Tuesday, December 14, 2010

What’s the difference between all these medications?

By Sara Coffey, D.O.

This is a question I am often asked by my patients. Several times a day we see commercials for prescription pills to treat a variety of diseases from high cholesterol to heart disease and treatment for mental illness is no different. Today I would like to talk about one of the most common mental illnesses, Depression and its treatment.

Depression affects roughly 15 million Americans adults, and it is an illness that can be readily treated with antidepressant medications, talk therapy or a combination of medication and talk therapy. Antidepressants have been around for decades and include several classes of medications that work on different chemicals in the brain, but today the first line treatment for depression are medications called, SSRI’s or Selective Serotonin Reuptake Inhibitors. For the most part medications in this class are very similar; they work by increasing the amount of serotonin between nerve cells which is thought to play a role in depression. Unlike a pain pill that works right away, antidepressants can take up to 4 to 6 weeks to have an affect.

Which SSRI a doctor chooses will depend on each individual patient. Just like every other medication, antidepressants can have side effects and interact with the body or other medications in a way that may be dangerous or uncomfortable for patients. Some SSRI’s may be more likely to make a person tired or sedated, while others may have a tendency to give a patient more energy. Depending on an individual’s depressive symptoms, your doctor might prescribe a medicine that would be more likely to help you fall asleep or feel more alert and energetic. Furthermore, certain SSRI’s have been studied more in patients with a particular medical disease, like heart disease for instance and this might leave a physician to try a medication that has research data to show that the medication is safe for their patient. Certainly, some medications work better in some patients than others, and after a period of 4-6 weeks of adequate dosages if no improvement in symptoms occurs your doctor will likely recommend increasing your dose or switching to another antidepressant to treat your depression. In some instances a physician might recommend augmenting your medication by adding another medication that works in a different way to treat your Depression.

Even if the first anti-depressant doesn’t seem to work for you, there are still other options for treatment. Newer medications that work on norepinephrine and dopamine in the brain are also used quite frequently to treat depression, and older medications to treat depression, although they often have more side effects are still effective in treating depression and can be used in refractory cases.

As a patient it is important for your prescribing doctor to know about your symptoms, side effects, and other medical history and current medications that you are taking. And, as always if you have any questions about the medications you are being prescribed don’t hesitate to ask your doctor about your concerns.

Thursday, December 9, 2010

Bipolar in kids? Probably not.

By Scott Benson, M.D.

The 5-year-old little girl had been referred to a therapist by her school because of her severe disruptive behavior. The almost daily tantrums had everyone concerned. She was uncooperative with the assessment and arrangements made for further evaluation. The therapist wrote a diagnosis of bipolar disorder.

The patient was certainly reactive to any limits and her tantrums seemed like they would never end. But she slept well at night; she rarely had behavior problems with her grandparents who provided afterschool care.

After a few parent training sessions with the little girl and her parents her behavior control improved. But continued treatment was threatened when her dad tried to get her on his new health insurance. The diagnosis of bipolar got the application bumped by the computer and it took a lot of calls and several letters to get her on the policy so that her treatment could continue.

At times it seems we are a little too quick to throw a label on a child’s behavior, and bipolar disorder seems to be the most popular current label.

But new research at the October meeting of the American Academy of Child and Adolescent Psychiatry found that children with some symptoms of mania probably do not have bipolar disorder.

Boris Birmaher, M.D., a child and adolescent psychiatrist at the University of Pittsburgh presented his group’s research. More than 2,000 children presenting to 10 different academic centers were included in the Longitudinal Assessment of Manic Symptoms (LAMS) study. 621 were found to have elevated symptoms of mania, but the full evaluation did not find sufficient symptoms for a diagnosis of bipolar disorder. Most had attention deficit hyperactivity disorder (ADHD), others had another disruptive behavior disorder. Children who did have bipolar disorder have poor function and are likely to require treatment in hospitals.

"Kids with manic symptoms don't necessarily have bipolar disorder," he told Reuters Health. On the other hand, "Many children with bipolar disorder are not being correctly diagnosed."

The LAMS study which will follow these children for five years should provide direction for the assessment and treatment of children with severe behavior problems. In the mean time parents should insist on an adequate evaluation for children with severe behaviors.

The Parents' Medication Guide for Bipolar Disorder in Children & Adolescents is a great source of information for understanding the evaluation process and treatment options. Or visit HealthyMinds.org for more information on bipolar disorder or mental health issues in children.

Wednesday, December 8, 2010

Parenting in the Internet Age

Facebook, blogging, Twitter, email, texting. How is a parent supposed to keep up with all of the technology available to children and teens in today’s world? Many parents and children struggle with safety on the Internet. Although there are no easy answers, some simple steps can help keep you and your child safe.

First, and most important: all of the things that make a good parent in everyday life also make a good parent on the Internet. Spend time with your child in their daily life and spend time with them learning about what they do online. Educate yourself on your child’s school and social life. In the same way, educate yourself about the websites they visit and who they are talking to online.

In addition, keep their access to technology limited and in public settings. Put the computer in the kitchen or the living room – in other words, in a place where secrecy is difficult and monitoring is easy. Online time should only come after homework and other activities are done for the day. Also, talk about what they are doing online, but do not invade their privacy by reading emails unless absolutely necessary. If you suspect dangerous things are happening by or to your child online, then invading their privacy may be necessary. Otherwise, encourage open communication and respect their privacy.

For more information:

Monday, December 6, 2010

Hypertexting and risky behaviors: A cautionary tale?

By Tristan Gorrindo, M.D.

Last month, researchers at the American Public Health Association’s annual meeting reported some alarming statistics about the connection between high levels of message texting and risky behaviors. In a study of high school students in the Midwest, the researchers found a relationship between those that send more than 120 texts per school day (20% of the students surveyed fell into this group) and increased experimentation with cigarettes and alcohol, binge drinking, physical fighting, and a high number of sexual partners. These results were widely reported by several major media outlets including CNN and the Associated Press .

While the authors of this research clearly state that they don’t think that “hypertexting” causes students to drink more or engage in risky behaviors, I worry that this fine-point is lost on most people who are just reading the headlines.

Since most of us don’t remember our high school statistics class, I think it’s worth thinking about how two ideas can be related (as they are here) but not necessarily in a causal relationship. An analogy I often use is the finding that yellow teeth and lung cancer are highly connected in research studies. It isn’t that tartar covered teeth cause lung cancer, or that lung cancer causes teeth to yellow. It turns out that there is a common root-cause of both– that is smoking cigarettes causes both yellow teeth and lung cancer.

In a similar manner, there might be an underlying root-cause (or several different causes), which cause kids to use cigarettes and alcohol and to be hypertexters. These root-causes might include poor parental supervision, mental illness, or even a learning disability, just to name a few. But until we conduct more careful studies, we won’t know for sure.

Certainly, parents should know how many texts per day their child is sending. And in the same way that I encourage parents to talk to their kids about alcohol use or sexual activity, they should also be talking to their kids about the ways in which they are using technology.

Friday, December 3, 2010

Coping with Stress in America

By Adair Parr, M.D.

survey by the American Psychological Association highlighted the negative impact that stress can have on families and children. This is an extremely important topic that affects many family caregivers, who are under a great deal of stress taking care of loved ones. More and more Americans are affected by stress. The survey indicates that many Americans feel that they are experiencing unhealthy amounts of stress. The economy is one of the main reasons. Fewer are satisfied with the ways that their employer helps employees balance work and non-work demands and many are concerned about job stability.
In addition, stress impacts the entire family. Children recognize when their parents are stressed and that could make them feel sad and worried. Nevertheless, parents frequently underestimate the impact that their own stress has on their children.

Stress affects both our mental and physical health. Some people manage stress by smoking, drinking or over-eating. That can lead to bigger problems. The study shows that Americans understand the importance of healthy behaviors like getting enough sleep, exercising and eating healthy. However, lack of time and motivation gets in the way of following through on these goals. Willpower was identified as a barrier to many healthy behaviors, even when they are recommended by a health care provider.
Managing your stress is extremely important. Stress does affect the family members you care for. There are healthy ways to manage your stress. Some suggestions are: exercising or playing sports; listening to music; spending time with friends and family; going to religious services; journaling; and practicing yoga / meditation. 

If you find that you are overwhelmed or suffering physical symptoms from stress like headache, poor appetite and insomnia, or if you are feeling depressed or suffering from chronic irritability and crying spells, you may need to see a mental health provider. The Healthy Minds website has brochures about dozens of mental health issues including early warning signs of mental illness.

Thursday, December 2, 2010

Where to go for Mental Health

Sara Coffey, D.O.

Trying to find the right doctor for you? With so many specialties and titles it can be confusing to navigate the complex array of mental health professionals. So, where do patients with mental illness start?

Understanding a doctors training and background may be the first place. Patients with mental illness may be seen by their primary care doctors, counselors, psychiatrists, or psychologists. But, what makes these professionals different? All physicians, either M.D.’s or D.O.’s (Osteopathic Doctors), have similar training. Most often, they have completed four years of undergraduate school, with an emphasis on science courses including biology and chemistry. Then they must pass an entrance exam to start a four-year medical school program where they will receive two more years of core science training as well as other courses to help them understand the human body, disease, and prevention. The last two years of medical school focus on clinical rotations through surgery, OB/GYN, psychiatry, internal medicine, family medicine, and include several months of extra training in a specialty area.
Upon completion of medical school, you are officially referred to as “doctor,” but a psychiatrist’s training does not end there. A residency program comes next with hands-on training under the guidance of a more seasoned physician. Take my background for example. As a psychiatry resident, my first year of residency training included two months working on an inpatient pediatric floor, two months on an inpatient general medical hospital floor, and two months on a neurology service. These rotations are important in psychiatry training because psychiatric patients often have other medical issues in addition to mental health problems. A physician should know the difference between anxiety and a heart attack.

It takes eight years or more of school and four to six years additional years of training to become a fully practicing psychiatrist. I’m on that path, and now I will be able to focus on my psychiatry specialty. That will give me the opportunity to learn the science and art of treating patients from experienced psychiatrists. My integrative medical training will also provide a solid foundation to work with a variety of patients and their mental illnesses.

Wednesday, December 1, 2010

Finding Meaning in Modern Life - Part 2

By Roberto Blanco, M.D.
Last month, I wrote about Viktor Frankl’s book “Man’s Search For Meaning” and how some of the principles in his book could be applied to modern life. In response to the blog, one of the readers, Mukesh Samani, asked what it was in Dr. Frankl’s book that touched me the most. I would like to take this opportunity to thank Mr. Samani for his question and to respond.

What touched me the most from Dr. Frankl’s work was his motivation to live, share his experience, and teach something positive. As a psychiatrist during a time when any type of self-revelation was taboo and frowned upon, he showed great courage in revealing some of the darkest, innermost details of his life to the entire world. He did this so others could learn from his experience.

As a Psychiatrist, I work with many people who may be down on their luck or are the victims of unfortunate situations. Like Dr. Frankl, the ones who are able to discuss their situation, find some meaning from it, and continue to move forward, generally do the best.

Mr. Samani also asked what is special or specific in Dr. Frankl’s model of psychotherapy known as Logotherapy. Mr. Samani, I would refer you back to Dr. Frankl’s book which has a nice summary on Logotherapy. I am not an expert on Logotherapy. However, in short, it is a therapy which focuses on man’s desire to find meaning as the main motivating force in life.

I see following role models, like Dr. Frankl, as a way to find meaning in life. Looking back on your own life, is it clear which people affected you the most in positive ways? What was it about these people that moved or affected you? Did they have some special characteristic that set them apart from others or allowed them to connect with you? If so, finding out what that is and trying to reproduce it with others can give your life more meaning.

I have a lot of admiration for Dr. Frankl’s work and I appreciate the comment from “Mary” about a new documentary coming out on his life titled “Viktor and I.” I’ll be interested to see how he used his experiences in his professional life and what he was like on a personal level from the perspective of his close friends, family and colleagues. Thank you for your comments and questions.