Saturday, September 28, 2013

John P O'Reardon on Mood Disorders - Devices to help depression

Great turnout! Ada and I worked hard notifying our Group about this knowledgeable speaker. Her husband Rich was downstairs in the 'bullpen' just in case we needed to pull him out to help fill up the room.

I always set up the room at the Giant in the morning. Suzanne, in the Community Room, helped me. All the staff are great at the Giant.

On two tables I put 3 years' worth of Compass mags, our MH magnet, brochures, plus the new edition of my 'book'

Hmmm. Is writing this self-serving?

After setting up, I went home and took a nap. I was exhausted since I was up until 3 a.m. working on an article for the Upper Moreland Hysterical Society.

John P O'Reardon, MD.

At Penn, he was an assistant professor. At the College of New Jersey and Dentistry he's a full professor. He does research into TMS, transcranial magnetic stimulation.

CONTACT DR O'REARDON at 856-482-9000 ext 228 and speak with Amanda.

When we began the program, I asked him where he was from (for the benefit of the audience).

"The Emerald Isle," he said.

We do need wizards to help people with hard-to-treat depression, which is O'Reardon's specialty.

About 80 percent of people with mood disorders respond to medication.

About 8 family members were in the audience including our lovely Carole Hodges, head of our Family Member Group.

Dr O stressed the importance of compassionate family members, who, he said, experience almost as much suffering as the individual.

They can encourage their loved one to take medication and not give up. When a patient takes new meds "It takes a long time for them to work, to produce the changes in your brain."

"The brain is a dark mysterious field. Our galaxy, The Milky Way, has about 400 billion stars. Our brains have 100 billion neurons but 100 billion connections."

Said the late poet Syvia Plath, "The mind is as wide as the sky."

No, Sylvia was not a member of New Directions.

We briefly discussed her tragic life and the web of suicide spun after her DBO: death by oven.


Click to enlarge on this handout. The info is covered in this post. Desiree: ask me for the sheet on Tuesday nite.


They should take a complete history of the patient, including Family History.

Genetic factors account for mood disorders, esp. bipolar and anxiety. "Oh, my mom was a nervous wreck," a patient will say.

My own 91-yo mother, bless her strongly beating heart, is quite the Anxiety Queen who loves nothing better than staying home.

The doctor, continued O'Reardon, should give the patient HOPE. It's more important than a prescription.

The initial diagnostic evaluation should take an hour. Follow-up med checks should last half an hour. The short med checks are due, of course, to insurance.

BTW, New Directions is gonna have a guest speaker in November who will talk about the Affordable Care Act. Thanks to Harriet for finding us the speaker. Will it be.....

O'Reardon was curious to know who our speakers are. I told him I'd asked Michael Thase, head of Penn's mood disorders program, and Rajnish Mago, head of Jefferson, and both of them wrote back with their regrets.

"Tell Rajnish Dr O'Reardon said to come and speak and he'll listen," said Dr O'Reardon.

Here's Rajnish now.

AT THE END of the psychiatric session, the doctor should not be looking down and writing his notes, he needs to pay attention to the patient and ask questions like, "Do you have any more questions? - Did I answer all your questions?"

There are at least 70 different treatments for mood disorders.

"I understand the suffering you are going through" is something a patient likes to hear.

Treating mood disorders is very challenging. It's important to get therapy once a week, he said. Changes take place in the neurons. Exercise also builds new neurons. Half an hour three times a week should be fine.


Yes! said the white-haired Dr O'Reardon, who wore a beautiful suit and tie.
 We now have DEVICES for the brain, non-invasive devices.

TMS - transcranial magnetic stimulation. It's now covered by Medicare. One of his patients was recently covered by Magellan.

Treatments are five days a week for FOUR TO SIX WEEKS for 30 minutes per session.

The stimulation turns on neurons that have been switched off by depression.

Now, I have no idea what that means, but I find it fascinating.

I'm thinking of my house now. I'm sitting in the living room typing this up. What if I can't switch on the light in the kitchen or the upstairs bedrooms?

Look! It worked.

There are NO side effects with TMS.

Effectiveness is 50 percent.

Most effective treatment is ECT, electroshock therapy, with a 75 percent success rate.

But the patient must be anesthetized. One of our gals had ECT with Dr Worthington, who Dr O said was excellent. We had him speak about 8 years ago. Super-smart.

