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BENEFITS OF AN AGENCY: Behavioral Health Network, D2 FALL MOVIES: Films coming to theaters, streaming services, D5 THE NEW YORK TIMES SUNDAY CROSSWORD, D8
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Behavioral Health Transcranial magnetic stimulation is a brain neuromodulation treatment that has become more readily available in recent years. It is used for the treatment of clinical depression that has failed standard treatment or when the patient is unable to tolerate standard approaches.
By Cori Urban
non-invasive brain modulation treatment called TMS,” Ackerman pointed out. There is about a 12 percent Transcranial magnetic risk of suffering from a serious stimulation is a brain neurodepressive episode during a modulation treatment that person’s lifetime. “The illness of depression is has become more readily relatively common and has a available in recent years. It prevalence of approximately 7 is used for the treatment of percent each year in the Unit- clinical depression that has failed standard treatment or ed States population,” noted Dr. Tedd Ackerman, medical when the patient is unable to director of behavioral health tolerate standard approaches. A candidate for TMS generat Holyoke Medical Center. “Clinical depression is a seri- ally would have tried a comous cause of disability and is bination of medication and psychotherapy. “People may also a significant contributor to mortality.” often wish to try TMS prior to electroconvulsive therapy, Clinical depression unlike common sadness is a conwhich is a much more invasive procedure that involves andition marked by ongoing esthesia; TMS does not,” said combination of symptoms including sadness, inability to Ackerman, who has found it experience pleasure, fatigue, to be a personally rewarding concentration problems and experience to be able to offer people who are suffering a thoughts of self-harm. It affects mood, thinking patterns new, non-invasive modality. and biology. Holyoke Medical Center began offering TMS services “It is different from common sadness that everyone in 2017. experiences,” Ackerman said. The treatment is said to feel “It can have pervasive effects like a series of tapping sensaon one’s relationships, work tions with periods of rest in life and health. It tends to be a between, for a total number of recurrent condition. Unforapproximately 3,000 pulses per treatment. tunately, clinical depression The patient is awake and tends to go undiagnosed and alert during the treatments, untreated.” But once diagnosed, it can which last just more than half an hour. The person is seated be treated. Initial treatment for clinical in a comfortable treatment depression is usually psycho- chair with a small headband therapy or medication, but affixed to the forehead with the magnets resting on the some trials have indicated that a combination of both is head. more effective. The patient can return to normal daily activities after “One of the exciting develtreatment. opments in psychiatry over Once daily treatment is the past number of years has complete, there will be six been the development of Special To The Republican
ibuprofen. “At Holyoke Medical Center we do everything we can to insure someone’s comfort during treatment,” Ackerman said. This may include changing the parameters of treatment or alternating where the magnetic coil is placed, a procedure called remapping. The magnet is about the size of a carton of milk, and the patient is not enclosed during treatment. The magnetic field strength is generally about the same as what is involved in an MRI device. “Neuro imaging of depressed patients shows decreased functioning in the left pre-frontal part of the brain; TMS tries to target this area,” Ackerman said. “It is thought that the mechanism of action involves changing brain cortical activity that connects to other areas of the brain, which ultimately increases neuro transmitter turnover and may normalize hypothalamic pituitary functioning that is often abnormally functioning in patients with clinical depression.” TMS is FDA-cleared to treat depression. Massachusetts insurances are covering TMS when criteria are met. Holyoke Medical Center Above: Dr. Tedd Ackerman stands next to the TMS chair at can treat up to 10 patients Holyoke Medical Center. (PHOTO COURTESY OF HMC) each day, operating 52 weeks a year. Treatments are five days a week except on major remission.” This is somewhat ment,” Ackerman said. holidays. Common side effects inhigher than in some initial “TMS is a safe, generally clude superficial scalp pain at studies. well-tolerated treatment for the site of treatment and ocStaff at the medical center has treated 277 patients since casional headache. Headache clinical depression that has not responded to standard and scalp pain are usually TMS was introduced there. self-limiting and may be alle- treatment. It has significantly Prior to the availability of viated by the use of Tylenol or improved numerous patients’ TMS at Holyoke Medical taper visits scheduled to gradually reduce the need for regular treatments. Improvement is often seen after 15-20 treatments, but may take longer with some patients. “Generally, at Holyoke Medical Center our response rate to TMS has been 66 percent having a significant response with improved quality of life,” Ackerman said. “Approximately 33 percent of the patients have achieved
Center, patients would have a psychiatric evaluation to confirm the diagnosis and whether or not there were any contraindications to treatment with TMS. These contraindications include implanted metallic hardware in the brain such as aneurysm clips, implanted electrical devices such as pacemakers or cochlear implants. “TMS is generally safe and well tolerated, and very few patients drop out of treat-
lives since we have started treating it at Holyoke Medical Center,” Ackerman said. “It gives patients an additional treatment beyond standard medication and psychotherapy.” Holyoke Medical Center staff will work with a patient’s current medical/psychiatric provider to see if TMS is an appropriate option. “Since depression can recur if TMS is effective, retreatment with TMS is often highly effective,” Ackerman said. Some people also find that medications, which previously were not effective, may be more helpful after treatment. TMS is being investigated for other psychiatric conditions including post-traumatic stress disorder, obsessive-compulsive disorder, adolescent depression, bipolar depression and neuromodulation post stroke. “There are also areas of investigation to try and reduce the time of treatment. These are exciting areas of research,” Ackerman said. If TMS is not beneficial in treating the person’s depression, other options to explore would include electroconvulsive therapy — which is offered at Holyoke Medical Center — and the medication Esketamine, a relatively newer option for depression resistant to treatment. Ask your doctor for more information or for more information, go online to holyokehealth.com/tms or call 413-535-4930.
Transcranial Magnetic Stimulation Therapy 413.535.4930 • holyokehealth.com/tms
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D2 | SUNDAY, SEPTEMBER 19, 2021
THE REPUBLICAN | MASSLIVE.COM
The Benefits of an
Agency It is likely not controversial to suggest that systems produce consistent results. The advantage of an educational system, a health care system, or an assembly line, is it produces similar outcomes over time. Confusingly, it is often a source of social/political tension that systems can also, through poor design or bad faith, consistently reproduce negative results, particularly for folks with less power to influence system construction. At the time I decided to pursue a career as a clinical social worker, I had been working for a number of years as a staff reporter at a community newspaper in a major urban center. I had covered enough election cycles, dips and spikes in violent crime, development projects, school system overhauls etc. to feel like I had a sense of the pros and cons of how most systems function. I imagined a future in private practice, supporting my clients to explore the intricacies of their experience of the world at a comfortable remove from any infrastructure. These days, I am regularly reminded of how system-engaged my work is by a sharp-witted client, whose most innocuous take on my employer, Behavioral Health Network (BHN), involves comparison to Wal-Mart. BHN does provide a wide array of services from, traditional psychotherapeutic and psychiatric supports, to residential; substance use treatment; and medical case management supports, as well as an array of supports for individuals experiencing psychiatric crisis, and much more. The benefits of a comprehensive community-based support model are strikingly clear from my current role as an outpatient clinician at BHN Carson Center for Development. Our specialty clinic, through a contract with the
Springfield-Area Office of the state Department of Developmental Services (DDS), primarily serves intellectually and developmentally disabled adults and children with co-occurring mental health issues. DDS clients’ lives are, by design, deeply and intimately mediated by systems. The model for DDS services is for various vocational, residential, clinical, and other supports to work together to facilitate maximal autonomy
David Taber, MSW, LCSW gave up on his dream of being a newspaper reporter years ago due to poor organizational and time management skills. He remains committed, however, to borderline comical remuneration, and so has since pursued a career in community mental health. He really should have gotten it together to sit for his LICSW exam by now. and community engagement. Of course, the range of available supports, and flexibility to make changes when something is not working are limited by budgetary, regulatory, and other constraints. The underlying premise of the model, however, is that, to the extent possible, it is beneficial for the individual’s support system to be flexible and responsive to their changing needs.
In this context, our work as psychotherapists is often centered on creating space with our clients where they can examine their relationships with their support systems, and determine how they want to manage those relationships to impact the system. Therapeutically, I have found that the possibility for clients of effecting systemic change— even on this micro-level, and through Herculean effort—is at least equally as therapeutic as the other, complementary intervention regularly explored in psychotherapy: The possibility that engaging with chronically misattuned systems can be rendered less traumatic through developing distress-tolerance and self-regulation skills. This is the crux of why and how community mental health agencies like BHN are so important. Practicing outpatient therapy from within a service-network-system means I can easily provide a referral for an I/DD client who is ready for the challenge of a neurologically integrated therapy group focused on building self-regulation skills. I can join with a client, at their direction, to coordinate with group home residential supports on how best to support them as they develop a clearer self-understanding of their own reactions and motivations. Writ large, my best hope is that, as a society, we are moving toward systems that harness increased information flows to provide increasingly flexible and accurate responses to people’s needs. State agencies like DDS and community mental health agencies like BHN are and should continue to demonstrate leadership in this direction.
For information call 413-246-9675 or visit bhninc.org
Healthy Habits for your daily routine can contribute to six pounds of Virginia Health System The right of weight loss over the course found that men between the of a single year. In addition, a ages of 71 and 93 who walked habits can study from the North Amermore than a quarter mile per day had half the incidence of ican Menopause Society help people found that stair climbing can dementia and Alzheimer’s help postmenopausal women disease as men who walked their risk for osteoless. A 15-minute walk live healthier reduce around the neighborhood porosis and help them lower each morning coupled with a lives, and such their blood pressure. 15-minute walk after dinner can help adults dramatically Drink habits need improve their overall health. more water not require The Centers for Disease Eat more Control and Prevention notes any major life that water helps the body greens maintain a normal temperaEating more greens is changes. ture, lubricates and cushions another healthy habit that A person’s habits can have a strong impact on his or her overall health. Unhealthy habits like smoking and living a sedentary lifestyle can increase a person’s risk for various conditions and diseases. On the flip side, healthy habits like eating a nutritious diet and getting enough sleep can bolster a person’s immune system and reduce his or her risk for various ailments. Some healthy habits, like daily exercise, can be time-consuming. Busy adults may not have time to exercise vigorously each day, though the U.S. Department of Health and Human Services urges men and women to find time for at least 150 minutes of moderate-intensity aerobic activity each week. But not all healthy habits take up time. In fact, adults can incorporate various healthy practices into their daily routines without skipping a beat.
Take the stairs
Mental Health | Addiction | Crisis | BHN TeleCare
Get Well. We Can Help. Call BHN today at 413-BHN-WORK (413-246-9675) 24-Hour Crisis Line: 413-733-6661 bhninc.org
Taking the stairs instead of the elevator can have a profound effect on overall health. According to Duke University, climbing just two flights of stairs combined per day
doesn’t require a major overhaul of an individual’s lifestyle. The U.S. Department of Agriculture notes that dark green leafy vegetables, such as spinach, are rich in vitamins A,C, E, and K. The Mayo Clinic notes that vitamin E alone can help people maintain their vision and promote a healthy reproductive system while also improving the health of the blood, brain and skin. The USDA also notes that green vegetables contain very little carbohydrates, sodium and cholesterol. Adults won’t have to reinvent the dietary Walking benefits the body wheel to incorporate more in myriad ways. For example, greens into their diets, and the Harvard School of Public the results of doing so can Health notes that women who have a significant, positive walk 30 minutes per day can effect on their overall health. reduce their risk of stroke by 20 percent and potentially by 40 percent if they walk briskly. In addition, researchers at the University joints, protects the spinal cord and other sensitive tissues, and helps to rid the body of waste through urination, perspiration and bowel movements. Adults who are thirsty can choose water over soda or other sugary beverages. The CDC notes that sugary beverages like soda and sports drinks contain calories but little nutritional value, making water a healthier way for individuals to quench their thirst.
Go for daily walks