Major depression is a serious medical illness that affects approximately 16.1 million Americans. Depression can cause ongoing sadness that changes how a person thinks, feels, and acts every day. While medication can help manage symptoms for many people, it is estimated that approximately 4 million patients do not benefit from taking standard antidepressant medication.
While the exact cause of depression is not known, the leading scientific theory is that it is caused by an imbalance of the brain’s neurotransmitters, which are chemical messengers that send signals between brain cells.
While antidepressant drugs work for many people, some 4 million people still do not receive adequate treatment. For these patients, the effects of depression can still be debilitating. These patients need a proven, safe depression treatment option. TMS Therapy can be an alternative solution.
Depression is a serious medical illness that lasts two weeks or more and interferes with a person’s ability to carry out daily tasks and enjoy activities that previously brought pleasure.
The United States National Institute of Mental Health maintains that, “Depression is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities. Major depression is disabling and prevents a person from functioning normally.” Depression causes pain and suffering not only to those who have the disorder, but to those who care about them. Depression can be a lethal disease leading to more than 1 million deaths from suicide each year. Along with being a huge economic burden, depression is a leading cause of disease burden and disability around the world. Researchers estimate that by the year 2030, depression will be the leading cause of disease burden worldwide.
There are non-drug and drug therapies available to treat depression. Depression is often initially treated with psychotherapy (talk therapy) and antidepressant medication administered together. Although antidepressants can be effective for some patients, they do not work for everybody. Additionally, antidepressants often result in unwanted side effects.
If a person has a first depression there is a 50% chance it will not return, which means there is a 50% chance it will return. If a person has a depression for a second time there is a 75% chance the depression will return and if a person has had a third depression there is a 93% chance the depression will return. We think that 93% chance is too low but is the extent of the research follow-up. As such, depression is a chronic and recurring illness. Chronic, meaning that we cannot cure it and recurring, meaning a person with this type depression is off their medicine, the depression will return.
Many patients do not receive adequate benefit from antidepressant medication and/or cannot tolerate the side effects caused by them.1 For these patients, alternative treatments that involve the use of a medical device are available. These treatments include:
"I have experienced ongoing depression for over 15 years. I enjoy the beach, boating, and traveling. Unfortunately, my depression made all of these very difficult for me. It affected my quality of life as well as my career. At about the 8th(TMS) treatment, I noticed a difference. My quality of life had improved and I didn’t have any side effects from the treatment."
“I’ve been clinically depressed 3-4 times, each time lasting 2-3 years…after I read some of the literature including the testimonials I decided to try NeuroStar TMS Therapy.
After about the second week of treatment and for the first two to three hours after I left the office I felt uplifted. The feeling remained and I started to feel better. I also didn’t get so concerned with stressful events and I worried less. It has been a year since my treatments and I can’t say I am depressed anymore. Previously, I was taking several different medications just to get some kind of relief. With NeuroStar TMS, I saw beneficial effects quicker than the medications and counseling – and there weren’t really side effects.”
Anxiety is good. Anxiety warns us of danger. It is designed to keep us out of dangerous places, and to motivate us and help us escape bad situations we find ourselves in. Our goal is to have our anxiety appropriate and proportionate to the immediate danger we face. Some animals, like zebras, are able to do this. When they are grazing and there are no predators around, they have little to no anxiety. Once a predator is spotted, they become anxious with their fight or flight system kicking in, so they can hopefully escape the clutches of a predator. But once they have escaped the predator and are no longer in danger, their anxiety leaves them until the next episode of danger (Sapolosky).
Unfortunately, humans are not like that. We have anticipatory anxiety as well as generalized anxiety, which is when people become anxious worrying about things that they anticipate facing. It has plagued most all of us at one time or another. Sometimes people have what is called free-floating are generalized anxiety, meaning that there is not a specific situation that is causing anxiety, but there is just background anxiety much of the time.
The most effective and quickest acting medications to treat anxiety are a class called benzodiazepines. They are inexpensive, work within 20 minutes and are generally quite effective in treating anxiety. For the overwhelming number of patients that take these medicines, they are safe and effective when taken as prescribed, and cause no problems as long as they are taken as directed. Unfortunately, there are groups of patients who overtake their medicines and can have an ever-escalating use of these medicines over time. Some have hypothesized that patients do not habituate to the anti-anxiety, effective medications but do habituate to other effects of the medicine such as euphoria, sedation, and a feeling of being “ high." Because of the potential medical risk and the unpleasantness of dealing with drug seeking medication abusers, more and more physicians are eliminating the use of benzodiazepines from their practice. Also, there is an increasing cry from the geriatric literature not to use benzodiazepines with the geriatric population due to potential cognitive impairment and an increased risk of falls. There are a number of other medicines that are not benzodiazepines that have excellent anti-anxiety profiles such as antidepressants.
There is a growing body of literature that suggests that TMS Therapy for treating anxiety and depression is an excellent solution. Many patients receive excellent anti-anxiety benefits from the classic protocol for treating depression. There is also a lot of investigation into using right-sided treatment for anxiety. Although it is a gross oversimplification to say that stimulation on the left side of the brain is excitatory and stimulation on the right side of the brain is inhibitory, those effects are seen with treatment. Oftentimes the anxiety protocols call for treatment of one pulse per second on the right side versus 10 pulses per second on the left side. Since TMS Therapy has not been “approved” for the treatment of anxiety, there are currently no insurance companies that cover the cost of this treatment. Given the safety profile in treatment efficacy studies that exist, our clinic offers TMS treatment for anxiety for patients for whom it is appropriate.
By Dr. Robert Sammons, Ph.D., M.D.
Balconi, M; Ferrari, C. Left DLPFC stimulation to reduce anxiety bias effect or how to reduce the positive anxiety subjects. Psychiatry Research. 2009(3):554-9, 2013 Oct 30.
Diefenbach, GJ et.al. Treating anxious depression using repetitive transcranial magnetic stimulation. Journal of Affective-Disorders. 151(1);365-8,2013 Oct.
Machado, S, et.al. Is rTMS an effective therapeutic strategy that can be used to treat anxiety disorders? Neuropharmacology, 62(1);125-34,2012 Jan.
No: Generalized anxiety disorder, also known as GAD, is characterized by persistent, excessive, and unrealistic worry about everyday things. People with this disorder experience exaggerated worry and tension, often expecting the worst, even when there is no apparent reason for concern. They anticipate disaster and are overly concerned about money, health, family, work, or other issues. Sometimes just the thought of getting through the day produces anxiety. They don’t know how to stop the worry cycle and feel it is beyond their control, even though they usually realize that their anxiety is more intense than the situation warrants.
Anxiety, or general anxiety, is a normal reaction to stressful and uncertain situations. It’s your body telling you to stay alert and protect yourself.
"My life with depression was not fun. I didn’t really find enjoyment in everyday things and I hated going to school. I had social anxiety along with depression. Even going to work was difficult. I didn’t want to wake up in the morning – I just wanted to go back to bed. Holding a job was difficult, and so was keeping relationships up. A Doctor told my dad about NeuroStar TMS Therapy and I looked into it and it seemed like it was a good option for me. The first week of treatment was a little bit rough, getting used to the NeuroStar machine, the tapping and the sound. By the end of the second week, I was falling asleep in the chair. Probably by the third and fourth week, everyone around me said I was starting to look and sound better… now I feel much better. I love life; I enjoy going to work and the gym. I have healthy relationships now. I have a lot of energy and I’m sleeping well."
"I’ve pretty much had depression since I was a child. I had separation anxiety in elementary school and it's basically followed me throughout my life in variant degrees. I first began taking antidepressants and it’s been over 20 years that I’ve been on them. My doctor and I were discussing new options and changing them again. NeuroStar TMS Therapy came along at the perfect time… because it felt like medication was putting a band-aid on my depression.
After about a week and a half (of TMS Therapy) I really started to feel different. I felt like I was alive – like the veil had been taken off of my eyes. I could see clearly and colors were brighter. Every day it gets better and better. Even though life still happens it is so much easier to deal with things… I don’t want to crawl under a table anymore."
If you look at how the body responds to complex situations, it generally does it in terms of a survival mechanism. Post Traumatic Stress Disorder (PTSD) is a survival mechanism. In order to receive a diagnosis of PTSD, by definition a person must have an experience that is above and beyond normative human existence. So, having a car almost back out and hit you at Wal-Mart doesn’t meet the criteria for PTSD. However, being in battle and seeing friends killed, being in a bad car accident, and being raped are all examples of situations which can frequently cause PTSD.
If you look at that from a survival mechanism, what PTSD does is cause anxiety and make people avoid or escape situations. The avoidance is generally called "bunkering up" by veterans. Oftentimes, people feel better when they are bunkered up. The reason is that they have identified a safe zone. If you look at the survival mechanism, it is what we call “one trial learning” in psychology. In one trial learning, oftentimes, the consequence of our behavior is so significant it only takes one time to learn we don’t want to do something. I frequently tell the story of pushing my grandmother’s old light switch in Tennessee when I was about six years old and getting shocked quite badly. I didn’t touch that light switch for another eight years. That is what you would call one trial learning.
With one trial learning, the body says “that was painful and I don’t want to do that again” so I avoid that particular light switch as well as any other light switches that may look like it and, sometimes, any light switch at all. For me it was just the one light switch although I am sure I was careful the next time I touched any light switch.
What happens in PTSD is the use of four psychological concepts that come together. The first two concepts are those of generalization and discrimination. Generalization is taking information derived in one situation and using it in a similar situation. For example, someone can probably start your car without having been inside that type of car. How are they able to do that? They are able to generalize from their experiences of starting a number of different cars and do so in your car. Instead of an ignition switch on the steering wheel it may be on the dash or vice versa, the windshield wiper knob may be on the left or right but, generally, we are able to generalize from our past experiences with other cars and start the car.
That process of generalization is what makes us the complex creatures we are. If we didn’t have that ability, we would be as dumb as computers. I don’t know about you, but I get frustrated when a computer can’t recognize what I want to do because I may not have put in a space, a dot or a particular type of dash. Computers are fast but they aren’t smart. We are able to make the generalizations and that is what gives us the robust, complex lives we are able to lead.
The other concept is that of discrimination. That is being able to identify items that are similar but discriminate between them because they are somewhat different. For example, you can go into a parking lot where there are two models of your car which are the same year, the same color etc., and you can still tell the cars apart. This is done either by the items in the car, the license plate or some outside damage. We can take items that are very similar and still be able to tell the differences. Eskimos are said to have between 18 and 30 different words for the color white in describing snow and ice. With non-Eskimos, they might see two or three colors but for Eskimos, their survival depends on not falling through the frozen water or snowdrifts, and these depend on their communicating the type of conditions they see. They do this by discriminating between pretty close colors of white or whitish blue.
With PTSD, what happens is that we over-generalize in a survival manner. It is like the light switch. If a person has a bad situation or a panic attack or anxiety in one situation, such as one store, he will then generalize the experience to all stores. The goal of therapy is to help patients make a discrimination. The discrimination is between a situation that was life threatening and really put the person into danger versus something that is not life threatening, such as being at Wal-Mart. It may be hard on your wallet but Wal-Mart is generally a pretty safe place to be.
The interesting thing is that most people feel safe when they are alone. The reality is they are more safe when others are around. Even in New York which used to be known as a cold place where people didn’t get involved, everyone tells you that you are safe when you are in a crowd. If you are in Times Square where people are eating, going to plays and looking at the sights, you are a whole lot safer than if you are the only person on the block in a neighborhood somewhere else in town. Being in Wal-Mart, where there are a lot of people, actually makes one safer although the generalization of most people with PTSD is that if they avoid or escape Wal-Mart they are safer.
