Transcription of Dark Days #34
Male: You are listening to The Dr. Lisa Radio Hour and Podcast recorded at the studios of Maine Magazine in Portland, Maine and broadcast on 1310 AM Portland, streaming live each week at 11am on wlobradio.com. Show summaries are available at http://www.doctorlisa.org. Download and become a podcast subscriber of Dr. Lisa Belisle through iTunes. See the Dr. Lisa website or Facebook page for details.
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Lisa: Hello. This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and Podcast show number 34, Dark Days, which is airing for the first time on Sunday, May 6th 2012 on wlobradio.com.
Today’s guests include Dr. Carole Orem-Hough, a South Portland psychologist and owner of the TMS Center of Maine; and Dr. Bryan Woods, attending psychiatrist from Geachy Hall in the Maine Medical Center.
Joining me in the studio today, as every week, is our cohost Genevieve Morgan, who’s the Wellness editor for Maine Magazine. Thank you for being here again, Gen.
Genevieve: Thanks so much for having me, Lisa. It’s a bright time of year to be talking about dark days, but I think it’s really a important topic.
Lisa: It’s probably an important topic to talk about during these bright times because there are always people in the community who are suffering from some sort of mental and emotional darkness, but maybe during these times of year when it’s so bright they’re feeling even less connected to the community, so we thought this would be a good time to talk about this.
Genevieve: It’s true. I think it might be harder at holidays or anytime when you’re supposed to be feeling joyful, when you’re not and a lot of times that’s just out of your control and I think that this is what the show is about. You and I have our own dark days this past year.
Lisa: Both of us have gone through some significant transitions and I think we’ve shared this with people who are listening to the podcast or the show as we’ve gone along and there’s pretty much no secrets. I, myself, transitioned out of 1 job where I was attending physician and teacher for a large local hospital. I’ve also gone through some major financial things as a result of that. I’ve had a major household move. I have moved my practice. I have moved out of my marriage, so lots of darkness and I’ve written about a lot of this in a bountiful blog.
People who are my patients and my friends … People who are paying attention, they know, that this is the reality. I’m dealing with the same sorts of darkness that a lot of people deal with in their lives and you as well, Gen.
Genevieve: I very much so. Last year, my mother was diagnosed with cancer so we, as a family, have been dealing with her treatment and recovery. I have, myself, gotten ill in the fall and then have been experiencing back pain for now, about 5 or 6 months serious chronic pain, which is in itself a very depressing thing, not only because pain is depressing of mood but also I’ve lost my capacity to exercise, my capacity to drive, my capacity to move around in the way that I’m used to. It’s a different kind of loss than yours but all of these losses create despair and that’s what we’re talking about.
Lisa: We’re talking about despair but we’re also talking about hope. One of the reasons we wanted to have this show is that there are resources in the community, whether you go to Dr. Carole Orem-Hough of the TMS Center of Maine, the local psychologist and deal with depression in that way or whether you end up needing to get medication from a psychiatrist, such as Dr. Bryan Woods, or whether you aren’t really quite to the point of depression but you start having to make significant lifestyle changes, there are things that you can do that can impact your mood in a significant way even when you’re going through the losses that you’ve described or the transitions that I have described.
Genevieve: What are some of the things that you prescribe for your patients?
Lisa: I think I’ve said this on previous shows. The interesting thing for me is that I’ve maintained a private practice throughout all of this and it is the private practice and my patients who’ve continued to come see me as a doctor. Even as I was feeling my own personal life was falling apart, I still felt as though I had a sense of purpose, I had something to offer. For me, the social connectivity there and the sense of purpose, those are 2 things that are so crucial to maintaining one’s sense of self and one’s positive outlook on life.
Maintaining one’s connections in whatever way is possible. It means your friends, your family members, continuing to show up in your primary relationship, significant other, spouse, boyfriend, girlfriend, and really try to share your feelings as difficult as that maybe for you or for them, also diet and exercise and a mindfulness practice.
Genevieve: One of the things that I found interesting about my own experience this year and because I am connected with so many wellness practitioners in Maine, I’ve had the advice to try and learn from the pain, try to understand what the purpose of all this is. I get very weary about I don’t think I deserve my back pain. I don’t think I willed it on myself but I did try to take it as what is this telling me and it really knocked me on my back. It made me go inward and particularly in the winter when it was easier to do that.
It’s hard because of my personality, but I tried to take that and use it with the understanding or the hope that eventually it would go away so that I wasn’t always going to be in that position. I did go into myself with the pain and the depression that came out of that.
Lisa: I think that’s really important point and in fact I think back to our first show that aired in September of 2011, talking to an author who wrote about her own loss and the loss of her mother and how she had to sift through the things in her life that had brought her to that place and sift through some of the things she needed to let go of with her mother. I know that for you, you had to let go of some things, the driving you described, some of the things that had become really essential to who you are.
John McCain, the musician, who also does the audio for the show is telling us about the German view of depression and this idea of digging and that he actually had to work through things is not a bad thing. It’s just working through the digging back through the things that you need to deal with in your life so that you can keep moving forward.
Genevieve: So that you can come out again with something new or hopefully something new.
Lisa: Yeah. I think that that is the idea that you can get stuck in your life and you can get stuck if you’ve decided that whatever identity you’ve had to discard is do you want identity with this fixed mindset. That’s who you are meant to be and now it’s gone and you failed and there’s nothing more to look forward to or you can have a growth mindset as difficult as it is. You can sit with your feelings, you can acknowledge the loss and you can keep moving forward. Take it as I need to work through these things, I need to fix whatever patterns or broken, I need to let go and I need to create my own evolving identity because none of us are fixed. We’re always ever evolving.
Genevieve: I think the important part of this is that at one point or another almost everyone will go through a transition or a loss that will create a depressed mood. Obviously, we’ll find out from our guests what is the difference between a minor depression and a major depression. You’re not alone if you’re out there having these feelings. We’ve gone through them recently and at some point everybody will.
Lisa: You’re not alone and some statistics suggest that depression is only even recognized about 40% of the time. Sometimes we’re not even sure that the people who we care about are depressed or that we ourselves are depressed.
The other important thing, you gave me this quote out of The Noonday Demon, which is a book about depression written by Andrew Solomon. The other piece to understand is that when we are depressed in large part is because we’re losing something that we care about whether it’s a job, an identity, a loved one. It’s because we are able to love that we experience this loss, so the quote that I thought was really powerful is, “Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.”
To understand that because we have, we can lose and because we love, we are able to grieve. Whatever form that takes, whether it’s an adjustment reaction as we’ll talk about with Dr. Woods or dysthymic disorder or even a depression or even lifelong struggles with emotional difficulties, it’s just part of being human. We all have this in us.
Genevieve: You can still have a good life even if you do suffer from chronic depression. There are tools out there. You can still have a good life.
Lisa: You can still have a very good life and we hope the people who are listening to our conversations with Dr. Carole Orem-Hough and Dr. Bryan Woods will find some inspiration, will maybe hear about some tools that might be useful in their own lives in dealing with their own dark days.
Each week on the Dr. Lisa Radio Hour and Podcast, we feature a segment we call Wellness Innovations, sponsored by the University of New England. This Wellness Innovation offers an evolutionary view of depression from an article in the March 1st volume of Molecular Psychiatry as reported by Emory News Center.
For several years, researchers have seen links between depression and inflammation or over activation of immune system. People with depression tend to have higher levels of inflammation even if they’re not fighting an infection. Infection was the major cause of death in human’s early history so surviving infection was a key determinant in whether someone was able to pass on his or her genes. This theory proposes that evolution and genetics have culminated in depressive symptoms and physical responses selected on the basis of reducing death from infection.
Fever, fatigue, inactivity, sleeplessness, social avoidance, and anorexia can all be seen as adopted behaviors in light of the need to contain infection. It also provides a new explanation for why stress is a major risk factor for depression and that stress pre-activates the immune system in anticipation of injury.
For information on this Wellness Innovation, visit doctorlisa.org. For more information on the University of New England, visit une.edu.
Male: This portion of the Dr. Lisa Radio Hour and Podcast has been brought to you by the University of New England, UNE, an innovative health sciences university grounded in the Liberal Arts. UNE is the number 1 educator of health professionals in Maine. Learn more about the University of New England at une.edu.
Lisa: Today on the Dr. Lisa Radio Hour and Podcast, we have the privilege of spending time with Dr. Carole Orem-Hough, who has been known to Genevieve Morgan and I for quite a while, at least in Maine because our audio guru John McCain works with her in her practice, and Genevieve is sitting here next to me.
Genevieve: Hi, Carole, nice to have you here today.
Carole: Thanks for having me.
Lisa: Your reputation precede you and not only does your reputation precede you as a person, as a friend and coworker of John’s but also what you do has very recently gotten some national acclaim. It’s so timely and interesting and it’s great to have you here. We really appreciate your coming in.
Carole: Thank you.
Lisa: Carole, your background is very interesting. You do currently psychology. I don’t know how you consider yourself a therapist or exactly what your … Define yourself a little bit here for us in your own words and then we’ll ask you how you got to be here.
Carole: I am a licensed psychologist. That’s how we term it here in Maine. The background was in Depth Psychology. I went to Pacifica Graduate Institute out in California actually and commuted for a couple of years to their program and then finally moved out to California to finish it. Anyway, my orientation from an educational perspective is one that is looking at the psyche, the unconscious and how all this informs our way of being in the world.
After I practiced for a while, I actually did my postdoctoral fellowship at Maine in McGeachy and started private practice after that. I needed more tools, I felt like, that could really structure things a little bit better so I trained in EMDR that was my first of a brain-based therapy.
Lisa: EMDR for people who aren’t familiar?
Carole: Stands for Eye Movement Desensitization Reprocessing.
Lisa: We’ll talk more about that.
Carole: I got trained in that and has become extremely, extremely helpful in terms of trauma resolution, not just what we call like a simple trauma which would be something like a tsunami. I know it didn’t sound simple, but something in the wrong place, wrong time not personal but even so far as to go to attachment traumas, which is why many, many people come to therapy is that there has been some wounding early on in their life, someone that needed to be there for them could not be for them in the way that they needed and so that actually it’s useful for that attachment trauma as well.
Lisa: I know the wounded warrior group that treats soldiers coming back from overseas uses EMDR quite a bit.
Carole: Yes, I have someone right now in treatment that is coming back from Afghanistan. He has more complex trauma, but it’s very, very helpful so anyway that was my first brain-based technique to learn. Even though I do confidence orientation of Depth Psychology, I found that very useful.
I then became aware of a treatment using psyche it’s called Internal Family Systems. We have a group here in Maine who practices this therapy so I went for one of the level-I trainings down in Boston for that which took a year. It was a really powerful way of accessing people’s parts, if you will, so different parts of the psyche that cause problems as well as those that don’t, but integrating the psyche which leaves me then to my more recent discovery in the last few years about Dan Siegel, who is a Harvard-trained psychiatrist.
I don’t know if you’ve heard of him, but he is very, very big with attachment and integration of the brain and understanding how when a brain is not integrated, the right and left brains are not connecting, the upper and lower brains are not connecting. When that’s happening, that’s when we get these psychological symptoms. He is a powerful force right now in the psychological community for us to understand better how the psyche works and how that most be helpful in healing that, so this Internal Family Systems is a great tool as well.
Lisa: You, yourself, did not come from … You didn’t go directly into psychology. You had a varied background.
Carole: Yes. I started in engineering. I went to Purdue University for engineering and came out of that and then went to work for a few years and then became interested in more the business side of things so I became interested and got an MBA from Creighton University at Omaha and then practiced that kind of work, if you will, for several years. I found that I really wanted to be more on the healing side of things. I had actually gotten into the medical world from more of products and those kinds of things. I felt like I wanted to really be more on the clinician side and giving to the people.
Lisa: How is this all come together for you today?
Carole: Today is actually really interesting to watch this organically unfold because I am practicing as a psychotherapist with EMDR and Internal Family Systems and Mindfulness, a stuff from Dan Siegel, but then also a year ago brought in a piece of equipment called the Transcranial Magnetic Stimulation machine by Neuronetics. With John’s help, we’ve been able to treat 12 people and basically assist people, not all 12 but I’d say 9 of the 12 have had significant reduction in their depression symptoms.
We use a scoring tool called the PHQ-9, which is a tool that the insurance companies like. It rates essentially 9 different symptoms, things like fatigue, problem sleeping, appetite problems, these kinds of things. People rate that on a scale of 0 to 3, 3 being worse so the worst score will be at 27. People come in for this treatment in the high teens or the 20s with the PHQ-9 score so it’s very, very depressed. They’re having a lot of problems, sometimes can’t work, things like that.
By the end of the TMS treatment, they’re down to 1, 2, sometimes 0. It’s remarkable and it’s not just we like … I like to use this scoring thing because it’s to quantify, I guess that’s the engineering part of me, then I just feel better. I think it helps people too to see that, wow, look at these scores how they’ve come down. It’s been an exciting process to learn more about the brain and then try to … Most recently I brought in another technique which I can tell you about as well, which is called neurofeedback which is another brain-based way of healing the brain.
Lisa: It’s interesting to me that you went to this Internal Family Systems model and Dan Siegel and you’re describing it as a way of integrating up and down and heart and brain, and it also sounds like maybe this is something you needed to do in your own life.
Carole: Most definitely. I found that I learned meditation 20 or 30 years ago and I have found that to be just a necessity now in my life, used to be something I practiced because someone told me it would be helpful, but now I actually feel the difference if I’m not coming from a more centered place. These tools have … I’ve done EMDR personally that’s been very helpful. I’ve done Internal Family Systems. I’m still doing that it’s very, very helpful.
Genevieve: Can we backtrack a little bit?
Carole: Sure.
Genevieve: Could you explain what TMS is, what it looks like to a patient?
Carole: Certainly. TMS stands for Transcranial, so it’s going to the cranium; Magnetic, using magnet; Stimulation, that’s stimulating the brain. What it does is it delivers a small magnetic pulse to the left prefrontal cortex. This is an area of the brain that we know and I have a picture if we want ever put it on. We know that the brain looks different in somebody who is a depressed person versus a non-depressed person. When someone is depressed, the brain is not balanced and there’s not a lot of metabolic activity.
Genevieve: We’re looking at a picture right now which is 2 brains; one is depressed, one is not depressed?
Carole: Right.
Genevieve: One that’s not depressed looks like a Ferris wheel or something.
Carole: It’s all lit up.
Genevieve: One that is depressed is very dark.
Carole: Right and just has a little bit lit up. What you’re seeing here is a lack of metabolic activity on the depressed brain and an imbalance where it’s not all communicating properly.
Genevieve: That’s scientifically shown and proven.
Carole: Yes. This is the PET scan from the Mayo Clinic, this particular photo. What we would translate that into for people to understand if you have a heart disease, your heart is going to look different. If you have diabetes, your pancreas is going to look different. We’re looking at depression now as an inflammatory illness. It’s a brain disease and then how do we treat that most effectively.
TMS is one tool for that. Obviously, the standards have been more in the lines of medication, talk therapy which can all still be helpful, but it’s nice that for people, who, that’s not working they have another alternative now.
Lisa: This is what was actually featured on the Dr. Oz Show I believe, not so long ago. How has that impacted your practice the fact that this has now become nationally recognized?
Carole: People are learning about it now, which is great. We’ve tried to spread the word through various means in the least, but I have not gotten that far so it’s been the chance person that hunts and googles depression and finds TMS. Now I’m getting calls almost daily from people who have loved … someone has told them about the Dr. Oz Show or they’ve seen it online now so it’s really, really helped.
Lisa: Who would be a candidate for TMS?
Carole: As we know now that depression is an inflammatory illness, in other words the longer it goes on the more inflammation occurs in the body and has a physical as well as emotional effect, really anyone who does not treat well with medication 1 or 2 times. We would give it a few times to try to get the meds going then they would be a candidate. What has traditionally been, TMS has traditionally been taught for the ones who are really treatment resistant but that’s not necessarily the case. It doesn’t need to be … They have to gone that far like 20 years of depression.
The actual best practices guidelines from the American Psychiatric Association now say that TMS should be the second line order of treatment. When someone is newly depressed, they come in to a psychiatrist or their PCP and they get evaluated and put on some sort of medication for it. If that medication is successful, great. If not, second line order of treatment is that we should look at something like TMS.
Lisa: That’s actually quite something. That’s very forward thinking of the FDA and the people who are putting together the best practices.
Carole: Yes. This is actually the American Psychiatric Association and that was done end of 2010.
Genevieve: We should just make it clear to listeners that this is FDA approved but it’s absolutely non-invasive and non-systemic. It’s just an electrical impulse.
Carole: Correct. It’s not like electric shock therapy which jolts your whole body. You have to have sedation. You can’t really do much for next day, you might lose memory. This is like in-and-out procedure. You come in 37 minutes for the treatment typically and then you would go back to work.
Lisa: What is it feel like? Describe to me when somebody comes in, what does it look like? What does it feel like?
Carole: It looks like a dentist chair and you tilt back in it and John places the magnet on the correct spot. The first treatment we have to figure out where the placement is and the correct dosage and so there’s an algorithm with the computer in the machine where we’re figuring that out using the motor cortex in somebody’s responses.
Lisa: How do you figure that out?
Carole: You want to know specifically?
Lisa: I’m fascinated. It’s just so interesting that you’re doing something that’s very physical for something that we always think about as being very emotional, spiritual, some sort of woo-woo thing, but this is very tangible.
Carole: Right. To explain and they showed this a little bit on the Dr. Oz is that a person has the right arm up like a hitchhiker and we have a magnet placed now. We move it to the motor cortex. That’s not where we’re going to do the treatment but that’s how we find the correct angle, the correct placement in the brain. There’s a thing called the homunculus that you probably know about, which shows where, depending on where you stimulate in the motor cortex, certain parts of your body will respond.
We’re looking for the specific area where the thumb twitches. We’re watching and loosening up holes so it’s tapped and we’re seeing if that thumb twitches or a finger twitches. Until it does, we move around and figure where that spot is. Then when we get that twitching, we know we’ve got the right area. We move forward and to the right placements about 5 centimeters forward.
Lisa: Does it hurt?
Carole: I didn’t like it. It does not hurt. It felt like a woodpecker. It’s hard to describe until you do it, but it’s a tap, tap, tap, tap, tap and then it pauses for 20 seconds and then tap, tap, tap, tap, tap pause for 20 seconds. We recommend people take an aspirin before they come, but I just recommend people like bring an iPod or something to listen to music. I didn’t think it was particularly pleasant.
Lisa: Like getting your legs waxed?
Carole: Yes. It’s not just like seeking out and go this will be fun. I didn’t think it was particularly pleasant experience, but it wasn’t painful.
Lisa: Tell me what EMDR … You talked about the use of EMDR for trauma. Tell me what does it like and what are the uses for that?
Carole: I think the place to start with that discussion really is also to explain trauma. There’s different types of trauma. There’s very simple trauma, which I mentioned was like a tsunami, wrong place wrong time.
Lisa: Sounds like a 911. You can’t help it. It just sort of…
Carole: It wasn’t personal. You’re hit with this people who suffer from PTSD after things like that. They can’t sleep, they have a startle response, so that’s 1 level of trauma then we move in to more of a little bit more personal which would be something like a rape, a home invasion where it’s more personal in the sense that it’s an invasion to you, but it’s not a person that you knew. Again, it’s a wrong place wrong time but a little more direct to you. Then when we go down to the most, which is when people have suffered from child abuse or neglect, it’s much more personal, so that’s more complex trauma.
Anyway, EMDR is used for all these different types of trauma and it’s very effective. In fact, like I said, I did it myself and that’s why I want to go get trained in it, moved, it’s thought move the therapeutic process along in terms of time maybe cut it by a third. What it’s actually doing is connecting the right and left hemispheres of the brain. The right holds the feeling and the affect of something. The left holds the narrative and the logic of it, if you will. When we have trauma, our brain stops. That integration stops connecting and so when we can do this by lateral stimulation, that’s what it is, so eyes are moving back and forth.
I also have like pods or earphones that can do the same thing, put sounds in, but the point is that it’s getting this connection going so that we move from that perhaps child state of being helpless and not understanding what’s going on and blaming ourselves typically as children to being able to integrate that experience and then come out of it more from an adult perspective, grown and more healthy, balanced obviously because you’ve grown and matured and be able to look at that experience adult-wise and say, “Wow.”
A lot of times it’s getting that you are not at fault. You suffered at hands of someone else or their problems caused them to be at certain way, just to facilitate a resolution a settling down of those charged pathways in the brain basically, so it’s quite stunning.
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Lisa: All of these things, whether it’s a personal trauma or a non-personal trauma, all of these things can contribute to depression.
Carole: Absolutely, yes.
Lisa: This is something that can start from very early on in one’s life and continue on through many years if not ever.
Carole: Correct. I think that’s the interesting connection as we talk about coming from this more depth perspective and knowing that there’s … you’re looking at underlying issues. I don’t see a real conflict because EMDR is getting to some of these much more deeper underlying issues and getting that to then resolve, so it actually maybe more of thought if it’s more cognitive type of treatment but in a way it’s working in a depth fashion.
Genevieve: You also spoke about neurofeedback. What is that?
Carole: Neurofeedback is a way of also integrating the brain and connecting parts that need to be connected. Sometimes brains are not integrated in the sense that they’re asymmetric in terms of their communication and other times it’s that we have a predominance of 1 frequency that’s driving a person. For example, when someone has a problem sleeping, instead of taking meds if you do neurofeedback that will bring down what we call the delta waves which are the waves we need to sleep. If they’re too high, then that person is not going to be able to fall asleep.
What neurofeedback does is essentially we do a quantitative EEG, so again we go technical, to map the brain and understand what areas of the brain are overactive, what areas are underactive. Then we use biofeedback essentially but for the brain treatment where a person is watching some game or whatever and they get positive feedback when the brain waves are within that range that we want them to be in and they don’t get rewarded when the brain waves are outside.
In other words, if someone is depressed, they’re going to have under arousal. They’re going to have brain waves that are too low and we want to bring those up. We’ll set a bar, let’s say … I don’t know. This is radio. Let’s say we have a scale 0 to 10 and it’s vertical. We’re going to set a bar like 4, let’s say, and everything above 4 they’re going to get rewarded for and so they’re going to say, “The brain starts to learn. There’s nothing that they didn’t solve until the brain learns to do this.” When they go below 4, which should be more with the depression kinda stuff, then they would not get rewarded.
The same is true with somebody who has a lot of anxiety. They have too high brain waves so we would set the bar, let’s say at 8, if I’m just using the same vertical visual and everything above 8 would not get rewarded and when they stayed under 8, their brain would get rewarded. Over time, brain changes with pulses and repetition and this works for TMS as well as neurofeedback. We try to treat people twice a week for about 45-minute sessions and over I’d say some people can respond and be completely finished within 20 weeks. Other people take a couple of years, so it just depends on what’s going on with the person.
Genevieve: The point of it is that because I’ve read about neurofeedback, especially with children and ADHD that you can … when you’re not on the machine, your brain has learned the way your comfort zone is and so you can access those waves when you’re off the machine to the point to train yourself like working out.
Carole: Right, exactly. You have read about it.
Genevieve: Yeah.
Carole: That’s the point.
Genevieve: I want to do it.
Carole: We call this neuroplasticity. It’s the buzzword around the brain now that we know. We used to think that there were certain times you had to learn something. If you didn’t learn that, then that was it. We know that there’s a plasticity throughout a lifespan so what we’re doing with these tools like TMS or like neurofeedback is we’re working with the neuroplasticity and trying to get the brain to hold how we train it.
Same with TMS. Sometimes people have to come in for a booster treatment. Sometimes they come in just for once every couple of months of treatment. It’s just to keep the brain in that range, keep it firing or to refer to neurofeedback keep the frequencies in balance.
Lisa: How is this similar or different from biofeedback?
Carole: Biofeedback would be, for instance, when someone has migraines. A great biofeedback treatment is to imagine that you are laying on a beach somewhere, put your hands out of your body. Imagine that there’s an umbrella over your whole body except for your hands and then your hands are baking in the sun. Do this for about 10 minutes. What will happen is your hands are going to get warm and the blood is going to come out of that constricted brain and the migraine will leave. That’s a biofeedback that’s working with the biological systems in the body.
Neurofeedback is similar although it’s the brain learning this. When actually someone does neurofeedback we’re not saying try to make this happen necessarily. It’s just they have an intent to have the brain helped with this and they’re watching some Pacman run around the screen whatever. When their brain starts to get okay, this is what makes them move then it starts traveling and that’s the conditioning, if you will. It’s like putting the blood out to the hands so it’s biofeedback for the brain.
Lisa: There’s also a similar thing and I don’t mean to keep pulling you into different therapies, but I’m fascinated by this because we’re approaching so many depression and psychological issues in so many different ways. There’s also something that the HeartMath Institute does, this whole entrainment thing and it’s similar where you’re attached. I think it’s your finger is attached to an electrode and then you look on the screen. There’s a balloon that goes up and down. Is there some similarities between that?
Carole: There are some similarities to that and there are other tools as well that can help train the breath and those different devices like that. They’re developing a website right now which will have that kind of equipment on it.
Genevieve: It’s very empowering for people. Rather than having to be medicated, they actually have the tools within them with the right conditioning that they can then help themselves.
Carole: I must say that it still needs to be an integrated effort. I hope people don’t take away from this that I just have to do TMS or I just have to do EMDR or neurofeedback, whatever. I find that people … The most success with this in terms of healing and really coming to balance is when we come at it from this multi-prong. It’s psychotherapy. It is maybe a brain-based treatment. It maybe a little bit of medication for a while, depending on the severity of somebody’s depression. Overall, I think when we have this wrap-around multi-pronged approach that’s the most beneficial to people.
Lisa: One of the things that you handed to me was this best practices treatment guideline for depression. I’m looking at the systemic drug side effects so there’s all kinds of side effects that occur within the body as a whole for drugs that are supposed to treat depression. What that also tells me is and I know this anyway as a healthcare provider, but there are very physical things that happen with depression there, things that you actually will have changes in your weight and what you want to eat. Is this a way that some people who might not consider themselves to be depressed is this a way that they can recognize that perhaps they do have depression as somebody’s physical side effects or physical effects?
Carole: Yes, definitely.
Lisa: Describe some of the things that you’ve seen people present with that might be physical in origin?
Carole: Physical in origin? I think what you described was the weight gain issue, the irritability I think that’s a big one. A lot of times when people are really irritable they don’t realize that that’s an angry depression or anxious depression. When people are burned out a lot of times too, they end up not recognizing that. It’s just they’ve had to paddle down too far for too long and it’s like an exhausted anxious depression.
Physically, I think when people end up with illnesses too, you can end up with high blood pressure and more heart disease, things like that from depression as well, so …
Genevieve: Chronic pain.
Carole: Chronic pain, exactly. It really can affect the entire physical body.
Lisa: Sleep, you mentioned. That’s one thing that seems to be very impacted by depression, anxiety, other psychological issues.
Carole: Absolutely. In fact, I know they’ve done studies recently where they believe they forget who the big grand day is in this perspective that they recommend the people with mental health focus and good, good sleep hygiene. I’ve worked with people like bipolar, whatever. If you can really get the sleep that you go to bed at the same time and wake up at the same time, have a little hour long sleep routine before you actually go to bed that whines you down, you’re not on the TV, you’re not on the computer, it makes a big difference in people’s emotional health.
Sleep is oftentimes where people … It’s very miserable to not get good solid sleep and that will oftentimes I think be a flag for people to get some help.
Lisa: Does all of us continue to appeal to that engineer side of you that the woman who went and got the MBA. It’s so interesting to me that you went to Depth Psychology and Internal Family Systems and yet you’re the woman who went to Purdue? Does this surprise you, wake up some morning surprised? Or you continue to just feel fulfilled?
Carole: I feel like I’m much more on my path, if you will, or in my correct line of work. There are other reasons why working an engineer. I was good at Math and Science so it’s not really great reason to become an engineer. I think that my own growth has informed me in the process. I still have that analytical head and so it helps I think to be able to learn and understand some of these technologies that can be intimidating perhaps to some, but I think that that helps me understand some of those.
My more genuine nature I think as I’ve grown through the years is more reflective and able to look at both right and left. I guess that’s a great way to put it. The left brain is totally this engineering MBA stuff typically and the right brain is much more of this internal, the patterns of things, how people are thinking, what’s driving them, what’s underneath their issues. It’s my own, I guess, integration as I’ve grown.
Lisa: Yeah and I think that was when I asked way back the question about this integration in your life that was where I was trying to get to was that piece. Were there challenges along the way for you personally as you’re exploring what your path was supposed to be?
Carole: Most definitely. Definitely, yeah. I think there’s a great term called the wounded healer, which I learned about when I was in graduate school and I think that that concept is very apt for myself anyway. When we go through life difficulties and things that are challenging, like a divorce and single parenting, things like that, then it allows you to relate in a deeper way I think and have empathy for people in all kinds of situations when you go through your own pain and struggles, and then find your way through to hopefully some sort resolution or at least insight about it so that it becomes something to learn from and grow from and not just the thing to overcome.
Lisa: I like that because I think this is the warrior mentality that we sometimes will espouse, like it’s a battle, it’s a fight. If you could just get to the other side, that’s all going to be good. What you’re describing is it really truly is integration. You’re never going to get rid of the things that you’ve gone through. They’re all woven into your past history.
Carole: Definitely and I think they can really help you as a person just the depth that comes from suffering and moving through things. There are still things that I’m struggling with but I find when you’re out there and trying to understand how things impact each other and where things fit then it all comes together.
I always remember the wounded healer image when working people, the humbling experience to work with people and to be a witness to their pain and whatever particular issue they’re going through. I think having had my own just makes you more able to be present not have to … I guess that’s another good point is that you don’t push away the pain, you don’t try to keep something from touching you. You’ve come move it in and digest it and let it move through.
I know in my pre-doctoral internship I was in a facility that was very, very challenging working with sexually-abused children and girls who were pregnant with their father’s babies and very challenging things. There was no support emotionally for that and the fact that the thought was you just sort of … I think people just disconnect from the pain and at the end of it, it was overwhelming. I really thought, “Wow. How do I learn how to do this work?”
With help of the post-doctoral internship and Dr. Sandy Cole particularly, really helped work it through and understand how you can use empathy in a positive way but not let it pierce you to the core where you’re going to not be able to work properly.
Lisa: I just think it’s so exciting what you’re doing, Carole, because it feels like the cutting edge of understanding depression as a physiologically-based disease and it’s about time that that came about and that you are actually offering tools to people to help them. How would people who are interested in finding out more about TMS, neurofeedback, EMDR go about asking their doctor or how do they find out more?
Carole: Sure. They could ask through doctor. We do have a website that’s in production that will talk about all of these, the neurofeedback and the EMDR and everything, but right now www.tmsofmaine that would be the website to look at. They can call me at 233-8804.
Genevieve: It is prescribed though.
Carole: I want to make … Let’s put this in because this is really important. This is a psychiatric procedure. I’m a psychologist just to be clear, so I’m not an MD or DO and psychiatrist needs to prescribe this. Presently, Mike Patnaude, who is a psychiatrist, he’s the medical director for the company, and he and another gentleman Dan Filene has also been trained, so either one of them would do a psych eval and evaluate the person and be there for the initial treatment to figure out the placement, to figure out the dosage so it’s still a medical procedure.
I’m just very interested in it so figured out a way to bring this to be. Then John McCain is the coordinator that does the rest of the treatments after we’ve gotten that all figured out, and carries out the doctor’s instructions.
Lisa: I’m so glad to have finally met you and I’m really excited by the work you’re doing. It’s interesting to me because as we’ve said over the last, I guess this is show 34, so the past 33 shows it’s all paths kindof leading to the same place and I love the technologies, finally bring us to a place that we’ve known about for centuries and other ways trying this medicine and that sort of thing.
Carole: It is exciting. It’s exciting to see that there’s new opportunities for people.
Lisa: Thank you for coming in, Carole.
Carole: Thank you, my pleasure.
Male: This segment of the Dr. Lisa Radio Hour and Podcast is brought to you by the following generous sponsors. Mike LePage and Beth Franklin of ReMax Heritage in Yarmouth, Maine. Honesty and integrity can take you home. With ReMax Heritage, it’s your move. Learn more at rheritage.com; and by Tom Shepard of Shepard Financial with offices in Yarmouth, Maine. The Shepard Financial team is there to help you evolve with your money. For more information on Shepard Financial’s refreshing perspective on investing, please email [email protected].
