>> UP NEXT ON "CYCLE OF HEALTH."

HELLO AND WELCOME TO A BRAND NEW SEASON OF CYCLE OF HEALTH, I'M DR. RICH O'NEILL.

TONIGHT, TREATING DEPRESSION.

>> WE HAVE TALK THERAPY, 20 OR 30 DIFFERENT ANTI-DEPRESS ACT PILLS THAT YOU TAKE BY MOUTH.

IF YOU WERE TO ASK ME FROM THAT PERSPECTIVE, WHAT IS THE BEST ACUTE TREATMENT TO GET SOMEBODY OUT OF A DEPRESSION PERCENTAGE WISE, IT'S ELECTROCONVULSIVE THERAPY.

♪ ♪ ♪ ♪ >> HELLO AND WELCOME TO A BRAND NEW SEASON OF CYCLE OF HEALTH, I'M DR. RICH O'NEILL.

TONIGHT'S TOPIC: TREATING DEPRESSION.

DEPRESSION IS MORE THAN JUST FEELING SAD; IT'S A SERIOUS MENTAL HEALTH CONDITION THAT CAN AFFECT ANYONE, REGARDLESS OF AGE, GENDER, OR BACKGROUND.

TONIGHT WE'RE JOINED BY DR. THOMAS SCHWARTZ, DISTINGUISHED TEACHING PROFESSOR OF PSYCHIATRY OF THE PLACE I WORK AT IN MY DAY JOB, DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES AT UPSTATE MEDICAL UNIVERSITY TO DISCUSS THE VARIOUS ASPECTS OF THIS CONDITION AND EXPLORE THE MANY WAYS IN WHICH IT CAN BE EFFECTIVELY TREATED AND MANAGED.

HOW ABOUT WE START WITH DEFINING DEPRESSION.

>> FROM A REALLY TECHNICAL POINT OF VIEW, JUST FOR A SECOND, JUST A SECOND, IT'S A COLLECTION OF NINE SYMPTOMS.

AND WE LOOK AT THOSE.

WE ASK ABOUT THEM.

WE MEASURE THEM.

IF YOU HAVE ENOUGH OF THOSE SYMPTOMS AND THEY'RE INTERFERING WITH YOUR LIFE, YOU MIGHT CALL IT A DEPRESSION.

A MUCH LESS TECHNICAL TERMS, THINK ABOUT BEING STUCK IN ONE EMOTION: SADNESS, FOR EXAMPLE.

A NEGATIVE EMOTION.

YOU ARE NOT ABLE TO FEEL ANYTHING GOOD.

SO TO ME, DEPRESSION IS REALLY BEING STUCK IN A NEGATIVE MOOD.

IT IS USUALLY SADNESS.

IT CAN BE IRRITABILITY.

IT CAN BE JUST FEELING BLANK, LIKE NOTHING.

SO THERE ARE A VARIETY OF NEGATIVE MOODS.

BUT THE WAY I THINK ABOUT IT, IT'S STUCK AND YOU CAN'T GO ANYWHERE ELSE.

>> SO THERE IS THE TECHNICAL DEFINITION, BUT ON THE EXPERIENCE LEVEL, IT'S JUST A KIND OF FLAT NO FEELING, NO RESPONSIVENESS, A STUCK FEELING.

>> YEAH, THINK ABOUT IF SOMETHING GOOD WERE TO HAPPEN TO YOU, YOU WON THE LOTTERY, SOMEBODY ASKED YOU OUT ON A DATE.

YOU GOT A GREAT NEW JOB AND NOTHING.

AND EVEN MAYBE YOU GET MORE SAD.

IT'S LIKE THERE IS NO WAY I'LL SUCCEED.

THIS CAN'T WORK.

SO EVEN IF GOOD THINGS HAPPEN, YOU REALLY DON'T HAVE THE ABILITY TO EXPERIENCE THEM.

IT'S A TOUGH POSITION TO BE IN.

>> IT'S NOT A CONSCIOUS CHOICE.

IT JUST HAPPENS TO YOU LIKE THAT.

>> YEAH.

>> AND WHAT ARE THE TREATMENTS FOR DEPRESSION?

WHAT ARE THE VARIOUS ONES?

>> ON ONE LEVEL, THIS WILL SOUND WEIRD.

NO TREATMENT, DON'T ACCEPT TREATMENT, DON'T GO FOR TREATMENT.

YOU ARE GOING TO SUFFER.

THIS IS A MOOD STATE THAT CAN GO ON FOR AT LEAST TWO WEEKS, COULD BE TWO MONTHS, COULD BE TWO YEARS.

DEPRESSIONS WILL OFTEN COME AND GO.

