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Dr. Stephen Manlove

Bipolar Disorder Treatment, Signs & Effects

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In honor of World Bipolar Day, our mental health providers wanted to share insightful information about this mental illness, including common signs we look for and treatment options. For those who have been diagnosed with bipolar disorder or think they may have bipolar disorder, it’s important to begin treatment right away. 

The rate of suicide among bipolar disorder patients is approximately 10–30 times higher than that of the general population (Suicide Risk in Bipolar Disorder: A Brief Review). While all psychiatric patients are at a higher risk of suicide compared to the general population, patients with bipolar disorder have the second highest risk of suicide (Comparison of Suicide Risk by Mental Illness). However, bipolar disorder can be managed with medication and psychotherapy.

If you or someone you know may have bipolar disorder, give us a call to schedule an initial appointment: 605-348-8000.

How does bipolar disorder affect you?

Those with bipolar disorder experience more extreme variations in their mood than the average person. These extreme highs (manic episodes) and lows (depressive episodes) can be very draining and can make it difficult to think clearly. 

One of the biggest strains that people with bipolar disorder experience is in their relationships. A manic episode can draw others in with your energy. During a manic episode, you may be seen as energetic, fun, or reactive by your loved ones. On the other hand, during a depressive episode, you may seem depressed, lethargic, or reclusive. These quick and dramatic changes can leave those around you confused or frustrated. 

Bipolar disorder can greatly affect your ability to excel at work or school. Extreme changes in mood can affect your energy level, ability to focus, and can make it hard to think clearly. It can also result in poor decision making or impulsive behaviors, which can lead to mistrust in work or school relationships. In a study of 9886 participants with bipolar disorder, 81.32% were unemployed (Predictors of Employment Status for Persons with Bipolar Disorder). 

What are the signs of bipolar disorder in adults?

Bipolar disorder is a mental health disorder that is characterized by sudden and dramatic changes in mood. They experience more extreme high and low moods compared to the average person during an episode. Episodes typically last for several days. Some people will experience a manic episode followed by a depressive episode, while others will experience depression and mania at the same time. 

Signs of a manic episode:

  • A high-energy mood that may be described as euphoric, energetic, or irritable
  • Decreased need for sleep
  • Overconfidence
  • Hyperactive thoughts
  • Inability to think clearly
  • Making impulsive decisions

Signs of a depressive episode:

  • A low-energy mood that may be described as depressed, hopeless, or lonely
  • Loss of interest in things you usually enjoy
  • Feeling unusually tired or lethargic
  • Increased need for sleep
  • Changes in weight
  • Intense feelings of guilt 
  • Inability to make decisions
  • Suicidal thoughts

Women with bipolar disorder tend to experience more depressive episodes or more extreme depressive episodes. 

Treatments for Bipolar Disorder

Does medication help bipolar disorders? If so, how long does it take for bipolar treatment to work?

Yes, medications can help manage bipolar disorder symptoms. Bipolar disorder is commonly treated with mood stabilizers such as lithium or an anticonvulsant. 

It typically takes a minimum of 2 weeks for mood stabilizers to begin working. However, it is common for medications to take 6 weeks to take full effect.  

Patients who undergo psychotherapy (also known as talk therapy) while taking medication for bipolar disorder see the most improvement in their symptoms. 

Can you fight bipolar disorder without medication?

In some cases, bipolar disorder can be managed with a combination of talk therapy and holistic practices including diet, exercise, stress management, sleep habits, and meditation. However, it’s best to manage bipolar disorder with a combination of medication, talk therapy, and holistic practices concurrently for the best results. 

Get Help With Bipolar Disorder

If you think you may have bipolar disorder, call today to schedule an initial appointment. Our mental health providers will take a thorough look at your symptoms and medical history to help design the best treatment plan for your condition. 

New patient appointments are available now! Complete our appointment request form to get started.

 

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Dr. Stephen Manlove

Eight Common Misconceptions About TMS Therapy for Depression

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Transcranial Magnetic Stimulation (TMS) is the most passive yet effective treatment available for depression, anxiety, PTSD, OCD, and schizophrenia. However, there are a lot of misconceptions about this treatment option.

Our psychiatric providers often recommend TMS to patients for a variety of reasons, but patients are often hesitant to give it a try because they are concerned about something they have heard about it. Often, the concerns of our patients are quickly resolved once they speak to their mental health provider.

If you or someone you know is hesitant to try TMS therapy for depression or other mental health conditions, read more about the eight common misconceptions below.

Misconception #1:

“TMS is the same as Electroconvulsive Therapy (ECT)”

Fact:

            TMS therapy for depression is an entirely different treatment modality than ECT. Both treatments address treatment-resistant depression, but that is where the similarities end. ECT deliberately triggers a controlled seizure passing a small electrical current through the brain. General anesthesia is necessary for this procedure, and patients may experience confusion and memory loss immediately following the treatment.