Our bodies are often the first indicators that something isn’t quite working. Are you having difficulty sleeping, anxiety or chronic pain issues? Maybe you’ve had a job loss, divorce or recent empty nest. Dr. Lisa specializes in helping people through times of change and inspiring individuals to create joyful sustainable lives. Visit doctorlisa.org and schedule your office visit or phone consult today.
Lisa: Today we have the good fortune to speak with Dr. Bryan Woods, who is an attending psychiatrist at McGeachy Hall at Maine Medical Center. Bryan is certified through the American Board of Psychiatry and Neurology, and is an attending at Maine Medical Center.
Bryan, you’ve got this very impressive resume. We’re thrilled to have you here. Thanks for coming in.
Bryan: Thank you for having me.
Lisa: I have Genevieve Morgan sitting across the microphone from me.
Genevieve: Good morning, Bryan.
Bryan: Good morning.
Lisa: I wanted to out you almost immediately as being the husband of Dr. Jeanette Andonian, who came in and did our kid show a few weeks back.
Bryan: Yes.
Lisa: We know you’re going to follow in her footsteps and do a really great job this morning.
Genevieve: I’ll do my best.
Lisa: Today we’re talking about something that’s a little bit different than kids and parenting although there’s definitely some crossover. We’re going to talk about dark days or depression. This is something that maybe is under recognized in our society. You get to see a lot of people coming in to McGeachy in Maine Medical Center who are impacted by this. In the general population, what type of incidence is there?
Bryan: About 15% of people will have a major depressive episode in their lifetime, but probably the majority of people are familiar with depression in one form or another, either minor depression or something we call dysthymia.
Lisa: Tell us what is the difference between major depression.
Bryan: Dysthymia is a minor form of depression. It is really less in severity. It tends to be longer in duration but less in severity is the essential difference. Dysthymia refers to a specific kind of minor depression, which is also different from what people would describe as the blues or just feeling down for a period of time.
The biggest differences between minor and major forms of depression are the intensity of the emotion, the intensity of the sadness. People who are blue are dysthymic. They typically feel sad but people with a major depression typically feel morose, something more than sad. Also the duration of the illness, to meet criteria, at least DSM criteria for major depressive episode it has to occur for a period of at least 2 weeks. Typically, the people we see in a clinic have had major symptoms for months or even years.
Then the third major difference is that major depression affects more areas of a person’s life than just their emotional life, just the way they feel in terms of spectrum of sadness to happiness. Major depression affects their thinking or the cognitive life. People tend to have slowed thinking. They have problems with memory. They have problems within decision, self-doubt and it has also effects on the body itself.
People with major depression tend … Because there is a connection between the mind and the body, people have real body or somatic symptoms we call it. They’ll generally feel a fatigue. There’ll be a sleep disturbance, either sleeping too much or too little, a lack of energy, weight gain or weight loss, and psychomotor agitation or retardation. It means they really have too much pointless energy or just not enough energy at all and not moving very much.
Lisa: There’s also something called an adjustment reaction or adjustment disorder?
Bryan: Yes. Sadness can occur in all kinds of different context, including adjustment disorders. An adjustment disorder is typically a briefer reaction in response to a specific negative event that’s occurred in a person’s life. To qualify as an adjustment disorder it has to be a set of symptoms that would typically be considered exaggerated for whatever the negative event was.
Lisa: How do people know when to get help from a psychiatrist?
Bryan: I think when people notice symptoms affecting their lives, if it starts to affect work, starts to affect their relationships or their quality of life that is really the time to seek help and it’s something more than just feeling sad on a few days or a couple of days a week.
Lisa: What type of help do you provide at McGeachy through Maine Medical Center?
Bryan: We have a team of at McGeachy and we provide psychopharmacology and psychotherapy, both individual and group therapy, the primary modalities at McGeachy.
Lisa: How do people know that it is time to seek help, whether it’s through therapy or whether it’s through medication? What tends to be the tipping point?
Bryan: I think people really reach a point where they’re unhappy enough, they just feel they need help and, again, I think it’s when it really starts to affect their lives. People will notice it affects their job, their relationship with friends, their relationship with their family. When people notice those kinds of changes I think that’s when they should get help. When they notice their life is different; my life is different and is significantly different in a negative way because of this depression that’s the time to get help.
Lisa: Do you have patients that come or are referred to you because their significant other or their friends have told them that they’re depressed? In other words, their relationships have changed significantly but they don’t recognize it.
Bryan: Yes, you do see that from time to time. Everybody’s depression manifests in different ways and some people have more insight into their own depression than others. Some people are very aware of their depression on a moment-to-moment basis. Other people don’t notice it and it’s family members have noticed that they’re different.
Lisa: How do you find yourself impacted by dealing with people day in and day out who have psychiatric problems?
Bryan: It can be a challenge at time to talk to people who are really in a bad place for 7 or 8 hours a day, 5 days a week. On the hand when you’re able to help people, that provides a tremendous amount of gratification. I think that’s what keeps most clinicians going is the people we can help and make a significant difference for them.
Lisa: You feel like there’s enough people that are in your practice that you are helping that this keeps moving you forward. You see this is somewhat of a mission perhaps?
Bryan: We don’t help everybody. My general impression treating depression is that there’s a small number of people who have a dramatic response to treatment and there’s a small number of people who really have no response. The majority of people have a moderate response so you are able to help most people.
Male: We’ll return to our interview after acknowledging the following generous sponsors. Akari, an urban sanctuary of beauty, wellness and style, located on Middle Street in Portland, Maine’s Old Port. Follow them on Facebook and learn more about their new boutique and medispa at akaribeauty.com; and by Dr. John Herzog of Orthopedic Specialists in Falmouth, Maine, makers of Dr. John’s Brain-ola cereal. Find them on the web at orthopedicspecialistsme.com.
Lisa: If someone is on a depression medication, are there other things they can do in their life to help boost the effect or shorten the time they have to be on the medication? Are there other therapies or nutrition or anything else you recommend?
Bryan: I think treatment of depression is being approaced a little bit different these days as opposed to years ago. We were treating depression as more of a lifestyle change that a lot of patients need to make. For some people who have their lives in a relatively good place, perhaps an anti-depressant medication is all they need but for the majority of people, they need more than that. There are multiple things wrong in their lives and really the most effective approach is a lifestyle approach.
I tell people there are 3 modalities with use to treat depression; medications, psychotherapy and then there are changes you’ll need to make in your own life to effect an improvement in your symptoms. I think that those lifestyle changes are very important. I think if people are depressed and they’re staying at home and they’re lying on the couch all day and they’re watching daytime television, taking a pill in the morning chances are isn’t going to be enough to really bring them out of that depression. They’re going to need to get up off the couch, start exercising really change their life.
I always recommend exercise, a balanced diet and a good sleep hygiene for patients. I think that those lifestyle changes are just as important for a lot of people as medication or psychotherapy is.
Lisa: What are some encouraging developments or trends that you see in your profession or on the horizon?
Bryan: I think parity for mental health reimbursement has been a positive development over the past years. I think at a state or federal level. There have been bills that have been passed to ensure … Parity meaning that people receive the same coverage for their mental illness that they do for their medical illness and I think that is a real positive development.
In a more medical or research front, I think genetics hold huge promise. Most mental illnesses are thought to be the causes or thought to be a combination of genetics and the environment or life experiences. I think we usually know more about life experiences when do about a person’s genetics. With the human genome project now, we’re going to be learning a lot more about the genetics.
I think that potential is largely unfilled. Again, there’s a large gap between the DNA code and an individual person, but I think as times goes on those gaps will be filled in and genetics will inform our assessment of individual patients and an individual patient’s genetic makeup will give us a lot more insight into what predispositions they have to mental illness and also what treatments will be effective for that individual patient.
Lisa: Where do people find out how to reach you or McGeachy Hall or Maine Medical Center? What’s the best way to access this information?
Bryan: MaineHealth has an intake number, 761-6644, for access both inpatient or outpatient services for adults or children and that’s the best way to access the system.
Lisa: Dr. Woods, this has been very helpful. I think our listeners are going to come away with some significant insights regarding depression in the state of mental illness in the world and perhaps ways that they can seek help. We appreciate your coming in and talking to us today about depression and dark days.
Bryan: I’m happy to do it and thank you for having me.
Lisa: This is Dr. Lisa Belisle. You’ve been listening to the Dr. Lisa Radio Hour and Podcast show number 34, Dark Days, airing for the first time on Sunday, May 6th 2012 on WLOB Radio, streaming wlobradio.com. Our guests have included Dr. Carole Orem-Hough and Dr. Bryan Woods.
If you are struggling with depression or transition of some sort or crisis, we invite you to go to that Dr. Lisa website, doctorlisa.org where we have listed resources, such as the Cumberland County Crisis Response, 774-HELP and the Sexual Assault Response Services of Southern Maine. We hope that some of these resources will be helpful to you as you’re dealing with your own dark days and we encourage you to let us know about your own resources perhaps that you found in this area. We also welcome your feedback about the show.
The Dr. Lisa Radio Hour and Podcast is pleased to be sponsored by a number of supportive and enlightened individuals who are out doing good works in the community. Tom Shepard of Shepard Financial is speaking about his concept, Evolve With Your Money on Friday, May 11th at Volunteers of America, A Celebration of Caring in Brunswick.
John Herzog of Orthopedic Specialists has a lecture on the integration of health, diet and exercise on May 18th at One City Center in Portland.
Robin Hodgskin of Morgan Stanley Smith Barney is offering the lecture Disrupt Yourself, featuring speaker Whitney Johnson at May 10th 2012 at the Regency in Portland.
You’ve been listening to the Dr. Lisa Radio Hour and Podcast. We appreciate your being a part of our community. We hope that you will take the time to go to our website, doctorlisa.org, to like us on Facebook, to subscribe to our e-News and to generally let us know how you think we’re doing. Thank you for being a part of our world, may you have a bountiful life.
Male: The Dr. Lisa Radio Hour and Podcast is made possible with the support of the following generous sponsors, Maine Magazine; Mike LePage and Beth Franklin of ReMax Heritage; Robin Hodgskin at Morgan Stanley Smith Barney; Dr. John Herzog of Orthopedic Specialists in Falmouth, Maine; Tom Shepard of Shepard Financial; Booth; UNE, the University of New England; and Akari.
The Dr. Lisa Radio Hour and Podcast is recorded in downtown Portland at the offices of Maine Magazine on 75 Market Street. It is produced by Kevin Thomas and Dr. Lisa Belisle, editorial content produced by Genevieve Morgan, audio production and original music by John C. McCain. Our assistant producer is Jane Pate.
For more information on our hosts, production team, Maine Magazine or any of the guests featured here today, visit us at doctorlisa.org and tune in every Sunday at 11am for the Dr. Lisa Radio Hour on WLOB Portland, Maine 1310 AM or streaming wlobradio.com. Show summaries are available at doctorlisa.org. Download and become a podcast subscriber of Dr. Lisa Belisle through iTunes. See the Dr. Lisa website or Facebook page for details.