Ketamine is an anesthetic medication used in general anesthesia and even veterinary medicine. I have previously posted an article regarding the use of ketamine for treating bipolar disorder. More recent studies are showing great hope for ketamine in that it might open the door to new ways of treating depression. Recent studies now show that ketamine might be used with treatment resistant depression. In past studies ketamine rapidly reduced suicidal ideations (thoughts) in patients with bipolar depression as well. What is exciting about this research is that ketamine takes effect in just minutes or hours and a single dose can alleviate depressive symptoms in 40 minutes and last up to 10 days. SSRIs have been known to prevent and reverse brain damage caused by depression by aiding in transforming stem cells into brain cells; this is known as neuro-genesis. Ketamine also repairs damage to the brain by rapidly aiding in the growth of new synapses and replacing damaged synapses (the connections between brain cells), and is associated with reversal of the atrophy caused by chronic stress. Ketamine is fast acting and may initially be used as a temporary medication used while starting on the SSRIs or SNRIs as these medications are building up in the blood stream during the first two weeks of treatment  Typically a benzodiazepine is used during this two week titration period. Ketamine treatment will undoubtedly be used for longer periods of treatment because of the fast acting benefits and its mechanism of action. Researchers also believe that ketamine will lead to new discoveries in fast acting treatments for depression.

An injection of the drug is the current method of delivery, nasal sprays, or possibly a patches might be the preferred method in the future to produce a fast rapid antidepressant affect in those with treatment-resistant depression. The question still remains regarding the optimal dose, and how often and how long to administer it. Once this is determined, the availability of rapid-acting antidepressants may be only steps away. Since this article was first written, much has been discussed about ketamine and its increasing use; many psychiatrists are in fact using ketamine in severe cases of bipolar depression accompanied by suicidal thoughts. They are using it because of the fast acting nature of the medication when needed in these crises situations.

Studies in Ketamine used for Depression Treatment are Very Encouraging

Ketamine works differently than the common antidepressants. SSRIs and SNRIs and even the older tricyclics regulate the neurotransmitters in the brain. Ketamine works differently as it works on the synapses between the cells and also has an effect on replacing damaged synapses that have been destroyed by prolonged stress and depression. Ketamine offers hope to those how don’t respond to the current antidepressants as well. Nationally this percentage of treatment refractory depression is as high as 20%; however, in my Scottsdale practice I would say the percentage of people that I treat who don’t respond to the current antidepressants is much lower – near 5%. Ketamine targets the brain’s glutamate system, lifts depression, and reduces suicidal thoughts with impressive speed. Researchers at the Connecticut Mental Health Center reported the results of the first trial to assess the treatment effects of a single dose of an N-methyl-D-aspartate (NMDA) receptor antagonist—ketamine hydrochloride—in patients with depression about a decade ago. In that study, subjects with depression saw significant improvement in depressive symptoms within 72 hours after a ketamine infusion, as measured by the 25-item Hamilton Depression Rating Scale, suggesting a potential role for NMDA receptor-modulating drugs in the treatment of depression.

In 2012 scientists working at the National Institute of Mental Health on ketamine said that patients with bipolar depression given a single ketamine infusion experienced a rapid and positive antidepressant response and reduced suicidal thoughts in these patients as well. Researchers still have a way to go before ketamine can be used in depression treatment, and very few are currently using it. Potential for abuse and side effects of hallucinations are just a few of the issues that must be dealt with before this drug can be safely used for treatment. Read the full article about ketamine and depression

this article depression treatment with ketamine is for informational purposes and not to be used in diagnosing or treating any illness

New Study Shows Link Between PTSD, Anxiety and Dynorphins

Studies have demonstrated that people with lower levels of dynorphins have more persistent activity in the amygdala, the area of the brain that governs the stress response. Dynorphins are a naturally occurring peptide that is also associated with the reduction of pain. There are three families of opioid peptides produced by the body: enkephalins, endorphins, and dynorphins. The increased level of dynorphin may play a key role in how one “forgets” the traumatic experience thus helping the anxiety or PTSD diminish.

Endorphins that are released after intense exercise are responsible for the runner’s high. Dynorphin is in the same family of chemicals and is responsible for mitigating the emotional response that is associated with stressful or traumatic events. Some people have a harder time than others stepping out of the emotional memory or ruminating over these events and it may be dynorphin that’s responsible for the difference. That is to say that our body chemistry does play a role in our thought processes and this would explain one of the reasons why people seem to have trouble with re-living past traumatic events. Understanding the body chemistry and how it relates to PTSD will lead to better PTSD treatment in the future.

A recent study showed that a group of mice were bred to not express the gene responsible for dynorphin had a prolonged stress response after being given unpleasant electric shocks. The mice remained anxious far longer after the shocks subsided than would be expected. Normal mice reacted to the shocks the same way early on, but as time passed, their stress reactions subsided at a normal rate.

Next, researchers applied the same logic to human participants whose levels of dynorphin fluctuate and vary by nature. People who had lower levels of dynorphin kept reacting to unpleasant stimuli longer than people who had more dynorphin. The people with lower levels of dynorphin also had more persistent activity in their amygdales, the area of the brain that governs the stress response. Finally, they also had less communication between their amygdalas and the prefrontal cortex areas of the brain which is responsible for conscious thought and executive function.

Researchers emphasize the fact that getting past stressful events is not a passive process – the brain is actually working hard to reconfigure itself after the event. Learning to get beyond the memory of acquired anxiety reactions isn’t a fading, but, rather, an active process, and may be facilitated by dynorphin. The architecture of the brain is ever changing and strongly impacted by our environment and how we react to it. This is especially true of those through the ages of early adulthood.

The Connection Beteween Anxiety and Dynorphin May Lead to Newer Treatments for PTSD and Anxiety

Hopefully the results will lead to new treatments for post-traumatic stress disorder PTSD and perhaps for other anxiety disorders, which affect many millions of people across the world. This may even open the door to new medications that regulate the levels of dynorphin similar to the SSRIs and SNRIs. Maybe in the future we will have dynorphin re-uptake inhibitors to treat anxiety and treat panic disorder? Some studies have also concluded that dynorphin may serve as an antidote to cocaine addiction. Most PTSD treatment would entail medication, exercise, cognitive behavioral therapy, maybe brain-spotting and other techniques of teaching you how to make friends with the “ghosts of the past”.  Are you seeking for an experienced Scottsdale psychiatrist? If you need an initial evaluation or seeking PTSD treatment please call my office to schedule an appointment. Read the complete study of Anxiety and dynorphin. The research was carried out by a team at Universität Bonn. If you are seeking an experienced psychiatrist in Scottsdale or Phoenix; please contact me to schedule an appointment.

this article on Anxiety and Dynorphin is not to be used to diagnose or treat any illness

In my Scottsdale psychiatry practice I treat a lot of depression, fibromyalgia, and related pain disorders. Often when treating depression, and treating somatization disorder we will prescribe antidepressants such as the SNRIs or Serotonin and Norepinephrine Reuptake Inhibitors, especially if the patient is suffering from somatization disorder (symptoms of bodily pain) along with depression. The SNRIs do a very good job of treating depression and the associated pain because the SNRIs, unlike the more well know SSRIs (Selective Serotonin Reuptake Inhibitors) not only increase serotonin levels, but also, increase norepinephrine levels in the brain. Norepinephrine is a chemical or neurotransmitter produced by the brain that blocks pain. Infact many of the psychotropic medicines used in treating depression have a mechanism of action that causes the body to stabilize its own chemistry such as the levels of norepinephrine, serotonin and dopamine. Sometimes patients don’t respond to the medications, may be treatment refractory, or may prefer treatment other than medication management.  Acupuncture has been shown to increase the levels of the neurotransmitters in the entire central nervous system in order to treat somatization disorder and fibromyalgia.

Depression, Fibromyalgia, and Somatization Disorder Often Share Comorbid Relationships

The National Institutes of Health estimates that between 3% and 6% of all Americans suffer from fibromyalgia. The DSM-IV states that up to 2% of women and less than .2% of men suffer from somatization disorder in the US. This imbalance is typical of depression in that women seem to suffer from depression at rates two times that of men. Fibromyalgia is treated with anti-depressants more specifically the SNRIs because depression and somatization disorder are closely associated with fibromyalgia, and share the same symptoms. Many pain disorders have been associated with certain psychiatric disorders. The term somatoform is used to describe these conditions. Acupuncture has been known to increase the pain fighting endorphins and enkephlins in the body. This by the way is one of the mechanisms of pain killers in that they increase the endorphins in the body to relieve the pain. Whether it is the opiates, SNRIs or acupuncture, the goal is to increase the norepinephrine and  endorphins in the body. The end result is the same among these treatments in that ultimately it is the body that increases the neurotransmitters in the system to fight the pain, not the drugs or needles. That is not to say that once these treatments are withdrawn the body naturally produces these substances on it’s own at a therapeutic level; but the body does right the wrong, so to say, with the use of these treatments.

