Situational Depression vs Clinical Depression

Vagal Nerve Stimulation: Treatment for Depression

February 20, 2011 - Genetics and Depression

Science, more specifically genetics seem to be making a lot of progress in the study of genetics and mental illness. I believe that psychiatry is cutting edge with regards to the genome and therapies other than medication that are being discovered.

I often get asked the questions: Can depression be genetic or is depression genetically inherited. Some studies have said that they can isolate parts of the brain or specific genes that could be the cause of depression, anxiety and other illnesses. Yet other articles claim that the environment can alter the genes which would give someone a genetic predisposition to depression or other mental illnesses. Still other research has claimed that toxins such as alcohol, tobacco, and other chemicals in the environment, or deficiencies of vitamins in early development can also lead to mental illness. What depression is caused by or major depressive disorder causes seem to be in the forefront of genetic studies. We have to remember that mental illness is no different than any other organ in the body not functioning properly. Often this escapes many people or they don’t understand the organic nature of these illnesses; however, NAMI and other organizations are doing a wonderful job of public awareness.

One article titled is depression curable, I have posted on my two websites claims to have isolated a certain area in the brain that is responsible for pleasure or the lack thereof. Genetic therapy might be able to repair or change the brain function by adding a missing brain protein p11 to that specific area of the brain.

Another article titled is anxiety genetic I also posted earlier says that fetal stress or traumatic events can cause the genes to “turn on or off”. Small chemical groups can cause protein complexes to bind to histones and these can control gene activity. The researchers have studied in detail a complex called PRC2 which can attach small chemical groups – methyl groups – to the histones. Protective complexes can bind to the histones when this marker is present and the genes are turned off. Their new results show that the protective complexes are lost and selected genes turned on when cells are exposed to external stress factors. You may find these fascinationg articles further back in this section of or under Articles of Interest on my website Scottsdale Psychiatrist.

This Article below is about genetic mutation as it is linked to depression. I found it in WebMD and it claims that scientists have found a biomarker or genetic mutation that influences how the brain responds to stress which plays a key role in depression. The study claims to have found a genetic mutation that precludes certain individuals from producing enough neuropeptide Y. When the brain produces an insufficient amount of this NPY they are prone to have more intense negative emotional responses when subjected to stressful situations. The interesting aspect of these findings is that they could possibly lead to genetic engineering and actually provide a “cure” for mental illness in the future. Currently we can treat the symptoms but seldom “cure” the illness unless the cause is a hormonal imbalance or if the symptoms are that of another illness that is treatable, such as some infectious diseases. Read the complete article on Genetics, Stress and Depression.

February 16, 2011 - Comorbidity and ADHD

When I see patients, almost 75% of the time they have comorbid illnesses which means more than one. We often see ADHD and anxiety in adults or ADHD and comorbid anxiety. Many people who have ADHD also have depression and/or anxiety. Some believe that the depression or anxiety is secondary to the ADHD. This is very important because we often have to discern which of the illnesses is the primary illness that is driving the co-morbid illness; to implement an effective treatment program. Often a patient might complain of symptoms of anxiety, so the practitioner will treat them for anxiety and the ADHD which is the primary illness will be taken as “confusion” caused by the anxiety. What ends up happening is the ADHD is never treated and it is the root cause of the anxiety; therefore, the patient never gets relief from the anxiety. If an anti-anxiety medication is prescribed, much of the time, this will not help the ADHD. This is why the initial evaluation is so crucial in the treatment planning and implementation.

This often works in reverse as well. Often the patient may be suffering from bipolar disorder and the practitioner will treat them for the depression anxiety comorbidity. Instead of giving the patient a mood stabilizer, the practitioner prescribes an SSRI to pick them up (which often send them into mania) and then an anti-anxiety medication to bring them down. Once again, the initial evaluation is of utmost importance in getting the appropriate diagnosis, which then leads us to the correct treatment course.

Establishing the primary illness instead of the secondary illness - if the practitioner focuses on the secondary illness such as depression which might be caused by the primary illness ADHD; then the ADHD will persist and continue cause the depressive episodes. There are several ways that a trained psychiatrist uses to determine the differences between the primary and secondary illnesses. This aspect of medicine is as much an art as it is science and comes with years of experience and study.

January 18, 2011 - Anxiety Disorder Research

Many of the articles of interest that I post on this website typically have to do with new discoveries in mental health and finding new causes and cures instead of treatments. Much current work in mental illness research is focusing in on genetics and discovering or isolating the genes that change or cause anxiety, depression and other mental illnesses.

This recent study seems to place its emphasis on an area of study not previously given much attention, neuronal gap junctions. This is also promising for opening a whole new area of investigation for not only Post Traumatic Stress Disorder and other anxiety disorders; but also Alzheimer's Dementia. This study may open up an entirely new area of studying the causes of anxiety as well as new medications and drug treatment for anxiety. This study also shows promise for many other mental illnesses because the study of neuronal gap junctions have not been an area of much interest until now.

UCLA life scientists have discovered what may be a completely unexplored drug target for the treatment of anxiety disorders.

