Dr Carolyn Kaufman Guest Blogs 21st Century Treatments for Depression

Hi everyone! On Monday I talked about how The Writer's Guide to Psychology is useful and generally fabulous. Today, the author, Dr. Carolyn Kaufman, is here to tell you about cutting edge treatments for depression.

I don't know if you folks know this, but Dr. Kaufman is an assistant professor at Columbus State Community College and also teaches classes at Otterbein College. She'll stop by later to answer any questions you have, but as a result of her teaching schedule, it will probably be in the afternoon and evening.

In addition, she's giving away one signed copy of The Writer's Guide to Psychology to one of my commenters today! I'll be announcing the winner Friday. And without further ado ...

If your character has a serious problem with depression, you probably think she has two options for treatment: psychotherapy or medications.  And you’d be right – sort of.  Those are the first two things a good therapist will try. But what happens if neither approach works?  Are there cool new 21^st-century alternatives?

You bet there are.

Now, in most cases, your character will start with psychotherapy, and in many cases, psychotherapy alone is sufficient.  Sometimes, however,  medications warrant serious consideration; here are a couple of examples of situations when your therapist will want to consider referring to a psychiatrist:

1. The client is so depressed that she’s unable to really get much out of therapy – she needs additional help.
2. The client has numerous close family members who are taking medication for the same condition – and they’re benefitting from that medication or medications.

Once in a while, however, an individual has what we call Treatment-Resistant Depression (TRD), which means that various psychotherapeutic approaches and medications have been inadequate to help the person.  Research suggests that for these people, Treatment as Usual (TAU) may only be successful in about 7% of cases.

The Old Standard

Traditionally, electroconvulsive therapy (ECT) has been used as a last-ditch effort in these situations.  The good news is that ECT is not the brutal, barbaric thing portrayed in most movies, where the wide-awake patient is strapped down and subjected to painful, terrifying shocks that cause convulsions.  Rather, the person is both asleep (thanks to a general anesthesia) and still (thanks to a muscle relaxant). Miraculously, some people feel significantly better after a single treatment, but for most people, several weeks’ worth of treatments are necessary.  After that, medications and psychotherapy are usually effective.

 The biggest downside of ECT is that it interferes with what we call the “consolidation” of memory.  In other words, over the few weeks that you’re doing ECT, you may have trouble storing information in long-term memory. That can certainly make it hard to remember your next appointment if you don’t have it written down!

Though most people say they would do ECT again if they needed it, and though it has been called “no more unpleasant” than going to the dentist (?!), some people have really bad experiences with it. For example, once in a while people who have undergone ECT say that they have problems with anterograde memory loss (which means they have trouble remembering things even after the ECT is done). Others say they have retrograde amnesia, which means they have forgotten chunks of their past.  The hard thing about these situations is that normally ECT is only done when the doctors don’t know what else to do to keep someone alive.  So which is worse – being dead, or having some memory loss?  The answer genuinely depends on the person. 

But scientists have been working on new, drug-free biological treatments for people with TRD.  Here are three.

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation is the least invasive of the three new treatments I want to discuss.  Unlike the other two, there is no surgery and no implantation of a device.

During TMS, the client sits in a chair that resembles a dentist’s chair (I know, what’s with the recurring dentist theme?), and an electromagnetic coil is placed near the left front of the head. The coil turns on and off rapidly, creating a magnetic field that stimulates the brain’s cells (called “neurons”) to release brain chemicals like serotonin and norepinephrine. (In people who are depressed, serotonin and norepinephrine levels are too low.)

The machine makes a very loud (and unpleasant) tap-tap-tap-tap sound as the electromagnetic coil is turned on and off, so both client and doctor wear earplugs. Many people experience prickling or discomfort of the scalp under the coil, and some experience twitching of facial muscles or headaches afterward. Research suggests, however, that about half of the people who undergo TMS experience some relief of their depression symptoms.

Vagus Nerve Stimulation (VNS)

Both Vagus Nerve Stimulation and the next treatment we talk about, Deep Brain Stimulation, involve a bigger commitment than TMS.  Both involve the surgical implantation of an expensive pacemaker-like device under the collarbone. 

With VNS, wires run from the main device up into the neck  and are wrapped around the vagus nerve, which travels up into the brain and down into the body.  Every five minutes, the VNS unit emits a mild electrical pulse.  At first, this pulse is noticeable: it feels like a very mild shock accompanied by the requisite prickle of electricity on the left side of the voice box.  Over time, however, the body adjusts and the individual is no longer aware of the pulses unless she’s paying close attention, exercising heavily, or speaking loudly (the pulse makes some people’s voices a little bit husky or hoarse). The prickling sensation goes away, and the pulse itself feels like a finger laid very lightly against the left side of the voice box.

