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.

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.

Parenting in the Internet Age

By Molly McVoy, M.D.

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:

http://www.webwisekids.org/

http://www.kids.gov/6_8/6_8_computers_internet.shtml
http://www.attorneygeneral.gov/uploadedFiles/Consumers/cybersafety.pdf

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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.
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Coping with Stress in America

By Adair Parr, M.D.

A 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.
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Where to go for Mental Health

By Sara Coffey, D.O.



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.

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.

National Caregivers Month: Alzheimer's Disease

By Felicia Wong, MD

Alzheimer’s Disease is a progressive, irreversible brain disease. The cause is poorly understood, and there is no known cure. Symptoms of Alzheimer’s include memory loss, confusion, impaired judgment, personality changes, disorientation and loss of language skills. It is the most common form of irreversible dementia.

Watching someone you love slowly lose their memory, thinking and reasoning skills can be heartbreaking. Caring for a person with Alzheimer’s Disease is a difficult task and can become overwhelming at times. As Alzheimer’s patients gradually lose their memory and their skills , each day brings new challenges to the caregiver. This is why I wanted to recognize caregivers for Alzheimer's patients in November, which is National Family Caregivers Month and Alzheimer's Disease Awareness Month.

Over time, communication diminishes, rewards decrease, and without strong support from family, friends and the community, caregivers of Alzheimer's patients face challenges to their very own well-being. Maintaining emotional and physical fitness while providing care for a loved one with Alzheimer’s Disease is crucial. Preparing and protecting yourself, understanding your loved one’s experience, and accepting help from others can reduce the stress associated with care-giving, and maximize the joys of being there for a loved one.

Here is a link to tips to help caregivers of loved ones with Alzheimer’s cope.

Additional support for Alzheimer’s and Dementia Caregivers, including warning signs of caregiver burnout, and tips on how to plan your own self care can be found on Helpguide.

Find additional information on Alzheimer's and other issues affecting mental health in seniors on the American Psychiatric Association's Healthy Minds website.
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National Family Caregivers Month: Self-Care for Caregivers

By Felicia Wong, MD

I love helping others. That is why I became a doctor, and why I love my job as a psychiatrist. But when I was a pre-medical student in college, my mom shared the following words of wisdom with me:  “In order to take care of others, you need to take care of yourself first.”

It took me a moment to understand the importance of the point she was making. I had taken a break from my community service projects due to a sports injury, and was eager to return to them. However, at that time, I was not fully recovered and was often in pain, and would tire easily. My mom encouraged me to take some more time off in order to focus on my own recovery and healing. Initially, I felt guilty taking the time out for myself. But in the end, I realized mom was right. Once I became strong and well again, I had so much more to offer to others.

Caregivers tend to be selfless, and expect a lot of themselves without recognizing their own need for self-care. Studies have found that caregivers have higher levels of depression and stress than non-caregivers. Sometimes caregivers are so committed to helping others that they forget to take care of themselves. They fail to recognize that if they drive themselves to exhaustion or sickness, they may not be able to help at all.

Warning signs of caregiver burnout from the non-profit Helpguide.org include:

• You have much less energy than you used to
• It seems like you catch every cold or flu that’s going around
• You’re constantly exhausted, even after sleeping or taking a break
• You neglect your own needs, either because you’re too busy or you don’t care anymore
• Your life revolves around caregiving, but it gives you little satisfaction
• You have trouble relaxing, even when help is available
• You’re increasingly impatient and irritable with the person you’re caring for
• You feel overwhelmed, helpless, and hopeless

Key strategies to prevent burnout include getting the help you need, seeking emotional support, and taking time out to care for yourself.

• Learn and use stress-reduction techniques.
• Attend to your own healthcare needs.
• Get proper rest and nutrition.
• Exercise regularly.
• Take time off without feeling guilty.
• Participate in pleasant, nurturing activities.
• Seek and accept the support of others.
• Seek supportive counseling when you need it, or talk to a trusted counselor or friend.
• Identify and acknowledge your feelings.
• Change the negative ways you view situations.
• Set goals.

For additional strategies for self-care for caregivers, visit the Family Caregiver Alliance, and watch for my next post on caring for someone with Alzheimer's. 

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National Family Caregivers Month

By Gariane Gunter, M.D.

