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…
Filed under depression, Diagnosis, Disease, Doctors, Education, life, medicine, Mental Illness, News, Psychiatrists, Psychology by on Jun 11th, 2020. Comment. 
There is paranoia about the coronavirus. Patients come into my office for other reasons and we have often ended up talking about it.
There are a variety of classifications of paranoid thoughts in the latest (fifth) edition of the Diagnostic and Statistical Manual of psychiatry. Even though I have to hang a moniker from it on my work in order to get paid by any insurance for my services, there have been plenty of research articles published by responsible people tho show that it is pretty much useless. Read more on The State Of The Coronavirus…
Filed under depression, Diagnosis, Doctors, Family, life, medicine, News by on May 1st, 2020. Comment.
A fair amount of psychiatric illnesses have a genetic component.
Being formally “diagnosed” by a doctor does not make them official.
It is hard to tell when a woman says “my mother was probably depressed and anxious” what was going on. There may be a genetic component. Read more on Family Histories…
Filed under depression, Diagnosis, Disease, Doctors, Family, life, Psychiatrists by on Mar 15th, 2020. Comment.
Sometimes a good psychosis or delusion, is less harmful than medication — especially in a person who has previously been compromised by illness.
The first I saw was a veteran many years ago. Curiously enough, he was the kind of “old salt” you see plenty in San Diego street clinics but I saw him back at the Wichita V.A.
Then as now I enjoy the older veterans, The kind of folks who, although they were members of a nameless hoard of uniformed youth, have assimilated the serviceman’s identity into their own. Read more on When A Doctor Decides Not To Treat The Hallucinations…
Filed under depression, Diagnosis, Doctors, Education, life, medicine, News, Psychology by on Jan 17th, 2020. Comment.
Here is an article that is what researchers call a “meta-analysis.”
That means that plenty of people have done research on something. So somebody throws together the statistics from several articles, on similar things, to give them more “power.” To show that they are pointing at one strong inference of proof. Read more on Doctor’s Burn Out Like Rocket Ships…
Filed under depression, Diagnosis, Doctors, News by on Dec 8th, 2019. Comment.
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…
Filed under depression, Family, life, News by on Oct 27th, 2019. Comment.
His mother had been seeing me and they had signed mutual releases. Mother wanted me to see him as soon as possible, because he was “nervous and unable to sit still at all.”
When he came, he denied a “nervousness” which his mother thought looked like “attention deficit disorder.”
I can’t treat what people don’t think they have.
He described problems with his girlfriend and his mother, since his mother had told him he could not go to a party in the home of his girlfriend’s family on the bad side of town, “where they would just as soon shoot you in the street as say ‘hello.'”
He sounded like he had pretty routine mother-and-girlfriend problems.
She contacted me on the weekend, worrying about him frequenting strip clubs, something I had not asked about and he had not told me about. Sometimes, she said he became so angry she physically feared him.
Their two narratives were simply inconsistent. I drew the line at her feeling scared of him physically.
I told her about “tough love,” and I told her if that happened again, to call the cops.
My husband reminded me of the ultimate authority in my profession — Hugh Laurie as “Dr. House” — who repeatedly said on television in public for all the world to hear, “Patients lie.”
Which one of them? Maybe both of them. I told her what I had told them; and would indeed, tell anybody who gave me the opportunity. I can try a session with the two of them together and help to resolve things, but I could not promise that it would resolve things. I would try. I always try as hard as I can to do the best that I can.
She said she knew this to be true.
I had told him and also told his mother on the phone, that the hardest thing a young man (or a young woman) ever had to do in his (her) life was establishing themselves as an individual distinct from parents. This usually meant a period of confusion before resolution. There may be (and there was) some confusion about vocational direction, too.
One can only press forward. The ability to communicate openly is precious, and irreplaceable.
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Filed under Alternative Medicine, depression, Diagnosis, Disease, Family, life, medicine, Mental Illness, Personality Disorders, Psychology, relationships by on Oct 11th, 2019. Comment.
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.
Filed under abuse, depression, medicine, prescription drugs by on Sep 30th, 2019. Comment.
These intrepid Aussies blew me away with a thoroughly researched article that really tells it like it is.
Everybody is depressed and anxious. I have seen enough figures saying that mostly all — 60 to 70% — psych meds are given for anxiety and depression. Some say 1/5 to 1/4 of the American/World/choose your country population is growing in anxiety and depression.
Depression can be a pretty darn serious illness that can bring a person’s productivity to a screeching halt.
I have survived numerous theories as to what actually causes depression. Earlier in my training I heard about families in Iowa (where presumably nobody ever moves) where generations of antisocial personality-disordered males had depressed wives,
I think that was supposed to prove the genetic nature of depression, but I always figured, if I were married to an antisocial male I would be depressed too.
I have heard depression blamed on all manners of pollution and industrial waste. Pesticides? Manufacture of plastics?
Just when people start finding all sorts of aches and pains and bodily problems concurrent with depression. Just when I start sending A LOT of my depressed patients to my clever P.A. to beef up their immune systems.
My P.A., (Physicians’ Assistant) Dr. Craig Jace, is a doctor of oriental medicine, a naturopath and homeopath and acupuncturist and probably a lot of stuff I forgot.
I can’t do everything by myself — but with people like Dr. Jace helping me, we are making progress!
Filed under depression, Diagnosis by on Sep 1st, 2019. Comment.
She had been one of the angriest patients I had ever seen. Yelling and screaming so much and walking out of my office so often that I had figured she was out of my practice.
She had been traumatized — not only raped, but abused in other ways — which she had been unable to detail.
Her husband had brought her back, and I gave her a little bit of medicine, slowly, then, I had been finally able to speak with her directly. Read more on Kindness Can Cure, Too…
Filed under abuse, depression, Doctors, Family, life, News by on Dec 27th, 2018. Comment.