TMS is a much milder treatment that uses electromagnetic pulses (similar to an MRI machine) to stimulate parts of the brain that are underactive in people with treatment-resistant depression. No sedation is necessary for TMS, and the patient is fully awake and alert throughout the process. TMS patients are immediately cleared to resume their daily activities, such as driving or returning to work because there is no recovery time required after treatment.

 

Misconception #2:

            “TMS works immediately.”

Fact:

            While some patients may report an improvement in their symptoms within the first week, TMS therapy for depression is not intended to offer immediate relief from depressive symptoms. Most patients can expect to begin noticing improvements within 3-4 weeks of their first TMS treatment. This timeline for improvements is similar to that of a medication trial.

 

Misconception #3:

            “TMS is painful.”

Fact:

            TMS treatments consist of tiny electromagnetic pulses that are administered through a figure 8 coil. Your TMS provider positions the coil to rest lightly on your scalp. While TMS treatments do create a clicking sound and an odd sensation on the scalp, it should not be painful. Patients have described TMS as “a tiny woodpecker” or similar to “a TENS unit on my head”.

If you experience discomfort, your technician can make adjustments to make the experience more comfortable. For example, your TMS provider may lower the intensity of the pulses or adjust the placement of the coil.

 

Misconception #4:

            “TMS patients must stop taking all their medications.”

Fact:

            Almost all medications are safe to take while you are receiving TMS therapy for depression. The only exception is medications that lower seizure thresholds, such as Wellbutrin.

Patients are urged to abstain from street drugs and alcohol during the course of their treatment since those also carry the risk of lowering their seizure threshold.

 

Misconception #5:

            “TMS is new and unproven.”

Fact:

            The technology behind TMS dates to the 1980s and has been FDA-approved for severe depression since 2008 after many studies proved that it is a safe and effective treatment. TMS is also FDA-approved for OCD and smoking cessation. Tens of thousands of patients have been successfully treated with TMS.

TMS is one of the safest mental health treatments and is one of the best options for pregnant patients.

 

Misconception #6:

            “TMS is too expensive.”

Fact:

            For most patients, TMS therapy is covered by insurance. Most insurance companies will cover all or part of the cost of TMS treatments due to their low risk and high success rate. 

We accept Medicare Part B with a qualifying secondary insurance or supplemental plan. Read our blog for more information about Medicare’s coverage of TMS therapy, including does Medicare cover Transcranial Magnetic Stimulation?

 

Misconception #7:

            “TMS is too time-consuming.”

Fact:

            It is true that TMS is administered daily for 30 treatments plus a taper phase. However, after the initial appointment, most appointments are only 30 minutes. Since TMS is a non-invasive procedure, patients are able to drive themselves home and immediately resume daily activities. Your Rapid City TMS provider will do everything possible to accommodate work schedules and other appointments.

TMS can provide lasting depression relief. Depression medications, on the other hand, typically must be taken daily for the rest of your life. TMS could give you the relief you are looking for without the side effects that are often experienced with antidepressant medications. The time that you commit to yourself with these treatments

 

Misconception #8:

            “TMS can alter my personality or destroy my memory.”

Fact:

            TMS targets a very small area of the brain that is underactive in patients with chronic depression. This treatment is very mild, and the intensity of the treatment is carefully monitored. The areas of the brain responsible for processing and storing memories are out of range of the pulses, leaving them unimpacted by the treatment. This also holds true for concerns about TMS therapy for depression altering a patient’s personality.

 

TMS is a safe and effective treatment option for most patients with depression, anxiety, PTSD, OCD, and schizophrenia. If you have not yet spoken to a mental health provider to see if TMS is right for you, give us a call to schedule an initial appointment with one of our mental health providers in Rapid City, SD.

If TMS is not the right fit for your needs, Manlove Brain and Body Health offers a full spectrum of psychiatric interventions, including cutting-edge treatment options. Our team is here to help you find the right fit for your mental health needs.

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Dr. Stephen Manlove

TMS Newly Approved for Teens – Drug Free Treatment For Depression

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Transcranial Magnetic Stimulation FDA-Approved for Teens 15 & Up

Transcranial Magnetic Stimulation (TMS) treatments are now FDA-approved for teens ages 15 and older. This gives parents and their teens a low-risk, non-medication depression treatment option to consider that can provide a longer-term solution for teen depression compared to medication options.  

While this depression treatment has been newly approved for teens, TMS has been used to treat adult patients for nearly two decades. It’s powerful enough to fight treatment-resistant depression and safe enough to be the recommended depression treatment for pregnant patients.

Get to know this safe and effective treatment for teen depression, and give us a call to talk to a provider to see if TMS is right for your teen. 

How does TMS work?

When we look at the brain scans of depressed patients, we see low levels of activity in their DLPFC (dorsolateral prefrontal cortex) compared to the average brain. TMS works by sending electromagnetic pulses into the brain to stimulate specific areas that control our mood. 

A TMS machine works similarly to an MRI machine and results in an increase in brain activity for most patients. Roughly 75% of patients report a significant lift in their mood after completing their TMS treatment series. 

