Getting Properly Diagnosed & Additional Therapies for Treatment-Resistant Depression with Dr. Alison McInnes

By Ruika Lin

Earlier this month, I wrote my first guest blog post for 2-Minute Mind Check on Mindfulness-Based Cognitive Therapy with Dr. Stu Eisendrath, diving deep into MBCT’s structure, benefits, and positive results in tackling Treatment-Resistant Depression (TRD). Today’s post is going to cover the two sessions delivered by Dr. Alison McInnes during last month’s Not Your Mother’s Therapy event: the essentials of getting properly diagnosed for depression, and additional therapies for TRD.

The evening began with Dr. McInnes’ discussion on how to get properly diagnosed for depression. First of all, a psychiatrist will do a standard clinical interview which will include discovery about the patient’s chief complaint, history of the present illness and when the symptoms started, any hospitalizations or suicide attempts, a detailed medication history, and medical history. A psychiatrist will also conduct an assessment of the severity and chronicity of the patient’s symptoms. Dr. McInnes’ also mentioned that a good primary care doctor can also diagnose depression, but TRD is the type of depression where a psychiatrist comes in and can be the most helpful.

Depression is a mental health disorder that can have different symptoms depending on the person. For most people, depression changes how they function day-to-day, typically for more than two weeks. Depression can be defined as either having little interest or pleasure in doing things, or feeling down, depressed, or hopeless. Even though symptoms can vary based on the individual, common ones include changes in sleep (too much or too little), appetite, and movement (less active or more irritable), lack of concentration, loss of energy, low self-esteem, hopelessness or guilty thoughts, physical pains, and self-harm or suicidal thoughts. In particular, Dr. McInnes stressed that any level of suicidal thoughts and attempts must be taken very seriously. A critical method for recording patients’ symptoms is a Patient Health Questionnaire (PHQ) used by psychiatrists in estimating the severity of depression via a standardized scale. The questionnaire is especially useful before and after treatment in order to assess both its effectiveness and whether the patient’s symptoms have improved.

Other helpful information that a psychiatrist might need to make a proper diagnosis includes family psychiatric history with response to medications, the patient’s level of substance abuse, social history or a history of trauma, and mental status. When making a potential diagnosis for depression, psychiatrists record the patient’s appearance, motor movements, eye contact, orientation, speech, mood (how the patient states he/she feels), affect (how psychiatrist thinks the patient appears - it’s important to know whether affect is consistent with the mood), thought processes and content, perceptual disturbances, insight/judgment, memory and more. The results of mood surveys can help psychiatrists quantify response to treatment. Several lab tests such as TSH (thyroid function) and Vitamin D levels - especially in older patients - can also be helpful in the diagnosis.

Following Dr. Stu Eisendrath’s informative session on MBCT, Dr. McInnes returned to the topic of Treatment-Resistant Depression and discussed a number of additional therapies for this more common type of depression. Honing in on the neuroscience of depression, Dr. McInnes shared that traditional antidepressants target the three neurotransmitters that are collectively referred to as the biogenic amines: serotonin, norepinephrine, and dopamine. All traditional antidepressants, including Prozac, Zoloft, Lexapro, Wellbutrin, and more, are some combinations of these three neurotransmitters. They take about four to six weeks to work, and can be very effective, with common side effects such as decreased libido, emotional numbing, and weight gain. Antidepressants can be used to treat both depression and anxiety including OCD, PTSD, and Social Anxiety Disorder (SAD).

For TRD patients who do not respond to at least two additional antidepressants, alternative therapies such as Transcranial Magnetic Stimulation (TMS), Electroconvulsive Therapy (ECT), and ketamine treatment can be helpful, as medications targeting the aforementioned neurotransmitters are not effective in 35-45% of patients. In addition, it’s also important to note that depression must be moderate to severe in nature to warrant these alternative therapies.

TMS is an FDA-approved treatment for TRD. The treatment involves sending magnetic pulses into areas of the brain that resets the brain’s neural circuitry to restore functional connectivity between brain regions implicated in mood disorder.  TMS treatment is structured as a 40-minute session per day for five days a week during a five-week period. Aside from headaches, TMS has minimal side effects.

