SPRAVATO An Alternative For Treatment-Resistant Depression

An Alternative For Treatment-Resistant Depression- SPRAVATO

Spravato Brochure

SPRAVATO™ is the only NMDA receptor antagonist approved in conjunction with an oral antidepressant for treatment-resistant depression. It contains esketamine, an alternative for treatment-resistant depression, and is a schedule III-controlled substance, related to ketamine, an anesthetic that also has been studied to help in the treatment of depression.

What Is Treatment-Resistant Depression?

The depression is considered resistant to treatment after failing to respond to two trials of antidepressants. About 30 percent of the patients suffering from depression do not respond to the standard treatments. Ketamine and esketamine are similar but not identical. They are enantiomers, meaning that their chemical structures are mirror images of each other. Both can be used as anesthetics but esketamine has more potency acting on the brain receptors.

Research On Ketamine And Esketamine

Ketamine IV has been extensively studied and there are numerous clinics throughout the US offering ketamine IV as a treatment for depression even though it does not have an FDA approval. The administration is done over a period of 40 minutes, at a subanesthetic dose.  We prefer to use Eskatemine Spravato because of its improved safety and FDA endorsement.

Administration Of Esketamine And Possible Side Effects

Esketamine can be administered intranasally, it is FDA approved and has less potential for dissociation and hopefully will be covered soon by the insurance carriers, has less potential for dissociation and hopefully will be covered soon by the insurance carriers. Because esketamine, like ketamine, has abuse potential, there are very strict rules related to its administration. It must be done in the doctor’s office, under direct supervision, followed by a period of two hours of observation. Following the administration, dissociative episodes can happen; therefore, the patient should not engage in driving or operating any machinery. The most common side effects are feeling dissociated from one’s body, dizziness, nausea, sedation, vertigo, anxiety, increased blood pressure, vomiting and feeling drunk.

Learn More

If you’d like to learn more about SPRAVATO for treatment-resistant depression and esketamine- call us to set up an appointment at 713-426-3100. If you’d like a brochure click here.

Learn more about Spravato here.

Can Magnets Really Help Depression? TMS Therapy Results

TMS Therapy and Depression Treatment

TMS and Depression Treatment

If you are suffering from major depression, you know that every day can seem difficult and hopeless. And you are not alone. The Latest Statistics on Major Depression from the National Institute of Mental Health(NIMH) in 2016 show that:

  • In the United States, an estimated 16.2 million adults in the United States had at least one major depressive episode. This number represents almost 7% of the United States population.
  • The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (10.9%).
  • The prevalence of major depressive episode was higher among adolescent females (19.4%) compared to males (6.4%).

Symptoms of Major Depressive Disorder

There are many different types of major depressive disorder. Each type can have a different cause, however, they all involve the same feeling of disinterest in activities you once enjoyed and feelings of hopelessness, sadness or anxiousness as well as other symptoms. See a mental health professional for a formal diagnosis, but to have a formal diagnosis of major depressive disorder you will need to experience a primarily depressed mood for two weeks or more, as well as other symptoms as outlined below.


Although the number and intensity of symptoms will vary for each individual, they are typically as follows:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment


Major Depression Can Cause Severe Impairment

In 2016, an estimated 10.3 million U.S. adults aged 18 or older had at least one major depressive episode with severe impairment. Severe impairment was indicated if their depression caused severe problems with their ability to manage at home, manage well at work, have relationships with others, or have a social life. Those adults who had major depression with severe impairment represented 4.3% of all U.S. adults.

For adolescents aged 12 to 17, approximately 9.0 percent had a Major Depressive Episode with severe impairment. Adolescents were defined as having a Major Depressive Episode with severe impairment if their depression caused severe problems with their ability to do chores at home, do well at work or school, get along with their family, or have a social life.


Depression Treatment Options

Common treatments for a major depressive episode may include antidepressants,  psychotherapy, exercise, TMS and electroconvulsive treatment (ECT). A prescribing psychiatrist can provide both psychotherapy services and prescribe antidepressants, which may differ for each person based on their individual considerations. However, ECT is generally avoided, except in extreme circumstances, in favor of both psychotherapy and antidepressants. ECT is generally avoided because the patient typically needs to be in the hospital and receive anesthesia. ECT may also cause some side effects, including confusion, disorientation, and memory loss. Unlike the TMS treatment that is noninvasive and done with the patient being awake, without any need for anesthesia.


Depression Treatment With TMS Therapy

What Is TMS Therapy?

tms machine depression treatmentTranscranial magnetic stimulation (TMS) is a non-invasive method for using a magnetic field to cause an electric current to flow in a small region of the brain via electromagnetic induction, which causes the excitation of neurons in the brain. During a TMS procedure, a magnetic field generator, or “coil”, is placed near the head of the person receiving the treatment. The neuron excitation is caused by the electric currents induced in the tissue by the rapidly alternating magnetic fields, a process called electromagnetic induction. The TMS machine triggers activity in the brain without applying electrodes on the brain and without surgery.


Who Is A Good Candidate For TMS?

A doctor can help decide if NeuroStar TMS Therapy is right for you. TMS Therapy has been approved for the treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode.

NeuroStar TMS Therapy is only available by prescription.


What Happens In A Typical TMS Procedure?

A typical TMS session lasts approximately 30-50 minutes and does not require anesthesia. Patients come to the office five times per week. The treatment goes on for six to eight weeks, for an average of 20-30 total treatments. The TMS treatment is time-intensive, but research shows it can provide long-lasting improvements.


What Happens During The TMS Procedure:

An electromagnetic coil is held against the forehead near an area of the brain that is thought to be involved in mood regulation.

