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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,” 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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Provider’s Perspective: Veteran Mental Health and the Invisible Wounds of War


Provider's Perspective: Veteran Mental Health and the Invisible Wounds of War

November 4, 2022
Teressa Carter – LCSW

This post was written by Teressa Carter, a therapist at Heading Health with extensive experience serving and treating active-duty service members and their families

 

In celebrating Veteran’s Day, I am honored to create a space to salute all who have served, and the sacrifices made by members of the U.S. armed forces and their families to preserve our freedom. This day is very personal for me as my family, and I celebrate the service and sacrifice of both my maternal and paternal grandfather, as well as my father, who all served in the United States Army. My six-year-old son is reminded that his father is a hero, having served in the United States Marine Corps. Aside from my familial connections to the military, I have had the privilege and the honor of providing mental health services to active-duty service members and their families of all branches.

A Military Mental Health Crisis

Veteran’s Day allows us to explore and assess how we can better support our veterans, especially when navigating their mental health. Recent research suggests 11 to 20 percent of veterans experience post-traumatic stress disorder (PTSD) in a given year. Suicide rates of military service members and veterans are also at an all-time high, with deaths by suicide having increased by 25% during 2020.

 

Despite the prevalence of mental health needs, veterans often struggle to find and stick with care. One study found that among the veterans with mental health needs, 55 percent did not seek treatment from Veterans Affairs. Some of the more commonly cited reasons for avoiding or not continuing with treatment include:

 

Given all of this, it’s vital that veterans have the tools to receive and stick with effective care and that clinicians know how to reach out and provide support to service members in need.

Advice for Veterans in Need of Mental Health Care

If you are a Veteran in need of mental health treatment, you are not alone, and great support is out there. I strongly encourage veterans to reach out to someone, whether your medical provider, your VA liaison, family, or friends, who can support and assist them in finding the right mental health treatment for their needs. Here are some other tips:

 

  • Look for clinicians that have either military experience or experience training to treat military-related issues.
  • The VA or Military OneSource are great resources for finding treatment options.
  • Prepare for your first intake. There will be a lot of information gathering. This is also where you have the opportunity to interview the therapist to make sure this is a good fit for you and that you feel comfortable.
  • Remember, mental health treatment is a process and should not be rushed. Prepare for this by viewing your treatment as a journey.
  • Share your feelings, hesitations, limitations, and boundaries with your therapist.
  • Always remember that getting help is a sign of strength and resilience.

Tips For Therapists Treating Veterans

There are several steps mental health professionals can take to ensure they are effectively reaching out to veterans in need and providing them with adequate care. 

Market Your Services to Veterans

The civilian mental health community should ensure they are marketing services to the veteran population. Here are some suggestions.

 

  • Add any military experience or previous work with the veteran population or armed services to your professional online profile.
  • Highlight if you have specialized training to treat conditions prevalent among veterans, such as PTSD, anxiety, depression, and addiction-related issues.
  • Advertise your services to agencies that cater to the veteran community, such as your local Veterans Affairs office, TRICARE, or Military OneSource. Make your services known and available through the base coordinator that assists Active-Duty service members transitioning to veteran status.
Build Rapport

In my career working with active-duty service members and veterans, I found building an initial rapport centered around trust, understanding, and respect was an absolute must. Here are 10 simple strategies I use to build rapport and develop a strong relationship with service members and veterans.

 

  1. Always thank the service members for their sacrifices.
  2. Share your background and personal experience with the military.
  3. Be honest about where your gaps in knowledge or understanding of the military lifestyle are.
  4. Emphasize your willingness to learn.
  5. Be curious. Inquire about their branch of service, rank, years of sacrifice, and duty stations.
  6. Explain that you are trying to obtain a deeper understanding of their unique service and experience.
  7. Create a safe space. Make sure your clinical area is quiet, private, and free from sudden noises or distractions that could trigger PTSD symptoms. Invite your veteran clients to share as much or as little of their military experience as they are comfortable disclosing.
  8. Allow veterans to speak freely and at their own pace.
  9. Never say, “I understand.” This could trigger the veteran client to be upset if you do not have military experience, especially direct combat experience.
  10. Refrain from using a lot of clinical jargon and acronyms. Veterans are used to clear, concise, and direct communication because of their military experience. Too much clinical jargon may create space for miscommunication and confusion.
Utilize Available Resources

An important aspect of providing mental health treatment to veterans is to have a working knowledge of available resources in the community and helping clients get connected to them. Here are some resources that may be helpful:

 

Address Family Needs 

Mental health providers will also need to address family needs when working with veterans, as families have also served and sacrificed. Additionally, the family is transitioning with their service members. For example, families may be transferring medical, educational, and social services from on-base providers to civilian providers. As a result, they must adapt to new doctors and mental health providers. They may also be moving to new homes in new neighborhoods, meaning the children will be transferring schools and making new friends. Adjusting to these changes can be challenging and added support can be helpful.  

