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.

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Posted in: Claudia Reardon MD,medication,psychiatrist,treatment

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.

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Posted in: Claudia Reardon MD,depression,medication,psychiatrist,treatment

What’s the difference between all these medications?

By Sara Coffey, D.O.





This is a question I am often asked by my patients. Several times a day we see commercials for prescription pills to treat a variety of diseases from high cholesterol to heart disease and treatment for mental illness is no different. Today I would like to talk about one of the most common mental illnesses, Depression and its treatment.

Depression affects roughly 15 million Americans adults, and it is an illness that can be readily treated with antidepressant medications, talk therapy or a combination of medication and talk therapy. Antidepressants have been around for decades and include several classes of medications that work on different chemicals in the brain, but today the first line treatment for depression are medications called, SSRI’s or Selective Serotonin Reuptake Inhibitors. For the most part medications in this class are very similar; they work by increasing the amount of serotonin between nerve cells which is thought to play a role in depression. Unlike a pain pill that works right away, antidepressants can take up to 4 to 6 weeks to have an affect.



Which SSRI a doctor chooses will depend on each individual patient. Just like every other medication, antidepressants can have side effects and interact with the body or other medications in a way that may be dangerous or uncomfortable for patients. Some SSRI’s may be more likely to make a person tired or sedated, while others may have a tendency to give a patient more energy. Depending on an individual’s depressive symptoms, your doctor might prescribe a medicine that would be more likely to help you fall asleep or feel more alert and energetic. Furthermore, certain SSRI’s have been studied more in patients with a particular medical disease, like heart disease for instance and this might leave a physician to try a medication that has research data to show that the medication is safe for their patient. Certainly, some medications work better in some patients than others, and after a period of 4-6 weeks of adequate dosages if no improvement in symptoms occurs your doctor will likely recommend increasing your dose or switching to another antidepressant to treat your depression. In some instances a physician might recommend augmenting your medication by adding another medication that works in a different way to treat your Depression.



Even if the first anti-depressant doesn’t seem to work for you, there are still other options for treatment. Newer medications that work on norepinephrine and dopamine in the brain are also used quite frequently to treat depression, and older medications to treat depression, although they often have more side effects are still effective in treating depression and can be used in refractory cases.



As a patient it is important for your prescribing doctor to know about your symptoms, side effects, and other medical history and current medications that you are taking. And, as always if you have any questions about the medications you are being prescribed don’t hesitate to ask your doctor about your concerns.

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Posted in: depression,medication,Sara Coffey DO,treatment

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.

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Posted in: psychiatrist,psychiatrist training,Sara Coffey DO,treatment

Family-Based Treatment May Benefit Teens with Anorexia

By Molly McVoy, MD



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

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



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



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



The HealthyMinds.org has more information on eating disorders. 

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Posted in: anorexia,eating disorder,healthy eating,Molly McVoy MD,parenting,teens,treatment

Won’t he just outgrow it?

By R. Scott Benson, MD





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

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



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



There are likely to be other programs that have good evidence to recommend them. Let me know of programs in your community and will can include those links.

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Posted in: ADHD,children,parenting,R Scott Benson MD,therapy,treatment

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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Posted in: ADHD,Felicia Wong MD,therapy,treatment

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!

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Posted in: anxiety,depression,getting help,Molly McVoy MD,psychiatrist,treatment

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,

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Posted in: Asian American,family,Felicia Wong MD,getting help,mental illness,minority mental health,psychiatrist,stigma,treatment

Won’t they do other drugs?

By R. Scott Benson, M.D.



This is a question I get every time I talk with a family about medication treatment for their child with attention deficit hyperactivity disorder (ADHD). And the best answer has been “some will, some won’t”.



But at the APA meeting in New Orleans there was a report from the research group at the Mass General in Boston. They have been able to suggest answers to a lot of question about the outcome of children with ADHD. There is a higher rate of substance use problems in adolescents and adults who have a diagnosis of ADHD. But in this 10 year follow-up of children they asked “What are the predictors?”



Their data confirmed that a diagnosis of ADHD was associated with an increased incidence of drug and alcohol problems. But the finding of severe conduct problems in these children was even more highly associated with future substance use problems.



The take home message for me is that medication alone will not be sufficient to address the severe problems that many children with ADHD present. Parent training, especially for those with severely disruptive behaviors, is a necessary, integral part of their treatment.

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Posted in: ADHD,alcohol,drug abuse,medication,parenting,R Scott Benson MD,substance abuse,teens,treatment

For Mental Health Month, Join a Former First Lady In Bringing Down Barriers to Mental Health Treatment.

By Roberto Blanco, M.D.



I was seeing a very depressed patient the other day and we were discussing how far he had fallen in his functioning since he had gotten ill. He said, “I used to be strong. I used to be able to provide for my family.” And yes, there was no doubt that he was unable to provide for his family now. Despite being relatively healthy physically, mental illness had made it so that he could not work, had difficulty leaving the house, or finding enjoyment in anything.



I try not to read too much into simple statements. But the phrase “I used to be strong” resonated with me because I think that it had something to do with why he waited until it was almost too late to seek treatment. While I think that he was trying to express the depths of his feelings of helplessness and need, his statement implied that he was now weak. Fatigue, lack of energy, and poor sleep from depression could make anybody weak. However, I don’t think that this is what he meant.



I often hear people stigmatizing mental illnesses like depression by saying that it only happens to “the weak”. One thing that I’ve learned from my experience practicing psychiatry is that it can affect anyone from CEOs to valedictorians to world-class athletes. Just like this patient indicated, it doesn’t matter how strong you are or think you are, mental illness can affect you if life and genetic predisposition put you in the wrong circumstances.



One of my main concerns with the stigmatization of mental illness is that if it is seen as a weakness, then the solution is often seen as needing to “be stronger”, deny a physiologic problem, and not seek help. As many mental illnesses are quite treatable with medications, psychosocial interventions, and therapy, this can often have tragic and unintended consequences such as loss of close relationships, occupations and careers, or even death.



The other concern is that if mental illness is seen as a fault of character and not as a group of illnesses, then appropriate and necessary resources and medical services won’t be available. In North Carolina, where I work, acknowledging that you need help is not the biggest barrier to treatment. Actually, it is trying to find a provider or an inpatient bed.



With the demand for inpatient psychiatric services skyrocketing in North Carolina, the number of psychiatric beds available has decreased and the outpatient mental health system, which was once a model nationally, has crumbled. It’s hard to imagine that with greatly increasing rates of kidney disease in this country that dialysis clinics or transplant services would be closing down. However, this is exactly what is happening to psychiatric services in North Carolina. It is a complex issue but is due to the national trend of closing state psychiatric hospitals as well as to the privatization and decentralization of outpatient mental health services.



Some people are taking notice of this disturbing trend, including the former First Lady of the United States, Rosalynn Carter. She has written a book on the mental health crisis in the United States and is encouraging people to be vigilant in taking care of their mental health, to overcome challenges, and to get involved.



May is Mental Health Month. So, please take this opportunity to join our former First Lady in advocating for mental illness treatment. Go to your local legislatures or call your congressional representatives and ask that they support funding for mental health services.

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Posted in: depression,getting help,Roberto Blanco MD,stigma,treatment

What is Psychotherapy?

By Gina Newsome Duncan, M.D.



Medical treatments and therapies can take on many different forms in order to accomplish healing. Most involve some sort of physical interaction between a patient and a healthcare provider as occurs in physical therapy, surgery, and in prescribing medication.



Psychotherapy can be defined as a treatment in which healing of emotional distress is accomplished through the verbal interaction between a patient and a professional psychotherapist.







Psychotherapy can take on many different forms and is practiced by different types of mental health professionals including psychiatrists, psychologists, and social workers.



Upsetting life events like the death of a loved one, medical illness, trauma, job and marital stress, depression and anxiety can all be effectively addressed in psychotherapy. Research shows that psychotherapy is linked to positive changes in the brain and body. Most patients who receive psychotherapy experience symptom relief and are better able to function in their lives. Other benefits include fewer sick days, job stability, fewer medical problems, and improved relationships.



There are many different therapy styles and techniques including Psychodynamic Psychotherapy, Cognitive Behavioral Therapy (CBT), Group Therapy, and Couples Therapy, among others. The type and length of therapy will usually depend on the patient’s circumstances or preference and on the therapist’s training.



For example, let’s imagine that a 37 year old woman* with no history of psychiatric problems begins experiencing significant anxiety and panic attacks. She is referred by her family physician to a psychiatrist to begin psychotherapy. The therapy would likely consist of weekly meetings in the psychiatrist’s office that would last for 45 minutes each. During those sessions, the psychiatrist would gather a history from the patient and use this information to help develop goals for the therapy. The history may uncover, for example, that the patient has two young children, is arguing frequently with her husband, and is facing potential layoffs on her job. Depending on the type of therapy the psychiatrist practices, the patient’s concerns may be addressed differently.



In a psychodynamic approach, the psychiatrist may encourage the patient to talk freely about “whatever comes to mind.” This would include her present-day stresses as well as previous experiences from her past that may be impacting how she is coping. For many of us, unresolved issues from our past cause us to repeat unhealthy patterns, particularly in our relationships. It may be revealed that the patient’s parents divorced when she was young, and that she fears the same could happen to her. By talking through these fears with the therapist, she may be able to find effective ways to address them and prevent them from building up into debilitating anxiety.



A CBT therapist, on the other hand, would be more focused in the “here and now”, actively helping the patient to identify the pattern of negative thinking that is behind her anxiety. Examples of negative thoughts are: “I’m a failure” or “I’m unlovable.” The therapist would then teach the patient new skills to help her change her thinking and behavior.



If the patient’s symptoms are severe, medication may be prescribed. If interested, she and her husband may also be referred to a couples’ therapist.



Finding a Psychotherapist



Since the primary tool in psychotherapy is the relationship between the therapist and the patient, finding a therapist with whom you feel comfortable is crucial. Good sources of referrals include family physicians, local psychiatric societies, medical schools, community health centers, and your health insurance carrier.



For persons of color and ethnic minorities, finding a psychotherapist can present a unique set of challenges. The mental health field is making strides to build a workforce that looks more like the population we serve. However, minorities are overrepresented in mental health disparities, and underrepresented in the field. Language barriers can prevent even the most well-meaning therapist from being able to provide effective care. For people in different faith communities, there may be the concern that a therapist would try to talk them out of their belief system or “brainwash” them into a different way of thinking.



Do you have to go to someone who is of the same background as you in order to have a good therapy experience? The answer is no. However, it is important that you find a culturally competent provider.



Here are some things to keep in mind when looking for a psychotherapist:



• The therapist should be empathic, allowing you time to talk, actively listening to you, and making a sincere effort to understand where you’re coming from.



• Bad signs: If you feel easily dismissed, judged, or stereotyped. Or if the therapist seems reluctant to engage you.



Finally, it’s good to keep an open mind. We are all part of the human family; good and bad therapists come in all colors! You may find that talking to someone of a different background enables you to open up more fully.



You should be up front about what you are hoping to gain from the therapy. For example, if your faith is important to you and you feel it is relevant to your therapy work, do not be afraid to say so. The therapist should not try to change or judge you for your beliefs.



* not based on a real person

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Posted in: treatment

When the treatment didn’t work.

By R. Scott Benson, M.D.



Once I realized how depressed his mother was I understood why the treatment for her son’s behavior problems had not worked. And there was nothing new about this scenario.



A study of the treatments for ADHD found that for most children the treatments were very effective – improvements in academic performance, peer and family relationship, and self-image. But in the group of children who did not get better, when the treatment didn’t work, there were high rates of depression in mothers.



The impact of depression on parents and parenting was the focus of a study from the National Research Council and the Institute of Medicine. Their report, Depression in Parents, Parenting, and Children, is available on-line. 7.5 million parents are affected with depression each year but fewer than a third receive any treatment. In addition to the stigma of seeking treatment there are practical barriers to care that need to be addressed. The children who are affected are treated in separate health care settings by professionals who are not prepared to look at the whole family. Many families face financial barriers to care since many health plans are not designed for the coordinated care these families need.