The effects of VNS take time, and patients may take up to a year to get the full effects.  The battery in the unit is said to last up to 7 years in some patients; when it runs out, a whole new pacemaker-like device has to be implanted.

Research argues that significantly more people with TRD respond to VNS therapy than treatment as usual (ie therapy and medication alone), with about a third of patients getting significant relief and up to 80% of patients getting some relief.

Deep Brain Stimulation (DBS)

Still in the experimental stages, Deep Brain Stimulation also involves the implantation of a pacemaker-like device under the collarbone.  Rather than wrapping around the vagus nerve, however, the electrodes are placed directly into the brain.  Patients are awake when the electrode is actually inserted, and many, fascinatingly, report an immediate lifting of their depression.  Early research has shown that patients have remained in remission while the current is left on, but experience a return of symptoms when the current is switched off.

What makes DBS unique is that it may help people for whom electroconvulsive therapy has not been effective.  TMS and VNS are not usually helpful for this group.

Since DBS has not been proven in large groups of people, it has not yet been approved for depression in North America.

Particularly with the last two treatments, you may think that you wouldn’t want someone implanting anything in your body – and especially in your brain – for any reason! But for people for whom depression is an unrelenting specter, these treatments offer new hope.  Unfortunately, although both TMS and VNS  have been FDA-approved for depression in the US, insurance companies aren’t usually willing to pay for them, forcing individuals to find ways to pay for them out of pocket.

For more information on TMS:

NAMI: http://www.nami.org/Content/ContentGroups/Helpline1/Transcranial_Magnetic_Stimulation_(rTMS).htm

Neurostar (company that makes the TMS machine): http://www.neurostartms.com/Home.aspx

For more information on VNS:

VNS and Me: Wordpress Blog of someone who was implanted with the VNS device: http://vnsandme.wordpress.com/

Cyberonics (company that makes the VNS device): http://us.cyberonics.com/en/vns-therapy/

For more information on DBS:

Time Magazine article: http://www.time.com/time/magazine/article/0,9171,1214939,00.html

What do you think? Had you heard of these treatments? What questions do you have for Dr. Kaufman (they don't have to be limited to these treatments--feel free to ask general questions or anything about The Writer's Guide)? Remember--one commenter will win a signed copy of The Writer's Guide to Psychology, so ask (or just comment) away! She'll stop by after 3pm (EST) to answer!

And finally, on the Sisterhood of the Traveling Blog front, Deb Salisbury is posting today about what she does when she loses her writing mojo. Please check it out!

Guest Post The Challenge of Prosperity

Today's guest post concerns the work of Dr. Cheryl Rampage, Senior Vice President for Programs and Academic Affairs at The Family Institute at Northwestern University. She has shown how a family's being financially well off can at times actually increase the risk of anxiety, depression, and substance abuse in their children.

Cheryl Rampage, Ph.D

When we think of wealth, we often think of all the opportunities and perks that come with it. However, the common misconception that wealth is the solution to all of our problems is negated by recent research that shows while money can give children a head start in life, it can actually impede on their personal and emotional growth as they get older. 

In fact, adolescents who come from a wealthy household are 20 to 30 percent more likely to suffer from depression or anxiety than other teens. But there are ways to combat it. 

Cheryl Rampage's Counseling@Northwestern’s paper, “The Challenge of Prosperity: Affluence and Psychological Distress Among Adolescents,” sheds light on this issue—and ways to address it. Interested readers can click on the title of the article to read the whole paper.

While her research shows that prosperity can impose psychological distress on youth, parents and guardians can step in by following best practices. According to Dr. Rampage, parents can mitigate the risks of wealth by providing structure at home, unconditional love and consistent communication with their adolescents. The infographic below illustrates the ways in which affluence affects children’s mental health in early childhood and adolescence and what parents can do to positively contribute to children’s overall development.

Learn more about the challenges of wealth and prosperity from an infographic. It is shown below and available in a larger image at http://counseling.northwestern.edu/mental-health-of-affluent-teens-the-challenge-of-prosperity/:

Brought to you by Counseling@Northwestern’s Online Masters in Counseling

Guest Post Breaking Free of Being the Perfect Child

Today's guest post is by Paul Taylor. This is the fourth post in which a writer recounts his or her own experience in a family with a problematic history, as well as its aftermath. Itillustrates a couple of themes of my blog very well: a family role that must be played by a member – or else - and the existential horror and despondency people feel when they try to break away from it. His criticism of cognitive psychotherapy for this sort of problem is also right on.

