning what not to say to someone with depression, in particular—can be challenging. Often times, well-meaning family members and friends can say things that inadvertently make the person feel worse. It's important to recognize that not knowing what to say is not a character flaw or a failing on your part. Depression can be difficult to understand for those who haven't experienced it, and even people with the best intentions can miss the mark. Fortunately, there are many ways to be supportive and show your loved one you care.

Identifying What Not to Say

First, let's explore what not to say to someone with depression. The following are usually said with good intentions, but are not usually helpful to someone dealing with depression:

"There are other people who have it worse."
"Just move on" or "Just [insert action here]."
"Why? What did you do?"
"What do you have to be depressed about?"
"Let it go."
"Cheer up!"
"It could always be worse."
"Snap out of it!"

The expressions above deny the pain a person with depression is experiencing, even though that is not the intention. Depression can also deplete a person's energy and motivation, so unsolicited advice like "just do [x]" is not helpful or effective. In addition, some of these well-meant expressions can sound unintentionally accusatory. To the person facing depression, they may sound like criticism—as if someone is questioning their willpower, strength, or character. It's also not supportive to make statements pointing out there are other people who "have it bad." Imagine going through a painful breakup and being told, "Other people are going through breakups, too. You're not the only one." Although it would be true that plenty of other people have broken hearts at any given moment, having that pointed out wouldn't change the pain you would be experiencing.

How to Help a Loved One with Depression

Supporting your loved one goes beyond knowing what not to say. The good news is that there are several options they can explore to treat and manage depression. And you can help them by being part of their support network. The best thing you can do for your loved one who has depression is be there for them. State clearly that you are willing to help them seek treatment, and be present.

Practice Active Listening

Giving our time to people is an act of compassion that can make a real difference. You can offer to be a sounding board for your loved one and say something like this: "If you need to talk, I'm here for you." Show that you're actively listening by empathetic statements like, "I'm sorry you're going through this." You can call to check in on your friend who has depression or offer to visit if they want company. Whatever you do, listen to them. Some people who are depressed want to communicate verbally; others prefer texts, emails, or a card.

Provide Concrete Support

You can also provide support by doing concrete things for them. For instance, you can bring over dinner or help them with groceries. Depression can make easy tasks seem difficult and difficult tasks seem impossible. You can help your friend by doing tasks like helping with household chores or babysitting for them so they have time to see a therapist.

Helping Your Loved One Get Help

Getting help can seem daunting to some people with depression. You can help a loved one with depression by encouraging them to pursue therapy and aiding them in that journey. This can include many things like helping them look up psychiatrists online or accompanying them to therapy appointments.

If you find yourself feeling discouraged, remember that there is hope for your loved one. But finding an effective treatment takes time, so be patient. If your loved one isn't responding to talk therapy or medication, it's important to know that there are other options available, including Transcranial Magnetic Stimulation . No matter what your loved one's next step is, every person dealing with depression needs to build a support network that includes their care team (usually a psychiatrist and a therapist) and supportive people in their life . Ultimately, the road to wellness is different for each person facing depression. So even if you feel you're not making a big difference, know that your presence alone can be powerful.

How Do Antidepressants Affect the Brain?

Mon, 04 Jan 2021 20:49:53 GMT

Medically reviewed on 9/21/2020 by
Dr. Geoffrey Grammer
Chief Medical Officier

If you're struggling with major depressive disorder , obsessive compulsive disorder , or another mental health condition, you've probably thought about using antidepressants. It's not uncommon for people considering, or even currently taking, antidepressants to ask questions like, "What do antidepressants do to the brain?" and "Do antidepressants permanently alter brain chemistry?" Knowing how antidepressants work with your brain chemistry can help you better understand how these medications may help you.

Many people have found relief from their symptoms by taking antidepressants. Scientists think antidepressants enhance the brain's ability to transmit signals that regulate moods. However, scientists still don't know precisely how the medications work . One theory is that people with depression have low levels of chemicals called neurotransmitters . Antidepressants may correct these chemical imbalances. Or, they may improve brain signaling by promoting the growth of new cells and connections in the brain.

How Does the Brain Transmit Signals?

Human brains are made up of approximately 100 billion cells. Between each cell are gaps called synapses. To transmit signals across synapses, brain cells secrete neurotransmitters. Neurotransmitters ferry across the synapses and are absorbed by neighboring brain cells. That stimulates these brain cells to secrete neurotransmitters of their own, which, in turn, activates their neighbors. In this way, messages are relayed through the vast network of brain cells. But brain cells also need to shut off signals. They have two ways of doing that: they can reabsorb excess neurotransmitters floating in the synapses, or they can break down and get rid of excess neurotransmitters. There are several kinds of neurotransmitters, including serotonin, dopamine, and norepinephrine. To work as efficiently as possible, different types of antidepressants have been developed to act on different neurotransmitters.

How Do Antidepressants Affect the Brain?

Many antidepressants are so-called "reuptake inhibitors." Ordinarily, brain cells make molecules that bind up excess neurotransmitters in synapses and recycle them. The neurotransmitters fit perfectly into these molecules, like keys into locks. Uptake inhibitors slip into molecules first, blocking neurotransmitters from getting in. As a result, more neurotransmitters remain in the synapses and increase the chances of stimulating neighboring cells. As their names suggest, selective serotonin reuptake inhibitors ( SSRIs ) block the reuptake (breakdown) of serotonin in the brain. Serotonin and norepinephrine reuptake inhibitors (SNRIs) block the reuptake of both neurotransmitters. NDRIs are norepinephrine and dopamine reuptake inhibitors. Tricyclics and tetracyclics (TCAs) work similarly, but they are used less frequently because they have more potential side effects.

O ther types of antidepressants work differently. Serotonin antagonist and reuptake inhibitors (SARIs) not only block the reuptake of serotonin, but they also help prevent serotonin from binding at certain sites, leaving more to act as messengers between neighboring brain cells. Monoamine oxidase inhibitors (MAOIs) maintain higher levels of neurotransmitters by inhibiting an enzyme that breaks them down.That said, emerging studies suggest that antidepressants may improve brain signaling by stimulating new growth of brain cells and expanded brain cell networks. Like cities and the roads connecting them, parts of the brain and networks linking them are continually evolving. Over time, they deteriorate and get repaired, re-routed, or expanded. This continual rebuilding and rewiring of the brain is a natural process called neuroplasticity. Antidepressants may aid this process.

Do Antidepressants Permanently Alter Brain Chemistry?

A ntidepressants are designed to alter brain chemistry to alleviate symptoms—thus, they do so while you are taking them. They may promote potentially beneficial structural brain changes, as well. As impressive as it may be, the brain's neuroplasticity isn't always positive. It's important to realize that depression itself has been shown to alter brain chemistry and cause structural brain changes. Antidepressants are intended to improve your brain chemistry and help reverse those structural changes. Doctors caution that it can take many weeks or months before patients begin to feel better and see improvements from taking antidepressants. The experience varies from person to person. Many individuals try different kinds of antidepressants to find what works well for them and what doesn't produce unpleasant side effects , such as dizziness, nausea, sexual dysfunction, or fatigue. For one in three people , antidepressants don't provide any relief.

As with all medications, you should explore the benefits and risks of using antidepressants in consultation with your doctor. And remember that other non-medication options exist that may relieve your symptoms. One such treatment is called transcranial magnetic stimulation (TMS) . It is a noninvasive, non-drug treatment that uses magnetic pulses to stimulate nerve cells to improve the brain signaling that helps regulate moods. All in all, antidepressants have helped many people live more fulfilling lives. But if they don't provide relief for you, or if their side effects prove too detrimental, talk with your doctor to see if TMS therapy might be right for you.

Is Depression Normal?

Mon, 21 Dec 2020 21:39:19 GMT

Imagine opening your laptop and Googling, "Do good people get cancer?" or asking a friend if you're "broken" because you have diabetes.

Scenarios like these may sound absurd when it comes to physical ailments, but they aren't so farfetched with mental illness. For many people struggling with depression, the diagnosis can feel like something that only happens to other people, and it can be hard to resist wondering if depression is "normal" or is something "normal people" experience.

So, is depression normal?

Depression means that the brain is not regulating mood as it ordinarily should, so in a sense it is not entirely normal. Being sad and having mood fluctuations from time to time is a normal part of life, but depression is different. It's an illness that, like most other illnesses, requires treatment.

Depression is a complicated condition that doesn't have a single specific cause. Instead, researchers believe it's caused by the confluence and interaction of many complex factors. Genetics, past experiences, stress levels, medications, and even the weather in your environment can trigger depression or leave you more vulnerable to developing it.

While these factors can predispose a person to becoming depressed, depression can affect anyone, regardless of their age, race, socioeconomic status, or gender. Some harmful attitudes toward depression do still exist, but they are fortunately fading away. Depression is no longer a taboo subject, and experiencing it does not mean that that you're a bad person, that you're weak, or that you did anything wrong.

How common is depression?

Depression is one of the most common mental health conditions, affecting more than 264 million people worldwide. Every year, an estimated 6.7 percent of adults experience depression, which means that 1 in 15 people around you may be living with depression. In fact, the lifetime risk for depression is 16.6 percent, which equates to 1 in every 6 people experiencing depression at some point in their life.

How Can You Treat Depression?

Depression shouldn't be left untreated because it can intensify and last indefinitely. Depression can also cause persistent physical symptoms like headaches, fatigue, nausea, and chronic pain. So how should you treat it?

First-line treatments for depression typically involve antidepressants and talk therapy. While these can be effective treatments for many people, they don't work well—or at all—for some individuals. Antidepressants, for instance, do not provide symptom relief for about one-third (33 percent) of people who use them. If you've tried two or more antidepressants with little to no effect, you may have treatment-resistant depression. If this is the case, or if you can't tolerate the side effects of antidepressants, you may want to consider TMS therapy.

Transcranial Magnetic Stimulation (TMS) therapy is effective for about 62.5 percent of people who do not find sufficient symptom relief from taking antidepressants. It uses gentle magnetic pulses to stimulate nerves in specific areas of the brain responsible for regulating mood and emotion, helping the brain perform these functions. TMS therapy is completely non-invasive, and a typical course of treatment lasts 6 to 9 weeks.

With guidance from your health care provider, you can explore different options for treating depression until you find the right one for you. If you're interested in learning more about TMS, you can browse more articles and resources on it.

Remember, you are not alone. Depression is common, and many people find effective treatment for it. Everyone's path to finding treatment for depression is different, but if you continue searching, you will likely find a treatment that works for you.

Men and Depression: Signs, Symptoms, and What Makes It Unique

Tue, 15 Dec 2020 16:32:00 GMT

Medically reviewed on 11/16/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director

Everyone's experience with depression is unique. But studies of men and depression reveal some general trends in how depression affects males and females differently. The causes of depression in men and women may be similar, but they may experience different symptoms and cope in differing ways. Men, their families, and their doctors may not immediately recognize the signs that they are depressed, so they may be less inclined to seek treatment.

For these reasons, they may be less likely to be diagnosed and treated for depression and continue to suffer needlessly. These factors may influence the reportedly higher incidence of depression among females (8.7 percent) compared to males (5.3 percent) in the United States population; it's possible that men are more often undiagnosed. According to a Journal of the American Medical Association Psychiatry study in 2013, nearly one-third of U.S. men (30.6 percent) experience depression in their lifetimes .

Similar Causes, Different Experiences

Are the causes of depression in men and women different? No. Both men and women can have underlying genetics and family histories that increase their susceptibility. Depression in men and women can be triggered by stress and/or grief from setbacks and losses in life, including illness, abuse, poverty, family conflicts, and losing loved ones or jobs. Older men who retire may experience a sudden loss of routine, power, and prestige that can diminish their self-esteem and cause depression. Remember that it's possible to develop depression without anything being "wrong" in a person's life. Depression causes many similar physical symptoms in men and women such as fatigue, sleep and eating problems, chronic pains, headaches, or digestive ailments. Both genders can also experience similar feelings of sadness, helplessness, hopelessness, guilt, and worthlessness.

However, our culture puts a stigma on men being emotional . Unlike women, many men are socially conditioned to bottle up their negative feelings or those that are seen as feminine. As a consequence, depressed men can become irritable, frustrated, and angry. They often deal with depression by working compulsively or engaging in rash behaviors, such as drinking too much, taking drugs, gambling, smoking, having unsafe sex, and reckless driving. They may not acknowledge that the physical ailments they are suffering—backaches, headaches, sleep problems, digestion problems, or sexual dysfunction—may be rooted in depression. Men are also three times more likely to die by suicide than women are. The way men experience depression masks it from themselves, their family, and their friends. Sometimes, even medical professionals overlook depression symptoms in men. Even if men recognize and acknowledge that they are depressed, the unfortunate stigma that depression is somehow "unmanly" can deter men from seeking treatment.

A Range of Treatment Options

Why let depression diminish the quality of your life? Various therapies, such as talk therapy and cognitive behavioral therapy, have brought relief to many men and helped them overcome depression and lead more fulfilling lives. Many people's symptoms are relieved by medications that adjust brain chemistry and functioning. Another option you may not have heard about is transcranial magnetic stimulation (TMS). This non-invasive, non-drug treatment uses magnetic pulses to improve brain signaling that regulates your mood. If you've already tried multiple therapies with disappointing results, TMS therapy may be right for you. As studies on men and depression have shown, they experience the same underlying condition as anyone else, but it can manifest differently. Learning what depression can look like in men, and acknowledging what you may be experiencing, is the first step to feeling yourself again.

TMS for OCD: An Effective Treatment Option to Relieve Symptoms

Mon, 14 Dec 2020 16:30:46 GMT

Medically reviewed on 11/20/2020 by
Dr. Steven Harvey
St. Louis Regional Medical Director

Obsessive-Compulsive Disorder (OCD) is a more common condition than you might think, affecting approximately 2.2 million Americans . People with OCD experience recurring intrusive obsessions (thoughts or images) and/or compulsions (urges to carry out certain repetitive behaviors). These symptoms can cause considerable disability and suffering. In 2018, the FDA approved Transcranial Magnetic Stimulation (TMS) as a treatment for OCD. A 2019 American Journal of Psychiatry study showed that TMS therapy for OCD significantly improved patient symptoms. If you're struggling with this disabling disorder, you may want to consider TMS for OCD.

What Are the Symptoms of OCD?

For people with OCD, obsessions and compulsions are part of their daily lives and consistently consume a great deal of their time and energy. OCD isn't just a personality quirk; it's more than wanting your pencils arranged just so or habitually locking and unlocking the front door. The obsessions and compulsions of those who suffer from OCD can be extreme, and can get in the way of everything in your life, including work, school, social activities, and relationships.

One familiar example of OCD is an obsession with contamination. Unfounded fears of germs or disease might trigger overpowering feelings of fear, disgust, or doubt. Those with OCD may try to ensure they are germ-free by compulsively washing their hands until they bleed. Or, cleaning their house repeatedly. Other common obsessions include the fear of losing control, not getting things perfect, or causing harm by failing to do something. As a result, individuals with OCD may repeat behaviors again and again to try to maintain a feeling of control. They may compulsively organize things in particular, precise ways to create a sense of orderliness. Or they may hoard items they think might come in handy in emergencies. They may constantly check if they turned off the stove or if their children are still in bed. Other well-documented obsessions include having unwanted sexual or violent thoughts, or feeling guilty of moral failure.

How Is OCD Treated?

We don't know exactly what is the cause of OCD, but we do know that certain medications are often a big help. About 40 to 60 percent of patients with OCD experience relief from their symptoms when using these medications. If they do help, the medications typically take many weeks before they start alleviating symptoms. They are known to cause side effects in some people as well. Among these are insomnia, weight gain, headaches, sedation, high blood pressure, sexual dysfunction, and gastrointestinal problems as such nausea and diarrhea. Another treatment for OCD is a type of cognitive behavioral therapy called exposure and response prevention (ERP). ERP involves systematically exposing a patient to whatever triggers their obsessions and compulsions under the guidance of a trained therapist or psychologist, teaching the patient incrementally how to mitigate their anxieties and to better tolerate the exposure.

What Is TMS for OCD?

TMS therapy for OCD is another treatment proven to be effective. While it can complement other treatments, TMS fills a crucial gap for people who don't see results from medications. TMS therapy is a non-invasive, drug-free outpatient treatment in which patients sit in a comfortable chair, awake and alert, while a device near their scalp delivers gentle magnetic pulses, similar to those in an MRI scan. The pulses stimulate changes in brain chemical signaling that can alleviate OCD symptoms. Although TMS for OCD has been approved by the FDA, it is not yet covered by most health insurance providers. To learn more about whether TMS therapy could be right for you, schedule a no-cost consultation . You deserve to break that exhausting cycle of obsessions and compulsions, so take the time to find a treatment that gets you back on track.

How Does Depression Affect the Body?

Thu, 03 Dec 2020 16:34:15 GMT

Medically reviewed on 11/26/2020 by
Dr. Kimberly Cress
Texas Regional Medical Director

Most people recognize the main emotional symptoms of depression: low mood, lack of energy, persistent sadness, and so on. But what about the physical symptoms of depression. These symptoms get less recognition, but they are worthy of attention. Depression can affect the entire body, not just your mood, and learning to identify its physical symptoms can help you see the whole picture, which is a crucial step toward wellness and healing. So how does depression affect the body? Here's an overview of the potential effects of the condition, as well as steps you can take to treat it and progress toward a healthier body and mind.

How Does Depression Affect the Body?

Not everybody with depression develops physical symptoms, but if you have dealt with depression for a significant amount of time, you might identify with these symptoms:

Changes in appetite: The brain regions affected by depression also influence how we eat and how we sleep. With depression, food cravings or appetite loss can cause weight gain or weight loss.
Trouble sleeping: Up to 90 percent of people with depression report insomnia. Have you been waking up earlier than usual or oversleeping? Do you feel unrefreshed after a full night of rest? If so, these could be physical symptoms of depression. People with depression are three times more likely to feel exhausted or chronically fatigued.
Gastrointestinal issues: Have you experienced stomach cramps, bloating, nausea, or a change in bowel habit? If so, it might be because the brain and the gut are intimately connected. A Harvard Medical School report says that a troubled brain can send signals to the intestine (and vice-versa): "A person's stomach or intestinal distress can be the cause or the product of anxiety, stress, or depression."
Pain: If everything hurts more than it once did, depression might be the cause. People with depression are three times more likely to develop chronic pain. Back pain, joint pain, and headaches are common. How does depression affect the body in this way? The chemical messengers that are disrupted by depression (including serotonin, noradrenaline, and dopamine) also regulate our response to pain. Research using brain scans suggests that some people with depression find it more difficult to tolerate pain.
Sexual dysfunction: Up to one-third of people with depression report decreased sex drive, and up to one-third of men with depression report erectile dysfunction. Depression medications can also trigger these issues.

If you believe your physical symptoms have been neglected in your medical journey, it is normal to feel frustrated. Fortunately, there are proactive steps you can take to treat your depression and ease the physical symptoms it can cause, or even eliminate them entirely.

Treating Depression Minimizes the Risk of Some Illnesses

A two-way relationship exists between depression and some illnesses. One in four people with cardiac issues have depression, but individuals with depression also have a 64 percent greater risk of developing coronary artery disease.

Similarly, diabetes and depression occur together approximately twice as frequently as chance alone would predict. While depression can affect your general health, you can leverage this information now to find treatment that will enhance your overall well-being in the long term. In fact, according to the highly encouraging findings of one Indiana study that followed up with people over eight years, treating depression as soon as possible decreased the risk of strokes and heart attacks by half.

This does not mean that depression causes strokes or heart attacks directly. Rather, exercising less, eating less healthily, or smoking more during a bout of depression could elevate the risks associated with heart problems and diabetes. Depression can also weaken the immune system, making it tougher to fight off infections. The good news is that reaching out for depression treatment may help to improve your physical health as well.

Your Next Steps to Positive Health

When you're ready to improve your mental and physical health with depression treatment, what are the next steps? Treatment for depression usually begins with talk therapy and medication. However, you may have treatment-resistant depression that will not respond well to medication. This is the case for one in three people .

If this applies to you, there are non-drug possibilities. Transcranial Magnetic Stimulation, or TMS, is an effective treatment for when at least two medications have not been effective for depression. It is a gentle and non-invasive treatment cleared by the FDA. TMS applies highly focused magnetic pulses to brain regions that regulate mood, helping to relieve some, or even all, symptoms of depression in many patients.

About two-thirds of patients report a reduction in depression symptoms at the completion of the acute phase of TMS therapy, which takes six to nine weeks. In the course of treating the mental and emotional symptoms of depression, TMS may help to restore aspects of your physical health as well. With depression, it is possible to find your own path to wellness. Once you have developed an understanding of how depression may be impacting you physically, you can seek treatment options that support both physical and emotional health.

Distinguishing the Negative Thought Patterns of OCD

Wed, 11 Nov 2020 15:36:00 GMT

The negative thought patterns associated with OCD are often similar to those associated with depression. Additionally, while we're all prone to occasionally ruminating on negative events or obsessing over issues, that doesn't necessarily indicate OCD. So how can we distinguish between OCD and depression? And when is rumination or obsession an indicator of OCD?

Negative Thoughts Tied to OCD Are More Severe and Frequent

Obsessions are recurrent intrusive thoughts, images, or urges that typically cause anxiety or distress. For example, some people with OCD report being overwhelmed by a fear of harming someone else. Others are preoccupied with thoughts of contamination from germs or household chemicals, while others repeatedly imagine violent or taboo scenes.

Recurrent negative thoughts occur in both depression and OCD, but there are some key differences:

Negative thoughts caused by OCD tend to be more frequent, more severe, and more intrusive than those caused by depression.
Negative thoughts caused by OCD may seem more illogical or irrational than negative thoughts associated with depression. Someone with depression might ruminate over a real-life concern, such as an elderly parent becoming unwell. In contrast, a person with OCD might develop an obsession with the notion that all of their neighbors will die unless they step over cracks in the sidewalk.
Finally, negative thoughts associated with OCD are often linked to compulsions, which is not usually the case with depression.

Compulsions Are Not Typically Seen in Depression

Compulsions are repetitive behaviors or acts that people with OCD perform to neutralize or get rid of obsessions and reduce the emotional distress associated with their obsessions. Some people tap or touch objects, often a specific number of times, while others check things repeatedly (e.g. locks, switches), excessively clean or wash their hands, count to a specific number constantly, or repeat words silently. These behaviors are typically not associated with depression.

A person with OCD may feel disgusted about their obsessions and know that their compulsions are extreme or illogical. Nonetheless, they might feel uneasy, incomplete, or overwhelmed by anxiety and distress until they have satisfied certain compulsions.

If you are experiencing symptoms of OCD, you may be inclined to judge yourself too harshly. But remember that obsessions and compulsions do not define you. They do not reflect who you truly are.

