Blog - CNY TMS Psychiatry

TMS Therapy: A New Potential Weight Loss Treatment

Tue, 10 Jan 2023 21:57:23 GMT

Are you struggling to lose weight? Have you tried diets, exercise, and other methods without success?

If so, you may want to consider TMS Therapy as an option. TMS Therapy, or Transcranial Magnetic Stimulation, is a relatively new treatment option proven to help with weight loss.

In this blog post, we'll explore the potential of TMS Therapy as a weight loss solution and discuss why it could be an excellent fit for your lifestyle.

What is TMS Therapy?

TMS Therapy is an FDA-approved non-invasive treatment that stimulates nerve cells in the brain by using magnetic fields. It is a safe, effective, and drug-free way to treat various mental health conditions such as depression, anxiety, and OCD. It has been used for many years, and recently its benefits have extended to weight loss.

How It Works

How does TMS Therapy work? By using electromagnetic pulses to stimulate targeted areas of the brain, the treatment helps regulate mood and behavior. The process involves placing a specialized coil over the scalp that sends out electric pulses.

The energy from the pulses can reach deep into the brain, activating specific regions that help modulate emotions and behaviors.

What Are the Side Effects?

TMS Therapy is a safe and effective weight loss treatment option with minimal side effects. The most common side effects reported from TMS Therapy are mild, such as headaches and tingling sensations. Other side effects may include jaw pain, scalp discomfort, and nausea. Most of these go away as a person adjusts to the treatment.

Overall, the potential side effects of TMS Therapy are generally mild and do not pose a significant risk for most people considering this form of treatment.

Before beginning treatment, it is essential to talk to your doctor about any potential side effects that could occur with this type of therapy.

Weight Loss Benefits of TMS Therapy

It's believed that TMS Therapy works by altering the way specific brain circuits function, which can lead to an improved mood and decreased cravings for food. By helping to improve self-control, TMS can result in healthier eating habits, ultimately leading to sustained weight loss.

TMS Therapy has also been found to help people manage stress more effectively , which can contribute to healthier eating habits. Studies have also shown that TMS can help to motivate and increase physical activity levels, leading to further weight loss.

By stimulating the parts of the brain responsible for regulating appetite, TMS can help people who struggle with emotional eating or unhealthy snacking habits.

What Makes TMS Different from Other Weight Loss Methods?

TMS Therapy is a relatively new weight loss treatment that has shown promising results in recent years. While it may sound complex, the process is quite simple.

TMS Therapy utilizes a strong magnetic field to stimulate specific brain areas responsible for regulating hunger and cravings. This stimulation can help to reduce the urge to overeat, allowing users to lose weight more naturally.

Unlike other weight loss treatments, such as diet and exercise, TMS does not require significant lifestyle changes. Patients can usually carry on with their regular daily routine while undergoing treatment. It also does not involve taking any drugs or supplements, meaning there is no risk of experiencing any severe, adverse side effects.

Additionally, unlike other methods, such as bariatric surgery or liposuction, TMS is entirely non-invasive and no recovery time is required . The procedure is relatively quick and painless, and patients can return to their daily activities immediately.

The most significant advantage of TMS Therapy is that it offers a safe, effective solution for those struggling to lose weight despite trying other methods. By targeting the source of the problem – your brain – TMS Therapy can give you the push you need to reach your weight loss goals without relying on dangerous or drastic measures.

The Bottom Line For TMS and Weight Loss

The bottom line is that TMS Therapy offers a safe, non-invasive way to help manage eating behaviors and cravings. For many, it can produce lasting lifestyle changes and support weight loss efforts long-term.

Contact us today if you're ready to ditch the fad diets and learn how TMS supports weight loss. We offer consultations for TMS therapy in Marcellus and Endicott, NY.

Discover what TMS can do for you--it may be the weight loss solution you've been longing for. Please don't hesitate to contact us via email at info@cnytms.com or by phone at 315-671-2140.

The Effects of Stress on Anxiety & How TMS Therapy Can Help

Tue, 08 Nov 2022 19:22:58 GMT

If you suffer from anxiety, you probably know that it can affect your health in ways that may surprise you. Stress and anxiety have been linked to several conditions, including heart disease and cancer – diseases that can be tough to fight against if you're already trying to manage stress and anxiety on top of everything else.

Fortunately, TMS therapy offers an alternative approach for treating stress and anxiety – without the side effects of other medications. Here's how stress affects anxiety and what TMS therapy can do about it.

Introduction to Stress

November is the month for International Stress Awareness--a vital cause dedicated to highlighting the importance of leading a fulfilling life. Bringing awareness to stress reminds us that there are situations in life that are out of our control and that there are serious health concerns associated with stress if we don't learn how to manage it effectively.

The World Health Organization defines stress as "any type of change that causes physical, emotional or psychological strain." Stress happens to your body when it demands your attention to a particular detail or circumstance. Everybody experiences it in some form or another.

People manifest stress in a variety of ways. A few common examples are anxiety, heartburn, trouble sleeping, changes in eating habits, difficulty focusing, increased use of alcohol and tobacco, fatigue, and the list goes on.

Understanding the Impact of Stress

The American Psychological Association conducted a survey about Stress in America . People reported the following symptoms related to their stress:

36% experience heightened nervousness or anxiousness
35% feel anger or irritability
45% have difficulty sleeping

Small doses of stress can be beneficial for performing tasks or self-protection, but large amounts can persistently trigger the fight, flee, or freeze response. When this happens, your body produces adrenaline and cortisol, the fight-flight-freeze hormones that give your body the energy it needs to act against a perceived threat.

Typically, this response fades relatively quickly. However, when the body continues to stay "revved up" in this way, physical and mental symptoms can worsen if not managed properly.

Stress awareness is essential because it can help people identify what stresses them, what causes their stress, and how to take steps toward recovery.

What is Anxiety?

Anxiety is a mental health condition that can have debilitating effects on a person's life. Symptoms include insomnia, shakiness, persistent worry or sense of dread, increased heart rate, difficulty concentrating, and more.

There are many different types of anxiety, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Stress is commonly linked to these disorders.

