Services

Psychiatric and Behavioral Treatments for Various Psychiatric Disorders

Psychiatry

Psychiatric Services
Patient comfort is our priority. We make sure that we provide a comfortable, non-judgmental, and relaxed environment for our patients. The initial consultation consists of a comprehensive psychiatric evaluation during which we find out about your symptoms, past history, and any other treatment you may have gone through in the past. The evaluation is part conversation and part filling out rating scales. Based on the evaluation, we come up with an appropriate treatment plan that we explain in detail to our patients so they know exactly what and why a certain treatment is being carried out.

At Suffolk Behavioral Medicine, we treat:

  • TMS Therapy for Medication Resistant Depression

  • Complex Psychopharmacology

  • ADHD/ADD

  • OCD and OCD Spectrum Conditions

  • Mood Disorders

  • Opioid Addiction with Suboxone Induction and Maintenance Treatment

Psychiatric Conditions
ADHD: Attention Deficit Hyperactivity Disorder is one of the most common childhood disorders that can continue into adulthood. Some of its prominent symptoms include:

  • Being Easily Distracted

  • Difficulty in completing a task

  • Becoming bored with a task within a few minutes

There is no clear cut cause of ADHD but many studies suggest that genes play a large role. Symptoms of ADHD appear at an early age and it’s important that parents and teachers look out for these symptoms and report them if they are present as these symptoms can hamper a child’s ability to do well in school and everyday life.

Bipolar Disorder: Bipolar Disorder, also known as manic-depressive illness, is a type of brain disorder that is characterized by unusual shifts in mood and behavior. People suffering from bipolar disorder usually experience episodes of intense emotional states.

An overly happy emotional state is referred to as a manic episode and an overly sad or hopeless state is referred to as a depressive episode. Symptoms of bipolar disorder usually develop in an individual’s late teen years or early adult years. Bipolar disorder can be treated with medication and people with bipolar disorder can lead healthy and happy lives.

Anxiety: People usually get anxious when faced with a difficult situation. Anxiety is a normal reaction to stress. However, when anxiety becomes excessive and starts to interfere with one’s daily life, it becomes a disabling disorder. Anxiety Disorder can be broken down into different types that encompass Panic disorders, Obsessive-Compulsive disorder, and Social phobias.

Panic Disorder: Panic disorder is characterized by sudden attacks of terror, a sense of unreality, and a fear of losing control. Physically, the person suffering the attack may feel weak, dizzy, or even sweaty. Panic attacks may occur at any time. They typically last for about ten minutes but can continue on longer.

OCD - Obsessive-Compulsive disorder is characterized by persistent negative thoughts that are controlled by repetitive rituals. For example, a person obsessed with germs may repetitively wash their hands. Other repetitive rituals include constantly checking doors to make sure they’re locked, checking the stove multiple times to make sure it’s off, or organizing and reorganizing things in search of perfection. Unlike healthy people who also carry out rituals, people with OCD differ because these rituals often end up controlling them and interfere daily life.

Social Phobias - Social phobias are characterized by feelings of excessive self-consciousness in everyday social situations and a chronic fear that they are being watched and judged by others. People diagnosed with a social phobia may worry about mundane situations for weeks at a time. They constantly feel overwhelmed and nervous about situations. Physically, they experience sweating, trembling, nausea, and difficulty talking. Social phobias are often successfully treated with medication and psychotherapy.

Psychiatric Rating Scales
How Rating Scales Work:
Cardiologists may use Electrocardiography to determine whether a patient complaining of chest pain may have abnormal heart muscle activity. Similarly, psychiatrists use rating scales to evaluate mental health. The rating scale approach converts qualitative symptoms, such as anxiety, into quantitative measures by asking the patient to rate their anxiety on a numerical scale. Rating scales can be of various types, but the most common rating scale used by psychiatrists is the self-rating scale. With certain disorders, such as delirium and dementia, where the patient’s verbal capacity or insight are compromised, self-rating scales don’t serve much purpose. But with conditions such as depression and anxiety, self-rating scaled can be very valuable.