Short electromagnetic pulses are administered through the coil. The magnetic pulses easily pass through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region.

Generally, the person feels and hears a slight knocking or tapping on the head as the pulses are administered.


Side Effects of TMS

For those who experience side effects, the most common side effect they have reported is a headache and/or pain or discomfort (tenderness) on the scalp, at or near the treatment site. However, this is usually transient; it occurs typically during the TMS treatment course and does not occur for most patients after the first week of treatment. There is a rare risk of seizure associated with the use of NeuroStar TMS (less than 0.1% per patient).


Who Is Not A Candidate For TMS

NeuroStar TMS Therapy should not be used with patients who have non-removable conductive metal in or near the head. NeuroStar TMS Therapy has not been studied in patients who have not received prior antidepressant treatment.


How To Pay For TMS Therapy Treatment

Insurance Coverage For TMS Therapy

Insurance coverage for TMS is expanding due to the increasing recognition by the insurance companies of the effectiveness of TMS. In Texas, TMS treatment is covered by Blue Cross Blue Shield, Cigna, and Optum (formerly United Behavioral Health).

If you don’t have these carriers, TMS Therapy® may be covered by your health insurance provider on a case-by-case basis.  Currently, insurance coverage for the TMS procedure varies and individual carriers and plans may determine coverage on a case-by-case basis.

Most insurers will only cover members after they have tried 3 or 4 medications without success, although this may change in the future, as was seen with Medicare when they changed this approval to 1 failure of medication. Although anyone can pay for the treatment out of pocket. Research shows that taking fewer medications before TMS can reduce the number of side effects of these medications, and increase the success rate of the TMS treatment.


Success Rate Using TMS With Major Depression

Repetitive transcranial magnetic stimulation, known as rTMS, may produce long-lasting changes in electro-cortical function. According to researchers, the pulses are thought to increase blood flow and encourage the growth of connections between brain cells. TMS can also cause the release of the neurotransmitters dopamine, serotonin and norepinephrine, which are chemicals that help send signals between cells. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan.

Midtown Psychiatry Experience With TMS

At Midtown Psychiatry and TMS Center, Dr White has been using TMS to help people with Major Depression since 2014. She has seen a success rate of  54% percent for patients who’ve tried TMS at her office that have seen improvements in their depression symptoms.

“For the people who do see an improvement, it can be life-changing, as many of those patients have suffered from Major Depression for years,” Dr. White says. The success stories of those helped using TMS can be seen in the note cards that Dr. White has posted on a bulletin board in her office.

The results Dr. White has seen in her office are similar to studies announced at the American Psychiatric Association meetings, which report that 53 percent of patients with medication-resistant depression who were treated with TMS reported no or mild depression following six weeks of treatment, according to results.

The TMS patients achieved better results than depressed patients who tried a different medication after failing to improve from past medication. Among patients trying a new medication, 38 percent saw improvements, according to study results.

However impressive the studies are, the studies and Dr. White caution that TMS does not work for everyone. In more serious cases of major depression, intensive outpatient treatment or hospitalization may be required.


TMS For Other Conditions

Research is ongoing into whether transcranial magnetic stimulation, or TMS, can help people with autism, schizophrenia, tinnitus, and a host of other conditions involving the brain. Although the FDA has approved TMS only for medication-resistant depression, the treatment has been approved in Europe for bipolar disorder, post-traumatic stress disorder, chronic pain, obsessive-compulsive disorder and adult ADHD, according to transcranialmagneticstimulation.com.


Integrative Treatment And Major Depression

Dr. White uses what she calls Integrative treatment, which, after a comprehensive evaluation, may include a combination of various therapeutic modalities such as relaxation, psychotherapy, yoga, medication, meditation, exercise, TMS therapy, nutritional supplementation, herbal medicine, vitamins, dietary changes, light therapy, and others. If you find yourself experiencing any of the symptoms of a major depressive disorder, you should seek assistance from a medical professional. Thankfully, in recent years, there is much less of a stigma for a major depressive disorder, and there is plenty of in-depth information available about depression online that you can discuss with your doctor.


What Our Patients Are Saying About TMS Treatment At Midtown Psychiatry

We have a bulletin board in our office which has note cards posted from people who have experienced TMS treatment in our Houston TMS Psychiatrist Office. Here are a few:

“As someone who has struggled with depression on and off my whole life and struggling with another long term episode I was excited to find a new treatment. After completing the TMS treatment I’ve been able to climb out of that depressive state and start doing the things I need to do to continue to enjoy my life. I would recommend the treatment.”

“My experience with TMS was very helpful. I went from being tired all day and not finding much pleasure in life to seeing hope for the future.”

“TMS help with my depression symptoms better than any medication ever has with no side effects. I would definitely recommend TMS to those suffering from depression and/or anxiety.”




You can hear from some of our patients as they discuss the real impact of TMS on their lives by watching Dr. White in a television video interview about TMS.


About Midtown Psychiatry & TMS Center

Midtown Psychiatry and TMS Center was created to provide the best possible mental health care available. With each patient, we strive to identify and treat the underlying causes of distress and symptoms of anxiety, depression, and other mental health issues. We work closely with patients and their families to create a treatment plan that addresses any imbalances we find. This may include addressing nutritional, lifestyle, and other core imbalances. Our treatment team, directed by Dr. Daniela White, MD, is dedicated to providing the best in diagnosis and treatment possible for a wide range of psychiatric issues, using an integrative treatment approach that improves the quality of life for our patients.

To that end, Midtown TMS and Psychiatry Center works in partnership with our patients and their families, advising them on options for treatment, such as psychotherapy, medication, TMS therapy, nutritional supplementation, vitamins, dietary changes, light therapy, yoga, meditation, exercise, herbal medicine, and others.

To learn more about TMS and our integrative treatment approach–make an appointment using the button or form on this page or call us directly at 713.426.3100.












Same Sadness, So Why Different Types Of Depression?

If It’s The Same Sadness, Why Are There Different Types Of Depression?

And How Does This Affect Your Treatment?

By Daniela M. White, MD

 depression treatment houston


It Is The Same Illness, So Why Different Medications?

I’m sure that some of you wonder that after seeing your psychiatrist that you received a different medication than your friend, coworker, or even family member. You have many of the same complaints of feeling sad, lacking interest and the energy to do much, isolating, crying at the drop of a hat and having ruminating bad thoughts that sometimes life is not worth living. You appear to have the same feelings, the same complaints, but are receiving different treatments and sometimes, a different diagnosis. This article describes why this might be the case.
From the beginning, it is worth noting that feeling sad, and crying when something bad and unexpected happens is perfectly normal, and oftentimes is expected.  Feeling of sadness by themselves, does not result in a diagnosis of clinical depression, unless several conditions are met at the same time.


Different Types of Depression

Even if the criteria for clinical depression is met, there are different types of depression, and they need to be approached with different treatments to obtain a response and eventually remission.

Response, in clinical terms, means that the treatment provides some relief.

Remission means that the symptoms become absent.


What is The Commonality Within A Depression Diagnosis?

In all the different types of depression, sadness is the main complaint, usually associated with low self-esteem, sometimes irritability and difficulties enjoying life and increased tendency to cry very easily. However, there are differences in duration, intensity and severity as well as the way these episodes are triggered that make the diagnosis and therefore treatment, different.

According to the Mayo Clinic, to get a diagnosis of clinical depression, one must meet the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association. The DSM is also used by mental health providers to provide a diagnosis of mental health conditions and by insurance companies to provide reimbursement for mental health treatment.

To get a diagnosis of clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, and nearly every day. At least one of the symptoms must be either a depressed mood or a loss of pleasure or interest. Signs and symptoms may include the following:

  • Depressed mood, such as feeling sad, empty or tearful (in children and teens, depressed mood can appear as constant irritability)
  • Feelings of worthlessness, or excessive or inappropriate guilt
  • Fatigue or loss of energy
  • Significantly reduced interest or feeling no pleasure in all or most activities
  • Insomnia or increased desire to sleep
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected)
  • Either restlessness or slowed behavior that can be observed by others
  • Trouble making decisions, or trouble thinking or concentrating
  • Recurrent thoughts of death or suicide, or a suicide attempt

For a diagnosis of clinical depression, your symptoms must be severe enough to cause noticeable problems in relationships with others, or interfere with your day-to-day activities, such as school, work, or social activities. Symptoms may be based on your own feelings, or on the observations of someone else.

Clinical depression can affect people of all ages, including children. However, clinical depression symptoms, even if they are severe, can usually get better with counseling, antidepressant medications or a combination of the two.


Types of Depression Diagnoses

The following list of diagnoses that most mental health clinicians might choose from when determining a diagnosis. The diagnosis is important because proper treatment depends on an accurate diagnosis:

  • Persistent Depressive Disorder (or dysthymia): 
  • Major Depressive Disorder, unipolar
  • Bipolar disorder, Depressed (bipolar disorder I, II and cyclothymia
  • Postpartum Depression
  • Premenstrual Dysphoric Disorder
  • Adjustment Disorder with depressive symptoms
  • Bereavement
  • Depression secondary to medical conditions
  • Substance Induced Depression

As an example of the difference between two types of depression, a lot of times people who have bipolar disorder spend most of their sick time depressed and not hypomanic, or in a state of elation. However, the treatment for a depressed episode of a bipolar disorder is typically a mood stabilizer and not an antidepressant that might make symptoms worse.  Having one episode of mania or hypomania, indicates a diagnosis of bipolar disorder and the treatment should focus on that, avoiding as much as possible an antidepressant without a mood stabilizer to start with.


How To Get The Most Out Of An Appointment With Your Care Provider

The best thing that a patient can do is to be as open as possible during the psychiatric evaluation and be willing to work with your doctor without leaving information out that might be essential not only in treating the symptoms but to avoid causing new ones.


Diagnoses Can Change Over Time

It is also worth remembering that your initial diagnosis is a working one that can evolve over time as more clinical information becomes available from the sessions. It is also important to see your psychiatrist often before the diagnosis is fully defined and until remission is achieved.


See Your Doctor And Psychiatrist Regularly, Even If You Are Feeling Better

Your primary health care and mental health care should be given in a coordinated manner. That is to say, your primary care doctor and mental health provider should be aware of the care the other is providing.  If you haven’t already done so, and you are feeling sad or depressed, we recommend that you first speak with your primary care doctor and get a complete physical exam. The goal of the physical exam would be to try and rule out a physical cause for your depression. During the physical exam, the doctor typically will focus on the most likely causes of depression, the endocrine and neurological systems of your body. The doctor will look for any health concerns that may be contributing to clinical depression symptoms. For example, hypothyroidism is typically caused by an under-active thyroid gland. The under-active thyroid is the most common medical condition that is associated with symptoms of depression. Other endocrine disorders that are associated with depression include hyperthyroidism, caused by an overactive thyroid, and Cushing’s disease, which is a disorder of the adrenal gland. Oftentimes, treating these issues can alleviate symptoms of depression. Also, your doctor might look at other medications that you are taking to see if any of the side effects include depression.