Treatment with Medical Acupuncture for Fibromyalgia and Other Pain Disorders is Becoming Commonplace

Many medical doctors are now opening pain management centers and including medical acupuncture as one of their primary forms of therapy. Acupuncture has been effective in many cases in treating fibromyalgia and somatization disorder. Watch this short video from Dr. Russell Berg with regards to his acupuncture treatment for fibromyalgia FMS. You will be amazed with the testimonies of his patients. Acupuncture Treatment Studies for Fibromyalgia FMS (National Institutes of Health, 1997) states:

“Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses. These responses can occur locally, i.e., at or close to the site of application, or at a distance, mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery. A focus of attention has been the role of endogenous opioids in acupuncture analgesia. Considerable evidence supports the claim that opioid peptides are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions. That opioid antagonists such as naloxone reverse the analgesic effects of acupuncture further strengthens this hypothesis.” Regarding stimulation by acupuncture, the NIH report also writes:

Acupuncture may activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects. Alteration in the secretion of neurotransmitters and neurohormones and changes in the regulation of blood flow, both centrally and peripherally, have been documented. “There is also evidence of alterations in immune functions produced by acupuncture. Which of these and other physiological changes mediate clinical effects is at present unclear. Findings from basic research have begun to elucidate the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function”.

According to experts the potential benefits of acupuncture include:

• Less pain
• Cost effective
• Better sleep
• Relaxation
• Possible immune system boost
• Better overall health
• No negative interactions with other treatments, including drugs
• Extremely mild side effects
• Low risk

The needles only penetrate about 1/3 of an inch. After insertion, the acupuncturist will gently twist them to position the needle in the acupuncture point. Usually, you might feel a mild pinch, or you might feel nothing at all. Once all the needles are in, it takes about 20 minutes or longer depending on your specific treatment plan. You’ll probably feel relaxed and sometimes patients fall asleep. Afterward, the acupuncturist will remove the needles, which shouldn’t hurt at all. Sometimes after your first treatment, you may feel some mild aches around your body or you may just feel very relaxed. It’s common to sleep more deeply than usual that night, which is a definite bonus for anyone with fibromyalgia. If you are in need of treatment for your depression and seeking an experienced Scottsdale psychiatrist, please call my office to set an appointment. If you think that acupuncture might be a good treatment option for you and to read more on acupuncture treatment for somatization disorder and fibromyalgia, visit Dr. Russell Berg’s site at Phoenix Chiropractor. Depending on the severity and chronicity the acupuncture treatments usually start making a change around the 5th session. Dr. Berg has had patients respond as few as 5 -10 sessions and others may take longer. His fees for acupuncture are $40 per session.

This article on depression treatment, somatization disorder and fibromyalgia is for general information only and not to be considered or used in diagnosing or treating any psychiatric illness

Dr. Russell Berg 
July 2012

S-Adenosyl-L-Methionine or more commonly SAMe is an important biological agent in the human body and participates in detoxification reactions and in the manufacture of brain chemicals, antioxidants, joint tissue structures, and many other important components. It is normally produced in the liver from the amino acid methionine which is abundant in most diets as well. Because there are no foods that have high SAMe levels, our bodies must make this compound. Folic acid and vitamin B12 are necessary for the synthesis of SAMe, and deficiencies of these vitamins results in low concentrations of SAMe in the central nervous system. SAMe has been found to raise levels of the neuro transmitter dopamine, and patients may have to notice the effects in as soon as a week. Dopamine is an important chemical produced by the brain and responsible for mood. Read more about depression treatment

Clinical Studies of SAMe used for depression treatment have been positive

In a meta-analysis of the most significant clinical studies, SAMe efficacy was shown to exceed that of placebo and was equal to or slightly better than tricyclic antidepressants providing a rapid onset of action with few side effects. The first serious application of SAMe was for depression treatment, but as cases were evaluated it became evident that the compound was also helpful for anxiety, panic attacks, and other problems such as arthritis. Often an elevation in the neurotransmitters,especially norepinephrine will help alleviate pain in fibromyalgia, arthritis and other pain disorders. SAMe is depleted in liver disease and is a precursor of the critical antioxidant tripeptide glutathione which is a primary protector in cells from free radical damage, and a key molecule in the detoxification process in the liver. SAMe slows the reuptake or breakdown of these neurotransmitters allowing them to work longer (similar to the SNRIs and SSRIs). SAMe also speeds production of the receptors which receive these neurotransmitters. The presence of additional receptors allows the neurotransmitters that are present to work more effectively. Some research suggests that SAMe may also make the existing receptors more responsive (better able to receive messages from neurotransmitters). All of these mechanisms combined seem to increase the levels of the neurotransmitters, which decreases depressive symptoms. Research confirms that both depressed and non-depressed people who supplement with SAMe have overall higher levels of serotonin, dopamine, and norepinephrine. If you use SAMe, you should begin treatment only with the support of a licensed health professional. As with any medicine you should check with your healthcare provider to ensure that SAMe will not affect or have a deleterious reaction or interaction with other medications that you are currently taking. Are you seeking a qualified and experienced Scottsdale psychiatrist? Are you in need of depression treatment in Scottsdale? Please contact my office to schedule an appointment. I have been a psychiatrist in Scottsdale since 2001 and have developed a great deal of discernment in depression treatment and treating anxiety, treating ADHD and OCD treatment.

This article on depression treatment with SAMe is for general information only and not to be considered or used in diagnosing or treating any psychiatric illness

As a psychiatrist in Scottsdale, I treat a lot of panic attacks and panic disorder. A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there may or may not be any real danger or apparent cause. When a panic attack occurs, you might feel like you’re losing control, experience the inability to swallow, feel like you’re choking, or having a heart attack and even dying. Many patients will go to the Emergency Room when they have these symptoms of a panic attack and are often given a benzodiazepine to calm them down and alleviate the symptoms. When panic attacks recur in one’s life with some regularity they are referred to as a panic disorder. The quick unset of the panic attack with seemingly no apparent environmental causes seems to be telltale symptom that differentiates a panic attack or disorder from other anxiety disorders. The severity coupled with the relatively short duration of the anxiety are also distinguishing features of a panic attack versus GAD generalized anxiety disorder. Panic attacks are relatively short lived and sometimes only minutes in duration whereas the symptoms of GAD are long term and less severe or acute in nature.

Nearly 20% of the adult population in the US has suffered from a panic attack at some point in their lives and nearly 1.7% of adult Americans suffer from panic disorder. Women seem to be twice as prone panic disorder than men (this is similar with depression as well). Often these panic attacks seem to first manifest between the ages of 15 and 20. Although panic disorder occurs twice as often in women versus men in adults, boys and girls tend to experience panic disorder at the same rate.

Some of the most common symptoms of panic attacks and panic disorder are dizziness, chest pains, choking, headaches, sweating, nausea, chills, problems swallowing or breathing, palpitations or erratic heartbeat, numbness, fear of losing control in formal settings, fear of dying, or back pain. Panic attacks in children may result in the child’s grades declining, avoiding school and other separations from parents, as well as substance abuse, depression, and suicidal thoughts. Panic attacks can occur while you are asleep and may manifest as nightmares and dreams of being out of control.

Once somebody has experienced a panic attack they will often try to avoid the situations that ostensibly triggered them and even develop a phobia from this avoidance. This avoidance can then become disabling in that some will avoid shopping, driving, crowds, and become reclusive and prisoners to their homes.

What are the Causes and Treatments of Panic Attacks or Panic Disorder

Panic attacks and panic disorder can be caused by environmental issues, physiological issues, or both. These causes of panic disorder are similar to the causes of most mental illnesses. Other factors that may play a role are genetics, brain injury, drug use, medications, thyroid conditions, diabetes, and other ostensibly non-related medical conditions. Panic disorder can be treated with medication, diet, exercise, behavioral modification, and counseling. Some individuals have found SAM-e to be very helpful for panic attacks. Sometimes just carrying an anti-anxiety pill in the purse or wallet is enough to prevent and minimize a panic attack. Read more about treating panic disorder. If you are seeking treatment for panic attacks or panic disorder from an experienced Scottsdale psychiatrist; please contact me through this website to schedule an appointment. I have been a psychiatrist in Scottsdale since 2001 and love treating panic disorder.

this article on panic attacks and panic disorder is not to be used to diagnose or treat any illness and is for informational purposes

We posted an article about the possible link between vitamin D levels in pregnant women and schizophrenia. Either a plethora or deficiency of vitamin D seemed to correlate to the child developing schizophrenia later in life. Now another study shows a connection between vitamin D and mental health; this study suggests a link between depression and low levels of vitamin D. This correlation was stronger in those with prior histories of depression. Researchers suggest that vitamin D levels might be better for preventing relapses rather than being used as a bio-marker. Researchers are still not sure if this relationship is causal or coincidental; yet the study is still quite useful. The psychiatric community has been searching for bio-markers and blood tests for early detection of mental illness for years. Additionally researchers may have found a blood test to detect a predisposition for depression; however, this tests doesn’t reveal any more than a psychiatric evaluation, which is much less expensive. Most people can know if they have a predisposition to depression or anxiety by understanding their family histories and taking measures in their lifestyles to avoid the stress or triggers that bring about an episode. Vitamins and exercise are very important to mental hygiene and overall good health, and this correlation of low levels of vitamin D and depression may prove to be quite telling in the near future.

