Another excellent YouTube video from “Living with Schizophrenia.” I think it’s relatable to all of those with a serious mental illness, but especially those battling schizophrenia.
Category: Mental Illness Treatments
Sigmund Freud and Psychoanalysis
Born Sigismund Schlomo Freud in Freiberg, Moravia, Freud was openly his mother’s favorite child; she called him “Golden Siggie.” When Freud was four years old, the family moved to Vienna and Sigismund became Sigmund. Sigmund completed a medical degree and in 1886 he opened a medical practice specializing in neurology, and married Martha Bernays. Eventually, he developed the “talking cure” that was to become an entirely new psychological approach: psychoanalysis.
In 1908, Freud established the Psychoanalytic Society, which ensured the future of his school of thought. During World War II, the Nazis publicly burned his work, and Freud moved to London. He died by assisted suicide, after enduring mouth cancer.
1900 The Interpretation of Dreams
1904 The Psychopathology of Everyday Life
1905 Three Essays on the Theory of Sexuality
1930 Civilization and Its Discontents”
Three Levels of Self-Validation
Acknowledging: The most basic level of self-validation is simply acknowledging the presence of the emotion rather than judging it; for example, telling yourself, I feel unhappy. Just acknowledging or naming the emotion and putting a period on the end of the sentence rather than going down the road of judging it validates the emotion.
Allowing: The second level of self-validation is allowing, which is essentially giving yourself permission to feel the feeling; for example, telling yourself, It’s okay that I feel unhappy. This takes not judging the feeling one step further, affirming that it’s okay to feel this way. This doesn’t mean liking the feeling or wanting it to hang around; it just means acknowledging that you’re allowed to feel the emotion.
Understanding: The highest (and hardest) level of self-validation is understanding. This level, which goes beyond not judging the emotion and saying it’s okay to feel it, involves having an understanding of it; for example, It makes sense that I feel unhappy, given the difficulties I have managing my emotions and the chaos this causes in my relationships and my life.
Source: DBT Made Simple
Justice system and mental health
Justice system and mental health:
~ 2 million people with mental illness are newly incarcerated each year.
~ Recent findings show that there are 10 times more individuals with serious mental illness in prisons and jails than in state mental hospitals.
~ 83% of inmates with mental illness did not have access to treatment after release.
~ In a recent outcome study, 64% of inmates with mental illness released from prison were rearrested within 18 months, and 48% were hospitalized within the same time period.
Three Styles of Thinking in DBT (Dialectical Behavioral Therapy)
Three Styles of Thinking in DBT
Marsha Linehan outlines three states of mind, or ways we have of thinking about things: the reasoning self, the emotional self, and the wise self.
The Reasoning Self:
The reasoning self: the part of ourselves that we use when we’re thinking logically or reasoning something out. When we use this part of ourselves, there are few or no emotions involved. If there are emotions present, they don’t significantly influence how we behave. Rather, the focus is on thinking logically about something: organizing your day at work, leaving instructions for the babysitter, deciding whether you should drive or take the subway to work, taking minutes at a meeting, and so on. It may take a while and you may need to help, but you can usually come up with at least one example.
The Emotional Self:
Usually we have more difficulties coming up with examples of times when we’ve acted from their emotional self—the part that often gets us into trouble, as our behaviors are controlled by the emotion we’re feeling in the moment. Some general examples, such as feeling angry and lashing out at someone, feeling anxious and avoiding whatever is causing the anxiety, or feeling depressed and withdrawing and isolating. Try to come up with some examples of your own: When have you acted from your emotional self? Usually you can relate to this thinking style and examples come rather easily.
The Wise Self:
The difficulty often lies in being able to see that you have a wise self, which is the combination of the reasoning self, the emotional self, and intuition. In other words, we feel our emotions and are still able to think straight, and we weigh the consequences of our actions and choose to act in a way that’s in our best interests in the long run, even if that means behaving in a way that’s quite difficult. Again, some examples: You’re having an argument with your partner, and instead of saying something hurtful that comes to mind, you bite your tongue because you know you’ll regret it later. You have an urge to drink, but part of you recognizes this as an ineffective way of coping, so you call your mother or go to an AA meeting instead.