SO I'M NOT ADVOCATING THIS, MIND YOU, BUT ONE IDEA IS THAT YOU CAN DO NOTHING.

BUT I THINK YOU ARE GOING TO SUFFER LONGER.

>> WHICH A LOT OF PEOPLE DO.

THEY JUST SUFFER THROUGH IT AND, YOU KNOW, KEEP GOING.

AND IT COULD BE DANGEROUS IF YOU ARE SUICIDAL, OF COURSE AND IF YOU DECIDE YOU WANT TO TAKE SOME ACTION, WHAT ARE THE OPTIONS?

>> SO I THINK THE MILDER LEVEL OF DEPRESSION, I THINK PSYCHO THERAPY IS A GREAT THING TO DO.

AND WHAT THE AUDIENCE MAY NOT KNOW.

THERE ARE A LOST TYPES OF PSYCHO THERAPY.

FOR EXAMPLE, EVERYBODY THINKS FROM THE MOVIES AND TV, WE WOULD BE LIE LYING ON A COUCH LIKE THIS ONE.

THAT KIND OF THERAPY IS STILL DONE.

BUT THERE ARE THERAPIES NOW THAT ARE 12 WEEKS LONG AND THEY'RE A LOT LIKE GOING TO PHYSICAL THERAPY IF YOU THROW YOUR BACK OUT.

TO ME, VERY MECHANICAL BEHAVIORAL WAYS TO FIGHT THROUGH YOUR DEPRESSION.

IT'S ALMOST LIKE PHYSICAL THERAPY FOR MENTAL HEALTH.

>> SO, SORRY.

A STRUCTURED APPROACH.

A STRUCTURE AND A PATH TYPICALLY TAKEN.

>> THAT SPEAKS TO SOME PEOPLE.

I KNOW WHAT I'M GETTING INTO.

IT'S VERY CONCRETE.

IT'S A 12-WEEK COMMITMENT TO LIKE A PROTOCOL OR LIKE GOING TO THE GYM TO GET IN SHAPE.

SO THERE ARE LOTS OF DIFFERENT TYPES.

VERY TALKATIVE TYPES, VERY EMOTIONAL TYPES AND VERY MECHANICAL TYPES OF PSYCHO THERAPY AND I THINK THE KEY IS, AS A PATIENT, IS TO FIND ONE THAT WORKS-FOR-YOU.

>> SO YOU CAN EXPLORE THE VARIOUS OPTIONS, SEE WHAT MIGHT FIT FOR YOU AND THEN TRY THEM OUT.

WHAT ABOUT MEDICATIONS?

>> YEAH, AND I THINK MEDICATIONS, WHEN YOU ARE MORE CERTAINLY SEVERELY DEPRESSED-- SOMETIMES PSYCHO THERAPY WON'T WORK.

YOU HAVE AN INABILITY TO THINK THROUGH YOUR SITUATION.

AND AS WE TALKED ABOUT, NO MATTER WHAT IS SAID, YOU ARE ALWAYS KIND OF IN A GLOOM OR DOOM MODE.

SO SOME DEPRESSIONS ARE SO BAD, I DON'T THINK TALK THERAPY HELPS.

AND WHEN YOU GET TOWARDS THAT ANGLE OR AREA, YOU ARE PROBABLY GOING TO WANT A MEDICATION.

AND THERE ARE ALL SORTS OF MEDICATIONS.

ALL SORTS OF SIDE EFFECTS YOU CAN HAVE AND ALL SORTS OF GOOD EFFECTS.

SO THERE IS A VARIETY OF MEDICINES THAT PEOPLE COULD TRY AS WELL.

>> AND THE COMBINATION-- SO PEOPLE WHO ARE SEVERELY DEPRESSED, YOU WOULD REALLY RECOMMEND A MEDICATION.

WHAT ABOUT THE COMBINATION OF THE TWO?

>> SO I THINK, PARTICULARLY IN THE MIDDLE, I THINK-- >> MODERATE DEPRESSION.

>> I THINK BOTH APPROACHES COMBINED IS A VERY GOOD THING TO DO AND YOU ARE COVERING ALL YOUR BASES.

SOME PEOPLE WILL NOT RESPOND TO PSYCHO THERAPY.

SOME PEOPLE WILL NOT RESPOND TO MEDICATIONS.

IF YOU GO WITH BOTH, LIKE A BLENDED APPROACH, I THINK YOU INCREASE YOUR ODDS.

AND THE OTHER IMPORTANT THING IS WHAT DOES THE PATIENT WANT TO DO?

I THINK THE PATIENT, IF THEY DON'T WANT ANY MANMADE SUBSTANCES OR PILLS, THEN LET'S GO WITH PSYCHO THERAPY.

