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Author Archives: Robert Pollack

Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

Music as Medicine: Ancient Wisdom, Modern Science


Healing Then and Now With Music


Therapeutic uses of music date back to antiquity. Healing shrines in Ancient Greece housed both hymn specialists and physicians.[2] Native American tribes chanted, danced, and played drums to heal illness. And early Christian priests used hymns to ease pain in the sick. Today, scientific studies confirm what the ancients seemed to know inherently: that music can be medicinal.[3]


The Ancient Greeks: Musical Wisdom


Hippocrates advocated a “healthy mind in a healthy body,” which included mental health care and art therapy. Music and drama were used to treat illness and improve behavior in his time. The notion was that healing the soul through music would also heal the body, with specific applications. The sounds of the flute and harp, for instance, were a treatment for gout.[5]


What Is Music Therapy? A Contemporary Definition


Today, music therapy aims to influence both emotion and physiology. Music therapy is an established allied healthcare profession that entails a therapeutic relationship between a patient and a board-certified music therapist. Treatment techniques are designed to achieve functional changes in mood, brain, and behavior.[6]


Imaging Studies: The Brain Dances to Music


Music modifies brainwaves, a phenomenon that can be seen through functional MRI (fMRI). Patterns of activity in the nucleus accumbens and auditory cortices indicate whether a person enjoys a particular piece of music or not. Another area of the brain, the superior temporal gyrus, serves as a music-recommendation system that helps people make choices about music they want to listen to and purchase.[8]


Reducing Blood Pressure


Music can influence blood pressure in both directions, based on speed and personal perceptions.[9] One study exposed patients with essential hypertension to 30 minutes of Beethoven’s violin concerto Op. 61, second movement (Larghetto). The results showed that both systolic and diastolic blood pressure were lowered significantly.[10]


Music and Dementia Patients


Recent studies have documented the positive effect that music has on dementia patients. Some scientists hypothesize that music regenerates or stimulates several areas of the brain while slowing down neurodegeneration. Patient choice of music yields the best results, and selections that include vocals tend to show the most promise in dementia treatment.[12,13]


Music and Learning


Companies like Brain.fm are creating music and sounds that condition the brain (brainwave entrainment) to reach specific cognitive states. Brainwave oscillations can be synchronized with music to achieve a desired state, such as relaxation, reduced pain, sleep, contentment, and others.


Music and Autism


Research suggests that music can improve communication, behavior, cognition, social interactions, and emotional regulation in those on the autism spectrum. It appears to do so by stimulating both hemispheres of the brain, organizing the sensory system, and increasing perceptual motor skills.[16]


Music as Sleep Medicine


Music has proven to be highly effective in improving sleep hygiene. One study showed improved sleep in elderly participants over 3 months from listening to slow, sedative music every night. Areas of improvement included sleep latency and efficiency as well as daytime function. Similar studies have shown fewer interruptions in sleep patterns and prolonged REM sleep in adults with insomnia.[18,19]


Depression and Anxiety


Music releases mood-enhancing chemicals into the body, including dopamine and endorphins. Mozart’s music in particular has been shown to promote dopaminergic neurotransmission. Music is consistently successful in treating anhedonia.[20]


Music in Pain Management


Music can be an important tool in chronic pain management. One meta-analysis found that soothing, slow, patient-selected music alleviated a wide variety of pain, including ophthalmologic, urologic, gynecologic, cardiac, and surgical, as measured by significantly reduced pain scores, decreased use of analgesics, and improved vital signs, such as lower cortisol or blood glucose levels.[21]


Music and Social Health


Active engagement with music raises IQ and can influence other processing systems, including motor skills, language, intellectual development, and perceptual cognition. Learning and playing an instrument creates a sense of achievement and builds self-esteem, self-discipline, and social and teamwork skills.[23]


Music’s Influence on Mental State and Mood


Music as a mood modulator is familiar to most people, but it also influences each person in very different ways, based on personal history of listening to and playing music, as well as individual sensitivity, receptivity, and age. Overall, music has a powerful and expedient impact on mood, outlook, motivational levels, and disposition.[24]


A New Frontier


Since the dawn of time, human beings have had an impulse to make music and have used music to heal and to achieve specific states. Today, science has caught up with what we have instinctively known all along, and the data fascinate many researchers. The type of music selected in therapy is crucial to success, as specific intensities and frequencies trigger different emotions and brainwaves in patients. As researchers continue their work to perfect the use of music as medicine, patients and their clinicians can safely experiment with their own music and use existing platforms, such as brainwave entrainment and EEG feedback, to help improve various aspects of health.


[Read the Original Slideshow Here]


March 27, 2018
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

New therapies like TBS bring better results.

Melissa Banks says she struggled with depression “on and off, but mostly on” since the age of ten. She traces the cause to early life experiences, and while she doesn’t have a personal recollection of the details, her mother has helped fill the gaps in her memory.“My twin brothers were born when I was not quite two,” Melissa shares. “My life until that point had been great. I was part of a young family, was the first daughter and everything was wonderful. Then, when my brothers were born, my mom suffered from postpartum depression. She now had three kids under two. One had food allergies, which they didn’t know anything about in 1974.


“My physical needs got met, but attention and affection were pretty much withdrawn at that age,” Melissa continues. “And then my parents split up when I was nine and divorced when I was ten.”
Melissa’s mother was busy with a full-time job 30 miles from home, and then with her pursuit of a Master’s degree at a college 120 miles away. Melissa took care of her brothers and kept house.


“I was a stay-at-home mom when I got home from school,” she remarks. “I never really felt like a kid. If I needed something, I was adding to the problem. The only way I got positive feedback was to fix other people’s problems.” When she was 14, her mother remarried – and Melissa’s life became more challenging.


“My stepfather was extremely emotionally abusive to me and very jealous of my relationship with my mom,” Melissa discloses. “I was suddenly displaced from their family.” They later moved to a town where Melissa knew no one, leaving her even more isolated. She wanted to live with her father, but he declined.


“The way I dealt with it was by excelling academically,” she remembers, “and I skipped a year of school so I could get out of that house.”


When Melissa left for Spain as an exchange student at 17, her mother and stepfather basically told her, “You don’t have a home to come back to. Have a good life alone.”


In Melissa’s absence, however, her mother saw the family dynamics from a new perspective.
“She realized I wasn’t making all that stuff up about my stepfather because he picked new people to abuse,” Melissa reports.


She and her mother eventually repaired their relationship, and Melissa has learned to coexist with her stepfather.
While that emotional burden has been lifted, physical misery still plagues her. Melissa has fibromyalgia, characterized by chronic muscle pain, fatigue and issues with sleep, memory and mood.


“I’m on a lot of medications to treat it,” she informs. “It’s hard to tell how severe it is because I don’t know what it’s like anymore to feel anything else. Everything hurts all the time.”
As if that wasn’t enough, Melissa’s shoulder ached from a torn ligament and rotator cuff, bursitis and a bone spur, which ended up requiring surgery.


Her struggle with depression also continued, although Melissa didn’t recognize the symptoms because they coincided with her physical ailments, and antidepressants hadn’t helped much in the past.


“There were days I couldn’t get out of bed,” Melissa acknowledges. “I thought about suicide. I didn’t think about it like maybe I should do it, but it was in the back of my mind. What stopped those thoughts from becoming more real was, Who would take care of my two cats?


Her mother lives four hours away, and the rest of the family is up north. Melissa does have close friends but didn’t share her feelings of hopelessness with them.


“How do you express something so overwhelming – that there’s no point in me being alive anymore?” she asks. “That’s not a story you tell someone because there is nothing they can do to fix it.”
Then Melissa’s mother stayed with her after her shoulder surgery, witnessed her behavior and informed her it wasn’t healthy.


21st Century Treatments


In August 2016, the two women came across an article written by Robert Pollack, MD, whose Fort Myers-based practice, Psychiatric Associates of Southwest Florida, embraces emerging therapies for treating depression based on pioneering discoveries about the brain.


“I called them that night, he called me back and we set up an appointment,” Melissa says. “Dr. Pollack got me in that week to do an evaluation.”


He decided her best option for getting well was six infusions of ketamine, an anesthesia drug introduced in the 1960s that acts more quickly than many antidepressants.


While the results aren’t always predictable, Dr. Pollack has found that 72 to 75 percent of his patients with treatment-resistant depression, PTSD, obsessive-compulsive disorder, and bipolar and postpartum depression have a positive response to ketamine.


Unfortunately, a disappointed Melissa wasn’t among them.


Dr. Pollack then suggested theta-burst stimulation (TBS), which uses magnetic pulses to mimic the natural rhythms of activity in the neurons of the brain. He not only hoped to alleviate Melissa’s depression but also to relieve her discomfort from fibromyalgia, which he sees as a related disorder.