November is National Family Caregivers Month and what a worthy group to stop and recognize. Those who are caregivers for family members or friends with mental illnesses need support and encouragement just as those caring for loved ones with other illnesses. There are many groups and resources available across the nation that are available to help. I would like to tell you about one of them.

The National Alliance on Mental Illness is a grassroots organization that was started in 1979. I have had the wonderful opportunity to work with them in my area and have seen firsthand the difference they make in the lives of those suffering from mental illnesses as well as their families. One special program they offer for family members is called Family-to-Family. The NAMI Family-to-Family Education Program is a free 12-week course for family caregivers of individuals with severe brain disorders (mental illnesses). NAMI recognizes that family members of people with serious mental illnesses need information and support to cope with the considerable stresses they experience.

The Family to Family Education Program is a structured, peer-led, 12-week information and support self-help class for such individuals. Research shows reduced subjective burden and increased empowerment among graduates. Family-to-Family classes are offered in hundreds of communities across the country. You can find more information on this program as well as many other resources available in your area by visiting NAMI online at www.nami.org. There you can find a support group, connect online in NAMI's discussion groups, contact your state or local NAMI and more. Caregivers please take the time to take care of you this month.
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Concussion: Getting Back in the Game?

American Psychiatric Association Healthy Minds blogger and sports psychiatriy expert Claudia Reardon, M.D., discusses concussions in young athletes in this video blog:

Depression: Should I Tell the Boss?

By Gina Newsome Duncan, MD

Depression is the leading cause of disability among people ages 15-44, affecting nearly 7 percent of the adult population in a given year. That means that close to one in ten American adults is suffering from depression at any given point in time. A recent CNN Health article highlighted the dilemma one woman with depression faced when considering whether to tell her employer.

It may not be talked about much, but depression is most certainly present in the workplace. What are the effects? People suffering from depression can experience a decrease in concentration, difficulty making decisions, feelings of isolation, feeling slowed down in their thinking and mental processing, and poor sleep, which can lead to daytime fatigue. All of these factors can result in poor job performance. In fact,a decline in job performance is often the wake-up call that someone is experiencing depression and needs to do something.

If you feel that you may be suffering from major depressive disorder and are concerned about the effect on your work, what should you do?

1. A good first step is to talk with a psychiatrist or your primary care physician about your symptoms and explore possible treatment options. Psychiatrists and primary care physicians are familiar with employment issues and should be able to get you started on a plan to address your concerns.
2. Find out about your company’s Employee Assistance Program (EAP). It is in your company’s best interest for you to function at your optimal level, and most large companies offer some type of EAP. In most cases, confidentiality and privacy requirements apply to EAP services, and the employer does not usually know who is or is not using them, except in cases where the employer referred the worker to the EAP. Employee Assistance Programs offer a broad range of services, including psychological assessment, counseling, support and referrals.

Other things to keep in mind:

Depression is real, but it is not as visible as something like a broken leg. Depression can be difficult for others to accept as a true illness or valid reason for being excused from work. As a society, we can be stoic when it comes to issues of emotional distress; “Just suck it up and keep going,” we tell ourselves and others. It can be hard for others to understand or appreciate the effects of a major depressive episode or another mental illness unless they or a loved one have experienced it. Employers are beginning to understand that attending to their employees’ mental health is not just a nice thing to do, it makes good business sense.

Federal laws protect the rights of workers who become medically ill or disabled. This includes workers who are unable to work due to a mental illness such as major depression. However, employer sensitivity toward such employees can vary, particularly if the employee has not taken official medical leave but is frequently calling out sick or requesting time off for regular psychiatrist or therapist appointments during work hours.

Whether or not to disclose your illness to your boss and/or your coworkers is an individual decision that depends on your company’s culture and your own preference. But here are a couple of thoughts to keep in mind: If your symptoms are not affecting your job performance in a visible way and if, with the help of your doctor, you have started a treatment plan that you are finding helpful, then disclosing your illness to your employer may not be necessary. If, on the other hand, your symptoms are severe, causing frequent missed days of work or other job performance issues that threaten your employment, and if you have not yet started treatment, then being proactive and addressing the issue with someone you trust, like a doctor, Employee Assistance Program or a boss, can be an important step.

