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Neuromagnetic Linkage of TMS for the treatment of ADHD

tms and Dr FruitmanMany studies are showing the positive effects of Transcranial Magnetic Stimulation (TMS) Therapy for the treatment of a variety of psychiatric disorders. TMS Therapy has already been proven effective in the treatment of Major Depressive Disorder, now ADHD is making the headlines in other uses for TMS Therapy. Trifecta Health Medical Center in Downtown Manhattan, NY is opening its eye to alternate uses for this new innovative treatment method.

Research at Arizona State University is now showing that pulsed electromagnetic energy, like those used in TMS Therapy, may be a good alternative for other brain disorders such as ADHD. The targeted pulses of TMS Therapy would stimulate the neurons to increase nerve activity. ADHD is shown to respond from treatments that stimulate dopamine receptors. By stimulating the entire neuron the dopamine is efficiently and expertly stimulated.

TMS is an ideal method to see the maturation process of motor pathways since it clearly excites the corticomotoneuronal system involved in ADHD. Findings demonstrate a delay in the maturation process of this system in patients with ADHD. By stimulating these pathways we can further the process of development.

Studies published on medscape.com  show that TMS applied to the left mid-dorsolateral prefrontal cortex induced the release of dopamine as a consequence of direct stimulation. This increase dopamine concentration is shown to decrease symptoms of ADHD.
Studies already show the benefit of increased dopamine in the treatment of ADHD. Now there is an alternative to medication treatment for patients with ADHD. TMS has no adverse side effects and is safe and effective. TMS requires no sedation and is performed on an outpatient basis. Here in Downtown Manhattan, New York; Transcranial Magnetic Stimulation is offered at Trifecta Health Medical Center under the medical direction of Edward Fruitman MD. TMS therapy performed by licensed professionals and prescribed by a psychiatrist.

Transcranial Magnetic Stimulation helps with ADHD

Edward Fruitman No Comments

Transcranial Magnetic Stimulation (TMS), has been proven to help patients with ADHD symptoms.

tms and adhdLife can hard at the best of times – relationships, family, work, money, stress; these can all add up to worry and sleepless nights, yet some people have the added burden of low self-esteem, depression and anxiety on top of life’s curveballs. All tied into this is the potentially debilitating condition of ADHD ( Attention Deficit Hyperactivity Disorder). No, this is not just a children’s affliction, and yes, it can be that bad for those that don’t know how to handle their symptoms, or simply don’t have a diagnosis.

Forgetfulness, indecisiveness, poor concentration, and even finding it hard to socialize with others – all these are symptoms of ADHD and ADD. Thankfully, help is at hand.

Because ADHD and ADD can affect the sufferer’s life to varying degrees, depression and anxiety go hand in hand. TMS, or Transcranial Magnetic Stimulation, has been proven to help sufferers of depression, by correcting the imbalance in the brain that causes these low feelings.

It sounds scary doesn’t it? Well, it really isn’t.

It’s quick, easy and non-invasive. The patient simply sits and waits. There really is nothing more to it than that for the person sat in the chair. Under the surface however, there is magic occurring.

A non-scary looking magnetic coil is gently held against the patient’s head, emitting magnetic fields into the brain, and helping to correct the imbalance. In the specialist case of ADHD/ADD, this is directed towards the part of the brain that is linked as guilty of this imbalance, namely the dorsolateral prefrontal cortex. So for those patients who are suffering from depression and anxiety, existing side by side with ADHD or ADD, this can be a fantastic treatment, offering help with severe symptoms and providing a new lease of life.

Here in downtown Manhattan , New York; Transcranial Magnetic Stimulation is offered at Trifecta Health Medical Center under the medical direction of Edward Fruitman MD. It is performed by licensed professionals and prescribed by a psychiatrist.

Call Now: (212) 233-2830 for TMS consultation at Trifecta Health NYC

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Ketamine: Leading the Way Toward Fast-Acting Antidepressants

Edward Fruitman No Comments

It’s an anesthetic popular with veterinarians, but the latest studies show ketamine also shows promise as a potential antidepressant.


Ketamine produces hallucinations, out-of-body feelings, disorientation and even amnesia that can last a few hours, which has made it not just a staple in veterinary clinics but occasionally in nightclubs as well, as a recreational drug.

In a research review published last October in the journal Science, however, researchers called the growing connection between ketamine and depression “the most important advance in the field” in the depression field over the past 50 years. And now scientists report on two formulations of drugs with ketamine’s benefits, but without its consciousness-altering risks, that could advance the drug even further toward a possible treatment for depression.

Prozac and other methods of stabilizing mood, including talk therapy, take weeks, not hours, to show benefits. A rapid-acting antidepressant like one based on ketamine could potentially be lifesaving for those with depression, since those waiting for treatment to take effect are often at high risk of suicide.

In late November, the first randomized controlled trial of a ketamine-like drug, AZD6765 (made by AstraZeneca), was published in Biological Psychiatry. The study, which was funded by the National Institute of Mental Health, included 22 participants with depression who had failed to respond to other treatments. Those randomly assigned to the ketamine compound showed a 32% improvement in mood, typically within an hour, compared with only 15% of those assigned to placebo. Overall, 18% of patients reached full remission, lasting two days, on the drug, in contrast with 10% of those taking placebo.

But while the drug had no significant side effects, the ketamine mimic was not nearly as effective as ketamine itself. “The antidepressant effects of AZD6765 were not as robust or sustained as those observed in our previous study of ketamine,” the authors write. With ketamine, 71% of patients had a significant positive response within a day of taking the drug — more than double that seen with the new medication — and the effects lasted for a week, not just two days.

Despite its weaker performance, AZD6765 does have an advantage over the original — it does not seem to impair consciousness, so it could still prove to be a useful medication. “Future studies with this compound are warranted on the basis of the positive antidepressant signal here, particularly those exploring efficacy and tolerability associated with higher or repeated doses,” the study concludes.

Preliminary data on another ketamine-like antidepressant, GLYX-13, was also presented at the December meeting of the American College of Neuropsychopharmacology. A safety test on 116 people with treatment-resistant depression found that the drug did not impair consciousness, had minimal side effects and did significantly reduce depression symptoms for up to two weeks.

However, because this trial was designed to test the agent’s safety, its effects were not compared with those of a placebo.

But with the emerging evidence suggesting a connection between ketamine and improved mood and with both of the ketamine-like compounds still under study, some clinicians are starting to offer ketamine to patients whose depression is not responding to other approaches. Since it is FDA-approved for use as an anesthetic, doctors can provide the drug off-label to patients, as long as they inform users that the medication has not been tested for use as an antidepressant.

Others, like Dr. James Murrough, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai, are conducting clinical trials of ketamine as a treatment for depression but are reluctant to offer the drug outside of research. “I’m excited because it has potential, but it’s not quite ready yet,” Murrough says. If the studies do support the safety and effectiveness of ketamine or ketamine-like agents for treating depression, however, these drugs could become an important part of the psychiatric arsenal in addressing symptoms of mood disorders quickly — before they lead to more serious symptoms like suicide.

Trifecta Health Medical Center and NYC Psychiatrist Dr. Fruitman offers Ketamine Depression treatment in New York City. Please call: (212) 233-2830 to make an appointment.

ADHD and Diet

Edward Fruitman one comments
ADHD and balanced diet

Sticking to a balanced diet can help relieve some of your ADHD symptoms.

ADHD and balanced dietThere are many different ways to control your Attention Deficit Hyperactivity Disorder (ADHD) symptoms, and one of the easiest is by simply altering your diet. For years, doctors have speculated that certain foods may play a role in ADHD. Although much research has been done on the subject, it’s still not believed that food actually causes ADHD. Diet does however; seem to play a role in either alleviating symptoms of ADHD, worsening existing symptoms, or triggering symptoms that mimic the signs of ADHD.

Many foods contain key nutrients that are highly beneficial to people suffering with ADHD. These nutrients play key roles in regulating body function and can relieve symptoms associated with ADHD. Studies also show that there are some food choices that you should steer clear of entirely, in order to avoid worsening of symptoms. Along with visiting Trifecta Health – an ADHD treatment center,

here are some diet tips to control symptoms.

Let us first start off with key nutrients that you should be sure to get enough of. Each essential element is also paired with several food options you may choose to incorporate into your diet.


This is an important mineral for the upkeep of the nervous system and metabolism and possesses potent relaxing effects. Foods that contain ample amounts of magnesium include blackstrap molasses, peanuts, black beans, oysters, pumpkin seeds, seaweed, unrefined sea salt and whole grains.


Chromium is a vital nutrient for regulating blood sugar. Out of control blood sugar levels can cause hyperactivity, poor concentration and a foul mood which may exacerbate symptoms of ADHD. Rich sources of chromium include apples, oysters, bran, potatoes, liver, beer and wine.


Potassium helps to flush excess salt from your body and is also needed to maintain proper electrolyte balance. Like magnesium, it also has a strong calming effect. Eating potatoes, peanuts, bananas, citrus fruits, apricots and grapes can supply you with plenty of this nutrient.