SOME PATIENTS DON'T WANT TO TALK.

LET'S GO WITH THE PILLS.

SO I DO THINK IT'S IMPORTANT TO WORK WITH THE PATIENT AND WHAT IS REALLY DRIVING-- WHAT SPEAKS TO THEM.

>> SO REALLY YOU ARE SUGGESTING THE PERSON THINK FOR THEMSELVES WHAT IT IS THAT I WOULD BE WILLING TO ENGAGE IN.

AM I WILLING TO TAKE THE MEDS, MAYBE PUT UP WITH SOME SIDE EFFECTS, DO PSYCHO THERAPY, TALK ABOUT SOME PROBABLY UNCOMFORTABLE THINGS, BE UNCOMFORTABLE AND SEE WHAT FEELS RIGHT, WHAT YOU ARE WILLING TO ENGAGE IN.

>> EXACTLY.

YEAH.

>> AND I KNOW THERE IS, YOU KNOW, A LOT OF NEW KINDS OF NON-TALK APPROACHES.

TELL US ABOUT THOSE SO IN THE WORLD OF TREATING DEPRESSION, WE HAVE THE TALK PSYCHO THERAPIES.

20 OR 30 DIFFERENT ANTIDEPRESSANT PILLS YOU TAKE BY MOUTH.

OVER THE YEARS WE'VE DEVELOPED DIFFERENT TREATMENTS SO GOING BACK TO THE 1920s, 24EUR9s 30s.

WE'VE HAVE ELECTROCONVULSIVE THERAPY, E.C.T.

SHOCK THERAPY.

IT HAS A BAD REPUTATION, CERTAINLY IN THE MOVIES AND THUNKS LIKE THAT BUT IT STILL REMAINS LIKELY THE BEST TREATMENT FOR GETTING SOMEBODY OUT OF AN ACUTE DEPRESSIVE STATE.

>> NOW WAIT A MINUTE.

SAY THAT AGAIN BECAUSE YOU KNOW, IT HAS SUCH A BAD RAP IN THE MEDIA, BUT SAY AGAIN WHAT YOU JUST SAID.

>> YEAH, AND MAYBE I'LL DO IT BY ANALOGY REALLY QUICKLY HERE, TOO.

IF SOMEBODY HAD A CANCER, THEY WANT THEIR CANCER DOCTOR TO LOOK AT THEM AND SAY WHAT ARE MY ODDS.

WHAT ARE MY PERCENTAGES?

AND CANCER DOCTORS ARE VERY GOOD ABOUT SHARING PERCENTAGES ABOUT WHAT TREATMENTS WOULD WORK.

IF YOU WERE TO ASK ME THAT FROM THAT PERSPECTIVE, WHAT IS THE BEST ACUTE TREATMENT TO GET SOMEBODY OUT OF A DEPRESSION, PERCENTAGE WISE, IT'S ELECTROCONVULSIVE THERAPY.

>> WOULD THAT APPLY ACROSS THE BOARD, MILD, IMMEDIATE MODERATE, SEVERE?

>> I THINK SO.

AGAIN, WE USUALLY SAVE THAT FOR MODERATE TO SEVERE DEPRESSIONS.

AND IN THIS AREA, WE USUALLY WAIT FOR PSYCHO THERAPY NOT TO WORK AND A COUPLE MEDICATIONS NO THE TO WORK.

SO WE TYPICALLY WON'T USE THAT WAY UP FRONT.

OTHER COUNTRIES DO.

IT'S A VERY SUCCESSFUL TREATMENT.

AND NOT A LOT OF SIDE EFFECTS WHEN THE TREATMENT IS OVER AT LEASTMENT YOU ARE NOT TAKING PILLS EVERY DAY.

>> WHEN YOU LOOK AT OLD MOVIES, IT LOOKS LIKE A HORROR SHOW.

WHAT IS IT ACTUALLY LIKE?

>> SO IN THE MODERN ERA, AGAIN, BELIEVE ME BACK IN THE 20s AND IT MIGHT HAVE LOOKED LIKE THAT.

>> PEOPLE BROKE BONES SOMETIMES... >> AND WE HAVE TO OWN THAT.

AND NOW IT'S A LOT LIKE, YOU GO TO THE OPERATING ROOM ALMOST, NOT FOR AN OPERATION, BUT THEY PUT AN I.V.

IN AND YOU ARE SEDATED.

YOU ARE KIND OF KNOCKED OUT.

IF YOU HAVE EVER HAD A COLONOSCOPY, YOU GO IN AND DON'T REMEMBER HAVING ONE.

>> I DON'T REMEMBER ANYTHING FROM IT.