TMS treatments are completed in short 30-minute appointments over a 6-week period. Some patients may require maintenance treatments at a decreased cadence after the initial treatment series.

Why was TMS therapy FDA-approved for teens?

TMS was FDA-approved for ages 15 and up for several reasons, including:

  • TMS therapy has been effective in treating adults with depression with minimal side effects. Roughly 75% of adult patients respond to TMS treatment (50% or greater improvement in symptoms). Side effects are temporary and can be minimized with the help of your teen’s TMS technician. Scalp discomfort and headaches are the most common side effects, but they begin to fade as soon as the TMS machine is turned off and completely subside after a good night’s rest. Serious side effects are rare. 
  • Unlike antidepressant medications, TMS does not affect other parts of the body. Because no medication is used with TMS treatments, there are no risks that are typically seen with antidepressant medications for teens. And, the electromagnetic pulses only affect the area of the brain that is involved in mood regulation. 
  • Increasing research over the years shows that TMS is safe for adolescents. In a recent article, A New Treatment for Adolescent Depression: FDA Approves Transcranial Magnetic Stimulation (TMS), Len Lantz, MD cites several studies that support the safety and effectiveness of TMS for teen depression.
  • TMS provides lasting depression relief. The magnetic pulses created by a TMS machine stimulate neuronal activity and growth in the brain. In 2023, Stanford Medical research found that TMS corrects the abnormal flow of electrons in the brain. Whether your teen’s depression is caused by an abnormal flow or low activity levels in the brain, TMS can resolve these potential problems, resulting in long-term depression relief.
  • TMS can be safely used in combination with other treatment methods or medications. Since TMS is a drug-free treatment and is completed via a non-invasive procedure, it can be safely combined with medications or other treatment methods. In severe depression cases, TMS can be safely combined with other treatments to improve symptoms rapidly.

Getting Your Teen Help For Depression

If this is your first time seeking help from a behavioral health specialist for your teen, you may have some additional questions. Here are some common questions I receive from teens and their parents at their first psychiatric appointment at our psychiatry clinic in Rapid City, SD. 

Is this depression? 

If you or your child are concerned they might have depression, don’t hesitate to see a medical provider. Depression in teens has become increasingly more common, especially after the COVID-19 pandemic. Likely, if you are concerned that your teen may have depression, they likely do have diagnosable depression. 

It’s common for parents or even practitioners to mistake teen depression symptoms for typical adolescent developmental changes or “growing pains”, so it’s best to seek help right away because the symptoms have likely been there for a while. Due to delayed diagnosis, teenagers tend to have more severe symptoms than adults when they are first seen by a mental health provider. 

If you think your teen may have depression, schedule an appointment with a psychiatrist to discuss their symptoms. Whether your teenager has a depressive disorder depends on their symptoms, severity, length, and frequency. Note any symptoms your teenager experiences, when they began, and anything that improves or worsens their symptoms to help provide your psychiatrist with the details they will need to make an accurate diagnosis.

The National Institute of Health states that suicide is the third leading cause of death among individuals between the ages of 15-24. (It’s the number one killer of children ages 10-14.) Treating depression is the number one way to prevent teen suicides. We encourage parents to always take their child’s concerns seriously. The earlier you seek treatment, the better. 

DON’T HESITATE: If you think your child is in crisis or suicidal, call or text the national suicide prevention hotline at 988 immediately.  

My child seems depressed. Did I do something wrong?

It is not unusual for a parent to feel like they did something wrong if their child has a mental health concern. Yet half of the world’s population will have a mental health disorder at some point in their life, and most begin in childhood, adolescence, or young adulthood (Queensland Brain Institute).

If your child comes to you with a mental health concern, that is a good sign. That means you have taught your child to recognize when something is wrong and to ask for help when they need it. The same goes if you recognize symptoms first and turn to professionals for help. 

In today’s world mental illnesses are recognized as part of life and no longer carry the stigma they once did. Especially among teens themselves, there is much less of a concern of social isolation if your teen opens up about having a mental health condition. If your teen has a mental health issue, you have the chance to show them two very important lessons: seeking help when you need it and putting your health first.

What are the safest and most effective treatment options for depression in teens?

The best treatment for your teen will depend on their unique symptoms. For example, some patients have difficulty sleeping, which we can address with certain types of depression medications.

Generally speaking, however, TMS is the safest and one of the most effective depression treatments on the market. And, now that it is FDA-approved for teens, TMS is the safest depression treatment available for teens.

Will my child need depression treatment their entire life?

Depending on the treatment that you, your teen, and their medical provider decide, your teen may need depression treatment for years. One of the greatest benefits of TMS treatment for teens is that it can provide lasting relief. After the initial 6 weeks of treatment, some patients will not need any further treatments, while others will require occasional maintenance treatments.

If being tied to an antidepressant medication for years is a concern, TMS may be the best option. Schedule an appointment today to talk to a provider to see if TMS is right for your teen. 

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Dr. Stephen Manlove

6 Ways to Stick to a Fitness Routine to Improve Mental Health

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Exercise Improves Mental Health – Here’s How

 

Exercising regularly is one of the most effective ways to manage your mental health naturally. In mild cases of depression, anxiety, or other mental health conditions, regular exercise alone may be enough to manage your symptoms, eliminating the need for psychiatric medications.  

How does exercise help the depressed brain? When people are depressed, their brains atrophy (shrink) and become less adaptable. Exercise stimulates the production of a hormone in your brain called brain-derived (from the brain) neurotrophic (nerve growth) factor (BDNF). BDNF stimulates brain growth and promotes neuroplasticity, the ability of the brain to adapt and change as it manages the complexities of life. This allows the brain to grow new cells, make more dynamic cells, make new connections, and repair itself, helping us heal parts of the brain that have atrophied. Exercise is the most effective way to trigger BDNF release. 

But can exercise help if you have several mental health issues at once or severe mental health conditions? Yes, exercising can improve your mental health even when you have multiple psychiatric conditions. As experts in treatment-resistant psychiatric conditions, our mental health providers have found that patients who exercise regularly in conjunction with other treatments are more likely to manage seemingly untreatable psychiatric conditions successfully.  

Exercising can be part of the solution to many mental health problems. Depending on the severity of your mental health conditions, you may need a comprehensive psychiatric care plan that includes exercise in addition to TMS, ketamine therapy, or antidepressant medications. 

At Manlove Brain and Body Health, exercising is an integral part of our psychiatric care plans because it helps improve the effects of all other psychiatric treatments. 

 

Pacing Yourself at the Gym

We know that regular exercise is good for our brain and body, so often, people set the intention to exercise more at the start of the new year but quickly lose motivation. How do you stick with it all year long?

1 Shift your mindset.

Exercise can improve your mental and emotional health, so make sure to prioritize it accordingly. When you shift your mindset to consider each workout as a commitment to caring for your physical and mental well-being, it becomes much easier to see its importance and make time for it. 

Before you get out of bed in the morning, determine when you will exercise that day and what exercise you will do. The question should not be will I, but rather when and how will I? 

2 Keep your fitness goal simple and realistic. 

It’s easier to commit to moving your body for a specific amount of time each day rather than trying to do a specific number of workouts each week. And, if you are too rigid in what your exercise looks like, it’s easy to burn out quickly. Keeping your goal simple allows you to add variety, which is one of the keys to staying consistent. 

Surprising fact: For most people, it’s easier to exercise every day for 10 minutes than it is to exercise two days a week for 35 minutes. Why? Committing to exercising daily removes the internal debate of deciding which days to work out.   

Commit to exercising one minute per day. If you exercise for a minute and don’t want to do more, give yourself permission to stop. Most people want to continue once they have started. If life happens and you can’t exercise one or two days per week, forgive yourself and pick it up the next day. 

Many people think that flexibility in your fitness routine hurts consistency when in reality, flexibility enables consistency. You do not need to go to the gym or pool every day. Adding movement in other ways, such as walking at your desk treadmill, stretching, or shoveling snow, may be a great way to infuse movement into your day. 

Any amount of physical activity will give you health benefits, but the more active you are, the more health benefits you will get. To get cardiovascular benefits out of your exercise, you need to exercise for a minimum of 10 continuous minutes. 

3 Use the start of the year to try out different classes. 

The people who stick with exercising consistently are the ones who figure out what types of exercise they enjoy. Use the first few weeks of the year to try out new classes. Try a few new classes to figure out which ones you like, and then rotate between the ones you enjoy for the rest of the year.

Fitness instructors know that most people will open a gym membership at the beginning of a new year, so they typically adjust their classes with this in mind. In January and February, they will provide breakdowns of the movements and slowly add progressions throughout the year. This makes the beginning of the year the best time to try a new class as they will likely be tailored to beginners. 

4 Take time to build strength.

Adding strength or resistance training exercises to your routine is not only a great way to vary your workouts, but it helps you see better results than if you focus on cardio alone; it improves balance, builds confidence, and helps you burn calories more efficiently throughout the day. 

While many people think of strength training as a young person’s game, it actually becomes more important the older we get. Strength or resistance training can help build and maintain healthy bones and joints, improve posture, and reduce the risk of falling. Older adults who participate in resistance training exercises reduce their risk of developing musculoskeletal disorders such as osteoarthritis, reduce joint and back pain, and are often independent for longer because they are able to maintain functional movements. 

Start by practicing the movements without any weight or resistance bands. Once you have the form down, gradually add weight. Only increase your weight when you feel you could have done more repetitions at the end of your circuit. 

5 Commit to a gym or club

For many people, going to a gym or community center is a commitment that keeps them going. Perhaps it gets them out of their home or office. It may be for social connection. Or they keep going so they don’t waste their investment. 

Visit a few gyms or community programs to see which one has the vibe you want. And remember, there may be more casual groups you can join for biking, walking, or volunteering to fight invasive plant species on your local trails. 

6 If a gym isn’t a positive experience, don’t go.

If you have no desire to go to a gym, don’t go. For individuals with anxiety or depression, an intense setting may not help their self-esteem and could even trigger their condition. 

Working out in the privacy of your own home is easier than ever with free or subscription-based online workouts. Simply search YouTube for a workout you enjoy – barre, strength training, kickboxing, yoga, pilates, step – and give it a try. 

Most online workouts don’t require any equipment. If you choose to invest in a few free weights and resistance bands, that’s typically all you need for almost any home workout. Just remember commitment and consistency are what’s important, so block out the time on your calendar and silence your phone!

Talk to your doctor before getting started.

Always talk to your doctor before starting a new fitness routine. Some underlying health conditions may make exercising more dangerous. However, most health conditions improve with exercise, so don’t let any existing conditions stop you from discussing an exercise plan with your doctor. 

 

Consistent exercise provides so many benefits for your physical and mental health. You won’t regret getting started. 

 

effective psychiatry starts in the lab, genetic testing for psychiatry
Dr. Stephen Manlove

Rapid City MD Says Effective Psychiatry Starts in the Lab

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Rapid City MD Says Effective Psychiatry Starts in the Lab

Genetic testing and lab work stop the wasteful, sometimes dangerous, trial-and-error approach to treating mental illness

No mental health patient has the luxury of time. Even mild cases of depression, anxiety, or OCD can impact your career, relationships, and happiness. Manlove Brain and Body Health, a psychiatry clinic in Rapid City, SD offers laboratory analysis and genetic testing for mental health patients to find the most effective psychiatric treatments for their needs, faster.

Founder of Manlove Brain and Body Health (MBBH), Stephen Manlove, MD and his team began offering laboratory analysis and genetic testing for patients who needed more than the common psychiatric treatment formula. Overtime, they become specialists in treatment resistant mental illnesses including major depressive disorder, anxiety, bipolar disorder, and more.

“Our laboratory workups and genetic testing identify chemical deficiencies that may cause or aggravate your condition. We originally only offered this to patients with resistant mental illnesses. However, we realized that this is a crucial tool to limit the trial-and-error process for psychiatric treatments to help all patients find the right mental health treatment”, says Dr. Manlove.

These tests help mental health providers rule out treatments that are unlikely to reduce symptoms or identify treatments that may have an unusually high benefit based on their patients’ genetics. Dr. Manlove and his team began offering these tests as an option to all patients no matter where they were in their mental health journey. The tests come with an additional cost but are relatively non-invasive for the patient.

Different doesn’t mean difficult.

Manlove Brain and Body Health takes a different approach to psychiatry. Different doesn’t mean difficult – especially for the patient. It means putting in the time to evaluate which treatment(s) will be best for you and your body.

Every medication we take has some draw back. That’s why we work to find the right combination of medications and limit adverse drug reactions.

What makes MBBH’s approach to psychiatry different?

  • Thorough Initial Appointments: MBBH schedules large blocks of time for new patient appointments. This gives your mental health provider the time they need to get a thorough understanding of the problem. They will look at any patterns, symptoms, and treatments that worked or didn’t work for you before making a treatment decision.
  • Psychiatry Based On Science: MBBH uses science to eliminate some of the guesswork. By utilizing genetic testing and laboratory analysis, we may be able to reduce the number of medications you need to try to find the right one. While this seems like a no-brainer, MBBH is one of just a few psychiatry clinics in South Dakota offering laboratory analysis and genetic testing for psychiatry.
  • Holistic Approach to Mental Health Treatment: Our providers have a good working knowledge of how the entire body affects the brain. Your physical health, social life, stress, activity level, and nutrition can influence your body’s response to treatment. We will work with you to improve your overall health to give you the best results.
  • Ongoing Check-Ins: As a patient at MBBH, you can trust that the staff will value and care for you. Your provider will meet with you in regularly scheduled check-ins to follow up on your progress and make adjustments as needed. Our goal is to limit the medications needed to reduce adverse side effects.

Advance your brain. Your body. Your life.

Get better, faster with a holistic psychiatric care plan. Manlove Brain and Body Health is now accepting new patients and has next-day appointments available. Call 605-348-8000 today to schedule a new patient appointment.

About MBBH

Manlove Brain + Body Health is a psychiatry clinic located in Rapid City, SD. Our mental health providers treat a wide range of mental illnesses in patients of all ages. MBBH offers innovative treatments including TMS, ketamine/esketamine (Spravato), VNS, and novel psychiatric medications covered by some insurers.

We currently accept the following commercial insurances:

United Health Care (UHC)
UMR
Medica
Wellmark BCBS
Health Partners
Cigna
Sanford
Avera
Dakotacare
Medicare with Secondary
Medicare Advantage through UCare or BCBS
Medical Assistance through UCare

Insurance information changes frequently. Please call our front desk at 605-348-8000 to confirm that Manlove Brain and Body Health is in-network with your insurance provider.

Dr. Stephen Manlove

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Jose Teixeira

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Gaylen Bendewald, LCSW-PIP

Finding Inner Peace Through Mindfulness

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The beauty of mindfulness is that it can help you uncover greater degrees of inner peace. I use the terms awareness and mindfulness interchangeably though I find awareness to be more descriptive of what we’re looking for as we walk through the introduction of practicing mindfulness below. 

Inner peace is the springboard for many positive emotions – joy, contentment, humor, satisfaction of one’s life, freedom, lightness of being. These all begin at the doorstep of peace. 

Mindfulness is a little like swimming in the ocean. You can go as deep as you want. This article goes ankle deep. It is up to you how far you want to take it from there. 

Our Thoughts vs. Our Selves

If you break down the sentence “I have a thought”, we see that an “I” has a “thought”. We don’t customarily think about the “I” and the “thought” as two separate things. However, if we challenge our mind to look at these separately, we begin to understand that thoughts are something that “I” have. Technically, one could say, I am not my thoughts. 

As a culture, we’ve been taught to associate our identities with the thoughts that we have – the thoughts about ourselves and the stories we tell ourselves. Another way of looking at our identity is our awareness. And, I would suggest that our awareness is actually the deepest part of who we are. 

This is a new way for most of us to see ourselves. Where is it that we attach our identity? Is it in the awareness or is it in the thoughts we have?

That’s where we begin. We could ask, where do thoughts come from? Part of the goal of mindfulness is to become a student of our own thoughts. We consider:

  • How do thoughts serve us? 
  • Do we have to believe all of our thoughts? 
  • What’s the relationship between our awareness and our thoughts? 

Taking a Step Back

When I was a kid, my friends and I liked to go to the movie theater to see scary movies. To cope with our fears during the films, we learned to mentally take a step back from the screen when it got too frightening. If you think about that, that is a very unique, very human ability. Animals to our knowledge can’t do this. 

By taking a step back we can change what our mind focuses on. For example, I can focus on the lights, the reactions of the people around me, the smell of popcorn, the fact that I’m out with my friends to give my mind a break. Then, when I am ready, I can re-immerse myself in the film. This is a really nimble ability that we have to take a step in or out of our situation. 

This same idea of taking a step back is how we begin to practice mindfulness. 

Upsetting Thoughts Destroy Inner Peace

Upsetting thoughts disrupt inner peace. Everyone has upsetting thoughts at times and everyone has their own kind of upsetting thoughts. There are typically two different styles:

  • Anxious/worrisome thoughts
  • Angry/frustrating thoughts

Upsetting thoughts can come out of nowhere. When you have an upsetting thought, whether you realize it or not, you have the choice to pay attention to that thought or to let it pass. 

Thoughts are a lot like clouds. They come somewhere from the west, they’re in front of us, and then they disappear somewhere to the east. They are always in motion.

If we decide to pay attention to an upsetting thought, we pull it into our consciousness. Thoughts have a way of just moving through, but we have to deliberately pull it into our consciousness for us to focus on them. 

When we begin to focus on that upsetting thought, it triggers other anxious/worrisome thoughts, so we let that cloud grow in size. Again, you have the same choice to focus on them or let them pass. It takes effort to bring thoughts into focus. 

When we start having anxious/worrisome thoughts, it creates anxious/worrisome feelings. Once we begin to have anxious/worrisome feelings, it feels more real. Feelings have a greater depth to them which hook us more. That’s what we want to find, what hooks us.

It would be normal to have a generic upsetting thought, followed by an anxious thought, and then a discouraged/depressed thought. At each point in this progression, we have the choice to let it pass or follow it down the path. 

If I choose to follow my upsetting thoughts, I will end up with a completely cloudy sky. No longer aware that I am a thinker having thoughts, I become lost in my thoughts. 

Step 1: Notice Upsetting Thoughts

The first step to being a student of our thoughts is to simply notice when we are having an upsetting thought. 

By simply planting the intention of noticing when you are having upsetting thoughts, you will begin to notice when you are having upsetting thoughts. 

We need to nurture this ability on a daily basis, reminding ourselves to catch ourselves having upsetting thoughts. As you practice, you’ll get faster at identifying them. The more quickly you can identify them, the easier it is to stop them before they get momentum going. 

Step 2: Identify Whether Your Thoughts Are Useful or Useless

Once we get a hang of noticing upsetting thoughts, have some curiosity about your upsetting thoughts. See what they do. See what they create for you. 

Some questions to consider:

  • Is there a connected theme?
  • Are they helpful in some way?
  • How do your thoughts affect your inner peace?

We can’t presume that all thoughts are helpful. We can protect our inner peace by identifying when we are having upsetting thoughts and understanding if they are useful or useless to us. 

Step 2: Catch & Release Upsetting Thoughts 

We all experience events of life. And when we do, we create and react to the commentaries that we use to describe those events and dramas. We are meaning seeking creatures, so we create stories about these events. They may be positive, neutral, negative, and even hostile. 

When we react and create these commentaries, we have a choice. Put strongly, we can become victims of our own emotions and our thoughts about those comments, or we can take a step back and witness these storylines as they develop. As Mark Twain said, “I’m an old man and have known a great many problems, most of them never happened.”

As we take a step back, we allow our thoughts to fade into silence. Again, thoughts are always in motion. Our brains are made for thinking. Our thoughts are valuable tools in the right context. They are here to serve us, but they can lead us astray. 

Our goal is to simply be more aware of our thoughts and which ones are useful and which are useless to us. Not all thoughts are created equal.   

Some thoughts are stickier than others, and no one will be perfect at this. It’s a matter of doing what we can to not be reactive to all of those storylines our minds create. As we do this, we begin to find peace.

Step 3: Focus on the Present

I used to have a Golden Retriever named Max. He could be asleep, but if you threw a stick, he had to go fetch it. I’d suggest that he didn’t have a choice, he was bred for that. People have more freedom than that. We don’t have to fetch every thought that comes into our mind. 

If you observe your mind, you’ll notice that it might dwell in the past or fixate on the future. Our mind has no time to waste. It has to find things that are potential threats or look for problems to solve. This isn’t a bad thing unless it leads us to places we don’t need to go. We want to notice that we are having thoughts and evaluate whether our fixation on the past or future is helping or hurting us.

We can become more aware by focusing on the present. You’ll notice that our mind is easily bored. In stillness, it has a tendency to race about for something to fill it. One way to embrace the stillness is to take a few deep breaths. Breathing is naturally relaxing and allows us to ground ourselves in the present moment. 

The mind can be afraid to be present to now. It’s afraid of what might be perceived as emptiness, but we may find beauty and delight in emptiness. 

The mind is not prone to trust life. It tends to thrash about looking for potential threats. Our mind tends to over prepare, becoming vigilant. The mind is always looking to create meaning out of things so that it doesn’t have to deal with emptiness. It’s amazing the way we flee emptiness. It’s also ironic that it’s the least thing we need to fear. 

Meditations On Now

Something about now is nurturing. It tends to be overlooked. Now is present. It touches stillness, and is often joyful. There’s a lightness of being in now; it does not get lost in the outer circumferences of life, the outside trivias and dramas that don’t amount to much. There’s a serenity to now. Now demands nothing. It simply is. The experience of now is an experience of a deeper reality. Now can lead to an awareness of the connection to a greater whole. I am now. This last one is a little more than ankle deep in the ocean, but it’s worth some reflection. 

Practice Protecting Your Peace Every Day

We find inner peace by valuing inner peace. I protect my peace and sense of wellbeing from upsetting thoughts that aren’t worth engaging in. It’s a choice. It’s a deeply human choice. And, it’s where real freedom exists. 

Mindfulness is all about being nimble with what we choose to think. We don’t have to go to every place that our thoughts take us. We all have these abilities, we just need to be deliberate in using them. We need to remember to take a step back and ask ourselves, is this a thought worth having? 

Join Us for Group Therapy

Manlove Brain + Body Health is now offering group therapy sessions for depression, anxiety, and PTSD. Learn more >

 

senior couple dancing in their home, TMS Therapy for Depression
Dr. Stephen Manlove

Medicare Increases Coverage of TMS Therapy for Depression

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A recent change in Medicare coverage will now make transcranial magnetic stimulation (TMS) therapy for depression much more accessible. After seeing the significant improvements in patients with treatment resistant depression along with its non-invasive nature and minimal side effects, Medicare will now cover TMS for patients with severe depression after failing just one antidepressant medication.  

Before this change Medicare – like most insurance companies –required that patients try 4 or more antidepressant medications before TMS would be covered. This change will help people with severe depression get the relief they need quickly. 

This will give severe depression patients a proven and non-medication treatment option to help them get their life back. 

We are hopeful that other insurance companies will follow Medicare’s lead to make TMS treatments for depression accessible to those who need them. 

What is TMS Therapy for Depression?

TMS is a non-invasive procedure for depression that uses magnetic fields to stimulate specific areas of the brain that regulate mood. During TMS treatment, you will be seated in a comfortable chair for the 15-30 minute session. A TMS technician will gently rest a plastic coil on your head which will produce an occasional beeping sound and a tapping sensation on your forehead. 

Side effects may include headaches, lightheadedness, or tiredness which are typically mild and dissipate quickly once the TMS machine is turned off. 

Patients may resume normal activities immediately following treatment. Patients may drive themselves home or return to work, making treatment sessions easy to work into your normal schedule. 

Most patients receive TMS therapy treatments 5 days a week for 6 weeks, followed by one treatment per week for an additional 6 weeks. Some patients see their depression go into complete remission after the initial treatment series and others may require occasional maintenance treatments.

At Manlove Brain + Body Health, we have seen a 75% success rate when we use TMS for treating depression. 

“TMS was miraculous for me and I do know a couple of other people who have had the same results with no relapse of symptoms. Give it a try.” – Shawn, Manlove Brain and Body Health TMS patient.

Is TMS “electric shock” treatment?

