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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Live Longer by Making Mental Wellness Your Mission

By Felicia Wong, M.D.

September is National Recovery Month and SAMHSA's National Wellness Week (Sept. 17-23), a time to remind us why "wellness" is so important to our overall health. Did you know, people with mental and substance use disorders die decades earlier than the general population, mostly due to preventable medical conditions?

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. In a past blog post, I identified coping tools for dealing with stress and boosting your overall well-being. Here are "Top 8 Tips for Mental Wellness." I hope you will take another look and share with your loved ones this week. 

1) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

2) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

3) Stay Positive. Positive emotions can boost your ability to bounce back from stress.

4) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

7) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

8) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

Which tips on this list are missing in your life? Today is the perfect time to take action! Your wellness matters. 

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Make Mental Health Your Priority Every Month

By Felicia Wong, M.D

As the month of May comes to an end, make a promise to yourself that personal mental wellness will remain a daily priority.  Mental Health America has been working for 100 years to promote well-being for all Americans and recently developed a resource called 10 Tools to Live Your Life Well based on extensive scientific evidence.

Each day, we face all sorts of demands and drama which can lead to insomnia, lack of concentration, problems in our relationships, and other mental health issues. 

These "10 Tools" provide proven, healthy ways to cope with stress and boost your overall well-being.  Make a commitment to follow this list and feel more relaxed, fulfilled, and focused long after Mental Heath Month is over. . .  

1) Connect with Others. People who feel connected are happier and healthier--and may even live longer.

2) Stay Positive. People who regularly focus on the positive in their lives are less upset by painful memories.

3) Get Physically Active. Exercise can help relieve insomnia and reduce depression.

4) Help Others. People who consistently help others experience less depression, greater calm, and fewer pains.

5) Get Enough Sleep. Not getting enough rest increases risks of weight gain, accidents, reduced memory, and heart problems.

6) Create Joy and Satisfaction. Positive emotions can boost your ability to bounce back from stress.

7) Eat Well. Eating healthy food and regular meals can increase your energy, lower the risk of developing certain diseases, and influence your mood.

8) Take Care of Your Spirit. People who have strong spiritual lives may be healthier and live longer. Spirituality seems to cut the stress that can contribute to disease.

9) Deal Better with Hard Times. People who can tackle problems or get support in a tough situation tend to feel less depressed.

10) Get Professional Help if You Need It. More than 80 percent of people who are treated for depression improve.

So now you know the tools. . . Today is the perfect time to start incorporating this list into your day-to-day routine.  For more information, go to http://www.liveyourlifewell.org/ . 
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Yoga Helps Heal Heart & Emotional Scars of Cancer

By Felicia Wong, M.D.

“Cancer is a very alienating and existential disease. I know of no other common disease that immediately causes so much fear, anxiety, depression, confusion, and a sense of impending disaster in a patient or his/her significant others when they hear the word “cancer” for the first time.” --- Murray Krelstein, MD, a psychiatrist and cancer survivor.

Although oncologists, family members, and friends can provide significant sources of support, adding a mental health professional to a cancer patient’s treatment team is often helpful. Talking about the emotions and worries associated with cancer can be difficult, and it is important to have a therapist who is familiar with these situations. Additionally, cancer patients and survivors often suffer from sleep disorders, depression, anxiety, fatigue, and other mood changes.

Researchers at the University of Rochester Medical Center found that among patients receiving chemotherapy, over three-quarters suffer from insomnia. Those who suffer from insomnia are, in turn, more likely to suffer from fatigue and depression. For 65% of cancer survivors, insomnia continues even after the completion of chemotherapy.

Cancer is a diagnosis that affects both body and mind. So, it makes sense that cancer patients and survivors practice yoga to improve their quality of life.

While research on the use of yoga for cancer is relatively new, there have been recent studies confirming yoga’s mental health benefits. A Harvard Health Publication highlights the benefits of yoga for stress, depression, and anxiety:

- By reducing perceived anxiety, yoga appears to adjust stress response systems. This, in turn, reduces heart rate, lowers blood pressure, and can make breathing easier.

