How to make the most out of your PrTMS Treatment

Today, instead of our standard topics in psychiatry, we’ll be discussing how to invest in yourself by making the most out of your PrTMS treatments.

1.          Exercise: whether or not you’re exercising to get into better shape or not, 30” of aerobic exercise daily not only increases the size of your gray matter (the thinking “smart” part of your brain), but it also works better than any antidepressant that we could prescribe!  Also, if you want to improve and reinforce your alpha wave, the best types of exercise are those that get your whole body moving in rhythmic motion (think: dancing, cross-country skiing, elliptical machine, swimming).  Anything that gets you “into the zone” improves your alpha wave and can improve your response to treatment. 

2.  Sleep hygiene!!!! (which means what, exactly?…)

        1. Going to bed/waking up same time every day (even on the weekends!)

        2.  Reserving the bed for SLEEP and SEX only.  Work in bed?  Your brain associates it with wakefulness.  No bueno.

        3.  No heavy meals or spicy foods prior to bedtime unless you want nightmares!

        4.  No carminatives (they relax your lower esophageal sphincter so when you lie down you’ll likely have reflux).  Biggest offenders: chocolate, caffeine, mint, alcohol.

        5.  No caffeine after 4pm.  None after noon if you’re sensitive.

        6.  NO BLUE LIGHT 2 hours prior to desired bedtime.  I don’t care if you have a filter on your phone.  It stimulates your pineal gland into thinking that it’s sunlight outside, which increases your cortisol, then suppresses your internal release of melatonin (the sleepy-bye chemical).

        7. Develop a wind-down ritual to signal your brain that it needs to go into shutdown mode soon.  Two hours prior to bedtime, dim all the lights, turn off all electronics, read a book, do some self-care or light stretching, and get yourself ready for bed.  All prep for the next day should be done prior to this.

        8.  Do all high-intensity exercise earlier in the day.  CrossFit, running, HIIT, can all elevate your heart rate and your cortisol right before bed, also no bueno.

        9.  If you have sleep apnea, or suspect that you may (your partner frequently complains about how loudly you snore or startle awake frequently throughout the night) now is the time to get it tested/treated.  You can’t expect anything to work to improve your brain if your sleep quality or quantity is compromised. 

3. Sunlight

We cave dwelling (office-working) creatures’ sleep schedules are no longer governed by the sun….however…we still have Circadian rhythms that must not be ignored if we want our hormones to work FOR us instead of AGAINST us.   EVERY DAY between 6-9 am we want you to get sunshine.  With no barrier (no glasses, no contacts, no windows) for at least 30 minutes.  Do not look DIRECTLY into the sun, mind you, but by getting the blue light frequency early in the am suppresses your body’s own melatonin release for another 10-12 hours (which would be the perfect bedtime for you around news time when you start getting the yawns!). If you live in a gray zone or rainy area, order a happy lamp off Amazon (you’ll want one with at least 10,000 lux so it is medical grade.) AVOID blue light at night (see “wind down time” under “sleep hygiene”).

4.  Avoid Central Nervous System depressants…AKA any drugs that slow you down!

Like: Opioids/narcotics/painkillers, benzodiazepines like Klonopin/Ativan/Xanax, sleep aids (OTC or prescribed…yes even Benadryl!), THC/Marijuana/weed (in ANY form), alcoholic beverages.  Like a salmon swimming upstream if you’re using any of these…PrTMS may eventually get there but it’s going to take a lot more work/time/effort!  Please be sure to speak with your prescriber before you decide to decrease or stop anything we’ve mentioned.  Do NOT let Google MD be your guide :)

5.  Meditation: if you’re like me and want to fall asleep the moment you close your eyes, you might be better off with a gadget like the Mendi or Muse headbands in combination with their respective phone apps.  Mendi is better for cognitive function in anxiety, anger issues, and ADHD.  Muse is great for alpha wave reinforcement and gives you feedback in real time.  Both help with attention and emotional regulation.  Both can be found on Amazon.

6. Good diet This looks different for different people depending on their metabolic needs, but the Mediterranean diet has been shown to improve brain function and longevity.  The long and short of it is: eat the fruit and vegetable rainbow, make sure your grains are whole and not refined, avoid sugars, and eat plenty of lean proteins and healthy fats in the form of clean olive oils, salmon, and nuts.  Avoid seed oils and deep fried anything, which can increase inflammation for years at a time!

 7.  Hydration. The ultimate goal is to drink half your body weight in ounces, and for every hour you work outside or exercise heavily, add a liter to that.  Work up to it over time or you’ll give yourself an arrhythmia.  Also, make sure your filtered water is clean and clear of heavy metals and other toxins, and try to make one of those liters in a day filled with clean electrolytes (Himalayan sea salt and a squeeze of lemon juice will do…you don’t need the high fructose corn syrup-containing “sports” beverages.)

 8.  Options for Supplementation (with links to Thorne to come…)

Problems with sleep?—> Try magnesium glycinate & threonine.  Avoid melatonin unless it’s for short-term use only (like to avoid jet lag)

ADHD?—>Try Omega 3’s and DHEA

Depression?—>Try Vitamin D with K2 and Omega 3’s

Problems with restless legs and muscle cramps?—>Try magnesium chloride orally and/or magnesium sulfate in an epsom salts bath, or magnesium lotion.  It’s more easily absorbed through the skin and less likely to cause GI symptoms.

Constipation from meds?—> magnesium citrate

Recovering from alcohol or chemotherapy?—> All the B vitamins

History of dementia in your family? —> Omega 3’s and phospholipids (they keep your neuronal membranes supple)

Also, talk to your doctor if you believe you may be suffering from thyroid or hormonal imbalances, are postpartum, perimenopausal or menopausal, or on any chemotherapeutic drug that can induce menopause.

 9.  Consistency!  Much like diet and exercise, a healing epiphany may not come to you overnight, but with consistency you will see results!  Sometimes it takes a couple of weeks before you start to notice changes, but don’t be discouraged!  You didn’t get here overnight.  We’ll also be meeting with you weekly to review your EEG and plan.

What to expect?

1.             You may or may not be able to come off your psychiatric medications.  First things first, we need to get you feeling better!  We can make changes as we go (in coordination with your treating provider if we’re not the ones who see you on an outpatient basis).  PLEASE DO NOT MAKE CHANGES ON YOUR OWN.  We’re here to help you but we can’t do that fully if we don’t know what’s going on.

 2.  You could get a headache or fatigue (we’re literally working out your brain) in the first few visits.  Make sure you’re adequately hydrated and grab a snack right after your visit (something small like an apple or granola bar is fine).  Just like you need a protein drink after hitting the gym, your brain needs replenishment too.

 3.  It may take several weeks before you start feeling better.  Still be consistent with treatment.  It’s a journey, much like one to better physical health, you don’t drop 20 pounds in the first gym visit!

 4.  Don’t live and die by the EEG.  Sometimes it will show great changes, sometimes it’s like watching paint dry from week to week.  The biggest concern we have is that you feel better and you’re more functional than you were when you first came to us.  If there ARE big changes on the EEG we will certainly point them out.  We consider the EEG a “brain vital sign” but it’s not the be all end all of your treatment.  If you have a horrible night’s sleep, it will likely show up in the EEG.  It doesn’t mean you’re back to square one.  It means your brain may be too tired to show an alpha wave.  We’ll be meeting with you at least once a week to review your EEG, your neurocognitive exams specific to your needs, and work together to make a path moving forward.   Some issues require a shorter or longer treatment course.

 If you found this information helpful, please like, subscribe, and follow us!  Tell your friends.  Follow our Podcast Psych Waves on Apple and Spotify, or we’re on TikTok, Instagram, and Facebook @AndersonClinicCincy.  And if you happen to be in the Cincinnati area and are looking for assistance with treatment-resistant depression, anxiety, or PTSD, please give us a call at (513) 321-1753.  Start feeling better faster.