Spreading Hope!

By Matt Goldenberg D.O.
@docgoldenberg 
“You treat a disease, you win, you lose. You treat a person, I guarantee you, you'll win, no matter what the outcome.” 

I whole-heartedly agree with that statement. However, I cannot take credit for those words. Those are the words of Robin Williams, or more specifically, the words of his character in Patch Adams.

I want to discuss the disease called depression. I will start by first discussing the diagnosis and the signs and symptoms of depression. I will then follow up with my thoughts on the various treatment options for depression and the strategies I employ with my patients to improve their outcomes. None of my thoughts and suggestions should serve in place of a formal consultation with a mental healthcare provider. However, I hope shedding light on mental health diagnoses like depression will lift the veil and social stigma on these chronic diseases that impact so many people.

Psychiatry has come a long way in the last decade. This is a time of continued discovery and increasing public awareness. The leaders of our professional organization, the American Psychiatric Association (APA), have suggested that we as mental health professionals are under a microscope. I agree that we are and I also strongly believe that we are up for the challenge. School shootings and celebrity suicides and overdoses have increasingly put a focus on mental health. Psychiatry has significantly improved the outcomes, treatment options and the prognosis of patients with mental illness. However, we still are unable to decrease the prevalence of the diseases we treat or prevent them. We know that the brain changes during an episode of depression and our treatments help it to return to normal (see the image below). Although we are getting closer, we still currently do not have widely accessible blood or imaging tests that can confirm our diagnosis or localize the area of disease.

I can say with certainty, however, we are able to accurately diagnose patients. We are able to identify medications, psychotherapies and other treatments that patients with a specific diagnosis or cluster of signs and symptoms often benefit from. There is strong evidence that our treatments decrease symptomatology and disability and improve quality of life, clinical outcomes and a patient’s prognosis.

Psychiatrists are trained to view the patient as a “whole person”. Psychiatry is a field of medicine whose assessment by definition includes all of the biological, psychological and social aspects of a patient’s life. We listen for the psychological and social factors that can contribute to disease. Oftentimes, the “whole story” can be more telling than only focusing on specific symptoms of a given disease. There is a saying, throughout all fields of medicine, that “most patients have not read the textbook.” In other words, patients usually do not present exactly as the textbook says they should. Stress and psychological factors can mimic chest pain, shortness of breath, gastrointestinal problems and a whole host of other diseases. If we do not step back and get the whole story, we can miss the root cause or the exacerbating factors of many manageable diseases which are of the mind.

Many of the diseases we treat, such as depression, are chronic illnesses which require lifelong treatment. Our treatments can improve a patient’s mental health and coping skills and decrease their symptomatology and substance use. We know through decades of research that these are modifiable risk factors for suicide. Therefore, Psychiatrists have the training and tools necessary to decrease a patient’s risk of attempting suicide. Our treatments have the potential to not only significantly improve the lives of our patients, but also the lives of their families and everyone who comes into contact with them. Anyone who tells you otherwise is misleading, misinformed or both.

I hope this information and the blogs to follow will give you hope. Mental illness can include symptoms which can be devastating and complications which can be life-threatening. However, it is important to state again, these are treatable diseases. If you or someone you know, would like to talk to someone, call your primary care doctor or your insurance company for a referral to a Psychiatrist. A true multi-disciplinary team also includes therapists, psychologists, nurses and social workers. You are never alone. You can call the national suicide helpline 24 hours a day, seven days a week (1-800-273-TALK (8255) or visit www.suicidepreventionlifeline.org). There are also local crisis lines likely available in your area and are an internet search away. If you are ever feeling unsafe, or fearing for the safety of a loved one, you can call 911 or go to the nearest emergency department.

It is time for everyone to understand that there is no shame in getting help for depression, much as there is no shame in getting help with diabetes or high cholesterol. Even if you have never suffered from depression, there is a lot you can learn.

Together we can raise awareness and spread truth and hope. I know that if we spread knowledge, and ignore the misinformation, we will overcome the complacency and ignorance that is so pervasive today. That is how we can best honor those we have lost. That is how we can best prevent the next death from mental illness and addiction.