Have you experienced firsthand the effects of depression in the workplace? If so, how was it addressed? How can we reduce the culture of stigma that surrounds mental illness in the workplace?
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Family-Based Treatment May Benefit Teens with Anorexia

By Molly McVoy, MD

A recent Wall Street Journal article reported on a study regarding teens with anorexia. The results of the study, published in the Archives of General Psychiatry, indicate that having parents actively involved in the treatment of adolescents with eating disorders is more effective than the traditional one-on-one treatment with a therapist.

The study looked at 120 teenagers using the Maudsley model versus traditional one-on-one therapy. The Maudsley model encourages parents to take charge of the eating habits of their children with eating disorders, such as anorexia. At one year, the study found that about 50 percent of patients treated with this family based therapy were in remission versus 23 percent in the more traditional individual therapy.

Anorexia nervosa is a serious, often life-threatening illness in which patients fear gaining weight to such a degree they restrict their diet and maintain a body weight below the 85 percent of a healthy weight. Successful treatment is intensive, involving medical monitoring, dietary interventions, therapy and, at times, medication.

This study adds to accumulating evidence that family involvement is critical in successful treatment of adolescents with eating disorders. As more studies are published with similar data, treatment centers for eating disorders and increasingly involving families in the intensive treatment programs.

The HealthyMinds.org has more information on eating disorders. 

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ADHD: Can My Kid Just Outgrow It?

By R. Scott Benson, MD


Won't he just outgrow it? This is the wish of every parent – that a little time, a little more love, or discipline, or happy thoughts will solve what might be a serious problem. And I hear this question often from parents of pre-schoolers who are having behavior problems in pre-K programs or daycare settings.

But we can’t wait. And now there is even more research to support the importance of a careful evaluation and treatment when indicated. This month’s Archives of General Psychiatry reports the results of a long term study of children who were diagnosed with ADHD between the ages of 4 and 6 years old. There was a control group of children without ADHD. As adolescents the children with the early diagnosis of ADHD had higher rates of depression and suicidal thoughts. Fortunately, there were no suicides in this study. Benjamin Lahey, Ph.D., the study director is a professor of health studies and psychiatry at the University of Chicago. He said the study “reinforces our belief that parents of young children with ADHD should pay close attention to their child’s behavior and its consequences and seek treatment to prevent possible long-term problems.”

So the better question is “What treatment is recommended for pre-schoolers?” And we have good science to help answer that question. Carefully managed studies have shown that pre-school children and their families should have at least 12 weeks of behavior management training as a first level of care. And this is not just any behavior management. At a conference in Florida, Dr. Regina Bussing recommended that families should consider a number of behavior training programs – the Positive Parenting Program, The Incredible Years, and Parent Child Interaction Therapy. These are intense programs that are very different from a few words of advice from a well-meaning pediatrician or the do-it-yourself manuals that are so prevalent in the bookstores.

Let us know of other successful behavior training programs in your community, and we will post those links here.

Supporting Gay Youth as a Way to Prevent Suicide

By Tristan Gorrindo, MD

Coming out of the closet is one of the hardest things that a gay, lesbian, or bisexual person will do.

“Coming out,” is the process of revealing to friends, parents, family members, and acquaintances that he or she is gay. It is more that just a simple act or decision to announce that a person is gay, but rather a process that unfolds overtime, usually in small steps. For many people, it involves telling one person, then a group of friends or family members, then classmates or co-workers, and finally the world at large. But for each person, the journey is different and often filled with emotional ups and downs.

Recent events in the national media have highlighted the issues surrounding coming out and youth suicide. By some estimates, as many as nine gay youth died by suicide since September 1, 2010. Government officials and celebrities have publicly referred to this as a national crisis.

Many population scientists have tried to understand why gay teens are at such high risk for suicide -- by some estimates 7 times the national average for their age. And although there are many possible contributors to what might make a gay teen suicidal, we must first remember that all teens, gay and straight alike, are struggling with basic questions about self-identity.

A friend of mine once described being a teenager is like, “being at a costume ball where the costumes and guests are constantly changing.” As part of normal teenage development, teens are “trying on” different roles, different groups of friends, and even different kinds of dress. It is a time when teens are first experimenting with the idea of romantic relationships and at the same time trying to separate from their parents. Gay teens have the added burden of sorting out the confusing, often negative messages from the culture about what it means to be gay. When these ingredients mix -- unsure sense of self-identify, novice experience with romance, trying to separate from one’s parents, and fear of what it means to be gay -- gay teens run the risk of feeling quite isolated and alone.

Regardless of one’s personal views of homosexuality, I think we can all agree on the importance of supporting our youth during difficult times. The American Psychiatric Association is committed to reducing the stigma around homosexuality and to promoting the psychological health of gay, straight, and bisexual individuals.

We owe it to our teens to make sure that they know that coming out is not a process that they have to go through alone. A wide variety of resources exist, from grass-roots YouTube videos which offer gay teens hope, as in The Make It Better Project, to 24-hour suicide hotline for gay teens offered through The Trevor Project. Additionally, The National Suicide Prevention Lifeline also is available 24/7 at 1-800-273-TALK (8255) to anyone struggling with suicidal thoughts. The Healthy Minds website is a source of clear factual information on sexual orientation. And let us not forget the parents that may also be struggling with how to help their gay child; for them there is support and advice offered through PFLAG.
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Anger: A Complicated Emotion

Anger is a normal emotion that can be useful in coping with the world. But anger expressed in excess or suppressed can cause problems. Healthy Minds blogger Molly McVoy, M.D., talks about anger, how to recognize inappropriate anger and what to do about it.

Athletes Suffer from Depression Too

By Claudia L. Reardon, M.D.

Athletes don’t get depressed, right? After all, they are so physically fit and healthy that they must be equally emotionally healthy. Unfortunately, this is not true. Just like the rest of us, athletes can be at risk for depression. This is the case all the way from the school-aged child playing on a recreational team, up to the professional athlete who makes a living playing his or her sport.

Whenever we see a news story about a famous athlete with depression or an athlete who has committed suicide, it tends to come as a big surprise since athletes tend to be glamorized and admired in our society. However, here are some things we know about the reality of depression in athletes:

1. Athletes seem to be at least as likely as the general population to suffer from depression.

2. Athletes who suffer multiple concussions are up to four times as likely as other athletes to suffer depression. Athletes in some sports, including football, hockey, and soccer, are especially likely to suffer concussions.

3. Overtraining syndrome can occur in athletes who are seriously training for an event and do so beyond the body’s ability to recover. Overtraining can look very similar to depression and can actually lead to full-blown depression. Like depression, overtraining can include fatigue, insomnia, appetite change, weight loss, difficulties with motivation, and poor concentration. Overtrained athletes usually notice that their sports performance worsens. They may develop more injuries; experience muscle and joint pain, and lose enthusiasm for their sport. If an athlete is overtrained, the treatment is usually to cut back on physical activity or do cross training at a lower intensity until the symptoms start to improve. If overtraining leads to full-blown depression, medication and/or talk therapy may also be helpful.

4. Besides concussions and overtraining, other common factors that can lead to depression in athletes include injuries, competitive failure, aging, retirement from sport, and the same daily stressors that can lead to depression in the general population.

5. In recent years, athletes across several sports have started to open up about their struggles with depression. Hopefully this will help athletes with depression to feel better about seeking help for this disorder.
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Working with Schools When your Child has Problems

By Gariane Gunter, M.D.

Well, we have made it through the first months of a new school year! However, for some students the start of a new year has been difficult. I have received many calls and heard numerous concerns from parents who are wondering how they can work with their child’s school to ensure a success. Below is a list of the Top Ten Tips for Working with Schools that was shared with me by a Lead School Psychologist in my area. I hope you have a great year!

Top Ten Tips for Working with Schools

1. Let the school know up front if you have concerns
2. It helps to be visible in the school but do not intrude on the learning
3. Every school is a little different in its approach

4. There are lots of different ways of working with student problems in schools. Not just one of them is right. 
5. If you want to talk to a classroom teacher, ask to make an appointment with them. When teachers are with students, their first responsibility is to teach and supervise them.
6. School folks got into education for the joy of working with students.
7. School Psychologists and Special Teachers are there to study individual students. Help them by giving your specific observations. Your observations matter.
8. Lots of teachers and other school folks use e-mail, but remember that teachers check e-mail when they have planning or breaks.
9. If you have made a request and you haven’t received a response, don’t wait too long before asking about it. Sometimes requests do get lost.
10. Schools can be fun places to be; it is where all children gather to learn. Enjoy your time there too!

Reference: Shirley A. Vickery, PhD

A Parent’s Guide To Social Networking

By Adair Parr, M.D.