TMS

About TMS
The Research of TMS
First used in 1985, TMS has been used by researchers around the world to help understand the function of different parts of the brain. Several hundred manuscripts have been published regarding its use in stimulating select regions of the brain. Since the mid-1990s, TMS has been studied as an antidepressant therapy.
Transcranial Magnetic Stimulation (TMS) Melville Transcranial Magnetic Stimulation (TMS) Melville Transcranial Magnetic Stimulation (TMS) Melville Transcranial Magnetic Stimulation (TMS) Melville Transcranial Magnetic Stimulation (TMS) Melville Transcranial Magnetic Stimulation (TMS) Melville

In 2006, the largest randomized, controlled study ever conducted with TMS Therapy was completed. This study was sponsored by Neuronetics and utilized the NeuroStar TMS Therapy system.

FDA Approval in October 2008: Recently, the NeuroStar TMS Therapy system, was cleared by the U.S. Food and Drug Administration for the treatment of adult patients with major depressive disorder who have failed to receive satisfactory improvement from prior medication antidepressant treatment 4 attempts of which 1 was adequate in the current episode. TMS is also approved for other medical uses.

What is transcranial magnetic stimulation?
Transcranial magnetic stimulation procedure used to treat major depressive disorder (MDD) or sometimes termed as "major depression.” The technique involves use of an electromagnetic coil to create electromagnetic pulses in the brain which have an antidepressant effect. It is an FDA-approved treatment for major depression.

What is NeuroStar TMS Therapy®
TMS (transcranial magnetic stimulation) Therapy is a new treatment cleared by the FDA for patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant medications.* Using pulsed magnetic fields, TMS Therapy stimulates the part of the brain thought to be involved with mood regulation. Performed [in our clinic] as an outpatient procedure NeuroStar TMS Therapy is:
Non-invasive, meaning that it does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment.
Non-systemic, meaning that it is not taken by mouth and does not circulate in the bloodstream throughout the body.
The typical treatment course consists of 5 treatments per week over a 4-6 week period (20-30 treatments). Each treatment session lasts approximately 37 minutes.

How TMS works
TMS Therapy Melville
How does TMS work?
TMS Therapy® is a short outpatient procedure performed right in a psychiatrist’s office. The treating clinician uses a treatment coil to send pulsed magnetic fields, similar in type and strength to those produced by a magnetic resonance imaging (MRI) machine, to the part of your brain thought to control mood.

TMS Therapy is a highly targeted treatment reaching 2-3 centimeters into the brain, directly beneath the treatment coil. The nature of the magnetic fields allows them to pass through a patient’s hair, skin, and skull and into the mood-regulating area without being distorted in any way. This method allows for a very accurate type of stimulation, minimizing the stimulation of brain tissue not involved in mood.

These magnetic pulses produce very small electrical currents. The amount of electricity created in the brain is very small and cannot be felt by a patient. These small electric currents can cause the neurons (brain cells) to fire or

TMS Therapy involves the use of very short repetitive pulses of magnetic energy to stimulate nerve cells in the brain. First used in 1985, TMS Therapy has been used by researchers around the world to help understand the function of different parts of the brain. Special sequences of repetitive TMS Therapy have been tested by Neuronetics to determine its safety and efficacy for the treatment of major depression. Neuronetics' pivotal trial is not the first to investigate the potential antidepressant effects of TMS Therapy. Early results from other trials have encouraged researchers to further investigate TMS Therapy as a treatment for major depression.

TMS Therapy Melville
Neuron Diagram
TMS Therapy Melville
Treatment Site

The NeuroStar TMS Therapy system generates highly concentrated, magnetic fields thorough a treatment coal which turn on and off very rapidly. These magnetic fields are the same type and strength as those produced by a magnetic resonance imaging (MRI) machine. The treatment coil is applied to the head above the left prefrontal cortex. This part of the brain is involved with mood regulation, and therefore is the location where the magnetic fields are focused. These magnetic fields do not directly affect the whole brain; they only reach about 2-3 centimeters into the brain directly beneath the treatment coil. As these magnetic fields move into the brain, they produce very small electrical currents. These electrical currents activate cells within the brain, which are thought to release neurotransmitters.

Once inside the brain, the dynamic (rapidly changing) nature of the magnetic pulses induces electrical charges to flow. The amount of electricity created in the brain is very small, and can not be felt by the patient. When in the correct orientation relative to brain cells (neurons), these very small electric charges can cause the neurons to fire or become active. (Figure 3) The objective of TMS Therapy is to stimulate (or activate) brain cells. Patients remain awake and alert during a TMS Therapy procedure.

