rEEG biomarker scanning

Mind Therapy Clinic utilizes innovative approaches to treating the most complicated to common problems. Trial and error, a frustrating aspect of current psychiatric treatment, is replaced with innovative and objective approaches. Technologies such as EEGs (eletroencephalograms), used to measure electrical activity in the brain, are used to match abnormal brain patterns with the improvements found using a specific drug or combinations.

Referenced-EEG or rEEG, a technology developed by CNS Response, provides the first clinically useful method of guiding medication treatment based upon identified brain abnormalities. The technology is based upon data collected from 7,000 patients over many years, treated with some 17,000 different medications. Because treatment is based upon selecting medications demonstrated to address specific brain abnormalities rather than on a group of symptoms, rEEG appears useful in treating a broad range of psychiatric diagnoses. Studies to date of rEEG have consistently shown effectiveness rates of greater than 65% in treatment unresponsive patients, a much higher rate than prior approaches.

Read rEEG Study on Depression

MindTherapy Clinic Medical Director publishes multi-site study demonstrating rEEG potential effectiveness to predict best medication choices for depression.

Dr. Mark Schiller, Founder and Medical Director of the MindTherapy Clinic is helping to prove that referenced-EEG "(rEEG)" guided pharmacotherapy represents an easy, relatively inexpensive, objective office procedure that builds upon clinical judgment to guide antidepressant medication choice." In partnership with his co-authors and researchers at Stanford, Harvard, Rush University, UC Irvine, and others, Schiller's research showed that patients with treatment resistant depression whose prescribing was guided by the rEEG improved at a statistically significant rate over control subjects whose treatment decisions were driven by the National Institute of Health's treatment protocol known as STAR*D, an industry standard.

"Referenced EEG [rEEG] is not a cure-all," Schiller says. "However, for many patients it gives us a non-invasive, relatively inexpensive way to obtain a set of brain measures that guide medication choices much more effectively than conventional methods alone." Schiller and the team's work is based on previous research that has shown EEG's usefulness to predict treatment response in depression including a study that used frontal lobe EEG examination to identify a biomarker that can predict the effectiveness of a particular SSRI. Referenced EEG differs from a standard EEG (QEEG) by comparing the findings to a database of normals and then to a database of individuals who are symptomatic for depression. "By comparing the QEEG in a given patient to QEEGs in a database of patients who have been tried on and responded to a specific medication, rEEG may be able to predict a response to a wide number of medications," according to the published report (p.2). Noteworthy is the way in which the rEEG suggests medication choices based on how the brain is functioning rather than the patient's report of depressive symptoms. This makes it possible for the psychiatrist to work outside the box of orthodox prescribing that historically has been informed by patient reports of how they feel. Now Dr. Schiller and colleagues may make medication choices based on how the brain will likely respond.

Study design

Participants in the study were 18 years of age or older who met current criteria for major depressive disorder and had recent medication failures using SSRIs or other antidepressants. They were divided into groups based on the number of previous medication failures: one group included subjects with depression treatment failure after one or more SSRIs in the current episode, and the other, those with failure after at least two classes of antidepressant in the current episode. Subjects were excluded from the study whose depression might have resulted from head injury, a seizure disorder, a bipolar condition, schizophrenia, dementia, developmental delay, substance abuse, pregnancy, or chronic pain. Although 465 volunteers with depression made themselves available for the study, 114 participants met the rigorous criteria and were then randomized into one of two treatment groups.

One group, the control group, received depression therapy based on a treatment algorithm designed to use the most effective medications suggested by the STAR*D treatment protocol. The other group received rEEG-guided therapy, the protocol under investigation. All subjects completed a washout period from their current medications (medically managed) and any other psychoactive substances prior to receiving either the control or the rEEG. Depression levels were measured using symptom checklists, specifically the QIDS-SR16 and the Q-LES-Q-SF. The measured treatment course averaged 115 days (about 16 weeks) following washout.

Results

Participants whose medication choices were guided by the rEEG protocol reported significantly less depression than their STAR*D treated counterparts. On the QIDs-SR16 (depression measure) the magnitude of improvement was 65% for rEEG compared to only 39% for the controls. Similar findings were obtained on the Q-LES-Q-SF as well as on 9 of the 12 secondary outcome measures employed. It was also true that week to week analysis showed statistically increasing improvement in the rEEG group demonstrating its superiority in reducing patients' depressive symptoms.

The article is in press: DeBattista C, et al., The use of referenced-EEG (rEEG) in assisting medication selection for the treatment of depression, Journal of Psychiatric Research (2010), doi:10.1016/j.jpsychires.2010.05.009. A web link offering the full text can be found at http://www.brainmed.nl/debattistajpsychresearchtheuseofreferencedeeg.pdf

For more information

To learn more about rEEG, its use at MindTherapy Clinic or to explore whether it might be right for a particular individual contact Dr. Schiller or the staff at MindTherapy Clinic: info@mindtherapyclinic.com or (415) 945-9870.

Suboxone & Vivitrol treatment

Suboxone

Suboxone is effective new treatment options for addiction to heroin and prescription narcotic painkillers such as Oxycontin and Vicodinare. Suboxone is a "partial opiate," meaning that it gives the brain something like what it is used to without the dangers associated with "full opiates" such as Heroin, Vicodin, or Methadone. It provides longer-lasting relief and reduce the reliance on daily medication dosages

Vivitrol Injections

Another new treatment option for addiction to heroin, morphine and opiate painkillers that was recently approved by the FDA consists of monthly injections of a drug called Vivitrol. This drug, known generically as naltrexone, works on the body differently than methadone or buprenorphine. It actually blocks the effects of opioid drugs and reduces the craving to take them.

Mindfulness-based group therapy

Mindfulness: Why is everyone paying so much attention?

If we are paying any mind at all to what the "buzz" is in psychology we have probably heard about mindfulness. Here at the MindTherapy Clinic we embrace mental health treatment modalities supported by research showing the method helps people to live healthier and happier lives. Mindfulness, although not a mental health treatment, is being integrated into psychotherapy and other health practices. Psychologists, doctors and researchers recognize mindfulness because it is safe for almost everyone, has no negative side effects, can be done alone or in a group, and can be practiced anywhere. Research has demonstrated that mindfulness practice, as a component of psychotherapy, speeds recovery and learning. The MindTherapy Clinic is offering several therapy groups and individual therapy utilizing mindfulness as a catalyst for personal exploration and growth.

What is mindfulness and what is it good for?

Mindfulness is a way of paying special attention to what is. What in the present moment is being experienced, while remaining open and accepting of one's present experience.

Mindfulness is a translation of the Pali word, sati, which is often defined as "being aware of, paying attention to and returning to," what is present in our awareness. It also has a connotation of being aware with a particular open non-judgmental attitude to the experiences of which we are being aware. It doesn't mean we will or will not like what we notice about our experience but rather that we will discover a loosening of our struggle with our experiences. One becomes more at ease with the natural tendency to prefer this or that, or dislike this or that, and less caught up in the sway of these forces or the need to "get it right." It can also increase concentration abilities by learning to tune out some of the "mind chatter" many experience. Mindfulness is a skill that can be developed and yet like many skills is to be practiced rather then mastered. Some experienced teachers have said that one's understanding of what mindfulness is actually changes as one's practice deepens and expands.

Much of what researchers are studying are the mindfulness techniques of the Buddhist traditions; yet, there are mindfulness practices in all the world's major spiritual traditions. Christian, Hindu, Islamic, Jewish, and Taoist traditions all include special ways of paying attention to one's direct experience of the present moment. What research in neuroscience has discovered is this type of mind training can actually affect the brain's physical structure as well as enhance communication between its various parts. These changes are referred to as neuroplasticity, changes in the connections of brain cells, and neurogenesis, growth of neurons or brain cells. Regular practice actually changes the way the brain cells, neurons, are communicating with one another. Mindfulness appears to activate this communication of neurons in particular areas of the brain. With mindfully focused ways of attending to experience one can develop new ways of perceiving and responding to one's experiences.

To learn more you might visit:

• Alterations in Brain and Immune Function Produced by Mindfulness Meditation: http://www.psychosomaticmedicine.org/cgi/content/full/65/4/564
• Mindfulness Meditation Helps Relationships: http://www.news-medical.net/news/2005/02/07/7660.aspx
• http://www.bemindful.org/mindtxprofnotes/MBREart.pdf

The MindTherapy Clinic offers Mindfulness-based therapy groups.

Please contact Jonathan Kabat for more information at (415) 630-2305