The family in my practice was struggling with their second grader and his behavior problems at school. The parents done all of the right things. They had been working with his teachers since kindergarten. They had tried a variety of behavior plans at home. There was no improvement, and his grades were falling in spite of good ability. Their pediatrician confirmed his attention problems and reluctantly they agreed to a trial of medicine.



There was not much improvement even with a higher dose. And there were unpleasant side effects with a second medicine. So she recommended a psychiatric evaluation.



The behaviors were typical of ADHD. But his mother gave a clue to the problem as she teared up, talking about the stress she was under with his problems and guilty feelings about not having enough time for her husband and other children. At a separate interview she described typical symptoms of depression. She had been in treatment during college but stopped treatment when she was first pregnant. I was able to make a referral to a colleague and as her mood improved her interaction with her children improved. And the smiley faces began appearing in the daily planner.

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Posted in: ADHD,family,parenting,treatment

Faith & Mental Wellness in the African American Community

By Gina N. Duncan, M.D.

For many in the African American community, faith is an integral part of life.  In one study, approximately 85 percent of African American respondents described themselves as “fairly religious” or “religious” and considered prayer a common way of coping with stress.   

My training as a psychiatrist coupled with my background enables me to have a unique perspective on the field of psychiatry as it relates to the African American community.  I come from a Southern, deeply religious African American family of educators.  My grandfather, a gifted musician, suffered from depression for most of his adult life.  While it did not prevent him from having a successful career as a school principal, civic leader, and church member, it did prevent him from enjoying his blessings more fully.  This has had a ripple effect in my family, which continues to be felt even three generations out.  Fortunately, because of the struggles we observed in our grandfather, the younger members of my family have become much more vocal about our own stresses, and are determined to not let history repeat itself.

For many of us, emotional issues and mental illness are inextricably linked to issues of faith.  Some may view depression as a punishment for sin, psychotic illness as the presence of demons, or anxiety as a lack of faith in God’s ability to provide.  As a person of faith myself, I can say that faith provides a holistic view of life and of the meaning behind our individual experiences and struggles.  However, that does not mean that we cannot make use of all the resources available to us.  After all, if we have a headache we take Tylenol, right?  And if your doctor tells you to take medicine for your diabetes and high blood pressure, you listen.

Some emotional problems can be fully resolved with talk therapy and support.  However, more serious problems such as recurrent depression, thoughts of suicide, schizophrenia, or bipolar disorder often require medication in addition to other forms of treatment.  This is an exciting time in the field of psychiatry and brain science, as we learn more and more about the biological basis of many mental illnesses.  And the good news is that there are many proven, effective treatments.

African Americans are a resilient people.  In honor of Black History Month, let’s make a commitment to living our best lives.  That means getting the help you need.  If you think you are suffering from depression, anxiety, or another mental illness, please know that it does not affect you alone.  It impacts your spouse, your children, and your community.  There are a lot of resources on HealthyMinds.org to help you get started.

Let your light shine—don’t let it be diminished by a treatable condition!

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Posted in: faith,Gina Duncan MD,minority mental health,treatment

Are You Shocked?

By Gariane Phillips Gunter, M.D.



I recently came across an interesting article in the Marie Claire magazine entitled, I Had Shock Therapy… And I’d Do It Again and thought we could talk about this type of therapy a bit. A special thank you to this woman for sharing her story with the world.



What is it? Electroconvulsive therapy also known as ECT, is a well-established psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Today, ECT is most often used as a treatment for severe major depression which has not responded to other treatment, and an estimated 1 million people worldwide receive ECT every year, usually in a course of 6–12 treatments administered 2 or 3 times a week.



Is ECT Effective? The 1999 U.S. Surgeon General's Report on Mental Health summarized psychiatric opinion at the time about the effectiveness of ECT. It stated that both clinical experience and published studies had determined ECT to be effective (with an average 60 to 70 percent remission rate) in the treatment of severe depression, some acute psychotic states, and mania. The report stated that ECT does not have a long-term protective effect against suicide and should be regarded as a short-term treatment for an acute episode of illness, to be followed by continuation therapy in the form of drug treatment or further ECT at weekly to monthly intervals.



