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Angela Couch, RN, MSN, PMHNP-BC
Lindner Center of HOPE, Pyschiatric Nurse Practitioner

Making decisions about which medication to prescribe is a complicated process.  Janicak, et al (2006, p. 1) described the complexity of the issue fairly well,

“…while improved therapies to ease a patient’s suffering are constantly emerging, the practitioner is required to continually assimilate new information about recent advances, including novel agents targeted to affect specific components of various neurotransmitter systems, combination strategies, alternative uses of existing agents, and the specialized requirements of a growing number of identified diagnostic subgroups.”

The clinician must first have identified a valid diagnosis, and determine whether treatment with medication is indicated.  In some cases, psychotherapy alone may be an adequate treatment; whereas pharmacotherapy is less frequently an adequate treatment all by itself and is often paired with psychotherapy.  Diagnosis will somewhat narrow the field of choices, and comorbid mental health conditions must be considered as well. If the patient has more than one mental illness, it is wonderful when there is a class of medication which may be able to treat all the symptoms in one drug, but often that is not the case.  Treatment of mood disorders is often prioritized, particularly if a bipolar spectrum illness is present. For instance, though antidepressants are generally a first line treatment for anxiety related disorders, giving an antidepressant to a patient with a bipolar spectrum illness can be quite destabilizing. In that case, the mood disorder should be addressed with mood stabilizing medication prior to consideration of antidepressant use.

There are potential risks and benefits to any medication, and the clinician much consider these and discuss them with the patient. Special populations require special considerations. Treating pregnant patients, children or adolescents, the elderly, or those with certain medical conditions, may pose additional risks; this may make many medications, which might otherwise be appropriate, be contraindicated due their side effects profile.  Sometimes, the potential side effects of a given medication may be beneficial to certain patients and their mental health or other comorbid symptoms, and this may help narrow the field of choices.  During treatment, the patient is continually reassessed to determine if they continue to benefit from the medication, and whether they are experiencing any side effects that should be closely monitored or may require a treatment modification.

Patients may have had prior positive or negative experiences on medications, and this can also help drive the decision making process. For instance, this may help a clinician to decide whether to try the same or very similar medication again, or to consider changing class of medication.  Sometimes, a close family member’s prior response to medication may be considered.

Pharmacogenetic testing is a recent advancement in pharmacotherapy.  There is a lack of consensus about the value of this genetic testing.  It would be misleading to state that the genetic testing results can indicate the medication to which a patient will respond favorably.  However, it can identify whether patients may metabolize various drugs that pass through the CYP P450 system in different ways, which may impact outcomes or suggest dose modification. Also, there a limited number of medications for which the FDA has specific labelling regarding recommendations for certain types of metabolizers. So it is possible that pharmacogenetic testing would be a consideration in the decision making process, but not a required one. It is not often covered well, if at all, by insurance, and the out of pocket portion can be cost prohibitive for some patients.

Practice guidelines can be very beneficial. For instance, the APA has been developing practice guidelines since 1991, and these cover a wide range of topics, which undergo periodic updates. The guidelines are formed by work groups of actively practicing psychiatrists who are selected based on their experience in various topic areas.  Recommendations are based on evidence that includes research studies and clinical consensus.

Last but not least, cost is a factor that unfortunately must be considered for many patients.  For those that have high deductible insurances, or no insurance, many drugs may be out of reach including those that may add an extra layer of medical monitoring such as frequent laboratory testing.

In summary, decision making regarding medication choice is complex process.

References:

APA Practice Guideline Development Process (n.d.) Retrieved from:  https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/APA_Guideline_Development_Process.pdf

Janicak, P.G., Davis, J. M, Preskorn, S.H., Ayd, F.J., Marder, S.R. & Pavuluri, M.N.  (2006). Principles and practice of psychopharmacotherapy (4th ed.).  Philadelphia, PA: Lippincott Williams & Wilkins.

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Lo que fui es lo que soy….

(“What I was is what I am”. An article addressing the challenges and consequences of immigration from a social and psychological perspective and how this process ends up shaping us in multiple and unexpected ways while trying to maintain and cultivate original roots.)