TMS is very different from “electric shock” treatment. ECT or “electric shock” treatment sends an electrical current through the brain to trigger a seizure while the patient is under general anesthesia. ECT is one of the most effective treatments for depression, but can come with serious side effects such as difficulties with learning and memory. 

TMS therapy for depression does not trigger a seizure and does not deliver electric shocks. You will remain awake during TMS treatment. A TMS machine uses electromagnetic waves that will produce a light tapping sensation and a beeping noise. TMS does not cause memory or learning problems, which can be associated with ECT treatments. 

Have another insurance provider?

No problem! We accept a wide variety of insurances. Give us a call or send us an email to see if your insurance provider is accepted at our psychiatry clinic. 

Get Started Today!

Call Manlove Brain + Body Health at 605-348-8000 or email [email protected] to talk to one of our mental health specialists to see if TMS therapy for depression is right for you.

ketamine rapid city
Dr. Stephen Manlove

How to Steer Clear of the Ketamine Wild West

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Know the difference between a ketamine clinic and a ketamine shop

Matthew Perrone, an Associated Press reporter, recently wrote Prescriptions For Ketamine Have Soared in Recent Years, Despite Little Research or Regulation. This article paints an alarming picture of ketamine use in pain management. Perrone suggests ketamine for pain could morph into the next opioid crisis. Ketamine helps with depression, anxiety, and PTSD when used correctly, despite some concerns from Perrone.

Ketamine therapy help stabilize patients with severe depression who have not found relief from other medications or therapies. Despite their life-saving qualities, these medication can be dangerous if they are not used carefully.

It is crucial to understand that ketamine therapy should not be used as a standalone solution. The key lies in integrating these medications into a comprehensive mental healthcare plan. A comprehensive plan may include counseling, TMS, VNS, or healthy lifestyle changes.

One of the concerns raised by Perrone is the lack of research and regulation surrounding ketamine use. It is true that more studies are needed to fully understand the long-term effects and potential risks associated with these medications. However, the medical community is actively gathering more data on these medications and has already established safety standards for safe use.

In the meantime, healthcare professionals must exercise caution and closely monitor patients who are prescribed ketamine for depression. Regular check-ins, thorough assessments, and open communication are essential to ensure patient safety. Additionally, patients should be educated about the risks of ketamine and adverse effects to watch for.

The increasing use of ketamine and Spravato in pain management and mental healthcare is a significant development. Ketamine prescribers who do not follow the current safety standards put their patients at risk. Plus, they spread fear that may prevent others from seeking help for depression.

Ketamine and Spravato are powerful drugs. When used correctly, the benefits are greater than the risks.

If you or someone you know is considering ketamine for depression, be wary of where you get it. Not all ketamine clinics are equal. Here’s what to look for in a provider who offers ketamine for depression:

  • Commitment to proven safety standards. There are well-established safety guidelines for ketamine. To be confident in the safety of your treatment, find a provider that follows the Risk Evaluation and Mitigation Strategy (REMS) protocol. The REMS protocol was developed for the FDA-approved nasal spray Spravato, which is a derivative of ketamine. They should also be compliant with the stringent American Psychiatric Association guidelines for providing ketamine/esketamine.

 

  • Full-spectrum care. Avoid “ketamine shops” that focus on ketamine alone. To find long-term help for depression, anxiety, or PTSD, look for a clinic that offers various mental health treatments. Other treatments to look for include transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS), electroconvulsive therapy (ECT), medication management, lifestyle medicine, and psychotherapy. The clinicians in those clinics can help you develop a treatment plan out of the many options available that best meets your needs.

 

  • Psychiatrist oversight. See a psychiatrist who offers ketamine as part of comprehensive mental health treatment. Psychiatrists can handle potent medications and understand when to use them safely. Psychiatrists also know how to handle psychological complications that may arise from mental illnesses and their treatments. Clinicians who lack either or both of these skill sets may endanger severely depressed patients by mistake.

 

  • In-office treatments only. To prevent addiction and abuse problems, we only give ketamine treatments in our Rapid City ketamine clinic. This is one of the many guidelines we follow from the FDA and the American Psychiatric Association. If ketamine is given outside of an office setting, this is a red flag. The provider does not follow the set safety standards.

 

  • Emphasis on a medically safe and comfortable treatment experience. Your provider can help you have a positive experience by providing a safe, warm, and comfortable environment. We recommend that our patients avoid using electronics and listen to peaceful music without lyrics. Your ketamine Rapid City provider at MBBH can adjust your dosage if you experience negative side effects.

 

Ketamine/esketamine is a life-changing drug for people with treatment-resistant depression, anxiety and other mental health conditions. We hope this gives you assurance that if try ketamine, you’re not headed into uncharted territory. Ensure your mental health team is experienced, capable of handling complex conditions and medications, and adheres to comprehensive safety guidelines.

To see if ketamine/esketamine is right for you, give Manlove Brain + Body Health a call: 605-348-8000.

For more information, read How One Patient’s ‘Weird’ Experience Could Have Been Life-Changing.