She said she was depressed and anxious. She was 38, large, and animated, with almost glazed over excited eyes, and talking a mile a minute.
Every person who tells me he or she is depressed gets asked the necessary questions to determine if he or she has manic-depressive illness, otherwise known as bipolar illness. The only way to determine this that I know about is by asking. Nobody who is depressed and comes in for treatment of same is going to spontaneously volunteer the info I need to make the diagnosis. Read more on Bipolar Could Be Misdiagnosed As Depression…
Filed under depression, Diagnosis, Disease by on Nov 5th, 2010. Comment. 
He was a pale faced, somewhat overweight 50 year old with a tired demeanor. He had a treatment resistant depression and I had asked his primary care physician to run some tests. He complained of not just lower back pain, but pain in all his joints, and I wanted to rule out autoimmune illness; things like rheumatoid arthritis, or even lupus. I also told him to review his pain meds with the doctor.
He claimed 8 months of sobriety from what had once been a pretty heavy alcohol habit. Who knows what is real or true? He had told me he had a couple “little relapses,” not unexpected in that sort of problem.
“The doctor says I am an addict and I am going to die from my pain meds, because I take too much of them. I told him if he would give me better ones or stronger ones, I would not have to take so much. It is his fault. I really hurt.” Read more on Death By Pain Pills…
Filed under depression, prescription drugs by on Nov 3rd, 2010. Comment.
The current litany is “The economy is bad and I need more money just to get by.” Patients tell me they are about to get evicted or starve to death. I know nothing about benefits or their politics, except that governmental entities have no money either and this route is harder.
A lot of people seem to think that their lives would be better if they were plugged into a job that fit them as well as a plaster cast fits a fracture. But instead, they usually tell me there are no jobs at all. I try to slip in a little bit of useful advice, but obviously personal experience is limited. I don’t even have a really good answer for the patients who say “you have a job. Lucky you. You can’t understand what I am going through.”
There are patients who amaze me with their resourcefulness. Mostly, the manics or hypomanics; depressed people seem more likely to get “stuck.” Read more on Brainpower Helps In Hard Times…
Filed under Brain, depression, politics by on Nov 2nd, 2010. Comment.
He looked different from most of the depressed patients that walk into a psychiatric clinic. He was 24, thin and spare. His hair was longer than average and hung loosely over his brow, his clothes were black and macabre –what the young folks call “Goth”. That style makes everyone look depressed, but I could tell his depression ran deeper than fashion styles.
He was actually a handsome young man, and he had sensibly avoided the face and body piercings that Goths favor. He was open about his choice of lifestyle, relishing his chance to educate me. But while he was talking, I could see he was so depressed, he could have been the poster child for the diagnostic manual.
But something more was going on here. He told me that he had adopted the Goth look at age 13; that nothing else could express how he felt about life — or rather, how he didn’t feel. Read more on What If Life Is Not Worth Living?…
Filed under depression by on Oct 10th, 2010. 2 Comments.
She was 29 and I thought she was beautiful, although nobody else did, I am sure. No normal scales in my clinic could weigh her, but I would put her between four and five hundred pounds. Except for someone who brought her to see me ( I think, in the back of a pickup truck, but I did not press the issue) she did not leave the house. Others did her shopping, she had some kind of public assistance.
She was on the standard medication for her depression as well as her panic attacks; paroxetine (Paxil) 40 mg, to lower their intensity and frequency, and a little bit of Xanax, which is supposed to stop such attacks in their tracks. She used it sparingly, hardly at all — no really — she did not use it. It did not work. The most addictive medication doctors give for this sort of thing and she didn’t even want it because it didn’t work. I love this woman, I loved her candor. She told me the last psychiatrists had renewed these medications for the last six months, even though they didn’t work.
What was wrong??? Read more on Panic and Diabetes…
Filed under depression, Diagnosis, weight by on Sep 3rd, 2010. Comment.