It’s also important to understand that acting from your wise self doesn’t necessarily entail a humongous achievement. Some smaller examples: You wake up in the morning and feel down; it’s cold, it’s still dark outside, and your first impulse is to call in sick. But instead you roll over, turn off the alarm, and get out of bed. This is your wise self. Or say it’s 5:00 p.m., your “partner’s going to be home from work soon, and you promised you would cook dinner, but you’re exhausted and don’t feel like it. Yet you do it anyway. This is your wise self.
Sometimes you’ll say something like, “But I have to go to work because I have to pay the bills; that’s not acting wisely. But the truth is, no one has to go to work, we choose to go to work. We could choose to not go and the bills wouldn’t get paid. When you make a choice to get out of bed and go to work, that choice comes from your wise self. You weighed the consequences and decided what would be more effective in the long run, even though it wasn’t necessarily the easy thing to do.
Sources: DBT Made Simple by Sheri Van Dijk
Treatment Resistant Depression
If you’ve been treated for depression but your symptoms haven’t improved, you may have treatment-resistant depression. Taking an antidepressant or going to psychological counseling (psychotherapy) eases depression symptoms for most people. But with treatment-resistant depression, standard treatments aren’t enough. They may not help much at all, or your symptoms may improve, only to keep coming back.
If your primary care doctor prescribed antidepressants and your depression symptoms continue despite treatment, ask your doctor if he or she can recommend a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist).
The psychiatrist reviews your medical history and may:
• Ask about life situations that might be contributing to your depression
• Consider your response to treatment, including medications, psychotherapy or other treatments you’ve tried
• Review all of the medications you’re taking, including nonprescription drugs and herbal supplements
• Discuss whether you’re taking your medications as prescribed and following other treatment steps
• Consider physical health conditions that can sometimes cause or worsen depression, such as thyroid disorders, chronic pain or heart problems
• Consider a diagnosis of another mental health condition,such as bipolar disorder, which can cause or worsen depression and may require different treatment; dysthymia, a mild but long-term (chronic) form of depression; or a personality disorder that contributes to the depression not getting better
Treatment-resistant depression symptoms can range from mild to severe and may require trying a number of approaches to identify what helps.
If you’ve already tried an antidepressant and it didn’t work, don’t lose hope. You and your doctor simply may not have found the right dose, medication or combination of medications that works for you. Here are some medication options that your doctor may discuss with you:
• Give your current medications more time. Antidepressants and other medications for depression typically take four to eight weeks to become fully effective and for side effects to ease up. For some people, it takes even longer.
• Increase your dose, if indicated. Because people respond to medications differently, you may benefit from a higher dose of medication than is usually prescribed. Ask your doctor whether this is an option for you — don’t change your dose on your own as several factors are involved in determining the proper dose.
• Switch antidepressants. For a number of people, the first antidepressant tried isn’t effective. You may need to try several before you find one that works for you.
• Add another type of antidepressant. Your doctor may prescribe two different classes of antidepressants at the same time. That way they’ll affect a wider range of brain chemicals linked to mood. These chemicals are neurotransmitters that include dopamine, serotonin and norepinephrine.
• Add a medication generally used for another condition.Your doctor may prescribe a medication that’s generally used for another mental or physical health problem, along with an antidepressant. This approach, known as augmentation, may include antipsychotics, mood stabilizers, anti-anxiety medications, thyroid hormone or other drugs.
• Consider the cytochrome P450 (CYP450) genotyping test, if available. This test checks for specific genes that indicate how well your body can process (metabolize) a medication. Because of inherited (genetic) traits that cause variations in certain cytochrome P450 enzymes, medications may affect people differently. But a CYP450 test isn’t a sure way to tell which antidepressant will work — it only provides clues. And this test is not always covered by insurance.