ECT is another FDA-approved method for rapidly treating severe depression, having been gradually refined over the years to be more effective with fewer side-effects. Similar to ketamine, ECT addresses suicidal ideation. But unlike ketamine, ECT can also treat psychotic depression. With ECT, electrodes are placed on the patient’s scape and a finely controlled electric current is applied while the patient is under general anesthesia, causing a brief seizure in the brain. Common side effects of ECT include short-term memory loss and complications of anesthesia, but patients can become remarkably better very fast, with about eight sessions needed in general.

 Emily Hine (Moderator), Dr. Alison McInnes, Dr. Stu Eisendrath  Not Your Mother’s Therapy - audience Q & A

Emily Hine (Moderator), Dr. Alison McInnes, Dr. Stu Eisendrath

Not Your Mother’s Therapy - audience Q & A

As for ketamine, Dr. McInnes devoted the rest of the evening diving deep into this particular treatment that targets a new class of neurotransmitters. Invented by Parke-Davis in 1962 as an anesthetic alternative to Phencyclidine (PCP), ketamine was widely popularized during the Vietnam War as a surgical anesthesia used among soldiers. In the 1970’s, ketamine was used to treat alcohol addiction in Russia. But in the 1990’s, ketamine’s remarkable and fast antidepressant response was discovered. Over the last few years, communities of patients who’ve received ketamine treatment strongly advocated for its wider accessibility, thanks to its effectiveness. As a result, in 2017, the APA issued a consensus statement on how to safely administer ketamine intravenously for depression.

Ketamine is an NMDA-receptor antagonist that acts on the glutamate neurotransmitter system which is different from the biogenic amines. As it can be a drug of abuse (though with weak addiction liability), and as there has been a lack of long-term safety data for repeated used, ketamine has yet to be paid for by insurance companies. However, given the lack of alternatives and advocacy from the community, psychiatrists have taken the initiative and treated patients in need.

Ketamine works by promoting neuroplasticity,  the formation of synapses (connection between neurons), leading to an increase in the potential for learning after  treatment. Given this increase in learning potential, even if the patient has failed multiple trials of psychotherapy in the past or found them unhelpful, all patients are strongly encouraged to participate in intensive, skills-based psychotherapy (CBT/DBT) with their new level of possibility for learning. Thanks to the new learning ability, therapy can become deeply enriched as well. In fact, MBCT has been found independently to be the most effective type of therapy to pair with ketamine treatment. In preparation for a ketamine infusion, patients are advised to avoid any stress-provoking stimuli prior to the treatment, avoid alcohol consumption and stop any benzodiazepines intake to maximize response of ketamine treatment.

Currently the way to access generic ketamine is through practitioners who administer it intravenously, intramuscularly, or provide an oral version. In 2019, an intranasal form of ketamine, Esketamine, will be FDA approved and marketed for use by the pharmaceutical company Janssen.

Candidates for Ketamine Therapy can be from all age ranges. Bipolar patients in a current depressive episode can also be treated, given that they have adequate mood stabilization and are not using any substances. PTSD, Generalized Anxiety Disorder (GAD), OCD, and SAD are also treatable with ketamine. A few exclusions include patients with active substance abuse, history of psychosis, history of increased intracranial pressure, pregnancy, uncontrolled hypertension, and previous negative response to ketamine.

Towards the end, Dr. McInnes also addressed a few psychedelics-based treatment in development, including the highly-structured nine-hour MDMA treatment sessions targeting PTSD, psilocybin for depression, and LSD for depression, the latter two both in very early stages of development. Dr. McInnes cautioned against microdosing on one’s own because exact dosing is important and because she believes psychedelics should be taken under the supervision of a therapist.  New treatments are constantly being developed and as an example, Dr. McInnes wrapped up her second talk with an incredibly sweet story of a therapy piglet helping with work stress on the East Coast, leaving me with a heartfelt smile on my face at the end of a highly-informative event.

Thanks to Emily Hine for moderating this discussion, to WeWork for hosting us, and to the 2-Minute Mind Check (2MMC) for organizing this informative conversation, Not Your Mother’s Therapy. As a San Francisco Bay Area community initiative aimed at helping employees in the Bay Area determine where they stand on the depression scale, 2MMC is a great place to find resources for you or your loved ones who are suffering. Don’t forget that you can check out more helpful blogs, as well as free depression tools and resources at 2-Minute Mind Check.

