 By: Jadon Webb. M.D., Ph.D.
Borderline Personality Disorder is a very common condition, and it very often gets confused with (or can co-occur with!) bipolar disorder, major depression, post traumatic stress disorder, and other psychiatric conditions. Unfortunately, psychiatric medications often do not provide as much help for depression symptoms in people who also have borderline personality. The depression symptoms can be harder to treat with medications, which can make finding the right medication regimen an additional challenge. Thankfully, other treatments are being developed that offer hope and promise for not only treating depression in borderline personality, but may also treat some of the core symptoms of the disorder itself. One especially promising treatment is transcranial direct current stimulation (tDCS). This is essentially the application of very low electrical stimulation to certain parts of the brain. Because the current is so low and safe, this can be safely done in outpatient settings, even sometimes at home A recent study showed that tDCS could improve executive functioning and control over negative emotions in clients suffering from borderline personality disorder. Other recent studies have also found positive results using tDCS. This could really be a game changer for patients who are suffering and not finding sufficient relief through standard medication approaches. We are excited to see more upcoming research on using tDCS for borderline personality disorder, and meantime, given how safe it is, it may be worth considering now. Consider talking to your clinician about if tDCS might be right for you!
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 By: Jadon Webb, M.D., Ph.D.
In January 2022, we were excited to publish the first ever report of using medication to treat the symptoms of misophonia. We feel that it is well past time to take misophonia symptoms seriously, and develop strategies and guidelines for using medications to help treat misophonia when it is safe and appropriate. Misophonia (and also Misokinesia) triggers often cause the patient’s brain to release a surge of adrenaline, causing “fight-or-flight” symptoms. These symptoms can include feelings of anger or rage, racing heart, tense muscles, feeling flushed or sweaty, and having “tunnel vision” where it can be hard to think about anything other than stopping the trigger. Medications that reduce fight-or-flight symptoms can be helpful in mental health disorders such as PTSD, and we think can also be very helpful in some cases of misophonia. Misophonia is still a relatively new and often misunderstood condition, and so it can sometimes be frustrating trying to describe it, and feel as if you have to “defend” the diagnosis. Because of this, it can sometimes be helpful to instead describe the specific symptoms that you are having in response to triggers when discussing possible treatments, including medications. This can help your provider collaborate with you to find medications that specifically target the unwanted symptoms. Good days are coming, misophonia is being taken seriously, and there are increasing possibilities for help!  By: Jadon Webb, MD, PhD
Safe, effective help for depression can sometimes be tricky. Medications such as antidepressants, and for severe depression ketamine, can be very effective, especially when combined with talk therapy. But these sometimes do not work well enough on their own, or they may have unwanted side effects. Many treatments of depression also take a long time, sometimes even weeks before they start to work. This can be a lot to ask of a patient, especially when they are suffering from severe depression. One of the challenges in how to fight depression is finding safe, rapidly effective treatments. As mentioned, ketamine can be a very effective, rapid antidepressant that we also use here at Bloom. Another possible rapid treatment for depression may be intravenous Vitamin C! Single infusions of Vitamin C in mice caused rapid antidepressant effects and regrowth of neuronal dendritic spines, very similar to the effect observed from ketamine infusion treatment. There is also some evidence that Vitamin C may help with symptoms of anxiety as well. This rapid antidepressant effect does appear consistent in multiple studies in mice, but remains to be worked out in humans. Meantime, many people incidentally notice feeling better after a Vitamin C infusion, and it is generally quite safe. Vitamin C is, after all, an important natural vitamin! Also, since it is readily water soluble, excess Vitamin C that is not needed can generally be excreted from the body with relative ease. If you need help with depression, and are wondering about rapid, natural treatments, talk to your provider for more information about Vitamin C!  By: Jadon Webb, M.D., Ph.D.
