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Pregnancy & Depression
January 18th, 2012
This finding supports a warning issued by the FDA during 2006 that alerted women that those taking SSRIs wer six times more likely to deliver babies with PPHN.
PPHN is high blood pressure in the arteries of the lungs. It causes the right ventricle of the heart- which must pump blood through the lungs to pick up oxygen- to work harder, too hard. This can ultimately cause weakening of the heart and heart failure.
Pulmonary hypertension affects about 1 in 1,000 newborns, but more than double that number of newborns of mothers taking antidepressants in the second half of their pregnancies seem to be affected. And an increased risk-though lower- appears to be present in those babies born to mothers who take antidepressants in the first half of their pregnancies.
Antidepressants of one kind or another have been implicated in- but not proven to be absolutely responsible for- increasing the risk of low birth weight, premaurity, and low blood sugar.
So, women should stop antidepressants when they learn they are pregnant, right? Not exactly. There are reasons to stop and theire are reasons to continue.
So, my advice is this:
1) If you are a woman considering pregnancy, try to stop or not to start antidepressants- as long as your symptoms are relatively mild. If you require treatment for depression, try psychotherapy or Transcranial Magnetic Stimulation (TMS), which treats depression with magnetic pulses delivered to the head and which has no known contraindications in pregnancy. But, if you have serious symptoms of depression, use SSRIs, with the advice and under the care of your physician.
2) If you find out you are pregnant while you are already taking anti-depressants, talk to your doctor about very slowly stopping them, but only if you can do so safely, without severe symptoms of depression returning.
3) Never stop antidepressants all of a sudden. This can cause serious symptoms that affect you and your unborn child.
4) Do not stop antidepressants during pregnancy if you have been suicidal while depressed in the past and antidepressants have been necessary to ward off thoughts of harming yourself.
As a final note, while many obstetricians and many primary care doctors are comfortable treating depression, I believe it is best to be seen by a psychiatrist if you are taking antidepressants and want to have a baby.
Tags: antidepressants, depression, major depression, mothers, neuropsychiatry, paxil, pregnancy, pregnant, prozac, psychiatrist, psychiatry, SSRI, SSRIs, therapy, tms, transcranial magnetic stimulation, Zoloft
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Depression Sufferers Turn to TMS
December 7th, 2011
San Diego News-Transcranial magnetic stimulation (TMS) does not require anti-depressants, and patients only need to relax in a chair while magnetic pulses are sent to key neurons in the brain.
Sonja Tanner, who is currently using TMS to treat her depression, has battled it for 25 years. “It’s been the battle of my life,” Tanner said.
Tanner has been on and off medication, but she recently turned to the Botkiss Center for TMS Therapy in Del Mar. She receives treatment by sitting in a chair, five days a week for 40 minutes, while pulses stimulate the parts of her brain that controls mood.
In about three weeks, she said she saw dramatic changes. “My focus was better, my memory was better, my anxiety was better,” Tanner said.
Dr. Philip Botkiss understands why some who have never heard of this may be skeptical. “Anything that’s new and different is going to be scrutinized in the psychiatric community and even by patients,” Botkiss said.
Tanner admitted she did not believe it would work either.
“I was the biggest skeptic, I really was … I have 25 years of non-effective treatment,” Tanner said.
The treatment has been approved by the FDA, and the American Psychiatric Association recently included TMS in its depression treatment guidelines. ”It’s still relatively new so I think the challenge will be to find where it fits in our entire set of tools,” said Dr. Catherine Moore, a longtime psychiatrist and past president of the San Diego Psychiatric Society.
”TMS has been a lifesaver for me,” Tanner said.
Tags: antidepressants, Anxiety, depression, major depression, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, psychology, therapy, tms, transcranial magnetic stimulation
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New Research Offers Anorexia Relief
November 29th, 2011
EuroNews (Nov. 21, 2011)- Katherine Damazer was at school doing exams when she became anorexic. Previously on holiday with her family in Tibet she caught a virus, became very ill and lost a lot of weight.
At first she enjoyed being thin, then dieting took over her life.
