Transcranial Magnetic Stimulus Improves Working Memory

New research from Duke University School of Medicine demonstrates that repetitive Transcranial Magnetic Stimulation improves working memory in healthy adults.

Working memory is the process of recalling and organizing information while performing a task. It allows us the ability to integrate memory into our interaction with the world, and underpins many important cognitive processes. It is involved in everything from following instructions to finding a new location when driving. Working memory declines in many neurodegenerative diseases. The loss of working memory is one of the primary symptoms of Alzheimer’s disease and other forms of dementia.

In this study, 29 younger adults and 18 older adults received rTMS to the left prefrontal cortex, an are of the brain involved in working memory and executive function. subjects received either 5Hz rTMS stimulation or a placebo-like sham procedure. All of the individuals that received rTMS improved on scores of working memory tasks, regardless of their age group. The effect seen was greatest on the hardest memory tasks.

TMS appears to be a promising therapy for memory enhancement, and may prove beneficial in improving function for those suffering from cognitive decline.

The full article can be found here:

Transcranial Magnetic Stimulus and Post-Concussion Syndrome

Post-concussion syndrome (PCS) is often an extremely debilitating consequence of mild traumatic brain injury. People who suffer concussions and mTBI develop neuropathological, neurophysiological, and neurocognitive changes, which leave the individual suffering from physical, cognitive, and emotional symptoms. If these symptoms persist long after the injury, their cluster of symptoms is called PCS. Without proper treatment, these symptoms can last for months or years. Even with traditional treatment, symptoms often do not fully resolve and can become permanently disabling.

Transcranial Magnetic Stimulus has been shown to be effective in the treatment of post-concussion syndrome. In a recent study, a group of individuals suffering from post-concussion syndrome received the application of 20 Hz rTMS to the left dorsolateral prefrontal cortex for thirteen treatment sessions over three weeks. Measures of depressive symptoms, working memory, cognitive ability, and overall PCS symptom intensity were recorded at the beginning and end of treatment, as well as at one and two months following treatment. Scores were compared with a sham treatment group.

Significant improvements were found at two months post-treatment in the measurement of symptom burden using the Rivermead Post Concussion Symptoms Questionnaire. There were no difference in scores between active and sham treatment groups immediately post-treatment, but over the next few months the active treatment group demonstrated dramatic improvement in their symptom scores.

The delayed response shown in the Rivermead scores seems to indicate that rTMS does not improve symptoms immediately after the treatment, but rather aids in long-term recovery of PCS symptoms. This demonstrates that TMS my be a uniquely effective treatment for resolving some of the persistent and debilitating consequences of post-concussion syndrome.

Framework Functional Psychiatry and TMS is proud to offer this revolutionary technology to our patients. It is an important part of our treatment to help solve the puzzle of post-concussive neuropsychiatric disorders and help brain injury survivors live their fullest lives.

Tha full paper can be found here:

Sleep and mood disorders

Sleep and mental health are closely connected. Sleep deprivation affects your psychological state and mental health. And those with mental health problems are more likely to have insomnia or other sleep disorders.

Americans are notoriously sleep deprived, but those with psychiatric conditions are even more likely to be yawning or groggy during the day. Chronic sleep problems affect 50% to 80% of patients in a typical psychiatric practice, compared with 10% to 18% of adults in the general U.S. population. Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).

Traditionally, clinicians treating patients with psychiatric disorders have viewed insomnia and other sleep disorders as symptoms. But studies in both adults and children suggest that sleep problems may raise risk for, and even directly contribute to, the development of some psychiatric disorders. This research has clinical application, because treating a sleep disorder may also help alleviate symptoms of a co-occurring mental health problem.

The brain basis of a mutual relationship between sleep and mental health is not yet completely understood. But neuroimaging and neurochemistry studies suggest that a good night’s sleep helps foster both mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability.

Here are a few simple tips to help you manage sleep issues:

Move your body – Exercise has been found to both lower anxiety and improve sleep. But try not to exercise right before sleep, as it can keep you awake. Moving your body in the morning or afternoon can help you get your sleeping and waking cycle back on track and also treat insomnia or sleep apnea.

Tailor your environment – Controlling light, sound, and temperature can help you get a good night’s rest. The darker, quieter, and cooler you can keep your bedroom, the greater chance you have of calming your mind and falling asleep. Taking a shower or bath shortly before bed can also help lower your body temperature and help you fall asleep more quickly.

Limit caffeine and alcohol – Drinking too much caffeine or consuming it too late in the day can increase anxiety and inhibit sleep. Consuming alcohol close to bedtime can also increase your heart rate and keep you up. Drink plenty of water throughout the day, but don’t drink too much before bedtime, as trips to the bathroom can keep you anxious and alert.

Calm your mind – There are many relaxation techniques that can help you calm your mind throughout the day and improve sleep. Mindfulness meditation, yoga, and breathing exercise can help you achieve calm, but it can also be as simple as taking a walk when you have a short break at work. If you practice techniques for calming your mind during the day, then it will be easier to trigger your relaxation response at night.