Soy venezolana. Soy psiquiatra y psicoanalista. Le debo a mi país la esencia de mi formación como professional y mi Corazon latino. Finalmente, luego de mucho esfuerzo  tengo una practica solida como psiquiatria y psicoterapeuta en Mason, Ohio. Volver a estudiar fue un requisito inevitable para poder recuperar un pedazo de mi identidad perdida que no cupo en mi maleta a la hora de emigrar y que alimentaba de forma negativa a la nostalgia que no he podido sacudirme desde que llegue a los Estados Unidos de America. Desde que empece a trabajar formalmente siempre había querido encontrar una manera que me acercara a la comunidad latina y desde donde pudiese compartir mis ideas y experiencias en relación a distintos temas relacionados a la salud mental. Es una deuda pendiente con mi raiz latina. Mi intención es abrir un espacio que considero indispensable para abordar la salud mental sin tapujos ni prejuicios hasta ahora muy ligados a la manera como nuestra cultura tiende a referirse a cualquiera que sea la enfermedad mental. Todos podemos hablar con comodidad y compartir nuestra experiencia y nuestro sufrimiento físico cualquiera que este sea pero cuando se trata de nuestro sufrimiento psíquico tendemos a esconderlo o a avergonzarnos y sin darnos cuenta terminamos aislándonos y de esta forma empeorando nuestra padecer.

Así que entre mis resoluciones de ano nuevo estuvo darle inicio a esta columna y como seguramente les ha pasado a ustedes tambien con sus propias resoluciones me ha costado arrancar y con mucha suerte estarán ustedes leyéndome antes de que el ano termine…. Es decir casi con un ano de retraso en mi calendario de ilusiones.

He decidido titular mi columna “Lo que fui es lo que soy”. Es el nombre de una de mis canciones preferidas y recoje lo que a mi manera de ver es una utopia porque no es posible negar los efectos del tiempo, el espacio y la distancia en la identidad de todo emigrante pero a la vez es tambien un ancla que me permite estar atenta a la necesidad de preservar y cultivar mi identidad Latina.

No hay duda que al pisar otro pais con el proposito de emigrar se produce una division, una ruptura entre lo que dejamos atras y lo que empezamos a construir. Sin duda las redes sociales, las llamadas telefonicas, el facetime o el whatsapp sirven de cuerda que intenta mantener cierta continuidad entre estos dos mundos. Eso contando con que el internet y las telefonicas esten de nuestro lado, cosa que no es lo usual en paises como el mio.  Es una cuerda que a veces se siente floja o muy tensa dependiendo el dia y el interlocutor y caminar en ella da mucho susto por no decir vertigo y es entonces cuando empezamos a evitarla o a caminar en puntillas para que no se rompa. Nos comunicamos menos con los que quedaron del otro lado, o decimos menos omitiendo asuntos importantes por aquello de no preocupar al otro y asi sin darnos cuentas vamos perdiendo gente querida muchas veces ignorando por que.

Hace poco lei que “la emigracion distorsiona las leyes de la fisica. Es todo alucinante y un poco incomprensible”. “ Todo el que emprende el largo y azaroso viaje de la migración —que te cambia como persona, que siempre te somete a toda clase de sorpresas, que te arroja a orillas inesperadas— se convertirá en otra persona más rápida e imprevisiblemente de lo que espera y de lo que hubiera pasado en lugar de origen. Todos cambiamos, queramos o no, a medida que vivimos, pero ese cambio se dispara si nos mudamos de ciudad o de país o de continente. Así que irse implica siempre, en cualquier contexto, que te harás otra persona más pronto que tarde, y por tanto irás dejando de tener cosas en común con quienes te rodeaban en tu mundo anterior.”

Esta columna es mi intento por mantener esa cuerda firme a sabiendas de que las consencuencias de la migracion son muchas, y algunas irreversibles.  No me queda otra que hacer el intento. Tratar de dibujar en este espacio maneras de navegar entre estos dos mundos y revisar sus consecuencias en lo psicologico. En mi proxima columna explorare el tema de el duelo como proceso inevitable en toda migracion.

Margot Brandi, MD
Medical Director, Sibcy House
Staff Psychiatrist

 

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By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry

 

Innovations in Mental Health Treatment

By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry
The past year has brought exciting innovations in treatment options for people with attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD.) The U.S. Food and Drug Administration (FDA) approved the marketing of two devices which offer non-medication alternatives for the treatment of OCD and ADHD.  In August 2018, the Brainsway Deep TMS (Transcranial Magnetic Stimulation) system was approved for the treatment of OCD.  Deep TMS uses specially designed magnets to stimulate specific larger volume areas of the brain beneath the surface of the skull.  It is a non-invasive treatment that involves five 20-minute sessions per week for six weeks while sitting in a chair wearing a helmet with a sensation of tapping during the treatment.  Patients can continue medication and psychotherapy while receiving deep TMS.  According to the National Institute of Mental Health (NIMH), the lifetime prevalence of OCD among U.S. adults is 2.3% and 50% of these have had serious impairment.  Having another treatment option will bring hope to many people with severe OCD.