About the author:

RUIKA LIN

Picture4.png

Born and raised in Sichuan, China, I’m a San Francisco-based bilingual content marketer, musician, and writer. Immensely curious about the human minds, I write about psychology and emotions, culture clashes, and music. Read my articles here, and connect with me on LinkedIn here.

When Antidepressants Are Not Enough: Mindfulness-Based Cognitive Therapy with Dr. Stu Eisendrath

By Ruika Lin

Last month’s Not Your Mother’s Therapy was the first 2-Minute Mind Check event that I had attended, a compelling delivery by two experts from the front lines of mental health and depression treatment: Dr. Stu Eisendrath with the UCSF Depression Center, and Dr. Alison McInnes with Actify Neurotherapies. With a keen interest in mental health and emotional education for many years, I always seek out activities and contents that broaden my knowledge in this field, so I came to the talk with a desire to learn more. As a beneficiary of and advocate for psychotherapy, I found the evening to be both resonating and highly informative. Dr. Eisendrath’s research into Mindfulness-Based Cognitive Therapy (MBCT) expanded my existing knowledge in and experience with traditional Cognitive Behavioral Therapy (CBT) and mindfulness practices. And Dr. McInnes dove deep into additional therapies for Treatment-Resistant Depression (TRD), topics that I wasn’t familiar with before but now am curious to dig deeper.

The evening began with Dr. Alison McInnes’ discussion on the essentials of getting properly diagnosed for depression. 350 million people suffer from depression worldwide, leading to nearly a million suicides every year. Getting properly diagnosed is the first step to healing before patients get to an irrevocable downward spiral. In her first session, Dr. McInnes explained what a psychiatrist observes and conducts to make a diagnosis, including a standard clinical interview, patient health questionnaire, lab tests, and more. I’ll write more about Dr. McInnes’ sessions in the next blog post.

Next, Dr. Stu Eisendrath examined a type of therapy treatment for patients that suffer from Treatment Resistant Depression (TRD): Mindfulness-Based Cognitive Therapy (MBCT). An interactive session, Dr. Eisendrath opened with a question to the audience on everyone’s experience level with mindfulness, and we all pleasantly discovered a community of folks familiar with the practice. As a tool for treating depression and anxiety, mindfulness is defined by Jon Kabat Zinn, the Founder of Mindfulness-Based Stress Reduction, as “the awareness that comes from paying attention, in a particular way; on purpose, in the present moment and non-judgmentally.” How can mindfulness practice be integrated into systematic depression treatment?

Before unveiling the application of mindfulness and MBCT in depression treatment, Dr. Eisendrath elaborated on the pervasiveness of depression around the globe. Depression is the number one cause of disability in the developed countries, and is projected to become the major cause of disability worldwide by 2020, outstripping other diseases such as dementia and cancer. Treatment Resistant Depression (TRD), the focus of Dr. Eisendrath’s talk, is a particular type of depression that the MBCT targets. TRD is usually defined as a patient who doesn’t respond to two or more antidepressant trials. Generally speaking, about a third of the patients receiving one antidepressant will recover completely; for those who don’t recover from the first antidepressant, about 15% will recover after the second. Even after four treatments, about 57% of the patients still do not fully recover, justifying the immense challenges of treating depression and the long-term disability that it causes. TRD therefore is associated with greater disability, mortality, risk of relapse, and societal cost than those who suffer from non-resistant forms of depression.

1.png

So where does mindfulness come in? MBCT is a group-based, 8-week, skills-based program that combines mindfulness meditation with concepts of Cognitive Behavioral Therapy (CBT) specifically developed for relapse prevention after patients fully recover. Through MBCT, patients learn to disengage from habitual (“automatic”) dysfunctional cognitive routines, particularly depression-related ruminative thought patterns. MBCT not only incorporates a wide range of formal practices such as body scan, mindful stretching/yoga, and silent meditation in the weekly sessions that patients attend, but it also teaches patients to informally integrate mindfulness into their everyday activities such as practicing mindful eating.

Multiple studies have shown that compared to treatment as usual, MBCT has demonstrated significantly better results in preventing another episode of depression. This means that a fully-recovered depression patient who receives MBCT afterwards has a much better chance of staying free from depression compared to patients without MBCT sessions. Even for patients who receive maintenance antidepressants after recovery, MBCT as a replacement produces an equal chance in preventing relapses long-term, a powerful illustration of MBCT’s potency to approximate medication.

