By: Jadon Webb, M.D., Ph.D.
Treating depression can be particularly difficult for people who have had traumatic things happen to them in the past . A history of childhood trauma can make symptoms of anxiety, depression, and Post traumatic stress (PTSD) harder to treat and more medication-resistant. This has been a source of continual pain and frustration at clinics across the country trying to help. An incredible new study published in 2021 found that ketamine treatment of depression was very effective for people who had suffered childhood trauma. In fact, there is some evidence that ketamine might be even more effective at treating adult depression if an individual had suffered childhood trauma. This is similar to findings from a 2019 study, and is completely unlike any other treatments for depression which generally don't work as well for those who have suffered trauma. This study offers great hope for those who carry around ancient wounds and continue to feel sad and hopeless. We also know that ketamine can be very effective at treating PTSD symptoms that can come from trauma, making it an even better choice for some people suffering from PTSD who are also depressed. We are eager to see this work replicated from other research groups. If the finding continues to hold, this is a game changer for those with trauma in their past.
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By: Jadon Webb, M.D., Ph.D. Ketamine is one of the most effective treatments we have for treating severe and treatment-resistant depression. We also know it is unusually good at treating feelings of hopelessness and suicidal thoughts. Given how remarkably effective ketamine has been at treating depression, there has been intense interest in the clinical and research community around what other kinds of mental health problems ketamine might treat. For years, clinicians incidentally noticed that it seemed to help clients who had experienced trauma, and were suffering from post-traumatic stress disorder (PTSD). Ketamine was increasingly being given for PTSD, with reports of it being highly effective, but no rigorous study had yet been done on whether it truly was effective, especially for chronic, long term PTSD. This year (2021), a well-designed, randomized clinical study was published in the American Journal of Psychiatry confirming that ketamine does seem to be very effective at treating chronic PTSD. This is extremely good news for anyone suffering from PTSD. This study treated 30 patients with chronic PTSD, and gave them six IV ketamine infusions over 2 weeks (a typical treatment protocol). It is worth noting a particularly impressive part of this study: their control group was not the usual inactive placebo as is done in most of these types of studies (such as giving a saline injection). Instead, the placebo arm of the study was the benzodiazepine midazolam, which produces clear psychiatric effects when given intravenously. Using midazolam for the control group was an elegant way to separate out the placebo effect, and see if the ketamine was producing real results in treating the PTSD. If study participants could feel psychoactive effects of receiving an IV infusion, there would be a strong chance they could experience a strong placebo effect, compared to if they had received something inactive like saline. By having both the active and placebos produce psychiatric effects, this problem is reduced, and it makes the results of this study much stronger and believable. The results of the study are quite impressive. Two-thirds of study participants responded to ketamine, while only 20% seemed to benefit from the midazolam control group. This is a very large effect for these types of clinical studies, much larger than is typically seen with oral medications. In plain language, it indicates that ketamine was extremely effective for treating these patients suffering from chronic PTSD. Bottom Line: If you or someone you are caring for is suffering from severe PTSD, or chronic PTSD that is not responding to conventional medications, it may be worth considering ketamine as a next step. There is great hope for this sometimes difficult to treat disorder! By: Jadon Webb, M.D., Ph.D. We know that ketamine is extremely effective at treating depression, hopelessness, and even suicidal thoughts. We are asked all the time if it is also effective at treating anxiety. A new study published this year suggests that it is effective in treating anxiety symptoms, and may be particularly effective at treating phobias. A phobia is excessive fear of a particular thing or situation. For example, being too afraid of spiders, storms, or getting into elevators. Another very common phobia is social phobia (related also to agoraphobia), which is excessive fear of being in certain social situations. The Covid pandemic and social isolation measures seem to have made social phobia symptoms much worse for many people. We have had numerous patients reach out for help for the first time because their social anxiety symptoms became unbearable as the pandemic wore on. One of the most effective ways to treat a phobia is exposure therapy, in which the patient is carefully exposed to slowly increasing intensity of the fearful stimulus, while maintaining a calm and safe frame of mind. Exposure therapy is very effective for many patients, but in some cases is not sufficient to take care of the problem. Various oral medications such as antidepressants sometimes help, but in severe cases it may not be enough, and the patient continues to suffer despite the best efforts of the treatment team. Ketamine given intravenously very quickly reduced phobia symptoms, and by giving the infusions once or twice weekly, they were able to maintain the benefits even at 3 months, which is when the study measurements ended. These are exciting results that come at a critical time when many people are suffering from anxiety and fear which is getting in the way of healthy living. It is such a wonderful thing to have another powerful treatment option.
Dr. Jadon Webb had the honor to do a presentation with Sandstone Care about the importance of families and getting mental health help during these difficult times (see video link above). (Dr. Webb's part of the presentation starts around 3:30)
It was a meaningful discussion, and we always enjoy the opportunity to collaborate with Sandstone. They are a fantastic local partner and resource for mental health and substance use concerns that need intensive help. I caught up afterwards with Marcello La Rocca, the Founder and Executive Director of Sandstone. Marcello is a good guy (I've known him for some time), and he cares about making sure mental health is accessible and done well. I asked if he had any words of wisdom as we emerge from the pandemic in a time of hardship. Marcello impressed the need to remember to take care of the caregivers. "Pandemic Fatigue" is starting to set in as the weeks of hardship now turn into months. Many patients are exhausted from all the uncertainty and troubling news. Therapists are also often struggling with fatigue! Mental Health is a tough business, and job burnout is always a threat. Add in a once-in-100-years pandemic, and that risk goes through the roof. Marcello understood this, and obviously cares about his staff. I was again impressed that when I asked him for one important idea, he chose the importance of caring for other caregivers (i.e. his staff). Not bad. This got me thinking about all of the other community therapists and caregivers out there, many going by the titles "parents" or “spouse” or “best friend”. If you are a human caring for the physical and mental well-being of another - thank you. You are doing a noble thing. And it can be exhausting. Especially during times of crisis and uncertainty. If you are a caregiver, remember that it’s ok to be tired sometimes. And it’s ok to get help, even when you are supposed to be the one helping. If you are feeling discouraged or run down, reach out today for help! Both you and the people you care for will be better for it. By: Jadon Webb, M.D., Ph.D. Many of us feel the stress of quarantine, covid, and the economy in our relationship with food. The perpetual stress of the unknown triggers our bodies to be in Fight of Flight mode. This can drastically affect appetite, as our brain focuses on basic survival instincts, and stops being as thoughtful and rational about things like healthy eating. When we experience frustration, irritation, and boredom our appetite typically increases, i.e. the dreaded “stress eating” that can lead to weight gain. I asked the owner of Grow Well Nutrition, Britta Bevlavi, what we can do to fight stress eating. Britta is a true dietary expert that has helped many of our clients. Britta impressed the idea of turning emotional eating (ie stress eating) into mindful eating. I knew she was on to something when she immediately pointed out that trying to shame or nag yourself into not stress eating does not work. I know that from personal experience! Thankfully, there is a way to program your mammalian stress-eating self, and it actually does work. The trick is to not think about eating less, but to instead pull your brain out of fight or flight, and into a mindful state. This mindful state is way better equipped to pay attention to your natural hunger and fullness cues, and to not overeat. In other words, you do not want to bully your emotional brain into doing the right thing, you want to get out of an emotional state of mind. You can start getting into this state of mind by taking a 30 minute “mindset break” before eating. To take a mindset break, first stop the negative input. Turn off any news, social media, or anything else that is filling your head with intense or negative thoughts. News and social media are almost always a source of stress, even when you aren’t consciously aware of it. If you have just been exposed to it, you are likely to be in a more emotional, reactive state. Just what you don’t want when you are about to eat. So turn them off! Next, do something rejuvenating. Listen to music, do meditation, or read a good book. These are positive mental activities will bring you to a much more calm state where you can be aware of your natural hunger and fullness signals. Add in 15 minutes of movement. Go walk around, stretch, and move. This brings your whole body into better alignment and makes it even easier to be attentive to natural eating signals. Finally, sit in a very specific, designated place for eating, like the kitchen table. I had never really thought of this, but it sounded obvious once Britta pointed it out. We humans are so sensitive to place conditioning, and quickly learn to associate certain places and times of day with certain activities. It’s easy to fall into a pattern of grabbing a handful of something as you walk through the kitchen or mindlessly snacking as you watch TV at night. But if if you make yourself go sit at the kitchen table, using silverware and plates/bowls, it helps make each eating time a specific, defined event, and you will be less prone to impulse eating. Britta refers to this as “eating with intention.” This can be a secret weapon against stress eating! By intentionally sitting in a specific place for eating free from distraction, you get to check in with physical cues of hunger and fullness, and rationally decide when it is time to eat, rather than being victim to whenever your emotions wash over you and make you impulsively eat. If you clear your head, move for a few minutes, and sit in a specific eating place, eating will be a very different experience.
Now as you do this, notice your feelings when eating - see if you are using food to get (or get away from) a certain emotion or feeling. Is it to end hunger, or is it to combat loneliness, anxiety, or insomnia? Just observe, and see what connects to what. Remember, don’t be judgmental or keep thinking about how you should be eating, just notice how you are feeling. This will give you great insight, and paradoxically, is often enough to start breaking up the emotional eating. Many habits change just by being observed. Incidentally, doing these mindset breaks is good for other reasons. It will make you feel more relaxed and even more productive. I’ve been trying this out, and it works. I plan to keep at this long after quarantine. TAKE HOME: Don’t try to bully yourself out of stress eating! Take a mindset break, and observe how you feel as you eat. You might find yourself naturally eating healthier. By: Jadon Webb, M.D., Ph.D. We’ve all been cooped up with our families for the past few weeks, and the emotional results of this have been… well, variable! Spending this much time with family, even the ones you normally get along with, can easily take its toll. But it’s also the relationship building opportunity of a lifetime, if used properly. I interviewed Heidi Sauder, PhD, a psychologist in the Denver area and owner of Enrich Relationship Center of Colorado, about connecting with your spouse during quarantine. She is a true relationship expert, and quite good at helping couples reconnect and find happiness together. Heidi suggested we think of creating “connection during chaos.” In her words, “decide to make your time together meaningful. It is often easier to focus on the negative or the things you can’t do or that are difficult. You don’t have to fall into that trap. Focus on and discuss your strengths as individuals and as a couple and how this sets you up to have valuable time together.” I liked how she phrased it as something to intentionally decide to do. It’s not something that will just passively happen. Here are some more practical suggestions she gives to her clients trying to grow closer to their spouse:
If you get stuck, download Gottman’s card decks for ideas on conversations and activities. Heidi also pointed out how you can make more out of mundane life activities. She calls it creating new rituals of connection: Maybe you’ve hurried out the door in the past with barely a peck on the cheek. Explore how saying “hello” and “goodbye” could feel more sensual or fun. Turn back the clock a bit and behave like you used to when dating! If you have kids, make sure to create your own time together where the kids do not intrude. Even if that means bribing them with video games or TV so that they leave you alone for an hour. Heidi shared a really cool resource for psychologically analyzing yourself. Consider taking these tests alone or with your significant other from AuthenticHappiness.org, through the University of Pennsylvania. Their Values in Action Questionnaire measures and rank orders your characterological strengths and virtues. If you have children, they have a version for them too. It’s a great way to discover more about each other and grow together! The War On COVID is at our doorstep, and our friends and neighbors are in its path. It is a once-in-a-generation struggle that will be remembered for centuries to come. One of our Nurse Health Consultants, Mia Orr, is fighting on the front lines. Her work caring for COVID patients was just featured in our local news. It’s really something to see. Mia and her colleagues are being pushed to their limits, often to exhaustion, surrounded through the day by those struggling to survive the war. They do this while knowing the personal risk of being exposed to this highly contagious illness. Yet they keep going. Showing up for long shifts, caring for those of us in this community, and helping ensure that in the end, we will win.
And despite all this, Mia joins us at Bloom to call our clients and make sure their mental health is cared for. She does this with such a cheerful, helpful attitude - you would never know she had just been in the middle of a deadly battle. Thank you for your service! A huge comet called Atlas is headed our way. Chances are, it will be visible to the eye by end of April. This is when COVID-19 should be peaking in the United States. By mid-May, if Comet Atlas does not break apart (comets sometimes disappointingly do this), it should become very bright... one of the best cosmic light displays in years. The timing and visual symbolism of Atlas and COVID-19 is striking. In April it was our duty was to hide from a force of nature, isolated in our homes as a deadly viral storm passed through. By May, this dark plague will likely begin receding. And a beautiful light will brighten the night sky, drawing us out from our homes to witness it. A comet with a tail millions of social-distancing units long! Like a rainbow after a deadly storm, perhaps Comet Atlas can be a symbol of this pandemic blowing away. And hopefully we will be able to watch it together, no longer in isolation. THE TAKE HOME:
Time to start hoarding telescopes! Good deals will vanish once this starts hitting the news. Want to change how you feel in the next 15 minutes? Try this experiment, and hack the programming in your brain’s emotional center. See below: How you feel has been partly determined by how those around you are feeling - whether you realize it or not. It’s also determined by organizations that send out carefully crafted signals (e.g. news stories) intentionally designed to play on your emotions.
Our brains are designed to look for danger signals from others around us, since knowing about a threat early on could let us take action. News organizations and politicians know this, and use it accordingly. Your brain’s danger detection meter is being exploited, just as junk food exploits your body’s normal nutritional needs. Most of the bad news we read does not actually help us stay safer or be better people, just as excessive junk food does not actually help us prepare for times of famine! In fact, bad news usually does just the opposite - it is about things we have little control over, and it makes us angry, anxious, and depressed. But we get addicted to it and keep consuming it, even though we know in the back of our heads that it’s slowly killing us. Last night I tried an experiment, and only allowed myself to read websites that only publish inspirational news (links at the end). The difference in how I felt was immense. It surprised me, even though I knew neurobiologically what I was trying to do. Within 15 minutes of reading these uplifting stories, I felt stronger, happier, and knew deep down that we would get through all of this. And I actually slept well. It was an astounding difference from the tense, gloomy way I had been feeling when reading the regular news earlier. Even as I write this blog article the next day, I still feel better and more hopeful, and am motivated to work harder and do my part to help out. It’s a total win all around. But here’s the weird thing - I can still feel the addiction to negative news. I have a strong urge to go back to the junk food panic and click on articles telling me how someone my age just died from COVID, gawk at pictures of hospital beds and scared/dying people, and wallow in the mud of how the economy will collapse and take us all with it (or whatever). Bad news is a hard habit to break, just like junk food. Part of us weirdly craves that next hit of panic news, just like we crave the hit we get from a 2,500 calorie burger. So don’t be hard on yourself if you find it hard to resist the bad news. In the past, it has taken me weeks to break the habit. But it sure is worth it. TAKE HOME: Try hacking your mood, and only read inspirational news for the next 15 minutes. See if you feel better. I definitely did. Some Example Positive News Sites: https://www.goodnewsnetwork.org/ https://www.sunnyskyz.com/good-news Millions of us have high cholesterol and take medication for it, usually a class of drugs called “statins”. As a psychiatrist, I’ve been interested in statins because they are cheap, safe, and might help treat depression and schizophrenia. And it gets better: statins may also improve survival and reduce symptoms during viral lung infections. One of the worst outcomes from COVID-19 (and the flu) is pneumonia. This is often what puts people in the ICU or kills them. Taking a statin was associated with a dramatically lower risk of being intubated or dying from viral pneumonia. It’s also associated with reduced length of stay in the hospital. So we have compelling data that a safe, cheap, easy-to-get drug may help with mental illness and serious viral infections. Why isn’t this being more definitively followed up on? It may partly have to do with how difficult it is for we humans to change the mental labels we have already assigned to things, including medications. A cholesterol pill is just not supposed to be an antidepressant or antipsychotic, so we don’t think to use it that way. A cholesterol pill is also not supposed to be a treatment for viral pneumonia, so maybe again we just aren’t thinking to use it that way. Cognitive traps like this can be sticky, and hard to get out of.
Since I am writing this during a pandemic, it hit home to read this 2008 Lancet paper. The authors warn that in a future pandemic, “supplies of affordable vaccines and antiviral agents will be unavailable to most people in the world.” They call for cheaper, generic agents such as statins (and chloroquine) to be considered as potential treatments because they “are inexpensive, could be stockpiled, and would be available on the first pandemic day”. The authors close by warning that “with a lack of realistic alternatives for confronting the next pandemic, research is urgently needed to determine whether these and other generic agents could mitigate the effects of what might otherwise become an unprecedented global public-health crisis.” What a shame that we didn’t aggressively follow up on the potential use of statins and other generic agents before this 2020 pandemic hit. Could cognitive labeling traps be partly to blame? Looking forward, we should keep an open mind about repurposing drugs, and not allow their labels to get so stuck on our heads that we can’t see the forest for the trees. And that includes their use in mental health. THE TAKE HOME: Statins are cheap, safe, and already used by millions. They may be effective agents in treating depression and psychosis, and perhaps even viral infections. Talk with your doctor about what this may mean for you. |
about the authorSJadon 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 |