Conclusion

As we gather to celebrate this upcoming holiday, please take a moment to acknowledge and honor the sacrifices of our veterans and active-duty service members. Please be an advocate in your community, workspace, and even your organization for increased support and resources for the veteran community. When you see a veteran, thank them for their sacrifice. Thank you to all who have served and the families that served along with them. 

 

If you know a veteran who may be experiencing mental health issues, please help them get care. You can do this by enrolling in their local VA and requesting mental health services. If you feel a veteran is experiencing a crisis, please call the national suicide hotline (988).

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Can Ketamine Treat PTSD?


Can Ketamine Treat PTSD?

November 3, 2022
health.hardvard.edu

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric condition caused by exposure to a terrifying or traumatic event. Individuals with PTSD may experience flashbacks, nightmares, severe anxiety, and uncontrollable or intrusive thoughts about the event. About eight percent of the population will experience PTSD over the course of their life. This condition is significantly more common among combat veterans, with nearly a quarter developing it during their lifetimes.

 

The standard treatment involves some form of psychotherapy, oral anti-depressants, or some combination. Many psychotherapies (e.g., exposure therapy, cognitive behavioral therapy, cognitive processing therapy, etc.) require patients to confront aspects of the traumatic event or how they think about it. While these therapies can be effective, they can also be stressful, causing many to stop treatment early.

 

The FDA has approved two medications, sertraline, and paroxetine, for the treatment of PTSD. These medications have several drawbacks. They take four to six weeks to start working. They also come with many side effects that lead many to stop taking them. Even when patients stick with the medications, only around 30 percent achieve remission. While other medicines have been used, the evidence for their efficacy remains questionable. As a result, there is a desperate need for faster, more effective, and more tolerable treatments for PTSD.

Why Test Ketamine for PTSD?

Over the past few years, ketamine has been explored as a potential solution. Researchers have turned to this medication for several reasons. One reason has to do with how ketamine acts in the brain. Ketamine is an N-methyl-D-aspartate receptor (NMDA) receptor antagonist. This means that it increases the amount of glutamate (a chemical messenger in the brain) and brain-derived neurotrophic factor (BDNF), which helps neurons grow and form new connections.

Credit: Yang H. Ku/C&EN

Early animal studies indicate that glutamate and BDNF play important roles in PTSD. One study found low levels of glutamate in mice exhibiting PTSD-like behavior after exposure to stress. Other experiments have found that several brain regions associated with fear and mood regulation had shrunk in mice after similar stress tests, suggesting BDNF might help rebuild these atrophied areas.

 

Ketamine is also well-established as a rapid-acting antidepressant. Since depression is a prominent symptom of PTSD, it should help with this part of the condition.

The Studies

Initial Experiments

With all this in mind, researchers turned theory into practice and began testing ketamine as a treatment for PTSD in human participants. In a 2013 study, an army veteran who was given a single infusion of ketamine experienced rapid and robust relief of his PTSD symptoms that lasted 15 days. 

 

Following this finding, another group of researchers conducted a randomized controlled trial (RCT), meaning they gave one group ketamine and another a placebo. They found that PTSD levels were significantly lower in the ketamine group 24 hours after the infusion, and the effects persisted for around seven days.  

 

Experimenters, hoping to extend the amount of time before symptoms returned, tried giving subjects repeated infusions of ketamine. In one study, patients received six infusions over two weeks. Eighty percent of patients achieved remission for 41 days on average

 

Ketamine With Psychotherapy

While 41 days is a significant amount of time, more sustained relief would be ideal. Instead of using more ketamine treatments, some researchers have explored whether the effect could be extended when combined with psychotherapy. 

 

One of the commonly cited reasons for doing this is that PTSD is associated with deficits in what is known as  “memory reconsolidation,” which occurs when a recalled memory is changed or altered in some way. Normal memories decay or degrade over time. Some theorists believe that for patients with PTSD, their trauma memories remain as clear and vivid as the day they were formed. Many therapies target this process of reconsolidation. 

