Dark Days #34

Dr. Carole Orem-Hough:

So we're looking at depression now as an inflammatory illness. It's a brain disease. And then how do we treat that most effectively? So TMS is one tool for that. I mean, 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.

Dr. Bryan Woods:

People really reach a point where they just, they're unhappy enough, they just feel they need help. And again, I think it's when it really starts to affect their lives, when people will notice it affects their job, their relationship with friends, their relationship with their family. People notice those kinds of changes. I think that's when they should get help.

Dr. Lisa Belisle:

Joining me in the studio today, as every week, is our co host, Genevieve Morgan, who is the wellness editor for Maine Magazine. Thank you for being here again, Jen.

Genevieve Morgan:

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 a really important topic and

Dr. Lisa Belisle:

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 Morgan:

It's true. I think it might be harder at holidays or anytime when people. 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 this show is about. You and I have had our own dark days this past year.

Dr. Lisa Belisle:

Well, 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 one job where I was a physician, 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've moved my practice, I've had. I've moved out of my marriage. So lots of darkness. And I've written about a lot of this on the Bountiful blog. So people who are my patients and my friends, people 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, Jen?

Genevieve Morgan:

Very much so. Last year, my mother was diagnosed with cancer. So we as a family have been dealing with her treatment and recovery. And I have myself gotten ill in the fall and then have been experiencing back pain for now about five or six 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. So it's a different kind of loss than yours. But it's all of these losses create despair. And that's what we're talking about.

Dr. Lisa Belisle:

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. I mean, whether you go to Dr. Carol Orumhof 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. Brian 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've described.

Genevieve Morgan:

What are some of the things that you prescribe for your patients?

Dr. Lisa Belisle:

Well, 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 have continued to come see me as a doctor, even as I was feeling my own personal life was falling apart, and I still felt as though I had a sense of purpose, I had something to offer. And for me, the social connectivity there and that sense of purpose, those are two things that are so crucial to maintaining one's sense of self and one's positive outlook on life. So maintaining one's connections in whatever way is possible, whether that means your friends, your family members, continuing to show up in your primary relationships, significant other, spouse, boyfriend, girlfriend, and really try to share your feelings, as difficult as that may be for you or for them, but also diet and exercise and a mindfulness practice.

Genevieve Morgan:

One of the things that I've 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 of this is. And I get very wary about. I don't think I deserved 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, and 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 that or the hope that eventually it would go away, so that I wasn't always gonna be in that position. But I did kind of go into myself with the pain and the depression that came out of that.

Dr. Lisa Belisle:

I think that's a 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 sort of 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 mot. I know that for you, you had to let go of some things, the driving you described, you know, some of the things that had become really central to who you were. 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 in, that you actually had to work through things. It's not A bad thing. It's sort of just working through the, you know, digging back through the things that you need to deal with in your life so that you can keep

Genevieve Morgan:

moving forward, so that you can come out again with something new or hopefully something new.

Dr. Lisa Belisle:

Yeah, I think that that's. That's. That is. The idea is 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. Is the one identity. This fixed mindset, that's. That's who you were meant to be, and now it's gone and you've 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 are 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 Morgan:

And 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. Our guests, you know, what is the difference between a minor depression and a major depression, but that you're not alone. If you're out there having these feelings. We've gone through them recently, and at

Dr. Lisa Belisle:

some point, everybody will, well, you're not alone. And, you know, some statistics suggest that depression is only even recognized about 40% of the time. So 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 know, 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, it is because we're losing something that we care about, whether it's a job, an identity, a loved one, but because we. 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. So to understand that because we have, we can lose, and because we love, we are able to grieve. And whatever form that takes, whether it's an adjustment reaction, as we'll talk about with Dr. Woods, or a dysthymic disorder or even a depression or even, you know, lifelong struggles with emotional difficulties. It's just part of being human. We all have this in us.

Genevieve Morgan:

And 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.