>> YOU DON'T REMEMBER BECAUSE YOU ARE UNDER ANESTHETIC AND YOU WAKE UP AND THANKS THINGS ARE GREAT.

THAT'S HOW WE DO ECT.

YOU ARE UNCONSCIOUS, YOU DON'T REMEMBER HAVING A SEIZURE.

YOUR MUSCLES ARE PARALYZED.

YOU DON'T MOVE.

YOU LIE STILL FOR A COUPLE OF MINUTES.

IT'S REALLY NOT BARBARIC THE WAY IT IS DONE NOW.

PEOPLE ARE NOT BREAKING BONES.

THEY'RE NOT HAVING A SEIZURE ON THE TABLE THAT YOU CAN SEE.

IT'S ONLY THE BRAIN IS HAVING A 30-SECOND SEIZURE.

>> SO WE ALSO HAVE THESE NEW ONES.

TRANS CRANIAL STIMULATION.

>> SO T.M.S.

TRANSCRANIAL MAGNETIC STIMULATION APPROVED IN THE EARLY 2000S FOR DEPRESSION.

APPROVED FOR THE MORE MILD TO MODERATE DEPRESSION.

YOU DIDN'T HAVE TO FAIL OR RESPOND TO FOUR OR FIVE DIFFERENT TREATMENTS.

WE PLACE AN MRI STRENGTH MAGNET, SMALL BUT POWERFUL OVER THE LEFT FRONT PART OF YOUR HEAD RIGHT IN THIS AREA, AND THE MAGNET CLICKS ON AND OFF FOR ABOUT A HALF HOUR.

>> JUST LIKE AN MRI.

>> YEAH.

>> FOR ABOUT A HALF HOUR.

>> YES.

WHEN THE MAGNET GOES ON AND OFF, IT CREATES LOW LEVELS OF ELECTRICITY.

IT'S NOT A SEIZURE OR A SPARK.

YOU DON'T FEEL ANYTHING BUT THE FRONT PART OF YOUR BRAIN WE THINK IS VERY SLOWED DOWN IN DEPRESSION.

SO IT'S THE FRONT PART OF YOUR BRAIN THAT CONTROLS YOUR EMOTIONS.

SO THINK ABOUT IT, IF YOU ARE STUCK IN A DEPRESSION, NEGATIVE MOOD, HAVE YOU LOST CONTROL OVER YOUR EMOTIONS.

SO WE STRENGTHEN THE FRONT PART OF THE BRAIN WITH A MAGNET AND A LITTLE BIT OF ELECTRICITY TO RESTORE ITS STRENGTH.

ITS ELECTRIC ELECTRICAL POWER.

AND THEN IT STARTS TO DAMPEN THE DEPRESSED PART OF THE BRAIN WHICH IS IN THE MIDDLE OF YOUR BRAIN.

RESTORES THE BALANCE OF NORMAL FUNCTION UP FRONT AND LOWERING THE EMOTIONAL PART OF YOUR BRAIN IN THE MIDDLE.

SO IT'S A MAGNET.

>> SO WHAT YOU SAY ELECTRICAL, YOU DON'T FEEL ANY SHOCK OR ANYTHING GOING THROUGH THE BRAIN.

THERE IS NO ARC FROM LIKE THE FRANKENSTEIN MOVIE.

>> NO, IT'S REALLY YOU SIT IN A DENTIST CHAIR, NOT TO SCARE PEOPLE.

BUT REMEMBER THE LIGHT THAT THEY BLIND YOU WITH.

WE HAVE A MAGNET ON THE ARM AND IT SITS RIGHT OVER HERE AND CLICKS AT YOU.

IT'S PRETTY BENIGN.

SIDE EFFECTS ARE ABOUT 0.

THERE IS A VERY RARE RISK THAT WE TRIGGER A SEIZURE IN PATIENTS WHO MAY HAVE-- THERE IS NO SIDE EFFECTS.

NO PILL, IT'S KIND OF NICE.

>> YOU ARE STIMULATING-- YOU TELL THEM THAT PART OF THE BRAIN, WAKE UP AND GET TO WORK.

GET BACK ON THE JOB.

AND TAKE OVER THIS PART OF THE BRAIN THAT IS MAKING YOU DEPRESSED.

>> IT'S RESTORING THE BALANCE.

AND MAINLY THE NEGATIVE IS THE TIME COMMITMENT IS A HALF HOUR A DAY MONDAY THROUGH FRIDAY FOR ABOUT SIX WEEKS.

SO HAVE YOU TO WORK IT INTO YOUR SCHEDULE.

THAT'S THE PROTOCOL.

BUT ABSOLUTELY, YEAH.

>> AND VEGAS VAGUS NERVE STIMULATION.