Why does MBCT work? Dr. Eisendrath further broke down mindfulness to reveal its effects on depression patients. It encourages us to focus on the here and now, increasing the chance of staying free from both depression and anxiety. The reason is that patients with these two types of disorders feel they either have already experienced a loss in the past (depression) or are anticipating a loss in the future (anxiety), feeling badly in both situations. Given that depression and anxiety are on a time continuum, mindfulness brings our attention to the present moment, and decreases ruminating and self-criticizing thoughts such as “If only I had spoken up to my boss…” or “If only I had done it differently...” With a selective attention on a narrow area such as our breaths, here and now, we reduce the bandwidth available for focusing on depressive themes.

Dr. Eisendrath then invited us all to engage in a brief mindfulness practice. With my feet planted on the floor, I first gently closed my eyes, focusing on my breaths moving in and out of my nostrils. Next, Dr. Eisendrath asked us to count each time we breathe in, but if our mind started to wander, we’d go back to zero and start counting again. After a few minutes of silence and as we brought our attention back to the room, aside from feeling peaceful and relaxed, some audience members also reflected on their wandering minds during the breathing exercise, easily distracted by the surrounding noise or interrupting thoughts. In addition, when asked if anyone was self-critical toward not being able to focus, a few hands rose as well.

Through this exercise, Dr. Eisendrath reveals that for depression patients, there’s a big inner critic saying “I’m not doing this right”, and the average number of breaths that people typically count to before the mind wanders is three. Our mind wanders all the time, generating thought after thought; and in depression, these thoughts tend to be negative. Focusing our attention through mindfulness, we can more easily let go of the negative thoughts and decrease rumination, both powerful factors in treating depression. Studies have repeatedly shown that women in particular have higher rates of rumination, so being aware of that can help women build their mindfulness muscle through day-to-day consistent practice.

Mindfulness also increases decentering, which helps us disassociate ourselves from our thoughts. We can observe our thoughts from a distance without letting them define who we are. Enhanced self-compassion is another positive effect of mindfulness, which emphasizes a  non-judgmental or non-criticizing view of self. If I made a mistake and criticized myself for being dumb or not good enough, that’s judgment right there, and self-judgment tends to exacerbate depression. On the other hand, if I shifted to the lens of self-compassion and said instead “I made a mistake, and it’s just part of being human,” I spread my sense of common humanity and cultivate more empathy towards both myself and others.

Readers may wonder what’s the difference between MBCT and traditional CBT approaches, and Dr. Eisendrath spent a few minutes on the comparison. Aside from the physical symptoms of depression, many of the symptoms are also thoughts. In fact, there are 30 most common depression-related thoughts cataloged, a major one being “I’m worthless”. Through CBT, we are taught to shift our thought from “I’m worthless” to “I helped an old person cross the street today, so I’m not a completely bad person after all.” While in the mindfulness approach, we say to ourselves “I’m having the thought that I’m a worthless person”, immediately creating that decentering and distancing between myself and my thoughts. From there, we have the choice to say, “How do I deal with that thought then? Well, maybe I can return to my breath for now and let that thought go.” In CBT, individuals challenge unhelpful thoughts and try to replace them with more beneficial ways of thinking, whereas in MBCT the focus is on distancing from and letting go of thoughts without judgement.

Dr. Eisendrath then shared some of his research from the Practicing Alternative to Heal from Depression (PATH-D) Study. In this trial, MBCT was compared to an active control condition, the Health-Enhancement Program (HEP), which consisted of nutritional counseling, physical exercise, and music therapy. Questions such as “is MBCT an efficacious augmentative treatment for reducing depressive symptoms in adults with TRD after 8 weeks?” or “What brain changes occur with MBCT?” were answered. The results showed that both programs had beneficial effects, but MBCT more significantly reduced the severity of the depressive symptoms compared to HEP. Furthermore, fMRI scans revealed that MBCT was correlated to a significantly increased activation in the brain enhancing the emotional regulation system compared to HEP. It also decreased activation of the ventral affective processing system, which is high in patients suffering from depression and anxiety.

Finally, Dr. Eisendrath shared a few valuable resources that help us practice mindfulness and meditation in our own time. For readers interested in learning more about MBCT, simply visit AccessMBCT.com and you can find the information you need, even discover different centers or teachers around the world that offer MBCT programs. Other physical sites including Spirit Rock in Marin County, Insight Meditation Centers, and San Francisco Zen Center, along with various meditation apps such as Calm, Insight Timer, and Headspace, are also available for us to explore mindfulness.

I’m grateful to Emily Hine, the moderator of this conversation, and to the whole team at 2-Minute Mind Check (2MMC) who hosted Dr. Eisendrath in this informative conversation, Not Your Mother’s Therapy. As a San Francisco Bay Area community initiative aimed at helping employees in the Bay Area determine where they stand on the depression scale, 2MMC is a great place to find resources for you or your loved ones who are suffering.

In my next guest post, I’ll dive deeper into Dr. Alison McInnes’ sessions for the night on getting properly diagnosed for depression and additional therapies for Treatment Resistant Depression. Stay tuned!

P.S. Don’t forget that you can check out more helpful blogs, as well as free depression tools and resources at 2-Minute Mind Check.

About the author:

RUIKA LIN

3.png

Born and raised in Sichuan, China, I’m a San Francisco-based bilingual content marketer, musician, and writer. Immensely curious about the human minds, I write about psychology and emotions, culture clashes, and music. Read my articles here, and connect with me on LinkedIn here.

 

7th ANNUAL HTF INNOVATION CONFERENCE

Common Good 2018.png

Attend the 7th Annual Health Technology Innovation Conference on May 14th-15th @ Stanford University

Get inspired as experts explore how advances in AI, VR, wearables, patient engagement, behavioral health, and healthy aging technologies can fundamentally transform our health.

Join us for 2 days of captivating keynotes, two tracks of thought provoking panels, an exhibition hall, an invite only innovation showcase, and intimate networking receptions tackling complex questions at the 7th Annual HTF Innovation Conference.

Clinicians, Technologists, Researchers, Entrepreneurs, Venture Capitalists, Public Health Officials, Not-For-Profit Organizations, Governmental Agencies and others will convene with a shared goal to accelerate bringing solutions to market for acute pain points.

Learn more at: http://healthtechnologyforum.com/2018-htf-innovation-conference/

Major depression spares no one — even sportswriters like me

My psychiatrist that morning took one look at my sad, desperate eyes, trembling body, the clothes hanging off a frame that shed 12 pounds in less than a week and declared that this dysfunctional journalist, husband and father of two should be hospitalized.

By sundown Dec. 12, I was wheeled, in surgical scrubs and socks, to the fifth floor of United Hospital’s mental health unit in St. Paul to join other patients navigating their own personal hells.

Rock bottom was all too real. Stripped of my clothes, belt, shoes and dignity, I was alone, uncertain and, when that steel-reinforced door locked behind me, a thousand miles from home.

More than 16 million adults in the U.S. suffered at least one major depressive episode in 2017, according to the Anxiety and Depression Association of America. The disease spares no one, carving a path of untreated destruction across all ethnic, racial and socioeconomic lines.

I was among those statistics.  Read Brian Murphy's story in the Twin Cities Pioneer Press.


Spring Breakers, Beware of the Impending Depression

After a recent week-long, ultra-relaxing yoga retreat in Panama—where I spent time doing yoga twice daily in a rainforest treehouse surrounded by monkeys and overlooking the beach—I expected to be relaxed, particularly because details were planned for

When a friend asked if I felt refreshed upon returning, however, I felt ridiculous telling the truth: I was hardly relaxed.

Instead, I felt overwhelmingly anxious and sad. I had a ton of laundry to do, what felt like a thousand emails to answer, a handful of looming deadlines to meet and an overall dread at being back to a life that didn’t include daily hammock naps and water from fresh-picked coconuts.

It turns out I’m not alone in this feeling of post-travel depression and anxiety.  Read more in this post by Ashley Ross in the Daily Beast.

 


How your next meal could help fight depression and stress

Do you find that food deeply affects your mood? Science is beginning to back up such gut feelings.

The link between poor diet and mood disorders has been long known, but what has been less clear is the direction of causality. When we're depressed, we tend to reach for lower-quality comfort foods, but can more comfort foods contribute to depression? And if we're depressed, can improving our diets improve our symptoms?

New research is helping to pave the way toward greater clarity. One small but important trial was recently published from Deakin University's Food and Mood Centre (the center's very name a testament this burgeoning line of research). It involved men and women who were taking antidepressants and/or were in regular psychotherapy.  Read more at CNN.com.

 

 


Depression Survival Guide (free) with music therapy playlists, meditation and mindfulness exercises, and more.

Tw-Depression Survival Guide.png

Record Numbers of College Students Are Seeking Treatment for Depression and Anxiety — But Schools Can't Keep Up

Between 2009 and 2015, the number of students visiting counseling centers increased by about 30% on average, while enrollment grew by less than 6%, the Center for Collegiate Mental Health found in a 2015 report. Students seeking help are increasingly likely to have attempted suicide or engaged in self-harm, the center found. In spring 2017, nearly 40% of college students said they had felt so depressed in the prior year that it was difficult for them to function, and 61% of students said they had “felt overwhelming anxiety” in the same time period, according to an American College Health Association survey of more than 63,000 students at 92 schools.

Read more in Katie Reilly's post in Time.

 


Not Your Mother's Therapy - Cutting Edge Depression Remedies!

Over the last few decades, there have been breakthrough technologies in the treatment of depression. Finding the right individual treatment is essential for overcoming the symptoms that can take away from optimal health and quality of life.

On March 14th (6-8pm) at WeWork Civic Center (San Francisco), we are joining with WeWork Civic Center and hosting Not Your Mother's Therapy - Cutting Edge Depression Remedies!, a panel of renowned experts in the treatment of depression:

  • Stuart Eisendrath, MD, Professor Emeritus at UCSF School of Medicine and Founding Director, the UCSF Depression Center
  • Alison McInnes MD, MS, Actify Neurotherapies
  • Emily Hine (moderator), Vice President of Meru Health and writer at Holy Sit.

They will explore topics including:

  • Getting diagnosed properly;
  • Mindfulness-based protocols that can change your relationship to depression;
  • Pros and cons of antidepressants;
  • Understanding TMS and ECT for treatment-resistant depression;
  • Ketamine, Psychedelics and more;
  • What's working in the digital therapeutic space;
  • Everyday lifestyle habits that help with low mood;
  • How to find the right therapist for you; and finally,
  • Identify which therapy is right for you & take the next steps toward your treatment. Hint: diagnoses first.

Our host is Emily Hine, a business executive whose inspires us to manage depression, and find spiritual awakening, optimum health and inner peace and compassion in a chaotic world. In her HineSights blog, Emily writes, "Depression has been my companion off and on since I was thirteen years old. Despite suffering from depression, I have been a talented athlete and student, had a successful career at Microsoft, and have run my own consulting company for more than a decade now. I’ve raised $150 million for nonprofits, and have been blessed to work with spiritual leaders, including the Dalai Lama. I’ve owned my own home, my own cars, and I know that hundreds of friends, colleagues, family members, and even acquaintances care about me. I’ve also healed myself from cancer without surgery, chemotherapy or radiation. And yet, even with all of these life blessings, I have also been a member of a secret underground club. I have been like so many others, including Robin Williams, who have tried to take our mental health issues underground where we thought we would be safe."

Tickets are Free with a $5-10 donation optional. Your RSVP ensures your seat:  Reserve Today.

Parking is available on the street and in a paid parking garage across the street. Light food and drinks will be available.  Hosted by WeWork.

About the Speakers

Stuart Eisendrath, MD

Dr. Eisendrath was the Founding Director of the UCSF Depression Center.  He has devoted his career to finding innovative treatments for treating depression.  Most recently his research has focused on the use of Mindfulness-Based Cognitive Therapy for treatment-resistant depression--those individuals who failed to fully recover despite usual treatments.  This approach is aimed at helping individuals to change their relationship to anxiety and depression. Dr. Eisendrath is Professor of Psychiatry Emeritus at UCSF. He is a senior Fellow of the Mind and Life Institute.

Alison McInnes, MD, MS, Actify Neurotherapies

Dr. Alison McInnes earned her Bachelors and Masters degrees in the biological sciences from Stanford University. She then went on to graduate Alpha Omega Alpha from Columbia College of Physicians and Surgeons and completed her residency at the University of California San Francisco. While there she received a Howard Hughes Research Fellowship to study the genetics of mood disorders. Subsequently, she went on to run her own NIMH funded laboratory as an Associate Professor at the Mount Sinai School of Medicine. Dr. McInnes then returned to the Bay area and founded Kaiser Permanente’s Regional Ketamine Therapy Program in 2014. As Medical Director of this program, she convened international conferences for Ketamine therapy, a tradition which will be carried forward in years to come. She brings her strong research background, to Actify Neurotherapies whose mission is to improve mental health through the safe delivery of researched, proven, and innovative treatments. Dr. McInnes is also passionate about yoga, hiking, and French bulldogs.