Psychological counseling (psychotherapy) by a psychiatrist, psychologist or other mental health professional can be very effective. For many people, psychotherapy combined with medication works best. It can help identify underlying concerns that may be adding to your depression. For example, psychotherapy can help you:
• Find better ways to cope with life’s challenges
• Deal with past emotional trauma
• Manage relationships in a healthier way
• Learn how to reduce the effects of stress in your life
• Address substance use issues
If counseling doesn’t seem helpful, talk to your psychotherapist about trying a different approach. Or consider seeing someone else. As with medications, it may take several tries to find a treatment that works. Psychotherapy for depression may include:
• Cognitive behavioral therapy. This common type of counseling addresses thoughts, feelings and behaviors that affect your mood. It helps you identify and change distorted or negative thinking patterns and teaches you skills to respond to life’s challenges in a positive way.
• Acceptance and commitment therapy. A form of cognitive behavioral therapy, acceptance and commitment therapy helps you to engage in positive behaviors, even when you have negative thoughts and emotions. It’s designed for treatment-resistant conditions.
• Interpersonal psychotherapy. Interpersonal psychotherapy focuses on resolving relationship issues that may contribute to your depression.
• Family or marital therapy. This type of therapy involves family members or your spouse or partner in counseling. Working out stress in your relationships can help with depression.
• Psychodynamic treatment. The aim of this counseling approach is to help you resolve underlying problems linked to your depression by exploring your feelings and beliefs in-depth.
• Dialectical behavioral therapy. This type of therapy helps you build acceptance strategies and problem-solving skills. This is useful for chronic suicidal thoughts or self-injury behaviors, which sometimes accompany treatment-resistant depression.
• Group psychotherapy. This type of counseling involves a group of people who struggle with depression working together with a psychotherapist.
Procedures to treat depression
If medications and psychotherapy aren’t working, you may want to talk to a psychiatrist about additional treatment options:
• Electroconvulsive therapy (ECT). While you are asleep, a carefully measured dose of electricity is passed through your brain, intentionally triggering a small, brief seizure. ECT seems to cause changes in brain chemistry that can relatively quickly reverse symptoms of major depression. Although there are potential side effects, such as temporary confusion or temporary memory loss, a series of ECT treatments may provide significant relief of severe depression.
• Repetitive transcranial magnetic stimulation (rTMS).Generally only used when ECT isn’t effective, rTMS uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. An electromagnetic coil is placed against your scalp near your forehead. The electromagnet used in rTMS creates electric currents that stimulate nerve cells in the region of your brain involved in mood control and depression.
• Vagus nerve stimulation (VNS). Generally, VNS is only tried after other brain stimulation therapies such as ECT and rTMS have not been successful in improving symptoms of depression. VNS stimulates the vagus nerve with electrical impulses. This treatment uses a device implanted in your chest that’s connected by a wire to a nerve in your neck (vagus nerve). Electrical signals from the implant travel along the vagus nerve to the mood centers of the brain, which may improve depression symptoms.
Be sure to find out whether your insurance covers any treatment that’s recommended.
Other steps you can take
To make the most of depression treatment:
• Stick to your treatment plan. Don’t skip therapy sessions or appointments. It’ll take time to get better. Even if you feel well, don’t skip your medications. If you stop, depression symptoms may come back, and you could experience withdrawal-like symptoms. If side effects or drug costs are a problem, talk with your doctor and pharmacist to discuss options.
• Stop drinking or using recreational drugs. Many people with depression drink too much alcohol or use recreational drugs or marijuana. In the long run, alcohol and drugs worsen depression and make it harder to treat. If you can’t stop drinking alcohol or using drugs on your own, talk to your doctor or mental health professional. Depression treatment may be unsuccessful until you address your substance use.