Is Rumination OCD? Are All Obsessions OCD?

Rumination and obsession are not necessarily indicative of OCD. These behaviors can be maladaptive at times, but occasionally they might also feel enjoyable or bring relief. If you have certain quirks or idiosyncrasies, such as the desire to organize books by color or line up stationary in a certain way, that doesn't mean you have OCD. Instead, you may have simply identified approaches that bring order to your environment and give you a sense of control.

In contrast, people with OCD experience extreme anxiety and distress about their obsessions and compulsions. These intrusive fixations can consume hours of their day, even if they try to ignore them, and they can interfere with their daily lives.

Your Next Steps to Positive Health

Treatment for OCD usually starts with cognitive behavioral therapy and medication, with 40 to 60 percent of patients achieving a partial response to these treatment approaches.

Transcranial magnetic stimulation (TMS) is an FDA-cleared treatment choice for when OCD symptoms do not respond fully to psychological therapy and medication. TMS is a non-invasive treatment that applies gentle magnetic pulses to brain regions associated with OCD. TMS has been shown to improve the negative thought patterns of OCD significantly.

Whichever empowering treatment avenue you choose to follow, know that there is hope.

Unveiling the Brain's Secrets: The History of Antidepressants

Tue, 10 Nov 2020 15:35:00 GMT

The history of antidepressants began, by chance, in the 1950s. Chemists developing a new treatment for tuberculosis tested the drug iproniazid on patients at Seaview Hospital on Staten Island. It was a crucial step in the history of depression treatment, as these patients experienced a dramatic change in well-being. Formerly lethargic and sad, they now reported better mood, increased appetite, and improved sleep. Life magazine even sent a photographer to document this remarkable story .

Iproniazid blocks an enzyme called MAO, which in turn breaks down chemical messengers such as serotonin, norepinephrine, and dopamine. Blocking MAO seems to restore these chemical messengers. Iproniazid helped to confirm the importance of the MAO system in depression, heralding a new class of depression medications called MAO inhibitors . However, their widespread use was limited by side effects such as elevated blood pressure and liver damage.

In the 1950s, the tricyclic antidepressants emerged. While imipramine was first tested in people with schizophrenia and proved ineffective, it showed better results in people with depression and was approved as a depression drug in 1959.

The Arrival of SSRIs: Progress but Room for Improvement

In the early 1970s, evidence for the role of serotonin in depression was gathering just as concerns were growing about the side effects of MAO inhibitors and tricyclic antidepressants.

Scientists thus turned their attention to SSRIs , or selective serotonin reuptake inhibitors. These drugs enhanced serotonin activity and seemed to carry fewer side effects than other antidepressants. A famous development in the history of antidepressants, fluoxetine was approved by the FDA in 1987 and reached the market the following year as Prozac ^® . A year later, almost 2.5 million prescriptions had been dispensed. Other SSRIs since released include paroxetine, sertraline, citalopram, escitalopram, and fluvoxamine.

In the 1980s and 1990s, new antidepressants that targeted the monoamine neurotransmitter system emerged, including bupropion (a dopamine-norepinephrine reuptake inhibitor) and venlafaxine (a serotonin-norepinephrine reuptake inhibitor).

Despite these advances, any history of depression treatment must admit to several drawbacks related to these medications. All antidepressants can carry side effects, including nausea, dizziness, insomnia, and sexual dysfunction. They usually take several weeks to take effect. Up to a third of people with depression don't respond to these drugs . These shortcomings meant a new era of depression treatment was needed.

Current Status of Antidepressants: Complicating the Chemical Imbalance

Depression was traditionally viewed as a chemical imbalance: a deficiency in a single chemical messenger in the gaps (or synapses) between nerve cells was believed to disrupt communication between these cells.

However, studies in the 1980s and beyond found some patients with depression had increased rather than decreased levels of these chemical messengers (or neurotransmitters). In addition, some effective depression medications decreased the level of a chemical messenger rather than increasing it. Finally, many treated with medications that enhanced serotonin didn't show an improvement in mood .

It was clear that depression wasn't related to a simple, single chemical deficiency. Instead, scientists designing new treatments began to understand that people with depression had widespread alterations in the function of neurotransmitters, structural changes in brain regions that regulated their mood and emotions, and changes in the brain's wiring or connectivity.

The next step was to find a drug that worked on the wider circuits and connections of the brain. That drug turned out to be one that had been used in operating theaters and on battlefields for decades.

Ketamine: An Anesthetic Repurposed

Ketamine has been used as an anesthetic since the 1960s. It targets the glutamate system, which is disrupted in depression (the glutamate pathway is an excitatory pathway that dials up brain processes).

In an influential study in 2000, a single injection of ketamine exerted a rapid antidepressant effect within 72 hours. This benefit lasted for several weeks. A nasal spray version called Spravato (esketamine) received FDA approval in 2019 as an add-on therapy for treatment-resistant depression.

The exciting story of ketamine has highlighted the need to think beyond a single chemical messenger when developing modern antidepressants. Esketamine triggers positive changes in the function of brain circuits and stimulates the regrowth of synapses, restoring connections between brain cells.

That said, there are drawbacks. Esketamine side effects include dissociative symptoms (out-of-body experiences and hallucinations), and it carries the potential for abuse. Response rates may be lower in older patients . It must be administered in a doctors' office or clinic.

Beyond Medications: Transcranial Magnetic Stimulation

Despite their long and storied history, medications are only one option, and important advances have been made in the non-medication treatment of depression.

Transcranial Magnetic Stimulation (TMS) is a non-drug, non-invasive option with a well-established position in the history of depression treatment. The technology dates to experiments on nerves and muscles in the 1790s. In his 1859 lecture at the Royal Institution of Great Britain, scientist Michael Faraday outlined some of the principles of electromagnetism that would influence the development of TMS. A fully functioning magnetic stimulator was introduced into clinical practice in the 1980s in Sheffield, England .

TMS applies highly focused magnetic pulses to brain regions that are crucial in the regulation of mood. TMS goes beyond correcting a simple chemical imbalance. Instead, it addresses the complex brain changes of depression, helping to form new connections between nerve cells in affected brain regions . It can help to relieve some, or even all, depression symptoms in many patients.

TMS is FDA-cleared for Major Depressive Disorder when one medication hasn't been effective (though most insurance policies will only cover it after two medications).

Your Future: Finding the Treatment That Works for You

Treatment has come a long way since those early TB drugs in the 1950s when the history of depression treatment first began.

At this new frontier, your choice of depression treatment goes beyond replacing a single chemical or modifying a single brain pathway. Depression researchers are beginning to see the bigger picture, and you should benefit from these scientific breakthroughs. By reaching out for your treatment of choice, you can take your next step toward living life the way you want to.

What is Low-grade Depression?

Thu, 05 Nov 2020 19:21:00 GMT

These last couple of months, the pressures of everyday life have increased dramatically. From the pandemic to politics, the constant barrage of ever-changing and uncertain news coverage makes it easy to become overwhelmed, concerned, and disheartened by the state of the world. If you’ve noticed sustained, yet subtle, feelings of hopelessness, sadness, or other depression symptoms, it’s possible that you’re experiencing low-grade depression.

What is low-grade depression?

Low-grade depression, sometimes referred to as persistent depressive disorder (PDD) or dysthymia , occurs when an individual experiences long-lasting and low-level feelings of unhappiness and depression. People with low-grade depression may not even be aware they are feeling unwell since their symptoms might be chronic and unknowingly normalized . Often, those with low-grade depression are high-functioning , but that doesn’t mean that they aren’t suffering from symptoms of depression.

What’s the difference between low-grade depression and major depressive disorder?

Don’t let the words “low-grade” and “major” mislead you: even though it may be more difficult to detect, low-grade depression can be just as disruptive to one’s overall happiness and wellbeing as major depressive disorder. Low grade depression has many similar symptoms to clinical depression and can include:

loss of appetite
insomnia
low self-esteem
negative thoughts
trouble focusing
feelings of guilt or shame

The significant difference between low-grade depression and MDD, however, surrounds the length and intensity of symptoms. As the name suggests, low-grade depression may not include all the criteria of major depressive disorder (MDD) but that does not negate its impact on one’s quality of life. Though episodes of low-grade depression and MDD can both last for long stretches of time, a PDD diagnosis is made when above mentioned symptoms last for two years or more (1 year for children or adolescents).

Should I get help for low-grade depression?

Yes. Because low-grade depression might just feel like a natural reaction to what’s happening in the world right now, those experiencing it might not know if they should get help for their depressive symptoms. You might think that since the symptoms aren’t severe, it isn’t worth seeking professional assistance. However, as with any other kind of depression and mental health condition, if you are noticing persistent symptoms it’s important to speak with a mental health professional. A mental health practitioner can provide resources and help you evaluate any treatments that might be helpful. In reaching out for professional advice, you can take control of your mental health, and begin finding solutions for improving your depression.

Understanding the Connection between Depression and Memory Loss Symptoms

Wed, 04 Nov 2020 13:41:00 GMT

Do you often lose track of where you left your keys or your phone? Do you find it difficult to recall what you've just read? Do you occasionally forget to take your medications?

If you have depression and memory loss symptoms, these issues might sound familiar to you. So, how can depression cause memory loss and what can we do about it? The answers lie within the connections and chemistry of our brains.

How Depression Leads to Forgetfulness

Persistent stress increases the brain's levels of the hormone cortisol, which, in turn, decreases the level of a chemical messenger called BDNF . This impairs the growth of nerve cells within the hippocampus of the brain.

We rely on the hippocampus for almost everything related to memory, including memory encoding (getting the information into our memory systems), storage, and retrieval. That is why shrinkage in the hippocampus can result in forgetfulness.

If you have depression and memory loss symptoms, you may have noticed problems with both your short-term memory and long-term memory. Occasionally forgetting where you put your phone or whether you turned off a light may not be a big deal, but losing track of where you are in a major work project or finding that you have only vague memories of a vacation you took a few years ago can have a real impact on your ability to accomplish and enjoy important life activities.

The Effect of Depression on Attention

Depression also affects the frontal lobe—the part of the brain behind the forehead. Studies of thousands of people with depression have found significantly reduced volume in this region.

The frontal lobe of the brain helps us to pay attention, so if you have depression, you may find that you're easily distracted. Perhaps you cannot concentrate fully during conversations with colleagues. You lose focus while reading a book, or you find it difficult to follow the plot of a TV show. Your friends, family, or co-workers might have even pointed these changes out to you.

The attention issues associated with frontal lobe shrinkage in depression can exacerbate the memory difficulties caused by a smaller hippocampus.

Treatment for Depression Helps Memory Loss

So depression can, in fact, cause memory loss. But fortunately, depression treatments can help reverse these brain changes.

Professor Ian Hickie, lead researcher of the world's biggest depression study on brain volume, has explained that "the hippocampus is unique in its ability to rapidly generate new connections between cells, and what are lost here [in depression] are connections between cells rather than the cells themselves." That means depression treatments can potentially stimulate the growth of new nerve cells and strengthen novel connections between them. Given that repeated episodes of depression increase the risk to the brain, Hickie and other researchers recommend seeking treatment early.

Transcranial Magnetic Stimulation (TMS) is a non-drug, non-invasive treatment option that helps to form new connections between nerve cells in the hippocampus and other brain regions affected by depression. It specifically increases levels of BDNF throughout the brain, thereby stimulating nerve cell growth. Patients whose depression improves with TMS treatment show improved performance on cognitive tests of verbal and visual memory, attention, and processing speed.

TMS is FDA-cleared and covered by most insurance when at least two antidepressant medications haven't been effective.

When undergoing treatment for depression, it can be reassuring to know you'll also be proactively addressing other brain changes that accompany the condition. Treatment that boosts your mood can also boost your memory, empowering you to live your best life and cherish the memories you make along the way.

Biological Causes of Treatment-Resistant Depression

Tue, 03 Nov 2020 14:51:00 GMT

It is understandable to feel frustrated if the symptoms of depression that you're experiencing haven't responded to medication or counseling. However, it's not uncommon to have depression that doesn't respond to first-line treatments like medication. In fact, about one in three people with depression experience symptoms that do not respond to medication.

There are several potential causes of treatment-resistant depression, and one is genetic makeup. The good news is that there are constructive ways to find your own path toward effective symptom treatment—DNA does not define destiny.

We All Respond Differently to Medications

You may be familiar with the idea that everyone's responses to medications are different. Imagine that you and a friend are taking the same painkiller after an injury. The resulting levels of that drug and its effect on receptors in your body can vary substantially compared to those in your friend's system, even if you are the same age and weight.

Many factors can account for this variability, such as your unique biology, diet, hormonal status, other medications, and liver or kidney issues. Crucially, genetic factors can strongly influence how your body reacts to a given medication. This is because our bodies' enzymes process the medications we take, and our genes influence how these enzymes function. That means our unique genetic blueprint directs how our enzymes break down and process medications.

Genes Can Influence the Effectiveness of Depression Medications

There's an important set of enzymes called the cytochrome P450 enzymes that breaks down ( metabolizes ) many commonly used antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. If someone has a genetic variation in these enzymes, these drugs could build up quickly without being broken down, which could lead to side effects. The drugs could also leave the patient's system prematurely before they have a chance to work fully. Both of these situations can contribute to treatment-resistant depression.

In addition, some people have genetic variations in the receptors targeted by common depression medications, which can make these medications less effective.

The extent to which genetic diversity affects response to depression medications for most patients is still under debate , and the FDA has advised caution around commercial tests that claim to predict a person's response to medications. Even if a genetic test confirms your susceptibility to developing lower or higher concentrations of a given medication in your blood, that laboratory test cannot forecast how it will function in your brain, and it cannot predict your clinical response in real life. You are more than your DNA.

However, this evolving science does suggest that some people with depression may have a genetic variation that could explain why they have not responded well to medications.

What Are the Options for Treatment-Resistant Depression?

Despite the causes of treatment-resistant depression, if you have it you are not alone. Roughly one -third of patients continue to experience symptoms of depression even after trying two medications, and many don't respond to medication at all.

However, there are meaningful steps you can take toward a better quality of life, even if genes are affecting your response to medications. Non-drug treatments exist that are entirely unaffected by any genetic variations that may be governing your body's reaction to medications.

Transcranial magnetic stimulation (TMS) is one non-drug, non-invasive therapy option. TMS applies gentle magnetic pulses to brain regions that are crucial to mood regulation. TMS is FDA-cleared for use when one medication has not been effective (but covered by most insurance after two).

Even if genes are interfering with the effectiveness of medications, those genes do not decide your future. Whichever treatment avenue you choose, there are empowering ways to manage the depression you're experiencing and find relief from your symptoms.

The Difference between Grief and Depression: How Are They Related?

Mon, 02 Nov 2020 16:15:00 GMT

Grief can hit hard, especially in the early moments of dealing with a loss. Your emotions can become so overwhelming that you might wonder if the sadness will ever go away. Depression can feel this way, too, and it helps to know the difference between grief and depression as you cope with your loss.

Grief can be uncomfortable, but in most cases you adjust to your loss and start feeling better over time. If you're still struggling for months, your grief may have developed into depression. While this may prolong your grief for a while, depression treatment can help. Here, we'll look at what a typical course of grief looks like, how it compares to depression, and some effective treatment options to consider.

What Typical Grief Looks Like

A typical grief experience includes several phases of emotion, each one showing a different way of coping with loss. These phases can include denial, anger, barganing, sadness, and acceptance. It's common to go through these phases in any order and often with phases occurring more than once.

Grief reactions come in waves with periods of adjustment in between. One week may seem calm, while the next could be full of emotional turmoil. Riding the ups and downs can be overwhelming at times, but these reactions are normal.

Your grief experience may follow some patterns, but your reaction to any particular loss is unique. Relationships, age, and life circumstances all play a part in how grief affects you and for how long. For most people, the first few weeks can be the hardest.

As the initial shock wears off, people start taking small steps back into their normal routines. Ups and downs are normal, but many people get engaged in their lives again after several months. Supportive relationships can help a grieving person find their new normal.

When Grief Turns into Depression

For some the grief can take a different direction. Grief can become depression when some of these symptoms linger or intensify:

Sadness
Loneliness and persistent longing
Isolation
Difficulty accepting a new reality
Numbness
Loss of meaning or purpose in life

Grief and depression share many symptoms and expressions. However, there are several ways to tell the difference between grief and depression. The difference often comes down to the duration and focus of symptoms. For example:

In Depression, symptoms can persist nearly all the time, while grief can come and go or you can predict when you may be feeling lower than usual, such as around your loved one's birthday or during the holidays.
Depression is often associated with feelings of worthlessness, while grief usually preserves self-worth.
Depression can cause someone to be inconsolable and isolate, while someone who is grieving usually accepts support from family and friends.
Suicidal thoughts are more commonly associated with depression than in grief.

There is substantial overlap between grief and depression. Previous distinctions between the two have been updated and no longer are considered mutually exclusive. If someone meets criteria for depression while dealing with a loss, the diagnosis of depression and treatment should be strongly considered.

One study of bereaved caregivers found that after about six months, up to a third of those experiencing grief met the criteria for major depression. A year after a loss, about one out of every four still had symptoms of depression. Whether you're experiencing grief or depression, it's important to get the care you need to start feeling better again.

Depression: Getting the Treatment You Need

Depression is common, but it can be harmful and may not resolve on its own. Whether depression is influenced by grief or develops for other reasons, it's a condition that requires treatment. Antidepressants and counseling therapy are the two most common treatments for depression. Each treatment can be used on its own, but they are most effective when used together.

If you are among the 30 percent of people who try antidepressants but don't feel better, you may be looking for other options. Transcranial Magnetic Stimulation (TMS) is a non-medication therapy that targets specific areas of the brain to reduce depression symptoms. A magnetic coil is placed near your skull to deliver brief pulses. These pulses are focused on areas of the brain that regulate mood. If you're still looking for relief after trying other treatments, TMS could be an effective option for you.

Find a Way to Move Forward

Grief is difficult for everyone. But if you can't move forward and feel like you're sinking, your grief may have turned into depression. Antidepressants and counseling therapy may provide what you need to recover from depression. TMS is another effective treatment method to consider as well, and you can reach out to Greenbrook TMS for more information. Sadness is a natural reaction to loss, but depression is a treatable condition that isn't part of typical grief. Get the support you need to keep moving forward.

4 Things to Know: When COVID-19 Makes Your Depression Worse

Fri, 30 Oct 2020 16:33:00 GMT

COVID-19 has upended almost every facet of life. For those struggling with depression or other mental health conditions, heightened stress and tension can make symptoms worse. Despite everything going on around us, it’s not only possible to manage your depression during the pandemic, but critical to get through this period of uncertainty and beyond it. Below are four things you need to know if COVID-19 is making your depression worse.

1. It's not just you: stressful situations can lead to

increased depression symptoms

Especially when everyone is under extra stressors and encountering new challenges, it’s important to continue any treatment that you had in place prior to the pandemic. For those who are already managing depression or find themselves with worse symptoms, continuing with talk therapy, taking antidepressants, or following through on non-drug therapies like TMS is crucial for maintaining consistency for your mental health. If you feel like your medication isn’t working anymore, it’s important to stay on it until you talk to a doctor about stopping. Stopping cold turkey could lead to discontinuation syndrome, which causes insomnia and flu like symptoms, among other indicators of withdrawal.

2. You’re not selfish for wanting to feel better

Feelings of depression, even during a crisis like the COVID-19 pandemic, are valid and understandable. Some people might feel their distress is less valid when thousands of lives have been lost, and many people are directly suffering from grief and loss. It’s important to know that it isn’t selfish to want to feel better, and another person’s suffering does not make your own less important. Experiencing depression, and wanting to improve your symptoms is justified, even if you have not been directly impacted by COVID-19.

3. Don’t make any changes to your treatment, especially regarding medication without talking to your doctor

If you find that your depression is getting worse, remember that it’s normal to feel bad when experiencing a stressful, elongated crisis. According to the CDC , those with depression and other mental health conditions “may be particularly vulnerable in an emergency… People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms.” The collective world experience we are living through right now has impacted so many parts of our lives that we take for granted. Anyone experiencing changes in symptoms should know that this is ordinary and natural, given the circumstances.

4. Treating depression is about more than just your mental health

Treating depression can help many other aspects of your health, including your physical health. Your mental health doesn’t effect just your mood, but also impacts how your body functions and operates . Untreated depression comes with the risk of a lowered immune system, digestive tract issues, insomnia, heart disease, and more. That means that getting help for your depression will not only help improve your mood and energy, but it’ll also help keep you physically well.

Understanding the Relationship between Depression and the Immune System

Wed, 28 Oct 2020 13:12:00 GMT

The immune system is one of the body's most valuable assets. Immune cells race to the site of a new infection or injury, where they work tirelessly against bacteria and viruses or repair tissue damage.

Yet depression and the immune system are inextricably linked. Research shows, for example, that depression is more common in people with other disorders of the immune system, such as diabetes and rheumatoid arthritis. For instance, diabetes doubles the risk of depression . At the same time, people with depression have up to t hree times as many inflammatory cells as those without depression. This excess of inflammatory cells signals that the immune system isn't functioning normally. People with treatment-resistant depression are even more likely to have elevated inflammatory markers.

However, these links also mean that seeking depression treatment can benefit your overall health. Read more for a closer look at the relationship between depression and the immune system.

How Depression Affects the Immune System

While evidence shows that depression and the immune system are connected, researchers don't fully understand that connection, though they have established some theories.

For example, chronic stress—an integral feature of depression—raises levels of a stress hormone called cortisol. This affects microglia cells, traditionally known as "housekeeper" cells because they calmly protect healthy nerve cells and efficiently remove debris. Their ability to migrate quickly to an accident site (any part of our body that is infected or injured) to do so highlights their crucial role in the body's immune response .

A stress-related cortisol surge causes previously calm housekeeper cells to go "rogue." The microglia begin to churn out cytokines , which are pro-inflammatory proteins. These cytokines damage the microglia themselves, causing them to churn out even more cytokines. This inflammatory cascade damages synapses—the gaps between nerve cells—and provokes inflammation throughout the brain. The brain regions responsible for controlling mood and emotion are especially susceptible to this inflammatory attack.

These dramatic events decrease the availability of chemical messengers like serotonin and dopamine, thus interrupting normal communication between our brain cells. These chemical messengers are especially important in regulating sleep, appetite, emotion, and memory—all things that are disrupted in depression.

In short, chronic stress can contribute to impaired function of the immune system, and this triggers an inflammatory response in the brain, leading to the symptoms of depression.

Which Immune Disorders Are Associated with Depression?

It's important to understand the basics of how depression and the immune system interact, but specific examples can help illuminate the relationship.

You're more likely to develop a common cold , for instance, if you've experienced ongoing psychological stress. Not only that, but a cold can linger for longer, far outstaying its welcome. Scientists believe this is because the immune system is dialed up with chronic stress, leading to excess inflammation.

If you have depression, you could have a greater tendency toward cardiovascular disease , another disorder related to inflammation. Up to 40 percent of people with heart disease develop depression at some point in their lives, and those with heart disease develop depression at three times the rate of the general population. People with depression have a 64 percent greater risk of developing coronary artery disease .

Evidence also points to a higher risk of cancer in people with depression. This could be related to a greater tendency of some patients with untreated depression to smoke, drink alcohol to excess, or remain sedentary—all risk factors for cancer. But there also appears to be a consistent, independent link between depression and an impaired immune system in cancer: the same pro-inflammatory proteins, cytokines, exist in both conditions. This association has been reported in pancreatic cancer and ovarian cancer , among others.

Reassuringly, treating depression could make a difference. Research published in the Journal of Clinical Oncology found that decreasing the symptoms of depression in women with advanced breast cancer was associated with longer subsequent survival .

Treating Your Mental Health Can Benefit Your Physical Well-Being

Indeed, seeking treatment for depression can help your physical and mental health alike. One study followed people over eight years and found that treating depression as soon as possible decreased their risk of strokes and heart attacks by half. Depression treatment has also been found to improve sugar levels , decrease pain , and boost cardiovascular health .

Remarkably, depression treatment can cause inflammation in the brain to vanish, showing how closely depression and the immune system are intertwined. A major study in the Lancet journal focused on people with longstanding untreated depression. These patients had high levels of immune system activation (as measured by activated microglia cells) that built year on year in brain regions crucial for mood and behavior. However, when these patients received antidepressant treatment, this yearly increase in inflammation disappeared .

Given the far-reaching impact of depression treatment on the brain and body, what can you do if depression medication hasn't provided the symptom relief you hoped for? One non-drug treatment option for depression is Transcranial Magnetic Stimulation (TMS). TMS applies highly focused magnetic pulses to the brain regions that regulate mood. TMS has been cleared by the FDA for Major Depressive Disorder and has been shown to decrease signals of brain inflammation in people with depression.

Whichever treatment option you choose, one thing is clear: proactively addressing your symptoms of depression can enhance your overall health. Dialing down your immune system to a healthy level by reaching out for depression treatment is a way to heal your body and mind.

How TMS Providers Are Supporting Patients in a Changing Digital World

Tue, 27 Oct 2020 21:07:00 GMT

Today's digital world is altering how many people prefer to access health care, and TMS providers are adapting to fit patients' needs and expectations.

Recognizing that young people often seek information in the same places they look for news and entertainment—Google and social media, for instance—industrial sectors from retail sales to financial planning have readily adopted smart technology to meet them. As the largest living adult population , millennials are driving trends , and many professional interactions are shifting from in person and over the phone to online.

Still, the health care industry has yet to fully incorporate technology solutions to maximize care delivery outside of traditional environments. While some patients may feel frustrated with the apparent lag in adaptation, others, such as seniors, may require special consideration to change their expectations of managing their health care with technology.

Greenbrook TMS is working to ensure that its patients are cared for in whatever way is most convenient and comfortable for them, and its TMS providers remain flexible in meeting their patients' needs.

Digital Technology and the Future of Health Care

Advances in digital technology will play an important role in the future of health care by connecting devices and embedding them with software and sensors to collect and exchange data, not only in doctors' offices and hospitals but in the places where people live, work, and play.

Accelerated by the COVID-19 pandemic , telehealth is the most notable technology being implemented today by health care providers. Some advantages of telehealth include expanded options for patients and providers for outreach, treatment delivery, and compliance monitoring—and, as a consequence, potentially improved clinical outcomes.

However, there are both pros and cons of telehealth. One disadvantage is that video telehealth services depend on both internet bandwidth and in-home computer equipment. Many people lack reliable broadband internet access or the equipment necessary to have an online appointment. For those who do have a workable setup, technology issues can still arise with sound delays, lighting issues, and audio glitches.

Telehealth and Psychiatry

Telehealth poses some unique challenges for psychiatry. One example is misdiagnosis. While patients often seek mental health care for what they believe is depression, a medical examination may determine that they are suffering from a neurological condition that has a secondary symptom of depression. Without an in-person assessment, the root problem would be missed, and the patient would be misdiagnosed.

Furthermore, developing face-to-face rapport is important in establishing a trusting, open relationship between patient and provider. With telehealth, your provider may have a harder time interpreting all the nuances of tone, body language, and facial expression than they would during an in-person visit.

TMS and Telehealth

While the pros and cons of telehealth may be weighted toward the pros for some patients, others might be more concerned about online health care and feel that it's neither convenient nor appropriate for them.

Greenbrook TMS offers telehealth appointments based on clinical suitability and patient preference. If you want to take advantage of telehealth and it is clinically appropriate, Greenbrook providers will offer it to accommodate your needs. If it's not clinically appropriate or you don't have the resources or preference for that mode of therapy, you have the option of an in-person examination.

Greenbrook TMS has always promoted patient convenience and choice. Unlike other depression treatments, however, TMS treatment has to be calibrated by a psychiatrist and administered by a technician, which requires an in-person visit. In other words, because TMS is a hands-on procedure, you will need to come in for a visit eventually . With this in mind, all Greenbrook centers are based on geographic proximity to people's homes and workplaces in appealing office spaces that are safe and spa-like, with treatments taking place in private rooms.

If you are considering TMS therapy, contact Greenbrook for a free consultation and see if a telehealth appointment is right for you.

The Relationship between Social Media and Depression

Mon, 26 Oct 2020 14:51:00 GMT

Among the world's 7.7 billion people, an astonishing 2.4 billion people have Facebook accounts , and internet users spend an average of 144 minutes per day on social networking sites. Yet while social media connects people online, it can also cause feelings of isolation and loneliness , potentially contributing to or exacerbating depression in many people. Social media's growing presence makes it necessary to explore the relationship between social media and depression.

Social Media and Unhealthy Comparisons

When you're browsing Instagram or Facebook, it's easy to forget that a photo is merely a snapshot of a moment in time—it rarely represents the full picture of a person's life. People on social media often present a filtered image, creating the impression that their lives are better than they really are; they tend to showcase happy milestones while omitting negative ones. For instance, a user is more likely to post after getting engaged than after a breakup. Consciously or unconsciously, you may compare yourself to your peers, which can foster feelings of inadequacy when social feeds are full of curated highlights.

Similarly, social media users also tend to post artfully cropped or edited photos of themselves, which can create unrealistic body image standards. People may feel pressure to live up to these standards when they compare themselves to friends. Poor body image can contribute to mental health problems , underscoring the relationship between social media and depression.

Fear of Missing Out

Because social media rewards users with "likes" and other forms of external approval, it can motivate people to cast themselves as happier than they really are and create a sense of unhealthy competition. These comparisons can also lead to "FOMO," or fear of missing out, which is the uneasy feeling that there is something more exciting or interesting than what you're currently doing. FOMO can instill anxiety and depression.

What's more, when you overemphasize social media, you may actually end up missing out on things that would bring you joy. For example, rather than enjoying a good meal and conversation with a friend, you may spend time trying to capture the perfect photo to post on social media. When sharing an experience online becomes more important than the experience itself, you may feel disconnected from your life .

Doomscrolling

Another phenomenon related to social media usage and depression is known as " doomscrolling ." When a tragic event happens, it's natural to want answers. The problem is when you continue to scroll through news that's saddening, disheartening, or depressing. People assume that getting answers will make them feel better, but doomscrolling through fifteen articles on a recent school shooting or celebrity death, for instance, can make you feel hopeless. Saturating daily feeds with stories on rising case counts, worsening economic impacts, and new but inconclusive research, the COVID-19 pandemic presents a special risk for doomscrolling and can leave you feeling particularly overwhelmed with bad news.

Social Media Usage and Depression: You're Not Alone

Comparisons, FOMO, and doomscrolling can make you feel lonely and isolated, which is detrimental to your mental health. Everyone has a need for human connection and feeling part of a community, and having a support network of people you can rely on is essential to being resilient. Resilient people can adapt to adversity and protect their mental health.

Social media can be a way to connect with your support network, but if it's contributing to your feelings of depression, remember that you're not alone. There's hope, and treatments are available to you, including talk therapy and antidepressants. If these treatments don't help alleviate symptoms, you can also try Transcranial Magnetic Stimulation (TMS), which stimulates areas of the brain to help with mood regulation. To learn more about TMS therapy, schedule your no-cost consultation .

4 Things to Know: Mental Health Resources for College Students Back at Home

dhageman@innovasium.com (Daniel Hageman) — Sun, 25 Oct 2020 15:24:00 GMT

Managing mental health in college can be hard enough, even without the COVID-19 pandemic to complicate things further. As colleges go remote for the fall semester or adapt to hybrid models of opening, those changes can be especially difficult if you’ve been relying on your university’s student health resources to manage your mental health. Here are 4 things to know if you’re back at home and not sure where to get the care you need.

If you’ve only seen a mental health professional at school, it can be tough to know how to get started at home with talk therapy or managing your medication. If you’re not sure where to go first, your primary care physician (the same doctor you’d go to for a physical illness) is a good place to start. Be sure to let them know about any medications or treatments that you’ve been receiving at school.

If you’re running low on your medication and don’t know how to refill it, you might be tempted to just stop taking it. You might even find that if you do stop suddenly, you’ll feel okay for a couple of weeks. But that’s because it can take a few weeks for the medication to leave your system. Once it does, you could be back to feeling like you did before you started treatment. It’s important to stay on any prescriptions until you talk to a doctor, not only because it’s important to keep treating your mental health, but because abruptly stopping medication can lead to discontinuation syndrome , which includes flu-like symptoms and can last for several weeks.

If you think that your parents will be supportive, try keeping them in the loop about how you’re doing and the fact that you’d like to keep seeing a doctor for your mental health. If you wish to maintain your confidentiality or if your parents are less supportive, framing your symptoms in physical terminology, such as fatigue or sleep disturbance, may help if they must be involved in your access to care. When you meet with a provider, ask to have some time alone with them, if this is not automatically provided. If cost is an issue, some mental health professionals work on a sliding scale and can help you get care at a more affordable price.

There have been so many changes in the past couple of months and this probably isn’t the college experience that you’ve been picturing. It’s okay to feel overwhelmed. Give yourself time to breathe and be disappointed, but know that there are places and people that can help you get through it. Remember that your mental health impacts every part of your life and it’s important to get the care you need.

What You Need to Know about Depression and Insomnia or Hypersomnia (Oversleeping)

Wed, 21 Oct 2020 15:58:00 GMT

When sleep is off-balance, the rest of life can feel like a hazy dream. Sleep problems are a common symptom of depression. One of the functions of sleep is to maintain emotional regulation. When your sleep is disrupted, it can make depression even worse. Fortunately, there are steps you can take to overcome the cycle of depression and insomnia. Here's a closer look at the link between depression and poor sleep, as well as some ways to treat depression for more restful sleep.

The Relationship between Sleep and Depression

Studies estimate that between 65 and 90 percent of adults with MDD experience sleep difficulties. The key link between sleep and depression is in the way that sleep habits affect serotonin levels in the brain. It is believed that sleep irregularities may create a vulnerability to depression because of the stress that disrupted circadian rhythms put on the body. People who sleep too much or too little in response to depression symptoms often experience a cyclical effect where initial poor sleep feeds those symptoms.

Depression and Insomnia

Insomnia is a condition characterized by difficulty falling asleep, difficulty staying asleep, or decreased total sleep time.

For roughly 75 percent of people with depression, insomnia is a familiar and unwelcome occurrence. Insomnia is not only a symptom of depression, but it is now also recognized as a possible precursor to and exacerbating factor for depression.

A more complete picture of the relationship between depression and insomnia is still emerging. Research suggests that circadian dysfunction is linked to mood changes that may overlap with depression symptoms, but it can be hard to determine whether certain symptoms are the result of depression, insomnia, or both.

Depression and Hypersomnia (Oversleeping)

Oversleeping is a symptom in roughly 15 percent of people with depression. For someone experiencing depression, for example, oversleeping might take the form of regularly sleeping into the afternoon or returning to bed shortly after waking up. Hypersomnia, as it's also known, is characterized by excessive time spent sleeping and/or frequent daytime sleepiness. A person with hypersomnia may experience difficulty waking, staying awake, remaining energized, or thinking clearly during the day. Quality of life can be negatively impacted if someone has a sense of sleepiness thoughout the day since this will distract from being mentally present in a given situation.

What Habits Can Improve Sleep?

It's been established that good sleep hygiene and bedtime habits can improve sleep quality. Cognitive Behavioral Therapy for Insomnia , referred to as CBT-i, is a good first line therapy for insomnia. For some people, however, habits that are generally effective, such as going to bed at the same time each night and eliminating naps during the day, aren't enough to regulate sleep. If you've tried those methods and are still feeling exhausted due to sleep issues, here are some lesser-known steps that may help:

Light therapy: this form of treatment uses a special box that mimics outdoor light, which can be particularly helpful for seasonal affective disorder (SAD), a condition that's tied to changes in the seasons. Natural light can help improve mood and alertness as well as boost your ability to sleep at night.
Sleeping with a weighted blanket: New research has found that a weighted blanket can improve sleep, decrease daytime drowsiness, and reduce insomnia by applying pressure to certain and muscles during sleep.
Going for a walk as soon as you wake up: Exercising each day may help you sleep better.

For many people with depression, sleep hygiene can only go so far in bringing about meaningful improvements. That's because you're treating symptoms of depression, not the depression itself. If this is the case for you, finding the right depression treatment to support good sleep habits is vital.

Looking beyond Habits: How to Get Help When You Can't Fix a Sleep Issue

For those who have tried depression medications without success, Transcranial Magnetic Stimulation (TMS) offers a drug-free, non-invasive treatment for depression that may help address sleep issues. TMS works by delivering gentle magnetic pulses to mood-regulating brain regions in order to relieve depression symptoms, which may help break cycles of insomnia or oversleeping.

If you're feeling hazy or exhausted due to depression-linked sleep issues, there are treatment options available beyond sleep medications and antidepressants, and TMS may be the option that works for you. To learn more, schedule a no-cost consultation .

What Can Cause Brain Fog?

Wed, 21 Oct 2020 15:50:00 GMT

What Is Brain Fog?

Brain fog is the term used to describe focus or memory issues that may leave you feeling like you're "in a fog." When you're overcome by brain fog, your mind feels fuzzy and disorganized. You may have difficulty remembering things, struggle to think clearly, and feel dazed.

Brain fog can be caused by changes in your body or your mental health. It can be a symptom of depression, but depression isn't the only possible cause. Healthy brain function depends on many body systems working well together, and when a medical or mental health condition develops, brain fog can be one of your first clues.

What Can Cause Brain Fog?

Several common medical conditions can cause brain fog, many of which are chronic. Living with these conditions can be frustrating and mentally exhausting, but learning more about what causes brain fog can help you seek the right treatment and improve your symptoms.

Depression

Memory, attention, and focus can all be affected by depression. Experts are still learning about the connection between depression and brain fog , but it is believed that depression could cause brain fog by interfering with the health and function of nerves in the brain, particularly in areas that control attention and memory.

Even if you're on antidepressants to treat depression, you may still experience some brain fog or other symptoms. This is because antidepressants may not be completely effective for everyone. In fact, about one in three people do not respond to antidepressants. Some antidepressants can also interfere with neurotransmitters that are involved in memory function or they may cause sleepiness which interferes with attention. Fortunately there are other treatment options for depression you can discuss with your healthcare provider.

Autoimmune disorders

Brain fog is a common symptom of celiac disease, lupus, diabetes, and other autoimmune disorders. Inflammation in various parts of the body is at the root of each of these conditions and connects to brain fog. The link between inflammation and brain alertness is being examined more closely through research.

Hormonal changes

The hormonal changes that occur during perimenopause, menopause, and pregnancy can lead to forgetfulness and clouded thinking. These effects can come and go as hormone levels change. Sleep disruption and mood swings are also common during these transitions, which can intensify the effects of brain fog.

Medication side effects

Some medications can affect the way your brain functions or cause drowsiness. These symptoms of brain fog may be short-term or ongoing as you take these medications. While antidepressants are generally intended to help with brain fog, some can cause brain fog as a side effect, depending on the medication and your unique response to it. Sedatives, pain medicine, bladder control medicine and antihistamines are some of the other types of medications that can lead to brain fog.

Allergies

Allergies can cause your nasal passages to become inflamed, which may lead to congestion or poor sleep, creating a foggy, tired feeling during the day. Inflammation can set up a cycle of daytime fatigue and poor sleep patterns. Other symptoms of allergies may include a runny nose, itchy eyes and skin, and sneezing.

Hypothyroidism

The thyroid gland is closely connected to your body's metabolism process. If your thyroid does not produce enough thyroid hormone, it can cause changes to brain function in addition to other symptoms which may include fatigue, sensitivity to cold, constipation, muscle weakness, weight gain, and dry skin.

Chronic fatigue syndrome

As its name suggests, chronic fatigue syndrome is characterized by constant fatigue with no clear underlying cause. While it may include other physical signs or symptoms such as enlarged lymph nodes, unexplained pain, headaches, and extreme exhaustion, it may also impair memory and concentration leading to a sense of brain fog.

Sleep apnea

Sleep apnea is a respiratory disorder that can result in poor sleep and low oxygen intake. Sleep apnea can be either due to difficulty getting air in through the air passages or due to a decrease drive to breathe during sleep. Changes in oxygen levels interfere with the necessary stages of sleep, decreasing restorative sleep that is needed to refresh the brain from the prior day's activities. This can led to dysfunction of the brain resulting in difficulty with thinking and memory.

Neurological conditions

There are multiple neurological conditions that can cause damage to nerves in the brain. Head injury, for example, can be associated with persistent symptoms afterwards leading to difficulties with attention and memory. Parkinson's disease, especially later in the illness can also result in memory difficulties creating a sense of brain fog. Certain vitamin deficiencies can also impact the health of nerves in the brain. There are numerous other neurological diseases that can give a sense of brain fog, which is why a medical evaluation can be important in trying to understand the cause.

Other causes of brain fog

Some common mild or temporary conditions can also cause brain fog. These include :

Lack of sleep
Poor diet
Stress
Dehydration

Learning More About Brain Fog

Brain fog can be frustrating to deal with, especially if you're also managing other uncomfortable symptoms. It can also be a sign of other serious issues, so it's critical to get to the root of the problem. Pay close attention to when and how often you are affected by brain fog, as well as any other symptoms that may be connected to the condition. A medical evaluation with your primary care provider is a good place to start for workup of any difficulties with level of alertness, attention, or memory.

If you suspect your brain fog is related to depression, it's important to seek the depression treatment that works for you. Antidepressants and talk therapy are two common options, but if those treatments aren't working—or if antidepressants are causing brain fog—you may want to consider transcranial magnetic stimulation (TMS) . TMS uses gentle, targeted magnetic pulses to treat depression, and it can be helpful for depression symptoms when other treatments have not been fully effective.

It can be easy to become discouraged by brain fog, but it's important to keep working with your doctor to understand the condition and identify the solution that works for you.

The Greenbrook TMS Difference

Mon, 19 Oct 2020 15:53:00 GMT

Greenbrook TMS was established in 2011 and quickly grew to become a leading provider of transcranial magnetic stimulation (TMS) therapy in the United States. Our patient-focused customer service model makes TMS easily accessible to patients and allows us to provide the best possible care.

Today, Greenbrook provides TMS therapy for depression at 125 centers spread across 13 states. We have provided more than 500,000 TMS treatments to more than 14,000 patients struggling with depression, and we remain open during the COVID-19 pandemic.

In a recent interview, our Chief Medical Officer, Dr. Geoffrey Grammer, discussed the unique experience that Greenbrook TMS offers patients with treatment-resistant depression.

What makes Greenbrook TMS patient-centered?

Greenbrook was designed and created by people who build health care companies for a living, with the goal of improving the patient experience. That positive patient experience starts with the first phone call, extends into handling all aspects of approval and billing of your insurance company, and results in a best-in-class treatment delivery.

We've worked to train our staff and design our waiting rooms, facilities, and website to be patient-centered. While receiving TMS therapy for depression, you're surrounded by friendly, helpful staff and aesthetically pleasing environments, all geared toward assisting you in your recovery.

Greenbrook is a leading TMS therapy provider. What does that mean for patients?

We have some of the best psychiatrists in the field that advise the company on appropriate standards of care. That ensures that whether you get treated in Washington, D.C., or Charlotte, North Carolina, you're going to get the same excellent care.

The sheer amount of resources is a huge benefit in helping to advise care delivery. We have a relationship with the academic community, the vendors of the devices, insurance companies, and psychiatrists , which means we get to incorporate the latest and greatest technologies and techniques for our patients.

Psychiatrists who are more isolated can't read every study out there or dive into every research initiative. But at Greenbrook, we have our finger on that pulse very strongly. Because of our size, entities are interested in keeping us informed, which ultimately benefits our patients, who get the best and latest evidence-based care in their therapy.

How long will a prospective patient have to wait to get in for treatment?

We recognize that when people need help, they don't need help six months from now; they need help today. Unlike some other psychiatric practices, we have stringent standards to get you on the road to recovery as quickly as possible. We aim to see you for your first appointment within a week or two with insurance approval and treatment initiation following shortly after.

How are you able to get new patients in for treatment in a week? What if you're booked up?

If there is a space or device availability issue, we acquire more space or purchase more devices. If there is a physician availability bottleneck, we partner with more doctors and we leverage staff to help with the patient experience. That frees up our affiliated physicians to do the medical decision-making and not get bogged down in paperwork or insurance claims and appeals — meaning the physicians can focus on what they're trained for, which is deciding on the best treatment option for you and handling the device settings.

Will patients have to travel far to be treated?

We recognize that for people to get TMS therapy, it needs to be convenient, so we build centers near where it's easy for people to visit. We don't want someone driving hours to get TMS therapy for depression.

When we grow into a new area, we look at where people live and work and open centers in convenient locations that are safe, close to major roads and have easy parking to make those centers as convenient as possible for patients. We are constantly expanding to bring this therapy to people who need it. Patients can go to our website, which has a location finder , so you can find the center nearest to your home.

What does Greenbrook TMS do to ease the burden of dealing with insurance companies?

We work with nearly every insurance provider, so you don't have to do much more than give us your insurance card to get coverage. Throughout the entire process, you will work with a Patient Consultant to find the status of your insurance requests. We have a well-trained team that files and processes claims, and we have a team that helps with appeals when needed.

How expensive is TMS therapy at Greenbrook TMS?

A lot of other providers will tack on miscellaneous fees, like a physician oversight fee, but we don't want any surprise billing out of Greenbrook.

We take most insurance, including Medicare and Medicaid at various center locations. We tell you the results of a benefits inquiry, so when you start, you know what it should cost. This allows you to make an informed choice if TMS therapy is right for you including consideration of the logistical and financial requirements.

What would you say to a patient considering TMS?

Of all the things I've done in medicine, the thing that has been most transformative has been TMS. It was clear very early on that TMS was a paradigm changer in the field of psychiatry. When people respond to TMS, they respond in ways that are far more dramatic than I've seen with other modalities. TMS is a safe, very well-tolerated treatment that works for the majority of patients who try it. Not treating depression is not only painful, but it can lead to actual medical damage, so the biggest risk in trying TMS often lies in not trying it at all.

Is Anger a Symptom of Depression? How Depression and Anger Are Connected

Mon, 19 Oct 2020 14:48:00 GMT

The sound of your spouse's voice taking Zoom calls in the dining room has become grating. On trips to the grocery store, you feel on edge and impatient with the other drivers on the road. And when you go around shutting the lights off for the night, all you see is clutter and your kids' toys on the floor. You aren't normally an angry person, but these frustrations stick with you all day now. This anger feels new, and with it has come depression symptoms like fatigue, trouble concentrating, and unexplained back pain.

This scenario raises an important question: is anger a symptom of depression? Yes, it is—yet it's often overlooked. Major depression and anger are closely connected, but the stereotype about depression is that a person only feels sad all the time. Because of this misunderstanding, many people wrestle with untreated depression disguised as anger every day. It's often easier to be angry than to face deep emotional pain.

If this sounds like you, don't give up seeking a solution. Take a closer look at how depression and anger are connected and how you can feel better with guidance and support.

Recognizing Anger as a Symptom of Depression

Experts believe that current research has yet to fully explore the relationship between major depression and anger. Some have suggested that at least a third or more of individuals with depression struggle with irritability and anger. It's easy to see how ongoing irritability could cause a person to lose their temper. Untreated depression symptoms like the following can wear a person down, leading to increased irritability over time:

Lack of sleep
Negative thoughts and ruminations
More perceived life stress (and more sensitivity to it)
Feelings of insufficient control over life
Feeling of hopelessness and helplessness

Major depression and anger can develop from two directions, each one triggering the other. When coping skills are tested and frustrations pile up, a person's emotions may flip from sadness to irritability. At some point, these feelings can boil over and come out as anger in the form of cutting words or physical aggression. On the other hand, chronic stressors can turn an irritable mood into an angry outburst. Ongoing stress and anger can increase the odds of developing depression over time.

Understanding Anger as a Defense Mechanism against Depression

While it's often difficult to talk about loneliness, hopelessness, and negative thoughts, anger can create a brief sense of power and control, deflecting attention from deeper emotional pain and vulnerability.

Men are more likely to experience depression through anger. Compared to women, men talk about their mental health less often and are less likely to seek help. These and other factors mean that men with depression often struggle for months or years without treatment.

Women also experience anger or irritability, but it is often not a dominant symptom. It's also more socially acceptable for women to express a wider range of emotions, making anger less likely to obscure other symptoms.

Small frustrations can be easy targets for pent-up anger, especially if you're feeling overwhelmed by depression. You may grumble at the grocery store clerk, make a rude remark to your spouse, or yell at your child after work. Getting mad might help you release some energy and emotion, but you may not feel better in the end. If this seems to be an ongoing cycle, your anger may stem from depression. Without treatment, getting angry may be one of the few ways you've found to cope with your feelings. And without help, you may feel stuck in your emotional state.

Seeking Treatment for Extreme Anger

Everyone feels angry sometimes—it's a part of being human. But extreme anger can threaten your job, relationships, and finances. Irritability can be a sign of medical problems like a possible concussion or an overactive thyroid . An irritable mood can also signal unstable blood sugar levels , a medical emergency for someone with or at risk for diabetes.

The good news is that you can reduce the impact of severe anger on your life with treatment and support. Whether your anger stems from depression, stress, or something else, you deserve to feel better.

Seeking treatment is a great step forward, but not all methods work on the first try. The search for helpful treatment can be frustrating, especially when you try several options with little success. It's natural to feel discouraged, but there is hope. If you've already tried a few treatment options, it may be time to look closer at Transcranial Magnetic Stimulation (TMS). TMS therapy is a safe and effective option for depression, which may be an underlying cause of severe anger issues.

Extreme anger doesn't have to take your life off track. Professional help is the key to feeling better, so keep seeking depression treatment until you find something that works for you . You may feel discouraged along the way, but remember that you have options. You can feel better, and TMS therapy could be the treatment that helps you get there.

Dealing with Depression Affecting Work: 5 Strategies for Office and Remote Work

Mon, 12 Oct 2020 16:17:00 GMT

Work stress is inescapable for most of us, but if you are living with depression, you may be experiencing added stress caused by your symptoms. Depression may affect work due to symptoms like lack of motivation, inability to focus, loss of energy, difficulty sleeping, and losing interest in work you previously enjoyed. This feeling of not being able to be as productive as usual can create a vicious cycle—you feel like you can't get work done because you're depressed, and depression symptoms may get worse because you can't get work done.

This is far from unusual. Greenbrook's Virginia Regional Medical Director, Dr. William Sauvé , notes that difficulty focusing is one of the most common—and least talked about—symptoms of depression.

"Cognitive impairment is a major symptom [of depression] and probably one of the most common. Word finding, processing speed, maintaining attention, switching attention—all of these cognitive skills are diminished in those with depression," he explains. "It can often be very subtle ... On the outside, coworkers wouldn't notice anything wrong. But my patients feel a little more slowed down, or as if it's taking more energy to focus and get work done."

If this sounds familiar, you're not alone. There are strategies you can implement during your work day that can help, as well as professional treatments that can lessen your symptoms.

Unique Challenges of Working from Home

If you're dealing with depression while working from home—especially if you're not accustomed to working from home—you are probably facing added stressors. When you're used to working in an office around people, shifting to working from home can cause feelings of loneliness or isolation, which can magnify depression. Plus, although you may not miss your commute, getting dressed and leaving your home may have provided a certain amount of structure to the day. With home and work being the same place, it is easy for boundaries to erode and work-life balance issues to arise.

In many cases, the same strategies for productivity and focus apply when you're working from home as when you're working in an office. If you're home, though, it may be a good idea to reach out to coworkers or a support network for help staying motivated and being held accountable. Knowing there are other people checking in on you could help lessen the feelings of isolation, making working from home with depression more bearable.

How to Reduce Your Symptoms

Here's a few strategies to make work a bit more manageable when keeping track of emails and deadlines begins to feel like a monumental task.

1. Be Realistic

Consider this example: Perhaps when you're feeling your best, you typically complete about 10 tasks per day. But when you're dealing with depression, maybe you can only complete five. This is common and understandable for those managing depression, and is not a personal failing. Instead of trying to force yourself to work harder, it's important to be realistic about what you can reasonably handle.

Take a look at your workload and determine the things that absolutely need to get done that day. By identifying the highest priorities, you can accomplish the essential tasks without overextending yourself. Setting realistic expectations for yourself is self-care, too.

2. Time Block

Sometimes, facing the expanse of a full work day can feel incredibly overwhelming, and procrastination comes in. Instead, try scheduling your tasks as if they're meetings so you have a manageable plan of how you will organize your day and your work. You can put chunks of time on a digital calendar to give yourself a visual of the day, or use focusing strategies like the Pomodoro Technique to help yourself avoid procrastination.

3. Break Tasks Down

Let's say that one of your tasks is to write an article. That's the big task, but that includes research, interviews, and writing. Rather than tell yourself you'll write the whole thing at once, focus on one bit of a project at a time. That way, you'll give yourself small wins, activating a small hit of dopamine from your body's reward system.

4. Talk to Your Boss

If you feel comfortable, it might be worth trying to talk to your boss so they know what's going on. They may be able to help you work out arrangements, such as moving some less-urgent assignments off your plate or giving you some extra time. If working from home might help, they could help you find a plan that works for both of you.

5. Take a Mental Health Day

Some days, none of these strategies will be enough—and that's okay! Just as you should take a sick day if you have the flu, you should take a mental health day if you need it. Just be sure not to spend the day checking your email or reaching out for updates. Try to unplug, and treat yourself to a nourishing activity like a massage or a long walk.

Taking Steps to Feel Better

Dealing with depression that's affecting your work can sometimes feel like wearing a heavy coat you can't take off. If you're struggling with depression, the strategies above can help in the short term. But they're no substitute for getting medical treatment.

Seeking treatment like psychotherapy and antidepressants can help you feel better at work and in all other areas of your life. If you're not sure where to start, your primary care provider can help.

However, if you've already begun seeking treatment and have tried multiple depression medications with no results, there are other options available to you. Non-medication treatments, such as Transcranial Magnetic Stimulation (TMS), often work where medications haven't.

It's important you find a treatment option that works well for you. After all, prioritizing and supporting your mental health is key to improving your quality of life, whether on the job or not.

Recognizing Mental Illness Awareness Week: What People with Mental Illness Want You to Know

Tue, 06 Oct 2020 20:49:00 GMT

Mental Illness Awareness Week, coinciding with World Mental Health Day 2020, is a time to highlight mental health conditions, and, for us at Greenbrook TMS, a time to advocate for our patients.

This year, Mental Illness Awareness Week begins on October 4 and culminates with World Mental Health Day on October 10. Since the theme this year is "What People with Mental Illness Want You to Know," I want to take this opportunity to address a few misconceptions about mental illness and mental health care. If you are a concerned friend or family member of someone experiencing depression or obsessive-compulsive disorder (OCD), debunking some of these misconceptions may help you better support them.

Mental Illness Is Real Illness

The more we learn about mental illness, the more we understand it is associated with biologically-based changes in brain function. If you develop moderate to severe depression, your brain isn't working correctly and you need medical help—not just a shift in attitude.

You wouldn't sit around with a broken leg and say, "You know what would make this better? Watching a funny movie." Yet, somehow, people tend to think those with mental illness, especially depression, will feel better if they would just pray, eat well, exercise, and do fun things. I think some people are afraid to acknowledge that the way we think and feel is controlled in part by an organ, the brain, because we want to have more control over how we think and act than we actually do. Regardless, if you know someone who is suffering then helping them to access medical care is the appropriate approach.

It's Okay to Help

If you feel someone you care about is experiencing depression, anger, or fear; is acting in a way that is no longer productive; or is acting differently from their typical behavior, it's okay to reach out. Rather than avoid the subject, you can let them know that you've noticed changes and that you care.

Also let them know that help is available. A person with mental illness needs to see a professional who can make an accurate diagnosis and start them on a formal treatment plan. An easy place to start is their primary care physician, who can refer them to a behavioral health specialist if necessary.

If you're worried someone is unsafe, you can ask them if they're thinking about hurting themselves or if they're suicidal. Studies show, asking questions about suicide does not encourage people to attempt suicide, so you don't have to worry about that.

However, being suicidal is not a requirement for accessing mental health care. We should not forget the medical consequences that depression can cause, even if your loved one isn't suicidal. Untreated depression can decrease your life expectancy up to a decade due to its many physical consequences. If I said you have a health condition that can cut ten years off your life, how seriously would you take it? That level of seriousness shouldn't change just because we're talking about mental illness instead of, say, diabetes.

Treatment Options for Depression

Like other bodily injuries and illnesses, modern medicine has afforded treatment options for people with depression. Antidepressant medication can be effective for about two-thirds of people . The types of medications prescribed for depression don't control the way you think or make you someone you're not, and you will not get addicted to these medications.

Therapy can be effective, but it has to be the right kind of therapy, not just a friendly, compassionate person talking with you about events from your week. Specific schools of therapy are like physical therapy for the brain, where your mind is reconditioned to think more accurately about the environment around you.

For many people with treatment-resistant depression, transcranial magnetic stimulation (TMS) succeeds where medication has failed . Among patients with Major Depressive Disorder who have received TMS, two out of three have reported a reduction in depression symptoms after completing the acute phase of treatment.

Mental Illness Is More than Depression

There are many conditions that fall under the mental illness category. While depression is more commonly discussed, it can be particularly challenging when someone has another condition that is less common and less well understood by others, like OCD . OCD can lead to inexplicable behaviors and consuming thoughts that don't necessarily make sense. You can't rationalize someone out of those thoughts and behaviors because the networks in the brain that allow them to switch from one set of thinking to another are impaired. A friend with OCD may shower thirty times a day, and telling them they're clean, they're wasting water, and their skin is going to get raw will not help them stop.

Like with depression, medication and therapy can be helpful. TMS is another option for treating OCD.

Getting Help

If you know someone who is experiencing symptoms of a possible mental illness, encourage them to seek medical care. Their symptoms sometimes can be more apparent to you than them and prompting them to seek care may be the push they need to get help.

Accessing help isn't as difficult as it used to be, but be careful with seeking all your information from the internet, which can descend into pseudoscience pretty quickly. Do listen to someone trained and licensed to provide care.

We at Greenbrook TMS want you to know that you are not alone. We provide free consultations for TMS therapy , and if you know someone who needs immediate help, please refer to our list of emergency resources . Visit the National Alliance on Mental Illness to learn more about Mental Illness Awareness Week and World Mental Health Day 2020.

Understanding the Link between Depression and Burnout at Work

Mon, 05 Oct 2020 15:38:00 GMT

Many people consider their job to be a source of stress, but it can be difficult to measure just how much of an impact that stress has on your mental and emotional health. Can stress at work lead to depression or worsen symptoms you're already feeling? And is there a clear correlation between depression and work performance?

Here's a look at the links between depression and burnout at work and why you should seek treatment for depression, no matter its cause.

Stress and Burnout at Work

Employment is a major component of people's lives, with complex tasks and social situations that allow multiple windows of entry for stress to intrude into people's lives. In the United States alone, 65 percent of surveyed workers report significant job-related stress .

Persistent job stress, as one might imagine, can lead to burnout at work. Characterized by extended feelings of exhaustion, detachment, and reduced accomplishment, burnout is quite common. Recent Gallup research found that 76 percent of Americans feel burned out at work "at least sometimes," while 28 percent feel burned out "very often" or "always."

Both burnout and workplace stress can play significant roles in the development or exacerbation of depression and other mental health conditions.

Work Stress, Burnout, and Depression

Workplace stress and burnout can develop from a variety of different causes. No one cause is worse than any other, as everyone experiences stress—and symptoms of depression —differently.

1. Excessive Work

Some jobs are stressful because you're being overworked. Work may leave you constantly physically tired and without the time to practice self-care. These types of jobs can impair your sleep quality, increasing your risk of developing hypertension , diabetes , and cardiovascular disease . Working excessive hours can affect more than just your physical health; it can also be associated with increased anxiety and depression symptoms and overall poorer states of mental health.

2. Job Pressure

Other jobs can be stressful in a different way—from unreasonable time pressures and strict deadlines to high stakes and a general lack of flexibility. These types of jobs and the stress they cause can have a significant negative impact on one's mental health. In fact, one study revealed that people with highly stressful jobs are at twice the risk of developing depression and anxiety as those with less stressful jobs.

Further, depression and work performance are strongly linked. Depression is known to reduce productivity , participation, and performance levels at work, potentially creating a harmful cycle where stress and depression at work compound.

3. Toxic Work Environments

With some jobs, it's not the tasks you perform that are stressful and damaging to your health. Instead, it's the environment and culture you have to navigate on a daily basis that takes its toll. Constant chaos, strained relationships with peers or supervisors, and disrespectful or inappropriate communication can all make a workplace unhealthy. Long-term exposure to and coping with these kinds of environments can contribute to depression.

Seeking Treatment for Depression from Burnout at Work

It can be easy to minimize mental health conditions that are not caused by factors seen as "traumatizing" or "dramatic" enough. However, in reality, the severity of mental health conditions is not determined by what brings them about. Depression associated with work stress or burnout is no less serious than depression stemming from other causes.

No matter what the trigger may be, depression is a clinical condition that should be treated. Antidepressants and cognitive behavioral therapy are typically the first line of treatment for depression. But if you've tried them and haven't seen the results you were looking for, you may want to consider Transcranial Magnetic Stimulation (TMS) therapy .

TMS is a non-invasive treatment that uses gentle magnetic pulses to activate specific brain regions involved in regulating mood and emotion. This treatment is effective for 2 out of 3, or approximately 62 percent , of people who haven't benefited from antidepressants.

Many patients report having positive experiences with TMS therapy—in regard to both the treatment sessions and the improvement in their symptoms. Whatever treatment path you choose, remember that you are taking positive steps on your journey to better health.

How Does Depression Affect the Brain?

Mon, 21 Sep 2020 19:39:00 GMT

Medically reviewed on 9/21/2020 by
Dr. Geoffrey Grammer
Chief Medical Officer

If you have symptoms of depression, it's natural to wonder what's going on in your body. The good news is that researchers have now answered two crucial questions: how does depression affect the brain, and what chemical imbalance causes depression? These discoveries can help you on your journey toward recovery.

How Does Depression Affect the Brain?

Brain cells talk to one another through chemical messengers (also called neurotransmitters) that are released from one cell and passed to the next. Depression is not caused by an imbalance in a single chemical and it's not simply a matter of one chemical being too high or too low. Instead, when someone has depression, we see changes in the normal function and effect of neurotransmitters .

Now, how do these chemical changes cause depression? Take a moment and imagine you're at the airport waiting for a flight connection. Picture the busy, bustling scene around you—hundreds of people all taking different journeys through the same interconnected system. Your brain is like the nation's airport network system. If there are major delays at an airport hub , these have larger effects throughout the rest of the airport network. That is just how it is for depression. Neurotransmitters interact with the brain's "flight paths," or nerve connections, and if one isn't operating properly, it may cause issues elsewhere.

The brain's physical structures (all those airport buildings) are also crucial. Some people who experience depression have subtle differences in these structures. We do not yet know why these variations occur—whether being depressed possibly causes these structural changes, or if the brain changes themselves cause depression.

It's important to remember that depression is not only about what happens within your brain; your life outside of it matters, too. Depression goes beyond those flight paths and those airport buildings. Several factors can interact with one another to trigger depression, including one's genetic blueprint and stress levels, as well as some medications. General health plays a role, too. For example, chronic pain can trigger or increase the chance of depression.

How Do Brain Changes Manifest as Depression Symptoms?

The system mainly implicated in depression is the limbic system. This is a set of structures concerned with emotions and memory, all underpinned by the hard work of those neurotransmitters.

Here are some of the major structures that appear to show subtle differences in some people with depression:

The hippocampus is associated with emotions and memory storage. It's susceptible to the effects of stress hormones, such as cortisol. If you experience long-term high levels of stress, that can increase your cortisol levels, which, in turn, affects the growth of nerve cells within the hippocampus. This may explain why many people with depression report memory and concentration difficulties. Numerous studies have shown that changes in the hippocampus can be reversed with depression treatment.
The hippocampus influences the functioning of the prefrontal cortex , the region toward the front of your brain. This region helps with decision-making, attention, and social behavior. Brain scans show minor and reversible changes in the prefrontal cortex. This could account for troubles with attention and decision-making seen in some with depression.
The amygdala is a structure deep within the brain that is associated with certain emotions, such as sorrow, fear, anger, and pleasure. Activity in the amygdala is higher when someone experiences depression. Like the hippocampus, it is sensitive to consistently high levels of cortisol. This increased activity in the amygdala could influence sleep patterns; up to 90 percent of people with depression report insomnia.

What Does This Mean for Treatment?

There are two promising and constructive messages to take from this evolving science.

Firstly, these brain changes are reversible—they can be remedied. Some depression treatments might even trigger the growth of new nerve cells and strengthen novel connections between cells.

Secondly, our understanding of the brain's biology has helped researchers design targeted and effective depression treatments. This knowledge could deliver treatments to you with a dedicated approach that suits you best.

What Treatments Address Chemical and Connectivity Issues?

Knowing which brain connections are affected has helped to unravel some of the mysteries of depression. Now, it is driving game-changing treatment options.

Transcranial magnetic stimulation (TMS) is a non-invasive and non-drug form of brain stimulation that goes far beyond correcting one chemical imbalance or one disrupted network connection. Instead, it addresses the complex brain changes of depression—those neurotransmitter and connectivity issues discussed earlier.

TMS applies highly focused magnetic pulses to brain regions that are crucial in the regulation of mood. Those focused magnetic pulses result in activation of the nerves in that area of the brain, which when given over time, can correct imbalances in function. Research supports its ability to form new connections between nerve cells affected by depression, including those within the hippocampus . It can help to relieve some, or even all, depression symptoms in many patients.

Understanding the science of depression has taken years, and there is still much more to learn. But in our quest to answer those vital questions—how does depression affect the brain, and what chemical imbalance causes depression—we have uncovered tailored treatments that acknowledge everyone's unique experiences.

This personalized knowledge can empower you to finally navigate your way toward recovery. Just like those airport hubs with their temporary flight delays, there are ways to get back on track once again.

Knowing Your Options for Telehealth Mental Health Care

Wed, 09 Sep 2020 18:45:00 GMT

Telehealth for mental health care has become normalized and widespread recently due to the COVID-19 pandemic. But before leaping into telehealth mental health care as a default option, it's important for us to consider the quality of care offered and the pros and cons of telehealth.

In a rush to accommodate providers and their patients, the Centers for Medicare and Medicaid Services, a federal agency under the Department of Health and Human Services, issued nationwide waivers to ease requirements that would have made telehealth problematic. Two months into the new normal, the American Psychiatric Association called for some of those changes to be made permanent to "ensure continuity of care and continued improved access to mental health and substance use care."

That is an alluring prospect to many providers, as telehealth reduces overhead expenses and is generally more convenient. However, psychiatry is a medical specialty that, at times, requires face-to-face assessments. Telehealth has provided a necessary service during the COVID-19 pandemic; however, providers should still weigh its convenience against what is best for the patient.

Pros and Cons of Telehealth

Telehealth was originally designed for patients who live in remote locations and have to travel long distances to meet with their provider. Because of the shortage of behavioral health specialists in rural areas, mental health care often falls on primary care physicians. Although they can certainly handle first-line interventions, their skill set reaches its limit in treatment-resistant diseases or complex cases.

That's where sub-specialty expertise should be employed, and that's where the real value of telehealth mental health care is manifested. It brings sub-specialty expertise to people in areas where that otherwise may not be available. If a patient needs to drive two hours for a visit, they are not likely to give the doctor a good interview—and it's especially impractical if the patient is stabilized on a medication and just needs a check-in for a refill. Similarly, if a patient has weekly talk therapy appointments but has to drive hours to get there, their attendance may drop off. In this case and others, telehealth is just as good as an in-person visit.