That brings us to the final two concepts involved. These are conditions which I will try to explain very quickly even though it actually took me several semesters in school to understand. The concepts are escape and avoidance conditioning. If a person doesn’t like going someplace where there are a lot of people like Wal-Mart--but he has to go--he finds that his anxiety will rise when he drives to Wal-Mart and when he walks into the store, his anxiety is high. If he has to stay in the store, he will go as quickly as possible to get the items he needs, check out quickly and after he leaves, he feels better. The concept of reinforcement is doing things that reduce anxiety. We will do things that make us feel better. If leaving Wal-Mart makes someone feel better, then he is reinforced to want to leave quickly.
I describe this as happening to me at my grandmother’s farm where she had a root cellar that was very acrid in smell and I was sure there was a monster in the cellar. I would avoid going into the cellar as much as possible. When I had to go in, I made the fastest trip down the stairs, grabbed the item she wanted and got out in record time. Here’s an important concept: Nothing ever happened to me in the cellar. One can then ask the question of why I didn’t learn the cellar was okay. The answer is that if we escape a situation before our anxiety goes away, we never learn the situation is okay. We only learn we are safe when we leave in spite of the fact there was actually no threat.
When people force themselves to go places, leave as quickly as they can during a time when their anxiety is still high and feel better when they leave, they never learn the situation is okay. This is true although they could do the same thing for 20 years and nothing bad ever happens. It is the law of nature. If your anxiety goes away by leaving a situation, you are then reinforced by believing that the place produces anxiety and the best way to get rid of the anxiety is to leave the situation. We call that escape conditioning and it is a classic aspect of PTSD.
The other aspect that is similar is avoidance conditioning. This is the concept describing a person who doesn’t go to Wal-Mart. He considers going, thinks it is not a safe place and when he avoids going, he keeps his anxiety low. Anything that reduces anxiety is reinforcing and, therefore, people avoid going as much as possible. By avoiding it, however, they never learn that Wal-Mart is an okay place to be.
So let me tie everything together with the knowledge of how PTSD comes about and with guidance of how we get rid of it. PTSD comes because it is a survival mechanism. The person has a life-threatening experience and, not surprisingly, he wants to avoid having it happen again. The way to avoid it is to generalize from the experience one has that is life-threatening to identical situations as well as similar situations. In terms of avoiding it, anxiety will build up and the anxiety is maintained in spite of the fact the new situations do not produce any harm. This occurs because a person has anxiety when he engages in behaviors, such as going into a store, and the anxiety is relieved only after leaving the store. In another way, a person may avoid going to the store altogether, again reducing anxiety, so the person never has an experience to learn he is okay.
What do I mean by that? The way we basically treat PTSD is to have the person engage in the activity and wait to leave until a point where the anxiety has gone away. Sometimes people will start off by doing this with imagery. Sometimes people will simply bite the bullet and go someplace. For example, if a person wanted to reduce his anxiety in going to Wal-Mart, he could walk three feet into the store, stand by the side and wait until his anxiety is gone. An interesting thing about anxiety is that the body doesn’t want to be anxious if there is no threat. Anxiety is good as it protects us from danger, but the body doesn’t want to waste its time feeling anxious and scared of things that aren’t a threat. This actually reduces a person’s effectiveness in protecting himself during an actual emergency. When you are so worried about things that aren’t a danger, you can’t really hone in on things that are a danger.
Therefore, the body’s anxiety will reduce if a person is in a situation and no harm comes. There is only so much we can do to ourselves in saying this is a bad place if nothing bad happens. If a person were to stand inside Wal-Mart for an hour and nothing bad occurs, another process called extinction will occur. The anxiety will go away because anxiety needs to be maintained. It is maintained in PTSD by escape and avoidance. If he subjects himself to a place and nothing happens to him, it is hard to tell the brain there is danger when nothing dangerous is happening. The process of extinction then occurs and the anxiety will go away.
The next time someone goes to Wal-Mart some anxiety may be present but it will not be as high or last as long. The other way a person can manage the situation is to walk into the middle of Wal-Mart, stand there and wait until the anxiety turns to boredom. The example is that if I had gone into my grandmother’s cellar and stayed there for two hours, I would have been bored to death. No giant spider or monster would have gotten me and, pretty soon, I would realize I was in a place that simply smelled bad and was boring. The next time I went into the cellar, the anxiety either would not be present or it would be very low. If I stayed until the anxiety went away again, it would only take several times until there would be no anxiety because there was nothing maintaining it.