- There is evidence that yoga practices helps increase heart rate variability, an indicator of the body's ability to respond to stress more flexibly.

Optimizing wellness after a cancer diagnosis and beyond involves a complex integration of interventions that address both the mind and the body. Ideally, a psychiatrist is part of the cancer treatment team. However, if this is not available, please ask your doctor for referrals.

For additional resources on coping with cancer:
http://www.cancersupportivecare.com/live.html
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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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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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Maternal Mental Health: Can Stress Harm Your Chances of Getting Pregnant?

By Felicia K. Wong, M.D.

Getting pregnant is an exhilarating experience for some couples. But it can also be a very frustrating, and heart-wrenching, experience for others. Age, smoking, obesity, and alcohol are studied and known factors to effect pregnancy success.


Anecdotal reports have long linked stress with infertility, but to-date, there has not been much scientific evidence to prove the connection. On August 11, 2010, the BBC published an interesting article describing an Oxford University study that demonstrates for the first time that high stress levels may delay pregnancy. Their findings suggest that perhaps the best thing a couple can do to prepare for pregnancy is to relax.


Dr. Cecilia Pyper, of the National Perinatal Epidemiology Unit at the University of Oxford, measured stress hormones in 274 healthy women aged 18-40 planning to have a baby naturally. They found that those who were most stressed had a reduced chance of becoming pregnant that month. Dr. Pyper said: "The findings support the idea that couples should aim to stay as relaxed as they can about trying for a baby....In some people's cases, it might be relevant to look at relaxation techniques, counselling and even approaches like yoga and meditation."


The study, aimed to improve understanding of the factors that influence pregnancy in normal healthy women, was published in the journal Fertility and Sterility. The research was carried out in collaboration with the Eunice Kennedy Shriver National Institute for Child Health and Human Development in the US. It is part of a larger study looking at the effect of factors like smoking, alcohol, and caffeine on chances of pregnancy.


This being the first of such studies, more research is needed to further link the role of stress and pregnancy. In the meantime, it can’t hurt to relax! 
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Getting Help: How to Start the Conversation and Find Professional Services

By Felicia Wong, M.D.

Many people don’t seek mental health care when they need it. This is particularly true for members of ethnic minorities, for whom physical illness is often considered more culturally acceptable than mental illness. Research has shown, for example, that Asian Americans are three times less likely than members of other ethnic groups to seek mental health services. This has more to do with lack of appropriate services, and barriers to services—including stigma, language and cultural differences—rather than the lack of need for services.

The important thing to remember is that with proper treatment, most symptoms of mental illness can be controlled. If the possibility of mental illness is a concern for you or someone you care about, please recognize there is no shame in seeking treatment and/or help.

Over the years, many people have asked me how to get help for themselves, a family member or a friend who is suffering. Navigating the mental health system is not easy, and the stigma and shame associated with mental illness make it even more difficult. Where someone may find it easy to ask a friend to recommend a family doctor or a dentist, people sometimes hesitate to ask about psychiatrists or therapists due to fears of being judged, or perhaps appearing "emotionally weak".

There are many places to go for help. A good place to start is by asking your family doctor or primary care doctor. In a crisis, emergency rooms can provide temporary relief for you or a loved one, and emergency room personnel may be able to guide you to further help.

Other potential resources include:

• mental health specialists such as psychiatrists, psychologists, social workers or mental health counselors;
• community mental health centers;
• hospital psychiatry departments, outpatient clinics and/or inpatient units;
• family services, social agencies, or clergy;
• peer support groups;
• private clinics and facilities;
• employee assistance program; or
• the phone book or web - search "mental health," "health," "social services," "hotlines," or "physicians" for phone numbers and addresses.

For more information on how to find and choose a psychiatrist and what to expect in treatment, read about Choosing a Psychiatrist on Healthyminds.org,

A Happy Heart may be a Healthier Heart

By Felicia K. Wong, M.D.

Heart disease is the leading cause of death in the United States. The month of February, “American Heart Month”, is dedicated to raising awareness about heart disease and increasing knowledge about prevention. In this post, I will discuss the connection between mental health and heart disease.


Depression is a risk factor for heart disease

Many studies have shown that negative emotions such as depression, anger and stress are risk factors for heart disease. The February 2006 issue of the Harvard Mental Health Letter notes that, “the recurrence of cardiovascular events is more closely linked to depression than to high cholesterol, smoking, high blood pressure or diabetes”. Antidepressant treatment may benefit depressed heart patients and possibly reduce their risk for future heart problems. Cardiac rehabilitation programs that provide patients with stress reduction and wellness strategies may also help reduce the impact that depression has on heart disease.

Happiness may protect against heart disease

People with a tendency to experience positive emotions, such happiness, enthusiasm and contentment, are less likely to develop heart disease than those who tend not to experience it, suggests a new study published in the February 17 advance online issue of the European Heart Journal, led by Karina Davidson, Ph.D. of Columbia University Medical Center. Dr. Davidson’s research team followed 1739 healthy adults living in Nova Scotia for 10 years and examined the impact of positive personality traits on heart disease risk. They found that the people in the study with the most negative emotions had the highest risk for heart disease, whereas those who scored highest for happiness had the lowest risk for heart disease.

The researchers’ speculations about how positive emotions might confer long-term protection against heart disease include:

Happy people may have a healthier lifestyle that decreases cardiac risk - eating and sleeping better, exercising more, and smoking less.

Happiness may promote a host of positive physical and chemical changes - such a reduction in stress hormones -- that are good for the heart.

There may be a genetic component - people who are predisposed to happiness might also be predisposed to have fewer heart attacks.

Davidson’s findings suggest that preventive strategies may be enhanced not only by reducing depressive symptoms but also by increasing positive affect. However, she states that the findings should be confirmed via clinical trials before making any clinical recommendations.

In the meantime, those interested in these preliminary findings can begin to take some simple steps to increase their positive affect. Dr. Davidson recommends, "If you enjoy reading novels, but never get around to it, commit to getting 15 minutes or so of [daily] reading in. If walking or listening to music improves your mood, get those activities in your schedule. Essentially, spending some few minutes each day truly relaxed and enjoying yourself is certainly good for your mental health, and may improve your physical health as well."

For more on the study, including theories on how happiness may protect the heart, as well as tips on how naturally negative people can become happy, please see the following article.

RELAX: Feel the stress melt away

By Felicia K. Wong, M.D.

The winter snow may still be months away from melting, but now that the hubbub of the holiday season has passed, it’s time to rest, relax and de-stress!

Easier said than done right? For many of us, finishing one project just means we can start the next. We live in a fast-paced society where there is a lot of pressure (both external and internal) to “go-go-go”. In other words, we live in a world that is full of stressors and stress.

Our body responds to stress by producing stress hormones. These hormones help you respond to “fight or flight” situations and historically helped our ancestors run to safety from lions. However, these days there are (usually) no lions to run from and instead, when the body is chronically stressed, these hormones can take a toll on physical and mental health. People who are under a lot of stress are often emotional – anxious, irritable and depressed.

Ideally, you can try to change the situation that is causing your stress. But if the situation is fixed, there are relaxation methods that can be useful strategies to cope with stress.

Relaxation is a skill. It is something that we are not necessarily born knowing how to do. Good news! Relaxing techniques can be learned and practiced.

I’d like to share with you a relaxation technique called Progressive Muscle Relaxation (PMR). This is a great way to reduce overall body tension. Here is a video to introduce the practice and help you get started:


Each person will find for themselves unique ways to relax – be it through exercise, yoga, music or meditation. PMR is just one strategy. There is no right or wrong way to relax, and no one technique that will work for everyone. So, find out which ones work the best for you and get started!

Before practicing PMR, consult with your physician if you have a history of serious injuries, muscle spasms, or back problems, because the deliberate muscle tensing of the PMR procedure could exacerbate these pre-existing conditions.