The psychological ability to adjust to chronic medical illness is an area where there has been very little study. Lately, I find myself working mostly with this population of people. I’m noticing that some adjust very well and some do it very poorly. It depends on a lot of factors.
The situation is clearest when the illness we’re talking about is back or neck pain. Back pain, more than neck pain, has been clearly correlated to the presence of major depression. If a person walks into the office crying and says they’re having trouble controlling what’s going on, it’s a pretty sure bet we’re dealing with depression.
Most back pain patients aren’t prepared for the kinds of life adjustments they are required to make. Generally, many will need to switch from a job that has involved lifting or other physical work to a job that is more sedentary. Quite honestly, most back pain patients are in no way prepared to do this. Mostly, this is because anything that is sedentary is going to require a higher level of education. Most of the folks I’m seeing are not highly educated, so the back pain leads to incapacity. Read more on Adjusting to Medical Illness…
Filed under depression, Diagnosis, Disease, Doctors, medicine, Mental Illness by on Nov 5th, 2012. Comment. 
Prison populations continue to rise while rehabilitation efforts, if they even exist, continue to fail. We can do so much better. The Washington state prison system might just be onto something really, really good. Read more on Let’s Help Prisoners Contribute to the Greater Social Good…
Filed under depression, News by on Oct 24th, 2012. Comment.
Britney Spears doesn’t make the news much anymore. Her career is probably still going strong, but her wild ways and scrapes with the law are old news. The media has latched on to new starlets and scandals, and they will never run out.
However, I noticed recently a story about conservatorship of this once-superstar (perhaps now only a mega-star?), and wanted to take the occasion to talk about this very serious legal step of conservatorship.
Miss Spears’ father is her conservator, and he wants her boyfriend appointed as a co-conservator over her well-being, and this might be a sign that he’s getting ready to marry her. There is something very wrong with this picture.
People having conservatorship over other people should not be taken lightly. Read more on Brittany Spears, Conservatorship and the Abuse of Power…
Filed under Celebrities, depression, Family, medicine, News, Psychiatrists by on Sep 3rd, 2012. Comment.
All right — I am married to a man I love and I dearly love my profession. So how could a “boy she has it all” woman like me possibly get depressed?
Mine didn’t look exactly like the criteria laid out in the DSM-IV. I mean, I am not going to sit around for two weeks feeling this way just so I can meet criteria. But other than the two-week bit — I was depressed. I did not want to do much of anything except cry. I could not believe the negative thoughts creeping into my consciousness and I was having a hell of a time pushing them out. I felt sleepy, listless, the whole nine yards.
I did not prescribe myself an antidepressant. I do not think that anybody really believes at this point that a congenital lack of antidepressant has made anybody depressed — ever. Read more on Things to Consider Before Reaching for Antidepressants…
Filed under depression by on Jun 14th, 2012. Comment.
Many people are proud of the state from which they came. But I value the state they (we, all of us) can go to.
It’s called a “Resource State.”
Don’t bother looking on a map – unless it is a map of the cerebral cortex. Yet, it isn’t clearly defined as a location in the brain either.
I know it sounds mysterious, but it is easy to access and the benefits once you get there are astronomical. I think I need to give you some illustrations to make my point.
Once when I was in prison (that always gets attention – but actually I was employed as a prison psychiatrist and not serving time for criminal activities) I treated a young man of 28 who was doing time for armed robbery. His problem was depression with occasional suicidal ideation. Read more on The Resource State — Your Magic Ticket To Happiness…
Filed under Brain Surgery, depression, medicine, News, prescription drugs by on Feb 16th, 2012. Comment.
Wouldn’t it be fun to just sit in front of the TV all day and watch your favorite shows?
Actually, it’s pretty darn depressing. Anyway, that’s what I have noticed, and now it’s official.
I cannot begin to guess the number of people I have diagnosed as depressed who watch television all day. I’ve noticed it for a long time, and part of my standard examination is to find out what people do with their daily lives.
Short answer – couch potato.
