Tuesday, 24 February 2015

Two Treatment Options for Major Depression: ECT and TMS

Major depression is the most severe form of depression and involves most or all of the symptoms associated with clinical depression. Although all the symptoms have to be taken seriously, recurring thoughts of suicide perhaps give the most concern.

The symptoms of major depression can sometimes appear fairly rapidly. In situations like this the usual pattern of prescribed antidepressant medication may not be enough. Partly, this is due to the fact that antidepressants can sometimes take weeks before any therapeutic effects are felt and partly because not everyone responds to antidepressants. This gap between the onset of treatment and the waiting time for a possible therapeutic outcome is a worrying and possibly dangerous period. Talk therapies such as cognitive behavioral therapy can be very effective in the treatment of depression but this does rely on the ability of the patient to be receptive.

In these circumstances physical methods of treatment such as electroconvulsive therapy (ECT) or the newer transcranial magnetic stimulation (TMS) may be considered. ECT is the older more controversial of these treatment options. Since first tested for a variety of mental health issues, the use of ECT has become more refined and better targeted. The basic procedure involves giving the patient an anesthetic and muscle relaxant followed by passing an electric current through the brain. Treatments are usually carried out two or three days a week for several weeks. There is evidence supporting the often fairly rapid improvement in mood using ECT but side effects relating to memory loss, ability to concentrate, headaches and confusion have all been reported – plus the relapse rate is high.

TMS is a relatively new and non-invasive form of treatment that uses targeted pulses of magnetic energy to stimulate certain areas of the brain associated with mood. The basic procedure involves two small electric coils being placed on the head whilst the patient, who remains awake, sits or reclines. Few if any side effects are reported and the benefits appear as effective, or more so, than ECT. Whilst this may sound impressive the down-side is that TMS is a treatment not a cure. However, in avoiding the side effects associated with ECT the choice, if it is available, points to TMS over ECT.

In describing these alternatives I wouldn’t want to leave you with the impression that these are the only alternatives. Various clinical trials have pointed to effective outcomes with deep brain stimulation (DBS), nutritional changes and light therapy. Narrowing down the best option for depression is often helped by the knowledge and skills of a trained neurologist.

Monday, 23 February 2015

Monitor These Lifestyle Stressors

Where you live and how you live can greatly influence your ability to manage stress. Your body will tell you when stress is building up and you push these aside at your peril. I’ve identified 10 lifestyle stressors that need to be monitored, and where necessary changed, in order to give your body and mind the upper hand.

Caffeine. Are you someone who just can’t get going without a morning fix of coffee? Like a lot of people you’ve probably become accustomed to the taste and the kick that coffee provides. Be aware however that caffeine blocks the action of GABA receptors that help calm us down.

Clothing. Who would have thought of clothing as a potential stressor? Wearing clothes that overheat you, or that are too tight or uncomfortable, actually piles on the stress and cause the stress hormone cortisol to course around the body.

Natural Light. You may not regard yourself as someone who suffers with seasonal depression but pretty much everyone feels better during long bright days. We can’t control the climate but we have a measure of control over whether we stay in or go outside. Combining daylight activities with a little exercise makes everyone feel better physically and mentally.

Light and Noise. I’m thinking here of unnatural light pollution that comes from traffic lights, buildings and other sources in towns and cities. Light pollution coupled with noise can easily disrupt sleep. We’re able to accommodate certain patterns of noise and can even find them comforting but certain noises appear more disruptive and disturbing. Every single one of us can make our own list but common problems stem from noise, loud music, traffic and aircraft.

Diet. Not just slimming diets, but the stuff you choose to eat and drink can profoundly affect your stress levels. Diets high in protein frequently lack essential minerals and fatty acids. Convenience foods are invariably full of additives that are either known or suspected of having an effect on the body and brain. The simple message here is to think about your food choices and to modify them towards more balanced and natural alternatives.

Intake. Yes, more about food and drink, but this time relating to adequate intake. For whatever reason many people don’t seem to drink enough fluid during the day. As the body starts to dehydrate it regards the situation as stressful and a release of stress hormones takes place. A similar reaction takes place when we feel hungry. The body much prefers a predictable pattern of food and fluid intake rather than a gulped coffee and a sandwich on the run. Break times are there for a reason, use them to their full effect and you’ll feel better.

Rhythm. By now you’re picking up on the fact that just because the world seems to operate on a 24 hour schedule your body does not. It doesn’t really matter how old you are, the fact is your body is a bit like the old person who has a schedule for the day and likes to keep it that way. Stress hormones fluctuate throughout the day quite naturally but they can change quickly in the event of disrupted sleep (shifting time zones, shift work, light or noise pollution). Chronic stress elevates stress hormones and further disrupts normal rhythms.

Illness. During illness the body fights infection with a variety of toxins. Part of the reason your mood goes into a slump is due to the fact that serotonin is converted to quinolinic acid in order to fight infection. Viruses also disrupt essential fatty acids necessary for normal brain function and this help to explain why you find it harder to concentrate and reason. As the infection subsides the chemistry of the body returns to normal and your mood improves. You can’t avoid all illnesses but you can resist them by eating a balanced diet, taking regular exercise and ensuring regular sleep.

Medication. A bit of a double-edged sword this one. As we all know medication is a wonderful tool but it can also be counterproductive in ways that are not always obvious. Busy lifestyles and sometimes costs sometimes mean it’s tempting to self-diagnose and self-medicate. You know that medication has side effects but you may know that over-the-counter products can be problematic. Anti-inflammatory drugs, for example, are closely related to the stress hormone cortisol and can cause anxiety and depression. The list of medicines is vast but the message is don’t take them unless you really need them and don’t self medicate for lengthy periods of time.

Booze. After a hard day at work one of the quickest and seemingly most effective ways to wind down is with a stiff drink, a beer or a glass of wine. The reason this is so effective and pleasurable is that it quickly over stimulates feel-good neurotransmitters like GABA, serotonin and dopamine. The grumpiness and low mood that arrive the following morning relates to the fact that these same neurotransmitters are excreted in urine to levels that then fall below normal.

This post is really about the combined and cumulative effects of the choices we make in the way we live. It’s also about taking time to stand back, look at what’s going on in your life and choosing to change. The support of others is useful and important but looking to yourself is always beneficial, even if it’s just one step at a time.