“I used to feel faint all the time and every morning I woke up and blacked out for a while every time I got out of bed, and I used to be freezing, constantly freezing and shivering and having funny heart palpitations and having this constant feeling like your stomach was eating itself. You’re just so hungry and it kind of becomes enjoyable and satisfying because you know you’re doing a really good job at having an eating disorder,” she laughs.
But it is no laughing matter. Anorexia nervosa is a complex condition.
A London-based team is investigating whether repetitive transcranial magnetic stimulation could help sufferers. They are targeting the part of the brain that is implicated in the experience of craving.
“We found that one session of Trans Cranial Magnetic Stimulation as we deliver it may reduce cravings in people with bulimia nervosa, food cravings. In people with anorexia nervosa we found that reduces their sense of fullness and fatness when they’re exposed to foods and it also reduces their anxiety,” says Consultant Psychiatrist at King’s College, London, Frederique Van den Eynde.
Professor of Eating Disorders Ulrike Schmidt says anorexia takes an enormous toll on the body.
“They have, typically, after a period of time, lots of physical disabilities, the bones crumble, osteoporosis develops, people have problems with all their internal organs,” she says.
Around a million people in the UK suffer from eating disorders and experts do not really know what causes them. Up to 20 per cent of sufferers will die from their illness, so any new potential therapy has to be good news for patients and their families.
Tags: anorexia, anorexia nervosa, Anxiety, depression, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, therapy, tms, transcranial magnetic stimulation
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TMS May Help Reduce Cigarette Cravings
November 7th, 2011
THURSDAY, Nov. 3 (HealthDay News) — In smokers, stimulating the brain in certain ways can manipulate their cravings for cigarettes, researchers have found.
The finding could lead to new treatments to help people kick the habit, according to the authors of the study published in the Oct. 15 issue of Biological Psychiatry.
Using brain imaging technology, researchers from Duke University Medical Center identified several regions of the cerebral cortex and the limbic system, which is involved in emotion, that are activated during cravings. Based on these studies, they used noninvasive magnetic stimulation of these areas of the brain in an attempt to manipulate these cravings.
“We directly stimulated a frontal brain region using magnetic fields and showed that it exaggerated smokers’ craving for cigarettes when they viewed smoking-related cues. By gaining a better understanding of how the brain influences craving responses, strategies for blocking these responses can be devised and ultimately, more effective smoking cessation treatments may be developed,” explained one of the study authors, Dr. Jed Rose, in a journal news release.
Although low-frequency stimulation did not reduce smokers’ cravings, high-frequency stimulation did have this effect when participants were viewing nonsmoking cues, the researchers found. They also noted that high-frequency stimulation reduced the ability of cigarettes to satisfy smokers’ cravings, an effect that helps keep them addicted.
More research is needed to explore how this could lead to new treatments to help smokers quit, the authors pointed out.
“This elegant study implicates the superior frontal gyrus in controlling the activity of the craving circuit,” Dr. John Krystal, editor of Biological Psychiatry, said in the news release. “Additional research will be needed to determine the potential value of repetitive [transcranial magnetic stimulation] as a treatment for smoking.”
Tags: addiction, ciggarettes, cravings, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, smoking, tms, transcranial magnetic stimulation
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Mal de Deparquement Syndrome and TMS
November 3rd, 2011
Dr. Yoon-Hee Cha, with UCLA’s Department of Neurology, answers the most commonly asked questions about Mal de Debarquement Syndrome:
What is Mal de Debarquement Syndrome?
Mal de debarquement syndrome is a term used to describe the persistent sensation of motion that people feel after they have been passively moved for a long time. It can happen with all kinds of travel but is most common after sea and air travel. It is a disorder of adulthood, with the average age of a first episode being about age 40, with women affected much more frequently than men, by at least a 3 to 1 ratio.
How can you treat it?
There is no cure for the disorder but benzodiazepines and antidepressants that raise serotonin tone can help manage symptoms in some people. For those people for whom medications don’t help and who have persistent symptoms, we are investigating neuromodulation tools like transcranial magnetic stimulation to see whether we can change the connectivity between different brain regions that may be driving the symptoms.
Can anything be done to prevent MdDS?