 

Ketamine is associated with neurogenesis. Recent studies have found that neurogenesis is important in reconsolidation. As a result, researchers have tested whether therapy might extend the effects of ketamine. One study which combined ketamine with prolonged exposure therapy found that after 90 days, the ketamine group had lower PTSD symptoms when compared to the group that received a placebo. 

Prevention Vs. Treatment

Aside from comparing ketamine with and without therapy, researchers have tested its effects on PTSD when administered at different stages in the PTSD process. A recent meta-analysis compiled all the research on combat veterans and found some surprising results. Most notably, they found that when given during the early stages of PTSD (1-3 months after the traumatic event), ketamine exacerbated their symptoms. However, when administered beyond this stage, ketamine was consistently helpful. Exactly why the timeline is so important is unclear. 

Conclusion

Ketamine appears to be a powerful treatment for PTSD. With that said, there are some caveats. When administered on its own, the effects are short-lasting. Repeated infusions can extend the benefits, but only to around 41 days. Psychotherapy may prolong the therapeutic results further, but more research will need to be done to confirm this. Lastly, the treatment may not work for all PTSD patients, especially those who experienced their trauma more recently.

 

 

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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Dia de los Muertos and the Impact of Culture on Grief and Mourning


Dia de los Muertos and the Impact of Culture on Grief and Mourning

November 1, 2022

This post was written by Patricia Hernandez, a therapist at Heading Health. Patricia is a licensed clinical social worker who strives to provide a diverse and culturally sensitive perspective.

 

 

Culture encompasses religion, food, what we wear, how we wear it, our language, marriage, music, what we believe is right or wrong, how we sit at the table, how we greet visitors, how we behave with loved ones and a million other things.” Cristina De Rossi, Anthropologist at Barnet and Southgate College in London.

Mexican-American Culture and Grief 

As a young child growing up in a Mexican-American household, culture was a significant part of my interpretation of death and the grieving and mourning process. For example, it was common to see ofrendas (an altar to honor the dead) year-round in my own home and those of my family members. These ofrendas were filled with pictures of deceased family and friends, religious candles, and saints. It was also commonplace to speak to the deceased, celebrate their birthdays, and express gratitude for their believed guidance and protection in our daily lives. 

 

It was not until I was introduced to other cultures that I learned this expression of grief and mourning was, in some ways, unique to Mexican American culture. 

 

Near the beginning of November, ofrendas grow to a larger scale in planning for Dia de los Muertos. Dia de los Muertos is a celebration deeply rooted in Mexican culture celebrated annually on November 1 and 2. It is believed that on these dates, the deceased cross the realm of the spirit world into the world of the living, and ofrendas help guide them on their journeys. 

 

Although there is no right or wrong way to have an ofrenda, most utilize the elements of Earth, Wind, Fire, and Paper to guide the deceased on their return to the world of the living. These elements are represented on the ofrenda by having food, water, candles, and papel picado (i.e., colorful and intricately cut paper)  that is said to move when the deceased are present. 

 

Grief Vs. Mourning

Though often used interchangeably, grief and mourning are notably different, and each plays a critical role in how we react to death and loss. Psychology Today distinguishes mourning as  the outward response to griefsuch as creating altars, planting a tree, and playing a song. In contrast, grief is defined as “the emotional response to a loss,” such as feeling sad, hopeless, or angry. 

 

Grief and mourning also differ in terms of their stages or components. The often cited stages of grief are denial, anger, bargaining, depression, and acceptance. The parts of mourning are equally important but less well-known. 

 

Psychologist J. William Worden divided the process of mourning into four tasks.

 

  • Task 1 –  “Accept the reality of the loss.” Here, an individual begins to move past the sense of disbelief by integrating death into their reality. 
  • Task 2 – “Process the pain of the grief,” where one begins to experience grief  “emotionally, cognitively, physically, and spiritually.” Doing so assists in refraining from avoidance. 
  • Task 3 – “Adjust to the world without the deceased.” These adjustments occur externally, internally, and spiritually. Externally, one may take on new responsibilities, internally one creates an understanding of who they are now as an individual, and spiritually, one may develop a new understanding of their belief systems.
  • Task 4 – “Find the balance of an enduring connection with the deceased while embracing a new version of a meaningful life.”

The tasks of mourning, much like the stages of grief, are nonlinear processes without a timeline.

 

The beliefs and traditions of Dia de los Muertos are a tangible example of how culture impacts not only grief but also mourning. Dia de los Muertos is a culturally accepted expression of love and remembrance that can help an individual through the tasks of mourning. It’s also a joyful time to commemorate the love that lives on for the deceased by creating altars, playing music, joining with loved ones, sharing memories, and continuing to honor the memory of the dead and integrate their memory into the present day.  This allows one to outwardly embrace the connection with the deceased as they proceed with life. 

Other Cultures and Grief 

Cultural norms related to grief and mourning can both support and impede one’s own individual grieving and mourning process. According to Grief Speaks, “stoic attitudes are common” among Asian-American cultures, whereas  “Haitians express grief with the physical manifestation of great emotion.” As there are differences in emotional expressions, there are also differences in timelines associated with mourning rituals. In Eastern Orthodox Christian funerals, it is normal to mourn loved ones up to 40 days after the funeral.” Mourning periods can also vary depending upon the relation of the deceased. In some Islamic communities, the mourning period can even be extended to four months and ten days for those who are widowed, whereas in some Jewish communities, the mourning period can last up to one year after the death of a parent. 

What’s “Normal” Grief?

Cultural rituals related to the grief and mourning process can help create predictability in a time of uncertainty. For many, these cultural norms are a sense of support, whereas for others, it may be a source of conflict if their current beliefs, or the beliefs of the deceased, are misaligned with the cultural norms. So the question is, what is normal when it comes to grief and mourning?

 

According to the DMS-5, a diagnostic and classification tool of mental disorders, a diagnosis of prolonged grief disorder is considered when “the loss of a loved one occurred at least a year ago for adults, and at least six months ago for children and adolescents.” Symptoms related to prolonged grief disorder can include intense loneliness, avoiding reminders of the deceased, and difficulty reintegrating into social groups, work, personal obligations, etc. With any diagnosis, it is also important to consider the symptomology in relation to social, cultural, or religious norms. However, not all grief leads to prolonged grief disorder. Depression, anxiety, and/or trauma, dependent on the events related to the death, can also occur. To meet the criteria for a diagnosis of any of the aforementioned conditions, impairment in daily functioning must be present. 

Seek Support 

For as much togetherness as many cultural norms bring to the grieving process, grief is also individualized and sometimes isolating. But there are means to seek support to help ease the feelings of loneliness, confusion, and isolation that can accompany grief. Seeking support and comfort in the predictability and structure of cultural norms can help ease the process of grief and the tasks of mourning. Seeking therapy can also help normalize and validate the thoughts, emotions, behaviors, and timelines associated with grief and mourning in both a cultural and individual context.

 

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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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.

 

Articles

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. 

 

 

 

If you need to see a mental health professional or could use help deciding which service is right for you, please call us 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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Is Ketamine a Psychedelic? Does it Matter?


Is Ketamine a Psychedelic? Does it Matter?

October 21, 2022

Over the past few years, psychedelics such as LSD and psilocybin mushrooms have garnered much attention as researchers explore their potential use in treating mental health conditions.   

 

Ketamine and its close cousin Spravato (esketamine) are often included in this motley crew of psychedelics due in part to their “mind-altering” effects.  

 

Though many are eager to label ketamine a psychedelic, others are less certain, feeling it would be most appropriate to avoid associating ketamine with psychedelics.  Let’s explore these different viewpoints to get a clearer sense of whether ketamine is genuinely a psychedelic and why the label matters, if it does at all.  

What is a Psychedelic? 

One obvious way of determining whether ketamine is a psychedelic is by comparing its features to those listed in its definition. Unfortunately, there are no agreed-upon criteria for what makes something a psychedelic drug. Experts waver on the importance of three conditions.

#1: Psychedelics Cause Altered States of Consciousness

Though there is much disagreement about what counts as a psychedelic, it’s generally accepted that they must induce specific mind-altering effects. Some argue this is all that is required. In other words, they claim that as long as the substance causes a “psychedelic experience,” then it’s a psychedelic.  

 

But what are psychedelic experiences? While the list is potentially endless, psychedelic experiences are generally thought to impact one’s perception of themselves and the world around them, alter the way they think and reason, and provide insights into how their mind works and the nature of reality. They include experiences like the sense of being at one with the world, distortions of space and time, profound inner peace, ego dissolution, and many more.  

#2: Their Conscious Effects Must Have Therapeutic Benefits

While many agree that psychedelics must cause certain altered states of consciousness, some argue that this isn’t enough. They claim that these changes in thought and perception must have a therapeutic effect on the mind or promote psychological growth. As Dr. Yehuda, director of the Center for Psychedelic Psychotherapy and Trauma Research at Mount Sinai Hospital in New York, notes when discussing ketamine’s status as a psychedelic:

 

The unanswered question in all of this is whether the transpersonal state is what heals you or whether it’s something about the molecule. […] The dissociation or psychoactive effects of ketamine might be incidental. They occur. But that’s not necessarily why the healing is happening.

 

For these experts, if ketamine’s mind-altering effects have nothing to do with its mental health benefits, then it’s not a psychedelic. 

#3: Psychedelics Must Act on Specific Areas in the Brain

In the world of psychedelics, some have been around for longer than others and are more well-studied. For example, mescaline and psilocybin mushrooms have been used since ancient times and were researched heavily in the 1950s and ‘60s. These compounds all appear to affect serotonin (a chemical messenger in the brain) at the “2A” receptor. 

 

Some researchers feel these “classical psychedelics” are the only true ones, and that what really matters when deciding whether to categorize a new agent as a psychedelic is how it works in the brain. As Dr. Yehuda notes:

 

When we talk about chemistry and drug development, we should mostly be defining a psychedelic drug on the basis of the chemistry of the molecule, its pharmacokinetics, and its mechanism of action. 

Does Ketamine Meet These Conditions?

How does ketamine stack up against these criteria? As far as its effects on the brain go, ketamine does not act as the classical psychedelics do. It works on N-methyl-D-aspartate (NMDA) receptors, causing an increase of glutamate and brain-derived neurotrophic factor (BDNF) instead of serotonin.  Under this condition, then, ketamine is not a psychedelic. 

Credit: Yang H. Ku/C&EN

 

However, acting on a specific set of serotonin receptors is not the only way to produce psychedelic experiences. As Dr. Steve Levine, co-founder of Heading Health states:

 

It does appear that subjective psychedelic effects may be induced by a number of stimuli or conditions that also include sensory deprivation, virtual reality, meditation, and suggestibility, among others, and not necessarily mediated through a particular brain receptor.

 

Importantly, many of these psychedelic experiences can be produced by ketamine. It is most commonly associated with dissociative experiences (i.e., the sense that one is separate from their thoughts and body). It can also cause distortions in one’s perception of space and time. Patients have also reported gaining new perspectives and an enhanced ability to make sense of their thoughts. Rarely, ketamine can cause delusions and delirium, otherwise known as psychotomimetic effects. In many ways, then, ketamine seems to have the right sorts of effects on the mind to be considered a psychedelic. 

 

However, it’s worth highlighting that the experiences won’t be identical to “classical psychedelics.” For example, psilocybin appears more likely to cause what’s known as ego dissolution, where one loses their subjective sense of self. Classical psychedelics may also have a greater tendency to induce visual distortions. In general, because they have different effects on the brain, their conscious effects will differ. As Dr. Arif Noorbaksh, Psychiatrist at Heading, states:

 

Ketamine is distinct because it works on a completely different neurotransmitter system (glutamate), exerts an effect in different areas of the brain, and as a result, the perceived effects are different.  They both result in non-ordinary states of consciousness, but the experience a particular person has when exposed to conventional psychedelics versus ketamine will be different.

 

When it comes to the therapeutic effects of the altered states of mind that ketamine puts subjects in, the evidence is mixed. A 2020 review concluded that overall, the evidence does not suggest that ketamine’s dissociative effects are responsible for its antidepressant properties. Others argue that ketamine’s ability to cause a shift in perspective and increase cognitive flexibility and open-mindedness are directly responsible for its therapeutic effects. For example, Celia Morgan, professor of psychopharmacology at the University of Exeter, found in a recent experiment that individuals who underwent ketamine and talk therapy experienced longer-lasting antidepressant effects. Professor Morgan notes that talk therapy “requires that individuals think differently about things and learn new ways of thinking about old problems.” As a result, ketamine’s ability to induce shifts in perspective and open-mindedness may explain why it appears to enhance the effects of therapy alone. 


Where does this leave us? According to some criteria, ketamine seems to be a psychedelic, while on others, it does not. The answer as to whether ketamine is a psychedelic, then, depends on who you ask and which criteria they feel are most essential.

Does it Matter What We Call It?

Some might think this is all just semantics and that there’s no real principle we can use to determine what to call ketamine. 

 

While the dispute may be verbal, how we talk about ketamine matters. As Dr. Noorbaksh notes:

 

I think it matters insofar as the term “psychedelic” comes with preconceived notions for many people, and it also places the emphasis on the acute effects of the agent rather than the potentially longer-term effects these agents can have on neuroplasticity, relation to self and others, and other important contributors to mental health.

 

As a result, it’s important to be mindful of the language we use to describe and categorize ketamine and to avoid clinging to one label or another without regard for how this impacts patients. As Dr. Levine suggests:

 

Ultimately, whether a molecule is “truly” a psychedelic is likely beside the point. […] Let’s not let feeling precious about terminology distract from the real goal, which is improving well-being in a safe and responsible way.  

 

 

 

Talk with your doctor to determine whether this treatment is right for you, or you can schedule an appointment with someone from our team of psychiatrists or therapists to advise you on this or any other potential treatments for depression, including ketamine, Spravato, and TMS. Call us at 805-204-2502 or request an appointment here.

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Ketamine Vs. Esketamine (Spravato) – What’s the Difference?


Ketamine Vs. Esketamine (Spravato) - What’s the Difference?

October 18, 2022
Source: NeuroMend

In 2019, 19 years after researchers first demonstrated ketamine’s therapeutic effects on depression, the Food and Drug Administration (FDA) approved Janssen Pharmaceuticals’ esketamine nasal spray (Spravato) for treatment-resistant depression. In 2020, it was also approved by the FDA for major depressive disorder (MDD) with co-occurring suicidal ideation. With similar names, ingredients, and research-backed mental health benefits, many are likely to wonder whether there are any important differences between the two and if there are any reasons for preferring one over the other. 

 

Let’s explore how they compare. 

What are They Made Of? 

Ketamine, or more specifically racemic ketamine, is made up of two enantiomers (i.e. pairs of molecules that are mirror images of each other), known as r- and s- ketamine (arketamine and esketamine). Esketamine contains only the S enantiomer.

How Do They Work?

Both ketamine and esketamine are thought to work by blocking N-methyl-D-aspartate (NMDA) receptors, which causes a release of glutamate (a chemical messenger in the brain) and, ultimately, brain-derived neurotrophic factor (BDNF), which helps neurons regrow and form new connections. 

 

Though they share this mechanism of action, esketamine has a four-fold higher affinity for the NMDA receptor, which means it is more potent. 

Which is More Effective?

For some drugs, one enantiomer is more “effective” than the other, which raises the question, are ketamine and esketamine equally beneficial?

In the past few years, several randomized controlled trials have directly compared the antidepressant effects of ketamine and esketamine. However, synthesizing their findings can be difficult as the studies utilize different methods of administration, treatment durations, depression-related outcomes, and more. 

 

Despite these obstacles, a team of researchers set out to comb through the data. They analyzed 36 randomized controlled trials comparing the efficacy of ketamine and esketamine on depression in a 2022 meta-analysis. They found that while the racemic mixture was more effective overall, the evidence suggests this is not the case when the same method of administration is used alongside doses that account for differences in potency. For example, one study found that when administered intravenously and in equally potent doses, both formulations had similar remission rates after 24 hours. 

Do They Feel the Same?

Both ketamine and esketamine are psychoactive substances, meaning they can alter one’s normal state of consciousness, affecting one’s thoughts, feelings, and perceptions. For example, ketamine is known for causing feelings of relaxation, dissociation, alterations in the perception of space and time, and more. A natural question, then, is whether the esketamine experience differs from the ketamine one. 

 

Answering this question exhaustively and definitively is challenging for several reasons. To start, ketamine and esketamine can cause a wide range of experiences, so much research needs to be done to demonstrate how likely each drug is to produce each one. Second, because esketamine is more potent, it’s not always clear that researchers have used equivalent doses. 

 

By and large, the experiences appear to be pretty similar. With that said, a few interesting preliminary findings reveal how they might differ. For example, some studies have found that ketamine is more likely to cause feelings of dissociation (i.e, a feeling of being disconnected or separate from one’s thoughts and body). 

 

Another important result has to do with how pleasurable the experiences are. Some studies indicate that the combination of ar- and esketamine is less likely to produce unpleasant reactions like stress and anxiety. For example, one researcher found that:

 

The (R)-enantiomer was able to balance the (S)-enantiomer’s adverse parts of the altered state of consciousness and promote positive psychedelic experiences so that a more coherent state of consciousness is experienced. 

 

It’s important to note that much future research will need to confirm these results and compare the drugs across all their potential subjective effects. It’s also worth pointing out that the therapeutic significance of ketamine and esketamine’s psychoactive effects is currently unclear, so any differences in how they feel may not impact how well they work.

What is the Treatment Like?

Treatments differ by how the drug is administered, the number of sessions needed, and appointment length. 