Most of the time these folks aren’t actually trying to change their lives or get better. This isn’t just a simple, “Oh, I gotta catch Jerry Springer!” or “Oprah is supposed to be good today!” Read more on TV And Depression…
Filed under depression, News by on Nov 25th, 2011. Comment.
Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers. He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.
The first class of drugs I think about, when I think of sudden death, are the stimulants. I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first. Doctors asked a lot of questions about chest pain, and administered an electrocardiogram. These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight. He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…
Filed under depression, Diagnosis, End Of Life, medicine, prescription drugs by on Aug 19th, 2011. Comment.
The next person to see me made a dramatic entrance. First, she had gotten a head start on her crying in the waiting room. But more than the sound of her crying and sobbing, she could barely make it through the waiting room door. I am no good at guessing someone’s weight. She later admitted to being 380 pounds. I took her word, as our clinic’s scale only went to 300. Her general appearance was that she was swollen with water – a human sponge. The edema bloated every part of her body, and her crying eyes were nearly swollen shut. I started by asking her when her problems began. She was now 42, and said she had thought everything was okay until age 15, when she had been raped by a “friend of the family.” This man was not really a friend, he was a person who went to the same church. Moreover, he was a Sunday school teacher. You would think that by now everyone would know that being a Sunday school teacher does not make someone a saint. But this family had not yet figured it out. In many such cases, this type of person is shielded by the religious community, and even the victim’s parents are often in denial. This woman was lucky. Her parents told her that they were going to prosecute this sinner to the extent of the law.
There was a trial, and she had testified. She thought everything had turned out great, and so did her parents. The rapist was convicted and sent to jail. Again, those who are experienced in these things know that this type of trauma is never over quite so easily. The woman went on with her life and ended up in a really abusive relationship — the kind where someone locks you up and won’t let you leave the house and beats you if you look out the window. By the time she got the courage to escape this living hell and seek a shelter, had a peck of kids. They lived in this shelter for over a year before she found that she had what it takes to start over. She went to school, gained some clerical skills, and started over. She was actually doing pretty well until something happened that triggered a demon she didn’t know had possessed her. She was called for jury duty and went, with pride, wanting to do her civic duty. She couldn’t. She had a panic attack as soon as she entered the courtroom. She ran to the ladies’ room, threw up, and tried to enter the courtroom again – and it was even worse. People thought she was having a heart attack, and they sent an ambulance for her. I do not recommend this means of getting out of jury duty, although it sure worked for her. Read more on Murphy’s Law Of Medicine At Work…
Filed under depression, Diagnosis, Doctors, prescription drugs by on Aug 17th, 2011. Comment.
I had a patient once, long ago and far away, who was the worst “Caffeine Fiend” – properly known as “caffeinism” in medical lingo — I had ever heard of.
He was only 27 but depression and obesity added ten or fifteen years to his appearance. He was single and did not have much of a social life, but he did not much care. He was one of the earlier generation of people to build himself a career doing something with computers, with some sort of techie abilities which I could not understand at all. That enabled him to work from home at least part of the time, and only occasionally would he have to make a mad run to and from his employers’ office. This was in rural northern California, somewhat removed from the Silicon Valley mainstream of this type of activity.
The “from” part was important, as he did not much like to hang around with other humans, much preferring the company of his computer. Read more on Tale Of A Caffeine Fiend…
Filed under depression, Diagnosis, eating disorders, Stimulants, weight by on Jun 16th, 2011. Comment.
Who should be worried about bath salts abuse?
I mean, what’s the worst that could happen? You should start smelling great? Believe me, I’ve had some people in my office that could use some abusive bathing.
But on a serious note, there have been some street drugs that are sold as bath salts and those can cause a lot of problems.
As far as the FDA is concerned, soap, bath oil, and legitimate bath salts aren’t regulated. As for the Fair Trade Commission, there are some labeling requirements for products that make a claim (such as moisturizing the skin).
But the bath salts that have the feds worried now are a legal high – and they want to make all “highs” illegal. Read more on Stimulating Bath Salts — Avoid At All Costs…
Filed under depression, News, Stimulants by on May 3rd, 2011. Comment.