Overall, persistent MdDS lasting over a month is uncommon, but there are many people who are prone to experiencing recurrent episodes of MdDS. Some of the common factors include sleep deprivation and stress during travel. So, I advise my patients to plan their trips so that they are not sleep deprived when traveling. In some people who tend to get MdDS very frequently, I have them take a small dose of valium during travel.
What kind of research are you doing?
A few years ago, I did a clinical study involving about 100 patients. Now we have about 300 people in our database. It was clear that there were no structural brain or inner ear abnormalities in these patients. And, why should they? All they did was to step off of a boat or plane and developed their symptoms. So, I decided that we needed to study this disorder with functional neuroimaging like PET and functional MRI to see changes in glucose metabolism, functional connectivity, and really fine volume changes. And, it was clear that many if not most people with MdDS were not responding to medication. Which is why I decided that we needed to use external neuromodulation to treat these patients.
What is neuromodulation?
Many disorders do not respond well to medication or other more traditional therapies. So, a growing body of researchers are trying induce brain activity changes externally. The most common form of neuromodulation practiced is transcranial magnetic stimulation, or TMS. TMS is one form of neuromodulation in which a changing magnetic field placed over the head is used to induce either an inhibitory or excitatory physiological change in the brain. The effects obtained depend on the frequency, intensity, and location of the stimulation. Other forms are transcranial direct current stimulation, or stimulating peripheral nerves as a window into altering brainstem activity.
We did a pilot study using 4 different TMS conditions and there was one condition that was associated with very significant reduction in symptoms in some of the participants. So, we are testing longer exposure to TMS to see whether can induce a longer duration of symptom relief.
Tags: mal de deparquement, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, therapy, tms, transcranial magnetic stimulation
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TMS Research on Social Behavior May Have Therapeutic Applications
October 26th, 2011
If the front part of the cerebral cortex is less active then people have less control over their social behaviour and automatically follow their inclinations more. This emerged from a study by Inge Volman that will be published on 25 October in the Journal Current Biology. The research was the first to make use of magnetic stimulation (TMS) to suppress this part at the front of the prefrontal cortex. During TMS a changing magnetic field on the head temporarily influences the activity of the underlying part of the brain.
Study subjects in whom the activity of the prefrontal cortex was temporarily suppressed could control their emotional impulses less well than normal. Their amygdala deep in the brain that is responsible for emotional reactions then becomes extra active. This emerged from the study by Inge Volman and her colleagues from the Behavioural Science Institute and the Donders Institute of Radboud University Nijmegen. This study is important for a good understanding of the role played by various parts of the brain and could in the future contribute to the treatment of aggression and social anxiety disorders.
Approach versus avoidance
Volman allowed the study subjects to perform a so-called approach-avoidance task in which they were shown emotional faces. Normally we withdraw when we see an angry face and try to come closer if we see a happy person. The study subjects were asked to respond in exactly the opposite manner. Using a joystick study subjects had to approach angry faces and push away happy faces. They were significantly worse at doing this after disruption of the aPFC. The emotion area – the amygdala – of the study subjects became extra active.
‘This ties in with what we already knew from animal and patient studies. Instead of just measuring and observing behaviour we can also directly influence brain activity with the help of TMS. Furthermore, combining TMS with fMRI makes the design of this study extra special, as then we can observe the effects in both the behaviour and the brain,’ says Volman.
Therapeutic application
Even though we do not know exactly how it works, TMS is already used commercially for the treatment of depression. Based on this study are there possible therapeutic applications of TMS in people who have a disrupted control system?
‘The effect of TMS is temporary and that makes it difficult to apply therapeutically. A possible application could be helping people to overcome a certain behaviour. For example, people suffering from a social anxiety disorder have a strong urge to avoid social situations, such as a party. They are often stuck in a vicious circle: as a result of this avoidance they never learn that they can cope with the situation and so the anxiety increases. This avoidance tendency could possibly be reduced with the help of TMS. Then after a treatment the patient might dare go to a party and discover that it was quite an enjoyable experience. He or she might then dare to go to another party without the need for TMS first.’