 

Getting the Inside Dope on Ketamine’s Mysterious Ability to Rapidly Relieve Depression

The notorious party drug may act as an antidepressant by blocking neural bursts in a little-understood brain region that may drive depression

Ketamine has been called the biggest thing to happen to psychiatry in 50 years, due to its uniquely rapid and sustained antidepressant effects. It improves symptoms in as little as 30 minutes, compared with weeks or even months for existing antidepressants, and is effective even for the roughly one third of patients with so-called treatment-resistant depression

Although there are multiple theories, researchers do not quite know how ketamine combats depression. Now, new research has uncovered a mechanism that may, in part, explain ketamine's antidepressant properties. Two studies, recently published in Nature, describe a distinctive pattern of neural activity that may drive depression in a region called the lateral habenula (LHb); Ketamine, in turn, blocks this activity in depression-prone rats.

Read more in Simon Makin's story in Scientific American.


Just One Hour of Exercise a Week May Help Prevent Depression

Regular exercise may prevent many cases of future depression, according to a new Australian study, and researchers say that as little as one hour a week can make a real difference.

The paper, published in the American Journal of Psychiatry, followed more than 22,000 healthy Norwegian adults without symptoms of anxiety or depression for an average of 11 years, asking them about their exercise habits and symptoms of depression and anxiety at the beginning and end of the study.

Read Amanda MacMillan's post in Time.

 


The Psychological Price of Entrepreneurship

By all counts and measures, Bradley Smith is an unequivocal business success. He's CEO of Rescue One Financial, an Irvine, California-based financial services company that had sales of nearly $32 million last year. Smith's company has grown some 1,400 percent in the last three years, landing it at No. 310 on this year's Inc. 500. So you might never guess that just five years ago, Smith was on the brink of financial ruin--and mental collapse.

Read this story by Jessica Bruder in Inc. Magazine.

 

 


Nothing worked for my depression — until I tried meditation

I’ve been on the wrong side of happy since I was 4, when my parents split. I don’t remember a sense of devastation, but I doubt this was a coincidence. An adverse childhood event such as divorce increases the risk of depression, especially when coupled with my father’s history of mental illness.  I decided to try meditation when pharmaceuticals let me down. A growing body of research supported the use of mindfulness techniques for preventing a depression relapse, and a friend of mine who battled anxiety had found relief through the practice.

Read Keri Wiginton's story in the Washington Post.

 

 


Pediatricians Call For Universal Depression Screening For Teens

Only about 50 percent of adolescents with depression get diagnosed before reaching adulthood. And as many as 2 in 3 depressed teens don't get the care that could help them.

"It's a huge problem," says Dr. Rachel Zuckerbrot, a board-certified child and adolescent psychiatrist and associate professor at Columbia University.

To address this divide, the American Academy of Pediatrics has issued updated guidelines this week that call for universal screening for depression.

Read more in this post by Allison Aubrey in Shots, NPR's Health Blog.

 

 

 


Diet and Depression

"Just this week, I have seen three patients with depression requiring treatment. Treatment options include medications, therapy, and self-care. Self-care includes things like sleep, physical activity, and diet, and is just as important as meds and therapy — sometimes more so. 

Diet is such an important component of mental health that it has inspired an entire field of medicine called nutritional psychiatry. Mind-body medicine specialist Eva Selhub, MD has written a superb summary of what nutritional psychiatry is and what it means for you right here on this blog, and it’s worth reading.

What it boils down to is that what we eat matters for every aspect of our health, but especially our mental health."  Read more in this post by Monique Tello, MD, MPH in Harvard Health Blog.

 


Transcranial magnetic stimulation (TMS): Hope for stubborn depression

What can people with depression do when they do not respond to first-line treatments? For several decades, electroconvulsive therapy (ECT or “shock therapy”) was the gold standard for treatment-resistant depression. In fact, ECT is still considered to be the most potent and effective treatment for this condition, and it continues to be used regularly across the country. For many people with depression, however, ECT can be too difficult to tolerate due to side effects on memory and cognition. For those individuals and the many others who have had an inadequate response to medications and therapy alone, there is a newer treatment option called transcranial magnetic stimulation (TMS).  Read more in this post by Adam P. Stern, MD published by Harvard Medical School.