The Link Between Stress and Anxiety

As the American Psychological Association says, "There's a fine line between stress and anxiety."

While both are internal, emotional responses to a trigger, stress typically comes from an external stimulus such as a pending work deadline, an argument with a friend, or more long-term events like a chronic illness. Anxiety differs because it is defined by excessive worry that does not dissipate after a stressor is gone or exists without any external trigger.

Anxiety and stress result in similar symptoms, such as difficulty sleeping, fatigue, irritability, muscle tension, and difficulty concentrating.

How TMS Therapy Can Help Relieve Stress & Anxiety

Mild stress and anxiety symptoms respond well to coping mechanisms like a nutritious diet, exercise, or good sleep. However, if stress doesn't respond to these stress management strategies, or the symptoms impact your ability to function, it may be time to reach out to a mental health professional for help.

At CNY TMS, we offer Transcranial Magnetic Stimulation --also known as TMS. TMS is a painless, noninvasive procedure that transmits magnetic pulses into the brain to alter nerve activity and help regulate mood.

For most people, there is a biological component involved in their anxiety symptoms. This biological component typically manifests in abnormalities in the brain's prefrontal cortex. TMS focuses on this area to relieve symptoms, especially for those who have not responded well to traditional interventions like medication.

Many people feel relief as soon as the first TMS treatment, while others notice a significant improvement after the first few.

Find the Relief You Deserve with CNY TMS

In honor of Stress Awareness this month, we hope you'll take the time to learn more about how stress and anxiety manifest in your life and how TMS therapy can help.

If you live near Marcellus or Endicott, New York, the CNY TMS team can help you cultivate a purpose-filled life. Please don't hesitate to contact us via email at info@cnytms.com or by phone at 315-671-2140.

National Suicide Prevention Awareness: How TMS Therapy Can Help

Sat, 17 Sep 2022 14:39:55 GMT

September is Suicide Prevention Awareness Month, a time to increase the dialogue around suicide and reduce the stigma around depression and other mental health conditions.

It is possible to prevent suicide if you have the proper tools. And if you're dealing with depression, then TMS Therapy and other modes of treatment are available to help those suffering from suicidality by treating underlying depression. Keep reading to learn about National Suicide Prevention Awareness Month and how TMS Therapy can help prevent death by suicide.

Why Suicide Prevention & Awareness Matter

Raising awareness about suicide prevention, gaining insight into mental illness, and having open, honest conversations with friends and family members about suicide may help to save lives. Stigma prevents people considering suicide and those around them from seeking the help they need.

Most people do not talk about it, but it's been shown that awareness and open dialogue can be beneficial to suicide prevention efforts. Talking about suicide allows individuals to share their stories, and the discussion may lead to them receiving the help they need.

Raising awareness about suicide prevention can demystify depression and let people know that help is available should they ever need it. It can also encourage people to speak up if they notice or hear someone in distress.

The Link Between Depression & Suicide

According to the Department of Health & Human Services (HHS), most people with depression don't commit suicide, but depression is associated with significantly higher suicide risk. Depression severity correlates with this risk.

2% of people who receive outpatient treatment for depression will die by suicide.
4% of people who receive inpatient treatment for depression will die by suicide.
6% of people who receive inpatient treatment following a suicide attempt will die by suicide.

The Center for Suicide Prevention also shares that "those suffering from depression are at 25 times greater risk for suicide than the general population."

Helping Someone Struggling With Depression & Suicidal Thoughts

If you believe someone may be having suicidal thoughts try and encourage them to talk about their feelings by asking one of the following questions:

"Are you thinking about suicide?",
"Are you having thoughts of ending your life?"
"Are you thinking about killing yourself?"
"I don't know how you're feeling, but I'd like to try and understand."

Also, be sure to:

Remind them how much you care and that they are not alone.
Be non-judgmental; do not criticize or blame them.
Talk about who they may hurt if they leave them behind.
Encourage them to find care and offer to help.
Keep promises and follow up on any commitments you make in providing support.

Listening is often enough, so long as you let them know you care and are there for them. You don't have to offer a solution or know all the answers.

Knowing The Warning Signs

People who are suicidal often exhibit warning signs through their words or actions. Here are some warning signs to watch out for:

Dramatic mood swings
Social withdrawal
Aggressive, impulsive, or reckless behavior
Increased drug or alcohol use
Tying up loose ends or giving away personal belongings
Buying a weapon or collecting pills
Saying goodbye to friends and family

Contacting Crisis Resources

If someone intends to kill themselves and they're in danger of doing so, you can help keep them safe by not leaving them alone, getting any dangerous items out of the way, and calling a mental health professional immediately.

For emergency help:

Call or text 988 immediately.
Chat the Suicide & Crisis Lifeline at 988lifeline.org.
Text NAMI to 741-741 to connect to the Crisis Text Line.
Take them to the nearest emergency room.

Connecting to Professional Care: TMS for Depression Can Help

TMS therapy is a noninvasive therapy that stimulates areas of the brain affecting one's emotional state, memories, appetite, and sleep patterns. It is FDA-approved for major depression, obsessive-compulsive disorder, chronic pain, and more.

One study , among many, produced results showing 77% of patients were found to have decreased suicidal thoughts in a study, and 71% reported having no suicidal thoughts after a course of TMS therapy sessions.

Seeking TMS Therapy for Depression in Syracuse & Binghamton

TMS therapy is one treatment option for depression that can help prevent death by suicide. To learn more about how TMS therapy works and if it's suitable for you or a loved one, contact us today to set up an appointment at one of our locations in Syracuse, NY, or Binghamton, NY. You do not have to suffer alone.

We look forward to helping you or someone you love to achieve a happier and happier life!

Reference Links:

https://www.nami.org/Get-Involved/Awareness-Events/Suicide-Prevention-Awareness-Month-(SPAM)

https://www.nami.org/NAMI/media/NAMI-Media/Infographics/NAMI_Suicide_2022_FINAL.pdf

https://988lifeline.org/promote-national-suicide-prevention-month/

https://www.southmiamirecovery.com/awareness-suicide-prevention/

https://www.rethink.org/advice-and-information/carers-hub/suicidal-thoughts-how-to-support-someone/

https://www.hhs.gov/answers/mental-health-and-substance-abuse/does-depression-increase-risk-of-suicide/index.html#:~:text=Although%20the%20majority%20of%20people,the%20severity%20of%20the%20depression .

http://www.tmswashington.com/wp-content/uploads/2020/02/Application-of-Transcranial-Magnetic-Stimulation-in-Reducing-Suicidal-Ideation-POSTER-2019.pdf

TMS Therapy for Teen Depression: A New Hope

Mon, 15 Aug 2022 17:23:08 GMT

Knowing your child is suffering from depression is beyond challenging, especially when you feel you've tried everything to help without any success.

Fortunately, TMS therapy, or transcranial magnetic stimulation, is a safe and effective option for teens suffering from depression , particularly those who have not yet responded to medication or traditional talk therapy.

Your teen deserves to live a joyful, purpose-filled life. Let's explore TMS therapy and how it can help.

Quick Guide to TMS Therapy

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation therapy that uses magnetic fields to stimulate nerve cells in the brain. TMS is a promising new treatment for adolescent depression, as research continues to find it safe and effective in clinical trials.

While the exact mechanism of how TMS works is still not fully understood, it is thought to work by modulating neurotransmitter activity and improving communication between different brain areas. It is FDA-approved to treat depression and obsessive-compulsive disorder (OCD), and most patients report improvements in their symptoms within the first few weeks of treatment.

How Does It Work?

TMS machines emit high-powered magnetic fields from a coil above the forehead, like MRIs but on a much smaller scale.

Electrical currents travel 2-3 centimeters into the brain, stimulating cellular activity and releasing neurotransmitters. It releases chemicals like serotonin, dopamine, and norepinephrine, which are crucial to achieving a balance among brain chemicals.

Check out the quick video below for a visual guide to what you can expect!

How Does It Feel?

TMS therapy is a non-invasive treatment, pleasantly accepted by most patients. Some people even feel relaxed and calm during a TMS session.

Others may experience a tapping sensation or a mild headache, but these side effects often dissipate as patients grow accustomed to the procedure.

TMS therapy does not require sedation, so it will not impair mental clarity or daily activity.

Benefits of TMS Therapy for Teens

TMS therapy may benefit your child if:

Your child has been diagnosed with depression, major depression, dysthymia, bipolar I or II, etc.
Your teen experiences adverse side effects when using antidepressants.
Your child's depression is worsening, regardless of antidepressant use.
The symptoms of your teen's depression have not responded to medication and counseling.

Whether your teen is resistant to treatment or experiences adverse side effects when taking medication for depression, there is still hope for remission.

Is It Safe?

TMS is safe and FDA-approved, with little to no side effects. Some patients may experience discomfort during or following the treatment, but this experience is often short-lived.

That said, a few people are not eligible for TMS. TMS is ineffective for patients with metal implants in or near the head due to its magnetic nature. A few examples include:

Aneurysm clips
Stents
Deep brain stimulators
Metallic ear or eye appliances
Shrapnel or bullet fragments
Pacemakers

However, your teen is entirely safe if they have braces or dental fillings.

Finally, if your child has a history of seizures, it's best to consult your medical provider about whether TMS therapy is safe for them.

What The Research Evidence Says About Teens & TMS

Multiple studies show TMS therapy is clinically effective and safe in children, teens, and adults.

Researchers from the Department of Neurology at the University of Colorado-Anschutz Medical Campus and the Neuroscience Institute at Georgia State University examined all current research available from PubMed regarding the safety of TMS in children in 2017. From a review of publications dating from 1985 to 2016, scientists inferred that the risk of TMS in children is the same as in adults--meaning little to no adverse side effects.

This conclusion was supported and enhanced by further research throughout the following years. One study by Cincinnati Children's Hospital and the University of Cincinnati College of Medicine examined 165 pediatric subjects undergoing TMS and found it to be equally safe in adults and children.

Another study published in 2021 found that TMS therapy was as tolerable, feasible, and safe for children as it was for adults. And yet another study , conducted in 2021, focused on adolescents and produced similar results.

How To Determine Whether TMS Is Right For Your Child

Symptoms of depression in teens include low energy levels, changes in sleep and eating patterns, difficulty concentrating on homework or schoolwork, and an overall lack of motivation. According to research , major depression in youth is often associated with:

Increased suicidality
Prolonged illness
Heightened risk of non-response to treatment

According to the same study, approximately 30-40% of youth undergoing behavioral therapy and SSRI medication will not respond positively to treatment.

You and your doctor should also consider the side effects of antidepressant medications when planning your child's care. Experts find that taking antidepressants in childhood or adolescence may increase the risk of suicidal thoughts, ideation, and planning.

It is suspected that teens who are free of the physical symptoms of depression may begin to recognize their cognitive and emotional symptoms, like thoughts of self-harm or suicide.

Relief From Depression Is Possible

Unfortunately, depression is incurable; however, treatments are available to make it easier to manage and overcome symptoms, even in the most challenging cases.

Therapy is always the first recommendation when treating depression, followed by medication. Today, there are more ways to find relief, especially for those who feel they've tried everything, and nothing has worked.

How To Determine Whether TMS Is Right For Your Child

Transcranial magnetic stimulation is painless with very few side effects. If your child has depression, there is hope for finding relief. Please don't hesitate to contact us.

To learn more about how TMS therapy works and if it's suitable for your teen, contact us today to set up an appointment at one of our locations in Endwell or Marcellus, NY.

We look forward to helping your teen achieve a healthier and happier life!

Slaying the Dragon

Fri, 01 Jul 2022 10:30:49 GMT

"May I continue to do the daily work necessary to slay it. And may my patient, with my help and the help of others around her, slay her dragon, too."

I was very recently sitting with a patient who was reviewing an incident she had with a coworker. She had been treated in a hostile and disrespectful manner during a work meeting. This wasn’t the first time, but only one in a series of negative experiences for this patient and the co-worker. We had spent time during a previous session trying to game plan an approach for the meeting, knowing that this other individual was toxic and would try to manipulate things in such a way as to gain control of her in their interactions. Knowing intellectually how one should act when one is being attacked did not prevent the incident from happening, unfortunately. She saw this last interaction, correctly, as a re-enactment, and not just with this individual but with all of the other individuals and situations she had found herself in over the years in which she had not stood up for herself. As we were talking, she asked me, pointedly, “Dr. Stepkovitch, what am I SUPPOSED to do? And I am not talking about him. I am talking about ME.” She had cut to the heart of the matter.

I found myself saying, “Slay the dragon within.”

I was referring to the story of Saint George, the early Christian saint who is the patron saint of the English as well as the Georgians, and still venerated by the Orthodox as well as the Catholics to this day. The legend goes as follows:

The dragon demanded tribute from the villagers. After they had run out of livestock and trinkets, they started to give up human tribute once a year to satisfy the dragon’s demands. The villagers, while not at all happy living under the thumb of the dragon, had decided that it was safer to live in servitude than to risk everything by disobeying the appetite of the dragon. One year, the dragon chose the princess to be sacrificed, horrifying the villagers. Saint George, a Roman soldier, heard about the dire situation of the princess. He found the dragon and slew it, thereby liberating the princess.

It’s very difficult to look within. To fully face our fears. To face the parts of ourselves that make us cringe, or even the parts that too often take charge of our lives. But if we are to liberate ourselves we will need courage, for it takes a great amount of courage to stand and face the dragon. And to ultimately defeat it. Good psychotherapy should help us in that struggle.

A funny thing happened during this session. I mentioned that the story of Saint George resonated with me, and that I had often thought that it would be good to write about him. She asked me why I hadn’t. I responded that it was a story that I wasn’t sure I was prepared to write about.

…..So here I am writing. I’d like to thank my patient for pushing me to face the dragon within me. May I continue to do the daily work necessary to slay it. And may my patient, with my help and the help of others around her, slay her dragon, too.

Jason Stepkovitch, MD

Treatment Options for Depression in Pregnant & Breastfeeding Patients

Mon, 21 Feb 2022 18:15:43 GMT

Transcranial Magnetic Stimulation as a Treatment for Depression in Pregnancy

Major depressive episodes occur in about 10 percent of pregnancies, and approximately 10 to 15 percent of women will experience depression post-delivery, known as postpartum depression. While some antidepressants, such as paxil, are considered unsafe in pregnancy, we generally recommend that mothers stay on their antidepressant medication over the course of their pregnancy. While millions of mothers have safely taken antidepressants through the course of their pregnancies, there is an extremely small correlation between SSRI exposure and something called persistent pulmonary hypertension of the newborn (PPHN). PPHN is a life-threatening condition caused by a failure of the normal circulatory transition that occurs after birth. The current thinking is that the risks to the baby of the mother lapsing into a depressive episode while pregnant are greater than the risks of exposure to an SSRI. Untreated depression in the mother can cause disruption in healthy attachment between baby and mom. Such attachment issues can cause delays in achieving developmental milestones as well as behavioral issues down the road, so that initial bond between mother and child is quite important.

For women with mild depression, psychotherapy alone may be an appropriate way of managing depressive symptoms over the course of their pregnancy and into that important, initial postpartum period. However, women with a history of more severe depressive episodes, or women struggling through more severe depressive symptoms over the course of their pregnancy will likely need more active psychiatric treatment. Medications may be the best option for many mothers.

I see TMS as a viable option for the management of depression during pregnancy and post-delivery that largely addresses the concerns about systemic treatment. Being targeted, magnetic therapy, TMS utilizes magnetic and electrical fields at a power roughly equivalent to an MRI. The coil is placed on the front of the head, far enough away from the uterus that any magnetic fields reaching lower parts of the body would be minimal. Multiple small studies have shown TMS in pregnancy to be both safe and effective. One such study ( An Open Label Pilot Study of Transcranial Magnetic Stimulation for Pregnant Women with Major Depressive Disorder | Journal of Women's Health ) showed that 70 percent of women who underwent TMS treatment benefited from the treatment. TMS treatment is very well tolerated, with rare side effects including dizziness and something called supine hypotensive syndrome, which comes from laying in a position which compresses the inferior vena cava, and which can largely be avoided by laying to the left side. So far, infants of mothers who have undergone TMS therapy show no evidence of any adverse side effects to the treatment.

Antidepressants and breastfeeding

Antidepressants do pass to the baby through breastmilk, with varying degrees of detectability. The only antidepressants which showed appreciable blood levels of medication in breastfeeding infants were fluoxetine (Prozac) and venlafaxine (Effexor), while most antidepressants produced only negligible or undetectable blood levels in infants of breastfeeding mothers.

Current guidelines recommend that mothers currently taking antidepressants remain on their antidepressant while breastfeeding. For more mild to moderate depression, it would be reasonable to consider psychotherapy-only treatment, in concert with focusing on other lifestyle changes like diet and exercise. For mothers who are firmly against any infant exposure to an antidepressant but who need more support, TMS may be a viable option, allowing a mother to continue breastfeeding while still ensuring robust treatment of her depression.

I’m Depressed and I have Bipolar Disorder: What Is the Best Treatment?

Thu, 03 Feb 2022 13:01:42 GMT

Bipolar disorder generally brings to mind the manic individual behaving erratically. I once had a manic patient who had stolen an ambulance out of an ER parking lot. Another had bought four vehicles she didn’t need from a local car dealer before coming down from her episode (I was not very happy with the car dealer who happily kept selling her vehicles). What sometimes gets lost in this heavily genetic condition is that much of the time bipolar individuals struggle with depression, and can look exactly like individuals suffering from major depression.

As a psychiatrist, taking a thorough, careful history is extremely important anytime a patient comes in complaining of any mood symptoms. The depressed or irritable patient will often forget to tell you about the episode four years ago when they were dancing on the tabletops at the local bar and couldn’t sleep for over a week. Even when a psychiatrist goes digging into the past, many patients have difficulty clearly remembering periods from several years ago. Other issues, such as PTSD or borderline personality traits, which can have overlapping symptoms such as mood swings, impulsive behavior, and problems with emotional regulation, can make piecing together past manic episodes challenging.

Once a bipolar diagnosis is confirmed in someone who is currently depressed, standard of care is focused on treating the current mood state while prophylactically addressing the risk of cycling into mania or hypomania. Unfortunately, psychiatrists do not have a wealth of proven options at their disposal when it comes to treating the depressive phase of bipolar disorder. We currently only have a handful of medications, all mood stabilizers, that have received FDA approval for this condition in Bipolar I: Seroquel, Latuda, Symbyax, and Vraylar.

Notice that there are no antidepressants on this list of medications. This may seem quite surprising given that antidepressants are prescribed quite commonly in bipolar depression to this day, and common-sensically one would think that depression would be treated with a medication class used to treat depression. There are a few issues here that need to be reinforced: 1) Though both share the same depressive symptoms, bipolar depression is an entirely different illness than major depression. 2) There is no clear evidence that antidepressants are effective in the treatment of bipolar depression, although the far-reaching majority of individuals suffering from bipolar disorder are, or have been at some point, on an antidepressant for the management of the depressive phase of the illness. 3) Antidepressants added to mood stabilizers may increase the risk of precipitating a manic episode.

I, like most psychiatrists, have many times prescribed antidepressants for my depressed bipolar patients merely because the mood stabilizers approved for this condition have not been effective in pulling the individual out of their depression. More effective and safe treatment options for our bipolar depressed patients has been an urgent need in psychiatry.

TMS is a very promising treatment option for those suffering from bipolar depression, although it has not yet received FDA approval and is not currently a covered treatment by major insurers. Multiple studies have shown TMS to be safe and effective in this often difficult-to-treat population of individuals. A recent study published by Dr Scott Aaronson at Johns Hopkins using TMS in bipolar depression produced impressive results. Out of 44 patients, 77 percent of the individuals who completed a full course of TMS experienced a 50 percent reduction in the severity of their symptoms. Forty-one percent of subjects experienced full remission of their depressive symptoms. Those results are as impressive, if not more, as the data we see in major depressive disorder, an FDA-approved indication for TMS.

TMS also appears to be safe and well-tolerated in individuals with bipolar depression. A major concern has been the risk of activation and inducing mania. This risk is rather low, with less than 10 percent of individuals in this study discontinuing treatment due to concerns over-activation. Clinics such as Johns Hopkins, which treat a significant number of individuals with bipolar depression, are finding that the risk of inducing mania can be further reduced by spacing treatments out a bit if the patient begins to experience irritability or euphoria during the course of treatment.

We’ve had several bipolar individuals seek TMS treatment at our clinic. The results so far have been very positive, and I strongly feel at this point that TMS should be included in the list of standard treatment options for the depressive phase of bipolar illness. We are hoping in the coming years that the FDA and major insurers will agree and begin providing coverage for this important treatment.

Lithium Uses in Mental Health

Fri, 16 Jul 2021 00:31:11 GMT

Lithium - About as Natural as it Gets

When a psychiatrist mentions lithium to a patient, the general reaction from the patient or family is often one of concern. Things must be getting serious if lithium is being discussed. And that is largely true. Lithium has been used for acute mania for over 70 years, and is also commonly used for the treatment of depression when antidepressants alone aren’t working.

Lithium is mined from the earth, and is an alkali metal used commonly in batteries. When combined with other elements, it can form salts, such as lithium carbonate or lithium citrate, which become the prescribable forms of lithium used in medicine. For those of you that believe that natural is the way to go, lithium is about as natural as it gets!

But there is a catch: lithium can cause significant problems if not monitored properly. Lithium has what is referred to as a narrow therapeutic window, meaning that it is easy for individuals to develop side effects if there is too much lithium in the bloodstream. Symptoms of lithium toxicity include diarrhea, tremor, confusion, and can progress to coma and even death. This is why psychiatrists regularly check lithium blood levels of their patients on lithium for the management of bipolar disorder or depression. People taking lithium at therapeutic doses have an approximately fifteen percent risk of developing thyroid issues. For individuals on long-term lithium treatment, there is also a low risk of damage to the kidneys.

So now that I’ve fully terrified you, I am going to make the case for this very important natural medication, perhaps to even consider taking it as a supplement…

Lithium increases the length of telomeres

Telomeres are the protective end caps on chromosomes. Every time a cell divides, our telomeres shorten. Once the telomeres get to a critical shortened length, the cell is incapable of dividing and ultimately dies. Things like childhood stressors, recurrent depressive episodes, obesity, and smoking can all reduce telomere length. Individuals on lithium for extended periods of time showed more normal telomere length compared to individuals who took lithium for only brief periods of time.

Lithium protects the health of neurons in the brain

Lithium increases a chemical called BDNF, known to stimulate growth of new neurons in the brain, and decreases chemicals BAX and P53, both known to induce cellular death. Lithium is associated with increased cortical volume, direct evidence that lithium may reduce the amount the brain shrinks, or atrophies, as we age.

Multiple studies have shown that lithium treatment, even at low doses, slows the rate of cognitive deterioration in aging, as well as lowering dementia rates.

Lithium may be anti-suicidal as well as anti-violent in some individuals

Multiple studies have found that areas of the world which have higher concentrations of lithium in drinking water also have lower rates of depression, completed suicides, as well as lower rates of interpersonal violence. When used in therapeutic doses, lithium can sometimes help in depressed individuals who struggle with suicidal thinking.

Lithium May Decrease the Incidence of Certain Illnesses

Risks of developing ALS, dementia, seizures, and even heart attacks may be reduced with chronic lithium treatment. For those with bipolar disorder, lithium has been shown to reduce mortality, regardless of cause. Animal studies have shown increased longevity when taking lithium.

Should Lithium Be Used as a Supplement?

There is not a consensus opinion on this. Many physicians are wary of lithium because of the baggage mentioned above, particularly the risks of lithium toxicity and hypothyroidism. But physicians are accustomed to utilizing lithium as a bipolar medication in which the risks of lithium toxicity would be real at standard doses, which can be up to 1800mg per day. Microdosing lithium, perhaps at 10mg a day (this is less than a tenth of the lowest prescribable form of lithium and about one percent of what a standard bipolar dose is), raises interesting possibilities. Given the evidence from groundwater studies, such dosing may provide some antisuicidal benefits to individuals suffering from depression. An interesting Brazilian study from 2013 found that even lower doses of lithium, literally 0.3mg/day, may afford protection from dementia in older individuals.

I think there is a strong case to be made that lithium is an underutilized treatment, both for the management of bipolar disorder and depression as a prescribed substance, as well as a supplementary treatment at microdoses. Lithium supplements can be purchased over the counter, generally in the form of lithium orotate, with tablets as low as 5mg. If you are considering lithium supplementation, I would strongly recommend discussing this with your physician before taking over-the-counter lithium orotate. The other alternative would be to move to an area with a higher concentration of lithium in its groundwater!

Jason Stepkovitch, MD

How Does TMS Therapy Work?

Sun, 04 Apr 2021 02:47:59 GMT

I was eating my lunch today, thinking about what my latest blog post would focus on, when my cell phone rang. It was the mother of one of my patients, a woman who has struggled with debilitating depression as well as a host of other psychiatric symptoms. Usually phone calls to psychiatrists, particularly mothers of adult patients, are harbingers of something serious, so I was prepared for bad news. This call was different. She called to let me know that she hadn’t seen her daughter look this good since before she became ill, that for the first time in a number of years she was able to look into her eyes and see the return of the sparkle that had once been there, but extinguished in the midst of her struggles. She said after their last visit together, she drove home in tears, as she had done many times in the past, I would imagine. But this time the tears were ones of joy.

Her daughter had gone through many of the standard medications and treatment modalities for her condition, and had also been hospitalized on multiple occasions. The change her mother witnessed occurred following a course of a treatment known as transcranial magnetic stimulation, or TMS.

TMS obtained its FDA approval in 2008 for the treatment of major depressive disorder, so it is not a new, unknown treatment. Countless studies over the past 12 years have shown that TMS consistently outperforms standard treatment for the management of depression, and it is being increasingly utilized in the management of PTSD, generalized anxiety, bipolar depression, as well as other neurocognitive conditions. At this point, TMS is a well-established treatment with a proven safety record.

TMS works on the idea that electrical stimulation is good for the brain. We’ve known this for years in psychiatry, with electroconvulsive therapy (ECT), more pejoratively known as ‘shock therapy’, being used when medications were ineffective in pulling an individual out of a depressive episode. I think it is important to differentiate between these two important treatments, so allow me to briefly review both.

ECT entails running a direct current across the entirety of the brain to the point that the patient is having a seizure. Done in the hospital, under general anesthesia and with close medical observation, it remains a very effective treatment for severe depression. But it has its problems, and not just from the history and stigma attached to it. It is generally done in the hospital, requiring the patient to be driven to and from the appointments, which are usually a series of 12 treatments. Other common problems are short term memory loss, and a sense of fogginess after the treatments.

TMS, done in an office-based setting, utilizes electromagnetic energy, approximately the power of an MRI, and, rather than hitting the entirety of the brain, as is done in ECT, TMS specifically targets the parts of the brain implicated in the problem we’re looking to address. In the case of depression, we’re usually looking to target the part of the brain known as the left dorsolateral prefrontal cortex, or DLPFC. We’ve observed that in depressed individuals, the DLPFC is less active, with less glucose uptake by neurons, less blood flow to that part of the brain, as well as changes in other markers of neuronal health, such as diminished secretion of something called BDNF, a neurochemical important for the generation of new neurons as well as improving neural connectivity.

With targeted electromagnetic stimulation, as in TMS, we can take bundles of neurons, and get them to depolarize, or discharge, in an oscillatory, synchronized fashion thousands of times in twenty minutes, the time the standard FDA-approved protocol takes to complete. When done repeatedly, 36 times in the case of a standard treatment course, what one sees, when treatment is successful, is evidence that repeated depolarization leads to improvement in neural connectivity, known clinically as neuroplasticity, as well as new neural growth. There is clear evidence of improvement in patterns of blood flow throughout the DLPFC after successful completion of TMS treatment, increased metabolic activity in this region, increased cerebrospinal fluid levels of BDNF, as well as increased cortical thickness.

Since we started treating patients with TMS in September, 2019, we’ve had a number of dramatic successes similar to the one mentioned above. Those sorts of phone calls are the reasons why one enters this field. I do want to reinforce, however, that TMS is not a perfect treatment. While about six in ten patients experience significant improvement, other patients experience only modest gains, and there are also patients who see no change in their symptoms whatsoever.

There are millions of individuals who struggle with severe depression which stubbornly hasn’t responded to treatment, be the treatment antidepressants, psychotherapy, or a combination of both. With TMS, which I believe is quickly changing the field of psychiatry, we now have a highly effective and safe tool for those individuals.

The Pandemic’s Impact on Mental Health

Wed, 16 Dec 2020 23:38:00 GMT

“Now is the winter of our discontent.”

-Shakespeare’s Richard III

There are times in life that one suffers. 2020 has been a year of collective suffering. In the US, hundreds of thousands have died directly from COVID. The economic livelihoods of countless thousands have been disrupted, with employees furloughed, and the doors of small businesses shuttered, many permanently. According to the CDC, overdose deaths have increased by 20 percent this year. Calls to domestic violence hotlines have increased by 30 percent. A CDC survey in June found that one in three individuals were experiencing anxiety or depressive symptoms, with 10 percent of individuals reporting suicidal thinking.

We’re being told that the answer is to keep ourselves as safe as possible. Wear masks when in public and around other individuals. Avoid shaking hands. Avoid going out unless absolutely necessary. Avoid in-person gatherings. Avoid…

Avoidance is an effective strategy when trying to curb a viral outbreak. It is also a very effective strategy if one looks to create anxiety and depression in a population. David Brooks, the New York Times columnist, wrote a prescient article last March on the propensity of pandemics to create distance, not to bring us together the way other crises can, as happened after 9/11. Fear of imminent death has a way of sowing separation, as every other individual, even those in our own family, becomes a potential threat. Once COVID has passed (yes, this will pass), some will perhaps have to live with the guilt that comes with knowing that one’s actions have led, directly or indirectly, to the suffering of others. This is how these sorts of events historically go.

The FDA just approved the Pfizer vaccine a few days ago, providing the hope of the beginning of an end. Still, we are several months away from the true alleviation of our situation. In the meantime, what are we to do?

Once safety has been attended to, as recommended by the medical establishment and the vast majority of our political leadership, I believe it has to include an awareness that safety in and of itself is inadequate and incomplete. As we limit our interactions, perhaps to a few close relatives, are we being attentive to those around us? Are we making extra effort to reach out not just to those we feel closest to, but to those who NEED us the most? Are we finding ways to stay involved with struggling relatives, friends, and acquaintances? Are we seeking ways to stay connected to our communities, where we can have the most immediate impact?

A sea of social workers, psychologists, and psychiatrists cannot replace the value of true, intimate human interaction, which, if it can’t be done in person, can less perfectly be done through our phones and computers. How many suicides and overdoses can be prevented in the coming months if we make that extra effort to pay attention to one another?

Lastly, a word about masks. I’ve heard and read a lot of vitriol directed at those who are seen in public not adhering to the mask mandates. The vast majority, no doubt, aren’t taking this thing as seriously as they should, and are putting themselves and others at unnecessary risk, particularly if they are also coming into close proximity to other individuals. I have a non-mask-wearing patient, who has agreed to let me write about her situation, which doesn’t fit neatly into this narrative. She was molested by a close family member as a child, and anything that covers her mouth causes a horrific flashback in which she re-experiences the events from her childhood. I think it would be very helpful to her if someone asked her how they could help her, rather than shoot her a dirty look, or worse, say something unkind, the next time she dares venture out in public. I’m sure there are many other individuals who, for various reasons, can’t wear masks. Shaming them isn’t right.

If we can maintain a sense of compassion for one another and not lose our moral compass through the remainder of this, while still taking safety seriously, we can avoid something that has the potential to be as dangerous to the mind as a virus is to the body - regret.

Simple Seasonal Affective Disorder Therapy You Should Try

Mon, 05 Oct 2020 02:07:00 GMT

Central New York is truly one of the most beautiful places on the planet. We have a wealth of lakes and rivers, forests, beautiful farmland, gorges, temperate summers, and plenty of snowy landscapes in the winter. What Syracuse and Central New York also possess are clouds, and… winter darkness. Syracuse ranks 8th from the bottom in the entire US in terms of possible sunshine. We just don’t get enough sunlight, particularly from November through March.

If you tend to feel sluggish in our Upstate winters, you may be suffering from seasonal affective disorder (SAD). Studies have shown that up to 9 percent of Alaskans and 15 percent of Canadians struggle with the “winter blues”. SAD is defined by at least 2 years of experiencing a major depressive episode during a specific season, almost exclusively winter in our climate. Symptoms of depression, beyond feeling down nearly every day for more than 2 consecutive weeks, include difficulties with concentration, having low energy, changes in appetite, problems with sleep, feelings of hopelessness or worthless, and, in severe cases, thoughts of suicide. Those suffering from SAD usually struggle with oversleeping and overeating, sometimes including carbohydrate cravings. This is not always the case in other forms of depression, in which individuals can struggle with insomnia or loss of appetite.

What Can I Do If I Struggle with Depression in the Winter?

There’s evidence that melatonin levels increase during the winter months as the days become shorter. If you are accustomed to taking melatonin for sleep, be aware that your body’s endogenous secretion of this hormone which regulates circadian rhythm has changed for the winter, and you may not need as much, or any.

Light therapy is safe but does have the potential for side effects, which can include headache, irritability, and, rarely, manic symptoms. You also want to be careful that any medications you are taking aren’t photosensitizing, from which prolonged exposure to bright light can cause a skin reaction, such as a rash or itching.

If you are at high risk for seasonal affective disorder, plan ahead. This includes proactively talking with your psychiatrist, therapist, or primary care physician about what options mentioned above would make the most sense for you. I hope this will be a winter of enjoyment for you, and not one that you merely muddle through!

Positive Psychology: How an Act of Kindness Can Change You

Tue, 01 Sep 2020 02:00:00 GMT

Last year, my wife was in a serious car accident. She was driving in the dark in the middle of a driving rainstorm, and due to the poor visibility clipped a parked car while driving down a main thoroughfare of Auburn, NY. The car’s right front tire was completely sheared off, causing the car to flip in the air before landing in the middle of the street, upside down. She found herself unable to get out of the vehicle before two passersby, both of whom had stopped to assist her rather than drive past, helped her unbuckle her seatbelt and safely exit the vehicle before EMS arrived. One of the men mentioned to her that he saw smoke coming from her engine and worried that her car might catch fire if she didn’t get out quickly. Thankfully, she walked away from the accident, bruised and only slightly injured.

She was heartened by the willingness of these total strangers to help her. Heroic is perhaps too strong a word to describe their actions. But still, they both were willing to incur a certain amount of personal risk to help someone they had never met. They stood in the middle of the road, exposed to oncoming traffic in a cold, driving rain, helping a woman get out of a vehicle that was possibly going to catch fire. Why do people do such things?

Neuroscientists would say that these individuals who decided to help my wife had their anterior cingulate cortices and anterior insulas activated, regions of the brain that light up during personal pain as well as empathic response. Other parts of the brain, such as the medial orbitofrontal cortex, ventral tegmental area, and putamen, were likely involved in the prosocial kindness response that motivated them to act.

The cynics amongst us might posit a universal egoist position to explain away kindness: that acts of kindness reduce the tension one faces internally when we experience a feeling of empathy but do nothing. The universal egoist is thus arguing that kindness is, at its core, still an act of self-interest. Thankfully, social psychologists have consistently found that when people do act, they tend to do so in the interest of alleviating the suffering of another individual, not to satisfy one’s own emotional needs.

Positive psychology, an area of psychology which focuses on the strengths that enable individuals to thrive, has found that committing oneself to routine acts of kindness, such as leaving a large tip for a server at a restaurant, increases a sense of positive emotional well-being and happiness.

We are all living through an unsettled period right now. No matter what news channel one watches these days, there will be images of angry individuals engaged in angry behaviors. Maybe angry commentators angrily attacking those they disagree with. Maybe we even feel we’re under assault personally. It’s not easy to be kind sometimes, particularly to those we disagree with, or worse, find to be offensive.

Still, even with all of the reasons and barriers which cause us to drift toward bitterness or anger, at the end of the day we need each other. All of us. Perhaps practicing a little kindness really does go a long way, and not just in helping ourselves feel better.

Diet & Mental Health

Thu, 13 Aug 2020 02:21:00 GMT

The area of nutritional psychiatry, a relatively young field, seeks to answer questions such as these. We know that several nutrients are good for brain health: omega three fatty acids, magnesium, zinc, vitamins B12 and folate, as well as vitamin D, amongst others. Amongst the various diet plans, the diet with the best available data on promoting brain and body health is a diet called the modified Mediterranean diet. The Modi-Medi diet, as it is commonly referred to, is a diet rich in variety: heavy on fresh fruits and vegetables, fish, lean meat, olive oil, legumes and nuts, with less of an emphasis on simple carbohydrates, processed meats and foods, and saturated fats.

A recent study, known as the SMILES study, looked at the implications the Modi-Medi diet has on depression. In the trial, 67 patients, all of whom suffered from clinical depression, were broken into two groups: a group of individuals who adhered to the Modi-Medi diet, and the “control” group. The group that committed to the healthy diet experienced a 32 percent remission rate of their depression, compared to an 8 percent remission rate in the control group.

I think it’s important to put a study such as this in context. The study is not implying that diet alone is a substitute for psychotherapy, medications, or other interventions like TMS. I believe, however, that the study does show that relying solely on “standard” treatment, without committing oneself to better living, including ensuring that our brains have the basic nutritional building blocks necessary to facilitate optimal neuronal functioning, will limit the outcomes of treatment.

Changing entrenched eating habits can be difficult, so it’s important to be kind to ourselves and forgiving if we adhere to any healthy diet plan imperfectly. This is particularly true when the fatigue and lack of motivation seen in depression gets in the way. I believe that what is important is that we have committed to living better, not just feeling better, and that we are making a good faith effort to make positive changes in our lives. Eating as well as possible is a big part of this. If changing poor eating habits seems like a monumental task, working in psychotherapy to address the behavioral components related to unhealthy eating patterns can improve the odds of adhering to a healthy diet like the modified Mediterranean diet, and not just in the short run, but well into the future.

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Sleep Disorder Treatment: Tips to Improve Your Sleep

Wed, 29 Jul 2020 22:00:00 GMT

“I Can’t Sleep.” It’s one of the most common complaints a psychiatrist hears over the course of the workday.

Insomnia is a massive topic to cover with a ton of new information coming out regularly, so I’ll try to hit on a few key points which I would want any patient of mine to be aware of. First of all, sleep is integral to our health, both physically and mentally. Insomnia is associated with obesity, increased cardiovascular and stroke risk, increased risk of developing memory issues later in life, such as Alzheimer’s dementia, increased diabetes risk, as well as suppression of our immune response which can leave us more susceptible to viral illness. Mentally, insomnia is often associated with depression and anxiety, amongst other mental health issues.

Why is sleep so important to us? While the answer to this question isn’t a simple one, current evidence would suggest that sleep, particularly the restorative, deep sleep seen in later stages allows the neurons in our brain to detoxify. During deep sleep, certain types of brain cells called glial cells literally shrink, allowing cerebrospinal fluid to flush toxins, such as beta amyloid and tau proteins (both seen in high amounts in the brains of those with Alzheimer’s disease), out of the brain.

Identifying the potential causes of insomnia, particularly chronic insomnia, is extremely important. Fully treating anxiety and depression, if present, is integral to improving sleep quality. At the same time, depression and anxiety are viewed as a sleep disorder, so treating the insomnia along with the other symptoms associated with these conditions is considered standard of care.

Addressing the behavioral components to insomnia are a must. Having a set schedule, both in terms of going to bed as well as waking up, every day of the week, is important. Allowing yourself time to wind down prior to going to bed, turning off devices and screens, limiting physical activity, not ingesting caffeinated beverages after late afternoon, and using the bedroom as a place of rest and relaxation rather than an entertainment center, are all things sleep experts recommend.

For those who struggle with racing thoughts, incorporating a meditation practice and/or utilizing deep breathing techniques can be quite helpful in developing the skill of quieting one’s mind at bedtime.

While medications, including prescription medications, can be invaluable tools in the management of acute, severe insomnia, overuse of these medications can become problematic and can have the unfortunate effect of the individual becoming psychologically dependent on the medication, believing that natural sleep is no longer possible without the aid of a pill. For our patients undergoing TMS, the right-sided, inhibitory protocol we use for anxiety tells neurons to slow down, facilitating a more relaxed state which has also been shown to improve insomnia. Psychotherapy is also a very important treatment option for individuals continuing to struggle when other efforts haven’t worked. A specific type of cognitive behavioral therapy, CBT-i, has been shown to be superior to medications in the treatment of insomnia. CBT-i can be done online, as this is a very structured form of therapy which is time-limited.

This is a very quick review of sleep and potential treatment options. If you or a loved one are suffering from insomnia, I would recommend talking with your primary care physician or your mental health provider about potential treatment recommendations.

Mental Health During Covid-19

Thu, 14 May 2020 21:33:00 GMT

To Our Prospective Patients Considering TMS

CNYTMS Psychiatry is following the recommendations of the Clinical TMS Society and continues to treat individuals during the present crisis, but with the utmost attention to safety and cleanliness. With the advantages of a small clinic in which it is rare for us to have significant numbers in our waiting room even during “normal” times, we presently do not allow more than one patient into the clinic at any given time. The clinic, both waiting room and treatment room, is thoroughly cleaned and disinfected following every patient encounter. Please do not hesitate to call us for any further questions about managing Covid in our clinic.