Anterior Prefrontal Cortex Inhibition Impairs Control over Social Emotional Action. Current Biology, 25 October 2011
Inge Volman, Karin Roelofs, Saskia Koch, Lennart Verhagen, Ivan Toni
Tags: agression, Anxiety, depression, major depression, neuropsychiatry, psychiatrist, psychiatry, therapy, tms, transcranial magnetic stimulation
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TMS Weighed for Resistant Anorexia Nervosa
October 21st, 2011
Patirce Wendling-FT. Lauderdale, FLA. What do atypical antipsychotics, an analeptic, and targeted magnets have in common? They all might play a role in the treatment of anorexia nervosa.
“When you have a disorder that is so treatment resistant, it’s like metastatic breast cancer; you have to think outside the box for new interventions,’ Dr. Alan S. Kaplan said at a workshop on eating disorders at the meeting.
Current statistics indicate that 20% of patients who are diagnosed with anorexia are resistant to any intervention, and remain chronically ill and disables. The needs of these patients have been largely neglected by the field, even though their numbers continue to grow because mortality has gradually decreases from 22% in older studies to about 8-10% today, said Dr. Kaplan, the Loretta Anne Rogers Chair in Eating Disorders and professor of psychiatry at the University of Toronto.
In his experience, many of these patients are now in their 40s and 50s, and have been ill for 20-30years. Most of them suffer from significant medical complications, including renal failure, cardiac arrhythmias, and osteoporosis with resulting hip fractures that have left them wheelchair bound.
“They are unbelievably disables,” he said. “They are more disabled on quality of life measurements than a comparative group of schizophrenics in the hospital. It’s a sobering experience to spend time with these patients.”
One novel approach that might be useful is use of repetitive transcranial magnetic stimulation (rTMS), which has been shown to be effective in some patients with depression, schizophrenia, and obsessive-compulsive disorder. Current magnets stimulate superficial cortical areas of the brain, but Dr. Kaplan suggests that a better target might be the insula-a cerebral cortex structure located deep within the lateral fissure that plays a role in interoceptive awareness and motor control.
His group has completed and unpublished meta-analysis of neuroimaging studies in anorexia which provides evidence of over-activity in the insula.
The team members have subsequently contracted with an Israeli biotechnology firm to construct a patented magnet for rTMS the will specifically target the insula. They also plan to launch an open-label pilot trial of rTMS for anorexia.
Tags: anorexia, anorexia nervosa, depression, eating disorders, neuropsychiatry, OCD, psychiatrist, psychiatry, tms, transcranial magnetic stimulation
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TMS: Initial Promise in Alzheimer’s Trial
October 13th, 2011
Deep transcranial magnetic stimulation (TMS) is a medical application of electromagnetic technology. It essentially relies on the fact that neurons communicate via chemical-electric signals; hence, like other electrical signals, neuronal communication should be able to be influenced by external magnetic fields, or pulses.
The Jerusalem-based company Brainsway has been applying deep TMS technology to potentially treat a number of clinical conditions, some of which have been previously reported here in Medgadget, such as depression, attention deficit disorder, and smoking addiction. Now, the company reports initial positive findings in a small trial of Alzheimer’s patients treated with deep TMS.
According to Brainsway’s press release:
The interim results are for 24 patients that were divided into three groups: a sham stimulation control group, a low-frequency (1 Hz) treatment group and a high-frequency (10 Hz) treatment group. Each subject received treatment over 8 weeks, and the efficacy of the treatment was evaluated both during the trial and over the course of the subsequent 8-week period.
The treatment was well-tolerated by all subjects, with no side-effects, except for one incident involving a sham control subject, which the principal investigator believes to be unrelated to the treatment.
The trial used the Alzheimer’s Disease Assessment Scale – Cognitive (ADAS-Cog) test (the main efficacy scale used in Alzheimer’s disease clinical trials), as well as additional accepted scales of disease severity (CGI, ADL, CDR) and a quality-of-life scale (QoL Caregiver Scale) to assess the efficacy of treatment. These are the main assessment scales used to evaluate efficacy in the literature.
Analysis of ADAS-Cog results revealed a 4.2-point improvement in the high-frequency treatment group, compared with a 1.8-point improvement in the sham control group, and a 1.4-point deterioration in the scores of the low-frequency treatment group, the latter occurring mainly during the 8 weeks post treatment. In addition, in the high-frequency treatment group, severity of cognitive impairment at entry into the trial was correlated with clinical improvement (the more severe the cognitive impairment, the more the patient improved following treatment).