If you are like most parents, your teenager knows more about social networking than you do. According to a Pew Internet Project study, nearly three-quarters of teens online use social networking sites. What’s more, many teenagers now access social networking through cell phones, further increasing their online presence. The phenomenal rise of Facebook is documented in the movie, The Social Network, which was number one at the box office this past weekend.

Are your teenagers on Facebook? Are you wondering where to draw the line? Many parents feel overwhelmed by understanding media and technology and feel that they will never catch up to their kids. While you may not text as fast as they do, making an effort to learn about social networking is important. Teens are designed to experiment with risky behavior and social networking is one area in which they may try such behaviors. By educating yourself on the topic, you will be better prepared as a parent to help your child to use media and social networking responsibly.

What can you do to help ensure your teen’s responsible use of social networking?

1. Talk to your kids about the media in their life. Ask your teen how social networking changes lives.
2. Keep the lines of communication open with your teen. Know who they are communicating with online.
3. Remind your teenager to limit the amount of personal information online.
4. Remember that everything your teenager posts is public information. Once it is posted, it is online forever.
5. Educate your teenager about cyberbullying and what to do if he or she is a victim of cyberbullying.
6. Model responsible media use behavior for your teenager.

The Healthy Minds website has additional information about mental health for college-age students and children. Check out these resources to help parents navigate the murky waters of social media:

• Common Sense Media
• Be Net Savvy
• Net Lingo
• Facebook Safety
• Frontline, KidsOnline 

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It's Not Your Fault

Healthy Minds. Healthy Lives. blogger Gariane Phillips Gunter, MD, talks about how individuals with mental illnesses cannot be blamed for mental illness and how to get help for someone struggling with mental health issues.

Finding Meaning in Modern Life

By Roberto Blanco, M.D.

During recent travels, I visited the Yad Vashem Holocaust Museum in Jerusalem and came across Man’s Search for Meaning at the bookstore. It is written by Dr. Viktor Frankl, a Viennese professor and psychiatrist before World War II, who became a holocaust survivor. Dr. Frankl narrates his experiences and observations in different concentration camps and describes how, against all odds, he survived.

Dr. Frankl, however, did not intend the book to be solely a tale about survival. As he explained in his preface to the 1984 edition, he wrote the book so that others could see concretely that life, even in the most hopeless and miserable conditions, holds meaning. He wanted to show how having meaning in one’s life is the most important aspect to living fulfilling lives. In the book, Dr. Frankl proposed that he was able to survive because of luck and because his faith that his survival had some great meaning was unshakeable. During years spent in brutal conditions in concentration camps, Dr. Frankl was able to endure by finding some goodness to hold on to, even if sometimes this goodness could only be found in his head. He also observed how those who eventually lost motivation and hope usually did not survive much longer.

It is difficult not to be inspired by Dr. Frankl’s story, but it makes me think about how difficult it can be to feel fulfilled in our modern world. How can a man who had everything in his life taken away from him, find more meaning in his life than many who have all of the freedoms and material possessions they could want? I think that the answer lies in slowing down to appreciate the little things in life and to appreciate the meaning of it all. Every day should serve as a challenge to find a meaning, even if it is a small one.

The ways in which people find meaning depend on their age, current role in life, and developmental stage. Some people are motivated by special people in their lives; the relationships that provide meaning often change as people become independent of parents, find partners, and then have children of their own. Others develop a relationship with a higher power, which also can change as they grow and change themselves. And finally, having a mission, vocation, or cause often gives people meaning to their lives. These often change, as well, as people change careers, go back to school, or have other new experiences.

On a day-to-day basis, here are some things that you can do to answer the challenge of the day:

1. Be kind to another person.
2. Strike up a conversation with a friendly stranger.
3. Re-connect with an old friend.
4. Reminisce about that special memory that brings back positive feelings.
5. Further your cause or mission in some way.
6. Participate in a favorite hobby, sport, or special interest.
7. Pray.
8. Go for a walk.
9. Tell that special someone how you feel about them.

I’m interested to hear, what is it that brings meaning to your life?

Mental Illness in School: No Child Left Behind?

By Molly McVoy, M.D.

How much do I tell my child’s teacher about her depression? About his bipolar disorder? About her ADHD? Will he fall behind if the teacher doesn’t know? Will she be judged if I tell the school? When do I get testing, an IEP, special Ed? What do those mean?

Parents of children with psychiatric illness struggle with these questions and many others. Often, there are no easy answers. A child’s success at school may be one of the best predictors of future success. Giving a child and his/her family the best tools to succeed in school is one of my top priorities as a child psychiatrist.

When deciding how much to tell your child’s school about his/her psychiatric illness, consider your child’s ability to function at school rather than his/her specific type of illness. You are not required to tell the school anything; that is up to you as a parent. If telling your child’s teacher about his/her psychiatric illness will give him/her a better chance to do well, then consider telling the teacher. If your child’s illness is affecting his/her day to day functioning and behavior at school, then consider telling the teacher. Teachers are your partners in helping your child succeed. If the illness is relatively well controlled and is not affecting his/her daily behavior at school, the school may not need to know. For more information, visit the American Academy of Child and Adolescent Psychiatry.

When it comes to accessing special education services, most schools and teachers want to do everything they can to help your child. I usually recommend families listen to the principal and teachers.They are the experts in education. However, if you are dissatisfied with the educational services you are receiving, my next recommendation is know your rights, know your state’s laws. Every state must provide a free education that meets the needs of each child – no matter what those needs are. What varies widely, however, is how each state manages that requirement. The U.S. Department of Education website has basic information on your rights as a parent and offers links to each state.html. Know your state law, know your rights. Come armed with that information and work with your doctor and school for your child to succeed!

Mental Health Disparities – Focus on Asian Americans

By Felicia Wong, M.D.
APA's Division of Diversity and Health Equity works to promote diversity and cultural competence and to eliminate disparities in mental health care. They published a report on Asian Americans and Mental Health that revealed some troubling statistics.





photo courtesy Bjoern Kommerell

• While the overall prevalence rate of mental illness is similar or somewhat lower among Asian Americans than whites, Asian Americans are significantly less likely to use mental health services than other populations.
• Asian Americans are much less likely than whites to report mental health problems to friends or relatives, psychiatrists or other mental health specialists, or to physicians. It has been postulated that shame and stigma figure prominently in the lower utilization rates of Asian American/Pacific Islander (AA/PI) communities.
• AA/PI’s often consider expression of mental illness a personal weakness and are more likely than Westerners to express emotional distress through physical symptoms.
• The suicide rates of elderly Asian American women and young Asian American women (15‐24 years old) are significantly higher than that of other women of the same ages.

In an attempt to address the barriers to mental health care that pertain to the Asian American community, I created a website http://www.asianmentalwellness.com/ which I hope will dispel some of the misconceptions that the AA/PI community may have about mental health, and will provide information and links that will help raise awareness about the importance of mental health and wellness. Please share this website with those who you feel might find it useful.
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Adult ADHD? Not just a diagnosis for kids

By Felicia Wong, M.D.

There have been several posts addressing ADHD in children on our blog, but did you know that ADHD can affect adults as well? An interesting article in the Wall Street Journal discusses adult attention-deficit/hyperactivity (ADHD) disorder, a condition that may affect up to 10 million Americans, only 4.4 percent of whom know it.

According to government data, an estimated eight percent of U.S. children have ADHD, and some 50 percent outgrow it. But what happens to those who don’t?


It was only in 1980 that therapists began to recognize that ADHD could persist in adults, and even now, getting an accurate diagnosis is tricky. It is controversial topic that has people taking sides. Some experts think that too many adults (and children) are being medicated for ADHD, often by doctors who have little knowledge or experience with this disorder. Others argue that those adults who have experienced functional impairment could benefit from ADHD medications and behavioral therapy.


Some adults whose ADHD is left untreated can encounter negative consequences including high incidence of substance abuse, automobile accidents, difficulty staying employed and maintaining relationships. Yet, adults with ADHD can also be highly intelligent, energetic, charismatic and creative. Those with ADHD may have the ability to focus intently on a narrow range of topics that interest them.


Many adults with ADHD have developed skills to compensate for their distractibility. Some excel in school at an early age, and don’t run into any problems until college/ grad school or starting at a challenging new job. Suddenly, their coping mechanisms are not as effective anymore.

An excerpt from the Wall Street Journal article:

We see people from all of the professions who have managed to succeed despite the limitations,  but they have often done it at significant cost," says Dr. Solanto. "They don't have time to enjoy life. They don't get their work done in the course of a day. They have to stay late after hours, or they are doing without sleep, frantically trying to meet deadlines. It ultimately takes a toll on their wellbeing and a toll on the people around them.

Adult ADHD is tricky to diagnosis and deciding whether to get help for it can be difficult as well. The symptoms that traditionally describe ADHD: restlessness, impatience, procrastination, chronic lateness, and difficulty getting organized, focusing, and finishing tasks are common in busy adults. But how can one tell if it’s just stress, or too much caffeine that is causing their symptoms? What about the stigma and perceptions associated with ADHD? What does it mean to suddenly discover at the age of 40, that you have ADHD?


The key word in determining whether an evaluation should be considered is impairment. As Dr. Jaksa from the article puts it, "Everyone gets distracted. Who's not late occasionally? But if you are chronically late, you lose your job and maybe your friends as well."


Experts say that those who suspect they have ADHD should have a thorough evaluation, with a psychologist or psychiatrist who specializes in the disorder, looking at how they functioned in early childhood, in school and social settings and personal relationships. Once ADHD is diagnosed, most experts recommend treatment with both medication and behavioral therapy.


Here are some adult ADHD key points:


• Adult ADHD can be comorbid with bipolar disorder, anxiety, and depression, further complicating diagnosis and treatment.


• For adults diagnosed with the condition, treatment can consist of behavioral therapy, medication, or both.


• People who think they may have ADHD should be evaluated by a psychiatrist who understands the disorder.


A recent study published in the August 25 issue of the Journal of the American Medical Association, cognitive behavioral therapy (CBT), "a form of psychotherapy that focuses on changing patterns of thought and behavior that are counterproductive, can help" adults with ADHD. For more information on that study and recent news about Adult ADHD – please visit the following links:


Los Angeles Times (8/24, Healy)


CNN (8/24, Landau)


HealthDay (8/24, Gardner)


Reuters (8/25, Pittman)


WebMD (8/24, Hendrick)


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Concluding the Mental Health Checkup: Personal Statement

By Gina Duncan, M.D.


Over the last several days, I provided a list of nine topics to reflect upon as you consider how you’re taking care of your mental health. Finally, to complete our mental health checkup, does the following statement apply to you:

“I am pleased with myself and where I am in my life. I acknowledge my past mistakes, but do not feel overburdened by them or unable to move forward. I am self-aware. I cannot always control my external circumstances, but I feel good about the way in which I am meeting the challenges I face, and I feel confident in my ability to succeed. I don’t expect myself to be perfect, but I do know that I am a person of worth who has something to offer this world. I have relationships that are meaningful, I contribute to others in ways that are fulfilling, and I feel in tune with myself and in sync with my surroundings.”

I want to encourage all of us to not just strive to “cope” with the stresses of everyday life, but to thrive.

What does mental health mean to you?

Mental Health Checkup: Mood, Concentration, Balance, Energy

By Gina Duncan, M.D.

I’m rounding out my list of topics to consider in a personal mental health checkup. Keep in mind, this list is not exhaustive. It’s meant to provide a starting point to help you examine how you’re doing emotionally and mentally.

Mood — Do your moods feel pretty stable, or are you experiencing significant mood swings (either highs or lows)? Are you crying more than usual? Feeling persistently depressed for two weeks or more and any thoughts of suicide could indicate clinical depression.

Concentration — Are you able to focus on the task at hand, whether at work or at home, and get it done in a timely manner? Or, do you find yourself overrun with missed deadlines and undone chores? Often the first sign that our concentration is waning is when our productivity goes down. Poor concentration is a hallmark of attention deficit hyperactivity disorder (ADHD) but it can also be a symptom of depression and anxiety and should not be overlooked.

Balance — Is there an appropriate balance between your home life and your work life? Between family time with your kids and “date nights” for you and your spouse? Are you getting in some “me-time”, including physical exercise and spiritual pursuits? Achieving perfect balance in your life is probably not possible, but that doesn’t mean it’s not worth striving for! Juggling too many responsibilities is a prime way to end up stressed out and unhealthy.

Energy — Do you feel that you have the energy to do the things you need and want to do? Fatigue can be a sign of depression, anxiety and other mental illnesses, but it can also be a symptom of many physical illnesses including cancer, diabetes and sleep apnea. If you find that you are feeling unusually fatigued or have other concerning symptoms, it is important that you contact your doctor right away.

In my next blog entry, the last in this series, I’ll provide a statement to help you consider whether you are thriving or just coping.