Not seeing your treating physician and mental health care provider regularly can leave side effects unaddressed or allow symptoms to progress or worsen.


Monotherapy Vs. Combination Drug Therapy

There are multiple medications and therapies now available. In psychiatry for bringing mental illness to remission, and it is not uncommon to try several medications before finding one or more that are effective. Combination drug therapy is a type of treatment that many doctors and psychiatrists have been increasingly utilizing during the past decade, especially for Major Depressive Disorder, where there is some research to suggest that taking antidepressants from multiple classes may be the best way to treat Major Depression.



Combination of Antidepressant Medications From Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized Study   Pierre Blier, M.D., Ph.D., Herbert E. Ward, M.D., Philippe Tremblay, M.D., Louise Laberge, M.D., Chantal Hébert, R.N., and Richard Bergeron, M.D., Ph.D.  March 1, 2010, American Journal of Psychiatry March 2010, Vol. 167, No. 3, pp. 281 – 288


http://www.webmd.com/depression/guide/depression-tests – 1

Can Antioxidants Help Treat Depression and Anxiety?

Antioxidants Depression and Anxiety

When it comes to stress-induced psychiatric disorders, anxiety and depression are the most common. I see this often in my practice. We know that stressful life events can produce a state of vulnerability to depression and anxiety in some people. The mechanisms that contribute to vulnerability of mental illness is an area which needs further study. Although promising research has been done in the past few years that indicates that there are biochemical changes that occur in the body as a result of stress that can be addressed.  For patients suffering from stress-induced psychiatric disorders, it is essential to understand the role of antioxidants on stress-induced psychiatric disorders so a plan can be created and implemented to help cope with the effects of stress.


Stress and Nutrition

Research has shown that stress places a demand on the body in terms of nutrition. During a period of stress, it has been discovered that there is an increase in adrenal production and mobilization. There is also an increase in vitamins and minerals, such as vitamin C, vitamin E, magnesium, potassium, and micronutrients, This further accelerates the metabolism of proteins, fats, and carbohydrates which produces quick energy that is needed to overcome the stress response.


Antioxidants and Stress

To combat the biochemical changes which occur as a result of stress, there is something researchers call “antioxidant defence” in the biological system. The research on this states that “primary defence is by enzymatic antioxidants such as superoxide dimutase, glutathione peroxidase, catalase, nicotanamide adenine diphosphate, glutathione transferase and glutathione reductase, while secondary defence is by the non-enzymatic antioxidants such as vitamin E (alphatocopherol), vitamin C (ascorbic acid), β-carotene, minerals, and trace elements like zinc.” This indicates that stress and vitamins are related and we need to replace any vitamins that are depleted in order to maintain healthy functioning.


What Are Antioxidants?

The term “antioxidant” was originally used to refer to a chemical which prevented the consumption of oxygen. We now use the term “antioxidant” to describe small molecules that interact with free radicals and neutralize them ensuring proper function of all physiological functions of the body. Free radicals and oxidants can play a dual role as both beneficial as well as toxic compounds. As such, they can either have a helpful or harmful effect on the body. Free radicals are continuously generated by our bodies through internal processes, exposure to different external pathogens or stress. The best sources of antioxidants come from richly colored fruits and vegetables. Different colors characterize different types of antioxidants.


Green Vegetables

Brightly colored green vegetables such as kale, broccoli, peas, zucchini celery, collard greens, asparagus, Brussel sprouts, and spinach are rich in lutein and zeaxanthin, antioxidant nutrients deposited in the retinas of your eyes. It is believed that eating an adequate amount of these green vegetables can help prevent the vision loss caused by macular degeneration.

The cabbage family is rich in B vitamins, needed to properly convert glucose to ATP.


Yellow and Orange Vegetables and Fruits

Carotenoids are yellow and orange vegetables and fruit, such as butternut squash, carrots, pumpkin, yellow and orange bell peppers, and sweet potatoes. The body converts carotenoids to the nutrient vitamin A which benefits your skin, bones, immune system, vision, bones, and heart.


Red Vegetables

Red vegetables also contain flavonoids called anthocyanins, which have properties of antioxidants and may help your memory, boost immunity, protect urinary tract and reduce your risk of disease. These include vegetables such as radishes, beets, red onions, and tomatoes. Many foods with natural red pigments also contain lycopene, which is an antioxidant phytonutrient which may help protect against cancer of the prostate.


Purple and Blue Vegetables

Purple and blue vegetables such as purple cabbage, purple onions, eggplant, purple peppers, and purple potatoes contain phenolic flavanoids and ellagic acid which are anti-inflammatory compounds. Eating these color vegetables may improve cognitive function, prevent some types of cancer, and reduce your risk of cardiovascular disease.


Oxidative Stress, Free Radicals and Illness

Researchers believe that a balance must be maintained between free radicals and antioxidants within the body for healthy functioning. If this balance is not maintained, the free radicals may exceed the body’s ability to neutralize them, which can change different proteins, molecules, DNA, lipids, and carbohydrates, resulting in illness. Antioxidants must be present in the body in order to stabilize the reaction by-products (free radicals), otherwise, it is believed that they damage the cellular tissue.

We get these needed antioxidants from our food. We know that if we eat a diet which is lacking proper nutrients our mitochondria cannot properly process glucose. This results in free radical by-products which can cause ongoing damage to cells and proteins. This, in turn, may accelerate the aging process, increase the risk of auto-immune diseases, degenerative diseases, cancer, and other illnesses.

The term of oxidative stress refers to this imbalance between the free radicals that become excessive to the antioxidants defenses, resulting in molecular changes and eventually illness.