There's a new type of ECT, which is administered with an INFUSION OF KETAMINE. Steven P Levine, MD, in Princeton gives ketamine infusions. Read his column about it here.

A new type of TMS is now being researched. sTMS. Dr O is researching this with an Australian team.

The Australian team can't wait to get to the office to do more research.

Deep Brain Stimulation is another treatment, pioneered by Helen Mayburg. It's also effective for Parkinson's.

Dr O likened today's treatment of depression to that of CARDIOLOGY 30 years ago. Back then, patients were told to change their diets and to exercise. Today the treatments include stents, defibrillators and pacemakers.

EXERCISE: half hour three times a week - this creates new neurons, swimming is good b/c it exercises the whole body.


Folic acid, 1 mg a day

Deplin, a stronger form of folic acid

Thyroid hormone

Dopamine agonists such as REQUIP and MIRAPEX, both used for Parkinson's.

Hormones such as testosterone.


Leading cause of death among teens is suicide.

Bipolar people must use a mood stabilizer. Taking antidepressants may make the bipolar worse.


SSRIs - 6 of them, including Prozac.

SNRIs - 3 of them Effextor, Cymbalta, Prestique

Wellbutrin is in a class by itself. 

Remeron is in a class by itself.

Max Deming is in a class by himself.

Photo: Blueberry Yogurt and white nectarines!
What a serotonin boost he is!

MAO Inhibitors work best for some people. These were the first antidepressants invented. The original eating restrictions have been loosened up.

Two of our people take NARDIL. Dr O said it's okay to eat yogurt and chocolate. And Ed may drink his Manhattans in moderation.

Aged cheese is forbidden. You'll get a splitting headache from a hypertensive event. 

Chinese food is prohibited b/c of the soy sauce, which is aged. That's the wrong word. Fermented! It just came to me while doublechecking this post.

Tyromines are the food component that has a bad reaction with MAOIs. 

Gosh, aren't we learning a lot today?

 Dr O suggested NEURONTIN for anxiety. Now, that's one thing I learned today. He also suggested benzos for anxiety, particularly Klonopin, which he much prefers over Xanax.

When Gerri complained about her three-year-long depression O'Reardon suggested she see Dr Mario Cristancho at Penn.

"He's good," he said. "I trained him myself."

Betsey asked a question about meds for older adults. She and I are going paddle-boating at Lake Galena in Chalfont tomro.

Hey, Betsey, wait for me! I'll just be a moment swimming toward you.

Betsey's question was understandable. We wonder how we're gonna feel in our later years. Will our meds continue to work?

"Every so often," said O'Reardon, "the cocktail needs to be adjusted."


We sent Dr O back to Cherry Hill with a pot of.... fill in the blank.

 Ada and Betsey. Ada, did you get a new back pack?

Then a dozen of us went downstairs to kvell over the program.

 Ann Tucker came all the way out from Q'town. Her mom was a member of ND and died four years ago. Her mom, a very calm woman who was a schoolteacher, and I would go swimming at one of Abington Township's swimming pools.

George and Ann Tucker raised their family on Acorn Lane, which is 7 minutes away from me. George was a classical music lover and jazz aficionado and I borrowed a number of his CDs - Mahler's Titan Symphony and Brubeck's Time Out. He used to drink his beverages out of jars.

Ann inherited his music collection.
 Kevin used to live in Woodwinds where my sister Donna now lives. FEMA is buying out her condo and she'll come live with me until she can get her own place.

George Tucker on the right is a schoolteacher at STEM Academy in Downingtown. He taught English in China during the summer and really enjoyed it. One of his Chinese students attends some of his classes at STEM, reporting in through Skype.

His class warmly welcomes her and want to chat her up, but she's all business and simply wants to learn.
I always like to relax with a cuppa decaf but the line was too long, so I bought a bowl of Egg Drop Soup at the Chinese concession at the Giant. Way too much sodium in there. I got very thirsty.
Ann Tucker, Jr, as she calls herself was very impressed with our Giant and all it offers. She shops at one is Q'town, but it's just a regular grocery store.

Ann is a psychotherapist. 

Her nephew Dan and I discussed Facebook and the difficulty of posting comments that may be taken out of context unless you know the person real well.
Desiree took a break and came all the way from Haverford, I think. Her 5-yo son Jonathan was having fun with his dad.

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