In April 2019, the Monarch eTNS (external trigeminal nerve stimulation) system was approved for the treatment of pediatric ADHD as monotherapy in children ages 7 through 12 years old who are not currently taking prescription ADHD medications. The Monarch eTNS System is intended to be used at home under the supervision of a caregiver when the child is sleep. The cell-phone sized device generates a low-level electrical pulse that feels like a tingling sensation and connects via a wire to a small patch that adheres to a patient’s forehead, just above the eyebrows. The system delivers electrical stimulation to the branches of the trigeminal nerve, which sends therapeutic signals to the parts of the brain thought to be involved in ADHD. The NIMH reports that the prevalence of ADHD is increasing, and severe ADHD is being diagnosed at an earlier age. This can be a treatment alternative for parents who prefer to avoid medications at an early age. Clinical response is expected in four weeks.

The mechanism of action of most antidepressants involve the neurotransmitters serotonin, norepinephrine, and dopamine. In March 2019, two antidepressants with novel mechanisms
of action were approved. Zulresso (brexanolone) was the first drug specifically approved for postpartum depression. Postpartum depression affects about 15% of women. Zulresso modulates the neurotransmitter GABA. It is administered as a 60-hour intravenous infusion in a registered healthcare facility. Symptom improvement was seen at the end of the infusion and at the end of 30-day follow-up. There has never been a medication that treats the symptoms of postpartum depression so rapidly, so this can significantly improve the quality
of life for the mother, infant, and her support system.

Spravato (esketamine) nasal spray was approved for treatment-resistant depression in conjunction with an oral antidepressant. Patients must have tried at least two antidepressant treatments at adequate doses for an adequate duration in the current depressive episode before trying Spravato. The spray must be administered in a certified medical office where the patient can be monitored. Spravato is taken twice a week for four weeks then once a week for a month, then once a week or once every two weeks. It is an antagonist of the NMDA receptor, a type of glutamate receptor. Approximately 30% of people with MDD are considered to have treatment-resistant symptoms and have the potential to benefit from esketamine.

For more information about these treatment options: https://www.brainsway.com/treatments/obsessive-compulsive-disorder 

http://www.monarch-etns.com/ 

https://www.zulresso.com/ 

https://www.spravato.com/

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By Jen Milau, APRN, PMHNP-BC
Lindner Center of HOPE,
Psychiatric Mental-Health Nurse Practitioner

 There’s no denying it: the advent of social media has changed the way we connect with one another. In some ways, these programs have offered an opportunity to locate and reconnect with lost friends or family members – a phenomenon that was not even fathomable until recent decades. However, this near-immediate accessibility of information, coupled with the rapid growth of social media sources, has not been accompanied by a “user guide” or an algorithm for appropriate and healthy incorporation into our daily lives. Instead, the technology has been thrust upon us as a society, and we have been left with the task of “figuring it out as we go.” In the field of psychiatry and mental health, we are seeing the repercussions of this in a number of unexpected ways, and those who have been hit the hardest are among our most vulnerable – children, adolescents, and young adults.

As a clinician working primarily with this population, I have been struck by the stark and abrupt increase in suicidality and mental health concerns within the last five years. According to the Centers for Disease Control, in 2017, suicide stood as a leading cause of death for individuals aged 10-34, second only to accidental injury. Just this year, the American Psychiatric Association (APA) published data Continued from page 1 which cites that “more U.S. adolescents and young adults in the late 2010s (vs. the mid-2000s) experienced serious psychological distress, major depression, and suicidal thoughts, and more attempted suicide and took their own lives… These trends are weak or nonexistent among adults 26 years old and over, suggesting a generational shift in mood disorders and suicide-related outcomes rather than an overall increase across all ages.” The specific data presented within this report reflect a 40-122% increase (depending on specific age range) in suicidality and psychological/mood disturbances among individuals age 12-25. So the question stands: why have young people been so disproportionately affected?