He was 23 years old with a rich ethnic heritage and identity that he said gave him strength. He looked like any one of hundreds, maybe thousands, of “youths” you could find on the streets. A couple of tattoos. The kind I would see when I was driving with my husband and think sometimes “wow, it was so much easier in the days of Marlon Brando movies.” I would have preferred a handsome renegade in a leather jacket to this obese, angry, unkempt person who clearly did not want to talk to anybody, including me. He was not my patient. A frustrated therapist asked me to see him because no medications had worked on him. She had expected me to come up with a miracle drug we could get samples.
He told me the same thing, over and over again, that he was doomed, that nobody could help him, that I was a nice lady, nicer than most, but I was wasting my time just like the rest of them.
He heard voices, always angry and deprecating voices, telling him he was going to die, that he was no good and deserved to be killed. Many times, in his life, he had attempted to prove the voices correct. Read more on The Devil’s Role In Mental Illness…
Filed under depression by on Jun 25th, 2010. Comment.
He did have obsessive compulsive disorder. He had been on a variety of medications which one might expect to be helpful with that, but which had not. In my experience this was not uncommon. He was seeing a therapist who was trying to help him with this, but who was doing traditional “insight oriented” therapy. Of course, this did not work. His worries were mainly about cleanliness and order; common ones. I recommended the most recent edition of hte book I have been recommending for years, in its most recent edition. (Bantam Press) Despite my efforts to avoid making his therapist sound like an idiot, I sent him to some of the wonderful free self-help you can find on the internet. But wait, there’s more. He said that he frequently heard, in his head certain lines or phrases of songs he had performed in the sixties. Not whole songs or even parts he liked. Just opening lines, or one line or phrase, that would repeat an infinity of times. He had tried to drown it out, all sorts of things, and yet he felt victim to it. It was frustrating and he did not know how to stop it. This was not conventional obsessive compulsive disorder. Read more on Musical Hallucinosis — Too Much Of A Good Thing?…
Filed under depression by on May 14th, 2010. Comment.
I have just successfully completed a birthday. Something not as simple as it sounds, for I am in the age range where most women watch for additional wrinkles in the mirror and try to figure out what to do about them at best. At worst, people easily fall into a low self-esteem gutter of wondering why their lives have not gone as planned.
Moi, I think it is time to think about birthdays in different ways. 
I explained it to another mental health professional, who happened to be sitting in a nearby office, and who is six years older than me, almost to the day. She had a birthday a few days before mine, and was clearly in the throes of a birthday related depression, telling me how beautiful she used to be, and how good life was when people still paid attention to her.
Now granted, when my husband and I first moved to Southern California I wondered if they institutionalized people over 40, for they were simply not seen on the streets. Of course, I understand better now. First they give them multiple face and body lifts. Then, they move them to collectives in Palm Springs, where they sing off-key in certain piano bars.
Birthday depression is a common problem, and not something people often go to a physician for. It is usually something dealt with in terms of common wisdom, often repeated, rarely effective. It is more a subject of support groups than of research. Read more on How To Survive Your Birthday…
Filed under depression by on Feb 12th, 2010. Comment.
She was a depressed woman in her 50’s, on conventional antidepressants, who I saw in a clinic. She had none of the “neurovegetative” signs of depression. That means, she slept well and ate well and her mood was acceptable. All of the things that we generally measure in antidepressant response were there, so there was really not a lot more for me to do, except to renew the prescription. I did ask a few questions.
Did she have a purpose in life? Yes, she had a job in a bookstore, which she enjoyed, and grown children, who had babies of their own, and she loved to play with them, but they lived a bit of a distance away, so she could not play with them as often as she liked.
So I asked her what was the most fun in her life. She started laughing wildly, and stamping her foot. I knew this had to be a good answer, and I was ready. I thought she was going to talk about drugs or sex. I was really surprised with what she came up with.
Read more on Happy Dances and the Contact High…
Filed under depression by on Dec 3rd, 2009. Comment.