It is hard being the perfect child. According to my family, I was born perfect. I was quiet and obedient and always willing to help out. From the time I was very small my family relied on me to be the good, responsible child. Although I was not too much older than my siblings and cousins I was relied on to make sure they were safe, happy, and cooperative too.

As I got older and some of the extended family moved away my responsibilities changed. I was now supposed to go to school and do all my work without complaint or question, answering any inquires about what I was learning with an in depth explanation. Then I was supposed to help my younger brother complete his school work while also teaching him what he missed in class due to his ADD. After that came helping with chores like ironing, laundry, dishes, yard work, vacuuming etc. That I was also supposed to do without complaint for as long as it took. 

Every member of the family had set chores and I was expected to not only do mine, as quickly and quietly as possible, but also “help out” with everyone else’s. That meant doing the dirtiest, hardest or most complex jobs while they watched and shook their heads –feeling helplessly confused all the while.

If I finished everything I was then expected to have “family time” which consisted of sitting around the television, watching something my brother and I were not interested in. I was supposed to keep him quietly entertained so we could “be a family.” If, by chance, there was time left over before bed I snuck in reading a chapter or two of my books, which were my only escape from reality.

When I got into my teen years and nothing changed, I began to become uncomfortable with the arrangement. 

I had not made many friends outside of school before then, of course, due to my packed schedule. When I attempted to make plans with friends and let my family know ahead of time, some emergency inevitably came up: a last minute project, a chore that had to be done RIGHT NOW, or just a guilt trip of “not being with your family.”After a few attempts I decided it was not worth the effort and went back to my routine.

Finally when I reached my twenties I realized that my life style was not normal. I started to try to pull away. I knew that I wanted to become my own person and not just the person they told me I was. I wanted to make choices based on my own needs and desires instead of doing what would make them happy or what would not get me in trouble with my family. It was very hard for me to break out of the thinking patterns that had formed from my many years as the perfect child. 

I constantly had to remind myself that I was not responsible for anyone else’s happiness or emotional welfare. I could not change anyone no matter how much I did for them or how much I loved them. In fact I was only allowing them to continue to suffer because they never had to grow as long as I picked up their slack.

At first I planned to move out. I started to squirrel away money for an apartment and shopped around near my work during lunch to see what I could afford. Then a few weeks before I decided I would make my move, a family member had to have emergency surgery.

Well, of course I couldn’t leave then. There was an actual sick person to take care of; the house had one less person to help with clean up, and the person that did not work and stayed home needed a break in the evenings. It was only reasonable.

Six months went by and I decided that I would take a smaller step towards being independent. I planned on going on a trip by myself for two weeks. I would use the money I had saved to pay for the gas, and I had a tent so I could just go on a road trip and camp along the way. I got permission from my work and was all ready to go. I decided to give my family two weeks’ notice so that they could adjust to the idea.

Bad idea.

As I started to pull away, my family teamed up against me. From telling me I was wrong in my thinking to guilt trips to outright anger and abuse, they piled on the difficulties and tried to make me conform to their way of thinking; the way that was easiest for them. I fought back for a while but eventually got worn out, and found myself being sucked back in.

I postponed my trip indefinitely.

However, this time I was aware of what was going on around me. I felt like I was living in another world. I watched in horror as I went through the same day-to-day routine of being the perfect child and cleaning up the messes they left behind. I felt disconnected from reality and just went through my days with a kind of hopeless, formless, pointless movement. Somehow I thought that as long as my body was moving I was still all right and functioning.

What I did not realize is that I had become seriously depressed. I had been depressed in the past but had repressed the dark times in my life to the point where I did not even remember them happening. I tried to function on auto-pilot without my own conscious approval. However, this time around the auto pilot would not engage. I had become too self-aware to let my brain slip into a waking coma.

It got to the point where I would be driving and would consider just letting go of the wheel and seeing what happened. After all, it did not matter one way or the other. What was the point of living like this?

After having several similar thoughts, I sought professional help. Although it did help to have my irrational thinking pointed out to me, it did not help in the sense of giving me something concrete to do.

“Move out,” they said, “Get away.”

Well, that is all well and good for someone to say, but the practicality of it was beyond me. I had been beaten down by the combined forces of my family. From bills to pay to broken down cars to guilt trips and attacks of hysteria I had so much to deal with that even planning a way out was beyond me.