The answer to this is complex, and certainly not yet fully understood. It is important to first consider what we know: Adolescence is a period of significant neurochemical and biological transformation. With these physiological changes comes the development of a sense of identity – a process fueled by social interactions, sexual exploration, experimentation with interests, exposure to information, and individual expression. These facets of development have not changed by any means. Rather, the way in which today’s youth is exposed to these experiences has shifted from primarily organic, physical, human interactions to online exchanges through a variety of social media and communication apps available with a simple tap of a finger. Since this happens behind a screen, kids are not faced with the immediate implications of their words or actions, as they do not witness the non-verbal cues accompanying a person’s response, and do not experience the inevitable feeling of anxiety that goes along with confrontation or conflict in a real-time situation. They have the opportunity to carefully calculate their responses over time, or blatantly ignore a person with whom they do not want to interact, rather than being placed into a situation that requires problem-solving and relational abilities in the immediate moment. This has led to a generation of individuals who have largely avoided natural social responses; in turn, we are seeing a serious rise in the prevalence of social anxiety and kids who are devoid of many vital interpersonal skills.

Additionally, within the world of social media, we are offered the opportunity to customize our “online identities” to mirror whichever characteristics we choose to share with others. Due to our human need for acceptance and attention, this usually results in the meticulous formation of an “ideal self” – one which typically is not reflective of our inherently flawed (and beautifully unique) personalities and instead represents a false utopian identity used to highlight those traits of ourselves and our lives that we feel may be most desirable to others. As this practice becomes typical of an entire society, we begin to unconsciously accept these “pseudo-selves” as reality, leading to the habit of comparing our actual lives to those that are portrayed on the internet. This can result in significant issues with self-esteem, increased self-doubt, shame, body image concerns, and social isolation – problems which, for an individual predisposed to mental illness, could trigger a major mood episode or exacerbation of anxiety symptoms.

Further, the immediate accessibility of information to which we have become accustomed has unfortunately led to an expectation for instant feedback and gratification that is simply not applicable to most real-life scenarios. Studies suggest that the neurochemical response to “likes” on a post or picture actually mirror that which is experienced with illicit drug use or other behavioral addictions. This, then, leads to further desire to obtain more likes, and the consequent sense of disappointment and desperation when posts do not receive the attention that we were expecting.

When we view these ideas in the context of an adolescent who is developmentally tasked with the goal of exploring and forming a sense of self while also battling the physical and emotional implications of rapid growth and hormone changes, this becomes extraordinarily problematic. Many patients that I see describe feelings of worthlessness and hopelessness due to their perception that they are not as “successful” as others they see online. For a child who has endured trauma, the ability to form harmful connections with ill-intentioned adults is too readily accessible, leading to exploitation and further exacerbation of trauma-related symptoms. Children with attention issues are experiencing insomnia due to being constantly stimulated by their devices into the nights, resulting in reduced academic performance and mood dysregulation. And most importantly – families are not connecting in the ways that are imperative for fostering well-adjusted and cognitively flexible young adults.

This being said – there is certainly hope for change moving forward. As we adapt to the presence of technology within our lives, we are learning more and more about the importance of moderation in regards to screen time and devices. As a clinician, I preach to my patients and their parents about the risks of social media and unlimited time with technology and encourage open conversations regarding limits and expectations for its use. I challenge parents to model what it looks like to balance screen time and “real” time, and recommend the implementation of rules for all members of the family, not just children or adolescents. By increasing the number of organic experiences and social interactions that our children have, we are preparing them to be able to adjust to the unexpected, unpredictable twists and turns.

 

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By Anna I. Guerdjikova, PhD, MSW, LSW

“Mens sana in corpore sano” is a Latin saying from the Satires of Juvenal (ad c.60–c.130) , literally translating to ‘a healthy mind in a healthy body’ and widely used nowadays to describe the concept of wellness – the need for both physical and mental wellbeing to be present for a person to be healthy. When raising children, paying attention to both aspects of health is indeed critical to ensure their bodies and minds grow and develop to the best of their potential. The mnemonic below (BE SAFE) can help with remembering the key concepts of how to parent healthy children.

B– Build sense of belonging. Ensure that your child socializes with an appropriate peer group, that they participate in activities suitable for their age and that they learn to develop nontoxic friendships. Spending time with relatives and family friends fosters sense of security and belonging and teaches children how to nurture meaningful relationships.