Normally, when people or animals experience a frightening event, they learn to fear the place of the event and any signals that were present at the time. This occurs because the nerve cells in certain brain regions increase their ability to excite or stimulate one another, said professor of psychology Michael Fanselow, a member of UCLA's Brain Research Institute.

Most neuroscience research has emphasized how this phenomenon occurs through chemical communication among neurotransmitters flowing across synapses - the space between neurons. However, there are also small, inhibitory neurons in these regions as well, which have direct electrical contact with one another through connecting channels known as "gap junctions," Fanselow said.
Gap junctions are very common in invertebrates but rare in mammals, where they are found on only certain inhibitory interneurons.

Because of this, no one has looked at the importance of these gap junctions for learning, memory and emotion," Fanselow said.

"We hypothesised that these gap junctions may be very important. Because the gap junctions cause the inhibitory neurons to fire together, they may cause these inhibitory neurons to act as a pacemaker for the excitatory neurons, making them fire at the same time so they are better able to make fear memories."

Fanselow's research team used several drugs in rats that block the gap junctions and found that they disrupted critical rhythms in the dorsal hippocampus - the brain region most involved in cognition - and prevented fear memories for places from forming. The drugs could block the formation of fear of places when given after the frightening experience.

Neuronal gap junctions may be an unexplored drug target for the treatment of anxiety disorders such as PTSD; they hold promise because giving a regular injection of drugs in a cavity near the abdomen worked as effectively as an injection directly into the brain. In addition, the injections worked when given right after the frightening experience.

"Because we don't know when a person will experience trauma, treatments that can work after the experience hold more promise," Fanselow said.

"The brain has many processes we have not yet explored," he added.

"Understanding them and how they normally work can open up new approaches that may help in very prevalent and debilitating diseases, such as anxiety disorders and memory disorders."

Neuronal gap junctions form where inhibitory neurons touch one another. They are like an opening between nerve cells, a gap in the membranes separating the cells from one another; they let the electrical activity in one neuron affect the neuron it touches.

"Our research shows a way that neurons can coordinate their activity, and this coordination is critical for memory formation," Fanselow said.

"Perhaps if we had a way of enhancing gap junction function, we may improve memory formation by facilitating gap junctions when memory is impaired by diseases such as Alzheimer's. However, we have not shown this yet."

"I was completely surprised by this discovery," he said. "I really thought we were taking a long shot and was surprised that gap junctions were not only playing a role but that their importance was so great.

"The formation of fear memories is the major cause of anxiety disorders. These disorders are very common and can be very debilitating. Gap junctions appear to be key in coordinating the activity of the network of neurons that produce fear memories, specifically, and probably other memories, generally, as well."

The research is published in the journal Science. To read the article at DNA Daily News and Analysis.

January 9, 2011 - Preventing Anxiety Relapse

This is one of the first studies that I have seen that finally addresses one very important question that my patients ask me, "When will I be able to stop taking my medication for Generalized Anxiety Disorder?”. I was never quite sure how to answer this many times extrapolating from my knowledge on the length of time it is necessary to keep one on antidepressant medication for the treatment of depression, which is six months to one year, I would answer them with this length of time. Now, from this study, it appears that I have some proof of greater efficacy by giving those patients this answer. It is best from the results of this study for patients to stay on the medication for a full 12 months. See my views on anxiety for more information on my clinical and practical observations.

I have seen patients who have wanted to try to come off their medication for the treatment of Generalized Anxiety prior to the 12 month interval. What tends to happen with tapers on the medication is that the symptoms of anxiety just reappear with the subtraction of the medication; but when patients have been on the main treatment with an antidepressant for treatment of either Major Depressive Disorder or Generalized Anxiety Disorder (yes, we do treat Generalized Anxiety with antidepressants too), for a full 12 months and are symptom free, if they have only had one episode, sometimes the patients are in remission and they remain symptom-free with a taper off the medication.

I would not recommend going off the medication all at once. I would recommend a taper off the medication with the help of your doctor.

Too often the patient starts to feel better and stops taking the medicine and ends up in relapse. One of the biggest issues a psychiatrist faces is having patients staying on their medications. Many of them feel an aversion to medicine due to side effects, cost, biases against medicine, or simply because they think they are "cured". Sometimes patients with chronic anxiety can taper over time and even learn to cope with the stress and triggers in life and get to a point of taking the medication as needed. But this is often the exception and even if this is the goal; they should taper at their Dr's. advice and rate and not their own. However, it is my opinion that severe the anxiety the patient should be on medication for at least 12 months before any changes are even considered.

From Medscape Medical News Psychiatry
Chronic Anxiety Requires Long-Term Treatment to Prevent Relapse
Fran Lowry

December 16, 2010 — Patients with chronic generalized anxiety disorder (GAD) who are receiving antidepressant therapy need to be continuously treated for at least 12 months to prevent relapse, according to a new study.

"Clinicians should not be afraid to treat their chronically anxious patients for at least 12 months and probably even longer," lead study author Karl Rickels, MD, Stuart and Emily Mudd Professor of Psychiatry at University of Pennsylvania, Philadelphia, told Medscape Medical News.

