What to do about side effects of antidepressant medications?

By Felicia K. Wong, M.D.

There are various treatment options for depression including therapy and medication. Antidepressant medications can be extremely helpful to the recovery and healing process of someone suffering from depression. However, sometimes medications that are meant to help may cause unpleasant side effects. The most common symptoms my patients report include headache or upset stomach. These typically improve after a few days and go away within a few weeks. If such side effects remain, you should discuss other options with your doctor / psychiatrist. He or she can try a different medication or treatment option; just be sure to stay in touch with your physician to find the best treatment choice for you.

If the side effects seem intolerable, you may be tempted to stop taking an antidepressant or to reduce your dose on your own. Don't do it. Stopping your antidepressant suddenly may cause your symptoms to return and could cause an unpleasant withdrawal-like reaction. That’s why it’s so important to talk to your doctor.

The Mayo Clinic provides a wonderful resource with practical tips for coping with some of the most common side effects of antidepressant medications that includes explanations for the side effects. For example, sometimes people may gain weight because of fluid retention or lack of physical activity, or because appetite returns or improves when depression symptoms ease up. The resource also presents coping strategies such as cutting back on sweets and sugary drinks, avoiding fast food, and getting regular exercise most days of the week – since exercise is also known to help with depression.

Find more tips at Mayo Clinic online.

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Too Much of a Good Thing: Exercise Addiction

By Claudia L. Reardon, M.D.

We all know it’s possible to have too much of a good thing. But can that apply to exercise too? Many people struggle to exercise even a small amount, so it might be hard to imagine that "exercise addiction" could be a problem. However, research shows that it can be, with one report estimating that 3% of the population could be addicted to exercise.

Some researchers suggest the following symptoms for "exercise addiction." These are some of the same symptoms of other addictions like alcoholism.

·    Tolerance: increasing the amount of exercise in order to feel the desired effect, be it a “buzz”  or sense of accomplishment.

·    Withdrawal: in the absence of exercise, experiencing negative effects such as anxiety, irritability, restlessness, and sleep problems.

·    Lack of control: unsuccessfully attempting to reduce exercise amount or to stop exercising for a certain period of time.

·    Intention effects: unable to stick to one’s intended routine as evidenced by exceeding the amount of time devoted to exercise or consistently going beyond the intended amount.

·    Time: a great deal of time is spent preparing for, engaging in, and recovering from exercise.

·    Reduction in other activities: as a direct result of exercise, social, occupational, and/or recreational activities occur less often or are stopped.

·    Continuance: continuing to exercise despite knowing that this activity is creating or worsening physical, psychological, and/or relationship problems.

·    Behaviors and conditions that often occur together with "exercise addiction" are eating disorders, excessive use of substances such as caffeine to improve athletic performance, and "work addiction."

It's important to point out that not all people who exercise at an intense level have an addiction. For example, competitive athletes often need to spend significant time and energy to their sports. Also, many people may be highly committed to their exercise routines without experiencing the negative effects that go along with an addiction. 

Usually, exercise is a very healthy and positive behavior, and most people benefit from a regular exercise schedule. However, if you think you or someone close to you may be suffering from "exercise addiction," you should seek help from a doctor. Cognitive behavioral therapy may be used to bring a patient back to a normal exercise schedule.

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Suicide Prevention for Seniors and African Americans

By Gina N. Duncan, M.D.

Don Cornelius’s death shocked many of us. The report that his death was a suicide has made it all the more tragic. Best known as the founder of Soul Train, Don was an icon in American music history. Unfortunately, as noted by others commenting on his death, the “Love, Peace, and Soul” he promoted as a public figure may have eluded Don in his personal life, particularly in his later years.

Now we are further shocked by the untimely death of Whitney Houston. Her battle with drug abuse was well known, though the cause of her death has not yet been determined. In our sensational, media-driven culture, the very personal details of celebrities’ mental, emotional, and family struggles are often on display for public entertainment, sympathy, judgment, and criticism. In recent years, with the tragic losses of Michael Jackson, Amy Winehouse, Heath Ledger, and others, the dangers of illegal and prescription drug abuse have been given an increasing spotlight in the media.
 

Don Cornelius’s death, however, highlights two mental health issues that are significantly under-discussed in the public: suicide in African Americans and in seniors.

Depression is under-diagnosed in older adults. It often co-occurs with medical illnesses such as heart disease, diabetes, stroke, and cancer, and can be associated with the social difficulties and financial strain many older adults experience. Because of this, we tend to accept depression as a natural consequence of aging, but this is not so. When depression is present, it not only diminishes a person’s quality of life but also increases his / her risk of death by delaying or worsening recovery from the medical illness or by suicide. Depression is also under-recognized and under-treated among African Americans and other minorities. 

I recently spoke at a National Alliance on Mental Illness (NAMI) program called "Sharing Hope: Understanding Mental Health" in Augusta, GA. “Sharing Hope” is an educational program designed to raise awareness of mental health issues in African American church congregations. One woman there told us that her brother had died from suicide not long ago. She explained that he had been troubled for some time and had made threats before but not acted on them. She asked: Were there signs she and her family missed? Was there some way they could have prevented it? She expressed feelings of guilt and shared that she and her family blamed themselves for not having done more, yet at the same time, they didn’t know what more they could have done. 

My heart goes out to her and to anyone who has been affected by the suicide of a loved one. Feelings of guilt, self-blame, and shame are common. Perhaps some consolation can be found in the recognition that it’s impossible to fully control the decisions and actions of another adult. There are support groups for survivors of suicide that provide a place to express these complex emotions. Seek support from your faith if that is relevant to you, and tune out those who would make negative remarks about your loved one's fate after death, as none of us have the final say in that matter. 

The best suicide prevention is early recognition and treatment of depression. Depression may be masked by factors such as medical illness, dementia, personality style, and other mental illnesses, so understand the symptoms. 

If you are concerned about a loved one, please follow these suggestions:

1)  Do not be afraid to ask if they are considering suicide--you will not plant the thought in their mind by asking.

2)   Stage an intervention if necessary, where you can express your concerns and encourage them to get treatment.

3)  Take any and all threats or gestures seriously--seek help from their doctor immediately or call 911.

We should celebrate the achievements of Whitney Houston, Don Cornelius, and the other amazing talents we’ve recently lost; our lives are richer for their contributions. I hope that by raising awareness of these critical mental health issues, their untimely deaths will cause others to seek help and to heal. 

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Fight for Your Right to Behavioral Health Benefits

By Carol McDaid, Co-Chair of the Parity Implementation Coalition

In 2008, Congress passed a law that requires health plans to provide benefits for addiction and mental illness that's equal to other medical benefits. Unfortunately, many people still don't know about this law called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (named after two bipartisan senators who experienced addiction/mental illness in their families).

Parity is personal to me. Did you know that 23 million people have a diagnosed substance use disorder but fewer than 10% receive any help for that condition? I am one of the lucky ones who got the treatment I needed to recover. When my insurance failed twice to provide the coverage promised in my employer-provided health benefit package, I got support from family and employers to help pay for the care I deserved.

When my insurance company refused to pay for any of my last residential treatment (after years of failed attempts at outpatient programs), I fought back. I used all of my internal and external appeals rights. It took me three years and a blizzard of paperwork, but one day a check for half of my treatment appeared in the mail.

Sadly, the average American family with a loved one suffering from addiction or mental illness lacks the resources to fight a three year battle with their insurer to get benefits they are entitled to - by law. Often afraid to discuss their illness with employers, they suffer in silence rather than using their behavioral health benefits promised by insurers. These victims become sicker and even unemployable – causing the burden of paying for their treatment to be shifted to the public sector, where taxpayers like you and me are forced to pick up the bill for health plans that simply will not pay their fair share.

Today, I use my skills as an advocate and former employee benefits analyst to fight for the rights of those coping with addictions and mental illnesses. I'm driven by the passion of my personal parity experience with insurance discrimination and my sense of justice and equality. Help for these conditions should not be limited to those who can afford to pay out-of-pocket or have the fortitude to fight long battles with insurers.

If you or a loved one have been unable to get your insurance to pay for addiction or mental health treatment, please share your story. 

I've been in the halls of Congress fighting this fight since 1993. I realize that laws and regulations are complex and often take many years to be fully implemented. I intend to fight this fight as long as it takes to end insurance discrimination against people suffering from addiction and mental illness. But, to be successful, we need your stories and a collective sense of outrage.

Join me. Share your personal parity story by sending an email to hsf@psych.org. Fight for your rights. Every 15 minutes in the U.S., someone dies from suicide. The clock is ticking.

Petitions by iPetitions.com

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Living in the Moment with Mindfulness

By Brandon Cornejo M.D., Ph.D.

I hope your first week of 2012 was a good one! How are those New Year's resolutions going? If your goal is to exercise more, my "Mindfulness" two-part blog post should help you stay motivated. In part-one of my post, I discussed the concept of "mindfulness" or living in the moment.

Now I will share how you can use mindfulness to stay focused on a particular goal like exercising. Since exercise and mindfulness enhance mood, decrease stress, and improve negative thinking, these tips will benefit us all as we enjoy 2012!



Tips for staying in the present moment while exercising:

·         One of the most basic tools that you can use in mindfulness is your breathing. By focusing on the sensation of air traveling in and out of your body (just like you do during meditation), you can be grounded in the present moment.

·         You may also try a mantra to stay in the "now" (for example, runners often count out their footsteps – “1, 2, 3…1, 2, 3” – or a mountain biker or skier may constantly remind themselves to “relax”).

·         Applying either technique will keep you in the moment rather than thinking about negative thoughts and feelings that influence behavior in a non-productive fashion during your exercise.

·         Paying attention to physical feelings of your body and your surroundings as you exercise will prevent you from going into “automatic pilot” (when you act and react without conscious awareness).

·         By learning to stay present, you can accept physical discomfort as a temporary state that will soon pass.

·         As you continue your workout, you can “label” both positive and negative thoughts that occur while exercising. Labeling these thoughts will help you understand which thoughts and feelings are limiting your success and need to be changed.

Try out some of these tips and see how you start removing unwanted negative thoughts to overcome challenges that may have held you back in the past. Mindfulness matters when it comes to achieving that New Year's resolution this year.

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