E– Educate and encourage. Encourage children to develop age appropriate competencies, both social and academic. Be their role model in teaching them respect, acceptance of diversity, responsibility, accountability and kindness. Reinforce positive behaviors and decision making, encourage them to help others by setting an example (like volunteering as a family).

S– Enough sleep is absolutely critical for wellness (9-13h/ night for ages 3-12; 8-10h/ night for teenagers).1 More than 70% of children in a contemporary family get less sleep than recommended, thus improving sleep hygiene for everyone in the household can significantly boost family wellness. Help them establish and keep a regulated schedule (even on weekends and during vacations) by setting an example and discussing the benefits of good sleeping habits.

A –According to the U.S. Department of Health and Human Services guideline issued in 2018, children 6 to 17 years of age can “achieve substantial health benefits by doing moderate-and vigorous-intensity physical activity for periods of time that add up to 60 minutes or more each day”.2 Unstructured play in the park, biking, walking, and sports, both recreational and competitive, they all count.

F –Appropriate food choices with up to 5 servings of fruits and veggies per day and at least a few family meals a week. Frequent family meals increase the odds of child positive social skills and engagement in school, and decrease the likelihood of child problematic social behaviors3; they also have protective effect on the mental health of adolescents, particularly for depressive symptoms in girls. 4

E -Limit use of electronics. In 2016, the American Pediatric Association issued recommendations regarding screen time use and while they vary by age group, the overarching idea with older children is to “balance media use with other healthy behaviors”. 5 For children younger than 18 months the use of screen media other than video-chatting, should be altogether avoided.

Raising healthy children is hard. Raising healthy children when the parent struggles with mental illness can be particularly challenging; it is of paramount importance for them to seek professional help, but to also solicit support for daily logistics from friends and family. The old African proverb “It takes a village to raise a child” is especially relevant when one or more members of the family are suffering with mental illness, thus actively requesting help, practicing self-care and knowing one’s limitations can improve the wellness of the entire family.

  1. https://edubirdie.com/articles/american-academy-of-pediatrics-announces-new-recommendations-for-childrens-media-use/
  2. J Fam Psychol. 2014 Aug;28(4):577-82. doi: 10.1037/fam0000014. Frequency of family meals and 6-11-year-old children’s social behaviors.Lora KR, Sisson SB, DeGrace BW, Morris AS
  3. J Nutr Educ Behav. 2017 Jan;49(1):67-72.e1. doi: 10.1016/j.jneb.2016.09.002. Family Meals and Adolescent Emotional Well-Being: Findings From a National Study. Utter J1, Denny S, Peiris-John R, Moselen E, Dyson B, Clark T.

120 Tools and Tricks to Protect Your Kids Online

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By Nicole Bosse, PsyD
Lindner Center of HOPE, Staff Psychologist

What is panic disorder? Panic disorder consists of recurrent unexpected panic attacks, specifically a spike of intense anxiety
or discomfort that reaches a peak in minutes that is followed by four or more of the following symptoms: racing heart/palpitations, sweating, trembling/shaking, shortness of breath, feelings of choking, chest pain or discomfort, nausea, dizziness, chills or heat sensations, numbness or tingling in the hands or feet, derealization, fear of losing control or going crazy, and fear of dying. This has to occur in combination with fear and worry about having additional attacks, and a significant change in behavior related to the attacks, such as avoiding situations or activities that might bring on panic.

When treating panic disorder, it is treated mostly from a cognitive behavioral approach. The cognitive piece targets the person’s misappraisals about the panic. Individuals with panic disorder tend to overestimate the likelihood of panic occurrence, underestimate one’s ability to cope with panic, and exaggerate the negative consequences of panic attacks.

By helping the individual to identify the misappraisals and working on challenging them, individuals are less fused with their thoughts and can start to think differently about things rather than buy into their thoughts as facts.

The behavioral piece of the approach involves exposure therapy, specifically exposure to what situations they avoid, but also interoceptive exposures. Interoceptive exposures involve gradually exposing oneself to the physical sensations of the panic attack that are feared. Working with a therapist to identify the exposures that rank from low to high is important. Once this is identified, the patient and therapist work from the least distressing to the most distressing. The following are some examples of possible interoceptive exposures:

* Running in Place

* Holding breath

* Head shaking (side to side)

* Spinning in a chair

* Mirror staring

* All over muscle tensing

* Straw breathing

* Over breathing

* Head between legs

The therapist and the individual work to complete just one of these exposures, five times during the day for about 30-60 seconds. This is done repeatedly every day until the person habituates to that sensation before moving on to the next exercise.