WE HAVE A PACE PAININGER FOR THE BRAIN-- A PACE MAKER FOR THE BRAIN.

IF YOU THINK ABOUT A HEART PACE MAKER SO BIG AND THEY PUT IT UNDERNEATH YOUR SKIN.

FOR A HEART PACE MAKER, THEY RUN THE WIRE TO YOUR HEART TO KEEP YOUR HEART BEATING NORMALLY.

WITH THE BRAIN PACE MAKER, THE WIRE GOES UNDER YOUR SKIN TO THE LEFT OF YOUR NECK.

YOU CAN'T SEE IT AND IT'S CONNECTED TO THE VAGUS NERVE ON THE LEFT SIDE THAT GOES INTO THE BRAIN AND SENDS SIGNALS OUT.

SO VERY SIMILAR TO THAT MAGNET APPROACH, WE ARE USING A LOW DOSE OF ELECTRICITY, NO SPARKS, NO ZAPS, NO SEIZURES BUT A LITTLE BIT OF ELECTRICITY RUNS FROM THE PACE MAKER UP THE WIRE INTO THE VAGUS NERVE INTO THE BRAIN AND AGAIN WE ARE TRYING TO RESTORE THAT BALANCE THAT WE WERE TALKING ABOUT.

SO WE HAVE A MAGNET MACHINE THAT RESTORES THAT BALANCE IN THE BRAIN AND WE HAVE A PACE MAKER MACHINE THAT CAN RESTORE THE BALANCE.

NOW, BECAUSE THIS IS SURGERY, THIS IS SOMETHING PROBABLY FOR THE MOST SEVERE DEPRESSIONS, THE MOST CHRONIC LONG LASTING DEPRESSIONS.

OUR AVERAGE PATIENT HAS NOT RESPONDED TO 10 DIFFERENT MEDICATIONS OR SO.

I DON'T WANT TO SAY LAST RESORT BUT BECAUSE IT'S A SURGICAL PROTOCOL, WE DON'T DO THIS ONE UP FRONT BUT WE DO HAVE A PACE MAKER OR COMPUTER CHIP FOR THE BRAIN NOW FOR DEPRESSION.

>> IT'S VAGUL NERVE SOMETIME STIMULATION.

IT'S RIGHT HERE IN THE NECK?

>> WE HAVE TWO OF THEM.

WE ARE BLESSED WITH TWO DIFFERENT ONES.

THE RIGHT VAGUS NERVE ON THIS SIDE IS REALLY THE NERVE THAT CONTROLS YOUR HEART RATE, YOUR BREATHING AND BODILY FUNCTION.

IT LEAVES THE BRAIN AND SENDS SIGNALS INTO YOUR BODY.

THE LEFT SIDED ONE IS THE RETURN FREEWAY AND IT'S IN THE SAME PART OF YOUR NECK ON THE OPPOSITE SIDE AND IT RUNS INTO THE BRAIN.

IT'S GIVING INFORMATION BACK TO THE BRAIN FROM YOUR WHOLE BODY.

SO WE ARE TAPPING INTO YOUR NERVOUS SYSTEM'S SUPER HIGHWAY.

>> LIKE 81 AND 690.

>> YEAH AND SO WE ARE REALLY USING THE BRAIN'S NERVES, WHICH ARE THEIR OWN WIRES.

WE ARE ATTACHING A WIRE TO YOUR NERVE, YOUR BODY'S WIRE AND JUST JOINING THE FLOW AND KIND OF INCREASING THE ACTIVITY THERE.

>> AND IT STIMULATES THE WHOLE BRAIN?

>> VERY SPECIFIC PARTS OF THE BRAIN.

AND AGAIN, NOT TO GET TOO TECHNICAL.

IT'S TRYING TO RESTORE THAT BALANCE THAT HAS BEEN LOST.

IT GETS REALLY TECHNICAL WHEN YOU GET INTO THE WIRING DIAGRAM.

SO HAVE YOU TO BE AN ENGINEER, I THINK, TO APPRECIATE IT.

YEAH.

>> SO I HAVE READ ALSO AND YOU SEE NOW PEOPLE TALKING ABOUT ES SCET MEAN...... >> ITS IS NOT PSYCHO THERAPY OR PILLS.

IT'S SOMETHING A PSYCHIATRIST CAN INTERVENE.

THINK IF YOU HAVE A CLOGGED ARTERY IN THE HEART, THE CARDIOLOGIST INTERVENES, REMOVES THE CLOG, YOU DRIVE OFF AND YOU ARE BETTER.

THEY ARE THE PSYCHIATRIST CAN PRESERVE THAT AND KEEP YOUR THERAPIST AND KEEP YOUR PRESCRIBER.