Oxidative Stress and Mental Health

Oxidative stress has been shown to be an important contributor to inflammatory conditions, and in recent years has been implicated in the underlying mechanisms that result in depression and anxiety. One of the proposed pathway in developing depression has been the increased oxidative stress which pairs up with inflammatory mechanism leading to cellular aging, and possibly depression and anxiety. Studies that look at the common factors that underlie depression, cellular aging, cancer and dementing illnesses seem to find the oxidative stress a common denominator.


Alternative Treatment and Depression

There is an ongoing research in finding “out of the box” modalities to help in the treatment of depression, and most of the alternatives to the traditional pharmacological treatment try to address the inflammation through moderate exercise and a noninflammatory diet. A diet that has anti-inflammatory properties is rich in flavonoids or  ‘nutraceuticals. ’  These seem to have good antioxidative properties, and are primarily found in brightly-colored fruits and vegetables. Others kinds are also found in food, the vitamins such as vitamin C (ascorbic acid), Vitamin E (tocopherols), or B carotenes.


Research On Antioxidants, Anxiety and Depression

In a study exploring the role of antioxidants in generalized anxiety disorder (GAD) and depression, it was observed that patients with GAD and depression had significantly lower levels of vitamins A, C, and E in comparison to healthy controls. The study results reported that after dietary supplementation of these vitamins for a period of 6 weeks, a significant reduction in anxiety and depression scores of patients was observed (P<0.001). A significant increase in the blood levels of antioxidants was observed in patients (P<0.05) except that of vitamin E in the group of depressed patients.


The Reality of Diets

We know that while the amount of antioxidants needed could be obtained through good nutrition, it would be necessary to eat between 6-10 servings of fruits and or vegetables daily. Oftentimes, that is not possible.  Therefore, we recommend supplementing with good multivitamin/antioxidants called nutraceuticals which gives you a better chance of ensuring that you are getting enough antioxidants and helps with good absorption and bioavailability.


Diet and Illness

Although further study on the effects of nutrition is needed to maximize the potential of nutrition on health, the research, to date, demonstrates clearly that diet can play a huge role in preventing or ameliorating illness. As can be seen from the research detailed above- having a diet rich in different colored vegetables, and supplementing with nutraceuticals can be a great start in getting the antioxidants your body needs.


Below is a list of references that can help you in your journey to feeling good both physically and mentally.  Click here to schedule a mental health consultation.



Role of antioxidants in generalised anxiety disorder and depression.

Gautam M, Agrawal M, Gautam M, Sharma P, Gautam AS, Gautam S.
Indian J Psychiatry. 2012 Jul;54(3):244-7.


“Minding My Mitochondria: How I overcame secondary progressive multiple sclerosis” By Terry Wahls, MD


Dr Wahls’ super-nutrient paleo diet, that reversed her Multiple Sclerosis


Phytochemical and Pharmacological Profile: A Review. … Lobo, V., A. Patil, A. Phatak, and N. Chandra. 2010. “Free Radicals, Antioxidants and Functional Foods: Impact on Human Health.” Pharmacognosy Reviews 4 (8): 118–126.


Free radicals, antioxidants in disease and health.

Pham-Huy LA1, He H, Pham-Huy C.
Int J Biomed Sci. 2008 Jun;4(2):89-96.


Depressive and Anxiety Disorders Showing Robust, but Non-Dynamic, 6-Year Longitudinal Association With Short Leukocyte Telomere Length.

Verhoeven JE1, van Oppen P1, Révész D1, Wolkowitz OM1, Penninx BW1.
Am J Psychiatry. 2016 Jun 1;173(6):617-24. doi: 10.1176/appi.ajp.2015.15070887. Epub 2016 Mar 4.


Psychiatrist for Depression Treatment

Psychiatrist for Depression Treatment Houston


Are You Feeling Anxious, Depressed or Struggling with Low Self-Esteem?

Feeling sad, discouraged, down, or irritable?

Life does not have to feel this bad.

At Midtown Psychiatry and TMS, we specialize in helping people manage their depression and get back their peace of mind.

Get the Right Help to Feel Better

We offer a free Phone Consultation

If you need a Psychiatrist for Depression Treatment Houston Psychiatrist Daniela White should be on the top of your list. She cares and offers the latest depression treatment.

Her integrative treatment model offer a wide range of holistic treatment options including medication and non-medication related choices.

Depression can affect all areas of your life and can really limit your potential and relationships- so we encourage you to get help right away to get things back on track.

Modern Depression treatment methods can be very effective in helping people feel more in control of their life and feelings.

Learn more about How to Cope with Depression

Call today for an appointment at 713.426.3100.


How To Check Your Antioxidant Levels

Are You Getting Enough Antioxidants? How To Check Your Antioxidant Levels

Check Your Antioxidant Levels


Why is knowing Your Antioxidant Level Important?

According to Dr. Richard Cutler, Director of Anti-Aging Research, National Institute of Health

“The amount of antioxidants that you maintain in your body is directly proportional to how long you will live.”

Also, the Journal of American Medical Association, reported in their June 19th, 2002 publication that “Low levels of antioxidant vitamins may increase the risk of several chronic diseases.”


How Can People Check Their Antioxidant Level Affordably, Safely and Accurately?

Using the Pharmanex BioPhotonic Scanner, anyone can get an immediate indication of their overall antioxidant levels.

The BioPhotonic Scanner is based on Nobel Prize winning science and is the only patented instrument that conducts a live, non-invasive, carotenoid level measurement in living tissue and provides an immediate personal antioxidant assessment in 30 seconds.


What Do You Do Once You Know Your Score?

Once your know your antioxidant level you can make informed decisions on any improvements in your diet and lifestyle.  Knowing your score can also help you make educated decisions on which supplements might be recommended that can improve your antioxidant levels.


How does the Scanner Measure Antioxidant Levels?

The Pharmanex BioPhotonic Scanner is the world’s first measuring tool that gives you a Skin Carotenoid Score (SCS)—immediate evidence of carotenoid antioxidant activity in your body. When you place the palm of your hand in front of the scanner’s safe, low-energy, blue light, you will obtain a reading within seconds,  of your skin’s carotenoid antioxidant levels. This gives you your Skin Carotenoid Scores (SCS).  This SCS score has been scientifically correlated to one’s overall antioxidant status.

Accordingly, the technology behind of the Pharmanex BioPhotonic Scanner,  is based on an optical method known as the Resonant Raman Spectroscopy, which has been used for many years in research laboratories.

Using optical signals at the skin surface, the Pharmanex BioPhotonic Scanner measures carotenoid levels in human tissue. These signals identify the unique molecular structure of carotenoids, allowing their measurement without interference by other molecular substances and providing the person being measured with their own score (SCS).


Got a Minute?

In less than a minute you can find out if your lifestyle, diet and any supplements you are taking provide you the antioxidant protection you need for maintaining good health.


What Does The Scanning Process Look Like?

Administering the scanning process involves having you simply place the palm of your hand in front of the Scanner’s safe, low-energy blue light. You will then obtain an immediate reading of the carotenoid antioxidant levels in your skin. This is your Skin Carotenoid Score.


Why Is It Important For Everyone To Have Their Carotenoid Levels Scanned?

By measuring the stable level of carotenoid antioxidants in your skin and generating your Skin Carotenoid Score, the Scanner provides a more accurate and reliable biomarker of your overall antioxidant health status than other methods of measuring antioxidants. Getting your Skin Carotenoid Score makes you aware of the antioxidant levels in your body. Knowing this score gives you important information which can motivate you to improve your overall antioxidant health.

If you are interested in getting your carotenoid levels scanned just ask one of our staff and we can refer you to a registered scanner or simply search by your zip code here


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Get Help For Bipolar Disorder

A Psychiatrist for Bipolar Disorder Discusses Symptoms and Treatment

psychiatrist for bipolar disorder

Do You Have Bipolar Disorder?

A number of people come to me suspecting they have bipolar disorder. These patients often report extreme emotional highs and lows, as well as some other common symptoms such as feeling sad or manic. However, not everyone who experiences these symptoms has bipolar disorder. I wanted to write this article to provide some information so that people can learn more about bipolar disorder, and can get the help they need.  Although this information will be helpful-nothing is more effective than an in-person session with a trained clinician so that you can be properly screened, and make sure that you can explore all possible treatment options.


Bipolar Disorder Defined

In laymen’s terms, Bipolar disorder (often called manic depression) is a mental health condition whereby people experience extreme highs (mania), as well as intense periods of sadness or depression. The phases of depression and mania are known as “episodes,” and they can shift quickly.

Bipolar Disorder and the Brain

Bipolar disorder is a brain disorder that causes unusual shifts in energy, mood, activity levels, and can affect the person’s ability to carry out daily tasks.


Types of Bipolar Disorder

There are four basic types of bipolar disorder. Each of these types involves distinct changes in energy, mood, and activity levels. These moods range from manic episodes (periods of extremely “up,” elated, and energized behavior), to depressive episodes where the client presents as “down,” very sad, or hopeless. Less severe manic periods are known as “hypomanic episodes.”


Commonalities in Bipolar Disorder

What is common in all types of bipolar disorder is that people with bipolar disorder experience periods of unusually intense emotion, changes in activity levels and sleep patterns, as well as unusual behaviors. These distinct periods are known as “mood episodes.” What is different with bipolar disorder, is that these mood episodes are drastically different from the behaviors and moods that are typical for that particular person. When people experience these mood episodes, we typically see extreme changes in the person’s activity, energy, and sleep patterns.

Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.


Diagnostic Criteria for Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing bipolar and related disorders. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.  Diagnostic criteria for bipolar and related disorders are based on the specific type of disorder:

For Bipolar I disorder, you have to have had at least one manic episode. The manic episode may be preceded, or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis).

For Bipolar II disorder, you have to have had at least one major depressive episode lasting at least 2 weeks and at least one hypomanic episode lasting at least four days. People with Bipolar disorder II have never had a manic episode. Major depressive episodes or the unpredictable changes in mood and behavior can cause distress or difficulty in areas of your life.

For Cyclothymic disorder you must have had it at least two years, or one year for children and teenagers, where you have had numerous periods of hypomania symptoms (this is the less severe episode than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode). During that time, symptoms occur at least half the time and never go away for more than two months. Symptoms cause significant distress in important areas of your life.

There are other types of Bipolar disorder, which include bipolar and related disorders caused by another medical condition, such as Cushing’s disease, stroke, or multiple sclerosis.  There is an additional type called substance and medication-induced bipolar and related disorder.

Note that Bipolar II disorder is not a milder form of Bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be dangerous and severe, individuals with Bipolar II disorder have been known to be depressed for longer periods of time, which can lead to significant impairment in their daily functioning.


Bipolar Disorder Treatment

With proper diagnosis and treatment, people who have bipolar disorder are able to lead healthy and productive lives. Speak with your doctor or a licensed mental health professional if you think you might have Bipolar disorder. We cannot stress enough that you should have a physical exam to rule out other conditions.  Some Bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make an accurate diagnosis.

If the problems are not caused by physical illnesses, a mental health evaluation should be done with a trained mental health professional, such as a psychiatrist, social worker, or psychologist who has experience in diagnosing and treating bipolar disorder.

Bipolar disorder can sometimes co-occur with another illnesses such as an anxiety disorder, eating disorder or with substance abuse. In addition, some people with Bipolar disorder are at higher risk for obesity, diabetes, thyroid disease, heart disease, migraine headaches, and other illnesses.


Want Help? Call Us

If you would like to set up an appointment for an evaluation call us at 713.426.3100.



Bipolar Disorder Treatments and Drugs

Bipolar Disorder Treatment Options

The good news is that treatment for Bipolar Disorder helps many people-even those with the most severe forms of bipolar disorder, to gain better control of their mood swings and other bipolar symptoms. A typical, effective, plan for treatment includes a combination of psychotherapy (also called “talk therapy”), and some type of medication.

No Quick Fixes

Bipolar disorder is a lifelong illness. Unfortunately, episodes of depression and mania often return over time. However, typically, many people with bipolar disorder are free of mood changes between episodes. Some people may have lingering symptoms. In the long-term, most people with bipolar disorder need continuous treatment to help to control any symptoms that arise.


Use of Medications for Bipolar Disorder

Bipolar Disorder Treatments and Drugs

Different types of medications are available that can help control symptoms of bipolar disorder. Oftentimes, those with Bipolar Disorder may need to try several different medications before finding ones that work best for them.

Medications generally used to treat bipolar disorder include:
  • Mood stabilizers
  • Atypical antipsychotics
  • Antidepressants


Those taking these medications should:

Make sure they take the time to talk with their pharmacist or doctor so they can understand the benefits and risks of the medication.

Do not suddenly stop taking a medication without first  talking to your doctor, because doing so may lead to “rebound” or worsening of the symptoms of bipolar disorder, and other uncomfortable or potentially dangerous withdrawal effects.

Immediately report any side effects or concerns to their doctor. The doctor may want to try a different medication, or adjust the dosage of the medication.


When done in combination with medication, psychotherapy (also known as “talk therapy”) can be an effective treatment for Bipolar Disorder. A professional therapist trained in helping people with Bipolar Disorder can offer support, education, and guidance to people with Bipolar Disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

  • Cognitive behavioral therapy (CBT)
  • Family-focused therapy
  • Interpersonal and social rhythm therapy
  • Psychoeducation

Other Treatment Options

Electroconvulsive Therapy (ECT)

This form of treatment has been proven to provide relief for people with severe bipolar disorder who have not been able to recover with other treatments. Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make taking medications too risky. Some short-term side effects can be seen with ECT such as confusion, disorientation, and memory loss. We recommend you discuss with your doctor the possible benefits and risks of using ECT.


Sleep Medications

Those with bipolar disorder who have trouble sleeping typically find that treatment is helpful. And in the case where sleeplessness does not improve, your medical provider may suggest a change in medications. If the problem continues, the doctor may prescribe sedatives or other sleep medications.



We do not recommend the use of supplements as there is not enough research done on natural or herbal supplements and their effect on bipolar disorder.

If you are taking any supplements we recommend that you let your primary care doctor or psychiatrist know about these and any over-the-counter medications because certain supplements taken together with medications may cause drug interactions that can be dangerous.


Getting Help For Bipolar Disorder

Your primary care physician or family doctor is the best resource to start so that any medical issues which may be impacting you can be ruled out.

They will typically refer you to a mental health practitioner. Ideally, if you suspect you have symptoms of Bipolar Disorder-you should request any provider you see has this specialization. In addition, to exploring medications through a psychiatrist, as mentioned above, some form of talk therapy have been shown to be helpful through the treatment process.

If you, or a loved one is in crisis- call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone and all calls are confidential.

If you would like to make an appointment to see our Integrative Psychiatrist for Bipolar Disorder and learn more about Bipolar Disorder Treatments and Drugs, call us at 713.426.3100.



Is Seasonal Depression Affecting You?

What To Do About The Holiday Blues?

seasonal depression

What are they and how do they affect us?

Many factors can lead to what we describe as the holidays blues: headaches, insomnia or sleeping too much, excessive worrying, difficulties concentrating, decreased interest in things that are normally enjoyable. They are usually transitory but sometimes they can trigger periods of feeling anxious and depressed that needs to be addressed with a therapist or psychiatrist. Many factors can lead to what we describe as the holidays blues: headaches, insomnia or sleeping too much, excessive worrying, difficulties concentrating, decreased interest in things that are normally enjoyable. They are usually transitory but sometimes they can trigger periods of feeling anxious and depressed that needs to be addressed with a therapist or psychiatrist.

Below, are some of the most common causes of these sad or anxious feelings around the holidays that affect what is supposed to be a time of joy and celebration. Below, are some of the most common causes of these sad or anxious feelings around the holidays that affect what is supposed to be a time of joy and celebration.

    1. Anniversaries of losses such as deaths, departures and breakups. Most people who lost the dear ones, either to death, illness, breakups or departures, anticipate the holidays as a time that instead of being happy, reminds them that their loved ones will not be around this time of the year. Family gatherings are vivid reminders of the person who is not present. Especially the first year after the loss, each holiday becomes an acute reliving of the painful feeling of separation and longing.

We recommend to our patients that they use these times to celebrate the life of their loved one, and reflect on the way they positively impacted the people that they left behind. By focusing on celebrating their lives rather than on the sad separation could help make the holiday times more bearable. We recommend to our patients that they use these times to celebrate the life of their loved one, and reflect on the way they positively impacted the people that they left behind. By focusing on celebrating their lives rather than on the sad separation could help make the holiday times more bearable.

    1. Remembering the happy times that are gone from the present is more common with people whose present lives are not ‘as happy’ as in the past with their departed loved one. Economic hardship, changed family dynamics and transitions through later stages of life can make these times difficult.

What we recommend is to try to spend as much time as possible with the remaining loved ones, focusing and cherishing the warmth and benefit of having healthy relationships, and on the positive light and influence in their lives.

    1. Seasonal depression is mostly seen in the parts of the world further away from the Equator. Some people are more sensitive to the diminished light during the winter months, which appears to decrease the internal brain production of serotonin.

We often suggest “light therapy” or phototherapy which is administered through light boxes which give off specific wavelengths of light, and are administered for a prescribed amount of time. Exposure to this light can result in reduced symptoms of decreased energy, increased appetite and drowsiness associated with this form of depression.  Providing light therapy through light boxes can reduce the symptoms of decreased energy, increased appetite and somnolence associated with this form of depression.

    1. Dealing with dysfunctional families. Some people anticipate with almost despair spending time with members of their family that they simply do not like, or have had previous, unhealed conflicts.

What we recommend is to attempt controlling only the things that can be controlled, such as the time and place where the gathering happen, keep any statements made to ‘I’ without assigning blame, and actively listening and avoiding ‘hot’ topics.

    1. Breakdown of routines during the holidays. Most people’s schedules becoming hectic and disorganized during the holidays, and neglect healthy routines such as exercising, eating healthy and allocating time for themselves.

What we recommend is to treat yourself first with a healthy regimen; avoid excessive consumption of alcohol or unhealthy foods, and keep a regular exercise and sleep schedule.

The bottom line is that the holidays do not have to be a time that causes you anxiety and sadness. Although some of this is natural, there are things you can do to lessen the severity.

For some people, taking the above steps is not enough, and there are other options that you can explore which include counseling, medication and other forms of intervention.
If you’d like to get some help in coping-please call us to set up a time to talk at 713.426.3100

Homocysteine and Depression: What You Need To Know

Ask your psychiatrist if Homocysteine could be contributing to your depression…

homocystein and depression

What is HCY?

Homocysteine (HCY) is an amino acid that is destructive to cell integrity and DNA, and is a risk factor for the development of vascular and neuropsychiatric pathologies.

HCY has been linked to cardiovascular diseases, but when it passes the blood-brain barrier, it contributes to other chronic disorders such as depression, dementia, bipolar disorder, schizophrenia, and acute events, like strokes.

Where do these amino acids come from? HCY is not obtained from the diet – it’s not present in a naturally occurring protein. An amino acid found in a normal diet, called methionine, is broken down to either cysteine (a ‘good’) amino acid or homocysteine (the ‘bad’ form).

What causes HCY Toxicity?

The mostly commonly suggested mechanisms are oxidative injury, direct vascular damage, impaired methylation and impaired DNA synthesis. Another possible mechanism is the possibility of a heightened the inflammatory process, which is associated with depression.

Causes for elevated HCY can be genetic, epigenetic, and environmental and lifestyle-related.

The most common causes of elevated HCY:

  • smoking
  • excessive alcohol consumption
  • lack of exercise
  • obesity
  • some medications
  • psychological stress

Exercise helps distribute the HCY more evenly throughout the body, facilitating metabolism.  Poor vitamin intake makes it impossible for the metabolism of homocysteine to a ‘good’ form (cysteine). Decreased magnesium levels also slows down the metabolism of HCY. Lipid lowering medications or anticonvulsants impair the HCY metabolism as well. Genetic predisposition, like a mutation in the MTHFR enzyme can also decrease the ability of the body to metabolize HCY efficiently (TT and CT are the most variants shown to be associated with depression).

Why and how is this important for the treatment of depression?

Based on the theory of impaired metabolism of HCY, the low monoamines levels (serotonin, dopamine, norepinephrine) are related to the lack of important coenzymes that are necessary for the metabolism of HCY and the synthesis of neurotransmitters.

The coenzymes necessary for the HCY reduction are fully metabolized B vitamins. If a patient with depression is genetically predisposed to not be able to metabolize them (such in CT and TT variants of MTHFR) then they will have high levels of HCY, which may cause a higher level of inflammation and neurotoxic effects on the brain.

How can we individualize the treatment of depression?
  1. Check for the MTHFR mutation. Although it is not the only etiological factor, it can suggest a polymorphism contributory to the inflammation and depression.
  2. Supplement treatment with antidepressants by adding metfolate at 15 mg/day. Depression has been associated with reduced metfolate. Supplementing can help the HCY metabolism, reducing its toxic effects on the brain.
  3. Supplement with complex B vitamins and other necessary micronutrients. Maximizing methylation with reduced complex B and micronutrients necessary in the metabolism of HCY. Many patients can benefit from this supplementation even in the presence of HCY and because they are safe, they should be more largely used as a routine addition to the antidepressant treatment.

If you like this article on Homocysteine and Depression, or have questions, schedule your first session by calling us at 713.426.3100.


  1. Homocysteine and Neuropsychiatric Disease: Angela Pana, MD, Psychiatric Ann. 2015;45(9):463-468.
  2. Inadequate Homocysteine Metabolism: A theory of Depression, Andrew Farah, MD. Psychiatr. Ann. 2015;45 (9): 469-472.
  3. Theory into Practice-Addressing the Homocysteine Basis of Depression. Andrew Farah, MD Psychiatr. Ann. 2015;45(9):473-477.