• Manage stress. Relationship issues, financial problems, an unhappy work life and many other issues can all contribute to stress, which in turn worsens depression. Try stress-reduction techniques such as yoga, tai chi, meditation, mindfulness, progressive muscle relaxation or writing your thoughts in a journal.
• Sleep well. Poor sleep may worsen depression. Both the amount of time and how well you sleep can affect your mood, energy level, ability to concentrate and resilience to stress. If you have trouble sleeping, research ways to improve your sleep habits or ask your doctor or mental health professional for advice.
• Get regular exercise. Exercise has a direct effect on mood. Even physical activity such as gardening or walking can reduce stress, improve sleep and ease depression symptoms.
Don’t settle for a treatment that’s partially effective at relieving your depression or one that works but causes intolerable side effects. Work with your doctor or other mental health professional to find the best treatment possible, even though it may take time and effort to try new approaches.
Sources: The Mayo Clinic, McLean Hospital, NAMI, NIH, NIMH
Psychotherapy: An Overview
Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist or other mental health provider.
During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behaviors. Psychotherapy helps you learn how to take control of your life and respond to challenging situations with healthy coping skills.
There are many types of psychotherapy, each with its own approach. The type of psychotherapy that’s right for you depends on your individual situation. Psychotherapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.
Why it’s done
Psychotherapy can be helpful in treating most mental health problems, including:
• Anxiety disorders, such as obsessive-compulsive disorder (OCD), phobias, panic disorder or post-traumatic stress disorder (PTSD)
• Mood disorders, such as depression or bipolar disorder
• Addictions, such as alcoholism, drug dependence or compulsive gambling
• Eating disorders, such as anorexia or bulimia
• Personality disorders, such as borderline personality disorder or dependent personality disorder
• Schizophrenia or other disorders that cause detachment from reality (psychotic disorders)
Not everyone who benefits from psychotherapy is diagnosed with a mental illness. Psychotherapy can help with a number of life’s stresses and conflicts that can affect anyone. For example, it may help you:
• Resolve conflicts with your partner or someone else in your life
• Relieve anxiety or stress due to work or other situations
• Cope with major life changes, such as divorce, the death of a loved one or the loss of a job
• Learn to manage unhealthy reactions, such as road rage or passive-aggressive behavior
• Come to terms with an ongoing or serious physical health problem, such as diabetes, cancer or long-term (chronic) pain
• Recover from physical or sexual abuse or witnessing violence
• Cope with sexual problems, whether they’re due to a physical or psychological cause
• Sleep better, if you have trouble getting to sleep or staying asleep (insomnia)
In some cases, psychotherapy can be as effective as medications, such as antidepressants. However, depending on your specific situation, psychotherapy alone may not be enough to ease the symptoms of a mental health condition. You may also need medications or other treatments.
Generally, there’s little risk in having psychotherapy. But because it can explore painful feelings and experiences, you may feel emotionally uncomfortable at times. However, any risks are minimized by working with a skilled therapist who can match the type and intensity of therapy with your needs.
The coping skills that you learn can help you manage and conquer negative feelings and fears.
How you prepare
Here’s how to get started:
• Find a therapist. Get a referral from a doctor, health insurance plan, friend or other trusted source. Many employers offer counseling services or referrals through employee assistance programs (EAPs). Or you can find a therapist on your own, for instance, by looking for a professional association on the Internet.
• Understand the costs. If you have health insurance, find out what coverage it offers for psychotherapy. Some health plans cover only a certain number of psychotherapy sessions a year. Also, talk to your therapist about fees and payment options.
• Review your concerns. Before your first appointment, think about what issues you’d like to work on. While you also can sort this out with your therapist, having some sense in advance may provide a good starting point.
Before seeing a psychotherapist, check his or her background, education, certification, and licensing. Psychotherapist is a general term rather than a job title or indication of education, training or licensure.
Trained psychotherapists can have a number of different job titles, depending on their education and role. Most have a master’s or doctoral degree with specific training in psychological counseling. Medical doctors who specialize in mental health (psychiatrists) can prescribe medications as well as provide psychotherapy.
Examples of psychotherapists include psychiatrists, psychologists, licensed professional counselors, licensed social workers, licensed marriage and family therapists, psychiatric nurses, or other licensed professionals with mental health training.
Make sure that the therapist you choose meets state certification and licensing requirements for his or her particular discipline. The key is to find a skilled therapist who can match the type and intensity of therapy with your needs.
What you can expect
Your first therapy session:
At the first psychotherapy session, the therapist typically gathers information about you and your needs. You may be asked to fill out forms about your current and past physical and emotional health. It might take a few sessions for your therapist to fully understand your situation and concerns and to determine the best approach or course of action.
The first session is also an opportunity for you to interview your therapist to see if his or her approach and personality are going to work for you. Make sure you understand:
• What type of therapy will be used
• The goals of your treatment
• The length of each session
• How many therapy sessions you may need
Don’t hesitate to ask questions anytime during your appointment. If you don’t feel comfortable with the first psychotherapist you see, try someone else. Having a good fit with your therapist is critical for psychotherapy to be effective.
You’ll likely meet in your therapist’s office or a clinic once a week or every other week for a session that lasts about 45 to 60 minutes. Psychotherapy, usually in a group session with a focus on safety and stabilization, also can take place in a hospital if you’ve been admitted for treatment.
Types of psychotherapy
There are a number of effective types of psychotherapy. Some work better than others in treating certain disorders and conditions. In many cases, therapists use a combination of techniques. Your therapist will consider your particular situation and preferences to determine which approach may be best for you.
Although many types of therapies exist, some psychotherapy techniques proven to be effective include:
• Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
• Dialectical behavior therapy, a type of CBT that teaches behavioral skills to help you handle stress, manage your emotions and improve your relationships with others
• Acceptance and commitment therapy, which helps you become aware of and accept your thoughts and feelings and commit to making changes, increasing your ability to cope with and adjust to situations
• Psychodynamic and psychoanalysis therapies, which focus on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts
• Interpersonal psychotherapy, which focuses on addressing problems with your current relationships with other people to improve your interpersonal skills — how you relate to others, such as family, friends and colleagues
• Supportive psychotherapy, which reinforces your ability to cope with stress and difficult situations
Psychotherapy is offered in different formats, including individual, couple, family or group therapy sessions, and it can be effective for all age groups.
For most types of psychotherapy, your therapist encourages you to talk about your thoughts and feelings and what’s troubling you. Don’t worry if you find it hard to open up about your feelings. Your therapist can help you gain more confidence and comfort as time goes on.
Because psychotherapy sometimes involves intense emotional discussions, you may find yourself crying, upset or even having an angry outburst during a session. Some people may feel physically exhausted after a session. Your therapist is there to help you cope with such feelings and emotions.
Your therapist may ask you to do “homework” — activities or practices that build on what you learn during your regular therapy sessions. Over time, discussing your concerns can help improve your mood, change the way you think and feel about yourself, and improve your ability to cope with problems.
Except in rare and specific circumstances, conversations with your therapist are confidential. However, a therapist may break confidentiality if there is an immediate threat to safety (yours or someone else’s) or when required by state or federal law to report concerns to authorities. Your therapist can answer questions about confidentiality.
Length of psychotherapy
The number of psychotherapy sessions you need — as well as how frequently you need to see your therapist — depends on such factors as:
• Your particular mental illness or situation
• Severity of your symptoms
• How long you’ve had symptoms or have been dealing with your situation
• How quickly you make progress
• How much stress you’re experiencing
• How much your mental health concerns interfere with day-to-day life
• How much support you receive from family members and others
• Cost and insurance limitations
It may take only weeks to help you cope with a short-term situation. Or, treatment may last a year or longer if you have a long-term mental illness or other long-term concerns.
Psychotherapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope in a healthy way and to feel better about yourself and your life.
Getting the most out of psychotherapy
Take steps to get the most out of your therapy and help make it a success:
• Make sure you feel comfortable with your therapist. If you don’t, look for another therapist with whom you feel more at ease.
• Approach therapy as a partnership. Therapy is most effective when you’re an active participant and share in decision-making. Make sure you and your therapist agree about the major issues and how to tackle them. Together, you can set goals and measure progress over time.
• Be open and honest. Success depends on willingness to share your thoughts, feelings and experiences, and to consider new insights, ideas and ways of doing things. If you’re reluctant to talk about certain issues because of painful emotions, embarrassment or fears about your therapist’s reaction, let your therapist know.
• Stick to your treatment plan. If you feel down or lack motivation, it may be tempting to skip psychotherapy sessions. Doing so can disrupt your progress. Try to attend all sessions and to give some thought to what you want to discuss.
• Don’t expect instant results. Working on emotional issues can be painful and may require hard work. You may need several sessions before you begin to see improvement.
• Do your homework between sessions. If your therapist asks you to document your thoughts in a journal or do other activities outside of your therapy sessions, follow through. These homework assignments can help you apply what you’ve learned in the therapy sessions to your life.
• If psychotherapy isn’t helping, talk to your therapist. If you don’t feel that you’re benefiting from therapy after several sessions, talk to your therapist about it. You and your therapist may decide to make some changes or try a different approach that may be more effective.
Sources: The Mayo Clinic, NAMI, NIH, NIMH
Transcranial magnetic stimulation (TMS)
Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. TMS is typically used when other depression treatments haven’t been effective.
This treatment for depression involves delivering repetitive magnetic pulses, so it’s called repetitive TMS or rTMS.
How it works
During an rTMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and depression. It’s thought to activate regions of the brain that have decreased activity in depression.
Though the biology of why rTMS works isn’t completely understood, the stimulation appears to impact how the brain is working, which in turn seems to ease depression symptoms and improve mood.
There are different ways to perform the procedure, and techniques may change as experts learn more about the most effective ways to perform treatments.
Why it’s done
Depression is a treatable condition, but for some people, standard treatments aren’t effective. Repetitive TMS is typically used when standard treatments such as medications and talk therapy (psychotherapy) don’t work.
Repetitive TMS is a noninvasive form of brain stimulation used for depression. Unlike vagus nerve stimulation or deep brain stimulation, rTMS does not require surgery or implantation of electrodes. And, unlike electroconvulsive therapy (ECT), rTMS doesn’t cause seizures or require sedation with anesthesia.
Generally, rTMS is considered safe and well-tolerated. However, it can cause some side effects.
Common side effects
Side effects are generally mild to moderate and improve shortly after an individual session and decrease over time with additional sessions. They may include:
• Scalp discomfort at the site of stimulation
• Tingling, spasms or twitching of facial muscles
Your doctor can adjust the level of stimulation to reduce symptoms or may recommend that you take an over-the-counter pain medication before the procedure.
Uncommon side effects
Serious side effects are rare. They may include:
• Mania, particularly in people with bipolar disorder
• Hearing loss if there is inadequate ear protection during treatment
More study is needed to determine whether rTMS may have any long-term side effects.
What you can expect
Repetitive TMS is usually done in a doctor’s office or clinic. It requires a series of treatment sessions to be effective. Generally, sessions are carried out daily, five times a week for four to six weeks.
Your first treatment
Before treatment begins, your doctor will need to identify the best place to put the magnets on your head and the best dose of magnetic energy for you. Your first appointment typically lasts about 60 minutes.
Most likely, during your first appointment:
• You’ll be taken to a treatment room, asked to sit in a reclining chair and given earplugs to wear during the procedure.
• An electromagnetic coil will be placed against your head and switched off and on repeatedly to produce stimulating pulses. This results in a tapping or clicking sound that usually lasts for a few seconds, followed by a pause. You’ll also feel a tapping sensation on your forehead. This part of the process is called mapping.
