Episode 52: When Depression Doesn’t Lift - Treatment Options, Crisis Support, and Hope with Dr. Mark Blair

You served as a medical director at Sun Behavioral and the chief medical officer at Columbus Springs.

While you were there, how did those experiences shape the way that you care for people that have got depression, especially if they were in crisis? And what did you learn about supporting their families? Then what led you to start Optimum Wellness and TMS and focus on treatment-resistant depression and things like deep TMS and ketamine?

Yeah, so working at Columbus Springs and later at Sun Behavioral really shaped the way I practice psychiatry.

In an inpatient setting, you're often seeing people at one of their most vulnerable points in their lives.

They may be severely depressed, suicidal, unable to function, or their family may be frightened and unsure of what to do.

One thing that experience taught me is that you can't just treat a diagnosis.

You have to understand the person, their level of safety, their support system, and what the family is experiencing as well.

Families are often the first people to notice that something has changed and they can be tremendously important in recovery.

Over the years, though, I also became increasingly frustrated seeing patients who had done everything we traditionally asked them to do.

They had taken medication after medication, gone to therapy, sometimes been hospitalized multiple times, and yet they were still depressed.

That was really the motivation behind starting Optimum in 2017.

I wanted to focus on treatments that work differently from simply trying another medication.

We initially became focused on TMS and specifically deep TMS, and we subsequently expanded into Spravato and IV ketamine therapy.

What I find most rewarding about interventional psychiatry is that sometimes we're seeing people who genuinely believe they've run out of options.

Being able to tell somebody that there are still things that we can do can itself be incredibly meaningful.

Thank you.

Rich, do you have a question?

Yes.

Before we talk about treatment-resistant depression, how can someone tell whether they may have clinical depression rather than just a period of sadness, grief, stress, or a difficult period? And when should someone seek professional evaluation?

Well, sadness is a normal human emotion.

Grief is a normal response to loss.

And all of us go through periods of stress where we may sleep poorly, feel overwhelmed, or simply not feel like ourselves.

Clinical depression becomes different, though, when the symptoms are persistent and begin affecting multiple areas of a person's life.

We usually think about symptoms lasting at least a couple of weeks and involving not only sadness, but often loss of interest or pleasure, changes in sleep or appetite, low energy, poor concentration, feelings of guilt or worthlessness, feelings of hopelessness, and sometimes thoughts about death or suicide.

The other thing I pay a great deal of attention to is function.

You served as a medical director at Sun Behavioral and the chief medical officer at Columbus Springs.

While you were there, how did those experiences shape the way that you care for people that have got depression, especially if they were in crisis? And what did you learn about supporting their families? Then what led you to start Optimum Wellness and TMS and focus on treatment-resistant depression and things like deep TMS and ketamine?

Yeah, so working at Columbus Springs and later at Sun Behavioral really shaped the way I practice psychiatry.

In an inpatient setting, you're often seeing people at one of their most vulnerable points in their lives.

They may be severely depressed, suicidal, unable to function, or their family may be frightened and unsure of what to do.

One thing that experience taught me is that you can't just treat a diagnosis.

You have to understand the person, their level of safety, their support system, and what the family is experiencing as well.

Families are often the first people to notice that something has changed and they can be tremendously important in recovery.

Over the years, though, I also became increasingly frustrated seeing patients who had done everything we traditionally asked them to do.

They had taken medication after medication, gone to therapy, sometimes been hospitalized multiple times, and yet they were still depressed.

That was really the motivation behind starting Optimum in 2017.

I wanted to focus on treatments that work differently from simply trying another medication.

We initially became focused on TMS and specifically deep TMS, and we subsequently expanded into Spravato and IV ketamine therapy.

What I find most rewarding about interventional psychiatry is that sometimes we're seeing people who genuinely believe they've run out of options.

Being able to tell somebody that there are still things that we can do can itself be incredibly meaningful.

Thank you.

Rich, do you have a question?

Yes.

Before we talk about treatment-resistant depression, how can someone tell whether they may have clinical depression rather than just a period of sadness, grief, stress, or a difficult period? And when should someone seek professional evaluation?

Well, sadness is a normal human emotion.

Grief is a normal response to loss.

And all of us go through periods of stress where we may sleep poorly, feel overwhelmed, or simply not feel like ourselves.

Clinical depression becomes different, though, when the symptoms are persistent and begin affecting multiple areas of a person's life.

We usually think about symptoms lasting at least a couple of weeks and involving not only sadness, but often loss of interest or pleasure, changes in sleep or appetite, low energy, poor concentration, feelings of guilt or worthlessness, feelings of hopelessness, and sometimes thoughts about death or suicide.

The other thing I pay a great deal of attention to is function.