 

Another exposure idea that is sometimes used is pretending to actually have a panic attack in a public area. This strategy is brought in when the person’s fear centers around the social consequences of having a panic attack, such as not wanting others to crowd around them or being embarrassed. For example, I have suggested that individual’s go to a store and practice sitting down somewhere to pretend they are dizzy or cannot catch their breath. This is a great strategy for teaching the person that what they typically fear in that situation is not as bad as they make it out in their mind. It actually usually ends up being pretty uneventful.

 

Exposures for the avoidance of situations is a little more specific for the person and their unique avoidances. Some common examples of avoidance that I have come across are the following: avoiding caffeine, avoiding intense exercise that increases their heart rate, avoiding being in a car, avoiding driving, avoiding going into stores, avoiding traveling far distances from one’s house, avoiding going places alone, avoiding going places without safety items (i.e., water, benzodiazepine, food, etc.), and avoiding places where the amount of time being there is uncertain (i.e., waiting in lines, sitting down at a restaurant, etc.)

Once the individual’s unique avoidances are identified, the therapist and individual work to create another hierarchy, ranking from low to high distress. For example, if someone avoids going certain distances from their house, some exposures could consist of walking down the street and gradually increasing the distance. A similar strategy could also be used for driving, gradually increasing the distance of driving from a person’s house. Similarly, for line waiting, the individual could practice waiting in lines and gradually increase the amount of time they wait in line, working up to actually waiting in the entire line and being uncertain of when it when it will end.

As you can see by the above described therapy, the main component is facing what the individual fears and letting the body learn that their anxiety will decrease without having to escape the situation. Panic disorder is a very treatable disorder, especially when engaging the correct therapy for it and when combined with the appropriate medication.

 

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 Innovations in Mental Health Treatment

By Danielle J. Johnson, MD, FAPA
Lindner Center of HOPE, Chief
of Adult Psychiatry

The past year has brought exciting innovations in treatment options for people with attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), and obsessive-compulsive disorder (OCD.) The U.S. Food and Drug Administration (FDA) approved the marketing of two devices which offer non-medication alternatives for the treatment of OCD and ADHD.  In August 2018, the Brainsway Deep TMS (Transcranial Magnetic Stimulation) system was approved for the treatment of OCD.  Deep TMS uses specially designed magnets to stimulate specific larger volume areas of the brain beneath the surface of the skull.  It is a non-invasive treatment that involves five 20-minute sessions per week for six weeks while sitting in a chair wearing a helmet with a sensation of tapping during the treatment.  Patients can continue medication and psychotherapy while receiving deep TMS.  According to the National Institute of Mental Health (NIMH), the lifetime prevalence of OCD among U.S. adults is 2.3% and 50% of these have had serious impairment.  Having another treatment option will bring hope to many people with severe OCD.

In April 2019, the Monarch eTNS (external trigeminal nerve stimulation) system was approved for the treatment of pediatric ADHD as monotherapy in children ages 7 through 12 years old who are not currently taking prescription ADHD medications. The Monarch eTNS System is intended to be used at home under the supervision of a caregiver when the child is sleep. The cell-phone sized device generates a low-level electrical pulse that feels like a tingling sensation and connects via a wire to a small patch that adheres to a patient’s forehead, just above the eyebrows. The system delivers electrical stimulation to the branches of the trigeminal nerve, which sends therapeutic signals to the parts of the brain thought to be involved in ADHD. The NIMH reports that the prevalence of ADHD is increasing, and severe ADHD is being diagnosed at an earlier age. This can be a treatment alternative for parents who prefer to avoid medications at an early age. Clinical response is expected in four weeks.

The mechanism of action of most antidepressants involve the neurotransmitters serotonin, norepinephrine, and dopamine. In March 2019, two antidepressants with novel mechanisms of action were approved. Zulresso (brexanolone) was the first drug specifically approved for postpartum depression. Postpartum depression affects about 15% of women. Zulresso modulates the neurotransmitter GABA. It is administered as a 60-hour intravenous infusion in a registered healthcare facility. Symptom improvement was seen at the end of the infusion and at the end of 30-day follow-up. There has never been a medication that treats the symptoms of postpartum depression so rapidly, so this can significantly improve the quality of life for the mother, infant, and her support system.

Spravato (esketamine) nasal spray was approved for treatment-resistant depression in conjunction with an oral antidepressant. Patients must have tried at least two antidepressant treatments at adequate doses for an adequate duration in the current depressive episode before trying Spravato. The spray must be administered in a certified medical office where the patient can be monitored. Spravato is taken twice a week for four weeks then once a week for a month, then once a week or once every two weeks. It is an antagonist of the NMDA receptor, a type of glutamate receptor. Approximately 30% of people with MDD are considered to have treatment-resistant symptoms and have the potential to benefit from esketamine.

For more information about these treatment options: https://www.brainsway.com/treatments/obsessive-compulsive-disorder 

http://www.monarch-etns.com/ 

https://www.zulresso.com/ 

https://www.spravato.com/

 

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Trevor Steinhauser’s struggle with mental illness began at an early age, but thanks to receiving early help and support for his symptoms, Trevor is feeling better and is now four years sober.

Trevor and Tracy Cummings, MD, Medical Director of Inpatient and Partial Hospital Program Services at Lindner Center of HOPE, spoke with Local 12’s Liz Bonis about mental illness warning signs to watch for in children, such as anxiety and panic attacks.

Trevor credits the Lindner Center of HOPE for helping him overcome his own issues with mental illness and substance abuse. By employing a team approach and giving him a voice in his own treatment, Trevor says the Center was the first to help him learn coping skills for lifelong problems, such as depression and anxiety.

According to Dr. Cummings, behaviors that lead to addiction often present in a person’s youth.

“The reality is that, in any given year, one in five of us are experiencing mental illness. About half of those cases started before age 14, so a lot of people have been having symptoms for a long time. They’ve just figured out ways to either adapt to those or not talk about those,” Dr. Cummings said.

Lindner Center of HOPE has a comprehensive program that treats both substance abuse and co-occurring mental health disorders. Learn more about our Intensive Outpatient program here.

 

 

Watch the full story from Trevor and Dr. Cummings’ sit down with Liz Bonis interview on local12.com

 

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Jennifer L. Farley, PsyD
Lindner Center of HOPE, Staff Psychologist

When horrible things happen, things that we didn’t want or expect, they can have a significant – and sometimes devastating – effect on our lives. This is especially the case when the horrible event was perceived as a risk to our life or the life of someone we care about. A traumatic event can be shocking, scary, and/or dangerous. It can affect the way we perceive our environment, it can lead us to do things we would not normally do, and it can affect the quality of our relationships. Hence, a trauma can negatively impact many aspects of our well-being.

When someone experiences a trauma, the effects of it can depend on a variety of factors such as the age when the trauma occurred, the duration of which the the trauma occurred, and the intensity of the negative effects of the trauma. These factors do not mean, for example, that one who experienced a one-time traumatic event “should” have a better mental health outcome than someone who experienced a repeated trauma; rather, it is helpful to understand the nature of the trauma and how individuals can be affected.

When a traumatic experience occurs, the limbic system in the brain is activated and initiates the “fight, flight, or freeze” response to protect the person from harm. Interested in touring Sometimes these responses are so strong that a person may do something they would not have imagined was possible. Imagine being able to move something very heavy to protect a child from harm’s way or to run fast away from danger. Other responses can lead one to experience “shock” to where one cannot process their environment in a way to elicit any response. During this “fight, flight, or freeze” response, the individual is not focused on problem-solving or rational thought process, which are functions elicited by the frontal lobe of the brain (the “executive” center, if you will). Instead, the person is focused on survival and protection.

Feeling afraid is natural during and after a traumatic experience. Also,most people recover from initial symptoms they may have after a trauma. However, there are some people who may experience anxiety long after the traumatic experience, even when they are no longer in danger. Some of these individuals may develop symptoms associated with Post Traumatic Stress Disorder (PTSD). People may experience flashbacks that triggers them to feeling the same intensity of fear they had during the trauma. People may develop a strong mistrust of others.

They may also develop feelings of guilt, as if they were responsible for the traumatic event. Some people may avoid certain places or things associated with the trauma. Nightmares may be common. People may also develop very unhealthy ways to cope with their symptoms of PTSD, for example, by “numbing” their feelings with alcohol and/or drugs or with self-harm behaviors. It is estimated that 7 or 8 out of every 100 people will experience PTSD at some point in their lives. When a traumatic event is experienced in a child, the negative effects upon that child’s social and emotional development can be even more profound. The attachment that child has to his or her loved ones can be severely impacted. They struggle to form healthy relationships with others. Their academic performances can be hindered, especially if they become focused on their worries instead of their school work.

