Nourish. Your diet has profound effects on your sleep, energy, and mood. Always be improving it. Eating healthy is so important that nutrition counseling is part of our practice. As patients begin to feel better, they make healthier food choices, which in turn helps them feel even better. We encourage our patients to replace processed and sugary foods with better options. As they experience the benefit of this, they feel motivated to make healthy food choices more often and incorporate them into their lifestyle.
As a part of my series about the “5 Things, Anyone Can Do To Optimize Their Mental Wellness” I had the pleasure of interviewing Dr. W. Nate Upshaw.
Dr. Upshaw is the medical director of NeuroSpa TMS and a board-certified psychiatrist with extensive specialized training in Psychodynamic Psychotherapy, an undergraduate degree in Nutrition and a clinical practice that incorporates “lifestyle modification” to promote overall wellness. He offers Transcranial Magnetic Stimulation (TMS) for depression. FDA approved in 2008 and covered by most insurances, TMS effectively treats depression without the unwanted side effects of medication.
Thank you so much for doing this with us! Our readers would love to “get to know you” a bit better. Can you share with us the backstory about what brought you to your specific career path?
I have always been passionate about health and wellness. In high school, I worked as a personal trainer. Studying to becoming a doctor was a natural decision for me. During medical school, I became fascinated with psychiatry because of the way it married medical knowledge with the human element. I was fortunate to receive training from Mark George, a pioneer in the field of Transcranial Magnetic Stimulation (TMS). Witnessing improvement with TMS that exceeded that of traditional psychiatric medication, I realized it would be the future of psychiatry. Since then I have worked to bring this life-changing treatment to as many people as possible.
Can you share the most interesting story that happened to you since you started your career?
One of the standout moments in my career began when I met with a patient who had been in psychotherapy for years with no relief. He couldn’t take medicines because of a medical condition. After TMS therapy, he saw complete improvement. His psychotherapist called to jokingly say I had cost her a long-term patient. Everyone’s story begins with a different scenario, but I see this happen over and over with TMS therapy. The satisfaction that comes from seeing a person return to living life to its fullest never grows old.
Can you share a story with us about the most humorous mistake you made when you were first starting? What lesson or take-away did you learn from that?
In medical school, psychiatric students and residents are taught not to wear ties when making rounds in the hospital. This is because we often encounter patients who have lost touch with reality and it can be dangerous. One day, I wore a tie, a patient grabbed me by it, and it took three people to get the tie off of me so I could escape the patient’s grip.
Don’t wear a tie to the hospital!
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
Dr. Francisco Fernandez, former chairman of the department of psychiatry for the University of South Florida (USF), was an early adopter of brain stimulation, including TMS. I was on staff at USF and Dr. Fernandez sent me to train with Mark George, a pioneer in TMS. Seeing the research behind TMS, and observing the results, was a turning point in my career. It has enabled me to offer hope and healing to people for whom other treatments were not working. Dr. Fernandez’s foresight, influence, and investment in me changed the trajectory of my career and continues to have a positive impact on outcomes for my patients.
It’s a rare opportunity to be at the forefront of medical advancement and help pave the way for its delivery to the people who need it. Dr. Fernandez’s vision and a quest for better mental health solutions opened the door for me. Ten years ago, no one knew what TMS was. Today, it’s a mainstream treatment covered by most insurances. Helping to make that happen has been an extremely rewarding part of my career.
What advice would you suggest to your colleagues in your industry to thrive and avoid burnout?
As a faculty member at the University of South Florida, I always challenged my students to find something they enjoyed and do it. That advice is applicable to everyone. Don’t choose a role because it requires the least effort or promises the most money. You won’t find it fulfilling. If you want to thrive, discover what you’re passionate about and pursue it.
What advice would you give to other leaders about how to create a fantastic work culture?
To create a fantastic work culture, leaders must find what motivates the people who work with them and make sure they’re in a role that suits them — then empower them to come up with solutions and trust them to do well. Most people want to do well at work. As leaders, it’s our responsibility to ensure our team members are positioned to succeed.
Ok thank you for all that. Now let’s move to the main focus of our interview. Mental health is often looked at in binary terms; those who are healthy and those who have mental illness. The truth, however, is that mental wellness is a huge spectrum. Even those who are “mentally healthy” can still improve their mental wellness. From your experience or research, what are five steps that each of us can take to improve or optimize our mental wellness. Can you please share a story or example for each.
TMS helps depression by increasing neuroplasticity and I give patients these tips to get the most out of their treatment.
- Interact. Loneliness is pervasive. Make a concerted effort to connect to others in a meaningful way. Lack of social interaction caused one professional to seek our help for depression. He had moved to Tampa from another metropolitan area as a result of a job transfer. The move took him from a home where he had lots of friends to a new town where he felt very alone and became depressed. In a depressed state, the ability to interact may be impaired, creating a vicious circle. Depression can make it hard for people to reach out and connect with others. Where a lack of social interaction is the precipitating factor in depression, treatment involves helping the patient build social interaction into their life. TMS treatment helped him feel well enough that he could begin to go out and meet people. He’s now built a strong social network and he feels great again. Sometimes when I first meet patients, they are so disabled by their depression that they can’t even drive themselves to the appointment. By the end of TMS therapy, people are naturally seeking more social interaction. I tell my patients that we want to get them feeling better so good things can happen to them.