"Full remission of symptoms should be the treatment goal, and this goal is not reached for many patients unless they are treated for at least 6 months."

The study is published in the December issue of the Archives of General Psychiatry.

There were very few data on long-term treatment of GAD with medication and no data at all on whether 12 months of treatment was better than 6 months of treatment, Dr. Rickels explained.

Therefore, he and his team set out to examine the long-term efficacy of treatment with venlafaxine extended release (XR) in patients with chronic GAD who had responded therapeutically to an initial 6-month course of venlafaxine XR treatment.

The 18-month study was composed of 3 treatment phases: a 6-month, open-label, venlafaxine XR, flexible-dose treatment phase, which included 268 patients; a 6-month, randomized, double-blind, placebo-controlled relapse phase, which included 136 (50.7%) of the open-label patients; and a final 6-month, randomized, double-blind, placebo-controlled relapse phase, which included 59 (43.4%) of the first relapse phase patients.

The study showed relapse rates in phase 2, or at months 6 through 12 of the study, were 9.8% for patients taking venlafaxine XR compared with 53.7% for patients taking placebo (P < .001).

Relapse rates after 12 months of venlafaxine XR treatment were 6.7% for patients who were taking venlafaxine XR for the full 18 months, 20.0% for patients taking placebo for 12 months (months 6 to 18), and 32.3% for placebo patients who switched at month 12 to placebo (P < .14).

The study also found that patients treated with venlafaxine XR for 12 months before being shifted to placebo experienced a lower relapse rate (32.4%) than patients shifted to placebo after taking venlafaxine XR for only 6 months (53.7%; P < .03).

A major limitation of the study was its high attrition rate, said Dr. Rickels.

"Only patients who are willing to take medication for their anxiety for an extended period of time, who are able to cope with the adverse events that may occur, and who are able to cope with the slow onset of improvement and are willing to go up to the highest doses of drug allowed by the [US Food and Drug Administration], will benefit from long-term treatment," he said. "This excluded 40 patients in our study who dropped out of treatment before completing at least 6 weeks of treatment."

Dr. Rickels said that patients particularly suited to long-term treatment are those patients who have had anxiety for several years and whose anxiety clearly affects their quality of life.

Commenting on the study for Medscape Medical News, Richard Steinbook, MD, professor of psychiatry at University of Miami Miller School of Medicine in Florida, said the study confirms clinical experience.

"This study confirms what we have always experienced clinically on a more scientific basis. Now we can say with more scientific certainty that these patients do require longer term treatment."

He also approved of the study design.

"This was a relapse prevention study. It gave patients the opportunity to compare themselves over the long haul with others who have been switched to placebo," Dr, Steinbook said.

"Dr. Rickels has been one of the mainstays in this area. He has spent over 30 years working with this group in a variety of treatment approaches. This is a useful study."

This study was supported by the USPublic Health Service. Wyeth Pharmaceuticals Inc provided all study medication. Dr. Rickels reports financial relationships with Cephalon Inc, Hoffman-LaRoche Inc, Jazz Pharmaceuticals, Johnson & Johnson, Novartis Pharmaceuticals, Pfizer Inc, Epix (PreDix) Pharmaceuticals, PGxHealth LLC, Genaissance Pharmaceuticals Inc, Pamlab, Pfizer Inc, Wyeth, Boehringer Ingelheim, and Neuropharm. Dr. Steinbook has disclosed no relevant financial relationships.

Arch Gen Psychiatry. 2010;67:1274-1281.

December 28, 2010 - Brain Spotting

I found this article interesting because what I post under Articles of Interest often has to do with new methods and breakthroughs in mental health and therapies for treatment refractory patients. I take a team approach to treating mental illness; Dr. Crow has been a long and trusted member of my team of whom I refer patients; I think you will find this interesting because this treatment is another alternative therapy such as Transcranial Magnetic Stimulation Therapy and Vagal Nerve Stimulation; just to mention a few.

Gregory M. Crow, Ph.D.
7510 E. Angus Dr.
Scottsdale, AZ 85251
(480) 947-1989

Arizona Brainspotting Center

Brainspottingis a newer method of stimulating and processing emotional pain. It was discovered and developed by David Grand, Ph.D. Dr. Grand is a Licensed Clinical Social Worker (New York). He is a psychotherapist, writer, and lecturer who maintains a private practice in Manhattan and Long Island, New York. His work is considered ground breaking and he has been interviewed on many national news programs. He is the author of Emotional Healing At Warp Speed (2001). Currently there are about 3000 therapists trained world-wide.

It is believed that distressing situations cause physical disturbances that are stored in the body and nervous system. Brainspotting is an experiential and heavily body-involved technique that facilitates physical release of emotional distress. Distress is normally well-contained, but there are times in our lives when that "pool of pain" is so full that it begins to leak into our lives in unpleasant ways. Distress can manifest, for example, in the presence of anxiety, depression, anger, need to control, illness and or a need to medicate in some way. It is reasonable to assume that most people come to therapy because they are experiencing such a containment failure- the pain is interfering with their everyday functioning.

Dr. Crow has trained extensively in Brainspotting with Dr. David Grand and others including Robert Weisz, Ph.D. (Brainspotting and Hypnotherapy Clinic and Milton Erickson Institute of New Mexico) and Lisa Schwarz, M.Ed. Dr. Crow runs a Brainspotting Consulting group in Scottsdale, AZ.

What is Brainspotting? (Answers from the developer, Dr. Grand)

Brainspotting is a powerful, focused treatment method that works by identifying, processing and releasing core neurophysiological sources of emotional and physical pain, trauma, dissociationand a variety of other challenging symptoms. Brainspotting is a simultaneous form of diagnosis and treatment, enhanced with Biolateral sound, which is deep, direct and powerful, yet focused and containing.

Brainspotting is a tool, within the clinical healing relationship, to neurobiologically locate, focus, process and release experiences and symptoms which are typically out of reach of the conscious mind and its cognitive and language capacity.

A "Brainspot" is the eye position which is related to the energetic/emotional activation of a traumatic or emotionally charged issue within the brain. Located by eye position, paired with externally observed and internally experienced reflexive responses, a Brainspot is actually a physiological subsystem holding emotional experience in memory form.

"Brainspotting is based on the profound attunement of the therapist with the patient, finding a somatic cue and extinguishing it by down-regulating the amygdala. It isn't just PNS (Parasympathetic Nervous System) activation that is facilitated, it is homeostasis." Robert Scaer, M.D. The Trauma Spectrum

This article if for informational purposes only and not intended for diagnosing or treating an illness

December 16, 2010 - Treatment Refractory Depression

This article was very interesting because if true; those who are suffer from treatment refractory depression will have other options of dealing with their disease. We could treat depression with a protein peptide (or by inserting a protein molecule) between two dopamine receptors. This would preclude the some of the associated side effects that many times come along with the antidepressant medications. These antidepressant medications are very effective; however, there is always a percentage of the population that cannot tolerate them This is a very interesting article because I have been posting articles on “genetic engineering” to treat depression; however this article seems to find that “molecular engineering” can accomplish the same and thus treat depression without the need for anti-depressant drugs and their potential associated side effects.

This would be a break through in psychiatry especially for those who are treatment refractory to medications or those who cannot tolerate the drugs due to intolerable side effects. Often patients that are treatment refractory have to go through ECT, Psychotropic Drugs, Vagal Nerve Stimulation, Transcranial Magnetic Stimulation and other treatments. Neurological protein may hold the key to new treatments for depression.

TORONTO, Nov. 29 /PRNewswire

Neuroscientists at the Center for Addiction and Mental Health (CAMH) have developed a protein peptide that may be a novel type of highly targeted treatment for depression with a low side-effect profile. Depression affects one in ten Canadians at some time in their lives and is a leading cause of disability worldwide.

The study published in this month's Nature Medicine found that coupling between two dopamine receptors was significantly elevated in the brains of people who had been diagnosed with major depression. "We identified a potential therapeutic target for development of novel anti-depressants." said Dr. Fang Liu, Principal Investigator and Senior Scientist in CAMH's Neuroscience Program and Associate Professor of Psychiatry at the University of Toronto. Working from this discovery, researchers sought to find a way to disrupt coupling between the two receptors in hopes that it would have an anti-depressant effect.

Using an autopsied brain study, Dr. Liu and her team initially found that coupling between two dopamine receptors was significantly elevated in the brains of people who had been diagnosed with major depression. They started by analyzing a specific dopamine signaling mechanism, the D1 and D2 receptor complex, to identify the sites where the two receptors bind together. With this information, they were able to generate a protein peptide to disrupt the binding of the two receptors. The peptide was then tested in animal models to compare the effects with existing anti-depressant medications.

"After we administered the peptide, we saw a marked improvement in depression-related behaviors. The improvement seen in the peptide group was equivalent to the improvement on traditional anti-depressant medication".

This peptide is an entirely new approach to treating depression, which has previously relied on medications that primarily block serotonin or norepinephrine transporters. These conventional antidepressant medications don't work for all patients, and can cause various side effects. "We are hopeful that our research will lead to new options for treatment that might have reduced side effects for patients with depression," Dr Liu stated.

The Centre for Addiction and Mental Health (CAMH) is Canada's largest mental health and addiction teaching hospital, as well as one of the world's leading research centers in its field. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues. CAMH is fully affiliated with the University of Toronto, and is a Pan American Health Organization/World Health Organization Collaborating Centre. For more information, please visit

SOURCE Centre for Addiction and Mental Health

This article is for informational purposes only and not to be used to diagnose or treat any mental illness

December 4, 2010 - Insomnia

Sleep to the brain is like insulin to the pancreas. We all need a good nights’ sleep to repair our bodies, keep our hearts healthy, reduce stress, help with memory and other mental tasks; and help control our body weight. Scientists believe that sleep maintains and repairs our bodies and minds. Every night we cycle through three stages of sleep ranging from light sleep to deep sleep, and finally, to rapid eye movement (REM) sleep. A complete sleep cycle takes ninety to one hundred minutes on average. While we sleep, our brains are using important neuronal connections that might otherwise get worse from lack of activity. During deep sleep, brain activity that control emotions, decision-making processes, and social interaction stops, allowing us to maintain optimal emotional and social functioning when we are awake. Cell repair and cell growth takes place to combat the affects of stress and UV rays in this stage as well. Hence, deep sleep is really beauty sleep.

