depression

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In 1987 I started my psychiatry residency. Since then, they have changed the Diagnostic and Statistic Manual three times and it still does not seem to be keeping up with how fast the world is changing around me.

I one saw lots of “lethargic” depressions. Slow and sleepy “ain’t got no energy” depressions. “I feel like a human blob” kind of depressions.

Now most of them turn out to be Type II (“adult onset”) sugar diabetes or the thyroid just stopped working for some creative reason. Read more on Then and Now…

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I always ask patients about alcohol.

They always minimize their use.

Mostly all of the patients who have psychopathology and make it in my door name “stress” as the causal factor in their illness. Read more on Alcohol? Who Are They Kidding?…

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It had been a routine email, the kind I ask my husband (total personal assistant) to arrange on my letterhead.

Although this young woman had been a psychiatric hospital inpatient for suicidality a few years ago, she was doing fairly well. We spent most of the time talking about her future education, and choice of profession. Read more on She Could Handle Money…

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A new patient came in this week, referred by a trusted therapist. She had been sexually abused at approximately age 7. She was depressed.

She was on a combination of an antidepressant and a sleeping pill. It seemed to work as well an anything would. The medications were the same kind of medications that I would generally use. Older, reliable, out of patent (more than 7 years old) and thus available in cheap generics.

When I asked her how much of her depression it had made go away, she said “50%.” I ordered my usual list of blood tests. They seemed exotic to her.

We couldn’t even tell if they were things she got ordered in her “annual physical.” She had some kind of blood tests done a month ago. She was reluctant to have more drawn, so I told her we could get the old ones. She looked relieved.

?Relieved?
She was visibly overweight. She had paid a well-known diet center to follow their plan. She had gotten down to her “target weight,” then gone on to gain back most of what she had lost.

She was plagued by seborrheic dematitis. This is not usually a difficult thing to control. She could cut her hair (which went down past her shoulders). She could wash it daily with the prescription shampoo that her primary doctor had (correctly) prescribed. She could wear a little cap, perhaps like the sequiny little one that I showed her I had worn that day.

It was plain to see on her face that I was frustrating her, I just seemed to have more solutions than she had problems.

She asked me if she could return for her next appointment in a month.

She was not suicidal.

I made it clear that if I waited one month I would not increase her medication, for she would have to stay on the same if I were to wait so long until seeing her.

She didn’t mind.

She was not alone among my patients to feel as she felt. I have always failed to understand patients such as she.

Her previous psychiatrist and her previous therapist, had dragged her along for approximately two years.

She had contributed to paying their living expenses, with her fees. Maybe they had improved her status some. I mean, to be fair, I had not seen what she had been like when she started.

Depression is common. Far and away the most common of psychiatric illness, no matter what measurements or statistics you believe.

There are aspects of it that clinical trials of medication have shown, time and time again, get better. Things like sleep, appetite, mood, concentration.

Enjoying life, living your dreams, and such do NOT respond to medication.

Having the desire to correct things than annoy you and make your life better; that is somewhere between spirituality and magic for many of my wide-eyed depressed patients.

Sometimes I am angry at my colleagues. They seem to have accepted the limitations put upon them by government and insurance and economics.

This does not much help the patient.

It takes more than a couple minutes in my office to pump up these things.

I have said “stay tuned” before, but now I must try to bring this message to more media.

Science exists, and ought to be serving humankind.

Stay tuned.

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Mature female patient: “So you’re Dr. Goldstein! Wow , you’re dressed so elegant! I mean I feel really self-conscious! I just threw on a t-shirt and shorts…”

Dr. G: “Don’t worry, darling. You got it right — I’m the one who’s supposed to get dressed up. Now, you’re not going to think much of me.” Read more on Dr. Estelle gets a new patient…smiling, laughing…

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She was an older woman, gray-haired and distinguished, one of those Canadian imports who had never forgotten her British roots. They were as close by as her slight English accent. I had known many people in Canada just like her, who would say “I’m just an old Brit” because that is what they felt like, in the “melting pot” America was alleged at one time to be, or in rich ethnic salad of Canada.

We knew her from her singing. We sang in a “showcase” of sorts in the San Diego region. My husband’s rich and jazzy baritone, my humorous songs or French songs long before my post-menopausal “croak” set in. Read more on Back To The Blitz…

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Here are both the original article and the review in “Mad in America,” a fairly radical review of opposing viewpoints in psychiatry which, I am often downright embarrassed to have to agree with.

The two German psychologists are right. Their initial assertions are unquestionable, Mental illness is going up indescribably quickly. Psychotropic medication is going up indescribably quickly. Read more on Biological Psychiatry…

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There was a saying in Northern France which roughly translates:

“Everything old is new again.

Holy basil oil, from the plant “Occinum basilicum” is good for killing little beasties. The sort you don’t particularly want around. Bacteria and fungi and such. Read more on Basil Oil…

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This report really rang true. I have a disproportionate amount of university graduate students in my practice who are anxious and depressed.

The first thing that came to mind here was a saying I first heard when I was in college.

“A university education is a prolongation of infancy.” Read more on The Psychological Needs Of Graduate Students…

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My preceptor — the professor who was responsible for teaching me about psychopharmacology — continuously complained about “polypharmacy.”

I would roll my eyes heavenward and give him one of my usual “clever” retorts like,”Who the heck is she? Your cleaning lady, maybe??” Read more on What We Do With Antidepressants…