As we embark on this season of holidays, I am mindful of the opportunity to take a step back and express gratitude. I am fortunate to work with patients and their loved ones, providers and mental health advocates who have a heart for, and deep commitment to, mental wellness. Thank you to each of you for what you are doing; you enrich my life as I watch your hard-fought journeys and your continued efforts to find meaningful breakthroughs for the toughest conditions we face.
Unfortunately, this season highlights mental health challenges …whether as a function of the time of year and related stressors such as overscheduling and family dynamics, or as a function of the crutches and substances used in order to manage discomfort and pain.
As you know, seasonal affective disorder (SAD) is a condition that impacts roughly 500,000 persons per year in the U.S. (source: Cleveland Clinic) and is attributed to less sunlight and darker days impacting the hypothalamus, or part of the brain that manages sleep, appetite, sex drive, body temperature, mood and activity. It appears that some people need more light to regulate bodily functions and this condition can be exacerbated in locations that do not have as much natural light in winter months. Symptoms of SAD include lack of energy, irritability, weakened immune system, lack of concentration, reduced libido, sleep problems, alcohol or drug use, anxiety, and thoughts of death or suicide.
Bright light or phototherapy is an effective treatment in up to 85% of SAD cases, particularly when combined with talk therapy and CBT as well as anti-depressants where necessary. Light therapy facilitates the release and absorption of serotonin, a neurotransmitter that affects how we feel, as well as the regulation in production of melatonin, the hormone produce when we are exposed to darkness.
When faced with darker days — or anticipating the stresses of the upcoming holidays and inherent challenges of endless tasks, high expectations and troublesome relatives – it’s not uncommon to turn to relief from drugs or alcohol under the guise of celebrating and increasing our sense of pleasure, or managing through and reducing our sense of pain. Whether it’s alcohol or drugs, the tipping point occurs when we think we need the substance to carry on, hide our use and/or will do whatever it takes to continue using.
Although all classes of alcohol and illicit drugs are problematic, last month the President declared a public health emergency to both highlight and manage the opioid epidemic which has exploded in the U.S. in recent years. In 2015, for example, American’s represented an astonishing 99.7% of the world’s opioid use, and from 2002-2016 overdose deaths from just one opioid — heroin — increased 533% from 2,086 to 13.219. Persons with depression are especially vulnerable to the use of opioids because these drugs disrupt the perception of pain and heighten feelings of euphoria…but the impact is temporary and users need more and more of the substance to maintain their sense of equilibrium. The ultimate price is paid by those who take their own lives, suffering silently under the weight of depression.
The cycle of pain, and the search for depression treatment, can and must be broken by more effective treatments that provide real relief. Deep TMS is one element in the toolbox. The game changer with TMS is that unlike antidepressants that may show a response or reduction in depressive symptoms) TMS treatment leads to remission (absence of depressive symptoms) in over 70% of patients when combined with other treatments (Harel et al, 2011). Isn’t it time for us to open our minds to new treatment options like this one that have proven clinical and real-world results and no adverse side effects?
As we move through the holidays and look to the new year I wish you peace, tranquility, wellness and meaningful, fulfilling relationships. Be well….