Getting safe, effective help after a traumatic experience can be difficult. Trauma can cause many different symptoms, including insomnia, nightmares, severe depression, generalized anxiety, panic attacks, and of course post-traumatic stress disorder (PTSD). Psychotherapy and prescribed medications can be very helpful. In severe or treatment resistant cases, ketamine can also be helpful. Meantime, most of us would prefer the least invasive, most “natural” way of addressing these symptoms. One of the challenges in treating trauma is helping the brain to re-frame bad memories as being less threatening. Research is underway to figure out how to help the brain “re-learn” to remember a safer version of the past event so that it does not continue to haunt the patient. Ketamine can help facilitate this neural rewiring process, and can be a very helpful way to boost the effectiveness of trauma therapy. It also turns out that a simple puzzle game, Tetris™, can help speed the healing of intrusive traumatic memories during therapy. In a 2018 study, patients who had just been in an auto accident were randomized to usual talk based trauma therapy, with half of patients also playing Tetris™ for 20 minutes during the session. The patients who played the game had fewer intrusive memories about the event. Simply playing a game reduced distressing memories from a trauma. This is truly amazing! We can’t wait to see how this safe, affordable, “natural” idea can be used to help people recover from the serious symptoms of trauma. Natural Treatment Highlight: Lemon Balm as a possible treatment for depression and anxiety1/26/2022  By: Jadon Webb, MD, PhD
Getting the safe, effective help for depression and generalized anxiety can sometimes seem difficult. Psychotherapy and prescribed medications can be very helpful, and are often the first-line treatments for these conditions. But even these treatments do not always work as well as we would hope, and medications can also have unwanted side effects. We totally understand why so many people are hesitant about starting psychiatric treatments. Nature itself provides us many proven ways to help with depression and anxiety. Natural things such as bright light, exercise, and socialization are critically important treatments of depression and anxiety. Lemon Balm (formally known as Melissa officinalis) is an herb that comes from the mint plant family. Some studies suggest it can potentially lower cholesterol and blood pressure. It may also provide help for depression and anxiety. Certain natural supplements also have scientific evidence for possibly being another one of the natural things to help with depression and anxiety. A scientific review from 2021 suggests that lemon balm appears to help with depression and anxiety, and that it seems to have few side effects. Many people with mental health concerns also often complain of “brain fog” and impaired cognition. There are also studies to suggest lemon balm may help with cognition, and it has even been considered as a possible adjunctive treatment for dementia. We caution that supplements (including lemon balm) do not have as much scientific evidence as an FDA regulated medication, and it is hard to be certain of the purity of any formulation. But that said, when considering how to fight depression and anxiety, it is important to consider all possible options, including those that nature provides! Cold Temperatures and Depression? Cryotherapy as a possible treatment for depression and anxiety1/4/2022  Getting help for depression and generalized anxiety can be tough. Talk therapy and medications can be very helpful, but do not always work as well as we would like. It is especially hard to completely treat severe depression. Treatments can also have unwanted side effects, so it is perfectly understandable why some patients are skeptical about what can be done.
Nature provides us many effective ways to address mental health concerns. Sleep, bright light, and exercise can be extremely effective treatments of depression and anxiety. Temperature may also be an unexpected ally. A study from 2020 found that briefly freezing people down to -100C (that’s really cold!) 10 times over about two weeks greatly reduced their depression symptoms. These were patients already taking an antidepressant, but not improving sufficiently on it. Depression symptoms clearly improved, and so did overall quality of life, which is especially impressive. Quality of life is an especially difficult thing to improve with psychiatric treatments. The idea of nearly freezing one’s self goes way back in our history. Many people in cold climates swear by the health benefits of swimming in extremely cold water for short periods of time. Maybe these “winter bathing clubs” like the Polar Bear Club are onto something more than just giving thrill seekers something to do. Maybe there really are mental health benefits that we never bothered to formally study until now? We still do not know the mechanism of why freezing would help with depression, and it is certainly possible that this method relies heavily on placebo effect since it is such a dramatic-looking treatment to undergo (dramatic looking treatments often have larger placebo responses). However, this latest study apparently administered a similar looking freeze protocol to the placebo clients, but just did not freeze them with as cold of temperatures as in the experimental condition. Since both groups underwent the dramatic looking procedure, perhaps there really is something specific to the very cold temperatures. We are by no means advocating you run out and jump into a cold lake, but we felt it was important to share this potentially effective idea of using cold temperature as one of the things to help with depression!  By: Shannon Keane, NP-C
Botulinum toxin type A (BTX-A), also known as onabotulinumtoxinA or Botox®, is commonly known for its aesthetic use in treating glabellar frown lines. Recent evidence suggests that Botox® injections may have beneficial psychological effects. A dermatologist published the first set of case series in 2006, reporting the potential role of Botox® in the treatment of depression. The research results revealed that Botox® injections were correlated with a significant improvement in depressive symptoms when compared with placebo. The potential mechanisms behind this correlation has not yet been proven, but many have proposed possible ideas of why Botox® may help ease depressive symptoms. The most common theory is the facial feedback hypothesis. This hypothesis, originated by Darwin in 1872, stated that one’s facial expression may directly affect their emotional state of mind. There are 42 individual facial muscles in a human being. Current evidence suggests that the corrugator muscle is activated in the forehead when one tends to be experiencing negative emotions. The corrugator muscle is located beneath the eye brows. One study found that depressed people tend to have overactive facial muscles when compared to the facial muscle movement of non-depressed people. Botox® injections into the corrugator muscle limits movement in that muscle, therefore minimizing the ability to frown or make a negative facial expression. This action may block typical sensory feedback from the nerves, particularly to the left amygdala to the brain. Research has demonstrated that over-activation of the amygdala is associated with negative emotions. Negative emotions may include: anger, depression, anxiety and fear. Botox® seems to actually reduce the activation of the amygdala by blocking the release of the neurotransmitter, acetylcholine. This results in a positive effect on mood. Another published study proposes that Botox® may produce antidepressant effects due to systemic distribution after injection. It’s important to note that the content of circulating Botox® is actually very low post- injection. Botox® might be a great option for you if you are opposed to taking a daily medication, or feel that you have tried many different anti-depressants, and have not yet seen improvement in your depressive symptoms. Botox® is a great alternative treatment option for many people suffering from depression. Ask your provider at Bloom about it at your next appointment to see if you are a good candidate!  By: Jadon Webb, M.D., Ph.D.
By the time most of us seek help for depression or anxiety, we usually are in a tough spot. Severe depression, anxiety, bipolar disorder, PTSD, and other diagnoses can become serious enough to clearly be a medical illness requiring prompt treatment. And while you are being treated, it is important to find ways to measure and track your symptoms to help ensure treatment is on the right track. When someone is suffering from moderate to severe major depression or generalized anxiety disorder, clinical rating scales such as the PHQ-9 (depression) or GAD-7 (anxiety) are very useful ways to gauge severity of the illness and monitor recovery during treatment. But as someone gets help for anxiety or depression, and begins to recover, these clinical rating scales can start to fade in how useful they are, since they were designed to measure fairly severe symptoms. They are less useful for measuring the overall quality of your life. Many patients in our practice note that they will recover from acute symptoms of severe depression or generalized anxiety disorder, and will truly feel better, but will; still have a sense that their life is still not as good as they want it to be. They can still feel lonely, and unfulfilled. There are some newer rating scales that can help measure overall life satisfaction, such as the Oxford Happiness Questionnaire. It can often be meaningful to take a test like this to get another look at how satisfied with life you currently are. If something is amiss in your life quality, this could mean needing to adjust what you do in talk therapy, or perhaps make some healthy needed life changes (exercise, socializing, job change). On occasion this can be a subtle indicator of a need to adjust medication for e.g. treatments of depression or anxiety. Life satisfaction questionnaires can be a very useful extra tool to assess how well you are doing overall. Consider trying this out, and talk to your provider about it!  By: Shannon Keane, NP-C
A study conducted in Taiwan in 2020 revealed that a higher reported “happiness” state during ketamine infusions predicted a better outcome in patients experiencing treatment resistant depression. This study assessed happiness levels three times throughout a low dose ketamine infusion. The researchers used a visual analog scale for happiness (VASH) which is essentially a rating scale from 0 to 10 measuring the level of reported happiness ( 0 being “not at all”, and 10 being “very”). The researchers found that there seemed to be a correlation between reported higher levels of happiness during the ketamine infusion with a greater reduction in depressive symptoms. This study demonstrated how the subjective mental state during a ketamine infusion is quite important when predicting if a ketamine series will be effective. Out of 71 patients in the study, 44 of them reported feelings of happiness during the ketamine infusion. Each patient’s depressive symptoms were monitored from pre-infusion to 2 weeks post infusion using the Hamilton Depression Rating Scale (HDRS). The researchers found that patients who consistently reported higher levels of happiness during their ketamine experience, also reported a reduction in their depressive symptoms for up to two weeks post-infusion. Ketamine infusions can help with depression, and can help you or a friend fight depression. This treatment for depression has demonstrated to be an effective, fast-acting and revolutionary option in psychiatry. Learn About Ketamine Therapy at Bloom Mental Health Referenced Study: Chen MH, Lin WC, Wu HJ, Bai YM, Li CT, Tsai SJ, Hong CJ, Tu PC, Cheng CM, Su TP. Happiness During Low-Dose Ketamine Infusion Predicts Treatment Response: Reexploring the Adjunctive Ketamine Study of Taiwanese Patients With Treatment-Resistant Depression. J Clin Psychiatry. 2020 Nov 10;81(6):20m13232. doi: 10.4088/JCP.20m13232. PMID: 33176071.  By: Jadon Webb, MD, PhD
It can be overwhelming being a parent looking for help dealing with depredssion in your child. You obviously want the safest, healthiest treatments possible. No experiments or high risk ideas! If you are considering medication for help with depression, you probably can see how many different possibilities there are. Dozens of different therapies and medications all promise help for depression, so how can you as a parent sort out the best ones? A scientific review from 2020 may be able to help you sort through the options. These researchers compared common medications and therapies that are used as treatments of depression, to see which was the safest and most effective. Surprisingly, the winner of it all was fluoxetine (generic Prozac™). After sorting through mounds of evidence, fluoxetine appears to have the strongest evidence for treating moderate or severe depression. This is extremely useful as a starting point for selecting a good first treatment for your child. Fluoxetine has been used since the 1980s, so there is considerable short and long term safety data. It is also much cheaper (sometimes literally hundreds of times cheaper) than some of the newer antidepressants that have no proven clinical advantage. This paper also notes that combining therapy with medication (such as cognitive behavioral therapy) is likely an even more effective approach. At Bloom we strongly encourage all clients with depression to be in therapy while we treat them. It works much better! If your child needs help for depression, especially for moderate to severe depression, talk to your provider about some of the trusted, older antidepressants such as fluoxetine. |
about the authorS
Jadon Webb, M.D., Ph.D.
Owner Bloom Mental Health 
Shannon Keane,
MSN, FNP-C, PMHNP-BC Clinical Director Disclaimer: this blog is NOT intended as medical advice and does not imply any kind of specific guidance or treatment recommendations, and should NOT be used to guide a treatment protocol. (read full disclaimer)
Afton Williamson,
DNP, MSN, FNP-BC Family Nurse Practitioner |