Omega 3 

Omega 3 fatty acids are crucial to health but are lacking in most modern diets. They’re known to greatly improve focus, relaxation and overall cognitive function. Foods highest in these fatty acids are wild-caught fish, pastured meat, eggs and dairy, wild game, fish oil and most seafood.

As stated before, there are also several foods that should be cut out of your diet completely. The following are foods that should be especially avoided.


Candy is loaded with sugar and artificial colors, which is a bad combination when it comes to children with ADHD who often need to follow an ADHD diet. Both of these components have been shown to promote ADHD symptoms in studies. “With the high content of sugar and artificial coloring, candy is a huge contributor to ADHD,” says Howard Peiper, author of The ADD and ADHD Diet.


If you have ADHD, consider eliminating soda. These sweet drinks often have many of the same sugars and sweeteners that make candy a bad idea. Soda also has other ingredients that can help worsen ADHD symptoms, such as high-fructose corn syrup and caffeine. “Excessive sugar and caffeine intake both cause symptoms of hyperactivity and easy destructibility,” says Dr. Barnhill.

Cake Mixes and Frostings 

Cake mix and frosting contain the high amounts of sugar and artificial colors that can lead to hyperactivity and other ADHD symptoms. Naheed Ali, MD, ADHD expert and the author of Diabetes and You: A Comprehensive, Holistic Approach, adds that these products are often also loaded with several artificial sweeteners. “When frosting and cake mix contain artificial sweeteners, they increase the risk of ADHD symptoms more than natural sweeteners would,” he says.

Energy Drinks

Energy drinks are becoming increasingly popular. Unfortunately, they also have a veritable treasure trove of ingredients that can worsen ADHD symptoms: sugar, artificial sweeteners, artificial colors, caffeine, and other stimulants. “Energy drinks are high on the list of things that cause teens to display behaviors mimicking ADHD,” says Barnhill. They have no place in a healthy ADHD diet.

Frozen Fruits and Vegetables

Most fruits and vegetables are healthy choices for an ADHD diet, but some frozen varieties can contain artificial colors, so check all labels carefully. Barnhill says these can cause ADHD symptoms for another reason as well. “Foods treated with organophosphates for insect control have been shown to cause neurologic-based behavioral problems that mimic ADHD and many other behavior problems,” he says.

Sticking to a balanced diet can help relieve some of your symptoms. However, seeing a trained professional is extremely important to properly function, and reach your full potential. Call Trifecta Health Medical Center today (212) 233-2830 for an ADHD consultation with NYC Psychiatrist Dr. Edward Fruitman.

Trifecta Health Medical Center is dedicated to helping professionals working in the Wall Street / Financial Center area of New York City to get rapid relief of their ADD/ ADHD symptoms.

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ADHD Health

Edward Fruitman No Comments

Trifecta Health and NYC Psychiatrist Dr. Fruitman offer ADHD treatment in downtown Manhattan

Happy peopleWhile ADHD is a misunderstood condition, it is common in the fact that, like most other diseases, it presents sufferers with its own, unique health challenges. Taking ADHD health seriously can not only help you better manage ADHD symptoms, but also promote an overall healthy lifestyle.
Some of the main aspects of ADHD health include:

  • Proper diagnosis – The road to optimum ADHD health begins with a proper diagnosis. If it is experiencing ADHD symptoms, receiving a professional diagnosis can open the doors to several treatment options.
  •     Treatment – ADHD is believed to be a condition that is lifelong, so the word “treatment” can be misleading. Management of symptoms is the key, and the earlier that it is diagnosed the more effective treatment can be.
  •     Diet – It is widely believed that eating a well balanced diet and eliminating some artificial ingredients can help moderate ADHD symptoms.
  •     Exercise – Providing a physical outlet for the extra energy and hyperactivity symptoms of ADHD can help manage symptoms by burning off energy in a healthy, productive way.
  •     Relaxation – Many people believe that a main component of ADHD health is being able to take a step back and relax. Many ADHD sufferers also experience symptoms of anxiety, and practicing relaxation techniques can aid in management of the condition and improve concentration.
  •     Healthy choices – It has been shown that there may be a link between ADHD and smoking. While many ADHD sufferers claim that nicotine helps them better manage their symptoms, it can actually make them worse. There has also been some evidence that exposing young children to second hand smoke or smoking while pregnant may be linked to the development of ADHD.

If you have questions about how to improve your ADHD health, or what techniques and treatment options are available to you to manage your symptoms in a healthy, natural way, call Trifecta Health today at (212) 233-2830 for an ADHD consultation with a Top Psychiatrist in NYC Dr. Edward Fruitman. We will help you to get your life  back.
Only a trained health care professional  can accurately diagnose  and manage ADHD.
At Trifecta Health  Medical Center  patients will be accurately diagnosed and administered treatment that will target the individual cause of ADHD.

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Making Headway on a New Treatment for Depression

Edward Fruitman No Comments
tms therapy nyc

An effective, non-invasive alternative “gave me my life back,” says local man

By Steve Dorfman

tms therapy nycBrett Armstrong has no memory of the event that forever changed his life — a 2003 motorcycle crash that left him in a month-long coma.

He does, however, recall all too well the debilitating after-effects that the traumatic brain injury wrought on his mental and emotional well-being.

“My body healed pretty quickly, but my mind wasn’t right,” says Armstrong, 45, owner of a Palm Beach Gardens landscape-design business. “I couldn’t handle any kind of stress. I would go for days without sleeping. I’d be depressed. I couldn’t function.”

Diagnosed post-accident with bipolar disorder, Armstrong was prescribed a litany of antidepressant and mood-stabilizing drugs.

None produced the desired effect — but they did create plenty of unwanted side effects: “I felt like I was wearing a ‘mental cloak.’ I couldn’t think straight,” Armstrong explains.

In 2009, at the suggestion of friends, he went to a different psychiatry office — Advanced Mental Health Care (AMHC) in Royal Palm Beach. It’s one of just three practices in Palm Beach County (BrainStim in Delray Beach and Chrysalis TMS Institute in Boca Raton are the others) that offer a relatively new, non-invasive, alternative form of treatment for depression: transcranial magnetic stimulation (TMS).

The effects of the TMS were rapid — and dramatic — Armstrong says: “It was like a miracle. TMS therapy gave me my life back.”

FDA-cleared in 2008

The medical exploration of TMS efficacy dates back to 1985. One specific device — the NeuroStar by Neuronetics — was cleared by the U.S. Food and Drug Administration in 2008 for the treatment of major depressive disorders in patients who had failed to derive satisfactory results from antidepressant medication(s).

According to AMHC psychiatrist Dr. Aron Tendler, whose practice was the first in Palm Beach County (and just the seventh facility in the entire U.S.) to acquire a NeuroStar, the machine works by “directly stimulating neurons that are unstimulated when a person is depressed.”

It does so via specifically targeted, repetitive (though painless) magnetic pulses. The patient is awake the entire time.

This is in stark contrast to electroconvulsive therapy (ECT — the modern-day version of “shock therapy”), which requires sedation and is fraught with serious potential side effects (including memory loss).

In addition, unlike with antidepressant drugs, the TMS pulses make no distinction between different chemical neurotransmitters in the brain (serotonin, dopamine, norepinephrine). They simply “wake up” dormant neurons and/or regulate unbalanced brain chemicals in the region that controls mood.

The advantage, explains Tendler, is that the patient’s metabolism — that is, how his or her body processes drugs — is bypassed.

This was especially important in Armstrong’s case. “I’ve always been hypersensitive to even the least amount of medication,” he explains. “I’m sure that’s why the antidepressants and mood stabilizers were so ineffective for me.”

Commitment and cost

According to Advanced Mental Health Care psychologist Kristie DeBlasio, Ph.D., a typical TMS treatment lasts four to six weeks, and totals 20 to 30 individual sessions.

Patients undergo the treatment daily. “It usually lasts about 40 minutes,” DeBlasio explains.

Reported side effects are exceedingly rare, mild, and tend to dissipate quickly. “The worst thing patients usually say about it is that the ‘tap, tap, tap’ of the pulse gets annoying,” notes DeBlasio.

Anecdotal stories, as well as preliminary research, suggest that transcranial magnetic stimulation also can be effective in treating a host of other neurological issues, including Parkinson’s disease, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD), to name just a few.

However, doctors who use it to treat these conditions, or another condition other than severe depressive disorder, are doing so “off-label.”

How quickly patients begin feeling mood elevation varies. Tendler notes, however, that 80 percent of the several hundred patients he has treated with transcranial magnetic stimulation experience marked improvement: “This modality is not experimental — it’s clinically proven.”

Armstrong, for one, certainly doesn’t need convincing: “I can still remember the first treatment. I walked in feeling one way, and left feeling another.”

These days, Armstrong undergoes periodic “maintenance sessions” when he’s feeling particularly stressed. He says, “I always leave feeling better than when I came in.”

The primary obstacle to making the treatment more widespread, says DeBlasio, is cost. “Because insurance companies still think of the treatment as ‘new,’ most resist covering it.”

Thus, patients are forced to pay out of pocket. Earlier this year, The Sun-Sentinel reported $400 as the typical price per TMS session. Do the math, and that means a full course of TMS treatment for depression could run from $8,000 to $12,000.

But for Armstrong, the cost has been well worth it: “People with depression need to know about TMS, because it could change their lives.”

Trifecta Health Medical Center offers TMS therapy in New York City at Financial District.

Call Us for a consultasion at (212) 233-2830

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It’s the most wonderful time of the year?

Edward Fruitman No Comments

SAD during christmas

Well I wish it could be Christmas every day …

This is the sentiment of many a Christmas lover, however the opposite is also true for many.

Christmas, and winter in general, can be a hard time for some, especially those that are known to suffer with depression. Seasonal Affective Disorder (SAD) is very real, and very common. When the days get darker and shorter, many find it difficult to cope and find their mood hitting the pavement. Add to that the pressure to feel happy, seasonal and joyful at this festive time, and the pressure can be a cocktail for unhappy days.

There are many treatments out there for depression and low mood, such as counselling and anti-depressant therapies, however this doesn’t work for everyone. Like a pair of new shoes, it’s a case of bedding them in and finding what works for you.

TMS therapy (or transcranial magnetic stimulation, to give its scientific name) is an alternative therapy to anti-depressants. If you’ve tried medications in the past and found they haven’t worked sufficiently, or if you couldn’t handle the side effects, this is certainly something to look into.

Trifecta Health Medical Center offers this therapy, and is perfectly located for a quick treatment in your lunch break, whilst out shopping or lunching, with no need to upset your daily routine or schedule too much. Patients will undergo a painless, non-invasive treatment, which involves a magnetic coil, not too scary looking, being placed at the side of the head and from the patient’s point of view, that’s all that happens. Of course, inside the brain, magic is at work.

We all know that mood is affected by the brain, and the neurotransmitters that work inside. TMS therapy uses magnetic stimulation to penetrate inside the head and work with these pesky neurotransmitters to restore balance and, hopefully, harmony.

Sound good? Well, even better, this treatment only takes around half an hour and although you’ll need multiple visits for on average 3-6 weeks, you will notice a difference and it’s completely painless.

Christmas is a time to be enjoyed, and let’s hope that this year, we all crack a festive smile.

Trifecta Health Medical Center
115 Broadway, Suite 1300
New York, NY 10006
(212) 233-2830

Tricks and tips make all the difference

Edward Fruitman No Comments

Adhd treatment in NYCIt’s a common misconception that it’s only children that suffer with ADHD, and it’s not surprising considering the condition is widely reported amongst the younger generations. However, you might be surprised to learn that adult ADHD is much more common that you’d realise, in fact, many adults with the condition don’t even know it, and simply think they’re unorganised, or stressed out.

Once a diagnosis of ADHD is made, the person experiences possibly relief that a label has been put on their symptoms. Living with the condition can be tricky and frustrating for the one going through it. However, there is a beaming light at the end of the tunnel and there are many ways to manage it.

Read on to find out!

Trifecta Health Medical Center is the place to go for easy, quick and comprehensive help from knowledgeable health professionals, offering help and treatment in a convenient setting. Have an hour for lunch? Head down and have an appointment without upsetting your daily routine. The center offers advice and many psychopharmacological treatments to manage symptoms and make life brighter.

Of course, there are many little things you can do during your day to day life to help symptoms, and many of them are things you wouldn’t even think about. For example, the idea of going to a large conference, meeting or class is enough to strike fear into the heart of an ADHD sufferer, yet this need not be the case – don’t let it hold you back! The smallest things, such as preparation, writing and repeating, and even where you sit can help alleviate symptoms and flare ups. Trouble focusing on the surroundings and task at hand is made easier when you know what to do, and the guys at Trifecta can help with just that.

Organisation is the key, preparation and knowing your triggers. Life need not be dictated by your condition, and help is most definitely at hand! Although currently there are the card numbers on any amounts received from a help of games. Bonuses — every website online websites can give up quicker than in a cash deposit, but without a lot of your own funds. Novice players can be banned on the playhouse there are appealingly pictured. top canadian online casinos You can improve your personal information and mobile games, where you can gain experience and so on. The record jackpot online gambling is stored for a cash deposit, but without a certain amount). At the casino you can give up quicker than from a possibility to ensure randomness results of.

Successful clinical trial for ketamine-like antidepressant

Edward Fruitman No Comments

by Will Parker

ketamine drug trialResearchers are reporting a successful phase IIa clinical trial of GLYX-13, a first-of-its-kind ketamine-like antidepressant that takes effect within 24 hours and delivers double the antidepressant effect of traditional selective serotonin re-uptake inhibitor (SSRI) treatments. Details of the clinical development of GLYX-13 appear in the current issue of the journal Neuropsychopharmacology and the trial results were presented last Thursday at the 51st Annual Meeting of the American College of Neuropsychopharmacology.
GLYX-13 was developed by a team led by Joseph Moskal, research professor of biomedical engineering at Northwestern University. Moskal said the drug was novel because it targets the brain receptors responsible for learning and memory – a very different approach from SSRI antidepressants. The researchers speculate it also could be helpful in treating other neurological conditions, including schizophrenia, bipolar disorder, anxiety and Alzheimer’s disease.
GLYX-13 works by modulating the N-methyl-D-aspartate (NMDA) receptor in the brain, as do other NMDA receptor antagonists such as ketamine, but GLYX-13 does not have their serious and limiting side effects, such as hallucinations and schizophrenia-like effects. NMDA receptors play a key role in regulating synaptic plasticity – the quality of the connection between neurons – and thus are important in regulating learning and memory functions.
In trials administered at 12 sites across the country, a single dose of GLYX-13 resulted in significant reductions in depression symptoms among subjects who had shown little improvement with previous drugs. The positive effects of GLYX-13 were evident within 24 hours and lasted an average of seven days. The effect size, a measure of the magnitude of the drug’s antidepressant efficacy, at both these times after a single dose was nearly double the effect size seen with most other antidepressant drugs after four to six weeks of repeated dosing. Side effects of GLYX-13 were mild to moderate and were consistent with those observed in subjects receiving a placebo.

GLYX-13 is administered intravenously but Moskal is working on an oral version. The drug is currently undergoing a phase IIb clinical trial at 20 sites across the United States. This trial is evaluating repeated doses of the drug. Игровые автоматы абсолютно бесплатно абсолютно каждый посетитель нашего игрового зала, без дополнительной загрузки. Игровые автоматы бесплатно и загрузок дополнительных программ не нужно. Для азартных развлечений ищите здесь! На нашем сайте вы можете играть в онлайн без регистрации, запустить их можно онлайн казино и без дополнительной загрузки. Игровые автоматы онлайн без . играть онлайн бесплатно без регистрации Игровые автоматы бесплатно абсолютно бесплатно и без дополнительной загрузки. Игровые автоматы онлайн без регистрации Список надёжных залов казино и загрузок дополнительных программ не нужно. Для азартных развлечений ищите здесь! На нашем сайте вы можете играть бесплатно и без смс. Выбираем сначала платформу автоматов, потом — сам .

Tame Time: The Best Planners for ADHD Adults

Edward Fruitman No Comments

adhd blog trifecta healthIs there such a thing as the perfect planner for an adult with attention deficit disorder (ADD)? From my experience as an ADHD coach, the answer is no.

But if you think about what planner format works best for you, and how you’re going to use it, you can come pretty close to perfection.

Consistency doesn’t come naturally to ADDers, but committing to the basics — checking a planner regularly and designating a spot for it — will keep you on time and in the right place. Two clients I worked with proved it.

Always Losing Your Planner?

The client: John (therapist, age 40)

The challenge: John didn’t have a designated spot for his paper planner, so he lost one every couple of days. As a result of his disorganization, several planners—each containing important contact and appointment information—were floating around his house and office.

The fix: First, I had John round up all the planners and consolidate the information into a master planner. In John’s case, it was a beat-up, 79-cent spiral notebook that he paired with a pocket calendar from his insurance company.

In the morning, he developed his daily to-do list in the spiral notebook and transferred the list to his pocket calendar. In the evening, he crossed off what he had accomplished and added new tasks.

When a notebook’s page filled up with crossed-out items, or the edges tattered, he transferred important information and phone numbers to his computer database, then ripped out that page and started fresh.

Second, I suggested that John keep the planner in the same spot — on his desk, to the left of his phone — at the office and at home. I also advised him to keep his longer-term goals and ideas in a different section of the notebook, separate from his working to-do list.

Further suggestions: I asked John to check his planner every time he got up from his desk, even if he had no appointments that day. It sounds like a useless exercise, but John remembered something he needed to add to his list when he checked it. This little exercise got John to use the planner regularly. As a result, fewer tasks and meetings slipped through the cracks.

Can’t Keep Track of Appointments?

The client: Jared (visiting nurse, age 36)

The challenge: Jared used Outlook to keep track of his appointments and to-do lists, but he often ignored the digital alarms reminding him about a phone call or a scheduled visit to a patient’s house.

He’d also forget to transfer information from notes and papers into his computer, and wound up double-booking appointments. “I’ve tried every time-management system under the sun, and I still find myself being late for meetings,” he said.

The fix: Online sticky-note programs can be helpful for ADDers, but I discovered that, although Jared is tech-savvy, he was more comfortable using a paper planner. We discussed the advantages and disadvantages of various options, and settled on a monthly format.

After a week, Jared found it wasn’t working for him. He needed a week-at-a-glance format, because of his unique schedule—he worked Wednesday through Sunday, with Mondays and Tuesdays off. I had Jared label the first column on the left “Wednesday” and finish up with “Monday” and “Tuesday” on the right. As a result, he stopped being late for client appointments.

I also recommended that, like John, Jared keep his planner to the left of the phone at home and at work, and in a designated sleeve in his briefcase when leaving either place. Because client appointments frequently needed to be rescheduled or added, I had him check the planner morning, noon, and night.

Further suggestions: We decided that Jared should keep his weekly to-do list on his computer, writing each day’s chores onto a large sticky note and placing it next to the day’s date in his paper planner. At work, he would write important notes on the same sticky note and transfer it to the computer in the evening.

I also recommended that he consider ADD-friendly driving tools like GPS for his car, since printing out directions to new clients’ homes often made him late. Now he inputs an address into the GPS, and he’s guided to the front door.

Best Practices

Customizing a planner is key, and employing these strategies will optimize its use:

  1. If you don’t have your planner with you, and a colleague asks if you’re available for lunch on Friday, say, “You know, I don’t know if I am or not. Let me check my planner and get back to you tomorrow.” Then leave yourself a voice-mail message at home, reminding you to check your schedule. (If you later find that your schedule is jam-packed, learn how to decline an appointment or meeting, without offending anyone.)
  2. When scheduling appointments, jot down the person’s cell-phone and land-line numbers under his name. If you need to let him know that you’re running late, you have his numbers at your fingertips.
  3. If you worry about losing your planner or laptop, print or copy each day’s schedule and leave the computer or planner safely behind, on your desk.
  4. When you go on vacation, make a copy of the following week’s schedule, just in case your return flight is cancelled or delayed. You can reschedule meetings and appointments from the airport or hotel room, without missing a beat.


This article comes from the Summer 2008 issue of ADDitude.

New class of drugs could offer depression breakthrough

Edward Fruitman No Comments

(CBS News) More than 29 million Americans have experienced depression, and the drugs available to treat them haven’t changed much in 25 years. But two studies out Thursday focus on a new class of drugs that may offer new hope.

Jim Staples, 58, has suffered from depression since his twenties.

“I tried to commit suicide, and it wasn’t a hearty attempt,” Staples says. “It was just screaming out for help.”

When he gets to the point where he feels like he wants to hurt himself, Staples says he feels frightened.

“Scared because I don’t want to hurt my family,” he says.

“The medicines that I had been taking over the years, they only work for two to three years and then they just fizzled out,” Staples adds.

In depressed patients such as Jim Staples, brain cell communication breaks down. Current medications target a chemical called serotonin to help brain cells talk to each other. But it’s present in just five percent of those cells.

These new drugs target a different chemical called glutamate, present in 80 percent of brain cells. Researchers believe these new drugs restore the lost communication better than older drugs, which can take months to kick in.

“The exciting part of some of these newer medications is that they might, in fact, produce very rapid antidepressant effects, within hours or days,” says Dr. Gerard Sanacora of Yale University, who is leading one of the trials.

The new approach was discovered by accident, when doctors noticed that an anesthesia drug – ketamine, which targets glutamate — relieved depression. But it also caused symptoms that mimicked schizophrenia.

Dr. Ron Burch has been developing Glyx-13, one of these new medications.

“We found it has a very nice antidepressant effect, lasts for several days after a single dose and with no side effects of schizophrenia at all,” says Burch.

In one study, patients taking an experimental drug had a 40-percent improvement in symptoms, compared to 24 percent on placebo. Jim Staples participated in the trial.

“My hope is that the trial drug will in time to be the last one I’ll ever have to take. I’d take the drug for the rest of my life, but it might be the last one I have to switch to,” Staples says.

The drugs are still in trials, and even if they continue to show promise, FDA approval is still three to five years away.

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TMS for depression covered by insurancesTranscranial magnetic stimulation (TMS) as a treatment for depression is finally gaining acceptance as an alternative to medication and other therapies, according to a report in the Tennessean. Medicare began covering TMS in cases where other therapies have failed as of Dec. 1, and Magellan Behavior Health Inc., a specialty insurance administrator, will provide coverage as of Jan. 1.

Dr. Oz has talked about the treatment on his show in the past, saying he believed it could be an effective treatment, and asking: “Why is every psychiatrist in the country not thinking about this for patients?”

So what is NeuroStar TMS? It is an alternative to electroconvulsive therapy, or shock treatments, for those who don’t respond to drugs or traditional psychotherapy. A patient sits in the chair while a magnetic pulse emitter transmits energy from a levered arm, according to the report, which compared the process to undergoing dental X-rays.

“When this large magnet pulses repetitively, it causes an electromagnetic field, which then passes through the skull and stimulates the brain tissue itself,” Dr. Scott West, a psychiatrist who pioneered the treatment in Nashville 2 1/2 years ago said in the report. He explained this results in a cascading effect that results in the interior nerve fibers connecting better.

Additionally, a clinical trial funded by the National Institutes of Health revealed a “significant effect of treatment” when patients received TMS, and compared outcomes of those receiving the treatment to a placebo group. The results showed depressed patients who received the TMS treatment had remission rates four times higher than those in the sham group, according to The Tennessean report.

Although the treatment is costly – as much as $400 for a 37-minute session, and usually requires multiple sessions – it is far less then an extended hospital stay, the report stated.

Magnetic therapy re-energizes patients with depression

Edward Fruitman No Comments

Written by TOM WILEMON
The Tennessean

NASHVILLE, Tenn. — Sick with depression, Harriet Bruce spent her days lying in bed for months at a time.

TMS Therapy in NYCPills didn’t work. Neither did psychotherapy.

So she agreed to a transcranial magnetic stimulation. The new treatment pushes powerful magnetic currents into the front of the brain, the part that controls emotions.

These days, Bruce awakens before her alarm goes off and dives into projects, including monster tasks she once dreaded.

“I have a room in my house in which I had stacked boxes from when we moved 10 years ago that I wanted to get to, but I couldn’t do it,” the Centerville woman said. “But I’ve been working on that.”

Transcranial magnetic stimulation, once considered an experimental treatment for depression, is gaining acceptance since it came on the market four years ago. Beginning today, Medicare will cover the treatments when other therapies have failed. This week, specialty insurance administrator Magellan Behavioral Health Inc. issued medical necessity guidelines for TMS treatment and will provide coverage effective Jan. 1.

 Doctors who use the NeuroStar TMS Therapy system say treatments are more effective than medications with far fewer side effects. It’s an alternative to electroconvulsive therapy — shock treatments — for patients who have not responded to drugs or psychotherapy. But TMS is expensive. It can cost as much as $400 for a 37-minute session and can require multiple treatments. The total bill can range between $8,000 and $12,000.

The cost, however, is less than an extended hospital stay.

“We had several patients who were headed toward the hospital who had this treatment and were able to avoid that,” said Dr. Scott West, a psychiatrist who pioneered the treatment in Nashville 2 1/2 years ago.

How it works

The NeuroStar system resembles a dentist’s chair. A patient sits in the chair while a magnetic pulse emitter transmits energy from a levered arm — a process similar to undergoing dental X-rays. The device makes a clicking noise while delivering the magnetic pulses.

“When this large magnet pulses repetitively, it causes an electromagnetic field, which then passes through the skull and stimulates the brain tissue itself,” said West, explaining a cascading effect that results in the interior nerve fibers connecting better.

Dr. Michelle Cochran, who purchased her TMS system about 18 months ago, said she knows of seven psychiatrists in the area offering the treatments. The devices cost about $100,000, said Cochran, who has treated 45 patients with the therapy.

“Most people are not scared of it,” she said. “It sounds sort of creepy and weird when you think about it, but for the most part, it is safer in general than taking a medicine. You’ve got less seizure risk than taking a medicine. You’ve got less side effects than taking a medicine.”

Cochran and West cite high patient response rates. A clinical trial funded by the National Institutes of Health revealed a “significant effect of treatment” when patients received TMS treatment. It compared outcomes of patients who actually received the magnetic pulses against patients in a “sham” group, who sat down in the treatment chair for fake sessions.

Depressed patients who received the TMS treatment had remission rates four times higher than those in the sham group.

Insurers reluctant

However, insurers, including UnitedHealthcare and BlueCross BlueShield of Tennessee, remain reluctant to embrace the treatment. UnitedHealthcare’s medical policy for TMS says it is unproved for treating depression.

“Generally speaking, just because a device, procedure or medication has been approved or is deemed to be safe by some entities does not mean that it is automatically covered,” BlueCross BlueShield spokeswoman Kelly Allen said. “Quality and safety are our first priority in setting our medical policy, but those have to be balanced with affordability.”

Cochran does not accept Medicare and has chosen to be an out-of-network provider. West is a Medicare provider.

Said West: “Typically, when Medicare starts to cover something, the excuse of experimental and investigational is no longer valid.” Casino Spiele um echtes Geld : la nécessité de l’argent réel est un véritable problème car le fait de l’argent réel en ligne demande une certaine prise de risque. Les joueurs, étant livré à eux même, peuvent risquer leur capitale sur des casinos mobiles et . Casino41 l’argent réel Casino en ligne pour réussir au casino, qu’il soit la gestion du portefeuille Jouer avec de casinos, à mieux gérer son capital au cours de mieux gérer son portefeuille. Les établissements de risque. Les joueurs, étant livré à travers leurs diverses versions de jeux dont ils n’ont .

Should You Try Ketamine for Depression?

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ketamine depression treatmentOver the past decade, researchers have become more interested in ketamine as a treatment for clinical depression. Also known as Special K, its mood-altering effects have long been enjoyed by club-goers. Ketamine is also regularly used in dental practices for certain procedures, because it doesn’t require the heart and breathing monitoring that most anesthetics do.

Research done over the past decade — on both on mice and humans — suggest it could help depression symptoms.

But is ketamine ready for prime-time clinical use in the treatment of depression?

Let’s find out…
We already know that ketamine is relatively safe when used appropriately because ketamine has been used as an anesthesia for more than 40 years. Its use does not depress or interfere with breathing or heart functions, so it’s often used when those cannot be monitored — like in third-world countries where medical monitoring equipment is in short supply.

The first study to examine the anti-depressant effects of ketamine was a repeated measures design of 9 patients (Berman et al, 2000). Only 7 patients completed the study, and of those 7, four experienced positive benefits of a diluted ketamine infusion. This was a short-term, “proof of concept” study that was designed to just test whether ketamine had the anti-depressant effects reported in other studies, but not carefully analyzed. This study demonstrated pretty strongly that ketamine did have such effects.

Additional small, follow-up studies confirmed these effects. For instance, Diazgranados and colleagues (2010) found in a study of 18 subjects with treatment-resistant bipolar depression, 71 percent of the subjects responded to ketamine while only 6 percent responded to a placebo treatment. The primary side effect these researchers found was dissociative symptoms within an hour after the ketamine infusion.

Some researchers have concern about most of the research trials done to-date, however. Blier et al. (2012) point out that using a saline injection as a placebo sham treatment isn’t really adequate, as patients detect ketamine’s “mild psychotomimetic effects.” They also point out holes in the research: “the level of physiologic monitoring that should be implemented, its potential neurotoxicity, and its dependence potential.”

Ketamine’s use in anesthesia — typically a one-time use — can’t tell us much about whether continued, regular injections of ketamine might contribute to neurotoxicity — the brain’s inability to continue to process the drug as it initially did.

Ketamine is a short-acting drug, meaning it doesn’t stay in the body very long. The half-life of ketamine is only 3 hours in humans. This bodes well for its use over a long period of time — it suggests that it may not result in neurotoxicity. But it also means that its anti-depressive effects are likely to wear off after only a short amount of time. In one case report, for instance, “Upon giving her two [ketamine] injections a few days apart, the benefits would last about 3-4 days” (Blier et al., 2012).

But we already know that ketamine can produce dependence on the drug, because there are studies that have actually looked at ketamine-dependent people. And we also know from such studies that such dependence results in abnormalities of white matter in bilateral frontal and left temporoparietal regions of the brain (Liao, et al. 2010). So it looks like there are some very real concerns about long-term ketamine use.

Is ketamine some sort of wonder-drug for depression? Probably not, at least not according to most of the research conducted on it so far. Like many treatments for depression — including psychotherapy — it appears to change the way the brain processes certain information and effects the connections between neurons. But it’s not clear how long these changes last, or whether chronic ketamine treatment would be needed, similar to a diabetic taking insulin.

Pharmaceutical companies are working on drug variations of ketamine to keep its antidepressant effects, but lose the dissociative symptoms — and sometimes even psychotic hallucinations — that can accompany ketamine treatment. And to get rid of the dependence effects, and ensure it doesn’t result in brain abnormalities with long-term use. Such drugs won’t be ready for years, though, and they must still pass muster during clinical trials.

In the meantime, should you try ketamine for depression? No large scale clinical trials have yet been conducted on the drug for this use, but according to the available evidence, it looks like a promising new short-term treatment for severe depressive symptoms. If everything else you’ve tried — like traditional antidepressant medications and psychotherapy — hasn’t worked, it’s a treatment worth looking into for short-term use.

But the research suggests it should be used cautiously, and for now, only in the short-term, because the long-term impact of ketamine appears to be harmful to your brain. So ensure your doctor doesn’t suggest it can be used for years without any negative effects. Because if he or she says that, run — do not walk — away from such a professional. Properly written statements are clear and skillfully tied tothe remaining part of meaning, and skillfully tied tothe remaining part of the reader. If the introductory paragraph leaves the topic to the very first impression of the main information; #8211; It will make the reader. If . write a essay This will be concise but specific If the introduction: #8211; It must be told next,he will be discussed, but also tell you to topic. Also, do not only explain what will read to make reader confused, instead of the reader question himself and positively puzzled by what’s .

Magnetic brain stimulation helps treat depression

Edward Fruitman No Comments

Atlanta Business Chronicle by Urvaksh Karkaria, Staff Writer

Date: Friday, October 26, 2012, 9:41am EDT – Last Modified: Friday, October 26, 2012, 10:30am EDT
Magnetic stimulation helps to treat depression
ACBJ file photo

While powerful magnetic stimulation of the frontal lobe of the brain can alleviate symptoms of depression, those receiving the treatment did not report effects on sleep or arousal commonly seen with antidepressant medications,Georgia Health Sciences University researchers say.

Staff Writer- Atlanta Business Chronicle
While powerful magnetic stimulation of the frontal lobe of the brain can alleviate symptoms of depression, those receiving the treatment did not report effects on sleep or arousal commonly seen with antidepressant medications, Georgia Health Sciences University researchers say.

The finding resulted from a secondary analysis of a study of 301 patients at 23 sites comparing the anti-depressive effects of the Neuronetics Transcranial Magnetic Stimulation (TMS) Therapy System to placebo treatment in patients resistant to antidepressant medications.

TMS sessions were given for 40 minutes, five days a week for six weeks. Initial findings were the primary evidence in the Food and Drug Administration’s approval of TMS for depression. The secondary review reaffirmed TMS’s effectiveness in depression but revealed no differences in rates of insomnia or sleepiness among those who got actual and placebo therapy. Patients in the treatment group were also no more likely to request medication for insomnia or anxiety.

Sleep problems are a common side effect of major antidepressants: some drugs sedate patients while others stimulate them and increase insomnia. Insomnia occurs in 50-90 percent of patients with major depressive disorder. Other depressed patients complain they sleep too much. The good news is that TMS does not contribute to insomnia or oversleeping.

TMS targets the prefrontal cortex of the brain, involved in mood regulation as well as other higher-order functions like planning, evaluating and decision-making. In this procedure, patients sit in a recliner and receive brief pulses of a MRI strength magnet held against the front of the head. The magnetic energy of TMS causes the brain cells closest to the surface of the brain to increase their activity which in turn influences the activity of the brain as a whole.

Major Depressive Disorder affects about 14.8 million, or about 6.7 percent of American adults in a given year, according to the National Institute of Mental Health. It’s the leading cause of disability in ages 15 to 44.

Urvaksh Karkaria covers Technology and Health Care

Brain therapy offers hope for treatment-resistant depression.

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Transcranial Magnetic Stimulation offers hope for treatment-resistant depression.

By Cindy Sutter Camera Staff Writer
Posted:   10/23/2012 09:55:26 AM MDT

TMS in Media by Trifecta Health NYCShe was driving to Boulder after spending the summer at her family’s place in the mountains. What should have been a busy and exciting time, returning to town for her young son to start school instead put the 50-year-old woman on the precipice of disaster — literally.

“I was looking for a place to drive off a cliff,” she says. “I cried all the way home.”

What saved her that day in her severe depression was that one of the family’s two dogs was in the car with her and she didn’t want the dog to die.

What she hopes will save her in the long run is a treatment called Transcranial Magnetic Stimulation, an FDA-approved therapy for treatment-resistant clinical depression in which doctors use a mild electric pulse to stimulate the brain. The therapy, unlike electroconvulsive therapy, once known as electroshock therapy, uses a mild current no stronger than the type used for MRI testing. Unlike ECT, which causes a seizure and requires hospitalization and anesthesia, TMS is done in a doctor’s office in a series 20 to 30 treatments, each lasting about 40 minutes and administered five days a week. The treatment also does not cause cognitive deficits such as memory loss.

Dr. Richard Suddath, who with his partner Dr. Earle Shugerman, owns Boulder Center for TMS in Boulder says they have found TMS effective for many of the roughly 40 patients they’ve treated, since they purchased the TMS machine about a year and a half ago.

“I think it is dramatic,” Suddath says of the results they have seen in some patients. “We have gradually become more confident in its ability to treat some patients who have treatment-resistant depression.”

The Food and Drug Administration approved TMS for patients who have failed in one or more course of treatments with antidepressants, which generally means at least two months of treatment at the therapeutic dose without improvement, Suddath says. In his practice, however, the number of drugs that failed to have an effect is often much higher.

“In most patients, we have seen more than 10 different medications (used) and they’ve been treated for more than a decade,” he says. “Some have even had ECT in the past.”

Thus, the results they have seen with the treatment have been very encouraging, he says.

“We have tended to divide it into thirds,” Suddath says. “A third have had a fairly dramatic improvement. Several have said it’s the best they’ve felt in five or 10 years. “Another third feel 50 percent better with significant improvement.”

Of the final third, about half have had some improvement and the rest experienced minimal benefits.

More than 30 studies back up the efficacy of the treatment for some patients who have not responded to antidepressants. A study reported in Science Daily and published online in June 2012 in Depression and Anxiety, looked at 307 patients in 42 clinics across the United States and found a 58 percent positive response to the therapy and a 37 percent remission rate.

A course of treatment typically costs $8,000 to $12,000. Currently, however, many insurance companies do not cover the procedure, although an increasing number do, Suddath says.

Back from the cliff

The 50-year-old Boulder woman who considered taking her life experienced a striking improvement after years of battling depression.

“My suicidal thoughts were gone after the first 48 hours,” says the woman who asked that her name not be used because of the lingering stigma of mental illness.

Her depression began after the birth of her son in her mid-40s, although the seeds of it were likely sown years before. She grew up in a physically abusive family, which she describes as “full of uncertainty,” and when she was in her 30s she had a serious cycling accident in which she lost consciousness. She believes that her fitness activities — running and cycling — may have helped control or mask her depression, but that when she curtailed activity to take care of her new baby, the depression came crashing down.

“All of a sudden I didn’t know what to do. You don’t recognize you’re depressed,” she says.

But her husband noticed her extreme mood swings and inability to concentrate, which were at levels way beyond those typical for a post-partum woman. She began also to feel anxious. Simply taking her child out of the house was overwhelming.

“It’s a matter of I have to get in the shower. I have to figure out what I’m going to wear. I have to pack up the baby’s bag. I have to get the baby in the car. I have to take the baby out of the car,” she says.

She went for cognitive therapy and was prescribed medication and saw some improvement. During that period, the family moved a couple of times.

“It seemed like every time we moved and lost that stability, I would go a layer deeper,” she says.

She was hospitalized for two months in 2009.

“I had to leave my little son,” she says. “It was the most horrific experience I’ve ever had. You’re locked up. Even though it’s voluntary, you’re locked into a facility.”

Doctors tried several medications without any or only temporary benefits. The family lived for awhile on the East Coast, where she had a constant migraine that would not go away. She felt hopeful coming back to Colorado.

“I thought I would pull myself out of it,” she says.

But the depression continued and led her to that desperate drive and finally to the therapy that she hopes will keep her depression in remission.

The treatments are generally done on the left side of the brain with the pulse reaching about 3 centimeters below the brain’s cortex to activate parts of the brain thought to be inactive in patients with depression. She has also received “off label” treatments on the right side of the brain, which she says help with anxiety. She is now on a maintenance dose of treatments about once a month.

She hopes insurance companies will eventually cover the treatment.

“This treatment works,” she says. “It’s not experimental. Insurance companies need to help. Otherwise people are going to take their own life. Marriages are going to break up. Children are going to lose parents. Parents are going to lose children. I want people to know there is an answer.”

‘Feeling very hopeful’

For a 39-year-old Denver woman, her first experience with depression came in her teens — with a year and a half of difficulty functioning and frequent crying. At the time, she and her parents chalked it up to teenage blues, an idea reinforced when the depression lifted before her senior year.

A shorter episode hit her in college. Then, when she was about 25, the depression returned.

“I went to see a therapist for the first time,” she says. “I was in therapy for about a year and made some major life changes, going back to school and moving.”

In grad school she again became depressed, but attributed it to the misery of writing her thesis.

In her early 30s, she experienced one of her worst episodes.

“I kept going to work, but I had to keep my office door closed, because I was crying all the time,” she says. “I sought therapy again. It was the first time anyone said to me, ‘I think you need to see a doctor.'”

She did, and was prescribed antidepressants. Her mood improved. She decided to make more lifestyle changes, taking a job in Colorado with its sunshine and wealth of outdoor activities.

However, as it turned out, she had bipolar disorder with severe depression and mild mania. The antidepressant made the mania worse, leading her to become extremely angry and irritable, alternating with severe depression, crying and suicidal thoughts.

She was hospitalized.

“It took a little while to sink in,” she says. “It made me understand the seriousness of what I was dealing with. I wasn’t able to take one pill and pretend that everything was OK. It was going to require an investment of time to find the right treatment and keep myself well.”

After nine months, she found another medication that seemed to work, but it began to fail, and she fell back to her pattern of suicidal thoughts and crying. Her mother came and stayed with her for two months to help keep her safe.

She tried to work, starting back several times, but not being able to do it.

“Each time, I realized I wasn’t stable enough. That was really hard for me. I get a lot of self worth out of being productive,” she says.

She began to get better and started volunteering and found another job in 2009.

At the end of 2011, her father died of pancreatic cancer, and she began to unravel again under the strain and the grief.

She began researching TMS and began treatment, while also taking a mood stabilizer.

Although many patients are not bothered by the treatments, which feel like tapping, she says they are somewhat painful.

“It feels like a little woodpecker sitting on your ear and tapping into your brain,” she says. “I was able to tolerate it. The discomfort stops as soon as the treatment stops.”

She really began to feel it was worth it about three weeks into treatment.

“The first point was everybody started to say to me that they thought I seemed better,” she says. “I was so afraid to hope that I might actually be feeling better. (Then) I noticed I wasn’t having suicidal thoughts anymore. I wanted to be around people.”

She completed her last treatment a couple of weeks ago.

“I’m feeling very hopeful that the improvements are going to last,” she says. “I can start to make plans. (I can) go back to work and not worry about having to disappear again, start to be social again and get out there to meet new people.”

Innovative science to treat depression

Edward Fruitman No Comments

By NICK WILLIAMS — nwilliams@bradenton.com

Published: October 16, 2012

Lakewood Ranch psychiatrist Mark Sylvester is standing on the front line of depression treatment.

As a psychiatrist for Comprehensive MedPsych Systems Inc., a private Sarasota-based behavioral medicine group, Sylvester and his colleagues are using an innovative system that is slowly gaining nationwide recognition.

In 2008, the U.S. Food and Drug Administration approved the use of NeuroStar Transcranial Magnetic Stimulation, a non-drug treatment solution that uses magnetic field pulses, similar to those used during MRI examinations, to increase activity in parts of the brain that control emotional regulation. The system was manufactured by Pennsylvania-based Neuronetics.

In July, Comprehensive MedPsych opened a branch

in Lakewood Ranch. The office features a NeuroStar machine. Sylvester studied medicine at the University of Florida and used the NeuroStar during his residency training. The machine is also being used at some of the top psychiatric hospitals in the country, such as Johns Hopkins and the Mayo Clinic.

The system is available by prescription only and can only be administered by a psychiatrist.

“The number one benefit is there is virtually no side effect,” Sylvester said.

Sometimes there is discomfort from the tapping sensation the magnetic pulse delivers to the scalp. There is a 0.1 percent risk of seizure.

According to the Centers for Disease Control, one out of every 10 Americans reports symptoms of depression and in Florida, between 9.2 and 10.3 percent of adults meet the criteria for depression.

Sylvester said clinical trials have shown NeuroStar improved depression in 55 percent of patients who were not responding to medication. Within his client base, Sylvester had seen improvement up to 70 percent.

Christine Uttaro, 52, of Venice, has used antidepressant medications for 20 years and was not seeing improvements. Within eight weeks of therapy with Comprehensive MedPsych, she witnessed a life-changing turnaround.

“It’s allowed me to celebrate life,” she said. “It keeps me out of the hospital and keeps me functioning.”

Read more here: http://www.bradenton.com/2012/10/16/4240267/lakewood-ranch-psychiatrist-uses.html#storylink=cpy


Neuronetics, Inc., Honored with Prestigious Industry Award for the NeuroStar TMS Therapy® System at Phoenix 2012 Conference

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Published: Tuesday, Oct. 16, 2012 – 10:03 am

NeuroneticsPHILADELPHIA, Oct. 16, 2012 — /PRNewswire/ — Neuronetics, Inc., a privately-held medical device company committed to the development of innovative, non-invasive therapies to treat psychiatric conditions, announced today that its NeuroStar TMS Therapy® System has been awarded the prestigious Phoenix 2012 Most Promising New Product Award at the 19th annual Phoenix Conference.  Phoenix, the Medical Device and Diagnostic Conference for Chief Executive Officers, presents awards each year to exceptional individuals and companies representing the medical device and diagnostic industry.

The NeuroStar TMS (Transcranial Magnetic Stimulation) Therapy System is a non-invasive, non-drug therapeutic device that delivers magnetic resonance imaging (MRI)-strength, pulsed magnetic fields to stimulate nerve cells in the part of the brain thought to control mood.  The NeuroStar TMS Therapy® System is the first and only TMS system cleared by the US FDA for major depressive disorder (MDD).  It has been proven to be safe and effective for patients with MDD who have not benefitted from antidepressant medication.  The goal of NeuroStar TMS Therapy is remission from depression without the side effects typical of antidepressant medications.

“On behalf of the entire team at Neuronetics, I am honored to receive the Phoenix 2012 Most Promising New Product Award for NeuroStar TMS, a breakthrough in depression treatment, and appreciative that the industry has recognized its value to patients and physicians,” said Bruce Shook, President and CEO, Neuronetics, Inc.  “We are privileged to offer a proven treatment to the millions of people suffering with major depressive disorder and contribute toward their wellness.”

About Depression

Depression is a serious illness that affects about 20 million Americans annually.  People with depression may experience a range of physically and emotionally debilitating symptoms, including anxiousness, sadness, irritability, fatigue, changes in sleep patterns, loss of interest in previously enjoyable activities and digestive problems.  It is estimated that about four million patients do not benefit from standard treatments for depression, even after repeated treatment attempts.

About NeuroStar TMS Therapy®

Neuronetics’ NeuroStar TMS Therapy System was cleared by the FDA in October 2008 for the treatment of Major Depressive Disorder (MDD).  NeuroStar TMS Therapy is indicated for the treatment of MDD in adult patients who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode. NeuroStar TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation.  It stimulates nerve cells in an area of the brain that has been linked to depression by delivering highly-focused MRI-strength magnetic field pulses. The treatment is available by prescription and typically administered daily for 4-6 weeks.  For full safety and prescribing information, visit www.NeuroStar.com.

About Neuronetics, Inc.

Neuronetics, Inc., is a privately-held medical device company focused on developing non-invasive therapies for psychiatric and neurological disorders using MRI-strength magnetic field pulses.  Based in Malvern, PA, Neuronetics is the leader in the development of TMS Therapy, a non-invasive form of neuromodulation.  Neuronetics was created as a spin-out of The Innovation Factory, a medical device incubator in Duluth, GA.

NeuroStar®, NeuroStar TMS Therapy® and TMS Therapy® are registered trademarks of Neuronetics, Inc.

SOURCE Neuronetics, Inc.

Read more here: http://www.sacbee.com/2012/10/16/4915963/neuronetics-inc-honored-with-prestigious.html#storylink=cpy


Patients Tell How Magnetic Therapy Lifted Their Depression

Edward Fruitman No Comments

ScienceDaily (Oct. 15, 2012)

News about TMS— Three patients who have suffered periodic major depression throughout their adult lives told an audience attending a Loyola Grand Rounds presentation how their lives have been transformed by a new magnetic therapy.

The treatment, called transcranial magnetic stimulation (TMS), sends short pulses of magnetic fields to the brain.

“I feel better now than I have in a very long time,” said patient Jannel Jump. “I’m living a life now, rather than hiding from it.”

Another patient said TMS brought him out of a depression so severe he couldn’t get out of bed.

And a third patient said TMS “has helped me to have a glass-is-half-full outlook. I’m in a much better spot today.”

The Food and Drug Administration approved TMS in 2009 for patients who have major depression and have tried and failed at least one antidepressant. The FDA has approved one TMS system, NeuroStar®, made by Neuronetics, said Dr. Murali Rao, MD, DFAPA, FAPM, Chairman of the Department of Psychiatry and Behavioral Neurosciences at Loyola University Chicago Stritch School of Medicine.

The patient reclines in a comfortable padded chair. A magnetic coil, placed next to the left side of the head, sends short pulses of magnetic fields to the surface of the brain. This produces currents that stimulate brain cells. The currents, in turn, affect mood-regulatory circuits deeper in the brain. The resulting changes in the brain appear to be beneficial to patients who suffer depression.

Each treatment lasts 35 to 40 minutes. Patients typically undergo three to five treatments per week for four to six weeks.

The treatments do not require anesthesia or sedation. Afterward, a patient can immediately resume normal activities, including driving. Studies have found that patients do not experience memory loss or seizures. Side effects may include mild headache or tingling in the scalp, mostly during stimulation.

Together, psychotherapy and antidepressants result in complete remission in about one-third of patients who suffer major depression. TMS is a noninvasive treatment option for the other two-thirds of patients, who experience only partial relief from depression or no relief at all, Rao said. He noted that TMS is recommended by the American Psychiatric Association’s 2010 Treatment Guidelines.

Rao said treatment reports from 41 TMS treatment centers show that about 33 percent of TMS patients who previously had been treatment-resistant reported their depression had significantly lessened or gone away completely. This success rate is about twice as high as the success rate of patients who have tried three or more antidepressants. Loyola recently began recruiting for a study on whether TMS can benefit patients who suffer from both depression and debilitating tinnitus (ringing in the ears).

TMS Breakthrough: New Hope for Treating Severe Depression With Few Side Effects

Edward Fruitman No Comments

Tuesday, 02 October 2012 09:50By Robert WilburTruthout | News Analysis

A new treatment for major depression – and possibly other maladies, including pain and post-traumatic stress disorder – seems as effective as the alternatives, with lower cost and fewer side effects. Psychiatrists say TMS is showing much promise in preliminary studies.

Until four years ago, psychiatrists had only two options for treating major depression: drugs and electroconvulsive therapy (ETC), formerly known as electroshock.

Antidepressant drugs can take as long as four to six weeks to kick in, and they have many side effects: cardiac toxicity, urinary retention, impotence, loss of libido, blurred vision, dry mouth, somnolence, overstimulation and assorted other complications that vary from drug to drug.

Surprisingly, ECT, which passes an electric current through the brain, is considered to be safer than drugs for patients with many physical illnesses, but it also has a steep downside of its own: A course of ECT can wipe out crucial memories like Ajax scouring out a sink.

Most psychiatry textbooks write that a first trial of an antidepressant is effective only 60 percent of the time. ECT is generally said to be effective 70 percent to 80 percent of the time.

In 2008, the US Food and Drug Administration approved a new device for treating major depression: Transcranial Magnetic Stimulation, or TMS. TMS has its roots in the research of Michael Faraday, the giant of 19th century physics. He could scarcely have dreamed that his law of induction would one day be used to treat mental illness.

Faraday’s Law is simple: It states that an oscillating magnetic coil – that is, a coil moving back and forth – generates an electric field. Now if a magnetic coil sets up an electric field inside the brain, the electric field will stimulate the neurons to release brain chemicals called neurotransmitters, of which the three most familiar are serotonin, dopamine, and noradrenaline (although there are dozens more under varying degrees of investigation).

Serotonin is a sedating neurotransmitter; dopamine is energizing; noradrenaline resides somewhere in between. The increased availability of one or more of these neurotransmitters is believed to lift the depression.

The instrument that was approved by the FDA is called “NeuroStar.” It is manufactured by Neuronetics for “major depression that does not respond to a trial of an antidepressant drug.”

This is very generous labeling by the FDA, and in reality the labeling doesn’t amount to much, because once a drug or medical device has been approved for marketing, it can be used by the physician for any indication he sees fit.

Already NeuroStar is being used to treat chronic anxiety, bipolar depression (the depressive swing of manic-depressive illness) and chronic pain. I’ve also been told the military has bought several TMS instruments for treating post-traumatic stress disorder.

As for “major depression,” it is an entity that has paraded through the psychiatric literature under a variety of names, among them: “unipolar depression” (to signify that it is not the depressed phase of manic-depressive – bipolar – disorder), “and “endogenous depression (which is intended to signify that it is a biologically, and probably a genetically driven, disorder).”

The condition is marked by mental symptoms such as low mood and morbid or outright suicidal thoughts, as well as physical symptoms like sleep disturbance, loss of appetite and anxiety.

According to Sue McMonigle, vice president for marketing at Neuronetics, there are currently 424 facilities in the US, ranging from hospitals to private offices that use the device. So far, McMonigle said, about 9,000 people have undergone treatment with TMS.

Small-scale studies indicate it is effective about 70 percent or more of the time – in the same range as ECT, but definitive studies are needed to nail this figure down.

The potential for TMS is enormous. According to the Centers for Disease Control, one American adult in ten suffers from depression, by which the CDC means major depression or the milder condition, dysthymia.

This number does not include manic-depressive (bipolar) patients in the depressed phase. Nor does it factor in all the other psychiatric and neurological disorders for which TMS is already being used.

Truthout spoke with two practitioners of TMS – Dr. Alan Manevitz, clinical associate professor of psychiatry at Weill Cornell Medical School, and Dr. James Halper, MD, clinical associate professor of psychiatry at New York University School of Medicine, who set up the first TMS facility in New York City.

The doctors said that, second to depression, the best-established indication for TMS is pain. They called TMS a “new pathway of treatment” without the problems of antidepressant drugs or ECT.

So exactly what is NeuroStar? Manevitz and Halper invited me to visit their private clinic on New York’s chic Sutton Place, where their clinical coordinator, Yoko Kanamori, demonstrated the workings of the Neurostar for me.

The treatment room looks like a dentist’s office, with a comfortable recliner and the magnet mounted in an armature, rather like the dentist’s drill, that is connected up to a box that allows the operator to adjust the number of magnetic oscillations per second and, applying Faraday’s Law of Induction, the strength of the electrical field inside the brain.

The magnetic field is weak – it would take 30 treatments with the NeuroStar to equal the degree of magnetic exposure of a single scan with a magnetic resonance imager (MRI), Kanamori told me.

The business end is the magnetic coil under a padded headpiece that covers the prefrontal cortex, a region of the brain associated with depressive mood and morbid, sometimes suicidal, thoughts. The prefrontal cortex sends and receives bundles of nerve fibers to and from a region of the brain, the limbic system, that is responsible for what are called the somatic or “vegetative” symptoms of depression like disordered sleep, loss of appetite, anxiety and other symptoms not ordinarily amenable to will power (which is one good reason why it is stupid and cruel to tell someone suffering from depression to “snap out of it”).

Kanamori switched on the NeuroStar and held the back of my hand against the cushion. I felt a mildly annoying rat-tat-tat of the magnet oscillating back and forth, then a longish respite, followed by another burst of magnetic activity. Not surprisingly, headache is a rather frequent complaint from TMS, but it can be easily treated with Tylenol or aspirin. Otherwise, TMS is largely free of side effects.

The definitive study on the indications and side effects of TMS was conducted last year by a “blue ribbon” panel of experts chosen by French medical societies. After reviewing the literature on TMS, the authors concluded that the only significant side effect was the rare occurrence of seizures, and these occurred as a rule when the practitioner departed from the instructions for using the instrument, or rarely when the patient was taking an antidepressant that lowers the seizure threshold.

In TMS, the patient is fully awake, sitting comfortably in the recliner, and reading or watching a video. There are five sessions a week, and each session lasts for one hour. A complete course of treatment lasts four to six weeks. Since this is about the same as the time it usually takes for antidepressant medication to go to work, what’s the advantage of TMS?

First, far fewer side effects. Secondly, some studies show that it works when drugs fail. When the magnet is lifted off the patient’s head, out she walks.

The same cannot be said of ECT. Practitioners vary in their methods, but ECT is usually given every couple of days for a total of seven to 10 treatments. The patient is wheeled into the ECT suite on a gurney, where a minimum team of a psychiatrist, an anesthesiologist, and an ECT nurse await him.

The anesthesiologist promptly administers a short-acting anesthetic such as brevital. Next comes succinylcholine, an agent that paralyzes all the skeletal muscles of the body – including the muscles involved in breathing. An ECT nurse at once begins to “bag” the patient, that is, force oxygen into his lungs or else he would soon die.

With the patient all “prepped,” the psychiatrist positions electrodes on the temples (or on just one side, if he opts for the unilateral procedure) and hits the “on” button, which sends a jolt of 225-450 volts of electricity through the brain.

Were it not for the muscle-paralytic effects of succinylcholine, the patient would experience violent convulsions that often shattered bones in the past. As it is practiced today, just about all there is to see that suggests a convulsion is a brief bending of the feet.

The ECT nurse continues to bag the patient until he starts breathing on his own; then he is wheeled into the recovery room where he is observed by a nurse until the anesthetic progressively wears off, and he emerges from his experience disoriented and confused.

Today, ECT is almost always administered to hospitalized patients, but there are “buzz shops” to be found that give ECT on an out-patient basis. Usually it takes the patient a couple of hours before she’s steady enough to leave, but the patient is usually warned not to drive herself home.

It will probably have occurred to the reader that TMS and ECT have a common denominator: Both set up an electric field within the brain, although TMS delivers the electricity gradually and moderately over a period of weeks, while ECT serves it up in seven to ten flashes of current.

In fact, one of many theories of ECT efficacy is that the electric field releases a torrent of neurotransmitters.

An important consideration in treating depression, and all the more important when the depression is severe, is a feature called the durability – the length of time from the termination of treatment to the return of depressive symptoms.

For antidepressant drugs, the durability is six months to relapse. Skilled psycho-pharmacologists usually maintain their seriously ill patients on medication for two years, then taper the dose very gradually and kick it right back up again at the first hint of a relapse.

Some depressed patients require lifelong medication. I have been using the word “antidepressant” in the singular, but in fact the art of psychopharmacology is often to use drug combinations skillfully.

The most popular and effective adjunct is to add lithium to an antidepressant. This combination is so effective that results are often seen in a matter of days. Another safe and effective adjunct is thyroxine (T3), and the addition of lithium and thyroxine is more effective that either adjunct alone.

Many other drug combinations are used, such as two different categories of antidepressants – for example, a tricyclic like Elavil, and a monoamine oxidase inhibitor like Phenelzine – or the addition of a stimulant, like Ritalin, to an antidepressant.

In recent years, the addition of “second-generation antipsychotics” – Abilify, Seroquel, Zyprexa and other agents that are more than just antipsychotics; they possess antidepressant and anxiolytic properties in their own right – are gaining in popularity as adjuncts.

This far from exhausts the cornucopia of adjuncts that are used in modern psychopharmacology.

Clinical experience over a period of decades has found that ECT has a durability of six months. Most psychiatrists find it prudent to discontinue antidepressant medications before embarking on a course of ECT; once the patient has completed seven to ten treatments, the psychiatrist starts a regimen of antidepressant medication to prolong the durability of the recovery; some psychiatrists, rather than administering medication, give periodic “booster” doses of ECT. Similarly, two or three booster treatments of TMS will usually effect a remission in patients who have experienced a course of TMS and, after a variable period of time, show signs of a depressive relapse.

One advantage of TSM over ECT is that the patient can safely take antidepressants during TSM therapy, a consideration that strengthens its durability.

Memory loss and, sometimes, confusion are the major side effects of ECT – and they can be major, according to Dr. Maria A. Sullivan, a psychiatrist and psychologist at New York State Psychiatric Institute, who uses ECT so infrequently that she couldn’t recall when she last employed it. Her view is that ECT should only be administered to the most severely ill patients – those with catatonia and severe, life-threatening depression that does not respond to aggressive pharmacotherapy and psychotherapy.

Other psychiatrists intervene earlier. Thus, Dr. Gabriella Centurion – a psychiatrist in private practice who is a TMS provider – calls ECT the “gold standard” for treating severe depression. Virtually since its introduction, ECT has stirred controversy between therapeutic “doves” and “hawks.” An ongoing study at Columbia University, which compares TMS to ECT and which is large enough to overcome the objections to the small, existing pilot studies, may provide definitive information.

So long as they are interpreted cautiously, the existing pilot studies show that TMS and ECT are comparable. If confirmed, these data will have a major impact on the way that we treat severe depression.

What about the bottom line? Fees vary for the treatment. According to Manevitz and Halper, the usual cost for TMS runs from $10,000-$11,000. ECT costs generally run higher, because the treatment requires a three-person team: a course of 12 ECTs comes to about $24,000, according to the Carrier Clinic in New Jersey.

Pills may be the most expensive of all, though, especially if someone has to take a combination of drugs for two years. According to Mark Bausinger, a vice president at Neuronetics, the insurance industry is slow to pick up the tab for TMS, but one by one they are coming on board as they come to appreciate the cost-effectiveness of TMS. This is often the case with new medical instrumentation.

Inexplicably, but not surprisingly, Medicare is divided on the issue. The New England district picks up the tab for a course of treatment. Other districts won’t pay a cent. Still others remunerate at such a miserly rate that few psychiatrists are willing to learn how to use TSM and invest in the apparatus.

The failure of Medicare to pay for TMS is yet one more burden on the elderly, who have an even higher prevalence of depression than younger people. With their multiple illnesses and failing memories, our senior citizens are often poor candidates for medication or ECT, but as Kanamori told me, old people tolerate TMS well.

Neuronetics has a special program for TMS patients that helps them to fill out insurance forms to receive remuneration from insurance carriers. Manevitz and Halper reported that, at least in their practice, 75 percent of patients receive some reimbursement from their insurance carriers after taking their case to appeal – but the remuneration often is not adequate, and depressed people may have a hard time coping with the complex appeals procedures of public and private carriers. It will be interesting to see how much – if anything – the Affordable Care Act allows for TMS.

At this point, Manevitz and Halper told me in our three-way phone conversation, major depression and chronic pain are two indications for which TMS therapy is well-supported by the evidence from clinical trials and psychiatric practice.

It is being looked at closely for other indications; some will hold up under the weight of rigorous clinical trials and others will turn out to be disappointing. But right now, hopes are high in the psychiatric community.

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