For these reasons, seeking psychological treatment as soon after a traumatic is experienced is highly recommended. Psychotherapy can help a person become more empowered over their fears through cognitive and behavioral strategies. Medication also can be indicated for people with PTSD, especially to help regulate sleep, reduce anxiety, and minimize depression. The goal for treatment would be to help the individual function better in several ways (e.g., socially, emotionally, and behaviorally) and to reduce the long-term impact that a trauma might have.

People may experience a traumatic event, but the symptoms associated with experiencing the trauma can be overcome.

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Elizabeth Mariutto, PsyD
Clinical Director of Partial Hospitalization and Intensive Outpatient Adult Eating Disorder Services and Staff Psychologist, Harold C. Schott Foundation Eating Disorders Program, Lindner Center of HOPE

“Every time I try a diet, I do okay for a while, and then I go back to my usual eating.” According to the National Eating Disorders Association, this is an incredibly common phenomenon, as 95% of those who diet regain any weight lost within one to five years. Despite the ineffectiveness of dieting, those that fall under the overweight category on BMI charts are often encouraged to do so by the medical community. Not only is this ineffective, but dieting has been found to be associated with increased binge eating and greater weight gain.

So what is the alternative? Mindful eating.  Research has found that those who struggle with binge eating, diabetes, and/or obesity may benefit from mindful eating. Keep in mind, mindful eating is not recommended for patients in the process of weight restoration or food exposure, specifically for those with Anorexia Nervosa, or those with gastrointestinal symptoms that may complicate hunger and fullness cues.

Author and psychologist Susan Albers defines mindful eating as awareness of the physical aspects of eating, the process of eating, and triggers for mindless eating. Individuals who eat mindfully slow down and take pause in their busy schedules to pay attention to their bodies and cues of hunger and fullness. The emptiness of one’s stomach, irritability, low energy, and difficulty concentrating can all be signs of hunger. When one eats, one should feel full but not stuffed, satisfied yet comfortable. Many who struggle with unhealthy eating have been so disconnected from their bodies that either they do not have awareness of these cues, or they wait until they are famished before eating and eat until they feel as if their stomachs could explode. They may focus on external cues to start and stop eating, such as if others around them are eating, rather than the internal cues of their body. To start the practice of mindful eating, it can be helpful to focus awareness on how long it has been since one has eaten and the content of what one ate at that time. Regular eating should take place within one hour of waking up in the morning, then at three to four hour increments throughout the day. Meals should balance carbohydrates with lipids and protein sources.  Starting with these guidelines can help one’s body self-regulate so that the hunger and fullness cues can kick in.

Mindful eating also distinguishes physical from emotional hunger.  Food has become tied to emotions in our society. People celebrate birthdays by baking a cake, revel in a promotion by going out to dinner, and calm themselves down after a stressful day by getting ice cream.  While all of these can still occur within mindful eating, a mindful eater will be intentional about this, as well as develop other self-soothing strategies. A mindful eater will tune in to the qualities of the foods he or she is choosing and ask him or herself, “Does this taste good? Does this food energize me or make me sluggish? Does my body thrive when I eat this?” A mindful eater will balance cravings with nutrition, allowing oneself to have all foods in moderation. This does not always mean choosing the “healthy” choice, but rather having self-compassion and flexibility around food. Mindless eaters may overeat sweets, chips, or fast food, tell themselves that they are a failure for consuming these items, and fall into hopelessness and despair, only to lead them back towards these foods repeatedly.  In fact, many comment that they do not even enjoy what they are eating. In contrast, a mindful eater may pick up fast food on a road trip, have a handful of chips with a sandwich, or try a coworker’s chocolate chip cookies; however, he or she will savor these items and consume them as part of a well-balanced diet. If one is full, one will stop eating, even if there is food left on the plate.

Lastly, mindful eaters set up an environment for success. They sit down at a table for meals rather than eating in front of the TV or grazing in the pantry. They do a lap at buffets prior to plating their food. They fill their house with diverse foods and ingredients and avoid buying trigger foods in bulk.  While it takes work, many learn to gain control over their eating with the principles of mindful eating.

References:

Albers, S. (2008). Eat, Drink and Be Mindful. Oakland, CA: New Harbinger Publications, Inc.

National Eating Disorders Association (2018). Statistics & Research on Eating Disorders. Retrieved from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders.