Crazy Talk

Vet the advisor BEFORE taking the advice

I'm not thrilled with the title but since it's been a while since I've posted I thought I'd get to the point instead of stressing over it.

In this age of information overload, time management is essential and I have been encountering a huge waste of time in my practice and in my life in general.  It has to do with coming across some piece of new information and springing into action only to find that the information was misleading or just plain wrong.  Sometimes looking back, I realize that the original source of the information may not have been the most reliable.  This can be a frequent occurrence when dealing with the internet.

But whether online or on TV (or in a blog), we have to get into the habit of considering the source before considering the information.  By actively seeking out trusted sources or at least having a basic method to evaluate sources, we can save an enormous amount of time otherwise wasted chasing "false leads". 

Advertisers want to sell you a product and they're getting more and more sneaky.  Product placements and "news" items that are actually promoting a specific product or service are everywhere. I'm not saying that anything that is advertised is of no use, but you have consider the source before you use the information to make a purchasing or consumption decision.

Psychiatry Needs Jargon

I read an article this week that compared diseases in psychiatry to diseases in other areas of medicine.  The article pointed out that other medical specialties have medical-sounding words to describe many of their conditions.  In other words, jargon.  In psychiatry we treat "depression" and "anxiety", words that have every day meaning that is related (but NOT equivalent to) the illness.  This creates a lot of confusion about what it means to be depressed versus suffering from Major Depressive Disorder as defined by the DSM IV. 

This problem has only been made worse by the increased coverage of mental health in the media.  Now people describe themselves as "having OCD"or "being ADD", or even "being Bipolar". 

It's great that there is a growing awareness of the existence of these various conditions.  The next step needs to be the recognition that these conditions are medical illnesses that are best treated by a doctor (and not the guy behind the counter at Vitamin Shoppe).

Don't be Arbitrary - Dosing

I've had a surge of this in my practice to decided to post about it.  What is "this"?  The "this" is patients arbitrarily deciding what dose of medication is their maximum.  Of course we want to use the minimum effective dose and of course side effects need to be addressed, but I'm talking about arbitrarily deciding not to go above a certain number.  If a recipe called for you to put something in the oven for 30 minutes at 400 degrees, you wouldn't just declare that 15 minutes was plenty and that you wouldn't go above 250 degrees.  You wouldn't do this because you know that the outcome of the dish wouldn't be the same.  It just wouldn't cook properly and would lead to a bad outcome.  The same is true with medication doses.  You can't cut the dose in half without likely reducing its effectiveness.  If you are worried about side effects, talk this over with your doctor.  Sometimes the side effects are independent of dose and sometimes they can be minimized by going slowly. 

It's a difficult decision to consider going on medications for any condition but once you've made that difficult leap, don't deprive yourself of relief by sabotaging the treatment by not taking the full dose.

Who are you calling "Bipolar"?

Over me lifetime, mental health and psychiatry have emerged from the shadows and into mainstream media.  From Dr. Melfi in The Sopranos to Hannibal Lechter in the Silence of the Lambs series to Gabriel Byrne in In Treatment on HBO, people are being exposed to the concepts and the terminology of psychiatry.

Overall, I think this is a good thing.  I believe that education about psychiatry and psychiatric illness will ultimately make appropriate treatment more accessible to us all. 

However, along with  the greater visibility comes the natural adoption of certain psychiatric terminology into mainstream language.  Psychiatry is especially susceptible to this because our technical terms can sound like everyday emotions that people are familiar with (depression, anxiety) or descriptive in such a way that people think they understand what the words refer to (bipolar, obsessive-compulsive).  The problem is that people's impressions of what the words mean are not always correct.  For a field in which stigma and irrational fear is a hallmark, this can create serious problems.

I am not about to tell people what words they can and cannot use, but I am hoping that people will think carefully about what certain labels mean depending on where they originate.  You can refer to your moody neighbor as seeming "bipolar" but understand that this does not mean that he necessarily has a mental illness or needs to be put on medications (though you might want him to be evaluated)

The First Step

When talking about substance abuse, we often hear people remark that the first step toward recovery is admitting that there is a problem.  Because of denial, people have to "hit rock bottom" before they'll seek help.

While we don't usually think about it this way, often the same is true for depression and anxiety or any problem that may call for treatment with a psychiatrist or psychologist.  Largely due to stigma, I think, people do not want to face the possibility that they can be helped by a psychiatrist or other mental health professional.  The resistance is so strong that people will go to great lengths to deny that there is a problem and avoid seeking help.

To these people I just want to point out that the point of getting an evaluation is to get help and feel better.  It's not necessarily a question of needing medication or a specific treatment but exploring the possibility that one can feel better or that life can be easier.

Ultimately, some of the patients I have worked with decide to deal with things without medications, but even these individuals are glad that they found out what was available to them.  And for each person who chooses to forgo medications, many more wonder why they held off considering medications for so long because they have made such a difference in their lives.

I am not at all on a crusade to get people to take medications but my main professional frustration is how many people suffer because they can't get past what it means to have a problem and ask for help.  People don't have to admit they have a problem, but rather consider that there may be helpful treatment.

Want to learn about mental illness?

I know this posting is overdue and was intended to review exercise tips but I wanted to write a quick post to let people know about a series appearing on public television and available online that provides basic information about various mental illnesses.  I haven't watched the series yet myself but I'm hopeful that it provides impartial information that can be a starting point for understanding various mental conditions including autism, schizophrenia, bipolar disorder, depression, PTSD, obsessive-compulsive disorder, and others.  In short, it covers most major mental illness.  I hope that it takes a step toward demystifying and destigmatizing mental illnesses.

Here's the URL: http://www.wliw.org/productions/local/healthy-minds/season-two-overview/164/

It is on WLIW21 and channel 13 in NY.  The hours are early AM and later in the evening so perhaps best to watch online.

Tougher times, same strategies

People have been asking me if I'm busier these days given the stress caused by the tough economic climate.  Certainly my patients are struggling with the disheartening reports in the news that seem to get worse daily.  But in the important ways, things are business as usual.  What I mean is that I try to have my patients focus on the things that they have control over, mostly their own choices and behavior.  There is no point to obsessing over what is happening with the economy because the macro issues are out of our control as individuals.  Now, this does not mean that we should ignore outside realities.  The things going on in the world should inform our decisions, but the key is to expend most of your energy on the things, the choices, the actions, that you actually control.  Secondly, in tough times like these, it makes sense to temper our expectations.  This does not mean that we cannot expect things for ourselves to improve; it just means that we need to understand that changes for the better are likely to take more time than they might otherwise.  But the usual strategies for success and positive change still apply.  Incremental improvements toward our goals will still get us where we want to be.  And history has shown that things will get better again.

Do what I suggest, not what I did

Contrary to what the lack of a post in August implies, I am actually working this August.

I was doing well with posts for a few months and have fallen off recently. I was thinking about why this is and I was vaguely aware that it is related to my frustration over not being able to fix the technical problem I have been having with not being able to increase the size of the font. As I mentioned in a recent post, I am stuck in this microscopic font. I have had an exchange with the tech support on this site, but after a few emails that were not helpful, I started avoiding the issue.

This is exactly what NOT to do and the kind of thing that derails many of the best intentioned plans. Eventually this technical problem will be dealt with. Either they will figure out why I am stuck in this font, or I will find a way to get around it, or I can even move my blog to a different site. There are many other possible solutions that aren't coming to me now but will if I continue to work on this problem.

The point is that giving up on a problem guarantees that your progress is halted. Even if they had fixed the problem, I have been avoiding the site for a month and would not have known. Now that I am back, the problem is not fixed (yet) but at least I am back to posting to my blog. This font is not ideal, but it should not stop me from posting altogether.

So please, when you encounter an obstacle that frustrates you, do not give up and decide that you are defeated. Instead, take a deep breath, regroup, and approach it again the best that you can. Every attempt that you make is different than the ones before because it has the experience of the previous attempts behind it. What does this mean? Keep trying because you might surprise yourself by succeeding the next time without necessarily knowing what you did differently

Physical Health

Patients and friends often ask me my opinion about the mind/body connection.  I can say without qualification that there is definitely a close link between mental health and physical health.  I spend a lot of my time in consultation discussing basic health practices that apply equally to mental health and physical health.  The mantra is sleep, exercise, nutrition.  No matter what someone comes in to see me for, this mantra will apply.  It is also a good guideline for anyone wondering what they can do to improve both their physical and mental health.  When things seem off balance, just pay attention to sleep, exercise, and nutrition.  Do not succumb to excuses for neglecting any of them.  Your body/brain does not care if you have a deadline at work or other obligations.  If you're not getting enough sleep, there is no solution other than getting yourself the sleep you need.  This is obvious, but worth saying because in the end, it's not a question of knowing what to do, but doing what you know.  If people simply did the things that they know they need to to maintain their health, people would feel a lot better.

How Do You Treat a Broken Leg?

So today's title is obviously not completely relevant to a mental health blog, at least not at first but read on.

It is an analogy that reflects a useful way to think about Depression (and some other mental illnesses).  In many ways Depression is to the brain as a fracture is to a limb.  Likewise, antidepressant medication is like a cast.  There is a recommended period of time that a bone requires to heal during which time a cast is necessary for the initial phase.  Even after the cast comes off, the bone still needs time to strengthen before it is ready for full stress.  The brain works the same way in recovering from Depression.  Medications should be taken for a certain length of time after the Depression has resolved.  Then the medications can be tapered.  It will still take some time for the brain to recover fully so stressful events may influence when the medication can be safely tapered.

I make this analogy because people desperately want to be off of medication due largely, I think, to the stigma associated with taking medication.  As a result the often stop medications as soon as they start feeling better, risking and often succumbing to an extended episode of Depression.  Just as you would not take a cast off before the doctor says so, so should anti-depressants be continued until the brain has been given some time to heal.