December 2013

Consider each patient as unique, listen to their concerns and provide quality treatment and enhance their quality of life.

 

January 7, 2014

Q:

I am always tired, have no energy but not depressed. Can you tell me what the problem might be? I get enough sleep, but I just lack energy.

A:

The most common symptoms of depression are a feeling of sadness and less interest in pleasurable activities. If fatigue is the main problem, it could be related to depression, but medical causes first need to be ruled out. Several medical conditions like hypothyroidism and anemia also have fatigue as a symptom. You should see your primary care physician to rule any other causes.

January 6, 2014

Q:

What causes a controlling personality? Is there any way that a person with a controlling personality can change? I ask because of a relative who often creates a negative mood and it is upsetting.

A:

Patients with personality disorders like
narcissistic personality disorder can be controlling. But other psychiatric
conditions can also lead to similar behavior. It is better to seek help and
receive the correct diagnosis so that proper treatment can be initiated. I hope
your relative will agree to an evaluation.

January 6, 2014

Q:

I have PTSD (and I’m managing a dissociative disorder). I attend Loyola full time, try to maintain a near 4.0 GPA (if possible), have just completed my first semester there as a transfer junior, and just broke up with a friend/intimate partner. Given all my stress and new adjustments, how do I cope with anxiety and depression without meds and without a therapist? Any tips?

A:

Post-Traumatic Stress Disorder and other
disorders are treated by psychotherapy, medications or combining both. With all
the added stressors, at the very least you should see a therapist.

January 6, 2014

Q:

How can I enjoy the holidays when my family members are alcoholics, drug addicts and severe narcissists? I’m starving for love yet I GAVE until my tank was empty. Nothing left. Now I am even abandoned by friends. My health is poor and I have a list of bizarre rare conditions. Who would want to love someone with so many physical and emotional scars? I just want to pull the down comforter up over my head and forget the world exists. What can I do?

A:

I am sorry to hear that you are going through this. Some symptoms of depression are a feeling
of sadness and less interest in pleasurable activities. People with depression
can have suicidal thoughts. If you are experiencing this, you need to seek help
right away. We advise our patients to call 911 or come to the emergency room.
You need support. It is better to start seeing a counselor. Based on the
evaluation and findings, you may need further help. If you take these steps,
you could start feeling better soon.

January 6, 2014

Q:

Do you consider depression to be almost an addiction? Like the person wants to be happy, but they’ve been sad so long that’s all they know and what they keep going back to even after feeling a little happiness. Also, when it comes to self-harm of a 17 year old, what would you advise to help them cope with problems in place of cutting? (I’m in therapy and on medications).

A:

People with depression can have addiction and people with
addiction can have depression, but both are separate conditions. Depression is
a chronic condition. At times it needs repeated evaluation and different
treatment strategies, including medication changes. For
cutting behaviors, a particular psychotherapy called Dialectical Behavior
Therapy (DBT) is very helpful.

December 30, 2013

Q:

Do anxiety symptoms come and go? And is it normal to feel strange sensations in one’s head that are unlikely to be headaches? I only get this at bedtime and when I think of someone that I dislike or things that I’m sad about.

A:

Anxiety comes in many forms. Some people experience panic attacks, which last for a few minutes. A panic attack is an abrupt surge of intense fear during which time four of the following symptoms can occur: palpitations, sweating, trembling, feeling of choking, chest pain, nausea, feeling dizzy and a numbness or tingling sensation. It is possible that this feeling of a strange sensation is related to anxiety. But you should first have a medical evaluation just to make sure that a medical condition is not causing this symptom.

December 16, 2013

Q:

I have anxiety and was put on Prozac years ago and was taken off of it. Recently I started with the same anxiety symptoms and my doctor put me back on the Prozac. My question is whether there are any new anxiety meds or is Prozac the best medication for this?

A:

Prozac comes under group of medications called SSRI (selective serotonin re-uptake inhibitor). Other SSRIs are Zoloft, Lexapro, Paxil, Celexa. They all work well for anxiety. Which medication is the best varies from individual to individual. Also, some people tolerate one medication without side effects better than others.

December 16, 2013

Q:

What is the best way to wean off of 60 mg of Cymbalta?

