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Can TMS Be Used to Treat Alzheimer’s Disease?

Can TMS Be Used to Treat Alzheimer's Disease?

December 20, 2022

Alzheimer’s disease is a complex brain disease that results in the progressive deterioration of one’s cognitive, emotional, and behavioral capacities. The condition affects nearly six million people in the United States age 65 and older.


Though there is no cure for AD, many treatments offer some amount of symptom reduction. While they are effective to some degree, there is much room for improvement.


In recent years, researchers have been exploring alternative ways of addressing the range of impairments caused by AD. In particular, they have explored whether transcranial-magnetic stimulation (TMS), a non-invasive, nonpharmacological procedure often used for psychiatric conditions such as treatment-resistant depression, may prove useful against the cognitive and emotion impairments experienced by individuals with AD.


If effective, this novel application of TMS could help AD patients maintain their capacities and improve their quality of life. Does the evidence support its use?


What is TMS?

Transcranial magnetic stimulation is a drug-free and noninvasive procedure used to treat various brain disorders, including several mental health conditions. It uses magnetic coils placed just above the scalp to send magnetic pulses into specific regions of the brain associated with symptoms of the condition it is being used to treat. For example, in the case of treatment-resistant depression, the pulses are sent toward regions of the brain associated with mood regulation.

By sending repeated pulses to these specific areas of the brain, TMS “trains” neurons in those locations to fire differently and create new, healthier connections.


Assessing the Efficacy of TMS for the Treatment of AD

TMS has been used to treat a wide range of issues associated with AD with varying degrees of efficacy and evidence backing its use.

TMS for Mood-Related Symptoms of AD

Though Alzheimer’s disease is mainly known for its effects on memory and cognition, it can also cause disruptions in mood and emotional regulation. For example, up to fifty percent of individuals with AD suffer from depression


Source: brainhope.com

Though the high prevalence of depression in AD patients is partially attributable to the stress of having the disease, it is likely also to be the direct result of the disease’s biological effects. For example, post-mortem studies have found that AD patients with depression were more likely to have lost neurons that respond to chemical messengers commonly targeted by anti-depressants, such as serotonin and norepinephrine.  


Several studies have found that AD patients treated with TMS experience improvements in their mood. For example, TMS has been associated with lower scores of depression and apathy among individuals with AD. This finding is supported by the fact that the treatment protocol for AD often targets the same brain area as the protocol for treatment-resistant depression, namely the left dorsolateral prefrontal cortex (L-DLPFC).

TMS for the Cognitive Symptoms of AD

Regarding cognitive symptoms, researchers are actively investigating whether and how much TMS helps. In particular, they have examined the effects of TMS on the following:


  • Memory (facial recognition, word recall, etc.)
  • Language function (e.g., sentence comprehension)
  • Executive function (e.g., verbal reasoning, problem-solving, planning, etc.)
  • Visuospatial skills (e.g., the ability to draw a clock)


While several studies have found positive results, others have failed to find a significant effect. Explaining this is difficult mainly because different researchers have utilized different protocols on different parts of the brain in patients at different disease stages. As a result, it is hard to determine whether the results are inconsistent because the treatment does not work or because some researchers are targeting the right areas in the right ways in the right patients while others are not.


Researchers have attempted to comb through the data to find patterns in when the treatment does and does not work. One finding that emerged most clearly is that TMS does not work in patients with more advanced AD, suggesting that if the treatment works at all, its efficacy depends on the individual’s disease stage.  


Even among the studies that have found positive results, patients may have improved for reasons that had nothing to do with the direct effect of TMS on AD. For example, improvements in depression are associated with gains in cognitive performance. Since TMS tends to alleviate depression in AD patients, this could explain why their cognitive symptoms improved and not that TMS treated the part of their cognitive dysfunction caused by their AD. 


Another issue stems from how the studies measure the subjects’ cognitive abilities. To determine whether symptoms improved over time, researchers had AD patients repeatedly take tests and perform tasks that allowed them to track how their performance changed as they continued to receive TMS. The problem with this method is that patients may get better with practice alone. This means we can’t be sure how much the positive effects are attributable to practice or to the impact of TMS on AD itself. While some studies included a control group that took the cognitive assessments while being given “sham” TMS, which does not stimulate the brain, the results were unclear.


So, does TMS work for Alzheimer’s disease? That depends in part on what symptoms we are concerned with. As far as depression goes, TMS appears to work just as well in AD patients. However, the results are less clear when it comes to cognitive impairments. Confounding variables and a lack of consistency in treatment protocols mean it’s too early to draw any confident conclusions.


If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists, who can see you in as little as one day via teletherapy. 

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Businesses are Prioritizing Employee Mental Health. Here’s Why

Employers are Prioritizing Employee Mental Health. Here's Why

December 16, 2022

Unfortunately, our mental health problems don’t wait at home while we work. Whatever stressors we are dealing with can latch on to us and linger in the background, exacerbated by various work-related stressors that pop up throughout the day. 


Over a quarter of adults experience mental health problems each year. Since employees can’t set down their mental health conditions before they clock in,  many struggle with mental illness at work. Aside from the immediate stress this puts on employees, it is also bad news for the companies that employ them. Mental illness and work-related stress are associated with a variety of adverse organizational outcomes including lower productivity and engagement, higher rates of burnout, decreased employee retention,  a decline in creativity, high turnover, and more. 


Despite the prevalence of mental illness and its harmful effect on employees and the companies they work for, mental health has typically not been a priority for most businesses. Until recently, employees were often left without adequate resources to quickly and affordably take care of their mental health needs. 


Fortunately, many companies now grasp the significance of maintaining a mentally healthy workforce. According to a 2022 report, 90 percent of employers are investing more in mental health programs. This marks a significant shift in the importance organizations are placing on mental health and their willingness to act as stewards of their employees’ mental well-being. 


Here’s why organizations are shifting gears to focus on helping their employees achieve and maintain mental wellness. 

Work-Related Stress is Common

One reason employers are offering comprehensive and holistic mental health care services is that work itself is stressful. In one survey, eighty-three percent of U.S. workers said they suffer from work-related stress, and 25 percent reported that their job is the number one stressor in their lives.


In some cases, work-related stress can become so severe that it results in an “occupation syndrome” called burnout.” According to the World Health Organization (WHO), this condition is characterized by


  • Feelings of energy depletion or exhaustion
  • Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
  • Reduced professional efficacy

Given the impact of burnout and the fact that work can be stressful by its very nature, employers now recognize they should provide workers with the tools they need to establish a healthy relationship with work and build the skills required to cope with work-related challenges.

Therapy Can Help

Burnout and other forms of work-related stress can be managed with psychotherapy. Therapy can combat work-related stress by helping employees become more mindful of what triggers workplace stress and how they react to it, build emotional resilience, and develop and maintain a healthier work-life balance.


Julia Lopez, Brand Manager at Heading Health, shares her experience of how therapy helped her navigate stress, including work stress:


Working with my therapist helped me understand aspects of work-related burnout that were and were not in my control. Through therapy, I learned how to practice better boundaries, acknowledge when I was putting too much pressure on myself, and on a larger scale, evaluate the relationship between my work and my identity.” She also noted, “Work is an incredibly important part of my life, but it’s not the totality of my life. Having a more appropriately-sized relationship with work actually helped me become more clear about my career goals and ultimately feel more effective in my job.


Julia is far from alone in her experience. Studies have shown that a variety of mental health techniques, from cognitive behavioral therapy to mindfulness-based stress reduction, are effective at helping employees combat burnout and other types of workplace stress.


Of course, employers shouldn’t just throw more mental health services on top of work-related stress and call it a day. Burnout is complicated and may require internal and external solutions. However, easily accessible and affordable mental health solutions can play an important role.

Good Mental Health is Good for Organizations

Employers generally understand the value of helping employees maintain their physical health. From mild colds to severe medical conditions, employees who aren’t physically well simply can’t perform at their best, if at all. 


Though it may not be as readily apparent, mental health is just as critical to a well-functioning organization. 

Happier Employees are More Productive and Creative

There is a well-established link between depression and motivation. Low motivation is so frequently experienced by individuals with depression that it’s listed as one of the condition’s main symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 


With that said, you’d expect employees who don’t feel their best to get less done, given that their low mood is taking their productive energy away from them. Recent research has verified this intuition.  One study found that happier employees are 13% more productive on average. 

Better Mental Health Leads to Stronger Engagement

Depression and anxiety can make it more difficult for individuals to be engaged at work, meaning they may struggle to approach their tasks, jobs, and colleagues with a positive, focused, and energized state of mind. Unsurprisingly, researchers have consistently found that burnout and other sources of work-related stress are associated with decreased levels of engagement.

Mental Wellness Can Boost Recruitment and Retention

Employees are increasingly evaluating potential employers’ ability to provide adequate mental health resources when applying for jobs. According to one report, 81 percent of respondents stated that how employers support mental health will be an important consideration when looking for future work.


Mental health has also become a more significant consideration for employees deciding whether to leave their current employer. A recent study found that one in four workers who left their jobs in the past two years did so because of its impact on mental health.

Investing in Mental Health Saves Companies Money

Mental illnesses such as depression cost companies an estimated $51 billion annually. From lower productivity to a lack of engagement to the loss of valuable talent, poor mental health dramatically affects companies’ bottom lines. 


Fortunately, employers can effectively combat this by investing in accessible, comprehensive mental health services. According to the World Economic Forum, employers see a $4 ROI for every dollar they spend on mental health care.


Mental health must continue to play a critical role in employers’ overall wellness strategies. From its impact on organizational outcomes, to its effects on the company’s bottom line, to the fact that workplaces are often a significant source of stress, organizations have strong altruistic and self-interested reasons to take care of their employees’ mental health. Investing in a flexible, accessible, and affordable option that provides employees with quick access to a range of services is a great place to start.

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How Ketamine Works Quickly When Other Treatments Have Failed

How Ketamine Works Quickly When Other Treatments Have Failed

December 7, 2022

Ketamine (and its cousin, Spravato®) are novel antidepressants that have been gaining recognition for their ability to provide rapid relief from the most severe forms of depression, including treatment-resistant depression (TRD) and depression with suicidal ideation. In addition to their quick effects, ketamine-based therapies can work even after several other treatments have failed to produce an adequate response. All of this raises the question, how does ketamine work, and what is it doing differently?


Researchers are continually increasing their understanding of how Ketamine works differently for depression and anxiety, and they have identified several promising mechanisms of action.


Here are six effects of ketamine that experts believe might explain why it can have such a rapid and significant impact on depression even when other treatments have failed.

#1: It Increases Glutamate and BDNF

Most antidepressants work on a set of chemical messengers in the brain called monoamines, which include serotonin, norepinephrine, and dopamine. Though effective, these medications can take over a month to start working, and some find they don’t provide adequate relief no matter how long they take them.


Dr. Steve Levine explains that targeting the glutamate system is markedly different than the way that traditional SSRIs work.



Ketamine-based therapies differ from these interventions by impacting glutamate, an excitatory neurotransmitter that research has continued to suggest plays a critical role in depression. When ketamine enters the brain, it binds to the N-methyl-D-aspartate receptor (NMDA) receptors, ultimately causing a surge of glutamate.

Credit: Yang H. Ku/C&EN

The rise in glutamate brings about other important changes. In particular, it leads to an increase in brain-derived neurotrophic factor (BDNF), which supports the survival of existing neurons and encourages the growth of new ones (more on this below).

#2: It Helps Neurons Grow and Connect

In order to adjust our thoughts and feelings to the world around us, our brains must be malleable and adaptable.


Ultimately, this means that our neurons (i.e., tiny nerve cells in the brain that send and receive information) must be able to grow, form, and modify connections with other neurons, in a phenomenon known as neuroplasticity. 


 Research has repeatedly found that neuroplasticity is impaired in depressed individuals. These processes are often deficient in parts of the brain that are important for mood regulation, including the prefrontal cortex, amygdala, and hippocampus.


Ketamine has clear links with neuroplasticity. For example, ketamine studies on rats with depression-like symptoms have found that symptom relief was associated with increases in neuroplasticity. Importantly, this happens rapidly. One study found that a single dose of ketamine began to reverse deficiencies in neuroplasticity within 12 hours.

#3: It Might Reduce Inflammation 

Inflammation is heavily associated with depression, with some estimates suggesting that approximately one-third of depressed patients have elevated inflammatory markers.


Some research findings indicate that, in addition to all of its other mechanisms, ketamine may improve depression by reducing inflammation.


Animal studies have found that ketamine may have anti-inflammatory effects. Some human studies have found similar results, but the findings have not been inconsistent.

#4: It Can Improve Sleep 

Consistently poor sleep is harmful to mental health. Researchers have found that ketamine might improve sleep in several ways and that these changes are associated with better therapeutic outcomes. For example, ketamine appears to improve slow-wave sleepdecrease early night awakenings, and strengthen circadian rhythms, sometimes after a single treatment. 


As is often the case, it is hard to determine which way the causal arrow goes. It could be that those who experience a robust antidepressant response sleep better because they are less depressed, or it could be that those who sleep better end up feeling better. Future studies will need to verify the connection between ketamine, sleep, and depression.

#5: It Can Make People More Optimistic

Optimism has an obvious connection with depression. The more you can focus on the positives or be confident that good things are coming your way, the better you’ll feel. These optimistic tendencies and outlooks can be more challenging for individuals suffering from depression.


A recent study explored whether one of the ways ketamine reduces the symptoms of depression is by increasing optimism. The research team found that within four hours of a ketamine infusion, individuals with TRD were more optimistic when judging the likelihood of experiencing adverse events in the future. Importantly, this optimistic reorientation was correlated with lower depression scores one week after treatment, suggesting that ketamine’s effect on optimistic beliefs may help explain ketamine’s rapid impact on depression.


#6: It Creates Profound Altered States of Consciousness

Ketamine is well-known for its psychoactive effects (i.e., changes in mood, feeling, thoughts, and perception). For example, when given at the doses used for depression, ketamine can cause dissociative states, where one feels disconnected from their body and thoughts

Given that ketamine consistently produces altered states of consciousness which begin to occur around 15 minutes after administration, it’s natural to wonder whether they play an active role in rapidly alleviating symptoms of depression. 


Because ketamine is a dissociative anesthetic, most research in this area has focused on whether ketamine’s dissociative effects may be connected with therapeutic outcomes. Findings have been inconsistent. While some studies have found that dissociative experiences are associated with better responses, others have not.


Ketamine can occasionally produce psychotomimetic effects (i.e., delusions, delirium, perceived distortions of space and time, etc.) and mystical experiences. A recent meta-analysis (i.e., a review of many studies) found that neither effect appears to be strongly associated with improvements in depression.


It is important to note that this area of research is still in its infancy, and few studies have been conducted with the explicit goal of assessing the antidepressant effects of the altered states of consciousness produced by ketamine. Much more research will need to be done before we can draw any confident conclusions. 


Key Takeaways

Ketamine-based therapies are rapid-acting interventions that work in unique ways to produce their therapeutic effects. Though there is much left to discover, experts have identified several mechanisms which might explain why ketamine can offer rapid relief from depression when other treatments have failed. In particular, ketamine-based therapies may work by:


  • Impacting different chemicals in the brain, like glutamate and BDNF
  • Helping neurons grow and form new connections in a process known as neuroplasticity
  • Reducing inflammation
  • Improving sleep
  • Increasing Optimism
  • Causing profound subjective experiences through its psychoactive effects

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Sugar, Mood, and Mental Health: Interview with a Nutritional Therapist

Sugar, Mood, and Mental Health: Interview with a Nutritional Therapist

December 2, 2022

The holiday season is a time of gatherings, gifts, and of course, a gluttonous indulgence in sweet treats.


While some sugar consumption is perfectly normal and healthy, a high-sugar diet, even temporarily, can negatively impact one’s mood and mental health. As a result, it’s important to be mindful of your sugar intake during the holidays and as you carry on afterward with your regular diet.


To learn about sugar’s connection with mood and mental health and how to adopt healthier habits, we sat down with Austin, Texas-based Registered Dietician Nutritionist Sally Twellman. She is our in-house nutritional therapist here at Heading Health, and she shared experience supporting mental health treatments with dietary and lifestyle changes.

Q & A with Sally Twellman RDN, LD

Are Sugar Rushes and Crashes Real? If So, What Causes Them?

Yes, for sure, and this goes for carbohydrates in general. When we have a large amount of carbohydrates, our blood sugar rises rapidly, which causes an equally sharp increase in insulin. This increase in insulin causes a rapid drop in blood sugar, and that’s when you get that slump, which can make you feel tired, lethargic, and even a little bit irritable. In turn, this can cause sugar cravings and, ultimately, a vicious feedback loop of sugar consumption followed by a crash followed by more sugar consumption, and so on. 

Are There Long-Term Mental Health Consequences of a High-Sugar Diet?

Very much so.


For example, a high-sugar diet is correlated with depression. One of the many ways it might contribute to depression is through frequent and erratic fluctuations in blood sugar levels. Some fluctuations are normal, but when the peaks become too large and too frequent, it is very stressful for the body and can contribute to chronic inflammation, which is associated with adverse mental health outcomes.


Another way that having a lot of sugar in your diet can impact mental health is through its connection with diabetes. Over time, people who eat a carbohydrate-heavy diet are disproportionately more likely to develop insulin resistance, predisposing them to depression.

The third way having lots of very sugary foods can impact mood is that it changes the gut microbiome. Your body adapts to whatever you eat, and if you mostly eat high carbohydrates and low-fiber foods, the bacteria you will grow more of will be the kind that thrives in that environment. And those bacteria are typically not the ones that are beneficial for maintaining good neurotransmitter production, which your brain needs to send messages chemical messages and, ultimately, to produce good feelings.

Is the Damage Reversible?

Yes. Even a dietary change of two weeks to a Mediterranean-based diet, for example, can have a profoundly positive impact on your gut microbiome. This means that if you’re experiencing a low mood resulting from a high-sugar diet, it’s possible to undo the damage and experience benefits after just a few weeks on a low-sugar, high-nutrient diet.

Does the Sugar Source Matter?

Absolutely. The source matters for a variety of reasons. For one thing, some sources make it much easier to consume lots of sugar than others, which is why I highly recommend people avoid sugar-sweetened beverages. We don’t really get that fullness factor like we do when we eat the same amount of sugar or calories in, say, a cookie. So, we can consume a lot of sugar just by drinking regular amounts of liquid without realizing it.

Also, some sugar sources contain ingredients that help to balance out the sugar and help our bodies break it down. Protein, fiber, and fat are good examples. When sugar comes from a source with sufficient amounts of fat or protein, it’s released incrementally into your bloodstream, which helps to avoid the kind of spikes and dips that are particularly unhealthy. So, if you want a cookie, try having it alongside some yogurt with protein and fat to help balance out your blood sugar.

Does the Type of Sugar Matter (e.g., Glucose vs. Fructose)?

In theory, it should matter because our liver is what’s primarily responsible for breaking down fructose. So, part of why food and drinks containing high fructose corn syrup are dangerous is because they can cause the liver to overwork, resulting in all sorts of problems. For example, nonalcoholic fatty liver disease can be caused by a high carbohydrate diet and insulin resistance. Over time, a fatty liver becomes inflamed, which can cause inflammation throughout the body, which, again, is associated with adverse mental health outcomes.

Is Fruit Okay?

You might think, “well, I shouldn’t eat fruit because fruit is high in sugar fruit and it’s high in fructose, which is harder to process,” but naturally occurring fructose isn’t the same as high fructose corn syrup. It’s also coupled with fiber and many other nutrients your body needs to break it down. So, for example, your body can break down the amount of sugar and carbohydrates in an apple in a healthy way because it also comes with things like magnesium and fiber, which it needs to support the good bacteria that help process sugar. So, fruit is not bad. It’s separate from things like gummy bears and other high-fructose snacks.

What About Artificial Sweeteners?

I’m not a fan of artificial sweeteners. They have been linked to things like migraines and changes in the microbiome, and they have to be detoxified by our overworked livers.


Also, even though artificial sweeteners have zero calories, they can still cause an increase in insulin. This is because part of what causes your body to release insulin is the sweet taste of sugar on your tongue.


Whenever you have something sweet, your brain will send signals down to your pancreas saying, “something sweet’s coming down. You better start pumping up insulin.” As a result, your insulin levels will increase, and these spikes can be just as significant as they would be with natural sugar.

So, if you feel like you need to add some sweetness to your beverages, try more natural sweeteners like honey and maple syrup. These may not taste as sweet as table sugar, but over time your taste preferences will adjust to the lower sweetness levels. Another option is to add natural sugar alternatives, like monk fruit or stevia if you like those.


You might think, “well, I shouldn’t eat fruit because fruit is high in sugar fruit and it’s high in fructose, which is harder to process,” but naturally occurring fructose isn’t the same as high fructose corn syrup. It’s also coupled with fiber and many other nutrients your body needs to break it down. So, for example, your body can break down the amount of sugar and carbohydrates in an apple in a healthy way because it also comes with things like magnesium and fiber, which it needs to support the good bacteria that help process sugar. So, fruit is not bad. It’s separate from things like gummy bears and other high-fructose snacks.

What’s a Good Tip for Managing Our Sugar Intake During the Holidays?

My basic recommendation is to be picky about the added sugar you take into your diet. As the holidays continue, it’s important to choose things that you thoroughly enjoy, like really delicious cookies or a great pie. Don’t waste it on sweethearts (unless you really like those, of course). It’s also best to choose something with nutritional value, like dark chocolate, which has antioxidants.

What’s the Best Way to Get Off of a High-Sugar Diet?

The best way is just to go cold turkey. Weaning yourself off incrementally by decreasing the amount of sugar you add to your coffee is generally less effective. Because you get such a robust physiological reward when you have sugar, your body will want more, and you’ll have to endure intense sugar cravings every time. So, it’s best to tough it out for a little while, and you will begin to crave it less.


People in Austin, Texas as well as Texans across the state connect with Sally to supplement their mental health care with nutritional support. Those interested in working with Sally are encouraged to reach out to Heading to set up a consultation.

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Patient Perspective: What Spravato® Did for My Anxiety and Depression.

Patient Perspective: What Spravato Did (and Didn't Do) for My Anxiety and Depression

December 1, 2022

This post was written by a member of our team who currently resides in Michigan and receives treatment there. In the interest of transparency, he is not a patient of Heading as Heading serves people in Texas. However, his treatment program and the experiences detailed are similar to those of patients at Heading. We are grateful that he wanted to share his story with us.



Over the past few months, I have been undergoing Spravato (intranasal esketamine) therapy to address my anxiety and depression. To help others considering or currently incorporating Spravato into their treatment plans, I have been documenting aspects of my experience. After the first few sessions, I described in great detail what the treatments feel like for me so that others can prepare themselves for Spravato’s psychoactive effects. 


In this post, I discuss Spravato’s effect on my mental health, including the benefits and residual issues, to provide a clear picture of what it did and didn’t do for me. 

Psychological Benefits

Less Fear and Anxiety

Though I deal with both depression and anxiety, the latter is my primary condition and may very well be responsible for the former. I’ve experienced heightened and unwarranted levels of stress and worry for as long as I can remember and have been diagnosed with several anxiety disorders, from generalized anxiety disorder (GAD) to obsessive-compulsive disorder (OCD), to several phobias.