Dr. Lisa Belisle:

You can still have a very good life. And we hope the people who are listening to our conversations with Dr. Carol Oram Huff and Dr. Brian 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 1 volume of Molecular Psychiatry as reported by Emory News Center. For several years, researchers have seen links between depression and inflammation or overactivation of the 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 humans 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 adaptive 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 preactivates the immune system in anticipation of injury. For information on this Wellness Innovation, visit drlisabelisle.com for more information on the University of New England, visit une.edu

Dr. Lisa Belisle:

Lisa Radio Hour and Podcast, we have the privilege of spending time with Dr. Carol Orum Huff, who has been known to Genevieve Morgan and I for quite a while, at least in name, because our Audio guru John McCain works with her in her practice. And Genevieve is sitting here next to me.

Genevieve Morgan:

Hi Carol, it's nice to have you here today.

Dr. Carole Orem-Hough:

Thanks for having me.

Dr. Lisa Belisle:

So your reputation precedes you. And not only does your reputation precede you as a person, as a friend and co worker of John's, but also what you do has very recently gotten some national acclaim. So it's so Timely and interesting. And it's great to have you here. We really appreciate you coming in.

Dr. Carole Orem-Hough:

Thank you, Carol.

Dr. Lisa Belisle:

Your background is very interesting. You do currently psychology. And I don't know how you consider yourself a therapist or exactly what you're tell us. Define yourself a little bit here for us and then we'll ask us how. In your own words. And then we'll ask you how you got to be here.

Dr. Carole Orem-Hough:

Okay. Well, I am a licensed psychologist is 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 years to their program and then finally moved out to California to finish it. Anyway, so my orientation from an educational perspective is one is looking at the psyche, the unconscious, and how all this informs our way of being in the world. And after I practiced for a while, I actually did my postdoctoral fellowship at Maine Med at Migichee and started private practice after that. And I needed more tools. I felt like that could really structure things a little bit better. So I became trained in emdr. That was my first sort of brain based therapy.

Dr. Lisa Belisle:

And emdr, for people who aren't familiar,

Dr. Carole Orem-Hough:

stands for eye movement desensitization, Reprocessing.

Dr. Lisa Belisle:

Okay. And we'll talk more about that.

Dr. Carole Orem-Hough:

Okay. And so I got trained in that. And it's become extremely, extremely helpful in terms of trauma resolution. Not just what we would call like a simple trauma, which would be something like a tsunami. I know it doesn't sound simple, but you know, something 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's been some sort of 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 is useful for that kind of attachment trauma as well.

Genevieve Morgan:

I know the Wounded warrior group that treats soldiers coming back from overseas uses EMDR quite a bit.

Dr. Carole Orem-Hough:

Yes. I have someone right now in treatment that is coming back from Afghanistan. So it's more complex trauma, but it's very, very helpful. So anyway, that was my first brain based sort of technique to learn. And even though I do come from this orientation of depth psychology, I found that very useful. I then became aware of a treatment using psyche, it's called Internal Family Systems. And we have a group here in Maine who practices this therapy. So I went for one of the Level 1 trainings down in Boston for that, which took a year. And 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 leads 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 kind of 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. And so he is a powerful force right now in the psychological community for us to understand better how the psyche works and how to most be helpful in healing that. So this internal family systems is a great tool as well.

Dr. Lisa Belisle:

But you yourself did not come from. You didn't go directly into psychology. You had a varied background.

Dr. Carole Orem-Hough:

Yes, I started 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 out in Omaha and then practiced that kind of work, if you will, for several years and 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 a products and those kinds of things. And I felt like I wanted to really be more on the clinician side and giving to the people.

Genevieve Morgan:

So how has this all come together for you today?

Dr. Carole Orem-Hough:

So today it's actually really interesting to watch this kind of organically unfold because I am practicing as a therapist, psychotherapist with EMDR and internal family systems and mindfulness, this stuff from Dan Siegel. But then also a year ago brought in a piece of equipment called a transcranial magnetic stimulation machine by Neuronetics. And so with John's help, we've been able to treat 12 people and basically assist people. Not all 12, but I'd say nine of the 12 have had significant reduction in their depression symptoms. We use a scoring tool called a PHQ9, which is a tool that the insurance companies like. And so it rates essentially nine different symptoms. Things like fatigue problems, sleeping, appetite problems, these kinds of things. Rate that on a scale of 0 to 3, 3 being worse. So the worst score would be a 27. So people come in for this treatment in the high teens or the 20s with the PHQ9 scores. So that's very, very depressed. Yeah, they're having a lot of problems, sometimes can't work, you know, things like that. And by the end of the TMS treatment, they're down to like a 1, 2, sometimes a 0. It's remarkable. And it's not just I like to use this scoring thing because it's easier to quantify, I guess that's the engineering part of me than to just say I feel better. And I think it helps people too, to, wow, look at these scores, how they've come down. So it's been an exciting process to kind of 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.

Dr. Lisa Belisle:

It's interesting to me that you went to this family internal family systems model in Dan Siegel and you're describing it as a way of integrating sort of up and down and heart and brain. And it also sounds like maybe this is something you needed to do in your own life.

Dr. Carole Orem-Hough:

Well, most definitely. I found that I Learned meditation, gosh, 20, 30 years ago. And I have found that to be just a necessity now in my life. It 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. So 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 Morgan:

Can we backtrack a little bit? Sure. Could you explain what TMS is? What it looks like to a patient?

Dr. Carole Orem-Hough:

Certainly TMS stands for transcranial. So it's going through the cranium magnetic using magnet stimulation that's stimulating the brain. What it does is 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 to ever put it on. We know that the brain looks different in somebody who is a depressed person versus a non depressed person. So when someone is depressed, the brain is not balanced and there's not a lot of metabolic activity.

Genevieve Morgan:

We're looking at a picture right now which is two brains. One's depressed, one's not depressed, and the one that's not depressed looks like a Ferris wheel or something.

Dr. Carole Orem-Hough:

It's all lit up.

Genevieve Morgan:

And the one that is depressed is very dark.

Dr. Carole Orem-Hough:

Right. And just has a little bit lit up. So what you're seeing here is a lack of metabolic activity on a depressed brain and an Imbalance, where it's not all communicating properly.

Genevieve Morgan:

And that's scientifically shown and proven.

Dr. Carole Orem-Hough:

Yes. This is a PET scan from the Mayo Clinic, this particular photo. So what we would, what we would translate that into for people is to understand if you have a heart disease, your heart's going to look different. If you have diabetes, your pancreas is going to look different. So we're looking at depression now as an inflammatory illness. It's a brain disease. And then how do we treat that most effectively? So TMS is one tool for that. I mean, 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.

Dr. Lisa Belisle:

And this is what was actually Featured on the Dr. Oz Show, I believe, not so long ago. So how has that impacted your practice, the fact that this has now become nationally recognized?

Dr. Carole Orem-Hough:

Well, people are learning about it now, which is great. We've tried to spread the word through various means in the last year, but have not gotten that far. So it's been the chance person that hunts Google's depression and finds tms. Now I'm getting calls almost daily from people who have loved, you know, someone's told them about the Dr. Oz show or they've seen it online now. So it's really, really helped.

Genevieve Morgan:

Who would be a candidate for tms?

Dr. Carole Orem-Hough:

As we know now that depression is an inflammatory illness. In other words, that the longer it goes on, the more inflammation occurs in the body. It has a physical as well as emotional effect. Really anyone who does not treat well with medication one or two times, you would give it a few times to try to get the meds going, then you, they would be a candidate. But what has traditionally been TMS has traditionally been thought of for the ones who are really treatment resistant. But that's not necessarily the case. It doesn't need to be. You know, they don't 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. So when someone's 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.

Dr. Lisa Belisle:

And that's actually quite something. I mean, that's very forward thinking of the FDA and the people who are putting together the best practices.

Dr. Carole Orem-Hough:

Yes, this is actually the American Psychiatric Association. And that was done the end of 2010.

Genevieve Morgan:

Because we should just make it clear to listeners that this is FDA approved. But it's absolutely non. Invasive.

Dr. Carole Orem-Hough:

Correct.

Genevieve Morgan:

And non systemic. It's just an electrical impulse.

Dr. Carole Orem-Hough:

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 the next day or so. You might lose memory. This is like an in and out procedure. You come in 37 minutes for the treatment, typically. And then you would go back to work.

Dr. Lisa Belisle:

And what does it feel like? What is it? What's described to me when somebody comes in, what does it look like? What does it feel like?

Dr. Carole Orem-Hough:

Well, it's like a dentist chair. 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 a computer in the machine where we're figuring that out using the motor cortex and somebody's.

Dr. Lisa Belisle:

And how do you figure that out?

Dr. Carole Orem-Hough:

Do you want to know specifically?

Dr. Lisa Belisle:

Well, I'm just. I'm fascinated. And it's just so interesting that you're doing something that's very physical for something that we always think about as being very kind of emotional, spiritual, some sort of woo woo thing. But this is very tangible.

Dr. Carole Orem-Hough:

Right. So to just explain. And they show 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 on. Now we move it to the motor cortex. That's not where we're going to do the treatment, but it's how we find the correct angle, the correct placement in the brain. And so there's a thing called a 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. So we're looking for the specific area where the thumb twitches. So we're watching and producing a pulse. So it's tap. And we're seeing if that thumb twitches or a finger twitches. And until it does, we move around and figure where that spot is. And then when we get that twitching, we know, okay, we've got the right area. Now we move forward to and to the right placement. It's about 5cm forward.

Genevieve Morgan:

Does it hurt?

Dr. Carole Orem-Hough:

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 Just, it's the way it's a tap, tap, tap, tap, tap, and then pull and 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 to, like, bring an ipod or something to listen to music. I didn't think it was particularly funny getting your legs waxed. Yeah, it's not, you know, you don't just, like, seek it out and go, this will be fun. I didn't think it was a particularly pleasant experience, but it wasn't painful.

Dr. Lisa Belisle:

Tell me what emdr. You talked about the use of EMDR for trauma. Tell me what that is like and what are the uses for that?

Dr. Carole Orem-Hough:

Well, I think the place to start with that discussion really is also to explain trauma. There's different types of trauma. There's your very simple trauma, which I mentioned was like a tsunami. Wrong place, wrong time.

Dr. Lisa Belisle:

It's not like a 9 11. You know, you'd. Can't help it. It just sort of.

Dr. Carole Orem-Hough:

It just happened. It wasn't personal. Yeah, you're just hit with this. People suffer from PTSD after things like that. They can't sleep, they have a startle response. So that's one level of trauma. Then we move into more of. A little bit more personal, which would be something like a rape or something, a home invasion, where it's personal. It's more personal in the sense that it's an invasion to you, but it's not a person that you knew. Again, kind of wrong place, wrong time, but a little more direct to you. And then we go down to the most, which is when people have suffered from some sort of child abuse or neglect. And it's much more personal. So that's more complex trauma. So 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 wanted to go get trained in it. It's thought to 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. It stops connecting. And so when we can do this, bilateral stimulation is what it is. So the eyes are moving back and forth. I also have, like, pods or earphones that couldn't 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, what's going on and blaming ourselves typically as children, to being able to integrate that experience and then come at 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 with adult eyes and say, wow, a lot of times it's getting that you were not at fault, that you suffered at the hands of someone else or their problems, caused them to be a certain way, and just facilitates sort of a resolution, a settling down of those charged pathways in the brain, basically. So it's quite stunning.

Dr. Lisa Belisle:

And all of these things, whether it's a personal trauma or a non personal trauma, all of these things can contribute to depression.

Dr. Carole Orem-Hough:

Absolutely, yes.

Dr. Lisa Belisle:

And this is something that can start from very early on in one's life and continue on for many years, if not ever.

Dr. Carole Orem-Hough:

Correct. And I think that's the interesting connection as we talk about coming from this more depth perspective and knowing that there's under, you know, you're looking at the 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 may be more thought of as more cognitive type of treatment, but in a way it's working in a depth fashion.

Genevieve Morgan:

You also spoke about neurofeedback. What is that?

Dr. Carole Orem-Hough:

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 one frequency that's driving a person. In other words, for example, when someone has problems 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. But if they're too high, then that person's not going to be able to fall asleep. So 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, and then we use a biofeedback essentially. But for the brain treatment, where a person is watching some sort of game or whatever and they get positive feedback when the brain waves are within the range that we want them to be in and they don't get rewarded when the brain waves are outside. So in other words, if someone is depressed, they're going to have under arousal, they're going to have brainwaves that are too low and we want to bring those up. So we'll set a bar. Say just, I don't know people, this is radio. So let's say we have a scale of 0 to 10 and we're gonna, and it's vertical, we're gonna set a bar at like 4, let's say. And everything above 4 they're gonna get rewarded for. And so they're gonna say ah. The brain starts to learn it's nothing that they themselves do. The brain learns to do this. And when they go below four, which would be more where they were, you know, the depression kind of stuff, then they would not get rewarded. The same is true if somebody 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. And so over time, brain changes with pulses and repetition. And this works for TMS as well as neurofeedback. So 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 with it 20 weeks, other people takes a couple years. So it just depends on what's going on with the person.

Genevieve Morgan:

And the point of it is that because I've read about neurofeedback, especially with children in adhd, that you can, when you're not on the machine, your brain has learned where your comfort zone is correct and so you can access those waves when you're off the machine. So you have to train yourself. Like working out, right?

Dr. Carole Orem-Hough:

Exactly. Oh, you have read about it. And it is, that's the point.

Genevieve Morgan:

I want to do it.

Dr. Carole Orem-Hough:

What we call this neuroplasticity is sort of 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. Now we know that there's a plasticity throughout the 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 then to hold how we train it. So same with tms, sometimes people have to come in for a booster treatment. Sometimes they come in just for once. Every couple months of treatment is just to keep the brain in that range, keep it firing, or to refer to neurofeedback, keep the frequencies in balance.

Dr. Lisa Belisle:

And how is this similar or different from biofeedback?

Dr. Carole Orem-Hough:

Well, 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 kind of over your whole body except for your hands. And then your hands are baking in the sun. Do this for about 10 minutes, and what will happen is your hands are going to get warm and the blood's going to come out of that constricted brain and the migraine will leave. So that's a biofeedback that's working with the biological systems in the body. Neurofeedback is similar, although it's the brain learning this. So when actually someone does neurofeedback, we're not saying try to make this happen unnecessarily. It's just they have an intent to have the brain helped with this. And they're watching some sort of little pac man run around a screen or whatever. And when their brain starts to get okay, this is what makes it move, then it starts traveling. And that's, you know, that's the conditioning, if you will. That's like the putting the blood out to the hands. So it's biofeedback for the brain.

Dr. Lisa Belisle:

And 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 this in so many depression and psychological issues in so many different ways. There's also something that the Heartmath Institute does, which this whole entrainment thing, and it's similar where you kind of. You're attached. I think it's your finger is attached to an electrode, and then you look on a screen, there's a balloon that goes up and down. So is there some similarities between that?

Dr. Carole Orem-Hough:

There's Some similarities to that and there's other tools as well that can help train the breath and there's different devices like that. I'm developing a website right now which will have that kind of equipment on it.

Genevieve Morgan:

It's very empowering for people. I mean, rather than having to be medicated, they actually have the tools within them.

Dr. Carole Orem-Hough:

Exactly.

Genevieve Morgan:

With the right conditioning that they can then help themselves.

Dr. Carole Orem-Hough:

And it's still though, I must say that it still needs to be an integrated effort. I hope people don't take away from this that oh, I just have to do TMS or I just have to do EMDR or I have to or neurofeedback, whatever. I find that people that get the most success with this in terms of healing and really coming to balance is when we come at it from this multi pronged, you know, it's psychotherapy, it is maybe a brain based treatment, it may be a little bit of medication for a while, depending on how the severity of somebody's depression. But overall I think when we have this sort of wraparound, multi pronged approach, that's the most beneficial to people.

Dr. Lisa Belisle:

One of the things that you handed to me was this best practices treatment guideline for depression. And 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. So 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 are things that you actually will have changes in your weight and what you want to eat. And 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 some of these physical side effects or physical effects? Absolutely.

Dr. Carole Orem-Hough:

Yes, definitely.

Dr. Lisa Belisle:

So describe some of the things that you've seen people present with that might be physical in origin.

Dr. Carole Orem-Hough:

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 this is like an angry depression, an anxious depression. When people are burned out. A lot of times too, they're end up not recognizing that it's just they've had to pedal down too far for too long and they're just, it's like an exhausted anxious depression physically. I think when people end up with illnesses too, I mean you can end up with high blood pressure, more heart disease, things like that. From Depression as well. So chronic pain. Chronic pain, exactly. So it really can affect the entire physical body.

Dr. Lisa Belisle:

And sleep you mentioned that's one thing that seems to be very impacted by depression, anxiety, other psychological issues.

Dr. Carole Orem-Hough:

Absolutely. In fact, I know they've done studies recently where they leave they. I forget who the big brand they is in this perspective, but that they recommend that people with mental health focus and good, good sleep hygiene and I've worked with people like bipolar, whatever, that if you can really get the sleep so that you go to bed the same time and wake up at the same time, kind of have a little hour long sleep sleep routine before you actually go to bed, that winds you down. You're not on the tv, you're not on the computer. It makes a big difference in people's emotional health. So, yeah, sleep is oftentimes where people, you know, it's very miserable to not get good solid sleep. And that will oftentimes, I think, be a flag for people to get some sort of help.

Dr. Lisa Belisle:

Does all of this continue to appeal to that engineer side of you that the woman who went and got the mba? I mean, 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. I mean, does this surprise you? Wake up some morning, surprise. Or do you continue to just feel fulfilled?

Dr. Carole Orem-Hough:

I feel like I'm much more on my path, if you will, or in my correct line of work. There were other reasons why I became an engineer. I was good at math and science, so that's not really a great reason to become an engineer. So I think that my own growth has informed me in the process. And yes, 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, but to some. But I think that that helps me understand some of those. But no, 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. Right. The left brain is totally this engineering, MBA stuff typically. And the right brain is much more this internal. The patterns of things, how people are thinking, what's driving them, what's underneath their issues. So it's my own, I guess, integration as I've grown.

Dr. Lisa Belisle:

Yeah. And I think that was when I asked way back the question about this and this integration in your life. That was sort of where I was trying to get to, was that piece. Were there challenges along the way for you personally, as you were exploring what your path was supposed to be?

Dr. Carole Orem-Hough:

Oh, 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. And that 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 of resolution or at least insight about it, so that it becomes something to learn from and grow from and not just a thing to overcome.

Dr. Lisa Belisle:

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 it's all going to be good. But 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, definitely.

Dr. Carole Orem-Hough:

And I think they can really help you as a person. Just the depth that comes from suffering and moving through things. And there's 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 and then it comes together. I always remember the wounded healer image when working with people. It's a 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 and 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'd kind of 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 that were pregnant with their father's babies and very challenging things. And there was no support emotionally for that. And the fact, the thought was that you just sort of. I think people just did disconnect from their pain. And at the end of it, it was overwhelming. I really thought, wow, how do I learned how to do this work? And then with help of the postdoctoral internship and Dr. Sandy Cole particularly, really helped kind of 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.

Genevieve Morgan:

I just think it's so exciting what you're doing, Carol, 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?