Depression?
What is Major Depressive Disorder?

Major depression is a common and serious medical illness affecting more than 13 million Americans or approximately 6.6 percent of the population in a given year. Unlike the normal ups and downs of everyday life, Major Depression is persistent and can significantly interfere with an individual's thoughts, behavior, mood, and even physical health. Mental illness is the leading cause of disability in the U.S. often impairing social, academic, and work functioning and causing significant emotional distress. Depression is the most predominant illness within the mental health arena.

Women are almost twice as likely as men to suffer from depression. However, some experts feel that depression in men is significantly under-reported. Major depression can occur at any age, including childhood, the teenage years, and adulthood. Major depression has no racial, ethnic, or socioeconomic boundaries. About two-thirds of those who experience an episode of depression will have at least one other episode in their lives. It is not unusual for depression sufferers to have more than one episode in any given year.

Major depression, also known as unipolar depression, is only one type of depressive disorder. Other depressive disorders include dysthymia (a type of chronic depression) and bipolar depression (the depressed phase of bipolar disorder or manic depression). Individuals suffering from bipolar disorder experience both depression and mania in a cyclical fashion. Mania often involves abnormally and persistently elevated mood or irritability, elevated activity, grandiosity, rapid speech, and racing thoughts.

Causes of Major Depressive Disorder
Scientists have not yet determined the root cause of major depression. However, there is strong evidence there may be several contributors to the illness. Psychological, biological, and environmental factors may all contribute to its development. Whatever the specific causes, research has firmly established that major depression is a biological brain disorder.

Serotonin, norepinephrine, and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Several theories attempting to explain depression are based on an imbalance of these chemical messengers. It is thought that most antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemicals.

Scientists have also found evidence of a genetic predisposition to major depression. There is an increased risk of developing depression when there is a family history of the illness. Not everyone with a genetic predisposition develops depression, but some people probably have a biological make-up that leaves them particularly vulnerable to developing depression.

Life events, such as the death of a loved one, chronic stress, and alcohol and drug abuse, may trigger episodes of depression. Some illnesses such as heart disease and cancer and some medications may also trigger a depressive episode. Often, however, depressive episodes occur spontaneously and are not triggered by a life crisis or physical illness.

Symptoms of Major Depressive Disorder
The onset of the first episode of major depressive disorder may not be obvious if it is gradual or mild. The symptoms of this disorder characteristically represent a significant change from how a person functioned before the illness. The symptoms of depression may include:

Feelings of Worthlessness, Hopelessness, Helplessness, or Guilt
Persistently Sad or Irritable Mood
Pronounced Changes in Sleep Habits and Energy Levels
Pessimistic Feelings About the Future
Trouble Making Decisions
Significant Weight Gain or Loss
Difficulty Thinking or Concentrating
Low Libido
Increased Agitation
Lack of Interest in or Pleasure From Activities Typically Enjoyed
Recurrent Thoughts of Death and/or Suicide
When several of these symptoms occur at the same time, last longer than two weeks, and interfere with ordinary functioning, individuals should seek professional advice and treatment. If left untreated, major depression can lead to attempted suicide.

Treatment for Major Depressive Disorder
Several types of treatment for major depression are available, and the type chosen depends on the individual and the severity of their illness. There are three basic types of treatment for depression in common use today: psychotherapy, medications, and electroconvulsive therapy (ECT). They may be used singly or in combination. NeuroStar® TMS Therapy is currently testing a fourth type.

Psychotherapy: There are several types of psychotherapy that have been shown to be effective for depression including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that some individuals with mild to moderate depression can at times be treated successfully with either of these therapies used alone. Other research on Major Depressive Disorder has indicated that the use of medication and psychotherapy together is more useful than either one utilized alone.

Cognitive-behavioral therapy (CBT) – helps to change the negative thinking and unsatisfying behavior associated with depression, while training people how to break the behavioral patterns that contribute to their illness.

Interpersonal therapy (IPT) – focuses on improving troubled personal relationships and on adapting to new life situations that may have contributed to an individual’s depression.

Medication: The first antidepressant medications were introduced in the 1950s. Research has shown that imbalances in neuro-transmitters like serotonin, dopamine, and norepinephrine can be modulated with antidepressants. The response to medication is gradual often taking 4-6 weeks to fully respond. Five groups of antidepressant medications are most often prescribed for depression:

Selective serotonin reuptake inhibitors (SSRIs) – useful as a first-line treatment, they act specifically on the neurotransmitter serotonin. In general, SSRIs cause fewer side effects than TCAs and MAOIs.

Serotonin and norepinephrine reuptake inhibitors (SNRIs) – useful as first-line treatments in people taking an antidepressant for the first time and for people who have not responded to other medications. In general, SNRIs cause fewer side effects than TCA and MAOIs.

Dopamine reuptake blocker – a newer antidepressant medication, it acts on the neurotransmitters dopamine and norepinephrine. In general, this class of medication causes fewer side effects than TCAs and MAOIs.

Tricyclic antidepressants (TCAs) – still widely used for severe depression. TCAs elevate mood in depressed individuals, re-establish their normal sleep, appetite, and energy level. The often times greater side effects of the tricyclic antidepressants may limit their usefulness in some individuals

Monoamine oxidase inhibitors (MAOIs) – are often effective in individuals who do not respond to other medications or who have "atypical" depressions with marked anxiety, excessive sleeping, irritability, hypochondria, or phobic characteristics. These medications are harder to use and require following a low tyramine diet.

Electroconvulsive therapy (ECT) - ECT is an effective treatment for severe depressive episodes. ECT employs the use of anesthesia and muscle relaxers during the procedure which involves the application of an electrical field to the head in order to produce a physical seizure. These treatments are given in the hospital.

For individuals where medication, psychotherapy, and a combination of the two prove to be ineffective or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide, ECT is often used. ECT may also be indicated for those who are not able to take antidepressant medications and do not respond to psychotherapy. Side effects on memory recall are troublesome for some individuals.

Vagus Nerve Stimulation (VNS Therapy™) – is a non-drug treatment available specifically for treatment-resistant depression. The actual procedure takes about an hour and is usually performed under general anesthesia on an outpatient basis. Two small incisions are required: one on the upper chest area for the pulse generator and one on the left neck for the thin, flexible wires that connect the pulse generator to the vagus nerve. This treatment is infrequently utilized.

Transcranial Magnetic Stimulation (TMS Therapy):

Neurostar TMS Therapy is a new treatment cleared by the US Food and Drug Administration (FDA) for patients suffering from depression who have not achieved satisfactory improvement from prior antidepressant treatment. TMS stands for "transcranial magnetic stimulation."

TMS Therapy is a treatment that can be performed in a psychiatrist's office, under their supervision, using medical device called the NeuroStar TMS Therapy system. NeuroStar TMS Therapy is:

Non-invasive, meaning that it does not involve surgery. It does not require any anesthesia or sedation, as the patient remains awake and alert during the treatment.
Non-systemic, meaning that it is not taken by mouth and does not circulate in the bloodstream throughout the body.

The typical initial treatment course consists of 5 treatments per week over a 4-6 week period, for an average of 20-30 total treatments. Each treatment session lasts approximately 40 minutes.

FAQ'S
Is NeuroStar TMS Therapy® a good alternative for patients who cannot tolerate the side effects associated with antidepressant medications?
TMS Therapy® is non-systemic (does not circulate in the blood throughout the body), so it does not have side effects such as weight gain, sexual dysfunction, nausea, dry mouth, sedation, etc. The most common side effects reported during clinical trials were headache and scalp discomfort – generally mild to moderate – occurring less frequently after the first week of treatment.

NeuroStar TMS Therapy has been cleared by the U.S. Food and Drug Administration (FDA) for the treatment of patients with depression who have failed to achieve satisfactory improvement from prior antidepressant medication.* Like any treatment option, you and your doctor should work together to find the most appropriate treatment option for you.

Is NeuroStar TMS Therapy like electroconvulsive therapy (ECT)?
No, the two procedures are very different. While both are effective in the treatment of depression, there are many differences in safety and tolerability.

During the TMS Therapy procedure, patients sit in a chair and are awake and alert throughout the entire 37-minute procedure – no sedation is used with TMS Therapy. Patients can transport themselves to and from treatment.

In over 10,000 active treatments with NeuroStar TMS Therapy in clinical trials, no seizures were observed. TMS Therapy was also shown to have no negative effects on memory function in these studies.

In contrast, "shock therapy," or electroconvulsive therapy (ECT), intentionally causes a seizure. Patients receiving ECT must be sedated with general anesthesia and paralyzed with muscle relaxants. Recovery from an ECT treatment session occurs slowly, and patients are usually closely monitored for minutes or a few hours after a treatment.
Short-term confusion and memory loss are common, and long-term disruptions in memory have been shown to occur and may persist indefinitely in some people. Because of the side effects associated with ECT, a significant amount of caregiver support is required.

What are the potential risks of NeuroStar TMS Therapy?
NeuroStar TMS Therapy is well tolerated and has been proven to be safe in clinical trials. Throughout over 10,000 active treatments performed in clinical trials, the most commonly reported side effect related to treatment was scalp discomfort during treatment sessions. This side effect was generally mild to moderate and occurred less frequently after the first week of treatment. Less than 5% of patients treated with NeuroStar TMS Therapy discontinued treatment due to side effects.

In NeuroStar clinical trials, over 10,000 TMS treatments demonstrated its safety, with no occurrence of seizures. However, there is a small risk of a seizure occurring during treatment. This risk is no greater than what has been observed with oral antidepressant medications.

While NeuroStar TMS Therapy has been proven effective, not all patients will benefit from it. Patients should be carefully monitored for worsening symptoms, signs or symptoms of suicidal behavior, and/or unusual behavior. Families and caregivers should also be aware of the need to observe patients and notify their treatment provider if symptoms worsen.

Does NeuroStar TMS Therapy cause memory loss?
No, TMS Therapy was systematically evaluated for its effects on memory. Clinical trials demonstrated that NeuroStar TMS Therapy does not result in any negative effects on memory or concentration.

Is TMS Therapy uncomfortable?
The most common side effect related to treatment was scalp discomfort during treatment sessions. This side effect was generally mild to moderate and occurred less frequently after the first week of treatment.

If necessary, you can treat this discomfort with an over-the-counter analgesic. If these side effects persist, your doctor can temporarily reduce the strength of the magnetic field pulses being administered in order to make treatment more comfortable.
Less than 5% of patients treated with NeuroStar TMS Therapy discontinued treatment due to side effects.

Suboxone

Suboxone Therapy
Suboxone is the first opioid medication approved under DATA 2000 for the treatment of opioid dependence in an office base setting. The primary active ingredient in Suboxone is buprenorphine. Buprenorphine acts as an opioid agonist. What that means is that since Buprenorphine is an opioid itself it produces typical opioid effects such as euphoria thus allowing the opioid individual to discontinue their abuse of opioid(s) without experiencing withdrawal symptoms. The effects of buprenorphine increase as you increase its dose, however, after a point the effects reach a plateau and no longer intensify even if the dose is increased. Because of this quality, one is less likely to become addicted to buprenorphine.

There are three phases of Suboxone Maintenance Therapy:
The Induction Phase: An individual may be administered buprenorphine if the opioid-addicted individual has abstained from using opioids for 12-24 hour and is experiencing withdrawal symptoms. Induction is usually for observational purposes in the physician’s office.

The Stabilization Phase: This phase begins once a patient has greatly reduced or completely stopped using his or her opioid. And no longer has cravings for it.
The Maintenance Phase: This is the final phase of Suboxone therapy. The maintenance phase is reached when the patient is in compliance with a steady phase of buprenorphine.

Suboxone therapy is a great treatment option for opiate addiction because it reduces opioid cravings and withdrawal symptoms. It also causes less euphoria than full opioid agonists such as morphine and heroin, resulting in a lower potential for abuse and less physical dependence.

Opioid Dependence
Opioid dependency is a medical diagnosis characterized by an individual’s inability to stop using Opioids despite negative consequences. Opioids are the most powerful known pain relievers that often produce euphoric effects. Dependency on Opioids occurs when the individual has a strong desire to take the drug and experiences a psychological withdrawal state when drug use is stopped or reduced. Persisting with the use of Opioids can lead to harmful consequences such as damage to the liver, depressive mood states, and impairment of cognitive functioning. Opioid dependence in the United States is growing at unprecedented rates, yet more than 75% of opiate addicts are untreated.