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How does your primary care doctor coordinate with your psychiatrist?

By Pierre Gingerich-Boberg, Medical Student
Reviewed by Claudia Reardon, MD

I’m stuck in behaviors that are making me unhealthy.  My smoking makes my asthma worse, and I don’t want to end up with emphysema like my dad.  I smoke when I’m anxious, and my finances, my teenager, my boss, and my increasing weight all make me anxious.  Now to top it off, my chronic headaches are getting worse.  My problems are physical, but I know they’re also mental.  But the idea of seeing a psychiatrist makes me even more anxious!  What should I do?

Patients need primary care doctors who can comprehensively address the varied aspects of their physical and mental health. Health systems are starting to recognize that multi-disciplinary teams (sometimes called patient-centered medical homes) can be an effective way to provide integrated care.  How might this look for our example patient?

First, it’s worth noting that traditional primary care doctors already spend a lot of effort helping patients with a wide spectrum of behavior issues.  We saw this for our example patient.  Her anxiety is an example of a classic mental health problem—others might be depression, panic attacks, and addictions. Primary care docs refer some of these patients to psychiatrists, but primary care docs are treating the majority directly.  Our patient’s headaches are likely a functional ailment. Like irritable bowel syndrome and general aches and pains, headaches are real problems that often defy simple solutions.  Standard treatments focus on limiting symptoms while helping patients cope with the stressors and psychological distress that often contribute.  Finally, our patient faces problems with health-related behaviors including tobacco use, diet, and stress management.  These and other common behaviors are hugely important for the development of chronic diseases.  

Our patient’s picture might seem complex, but primary care doctors face such complexity (and more) every day! Frankly, patients often are dealing with too much for their doctors to address optimally in a 15-20 minute time slot. One approach is to triage—to ask what’s treatable and doable, and what can wait until the next appointment. The limited time available for counseling tends to push primary care doctors toward relying on treatment with psych meds. A second approach is to refer the patient to a psychiatrist.  But psychiatrists in many communities are spread too thin, so patients often wait weeks or months for an appointment. Then there’s stigma--our example patient’s anxiety around psychiatric care is actually pretty typical.  This helps push up no-show rates for first visits with a psychiatrist to 30 or 40%.  It’s no wonder that careful studies show that only a fraction of the mental health problems in our communities are ever diagnosed, and fewer still are adequately treated.

A third option returns us to the medical home concept.  At the VA and increasingly in federally qualified health centers (FQHCs), mental health services are being brought into the primary care setting.  Here, behavioral health consultants (BHCs) share space with primary care doctors.  These are generally psychologists or social workers, that is, non-physicians. BHCs’ schedules are intentionally left mostly open, so that they’re available to see patients immediately after a non-threatening ‘warm handoff’ from the primary care doc.  The BHC can offer expert counseling for the patient, and advise the primary care provider on diagnosis and treatment.  BHCs arrange for a small subset of their patients to get a subsequent visit with a psychiatrist (a specialist physician), who is also in-house.   All the BHC patients get systematic evaluation and follow-up by phone or with visits to make sure their needs don’t fall through the cracks.

When a behavioral health consultation system is in place, problems of waiting times, missed appointments, and incomplete records are eliminated for most behavioral health visits.  Primary care docs have more time to focus on medical issues, while getting the expert consultation they need to optimize behavioral health care for their patients. Finally, because most behavioral issues can be addressed efficiently by BHCs, specialty psychiatrists are not so swamped, and waiting times can be greatly shortened for the small group of patients needing psychiatric care beyond what can be managed in the primary care setting. Tweet

Depression & Cancer

By Brad Zehring, DO @DrZehringDO

“Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul”  - Jim Valvano

But, what happens when it does?

Depression is a multifactorial disorder that requires acknowledgement of the biological, psychological, and social aspects of a person’s life. Professionals in the mental health community describe this as the biopsychosocial model. It provides an understanding of the factors influencing a person’s mental and physical state of being.

