ASHA BIPOLAR CLINIC

About Us

Asha Bipolar Clinic (ABC) is a specialty clinic, the clinical unit of Asha Academy Mood Disorders, offering services to patients ailing with mood and anxiety disorders with special focus on Bipolar disorder and OCD for more than a decade. ABC aims to provide a structured, comprehensive, psychiatric care to clients with Mood Disorders.

Mood Disorders, in about 40%, have their onset beforethe age of 25 years...

Loud thinking of my experiences as a clinical Psychiatrist over four decades, with focused attention in ABC over a decade; challenges in the management of patients with Mood disorders...moments of fulfilling professional satisfaction; feelings of helpless inadequacy at failures, frustrations of "what next and how" not infrequently... at therapeutic crossroads on occasions...my clinical travels with my patients..."I am S.L one of your Bipolar patients. I have been your patient for the last 11years. You have seen me through all difficult times, ups and downs. I have always seen a smile on your face whenever I came through OK and a worried look, when things turned out challenging. You truly care for your patients"...

I salute my patients who taught me empathic codes of life...for my Learning and Unlearnings...

Vision

Reinventing "Recovery a Reality" in Mood Disorders

Mission

To evolve Therapeutic Concepts to
Hasten Recovery process in Mood Disorders
Functional Reintegration
Prevent Recurrence to the best possible extent

Bipolar Disorder (BD)

BD is a major psychiatric disorder affecting about 1% of population, with equal risk in males and females, with first episode of illness occurring at 15-30 years age in about 40%.

Bipolar Disorder (BD) is The Most Unique Disorder, one and only one of its kind in the Diagnostic literature of science of Medicine, with clinical symptom profile of opposite poles (“Depression” with extreme sadness, dullness & “Mania” with extreme happiness and enthusiasm) described under one single entity of a Disorder! No other disorder in Medical Science has this polar variation of symptomatic presentational structure, under a single diagnostic entity!!!

For many reasons, it may take years to diagnose bipolar disorder. As an example, a person may have multiple episodes of depression which is treated with the diagnosis of Recurrent Depressive Disorder. Perfectly correct. Later, may be after many years, if the patient develops a manic episode the diagnosis gets revised as Bipolar Disorder.

ABC’s RCs

Recovery

Reintegration

Recurrence prevention

Comorbidity management

Collaborative care

1. RECOVERY: Symptomatic recovery of the current episode - of any polarity, any degree of severity, any duration, at any age – is the immediate goal. Patient must recover from the current episode (a norm in about 80-90% patients). Minimal Polypharmacy is the chosen path. Patient’s complete recovery from the present episode has two important spin offs – 1. Short term - Patient is asymptomatic 2. Long term – cementing a belief in the success of the treating clinician’s therapeutic skills and laying the foundation for a satisfactory Therapeutic Alliance. This facilitates better compliance, one of the essential components in the Prophylaxis of BD!

2. REINTEGRATION: Aided by Symptomatic recovery, attainment of Premorbid Functional status is the next goal. Two important road blocks are a) Adverse Event profile of the medications prescribed and b) Cognitive impairment, which need to be minimised with a personalised therapeutic strategy.

3. RECURRNCE Prevention (Prophylaxis): This needs to be based on an individualized long term therapeutic strategy depending on the episodes - frequency, severity, acuteness of onset, suicidality, hospitalization risk, disability….Long term effective prophylaxis (no future episodes) is the desired goal, but seemingly difficult in the real life clinical practice! Prophylaxis, we opine, is to be need based, clinician advised, compliance determined with patient’s concurrence!

4. COMORBIDITY (Dual Diagnosis): Large number of patients with BD also suffer from other psychiatric disorders like OCD, Panic disorder, Phobias, Personality Disorders, and Substance abuse, with varying severity. Effective treatment of these comorbid conditions also should be taken up with concomitant pharmacotherapy and supportive counseling.

5. COLLABORATIVE Care: Recovery being the rule, patient in the euthymic state along with the caregivers should be involved to participate in psychoeducation sessions.

At ABC we have taken a conscious, though debated, decision not to initiate medication for Prophylaxis at First episode itself – Controversial conceptual therapeutic paradigm shift, which is blamed as a “Mistaken Kindness” approach…

ABC differs with (with due respects and apologies to) several algorithms and protocols in the prophylactic management strategy, reasons being:

1. The long term course of BD, at least in about a third of patients, is “random and chaotic” and it is nearly impossible to predict the next episode’s onset, polarity, and severity…

2. Therapeutic effectiveness of “mood stabilisers”, but for Lithium, has “lacunae in their evidence” and the approved medications are therapeutically “unsatisfactory in the day to day clinical experience”

3. Adverse events of medication is one of the significant reasons impeding a patient attaining functional recovery.

And so at ABC the Therapeutic Strategy for Prophylaxis of BD remains

1. Need based

2. Compliance Determined

3. Collaborative concurrence with patient and caregivers

And also at ABC we take a liberal approach in the prescription of Antidepressants, mostly SSRI, in the treatment of Bipolar Depression…

1. Considering the evidence of suicide prevention benefit of antidepressants. It is documented that 15% of patients with BD end their lives with suicide. Evidence for suicide prevention efficacy of Quetiapine and Lamotrigine is not well documented.

2. Treatment of comorbid disorders like OCD, OCPD, Panic, Phobia and other Anxiety disorders (> 50% of patients with BD have comorbidity) for which SSRI are the drug of choice. Untreated co morbid disorder adds to the disability in BD. Hence the need, for early and correct diagnosis of co morbid disorder and also effective pharmacotherapy and counseling.

Pharmacotherapy of BD is riddled with controversies on several DOs and DON’Ts, and effective treatment of BD is a fine Art of Therapeutics!

Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD): This is the most common of all the mood disorders affecting about 5% of the population,

Major Depressive Disorder (MDD): This is the most common of all the mood disorders affecting about 5% of the population, twice as common in females, in about 30-40% starting in the age group of 15-30 years, the predominant symptom being feelings of sadness. Sad mood lasting for most of the time in the day, most of the days in a week for at least two weeks is the requirement for the diagnosis. Inability to experience pleasure, loss of interest, insomnia, loss of appetite, negative thoughts, inferiority feelings, hopeless and helpless, dullness, lethargy, pains and aches all over the body are some common symptoms. Anxiety is a common comorbidity. Suicide is a major and real risk, with about 15% ending their lives with self harm.

Sadness is a normal emotional response to loss; depressive disorder is a disorder like any other medical illness, often occurring without context. Stress can lead to sadness, we all know; but depressive disorder can exaggerate and magnify a minor stress and make the person experience it as seriously disturbing! No one is immune from developing depressive disorder, similar to Diabetes, Typhoid etc. Incidence of depressive disorder seems to be on the increase in the population in a similar way as is happening with diabetes. Genetic vulnerability, Brain neurotransmitter dysfunction play a major role in the causation of Depressive Disorder and psychosocial stress can be the last straw! Whatever may the causative factor, the final common pathway in depression could be the “serotonergic dysfunction” which is amenable to SSRI, to a large extent in a majority of patients.

There are several types of Depressive disorders – Recurrent Depressive disorder, Psychotic Depression, Bipolar Depression, Postpartum Depression, Melancholia etc. In Melancholia the characteristic features are – 1. Waking up at around 2-3 am (Late insomnia) 2. Symptoms typically are severe in the mornings and becoming better by evening hours (diurnal variation).

Often patients present with numerous body aches and pains without expression of sad mood, for fear of stigma.

About 50% patients have only one episode of Depressive disorder; the rest of 50% having multiple episodes in their life time. The episodes are curable in a significant group.

Treatment is generally with SSRI antidepressants and counseling. At ABC we routinely follow a protocol of SSRI monotherapy, along with counseling which usually is for about 3- 4 sessions at our clinic. A small dose of benzodiazepine is added for relief of anxiety and for better sleep, which is generally stopped after the first few months. Important point to note is that in a majority it takes about 3-4 weeks for the patient to experience significant relief from depression. As on today this is a major short coming of the antidepressant medication.

Protocol for MDD at ABC is –

Visit 1 – initial evaluation and diagnosis, starting on antidepressant medication

Visits 2 to 4 – Counseling sessions, Psychoeducation, Titration of drug dosage (within a period of 7-10 days)

Visits 5 & 6 – between 4-8 weeks. Remission can be expected around this period

Visits 7 to 10 - (in those patients who recovered) frequency of visits at 1-2 month intervals. We down titrate the medication in about 9-12 months based on the levels of improvement

In patients with Psychotic Depression, Chronic depression, Recurrent depression, Bipolar depression etc – Protocols vary with some modifications

REGULAR MEDICATION, about 8 hours of Sleep - are the general suggestions to patient

Education about the Suicidal Risk, Biological reasons as the causative factors, need for empathic support – are the points for caregivers

Good compliance to medication and Good family support systems are essential.

SSRI Antidepressants are reasonably safe medicines without any major serious short term and long term adverse events in a majority of patients. But as we all know, no medication can be counted as absolutely safe!

In a majority of patients, after recovery from MDD, life can be as “Normal” as any other average human being!

Depressive Disorder – Let us talk, Let us treat….Bring back the smiles…Reintegrate into the society as another well-functioning human!

Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a new diagnostic entity included in depressive disorders along with MDD.

Premenstrual Dysphoric Disorder(PMDD)

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Obsessive-compulsive disorder (OCD)

(OCD) is a mental disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations

Services

Consultation and Inpatient Treatments

Diagnostics and Therapeutics

After registration, you will be called in for an initial assessment by a doctor, with whom you might have to share your reason for visiting this hospital. This interview involves a detailed evaluation and the doctor will ask you relevant questions to arrive at a diagnosis and will discuss various management plans. A revision of current and past therapeutics will be performed. A detailed evaluation may also include a few blood investigations and certain psychological investigations to compliment the diagnostic evaluation.

Counseling

Individual and Group counseling

Care giver meetings

Tele Psychiatric services

Wellness clinics

Neuromodulatory therapies

Biofeedback Sessions

Biofeedback is a technique you can use to learn to control some of your body's functions, such as your heart rate, depth of breathing, muscle tension and relaxation. . During biofeedback, you're connected to electrical sensors that help you receive information about your body. In essence, biofeedback gives you the ability to practice new ways to control your body, often to improve a health condition or physical performance.

Repetitive Transcranial Magnetic Stimulation:

Transcranial magnetic stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of Depressive disorders, OCD, Anxiety disorders. During an rTMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the region of your brain involved in mood control and anxiety. It's thought to activate regions of the brain that have decreased activity in depression.

Trandcranial Direct Current Stimulation

Transcranial Direct Current Stimulation (tDCS) is a noninvasive, painless procedure that uses weak electrical currents applied to the head in order to enhance brain activity. It is used in patients with Depressive disorders, OCD and chronic neuropathic pain

Electro Convulsive Therapy

Electroconvulsive therapy (ECT) is a safe and effective treatment for certain psychiatric disorders. ECT is most commonly used to treat severe depression (major depression), intense suicidal ideation, Bipolar disorder and Psychosis. You will be subjected to a certain blood investigations and ECG, evaluated for fitness to undergo Anesthesia by an Anesthesiologist. During ECT, a small amount of electrical current is passed through the brain while the patient is under general anesthesia. This current causes a seizure that affects the entire brain, including the parts that control mood, appetite, and sleep

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Team

Dr.M.S.Reddy

MD.Asha Bipolar Clinic , psychiatrist

An eminent psychiatrist with about four decades of clinical experience in the field of Psychiatry; received his masters from Christian Medical College, Vellore. He served in many prominent positions for Indian Association of Private Psychiatry, Indian Association of Biological Psychiatry, Asian Network of Bipolar Disorders and Asian association of neuro- psychopharmacology and was editor of Indian Journal of Psychological Medicine for about a decade. He is currently the secretary of Society for Bipolar Disorders, India.

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Dr.Swetha Reddy

Consultant Psychiatrist

Dr. Swetha Reddy received her master’s degree in psychiatry from The National Board of Examinations, New Delhi. Along with general psychiatry, she has special interests in mood disorders and OCD

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Ms. D. Manasa

Consultant Psychiatrist

She is a trained counselor from Christian Counseling Centre Vellore, with experience of supervised counseling in grief from Christian Medical College, Vellore. She has masters in clinical psychology from IGNOU and masters in family and marriage counseling from Osmania University.

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Contact

Location:

Road No: 14, Banjarahills, Hyderabad - 500034

Email:

drmsreddy@ashabipolarclinic.com

Call:

+91-040-66752222

+91-7337455566

Welcome to ASHA BIPOLAR CLINIC

Welcome to ASHA BIOLAR CLINIC

Welcome to ASHA BIOLAR CLINIC

Welcome to ASHA BIOLAR CLINIC

Welcome to ASHA BIOLAR CLINIC

Welcome to ASHA BIOLAR CLINIC

About Us

Mood Disorders, in about 40%, have their onset beforethe age of 25 years...

Vision

Mission

Bipolar Disorder (BD)

Major Depressive Disorder (MDD)

Disruptive Mood Dysregulation Disorder (DMDD)

Premenstrual Dysphoric Disorder(PMDD)

Obsessive-compulsive disorder (OCD)

Services

Diagnostics and Therapeutics

Counseling

Individual and Group counseling

Care giver meetings

Tele Psychiatric services

Wellness clinics

Biofeedback Sessions

Repetitive Transcranial Magnetic Stimulation:

Trandcranial Direct Current Stimulation

Electro Convulsive Therapy

Call To Action

Portfolio

Team

Dr.M.S.Reddy

Dr.Swetha Reddy

Ms. D. Manasa

Contact

Location:

Email:

Call: