Category Archives: Mental Health

Neurostimulation for Therapy-Resistant Depression (TRD)

Vagus Nerve Stimulation (VNS) and Other Augmentation Strategies for Therapy-Resistant Depression (TRD): Review of the Evidence and Clinical Advice for Use  – Free full text /PMC5902793/ – Apr 2018

This mini-review provides a comprehensive overview of augmentation pharmacotherapy and neurostimulation-based treatment strategies, with a special focus on VNS in TRD, and provides practical clinical advice for how to select TRD patients for add-on neurostimulation treatment strategies.

In addition to electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS) is one of the approved neurostimulation tools for treatment of major depression.

If it weren’t so hard to get insurance to pay for these treatments, I’d have tried them long ago. However, the treatments of rTMS have to be frequent (almost daily for a while) and don’t always last longer than weeks (or even days) and I’m not going to drive an hour to appointments every few days.  Continue reading

Neurobiology and Neurophysiology of Breath

Neurobiology and Neurophysiology of Breath Practices in Psychiatric Care | Psychiatric Times – by Patricia L. Gerbarg, MD and Richard P. Brown, MD – Nov 30, 2016

Because the physical act of breathing stimulates the vagus nerve, it has a powerful effect on our whole nervous system.

Autonomic nervous system dysfunction is associated with most disorders seen in pediatric and adult psychiatric practice, including anxiety disorders, depression, PTSD, hostility and aggression, attention deficit disorders, and autism spectrum disorder.

Increasing the underactivity of the parasympathetic branch and correcting the erratic or overactivity of the sympathetic branch can improve stress resilience and ameliorate psychological and physical symptoms.    Continue reading

When Is Depression Terminal? Deliberative Suicide

When Is Depression a Terminal Illness? Deliberative Suicide in Chronic Mental Illnessby Constance E. George, MD, MA – Jun 2016

In this discussion about the validity of suicide in patients with untreatable depression, it struck me that it could just as well apply to patients with chronic pain, untreatable without opioids, when opioids are no longer allowed.

This article concludes:

“So, an important lesson … has to do with understanding that mental illness can be a terminal illness and that the concept of hope has therapeutic limitations.” Continue reading

Pain, gastrointestinal dysfunction, psychiatric disorders with EDS

Pain and gastrointestinal dysfunction are significant associations with psychiatric disorders in patients with Ehlers-Danlos syndrome and hypermobility spectrum disorders – PubMed – NCBI – Mar 2019

Unfortunately, we don’t have access to the full article, but even the abstract shows that EDS is a systemic dysfunction. Symptoms show up in various bodily systems, leading to both physical and mental health problems.

In this retrospective study, we investigate the frequency and types of psychiatric disorders and their relationship to systemic manifestations in a cohort of 391 Ehlers-Danlos syndromes (EDS) and hypermobility spectrum disorder (HSD) patients based on the current 2017 International Classification of EDS diagnostic criteria.   Continue reading

What you say (and don’t say) could save a person’s life

Suicide prevention experts: What you say (and don’t say) could save a person’s life Alia E. Dastagir, USA TODAY – Sept. 2018

On average, there are more than 128 suicides per day in the United States, attempted by people with and without known mental health conditions. USA TODAY.

It’s crazy that even the most biased and highest estimates (by the conflation of any and all drugs) of overdose deaths are only about half the number of suicides, but no big money groups or politicians are advocating for “suicide prevention”.

So suicide deaths are almost twice as common as “opioid overdose” deaths, yet very little is being done to address this much more serious issue. Continue reading

Opiods as Antidepressants

Opiates as antidepressants. – PubMed – NCBI – Curr Pharm Des. 2009

Antidepressants are frequently touted as useful for chronic pain and it’s not clear if that is because they relieve pain-induced depression and thus make the pain less bothersome or if they specifically relieve the pain.

Here are two research studies showing that opioids may directly relieve depression, not just pain, further complicating the two-way relationships between pain and depression and also between pain-relievers and “depression-relievers”.

The pathophysiology of mood disorders involves several genetic and social predisposing factors, as well as a dysregulated response to a chronic stressor, i.e. chronic pain. Continue reading

Opioids enhance some antidepressants

Cooperative opioid and serotonergic mechanisms generate superior antidepressant-like effects in a mice model of depression | International Journal of Neuropsychopharmacology | Oxford Academic – free full text – September 2009

Perhaps this is another way that opioids help us deal with chronic pain. I know I’m more depressed when I’m having serious pain because it reminds me of all I’ve had to give up because of it. My future looks pretty grim when viewed through a thick haze of pain.

On days my pain isn’t so bad or I’ve managed to get it under control with opioid medication, I feel more hopeful about the future as I busy myself with all kinds of little tasks I cannot do when my pain is bad.

The opioid system has been implicated in the aetiology of depression, and some preclinical and clinical data suggest that opioids possess a genuine antidepressant-like effect.

Continue reading

Mindfulness Research’s Huge Problem

Mindfulness research’s huge problem with uninformative control groupsby James C Coyne – June 2016

Are enthusiasts protecting cherished beliefs about the power of mindfulness from disconfirmation?

Do any advantages of mindfulness training disappear in a fairly matched cage fight with a treatment of comparable frequency and intensity?

Finally, a more thorough look at the research indicates that mindfulness is more a placebo response than a treatment. It makes no sense that it’s recommended by medical experts in the place of effective medication.  Continue reading

Fast-Acting Depression Drug Approved

Fast-Acting Depression Drug, Newly Approved, Could Help MillionsBy Benedict CareyMar 2019

This is wonderful news because it’s from a different drug class than what’s been available.

This new approach brings fresh hope for those of us who have been hanging on, gritting our teeth, and tolerating our treatment-resistant depression because we can’t get sufficient relief from the current medications.

A nasal spray version of the drug ketamine has shown promise as an antidepressant, even if its properties still aren’t well understood. Continue reading

DSM-V splits drug dependence by specific drug

With what we know about addiction these days, it makes no sense to split the “substance dependence” diagnoses into groups by the specific drug. Addiction happens when the brain habituates to a malfunction of satisfying cravings despite increasing harms.

It’s the users that become addicted and have a problem, not the substance!

Wikipedia information on DSM-5

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA).   Continue reading