ANDY SCET ES KETAMINE-- IT IS A NOSE SPRAY.

IT STARTED OUT AS AN I.V.

WHICH IS A LITTLE ANNOYING, HAVE YOU TO PUT AN I.V.

IN THEY TOOK KETAMINE AND SPLIT IT IN HALF AND S-KETAMINE.

IT'S NOSE SPRAY.

YOU SIT IN THE DENTIST'S CHAIR.

NO PAIN INVOLVED.

YOU TAKE NOSE SPRAY AND SIT WITH US FOR TWO HOURS AND YOU DO GET IF YOU HADSY, DISCONNECTED.

IT'S A FORM OF INTOXICATION.

THAT'S THE SIDE EFFECT PROFILE.

PROBABLY LASTS ABOUT I HALF HOUR AND AFTER TWO HOURS, HAVE YOU INTO SIDE EFFECTS AND YOU GOAT GO HOME.

WE DO THAT TWICE A WEEK, MAYBE ONCE A WEEK IT'S JUST A DIFFERENT APPROACH.

IT USES GLUTE MATE.

THEY'RE NOT BETTER.

THEY'RE JUST DIFFERENT.

SOMETIMES YOU NEED TO TRY DIFFERENT THINGS.

>> SO LOTS OF DIFFERENT OPTIONS DO YOU TYPICALLY MONITOR PROGRESS AS WE GO ALONG.

SOMEBODY IS INVOLVED IN ONE OF THESE TREATMENTS.

>> PSYCHO THERAPIST, NURSE PRACTITIONER, ET CETERA, ARE ALWAYS ASKING HOW ARE YOU DOING, HOW ARE THE LAST FEW WEEKS.

LIKE ANY GOOD CLINICIANS, WE WANT TO CHECK IN WITH YOU.

WE THINK THERE IS A BROAD APPROACH THAT WE ALL DO.

SOMEBODY WHO IS MORE EXACTING, PARTICULARLY IF YOU LOSE MEDICATIONS OR ONE OF THESE INTERVENTIONS WE ASKING ABOUT THE NINE SYMPTOMS.

HOW IS YOUR SLEEP, FOOD, GUILT, INTEREST, ET CETERA.

WE WANT TO FIGURE OUT WHICH SYMPTOMS GET BETTER AND WHICH ONES WE NEED TO FIX.

WE LIKE GETTING PEOPLE INTO REMISSION.

IN CANCER IT MEANS NO MORE CANCER.

IN DEPRESSION, WE WANT NO MORE OF THE NINE SYMPTOMS.

MORE EXACT WAY IS THE CHECKLIST.

I CAN ASK YOU THESE THINGS OR HAVE YOU DO A CHECKLIST.

I HAVE THIS.

I DON'T HAVE THAT.

THAT MAKES US MORE ACCURATE.

THE PATIENT'S REPORT YOU CANS RIGHT?

SO I THINK THESE ARE ALL THE WAYS WE CAN DO THAT.

>> SO I'VE GOT MY CHECKLIST HERE.

ACTUALLY SOME CHECKS ABOUT WHAT WE WERE ALREADY TALKED ABOUT.

ONE OF THE THINGS WE HAVEN'T GOTTEN TO YET IS WHAT CRITERIA DO YOU USE TO DETERMINE WHICH OF THESE ARE THE MOST APPROPRIATE.

I KNOW YOU TALKED ABOUT THE ONES THAT APPEAL TO THE PATIENT BUT ARE THERE OTHER CRITERIA YOU USE?

>> I THINK THE EARLIEST CRITERIA IS WHAT IS THE PATIENT WILLING TO DO, WANTING TO DO, AT A MINIMUM WE DON'T MAKE PEOPLE DO TREATMENTS.

WHAT DOES THE PATIENT WANT TO DO.

THAT'S CRITERIA ONE.

MAKE SURE THEY HAVE DEPRESSION.

MAKE A GOOD DIAGNOSIS AND IF YOU HAVE THAT DIAGNOSE IS THERE IS A DETRIGS TREE, 20, 30 DIFFERENT TREATMENTS.

PILLS, FOREIGN INTERVENTIONS, PROs AND CONS TO EACH ONE.

WE HAVE MEDICATIONS THAT ARE VERY SEDATING AND PEOPLE DON'T LIKE THAT EXCEPT FOR PEOPLE WITH INSOMNIA.

SOMETIMES SIDE EFFECTS ARE BAD.

BUT SOMETIMES YOU USE THEM FOR GOOD.

AND YOU HAVE THESE DISCUSSIONS WITH YOUR PATIENT.

AND THAT MAY NUDGE YOU ALONG TREATMENTS.