A:

It depends on how long you have been taking the medication. If you have been on it for more than three months, then the medication dose needs to be gradually decreased under the supervision of a medical provider. Stopping the medication abruptly can lead to withdrawal symptoms. Some people tolerate coming off medication quickly, others need more time. Again, it varies from person to person and always should be done under supervision.

December 16, 2013

Q:

What are some ways to differentiate between psychological problems like stress, anxiety and OCD behavior versus the aging process?

A:

Aging usually is an emotionally healthy process while anxiety or OCD are not part of normal aging. Anxiety is a state of intense worrying. And OCD is a state of recurrent and persistent thoughts accompanied by repetitive behaviors like hand washing, lining up items and checking etc. If these symptoms are present, especially if they are affecting your day-to-day life, then it is better to get evaluated by a mental health provider.

December 16, 2013

Q:

How do I handle the stress of being dumped for another woman. I can’t eat, sleep and barely get to work. I’m trying to hold on.

A:

Sorry to see that you are going through this. You have mentioned poor appetite, problems sleeping and a drop in motivation. These symptoms along with feeling sad and a lack of interest in usual pleasurable activities for two weeks or more could mean that you are experiencing depression. I recommend you a mental health provider and get evaluated for depression. Even if it is not clinical depression, seeing a counselor will be beneficial and make you feel better.

December 11, 2013

Q:

Are fainting spells a common symptom of anxiety?

A:

A panic attack is a form of anxiety in which a person feels a sudden surge of intense fear that peaks within minutes. It is accompanied by other symptoms like palpitations, sweating, trembling, dizziness, lightheadedness or fainting. This is different from a kind of anxiety called generalized anxiety in which patients suffer from excessive worry and they feel restless, fatigued and at times feel that their mind suddenly goes blank, etc. Fainting usually is not part of this kind of anxiety. As always, one needs to have a thorough medical and neurological workup to make sure that a medical problem is not causing the fainting spells.

December 9, 2013

Q:

Can stress cause pain for as long as four years in the same area?

A:

First, a medical workup should be completed to make sure that medical illnesses are ruled out. Doctors often see patients who are experiencing pain, but it is unclear what is causing the pain. Several factors may be involved, including conditions like fibromyalgia, Irritable Bowel Syndrome and non-cardiac chest pain, etc. Patients should have regular checkups with their doctors. Often doctors will refer patients with undiagnosed pain to a counselor or psychiatrist. Conditions like depression, anxiety and somatoform disorders all can cause body pain. And situational stress can exacerbate pain. All these can also lead to chronic pain, usually back pain, headache, chest pain and pain related to fibromyalgia.

December 9, 2013

Q:

How do you rate medicines? Do you tell patients to get to one instead of four within a month? Do you consider the entire person?

A:

It depends on the type of situation. It is not generally advisable for a patient in psychiatry to get started on four medications within a month. If there are side effects, it can be very difficult to know which medication is responsible. If there is a crisis, patients can be closely monitored in an intensive outpatient treatment program in which medications and counseling are provided.

December 5, 2013

Q:

I get chest pains and feel dizzy when I feel an anxiety attack coming on. What is the best way to minimize these symptoms?

A:

First thing, it is always advisable to have a basic medical workup completed by your primary care physician to make sure that symptoms are not from any medical conditions. Anxiety can be treated with psychotherapy, medications or a combination of both. The psychotherapy technique that works well for anxiety attack is called cognitive behavioral therapy. Psychotherapists can teach you skills including breathing exercises and relaxation techniques. Medications like Xanax or Ativan can be taken as needed. Other medications like Zoloft, Paxil and Lexapro also work well.

December 5, 2013

Q:

I have been experiencing moments of dizziness for the past few months. I have had blood tests done, but nothing seems to explain why I am experiencing this. My general practitioner believes it may be panic attacks. Is this possible?

A:

If you experience only dizziness, you may not meet the criteria for panic attack. A panic attack is an intense fear accompanied by at least four symptoms that develop abruptly, including palpitations, sweating, trembling, shortness of breath, feeling of choking, dizziness, chest pain and nausea.

December 5, 2013

Q:

Can a panic attack last more than an hour?

A:

Panic attack by definition peaks within 10 minutes. Many patients have symptoms lasting for more than 10 minutes. It usually is the anxiety after a panic attack and this anxiety can last longer.

December 5, 2013

Q:

What are your beliefs about fibromyalgia? I had one doctor at LUMC diagnose it but have a LUMC PCP who doesn’t believe it exists. It hasn’t stopped me from doing anything. But I just wanted to inquire.

A:

According to the American College of Rheumatology,  fibromyalgia is a common health problem that causes widespread pain and tenderness, affects 2 percent to 4 percent of the population and mostly affects women.  But there are controversies about this condition.

Apart from pain and tenderness, these patients usually have depression and now there are a few medications approved by FDA to treat the pain and depression. Many patients find these medications helpful.

December 5, 2013

Q:

What is anxiety?

A:

It is excessive worry to the point of being apprehensive, accompanied by one or more of the following: restlessness, difficulty concentrating, muscle tension or trouble sleeping.

December 2, 2013

Q:

Do I need psychotherapy? How would that help?

A:

Psychotherapy, or “talk therapy,” is sometimes used alone for treatment of mild depression; for moderate to severe depression, it is often used in combination with antidepressant medications. Psychotherapy may involve only the individual patient, but it can include others. For example, family or couples therapy can help address specific issues arising within these close relationships. Group therapy involves people with similar illnesses. Depending on the severity of the depression, treatment can take a few weeks or substantially longer. However, in many cases, significant improvement can be made in 10-15 sessions.

December 2, 2013

Q:

Some say my mom is depressed, some say she has early dementia. What is Alzheimer’s and what are the symptoms?

A:

Alzheimer’s disease is a progressive neurodegenerative condition that causes dementia by slowly killing nerve cells in the brain. It gradually destroys a person’s memory and ability to learn, reason, make judgments, communicate and carry out daily activities. First identified in 1907 by the German physician Aloes Alzheimer, the illness afflicts about 5.4 million Americans. At least 1 in 20 adults aged 65 and older suffers from the disease.

Alzheimer’s disease is one of the most common forms of dementia, a group of conditions that slowly destroys brain cells and leads to a decline in mental function.

People suffering from Alzheimer’s disease first develop subtle personality changes and memory loss that differs from normal age-related memory problems. They seem to tire or become upset or anxious more easily. They do not cope well with change. For example, they can follow familiar routes but traveling to a new place confuses them and they easily become lost.

In the early stages of the illness, people with Alzheimer’s disease are particularly susceptible to depression. Their condition also may be aggravated by reactions to medications or an unsuitable living environment, and the erosion of their intimate relationships may increase their suffering.

December 2, 2013

Q:

I have been on so many antidepressants. None of them seem to help. Are there any other options?

A:

Until recently, ECT was the “last stop” when it came to treatment. But now we have TMS (transcranial magnetic stimulation), a new FDA-approved option for treatment of depression for someone who has not responded to antidepressant medication. TMS is a noninvasive outpatient procedure that does not require anesthesia. More than 50 percent of patients show significant response to TMS treatment and nearly 35 percent undergo complete remission (a complete freedom from depressive symptoms).

December 2, 2013

Q:

What is clinical depression?

A:

Depression is common. It affects nearly 1 in 10 adults each year — nearly twice as many women as men. It’s also important to note that depression can strike at any time, but on average, first appears during the late teens to mid-20s. Depression is also common in older adults. Fortunately, depression is very treatable.

Depression is a medical illness that negatively affects how you feel, the way you think and how you act. In addition to the knowledge that depression contributes both to disability and diminished survival among the medically ill, it is increasingly evident that major depression is a multisystemic disorder that affects both brain and bodily functions.

Depression has a variety of symptoms, but the most common are a deep feeling of sadness or a marked loss of interest or pleasure in activities. Other symptoms include: changes in appetite that result in weight loss or gain unrelated to dieting; insomnia or oversleeping; loss of energy or increased fatigue; restlessness or irritability; feelings of worthlessness or inappropriate guilt; difficulty thinking, concentrating, or making decisions; thoughts of death or suicide or attempts at suicide.

December 2, 2013

Q:

What is the difference between a psychiatrist and psychologist?

A:

A psychiatrist is a medical doctor with special training in psychiatry who is able to conduct psychotherapy and prescribe medications and other medical treatments.

A psychologist usually has an advanced degree, most commonly in clinical psychology, and often has extensive training in research.  Psychologists treat mental disorders with psychotherapy and some specialize in psychological testing and evaluation.