Category "Therapy"


Ketamine for depression divides experts: ‘I’ve seen these drugs come and go’ – National

by BBG Hub

Depression can be completely debilitating, making it difficult to do even the simplest tasks — like getting out of bed or brushing one’s teeth.

Unfortunately, it’s very common. According to the World Health Organization, more than 300 million people around the world are currently suffering from depression.

Now, there may be a new way to treat the illness: ketamine.

READ MORE: ‘Emotionally draining’: The effect depression has on tasks like brushing hair, showering

Ketamine is commonly used as an anesthetic and painkiller in animal and human surgery. It also rose to popularity as a party drug in the 1990s. Now, it’s being lauded as a possible cure for treatment-resistant depression.

“We have a large sub population in our country with depression who can’t work… they just can’t break this vicious cycle,” said Dr. Roger McIntyre, president of the Canadian Rapid Treatment Centre of Excellence (CRTCE).

McIntyre hopes ketamine can break that cycle.

The CRTCE, which administers rapid onset treatments for depression in the form of ketamine injections, is the first of its kind in Canada.

How does the treatment work?

At the CRTCE, ketamine is delivered through intravenous infusion. According to the clinic’s website, “the protocol for administering ketamine is still being refined. Nonetheless… most individuals will receive four infusions (i.e. two infusions per week for two weeks).”

The cost of this treatment at the CRTCE is $3,000, and it is not paid for by the public health plan of Ontario (OHIP).

The process is overseen by a physician trained in anesthesia, as well as a nurse.

“The dose of ketamine by someone on the street… is about 10 times higher than the dose [you would be given] if you went to the hospital this afternoon for a procedure that required anesthesia,” said McIntyre. “The dose that we use to treat depression is about one-10th… of the dose used in anesthesia. So we’re using ‘sub-anesthetic doses.”

According to McIntyre, this does not mean the process is without safety concerns.

WATCH BELOW: ‘He likes to give hugs’: Man says emotional support alligator helps his depression

“[We] know it’s generally well received by patients, but it would be inaccurate to say that you don’t get any side effects,” said McIntyre. 

According to Centre for Addiction and Mental Health (CAMH), ketamine can produce “vivid dreams and a feeling that the mind is separated from the body.” This effect is known as “dissociation.”

The intensity of the effects depend on several factors, including: your age, your body weight, how much you take, how often you take it, how you take the drug and more.

“Some people do become addicted, and continue to use ketamine even when they plan not to or despite its negative effects,” as stated on the CAMH website.

Ketamine works faster than other treatments

If a patient presents with intense suicidal thoughts, ketamine may be a more effective short-term treatment than other antidepressant medication.

“Most antidepressants take approximately four, six or even eight weeks to work. That’s a long time,” said McIntyre. “If you’re suffering, ketamine can work within one day.”

Dr. David Gratzer, a psychiatrist at CAMH, is hopeful about the effects of ketamine on depression for this reason.

READ MORE: 8 signs your child may be going through depression

“We are looking for a way of providing more rapid relief of depression than one might ordinarily see with Prozac and [similar] drugs,” said Gratzer.

“The evidence is there but we have to take it with a grain of salt because it’s early days. That being said, we do seem to find evidence that it helps people very quickly, particularly people who have many thoughts of suicide.”

Ketamine is a last-ditch effort for those who have tried everything else

Depression is difficult to understand — even for medical professionals.

“As with most diseases in physical medicine and mental health, we have a sense of what’s involved but we don’t exactly know,” said Gratzer.

According to Gratzer, doctors do know that family history and certain traumatic life events are connected with a higher risk of depression.

“However, two people can be raised in the same household and eat the same foods and have a relatively similar childhood and one can get heart disease while the other doesn’t,” said Gratzer.

WATCH BELOW: Study links exposure to infection in the womb to increased risk of autism, depression

“Likewise, you can get [depression] and your sibling may not. So, while we do recognize there’s a strong genetic component… it’s not 100 per cent. There’s more going on.”

Because of the evasive nature of depression, finding a treatment that works can be difficult.

Once someone is diagnosed, they are usually prescribed one of or a combination of three kinds of treatment: exercise, talk therapy and medication. According to Gratzer, patients “do the best” when they do all three.

READ MORE: Is ASMR an effective way to treat anxiety and depression?

But, for some patients, none of these treatments work. And that’s where ketamine can be an exciting option.

“Ketamine is one of a handful of medications that is out of the box,” said Gratzer. 

To be eligible for treatment at the CRTCE, there are three criteria: you are over the age of 18, you are medically stable and you have had a minimum of two other treatments for your depression.

‘Early reports are good, but now we need to take it to the next step’

McIntyre admits that the full effects (positive and negative) of the drug are unknown.

An issue McIntyre and his team are paying close attention to is the impact ketamine can have on other organs, like the kidney or the bladder.

Another is whether ketamine can act as a gateway to other, more severe drug abuse, said McIntyre. 

The CRTCE website states that, “it is critical to understand that ketamine researchers are still exploring a multitude of ways that ketamine infusions impact the human brain. They are working towards understanding why this form of treatment works so quickly and effectively.”

Despite its positive impact thus far, Gratzer isn’t ready to call ketamine a “wonder drug” yet.

WATCH BELOW: 5 ways to help a friend with postpartum depression

“I’m optimistic, but I’ve got a few gray hairs, so I’ve seen these wonder drugs come and go,” he said.

“We need to take it to the next step… can we use it on more people safely? What sort of side effects do they get? Are the effects [on depression] we see with ketamine lasting?”

Gratzer is interested to see whether the effects of ketamine can remain beyond the days after it’s injected.

“It’s great that some people might see relief… if you’ve got a pain on your left hand, it’s great that you feel better with a Tylenol. But that tends to fade and maybe what you really have is a little infection of the skin and what you should really take is antibiotics,” said Gratzer. 

“I hope this is working out because it will be helpful, but I don’t really know and I don’t want to be too optimistic. Like a lot of private healthcare, the sales pitch may not be as good as the reality.”

If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.

The Canadian Association for Suicide Prevention, Depression Hurts and Kids Help Phone 1-800-668-6868 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.

[email protected]

© 2019 Global News, a division of Corus Entertainment Inc.

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As a person of colour, it’s a struggle to find therapists who look like you – National

by BBG Hub

“Depression” was not a word Sally Yue Lin ever learned in Mandarin.

There were euphemisms for things like anxiety, abuse or trauma, but Lin, 28, never thought about seeing a therapist.

She saw her first one at the age of 20, when she was living in Montreal with roommates.

“The therapist I saw was an older, white woman who gave me pamphlets on breathing exercises; there was no follow-up and I felt even more isolated and misunderstood.”

Lin spent years trying to find a therapist who was a person of colour (POC). Like many, it was important for the now-Victoria, B.C., resident to find someone who she could trust, but also, and more importantly, someone who would be able to recognize some of her lived experiences.

READ MORE: Living In Colour explores how race, ethnicity impacts the daily experience of PoCs

“My experience as a racialized Asian femme person made me more vulnerable to sexual violence and harassment,” she continued. “My Chinese culture and identity as a diasporic person is both a treasure and a burden.”

To complicate matters, Lin was estranged from her father, which was simultaneously difficult and liberating. For her, respecting one’s elders was a common belief in her household, something one of her white male therapists didn’t understand.

“It is a very sensitive topic for me and brings up a lot of memories of domestic abuse and trauma,” she said. “Despite my reluctance, the therapist asked me to imagine that my dad was sitting next to me in the room.”

READ MORE: 8 signs your child may be going through depression

It was the last time she saw that particular therapist.

“I wanted a therapist who was at least willing to acknowledge and learn, not… from me, their client, having to teach them,” she said. “I don’t need them to have the same experience, just the willingness to recognize my lived experience, my culture, and my heritage — both the good, the bad, and the grey.”

A mountain of hurdles

There are mountains of barriers for POC to find therapists of colour. Sometimes it’s about location; people like Lin who live in predominantly white Canadian cities have an especially hard time. Others have a hard time accessing therapists or paying for it.

Sometimes there are language barriers for immigrants who don’t speak English as their first language, so it can even be difficult to describe what you’re going through in your mother tongue.

For some, conversations around depression, anxiety or abuse don’t happen in the households, and the thought of telling a stranger can seem overwhelming. Some POC also fear that if they tell someone in their community their most personal traumas, it may somehow get back to their family members or friends.

There’s a larger problem within the profession itself with a lack of representation of POC — whether it’s in counselling, psychological or social services, said psychologist and educator Dr. Jeffrey Ansloos of the University of Toronto.

WATCH: Living In Colour: Mental health impact of discrimination

Stigma and stereotypes follow people who pursue psychotherapy in the first place, and the added weight of being a POC contributes to the difficulty.

“Specifically that there is something greatly wrong [with them],” he clarified.

In his work with the Indigenous community, Ansloos is a firm believer that therapy is often rooted in most communities of colour, but it doesn’t look like what we typically picture as “therapy.”

“It may not all look like psychotherapy, but I think there are natural helping roles that exist within every culture,” Ansloos explained. “We can do a lot even on the level of promoting mental health by really supporting diverse communities in elevating the value of these different roles that people hold.”

READ MORE: Check up on your mental health by asking yourself these questions

The end goal is to find a therapist you can connect with. For example, some young South Asian women may face greater pressure to get married, or Indigenous youth may experience inter-generational trauma or verbal abuse — these specific things impact mental health, and a therapist with the same experiences may be more understanding.

Ansloos said the good news is that POC’s perception of mental health and seeking help is shifting, and more want to openly discuss it.

The struggle to find one

But talking about it is hard when you can’t find a person to talk to. Sarp Kizir, 39, looked for a therapist of colour for nearly a decade. “I was checking names and last names. Sometimes I gave up and just went with whoever was available and accepting new clients,” he told Global News.

The Ottawa native, who is a child of immigrants, often felt vulnerable when he had to explain his experiences to a therapist. Today, he works with one who is nurturing. “There are things that I don’t feel pressured to over-explain because she just gets it.”

READ MORE: Depression leads to shorter lifespan — Canadian study

Emile Wickham, 32, of Markham, Ont., is still searching for a black therapist. In and out of therapy for 10 years, all of his therapists have been non-black. Paying for therapy has been his biggest hurdle.

I wanted to try the services of a therapist to specifically engage [in] my past,” he told Global News. He reached out to an acquaintance who was a therapist and with her network, found someone who offered a subsidized rate of $75 an hour.

“Even with that rate, I’ve been on and off for long periods because I simply couldn’t afford it.”

Jason Ip, 30, was looking for a queer POC therapist, and even in a city like Toronto, he found one person through a friend who fit the criteria. Today, he sees a white therapist who he feels comfortable with.

Credit: Getty Images

“I speak to him about my lived experience, he listens and empathizes, which is the best I can ask for, given the restrictions I had when I was originally doing my search.”

And even when POC find therapists who fit their needs, it’s often expensive or hard to schedule an appointment. Navi Gill of Vancouver tells Global News private practices range from $100 to $300 an hour, and psychologists in the past told her their practices were incredibly busy.

“There is a big shortage of Punjabi-speaking therapists out there.” She said South Asians in B.C. often turn to more community-based groups like the South Asian Mental Health Alliance and sometimes Gurdwaras (temples).

Tackling the problems

These are all struggles and loopholes that therapist Premala Matthen is familiar with. As a queer therapist of colour in Vancouver, she said clients often come to her seeking POC. She said there’s a larger problem of racism not being understood as a traumatic experience.

“When I went through counselling school, there was a little bit on multiculturalism, but not nearly enough,” she said. “I’ve had clients who tried to talk to white therapists about racism and not be understood or their experiences [were] minimized.”

Ansloos sees this problem within the educational system and added psychotherapy has predominately been developed by white mental-health experts and continues to be taught today. On top of this, there is an underrepresented number of POCs in graduate-level programs and this translates through a range of professions like social work, counselling and medicine.

“[There needs to be] more strategic recruitment and also funding,” he explained, adding another solution could be initiating alternative approaches to admissions targeting POCs.

READ MORE: Living with a mental health disorder in warmer months can be ‘suffocating’

Professional training needs to more broadly reflect people’s lived experiences, beyond white culture, he said. “That means when we have conversations about family, mental illness, identity, religion, spirituality or culture, people need to see their life more fully in what’s being taught.”

There’s also merit to further educate POC who may have unconventional roles in mental health. For example, Ansloos worked on a study that showed conservative Muslim women from countries like Jordan or Iraq were going to midwives for mental health-life services. “Does it make more sense to train the midwives? We need to be thinking more creatively.”

There’s often the criticism that any therapist, white or a POC, should be able to sit and speak with a POC seeking guidance — often as a blank slate. But he argued there are still valid reasons for POC to want therapists of colour.

Solutions for POC seeking help

But change like this takes time and funding from bodies of government plays a huge role. Plenty of organizations across Canada are doing the groundwork to promote mental health and support in their communities and larger organizations like Mental Health Commission of Canada recognize diversity in therapy is needed.

But these are all larger picture solutions. Sometimes, the biggest struggle is an isolated POC in a small city who is desperately needing the support of someone who looks like them. These are often the people that can’t afford therapy or talk to others about their mental health. So how do they get help?

Credit: Getty Images

Ansloos said it starts with recognizing you’re not trying to find someone who is exactly like you (he argued this type of therapy won’t be effective), but someone you can trust. “Trust doesn’t require sameness, but a relationship.” And even if you see a therapist who is white or a POC, be honest with them about what you are looking for.

“I encourage clients to tell me about their expectations and their concerns of beginning therapy — make that part of the process.”

READ MORE: 5 simple ways to manage your daily anxiety

He, along with Matthen, believe in the importance of POC speaking with other POC about their search. Share information about the therapists you find and for therapists of colour, create a reference list for other people in the community you can refer to. Ansloos said for clients, doing research through Psychology Today, colleges of social workers, therapists of psychologists and even more grassroots organizations is helpful.  

Matthen said for people in more remote communities, plenty of therapists of colour offer sessions over video. Apps, forums or groups on social media can be beneficial (and less expensive). Sometimes, just speaking with family and friends is a start.

But both experts recognize finances are the biggest reason people don’t seek help and one of the main reasons therapy is so inaccessible to POC. Therapy can start at $80 and can shoot up to $250 depending on the profession. Many Canadians also have insurance that covers forms of therapy, but this is often limited.

Credit: Getty Images

Ansloos said for people on tight budgets, group therapy or low-fee clinics with trainees may be options. “But we need to be thinking more broadly. How do we integrate mental health practices in an everyday setting?” While he understands these options may not be available for all POCs, it’s the ongoing open conversations about mental health at places like work, school or home that need to continue.

READ MORE: Depression and romantic relationships — how to support someone you love

But for some, the wait is worth it. Today, Lin sees a therapist of colour who works with the LGBTQ+ community. “I always leave the session feeling supported, understood, seen, and like I have tangible steps forward towards improved mental health.”

[email protected]

© 2018 Global News, a division of Corus Entertainment Inc.

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Dialectical behavior therapy: Selena Gomez is an advocate, but what is it? – National

by BBG Hub

Pop singer Selena Gomez recently entered a treatment facility to address her ongoing issues related to anxiety and depression, and is reportedly receiving dialectical behavior therapy (DBT), a complex type of therapy that was first developed to treat borderline personality disorder but is now used to treat a host of mental health conditions.

The 26-year-old was hospitalized twice in late September and early October, and has suffered from “an emotional breakdown.” Gomez is now reportedly at an east coast psychiatric facility and is receiving DBT — something she has talked about in the past.

WATCH BELOW: Selena Gomez suffers emotional ‘breakdown,’ enters psychiatric facility

“DBT has completely changed my life,” she told Vogue in March 2017. “I wish more people would talk about therapy.”

But what exactly is DBT, and how does it differ from other forms of therapy? According to Dr. Shelley McMain, an associate professor in the Department of Psychiatry at the University of Toronto and the head of the Borderline Personality Disorder Clinic at Toronto’s Centre for Addiction and Mental Health (CAMH), DBT is “a broad-based cognitive behaviour therapy” that has a “strong focus on acceptance.”

What is DBT?

DBT was originally developed by American psychologist Dr. Marsha Linehan in the 80s to treat patients with borderline personality disorder and chronic suicidal ideation. McMain said the first treatment study of DBT was published in 1991, which showed it was an effective treatment for people with borderline personality disorder — something people thought was previously untreatable.

DBT treatment, according to McMain, integrates two seemingly opposite strategies: acceptance of experiences and behaviours, and the skills to make change and better manage emotion.

“In practice, DBT therapists tend to move very rapidly between very opposite ways of engaging,” McMain told Global News. “On the one hand [they’re] conveying a very strong message of acceptance, and coupling that with a very strong emphasis or message to the individual that they need to make changes.”

READ MORE: Are you suffering from mental fatigue? Here’s what to look for

How does DBT work?

DBT is based on cognitive behaviour therapy (CBT), a popular form of psychotherapy used to treat many mental health issues, including anxiety and depression, CAMH says. With CBT, people are taught to challenge and change their thoughts and behaviours. But with DBT, people are instead taught to accept their thoughts and feelings, while also learning techniques to deal with them.

DBT programs often require a one-year commitment, according to CAMH. There are shorter programs, however, which can help people manage their emotions.

READ MORE: Falling out of love can happen, but some still make marriage work

When someone is undergoing DBT, they typically have both one-on-one counselling and group therapy. This is also what differs it from many other types of therapy, which are typically done in a patient/therapist-only environment.

“As it was originally designed, standard DBT is a comprehensive multimodal treatment, and there are four core modules,” McMain said.

“There’s individual therapy, there’s skills training — which is done in the often in groups — there’s also after-hour coaching so clients have the ability to contact therapists outside of regular hours, and there’s also a consultation meeting for clinicians which is held once a week, and that’s designed to treat the therapist.”

What is DBT used for?

DBT is now more widely used to treat other mental health issues including self-harm, depression, PTSD, eating disorders and substance abuse issues.

“Often, DBT is really geared towards people who have multiple, often complex, disorders,” McMain said. “Many individuals being treated with DBT may have comorbid personality disorder and post-traumatic stress disorder, and meet criteria for a mood disorder or anxiety disorder.”

[email protected]

© 2018 Global News, a division of Corus Entertainment Inc.

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