WHEN YOU GET TO THE INTERVENTIONS, USUALLY IT'S 3, 4, 5 THINGS HAVE NOT HELPED YOU, SO EVEN THOUGH T.M.S.

WAS STUDIED FOR MILDER DEPRESSION, MANY OF THE INSURANCE COMPANIES WILL MAKE YOU FAIL TO RESPOND TO THREE OR FOUR TREATMENTS.

KETAMINE SHOULD BE A COUPLE TREATMENTS BUT A LOT OF INSURANCE COMPANIES HAVE A FOUR TREATMENT RULE.

>> THESE ARE TO SAVE MONEY?

>> I THIS I SO.

AND AGAIN, THEY'RE EXPENSIVE INTERVENTIONS COMPARED TO SOME OF THE PILLS THAT WE HAVE.

I THINK IF YOU ARE LOOKING AT THOSE INTERVENTIONS, YOU HAVE TO THINK HAVE I BEEN ON FOUR ANTIDEPRESSANTS AND THEY DIDN'T WORK?

HAVE I DONE PSYCHO THERAPY AND IT DIDN'T WORK.

YOU ARE NOW IN A MORE CHRONIC DEPRESSED STATE, TREATMENT RESISTANT STATES AND MAYBE THE INTERVENTIONS ARE A SMART THING TO LOOK AT.

IF YOU ARE SCARED OF THE INTERVENTIONS AND DON'T WANT TO TO DO THEM, THERE ARE PLENTY OF OTHER PSYCHO THERAPIES AND OTHER OPTIONS.

>> WELL, THAT'S ALMOST ALL THE TIME WE HAVE TODAY.

I WANT TO THANK OUR GUEST Dr. THOMAS SCHWARTZ, DISTINGUISHED TEACHING PROFESSOR OF PSYCHIATRY AND BEHAVIORAL SCIENCES AT UPSTATE MEDICAL UNIVERSITY FOR JOINING US TO TALK ABOUT THIS IMPORTANT TOPIC.

I WANT TO LAUNCH A ANY REGULAR SEGMENT FOR STIEK PSYCH LAUGH TER IS THE BEST P MEDICINE AND HAS BEEN SHOWN TO PROVIDE NUMEROUS HEALTH BENEFITS REDUCING STRESS, RELIEVING PAIN, BOOSTING THE I MOON SYSTEM, ENHANCING SOCIAL CONNECTIONS AND PARTICULARLY FITTING FOR TONIGHT'S SHOW, IMPROVING MOOD.

WITH THAT IN MOD, TOM, WHAT HAPPENS IF YOU BOIL A FUNNY BONE?

>> I DON'T KNOW, RICH.

>> IT BECOMES A LAUGHING STOCK.

ISN'T THAT HUMERUS... LIKE THE BONE, GET IT?

>> I GET IT.

>> NOW, TOM, WHAT DO YOU GET IF TWO SHRINKS DO TWO TV SHOWS?

>> YOU GOT ME.

I DON'T KNOW, RICH.

>> A MINI SERIES.

AND TOM, WHILE YOU ARE HERE, NOT TO PUT YOU ON THE SPOT OR ANYTHING, BUT HOW ABOUT THAT RAISE WE HAVE BEEN TALKING ABOUT?

NOW THAT'S A FUNNY.

[LAUGHTER] >> IF YOU WOULD LIKE YOUR JOKE IN LAUGHTER IS BEST MEDICINE, YOU CAN SUBMIT IT THROUGH OUR WEBSITE WCNY.ORG/"CYCLE OF HEALTH."

AND YOU CAN ALSO DISCOVER THAT SPOT, MORE OF OUR PROGRAM.

TO HEAR OUR NEW COMMUNITY FM RADIO SHOW, CHECK UP FROM THE NECK UP, VISIT WCNY.ORG/COMMUNITYFM AND BE ON THE LOOKOUT FOR A FUTURE EPISODE WHERE DR. SCHWARTZ WILL JOIN ME TO DISCUSS THIS TOPIC EVEN FURTHER.

DIFFERENT TYPES OF DEPRESSION, HOW TO PICK A THERAPIST, DIFFERENT TYPES OF MENTAL HEALTH PROFESSIONALS, LIFESTYLE FACTORS THAT MIGHT PREVENT DEPRESSION AND IF WE TALK REALLY FAST, EVEN MORE.

FOR 'CYCLE OF HEALTH,' I'M PSYCHOLOGIST DR. RICH O'NEILL.

THANKS FOR CHECKING IN.

HI, I'M PSYCHOLOGIST Dr. RICH O'NEILL WITH THIS WEEK'S CHECK UP FROM OUR NECK UP.

Mrs. McCUE SHUNS THE GRIM REAPER, OR A COMEDY A DAY KEEPS THE DOCTOR AWAY.

WELL, FOLKS, A FEW YEARS AGO WHEN I WAS A TEENAGER, I TOLD MY FRIEND'S MOM THE BOUYANT Ms. McCUE HOW I LOVED THIS GRIM, DARK MOVIE I HAD SEEN.

SHE SAID, I DON'T WATCH SHOWS LIKE THAT ANYMORE RITCHIE.

LIFE IS DEPRESSING ENOUGH.

IT'S NOT GOOD TO GET UPSET.

IN THE 50 YEARS SINCE, SCIENCE HAS SHOWN, Mrs. M'S HYPOTHESIS WAS RIGHT.

ANGER, DEPRESSION AND STRESS AIN'T GOOD FOR US.

ALL LINKED TO HEART DISEASE AND AN EARLY VISIT FROM THE GRIM REAPER.

WHO ODDLY ENOUGH HAD A CAMEO IN THAT BIRDMAN MOVIE I TALKED ABOUT.

IN FACT, STUDIES SHOW, DEPRESSED PEOPLE ARE MUCH MORE LIKELY TO GET HEART DISEASE AND TO DIE FROM IT AND ANGRY PEOPLE WHO HAD A HEART ATTACK, ARE 50% MORE LIKELY TO HAVE ANOTHER IN THE NEXT 10 YEARS THAN MORE CHIPPER HEART ATTACKERS.

WHY?

WELL, AMONG OTHER THINGS, 3W4R-7 BLOOD PRESSURE AND HEART DISEASE ARE LINKED TO BLOOD VESSEL CONSTRICTION AND RESEARCHERS FOUND THAT WHEN PEOPLE WATCHED 15 MINUTES OF A DISTRESSING MOVIE, BLOOD FLOW REDUCED BY A THIRD OR MORE WHILE THOSE LAUGHING ALONG TO 15 MINUTES OF COMEDY HAD BLOOD FLOW INCREASE BY 20%.

A 50% DIFFERENCE.

SO, MY PRECIPITATION?

TAKE TWO COMEDIES AND DON'T CALL THE AMBULANCE IN THE MORNING.

I'M Dr.

NECK UP, RICH, MAD AS HECK AND NOT GOING TO DO THAT ANYMORE, O'NEILL.

THANKS FOR CHECKING IN.

>> SO, TOM, YOUR TECH, RYAN, IS GOING TO HELP US OUT BY BEING A PRETEND PATIENT TODAY.

SHOW US WHAT THE VNS PACE MAKER ACTUALLY LOOKS LIKE.

>> SO THE PACE MAKER LOOKS LIKE A HEART PACE MAKER AND GENERALLY THE SURGEON PUTS IT UNDER YOUR SKIN OFTEN THROUGH YOUR ARM PIT.

SO IT WILL SIT RIGHT UNDER YOUR SKIN HERE AND THEN THIS DEVICE, SENDS LITTLE BITS OF ELECTRICITY, NOT A SHOCK, NOT A SEIZURE, YOU REALLY DON'T FEEL IT.

BUT IT SENDS A LITTLE ELECTRICITY EVERY FIVE MINUTES UP THROUGH THE VAGUS NERVE INTO YOUR BRAIN.

SO EVERYTHING IS DONE THROUGH A TABLET, LITTLE COMPUTER.

AND WE HAVE SOMETHING CALLED A WAND.

SO IF RYAN WERE A PATIENT, HE WOULD HAVE A PACE MAKER AND HE WOULD HOLD THIS.

I'LL LET RYAN HOLD ON TO THAT.

AND THIS WAND JUST USES RADIO FREQUENT.

SO-- RADIO FREQUENCY.

SO I TALK TO MY COMPUTER.

THE COMPUTER TALKS TO THE WAND.

THE WAND TALKS TO THE PACE MAKER.

AND I CAN CHANGE THE SETTINGS.

I CAN RAISE THE DOSE HIGHER OR LOWER.

IF HE HAS SIDE EFFECTS OF ANY KIND, I CAN LOWER THOSE.

>> SO MODULATES HOW MUCH PULSE GOES UP THROUGH THE WIRE.

>> MODULATES THE ELECTRICITY, HOW OFTEN, THE SHAPE OF THE ELECTRICITY.

SO A COUPLE DIFFERENT-- THIS WAS LIVE, I WOULD BE TAPPING INTO THE COMPUTER TRYING TO MAKE SOME ADJUSTMENTS.

BUT THAT'S BUILT IN.

YOU GO HOME WITH IT AND IT'S ALWAYS WORKING.

>> GREAT.

THANK YOU, GENTLEMEN, VERY MUCH.

APPRECIATE IT.