Saturday, June 11, 2011
Dr John P O'Reardon speaks to enthusiastic group on "Hope for Depression"
Photo from 2002 Psychiatric Times article on Dr O'Reardon Read it!
NOTE: Dr O'Reardon is no longer at Penn. As of October 3, 2011, he works at the University of Medicine and Dentistry in NJ. Phone is 856-482-9000.
Dr O'Reardon was one of the most learned speakers we've ever had at New Directions. He spoke for 90 minutes, including lots of Q&A, at the Willow Grove Giant Supermarket, second floor classroom.
When I walked into the room - The Thunderbolt - named after one of the roller coasters at the former Willow Grove amusement park - I was shocked.
The room was full!
I saw a few people I knew - Hi Ron, Hi Sandy, Hi Betsey (!), Hi Stephen, who I met when we were both census workers - but other than that, most people were total strangers. I love when that happens.
Then my sister Ellen came in along w/ our brother/law Rich Pomper who's a marriage and family therapist in Eugene, OR. Rich and his wife, my youngest sister, Amy, are staying nearby at mom's house.
My sister Amy is a librarian at ORI. She's in town for a library convention.
I went shopping at the Giant early this morning. Bought my contributions to our family reunion later this afternoon, including jumbo shrimp for an appetizer.
Then I bot Dr O'Reardon's gift. As I said to him at the end of his lecture, We'll negotiate about your gift. I bot you two, you can have whatever you want. I bot you a blueberry bush...
What's the other one? he asked.
A beautiful white chrisanthemum.
I'll take that, he said.
I also gave him a letter saying New Directions is making a donation in his name to NARSAD, soon to be renamed the Brain and Behavioral Research Foundation.
As a research-psychiatrist at the University of Pennsylvania, O'Reardon's research is focused on transcranial magnetic stimulation (TMS) for treating depression. He's been researching it since 1998, working with the manufacturers of the machine. He's been able to keep the cost down for treatments b/c of their partnership.
Insurance doesn't cover the treatments since they're new. They're very expensive. O'Reardon said the patient should know after 20 treatments if they work or not.
Last October, we hosted psychiatrist Terry Boyadjis who spoke on TMS in this very same room.
I am trying to be very mature and not insert a personal comment, which would be: All I do is write and eat peanuts.
Followed closely by: My bad leg makes it very difficult for me to get up and fetch my notes from the talk.
Okay, now it's seven hours later.
O'Reardon, who lives in Cherry Hill, had trouble finding the Giant, so everyone was gathered and we waited for him to arrive.
A natural instinct is that people wanted to go out and search the store for him.
Well, I thought, let's get started without him.
How did you find out about the talk? I asked the group.
The Intelligencer, said many people.
By email, said others. Mostly they got emails from NAMI.
A few found out about it on our new website.
Oh, I tried so hard to get a good-sized crowd. I'd lie awake thinking, how can I get word out?
Then I introduced some people in the room.
Scott Johnston, PhD, used to work for the innovative housing program Project Transition. Now he works here. He's involved in film-making. I watched a couple seconds of the film about a man w/ Asperger's and it's terrific!
Jazmin learned of the program from Fran Hazam of MHASP. Jazmin is in the Family Inclusion Program at DBHIDS, a Phila program.
Jazmin Banks and her son
How many family members are here? I asked.
One third of the audience of about 25 or so raised their hands.
By now the audience is getting warmed up and are into the conversation. Me, I'm wondering where the heck the doctor is. How lost is he?
I keep glancing over at the door.
He enters wearing a beautiful suit and tie and shiny black shoes.
We shake hands. I'm wearing my Ask Me Why I've Got 3 Kidneys shirt and had indeed answered this question to the crowd while awaiting the doctor.
HIGHLIGHTS OF HIS TALK
When you're depressed, said O'Reardon, the first thing to try is therapy. He said that psychotherapy creates changes in the neurons in the brain.
We have 100 billion neurons in our brain, as many as stars in the galaxy. And 100 trillion connections.
Hope is an antidepressant.
Find support from family and friends and fellow sufferers.
People look at 'finding the right antidepressant' as the Biological Quest for the Holy Grail. He tells them it takes many things to get you better.
What causes depression, asked an audience member.
There are predisposing factors to depression. If someone close to you has it, this indicates you may be at risk.
Your childhood environment has a lot to do with it. Did you grow up and suffer trauma? Were you abused, neglected or bullied?
Did someone in the family commit suicide?
Sometimes, things just wear you down, such as going to college or getting divorced.
Chronic pain can be a factor.
O'Reardon emphasized the often-overlooked condition of sleep apnea which can lead to depression, a person who is constantly tired. Seek out a sleep disorders center and get tested.
O'Reardon was interviewed on WHYY-FM about his work. He discussed patient Tara Aliotta, who was exposed to extremely traumatic events in her childhood. No child should be treated like Tara was.
Once depressed, there are "perpetuating factors" that make you more vulnerable to continued depression.
Good sleep hygiene is very important. Have a routine where you awake at the same time of day and go to sleep at the same time of night.
We can help patients a lot by dealing with their perpetuating factors.
Try to stop smoking.
New neurons are made thru therapy and exercise.
Over time you see a gradual improvement.
What kind of therapy is the best? "Whatever works for you." What he really likes, however, is Cognitive Therapy.
COGNITIVE THERAPY, such as at the Beck Institute or University of PA's Cognitive Behavioral Dept., is the most studied of all therapies.
CT trains you to step back and look at what's happening to you by looking at the facts, not emotions. Is the situation really as hopeless as you think? Is the future as bleak?
This man knows his meds more than anyone I've ever met. (Boyadjis was also good, but spent most of last October's talk focused on his NeuroStar TMS machine.)
He passed out a handout of meds and their categories. If I'd had time I would've asked why Lamictal is considered a mood stabilizer, rather than an antidepressant.
First page of med handout. O'Reardon's new patients fill this out. Click once or twice to enlarge
The older antidepressants - MAOIs and TCAs - were not helpful for anxiety, as are the newer ones.
Page 2 of med handout.
Take note of:
- 2 types of antipsychotic drugs - the newer "atypicals" and the older, original "typicals." The two classes are related but have different effects on the brain. The atypicals work on dopamine as well as serotonin and other receptors. They are very effective on mood.
Antipsychotics were first used w/schizophrenia, but were found to "work really well for bipolar." Abilify is a good "enhancer," an add-on med that augments other drugs.
- Different classifications for sleep aids or anxiety aids. One class is the Hypnotics (Ambien, Restoril, etc), the other Benzodiazepines (Ativan, Klonopin, Valium, Xanax, etc)
"Benzodiazipines are not bad drugs. They're tricky, tho, b/c over time they may cause tolerance." They may not work as well or stop working entirely. He believes people in their 20s should be wary of the benzos in case their condition becomes lifelong.
Find out why you're not sleeping well. Do you lie in bed and worry? What can you do to prevent this?
Melatonin is an over-the-counter OTC drug you can take. Always check w/your doctor before adding an OTC drug.
- Somatic treatments. Hands-on treatments, no drugs, such as ECT, Light therapy, TMS, VNS. And the newer DBS or deep brain stimulation
As we know, different brain areas are affected by each drug. The SSRIs (Prozac, etc) affect serotonin. They have both antidepressant and antianxiety properties. It's hard to overdose on an SSRI.
The antidepressant Cymbalta affects both serotonin and norepinephrine. As such it is helpful for chronic pain and is prescribed for fibromyalgia.
Welbutrin has a variety of uses (stop smoking under the name Zyban). It's non-sedating and is the only drug that doesn't impair sexual function.
For sleep, the drug trazodone (Desyrel) is presecribed. If you wake up during the nite, you can then take Remeron, for those w/ "double insomnia."
WHAT O'REARDON DOES DIFFERENTLY
- Make sure the meds are adjusted properly... is patient on the right dosage? Has he/she been on them long enough? Need at least one month before efficacy is shown. (Not easy to wait that long, but necessary)
- Try meds that have been forgotten, such as the MAOIs (the first antidepressants invented, in the 1950s) - Parnate, Marplan, Mannerix, Nardil, and the newer Emsam patch. When invented, there was no such category as "antidepressants." They were known as psych "energizers."
At the time, said O'Reardon, they were way overused, but subsequently psychiatrists have lost the art of using them.
- You don't wanna keep adding on more meds. You can make it worse. One woman in the audience was taking 6 meds. "You probly are on too many," he said. She named her meds.
"You shouldn't be taking 3 from the same group."
Unfortunately we don't have a brain scan to help you.
He mentioned psychiatrist Daniel Amen whose brain scans are purported to pinpoint what brain areas are affected by depression or other psychiatric conditions.