“Absolutely there’s a direct connection between the degree of depression and pain perception,” he asserts, “so we really do need to go after both aspects.”


The prescribed TBS regimen was five straight days for two weeks. But after Melissa’s third treatment, Hurricane Irma interrupted that schedule and forced her to evacuate when she lost power at her Naples home. She finally resumed therapy after about three weeks.


No “Magic Bullet”


Despite that gap in her treatment, Melissa reports that her depression is virtually in remission and she no longer feels hopeless or thinks about ending her life.


Her results from a recent PHQ-9 screening questionnaire support her assessment. The PHQ-9rates the frequency of various symptoms in order to measure the level of a patient’s depression, from minimal (zero to four) to severe (20 to 27). Melissa’s test score was a one,
Dr. Pollack confirms.


“Melissa came to us at a point where she couldn’t get out of bed, couldn’t go to work, couldn’t function,” he notes. “Now, she’s going to work and has a significant degree of relief. We were able to get her off a lot of antidepressants.”


While Melissa is enjoying dramatic results from her therapy, Dr. Pollack cautions that treatment of depression and other mental health issues is not an exact science and that there are no “magic bullet” solutions.


“We don’t have all the answers yet,” he expounds. “Eventually, we’re looking at a different direction in the treatment of depression. It’s based more on knowing the patient’s genetics and neurochemistry. We’re going to see gene sequencing approaches to these illnesses very, very soon. What we did two years ago won’t be recognizable two years from now.”


That means mental health professionals must keep up with the ever-changing science by tapping into information available online and from peers.


“This age of psychiatry is truly a collaborative science,” Dr. Pollack emphasizes. “What we all want is to make patients better.”


Melissa is proof that life-changing outcomes are possible for patients and practitioners willing to try innovative therapies until they find what works best.


“Let’s use the tools that we have,” she concludes. “I’m all about being focused on the results.”

February 5, 2018
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.

Transcranial Magnetic Stimulation vs. Traditional Pharmacotherapy for Major Depressive Disorder

Repetitive transcranial magnetic stimulation (rTMS) is a novel, non-invasive method of activating neural signals through the use of strong, time-varying electromagnetic fields. rTMS is primarily used for patients with treatment-resistant depression. As its reputation has grown, so has its demand. But in the world of health economics and Return on Investment (ROI) ratios, is rTMS a viable option for the millions of people suffering from depression? To date, no such analysis has examined the cost-effectiveness of rTMS as a first line or at least an earlier treatment option over a patient’s lifetime.


To investigate this question, Voight and Leuchter (2017) used Markov simulation modeling to analyze direct costs and quality adjusted life years (QALYs) of rTMS versus medication therapy in patients with newly diagnosed Major Depressive Disorder (MDD) who were age 20-59 and had not improved after a single pharmacotherapy trial. Response and remission rates, quality of life outcomes and life expectancy were culled from the scientific literature. The baseline for treatment costs was derived from federal Medicare reimbursement data. Additional baseline data included QALYs, assessment of superiority, analysis of instrument sensitivity, and lastly, a discount rate of 3% was applied.


The results of this complicated health/economic analysis revealed the superiority of rTMS over currently available pharmacotherapy across the lifespan of adults with MDD, assuming the current costs of treatment remain stable.


Why Does This Matter?


The mortality rate for untreated or undertreated depression is between 15 and 20 percent and growing as addictive disease and chronic pain are increasing, and are bi-directionally associated with MDD.


During a recent visit to China, I heard the simple but inescapable logic of TMS therapy as a first line treatment for depression. Simply stated, the Chinese doctors assert, “Why treat every cell in the body when only the brain causes depression?” So, not only is TMS/rTMS safe and effective and approved by the FDA for refractory depression, but it is also life-saving and life giving. TMS has a very high success rate, and these economic data reveal important cost benefits over other less effective treatments. It is really a no brainer.


Voigt J, Carpenter L, Leuchter A. Cost effectiveness analysis comparing repetitive transcranial magnetic stimulation to antidepressant medications after a first treatment failure for major depressive disorder in newly diagnosed patients – A lifetime analysis. PloS one. 2017;12(10): e0186950.

January 26, 2018
Robert Pollack

About Robert Pollack

Board Certified Psychiatrist in practice over 42 years. Currently focused on Genomic Assessments as part of our treatment assessments and Transcranial Magnetic Stimulation (TMS) therapy along with general adult psychiatry. Currently serve on adjunct faculties of UCF, FSU, USF and Uof F. We currently accept most Insurances.