Dr. Carole Orem-Hough:

Sure, they could ask their doctor. We do have a website that's in production that will talk about all this, the neurofeedback and the EMDR and everything. But right now, www.tmsofmain that would be the website to look at. They can call me at 28804.

Genevieve Morgan:

It is prescribed, though.

Dr. Carole Orem-Hough:

Oh, and I want to make. Let's put this in. Yeah, because this is really important. This is a psychiatric procedure. Say I'm a psychologist, just to be clear. So I'm not an MD or a do and a psychiatrist needs to prescribe this. So presently, Mike Patenaud, who's 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 just am very interested in it. So figured out a way to bring this to be. And 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.

Dr. Lisa Belisle:

Well, 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 like all paths kind of leading to the same place. And I love that technology is finally bringing us to a place that we've known about for centuries and other ways, Chinese medicine, that sort of thing.

Dr. Carole Orem-Hough:

It is exciting. It's exciting to see that there's now there's new opportunities for people.

Dr. Lisa Belisle:

Well, thank you for coming in, Carol.

Dr. Carole Orem-Hough:

Oh, thank you. My pleasure.

Dr. Lisa Belisle:

Today we have the good fortune to speak with Dr. Brian woods, who is an attending psychiatrist at McGeechee hall at Maine Medical Center. Brian is certified through the American Board of Psychiatry and Neurology and is an attending at Maine Medical Center. Brian, you've got this very impressive resume. We're thrilled to have you here. Thanks for coming in.

Dr. Bryan Woods:

Oh, thank you for having me.

Dr. Lisa Belisle:

And I have Genevieve Morgan sitting across the microphone from me.

Genevieve Morgan:

Good morning, Brian.

Dr. Bryan Woods:

Good morning.

Dr. Lisa Belisle:

I wanted to out you almost immediately as being the husband of Jeanette Andonian. Dr. Jeanette Andonian, who came in and did our kids show a few weeks back.

Dr. Bryan Woods:

Yes.

Dr. Lisa Belisle:

So we know you're gonna follow in her footsteps and do a really great job this morning.

Dr. Bryan Woods:

Well, I'll do my best.

Dr. Lisa Belisle:

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, and this is something that maybe is under recognized in our society. You get to see a lot of it. You get to see a lot of people coming in to Migechee and Maine Medical center who are impacted by this. But in the general population, what type of incidence is there?

Dr. Bryan Woods:

There's about a 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.

Dr. Lisa Belisle:

And tell us what is the difference between major depression and dysthymia?

Dr. Bryan Woods:

Well, dysthymia is a minor form of depression that 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 kind of 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 that are blue or 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 a major depressive episode, it has to occur for a period of at least two weeks. But typically the people we see in the clinic have had major symptoms for months or even years. And 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 a spectrum of sadness to happiness. Major depression affects their thinking or their cognitive life. People tend to have slowed thinking. They have problems with memory, they have problems with indecision, self doubt. And then there's 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 means they really have too much kind of pointless energy or just not enough energy at all. And not moving, not moving very much.

Dr. Lisa Belisle:

And there's also something called an adjustment reaction or adjustment disorder.

Dr. Bryan Woods:

Adjustment? Yes. I mean, sadness can occur in all kinds of different contexts, 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. And to qualify as an adjustment disorder, it has to be a set of symptoms that would tip typically be considered exaggerated for whatever the negative event was.

Genevieve Morgan:

So how do people know when to get help from a psychiatrist?

Dr. Bryan Woods:

Well, I think when people notice symptoms affecting their lives, if it starts to affect work or starts to affect their relationships or their quality of life, that is really the time to seek help when it's something more than just feeling sad on a few days or a couple of days a week.

Dr. Lisa Belisle:

And what type of help do you provide at Magici through and Me Medical Center?

Dr. Bryan Woods:

Well, we have a team approach at McGeechee and we provide psychopharmacology and psychotherapy, both individual and group therapy, the primary modalities at Migici.

Dr. Lisa Belisle:

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?

Dr. Bryan Woods:

Well, I think people really reach a point where they just. They're unhappy enough. They just feel they need help people. And again, I think that'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, significantly different in a negative way because of this depression. That's the time to get help.

Genevieve Morgan:

Do you have patients that come or are referred to because their significant other or their friends have told them that they're depressed? So in other words, their relationships have changed significantly, but they don't recognize it.

Dr. Bryan Woods:

But yes, you do see that from time to time. And everybody's depression manifests in different ways. And some people have more insight into their own depression than others. And 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 that notice that they're different.

Dr. Lisa Belisle:

How do you find yourself impacted by dealing with people day in and day out who have psychiatric problems?

Dr. Bryan Woods:

It can be a challenge at times to talk to people who are really in a bad place for seven or eight hours a day, five days a week. But on the other 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.

Dr. Lisa Belisle:

And you feel like there's enough people that are in your practice that you are helping, that this kind of keeps moving you forward. You see this as somewhat of a mission, perhaps?

Dr. Bryan Woods:

Well, we don't help everybody. And 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. And the majority of people have a moderate response. So. So you are able to help most people.

Genevieve Morgan:

now if someone's 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? I mean, can you. Are there other therapies or nutrition or anything else you recommend?

Dr. Bryan Woods:

Well, I think treatment of depression is being approached a little bit different these days, as opposed to years ago. We are treating depression as more of a lifestyle change that a lot of patients need to make. I mean, for some people who have their lives in a relatively good place, perhaps an antidepressant 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 sort of three modalities we use to treat depression. Medications, psychotherapy, and then there's changes you'll need to make in your own life to affect an improvement in your symptoms. And 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 and, you know, 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. So I always recommend exercise, a balanced diet and good sleep hygiene. And I think that those sorts of lifestyle changes are just as important for a lot of people as medication or psychotherapy is.

Dr. Lisa Belisle:

What are some encouraging developments or trends that you see in your profession or on the horizon?

Dr. Bryan Woods:

Well, I think, you know, parity for mental health reimbursement has been a positive development over the past years. You know, I think at a state and federal level, there have been 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. I think on a more sort of medical or research front, I think genetics holds huge promise. Most mental illnesses are thought to be. Their causes are thought to be a combination of genetics and the environment or life experiences. And I think we usually know more about life experiences than we do about a person's genetics. With the Human Genome Project now, we're going to be learning a lot more about the genetics, and I think that that potential is largely unfilled. There's a. Again, there's a large gap between the DNA code and an individual person. But I think as time goes on, those gaps will be filled in and genetics will inform our assessment of individual patients and individual patients genetic makeup will give us a lot more insight into what sort of predispositions they have to mental illness and also what sort of treatments will be effective for that individual patient?

Dr. Lisa Belisle:

Where do people find out how to reach you or McGeechee hall or Maine Medical Center? What's the best way to access this information?

Dr. Bryan Woods:

Well, Maine Health has an intake number 761-6644 for access both to inpatient or outpatient services for adults or children, and that's the best way to access the system.

Dr. Lisa Belisle:

Dr. Woods, this has been very helpful. I think our listeners are going to come away with some significant insights regarding depression and the state of mental illness in the world and perhaps ways that they can seek help. So we appreciate your coming in and talking to us today about depression and dark days.

Dr. Bryan Woods:

Well, I'm happy to do it and thank you for having me.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle. If you are struggling with depression or transition of some sort or crisis, we invite you to go to the Dr. Lisa website, doctor. 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 are 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 this 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 Sheppard of Shepherd Financial is speaking about his concept Evolve with youh Money on Friday, May 11 at Volunteers of America, A Celebration of Caring in Brunswick. John Herzog of Orthopedic Specialist has a lecture on the Integration of Health, Diet and exercise on May 18th at One City center in Portland and Robin Hodgkin of Morgan Stanley Smith Barney is offering the lecture Disrupt Yourself featuring speaker Whitney Johnson at May 10, 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 D O C t o r lisa.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.

Dr. Lisa Belisle:

Sat.