What are the side effects? Aside from effects in the brain, the general physical risks of ECT are similar to those of brief general anesthesia. Immediately following treatment the most common effects are confusion and memory loss which usually disappears after a few hours.



Famous people who have undergone ECT



Kitty Dukakis, wife of former Massachusetts governor and 1988 Democratic presidential nominee Michael Dukakis and author of Shock, a book chronicling her experiences with ECT.



Carrie Fisher, American actress and novelist. Fisher speaks at length of her experiences with ECT in her autobiography Wishful Drinking.



In my experience, I have come across many people who feel that ECT saved their lives as well as others who did not feel that it was effective. Careful discussion with a mental health professional can help you make the decision that is best for you. I wish you all a healthy and happy 2010.











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Posted in: depression,Gariane Phillips Gunter MD,treatment

An Ounce of Prevention is Worth a Pound of Cure in Mental Health Treatment

By Roberto Blanco



Benjamin Franklin’s quote, “an ounce of prevention is worth a pound of cure,” can be applied to many arenas of life. From my experience in the mental health system, I believe that it is also quite an appropriate saying for mental health.



I work at a local crisis and assessment center in North Carolina and see many patients who come in with psychiatric emergencies. For a variety of reasons, a lot of these patients arrive in a dangerous state or have substance abuse problems that are out of control. They are in crisis and often need immediate action in order to assure their safety.





While many crises are an unfortunate result of untreated mental illness or painful circumstances, it is hard to ignore the great number of crises that could have been averted with some preventative mental hygiene. Many people become sick because they aren’t doing things that can keep them out of hospitals such as taking medicine regularly, going to therapy, or getting support from friends, family or community centers.



Just as you would not want to meet with your financial counselor to plan out retirement the day before you retire, you should be taking regular, proactive steps to take good care of your mental health before a crisis is at hand or, ideally, in order to prevent a crisis.



Here are some things you or your loved ones can do to help prevent mental health crises:



1. Engage in regularly scheduled therapy sessions.



2. Attend psychiatric appointments regularly and take medications as prescribed.



3. Create a Crisis Plan (a plan to follow in case of an emergency). These plans should include techniques to try to calm the situation (i.e. going for walks, deep breathing exercises, or listening to music are some favorites) along with the names and phone numbers of close supports, on-call mental health professionals, and emergency agencies. Keep this plan close at hand at all times.



4. If a significant portion of the problem is with a close relationship, consider going to family or couples counseling.



5. If you are running out of medication, call for refills at least 3-4 business days (7-9 business days for controlled substances or stimulants) before you will be out of medicine. This will assure that your doctor can supply you with the appropriate refill of medication in time.



6. Engage in regular, renewing self-care activities such as exercise, sleep, and fulfilling hobbies. Lack of sleep is often a cause and symptom of most mental illnesses.



7. Educate and advocate for yourself and your family. Learn as much as you can from many different perspectives about your illness. The National Institute of Mental Health has patient information available on a variety of diagnoses and topics. In addition, our very own APA Healthy Minds site has useful information on a variety of topics. Consider joining the National Alliance on Mental Illness and find your local chapter meeting location and time for support from other mental health consumers and families.

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Posted in: getting help,mental illness,Roberto Blanco MD,treatment

Eight Questions Parents Should Ask About Psychiatric Medications

By R. Scott Benson, M.D.



As a child and adolescent psychiatrist I talk to many parents about treatment options for their children. Whether it be talk therapy or medication, any recommendation for treatment should be based on a thoughtful evaluation.



If medication is recommended, parents find the following questions help in navigating this process. This dialogue with your child's doctor is a first step in forming a team effort for your child's treatment.

1. How will the medication help my child? How long before I see improvement?


2. What are the side effects which commonly occur with this medication?


3. Is this medication addictive? Can it be abused?


4. Are there any tests which need to be done before my child begins taking the medication? Will any tests need to be done while my child is taking the medication?


5. How will my child's response to medication be monitored? How often?


6. Are there any other medications or foods to avoid?


7. How long will my child need to take this medication?


8. What do I do if a problem develops (e.g. if my child becomes ill, doses are missed, or side effects develop)?

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Posted in: children,medication,treatment