 


Nearly One in 12 U.S. Adults Reports Having Depression

Women Twice as Likely as Men to Be Depressed

A National Center for Health Statistics (NCHS) Data Brief(www.cdc.gov) issued Feb. 13 shows that more than 8 percent of adults older than 20 reported having depression during a given two-week period. Of that total, the prevalence of depression among women was almost double that seen in men. The brief, which used 2013-16 data from the National Health and Nutrition Examination Survey, also found that about 80 percent of adults with depression reported at least some problems performing daily tasks. Specifically, about 50 percent of adults with depression reported some degree of difficulty with work, home or social activities because of their depression symptoms, and 30 percent reported moderate or extreme difficulty.

Read more at the American Academy of Family Physicians.

 

New studies zero in on roots of depression and why ketamine reverses it

While we have a number of treatments available for clinical depression, many of them have a significant side effects, and a lot of people struggle to find a drug that they respond to.

In that light, it came as a bit of a shock when we discovered a drug we'd been using recreationally and for anesthesia could lift the symptoms of depression in less than 24 hours. Unfortunately, the drug in question, ketamine, also has a collection of unpleasant side-effects, and we had no idea how it was working.

But there's been significant progress in unravelling the confusion over ketamine, with researchers identifying a ketamine derivative that tackles depression with far fewer side effects. And this week, a team of researchers at China's Zhejiang University announced that they've figured out where in the brain ketamine acts when it blocks depression, a finding that gives us significant insights into the biology of the disorder.  Read this post by John Timmer in Ars Technica.

Over the last few decades, there have been breakthrough technologies in the treatment of depression. Finding the right individual treatment is essential for overcoming the symptoms that can take away from optimal health and quality of life.

On March 14th in San Francisco, we're hosting Not Your Mother's Therapy - Cutting Edge Depression Remedies! where a panel of experts will discuss:

  • Getting diagnosed properly;

  • Mindfulness-based protocols that can change your relationship to depression;

  • Pros and cons of antidepressants;

  • Understanding TMS and ECT for treatment-resistant depression;

  • Ketamine, Psychedelics and more;

  • What's working in the digital therapeutic space;

  • Everyday lifestyle habits that help with low mood;

  • How to find the right therapist for you; and finally,

  • Identify which therapy is right for you & take the next steps toward your treatment. Hint: diagnoses first.

Speakers for this event include renowned industry leaders:

  • Stuart Eisendrath, MD, Professor Emeritus at UCSF School of Medicine and Founding Director, the UCSF Depression Center

  • Alison McInnes, MD, MS, Actify Neurotherapies

  • Emily Hine (moderator), Vice President of Meru Health and writer at Holy Sit.

If you or someone you know suffers from depression, stress or anxiety, please join us for this empowering conversation about the latest trends in depression treatment. You’ll leave with new ideas, strategies, and most importantly hope for a brighter future.  Reserve a Seat Today.

 

Under the Darkness of Depression a Cyclist Pursues Zen by Bike

"I was in his office seeking help for my depression, anxiety, and irritability. For more than a year I’d been struggling with some of my personal relationships, but most especially with my wife Shana and our young sons, who are 8 and 5. I could go from calm to explosive almost as quickly as a firecracker. My boys thought me angry, sometimes mean. Shana and I had been distant for months; I couldn’t recall the last time we’d kissed.

At 53, I had already been through four depressive episodes. I had always resisted taking medication, wanting to feel the full range of my emotions. But with the well-being of three other people at stake, I was open to seeing if I could be medicated into a more placid version of myself."

Read more from author Patrick Brady in Bicycling Magazine.

 

1 in 5 college students have anxiety or depression. Here’s why

Many of us think of college as a wondrous time of new experiences and great freedom to explore new ideas and find one’s true self.

In recent years, however, depression and anxiety have afflicted college students at alarming rates. As noted in the latest Center for Collegiate Mental Health report, anxiety and depression are the top reasons that college students seek counseling.

Research shows that nearly 1 in 5 university students are affected with anxiety or depression.

Read more in The Conversation.