There are very complex processes at work forming and maintaining PTSD--generalization, avoidance conditioning and escape conditioning. The way we overcome this is by making discriminations between situations that are truly dangerous versus those over which we have anxiety but which don’t produce real danger. The way the anxiety is reduced is through the process of extinction, being someplace where your anxiety may be high, if you stay long enough and there is no danger, your anxiety will go away.
By Dr. Robert Sammons, Ph.D., M.D.
PTSD is diagnosed after a person experiences symptoms for at least one month following a traumatic event. However symptoms may not appear until several months or even years later. The disorder is characterized by three main types of symptoms:
Research has shown that certain types of therapy and medicine are effective for both depression and PTSD. Since the symptoms of PTSD and depression can overlap, treatment that helps with PTSD may also result in improvement of depression. Cognitive behavioral therapy (CBT) is a type of therapy that is proven effective for both problems. CBT can help patients change negative styles of thinking and acting that can lead to both depression and PTSD. A type of medicine that is effective for both depression and PTSD is a Selective Serotonin Reuptake Inhibitor (SSRI).
Depression is common in those who have PTSD. The symptoms of depression can make it hard to function, and may also get in the way of your getting treatment. Be aware that there are effective treatments for both depression and PTSD. If you think you may be depressed, talk to your doctor.
According to Wikipedia: Tinnitus (/ˈtɪnɪtəs/ or /tɪˈnaɪtəs/) is the hearing of sound when no external sound is present. While often described as a ringing, it may also sound like a clicking, hiss or roaring.Rarely, unclear voices or music are heard. The sound may be soft or loud, low pitched or high pitched and appear to be coming from one ear or both. Most of the time, it comes on gradually. In some people, the sound causes depression, anxiety or interferes with concentration.
Tinnitus is not a disease but a symptom that can result from a number of underlying causes. One of the most common causes is noise-induced hearing loss. Other causes include:ear infections, disease of the heart or blood vessels, Meniere's disease, brain tumors, exposure to certain medications, a previous head injury and earwax. It is more common in those with depression.
Tinnitus impacts the patient’s life in many varied ways. These were the reported difficulties from a patient group that we saw in Portland, and that represented the worst of the worst cases in the United States(Martin et al., 2002).
We ended up seeing many patients from all over when other practitioners came to a dead-end in treatment. Some of the troubles include poor concentration, difficulty in relaxation, irritability, discomfort in quiet, sleep problems, feelings of depression, interference with work or social activities, and more. Over two-thirds of our patients came in with multiple problems in these areas. Keep in mind that these patients are devastated psychologically, emotionally, and often socially.
A postpartum period or postnatal period is the period beginning immediately after the birth of a child and extending for about six weeks. Less frequently used are the terms puerperium or puerperal period. The World Health Organization (WHO) describes the postnatal period as the most critical and yet the most neglected phase in the lives of mothers and babies; most deaths occur during the postnatal period. It is the time after birth, a time in which the mother's body, including hormone levels and uterus size, returns to a non-pregnant state.
Many women don’t know that postpartum depression is only one in a wider spectrum of perinatal mental illnesses. (The word “perinatal,” by the way, means during pregnancy and after birth, so perinatal mental illnesses are those that happen any time during pregnancy or the first year postpartum.) Not everyone experiences the deep sadness and disconnection of postpartum depression.
Here is a list of perinatal mood and anxiety disorders we think you should know about:
There are many different symptoms and you may have only some of them. These are not one-size-fits-all illnesses – every mom is an individual. Read The Symptoms of Postpartum Depression & Anxiety (In Plain Mama English), which will give you a full list of possible symptoms. If you have some of the symptoms listed, and have had them for two weeks or more, call your doctor. What you are going through is temporary and treatable with professional help. This can be fixed.
Let's talk about the hope TMS Therapy is offering patients for treating depression. Many people are looking for a solution for depression for themselves or for a loved one. We understand the struggles and impact of this illness and realize that you may have questions about this therapy, and if it would be helpful.