CDR, ADL, CGI and QoL Caregiver Scale scores indicated that high-frequency treatment halted the deterioration of the disease and even produced a moderate improvement relative to sham treatment. Similar to the ADAS-Cog test results, these scores also indicated a worsening in the condition of patients treated with low-frequency electromagnetic stimulation.
The principle investigator commented, “The interim results from the trial indicate that Deep TMS therapy for Alzheimer’s disease patients is safe and side-effect-free. Although the small sample size somewhat hampers our ability to draw any definitive conclusions concerning treatment efficacy, the results nonetheless suggest that high-frequency treatment leads to improvement on Alzheimer’s disease assessment scales, whereas low-frequency and sham treatment do not.”
Tags: adhd, alzheimers, dementia, depression, neuropsychiatry, psychiatrist, psychiatry, tms, transcranial magnetic stimulation
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TMS Increases Brain Activity to Battle Severe Depression
September 30th, 2011
Mlive.com, Sept. 26th- It wasn’t long ago that Phyllis Myers felt wrapped in a fog of confusion and despair.She read obituaries and envied the people who died in car accidents. She prayed to God to spare a child from having cancer by giving it to her.
She battled her depression with every tool she could find: She took two antidepressants, saw a psychotherapist, went for daily walks and used light therapy in winter. She forced herself out of bed every morning and stayed involved in social activities.
Still, she felt “totally debilitated.” She gave up her home-based quilting business because the cognitive effects of depression left her unable to recall how to use the software for her quilting machine. “It felt like I was spiritually abandoned,” said Myers, a petite 60-year-old Grand Rapids woman with three children and four grandchildren.
When she was offered the option of trying transcranial magnetic stimulation, a new therapy for severe depression, Myers didn’t hesitate: She said, “Sign me up.” Today, a year after receiving treatment, she finds it difficult to describe the changes in her life.
“Unbelievable,” she said. “I’m almost back to where I was before. I’m at 90 percent, maybe even 95.”
The treatment, called TMS, is a relatively new approach to treating severe depression. Approved in 2008 by the U.S. Food and Drug Administration, it is available locally only through Psychiatric Centers.
Dr. Henry Mulder said he and his partner, Dr. Phil Fox, were eager to provide the treatment after following its progress through clinical trials. Mulder said MRI brain scans show it causes an immediate increase in activity in the brain’s parietal cortex, which is transmitted to the amygdala, a structure deep in the brain that is involved with mood. “Those areas of the brain that are underactive in depression get stimulated back up to their normal activity level,” he said.
A patient usually receives 30 to 36 daily treatments, each lasting 39 minutes. Treatment continues until no more progress is seen. However, some patients report improvement continues for a month or two afterward.
“It works well with people who have failed many drug trials,” he said. “We’ve treated a lot of people who have failed three, four medication trials, or more than that.”
Finding better treatments for severe depression is crucial, Mulder said. Despite the development of new of anti-depressants and growing acceptance of medications, many patients still are debilitated by the disease.
Mulder’s office has treated nearly 30 patients since acquiring the machine 15 months ago. Only one has come back for a refresher treatment. Mulder said his statistics are better because he keeps patients on medication while undergoing treatment, so they benefit from the combined effect. “TMS stimulates the activity of the cells, and the medication improves the transmission of impulses between nerve cells, so you’re kind of hitting the same problem in two places,” Mulder said. “It definitely works better when used in combination.”
When Myers underwent daily treatments, she felt a tapping sensation on her scalp. It was uncomfortable, she said, but not painful. The results were evident almost immediately, however. Within days, she felt better. Within a couple of weeks, she launched a home-based business with her daughter making and selling granola bars. She has not yet achieved her goal to live without medications. She still takes Cymbalta and Lexapro — although she has reduced the dose of Cymbalta.
“My psychologist recommended I stay on it through the winter, because winters are really, really hard for me,” she said.
Still, she said she is far ahead of where she was before treatment.
“I’m thrilled,” she said. “I’m just thrilled.”
Tags: depression, major depression, neuropsychiatry, neurotransmitters, psychiatrist, psychiatry, psychology, tms, transcranial magnetic stimulation
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