Sleep also strengthens our immune system and helps our bodies fight infection. This is because our immune system releases a sleep inducing chemical while fighting a flu or an infection. Sleep helps the body conserve energy and other resources that the immune system requires to mount an effective attack. Start your insomnia treatment as soon as possible to prevent sleep deprivation.

Insomnia is not an illness but rather a symptom of something else. Unfortunately, many people treat it as an illness and never get to the underlying cause. Almost 90% of people with depression and anxiety, suffer from insomnia. One should get a complete physical and mental examination to rule out these factors. Diet, lack of exercise, stress, mental illness, acute crises, and physical inactivity can each be responsible for insomnia.

Sleep aids do play a significant role (temporarily) in dealing with the underlying causes of insomnia because lack of sleep begets more sleeplessness and spirals downward from there. If you are suffering from insomnia, you need to see your doctor to learn what is causing it. Often insomnia is caused by sleep apnea which is a very serious condition – yet easily treatable.

I know of a gentleman who was waking 6 times a night to use the restroom and then could not get back to sleep. Even though he was not overweight, didn’t snore or have the “typical profile”; he tested positive for sleep apnea. Now that he is on a CPAP machine, he now sleeps soundly throughout the entire night without waking once. Surprisingly his apnea episodes are central in nature, the CPAP machine is still effective in treating his condition with great success! Sleep apnea is more prevalent than most believe; one need not be obese to suffer from sleep apnea because there is also a condition referred to earlier in this article of central apnea which involves the brain failing to “tell the body to breath”. Obstructive sleep apnea is caused from the soft tissues of the neck obstructing the opening to the lungs, therefore, air can’t get to them. This is caused usually from obesity.

Here are some statistics that you might find interesting: •People today are sleeping on average 20% less than they did 100 years ago.

•Over 30 Million Americans suffer from insomnia (10%)

•1 in 3 people suffer from some form of insomnia during their lifetime

•20-40% of adults in the US experience insomnia in any given year

•51% of Americans are losing sleep due to stress and/or anxiety

•40% – 60% of people over 60 suffer from insomnia

•Women are between 1.5 and 2 times more likely to suffer from insomnia than men

•2 Million American children experience sleep disorders, including insomnia

•Approx 35% of insomniacs have a family history of insomnia

•Approx 10 Million people in the US use prescription sleep aids/insomnia medications to help them sleep

•The average person needs eight hours of sleep, while infants need sixteen hours of sleep, and teenagers need about nine hours.

•People who suffer from sleep deprivation are 27% more likely to become overweight.

You need your sleep for your mental hygiene and overall health – don’t dismiss insomnia as typical of a “busy person” - get help!

This article is for informational purposes only and not to be used for diagnosing, or treating a particular condition

What is Transcranial Magnetic Stimulation TMS:
Dr. Denise Lin, Advanced Psychiatric Care of Santa Barbara (805) 845-2323

What is Transcranial Magnetic Stimulation Therapy. TMS is way of targeting specific areas of the brain with a strong, pulsed magnetic field to stimulate brain cells. Stimulating brain cells to treat psychiatric disorders is a growing area of research and clinical practice. Seven of the top ten academic centers that train new psychiatrists are now providing TMS and there are about 260 TMS centers across the US.

What are the biological effects of TMS Therapy?

When brain cells are stimulated, they release brain chemicals called neurotransmitters. These substances are important for mood and anxiety regulation. During Transcranial Magnetic Stimulation Therapy, an area about the size of a golf ball near the brain surface (the cortex) is directly stimulated by the magnetic field. In addition, there are circuits which connect the surface of the brain to deeper brain structures allowing activation of several other areas of the brain also. All these areas are involved in mood regulation.

Who might benefit from TMS Therapy?

TMS is FDA-approved for the treatment of adults with depression that has not responded adequately to an antidepressant medication. The original research was done on people with medication-resistant depression that had not responded to between 1 and 23 different antidepressant medications. More than half of these people had a marked improvement and one-third had full remission of their depression symptoms with Transcranial Magnetic Stimulation Therapy TMS. Considering how tough their cases of depression were, these numbers are quite impressive.

Some TMS psychiatrists are using TMS off-label to treat people with anxiety disorders or bipolar depression. Pregnant or breast-feeding women with depression have also been treated successfully. There is some evidence that it can help migraine sufferers and people suffering from tinnitus also.

Can you use medications during TMS Therapy?

Yes. Transcranial Magnetic Stimulation Therapy TMS is safe to use with or without antidepressant medications. This would be discussed ahead of time with your TMS psychiatrist. Some doctors might also recommend certain nutritional supplements to take during TMS Therapy.

How many treatments does it take?

A typical treatment course for depression is 20-30 treatments. Each treatment lasts about 40 minutes. The treatments are usually done daily, Monday through Friday for 4-6 weeks and are done in a comfortable office setting.

Does TMS require sedatives? Is there any downtime?
No sedatives are needed, and so you can drive, work, eat and do any of your normal activities before and after treatment sessions.

Does insurance cover TMS Therapy?

Starting in January 2011 Transcranial Magnetic Stimulation Therapy TMS will have an official CPT code that insurance companies recognize. This will make it much more likely to be a covered procedure. Previously, insurance companies covered TMS on a case-by-case basis and appeals were sometimes needed if the insurance company denies it at first.

If TMS is appropriate for you, your TMS psychiatrist and the Neuronetics Care Connection will work to provide your insurance company with the information it needs and if necessary, they will help you with the appeals process.

November 19, 2010 - Intimacy Issues Common to Men

Gregory Crow PhD
(480) 947-1989

I don't typically deal with men's issues or relationship help for men; however, one of my colleagues and members of my team of professionals Dr. Gregory Crow does. Many of men's issues today stem from intimacy and I thought this would be a great article to post because identifying the issue is the first step in the recovery process, the next step is seeking help...I hope you find this article helpful and please feel free to call Dr. Crow directly; he is very affable, approachable and understanding. You will enjoy working with him.


For many years now I have been treating men who desire to restore their integrity and their marriages (and families). All of us struggle to be pure in heart. All of us have stress and family issues and all of us medicate. It could be alcohol, drugs, gambling, over-eating, shopping, working-the list goes on and on. Gaming and excessive time spent on various video venues are huge now. For some, unhealthy sexual practices are the “medication of choice.” All of these practices become intimacy issues for men.

While these various problems need specialized help, the process of recovery for all these issues is much the same. Many, if not most, men have several of these “medications” in their lives.

No one decides what they will use to “zone out” from the stresses of life (for some it is more about the mood-altering thrill). We just happen upon it. For many men I treat, it was the discovery of pornography at a young age that initially excited them and later became a habit they could not retire from on their own. For some it is womanizing-enjoying the attention of an attractive female and the thrill of flirting with and eventually sleeping with women other than the girlfriend or wife that gives them the short-term escape or thrill they are looking for. Obviously these behaviors prohibit and destroy the natural sweet intimacy between men and their wives. I commonly hear that men assume they will grow out of these habits, only to find that in some cases they cannot quit on their own. For those who have crossed that line, awareness is not enough and it is usually when their relationships are on the brink (“get help or we’re done”) that help is sought out. At this point men are typically already experiencing a marriage without intimacy, leading their wives to take a stand-it’s me or your habit.

It is important to note that whether or not the behavior has escalated to something the man cannot stop on his own (one definition of addiction), the opportunity to work with any man who is involved in these marriage-busting behaviors is critical. Many non-addicted men can be helped before they do more damage to their marriages, families and themselves.

I have found that Group Therapy, which calls men to a higher degree of vulnerability and accountability, breaks the power of the behavior and the secret life necessary to practice it. Many times the partner doesn’t know the half of the story when they find evidence that confirms their suspicion that something or someone is lurking in the shadows, interfering with their relationship. Getting the truth on the table and having the opportunity for continuing accountability such as the group provides really helps. The habits are exposed for what they are-mood-altering behaviors that have some level of harmful consequence to the relationship and which will never meet our needs for real intimacy-including a healthy sex life with our partner.

Individual Therapy is also critical because it helps to identify “the why.” This is the exploration of each individual’s adaptation to their experiences in both childhood and adult life. Unfinished business (that all of us have) is processed so that we can make better choices and be less distressed day to day. Brain spotting is one technique that is utilized to stimulate and process emotional issues. Education and guidance in these matters is also very important, along with providing a safe, non-judging place to talk in the first place.

Lastly, Couples’ Therapy is where all the gains from the other work pays off as issues each person has with their partner get “hashed out.” I have special training in a type of marriage counseling called Emotional Focused Therapy for Couples. This therapy has been found to have a high rate of success. It helps couples identify their marriage “dance” and change it. Each partner is guided to become more vulnerable so that heart-felt issues can be shared in a way that empathy develops. This causes softening of our hearts and the opportunity for re-connection! I have years of experience in marriage counseling in Scottsdale.

For most men, the processes I’ve mentioned above don’t just help them with problem behaviors-as they continue to do the work they move well beyond this into learning much about being healthy persons. They often become the leaders their wives and children always needed them to be at home.

It is true that recovery is possible, more than likely in fact, when a man commits to do whatever is necessary to change- and follows up on that commitment. A man must work to change for himself first-to be the man HE really wants to be. The good news is that when he does that, often times everything else falls into place!

November 14, 2010 - Anxiety and Depression Triggers

Many of us in health care are familiar with Seasonal Depression or Anxiety. This is a term which describes a "trigger" that provokes a depressive episode or anxiety attack. I have known individuals who experience the these seasonal issues. Each of these individuals have the tendency to experience an anxiety attack when the seasons change from spring to summer. Ironic because we would think that these anxiety or depressive episodes would be brought on by the shorter and colder days of the winter season. One of these individuals does also has the tendency to suffer from anxiety in the winter as well.

We don't know exactly why the changing of the seasons has this impact on mental conditions but the occurrences happen too often to write them off as aberrations. In both cases each person is aware of these triggers. This is key; they both go to their doctors to get some extra medication to preempt a full anxiety or depressive episode. One individual will have his doctor give him a two week supply of Klonopin which seems to do the job of staving off the anxiety attack; and the other gentleman deals with an increase in his SSRI's.

Some keys to avoiding Seasonal Depression is to 1. Acknowledge it. 2. Prepare for it and 3. Change your environment to possibly avoid future occurrences. Sometimes just knowing that you have the extra "meds" is enough to stave off the anxiety attack without having to ever resort to using the medication. Changing your environment can also be great help. If the short cold days of winter tend to bring on a depressive episode; put your lights and appliances on timers so you don't go home to a dark house. Keep the TV and or radio on as well. These little things will sometimes keeps these triggers from sending you into an anxiety, panic attack or depressive episode. Always keep your doctor informed as well so he or she can be there to help you; it is often easier to prevent an episode than go through one and your support network is key. Stay close to your friends, do some introspection as to why these triggers occur. Maybe you can get to the root causes and alleviate the problems as time goes on. These seasonal changes might bring on a feeling of "change" occurring in your life of which you feel a loss of control which is making you anxious or depressed? Maybe they bring back old memories and hurts that have to be dealt with instead of glossed over? It was once said that a great work of art is first and foremost a "work". So is a good healthy life; we have to keep working at it day by day.

This article is for informational purposes only and not meant to diagnose or treat any mental illness

November 8, 2010 - Dealing with the Holiday Blues

Medical News Today
I saw this article in the Medical News Today; most of the article is about defining, diagnosing,and treating anxiety disorders; however, this portion of the article I thought would be good bit of information to post. This deals with the "holiday Blues"; not what we would call major, clinical or a true depressive or anxiety disorder; but rather situations that cause grief and stress in our lives.

Many of us as we enter the holiday season have such high expectations of how we are "supposed" to feel joy unspeakable, happiness and glee that often our inability to meet these self imposed expectations can cause us some anxiety and depression. For "minor' cases of anxiety and depression what we might call "situational" depression or anxiety, we can learn what triggers these episodes, and learn to change our thinking. Maybe lower the expectations - who says we have to be elated during the holidays? Especially during one of the worst recessions most of us have ever experienced. If your anxiety is a bit more than minor, you have been treated by a medical doctor in the past; you need to tell your doctor about the fears of an episode coming on; or ask him/her to help you deal with the "triggers" of these attacks.
Following are some "tips" from the article to avoid and "stave off" the holiday blues:

Things to consider:
  • Learn to manage stress in your life. Keep an eye on pressures and deadlines, and commit to taking time away from study or work.  
  • Learn a variety of relaxation techniques. Information about physical relaxation methods and meditation techniques can be found in book stores and health food shops.  
  • Practice deep abdominal breathing. This consists of breathing in deeply and slowly through your nose, taking the air right down to your abdomen, and then breathing out slowly and gently through your mouth. Breathing deeply for too long may lead to dizziness from the extra oxygen.  
  • Learn to replace "negative self talk" with "coping self talk." Make a list of the negative thoughts you have, and write a list of positive, believable thoughts to replace them. Replace negative thoughts with positive ones.  
  • Picture yourself successfully facing and conquering a specific fear.  
  • Talk with a person who is supportive.  
  • Meditate, Exercise.  
  • Take a long, warm bath.  
  • Rest in a dark room. 
  • Go to your religious services, you will find hope and a support group.  
  • Go contribute time to charity and homeless shelters-you will find many reasons to be grateful for what you have and it is more blessed to give than receive - which should be the purpose of the seasons.  
  • Start looking at the holidays as a time to make someone else a life joyful and take the attention off of your life. This is also referred to as Cognitive Behavior Therapy.
To read the rest of this article click here on Medical News Today

This article is not meant to diagnose or treat any medical or psychiatric illness and is for informational purposes only 

October 29, 2010 - Promises and Hope

There has been very much research being financed and conducted with regards to identifying certain genes that "might" be responsible for mental illness. Several studies have shown that certain environmental stressors could be responsible for the genetics that lead to anxiety and depression. Other studies have claimed to find the genes and a way of manipulating these genes to actually "cure" depression and anxiety instead of simply treating the symptoms.

I have posted several articles on this site as well as psychiatrist scottsdale. Please continue to check out this site and the "Articles of Interest" tab on .As we enter this age of genetic in mental health; the impact will be of the greatest significance. We know that mental illness affects a large portion of our population; and its consequences even a larger segment of our population. The sooner we can get these diseases, the better off we will all be.

Especially since it seems as though mental illness has almost been epidemic over the past 20 years. Now I say this cautiously because these figures can be skewed by many factors such as the illnesses be less stigmatized, therefore many more are acknowledging their illnesses, or that we have more treatments available so more people are coming forward to acknowledge their illness. Or it could be that our environment of pollutants in our air, water, food and levels of stress in our lives is actually adding to the incidences of various illnesses.

None the less, I am glad that you have taken time to read this short article and please come back to this site as well as psychiatrist scottsdale often.

These articles are for information only and not to be used to diagnose or treat any mental illness

October 2010 - Genetics

I have just posted several articles on psychiatrist scottsdale under "articles of interest" that are very interesting. One of them claims that environmental stressors can change certain genes that are responsible for anxiety and other mental illnesses. In essence the article claims that fetal environmental stress is responsible for the genetics that are responsible for mental illness. I also believe that these genetic changes or at least changes in the neurons that control our mood can take place at any age due to traumatic stress or drug abuse or injury to the brain.

I am posting another article this week which will discuss the break through in genetics and the possibility of "curing" mental illness instead of just treating its symptoms. This is accomplished by locating the areas of the brain responsible for deriving pleasure and thus permitting the brain to regulate its chemical balances.

October 18, 2010 - A Cure for Depression?

I saw this article in the Scientific Daily News; Scientists seem to have "possibly" pinned down the gene that is responsible for depression. If so this could mean that in years to come we are looking at a cure for depression and other mental illnesses instead of just treating the symptoms.

ScienceDaily (Oct. 18, 2010) — Yale University researchers have found a gene that seems to be a key contributor to the onset of depression and is a promising target for a new class of antidepressants, they report Oct. 17 in the journal Nature Medicine.

"This could be a primary cause, or at least a major contributing factor, to the signaling abnormalities that lead to depression," said Ronald S. Duman, professor of psychiatry and pharmacology at Yale and senior author of the study.

Scientists have had a difficult time pinning down the cause of depression, which afflicts almost 16 percent of Americans in any given year and carries an annual economic burden of $100 billion.

Symptoms of depression vary widely among individuals. Most now believe that multiple physiological processes are involved in major depressive disorder. That explains why people respond differently to most commonly prescribed antidepressants, which work by manipulating the uptake of the neurotransmitter serotonin. However, as many as 40 percent of depressed patients do not respond to currently available medications, which take weeks to months to produce a therapeutic response.

Duman's team did whole genome scans on tissue samples from 21 deceased individuals who had been diagnosed with depression and compared gene expression levels to those of 18 individuals who had not been diagnosed with depression. They found that one gene called MKP-1 was increased more than two-fold in the brain tissues of depressed individuals.

This was particularly exciting, say the researchers, because the gene inactivates a molecular pathway crucial to the survival and function of neurons and its impairment has been implicated in depression as well as other disorders. Duman's team also found that when the MKP-1 gene is knocked out in mice, the mice become resilient to stress. When the gene is activated, mice exhibit symptoms that mimic depression.

The finding that a negative regulator of a key neuronal signaling pathway is increased in depression also identifies MKP-1 as a potential target for a novel class of therapeutic agents, particularly for treatment resistant depression.

Other Yale authors include Vanja Duric, Mounira Banasr, Pawel Licznerski, Heath D Schmidt, Arthur A Simen and Samuel S Newton. The work was funded by the U.S. Health Service and State of Connecticut, Connecticut Mental Health Center.

These articles are for information only and not to be used to diagnose or treat any mental illness

September 2010 - Off Label Medications

I thought the following was an interesting article and worthy of posting; my husband suffers from chronic back pain and went in for an unrelated surgical procedure. For 8 weeks after the procedure he was free of back pain; we had suspected that the anesthetic (though a low dose for twilight sleep) was responsible for his freedom from pain.

Quite often, many drugs are discovered to address issues other than their intended use. We call this using drugs off label. For example; anti-seizure medications are used as mood-stabilizers, often anti-depressants are used to treat fibromyalgia; Vagal nerve stimulation used to control seizures are being used to control depression. Often hormones and other physical issues can be responsible for depression, anxiety, symptoms of bipolar disorder; a good psychiatrist will always screen to rule out these physical, hormonal or bodily injuries as the cause.

Anesthetic Shows Promise for Bipolar Disorder
Single Injection of Ketamine Provides Relief From Depression in 40 Minutes
By Katrina Woznicki

WebMD Health News Reviewed by Laura J. Martin, MD Aug. 2, 2010 -- Patients with bipolar disorder who failed to find relief from their depression with other standard treatments experienced fast-acting relief from a single intravenous (IV) dose of a drug called ketamine, according to a new, small study.

Researchers at the National Institute of Mental Health in Bethesda, Md., found that ketamine, an anesthetic, improved symptoms of depression within 40 minutes of injection. The beneficial effects remained significant one day and even two days after the injection, suggesting that ketamine was both fast-acting and long-lasting, the authors report in the August issue of Archives of General Psychiatry. These results are noteworthy, the researchers say, since patients often experience a long lag between the time they take their depression treatment to the time they feel an improvement in their mood. Overall, 71% of the patients responded to the ketamine and reported an improvement in symptoms, compared with 6% of patients given a placebo. - End of article  Copyright ©2009, WebMD, LLC

If you ever have an experience whereby one medication that you are taking is having a positive or negative effect on another medical issue; please tell your doctor and/or write the drug company. This is how most of these off-label discoveries are made.

These articles are for information only and not to be used to diagnose or treat any mental illness