“Shoot. What’s the alcohol withdrawal protocol again?”

“Dude, just look it up. Again.”

I was with a fellow psych resident in the hallway of the PES or psychiatric emergency services. This was the 4th patient of my shift who was having a worse time than I was.

Thank goodness for the giant pockets of my white coat where I stored important bits of paper and “pocket-sized” reference books that had titrations and protocols and acronyms and all the things a resident needs to survive and not hurt patients.

But tucked safely in my top left pocket? My iPod Touch, tiny miracle of technology, another new, mind-blowing Apple product.

When I was a new resident there were no iPhones yet. The iPod Touch was the precursor and kicked some serious butt against all those little books and manuals and papers shoved in my other, overstuffed pockets.

The best part of this fancy new piece of tech? An app called Epocrates which is what I still use now for dosing and interactions of prescription medications (especially the ones I don’t have memorized).

As a new doctor this was gold. I think i got a few extra hours of sleep, looked smarter in front of my attendings after a night of call, and knew I was taking better care of patients with up-to-date data right at my fingers instead of lodged in my brain under the haze of being up for 33.27 hours helping sick people in the ER.

Kind of like Photobiomodulation!

??

Photobiomodulation (PMB) is not new, but it’s new to me and still new-ish to a lot of specialties. And even though it’s been around for over 20 years we don’t have it all dialed in for psychiatry yet.

PBM is the process of exposing people’s heads (and ultimately brains) to near infrared light, usually from a laser, to improve the cognitive and emotional function.

There’s no invasive procedure and there are few side effects other than maybe headaches, skin warming, and irritability in some people. PBM is low cost and can even be performed by the patient at home!

The uses and improvements are far reaching! PBM is used for stroke victims, musculoskeletal injuries, wound healing, TBIs, and Alzheimer’s and Parkinson’s Diseases. And now we’re seeing good results in older adults with cognitive decline, people diagnosed with mood disorders, and even ADHD.

This is amazing stuff!! Kind of like having a ginormous medication resource in my pocket so that I didn’t accidentally give someone the wrong dose of Ativan (or order the suppository instead of an IV infusion! Oops.).

If this sounds like futuristic sci-if stuff, that’s reasonable. Because didn’t the idea of everyone having a cell phone, like a tiny little Commodore 64, in their pockets seem nuts? People worried about safety and cost and satellites and all sorts of other stuff.

Yet here we are, each of us with a cell phone an arm’s reach from us at all times.

PBM isn’t available to everyone, everywhere. And as we get more data, we’ll find that it’s probably not a safe, cure all for everything (No, you can’t just spray some Windex on it. What was that movie from again?).

Want to know some specifics about PBM?

• PBM is based on the mitochondrial reaction to the photons in light
• It can cause up- or downregulation on the cytochrome c oxidase synthase in cellular respiration which is very specific for increasing the energy production in mitochondria inside cells (the “powerhouse” as it was called in high school biology).
• It’s safe, noninvasive, can be self-administered at home, and is good for long-term treatments
• Penetration of visible light is limited (there’s a lot to get through to get to the brain: hair, skin, blood vessels, the skull!) but PBM uses near-infrared light which reaches deeper tissues for light directly applied outside the head. Totally wild, right?
• There’s increased cognitive and emotional functions when the laser is aimed at the prefrontal cortex, improving cerebral oxygenation which is great for neurons. There’s also data that shows positive impacts on working memory and attention.
• PBM could improve cognition in middle-aged and older adults at risk of cognitive decline, and may even become a preventive intervention for people potentially at risk
• The downstream effects of increased ATP (energy) production include not only increased cellular energy but also potential improvements in intercellular signaling
• LEDs used in home devices might not provide sufficient light penetration to see the mitochondrial enhancement in brain cells we’re looking for, but the researchers are trying to get this all figured out!

If you’re susceptible to good marketing (I love me some good marketing, take my money ShamWow!), FDA approval isn’t required for the LED versions, so it’s hard to know how effective they are. And we don’t have good data on how skin pigment affects the process yet either.

So why tell you about this if you can’t just recommend it to all your clients? (Heck, they’re still trying to figure out what kind of thing to use! A laser or a light bulb!!)

Because it’s coming! And it’s so exciting!!

People that don’t want to take a pill (or can’t tolerate or don’t respond to medications) will have safe, accessible options!

What if this becomes part of a personal wellness routine? People take vitamins and use exercise bands or weights at home. What about an LED brain light to help you have a more fulfilling or effective day?

Improved memory, attention, and emotions?

Yes, please.

Let’s feel excited for all the things out there that we’re just starting to discover. Ways to help that we never imagined!

Just like cell phones.

Cheers to healthy brains,

Dr. B

Jessica Beachkofsky, MD

Your friendly online psychiatrist!

​
P.S. the movie is My Big Fat Greek Wedding! I had to look it up. Here’s a clip…

​P.P.S. Did you know you can still buy ShamWow? Ahhh…. The nostalgia of “as seen on tv” products. Is it weird that I want to buy it again now?