When mental health professionals talk about depression they often do so in regards to Major Depressive Disorder (MDD). According to DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), 5 out of 9 criteria are needed to diagnose MDD. It requires a depressed mood or anhedonia (lack of enjoying what was previously enjoyed) for greater than 2 weeks including: disturbances in sleep, guilty/hopeless/worthless feelings, poor concentration, low energy, changes in appetite (weight loss or weight gain), psychomotor agitation or retardation, and suicidal ideation.

Depression affects your entire body. But, the physical aspects of depression are often overlooked. It is common for people with depression to experience weight changes, digestive problems, headaches, back pain, muscle and joint pain, and disruptions in sleep cycle. Many symptoms that are present in cancer.

Depression has been linked with many health problems, including cancer. Cancer is a heavy word. The enormity of the word brings many images to the forefront of our imagination: radiation, chemotherapy, losing hair, sickness, weakness, and death - among others. There is so much symptom overlap between cancer and depression it can be hard to recognize the etiology of the symptoms.

It is important that health care professionals, family members, and other caretakers are vigilant with a person’s mental well being after they are diagnosed with cancer. Even if a person has never experienced depression previously, their risk of depression is increased when they find out they have cancer. Research shows that the incidence of depression increases proportionately with the cancer’s progression. It is believed those with depression have increased likelihood of depression because of increased immune response (cytokines) within the body.

It is important not to assume that someone with cancer has an appropriate depressed mood due to his or her circumstances.  This is why it is important to screen for depression in those diagnosed with cancer. Screening for depression can help “tease out” symptoms related to depression and symptoms related to the cancer. Treating depression in patients with cancer can help them focus on their treatment and have the motivation to do everything needed to possibly achieve remission. Proper treatment gives them the ability to focus on their future. Cancer alone is enough, but when combined with untreated depression the results can be deadly.

After recognizing depression in someone with cancer, there are ways to treat depression in parallel with cancer treatment. There are two forms of treatment. One involves medication and the other involves psychotherapy, or talk therapy. The typical medications for depression are antidepressants like Selective Serotonin Reuptake Inhibitors (SSRI) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). These medications have been around for a long time and are generally well tolerated. They take anywhere from 2-6 weeks for clinical efficacy. These medications should be monitored with cancer treatment, as there can be drug interactions and side effects that may not be present in someone taking these medications without cancer. In addition to medications, psychotherapy can be effective. More specifically, Cognitive Behavioral Therapy (CBT) can help people change their negative thoughts about cancer and their future. For the most efficacious treatment a combination of both should be implemented.

Cancer is a serious illness and a well-developed multi-disciplinary approach is necessary to best treat the patient. Cancer can cause a lot of different disturbances in physical and mental health. It is important to have health professionals, like psychiatrists and psychologists, part of the treatment team to ensure proper treatment of the whole patient.

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How Psychotherapy Changes the Brain

By Serina Deen, MDMPH

When I first see patients for evaluation, they often tell me that they’ve debated starting a “biological” treatment such as medication, versus a “psychological” treatment such as psychotherapy. I’m happy to report that as brain imaging technology advances, we’re finding that this distinction may be obsolete. 

Psychotherapy is also “biological” in that it can lead to real functional and structural changes in the brain.   In fact, sometimes psychotherapy and medication produce surprisingly similar changes in the brain.  We still have a lot to learn about the topic, but below are some examples of what researchers have been finding so far.

Functional Changes in the Brain:
In one study, researchers at UCLA found that people who suffered from depression had abnormally high activity in an area of the brain called the prefrontal cortex.  Those who got better after they were treated with a type of therapy called interpersonal therapy (IPT) showed a decrease in activity in the prefrontal cortex after treatment.  In other words, IPT seemed to “normalize” brain activity in this hyperactive region.

Another study looked at people who have obsessive compulsive disorder (OCD), who tend to have an overactive area of the brain called the caudate nucleus.  Treatment with a type of therapy called cognitive behavior therapy (CBT) was associated with a decrease in the hyperactivity of the caudate nucleus, and the effect was most evident in people who had a good response to CBT.  In other words, the better the therapy seemed to work, the more the brain activity changed.