• Your doctor will determine the amount of magnetic energy needed by increasing the magnetic dose until your fingers or hands twitch. Known as your motor threshold, this is used as a reference point in determining the right dose for you. During the course of treatment, the amount of stimulation can be changed, depending on your symptoms and side effects.
During each treatment
Once the coil placement and dose are identified, you’re ready to begin. Here’s what to expect during each treatment:
• You’ll sit in a comfortable chair, wearing ear plugs, with the magnetic coil placed against your head.
• When the machine is turned on, you’ll hear clicking sounds and feel tapping on your forehead.
• The procedure will last about 40 minutes, and you’ll remain awake and alert. You may feel some scalp discomfort during the treatment and for a short time afterward.
After each treatment
You can return to your normal daily activities after your treatment. Typically, between treatments, you can expect to work and drive.
If rTMS works for you, your depression symptoms may improve or go away completely. Symptom relief may take a few weeks of treatment.
The effectiveness of rTMS may improve as researchers learn more about techniques, the number of stimulations required and the best sites on the brain to stimulate.
After completion of an rTMS treatment series, standard care for depression ― such as medication and psychotherapy ― may be recommended as ongoing treatment.
It’s not yet known if maintenance rTMS sessions will benefit your depression. This involves continuing treatment when you are symptom-free with the hope that it will prevent the return of symptoms.
However, if your depression improves with rTMS, and then later you have another episode of symptoms, your rTMS treatment can be repeated. This is called re-induction. Some insurance companies will cover re-induction.
If your symptoms improve with rTMS, discuss ongoing or maintenance treatment options for your depression with your doctor.
Source: The Mayo Clinic
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.
ECT often works when other treatments are unsuccessful and when the full course of treatment is completed, but it may not work for everyone.
Much of the stigma attached to ECT is based on early treatments in which high doses of electricity were administered without anesthesia, leading to memory loss, fractured bones and other serious side effects.
Why it’s done
Electroconvulsive therapy (ECT) can provide rapid, significant improvements in severe symptoms of several mental health conditions. ECT is used to treat:
• Severe depression, particularly when accompanied by detachment from reality (psychosis), a desire to commit suicide or refusal to eat.
• Treatment-resistant depression, a severe depression that doesn’t improve with medications or other treatments.
• Severe mania, a state of intense euphoria, agitation or hyperactivity that occurs as part of bipolar disorder. Other signs of mania include impaired decision-making, impulsive or risky behavior, substance abuse, and psychosis.
• Catatonia, characterized by lack of movement, fast or strange movements, lack of speech, and other symptoms. It’s associated with schizophrenia and certain other psychiatric disorders. In some cases, catatonia is caused by a medical illness.
• Agitation and aggression in people with dementia, which can be difficult to treat and negatively affect quality of life.
ECT may be a good treatment option when medications aren’t tolerated or other forms of therapy haven’t worked. In some cases ECT is used:
• During pregnancy, when medications can’t be taken because they might harm the developing fetus
• In older adults who can’t tolerate drug side effects
• In people who prefer ECT treatments over taking medications
• When ECT has been successful in the past
Although ECT is generally safe, risks and side effects may include:
• Confusion. Immediately after treatment, you may experience confusion, which can last from a few minutes to several hours. You may not know where you are or why you’re there. Rarely, confusion may last several days or longer. Confusion is generally more noticeable in older adults.
• Memory loss. Some people have trouble remembering events that occurred right before treatment or in the weeks or months before treatment or, rarely, from previous years. This condition is called retrograde amnesia. You may also have trouble recalling events that occurred during the weeks of your treatment. For most people, these memory problems usually improve within a couple of months after treatment ends.
• Physical side effects. On the days of an ECT treatment, some people experience nausea, headache, jaw pain or muscle ache. These generally can be treated with medications.
• Medical complications. As with any type of medical procedure, especially one that involves anesthesia, there are risks of medical complications. During ECT, heart rate and blood pressure increase, and in rare cases, that can lead to serious heart problems. If you have heart problems, ECT may be more risky.
What you can expect
The ECT procedure takes about five to 10 minutes, with added time for preparation and recovery. ECT can be done while you’re hospitalized or as an outpatient procedure.
Before the procedure
To get ready for the ECT procedure:
• You’ll have general anesthesia. So you can expect dietary restrictions before the procedure. Typically, this means no food or water after midnight and only a sip of water to take any morning medications. Your health care team will give you specific instructions before your procedure.
• You may have a brief physical exam.This is basically to check your heart and lungs.
• You’ll have an intravenous (IV) line inserted. Your nurse or other team member inserts an IV tube into your arm or hand through which medications or fluids can be given.
• You’ll have electrode pads placed on your head. Each pad is about the size of a silver dollar. ECT can be unilateral, in which electric currents focus on only one side of the brain, or bilateral, in which both sides of the brain receive focused electric currents.
Anesthesia and medications
At the start of the procedure, you’ll receive these medications through your IV:
• An anesthetic to make you unconscious and unaware of the procedure
• A muscle relaxant to help minimize the seizure and prevent injury
You may receive other medications, depending on any health conditions you have or your previous reactions to ECT.
During the procedure:
• A blood pressure cuff placed around one ankle stops the muscle relaxant medication from entering your foot and affecting the muscles there. When the procedure begins, your doctor can monitor seizure activity by watching for movement in that foot.
• Monitors check your brain, heart, blood pressure and oxygen use.
• You may be given oxygen through an oxygen mask.
• You may also be given a mouth guard to help protect your teeth and tongue from injury.
Inducing a brief seizure
When you’re asleep from the anesthetic and your muscles are relaxed, the doctor presses a button on the ECT machine. This causes a small amount of electric current to pass through the electrodes to your brain, producing a seizure that usually lasts less than 60 seconds.
• Because of the anesthetic and muscle relaxant, you remain relaxed and unaware of the seizure. The only outward indication that you’re having a seizure may be a rhythmic movement of your foot if there’s a blood pressure cuff around your ankle.
• Internally, activity in your brain increases dramatically. A test called an electroencephalogram (EEG) records the electrical activity in your brain. Sudden, increased activity on the EEG signals the beginning of a seizure, followed by a leveling off that shows the seizure is over.
A few minutes later, the effects of the short-acting anesthetic and muscle relaxant begin to wear off. You’re taken to a recovery area, where you’re monitored for any potential problems. When you wake up, you may experience a period of confusion lasting from a few minutes to a few hours or more.
Series of treatments
In the United States, ECT treatments are generally given two to three times weekly for three to four weeks — for a total of six to 12 treatments. Some doctors use a newer technique called right unilateral ultrabrief pulse electroconvulsive therapy that’s done daily on weekdays.
The number and type of treatments you’ll need depend on the severity of your symptoms and how rapidly they improve.
You can generally return to normal activities a few hours after the procedure. However, some people may be advised not to return to work, make important decisions, or drive until one to two weeks after the last ECT in a series, or for at least 24 hours after a single treatment during maintenance therapy. Resuming activities depends on when memory loss and confusion are resolved.
Many people begin to notice an improvement in their symptoms after about six treatments with electroconvulsive therapy. Full improvement may take longer, though ECT may not work for everyone. Response to antidepressant medications, in comparison, can take several weeks or more.
No one knows for certain how ECT helps treat severe depression and other mental illnesses. What is known, though, is that many chemical aspects of brain function are changed during and after seizure activity. These chemical changes may build upon one another, somehow reducing symptoms of severe depression or other mental illnesses. That’s why ECT is most effective in people who receive a full course of multiple treatments.
Even after your symptoms improve, you’ll still need ongoing depression treatment to prevent a recurrence. Ongoing treatment may be ECT with less frequency, but more often, it includes antidepressants or other medications, or psychological counseling (psychotherapy).
Source: The Mayo Clinic