Esketamine is only available as a nasal spray called Spravato. For this treatment, patients visit their physician’s office twice a week for the first four weeks, once a week for the next four weeks, and then bi-weekly if needed for maintenance. Each appointment lasts two and a half hours.

 

Ketamine is available in several different forms, each with a slightly different protocol. At Heading, we offer intramuscular ketamine. This treatment takes place over three weeks, with three sessions in the first week, two in the second, and one in the third. Patients may continue to receive additional treatments for maintenance if needed. Each appointment lasts around an hour and a half. 

Does Insurance Cover Them?

Several insurance companies cover Spravato for treatment-resistant depression and MDD with suicidal ideation. While ketamine can be more difficult to find coverage for, our team has worked closely with insurance companies to ensure we can secure coverage for most patients.  Click here for a complete list of participating providers.

 

Talk with your doctor to determine whether one of these treatments is right for you, or you can schedule an appointment with one of our team of psychiatrists or therapists to advise you on potential treatments for depression, including ketamine, Spravato, and TMS. Call us at 805-204-2502 or request an appointment here.

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The Surprising Connections Between Caffeine and Mental Health


The Surprising Connections Between Caffeine and Mental Health

October 13, 2022

Between coffee, tea, soft drinks, and energy drinks, caffeine is one of the most commonly consumed psychoactive drugs. According to the Centers for Disease Control and Prevention (CDC), around 80 percent of U.S. adults consume caffeine daily. 

 

Despite its widespread popularity or perhaps because of it, caffeine often goes under the radar as something with no significant effects other than a short boost in attention and alertness. However, caffeine can have important effects on one’s mood and overall mental health that are worth considering when deciding whether to include it in your diet.



Depression

It’s well known that caffeine can provide a short-term elevation in one’s mood. However, it may also have a beneficial effect on depression. A recent meta-analysis of seven studies found that the risk of depression decreased by eight percent per cup of coffee when consumed in moderate amounts.

 

The data only shows that caffeine use is correlated with lower rates of depression, not that it causes it. However, we know that caffeine promotes the release of dopamine and that dopamine deficiencies may contribute to depression. This is why some antidepressants, such as bupropion and phenelzine, modulate dopamine signaling. Additionally, when consumed from natural sources like coffee, caffeine also comes with other ingredients which can reduce inflammation and oxidative stress in the brain (more on this below).

 

Anxiety

Caffeine stimulates the release of cortisol, epinephrine, and norepinephrine, which are associated with feelings of stress and anxiety. This is likely why some feel anxious and jittery after a cup of coffee. Some individuals may even experience anxiety that is severe enough to warrant the diagnosis of a caffeine-induced anxiety disorder, according to the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

 

Several factors may explain why some are more prone to experience anxiety from caffeine. One obvious factor is how anxious they are in general. Studies have found that patients with panic disorder, generalized anxiety disorder, and social anxiety disorder tend to experience stronger anxiety-promoting effects from caffeine. 

 

The source of one’s anxious tendencies may play an important role in determining whether coffee makes them feel more or less nervous. For example, individuals with attention deficit hyperactivity disorder (ADHD) sometimes experience anxiety that stems from difficulties in concentration and executive control. Because caffeine can enhance attention and concentration, it can alleviate stress in individuals with ADHD. 

 

Aside from baseline anxiety symptoms, there may also be a genetic component that explains why some individuals are more likely to experience anxiety from caffeine. Studies have found that specific gene variants for the receptor that caffeine binds to can make one more susceptible to its anxiety-inducing effects. 



Interactions With Antidepressants

Caffeine can alter how our bodies process and respond to certain drugs, including some antidepressants. One way it can do this is by slowing down or speeding up the rate at which our livers break down antidepressants, impacting how much of the drugs build up in our systems. 

 

Some antidepressants can have an activating or energizing effect. When combined with caffeine, some patients might find that the compounds work together to produce feelings of tension and anxiety. Patients should be mindful of how their body reacts to caffeine while on antidepressants and discuss any adverse reactions with their physician. 



Sleep

Caffeine looks similar to a neurotransmitter called adenosine, which is partially responsible for regulating our sleep-wake cycles. When adenosine binds to its receptor, it tells the brain it’s time to sleep. Because of its resemblance to adenosine, caffeine can bind to the same receptor and block adenosine in the process. This prevents adenosine from triggering sleepiness. 

 

Caffeine can interfere with sleep for much longer than one might initially think. This is because several of caffeine’s metabolites (i.e., the chemicals produced as the body breaks down caffeine) can also cause wakefulness. While individual factors affect how long this process takes, caffeine and its metabolites can negatively impact sleep for up to 12 hours.  

 

A poor night’s sleep can lower one’s mood and exacerbate a range of symptoms associated with mental health conditions, so it’s important to be mindful of how caffeine affects your ability to sleep and to avoid consuming it within 12 hours of your bedtime. 



Naturally Occurring Sources of Caffeine Are Better

It’s best to get caffeine from natural sources like coffee and tea instead of synthetic sources like caffeine pills or energy drinks. The reason is that natural sources of caffeine come with other healthy ingredients. For example, tea contains antioxidants that can decrease oxidative stress in the brain, a change associated with improvements in depression. Similarly, caffeine contains chlorogenic acid, an antioxidant and anti-inflammatory. Naturally occurring sources of caffeine may also include a class of compounds known as phenols, which studies have found can work synergistically with caffeine to heal our bodies and minds. 





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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TMS for OCD


TMS for OCD

October 11, 2022

Obsessive-compulsive disorder (OCD) is a condition characterized by recurrent, unpleasant intrusive thoughts and repetitive behaviors aimed at reducing anxiety or preventing some undesirable event. It currently afflicts between two to three million U.S. adults.

 

The condition is typically treated with some combination of cognitive-behavioral therapy (CBT) and a type of oral antidepressant called selective serotonin reuptake inhibitors. However, studies indicate that around half of OCD patients fail to respond adequately to the standard treatments. Moreover, many that respond to SSRIs discontinue due to undesirable side effects (e.g., weight gain, sexual dysfunction, emotional numbness, etc.). 

 

Because of this, researchers began to search for novel treatments. Many focused on finding new applications for a non-invasive procedure called transcranial magnetic stimulation (TMS), initially approved by the FDA for treatment-resistant depression in 2008. In 2018, TMS became FDA-approved for OCD. 

 

Here are answers to common questions about this new intervention.  

What is TMS?

TMS 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 conditions 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 areas to fire differently and create new, healthier connections.

How Does TMS for OCD Work?

TMS for OCD works in much the same way as TMS for treat-resistant depression, except for two key differences. First, the magnetic pulses are directed at deeper structures in the brain, which are more closely associated with OCD. For example, one of the primary targets is the right orbitofrontal cortex, which studies have found is hyperactive in adults with OCD. It is also thought to be partially responsible for the unending urge to repeat compulsive behaviors that individuals with OCD experience. Other targeted areas include the supplementary motor cortex, medial prefrontal cortex, and anterior cingulate cortex.

 

Unlike treatment-resistant depression, which is associated with underactive neurons in parts of the brain related to mood regulation, OCD is connected with brain regions firing too much. As a result, in addition to targeting different areas of the brain, technicians utilize another type of stimulation called low wave stimulation, which inhibits, rather than activates, regional brain activity.  

 

What are the Advantages of TMS for OCD

TMS has several advantages compared to the first-line oral medications used to treat OCD. 

 

One of the problems with oral medications is that they are often imprecise, spreading throughout the brain and targeting many more areas than are directly implicated in the conditions they are meant to treat. This causes many unwanted side effects, such as weight gain, sexual dysfunction, emotional numbing, and more. TMS can deliver incredibly localized treatments, targeting the very source of the symptoms and avoiding unwanted side effects. 

 

Aside from lacking precision, first-line oral medications often must be taken continuously to cause and maintain their therapeutic effects. After a round of TMS treatments, the benefits can last for a substantial period of time. On average, results last between four to fourteen weeks and can easily be sustained with quick maintenance sessions.  

How Heading Does TMS for OCD Differently

In many cases, TMS is offered as a standalone treatment. While it can be very effective on its own, studies have found its effects can be amplified when combined with other interventions. For example, one experiment found that patients who underwent TMS and CBT experienced nearly a 60 percent drop in their OCD symptoms and that for 80 percent of the subjects, their symptoms decreased by at least 40 percent. 

 

At Heading, patients have access to our integrated team of mental health specialists with wide-ranging expertise to complement their TMS and enhance its therapeutic effects. By combing TMS with other therapies, our patients benefit from the synergistic effects of a holistic approach to mental health.

 

Talk with your doctor to determine whether this treatment is right for you or schedule an appointment with one of our psychiatrists or therapists to advise you on this or any other potential treatments, including ketamine, Spravato, and TMS. Call us at 805-204-2502 or request an appointment here

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