I checked out. I really did. I went to work every day and somehow managed to crank out my job with no brain power. I got home and took care of the chores and bills and things that needed to be done. I chatted pleasantly about the weather, feigned listening attentively to problems, and worked steadily until it was time to fall into bed and start the whole day over again.

Weekends and weekdays were indistinguishable except for the physical activity required. It was much more restful at work, sitting at a desk, then at home running errands, cleaning up messes, and trying to pretend everything was fine.

Hopeless does not even begin to describe it.

I tried to express to my family why I was so angry, or stressed, or just listless. Their solution:

“Just stop thinking so much. Everything will work out.”

Eventually I got fed up with the whole thing. Working with friends I came up with a way to get out of the house. One day I just moved, taking only a couple of bags of clothes and tossing them in the trunk of my car I left.

After the meltdown, things changed. I was still the ‘perfect child’ in some ways but I learned the benefits of boundaries and getting away from people. The physical distance helped me to create a personal space where I could feel safe and grow. It was still very hard for a long time but it has gradually gotten better. My family still attempts guilt trips and manipulation but now that I have time to see things as they really are I can resist them and deal with them in a healthier way.

Author Bio:

Paul Taylor started www.babysittingjobs.com which offers an aggregated look at those sites to help families find sitters and to help sitters find families easier than ever. He loves writing, with the help of his wife. He has contributed quality articles for different blogs & websites.

GUEST POST When Conflict Brings You Together… And Then Drives You Apart

You initially bonded over a drink as you both shared similar tales about upbringings that could have mirrored one another’s. The abusive relationship with alcohol and drugs, the physical bruises that left far deeper emotional ones, the lack of communication within the family… these were things you both experienced and they bonded you together. You became inseparable because no one else could possibly understand what you had gone through. Until one day it all fell apart. The very glue that held you two together in the first place became a repellant, something you want nothing more than to leave behind forever, but their presence is a constant reminder…

This situation happens more often than you probably realize. Two people with common conflicts in their backgrounds meet and fall madly in love with one another, bonded by their mutual past troubles. This was true for one of my acquaintance and his wife. They both shared rough upbringings and came from broken families, and this shared past made them inseparable… for a while. 

This scenario is all too common for people coming from broken pasts. The troubles they face bind them in a way that true love, shared passions, and positive upbringings binds others, until one day the past troubles become a rock in your shoe. It’s annoying, but not entirely detrimental.

However that rock slowly morphs into a wedge that creates more conflict, and before you know it a full-blown wall between you and your professed lover. Such was true for my acquaintance. He and his wife followed a tumultuous course; one that almost exceeded his own troubled past, until they finally couldn’t stand to be around each other anymore. But why does this happen? How does something so binding become something so revolting?

One reason is that the constant reminder becomes unbearable. While you were initially able to share and empathize with one another over similar circumstances, when that becomes the defining point in your relationship the reminder of your past can become the only thing you’re able to see when you look at your partner. And that constant reminder can become unbearable to the point that it ruins the relationship. For my acquaintance, this meant turning to alcohol and drugs in an effort to blur reality and forget. It meant turning into himself and all the dark demons that had been following him.

Then there’s the point of needing to actually deal with the source of the problems. Being able to talk about something and share experiences with one another is not synonymous with actually confronting demons in your past and dealing with them. Sure you can talk through some of the basics of problems that are rooted in your past with someone who has been through a similar upbringing; however the basics are just that – they’re a superficial way of “dealing” with all of the negative emotions. 

What you really need is to talk to someone who is trained in helping individuals move past life events that have had a negative impact. At that point one or both of you should consider seeking professional help.

When you’re commiserating with someone over conflicted experiences you likely are only able to add your own two cents about a similar event. This rallying of negative emotions only adds fuel to the fire, and instead of diminishing the negativity it helps it flourish. For my acquaintance this meant that they went through harsh benders on drugs and alcohol together, pooling their shared miseries and fighting as they regained soberness. It was a never-ending cycle of bad happening upon worse, until they finally came up for air and found the strength to separate from one another. 

Neither is perfect now, but both are at least pursuing a future that doesn’t include rebounding negativity off of one another.

Dating someone who has a similar conflicted upbringing as you can be a breath of fresh air at first. However if left untreated, it can become stale, or worse, drive the two of you farther into a pit of despair, leaving your relationship stagnant instead of thriving.

Elizabeth’s Bio:

Liz just a simple lady tries to convey some of what it is like to date online through dating websites. For any further information on online dating you can email her at: liznelson17 “@ “gmail.com.