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Treating Depression Without Drugs

Mental Health

For people suffering from major depression, counseling and drug therapy are typically the first line of treatment. But those methods don’t always work— or have only a negligible effect— for an estimated 10 percent to 30 percent of patients.

Recently, doctors have been employing a new tool in the fight against drug-resistant depression: transcranial magnetic stimulation, or TMS. The treatment, which was first approved by the Food and Drug Administration in 2008, uses an electromagnetic angus greig coil to transmit a series of short magnetic pulses—like an MRI— directed at a patient’s prefrontal cortex, which plays a role in regulating mood. Depending on how they respond to treatment, patients typically undergo the 30- to 45-minute sessions five days a week for six weeks.

So far, the procedure appears to be effective in about 50 percent to 60 percent of patients, says Irving Reti, a psychiatrist and director of the Brain Stimulation Program at Johns Hopkins. “These are much higher rates than we’d see if the patient just tried another medication.”

Reti stresses that TMS doesn’t “cure” depression, but a majority of patients retain positive results for more than a year, after which they can return for additional treatments.

“The whole neural modulation field is one that’s going to continue to grow, as we learn more about the circuitry of the brain that has gone awry,” Reti says. “This is just the start.”

Snap Judgments


Trash or treasure? Your brain answers that question in less than a 10th of a second—about the same amount of time it takes to simply recognize an object.

If you’ve ever made quick work of a sale rack, you’ve experienced that rush from finding a gem among the junk, says Johns Hopkins neuroscientist Ed Connor.

“My wife is flipping through the racks at Anthropologie at, like, two items per second, and there’s an instant, ‘No, no, no, maybe, yes—try this on!’” he says. “It’s an example of how all through life, we see things and attach value to them very quickly.”

This innate sense of value begins in the visual cortex—earlier in our cognitive feedback loop than previously thought. And while the ability to rapidly grade something’s quality may seem a little trivial, it was vital to our evolution.

“We need to instantly evaluate and understand things in the world to form fast, appropriate behavioral responses,” Connor says. “Seconds count when competing for food or evading predators.” And sometimes even when snatching up bargains.

snap judgements

Of Headaches and Hormones


If you’re a woman who suffers from headaches—and it seems that you get them more often than most of the men in your life—you’re not imagining it.

Periods, pregnancy, oral contraceptives, lactation, menopause, and hysterectomy all bring fluctuations in estrogen levels that can spark tension headaches or migraines, says neurologist Nauman Tariq, director of the Johns Hopkins Headache Center.

Understanding how hormones affect your headaches is the first step in finding treatment options. Think your period is causing them? Tariq suggests tracking your menstrual cycle using a calendar. If your cycle corresponds with the onset of headaches, your doctor may suggest taking ibuprofen each month before your cycle begins. Although they are sometimes the cause of headaches, birth control pills or hormone replacement therapy may also help some headache sufferers.

Drinking more water—think 1½ to 2 liters daily—and avoiding alcohol and stress can also help manage migraine symptoms. Sleep is critical, so you should avoid excess caffeine and stay consistent with your sleep, wake-up, and meal times. Physical therapy can help if you carry a lot of tension in your neck and shoulders, and behavioral therapy and relaxation training can also help with stress reduction to treat headaches.

Headaches and hormones

The Urgency Trap

Behavioral Science

You know you should make that doctor’s appointment you’ve been putting off, but discovering a coupon that’s about to expire has you racing to the store instead. Why is it that we procrastinate on one task while jumping right on another? Sometimes it’s because we cave in to a false sense of urgency when faced with a deadline, such as an expiration date, says Meng Zhu, associate professor of marketing at the Johns Hopkins Carey Business School. “People are not totally rational,” Zhu says. They pay attention to the reward they’ll receive, but they pay even more attention to time limits. Zhu calls this the “mere urgency effect.”

So how do we fight the urge for urgency? Zhu says to break big tasks into smaller chunks, with a shorter deadline for each. Another tip: When she needs to do something important, Zhu keeps her cellphone out of arm’s reach so that “merely urgent” emails and social media posts can’t distract her.

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