There is absolutely no scientific proof validating his claims.
There is now a new technique being used to see if an antidepressant may indeed be working after a patient takes it. He has an EEG - which measures electrical activity in the brain - a week after taking the new drug. If changes are noted, the patient remains on the new drug.
GOOD SUCCESS BY ADDING over-the-counter "ENHANCERS"
If a drug is working fairly well, but not up to its full potential, some enhancers include:
- 1 mg of folic acid
- Fish oil which is often used as a mood stabilizer
*There are also enhancers that are drugs such as lithium, Synthroid, Abilify.
ECT (electroshock therapy) is the oldest, still-used treatment. Today it's much safer and there's less memory loss. In the past, electrodes were placed unilaterally across the scalp and both sides of the brain were stimulated.
Today it's only the right side.
A drawback is that anesthesia is used.
One of his patients gets monthly treatments of ECT and is on zero drugs.
Usually a series of treatments are prescribed. You should know after the 4th, 5th or 6th treatment if they work.
TRANSCRANIAL MAGNETIC STIMULATION is the safest treatment.
"Transcranial" means across the skull. Magnetic pulses are delivered to the brain, the same strength as an MRI.
It's FDA-approved only for depression. Bipolar depression responds well, as does unipolar depression.
By applying the pulses to different brain areas, other conditions will be treated in the future: hallucinations in schizophrenia, migraines, PTSD.
There's no need to go off your meds while undergoing TMS.
O'Reardon treats the toughest cases, usually people who have had severe depressions for as long as 25 years or more.
It's an effective treatment for pregnant women as it doesn't touch the fetus.
Most people prefer it, he says. You sit in a comfortable arm-chair. Side effects are minimal.
Success rate is calculated on longevity and severity of each patient's depression.
Remember, these are severely depressed patients.
TMS success rate is about 50 percent, same as ECT.
Drawback is that insurance won't pay. 200 centers offer it across the nation.
The cost varies with your geographic location.
"We keep the cost as cheap as possible," said O'Reardon. "Think of it as an investment."
In academic settings, like the U of PA, the cost varies from $300 to $500 per session. At Penn, it's $200 a session. As mentioned, the patient knows by the 20th treatment if it will help.
Another RuthDeming aside: I was hoping to keep this blog post short. Quite frankly, I find the information so fascinating I wanna get it all in here.
Taking notes is a hard job. Half of mine are illegible, so, as the saying goes, "When in doubt, leave it out."
WHY IS THERE HOPE?
"I've not met a patient yet who has run out of the potentially endless treatment options," said O'Reardon.
He emphasized the value of therapy, a good, skillful therapist. If you're not making progress, change therapists.
Also, make lifestyle changes. Job, living situation, etc.
Although there is always hope, sometimes it's best to accept the fact that you're living with a chronic illness, no matter what it is.
Ask yourself, Can I function despite how ill I am? Even though you're hardly as good as you want to be, find satisfaction in what you can do. Count your blessings.
Illnesses always fluctuate. Good days and bad days. Sometimes there are even spontaneous remissions that we don't understand.
It's hard to predict the course of an illness. Every brain has a mind of its own.
Always get a second opinion, a fresh set of eyes.
But keep the door nicely open, don't burn any bridges, in case you want to go back.
The Internet has good information but it's also inaccurate.
Hippocrates, the father of medicine, lived 2500 years ago.
Insulin wasn't invented until 1930.
The first effective antidepressant was invented in 1950.
Every patient is a textbook.
- Bad memory
An older gentleman on psych meds said his memory was failing. What should he do?
O'Reardon doubted that he had dementia, stating that people w/dementia are unaware of it.
He suggested taking a paper and pencil test to detect memory loss.
(When I was on lithium, my memory was terrible. It felt like I had "cloud cover" in my brain.)
O'Reardon said that meds that cause sedation do slow down your brain and affect memory.
Depression itself robs people of their memory, as does excessive worry and stress.
He suggested relaxation exercises as well as exercise.
- Can drug use precipitate depression?
Yes, for both legal and illicit drugs, namely:
Cocaine, amphetamines, and opiates deplete some neurotransmitters like dopamine after long-term use.
The following drugs can change the immune system, which can affect mood:
- Why did my bipolar go away?
That was me who asked the question. "Spontaneous remission" was his first reply, followed by the kind of work I do.
Yeah, writing and eating peanuts.
I say goodbye to everyone as they leave.