These conditions are driven, at least partly, by intense feelings of anxiety and fear. One of the more noticeable effects of Spravato has been that the subjective sensation of anxiety has diminished dramatically. I am far less prone to feel the icy cold tension that ripples through my body when I encounter a situation I perceive as dangerous or threatening in some way.


This therapeutic effect of Spravato had a positive downstream impact on other symptoms. For example, phobias are much more manageable as the fear I would typically feel when thinking about or encountering what I’m afraid of is less intense. Though I have not been able to try it yet, I think this change would enhance exposure therapy and allow me to chip away at my fears even further.


Increased Empathy

In my previous post, I noted that during my Spravato sessions, I felt more empathetic and compassionate. For example, I often found myself thinking through past debates or arguments and having an easier time seeing things from the other side’s perspective. This effect tends to persist even after the psychoactive effects of Spravato have worn off. I find that I am generally kinder and more agreeable.



As part of my anxiety and depression, I have struggled to bounce back from obstacles and setbacks. 


Since starting my Spravato treatments, I have noticed that I am much less likely to get knocked down by an unexpected obstacle. Though I may experience shorter-term stress, it’s generally less intense and tends not to drag me down the way it used to. I’m also much better at actually solving the problems I encounter. Whereas before, I may have viewed a challenge as insurmountable, I’m now much more inclined to feel I have the resources and capacities to think my way through it. 

More generally, I have felt more optimistic. I evaluate situations more favorably and view positive outcomes as more likely to occur. Recent research suggests this may be one of the main ways Spravato® works. Specifically, one experiment found that individuals with treatment-resistant depression (TRD) who received ketamine treatments showed an increase in optimism about their personal lives as soon as four hours after their first ketamine dose and that this was correlated with improvements in depression.


Openness to New Experiences

I’ve always struggled to get myself to try new things. I like consistency and predictability, and new experiences get in the way of maintaining my desired level of stability.


Spravato® has started to weaken this disposition. A notable example of this involves my diet. I’ve been a picky eater my whole life and have always found it difficult to expand my palette. Opportunities to try new foods used to fill me with anxiety. Whenever I overcame this wall of fear, my mind reacted negatively to the novel tastes and sensations. Since starting my Spravato® treatments, my ability to eat and enjoy new foods has seen a noticeable improvement. For example, I tried fish for the first time in my life, which I had all but written off entirely.


I still like to stick with what’s familiar, but by and large, I am significantly less thrown off by change and novelty and have a much easier time opening up to new experiences.

Remaining Issues


My depressive and anxious tendencies contain both cognitive and affective components. There are feelings of depression and anxiety, but there are also negative thought patterns associated with them. 


While the feeling of anxiety has diminished, some cognitive components have stuck around. In particular, my tendency to ruminate remains and continues to interfere with my ability to get things done. When there is something I’m worried about, I still get stuck in negative thought loops about it. While it’s somewhat easier to pull my mind away from the potentially bad outcomes, my negative thoughts remain magnetic, pulling my mind toward them even when I know it would be best to think about something else. 


Anhedonia/Lack of Pleasure

One of the hallmarks of depression is the inability to experience pleasure or find joy in activities, also known as anhedonia. Over the past few years, I’ve begun to experience this symptom, albeit to a limited degree. 


I was surprised that Spravato® didn’t address this component of my depression, as several studies have found that ketamine is highly effective at treating anhedonia. To understand why it didn’t work in my case, I searched for more detailed research on the topic and came across an interesting finding. Specifically, I discovered that some studies have found evidence that taking benzodiazepines (e.g., Ativan, Xanax, Valium, etc.) while undergoing ketamine therapy appears to decrease the chances that you’ll experience an improvement in your ability to experience pleasure. For example, one study found that none of the participants who found relief from this symptom were taking benzodiazepines.  


Because I have been taking Ativan for years before and throughout my Spravato® treatments, this might explain why my anhedonia remains.



Spravato® has improved my mental health in several significant ways. I’m less anxious and more empathetic, resilient, and open to new experiences. As I mentioned it also hasn’t completely eliminated all of my symptoms as I still tend to ruminate and am working to regain pleasure and joy from my usual activities. Does the fact that I’m not entirely cured mean Spravato® isn’t a good tool for me? I don’t think so. 


I’ve experienced improvement. I am far better off than before and more able to tackle what’s left with therapy or other medications. 


Residual symptoms may lead some to question whether it was worth it has more to do with how Spravato®’s efficacy is represented than anything else. Often, it’s depicted as a magical cure-all. While this may be the case for some people, it likely won’t be for many others. There’s always more work to do. But that doesn’t mean Spravato® isn’t a valuable option. 


In my case, it will continue to play an important role in my journey to mental wellness.


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Black Friday Isn’t Great for Your Mind: 10 Mental Health Alternatives

Black Friday Hype Isn't Great for Your Mind: 10 Mental Health Alternatives

November 21, 2022

As the holiday season kicks into full gear, the pressure to spend on gifts and gadgets steadily increases. 


One of the biggest offenders is Black Friday, which encourages shoppers to make impulsive buys on once-a-year sales at big box retailers. Whether due to a desire to snag some cool tech or a more altruistic motive of getting friends and family the best gifts they can, many feel compelled to partake in the Black Friday deals. In 2021, 155 million Americans shopped on Black Friday.


Though the impact can be mundane, Black Friday shopping often isn’t the best thing to do for one’s mental health. Whether it be the stress of straining one’s budget or the disappointment that follows an impulse buy, participating in Black Friday can leave you feeling down and depressed. 


While Black Friday shopping can seem almost irresistible, the truth is that there are several accessible alternatives.


Check out 10 of our favorite options below. 

10 Alternatives to Black Friday Shopping

#1 Focus on Your Financial Health

Instead of stretching your budget on items you may not need or end up using, try using Black Friday as an opportunity to adopt healthier financial habits. Helena Hernandez, a physician assistant at Heading Health, recommends “establishing financial boundaries.” Take some time to review your budget and decide on your limits. Then make a point of sticking to them to maintain your financial wellness during the holiday season.