- Nourish. Your diet has profound effects on your sleep, energy, and mood. Always be improving it. Eating healthy is so important that nutrition counseling is part of our practice. As patients begin to feel better, they make healthier food choices, which in turn helps them feel even better. We encourage our patients to replace processed and sugary foods with better options. As they experience the benefit of this, they feel motivated to make healthy food choices more often and incorporate them into their lifestyle.
- Exercise. Outdoor morning exercise is especially beneficial because of light frequencies present at that time, but all exercise is positive. Neuroplasticity changes the way the brain is connected to itself. Improvement in depression does not happen apart from neuroplasticity. Once TMS begins to increase the brain’s neuroplasticity we want to restructure it in positive ways. Exercise, fresh outside air, and early morning sunlight are all part of this. When one of our patients was not improving, we met with her family and learned she was staying inside all day with the blinds drawn. With encouragement, she began getting outside for early morning sunlight, fresh air, and a brief walk — and began to experience improvement almost immediately
- Connect. Make mindfulness, meditation, spirituality or nature a part of your day. One patient shared that she used to attend church regularly and place importance on her spiritual life, but she had walked away from that. Connecting to that again was an important part of her recovery. Getting outside of ourselves, helping others, being part of something bigger than ourselves — these are psychologically important for wellbeing and key to our mental health.
- Sleep. Trying to optimize mental health without quality sleep is like fighting with one arm tied behind your back. If you’re tired after eight hours of sleep, get a sleep study to check for sleep apnea. A patient came to see me for depression and we uncovered that he had sleep apnea. Once it was treated, his depression went away. Issues that are easily fixable can have a big impact on mental health. Patients who are struggling with depression, and not feeling refreshed when they wake in the morning, should take a home sleep test to screen for sleep apnea.
Much of my expertise focuses on helping people to plan for after retirement. Retirement is a dramatic ‘life course transition’ that can impact one’s health. In addition to the ideas you mentioned earlier, are there things that one should do to optimize mental wellness after retirement? Please share a story or an example for each.
Being based in Florida, I see a lot of people who are retired. They felt fine before retirement, but after leaving the workforce, they became depressed because they lacked a sense of purpose. When I was with Bay Pines VA Hospital in St. Petersburg, I was the medical director of the Psychosocial Rehabilitation and Recovery Center. The whole point of the center is helping people who’ve lost their sense of purpose, because of retirement or disability, to connect with something in the community that gives their lives meaning. We helped them identify something important to them and invest their life in it in a meaningful way. We all need purpose. The purpose is our reason to get up in the morning.
How about teens and pre teens. Are there any specific new ideas you would suggest for teens and pre teens to optimize their mental wellness?
I see a lot of teens and preteens in my private practice and for many of them, neurotoxicity from e-cigarettes and cannabis use is a primary issue. Kids carry e-cigarettes in their backpacks, and the amount of nicotine they’re taking in through them would blow your mind. It’s exponentially more than they would get by smoking a cigarette and the neurotoxicity they suffer is much greater. I recently met with a teen whose pediatrician was admitting him to a psychiatric hospital. He had no prior history of mental health issues, yet he was extremely anxious and borderline psychotic. We uncovered that he had high levels of nicotine from using an e-cigarette on a daily basis — — enough to push him into psychosis. We were able to help him get off nicotine and he’s doing extremely well.
Another looming concern is the risk of THC for teens. Vaping and using marijuana are increasing in prevalence, and there is a lot of new research, that the public isn’t aware of yet, about the effect THC has on the developing brain.
Is there a particular book that made a significant impact on you? Can you share a story?
“The Suffering Stranger” by Donna Orange has had a huge impact on the way I approach helping people with mental health issues. It helped me see my patients not as depressed people, but as people suffering from depression.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
This is what we’re doing with our TMS clinic. Our goal is to reach people who are suffering from depression and make it easy for them to learn about TMS therapy, access treatment and feel better. We integrate TMS therapy with lifestyle elements of mental health. Our clinics make it easy for people to access care without jumping through a lot of hoops.
Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life?
Maya Angelou said, “I am a human being, nothing human can be alien to me.” Her statement echoed that of playwright Terrance who lived in Rome around 170 BC and said, “Homo sum, humani nihil a me alienum puto.” My commitment to my patients also echoes this as well, “If you’re struggling with something, you’re not the first. You’re a human being. Your struggle is part of being a human being — and we’re going to figure it out.”
What is the best way our readers can follow you on social media?
I’ve recently joined Twitter and will be sharing mental health news and tips along with information about TMS and how it’s helping people overcome depression without medications. You can follow me @drnateupshaw, https://twitter.com/drnateupshaw.
You can also follow NeuroSpa TMS Therapy Centers on Facebook at https://www.facebook.com/neurospatms/
Thank you for these fantastic insights. We wish you only continued success in your great work!