Changes in Brain Volume:

People with chronic fatigue syndrome (CFS) suffer from debilitating fatigue.  People with CFS tend to have a decrease in a type of brain tissue called grey matter in the prefrontal cortex of the brain.  Researchers in the Netherlands gave people with CFS 16 sessions of CBT, and found significant increases in gray matter volume in the prefrontal cortex.  This seems to suggest that the CFS patients were able to “recover” some gray matter volume after CBT.

Similarities and Differences to Medications

Psychotherapy sometimes seems to work in similar ways as medications, and other times appears to have different mechanisms of action.

In the study mentioned previously about people with depression, both IPT and the antidepressant paroxetine (Paxil) showed a decrease in prefrontal cortex activity.  And with OCD patients, both CBT and the antidepressant fluoxetine (Prozac) produced similar decreases in activity in the caudate nucleus. 

However in a different study, the antidepressant Venlafaxine (Effexor) produced changes in different parts of the brain than IPT in depressed patients.  This shows that there is variability in how different treatments work in the brain.

How Psychotherapy Produces Brain Change

We now know that the brain keeps changing, even after we become adults.  Learning leads to the production of new proteins, which in turn can change connectivity in our brains in a process called neuroplasticity.   Indeed, researchers in Germany showed that certain neurochemicals involved in neuroplasticity increased in depressed patients who got better after a course of interpersonal therapy. 

Picking a Treatment that Works Best for You
Even though we know that both medication and psychotherapy can change our brain, we still have a long way to go in learning exactly how that happens and when to use what treatment. Given a specific mental illness, sometimes medications work best, sometimes psychotherapies are the best option, and sometimes it’s a combination of the two.  In addition, there are different types of psychotherapies that work for different illnesses, just as there are many different types of medications.  If you’re considering seeking help for mental illness, it would be helpful to talk with a trained professional about what would work best for you. 

Read tips on what to expect during your first visit with a psychiatrist  

"Let's Talk Facts" brochure on Psychotherapy

Brain Awareness blog post from NIMH Director Tom Insel, MD

APA Releases List of Five Uses of Psychiatric Medication to Question

Six tips for talking to your doctor about medication

For more information about psychotherapy

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What to expect for your first visit with your psychiatrist

By David Goldsmith, M.D., & Arshya Vahabzadeh, M.D. Follow @VahabzadehMD
Resident Psychiatrists, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine

Your Psychiatrist’s Training

A psychiatrist is a physician who is specially trained to diagnose and treat people who are experiencing a wide range of issues, from emotional distress to more severe mental health concerns. People may make their first appointment to visit a psychiatrist when they are having difficulties at work, in relationships, or even as a result of medical conditions. These patients could be experiencing many different symptoms including sadness, lack of energy, anxiety, or mood swings. Other symptoms could include problems with sleep, memory, or appetite. In some circumstances, the symptoms may be much more severe and include hallucinations or suicidal thoughts.

Following medical school, a psychiatrist must undergo at least four years of residency training. He/she will spend that time seeing a wide variety of patients with different psychiatric and medical issues. Some psychiatrists may have additional expertise like treating children or people suffering from drug addiction.

Psychiatrists learn to understand and diagnose complex mental illnesses, including schizophrenia, depression, bipolar disorder, and anxiety. As such, psychiatrists are trained to realize that talking about some issues is quite difficult, so they know how to work with patients who can become very emotional or anxious.

Your First Appointment

The first appointment with a psychiatrist is often an initial evaluation, or intake visit, when the psychiatrist will want to get to know you and what difficulties you are experiencing. These appointments may vary in length but are typically between 40-90 minutes. Your psychiatrist will ask you what kind of issues are concerning you, and how are they affecting your life?

You will be asked about a range of symptoms, and how you have tried to cope with them. Your psychiatrist will want to know about any medical conditions you have now or had in the past. He or she will want to know about past visits with mental health professionals. Many medical and psychiatric conditions may run in families, and usually the psychiatrist will ask you about your family’s health history. They will also ask you about your current medications, both for medical and psychiatric conditions.

Once your psychiatrist has asked you these questions, he or she will make a plan with you and may recommend that you see a particular specialist or have some laboratory tests. Your psychiatrist may suggest a style of talk therapy (psychotherapy) or in some instances, suggest a medication to help with your symptoms.

Your doctor will likely schedule another appointment, so that you can discuss how the treatment plan is going and whether your symptoms have improved. It is very important to ask questions about anything you may not understand, or why you are being prescribed a certain medication or type of therapy. Your psychiatrist will be more than happy to answer your questions and explain things to you in more detail.

Tips for Your First Visit

• Write down a list of symptoms that you have been having if you feel you may forget to mention them.
• Bring along any medical or mental health records that you believe are important.
• It may help to bring a list of your medications.
• You can ask a friend or family member to come to your appointment if you feel that they can provide a unique perspective and make you feel less anxious.
• Always feel free to ask questions about the diagnosis and about any treatments offered.

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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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Six Tips for Talking to your Doctor about Medication

By Claudia L. Reardon, M.D.

In my last blog, I addressed the factors psychiatrists consider in choosing a given psychiatric medication for a patient. I emphasized the importance of medication selection being a collaborative process between the physician and the patient. In the midst of an appointment with a psychiatrist, though, it can be difficult for a patient to know what to ask, and when and how to ask it. This article includes tips for patients to help them work with their physicians in finding the best medications.

1. Ask the psychiatrist, “How did you pick that medicine?” Even if you can think of nothing else to ask during an appointment, this single question will probably lead to a wealth of useful information. For example, it might lead to a discussion of the target symptoms, how the medication affects other medications or medical conditions, and side effects.
2. Make a list of medication questions to ask your psychiatrist at your next appointment. I find it extremely useful when my patients come in with a list of questions they have made since I last saw them in my office. This way, patients are sure not to forget to ask anything important to them.
3. Take notes during your appointments. It can be difficult to remember everything your psychiatrist says during your appointment, and so bringing a note pad and pen along to take notes can be useful so that later you can remember what was discussed.
4. Read books. There are a number of excellent books available for patients on psychiatric medications. In my experience, patients find especially useful the book Instant Psychopharmacology by Ronald Diamond, M.D.
5. Visit websites. Patients should be careful about which websites they visit, as not all are reliable sources of medication information. However, in addition to www.HealthyMinds.org, another reputable site is the NAMI medication website. Go to the NAMI webpage (www.nami.org) and click on the “Medications” tab on the top toolbar.
6. Try not to be embarrassed. Many patients are embarrassed to talk about concerns they have about medications, especially side effects that they find difficult to discuss. However, remember that physicians hear about all kinds of different side effects, and it is pretty hard to embarrass a physician when it comes to talk about the human body!

In addition to these strategies, you might have found others that work for you in keeping you engaged in your medication treatment. It is imperative to keep the lines of communication open with your psychiatrist and to remember that your physician is there to answer any questions you have.

Which Medicines and When: Collaborative Process of Finding the Right Medicines

By Claudia L. Reardon, M.D.

Many patients have long and trying journeys on the way to finding medication regimens that work for their psychiatric symptoms. It isn’t always obvious why psychiatrists choose certain medications and avoid others for given patients. In this blog post, I will review the process by which a physician chooses a psychiatric medication. The more the patient knows about how the psychiatrist is thinking through the medication decision-making, the more active a role that patient can play in the process. 

Psychiatrists consider the following issues when prescribing a medication:

1. Target symptoms. A patient might have many different symptoms, for example, depressed mood, anxiety, trouble with concentration, and severe insomnia. It is important to decide which symptoms should be addressed first, since it is likely that one single medicine will not help all of the symptoms. Doctors often prefer not to start multiple medications at the same time, as it otherwise can be difficult to figure out which medicine is helping or which is causing side effects. Thus, in a patient with the above symptoms, the physician might first choose to address the patient’s depressed mood with an antidepressant. Since trouble with concentration and severe insomnia could be caused by depression, it is possible that treatment with an antidepressant will help those symptoms as well. It is important to address the symptoms in the order that makes the most sense.
2. Psychiatric diagnosis. The physician cannot simply treat a target symptom with a medication without knowing the overall psychiatric diagnosis. For example, depressed mood could be due to many different diagnoses, including major depressive disorder, bipolar disorder, schizoaffective disorder, drug or alcohol abuse, or medical problems such as low thyroid. All of these would have different treatments. Major depressive disorder would be treated with antidepressants, while antidepressants can actually sometimes worsen bipolar disorder. Likewise, if a patient’s depression is caused by a medical problem, it is essential that the medical problem be addressed rather than simply “band-aiding” the symptom of depression with an antidepressant.
3. Medical conditions and other medications. It is critical that the physician be aware of all the patients’ medical issues and other medications they are taking. Certain psychiatric medications would be dangerous if prescribed to patients with certain medical problems. For example, some medications can worsen seizure disorders, cause abnormal heart rhythms, or worsen diabetes. Additionally, some psychiatric medications can have dangerous interactions with other medications.
4. Side effects. Psychiatrists must consider how a given medication’s side effects will impact a given patient. For example, a patient who drives heavy machinery for a living should probably not take a medication that causes drowsiness. On the other hand, sometimes physicians can “take advantage” of side effects. For example, if a patient is sleeping and eating poorly, the doctor might prescribe a medication with sleepiness and increased appetite as side effects.
5. History of response. If a patient or his or her family member has had a good response to a medication in the past, that might be a good reason to choose that medicine now.
6. Patient preferences. Finally, and most importantly, the physician must make sure that the patient is willing and able to take the medication being prescribed. If the patient feels that the side effects are intolerable, or simply cannot afford it, it doesn’t matter how reasonable the choice of medication might be since the patient will not take it. The physician should check with patient to ensure they are comfortable with the medication being prescribed. Likewise, patients should not hesitate to speak up if they have concerns about a medication being prescribed for them.

In summary, physicians consider a multitude of factors in choosing a psychiatric medication for a patient. Ultimately, the decision about a medication should be a collaborative one between the psychiatrist and the patient.

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.

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.

Getting Help Gets a Good Customer Review

By Molly McVoy, M.D.

A recent survey published in Consumer Reports, found that respondents reported the highest satisfaction for the combination of medication and talk therapy, when compared to talk therapy or medication alone.

The survey reported on over 1500 people treated for anxiety, depression or both. They also found that readers reported a higher satisfaction with treatment by a psychiatrist than by other mental health professionals (psychologists, social workers, and licensed professional counselors).
 
This is good news for psychiatrists and the mental health community in general. This is one indicator that the public feels treatment works and that psychiatrists help.


In addition, this consumer report supports the scientific evidence we already have – depression and anxiety treatment does work! In study after study, approximately 2/3 of patients respond to treatment for depression with an even higher percentage responding to treatment for anxiety disorders.

The bottom line is, treatment works and, it appears, most of the public knows it!

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,

Maintaining Health in Stressful Jobs

By Bill Callahan, M.D.

I have been asked frequently in the past 10 days how psychiatrists deal with their own reactions to what they hear every day and what its impact is on them.



When I became a psychiatrist after five years as a flight surgeon in the military, I was struck by how much of the four years it takes after medical school to become a psychiatrist was spent on making sure that we dealt with our emotions, knew our own warning signs for stress, and would set limits on a reasonable work load. We are also trained to know when to ask for a consultation with a colleague, or to get additional training for ourselves. Our educational requirements are life-long and part of our commitment to do our best for you.

A big part of my role is to be the “personal trainer for emotions.” At the end of each day, after spending eight hours immersed in the emotions and struggles of other people, I spend some time experiencing the different emotions that work caused in me. That will mean being able to cry to relieve sadness that is created, feeling the full impact of anger, as well as the affection I feel for the people I work with. This process lowers anxiety and stress and prevents a toxic buildup of emotion every day.

In future posts I will talk about how to feel healthy anger, since I find this is the most misunderstood emotion, and the fear of feeling it is a major source of stress for many.

I already had the fundamentals of a healthy life from my military flight surgeon experiences. Daily exercise for at least 45 minutes, combining aerobic and weight training, sleeping from 7 to 9 hours a day, moderate alcohol use and avoiding it all together when under increased stress or emotional strain, and making sure I took time to have fun with family and friends are things we can all do as well.

Please leave your own tips for what you do to relieve stress in the comment section.