However, there are also some challenges to telehealth. As many people have experienced during the pandemic, the availability of video telehealth services is predicated upon internet bandwidth, as well as in-home computer equipment. At worst, many people do not have reliable broadband internet access or suitable equipment to have a satisfactory appointment. For those who do have a workable setup, technology issues can still arise, with sound delays, lighting issues, and audio glitches.

What's more, patients often seek mental health care for what they believe is depression, but upon a medical examination, the physician may determine the patient is suffering from a neurological condition that can have a secondary symptom of depression. Without an in-person assessment, the root problem would be missed and the patient would be misdiagnosed.

Telehealth Options at Greenbrook TMS

Another concern about the push for telehealth is that providers may prefer the convenience of remote visits without accounting for patient preference. Telehealth should not be used as a service to the provider, but rather to the patient. At Greenbrook TMS, we offer telehealth mental health care appointments based on clinical suitability and patient preference. If you want to take advantage of telehealth and it is clinically appropriate, we will offer it to better accommodate your needs. If it's not clinically appropriate or if you don't have the resources or preference for that mode of therapy, you have the option of an in-person examination.

Greenbrook TMS has always promoted patient convenience and choice. So although the regulations for telehealth are relaxed, we've retained the option for face-to-face visits using various hygiene and social distancing measures to maintain safety. Because TMS is a hands-on procedure , you will come in for a visit eventually, but we want you to feel reassured with the knowledge that Greenbrook TMS offers the types of appointments that best serve you. If you are considering TMS therapy, you can reach out to us for a consultation , and we will help you determine whether a telehealth appointment is right for you.

When Mindfulness Isn't Enough: Navigating Self-Care for Depression

Wed, 12 Aug 2020 20:10:00 GMT

The concept of self-care for depression has been surging in popularity over the past few years. In fact, self-care was the biggest app trend in 2018, and the trend certainly isn't over yet.

Self-care ideas for depression include everything from exercise and nutrition to mindfulness and coloring books. Though many people have found self-care to be effective, there are also many frustrated patients with clinical depression who experience little to no benefit. Despite their best efforts, they find that self-care for depression does not alleviate their symptoms.

Hitting the proverbial brick wall after engaging in several self-care activities can be disheartening. If you are seeing little or no improvement after trying some self-care strategies, it's important to recognize this is a common experience and nothing to be ashamed of. Social media makes it seem like improving a bad mood is just a bubble bath away, and that can be true for the occasional bad day or stressful week at work. But when you're struggling with depression, self-care strategies aren't a substitute for appropriate medical treatment. Because depression comes with many physical and psychological risks, it's important to seek out effective depression treatment.

What Is Self-Care for Depression?

"Self-care" has become a ubiquitous buzzword associated with a wide range of activities, such as journaling or performing meditation.

In essence, self-care is about caring for yourself. It's any activity a person deliberately engages in to take care of their mental, emotional, and physical health. Self-care can help people improve their moods, reduce anxiety, and enhance interpersonal relationships.

Still, when it comes to depression, the evidence supporting self-care can vary.

Exercising Into Self-Care

Exercise is one of the most popular self-care activities often recommended. Although exercise has proven effective for many , there are also people who have tried exercise and found limited benefits or no relief. In fact, a recent University of Michigan Ann Arbor study on exercise and depression suggests that women do not benefit as much as men.

Exercise can be associated with lower risk of depression, but its efficacy in moderate to severe depression is not confirmed. Asking someone who is depressed to exercise can not only be unhelpful, but it can add to a sense of shame and guilt that the person with depression is unfairly placing upon themselves.

Generally speaking, exercise is a good idea, but people with depression should look for professional treatments, as well.

Diet & Nutrition: Inconclusive Evidence

Health care professionals often recommend changes in diet and improved nutrition. A few studies have shown a correlation between a healthier diet and improved depression symptoms, but no one has yet proven that poor diet causes depression .

More research is needed to conclusively establish if changes in diet can reliably diminish depressive symptoms. After all, not everyone who changes their diet has the same experience. Many people feel disappointed when their depression persists despite modifying their diet. Good nutrition may be one piece of the puzzle, but further research is needed before considering diet change a treatment on its own.

What About Mindfulness?

One of the most common self-care strategies therapists recommend is mindfulness, which has become increasingly popular in recent years. Mindfulness is about being present; it's about " maintaining a moment-by-moment awareness of our thoughts, feelings, bodily sensations, and surrounding environment, through a gentle, nurturing lens." Meditation is the most well-known mindfulness discipline.

There are studies that have shown mindfulness is promising and can improve the quality of life for people with depression . Though there are many benefits to mindfulness, such as improving interpersonal interactions and decreasing anxiety, not everyone gets a boost from it. In fact, there are critics who question the "hard science" of mindfulness. For many people experiencing depression, mindfulness does not give them the relief they are seeking.

When Self-Care for Depression Isn't Enough

Self-care undeniably helps some people, but the reality is that not everyone finds it beneficial. Ultimately, when it comes to self-care for depression, there is no one size fits all solution.

In most cases, self-care is most effective when done alongside proven depression treatments, such as talk therapy and medication. If the combination of self-care and medical intervention still hasn't helped, you may have treatment-resistant depression.

What Is Treatment-Resistant Depression?

Treatment-resistant depression, or TRD, is one type of depression. People with TRD have major depression that persists despite trying other common treatments. Patients with TRD have often endured a revolving door of medications, and many have also exhausted a variety of self-care ideas for depression.

Living with TRD can be challenging, but thankfully, all hope is not lost. There are several treatment options available for TRD, including non-medication treatments.

TMS: A Reliable Option for Treatment

In recent years, TRD has received more attention. If you have not found the relief you are looking for despite trying medications and talk therapy, consider looking into other medical treatments, such as transcranial magnetic stimulation (TMS).

TMS is an FDA-cleared, non-invasive therapy for the treatment of Major Depressive Disorder and other mental health conditions. It works by providing local electromagnetic stimulation to specific brain regions known to be directly associated with mood regulation. TMS patients often show significant improvement in symptoms of treatment resistant depression .

If you have sought treatment and tried several forms of self-care but are still facing depression, remember that you are not alone. Self-care has different levels of effectiveness for everyone, and it's not uncommon for it to have limited effect or even no effect at all. That doesn't mean your only choice is to continue trying different medications, though. Treatments like TMS offer another route worth considering.

"The stress level of the nation is up by easily 15 percent." - Dr. William Sauvé on WUSA 9

dhageman@innovasium.com (Daniel Hageman) — Wed, 12 Aug 2020 18:28:00 GMT

Greenbrook's Virginia Regional Medical director, Dr. William Sauvé , was recently interviewed on WUSA 9. Dr. Sauvé discussed various topics surrounding Transcranial Magnetic Stimulation (TMS) and what to expect from this treatment. Kristen Berset-Harris, Great Day Washington host, asked Dr. Sauvé if he has seen any changes in patients since COVID-19 began. Dr. Sauvé expressed how this change in the world has affected the number of cases of depression he has seen in the last few months:

Dr. Sauvé also explained what TMS is and how it works. TMS has been an FDA-cleared treatment since 2008 and delivers magnetic stimulation to the parts of the brain known to be underactive in people with depression. Dr. Sauvé also describes how it feels to get TMS therapy, how patients are able to drive themselves home or back to work immediately after treatment, and the ease in which patients fit TMS into their daily schedules. Dr. Sauvé says most of his patients watch television, play on their phones, or even bring their laptops to do their work during their treatment time.

Dr. Sauvé additionally touches on insurance coverage. Greenbrook TMS therapy is covered by major insurance companies, including Aetna, Anthem, BlueCross BlueShield, Humana, United Healthcare, and others. Medicare and Medicaid are accepted at various center locations; call 855-940-4867 to find a nearby location or enter your zip code in our center locator. During your consultation, a Patient Consultant will discuss any questions you may have regarding insurance coverage, costs, payments, and reimbursement.

We are currently offering no-cost consultations via virtual appointments or in-person visits. If you are ready to schedule a free consultation click here

See the full interview below:

Greenbrook's Dr. Geoffrey Grammer on Facebook Live

dhageman@innovasium.com (Daniel Hageman) — Wed, 08 Jul 2020 21:02:00 GMT

Dr. Geoffrey Grammer, Greenbrook's Chief Medical Officer, was featured on a recent Facebook Live Event to discuss depression treatment options, when to access treatment, and much more.

Dr. Geoffrey Gramme r, Greenbrook's Chief Medical Officer, was featured on a recent Facebook Live event hosted by NeuroStar. Dr. Grammer discussed depression, treatment options, and answered questions live.

An important first step in getting the right depression treatment is to recognize when you may be experiencing an episode of depression. Dr. Grammer advises that there are a "constellation of symptoms" of Major Depressive Disorder; if you've experienced some of the following symptoms for more than two weeks, you should reach out to a medical professional:

Dr. Grammer emphasizes that depression requires medical intervention. He explains that when he was in the Army, he had a patient with severe depressive symptoms who had been struggling for quite some time. This patient had informed her supervisor that she was having difficulty, and her supervisor tried to help her by talking with her and suggesting lifestyle modifications. Despite that, the patient's depression symptoms worsened and hit a critical point. It wasn't until she was able to get medical treatment that she began to feel better. That's because, as Dr. Grammer says, "depression is a medical disease that requires medical intervention." Though well-intentioned, lifestyle modifications are not always enough to reduce depression symptoms.

Dr. Grammer describes the different methods of depression treatment such as medication management, talk therapy, or TMS therapy. Transcranial Magnetic Stimulation (TMS) therapy is an FDA-cleared treatment to treat depression and obsessive-compulsive disorder. TMS therapy delivers magnetic stimulation to the parts of the brain known to be underactive in people with depression.

The full video is below:

Minority Mental Health Awareness Month Resources

dhageman@innovasium.com (Daniel Hageman) — Wed, 01 Jul 2020 15:55:00 GMT

Depression can affect anyone and doesn’t discriminate across race, gender, or socioeconomic class, but BIPOC (Black, Indigenous, and People of Color) communities and other groups can face additional challenges when accessing mental health care. Whether you’re interested in learning more about the impact of mental illness or would like to find treatment for a mental health condition, we’ve compiled a list of resources and information from groups including Mental Health America (MHA), National Alliance on Mental Illness (NAMI), Anxiety and Depression Association of America (ADAA), and the U.S. Department of Health and Human Services Office of Minority Health (OMH) below.

No matter who you are, we urge you to reach out for help if you’re struggling with your mental health.

For immediate help : If the situation is potentially life-threatening, get immediate emergency assistance by calling 911.

The National Suicide Prevention Lifeline is accessible through 1‑800‑273‑TALK (8255) or Live Online Chat and features trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals.

The SAMHSA National Helpline is available at 1‑800‑662-HELP (1‑800‑662‑4357) and is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental health and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations. Callers can also order free publications and other information.

8 Steps to Caring for your Mental Health During COVID-19

Tue, 30 Jun 2020 14:04:00 GMT

As COVID-19 impacts the world in an unprecedented way, it's more important than ever to support and manage your mental health. Anyone's resiliency can be taxed by factors such as loss of control, social isolation, fast-moving information, mortality fears, and an uncertain end date to this situation. For those already managing depression, maintaining your mental health during the coronavirus can be an even bigger challenge. However, there are many small things you can do to help yourself push through this difficult time. I'd like to offer some actionable strategies to preserve your physical and mental well-being during this crisis.

Maintain Normalcy With a Routine

We all will need to establish a new sense of normal by modifying our lifestyle to stay physically well and sustain good mental health. Here are some simple steps to help you set up a new routine. Consider selecting one or two to start with, and then gradually adopt more habits from there:

Step 1: Wake up at the same time every day, even if it means you have to set an alarm.

Step 2: Take care of your normal hygiene tasks, such as showering and brushing your teeth.

Step 3: Get out of your pajamas and put on daytime clothes each day.

Step 4: Prepare breakfast, and continue to eat nutritious meals throughout the day using a variety of food groups. Do try to eat regularly, but avoid eating non-nutritious foods in excess. Also, avoid excessive alcohol consumption and illicit drug use.

Step 5: Utilize technology to reach out to friends and family , whether on the telephone or the internet. This will help you to feel more connected and less socially isolated.

Step 6: Get some exercise. It's just as important as ever.

Step 7: Go outside for some fresh air and sunshine while staying compliant with recommended social distancing guidelines.

Step 8: Establish a bedtime and stick to it each night so your circadian rhythm doesn't become imbalanced.

Additionally, challenge yourself with something that will exercise your mind, such as learning a new skill or playing a game with others in your household or with friends online. You may want to try building a model, painting by numbers, or knitting a scarf. Identify little things you can accomplish in a specific period of time, not big projects that might be difficult to accomplish or would take extended time to complete. These tasks can offer you a reprieve from the general feelings of uncertainty during this time.

Managing Your Mental Health Care

Fostering a robust immune system and protecting your mental health during the coronavirus crisis are big parts of your overall well-being. The Centers for Disease Control and Prevention recommend patients continue with their mental health care . While for some this may mean keeping up with talk therapy appointments and medication regimens, at Greenbrook NeuroHealth Centers we want you to feel reassured that you can still get TMS therapy at our locations, which remain open to provide needed care to our patients even as the world practices social distancing and sheltering in place.

To ensure your TMS treatments are provided as safely as possible, we are continually updating our policies and procedures to account for COVID-19 considerations. As of today:

What to Do If Your Symptoms Worsen

A pandemic can challenge anyone's coping mechanisms. Disruptions to routines create barriers to coping strategies, which makes managing your mental health during a crisis an additional trial to contend with. You may find yourself tending toward catastrophic thinking due to the narrative of this pandemic, which can create a harmful feedback loop. You may also find yourself tempted to adopt unproductive coping strategies.

You can prevent worsening symptoms by working on a healthy routine, staying mentally active, and avoiding maladaptive behaviors, such as sitting on the couch all day or not connecting with friends and family. Don't hesitate to reach out to a professional if you need to. Let your provider know if you have difficulties with sleep or nutrition, you develop thoughts of self-harm, or you notice your symptoms getting worse over time. If you are taking medications, make sure to take them as prescribed. Don't compensate by taking more than prescribed or try to ration them by taking less. If you need immediate help, please refer to our list of emergency resources .

Above all, stay engaged in your mental health care. Getting support and treatment for your mental health is no less important than fixing a broken arm or seeing a cardiologist for heart disease. Mental health treatment should not wait, so please reach out to us if you need assistance. We at Greenbrook TMS care about your well-being. We will be here for you during this pandemic and as you take steps to recover.

Do I Have Treatment-Resistant Depression?

Thu, 25 Jun 2020 14:12:00 GMT

If you find that your depression medication isn’t working, you may be starting to feel anxious or frustrated. Trying a series of new medications can be a drain on anyone, especially if you’re still dealing with the symptoms of depression. If you’re asking why you can't find a medication that works, know that you are far from the only person asking this question.

Although many people do respond to common depression treatments, such as medication, talk therapy, or a combination of the two, it can take a while to find a treatment that works for you. For some, it eventually becomes clear that depression isn't getting better with medication, and it may be time to look for a different type of treatment. If that's the case for you, you may have treatment-resistant depression (TRD). Read on to learn what TRD is and what you can do if you think you may have it.

What Is Treatment-Resistant Depression?

TRD isn't an official diagnosis. Instead, it's a term used to describe depression that doesn't respond to two or more medications. If your medication isn't helping, you're not out of options—even if it feels that way. It is common to not find relief with the first depression medication you try. In fact, it's estimated that only half of people with depression respond to their first medication trial.

Some people may experience partial relief with medication, meaning you may still face residual symptoms such as sleep disturbance, lack of interest in activities, or poor concentration. At times, this partial relief is made less beneficial by intolerable side effects like stomach pains, low libido, or insomnia—all on top of residual depression symptoms. There are also some cases where symptoms may seem to get worse after each treatment attempt. If these situations sound familiar to you, remember that you still have options, and there is hope.

Do I Have Treatment-Resistant Depression?

On top of the feelings that depression normally brings, trying several treatments and failing to find results probably brings feelings of hopelessness, frustration, or despair. You may feel like you’re the only person who can't feel better with treatment, but you're actually in good company—few people find something that works on the first try.

Typically, it takes four to six weeks for someone to fully respond to medication, so your doctor will want to make sure you've given your current treatment enough time to work. After that time frame has passed, your doctor will likely want you to try another type of medication. A doctor will conclude that you have TRD after you've tried at least two depression medications.

If you think you may have TRD, contact your doctor. Changing a medication routine on your own can be dangerous. Your doctor will also check to see if you have the right dosage and are taking your medication correctly. They might want to try a different class of medication, such as switching from a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake Inhibitor (SNRI), or add on a medication (called adjunct therapy) if you are experiencing partial relief.

What Are My Options If I Have TRD?

You have many more options than you think if your symptoms of depression are not getting better with medication. There are many treatment possibilities for those diagnosed with TRD. Some of these options include electroconvulsive therapy, vagus nerve stimulation, ketamine, and transcranial magnetic stimulation (TMS). Of these treatments, TMS is arguably the least invasive, as it doesn't require any sedation and doesn't cause any drug-related side effects.

If you're not sure where to turn next for depression treatment, it may be time to consider an alternative treatment. At Greenbrook, we're here to help you figure out your next step together. You might find that there are far more solutions for TRD than you think.

Greenbrook Drs. Sauvé and Harvey on The Medical Beat

dhageman@innovasium.com (Daniel Hageman) — Sat, 16 May 2020 16:11:00 GMT

Every week, Dr. Steven Harvey, Greenbrook's St. Louis Regional Medical Director, discusses a wide variety of topics regarding mental health topics on The Medical Beat.

Every week Dr. Steven Harvey , Greenbrook's St. Louis Regional Medical Director, discusses a wide variety of topics regarding mental health on The Medical Beat . This week Dr. Harvey had the pleasure of talking to his very own Greenbrook colleague, Virginia Regional Medical Director Dr. William Sauvé . Dr. Sauvé began practicing psychiatry in the U.S. Marines and later served as a Division Officer of inpatient psychiatry at the Naval Medical Center of San Diego. Dr. Sauvé started working with Greenbrook in 2014 and has since been providing TMS therapy throughout our Virginia centers.

On this installment of The Medical Beat, Dr. Harvey and Dr. Sauvé discussed TMS therapy-- specifically how TMS works, and misconceptions many have regarding depression and TMS treatment. TMS stands for transcranial magnetic stimulation and is a treatment for those struggling with treatment-resistant depression and OCD (obsessive-compulsive disorder). TMS is an FDA-cleared treatment that delivers magnetic stimulation to the parts of the brain known to be underactive in people with depression or OCD.

The doctors discuss at what point it makes sense for people to try TMS. Dr. Sauvé explains that although TMS can be used alongside medication (" TMS can fit in while people are trying medications") or as a stand-alone treatment, most times TMS is used in conjunction with their medication to help treat depression. The doctors also shared their experiences with patients who transformed after receiving TMS treatment. To hear more from these doctors listen to the full podcast below.

May is Mental Health Awareness Month 2020

dhageman@innovasium.com (Daniel Hageman) — Fri, 01 May 2020 22:28:00 GMT

Mental health is an essential part of overall health, and it’s now more important than ever to support mental well-being for ourselves, our loved ones, and for our communities.

Juggling work, family and financial stresses can be overwhelming even in the best of times. The addition of social distancing, changes to work and family routines, and other effects of the COVID-19 pandemic can worsen existing mental health concerns and even trigger new symptoms.

Mental Health America, the non-profit advocacy organization that launched the observance, has announced that the theme for Mental Health Awareness Month 2020 is Tools to Thrive , and they have created an online toolkit. We’d like to share parts of the toolkit that are especially relevant right now.

If you need immediate help:

National Suicide Prevention Lifeline – 1‑800‑273‑TALK (8255) or Live Online Chat

SAMHSA National Helpline – 1‑800‑662-HELP (1‑800‑662‑4357)

Depression Resources

The information above was retrieved from MHM Mental Health Awareness Month 2020 toolkit

"There's a lot of uncertainty" - Dr. Geoffrey Grammer on WINC

dhageman@innovasium.com (Daniel Hageman) — Wed, 29 Apr 2020 23:23:00 GMT

Greenbrook's Chief Medical Officer, Dr. Geoffrey Grammer , was recently on 92.5 WINC to discuss ways we can handle the stress of social distancing during the COVID-19 pandemic. With the pandemic, so many of us are feeling anxious, scared, or isolated. Dr. Grammer discusses TMS (Transcranial Magnetic Stimulation) therapy and how it can help you through some of those feelings. TMS is an FDA-cleared treatment to treat depression and obsessive-compulsive disorder. TMS therapy delivers magnetic stimulation to the parts of the brain known to be underactive in people with depression.

Dr. Grammer provides a few insights into how society is handling this pandemic. He says that "The virus is something that we can't see or feel and that can make it difficult to identify the threat and react to that environmental threat ... There's a lot of uncertainty during this period. There is also the economic uncertainty, they do not know if their employment is going to change, for a lot of people their employment has changed. Adding to this it just creates this sense of uneasiness."

Dr. Grammer recognizes that anyone with pre-existing psychiatric symptoms may have symptoms worsen during this time and says that for those who haven't experienced psychiatric symptoms in the past, they may begin to experience them now. It is important that these people access mental health care to maintain their emotional and physical health. Dr. Grammer recommends that if you have a provider that you are seeing to continue to see that provider. If you do not have a provider, you can reach out to your primary care provider and make referrals as needed.

To see all upcoming Greenbrook TMS provider interviews, click here

Now is a great time to get help for depression. Here are 8 reasons why

dhageman@innovasium.com (Daniel Hageman) — Tue, 28 Apr 2020 20:47:00 GMT

While we are weathering the COVID-19 pandemic, you may be thinking now is not the time to explore options for treatment-resistant depression. But we believe you deserve to feel better, and we have eight reasons why you shouldn’t wait to get the help you n

1. Depression hurts. You probably know that depression can hurt your emotions, but did you also know that it can cause physical pain and suffering ? Depression is known to cause chronic joint pain, limb pain, back pain, gastrointestinal problems, tiredness, and sleep disturbances. If your depression goes untreated, these physical symptoms can actually make your depression worse.

2. Depression interferes with relationships. Interpersonal relationships are some of the most cognitively intensive tasks people can engage in. Long-term friendships or romantic relationships require a variety of emotional regulation and cognitive framing skills. When you’re depressed, your communication can become cloudy and your patience can shorten, leading to unnecessary relationship demise .

3. Depression is bad for your overall health. Depression is associated with an increased risk of diabetes , heart disease , some cancers, and an overall increase in mortality. In fact, it can drastically decrease life expectancy by a decade or more, and 30 percent of patients with treatment-resistant depression attempt suicide at least once during their lifetime.

4. Depression can influence the development and wellbeing of children of depressed parents. Families are complex systems where each person in the family can impact everyone else. One parent suffering from depression can impact the parenting style of the other parent. A parent with a history of depression can cause an increase in the risk of emotional and behavioral problems in their children.

5. Depression increases the risk of substance use disorders. Often when someone is depressed, they will turn to alcohol or drugs to feel better, which can lead to a substance use disorder. The cost of excessive alcohol use or illicit drug use can be catastrophic, interfering in all facets of a person’s life, and often resulting in serious legal consequences. Also, while people may temporarily feel better during intoxication, the continued use of substances can exacerbate underlying symptoms of depression.

6. Depression can affect work performance . Depression can cost the global economy hundreds of billions of dollars per year. Approximately half of that is associated with work absenteeism and poor work performance . Pushing through the symptoms of depression is like building a house with a broken arm—without treatment, your work will not be anywhere near its best.

7. Depression is associated with an increase in utilization of medical services. Because depression is associated with worsening of other medical conditions, patients with depression have increased use of medical services including the emergency room . Besides the cost burden, now, more than ever, depression should be treated in an outpatient setting to reduce the risk of accessing the emergency room—it’s less expensive, less resource-intensive, and safer during the COVID-19 pandemic. However, anyone who has a mental health emergency should access emergency medical services.

8. Get help if you have depression. Depression is not a weakness but a real disease that requires medical treatment. Fortunately, many treatment options are available for depression, including the non-invasive, FDA-cleared, non-drug option of Transcranial Magnetic Stimulation, or TMS therapy . Greenbrook TMS is here for you. Get help for your treatment-resistant depression today by scheduling a consultation with a member of our care team.

"Maintain as much social support as you can" -Dr. Sauvé on WPTE 94.9

dhageman@innovasium.com (Daniel Hageman) — Mon, 27 Apr 2020 20:43:00 GMT

Greenbrook's Virginia Regional Medical director, Dr. William Sauvé, was recently on 94.9 The Point. Dr. Sauvé was featured on Mike and Woo Woo in the Morning to discuss various topics surrounding COVID-19. During this interview, they considered several ch

Greenbrook's Virginia Regional Medical director, Dr. William Sauvé , was recently on 94.9 The Point. Dr. Sauvé was featured on Mike and Woo Woo in the Morning to discuss various topics surrounding COVID-19. During this interview, Dr. Sauvé emphasized the importance of seeking out "as much social support as you can" in order to help maintain mental health. Beyond texting or calling, Dr. Sauvé highlighted the utility of video conferencing, which "allows the opportunity to still commiserate and feel like we have those people that love us around us" even if we can't be in the same room with them.

During the interview, Dr. Sauvé and the hosts discussed how people are using social media differently than they used to before social distancing. Prior to COVID-19, many used social media as a way to pass the time without the need or desire for true engagement on the platforms. Now, with quarantine and stay-at-home orders in place, people are finding that social media does allow them to foster a sense of connection. Dr. Sauvé stresses that rather than scrolling through a feed without engaging, you can "let them [family and friends] know that you want to talk to that person specifically so that they can tell you about their life and how they are doing."

Dr. Sauvé also explained what TMS is and how it works. TMS stands for Transcranial Magnetic Stimulation and is an FDA-cleared treatment that delivers magnetic stimulation to the parts of the brain known to be underactive in people with depression. Show host Mike brought up a point that we often hear from our patients as a point of frustration when it comes to treating depression, which is how "oftentimes you are jumping from medications to medications to find the right mixture to try to settle yourself into being in a good space." Mike went on to note that the need for social distancing and shelter-in-place orders during COVID-19 is making managing mental health a struggle for many, and asked Dr. Sauvé for any recommendations for coping with isolation and mental illness.

Dr. Sauvé recommends getting outside as much as possible, and advises that getting at least 15 minutes a day of sunshine by walking, biking, or running is sufficient to get your Vitamin D intake for the day. A side benefit of spending time outside-- getting to see other people while still following social distancing guidelines by waving or stopping to chat with a neighbor. To hear more from Dr. Sauvé, watch the full segments below!

Part One:

Part Two:

To see all upcoming Greenbrook TMS provider interviews, click here

"Good mental health care is not an elective procedure" - Dr. William Sauvé on WTVR-FM

dhageman@innovasium.com (Daniel Hageman) — Thu, 23 Apr 2020 14:57:00 GMT

Greenbrook's Virginia Regional Medical Director, Dr. William Sauvé, was recently on 98.1 WTVR to discuss mental health care during the COVID-19 crisis.

Greenbrook's Virginia Regional Medical Director, Dr. William Sauvé , was recently on 98.1 WTVR to discuss mental health care during the COVID-19 crisis. Dr. Sauvé began practicing psychiatry in the U.S. Marines and later served as a Division Officer of inpatient psychiatry at the Naval Medical Center of San Diego. Dr. Sauvé started working with Greenbrook in 2014 and has since been providing TMS Therapy throughout our Virginia centers. Dr. Sauvé was interviewed by Jeff Wicker and Rebecca Wilde to discuss the basics of TMS Therapy and various changes to the mental health environment since COVID-19 began.

Dr. Sauvé explains that during a crisis such as the COVID-19 pandemic, many people worry about their basic necessities such as water, food, and safety. But, as Dr. Sauvé explains, mental health is just as much of a necessity as physical health. "Isolation cannot cause mental health illness. People are doing well enough and functioning okay . This is not the same thing as being well ... People are putting up with not feeling well every single day-- no one told them that they shouldn't be feeling this way."

As a mechanism for coping with isolation, Dr. Sauvé recommends continuing to stay connected with your loved ones by utilizing video conferencing services such as WebEx, Zoom, Microsoft Teams, or Google Meet to connect with your friends or co-workers after work. During the interview, Dr. Sauvé was asked how a person can tell when the time is right to see a mental health professional. Dr. Sauvé says that "if you are wondering if it is time to give a mental health professional a call.. that means you should call. The first thing I do is help [a person seeking advice] decide whether or not what is bothering them constitutes something that needs treatment or if I can reassure them they are doing okay."

Dr. Sauvé's stresses that during COVID-19, "good mental health care is not an elective procedure. Hospitals have been suspending elective procedures and only focusing on the essentials. Elective procedures mean things that can wait. Mental health is not that. Any kind of mental health or depression is no exception. That is a serious illness that has the potential to wreck someone's life. Every minute wasted is a minute of life that someone cannot get back."

If you have questions or concerns about your mental health, know that help is available. Call a mental health professional or reach out to us at 855-940-4867 .

Listen to Dr. Sauvé's full interview below:

To see all upcoming Greenbrook TMS provider interviews, click here

"Everyone feels a sense of powerlessness" - Dr. Misty Borst on WRNR

dhageman@innovasium.com (Daniel Hageman) — Wed, 22 Apr 2020 21:28:00 GMT

Greenbrook's Maryland Medical Director, Dr. Misty Borst , was recently on WRWR. Dr. Borst received her medical degree from the Medical University of South Carolina and has been practicing TMS therapy since 2016. During the interview, Dr. Borst touched on how to maintain a normal routine, how to live peacefully at home with others, and when you should see a mental health professional.

Dr. Borst gave a few recommendations on how to maintain a normal routine during quarantine:

Dr. Borst also touched on how to handle living at home with others. While practicing social isolation you may still find yourself bothered by those you are living with. Dr. Borst recommends creating a specific area where you can work and where you can relax. This area should be designated to you and allow for some time for yourself. Dr. Borst also gave some recommendations on the amount of news that you are consuming. While reading the news to stay up-to-date is important, Dr. Borst advises that "if you are dwelling on negative news, it has a way to start to affect our brains and how we think. Its kind of like that phrase 'you are what you eat--' we can think about it for our brains. If you are constantly exposing your brain to negative, stressful, and anxiety-provoking situations our brain creates that as our default way of thinking."

Lastly, Dr. Borst points out the difference between situational depression and major depressive disorder. She highlights the symptoms of major depressive disorder and when you should reach out to a mental health care professional. These symptoms include:

If you're experiencing these symptoms for two weeks or longer, it's time to seek medical help or call Greenbrook TMS. Listen to the full interview below:

To see all upcoming Greenbrook TMS provider interviews, click here

Five Ways to Stay Connected During Social Distancing

dhageman@innovasium.com (Daniel Hageman) — Tue, 21 Apr 2020 19:51:00 GMT

Life can feel uncertain right now, particularly when things seem to be changing so rapidly. Especially if you are used to frequent human interaction, this new reality can create feelings of loneliness, seclusion, and isolation.

Social distancing due to the COVID-19 outbreak has caused many changes to daily routines. Life can feel uncertain right now, particularly when things seem to be changing so rapidly. Especially if you are used to frequent human interaction, this new reality can create feelings of loneliness, seclusion, and isolation. Managing your mental health is important during these uncertain times, and keeping connected to loved ones is an important tool for navigating this new environment. Here are five ways to stay connected to family and friends during social distancing.

During a time like this, many people can feel the impacts of spending time by themselves or with less company than usual. Reach out to the people you care about via text, email, or phone call. Reconnect with a friend or family member you haven't talked to in a while or check in on a friend who might be feeling especially isolated. If you have a family member or friend who is in an at-risk group, check in with how they are doing. Even just saying hello can make someone’s day, and brighten yours as well.

Social media can be a great tool to stay connected, but endless scrolling through social media platforms while social distancing could potentially increase anxiety, worry, and feelings of loneliness. It can help to approach your usage with more intention. One way is to go back to the “social” aspect of “social media.” Rather than getting sucked into scrolling through your entire feed without meaningfully engaging, pick a couple of people you’d like to check in on. Take time to scroll through their posts and leave a few comments.

Video chatting technology is a great way to stay connected with friends and family. Dr. Elizabeth Dorrance Hall explains that “video chat allows us to see the other person’s nonverbal behaviors, which alerts us to their mood and allows for clear, more effective communication. In times where people are socially isolated, rich nonverbal cues can be even more important because they provide a feeling of ‘presence’ that audio-only phone calls lack.” Schedule times to check in with your loved ones and stick to those meeting times. Ask your friends how they are doing, but also don’t feel pressure to talk about the news. Just seeing a friend or family member’s face and talking with them can help bring some sense of normalcy back into our daily routines and help maintain relationships.

Technology is powerful, and there are many different ways it can be used to create connection, even from a physical distance. Watch a movie or TV show at the same time as friends and text each other while you are watching. Have video dinner dates with friends and family. Form a book club or discussion group about a topic you find interesting, and hold your meeting via social media and video-chatting technology. Call or video chat a friend while you are exercising or going on a walk, and schedule virtual exercise sessions with each other.

Since social distancing began, companies have been implementing solutions to provide content and connection for consumers. If there are activities or events that are part of your normal day, looking for digital alternatives will allow you to stay connected to your passions and routine. Stream a live gym class , livestream a concert , or virtually tour a museum . There are increasingly more digital ways to continue every day activities, and doing so can help ease feelings of isolation or unwanted solitude.

The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.

Always consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

"The whole world is going through something" - Dr. Misty Borst on WBAL

dhageman@innovasium.com (Daniel Hageman) — Mon, 20 Apr 2020 20:31:00 GMT

Greenbrook's Maryland Medical Director, Dr. Misty Borst , was recently on WBAL TV11. Dr. Borst received her medical degree from the Medical University of South Carolina and has been practicing TMS therapy since 2016. During the WBAL segments "This is how to stay positive while staying at home" Dr. Borst touched on a variety of topics. Topics including creating a schedule, how to help the elderly around you, and when you should seek mental health help.

Dr. Borst provided a few tips on how to stay positive and motivated in this uncertain time.

Dr. Borst also touches on a few ways to maintain peace within the tight quarters of your home. Dr. Borst recommends setting up designated spaces for work, playing with the kids, and free time. Dr. Borst was also asked when is the appropriate time to reach out to a mental health professional for more help . Dr. Borst explains "If you are experiencing hopelessness, worthlessness, guilt, or if you are not enjoying things that you used to enjoy. If your sleep, appetite, or energy is disrupted, whether too much sleep or too little. If you are having any of these symptoms and are last two weeks or longer it is appropriate to reach out to a mental health professional." Watch the full interview below to learn more:

https://www.wbaltv.com/article/coronavirus-dealing-with-anxiety-depression-while-staying-at-home/32040625

To see all upcoming Greenbrook TMS provider interviews, click here

"We want to keep everyone in as good a shape as possible" -Dr. Steven Harvey on WIL

dhageman@innovasium.com (Daniel Hageman) — Mon, 20 Apr 2020 15:48:00 GMT

Greenbrook's St. Louis Regional Manager, Dr. Steven Harvey , was recently on 92.3 WIL to discuss mental health care during the COVID-19 crisis. Dr. Harvey joined Greenbrook TMS in 2018 as Regional Medical Director of our Greater St. Louis region. Dr. Harvey has been practicing general psychiatry since 1996 after receiving his medical degree from the Washington University School of Medicine in St. Louis. During the interview on WIL, Dr. Harvey touched on TMS therapy and how it works. COVID-19 is not only affecting life at home but may also be impacting people's mental health. Dr. Harvey recognizes that "everyone is worried about themselves, worried about their loved ones, worried about the economy, and all of the uncertainty." COVID-19 has created unwanted stressors in everyday life.

Dr. Harvey spoke about the basics of TMS therapy. TMS stands for transcranial magnetic stimulation and is a treatment for those struggling with treatment-resistant depression and OCD (obsessive compulsive disorder). TMS is an FDA-cleared treatment that delivers magnetic stimulation to the parts of the brain known to be underactive in people with depression or OCD. Dr. Harvey says that TMS therapy is "for those who have already tried other treatments and those other treatments didn't work. Typically our patients have already have tried medications or talk therapy and are still not doing well. In those cases, TMS is a very great option."

Greenbrook TMS is open to help our communities and we're taking precautions to help ensure the safety of both our patients and staff during this pandemic.

If you are interested in TMS you can learn more information about how TMS works below by listening to the full interview below:

To see all upcoming Greenbrook TMS provider interviews, click here

"COVID-19 is a big change for everybody in a lot of different ways" -Dr. Misty Borst on WLIF

dhageman@innovasium.com (Daniel Hageman) — Sun, 19 Apr 2020 15:58:00 GMT

Greenbrook's Maryland Medical Director, Dr. Misty Borst, was recently on 101.9 WLIF to discuss mental health during COVID-19. The current pandemic has created a lot of stress and uncertainty, and Dr. Borst advises on ways to maintain your mental health

Greenbrook's Maryland Medical Director, Dr. Misty Borst , was recently on 101.9 WLIF. Dr. Borst received her medical degree from the Medical University of South Carolina and has been practicing TMS therapy since 2016 . During her 101.9 WLIF interview, Dr. Borst addressed how COVID-19 is affecting mental health.

The current pandemic has created a lot of stress and uncertainty, and Dr. Borst advises on ways to maintain your mental health during this time by:

During the interview, Dr. Borst also touches on the basics of TMS therapy. TMS stands for transcranial magnetic stimulation and is an FDA-cleared, non-invasive treatment for treatment-resistant depression and obsessive compulsive disorder. TMS therapy uses an electromagnetic pulse over a specific part of the brain that regulates your mood. TMS has minimal side effects in comparison to those of medication management. Unlike drug-related side effects which include insomnia, weight gain and nausea, the most common side effect of TMS therapy is mild to moderate headache.

Dr. Borst also touches on Greenbrook's increased patient access to telehealth. Greenbrook is now offering select appointments to take place via phone call or videoconference. If you have questions about whether TMS is right for you, if TMS is covered by your insurance, or general questions about TMS therapy, schedule your no-cost consultation here .

Hear Dr. Borst's full interview below:

To see all upcoming Greenbrook TMS provider interviews, click here

"Being isolated is very difficult for most people" - Dr. Sauvé on WINA

dhageman@innovasium.com (Daniel Hageman) — Sat, 18 Apr 2020 15:59:00 GMT

Greenbrook's Virginia Regional Medical Director, Dr. William Sauvé, was recently on 98.9 FM WINA to discuss mental health care during the COVID-19 crisis.

Greenbrook's Virginia Regional Medical Director, Dr. William Sauvé , was recently on 98.9 FM WINA to discuss mental health care during the COVID-19 crisis. Dr. Sauvé began practicing psychiatry in the U.S. Marines and later served as a Division Officer of inpatient psychiatry at the Naval Medical Center of San Diego. Dr. Sauvé started working with Greenbrook in 2014 and has since been practicing TMS Therapy throughout our Virginia centers.

Dr. Sauvé was interviewed by WINA's Les Sinclair, in a segment titled "Mental Health in the Time of COVID-19." Dr. Sauvé was asked at what point a person should reach out to a professional regarding mental health and he advised that if a person has any questions regarding mental health, that's "the very first sign that it's worth making a call." Dr. Sauve noted that with many practices utilizing telemedicine during COVID-19, accessing remote care is possible. Greenbrook TMS is currently offering select appointments, including consultations , via phone call or videoconference.

The impact of social isolation on mental health was also discussed during the interview. Dr. Sauvé says that "being isolated is very difficult for most people. Humans by definition are typically social creatures, we rely on a certain amount of social contact to feel well." Dr. Sauvé makes a few recommendations for managing your stress and mental health during the quarantine, including:

Dr. Sauvé also discussed the basics of how TMS therapy works and the steps Greenbrook has taken to help ensure the safety of both our patients and staff during this pandemic.

Listen below to learn more about Dr. Sauvé's advice on mental health during COVID-19:

To see all upcoming Greenbrook TMS provider interviews, click here

"We want to be part of that fight to keep people well" - Dr. Grammer on WUSA 9

dhageman@innovasium.com (Daniel Hageman) — Tue, 14 Apr 2020 18:51:00 GMT

Greenbrook's Chief Medical Officer, Dr. Geoffrey Grammer, was recently on WUSA 9 discussing Greenbrook TMS therapy. Beyond explaining the basic mechnisms of using TMS therapy for treatment-resistant depression and obsessive compulsive disorder (OCD), Dr.

Greenbrook's Chief Medical Officer, Dr. Geoffrey Grammer , was recently on WUSA 9 discussing Greenbrook TMS therapy. Beyond explaining the fundamental mechanisms of using TMS therapy for treatment-resistant depression and Obsessive-Compulsive Disorder (OCD), Dr. Grammer also explained what makes TMS a more tailored treatment to each individual's brain. Unlike antidepressants, which can have systemic side effects such as nausea or weight gain and which don't provide adequate relief from depression symptoms for about one-third of the people taking them, TMS therapy uses gentle magnetic pulses to re-activate the parts of the brain responsible for depression.

During the segment, Dr. Grammer also discussed the specific ways in which we're responding to the COVID-19 crisis to keep patients and staff safe while still providing this important treatment for those struggling with treatment-resistant depression. Dr. Grammer says that "The CDC [Centers for Disease Control and Prevention] is encouraging people who are engaged in mental health care to stay engaged in mental health care, and we definitely want to be part of that fight to help keep people well and, candidly, to keep people home and healthy as opposed to having to go to the hospital or the emergency room, which right now is the front line of the pandemic." Because TMS therapy is a treatment with daily center visits, we've instituted a variety of hygiene and social distancing measures, explained by Dr. Grammer in the segment.

Watch below to see the segment in full:

To see all upcoming Greenbrook TMS provider interviews, click here

Trusted Health Resources for COVID-19

Mon, 13 Apr 2020 19:31:00 GMT

One part of managing mental (and physical) health during the COVID-19 pandemic is choosing trusted news sources when you're looking for information. The National Alliance on Mental Illness (NAMI) has the following guidelines for news consumption related to COVID-19:

Watching or listening to the same news constantly can increase stress. Reading can be an easier medium to control how much and what kind of information you’re absorbing.
Set limits on when and for how long you consume news and information, including through social media. It may help you to choose a couple of fifteen-minute blocks each day when you will check news/social media and limit your news consumption to that time.

False information spreads very easily on social media and can have serious consequences for individual and public health. Always verify sources and make sure they are reputable, especially before sharing anything.

To ensure you have the most up-to-date and accurate information, use any of the trusted resources listed below:

Learn about the science of COVID-19:

Learn about national and international efforts to address the pandemic:

Learn about what's happening in your state:

Always consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

Is it Depression or is it Quarantine? 5 Ways to Tell the Difference

Thu, 09 Apr 2020 16:55:00 GMT

Where’s the line between the onset of an episode of depression and a normal reaction to what’s going on in the world right now? Dr. Misty Borst , Greenbrook TMS Maryland Medical Director, says that “There are plenty of times in our lives where we have a lot of unfortunate things or stressful things happening all at the same time. That makes us feel depressed, but it also can change our brain and how our brain works.” Here are five ways to tell the difference between simply reacting to the changes and disruptions we’ve all recently experienced versus a depressive episode that should be addressed by a medical professional.

1. Your regular coping strategies aren't working

Making sure that we’re getting regular exercise, adequate sleep, and nutritious food are the first things many of us look to when we feel that something is wrong. Oftentimes, getting back on a good sleep schedule or putting the phone down for some fresh air can be enough to pull us out of a funk. But if you’ve exhausted your list of mood boosters and find that you’re still struggling, what you’re dealing with may be more complex than just a temporary spell.

2. You're having persistent symptoms of depression

Transient depressive symptoms or feelings of stress, anger, or anxiety are commonplace reactions to what’s going on in the world right now. But when your feelings aren’t going away within two weeks or are interfering with your ability to sleep, work, and take care of your basic needs then it can be a cause for concern. Depression symptoms include:

Fatigue or decreased energy
Excessive sleep or difficulty with early-morning waking
Changes in weight from decreased or increased appetite
Persistent aches or pains, headaches, cramps, or digestive problems
Depressed mood or feelings of worthlessness or guilt
Difficulty thinking, concentrating, or making decisions
Loss of interest in activities
Thoughts of self-harm or suicide

3. You have risk factors of depression

While having risk factors for depression doesn’t guarantee that someone will experience the onset of a depressive episode, it can make it more likely. These risk factors include:

Chronic medical illness, such as cancer, diabetes or heart disease
Social isolation
Disability
Personal or family history of depression
Stressful life events such as the loss of a spouse, divorce, or taking care of someone with chronic illness
Use of certain medications
Brain disease
Misuse of alcohol or drugs

4. You're self-medicating to try and feel better

Self-medicating takes many forms. It’s most commonly associated with excessive alcohol use or drug abuse, but self-medicating looks different for everyone . You may be working too much, sleeping too much, or eating too much in an effort to dampen negative feelings and find some comfort. Temporary overindulgence is usually harmless but once your habits are becoming unproductive or interfering with daily functioning, it’s time to consider the root cause.

5. You're withdrawing and (emotionally) isolating

Social distancing is important to help stop the spread of COVID-19, but only pertains to physical rather than emotional proximity. Social distancing doesn’t mean that you can’t talk on the phone, have a video chat, or text a friend. As we’re adjusting to this new normal, it’s okay to take some time to think about your feelings and regroup emotionally. But habitually retreating from friends and loved ones is a common depression symptom, whether due to lacking the energy it takes to put up a “happy face,” guilt over feeling low, or feeling that friends and family aren’t interested.

If these signs sound familiar to you, know that you’re not alone and that depression treatment is available. Reach out to a medical professional to find out what your next steps are, whether it’s antidepressant medication, talk therapy, or TMS therapy . TMS therapy is an FDA-cleared, non-drug treatment which uses gentle m agnetic pulses to stimulate the parts of the brain that are responsible for depression. Schedule your free consultation or enter your zip code in our center locator to find a TMS center near you .

Always consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

Greenbrook TMS Patient Journeys: Josephine

Tue, 07 Apr 2020 20:33:00 GMT

Josephine is a 67 year old retired teacher from Missouri. She completed treatment with Greenbrook TMS six months ago. We spoke with her to learn more about how she found her way to Greenbrook TMS and what life has been like since completing treatment.

My father died in 1996. I was just so sad, and as the sadness left me as time went on, the general sadness of depression continued. And that’s what I couldn’t figure out. Even though I was on Prozac I continued to be sad. It worked for a little while and my doctor kept switching my antidepressants but over the course of decades nothing really helped. I would still suffer bouts of depression. I remember experiencing depression at one point where I couldn’t even talk, which was probably the most painful experience I had because I was totally non-functional. I would have much preferred a serious physical disease because depression is just so misunderstood and just so debilitating.

When I moved to St Louis, I happened to go on the internet and found you. I read about TMS therapy and I thought okay, why not give it a try? I must admit that I was skeptical that it would work, I really really was. But I was at my wit’s end.

The medications just weren’t working. Even when I had good events or the uplifting spirits that holidays bring, I wasn’t feeling that.

I had gone through a lot of changes and all the stressors of moving and I thought, I have to take action. I can’t do this myself .

I noticed a difference after two weeks, it was unbelievable. I quit crying, I had a real lift in my mood, and I started telling everybody about it. My close friends would remark and compliment me and say “Wow! That’s our old Josie.” They were very sweet. I couldn’t be more pleased. It was helpful when I would go into the office to talk to people going through the same thing. I remember one older gentleman who would come in the same time I did, and I just noticed that he started smiling more and talking to me more. He became more cheery.

When I was in the waiting room, I would go at the same time every morning for treatment and I felt like I was in a cohort group because some people would come in at 10 or 11 am and I would run into them every day. I would ask them how they’re doing and we had all sort of connected. And they were all doing really well, too—people of all ages. It really gave me hope.

I used to get tremendous pleasure out of reading, but I’d given that up. Now I’m back to reading again. I enjoy those simple pleasures. It’s not like I have to win the lottery to be happy. I just became more active, I went back to my fitness habits, I enjoyed cooking again, entertaining friends. It really helped me socially. I remember that I wanted to be with people. By nature I’m an introvert but that sort of changed. I talk to people more often, even strangers. And it was fun! It gave me more fun in my life. I don’t know how you quantify “fun” but on a fun scale I really really went up. And I noticed it truly after 2 weeks. I really noticed that I became more honest with people. I was able to explain my depression. Before I was ashamed of it but I no longer felt ashamed because I was proud of my improvement.

I had wonderful Technicians that were very kind and entertaining, so every 20 minute session would go by so fast and I really looked forward to them because I had this attitude that with every session, I was getting better.

And the TMS technicians were so good at explaining everything to me, and they talked me through everything. I felt like we were a team. It was very important to me to have that connection with them. All of them were excellent people.

They weren’t always the same people but I knew them by name but they really believed in the treatment and that helped me believe in the treatment. So kudos to them! They were so committed to it, I could feel it. It wasn’t just a job to them. It made me feel normal. I didn’t just give them answers they wanted to hear, but I told them the truth.

Now when I face situational depression, I’m able to recognize it and say “this too shall pass” because everyone faces tragic events and stressors in their lives and then it goes away. I’m able to recognize the difference between ongoing depression and situational depression. I just feel stronger and I’m able to bounce back in a rational way. It really helps to know that depression is a brain malfunction. It’s not that something is wrong with me emotionally, but it’s hereditary in my family. I’m not unique-- other people go though this too.

If I’d known about this before, I would have gotten treatment sooner. I had gotten to the point where I was hopeless. I’d just tried everything. I’ve come to realize that antidepressants aren’t cookie-cutter. Everyone’s brain is different. I consider myself a well-balanced person but this depression was just a plague that went on for decades.

I couldn’t brag more about the results. I’m off all of my antidepressant medications. If my depression ever comes back, I wouldn’t hesitate to go back to Greenbrook TMS.

Dr. Stephanie Lirio on AM Tampa Bay

dhageman@innovasium.com (Daniel Hageman) — Mon, 06 Apr 2020 22:50:00 GMT

Greenbrook's Florida Regional Medical Director, Dr. Stephanie Lirio, was recently on AM Tampa Bay to discuss TMS therapy.

Greenbrook's Florida Medical Director, Dr. Stephanie Lirio , was recently on AM Tampa Bay to discuss TMS therapy. Dr. Lirio joined Greenbrook TMS in 2019. She received her medical degree from New York Medical College, and completed her psychiatry residency at the University of Pennsylvania.

During the AM Tampa Bay interview, Dr. Lirio discusses TMS (Transcranial Magnetic Stimulation) therapy and how it works. TMS is an FDA-cleared treatment that delivers magnetic stimulation to the parts of the brain known to be underactive in people with depression. Dr. Lirio explains that TMS therapy is "for people who have tried a number of medications to treat their depression or talk treatment and haven't had an adequate response," which is an estimated one in three individuals.

Dr. Lirio also discusses the side effects of TMS therapy. Unlike drug-related side effects which can include insomnia, weight gain, and nausea, the most common side effect of TMS therapy is mild to moderate headache at the site of the magnetic pulse, which can be treated by over-the-counter pain relievers such as Tylenol. During treatment, the TMS technician can also make adjustments if the treatment is uncomfortable. If you are interested in learning more about how TMS works visit our resource page . Listen to the full interview below for more information:

To see all upcoming Greenbrook TMS provider interviews, click here

"People are trying to get a sense of control" - Dr. Geoffrey Grammer on WMAL

dhageman@innovasium.com (Daniel Hageman) — Mon, 06 Apr 2020 22:26:00 GMT

Greenbrook's Chief Medical Officer, Dr. Geoffrey Grammer, was recently on WMAL Mornings on the mall to discuss ways we can handle the stress of social distancing during the COVID-19 pandemic.

Greenbrook's Chief Medical Officer, Dr. Geoffrey Grammer , was recently on WMAL Mornings on the Mall to discuss ways we can handle the stress of social distancing during the COVID-19 pandemic. Dr. Grammer was interviewed by WMAL's Vince Coglianese and Mary Walter. Dr. Grammer discussed how for some people this is a very stressful time. Some may need more help than others to cope during the coronavirus pandemic.

COVID-19 has affected most of the population. Dr. Grammer discusses how the virus is not a tangible thing, and many are having a difficult time handling something that is out of their control. People are reverting to things that are less productive to help them feel in control. Dr. Grammer recommends that everyone needs to be mindful during the decision-making for this issue rather than acting on emotions.

Another issue that was discussed is getting people to get past the stigma of depression treatment. Dr. Grammer explained how the brain controls thoughts and emotions just like any other organ in our boy. If that organ is not properly functioning it can result in negative behaviors. TMS Therapy allows those neurons to work properly in the brain by making the neurons active and restoring them to their normal function. This will then lead to relief in depression symptoms. Finally, Dr. Grammer touches on the proper precautions Greenbrook has implemented to maintain safety for our patients and staff.

Click below to hear the segment in full:

To see all upcoming Greenbrook TMS provider interviews, click here

Managing Mental Health in Turbulent Times

dhageman@innovasium.com (Daniel Hageman) — Tue, 24 Mar 2020 18:55:00 GMT

With the rapidly evolving news of the COVID-19 outbreak, it’s easy to feel overwhelmed and unsure. For all of us who struggle with our mental health, the rapidly changing environment can magnify any challenges that we’ve been dealing with. It’s important to do what we can to tend to our emotional wellbeing as we navigate the next few weeks. If you’re finding that your anxiety or depression is feeling harder to manage, here are a few ways you can get through:

“Headline Stress Disorder,” a term coined for the anxiety resulting from the 24 hour news cycle, can be ramped up when always-emerging information about the outbreak is readily available. If around-the-clock coverage of the Coronavirus is causing you distress, try disabling news push notifications on your phone and set aside one block of time a day to follow the coverage, rather than continuously checking in. When you do read Coronavirus-related news, make sure you choose trusted sources such as the Centers for Disease Control (CDC), World Health Organization (WHO), or local health authorities.

Guidelines for personal care include avoiding touching your face, washing your hands often for 20 seconds, covering your mouth when you cough or sneeze, avoiding contact with those who are unwell, and staying home if you’re feeling sick (except to get medical care). For more health guidelines, choose trusted organizations such as the CDC or WHO .

Our self-care practices often go neglected in periods of high stress, but staying on top of getting adequate sleep, nutritious food, and vitamins can help keep stress levels down and your immune system strong. If gyms and other exercise locations are closed in your area, try one of the many fitness classes that can be streamed online.

Be sure to stay in touch with your friends and family to let them know how you’re feeling, or ask them to check in on you if you know that you tend to isolate when stressed. If constant discussion of Coronavirus stresses you out, it’s okay to ask for some COVID-19-free time. If you feel that your anxiety or depression is interfering with daily functioning, seek out help from a medical professional. Remember that mental health is just as important as physical health, and that help is available when you want it.

Always consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

Out of the Darkness 2020 Walks for Suicide Prevention

dhageman@innovasium.com (Daniel Hageman) — Wed, 11 Mar 2020 17:33:00 GMT

Greenbrook is proud to sponsor Out Of The Darkness walks, the signature event of the American Foundation for Suicide Prevention, in cities throughout our regions from March to November.

Greenbrook is proud to sponsor Out Of The Darkness walks, the signature event of the American Foundation for Suicide Prevention, in cities throughout our regions from March to November. These virtual community walks aim to bring awareness to the high rate of suicide in the U.S., provide support and comfort to those affected by suicide, and raise funds for research and education about mental illnesses that lead to suicide. With suicide the second highest cause of death for ages 15-44 in America, events like Out of the Darkness walks are crucial to offer solutions to those who have lost hope.

Greenbrook will join the communities we support for this crucial cause and be part of the work to destigmatize mental illness. The U.S. Department of Health and Human Services (HHS) estimates that nearly 60% of those who die from suicide have suffered major depressive disorder (MDD) or another mood disorder. Because of this, identifying and treating patients with MDD is critically important in the effort to prevent suicide.

We invite you to join us to support the American Foundation for Suicide Prevention’s cause in a city near you! Whether you are attending a walk, walking in your own neighborhood, or participating virtually. For more information about Out Of The Darkness or the event, click on the event name below:

Michigan Out of the Darkness Experience

Saturday, September 26, 2020 @ 10am

Cleveland Experience

Saturday, September 26, 2020

Suffolk Experience

Saturday, September 26, 2020

St. Louis Experience

Sunday, September 27, 2020 @ 11am

Lynchburg Experience

Saturday, October 3, 2020

Montgomery County Out of the Darkness Walk

Sunday, October 17, 2020 @ 10am

St. Petersburg Experience

Saturday, November 7, 2020 @ 10am

Greater Houston Area Experience

Saturday, November 7, 2020 @ 10am

Central Carolina Experience

Sunday, November 7, 2020 @ 12pm

Charlotte Metro Experience

Saturday, November 7, 2020 @ 12pm

Columbia Area Experience

Saturday, November 8, 2020 @ 2pm

Celebrating Pride 2020

dhageman@innovasium.com (Daniel Hageman) — Fri, 06 Mar 2020 21:13:00 GMT

We're excited to announce that Greenbrook will be participating in Pride 2020 celebrations in cities throughout our regions from March through October. Pride events celebrate diversity among the LGBTQ community, their friends, families, and allies. As a mental health company, we are excited to support these celebrations with the knowledge that depression doesn't discriminate across gender, race, or orientation. As we celebrate the strides in civil rights for the LGBTQ community, we also look towards those strides improving access to care for those who need it. Pride parades and festivals are a great opportunity to be part of an important cause for our community, patients, and care team.

On the day of the festivals, our care team members will host a booth with giveaways. We invite you to join the festivities in a city near you! For more information about Pride or to attend an event, click on the corresponding link below:

Tampa Pride

Saturday, March 28, 2020 @ 4pm
Historic Ybor City
Tampa, FL

Raleigh Pride

Saturday, May 30, 2020 @ 11am-6pm
Downtown Raleigh
Raleigh, NC

Cleveland Pride

Saturday, June 6, 2020
Downtown Cleveland
Cleveland, OH

Delaware Pride

Saturday, June 6, 2020 @ 10am
Legislative Mall
Dover, DE

Baltimore Pride Festival

Sunday, June 21, 2020 @ 12-6pm
Druid Hill Park
Baltimore, MD

St. Louis Pride

Saturday, June 27, 2020 @ 1pm
Soldiers Memorial Military Museum
St. Louis, MO

Houston Pride Festival

Saturday, June 27, 2020 @ 12pm
Location to be announced
Houston, TX

Annapolis Pride Festival

Saturday, June 27, 2020 @ 12pm
Whitmore Park
Annapolis, MD

Charlotte Pride Festival

Saturday, August 1, 2020
Location to be announced
Charlotte, NC

Austin Pride

Saturday, August 15, 2020 @ 11am
Fiesta Gardens
Austin, TX

Hartford Pride

Saturday, September 12, 2020
Bushnell Park
Hartford, CT

Blue Ridge Pride

Saturday, September 26, 2020 @ 10am
Location to be announced
Ashville, NC

Greensboro Pride

Sunday, October 11, 2020 @ 11am
South Elm Street
Greensboro, NC

Columbia Pride

Saturday, October 17, 2020
Main Street
Columbia, SC

Greenbrook TMS Care Team Spotlight: A Conversation with Dr. Kim Cress

dhageman@innovasium.com (Daniel Hageman) — Mon, 24 Feb 2020 22:55:00 GMT

What initially drew you to psychiatry and to TMS Therapy in particular?

I always had an interest in medicine and in helping others. What really drew me to psychiatry was getting the time to be with my patients and get to know them. In 2010, I was working with one particular patient who, no matter which depression medication she tried, she had side effects to everything. She was so drained by depression that she was willing to try anything. While ECT (electroconvulsive therapy) was an option, she wouldn’t consider it because of the side effects and she was afraid of the memory loss that’s associated with ECT. I knew there had to be less invasive options we should explore first, so I looked into TMS Therapy and I dug into the literature.

The more I dug into it, rather than referring this patient to TMS Therapy through another provider, I elected to start using it in my own practice. I saw the utility in being able to use it not just for individuals like my patient who had so many side effects to medications that prevented them from getting to remission but also because I had patients who weren’t able to get to remission despite being on multiple medications. I felt like TMS would have value to not just that one particular patient but to many.

What’s the difference between ECT and TMS Therapy?

Individuals treated with ECT undergo anesthesia and there are concerns with retrograde amnesia. Individuals can have problem with recall of previous events, which can be of concern to patients. For some patients who are professionals, they don’t want to put themselves at that type of risk cognitively and won’t entertain ECT as a treatment option.

I would always pick TMS Therapy over ECT except in select cases where someone is actively suicidal or catatonic because with TMS Therapy, individuals can come in, they can drive on their own, they can resume normal activities— getting back to school or work or whatever their situation may be, after receiving the TMS treatment. There’s no concerns in regard to cognitive side effects.

What’s the most common question patients have about Greenbrook TMS Therapy?

The most common question is Will this work for me? Most individuals come to me with not years of depression, but decades, and they find themselves feeling kind of hopeless. They’ve tried multiple medications and are asking Why is this going to be any different? I failed this medication and that medication, why should I have any hope that this is going to work? So then we have a conversation in the context of how TMS Therapy is different, and how it isn’t another medication.

What happens during the TMS Therapy consultation?

Once someone has contacted us either through the website or called 855-940-4867, we’ll schedule the consultation to learn about the individual’s history and background. We love to have family in on the consultation because they provide such pivotal information. Oftentimes individuals who are depressed don’t see the value or the struggles, because they tend to minimize it or they’re better but not where they need to be.

I have a patient who I’ve known for a very long time, who had completed a treatment course years and years ago with me. She said she was “okay,” but her definition of okay was having one shower a week and getting up in the morning but going back to bed for a couple hours. To her it was okay because she wasn’t suicidal or in the very depths of depression like she had been in times past. So oftentimes, individuals can’t discern that there’s still dysfunction and a loved one can see that, and help them identify that Hey, you’re really still struggling and really have to force yourself to do things, and there’s really not the joy in life that there used to be .

What’s the first Greenbrook TMS Therapy treatment session like?

During the first TMS Therapy session, the psychiatrist is assessing, prescribing and administering the initial treatment protocol. It’s also the longest session because we’re setting up treatment that is specific for that patient. The treatment course is established with putting the chair to their height to get them comfortable, we work to identify the intensity of the magnetic field we need to treat them, and then the localization of where we are treating. We spend that time to tailor each treatment to the individual. It’s important to educate patients and let them know what to expect.

What does the treatment feel like?

My very first patient said the treatment feels like Woody Woodpecker-- they describe it as a tapping sensation, as if I’m tapping on your leg. You’ll get to a point where you desensitize and you’re able to ignore it. And you’ll find yourself able to watch TV, talk, to listen to music, and be very comfortable and not find yourself in any type of discomfort or pain during the course of treatment.

How long does it take to know that TMS Therapy is working?

After a couple of weeks patients have more energy, they’re sleeping better. They’ll mention running errands or meeting with a friend for lunch—going out and doing things which were challenging for them before. We’ll see the smiles and the changes within them—they’re engaging in conversation more readily rather than coming in and being quiet during treatment, they’re taking initiative in conversation.

Managing Mental Health in College

dhageman@innovasium.com (Daniel Hageman) — Sat, 01 Feb 2020 00:05:00 GMT

Between balancing a course load, social circles, family obligations, and a job, many college students have trouble prioritizing their mental health despite an estimated 39 percent of them experiencing a significant mental health issue during college. If you’re feeling overwhelmed with trying to make the most of your college experience while managing your stress levels, here are a few ways you can incorporate mental wellness into your daily routine:

In a culture where we all want to maximize our days, it can feel like every single thing we do “has to be” oriented towards a specific goal or otherwise it's a waste of time. Even though productivity is important, it's just as critical to carve some time out for yourself where you can do something that you enjoy for the sake of enjoying it, rather than a side hustle or a means to self-improvement. Giving yourself time to decompress will allow you to maximize your productivity once it's time to get back to work, and engaging in creative tasks has been shown to lead to benefits in physical and mental health.

Stress relief looks different for everyone and college is a great time to find out what works well for you. It’s a good idea to try out a few different stress relief techniques and find practices that you can rotate depending on how much time you have. If you’re in the middle of studying for finals you might not have the time for a long gym session, but you can do a five-minute breathing exercise to help clear your mind. Look for stress relievers that aren't dependent on location or spending any money, such as going for a walk, meditating, or journaling so that you can use them anytime and anywhere.

With so much to do, it’s easy to forget about the small things that will keep your body healthy. When it comes to getting eight hours of sleep, eating three meals a day, or making sure you’re exercising daily, these simple tasks are often the first to become neglected when other responsibilities arise. But staying properly fueled and in good shape will help manage your stress and keep your mind and body working together to tackle everything you need done.

Whether it’s your friends, a club, or your counselor, find people who are interested in your well-being and want to see you do well. The friends you go to parties with are lots of fun, but they should also genuinely care about helping you to become the best version of yourself. Have people in your corner that are there with you when you’re struggling and can help you keep a sense of perspective in reaching your goals. If you feel like the friends you have now aren't the best ones for you, that's okay! Make a list of your goals and think about where people with those same goals like to spend time. If you want to get fit, join a sports club. If you want to focus on making the Dean's List, start a study group with your classmates.

Some people swear by physical planners, others like to keep their due dates digital. Once you find what works for you, an organization system will give you the freedom to not stress about remembering last-minute assignments. And as fans of Marie Kondo can attest, getting and staying organized can help you feel like you have more breathing room to focus on what's most important. To incorporate creativity into your organizing, try your hand at bullet journaling so that you can add drawings, self-care goals, and future plans.

It’s easy to place the blame on ourselves when we feel overwhelmed. Maybe if we just try harder or sacrifice more of our time, we will be able to get everything we want to be done and stop feeling so anxious or overworked. But if you are doing all you can and you're still feeling like you're having trouble keeping up, then it’s time to talk to someone about it. Virtually every university has mental health counseling services, usually available at no cost to students. If you aren't sure where to start, you can also talk to your Resident Advisor (RA), a trusted teacher, or a coach. There are many services available to help you, whether it's talking with a counselor or being assigned a peer mentor to check in with you.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.

Always consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

Greenbrook TMS Patient Journeys: Danielle

dhageman@innovasium.com (Daniel Hageman) — Thu, 23 Jan 2020 01:38:00 GMT

"Sometimes I would have bouts where the depression got worse and I’d need to go on more medication. That’s what happened when a friend of mine had passed away unexpectedly and it had really thrown me for a loop that my medication couldn’t pull me out of."

Danielle is 59 years old and lives in North Carolina. She completed Greenbrook TMS Therapy a year and a half ago. We spoke with her to learn more about how she found her way to Greenbrook TMS and what life has been like since completing treatment.

I’d had depression for a very long time. It was chronic, and I was always on antidepressant medication. Sometimes I would have bouts where the depression got worse and I’d need to go on more medication. That’s what happened when a friend of mine had passed away unexpectedly and it had really thrown me for a loop that my medication couldn’t pull me out of.

When my friend died unexpectedly, it really knocked me for a loop. My psychiatrist told me I should take time off of work, but it wasn’t an option for me. It was a very dark time. I was very argumentative with my husband, I didn’t want to do anything with him. Unfortunately whenever I get depressed, I get irritable and anxious, and I cry a lot. That’s where I was. At that time I had suicidal thoughts, and was just very depressed, and just having to force myself to go to work was tough. My husband would drive me 45 minutes to work and pick me back up, and getting through the shift was very hard. It was very, very dark. I would make jokes—not in a funny manner, but in an irritated manner like “ Why don’t you just get a gun and shoot me ,” that type of thing. I wasn’t serious but I was serious. I just didn’t want to deal with it anymore.

My doctor gave me the option of taking more medication or trying TMS, and I didn’t want to take another pill—I wanted to try something different rather than another pharmaceutical treatment. Once I read about it, I wanted to try it.

For my first session at Greenbrook TMS, I wasn’t nervous. My husband went with me because he was really interested in the mechanics and the treatment. The only thing I was taken aback by is that I have chronic migraines and the intensity of the pulses was a little too high. The staff immediately noticed I flinched, so the doctor and Techs went down on the intensity and we went more slowly building up, so it wasn’t scary. Within two or three sessions I was relaxed during the whole procedure, no problem at all. I felt like, I’m doing this and it’s going to get better.

It was my 17th treatment and I had gone to West Virginia where my son and daughter live. I have a granddaugher that was about six months old at the time. I was holding her and there wasn’t a lot of particular joy in holding her and playing with her the first evening I was there.

But then the next morning when I woke up it was like somebody had flipped a switch. It was a new me. That’s exactly what I told my Tech when I went back in for my next treatment on Monday, it was like someone had flipped a switch on that Saturday morning. It was unreal. And when I picked up my granddaughter and started playing with her, I got her laughing and cooing at me and just felt like "Wow, this is what it feels like to be a grandma!" I was just having a blast with her, and the feeling didn’t go away. It was there.

And with depression, when you’re on medication, you’ll have fleeting feelings like that. But this was sustained. It didn’t go away. It was here to stay. It meant so much to me and I had waited so long to be a grandmother. It was great to have that feeling. It was wonderful.

My husband definitely noticed. His nickname for me is “Ladybug” and he’d say, “ I’m starting to see glimpses of the Bug again! I think the Bug is back! ” I wasn’t hiding in bed anymore, I was going outside to sit on the porch.

I am a stressful person. I do have anxiety and I let myself get anxious about things. Nowadays, I tell myself, as Mr. Rogers said, look for the good things . Focus on the future and think about good things that will happen in the future. And now, I think about my granddaughter and her laughter, and the next time I’ll get to see her. It helps. I have so much to look forward to now. In a lot of ways, Greenbrook TMS helped. I’d experienced another loss in March and though it was very hard, I was able to handle it pretty well. Before, I’d get jumbled up in the negativity.

I would have had TMS Therapy sooner. I wish I knew about it years ago. I feel so much better. I feel like the old me. I’m thankful for Greenbrook TMS. I am.

I never had a doubt that it would make some change, but I never expected the change that it made. I mean, truthfully. I never expected the extent of how helpful it was and just how that light switch went off for me.

Veterans & Mental Health: How to Help

dhageman@innovasium.com (Daniel Hageman) — Tue, 21 Jan 2020 19:15:00 GMT

The stress of military service and deployments takes a toll on both soldiers and their families. With higher rates of depression, anxiety, and posttraumatic stress disorder (PTSD) as compared to civilians, it’s unfortunately all-too-common for our veteran

Similar to the obstacles that civilians face when accessing mental healthcare, the Government Accountability Office (GAO) reported that among veterans, key barriers to receiving mental health treatment include:

Many veterans avoid seeking help out of concern of appearing “weak” or “damaged.” But the truth is that many millions of Americans have depression , and according to veteran and host of the VetStory podcast Rod Rodriguez, “in the veteran community, one in three veterans suffer from some sort of depression.” Rod recently had Col. (Retired) Geoffrey Grammer , MD, Greenbrook’s Chief Medical Officer and Bill Leonard , Greenbrook’s founder, on an episode of VetStory to discuss depression among veterans and how TMS Therapy can be an effective treatment option when medications haven’t helped.

The need for effective depression treatment is apparent. According to 2019’s National Veteran Suicide Prevention Annual Report , in 2017 veterans made up 7.9% of the U.S. adult population but represented 13.5% of all adult suicides. Because a mood disorder (such as depression) is present in an estimated 60% of people who die from suicide, one way to prevent suicide is to be on the lookout for signs of depression and encourage people to seek treatment. Though a diagnosis should be made only by a qualified medical professional, symptoms of depression include:

If you’ve noticed these symptoms in someone you know, encourage them to seek help. That can be easier said than done, especially with a veteran who doesn’t want to appear as anything less than strong. Sometimes, flat-out asking someone “Are you depressed?” can be met with denial or hostility because it feels like an accusation.

Greenbrook’s Dr. Grammer says that in situations like these, you can try a different approach with someone who’s reluctant to get treatment. He says that “For some people, hearing ‘ you’re depressed’ can seem nebulous and make it hard to integrate into their decision-making process. What you can do instead is focus on the particular symptoms that are impacting a person’s life with statements like ‘I’ve seen that you’re not sleeping well ,’ ‘ You’re not eating well,’ ‘You seem tired all the time, ’ or ‘ You don’t look like you’re feeling well.’ No one wants to feel bad, so if you ask them how they’d like to feel and they respond that they’d like more energy or they would like to not feel sad all the time, that can be a way of motivating people. You can tell them ‘ If you want to feel differently, let’s go figure out what’s wrong. Let’s figure out why you’re not where you want to be, and let’s get you in to see someone.’ ”

For more, visit the U.S. Department of Veterans Affairs Mental Health resources. If the situation is potentially life-threatening, get immediate emergency assistance by calling 911, available 24 hours a day.

Always consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

Greenbrook TMS Care Team Spotlight: A Conversation with Dr. Misty Borst

dhageman@innovasium.com (Daniel Hageman) — Tue, 01 Oct 2019 21:23:00 GMT

Dr. Misty Borst joined Greenbrook TMS in November 2016 as Medical Director at our Columbia center in Maryland. Originally from South Carolina, Dr. Borst has worked in both inpatient and outpatient settings and has been treating patients with TMS since 2016. Dr. Borst is board certified in adult psychiatry and is a member of the American Psychiatric Association as well as the Maryland Psychiatric Society. Read on to learn about her thoughts on TMS therapy.

How did you become interested in psychiatry?

Once I was into my psychiatry rotation during medical school, I loved it. I loved the amount of gray area in psychiatry—For four patients, even if they all have depression, that depression was different in each of them. I really appreciated that the gray area felt artistic- a lot of thought had to be put into each particular person’s situation. I’m sure that’s true for all types of medicine, but it really resonated with me in the world of psychiatry.

What drew you to TMS?

The statistics are quite compelling. When you look at the success rates once a patient has tried a certain number of medications, TMS therapy is statistically a far better option for many depressed patients. In addition, TMS is personalized for each patient and as a treatment modality, it has so few side effects. Any psychiatrist should be interested in anything that is new and can help our patients.

Does medication work for everyone with depression?

If a person feels very depressed and the antidepressants work even a little bit, they are initially pleased with that because it is better than where they were. Over the course of months, some people will realize that it’s just not enough. Some people may feel somewhat better with the medication and get used to that and accept that this is their new normal, but it doesn’t necessarily have to be. They will say they’re fine, but we know from a clinical standpoint, there can be further improvement. We want them to be better than fine.

Do people have to stop taking their medication before starting Greenbrook TMS therapy?

Generally, we keep people on the same medications they were on prior to starting TMS therapy unless they were having a particular side effect and want to be off a medication. In general if a person does well with TMS and gets a good response, I recommend they wait a few months to see things are remaining as they want them to be. Then, if they want to try decreasing their medication, that is a perfectly okay time to talk with their doctor about it.

What happens when Greenbrook TMS Therapy begins working?

People will notice the patient looks a little brighter or less weighed down. Once the treatment starts working, when someone walks into the office, we can get a sense that things are starting to turn around. Throughout the course of treatment, the physical manifestations of depression will start to change: a patient’s sleep will improve, their energy and motivation will pick up. And they will start to feel relief from their sadness or hopelessness.

What’s the most rewarding part of your work?

Seeing the changes in patients. I had a patient just last month who had tried many different antidepressants over the course of years and hadn’t had much success with any of them. Once he went through TMS Therapy, he was like a different person. A very happy, new person. He was bright, excited, and he recognized that he felt completely different and much better. His family saw it, too.

What are patients often surprised by?

Many people find it a little daunting that treatments are five days a week for several weeks. Then they are surprised when they find themselves looking forward to TMS sessions each day. Patients like taking a break from their day and having time where outside stressors can’t get to them. During treatment they can reliably get away from everything and they don’t mind it as much as they thought they would. The sessions are fairly quick, patients can drive themselves, and they can get in and out efficiently.

How can depression affect a person’s family life or career?

Depression can certainly affect everything in a negative way. I see patients who end up just spending their time after work in their bedroom instead of hanging out with their kids. It can diminish relationships between parents and kids and can cause strain between spouses. Depression is great at facilitating distance between people. At work, depression can decrease a person’s productivity to the point where managers might notice. I’ve seen patients with depression become less able to tolerate stressors, so they’re getting irritable or snappy at a coworker when normally, if they weren’t depressed, they would be able to handle the stress and brush it off. All those little micro-insults are so much harder to handle if you’re depressed.

If you think someone you know is depressed, how do you bring it up?

If you notice a friend or family member isn’t wanting to hang out as much, if they aren’t as social or if they are isolating, those are signs something is going on with them and maybe they are struggling. If they look more disheveled or are having major changes with their sleep or their weight, those can be more obvious signs. But socially and emotionally, if they seem like they aren’t themselves that’s enough to warrant concern. If you’re worried about someone, you can start by asking how that person is doing. You might have to persist a little bit in asking. Sometimes you have to risk having an awkward conversation or feeling a little uncomfortable to pull it out of a person. Maybe they’re okay, or maybe it’s something else, but it’s worth double checking.

Greenbrook TMS Care Team Spotlight: A Conversation with Dr. Will Sauvé

dhageman@innovasium.com (Daniel Hageman) — Wed, 14 Aug 2019 20:41:00 GMT

"Usually in my pre-assessment with patients, I’ll look them in the eye and tell them “Your work is done. We’ll take it from here.” We know how to fill out the forms, we know how to make the phone calls— all you need to do is show up for treatment and we’ll do the rest."

What drew you to psychiatry initially, and how did you hear about TMS Therapy? When I began my clinical rotation in psychiatry I just fell in love with it. I’d been practicing psychiatry for about 6 years before training with TMS— when the United States Navy Medical Center in San Diego began providing TMS Therapy to active duty sailors and veterans in 2010, it was the first time I’d heard of it. Once I learned about the science behind TMS Therapy, I was in . I was drawn to it because I’ve always enjoyed the procedural side of psychiatry—I’ve never been the type to want to sit in an office, meet with a patient once a month to prescribe medication, then send people on their way.

What’s a common question you get from patients? Finances are a big one. The thing that I love the most about Greenbrook is that the majority of the time, I can reassure people that the finances won’t be a worry. People are afraid of whether or not TMS will be covered, they’re afraid of the paperwork, they’re afraid of the insurance process. And usually in my pre-assessment with patients, I’ll look them in the eye and tell them “Your work is done. We’ll take it from here.” We know how to fill out the forms, we know how to make the phone calls— all you need to do is show up for treatment and we’ll do the rest. TMS therapy is covered by nearly every health insurance provider, including Medicare and Medicaid.

What are some of the most common symptoms of depression? Cognitive impairment is a major symptom and probably the most common. Word finding, processing speed, maintaining attention, switching attention—all of these cognitive skills are diminished in those with depression. It can often be very subtle—for example, I’ve had patients who are professionals or executives in careers that require sharp decision-making skills. On the outside, their coworkers wouldn’t notice anything wrong. But my patients feel a little more slowed down, or like it’s taking more energy to focus and get work done.

So many people with depression are prescribed medication—are most of your TMS Therapy patients people who are already on prescription meds? Most of my patients have tried multiple prescription medications before coming to Greenbrook TMS, and they’re split about 50-50 in terms of any medication-related issues: for about half of them, the antidepressants aren’t doing much to help. For the other half, they are experiencing side effects that are difficult to deal with—nausea, sleepiness. Weight gain is a big issue, and lots of people have trouble maintaining the body composition that they’d prefer while they’re on medication.

What should I do if my antidepressant isn’t working? You’ll know if a medication is working within weeks, so you should never stay on a drug that isn’t doing anything for months or years. One thing that always irks me is the idea that someone has to be on antidepressants for the rest of their lives, even when the drug isn’t doing much for them. If a patient does achieve remission from antidepressants, there’s no need to be on them forever. 6 months or 12 months later, you should be looking into stopping taking the medication. And interestingly, if you do get someone into remission on a drug and they later develop depression again, it’s highly unlikely for that drug to ever work for them again. And that’s something that’s interesting about TMS Therapy: it almost always works twice. I’ve noticed that for younger patients, they’re completely unimpressed with medication—they’ve tried one antidepressant, it didn’t work, and they’re ready to move on to something that will get them where they need to be instead of losing good years.

What’s the best way to find out if I’m a good candidate for Greenbrook TMS Therapy ? There’s a consultation form on our website, or if you’d like to speak with someone you can always call us at 855-940-4867. Generally, TMS Therapy isn’t for people with seizure disorders or any metallic implants in the head—but even if you’re not sure if you’re a good candidate or not, definitely talk to us to find out. It’s a case-by-case basis and everyone is different, so we’ll sit down with you and get your individual medical history to see if you’d be a good fit.

What’s the most rewarding part of your work ? Seeing people get better—and this is something my colleagues and I often talk about: there are no psychiatrists in the country who get to spend as much time talking to people in remission as much as we do as TMS providers. At least once a week, I have people who tell me they haven’t felt this good in 30 years, or haven’t felt this way since they were a little kid.

What else do patients experience when they start to feel better with TMS Therapy? People start to do the things they used to—they start to enjoy their hobbies again. I get a lot of patients that are so excited that they’re reading books for fun again. They used to read years and years ago, but their depression makes it hard for them to concentrate. They’ll sit down with a book and read the same page 3 times, then they give up because it’s too frustrating. So when people tell me that they’re reading for fun like they used to, it’s a huge deal for them. And it’s incredible to me because it means their brain is firing up like it used to!

Bruce Springsteen's Journey through Depression

dhageman@innovasium.com (Daniel Hageman) — Thu, 29 Nov 2018 16:36:00 GMT

Rock music icon Bruce Springsteen recently spoke of his struggles with Depression during an interview with Esquire Magazine. His illustrious career, which includes winning 20 Grammy Awards, has also been marked by periods of intense struggle with his mental health.

Now 69, Springsteen has spent decades in the public eye. He's also spent decades fighting against the problems that stemmed from his childhood, which have led him to a "lifelong quest" to come to terms with. He first entered therapy in his 30s, and credits the skills he learned during therapy sessions in pulling him out of the breakdown that he suffered when he was 32. His next breakdown, which occurred in his 60s, led him to what he calls "agitated depression," which he describes as a state " where feelings became so overwhelmingly uncomfortable that I simply couldn’t find a twelve-by-twelve piece of the floor to stand on, where I could feel a sense of peace on. I had no inner peace whatsoever."

Springsteen's revelations come at a time when public consciousness is starting to shift to awareness that no one, not even a celebrity at the pinnacle of his or her career, is immune from mental illness. Springsteen is not the only celebrity that has gone public about depression or anxiety. From Olympic athletes like Michael Phelps or Missy Franklin to actors such as Dwayne "The Rock" Johnson , there has been increased public attention on mental illness. The honesty and candor of public figures opens the doors for others who have been reluctant or ashamed to seek professional health for their own struggles and raises awareness of "high-functioning depression."

High-functioning depression is a non-clinical term for a type of depression that occurs in a person who is outwardly successful and happy but inwardly struggling with depression, stress, or anxiety. Those that are able to maintain their careers and relationships can feel immense pressure to keep performing to the expectations of those around them and are often reluctant to seek help for fear of letting people down. Symptoms of high functioning depression can include:

If you recognize these symptoms or other symptoms of depression in yourself or a loved one, seek professional help. Whether through antidepressant medication, talk therapy, or TMS Therapy, relief from your symptoms and recovery is possible.

To learn more about TMS Therapy, schedule your Free Consultation .

TMS NeuroHealth Centers: First Non-Drug Treatment for Depression Center in Tyson’s Corner

Tue, 20 Dec 2011 17:53:00 GMT

It is now official! Our first Greenbrook TMS NeuroHealth Centers location is open for business. The first of a national network of centers offering Transcranial Magnetic Stimulation Therapy, Tyson’s Corner (McLean, Virginia) opened its doors in November, 2011. TMS Therapy is an FDA-cleared, non-invasive medical treatment for patients with depression without any of the side effects typically experienced with antidepressant medication, such as weight gain, sexual problems or fatigue. It uses highly focused magnetic pulses to gently stimulate the area of the brain that controls mood. This specific area has been identified as under active in people who suffer from depression. Stimulation leads to the release of chemical neurotransmitters, relieving the symptoms of depression.

TMS Therapy is an FDA-cleared, non-invasive medical treatment for patients with depression without any of the side effects typically experienced with antidepressant medication, such as weight gain, sexual problems or fatigue. It uses highly focused magnetic pulses to gently stimulate the area of the brain that controls mood. This specific area has been identified as under active in people who suffer from depression. Stimulation leads to the release of chemical neurotransmitters, relieving the symptoms of depression.

TMS treatments take less than an hour and are conducted in-office at our comfortable TMS NeuroHealth Centers, over a six week period. Patients can resume normal activities, such as driving themselves home or to work, immediately following treatment.

Dr. Niku Singh, Medical Director of Greenbrook TMS NeuroHealth Centers, Tysons Corner commented, “depression is a physical condition and we are excited to offer this most advanced targeted therapy that stimulates the area of the brain affected. Studies have shown that 1 in 2 patients experience significant improvement and 1 in 3 are completely free of depression symptoms after six weeks of TMS Therapy. These results exceed what can be expected from anti-depressant medication”.

Anyone interested in learning more about Greenbrook TMS NeuroHealth Centers can call 1-855-333-4TMS (4867)

Greenbrook Blog

Why Trying More Medications May Not Be the Answer for Your Depression

If antidepressants haven't worked, you may need a different kind of treatment for depression, not another medication.

What is Treatment-Resistant Depression?

Enter NeuroStar TMS

Finding Hope After Medications Haven't Worked

Sources:

Why Over 2,200 Patients Have Given Greenbrook Mental Wellness Centers a 5-Star Review

How compassionate care, innovative treatments, and personalized support are helping patients find relief from depression.

Why Our Patients Chose Greenbrook Mental Wellness Centers

Hearing From People Who Were Once in Your Shoes

How Greenbrook’s Care Team Helps Patients Find Relief from Their Depression

A look inside Greenbrook Mental Wellness Centers’ commitment to clinical excellence and compassionate care.

Does SPRAVATO® Work? A Look at What the Evidence Says

Understanding how SPRAVATO® works, what clinical evidence shows, and whether it can help adults with treatment-resistant depression find relief.

* Based on results of SPRAVATO® long-term clinical study; additional details available in the Prescribing Information insert. ﻿

What is SPRAVATO®?

Effectiveness in Clinical Research

* Based on results of SPRAVATO® long-term clinical study; additional details available in the Prescribing Information insert.

Why Choose Greenbrook for Your SPRAVATO® Treatment

In Summary

Is NeuroStar TMS Effective? An Explanation For Those With Treatment-Resistant Depression

What is NeuroStar TMS?

What Does The Evidence Say?

Why is NeuroStar a Good Option For People With Treatment-Resistant Depression?

1. Works Differently from Medications

2. Outpatient and Convenient

3. Supported by Clinical Research

In Summary

Why Patients Choose Greenbrook for Mental Health Care

Dr. Misty Borst answers common questions about care options and what to expect at Greenbrook Mental Wellness Centers

How Insurance Verification Works at Greenbrook

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Understanding insurance benefits, in-network coverage, and out-of-pocket costs explained by an expert.

New Year, New Mental Health Journey

How to start 2026 with a healthier mindset

Write an "Ins and Outs" List

Re-evaluate Your Current Treatment

Build a "Mental Health Menu"

Explore New Treatment Options

"I Have My Mom Back": A Powerful Story of Healing with NeuroStar TMS at Greenbrook

Helping others can be one of the most fulfilling parts of life—and for Hector, a Behavioral Health Technician at Greenbrook, that purpose is deeply personal.

This Year We Are Thankful For

As the season of gratitude arrives, we're taking a moment to reflect on the stories, people, and small but meaningful moments that inspire our work everyday at Greenbrook Mental Wellness Centers.

Finding Relief After 10 Years of Depression: Brittany's Journey with NeuroStar TMS

Brittany lived with depression for more than a decade.

Abigail's Experience: How NeuroStar TMS Fit into Her OCD Treatment Plan

For more than a decade, Abigail felt like her life was controlled by a cycle of trial and error with medications. Diagnosed with obsessive-compulsive disorder (OCD) at a young age, she had spent years hoping for relief that never fully came.

Laura's Battle with Hidden Depression and the Power of SPRAVATO® (esketamine) Nasal Spray

Discover how Laura's experience with SPRAVATO® helped her with her depression and reconnect with her family.

Re-discovering Self-Love Through SPRAVATO® at Greenbrook

Watch how personalized treatment and support from the Greenbrook Care Team helped Tori overcome depression and reconnect with herself.

Overcoming Treatment-Resistant Depression

Jackie's Success With NeuroStar® TMS Therapy at Greenbrook

Kimberly's Breakthrough: How NeuroStar® Brought Depression Relief

Watch Kimberly's inspiring journey as she shares how Greenbrook's Care Team and NeuroStar TMS helped her reclaim her life.

Reclaiming Life in Her Twenties: Chloe's Journey with NeuroStar® TMS

A Passion for Helping People

Kelly’s Journey as a Senior Behavioral Health Technician at Greenbrook Mental Wellness Centers

Seeing Progress in Mental Health Treatment

Empowering Patients Through Compassion and Expertise

Specialized Care That Sets Greenbrook Apart

A Patient's Journey Through SPRAVATO® Treatment at Greenbrook

The Treatment Journey

Step 1: Initial Evaluation

Step 2: The First Treatment

Step 3: The Observation Period

Step 4: Ongoing Treatment Plan

Step 5: Life With SPRAVATO®

SPRAVATO® (esketamine) Nasal Spray FAQs

SPRAVATO® FAQs

Q: What should I do to prepare for my first treatment?

Q: How long to the side effects last?

Q: What do people do during the two-hour observation period?

Q: If I don't really get any side effects, do I have to stay the whole two hours for observation?

Q: Am I able to drive myself home after treatment?

Q: What will SPRAVATO® taste like?

Q: What if I need to go to the bathroom during the observation period?

Q: Does Greenbrook provide IV ketamine treatments?

Q: I have a teenager who I think could benefit from SPRAVATO® treatments, do you treat adolescents?

* Based on results of SPRAVATO® long-term clinical study; additional details available in the Prescribing Information insert.

Greenbrook Mental Wellness Centers

The Heart of My Work: Patient Care 