Dear Dr. Bouras,

I have been reading about this new TMS Therapy for depression. Over the years, a lot of people have used different magnetic therapies for different ailments. How is this different?

Carl

A:

Dear Carl,

Thank you for your question. I have been getting the same question from other individuals, including even physicians who are not familiar with TMS Therapy.

Transcranial Magnetic Stimulation (TMS for short) therapy has been approved by the FDA, the same agency which approves all the medications we prescribe. That means that there were clinical studies, placebo-controlled and double-blinded that showed both efficacy (it works) and safety (it is safe) to be prescribed to patients with depression. In contrast, other "magnetic therapies" that people might have heard of have no scientific basis.

TMS therapy uses a magnetic field (similar in strength as MRI machines) as a way to "jump over" the skin and skull in order to reach specific areas of the brain. By rapidly changing the field, a small electric current is induced inside the brain which in turn stimulates the brain cells to be "more active." Higher activity of the brain cells causes higher level of neurotransmitters (NTs) like serotonin, norepinephrine, and dopamine, which in turn help with depression. These are the same NTs that are increased when we use antidepressants. In contrast, other "magnetic therapies" use weak magnets (do not penetrate to the brain) that are static (do not produce an electrical current).  

CNN rated TMS Therapy as the top ten (10) innovations for 2009 (click #5). This is a breakthrough therapy for patients suffering from depression. You can also see what media says about TMS therapy.

Dr. Bouras

Dr. Bouras,

In these days of economic stress, many employers are forced to ask their employees to “do more with less.” The terms burnout or compassion fatigue are getting more and more attention. Is there a difference between ‘burnout at work’ and depression? Many Primary Care Physicians wish to prescribe antidepressants for burnout, but I cannot help but wonder if this is the only or best way to treat burnout.

Susan.

Dear Susan,

Thank you for your question. Burnout is a modern phenomenon where people try to squeeze more and morecommitments in the same amount of time. People end up feeling overwhelmed, physically exhausted, and mentally drained, to the point that they no longer enjoy their work. They tend to isolate more, detaching themselves from what they do. They may lose motivation, feel hopeless and helpless, and even develop depression.

Compassion fatigue (CF) is a form of burnout that we typically see in caregivers. Caring for an elderly parent or a chronically ill child can lead to CF, but more commonly it is health care workers (physicians, nurses, etc.) who are more likely to become "compassion fatigued."

Increasing demands at the workplace is a catalyst for people to develop CF. People might take on more job duties and responsibities, work through lunch or stay late to finish paperwork, complain excessively about the work load, becoming too tired to exercise, eat more "comfort" type of foods, and they might even try to self-medicate with alcohol or drugs.  If one has a history of depression or anxiety, one might experience that those symptoms are coming back.

If you feel that you might be burned out, probably you are. Becoming aware of your burnout or CF is a good first step to getting control of your life and reestablishing your priorities. You need to become "selfish" again, in that you need to take care of yourself. Eating healthy, staying hydrated with drinking plenty of fluids, getting plenty of sleep and rest, and making time to exercise are all common-sense things that we usually neglect to do. Instead of isolating, talk to someone; talk to your spouse, your family, your friends or co-workers. Learn how to set boundaries, by being  assertive and say 'no' to prevent overextending yourself. Talk to your supervisor about your concerns of burnout, your job duties and responsibilities, and realistic ways to solve any problems. You might need to learn more about time or stress management.

Sometimes talking to a professional therapist is helpful to put things in perspective and decide on your life goals and dreams. Talking to your family doctor can help you get started on feeling better. Antidepressants may also be used if the symptoms of burnout have led to symptoms of depression.

So, try to avoid burnout by keeping a balanced life between home and work. Take a break from work to "recharge" your batteries. And, don't forget to laugh…

Dr. Bouras

Dr. Bouras,

My wife is going through menopause. She wakes several times during the night with hot flashes, so she does not get good quality sleep. She has increased anxiety and irritability at times. She seems to be more emotional, crying more easily. However, she is able to "rally" after weekend naps. She enjoys going on trips and laughs and smiles at those times. Is she likely to be suffering from depression, or just the ups and downs of hormonal changes?

Michael

A:

Dear Michael,

Thank you for your question. You have certainly observed quite a "roller-coaster" of emotions in your wife! Any hormonal fluctuationscan definitely affect how one feels.  Different women cope differently with menopausal changes. To be diagnosed with clinical depression, one must meet certain criteria including anhedonia (unable to enjoy things that one used to) or irritability. If your wife enjoys going on trips, then she probably does not have anhedonia, but then again, she does get irritable.  You mention that your wife does well on the weekends and on trips. Is she stressed out more during the week? Have there been any changes in your lives, such as having to take care of grandchildren or elderly parents, having recently moved, or having some change in financial or occupational status? Does she or anyone in her family have any prior history of clinical depression? Your wife's symptoms appear to be severe enough for you to be concerned. It is difficult to make an accurate diagnosis without a clinical evaluation and further information. Your wife should discuss her symptoms with her family doctor and/or obgyn for further assessment and treatment options for symptoms relief.

Best wishes to you and your wife.

Dr. Bouras

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