Tag Archives: CBT

Testosterone, Electrodes, and Depression

Laboratory rat

Because I’ve been broke and at near-wit’s end about my lingering untreated “emotional issues,” over the past few years I’ve participated in a few clinical research studies.  I have been slightly less than desperate to make money as well as try new forms of treatment to see if anything would break through my stubbornness and alleviate some of this debilitating melancholy.

My first experience was simple: fill out a lengthy questionnaire and donate some vials of blood for testing. The study was to determine whether or not there was a direct relationship between genetics and anxiety. There was monetary compensation (my main motive) as well as a follow-up questionnaire that you completed at your leisure and later sent in (with another compensation). The hardest part of the study was emotionally dealing with the consequences that come from evaluating your past and present state of mental health. This sounds easier than done. Anyone who has had a psycho-evaluation knows how personal and emotionally draining it can be.

images (1)My second experience involved the antidepressant effects of testosterone when administered to women with Major Depressive Disorder. (Note: I was assured that at every weekly visit the blood they sent to the lab would be monitored to make sure my levels did not exceed the otherwise normal amount of testosterone.) This was a blind study; there was a 50 percent chance I would receive the active testosterone cream and a 50 percent chance I would receive the placebo. Either way, the lotion had to be applied each night for about three months. Each night I recorded what time I applied the cream, the amount I applied (which was predetermined by the study group), and any side effects that I may have experienced. I never noticed any side effects. David thinks my depression did lift, but only slightly. My participation fell around the time of year that the days grow brighter and longer, so my winter blues may have lifted a little on their own because of seasonal changes. As with the first study, the hardest part of this study were the extensive interviews each visit. I had the same packet of “self reports” to fill out each time, in order to monitor any mental changes. The questions involved changes in mood, appetite, sleep disturbances, and libido. The baseline visit was incredibly grueling. It was, of course, an in-depth psycho-evaluation which left me feeling more dreadful than before and hoping that I wasn’t receiving the placebo. They assured me that at the end of the study when the results were un-blinded, they would inform me what I was administered. I honestly think it was the placebo. But then again, I don’t hold much hope for anything.

Electric_chairMy most recent research study involved the effects of transcranial direct current stimulation (tDCS) on Major Depressive Disorder, which was described as “a device to send weak electrical currents to your brain through your scalp.” The study was based out of the Mood Disorders Clinical Studies wing of Butler Hospital in Providence, RI and included 12 treatment sessions followed by 2 interview follow-ups.

The process was simple, although strangely similar to a death-row electrocution.

When I arrived for my first treatment, after another brief interview, I was instructed to sit in an office chair in front of a small table with a Dell laptop facing me. The whole procedure took place in a small office room, sparsely decorated, and with a window overlooking the psychiatric hospital grounds. A social worker who would be leading my participation throughout the process, along with an assistant, measured my head to find the central, topmost point. (They mentioned what a symmetrical head I have: 38″ by 38″. It’s really hard to find hats that fit.) These numbers were divided in half to find the intersection. From there they measured about 3.8″ to the right and left just anterior to my temples. They wet two sponges, warmed them in a microwave for about 30 seconds (purely for my comfort–their idea), and placed them on the two points they had marked. The sponges are each two thin blue pads held together at the corners, with a space in between to fit the electrodes. imagesA strap is placed under your chin, over the pads to keep them in place, and around behind the nape of your neck. Throughout the experiment the saline solution from the sponges dripped down my hair and onto my shoulders.  Since I redyed my hair one week prior, I accidentally turned a part of the towel they gave me blue. A week or two later I went to grab the towel they provided and noticed it was the same one, still with a blue stain. I was hoping they would have washed it by then. I guess I’ll forever be remembered at Butler Hospital as the girl who turned the towels blue. (I had a similar incidence at McLean Hospital last fall when my hair was purple, but that time I was inpatient and had wet my entire hair. You don’t always plan for hospitalizations and I had just dyed my hair. Oh well. I guess I’m leaving my mark of hair dye at every psychiatric hospital I’ve been to.)

During the treatment, you either received a fake or actual stimulation. They never alluded to the correlation between the sensations I felt and whether it was actual stimulation coursing through my head. The sensation felt like a burning/itching/pins-and-needles feeling, only tolerable. The feeling stopped as soon as the machine turned off and there were no residual effects on the way home.

As I sat there, hooked up to the tDCS machine, I worked on a Dialectical Behavior therapy (DBT) computer program, watching videos and then applying the lessons to real-life situations. There was homework as well which was strongly recommended, but optional.

I finished the study, I completed most of the homework, and was later paid for my participation. Overall, I didn’t personally notice a difference. There was a time in the beginning where the lessons of DBT were helpful which in turn made me feel more hopeful, but once something happened in my personal life, that hopefulness quickly dissipated.

I wonder if my depression is treatment-resistant or if my stubbornness truly runs so deep that even I won’t allow myself to feel better. I could have just bad luck and received placebos for both treatments. Either way, they were interesting experiences and I would consider participating in future studies. I am, after all, becoming a regular at the Mood Disorders Research Clinic at Butler Hospital, even on the phone they know who I am.

 

(If you are interested in participating in a clinical trial, check out your local hospital web pages or visit ClinicalTrials.gov.)

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Sadness Inside & Out

Monday night, David and I went to the drive-in theater to see the new Pixar movie, Inside Out. I laughed, I cried, I went emotionally numb, I was scared of my own feelings and then ultimately experienced an overwhelming sense of revelation to the inner workings of my mind.

SADNESS_Fullbody_RenderI was pleasantly surprised about the concept developed for the plot of this movie. The story follows the emotional roller coaster that is the prepubescent life of a young girl named Riley dealing with the struggles of moving to a new city, starting a new school, and leaving her friends and past life behind. The cast of characters that are the makeup of the young girl’s emotional mainframe each represent a primary emotion: Joy, Fear, Anger, Disgust, and of course, Sadness. Within the emotional universe where they live are lands of long-term memory banks, a train of thought, the subconscious, and Personality Islands including: Honesty Island, Friendship Island, and Goofy Island. There are valuable core memories and memories that fade and are subject to the clean-up crew who collect and dispose of useless, old memories (albeit leaving a few bizarre memories that most of us recall at the most unrelated moments–memories of information that would be useful to a pop-culture wiz who probably had been subjected to years of subliminal messaging). All of these memories are literally colored with their corresponding emotion that was present at the time: anger-red, disgust-green, fear-purple, joy-yellow, and sadness-blue.

Without revealing too much about the premise of the movie, there is a breakdown in the balance of the emotions; Joy and Sadness become a focus and get lost within Riley’s mind. Each consecutive emotional disruption corresponds with what life event Riley is experiencing; although instead of her actions controlling her emotional mind, the characters of her emotional mind quickly react and decide what she should be feeling at the time and how she should respond to certain stimuli. The entire movie is a metaphor in-plain-sight, allowing the viewer to think about their own emotional mind while enjoying a frolicking animated Pixar movie. I couldn’t help but wonder throughout the movie if the writers were themselves psychologists, and whether they based the movie off of the understandings of Mindfulness that is so prevalent throughout Dialectical Behavior Therapy (DBT).

I see absolutely nothing wrong with this.

The world needs more movies like this one, especially during times of great hardship. There are more tragic, sometimes preventable, causes to breakdowns in our family systems today and more impeding situations such as technology that stunt the healthy growth of a nurturing, balanced family. An emotionally needy child that goes unnoticed may develop skewed perceptions of future relationships and of his/her own self. Although Riley grew up in a balanced environment, she is still controlled by her many emotions that react to the situational changes in her life. This means that even though someone may have had an emotionally nurturing childhood, he/she can still be subject to irrational automatic thoughts. This movie encourages the viewer to reflect upon his/her emotional reactions and how his/her automatic thoughts may not be the rational ones.

My current research study is partially comprised of the teachings of Cognitive Behavior Therapy (CBT)–where you focus on your automatic thoughts and determine whether they are rational or not, whether there is factual evidence to support them or whether they stem from an overactive emotion. The Emotions in the movie react without rationalizing the situation. This causes a chain of events in the breakdown of the little girl’s emotional state until she eventually becomes numb.

We’ve all been there before. We’ve all been controlled by Joy, Anger, Fear, Disgust, and of course, Sadness. Some people experience one emotion stronger than the others and this is what the movie teaches us: All of our emotions are Sadness_Julieimportant, and there is a time when focusing on one emotion over another is appropriate, but not to allow this to happen all the time.

Now when I find myself falling down into that deep melancholic hole, I try to picture(when I’m aware of it) my emotions as these animated Pixar characters, and which one is taking total control. It helps me to personify intangible feelings. If I can put a face to a name, I can work to organize and understand my thoughts and thought processes. So for now, I’ve put Sadness on my desktop, my cell phone, and on my shoulder. The artists at Pixar have created a tiny character that illustrates my depression almost perfectly–even down to my blue hair.