Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for July, 2019

Machines For The Mind

Posted by Dr. Vollmer on July 30, 2019

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Transcranial Magnetic Stimulation….the neuromodulation device FDA approved treatment for depression. Trigeminal Nerve Stimulation..the neuromodulation device FDA approved treatment for ADHD in 7-12 year olds. Cervella, the neuromodulation device, FDA approved treatment for depression, anxiety and insomnia. All of these devices deliver electrical current to the brain/nerve endings via an external device. The mechanism of action, like antidepressants, is not known. The theory is that neural networks need a re-boot to treat psychic pain. These machines help us move away from the “chemical imbalance” theory to a “neural network malfunction” theory. Of course both mechanisms could be at play, but we do not know that yet. We know that FDA approval hinges on beating the placebo response, but we also know that all psychiatric illnesses have a high placebo response. My point is that we come from a place of humility, of not knowing how we help people, and yet, trying all of our tools, including psychodynamic tools, to help with suffering. The broader and deeper our toolbox the more likely we can help those in need and so I welcome these additions to our armamentarium.

 

 

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Mental Illness vs. Mental Suffering

Posted by Dr. Vollmer on July 29, 2019

 

 

The human condition means that sadness, fear, depression, excitement, enthusiasm, low activity levels and high activity levels are all experiences we cycle through to a greater or lesser extent. Oftentimes, in an effort to help others, providers over-diagnose these mental states by telling the patient that he/she has a mental illness, when in fact, he/she is suffering. Why is this distinction so critical? Mental illness implies psychopathology, that something is terribly wrong with that person. Mental suffering implies a hard time, something we can all relate to. To include others in a shared humanity is the job of providers to help patients in need. To separate out patients with a diagnosis should be done cautiously and rarely, as mental illness, is indeed rare. However with the DSM 5 hitting our trails, and the abundance of medications available to help mental suffering, there has been an explosion of both diagnosis and treatment which I believe has distracted patients and their families from understanding the deep roots of mental awareness. I think we can help those with mental suffering without diagnosing them with a mental illness. I know insurance companies make this hard, but we, as providers, must push back and tell patients that our medications (and now our machines) can help mental suffering, but this by no means implies a mental illness. Putting the locus on the common humanity along with its shared ups and downs, allows us to provide compassion, while still having the goal of minimizing psychic pain. And so I begin to make this point. More to follow. Thanks for reading.

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Checking In…

Posted by Dr. Vollmer on July 24, 2019

Hello Dear Readers,
I am checking in to see about suggestions for future blog topics.

I also want to mention that I have traveled the country giving talks about the evolution of psychiatry and one participant said “I am going to remember that you said there was a difference between mental suffering and mental illness.” I repeat that now in all of my lectures. We, as psychiatrists, have over-diagnosed children and adults with mental illness, thereby causing people to externalize rather than internalize their issues. They seek quick fixes as opposed to deep introspection and reflection. Our medications and our new neuromodulation devices have encouraged people to look for the next “fix” and although I think our tools are very helpful, I also think there is tremendous value in psychological growth and development.

I consider myself an ambassador for the “old school” of psychiatry where symptoms were put in historical context, while at the same time, being schooled in the new world of psychiatry which now includes Ketamine, intranasal, and machines including TMS, trans-cranial magnetic stimulation, and TNS-trigeminal nerve stimulation, and Cervella-a headset which is FDA approved for depression, insomnia and anxiety. Come hear me at Pri-Med, or come talk to me on my blog. Cheers!

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