#2 Volunteer or Donate to a Charity

Studies show that doing good deeds makes us feel good. To improve your mental health while helping those in need, consider volunteering or donating to charity. Check out Charity Navigator to find causes that align with your values, or go to Volunteer Match to find volunteer opportunities in your local area. 

#3 Start a Gratitude Journal

Black Friday pushes us to feel like what we have isn’t enough. If it didn’t, we wouldn’t go out and spend more. Unfortunately, while an extra product or two might temporarily leave you feeling more fulfilled, that sensation is unlikely to last. A better solution is to turn your attention away from what you don’t have and toward what you do. Consider making a list a running list of things about your life that bring you joy and focus on them every morning or whenever you feel a bit down.    

#4 Throw a Leftover Dinner Party

According to the nonprofit organization Feeding America, Americans waste 130 billion meals every year. Instead of buying more products that might also go to waste, consider holding a leftover dinner party to 

make full use of the resources you already have. With a cleaner fridge and a house full of friends, you’ll surely have a better time than waiting in line for another Black Friday deal.  

#5 Celebrate Bright Friday

Another way to combat the waste associated with Black Friday is by celebrating Bright Friday, which was created to raise awareness about textile waste in fashion and e-commerce. Shoppers are encouraged to maximize the value of what they already have by swapping, restyling, and refashioning their clothing.

#6 Connect with Nature

Instead of spending time waiting inside in long lines or at home playing with your new gadgets, use Black Friday as a reminder to tap into nature’s protective effects on mental health

Visit a national park if you can access one, or go to a local nature site. Check out All Trails to find nearby places to hike, mountain bike, camp, and more. 

#7 Talk to Your Kids About the Value of Experiences

A recent study found that, by and large, experiences make people happier than possessions. Lead Author and Marketing Professor Amit Kumar notes:


If you want to be happier, it might be wise to shift some of your consumption away from material goods and a bit more toward experiences, […] That would likely lead to greater well-being.


Use Black Friday as an opportunity to instill this knowledge in your children. Take them on one of their favorite outings and document the experience so they can re-live the joy of that day and internalize the value of experiences over possessions.  

#8 Wait for Small Business Saturday

In contrast to the big box retailers that are the focus of Black Friday, Small Business Saturday is about shopping at small, brick-and-mortar stores. If you’ve got to do some deal hunting, consider saving it for Small Business Saturday and support local business owners in the process.

#9 Go Somewhere That’s Normally Too Busy

With so many people either shopping at home or flocking to retail stores, other services are likely to experience a drop in attendance. Use this as a chance to enjoy an ordinarily bustling activity in peace and quiet. For example, consider going to your local coffee shop, gym, or favorite restaurant. Of course, some of these places might still see heavy traffic, so be sure to call ahead and ask how busy they are.  

#10 Consider What Your Loved Ones Would Say

Even with all these alternative activities in mind, participating in Black Friday might still seem tempting, especially when purchasing gifts for the Holiday season. To help curb its residual pull, consider what your loved ones might say. Would they want you to strain your budget and risk your mental wellness to get them a gift? Reflecting on this fact will likely undermine our more altruistic reasons for doing a bit of Black Friday shopping. 

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Blog depression wellness

How to Support Grieving Loved Ones During the Holidays

How to Support Grieving Loved Ones During the Holidays

Julia Lopez

November 17, 2022

The spirit of the holiday season is one of joy, hope, and gratitude. Yet, for many people, it can also be the most difficult time of the year.

Be it the loss of a loved one, relationship turmoil, distance, or financial instability, there are many reasons why the pressure of get-togethers, transitions, and gift-giving can bring up heavy emotions. It’s likely that you know someone who experiences grief during the holiday season, and it is also likely that we all, at some point in our lives, will experience loss that feels more profound and intense as special dates on the calendar draw near. 

We asked clinical staff at Heading Health, a mental health care service and clinic based out of Austin, Texas, for their thoughts on how to best support loved ones who struggle with grief and loss during the holiday season. 

Be Proactive 

When people experience grief, they may not outwardly make their feelings known. It can be difficult to know exactly what to say and easy to interpret someone’s silence as “ok-ness.” 

Psychiatric Physician Assistant at Heading Health, Helena Hernandez, suggests being proactive when it comes to checking in with someone who may be hurting during the holidays. 

“Make time to talk to your loved one alone. Take time to sit with them at dinner,” Helena shares. She added, “And if your loved one is far away, make time to check on them from a distance.”

Acknowledge that Grief Looks Different for Everyone

The journey through loss has no road map. Acknowledging your loved one’s unique experience and grieving process can convey not only your love for them but also your respect. 

“It’s important to remember there is no ‘normal’ time frame for processing grief and loss,” said Victor Furtik, a licensed professional counselor at Heading who specializes in working with people who experience anxiety, depression, and those navigating big life changes. 

Victor emphasized the importance of asking questions and remaining open to the answers, “A simple question like, “What kind of support would be most helpful right now?’ can help empower your loved one to articulate and identify their needs and let them know that you care.”

Even If it’s Awkward, Reach Out Anyway

Sometimes, in an effort to avoid saying the wrong thing, it can be tempting to not do anything at all. Remember that a simple gesture, outreach, or loving sentiment can go a long way in letting people know they are not alone. 

There are never perfect words to say, but considering what is within your reach rather than what is not can stimulate courage to offer support even if you’re not quite sure of what to say.


“Reach out. Offer support within your own limits, but just reaching out helps” suggests Andrea Marquez LCSW, a therapist at Heading Health.

Finally, if you know someone who is dealing with mental illness, grief, or loss and you feel that they are in a dark place, know that help is always available. 211texas.org is a digest of resources, including hotlines for those in crisis. 988 is also the new suicide hotline offering a simple and easy-to-remember three-digit number offering support via phone or text when people need it most.

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4 Tips for Maintaining Your Mental Health During the Winter

4 Tips for Maintaining Your Mental Health During the Winter

January 12, 2023

When the temperature drops and the daytime is short, some find stress levels rise and mood dips. While it may seem like there isn’t much one can do to stave off the negative impact of these inevitable seasonable changes, this isn’t true.


To find out the simplest and most effective tips, we compiled helpful tips and spoke with some experts right here at Heading Health.


Here’s what we’ve learned.

Keep Up with Your Appointments

The winter months can make planning and maintaining appointments more challenging. Busier schedules can drain your energy and make it hard to find a time that works.

A cold, dark day can make it tempting to stay inside and cancel an appointment you’ve already made. If your mood has already been negatively impacted by the winter months, a lack of motivation can make scheduling and attending an appointment seem overwhelming. 


All of these factors contribute to missed appointments for mental and physical health. It’s no surprise that this can take a toll on your mental health, exacerbating issues if you already have them or putting you at risk of developing them. It’s vital that you keep up with your scheduled appointments despite the extra energy required to do so during the winter. 

Victor Furtick, a clinical social worker here at Heading Health, notes that when it comes to avoiding missed appointments, “keeping organized and establishing a consistent structure is key.” 


He recommends:


  • Getting ahead of any appointments that need to be rescheduled by communicating in advance with the care team
  • Creating a calendar system to help you track appointments
  • Setting up reminder texts and emails so you don’t forget about your appointments during the hustle and bustle of the holiday season

Stay Physically Active

As colder temperatures make outdoor activities less desirable or feasible, it’s easy to take on a less active lifestyle. While this may seem like a harmless change, you may be making yourself more vulnerable to feelings of depression and anxiety, as studies have repeatedly connected exercise to improvements in mood and stress reduction. Here are a few simple tips for staying active in the winter.


  • Remember, even the small stuff counts: Small daily activities, from vacuuming to doing the dishes, can still have a positive impact on mental health. So, instead of thinking that if you can’t get in a “regular” workout, you might as well sit around, remember that even just a little exercise can make a difference.
  • Consider Adding Movement to your Work routine: Working from home has afforded greater wardrobe flexibility. Take advantage of this and try wearing workout clothes during the day. This can help get you in the right mindset to try some at-home workouts. If you work from the office, consider taking walking breaks, walking meetings, and walking lunches. Anything to get up and get moving helps (even if you have to bundle up!)
  • Try winter activities: There’s a saying that goes, “There’s no such thing as bad weather, only bad clothes.”  For extreme conditions that may be a stretch. But on average it’s sage advice. Bundling up during the winter and taking advantage of opportunities to stay active is often a matter of a wardrobe and a mindset switch. While the cold of the winter can make exercise more difficult, it can also make it more fun, especially if you live in an area where it gets cold enough to snow. Consider trying things like cross-country skiing, snow-shoeing, or ice-skating. Or, simply continue your walking, or hiking routines and embrace the sights and sounds the season can offer. 

Get a Light Box

Regular and repeated exposure to sunlight plays a significant role in maintaining our mental health.

As a result, the lack of sunlight in the winter is one of the main reasons it can strain our mental well-being. As the days grow shorter and we spend more time inside, our time in front of the sun gets smaller and smaller. As a result, we become more prone to experiencing feelings of depression and anxiety. 


For some people, the impact is so severe that they develop what is known as seasonal affective disorder (SAD), characterized by fatigue, depression, hopelessness, and social withdrawal. The main treatment for this condition is bright light therapy, where people sit in front of a special lamp for 20-30 minutes every morning. Recent research has found that this technique can be helpful for individuals with other mental health conditions, including depression and bipolar disorder


If you are experiencing a drop in mood during winter, consider purchasing a bright light box. If you do, be sure to find the right one, as some will be more effective than others. Dr. Richard S. Schwartz, associate professor of psychiatry at Harvard Medical School, recommends looking for a light box that:


  • Emits 10,000 lux (a measure of light intensity)
  • Has a screen size of at least 200 square inches
  • Has an ultraviolet (UV) filter, as UV light can be harmful with long-term exposure

More detailed advice on selecting a box can be found here.


Maintain Social Connections

Despite or because of all the holiday events, many may find themselves withdrawing from their social connections, which can quickly lead to feelings of loneliness and isolation. Here are a few tips to help maintain a sense of social connectedness during the winter. 


  • Make a winter bucket list: Create a list of activities you’d like to complete before the winter ends and challenge your friends to join you.
  • Start a hobby: Though hobbies can be a solitary activity, they frequently encourage people to get out in their communities, join clubs, meet with other hobbyists, and ultimately form new bonds.
  • Hang out with your pets: Manager of Community Outreach, Anit Kaur, reminds us that bonding with our pets can be a good substitute for human interaction. If you have a furry friend, be sure to spend some extra time with them if the winter if it’s putting a strain on your regular socializing.
  • Don’t forget about virtual gatherings: If an in-person connection isn’t possible, schedule a virtual one. While it may not bring the same benefits as being in the same physical space, virtual gatherings can still combat feelings of loneliness and isolation. Try organizing a virtual book club, happy hour, cook-off, or trivia night.

These tips are for general mental wellbeing, and may not be suitable if you are in distress. If you are experiencing mental health challenges that do not resolve in a few days you may want to consider reaching out for help from a therapist or medical professional. And, as always, if you are in a crisis please text #741741 or dial #988.

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Upcoming Events and Content in Honor of Veteran’s Days

Upcoming Events and Content in Honor of Veteran's Day

October 28, 2022

During the week of Veterans Day, Heading Health will be hosting events and publishing articles to honor our military veterans. We will be taking a close look at the mental health issues veterans face, highlighting providers who specialize in treating veterans and gathering insights from their experience, as well as discussing the therapeutic potential of psychedelics as treatments for service-induced mental health conditions.


Check out the details of these events and others in the Austin area below.


Heading Health Speaker Series: What Now? How Veterans Can Overcome Post-Deployment Hurdles to Happiness

Teressa Carter – LCSW

In the Heading Health Speaker Series events, we highlight perspectives from our team of mental health professionals to learn from their unique backgrounds, experiences, and viewpoints.

Femi Olukaya – LPC


In our Veteran’s Day edition, nutritional therapist Sally Twellman will interview Femi Olukaya, a therapist and military veteran, and Teressa Carter, a social worker with experience serving and treating active duty service members. They will explore the difficulties veterans face when integrating back into civilian and family life, the problems this can cause, and what we can do to soften the landing and ease their transitions back home. 


This event will be recorded and available to stream on YouTube. Stay tuned for more details.



Provider’s Perspective: Why Veterans Struggle to Seek Mental Health Care and What to Do About It

Despite the prevalence of mental health issues among veterans, many struggle to seek out help. In this article, Teressa Carter, will take a deep dive into this problem, offer suggestions for veterans and active military members unsure of whether or how to seek care, and provide advice for clinicians to help them perform patient outreach and build rapport with military clients. 


Ketamine for PTSD

Estimates suggest that 10-20 percent of veterans have post-traumatic stress disorder (PTSD), characterized by flashbacks, nightmares, and severe anxiety caused by exposure to a terrifying event. Recent research shows that ketamine may help veterans recover from this debilitating illness. This post will summarize the research, highlight key findings, and explore what this means for future treatments for PTSD.


Other Events in the Austin Area

The Rebirth: A Veterans Day Celebration Exploring Psychedelic Medicine

This three-part event will highlight the healing power of psychedelics for veterans. Specifically, it will include:


  1. A showing of the documentary film From Shock to Awe, which covers the lives of U.S. military combat veterans and highlights the transformational impact psychedelics have had on their mental health
  2. An expert panel which will discuss the importance of psychedelics and the urgent need to increase accessibility to these alternative treatments.
  3. A chance to hang out, listen to music, and catch up with friends at famed music club, Antonne’s


This event will take place on Friday, November 11, from 3:00 PM – 11:00 PM CST.


Get your tickets here.



The Mission Within: Psychedelics & Healing the Wounds of War

Founded by Dr. Martin Polanco, The Mission Within offers psychedelics such as ibogaine, 5-MeO-DMT, and psilocybin to treat veterans with traumatic brain injury (mTBI), PTSD, depression, and addiction as a result of experiences during military service.


In this panel, you’ll hear from veterans who participated in The Mission Within and how psychedelics helped them overcome service-related trauma and heal their relationships with loved ones.


This event will take place on November 3, from 6:45 PM – 8:30 PM CST.


RSVP here.




If you feel you need to see a mental health professional or could use help deciding which service is right for you, please give us a call at 805-204-2502 or fill out an appointment request here. We have a wide variety of providers, including therapists, psychiatrists, nurse practitioners, and nutritional therapists who can see you in as little as one day via teletherapy.  

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Treatment-Resistant Depression

Treatment-Resistant Depression

October 24, 2022

When treating depression, physicians often prescribe a first-line anti-depressant (e.g., Zoloft, Prozac, and Lexapro). While these treatments work for many, a significant portion find that their symptoms remain even after trying several antidepressants. Known as treatment-resistant depression (TRD), this condition affects around 30 percent of adults with major depressive disorder (MDD).


Despite its prevalence, many are unaware of treatment-resistant depression, how to determine if they might have it, or what to do about it. 


Explore answers to these questions and more below.

When is Depression Treatment Resistant?

Treatment-resistant depression is generally defined as a lack of response to a few adequate trials of antidepressants. However, this leaves several questions open, including:


  • What counts as a lack of response?
  • What is an adequate trial?
  • How many antidepressants must a patient have tried?


It’s important to note that there are no universal answers to these questions. Instead of settling them, try answering the following questions:


  • Have your treatments failed to make you feel good?
  • Do you still not feel like your old self?
  • Have the side effects been difficult to manage?


Answering yes to any of these questions means you’re not getting the help you need, and it’s time to talk to your physician, who can decide the next best course of action. 

Risk Factors for Treatment-Resistant Depression

Though researchers are still uncovering all traits that can increase the chances of having or developing TRD, we know several factors are associated with the condition. In particular, depression is more likely to be treatment-resistant:


  • If it began at an early age
  • The longer one has had depression
  • The more frequent or longer lasting one’s depressive episodes are
  • When there are ongoing stressors
  • If one has other physical or mental health conditions

What to Do About Treatment-Resistant Depression

Treatment-resistant depression is treatable. Below are steps you and your physician can take to alleviate your depressive symptoms that haven’t responded to the first few treatments.


  • Confirm your diagnosis: Depression that co-occurs with or is caused by other mental health conditions may require a different treatment protocol. As a result, your physician should confirm your diagnosis if your depression isn’t improving in response to treatment.
  • Add on talk therapy: Medications often work best when combined with some form of talk therapy. If you find your depression hasn’t responded adequately to your antidepressants, adding on therapy can give them a boost and help alleviate symptoms.  
  • Change your medications: Just because a few medicines haven’t worked doesn’t mean none will. Newer anti-depressants (e.g., Spravato and Auvelity) that act on different neurotransmitters than first-line treatments can provide relief even when the standard solutions haven’t worked.
  • Try a non-medication-based intervention: While oral antidepressants are the most common medical treatment for depression, other options exist. For example, transcranial magnetic stimulation (TMS) is a non-invasive procedure where magnetic pulses are used to modulate activity in parts of the brain associated with mood regulation and is FDA approved for treatment-resistant depression.

How We Treat TRD at Heading Health

At Heading, we offer a comprehensive set of solutions to tackle TRD from every angle and provide rapid and sustained relief. We work hard to ensure that cost is not a barrier to accessing the interventions you need. We work with most insurance plans, from United Healthcare to Medicare to Blue Cross Blue Shield, and can provide coverage for all of our services, including ketamine, Spravato, and TMS, for most patients with TRD. Click here for a complete list of participating providers and to schedule a consultation to see whether our solutions are right for you.  

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