These Studies of Vitamin D Deficiency and Depression May Lead to Better Treatments

Many of these studies ultimately lead to better treatments so they are quite prolific. This study between low levels of vitamin D and depression involved 12,500 patients of which 12% had experienced depression in the past. Low vitamin D levels were common among the entire group and about half of those in the group were considered deficient in vitamin D. The levels of vitamin D did not differ significantly between the participants with a history of depression and those without any prior episodes. Those with higher levels of vitamin D seemed to have a decreased risk for depression, albeit this doesn’t seem to be the case with the elderly. The correlation between those deficient in vitamin D and depression is much stronger than those who are not deficient.

Some of the conclusions of the study were that vitamin D is important for the brain and might be involved in the development of depression. A One year study in Norway concluded that vitamin D deficiency is strongly associated with depression but again, there aren’t enough studies to warrant this finding as conclusive. These studies at the very least should shed some light on the need for vitamin D and its importance. Many studies have come out which seem to show that very large percentage of the population has low levels of vitamin D. Studies with vitamin D and depression vary in dosage from 10,000 IU per week to 50,000 IU per week. Vitamin D levels need to be checked through a blood test before beginning therapy.

Subsequent to this article, a study in 2012 posted in the British Journal of Medicine 2012 makes the claim that vitamin D deficiency can play a role in depression (there is a Vitamin D receptor in the region of the brain responsible for depression); however, vitamin D supplements above deficient levels have no effect in treating depression. Hence treating severe vitamin D deficiency may reduce the symptoms of depression; however, treating depression with vitamin D if there is no deficiency will not remit the symptoms. Read the full article on Low levels of vitamin D and depression.

this article on low levels of vitamin D and depression is not to be used to diagnose or treat any illness

I have mentioned in many of my articles that the newer antidepressants have been shown in studies to protect the brain from damage and loss of neurons. They have a positive effect of reducing the loss of volume in the area of the brain known as the hippocampus. In short the SSRIs have been shown to cause the stem cells in the hippocampus to mature into adult brain cells and replace the damaged cells. This study shows hope for the future in new and better antidepressants and maybe even reversing memory loss. Other medications are also being tested for use in treating depression and bipolar disorder that also have a mechanism that replaces the synapses in the brain that have been damaged by stress. One drug that is fast acting and accomplishes this is ketamine.

Intuitively we know that most bodily illnesses have a deleterious effect on our physiology if left untreated, and mental illness is no different since we are dealing with a physical illness (in many if not most cases). With mental illness, the physiological or genetic issues are an issue of the brain’s inability to produce the balance of neurotransmitters. This study about depression and the hippocampus concluded that certain antidepressants might assist in the reduction of neuron loss due to the destruction done by stress and depression through neuorgenesis or the process of transforming stem cells into adult hippocampal cells. Studies have shown that in many cases aging alone will cause the protective sheathing around the nerve to dissipate, and hippocampal volume loss which one of the reasons why our memories wane as we age.

A Study in 2003 on the Loss of Volume in the Hippocampal Region of the Brain and Antidepressants

following is an excerpt from one such study:

The purpose of this study was to investigate the effect of antidepressant treatment on hippocampus volumes in patients with major depression. For 38 female outpatients the total time each had been in a depressive episode was divided into days during which the patient was receiving antidepressant medication and days during which no antidepressant treatment was received. Hippocampal gray matter volumes were determined by high resolution magnetic resonance imaging and unbiased stereo-logical measurement. Longer durations during which depressive episodes went untreated with antidepressant medication were associated with reductions in hippocampal volume. There was no significant relationship between hippocampal volume loss and time depressed while taking antidepressant medication or with lifetime exposure to antidepressants. The conclusions were that antidepressants may have a neuro-protective effect during depression. Read the complete study regarding Depression and Hippocampal Volume Loss.

An Article in the Psychiatric News November 2011 and the Science Daily April 2011 cites a study that was conducted at King’s College in London which demonstrated that the presence of antidepressants in the brain activate the birth of new neurons in the hippocampus. In short the antidepressants exert their effects through the glucocoricoid receptors which stimulate nerve generation. The antidepressants activate the glucocorticoid receptors, and these receptors increase the synthesis of the genes that increase neurogenesis. The article also quoted an expert in this field from Columbia University Maura Bold-rini M.D., PhD as saying “Stress is known to reduce hippocampal neurogenesis throughout species…Antidepressants have shown a significant role in reversing the negative effects of stress on neurogenesis.” Therefore this study vindicates the original study conducted in 2003 by Yvette I. Sheline, M.D.; Mokhtar H. Gado, M.D.; Helena C. Kraemer, Ph.D.

Antidepressants May Assist in Restoring Memory and Replacing Damaged Brain Cells

What does all of this mean? If you are suffering from depression, or anxiety, if left on treated you may run the risk of brain damage, and possibly early onset memory loss. These studies also open the door for more investigation as to how the antidepressants affect the genes in the brain, will open the gate for new research, and maybe change the direction of treating or even curing depression in the future. These studies show promise because the show how the SSRIs turn the immature stem cells into adult brain cells and “might” replace all of the damaged memory loss caused by stress…in the future. Read the full article on this latest research of SSRIs and hippocampal neurogenesis

this article on do antidepressants protect the brain is for informational purposes and not for diagnosing or treating any mental illness

I have always been concerned with the healthcare system run by the states and municipalities. My concerns are that the lack of advocates for mental illness and consequently; when there are budget cuts, these are the first to lose funding. I recently read an article where the city of Flagstaff, AZ had to cut off its subsidizing of psychotropic drugs. As a result of this the emergency rooms began to see an enormous increase in attempted suicides from patients decompensating from the medications that were keeping them stable. I don’t believe that there are not enough advocates for the mentally Ill nor is there an understanding of the cost to the public if people are deprived of this healthcare. This might be a decision that many of us will have to make in the near future.

The cost of limiting healthcare for mental health to the community has far reaching implications

The cost of not providing a subsidy healthcare for mental health such as psychotropic medication will far outweigh the cost of assisting those who cannot afford the medications needed to remain stable and lead productive lives. Typically we see with state and municipal agencies great resistance to providing the right medications for patients and what they do approve are very limited and antiquated drugs. This is also an issue in the private sector, yet not as often as with the public financing. Great concerns lie ahead of us if we socialize our medicine because we will see a rationing of healthcare and there is great trepidation with how the government will deal with the mental health issues. Following is an article that discusses private vs public healthcare in the UK which includes the issues of healthcare on mental health and the net effects.

Private vs Public Health Care: Let the battle commence
by John T. Hughes – January 2012

Here in the UK, we seem to have a peculiar British habit of complaining about the NHS whilst simultaneously championing the right to free health care. For the 11% of the population (figures from 2009) who have purchased private medical insurance, its less about taking our free national health service for granted but rather the freedom to have more choice about when, where and how they receive treatment should anything occur. As the war rages on about the best form of medical care, we discuss the advantages and disadvantages of both public and private health care.

Advantages of the NHS (National Health Care System)

A free service: Funded by theUKtax payer, the NHS is free at the point of delivery, although charges for prescriptions apply. As David Cameron said in 2009: “No matter who you are, where you are from or how much money you’ve got — you know that the NHS will look after you.”

Range of health care services: The NHS covers everything from flu and vaccinations, to mental illness and specialized treatment of illnesses and diseases. You can also receive treatment at any hospital or centre in the UK.

Disadvantages of the NHS

Long waiting times: Whilst the NHS aims to care for everyone, as a result its resources can become seriously overstretched with waiting times for treatment and even consultations with specialists. Urgent cases will be seen promptly, however, if you are less severely effected you may face increased waiting times.

Stress: An NHS patient may suffer from stress and discomfort as a result of longer waiting times for treatment. It is impossible to measure the long term effect this can have on a patients’ recovery time and mental and physical health.

Some additional costs: Although the majority of NHS services are free, you may have to pay for alternative treatments such as acupuncture or homeopathy which are often offered as part-and-parcel of a private medical care system.

Advantages of Private Health Care:

Shorter waiting times: The NHS has worked hard to reduce waiting times in recent years but its policy still states that patients can wait a maximum of 18 weeks for treatment from the point of initial referral. Private Health care has significantly shorter waiting times giving you treatment when you need it.

Flexible appointment times: Private medical care gives you appointments when you want it; after working hours in the evening or the weekends so you don’t have to take time off work.

Choice of treatment location: You can decide where you wish to be treated; near family, home or work perhaps.

Consultants of your choice: Those seeking private medical care have access to the specific consultants they wish to see and most likely be treated by the same consultant though out. Alternatively, as an NHS patient you will only be referred to a consultant may if your problem is complex.

Peace of mind: For you and your family that you are receiving the best treatment possible.

Privacy and comfort: Those treated within the private health care system will often be given their own room helping you relax during a stressful period.

Disadvantages of Private Medical Care

Expense: Treatment though a private medical care service can prove costly, unless covered by private medical insurance.

Some waiting times: A specialist consultant could be in high demand particularly at busy times such as after work or at weekends.

So, where do all these pros and cons leave the average UK person? Ultimately, deciding whether to stick with the NHS or go private is a personal decision.  As with deciding on any insurance policy, individuals must weigh up the risk involved should anything unexpected occur – how comfortable would you feel if you or your family had to be treated by the NHS in an emergency situation?

Private medical insurance can offer peace of mind to policy holders who can be reassured they are entitled to prompt treatment and the best service.

Most significantly, the decision to go private will also be largely swayed by financial costs. Most people in the UK can not realistically afford the advantages of private treatment unless covered by private medical insurance – bought through a company or individual medical insurance scheme. A private medical insurance policy is usually paid for in affordable small monthly installments.

There are many companies offering company, family and individual private medical insurance, all offering differing levels of cover. Selecting the best for your circumstances can be a confusing process and it is worth talking to a private medical insurance broker who can compare a broad range of policies to put you in touch with the best for your needs.

- John T. Hughes writes for Private medical insurance UK, helping consumers to find the right medical insurance specialist.

This article on Healthcare and Mental Health is strictly for information purposes and not an endorsement for any company

DBS  for treating depression is a breakthrough in Deep Brain Stimulation therapy which has had great success in controlling limb tremors in thousands of people with Parkinson’s disease. Now DBS is in the experimental stage of being used to treat patients with OCD and Depression. Read the article titled Treatment Resistant OCD which deals with Deep Brain Stimulation and OCD. The therapy involves a tiny implant being embedded in the brain which delivers electrical stimulation to targeted neurons in the brain to make them fire or suppress them from firing. This is the premise of DBS and depression in that scientists may be able to target the region of the brain that needs to be stimulated, thus remitting the symptoms and the brain chemistry responsible for depression. Other studies are being conducted on the hormone, melanocortin and the MCR4 receptor that is involved in the synapses; both of which play a role in pleasure and pain, depression, and anxiety.

DBS and Depression – Scientists claim that the new Implants may show benefits that “some are more or less completely cured”

Scientists in Australia are now working to modify the implants of the DBS device in order to target the neurons responsible for major depression. When DBS was first used to treat Parkinson’s and other seizure disorders; the areas of the brain that needed to be stimulated were somewhat transient which made it more difficult to achieve the maximum efficacy of DBS. The implants are easier to work with in treating mental illness since the parts of the brain that are involved with the depression or OCD are quite fixed or stationary. A similar therapy: Vagal Nerve Stimulation was also first used to treat Epilepsy and Parkinson’s disease and later discovered that those being treated noticed a marketed improvement with their symptoms of depression. You can read more about this in my article and video I posted on Vagal Nerve Stimulation (VNS). These DBS implants operate similarly to cochlear implants for helping deaf people hear again. The electrical stimulation emitted can make neurons fire or cause them to be suppressed from firing. The theory is that you can shut down areas causing symptoms related to conditions such as Parkinson’s, epilepsy, obsessive compulsive disorder (OCD) and chronic depression.

Professor Hugh McDermott, of the Bionics Institute in Melbourne helped develop the cochlear implant and has been working on developing the technology for use in blind people, and others with movement and psychiatric disorders. DBS and Depression hold great promise for the future. Regarding the early use of the device Professor McDermott said, “Three patients had obsessive compulsive disorder OCD, one epilepsy and five severe depression.” “Some are more or less completely cured” said McDermott. Associate Professor Bittar says this technology is in its early days and more needs to be done to improve the implants, yet the results have been promising. Bitter said, “One lady, who was housebound, packed up her bags and went traveling after the surgery. She was over the moon. She still is.”

DBS and Depression – New Therapies Lasting Effects

Unlike traditional medications where the effects can subside after long periods of use, Associate Professor Bittar has noticed the implants continue to benefit his depressed patients that  had the implant placed four years ago. For some of the OCD patients the implants have had just as big an impact.

“About half get a dramatic benefit and some are more or less completely cured,” said Professor McDermott, who discussed his work at the International Conference on Medical Bionics held onVictoria’s Phillip Island.

“They go from institutional care to a relatively normal life where they can have a job and pretty much normal social interactions again. ”It’s a miraculous benefit for those people. But it doesn’t do that for everybody at the moment.”

DBS and Depression – How does it work?

Wires run from skull to power pack under the skin. While the implants help some patients, the devices are still considered fairly crude. Surgeons use a hole in the skull to insert the implants in a certain part of the brain depending on the disorder they want to treat. Some patients have not been pleased with the rectangular power pack protruding under their skin, the wires connected to the brain implant sometimes break as a result of normal head and neck movement during the day.

It can also take time to work out the right amount of electrical stimulation needed, and there can be side effects including speech and balance problems.

Scientists including Professor McDermott are aiming to develop wireless versions of the implants similar to the cochlear ones. And instead of having a battery pack implanted in the chest, a rechargeable battery would sit behind the recipient’s ear.

Again Technology is offering us some hope for better treatments of OCD, Depression and maybe other mental illnesses which may ultimately lead to a cure some day! Read the complete article: DBS and Depression.

This article on DBS and Depression is for informational purposes and not for the diagnosing or treating of any mental illness.

Is there a genetic connection with bipolar disorder? Researchers at the University of Leeds investigating the genetic causes of bipolar disorder have identified two new drugs. One of which has already been found safe in clinical trials with laboratory mice, which shows signs of being effective in treating bipolar disorder.

Bipolar disorder like autism is thought to be a “spectrum of disorders” and seems to run in families and is believed to be caused by both genetic and environmental factors. Bipolar disorder effects 1% of the general population. Read my article on the inextricable relationship between the environment and genetics with regards to anxiety Is Anxiety Genetic?

A Genetic Connection with Bipolar Disorder Would not be an Unusual Discovery

Many studies show either a genetic connection to depression, anxiety, OCD, ADHD, schizophrenia, and now a study shows a genetic connection with bipolar disorder. Dr Steve Clapcote at the University of Leeds, who led the study says: “We suspected from published studies of bipolar patients that levels of enzymes known as NKA or sodium pumps may be abnormal in bipolar disorder, but so far the evidence has not been convincing enough to warrant detailed clinical investigations.”

The research on the genetic connection with bipolar disorder published in the US journal Proceedings of the National Academy of Sciences (PNAS) used a strain of genetically modified mice that exhibit symptoms very similar to humans in the manic phase of the disorder. The mice were bred with a particular mutation that prevents the NKA enzyme from functioning normally. When tested the mice showed characteristics closely associated with bipolar disorder, such as an increased tendency to take risks, hyperactivity, and disturbed sleep patterns. They also exhibited reduced mania when treated with anti-manic drugs.

Current drugs available to treat bipolar disorder are limited to Lithium, Valproate and some antipsychotic medications . These can’t be matched to specific types of bipolar disorder and can many times cause unpleasant side effects. There is therefore a need for treatments which can be better targeted, and which are more effective and better tolerated by patients. One of the major challenges is finding the right medication for each patient, this often involves much time and side effects for the patient.

The Leeds researchers found that the mice showed decreased activity of the NKA enzyme as well as increased activity of a protein called ERK. Drugs known to have an effect on these two elements were administered to the mice, including Rostafuroxin, a drug used to treat high blood pressure and another drug SL327; both reduced their manic-like behavior.

The researchers now feel justified in screening people with bipolar disorder to look for genetic mutations in the same NKA enzyme that affected the mice. The researchers believe that this will help identify and target the type of  bipolar disorder and increase the efficacy of treatment by finding the best medication sooner. They also believe that further studies might reveal what biochemical changes occurred in the drug-treated mice to find out how the drugs work. Understanding the mechanism of action or how a disease works on the brain chemistry is half the battle of coming up with an effective treatment that produces the greatest efficacy with the fewest side effects. Establishing a genetic connection with bipolar disorder is exciting news because as studies reveal and isolate the genes responsible for this illness and may open the door for more effective medications and even a possible cure through genetic engineering.

This article on the genetic connection with bipolar disorder is not for diagnosing or treating any mental illness and is strictly preliminary research