Limit screen time – Your phone, tablet, and TV emit light that keeps your brain awake, so try to limit them an hour before bedtime. Checking email or doing work right before bed can also trigger anxious thoughts and make it difficult to calm your brain. Consider setting an alarm to remind you to shut screens off at an adequate time before bed. Instead, consider listening to music or reading a book to quiet your mind.

Ask for help – Sometimes managing anxious worry and improving sleep is more complicated than simply turning off your phone or getting adequate exercise. Never hesitate to ask for help if you need it.  Sleep problems and anxiety are highly treatable, and are another critical part of your framework.


Can depression be a problem with the vestibular system?

Depression is at its heart a disorder of the left prefrontal cortex in most cases. Research consistently demonstrates that these areas of the left brain demonstrate lower metabolic activity than other aspects of the cerebral cortex. But why?

A fundamental concept in neurology is that if neurological pathway “A” projects to pool of neurons “B,” and something decreases the frequency of firing of pathway A, pool B will show decreased activity, decreased regional metabolism, and decreased oxygen utilization. This mechanism, known as diaschisis, shows how the nervous system is interconnected, and that damage or dysfunction in one region will inevitably lead to problems in other areas.

The vestibular system is comprised of the inner ear apparatus and associated pathways. It allows us to understand where our head is in relation to gravity, how our head is moving in relation to the environment, and thus where our body is located in space. The input to the brain from both sides of the vestibular system needs to be symmetrical in order to function effectively; the brain needs the same input from both inner ears to be able to properly localize the body. If these systems become significantly impaired, this can lead to dizziness, balance problems, and vertigo.

The input from the vestibular system ascends to stimulate the cerebral cortex. Input from the right inner ear goes to both sides of the brain, but has a preferential activation of the left prefrontal cortex.  Asymmetries in vestibular activation, even small ones, can create decreases in activation of the brain that need not manifest as dizziness or vertigo. Recently published research demonstrates that major depressive patients show an abnormal pattern of vestibular activity with lower function at the right side compared to left. This raises the possibility of vestibular asymmetries as a biomarker of major depression. It also reveals another potential cause of major depressive disorder for some patients. Vestibular function is another critical aspect of your framework that needs to be evaluated and treated when necessary.

The full article can be found here:;year=2018;volume=3;issue=2;spage=36;epage=42;aulast=Soza

Exercise as an antidepressant

An analysis of randomized controlled clinical trials indicates that supervised aerobic exercise has large antidepressant treatment effects for patients with major depression. The systematic review and meta-analysis is published in Depression and Anxiety.

Across 11 eligible trials involving 455 adult patients (18-65 years old) with major depression as a primary disorder, supervised aerobic exercise was performed on average for 45 minutes, at moderate intensity, 3 times per week, and for 9.2 weeks. It showed a significantly large overall antidepressant effect compared with antidepressant medication and/or psychological therapies.

Also, aerobic exercise revealed moderate-to-large antidepressant effects among trials with lower risk of bias, as well as large antidepressant effects among trials with short-term interventions (up to 4 weeks) and trials involving preferences for exercise.

Subgroup analyses revealed comparable effects for aerobic exercise across various settings and delivery formats, and in both outpatients and inpatients regardless of symptom severity.

“Collectively, this study has found that supervised aerobic exercise can significantly support major depression treatment in mental health services,” said lead author Dr. Ioannis D. Morres, of the University of Thessaly, in Greece.


The full article can be found here:

The role of inflammation in depression

Depression has been long understood to involve changes in function within pathways in the brain’s prefrontal cortex. These brain systems require monoamine neurotransmitters to adequately function, including serotonin, dopamine, and norepinephrine. Most psychiatric medications used to treat depression target these neurotransmitter systems in one manner or another. However, it is fundamentally inappropriate to reduce depression to a simple neurotransmitter deficit. There are other neurological and physiological processes involved in depressive disorders, and medicine is still in the early stages of understanding the myriad factors that lead to a depressive condition.

A great deal of recent scientific investigation has focused on the role of inflammation in the pathophysiology of depression. An article in Psychiatric Times by Dr. Andrew Miller addresses the current state of knowledge regarding the influence of inflammation in depressive disorders. While we know that depression is not an inflammatory disorder in and of itself, there are often increased markers of inflammation in depressed patients compared with controls. Inflammation has been shown to affect subcortical and cortical brain circuits associated with motivation and motor activity as well as cortical brain regions associated with arousal, anxiety, and alarm. Inflammatory markers have been shown to be associated with suicidal ideation and suicide attempts.

Inflammation has been shown to also decrease the precursors for monoamine neurotransmitters. It can decrease Brain Derived Neurotrophic Factor (BDNF), a primary signaling molecule that allows neurons to form new connections. Inflammatory markers can predict treatment response to medications, in that patients with higher inflammatory loads are less likely to have a positive response to serotonin reuptake inhibitor antidepressants.

All of this strongly implies that strategies to reduce inflammation are an essential component of a healthy emotional framework.

The full article can be found here: