My heart skips a beat... Dear Dr. Archer,
I am 28 years old, and have been on Adderall or some form of stimulant since I was in second grade. I had stopped taking it after high school.
I graduated with my first bachelor's degree in 2005, and shortly afterwards, decided to return to school to major in nursing. About a year ago, I listened to my heart with a stethoscope and noticed an arrhythmia. It sounds like my heart is skipping beats. Someone told me this condition could be completely benign, but other sources say otherwise.
I graduate in two months and continue to take Adderall, but I am in fear of my health. I don't have insurance, so it would be difficult for me to have any tests run at this time.
My question is whether it is common to have benign arrhythmia from Adderall, whether this medication could have caused this, and whether I should continue to take it for the next couple of months until after my NCLEX or not. It is practically unnoticeable when I'm not on Adderall, but it does skip a beat every once in a while still. Thank you for any advice you can give me.
Corey
Hi Corey,
In Canada, Adderall was pulled from the market because it was linked to 20 sudden deaths and 12 strokes. Fourteen of the deaths and two of the strokes were children. The U.S. Food and Drug Administration said it had evaluated the same reports as Canadian regulators, and did not think the data warranted pulling the drug from the U.S. market.
I strongly advise you to stop the Adderall and get this evaluated as soon as possible! You're in nursing, so you should have enough contact with doctors that you can get one to do an assessment. If you have an underlying heart condition, the Adderall could, indeed, make it worse. I definitely don't think it's worth the risk.
Dr. Archer
Which problem do I treat first...
Dear Dr. Archer,
I have a few problems, the first is having trouble sleeping at night. I think I may have restless leg syndrome. I am tired all the time and my legs feel strange at night when I go to bed.
Secondly, I believe I may have ADHD. I read the symptoms for ADHD, and I can relate. I interrupt people, constantly forget things, I make excuses for tedious work, and I have a difficult time reading and retaining information.
My third problem and the most important is lately I have had some panic attacks and I am afraid to go anywhere with people. For example, I avoid going to Walmart, and instead go to a small grocery store. I attended a football game recently and had trouble going in the stadium. When I got in, I had to move to higher seats, away from everyone.
Also, when I am driving, I start thinking about my breathing and eventually have a hard time catching my breath. I am afraid to drive over bridges because I might pass out. I don't know what to do.
Jack
Dear Jack,
The first thing you need to do is make an appointment with a psychiatrist because I suspect you have a chemical imbalance. Each one of the problems which you listed are highly treatable conditions, but it's hard for me to know which is primary based on this brief email.
You need to be assessed by a trusted doctor soon, who depending on the actual diagnosis, should be able to provide medications that will address your concerns. You will find that before long, you will feel rested, you will be able to concentrate more effectively, and you will not be experiencing the debilitating effects of panic attacks.
Jack, with the right medications, you will find life will become much more enjoyable and fulfilling. Make the appointment for your evaluation now and good luck.
Dr. Archer
Death and severe stress in my family...
Dear Dr. Archer,
Can a person be prescribed too much medication? I live in a haze; I can't remember things, I can't concentrate, and I have no sense of time. I have not worked in four years and my doctor won't let me go back. I have been diagnosed with depression, Post-traumatic stress disorder, (PTSD), Obsessive-compulsive disorder, (OCD), and anxiety disorder. I don't sleep for days. I used to sleep all the time but now it's the opposite. I take Clonazepam, Lorazepam, Wellbutrin, Cymbalta, Seroquel, Topamax; I have migraines, and I take Naproxen, and Dilaudid.
I am 41, and married to a great guy for 22 years. We had our first child who was very sick and had many open heart surgeries. He then broke his neck and spent another six months in traction and had two spinal fusions. He then had more heart surgery. During all this I had two more boys. At 13 years of age, my oldest had his last surgery. We always had to fly about 2000 miles for his surgeries and we'd be gone months at a time. We mistakenly thought we'd finally get to be a normal family. Ten months later, our middle son was hit by a car and killed.
He was only nine years old. On top of that, my father-in-law died of a heart attack. My dad had a quadruple by-pass, now he's in his last stages of Alzheimer's. A couple years after my son's death was when I was diagnosed with depression and the disorders. Since then, I even have a two year period I don't remember at all.
I am a correctional officer and because of the state I am in, I am not allowed back at work for fear of putting myself or others in danger. I've been suicidal in the past, even though I'm a Christian. I don't want to live like this anymore. I know I'm hurting everyone around me and I feel even worse knowing that fact. I skip my medications often to try and be 'normal,' but withdrawals are bad and I get down even worse. I feel stuck, and don't know how long I can continue this. Do you know what I can do?
Julie
Hi Julie,
The number one rule when treating with psychiatric medications is that if they are not working, they must be changed. You're on two antidepressants, two anti-anxiety medications, an anti-psychotic, a mood stabilizer and a narcotic pain killer. It is quite clear, based on your email, that these are not working for you. This seems like too much medication to me, but I do not know your full case or the rationale for this combination.
Julie, you must tell your doctor exactly what you have told me. You also must tell him you have had thoughts of suicide. Full disclosure is needed with your psychiatrist in order to maximize your treatment. If you don't feel you are getting anywhere with your current doctor, then you need a second opinion. This is not uncommon, considering the number of medications you are on, plus two heads are often better than one. You can ask your present doctor, a trusted family member or friend, or your health insurance provider.
Finally, understand that the one thing you must bring to the table is the will to never give up. It's crucial to have patience with your doctor, the medications and yourself.
There are hundreds of medication combinations we try for various diagnosis, and you never know when you'll find a combo that will work, so you must be patient, hang in there, allow the Doc to try various combos and maintain a positive mental outlook that you will get better.
Dr. Archer
I feel anxious all of the time...
Dear Dr. Archer,
I have had an anxiety disorder which is extremely difficult and draining. Over the last seven years I had plenty of stress with work, death in the family, as well as health issues, which completely shattered my nerves.
It was when I had a massive panic attack in February of this year that you can say, it switched over to anxiety & panic disorder. The panic attacks just kept occurring, and I feel anxious literally all the time.
Two weeks ago my doctor prescribed 10mg Lexapro & 0.5 Xanax, no more than one per day, as needed.
It was after eight days on the medication that I suddenly felt a big relief. The anxiety was 90% gone and I experienced no panic attacks!
For the first time in a long time, I felt alive again. Then, during the last three days my anxiety started creeping back again.
My biggest difficulty is that my anxiety causes me to be really lightheaded. When I am not anxious, I am not lightheaded. I have gone through all the tests regarding my lightheadedness, and all is fine. This is what is most difficult.
Now, I would like to know from you, is this normal with Lexapro, and will I get better? Also, does this mean that my dosage should increase? I only have an appointment with my doctor in two weeks, as he is fully booked. I am also quite scared to take Xanax for fear of becoming dependant. I am so tired and just want my life back.
Jay
Hi Jay,
This is not uncommon, to have a brief respite from symptoms and to start relapsing right after medications are started. In most cases, a simple dose increase will do the trick. Obviously I don't know for certain if this is your case. You must discuss this with your doctor. I recommend placing a phone call to his office to quickly discuss this before your next visit.
As for as your concerns regarding Xanax, yes, this can be an addictive medication, so caution is always called for when prescribing and taking this medication. However, it is a very effective medication for panic attacks. It is very common to use Xanax in combination with an anti-depressant such as Lexapro. Xanax works quickly, and then Lexapro gradually starts kicking in over time. Often, when the proper anti-depressant dose is reached, the Xanax can be discontinued. You should be just fine as long as you take your medication exactly as your doctor prescribes it to you.
Dr. Archer
My 88 year old mom wants to die and asked me to help...
Dear Dr. Archer,
I am a 60 year old woman who is trying to help my 88 year old mom who has been diagnosed with dementia and/or a chemical imbalance. The psychiatrist had to come to my mother's home to diagnose her because my mom refused to go an appointment. Presently I have power of attorney, but I can use this information to perhaps someday get guardianship.
My mom suffers from high blood pressure and a thyroid condition and takes medications for these two conditions. Mom has been a very depressed person and reclusive for most of her life. My dad died about 20 years ago. About five years ago she fell and broke her hip and became more depressed. She stopped driving about three years ago, and now she won't bathe, dress, or leave her condo. If I didn't prepare food for her every week and bring it to her she wouldn't eat. She weighs about 89 pounds and is very weak. She doesn't walk normally, she shuffles.
She refuses to go to any other doctor except her endocrinologist. He diagnosed a chemical imbalance and suggested several different antidepressants, one of which was Trazodone, which she took for six months with no results. She refuses to take any other antidepressant because she says it makes her sick to her stomach. I have suggested cognitive therapy but she says she can't afford it, even though she can. She refuses to move out of her condo to assisted living. She has no friends, no family except me, and I am an only child. My daughter who was helping me stopped in disgust and won't help anymore. My mom can be very contrary and complains constantly. She says she wants to die and has asked me help her die.
I am so depressed just from the pressure of trying to help out and cook food for her, plus I work for eight hours a day. I am at a loss. The psychiatrist told me if she won't get help then I should stop bringing her food. Other doctors have said the same thing that the only way I can get her help is to let her be near death before I could get help from a hospital.
With the heath care system, I just don't know what to do anymore.Should I stop helping her in order to get help? I called a geriatric mental hospital to see if I could check her in, but they said she would have to admit herself. She knows what's going on, so it's hard to fool her. She cries all the time and says she is lonely. She always says she wishes she felt better but when I suggest going to another doctor she says I am fighting with her.
She looks terrible, wears old worn and torn clothing, and putters around her condo all day. Can you give me some direction on this? I certainly cannot get that from her endocrinologist; he has told me I am lucky he is still seeing her because no other doctor would because she is so argumentative. I am at my wits end. Thanks for allowing me to write you. It helps to just vent.
Kathy
Hi Kathy,
I agree with your doctors, she definitely needs help. In cases like this, it's always very difficult to assess whether the underlying condition is dementia or depression so antidepressants are always worth a try. Of course, since she refuses to take them there is not much you can do; you can't force her. Try to explain to her, with much sensitivity, that you love her and want her to enjoy what life she has left. Tell her she owes it to her family, as well as herself, to give the medication a try. The rest will be up to her. With that said, I also want to give advice to you, Kathy.
You must realize that you can only do so much with an individual who doesn't want help. You must tell your mom this. Next, you must devote a certain amount of time to her and that's it. You absolutely must take care of yourself and that means having time just for you. So, set up a schedule of when you will be available to her and stick to it! Periodically discuss options for help but let her know the final decision is hers. If this doesn't help you feel better you may have a chemical imbalance of the brain yourself and need an eval. Take care.
Dr. Archer
I am tired of not feeling alive...
Dear Dr. Archer,
I am tired of not feeling alive. I feel like life is a movie and I am just watching it from a distance. My body does not even feel like it's my own. I feel like I am sitting inside myself, and my body is covering me like a shell. I don't feel fresh in the morning, either.
I don't feel like dressing and I don't feel excited about anything. I have stopped driving because I have had panic attacks while operating a vehicle.
I feel irritable and it is like I am pinned to the wall with two small children to care for. I don't know what to do or who to turn to. Please help me.
Shaista,
Hi Shaista,
Your story sounds exactly like a chemical imbalance of the brain to me. I suspect major depression.
Depression is a real disease, which is caused by a chemical imbalance in the brain, and it can happen to anyone. Ten to twenty percent of the population will suffer from depression at least once in their life, affects twice as many women as men, and usually strikes between the ages of 25 and 45.
Depression will make you feel exhausted, worthless, helpless and hopeless. You may feel like you want to just give up. Please realize, Shaista, that these feelings are part of the depression.
Your first step is very simple: You MUST get an evaluation by a psychiatrist right away. Sometimes taking the first step to get help can make all the difference in the world. As treatment begins to take effect, your negative thinking will begin to fade, and eventually you will return to a life you can enjoy.
In the meantime, Shaista, please try to do the following:
*Do not take on additional responsibilities, and do not set difficult goals for yourself. Give yourself a break.
*Change large tasks into a few small ones. And then do what you can.
*Be patient with yourself. If you expect too much too soon, you may only bring on feelings of failure.
*Force yourself to engage in activities that might make you feel better even if you don't want to.
The key to recovery is to start small and build from there and you writing to me was a huge first step. Feeling better will take time, but it can be done if you make positive choices for yourself each and every day. Good luck.
Dr. Archer
I'm having problems with psychosis and seizures...
Dear Dr. Archer,
I am a 23 year old female. In 2007 I had a year long progression of psychosis. It started with fainting and dizziness, as well as convulsions and seizures. I was either very tired or hyper. At that point I was not hearing voices, but they soon occurred.
Now, I am experiencing these same symptoms. I have researched, best I could, and found case studies that involved the same symptoms that I was experiencing, and they were deemed psychosis. Could you tell me if these could be symptoms like what I read in the case studies? I am extremely stressed and my symptoms are brought on by stress.
I was also in the hospital a couple months ago for aspirating. I was put on a ventilator and lost breathing for a couple minutes. I developed pneumonia from that and thought I was getting better.
Can I get psychosis from an infection and will I get all the same symptoms as my other severe psychotic episode? I was able to get Zyprexa prescribed to me for those "just in case moments," but I think I am having psychosis. How long does it usually take to get over symptoms?
Plus, I don't want to gain weight again. Are these symptoms abnormal or unusual signs of psychosis? From what I understand, I think there is a correlation between epilepsy and psychosis, and visa versa. Can you please help????
Alisha
Hi Alisha,
The correlation between seizures and psychosis is still controversial, but most doctors now agree that certain types of seizure disorders can generate an increased risk for psychiatric problems. Any type of stress can bring on a psychotic episode in a susceptible individual, and this includes physical as well as emotional stress. These can include infections, long hospital stays or being on a ventilator. Sometimes treatment of the underlying seizure activity can make psychosis worse, and yet, at other times it can make it better. Every case is different, Alisha, because every person is different.
In addition, I'm concerned that you are taking the potent anti-psychotic Zyprexa as needed. Zyprexa should only be taken exactly as it was prescribed. You should take it only according to your doctor's instructions, and if it's not working then let him know. Weight gain is the least of your concerns right now- get the psych problem cured first and then you can worry about the weight.
Bottom line is, your case is extremely difficult. This is not something you should be trying to figure out or treat on your own. This is highly complex and you must have both a psychiatrist AND a neurologist involved in your care. Find doctors you trust, and then work with them to treat both the epilepsy and your psychiatric condition. I'm glad you want to educate yourself, but personal research and internet advice does not take the place of a trusted Doc.
Dr. Archer
Does excessive worry cause a chemical imbalance...
Dear Dr. Archer,
A while back I came down with a bad chest-infection and bronchitis that lasted around three weeks. During this time I was prescribed antibiotics and an inhaler.
I became very anxious and nervous about my health, since I was missing time off work and very sick. One of the symptoms I Googled that really worried me was my 'white-furry tongue,' especially in the mornings. The google search says it could be HIV/AIDS. I was scared for months and finally got tested, which was negative.
Shortly after I developed extreme insomnia. A sleep study showed I was only getting 11% deep sleep. I was offered anti-depressants but scared to take them due to side-effects and possibly worse insomnia! So far I have started working with a naturopathic doctor who determined only my Norepinephrine and Serotonin were normal. I am going to see a psychologist next Wednesday to talk.
My main question to you is, do you believe all that excessive worry caused my chemical imbalance? I do! If so, can it naturally balance out, as I was told by an Emergency Doctor? Would keeping stress-free, exercising, meditating, etc. eventually restore them? If not, or to speed up the process, could I choose to take the correct supplements such as amino acids?
What are your thoughts please. I need my sleep and energy back. On those nights that I do sleep, I feel great, am full of energy and have little to no anxiety!
AP
Hi AP,
Much like the chicken and egg, it's always tough to tell if a chemical imbalance was caused by stress or whether an underlying chemical imbalance was the cause of not being able to handle stress. The key here is that we don't need to know which came first; we treat the symptoms that are present. Also, the treatment can indeed be focused on therapy and how to deal with stress better, along with healthy sleep, diet and exercise OR medication OR both.
So, AP, if you prefer to go without medication that's cool. Many folks can't afford therapy over time and opt to take medication, and that's cool also.
Finally, in more severe cases, we would definitely use meds and sometimes use both. Keep an open mind about all accepted types of treatment and see which works best for you. You can discuss this with your psychologist.
One other note is that there is no scientific evidence now that naturopathic medicine, supplements or diet treats anxiety. Being healthy is always helpful, but I don't recommend taking supplements, mainly because we have no evidence they work. Also, they are not regulated for purity. In addition there is not yet a reliable test that can look at brain chemistry levels and determine a condition or treatment. Good luck.
Dr. Archer.
I constantly put myself in dangerous situations...
Dear Dr. Archer,
I'm a 20-year-old girl with moderate clinical depression.
I was first diagnosed with depression at ten years of age and have been on and off anti-depressants since then. I have also been to eight different psychologist, psychiatrists and therapists. None of these have been able to help me.
In my junior year of high school I started engaging in some destructive behavior. I was smoking weed and snorting cocaine as often as I could get my hands on it. I had no problem using people for drugs. Then, at the end of my senior year, I had a break down. My mom and I had a huge fight and she left for a few days.
A couple of nights later I did alot of coke, and came home to an empty house. My dad was at praise band practice then went out for drinks and my mom was missing. I started crying uncontrollably and wanted to kill myself.
I took my mom's bottle of Ambien and swallowed between 15 and 20 pills, went to bed, and prayed I wouldn't wake up. Well, I woke up and I was a mess.
At work that day I started crying and called my mom and told her I needed help. I was taken to a hospital where they watched me for a while and ran some tests. I stopped doing coke. And my mom moved back in. Now I'm experiencing the same reckless behavior. I don't have that many friends because I've been wanting to be alone lately or spending plenty of time with my boyfriend and his friends. I'm now losing what girlfriends I do have.
Now that you know some of my background, I'll get to the point. I'm constantly putting myself in dangerous, reckless situations, such as drugs, drinking, driving impaired, speeding, smoking and suicidal thoughts. What is causing this? Why do I do this? How can I stop? Thank you so much, I would really appreciate hearing back from you.
Sarah
Hi Sarah,
It's very clear you have a psychiatric condition and, though I'm not sure exactly what it is, I suspect Bipolar Disorder. This is a severe mood swing disorder which fluctuates from depressed lows to manic highs. This disorder can often include reckless behavior.I'm very concerned about you, Sarah, and I don't care how many psychiatrists you have seen in the past, you absolutely need one now!
You must find a doctor that you like and trust, and then stick with him in order to allow sufficient trials of medications and combos to treat your condition. When you find the right medication that works for you, it can make all the difference in the world. Also, some patients stop taking the medication because they feel better. This can lead to a relapse very quickly
In addition, Sarah, you should talk to trusted friends and family about your condition since you need as much support now as possible. A support group can also be extremely beneficial, ask your Doc what he recommends.
Finally, if you have any thoughts of suicide, you must go to the ER immediately. Suicide is a very real risk during both mania and depression.
These thoughts require immediate emergency attention. I don't want you to harm yourself, either intentionally or unintentionally. Sarah, this is a treatable condition. Please see a psychiatrist immediately.
Dr. Archer.
I keep relapsing when I stop my medications...
Dear Dr. Archer,
Please allow me to tell you a little bit of my medical history.
In 1996 I began taking Sertraline and Stellazine to control the severe anxiety I was experiencing. The medications and the doses took care of my anxiety concerns perfectly. I had no side effects, nor was there worsening of anxiety.
After a year, I stopped the Sertraline but resumed taking It again two weeks later. I began experiencing severe panic attacks the second time around but kept taking It. After a few weeks I was fine again, and six months later I stopped it again. I resumed taking it a week later, but again, the panic attacks started so I switched to Paxil and had neither side effects nor panic attacks. I then increased my dosage and the anxiety was well under control.
After a year, I ceased taking Paxil, but began taking it again two weeks later. I started getting panic attacks from that also, but I stayed with it and within two weeks I was fine. Eventually I switched back to Sertraline, but after six years, it stopped being effective. In 2005 I started taking Effexor and experienced a severe panic reaction. I began to take it daily experiencing no problems; I then Increased it to twice a day. It did the job, but a year later I stopped the Effexor and haven't taken it again, due to the chances of another panic attack.
I was thinking of resuming Prozac again, and my doctor told me that Prozac is less likely to cause initial panic or worsening of symptoms. I read, however, that Prozac more often causes initial anxiety. What do you think about starting Prozac at a low dose when taking all this history into account? Do you believe I will get worse at the beginning?
Carlos
Hi Carlos,
The most important fact you must understand is that every time you stop your medication, the panic attacks return. It seems that all of these medications worked for you, so my question is, why do you keep stopping them? You also say "I" frequently, implying that you are doing this without your doctor's knowledge.
Carlos, panic attacks can be severe and debilitating. The more times you relapse, the greater likelihood that the condition will get worse. So my advice is that you talk to your Doc and come up with a plan for long term treatment. The name of the medication is no more important than taking it consistently and faithfully over a long period of time. After the number of relapses you've had, I would have my patients in treatment for at least two years with lifetime treatment being a possibility.
Now, obviously I don't know all the particulars of your case, so you must discuss this with your physician. Again, relapse of any psychiatric condition may cause the disease to get worse, so please, please don't play around with this by self adjusting your meds. Good luck.
Dr. Archer
I'm not sure how to cope...
Dear Dr. Archer,
I have been diagnosed with severe depression and anorexia. I am currently struggling to make ends meet as a single mom of four. I am about to go back to court in an attempt to get an increase of child support from my ex.
I am also trying to get through a short sale on an investment property gone bad, and keep from losing the property where I run my business. If that isn't enough, I am in love with an unavailable, married man.
Lately, the anxiety and frustration of all of this has turned me back to alcohol, isolation and thoughts of suicide. The suicidal thoughts are not nearly as strong as they were about a year ago, but without medical insurance to help with medications, I am not sure how to cope. Any advice would be greatly appreciated.
Amber
Hi Amber,
I am very concerned about your suicidal thoughts. It doesn't matter how strong they are, Amber. You must take action at once! If you've been diagnosed with depression and anorexia, then you must have seen a doctor or therapist, and you should see them again immediately.
In addition, I recommend a visit to the emergency room if you have suicidal thoughts at any point. They can do an assessment and get you set up with a doctor. It is against the law for an ER not to treat a person based on monetary concerns so insurance is not the issue right now. You could also look into a free mental health clinic which every community has in some form. Again, Amber, you must get this assessed right away.
Dr. Archer.
I feel timid and misguided...
Dear Dr. Archer,
I am a 46 year old divorced guy. My main problem is a driving phobia.
I divorced about 15 years ago, and have one son. When his mom and I split, he went to live with her, and I drove them to the airport. I broke down in the bathroom, and when I got my composure, I started the long drive home, which was about 150 miles. That's when it hit me.
Never even hearing of the term panic attack, I thought I was having a heart attack, brain aneurysm or something. Well, needless to say, it repeated itself every time I drove on the freeway. Even though I associated the panic with driving, knowing full well that it was caused by my reaction to the situation, I still, to this very day, cannot break that mental trap. It's an automatic response.
I carry plenty of guilt, regret and such about my past mistakes. I consider my life up to this point a failure, so I guess I'm depressed too. I have no job and I live with friends. I can spend hours when I'm alone replaying my life and feeling sorry for myself. Eventually I get to the point where I convince myself of the truth, that the past is over and I need to take the necessary steps to get back on track.
Unfortunately, I keep falling right back into the pit of self pity. I'm wondering how common this is in your overall experience and what might be a good approach for me to tackle these feelings. There was a time where I was nearly fearless and took the world head on. Now I feel timid and misguided. I want my old life back! Thanks for your time.
Tom
Hi Tom,
Sometimes a stressful situation can bring on a panic attack and then the panic attacks continue when the stress is gone. You need to understand that panic attacks are caused by an underlying chemical imbalance of the brain and often require medication to treat. This could mean that you had a predilection for panic attacks and perhaps would have developed them even without the situation.
Now, couple in the fact that you are also are depressed and that's even more of a red flag. Symptoms of depression also include guilt, regret and feeling like being a failure. Those are the exact symptoms you describe.
Much like weeds, you must get to the root of your panic attacks. Otherwise, they may grow back. Panic attacks can be devastating to your body, mind and your relationships. And they can return more often with more intensity than before.
So, Tom, you must get a psychiatric evaluation as soon as possible! I strongly suspect a chemical imbalance for both panic attacks and depression. If you do, indeed, have this and get it treated with medication, it could make all the difference in the world. Good luck,Tom.
Dr. Archer
I go crazy worrying about my daughter and grandson...
Dear Dr. Archer,
I am a 59 year old woman. When I was in my 30's, I developed a chemical imbalance. However, I have not needed to be on medication for over ten years.I have a depressed personality; I am always waiting for the other shoe to drop. I always seem to be battling these thoughts. I constantly have feelings of dread and worry about things that might never happen.
I was sexually abused as a teen, and have just come to forgive and accept that my abuser was a sick man. My daughter has been on drugs.
The fear of something happening to her, or perhaps her dying and my 3 year old grandson, being with her alone at night, sends waves of fear over me that something horrible will happen. I tell myself not to worry, try to distract my day, and deny myself the impulse to speed over to her house to make sure everything is fine.
Sometimes, it gets the best of me. I go crazy until I find her and hear her voice. The rational part of me knows that 90% of all the things we worry about never happen. The other part of me would blame myself if something did happen. Her drug abuse was triggered by seeing her boyfriend minutes after he shot and killed himself. It has been ten years, and she still grieves.
How can I control these horrible thoughts? Am I mentally ill?
Marilyn
Hi Marilyn,
I think your worry and anxiety could represent a low grade chemical imbalance depression. The stress of your daughter's situation is making this worse. I think you should revisit your doctor and get an evaluation. If medication worked before, then it should work again.
But after that there is more you must do. I am concerned about both your daughter and your grandson. If she is doing drugs and is neglecting her son, then you must have a talk with her and tell her that the child must come first.
Mothers who are involved in drugs usually have control problems with their children, and it get worse as the child ages. Conduct problems in childhood and early adolescence are thought to be one of the most important indicators of adolescent drug use and delinquency. If she continues her dangerous behavior, then you must report her to child protection. This is never easy to do with your own daughter but think of the poor child and what he's being subjected to! Rather than doing nothing and worrying you must take action, Marilyn.
Again, a young child must always be the priority. In addition, you need to talk to her about a treatment program. Check resources in your area to find what is available., start by asking the Doc that you see for your psych assessment. You must help your daughter realize she is not only hurting herself, but her son, as well. Good luck, Marilyn.
Dr. Archer
My husband is embarrassed by my mental illness...
Dear Dr. Archer,
Eighteen months ago, after an intended overdose, I was hospitalized and evaluated for several days. I was shocked and stunned to learn several illnesses were present. Major depression, OCD, Anxiety disorder, and Bipolar disorder. This first event occurred when I was 47 years of age.
There have been three more similar events, all overdoses, all at my own hand. All four occurred within a 10 month time frame. Often, I reflect and wonder if my life has been a waste. There are times in my life I can identify as being riddled with mental illnesses. The pain I feel from the depression, both physically and emotionally, is genuine. Often, I isolate myself when the depression is severe. Please note, I do not suffer from addiction illnesses, (drugs, alcohol, and such), which I do know very frequently exist in concert with various mental illnesses.
My husband is very embarrassed by my multiple illnesses, and often remarks how he is unable to discern if my illnesses are real, or if I am using my illnesses as an excuse to pamper myself. It is my habit, or pattern, to implode. No meltdowns in public--always a facade in public, on my part.
About two weeks ago, my husband and I sat down and talked. And talk he did! For three hours, I heard nothing but negative, mostly untrue comments about myself. There is no responding to his opinions. He tells me nothing comes from my heart, and in particular, since he has known me for so long, he is able to know what I am thinking. An attempt was made a few nights ago to remedy a few remarks, and to give me a forum. I said one thing, and he was back to berating me about my flaws.
Within in a week's time, I have endured verbal lashings, which have absolutely frazzled me, leaving me feeling very fragile. Both of these dialogues, (he spoke, I did not), have resulted in great emotional hurt and pain to me. I find that my hurt and pain are being replaced with anger and disdain, and an element of indifference towards him. I find that these "discussions" have forced me to consider my future with my husband. I do not like what could lie ahead.
For the time being, I am keeping myself out of any more discussions, as I have only regressed. Often, I feel my mental illnesses make me an easy target for my husband. The stigma and lack of understanding of the mentally ill, discredits any feelings and/or opinions an ill person might receive. It is this very issue which concerns me regarding my husband. He has no desire to learn about mental illnesses, at least for now.
In closing, I cannot begin to thank you for allowing me to vent. For the record, I am in cognitive therapy, and under an MD's care. I've been very good about my therapy remaining constant, and taking my medications.
Dr. Archer, it is always a pleasure to see you on Issues, with Jane Velez-Mitchell. They aren't kidding when they claim to need a psychiatrist in the house! Some of the topics and the people profiled make me feel, well, quite normal! Sir, I wish you and your staff only wonderful things. Once again, I thank you for your time.
Maria
Hi Maria,
I'm so glad you are getting help with a doctor and a therapist. Thank goodness for that! As for your psychiatric problems and your husband's disbelief that your illnesses are real, I must point out that folks without serious problems DO NOT ATTEMPT SUICIDE! I'm extremely concerned by his lack of empathy and understanding for you, Maria, and I agree that this must change for the marriage to have any chance at all.
Since you cannot get a word in edgewise with him, I recommend that you talk to your doctor and/or therapist about involving him in some of your therapy sessions. That way he can better understand exactly what you are going through. In addition, this can serve to educate him on the various types of mental illnesses you suffer from. If he refuses to go, then this is giving you a huge red flag as to how committed he really is to making the marriage work.
This needs to be solved sooner rather than later, not only for the sake of your marriage but also because stress is the number one trigger for relapse in psychiatric conditions. This has to be incredibly difficult for you to deal with. Make this a priority in going forward in your therapy, Maria. I wish you the best.
Dr. Archer
I'm so anxious all the time...
Dear Dr D,
My name is Michele and I have major anxiety, panic disorders, OCD and depression. I had a great childhood growing up, and family and friends are always there for me. I have a great support system. I love and believe in God.
Why do I have so much fear and panic attacks all the time? I am taking medications. I have a learning disability and social phobias. I only leave my house about one or two times a week. I feel safer at home and I am afraid to be around people I do not know. I still feel anxious though, even if I am at home not really having anything to fear.
The fear and panic comes on it's own. I feel doom. Why do you think this is happening? I would appreciate any advice you could give me. Thank you and God Bless!
Michele
Hi Michele,
You've summed up Panic Disorder and Generalized Anxiety Disorder perfectly. These are caused by a chemical imbalance of the brain and the crucial point here is that there doesn't need to be an external reason for the symptoms!
From what you describe, your condition is definitely not under control, not even close. Thus you must return to your treating physician and tell him what you just told me. Perhaps the dose of your current medication needs to be increased, or perhaps you need a combination or a completely new medication entirely. You must understand, Michelle, that your psychiatric condition is not completely treated until ALL of your symptoms are gone!
So many times I see patients that are partially treated and they think that they're doing as well as they can and will just have to live with the residual symptoms. Wrong! Again the goal is to treat each and every last symptom until they are gone. It is important, Michele, that you do not give up hope. Panic Disorder and Generalized Anxiety Disorder are highly treatable. There are numerous treatments to choose from that are extremely effective.
Now, granted this doesn't always happen that every symptom can be completely cured, but the harder a Doc tries to resolve everything, the higher the success rate. The best way to achieve success is to work closely with your doctor so both of you can find the right medication or combination of medications that will work best for you. Good luck.
Dr. Archer
I have no self confidence...
Dear Dr. Archer,
I am a 25 year old female. I have lived in the city my whole life, but many people comment to me that I don't act like a city girl. That didn't bother me at first, until I realized I am not bold or aggressive, which made people make this comment.
I do very well in school and tend to study alone. However, when asked to perform in front of my peers, I begin to tremble and feel I am doomed for failure. I now realize that my fear is a great barrier for my success.
I attended yoga and meditation, hoping that would help, but it did not. Nothing seems to bring me peace. My colleagues seem to be so self confident, that I would like to be the same. However, some of them bully me. When I was a girl I didn't let this affect me, but now that I am an adult, every morning when I get up I have a feeling of fear and dread. It takes at least a half hour to get my composure.
Dr. Archer, is this curable? I am afraid to take psychiatric drugs, first because of their side effects and second, because of money. Please guide me.
Vinisha
Hi Vinisha,
This sounds like Social Anxiety Disorder to me, which is anxiety related to social settings like crowds, public speaking and interacting with others. People who suffer from this disorder suffer an intense and persistent fear of being scrutinized by others. They are afraid of doing something embarrassing. They may find their anxiety unreasonable, yet they cannot overcome it by themselves.
Vinisha, up to 13% of U.S. adults will have social anxiety disorder at some point in their life. A recent estimate indicates that as many adults have social anxiety disorder as have major depressive disorder. It is caused by a chemical imbalance and can be treated with medication. In milder cases, it can be treated by therapy, as well. Serotonin is one brain chemical that has been linked to social anxiety disorder, as well as to the depression that often accompanies it. Prescription medication that affects serotonin may help relieve your symptoms.
So Vinisha, my advice to you is to see a doctor and explain what is going on and get a diagnosis. With the right medication, you should feel better and be able to handle yourself in stressful situations. I know health care can be quite expensive. If you have health insurance, it usually pays at least part of your medical costs. Contact your local health unit. Don't be shy; they are there to help you. Get the help you need and deserve. Good luck.
Dr. Archer
I'm just so sad all the time...
Dear Dr. Archer,
I have seen you often on "Issues with Jane Velez-Mitchell" on CNN/HLN and really felt like you were someone who listens and sincerely cares about people. So I googled you, found your Wikipedia page and here I am.
I am a 39 year old single mom of a special needs daughter who is almost 12 years old. I have suffered from high anxiety and panic attacks since I was 15 years old. In 1995 they became so severe at one point I was put on permanent Social Security Disability because my doctor and I could not get the anxiety under control.
Since I was 19, I have been on some sort of anti-depressant. They work for a while and then I have to switch to something else. I feel like I am wasting away, and not showing my daughter any fun. I would like for her to have a good example of life in general. I want to enjoy life again. I used to be happy and outgoing and have friends. Now I have none of that except in once in a while. I used to be a size 6, but since I turned 30, I have gained 50 pounds, which I desperately want to lose. I let myself go to the point where I am wearing sweats, tank-tops and tennis shoes, I don't wear makeup anymore because I feel like a cow. I don't even want to fix my hair.
My life is just nothing, and I can't get back on track. I don't want to be on disability anymore. I would like to get my real estate license and get a job and make my daughter proud. Instead, I wonder if I will have enough money for food for the month. I am just so sad all the time.
Jennifer
Hi Jennifer,
What's clear from your story is not only do you have anxiety and panic attacks, but you clearly have depression as well. This is probably due to a chemical imbalance of the brain. It's important to realize that this needs to be a focus of your treatment as well.
So, I'm glad you are with a doctor to treat your symptoms with medication. It's not uncommon for anti-depressants to stop working after a while. The doctor at that point will usually opt to go up on the dose of the medication. This can be continued to the maximum dosage. If symptoms are still present, then the choice is to add another drug to the medication vs changing the med completely. I usually will add a medication if it appears the first medicine has shown some benefit.
Now here is where it gets complex, Jennifer, because there are dozens of medications to choose from and they can be mixed, in varying combinations so it's important that you and your doctor keep a log of what works for you, and which medication treats which symptom. Often different medications will treat different symptoms, and if you combine these then you will get a synergistic effect. Also, therapy can be very important to help you develop a better self esteem, diminish your negative thoughts and teach you to cope with stress better.
So Jennifer there is no magic answer here. But I think talking to your doctor about your depression is important and then after that, it is trial and error to find what works best for you. Most importantly, never give up!
Dr. Archer
I've suffered from depression for 30 years...
Dear Dr. Archer,
First of all, I'd like to say what you are doing is wonderful. You are a truly caring man.
I am a 45 year old female and have been suffering from depression, insomnia and anxiety disorder since I was 15 years old. I have taken just about every antidepressant and anxiety medication on the market. After taking an antidepressant for a period of time, they seem stop working.It is a constant battle trying to find the new drug cocktail that will work.I imagine my psychiatrist gets frustrated, but he is quite tolerant.
After thirty years, I am now accepting of my condition. I realize that I will always be on medication, whatever medication that may be. My concern is something other than the depression & anxiety.
I experienced a miscarriage in 2004. Since that time, I have developed a social phobia. I don't want to leave the house, usually not even leave my bedroom. I applied for SSDI and have seen six psychiatrists and two psychologists since I applied years ago. Many think I have agoraphobia, but I don't think that is the case. I do not want social interaction, aside from a small group of friends. I have my "safe people" and "safe zones". Aside from that, I have to be sedated on Xanax if I need to go to the supermarket etc.
Since the social phobia began, it has had a domino effect. I am developing more phobias. Insects, bacteria, a bathroom phobia (I can not shower unless I am alone in the house), commitment phobia, intimacy phobia; I am even getting a phobia about developing more phobias!
In January of this year, I had my SSDI hearing, and it was very stressful. I have not yet received a decision from the judge. Shortly after the hearing, I began having nightmares and would wake myself up screaming. It became so bad if someone tried to wake me up, I would be combative and would not recall the incident.
I also began self-mutilating. I wasn't cutting myself; I began picking at my skin. It seemed more of a nervous, obsessive thing. My doctor was very concerned and warned me that I could be dangerous and suggested a couple of different medication, I believe clomipramine or Luvox. I asked him if I could try Lamictal; I had taken it before and it helped with many of my issues in the past. To humor me, he prescribed it. The Lamictal stopped the nightmares and my combative sleep episodes in a short time. He did inform me that Lamictal would not help with phobias and still would prefer I tried clomipramine.
My doctor would like me to see a psychotherapist; he is a psychiatrist, but does not do psychotherapy. Do you think that would help? I don't know what to do anymore. It takes me so long to even feel comfortable talking to a new person. Strange though, I have no problem on social network sites.
I know I have a chemical imbalance and anxiety disorder, but I have learned to live with it. The increasing phobias is my major concern. Sometimes I don't eat because I think about all the bacteria that is on food. I don't even want people touching me because I worry about bacteria and intimacy. I have had no life for five years now.
Currently, I have an prescription for Xanax (1mg) to take 3-4 times a day for major anxiety.Depending on how anxious I am, I take less or more and my doctor is aware of that. I am taking 50mg of Lamictal a day. My dose was increased to 75 mg, but the higher dose made me a little too aggressive. Not sure how much you can help, but I will appreciate any advice. I would like to hear your thoughts on psychotherapy for phobias and the drug clomipramine. I know Lamictal can be a dangerous drug, but the side effects of clomipramine scared me more. Also, I think clomipramine is tricyclic? I didn't have a good reaction to Pamelor or Sinnequan.
If I was your patient, what would you suggest? Thank you for your help.
Christine
Hi Christine,
Thank you for the nice complement. Yes it sounds like you have a chemical imbalance of the brain. Also, it sounds like your psychiatrist has been very patient and creative in trying numerous medications and combos. You must understand that there is no way I can instruct you over the internet with just this small amount of information. Your case is complex and the key in all of these cases is flexibility, as well as trial and error with many medications and combinations of medications and to never give up. There is never a magic pill or combo that always works because each and every one of us has a different set of brain chemistry issues, as well as a set of circumstances. So my advice is to keep working with your Doctor and perhaps even get a second opinion from a Medical Center teaching program where they are up on new state of the art treatments.
However, I will also share a few thoughts with you about your situation. First, we now realize that many psychiatric conditions we once thought of as discreet and separate are actually part of a continuum of disease. For example, anxiety and depression are not only similar in that many of the same medications treat both, but there is mounting evidence that untreated anxiety may lead to depression.
In addition, social anxiety is a variant of anxiety and agoraphobia is a variant of Panic attacks, which are a type of anxiety disorder. See how complex all this is? Thus, what I like to do is go by symptoms and treat all of the symptoms a patient has, regardless of the actual diagnosis. So in this case I would view your social anxiety and phobias as just more symptoms that need to be addressed in the over-all scheme of things. Also, since stress plays a role in mental illnesses then yes, a therapist can always be helpful in at least teaching how to better cope with stress.
I wish I could help you more. In closing, let me say if you were my patient then I would never, ever give up and I would keep trying medication after medication and various combinations. I would record what symptoms were made better with each treatment, and I would have you keep a journal documenting your thoughts on everything that was tried. Again, Christine, don't give up, and keep on trying. The right treatment may be the next one you try.
Dr. Archer
I have withdrawal symptoms when I stop my med...
Dear Dr. Archer,
I took Lexapro approximately three years, and I tapered off the medication. I still had withdrawal side effects:- funny feelings in my head and chest. When I told my doctor, she acted like she had never heard of such a thing. She insinuated that my side effects were anxiety related.
I have been on Effexor about 22 months. I have recently tapered off the med. I did this over a four week period. I have not taken a dose for about two weeks, but I continue to have withdrawal side effects: headaches, funny feelings in my head and palpitations.
I am hesitant to contact my doctor. She was dubious of my side effects before, but the palpitations are beginning to worry me. I have read many articles and blogs on the internet about Effexor withdrawal, and it seems many people experience the same problems that I do. Some experience these side effects for a substantial length of time after stopping Effexor.
I wish I had never taken this drug. I would like some advice from a professional who is, hopefully, familiar with this problem. By the way, I feel pretty good emotionally. Thank you.
Sherri
Hi Sherri,
The question in cases like yours should always be, is this withdrawal or is this a return of the original symptoms?
The way to tell is that withdrawal symptoms will subside over time, though I have had some cases where this takes a month or more. On the other hand, a return of symptoms gets worse over time or doesn't improve. Your psychiatrist could be correct that this is anxiety, but the key is that both medications you mention work well for anxiety. Often anxiety or depression need long term treatment.
So my question is, why are you stopping the medication in the first place? If you feel good when taking it and bad when not, then that is a pretty good indicator that it works. So, Sherri, It seems to me that continuing the medication is the easiest solution. However, since I don't know your whole case, you must discuss this with your doctor. Good luck.
Dr. Archer
I want to help my friend who has Bipolar Disorder...
Hi Dr D,
You look nice and very friendly on your chair. Anyway, I'm asking for help on behalf of my friend, Arlene, who has recently been diagnosed with Bipolar 2. I'm extremely concerned for her well-being as, since her diagnosis, she has been behaving very strangely and has experienced serious side effects. She is 21, and has experienced a series of traumatic events in her past.
When she was about 13 she was in a car accident with her cousin. Her cousin was in a coma as a result of this accident, and after several months, died. I know that this has been a source of great angst for her and her family, and they have all struggled, even to this day, to come to terms with that accident.
More recently, she ended a two year relationship with an emotionally manipulative boyfriend, only to discover that she was pregnant with his child. He refused to accept that he was the father, and after some time of considering her circumstances, she chose to abort the pregnancy. After this, she went to her family doctor, as she had been crying uncontrollably and feeling hopeless; she was put on an anti-depressant. This helped for most of this year, and she seemed to be getting back on track.
About two months ago, she decided to cease her studies, which came as a huge shock to her parents, as all through her life she has been a pillar of strength and achievement in her family. She has always held her emotions in, and achieved to her best ability, being an A-student and a brilliant pianist and musician. Her parents immediately sent her to a psychologist who had her admitted to a psychiatric clinic where she stayed for three weeks and was diagnosed with Bipolar 2.
I've been best friends with Arlene for seven years and since she came out of the clinic, I feel like I don't know her. In our friendship, I have seen her high and low, but no more so than myself or any of our other friends. She has completely changed, and has struggled to adapt to her medication.
She's been hallucinating, and experiencing serious highs and lows for weekly periods, which she never had before. Its almost as if, now that she has been told she has bipolar, she is behaving the part. I can't help but think that she has been bullied into her position by her family and her doctors. Could she have been misdiagnosed?
I would really appreciate feedback, as I am so confused about her behavior. I'm not sure how to handle this situation. Thanks.
Sheryl
Hi Sheryl,
Thank you Sheryl for your compliment. Based on the symptoms you describe at various times in Arlene's life: crying uncontrollably, feeling hopeless, hallucinating, coupled with 3 weeks in a psychiatric hospital and a bipolar diagnosis, I do not think she has been bullied into believing that she has a psychiatric illness. Folks always say to me that their friend, lover, family member was too smart and strong to develop a psychiatric condition.
But here's the deal, Sheryl. What you describe with your friend happens every single day. That's why mental illness MUST be diagnosed and treated like a medical condition. It can strike in someone who is otherwise happy and healthy and the key is, if it is present yet treated early, then typically that individual can go on to live a normal life.
So you must support your friend and her treatment. Clearly what she's on now is not working, so get her back in to see her doctor. You also may wish to talk to her about obtaining a second opinion. But no matter what, you must accept her condition as real and give her as much support as possible. Best regards.
Dr. Archer
I felt normal so I stopped my medication...
Hello Dr. Archer,
I was hospitalized in a community center three times. I took two psychiatric medications daily. I gradually stopped taking the medications. It has been about three months and I feel normal. Would it be ok not to take them anymore?
Nir
Hi Nir,
Though I usually only answer stories, this is so important I must offer my advice.
First: Never, ever, ever stop your medication without discussing it with your psychiatrist. Next, if you were hospitalized three times, this tells me you have a severe psychiatric condition, and in no way would you be ready to stop your medications in only three months.
The psychiatric medications are very tricky, Nir, because they may take weeks to build up in your system and take effect. But, by the same token you can stop them and they may keep working for weeks before you gradually get them out of your body and slowly start to relapse. Changes in brain chemistry take time.
My strong advice is for you to return to your doctor immediately and discuss what you've done. Then follow his advice to the letter. Take care.
Dr. Archer
I've taken numerous meds for my depression with no relief...
Dear Dr. Archer,
I am a 27 year old female who suffers from severe depression, anxiety, compulsive problems and chronic insomnia. I only get about one to three hours of sleep a night. In the seven months I have received treatment, I have been prescribed the following medications: Effexor, Zoloft, Mirtazapam, Risperdal, Cymbalta, Seroquel, among others.
I have stopped taking all antidepressants and am presently taking Valium in order to sleep. I want to find another psychiatrist, because even with the Valium, I still am only getting one to three hours of sleep a night. I don't know what to do and I have really tried to be patient, but I am getting nowhere.
It is difficult to talk to my parents, to leave my bedroom or even to adjust the volume of television with the remote control. I am not working and I do not go anywhere. Can you please provide me with your expertise and some suggestions that I could possibly put forth to my doctor. Please help me if you can, or if you have any ideas which may help me find relief. Warm regards.
Maree
Hi Maree,
The deal here is that if you have a diagnosis of severe depression along with anxiety, then you must be on an antidepressant. Valium is for anxiety and can work for sleep but it does not work for depression.
You must understand, Maree, that more than likely the depression is causing your insomnia. Clinical depression is not just feeling sad. It is an illness that can challenge your ability to perform daily activities and has physical symptoms like poor sleep, poor appetite, racing thoughts, pounding heart and upset stomach.
Depression represents a burden for not only you, Maree, but for your family as well, and that burden can seem overwhelming. As for recommending medication for you to take, I really can't do that just based on what you told me or via the Internet.
What you must do is make a record of every med you've taken and how well it worked and bring that record to your new psychiatrist. Also going forward, you must keep a record of every trial of medication that you are given so both you and your doctor have an idea about what works and doesn't.
Depression can be treated effectively in most people. The biggest barriers to overcoming depression are recognition of having depression and then seeking appropriate treatment.
You and your doctor have work to do. Together you will find the right medication or combo of meds that will work for you. I wish you much success.
Dr. Archer
My depression is treated but I still can't sleep...
Dear Dr. Archer,
I have Lupus Erythematosus and Sjogren's Syndrome and can't go out in the sun. My sleep schedule is totally messed up and I am having trouble getting back on a normal schedule. I had been diagnosed by a counselor with major recurrent depression years ago, and that was before I was diagnosed with the Lupus. As far as the depression, I feel better now than I ever have. However, I was so far down that I am not certain I am out of the woods yet, even though I have improved drastically.
I take 20 mg of Prozac per day and have begun to take melatonin to try to make myself go to sleep. I am not seeing improvement because I still feel groggy for hours after I wake up. I am not sleepy when I am supposed to be, and I am sleepy when I am supposed to be awake.
Unfortunately, my 9 year old son is on the same schedule as I am, and school will begin soon. I have tried Benadryl to make me go to sleep. Sometimes it works, but most of the time it is time delayed or gives me restless legs. I have also recently tried Ambien but that wears off in four hours and then I am wide awake
.
Do you have any ideas on how to break this vicious cycle? I am a single mom and am attending graduate school, so I am not exactly stress free! Thanks for your help.
Melanie Brown
Hi Melanie,
I am so happy the Prozac is working for you. However, you must understand that your depression is not treated until you are sleeping normally. There are two possibilities here. First and most likely, is that your depression is not completely treated and you need more Prozac or perhaps an added medication along with the Prozac in combination will work for you. Second, the sleep is a separate issue that needs to be treated with sleeping pills. In any event you must sleep to fully feel normal.
So you must see your doctor and discuss this with him. In modern psychiatry we treat a condition until all symptoms are gone. Don't make the mistake Melanie of thinking that just because you feel better you are well. I always want my patients to feel "perfectly normal" before I consider the treatment a success. Good luck.
Dr. Archer
I have OCD and ADHD...
Dear Dr. Archer,
I'm a 37 year young female and I believe I inherited ADHD from my Dad and OCD from my Mom.
The ADHD symptoms I have are typical: general underachievement, inability to complete projects, inability to maintain organization, very low self esteem, depression, and an impulse escape into stimulation. The OCD has manifested in a past wrought with anorexia, dysmorphia, social anxiety, compulsive nail biting with skin picking and insomnia. Treatment has been very difficult, as medications usually given for ADHD seem to trigger my OCD.
I have tried many different drugs without the desired effects until I was prescribed Zoloft. However, I developed a rash from my chest up, so I stopped taking it immediately. Before I stopped, however, there was a window of time where I felt a lovely sense of well being that was foreign to me before and since. I have a friend who suffered extreme anxiety and had an allergic reaction, (asthma), when he tried Zoloft as well. He liked the way it made him feel so much he decided to quit temporarily and then acclimate his body to it very slowly until he reached a full but low dose over a period of months.
I told my doctor I wanted to try this method and he responded, "Just take these Lexapro samples. It's not worth dying over! You have OCD and are obsessing on Zoloft." But I've taken Lexapro before and still had my compulsions. I would like to go get a second and third opinion but can't afford it. I have not taken the Lexapro samples yet, and have been considering buying Zoloft either online or from my friend and trying this little experiment on my own.
I am sure no Doctor would advise this, but if I tried very low doses what is the likelihood that I could severely damage my liver? Could I really die? I would, of course, stop if I developed a rash again. After trying Lexapro, Propranolol, Ambien, Xanax, Lunesta, Prozac, Welbutrin, Ritalin, and many more, five years of expensive therapy, exercise, fish oil, ginko, ginsing, and more, and ongoing positive reaffirmations, I still feel like a frustrated, underachieving, obsessive mess. Not to mention my partner's frustration living with me.
My question is, have you heard of anyone trying this with any success?
What would you do? Have you heard of any other drugs for hybrid cases like mine? Thank you for your time and care.
Terry
Hi Terry,
First yes, I've certainly seen cases of ADHD and OCD together, not often, but I have seen it. And yes, it is difficult to treat. The fact that the Zoloft works is encouraging, but the rash is not good. The rash most probably represents an allergic reaction and this means that it would most likely come back if you restarted the Zoloft. Sometimes these reactions can, indeed, be severe and life threatening. I've heard of patients restarting a medication at very low doses and slowly going up, but I could never recommend this and your doctor is right, you could die from the reaction.
On the other hand, I don't understand the Lexapro since you've taken it once before without benefit. You've certainly taken plenty of medications, but there are many you haven't tried. Some of these are similar to Zoloft. I would go through every single one there is and then start trying combinations.
Justin Timberlake in a recent interview stated that he, also, was diagnosed with both ADHD and OCD. He admitted it took a long time, but he had to work with his doctor to find the right combination of medications that worked for him. So Terry, I really think you need to find the funds and get a second opinion. Remember that each patient is different, and you need to be patient and work with your doctor while he or she tries to find the right combination of medications for you.
There is nothing more important than your health and your psychiatric condition is definitely treatable.
Dr. Archer
What works for OCD and depression together...
Dear Dr. Archer,
I am an assistant customer service manager for a large grocery chain in North Carolina. I was on disability for over ten years. I needed to go back to work in order to get insurance so that I would be able to obtain a therapist. I have been hospitalized for psychiatric reasons several times, and received ECT, (shock therapy), for depression.
I am presently on Zoloft- 300 mg at night. Is there any other medication for OCD than what I'm taking now? The Zoloft helps some, but does not stop the OCD. I realize there is no medication that stops this illness.
Other medications I am presently taking are Vistaril and Geodon. Checking and counting the same thing over and over never goes away. Thoughts of suicide are never far away. Is there any new treatment for OCD or new medications that may be more helpful? I was on Luvox for several years and it stopped helping altogether. I am afaid the same thing is happening with the Zoloft. I hope you can help.
Lynnadl
Hi Lynnadl,
You have a very complicated psychiatric history and I wouldn't dare try to treat you over the internet. I will make a few comments, though.
First, with severe depression, you have to make sure you let your doctors know any time you have suicidal thoughts. This can be treated and I wouldn't want you to do anything rash, so full disclosure to your doctors is a must.
Next, since you are on very potent medications, I'm assuming you have a psychiatrist as well as a therapist, and I totally agree with that. The more mental health treatment you can get the better. Also, you must realize that virtually all psychiatric conditions have the potential to be treated and moderated, and with both depression and OCD, the odds are good that the symptoms can be brought under control for most patients.
But the most important thing I will tell you, Lynnadl, is that you must never lose hope! Treating severe psychiatric conditions, (including OCD and Major Depression), is never easy and often requires multiple trials of medications and combinations of medications. Unfortunately, every regimen can take from 2-4 weeks before it kicks in, so patience is absolutely paramount.
So, make sure you're with a doctor you trust and like and then be prepared to keep trying meds until you find something that works. If you are not sure, you can always seek a second opinion. Hang in there and good luck!
Dr. Archer
I am self-conscious and anxious in all social situations...
Dear Dr. Archer,
Some years ago, I became intrigued by the idea that I had the power to profoundly change lives, (particularly my own), with a single action, in a single moment. The best example I can think of is when driving at a high rate of speed, how easy it would be to just change direction and drive into oncoming traffic.
Somehow I managed to let this idea affect my social life. Rather than driving into traffic, I became curious about my behavior in social situations. It occurred to me that during a conversation, rather than responding, I had the power to not respond at all, and not conform to the social norm.
Although I never intentionally carried out the idea, it came to dominate my thoughts during conversations, and rather than paying attention to what other people were saying, I was pre-occupied with this bizarre, self-destructive conduct. To my horror, it was also self-fulfilling. I would end up not responding normally because I had not been paying attention.
Over time this bizarre glitch became very stressful. I lost plenty of friends, mainly because I would avoid social situations so I wouldn't have to endure the stress of these overwhelming thoughts and situations.
Years later, the result is that I am extremely self-conscious and anxious in all social situations. This weird idea no longer dominates my thoughts; instead I am pre-occupied thinking about how to respond rather than simply responding naturally.
The worst part is that the damage to my life was self-inflicted. I'm ashamed and distraught that I allowed it to happen. But at the same time, I have hope that if I had the power to create this problem, I also have the power to reverse it.
I have never told this to anybody else because it doesn't really make sense. I believed I would have to figure it out for myself. But so far, I haven't. I hope you can help.
Joe
Hi Joe,
There's no doubt that we each have the ability to change ourselves with the way we think. Research has actually shown that those with a positive attitude are happier with their lives than those without, regardless of life circumstances. That being said, I want to offer another possible explanation for your behavior. You sound like you have a chemical imbalance of the brain and I would suspect the possibility Social Anxiety Disorder or less likely, OCD (Obsessive Compulsive Disorder).
Usually, people with social anxiety disorder feel that something is wrong, but fail to realize their feelings are a sign of illness. Symptoms can include, but are not limited to, intense anxiety in social situations, avoidance of social situations, confusion, pounding heart, sweating, and muscle tension. It is the most common anxiety disorder and the third most common mental disorder in the U.S. An estimated 19.2 million Americans have social anxiety disorder, and it usually occurs in adolescence and early adulthood, but can occur at any time.
This is important to consider, Joe, for if a chemical imbalance is present this may not be your fault at all. Rather, the condition predisposed you to the anxious and bizarre thinking. The first thing you should do is schedule a psychiatric evaluation. If you do indeed, have this condition, it is very treatable with medication. You may find that once treated, you are able to fully enjoy social situations again and that you no longer have the thoughts that are hampering your social life. Good luck.
Dr. Archer
Do anti-depressants cause weight gain...
Dear Dr. Archer,
Since you cannot answer my question on Facebook, you informed me to ask it here for legal reasons. Knowing that everyone's body is different, what is the normal weight gain in pounds for someone like me taking 10 mg of Lexapro daily?
Also, I take Levoxil for my thyroid. Can hypothyroidism, (I think that's what it is called), also cause me to gain weight?
Can normal exercise, like walking, overcome the weight gain caused by Lexapro and allow me to start dropping some pounds?
Bob
Hi Bob,
Yes for medical and legal reasons I can only answer questions through the website, where we have a list of terms and conditions that must be agreed to by anyone submitting a question. I get many questions on Face Book and if it were up to me I would love to be able to answer them there.
Weight gain is definitely a potential side effect of Lexapro. However, as with all side effects, it is impossible to say in any given case if this will be a problem and if so, how significant it will be. In addition, hypothyroidism is a known cause for weight gain if not treated completely.
Exercise is beneficial for many health reasons including weight gain, but again, it's up to the individual as to how much is enough or needed. I encourage my patients that do not do any other exercise to walk 30 minutes a day, 5 days a week.
My advice, Bob, is to see your Doc and make sure your thyroid levels are normal. If so, and the weight is still a problem even with exercise. then it would be worth discussing with your psychiatrist to see if another antidepressant with less of a weight gain profile would be worth a try. Take care.
Dr.D
I have multiple personalities and OCD...
Dear Dr. Archer,
I am 53 years old and originally from Long Island, NY. I see you often on "Issues" with Jane Velez-Mitchell on HLN. You seem to be a very caring person.
It is difficult for me to say this, but I was diagnosed with DID (Dissociative Identity Disorder) and OCD (Obsessive Compulsive Disorder) in 1991. I had been in treatment six days a week before that diagnosis. I was hospitalized because of depression.
I now have a psychologist I see for therapy and a psychiatrist I see for medication. The OCD began when I went to college. I couldn't finish school because of the disorder. I couldn't tell anyone what was happening because they would think I was crazy or strange. I couldn't read. To tell you the truth, I didn't know my condition had a name.
I would have to know the first and last word on the page. I would have to know which words were capitalized and where the comas were in the sentences. I couldn't turn in papers to professors because if I turned the paper in, then I wouldn't be sure if what I wrote was really written, or if something else was on the paper and was hiding what I had really written. Perhaps I had written something bad. I would get headaches. On some days I would wake up and be in different clothes and in strange places.
This issue seemed to become clear to me in 1993 when, with the help of my doctor, I remembered things that had happened in college. Specifically, I remember packing for school. I was looking for a handkerchief in my father's dresser drawer. In the back of the drawer I found a very old toothbrush. I do not know why but something caused me to take that toothbrush to school. Then, one morning at school I accidentally used that toothbrush instead of my regular toothbrush. A day or so later, I was unable to brush my teeth in a normal manner and my OCD started soon thereafter.
Lynn
Hi Lynn,
DID (Dissociative Identity Disorder) is better known as Multiple Personality Disorder and is a controversial diagnosis in Psychiatry today. The diagnosis requires that at least two distinct personalities routinely take control of an individual's behavior. It is associated with memory loss that goes beyond forgetfulness. Also, the symptoms cannot be due to drug use. That being said, the symptoms that represent DID do respond to behavioral therapy, whether there are true 'multiple personalities' present or not, so seeing a psychologist is appropriate for this.
More importantly though, the key is to treat any underlying psychiatric conditions that are present since these symptoms may be the true culprit. In this case that means addressing the OCD. Obsessive-Compulsive Disorder is an anxiety disorder which is characterized by uncontrollable intrusive thoughts. Sufferers often try to keep their compulsive behaviors hidden from others because of embarrassment, humiliation or fear of being seen as odd or different.
You are not alone, Lynn. About six million Americans suffer from OCD, and it is the fourth most common mental disorder. There are many medications that are helpful in this condition, with the most recent addition being Luvox CR. The key is to work closely with your Psychiatrist as he tries different medications and combinations to see what works best for you. There is no one right medical regimen; it is all based on the individual and how they respond.
Sometimes it can take numerous trials to find what works, but you must never give up until you are happy that your treatment is working for you. Sometimes I have tried 20 different medications and combinations for a patient without success, only to have regimen 21 be a complete success. Do not lose hope, Lynn. Work together with your Psychiatrist until the two of you find YOUR right regimen.
Dr. Archer
Am I getting depressed again...
Dr D,
Ten years ago I was treated for depression after a bitter divorce. I saw a psychiatrist who prescribed Prozac. I also had counseling, and after a year I felt normal again. That was the worst time of my life.
I am now remarried to a wonderful woman, have a great job and good relationships with my ex and my kids. But I can feel that I am getting depressed again! There's no reason for this at all. I'm not sleeping and that is how it began the last time. I'm terrified that I am heading back to that bottomless pit again. What do I do?
Rob
Hi Rob,
Though I can't know for sure that you are relapsing into depression, you sound like you're convinced and you are probably correct. A couple of points here. First, there doesn't have to be a reason for depression. Sometimes a chemical imbalance has no other cause than genetics.
Next, you may be under stress and not realize it. For example, in these tough economic times I have seen many patients that are under incredible monetary stress and don't even realize that it is affecting their mental health.
However, the most important thing for you to do now is to stop this before it gets any worse. That means you need to revisit your psychiatrist for a re-evaluation. The good news here is that once a medication works for a chemical imbalance depression, it typically will work again. Thus the Prozac would more than likely still be effective.
So, Rob, see your Doc now and get the immediate symptoms under control. The earlier you seek help, the easier to treat most psychiatric diagnosis.
Once the condition is better then you may also want to re-enter counseling to see if perhaps there are some other things going on that should be addressed. I suspect the economy is playing more of a role than you realize. But first things first, get in to see your Doc immediately. Take care.
Dr. Archer
Is it depression or withdrawal from drugs...
Dear Dr. Archer,
I am a 30 year old female and have had a methamphetamine problem for four years. I am now sober for 35 days.
My mom, who suffered from schizophrenia, died of cancer six months ago at the age of 59. We were extremely close, and I was grateful that I was able to care for her at home. I worked diligently to make her comfortable and was dedicated in making her last days as enjoyable as possible. I miss her terribly.
I was a somewhat functioning drug addict and really got into the drugs after my mom passed away. Even though it has been six months, it feels like my mom passed away just yesterday. It is extremely painful, and it does not seem real. I attend outpatient counseling for my drug problem, and so far it is working to my advantage.
I guess what I'm trying to say is that I feel tired all the time. I don't know if it's depression or withdrawal from the drugs, or both. My motivation and drive is not what I want it to be. I wish my mom were still with me. I feel like she took a part of me with her. I realize now that I wasn't ready for her death. It was only a year from her diagnosis to her passing, and I still can't believe she is actually gone. I miss her so much.
Jamie
Hi Jamie,
I'm so sorry to hear about your Mom, yet I applaud you for taking charge of your addiction and seeking treatment. As far as your fatigue, that is very common after coming off a stimulant like meth, even months after you have stopped using. Factor in the grief from the loss of your mom, and it sounds like you have developed a chemical imbalance depression that needs treatment.
So, Jamie, talk to your therapist about a referral to a psychiatrist for an evaluation. Medication could make a huge difference while you work on your addiction and cope with your loss. Take care.
Dr. Archer
I'm addicted to fast food...
Dear Dr. Archer,
Is it possible to be addicted to fast food, or is it an obsession? I am a very athletic, healthy woman in her early 30's. Lately, I wake up and start thinking about where I can drive thru to eat. Even if I eat breakfast, I will still go to the drive thru. Sometimes at lunch, I will try to talk myself out of fast food, only to drive back around, or go to another place to get something that is bad for me.
Sometimes I cry because I am so mad with myself. Sometimes I order the worst food, either with the feeling that I am rewarding myself or punishing myself. I always feel so nasty after I eat, like I could be sick, but I don't want to throw up. It's a horrible habit, and the only way I don't weigh 400 pounds is because I work out regularly. On the weekends, or when I'm at work, I am fine. I don't go to the store to buy junk food. This only happens when I am in my car.
I am very worried, and I'm afraid that I'm developing some strange obsession. I feel even crazier because I talk to myself about this problem.
I talk myself out of the drive through food, and then get angry at myself when I relinquish into my desires. What am I supposed to do? Is there medicine for this?
Andrea
Hi Andrea,
First of all, any addiction is related to compulsive behavior, so it is possible to be addicted to just about anything you can think of, including: shopping, sex, drugs, food, gambling, alcohol and, yes, even fast food.
I've never seen what you describe before but the underlying cause for addiction has a genetic/brain chemistry basis coupled with thoughts and compulsions for the item of addiction. However, your condition sounds more to me like an Obsessive Compulsive disorder which would comprise obsessive thoughts about fast food coupled with compulsive eating. And, yes, this can indeed be treated with medication.
Since this seems to be getting worse and you have developed crying spells, talking to yourself and are constantly thinking about fast food I recommend a psychiatric evaluation for possible medication treatment right away.
Counseling could also work in this case, but the longer a condition like this goes untreated the harder it becomes to treat. So, Andrea, see a Doc and try the meds if he finds they are indicated. If not he can recommend a therapist.
Dr. Archer
I have a hard time controlling myself...
Dear Dr. Archer,
For as long as I can remember, I have had a hard time controlling myself, such as going to work: I take a day or two off once a week or every few weeks . I also can't control how much I eat.
Sometimes I seek sexual gratification even so far as to be with both men and women, although I try to keep a steady balance with both.
I try to go to work, but sometimes I get to the parking lot and it becomes almost impossible to get myself in the door and stay. I only feel comfortable at home; I don't go out much and keep to myself.
I have a girlfriend and I don’t want her to know I take off or do some of the things I do with men or work. I try to tell myself its because I'm lazy but I get almost frantic about even going to work. I don't like to go to family or friends functions anymore.
I just dont know if there is something wrong, should I see someone? I just am starting to get worried about how my life will pan out if I keep going this way.
James
Hi James,
There are a number of separate incidents I'd like to discuss here. First, your job. Do you enjoy your job on the good days, or is it a job that you just really don't like? If it's a normally enjoyable job, and you are avoiding it, that's way different than if you hate your job and avoid it. If you hate your job, then start looking for another now. If you like it and can’t get in the door then that suggests anxiety.
Next, if you are avoiding family and social functions to stay home that could signal an anxiety problem, in particular social anxiety disorder, which is very treatable. However, it sounds like you aren't afraid of people, because you are having sexual hookups with men and women.
My advice to you is this: First, schedule an appointment with a psychiatrist to have an evaluation. This could be a chemical imbalance and that is treatable. As I said before, if it's social anxiety disorder, it could explain your aversion to social activities and the worry you feel in your parking lot at work. Next, you MUST tell your girlfriend that you are sleeping with other people, especially random men. It puts her at risk of sexually transmitted diseases, and it is not fair to her to keep her in the dark. Your level of bisexuality is not the issue here and once you talk about it, the stress you are feeling may be lessened.
You first must be true to yourself James and next to your girlfriend and family. Only honesty will set you free. Good luck,
Dr. Archer
I'm not motivated and I can't concentrate...
Dear Dr. Archer,
I am a 29 year old male from southeast Asia. I have a huge problem when I try to concentrate on studying. I have been trying for the past five years to prepare for a specialization exam. Unfortunately, I have wasted plenty of time and energy, and am still not prepared to take the exam.
Besides having trouble concentrating when I attempt to study, I have trouble sitting for more than thirty minutes. I try to memorize information, but tend to forget very easily. Even if I get a good night's sleep, I always seem to be very sleepy in the morning. I find it impossible to get myself motivated. I believe I am depressed. I have become a burden on my parents. They are fed up and extremely disappointed in me.
Please, please help me. I want to get out of this mental slump in which I find myself. I want to be able to concentrate when I study; I would like to have my mind fully alert and fresh. I want to have confidence and self worth, and to have energy to carry out my daily routines and to prepare and pass my exams. Do you have any suggestions for me?
GTP
Hi GTP,
When you combine your symptoms of poor concentration, poor sleep, no motivation and feelings of depression, then the most likely diagnosis is a chemical imbalance depression. Obviously, I can't make this diagnosis over the internet but I can tell you, GTP, that you must see a psychiatrist for an evaluation; I suspect that medication would help you.
I will also point out here that Adult Attention Deficit Disorder has become a very popular diagnosis recently, but the poor concentration is often in reality caused by another type of chemical imbalance, either depression or anxiety. In any event, your condition can most likely be treated easily so get an eval soon. Take Care.
Dr. Archer
I can't tell what's real vs. what's in my head...
Dear Dr. Archer,
I am beginning to have trouble differentiating what's in my head to what's actually reality. I spend much of my time alone in fear that something I do or say will affect my social standing with friends and co-workers. Much of my time with family and friends are spent explaining or rationalizing my behavior. My biggest concern is that I cannot tell if I have a genuine problem, or if I am fabricating things in my head based on something I've seen, thought or heard.
The first time I started to question my mental state was after my girlfriend of 3 years cheated on me. I didn't get angry, nor did I cry. I just waved it off. We made plans to watch a movie at home. I went out to buy some snacks for the movie. I thought I remembered every minute of my trip to the store and back. When I got home, however, she was in tears because she said I had been gone for three hours. My phone had 15 missed calls. Sometime later my family convinced me that, because of her infidelity, I should leave. I didn't like the idea, but I accepted and went along with their advice, believing they knew what was best.
That was 18 months ago, and currently I am living with my brother. He has not noticed my concerns, and I have not mentioned them to him. I have learned to be less trusting and naive. I find in every facet of my life I take a firm "I don't care" attitude with situations that make me upset, emotional or angry.
Most recently, I have been having thoughts and dreams that I barely remember. They eventually work their way into my thought process: talking to my friends about events that never happened, or being part of undertakings I was never involved with. Additionally, I find myself remembering things that are memories etched in my mind and asking myself, "did that really happen?"
I have been taking St. John's Wort in an attempt to raise my mood, but I find that this does nothing to help. I need to know if I'm experiencing something normal, or if it's depression, or perhaps a lack of self-confidence. I do not want to be a liability to my family and friends. If this gets any worse than it is already, that's exactly what I'll be. Thank You in advance.
Aaron
Hi Aaron,
I can tell you that anytime you're not sure whether you are experiencing reality versus just thinking or dreaming, that this is not normal. I'm very concerned that you may have a chemical imbalance of the brain. This could be anything from anxiety to depression to early psychosis. I just can't be sure based on what you've written. St. Johns Wort is a herbal treatment that initially showed promise, but the latest studies indicate that it is no better than placebo, so I do not believe this is the answer.
What's clear is that you must schedule a psychiatric visit for an assessment. By being under the direct care of a psychiatrist, you will receive the proper treatment for your particular illness. I suspect, from what you have told me, that medication will be indicated. In addition you must also discuss this with your family as I suspect that they must be very worried. One more thing, Aaron. Please schedule an appointment as soon as you can. Your condition sounds like it's still in a very early phase, and the sooner you treat a chemical imbalance, the easier it is to manage. Good luck.
Dr. Archer
How can I find a psychiatrist...
Dear Dr. Archer,
I am writing for a friend who is searching for a psychiatrist who will correctly diagnose her problem. She is having difficulty balancing work, parenting and going to school. She has a major anxiety disorder. She's already been diagnosed and treated for ADD. She doesn't take her medication because she says it causes her increased anxiety and stress. She's only been able to obtain various medications to address certain symptoms from family practitioners, but she needs a psychiatrist.
I know there's help out there, and that is why it is so difficult to see her in this state. I am afraid that she may have other mental problems that have not been diagnosed. Also, her son is starting to pull his hair out in clumps. Without a proper diagnosis for her soon, I am afraid the situation will get worse for both of them. She needs help immediately. Please advise!
Gwen
Hi Gwen,
You raise some good questions. The best way to find a good psychiatrist is to talk to trusted family and friends and ask for recommendations. You'll be surprised how many have seen a mental health professional.
If you want to keep it confidential, then your family doctor is a good place to start. He'll have a working relationship with the psychiatrists in the region, and can give you a referral, as well. In addition you can look in the local phone book or go online to do a search. Tell her not to delay. This needs to be addressed right away.
As for her son, please see my blog on his condition entitled
Trichotillomania. This also needs to be evaluated and treated by a psychiatrist so they probably could see the same one. It is very nice that you have taken the time to help your friend. Take care.
Dr. Archer
My best friend is cutting herself...
Dear Dr. Archer:
My best friend and myself are 50 years old. She lost her husband 9 years ago. It was extremely traumatic for her. He was only 40 years old and had a massive heart attack, and died in her arms.
Her son is on heroin and is presently in jail. She has began cutting herself, and I don't know how to help her. She just recently began seeing a counselor. She confessed to me last night that she cut herself again, rather than taking Vicodin. She believes cutting is the lesser of the two evils.
I told her to inform her counselor that she cut herself. She refuses, saying she doesn't know her well enough. I told her that her therapist can not help her if she isn't completely honest with her. I have plenty going on in my life right now and have my own problems. I don't know what to say or do for my friend.
I told her I would not tell anyone, but this is too much for me to bear alone. Should I tell her sisters? I don't know what to do.
Debbie
Hi Debbie,
Cutting oneself is the process of taking a sharp object and deliberately cutting into the flesh. It's known as self harm, self injury or deliberate self harm. There are many theories about the psychiatry/psychology of this condition.
The psychological theory I like best states that the self inflicted pain of the cutting is used to cover up and deflect from an emotional pain, in this case, the death of her husband. As for the psychiatry, many of these cases are associated with major chemical imbalances of the brain. Most common is depression, and again that would fit in this case as well.
Chemical imbalance depression is very treatable. The focus here is to get an appointment with a psychiatrist for her as soon as possible for an evaluation to see if meds are indicated. So, Debbie, first you must discuss this with her. Show her my answer if need be. I think the odds are that she's depressed and you need to tell her that this can be treated.
If she refuses then you must tell her that you have to go to her family and that you will do whatever it takes to get her help. Also, as a last resort, you can call the therapist's office. The therapist can't talk to you because of confidentiality, but you can tell the office exactly what's going on.
Dr. Archer
I fear I'll contract an incurable disease...
Dr. Archer,
I am a 33 year old man. I find myself under undue amounts of self-imposed stress. I look at what is going on in today's world and it frightens me. When I hear about different diseases, I wonder if I will become afflicted with them. I have unrealistic fears that I could contract an incurable disease and suffer horribly.
The unknown causes me undue distress and anxiety each and every night. These feelings of dread cause me to worry about the possibility of me being away from home and becoming violently ill. What if I became sick and was not near a hospital? What would happen to me? In the past, I truly enjoyed traveling. These days, I find I have absolutely no desire to travel whatsoever. I could catch a disease from others that maybe didn't realize they were sick.
I am in good health, yet I worry about having a heart attack. I have no heart problems at all, yet my mind will not accept that fact. I exercise and feel good when I do. Yet I still have foreboding thoughts that something is wrong. I eat well, yet avoid some diets, thinking they will affect my health. I look older than my friends that are my age.
In short, I fear everything. I don't know what to do anymore. I don't want to live in fear like this another day, but I cannot seem to put my fears aside. Please help me.
Christopher
Hi Christopher,
It sounds like you have a classic case of obsession with disease and germs. Most cases like this are coupled with compulsions such as long and frequent showers with disinfectant, hand washing constantly, all day use of sanitizer, refusal to touch others for fear of infection, etc... When coupled with the compulsions, this would be called Obsessive compulsive disorder (OCD).
The good news, Christopher, is that either with or without compulsions this condition can be evaluated and often treated with medication. So you need to schedule an appointment with a psychiatrist for an eval as soon as possible.
I'm glad you wrote me because it sounds like this is getting worse and most folks would not think that this could be caused by a chemical imbalance of the brain. So don't delay; schedule an appointment right away. Good luck.
Dr D
I have thoughts of suicide...
Dear Dr. Archer:
My problem is that I have thoughts of suicide. I would not carry it out, however, because of my grown child and my grandchildren. I lost everything to Hurricane Ike and feel as if I am just going through some of life's motions. I used to be happy, carefree, and very out-going. I loved life and lived it to the fullest. Now sometimes I don't get dressed for days, and I have no desire to leave the house unless I absolutely have to. THIS IS NOT WHO I AM AND I DETEST IT!
About fifteen years ago, I was diagnosed as Bi-Polar. I was put on meds to control that disorder. Then, another doctor informed me that I was not Bi-Polar. I had to be taken off all meds because I had developed extreme liver problems (that has since cleared up). That doctor said that he would have to find something else that I could take that would not affect my liver. Well, that never happened and that was 3 years ago.
I felt fine, though. Unfortunately, everything came crashing down after Ike. I feel like a mis-placed person. I am renting a home, I no longer have a job, and, of course, I have no medical insurance. I go to the doctor when I have to, but am in dire need to talk to someone who specializes in this type of behavior or symptoms. I have little money. Thank you so much for your help.
Numb
Dear Numb,
I wish you had placed an email address in your question. I'm worried about you! Thoughts of suicide are a psychiatric emergency. You MUST visit a Doctor immediately. If you can't afford one, then go to the nearest emergency room. It sounds to me like you have a chemical imbalance of the brain and this can be treated with meds, but only if you go see a Doctor.
There are many psychiatric meds that don't affect the liver, so that should not be a problem. Also, it is not uncommon for a stress like a hurricane to trigger either a relapse or a new chemical imbalance. After you see a Doctor and get evaluated then, you can proceed for follow up in a Mental Health clinic, which is either free or has a sliding scale.
Please don't delay going to see a Doctor, Numb. This is a treatable condition and this should be the number one priority in your life right now.
Dr. Archer
I was misdiagnosed...
Dear Dr. Archer:
I am 21 years old and I live in England. When I was 16 years old, I was diagnosed with Borderline Personality Disorder (BPD). In 2005 I took a psychology class and realized that my diagnosis was wrong. I have been arguing my case for four years now, and the Mental Health Service has actually blocked me from any acute level of service. I have made various complaints against them, which they deny, even though I have provided proof of my allegations. These people are rude and, on more than one occasion, have told me that they don't care.
In 2008, I obtained a second opinion through a psychologist. In her opinion, she stated that she did not believe I had BPD. She also stated that the service should be doing more to support me. The Mental Health Service feels it is best not to do anything until they receive yet another opinion on my condition. Until then, they have ceased any involvement with me. But I am still having trouble sleeping and need care.
My diagnosis is wrong. They should be reassessing me and changing my care plan. I feel like no one wants to admit to making a mistake. Meanwhile, I am not getting the level of care that I need. Please help me if you can. I feel very confused, and don't feel like I can move things forward on my own. Thank you.
Jenny
Hi Jenny,
I'm assuming that the Mental Health Service in the UK is similar to our Public Mental Health System here in the United States. You have obviously received two different opinions that disagree, and you believe your private psychologist is correct. My thought is, why bother with the Service? You have a psychologist and you seem to like her. Why not get her to recommend a Doc for meds and continue to use her for therapy?
Obviously, I can't give an opinion as to your diagnosis over the internet, but the important thing in getting medical or psychiatric treatment is to find a Doc you like and trust, and then to stick with them. The only way this would not hold true, Jenny, is if money is an issue and you can't afford to stay in the private sector.
Unfortunately, in that case, you may be forced to fight the bureaucratic battle with The Service. However, if you can afford it, you must realize that nothing is more important to your individual well being than your health. Better skimping on something else and getting the proper mental health treatment from someone you agree with. Take Care
Dr. Archer
I relapse whenever I stop my meds...
Dear Dr D,
I am a 33 year old woman, and have plenty of stress in my life, but I don't think I have the correct tools to cope with my stress properly. I have suffered from panic attacks for several years and have been on Sertraline for about seven years.
Is it possible, even with having two relapses when getting off medication, to control panic attacks with cognitive therapy? Is there a cure, or will I have to be on medication for the rest of my life? The meds help, but like anyone else, I would rather not have to take them. I would like to try to handle this on my own, but don't want to have another relapse, either. I am frustrated and find myself envious of people who handle their fears.
I am sure my childhood has a huge impact on my anxiety. My dad left when I was an infant and my mom suddenly became a single mother of three kids. We were sent to the babysitters' house while my mom worked three jobs. While at the babysitters we were physically and sexually abused. My mom remarried and divorced two more times by the time I was 11 years old.
I have tons of drive to be successful, and a huge fear of failure and loss of control. I believe, as I have gotten older, I have been able to let go of some of my issues. Your thoughts on my situation, Dr. Archer, would be appreciated. Thank you for your time!! Ashley
Hi Ashley,
You've been diagnosed as having panic attacks and prescribed Sertraline for this condition for 7 years. You seem to do well when you take it but have relapsed twice when you stopped. You need to think about what this is telling you.
Panic Attacks are caused by a chemical imbalance of the brain and sometimes require long term or even lifetime treatment. No one likes to take meds since we all see that as a personal weakness, whether the condition is medical or psychiatric. But the fact is that the human lifespan has increased by decades in the last century due to the advances of modern medicine.
My advice, Ashley, is to talk to your Doc about your med treatment and ask about counseling. Psychotherapy could be beneficial in helping you deal with current stress and your abusive childhood. However, if you do have to take Sertraline long term and can lead a normal life, well, that's really not such a bad deal in the grand scheme of things is it?
So, take your med, try some counseling, stop worrying about it and get on with your life.
Dr. Archer
I need to get help...
Dear Dr D,
My name is Jammie. I am 26 years old, and I have an extremely messed up life.
I have two children. I also have severe anxiety issues that started about a month ago. I have nightmares regarding death. I break out in sweats at night. Sometimes I just want to cry.
There is nothing physically wrong with me; I don't have a terminal illness or anything like that. About a month ago four teenagers were struck by a drunk driver and killed. All four of these teens lived close to my house, and ever since then, I just keep thinking about dying. It won't stop, and I don't know what to do.
When I was four years old my dad was hit by a car while crossing the street, and he died. My mother took me to the funeral and I remember it like it was yesterday. A month later my mother went to prison and I was put into foster care, where several bad things happened to me. I have never told anyone about those instances, so I don't want to get into detail about them. Shortly after, my grandmother fought for me and was awarded custody. I went through plenty of counseling, and everything was good.
Then , I had my first daughter. My husband and I were having problems, and I tried cutting my wrist. Please understand, my whole life I have suffered with self image problems. I always felt like no one loved me, so, what was the point? I was eventually committed and they told me I was Bipolar/Manic Depressant. My husband doesn't know how to handle this; I am afraid to go anywhere or do anything.
Just a month ago I used to do my hair and make-up every day; now I just sit around in my pajamas. He hates it that I am this way, and even the children have noticed the difference in me. I want to overcome this disorder so I can act the way I was a month ago. I love my husband and I love my children. I am afraid I am going to lose them.
I don't have insurance, so I sit here every day and suffer, instead of getting help. I am hoping you can help me with this situation. Please, I am at my wits end.
Jammie
Hi Jammie,
I don't understand the whole picture here. You said you were committed and diagnosed with Bipolar Disorder? I'm assuming they must have prescribed meds? Who's following you up after your hospitalization?
Conditions such as Bipolar Disorder often require long term treatment with medication. All cities/regions have programs for the uninsured, with either free or sliding scale treatment for mental illness.
So, Jamie, you absolutely must schedule a follow up with a psychiatrist as soon as possible to assess and treat this condition. Don't delay, even for a day. This is treatable and your responsibility at this point is to get into see someone. Also, if you have any thoughts of self harm, then you must go immediately to the emergency room. Explain all this to your husband and get an appointment now!
Dr. Archer
I attempted suicide and my girlfriend dumped me...
Dear Dr. Archer,
My now ex-girlfriend of 3 years is Bipolar. She has been going through a manic period in which she wants nothing to do with me. I was recently diagnosed with Anxiety Disorder and Depression. She has had a pretty disturbing past, to the point where it is scary. It is because of her that I am contacting you.
She broke off our relationship two days ago because I tried to commit suicide four days ago. That may sound backwards, and it seems like she never really loved me if she would leave me for that, but here's the thing: She never knew I had those problems. I never even really knew what was wrong with me until my trip to the hospital at which point I was started on medication.
She says she will never be able to forgive me, and that is why we can't be together anymore. She says I broke her trust. I understand that all of this is true, and I know there really may not be any way to mend this relationship. But I can't go on for the rest of my life knowing she still hasn't forgiven me. I love her too much to do that.
Everybody has been saying, "just give it time, give it time." I know that I should just give it time, but what do I do when she's ready to speak to me again? Is there any way to get through to her so she understands that what I did was necessary and now I'm being treated? That I wish with every bone in my body that I didn't hurt her, even though I knew it was going to?
She has pretty much said she hates me, but I know she only hates what I DID, not ME. I am lost and confused. please help.
Dani
Hi Dani,
First of all, attempting self harm is never necessary and is typically caused by a psychiatric illness. Next, I must tell you at this point that your ex-girlfriend is the least of your problems. You attempted suicide ended you up in the hospital and you are now on medication. And you have a chemical imbalance of the brain and Im so glad you've received meds and professional help. But you must follow through with this help and make sure your condition is in complete remission.
Now that you know you have a psychiatric diagnosis, your only goal must be to get well. I assume you have a follow up with the Doc that treated you in the hospital. If not, then you need to schedule an appointment with a psychiatrist immediately. At this time you must deal with your own problems before you even think about trying to win your girlfriend back.
In addition, she has problems of her own with her Bipolar Disorder and her current manic episode. If shes not already seeing a psychiatrist, then she needs to see one herself.
Heres the deal, Dani. In order for this relationship to have any chance of working you must be strong, healthy and happy with yourself. Then decide if you even want her in your life. If so, then you should have a conversation with her about where this goes from here.
In summary, focus on yourself, See your Doctor, go to therapy, take the meds he recommends and get completely well. Then reassess how you feel about your ex-girlfriend. Take your time here, there is no rush to make an immediate decision. Take Care.
Dr. Archer
Could I have inherited my family's chemical imbalances...
Dear Dr. Archer,
I am a 60 year old woman with a family history of Bipolar Disorder and other psychiatric conditions. My mother and three sisters all have this disorder as well. I have had mood swings and depression for years and this seems to be getting worse as I get older.
My doctor has given me Zoloft and other meds for this condition. I have had side affects from all of the medications and have gotten off them. The worse side affects are nightmares and sleeplessness. Could I have a chemical imbalance of the brain? What tests are done for this condition? I really need help. I'm so tired all the time.
Shelley
Hi Shelley,
The number one predictor for developing a chemical imbalance of the brain is a family history, and the more members of your immediate family that have a psychiatric condition, the greater likelihood that you will also develop one. Your symptoms of mood swings and depression, and your family history of Bipolar Disorder lead me to suspect that you also have this condition.
But Shelley, you need to schedule an appointment with a Psychiatrist for a full evaluation and diagnosis. There are no definitive tests for this; the psychiatric interview will review all of your symptoms which is how a diagnosis is made. If your Doc does find Bipolar Disorder then he would place you on a mood stabilizer to control your high and low mood swings.
This condition is treatable and the earlier you get treatment the easier the condition is to manage. So, Shelley, don't delay. Schedule an appointment immediately.
Dr. Archer
Does biofeedback work better than medication...
Dear Dr. Archer,
I battle depression and ADD/ADHD, along with a number of other physical health issues, for which I take medications. I have no real improvements when taking any type of anti-depressant, (most recently SNRIs). I deal with a lot of stress in my marriage, child rearing, and especially work. Medications seem to be a day-to-day fix. I want something that fixes it all.
Do you think biofeedback would be a better option? I'm wondering if that would be more worth my time.
Rena
Hi Rena,
Biofeedback is a form of relaxation therapy that utilizes monitors to quantify a patient's bodily functions, including heart rate, blood pressure, skin temperature, muscle tension and in some cases, brain waves (neurofeedback). There is no good evidence that biofeedback can treat a chemical imbalance psychiatric condition. However, it is effective in helping with relaxation and there are now home units available that you can buy and use on your own.
What you must realize, Rena, is that the symptoms you are experiencing are the disease and if the meds are working day to day then that's great. That's what they were designed to do. If you need help coping with stress, then I think a therapist would be more cost effective than biofeedback. However don't stop your meds unless your Doc recommends it. Good luck.
Dr. Archer
No medication has worked for my mood swings...
Dear Dr. Archer,
I'm from Scotland and have been suffering from depression for 12 years.
My psychiatrist has diagnosed me with Cyclothmic Disorder. I have been on many antidepressants but none of them have been much help to me. I was wondering if you have any more advice or an explanation about this?
Recently she has prescribed Lithium. Do you think Lithium will help as she says? For now she does not want to give me another antidepressant, as none seem to work. I am feeling that Lithium is my best hope, but I don't know what the next step will be if this does not work.
Jerry
Hi Jerry,
Cyclothymic Disorder is a mild type of Bipolar disorder which consists of cycling mood swings from highs to lows. We describe any type of mood swing illness as a Bipolar Spectrum Disorder and there are several different types of conditions in this spectrum and they are categorized by severity. Lithium is an excellent drug for Bipolar spectrum illnesses and hopefully it will work for you.
The most important thing here, Gary, is to work closely with your psychiatrist and never give up. Remember that all it takes is the right med or combo to treat an illness like this. However, sometimes it takes a lot of trial and error to figure it all out. If Lithium doesnt work there are literally dozens of medications and hundreds of combinations that may be effective.
Dr. Archer
My father-in-law doesn’t want to get well…Dear Dr. Archer,
My father-in-law has been quite depressed since his surgery 2 years ago. The depression has become more severe over the last 3-4 months. He is constantly withdrawn, doesn't talk much & keeps complaining that he will never get better.He does not even try to do anything that we tell him to do that might possibly get him out of this misery. If we insist and make him do something, like going for a walk, (usually he does not even want to step out of the house), he gets angry & shows it by not taking his medicine or eating his meals on time.He is negative about everyone, including his wife. She has severe diabetes but he hardly bothers about her and keeps complaining about himself. He even goes to the extent of saying that she is probably happy seeing him like this, in spite of the fact that she is always doing things for him and is worried about him all the time.We have tried talking to him in every possible way. He is already taking anti- depressants & other medications. But we really don't know how to get him out of this gloom. He just doesn't want to try anything. If we talk to him or ask him anything, he replies in sort of a sarcastic way, like: "Of course, I will do everything you people tell me to do," or, "that's what I have been doing," or, "tell me what you want to hear." Please help us out!RollsHi Rolls,
Though I can’t make a diagnosis over the internet, it certainly sounds like your father-in-law has a chemical imbalance of the brain (CIB) and is suffering from depression. Just because he’s taking medication doesn’t mean these meds are working. So Rolls, you must bring him back to his Doctor and let him know exactly what’s going on.
There are many drugs that work for depression. Sometimes a combination of meds is needed, but it all depends on the individual and how they respond to their prescriptions. The key in treating any psychiatric condition is to make sure all symptoms are addressed are under control which is obviously not the case here. In order to assess/treat this properly your father-in-law must work very closely with his Doc and be totally honest. If you’ve already tried the above then you may want to consider obtaining a second opinion from a psychiatrist (obviously your father-in-law would have to approve this). But remember, whatever you do, don’t give up!
Dr. Archer
I want my life back...
Dear Dr. Archer,
You really seem to connect with those of us who are hurting in one way or another. Life has become unbearable for me. I am a 65 year old female with a terrible problem. I have a myriad of health issues, including leukemia, heart disease, joint problems, fibromyalgia, degenerative disease, etc. I use food as my comfort, and because of this, I have always battled a weight problem: I weigh over 300 pounds.
I can hardly walk, and I suffer immensely. I have been to many doctors, trying to find a way out. I had a career as a professional musician that brought my husband and me a great deal of enjoyment. However, I can no longer travel. I know that I am extremely depressed; most of the time I don't even want to get out of bed. I cry constantly and have a volatile temper. I take it out on a loving and caring spouse that does not deserve this type of treatment. You may say, "count your blessings," but I can think of nothing that brings me joy. Not my religion, not my music, not even my family.
My fear is being bedridden and having to depend on others to take care of me. Is there anything that can get me out of this situation? I just want my life back. I have tried all of the antidepressants, but they hurt my stomach so badly; I can't tolerate them. I was just given Cymbalta today, but I don't think it will help, or that anything will help me for that matter.
I wish you could tell me what it is that is eating at me. Growing up with an alcoholic father may be a factor. I have medicare and supplemental insurance, but not an abundance of money.
Mary
Hi Mary,
My job as a psychiatrist is to evaluate for a chemical imbalance, give good common sense advice and provide hope. Thank you for your compliment- I always try to put myself in the position of those asking for advice and I think that helps.
You absolutely have all of the symptoms of a chemical imbalance depression and if you're not already seeing one, you must see a Psychiatrist as soon as possible! Most Psychiatrists will accept Medicare so that should not represent a problem.
If your Doc does, indeed, diagnose you with depression, then you need to ask him about Emsam which is an antidepressant given via a skin patch--hence no stomach upset. Also, there are many meds that can be given to treat the stomach problems that you are suffering and you probably need an evaluation for that as well.
The important thing is to not give up trying to get this thing treated. You must focus on one thing at a time and your goal must be a comfortable life. Often, in cases like this, a therapist can be helpful as a sounding board to discuss you problems. Hang in there Mary, sometimes all it takes is one med to make all the difference in the world.
Dr. Archer
I’m worried that my son’s medications will screw him up...
Dear Dr. Archer,
I am writing to ask about my son. He just turned 7 and was diagnosed in Kindergarten with ADHD. He is now in the first grade, which he will have to repeat. We have tried several different medications, from Concerta, to Vyvanse, and many in between. He has never been on Adderal or Ritalin, which I am opposed to. He saw a child psychologist 2 months ago, and was again diagnosed with ADHD.
The problem I am having is that I don’t like to switch meds so much, and I don’t want to “screw” him up. All of the medications he has been on before either didn’t work at all, made him a zombie, worked for a short time, made him overly emotional, made him not eat, or caused different “tics”. Within the last month they have upped and lowered his dosage between morning and nights, but he was having plenty of sleepless nights, not eating, and having tics. He was doing better in school, then regressed. So they flipped his medication again.
He is still having some tics, doing better in school, but is still having a hard time falling asleep and doesn’t want to eat. He is very emotional too. I’m concerned with him not wanting to eat, I literally have to force him to eat and it’s a struggle with lots of crying. I’m also worried about his anger; he often yells and throws things at his sister. He also has a very hard time doing his homework; it usually takes up to 6 hours, with lots of yelling and fighting. Afterward, he has no memory of the events. He was trying hard to learn, but now couldn't care less.
I’m lost and tired of trying so many pills, I know every kid is different, and I don’t want to get him “hooked” on anything. These are the most important years for school; learning, growing and everyday is hard with him. I’ve even tried vitamins and supplements with no luck. They said the meds they are giving him are not habit forming, but I want to get it right so this next school year will be easier and he can learn the things he needs. I also don’t know about his anger, or if there is an underlying problem… or is this just a side effect of the medication. Any suggestion would be helpful. Thanks,
Jill
Hi Jill,
I totally agree that this is an important time in your son's development and you’re right; you don’t want to “screw him up”. However, thebest way to help this situation is to find the right medication or combination.Sometimes this means trying many different meds until the right one/combo is found. Every med has it's advantages and disadvantages; it all depends on the individual.
The side effects you list are known to be possible with thesemeds and can sometimes be treated with dosage adjustments or other meds. I alsowant to point out that you should not limit the meds you allow the Doc to try(for example Concerta is a sustained type of Ritalin). Often it’s one certain drug that can work and make all the difference in the world, but sometimes you need to try many others to finally figure this out. Also, no research shows that vitamins or supplements are effective in this condition.
So Jill my advice is to first work with your Doc and focus on treating the symptoms that your son exhibits. Don’t worry about side effects or getting “hooked” for now, just find a med/combo that works! Side effects can always be treated down the road and these drugs have low “addiction” potential if taken as prescribed. Also remember that you can always get a second psychiatric opinion if you want to verify the diagnosis.
Dr D
I have been depressed since I was 17...
Dear Dr. Archer,
I'm 54 and have had clinical depression since I was 17 (or that's when I was aware something was wrong), and did not find the right medication until I was 33 (Nardil). I've had many episodes of severe depression. The last 5-7 years I have been through an increasing amount stress some cases being traumatizing.
A few years ago concentration and confusion became apparent but I was not aware of what was going on and thought things were getting better. However, they were not and they intensified within the last 8 months, with me thinking things would get better since I was out of the stressful situation. They increased to the point of poor performance in my job.
I have a new job now and I could not learn, I could not retain, I stayed confused, the things I was proficient at for 15+ years were confusing me, my trying to concentrate snowballed into one big confusion. I would be fine at the end of a horrible day, telling myself it was all going great, would be OK, I would get this. My short term memory is seriously impacted to the point of there being no possible explanation how or why something simple happened or having no recollection of what happened minutes to hours ago. My normal every day duties are impacted and I cannot perform any job at this time.
I am now taking a mood stabilizer along with my antidepressants and my psychiatrist is prepared to endorse a medical retirement and I am in total agreement with him. Today's economy would prove me ignorant not to work but the escape from this stress, which is also increased in the work place due to the economy, is worth more than money could buy. It has taken a few years to get to this point and my question is will it get better, stabilize, or get worse with age?
Sean
Hi Sean,
I have a few of observations here. Thank goodness you were able to find a medication that worked for you, although it sounds like your life has still been a real struggle. Repeated episodes of depression are never healthy for the brain and if left unchecked they become more difficult to treat and can cause cognitive impairment like you're describing. Based solely on your history, I agree with you and your psychiatrist that disability should be considered.
My main concern at this point is your memory and concentration. There are three possibilities in your situation. First, this could be a medication side effect and a switch to a new med combo could make a difference. Next, the stress of work has become so overwhelming that it's making your symptoms worse in which case the leave would be very helpful and therapeutic. Finally, you are developing a dementia that would need to be completely worked up in its own right.
My advice is to keep working with your psychiatrist and figure out exactly what the cause is so that you can either take steps to treat it or at least have an understanding about what's going on. Take care.
Dr. Archer
I can never finish anything that I start...
Dear Dr. Archer,
I'm a 38 year old male with problems I can't solve. I never complete anything I start, I always end up losing my job, not that I'm mean or irresponsible, it's just I've never had a career. My wife says I have mental issues, chemically Imbalanced, whatever that means. Sometimes I can start something and it will be full steam ahead but I get bored with just about everything fast. The only thing I've ever been truly successful in was illegal. I'm trying to find myself and my purpose. I've read so many book on positive thinking, I've joined the Masons, NA, public speaking to name a few and it seems to always ends the same way. I get totally bored with it. I've been abusive to my wife, I have an uncontrollable rage that lies within. Sometimes the smallest thing can take me to a place where I just don't care. There is so much more I could speak on but that would take days. If there is any advice you could offer it would be greatly appreciated. THANK YOU
Kenneth
Hi Kenneth,
I think your wife is correct, it sounds like you have a chemical imbalance. Though initially I was thinking Attention Deficit Disorder, when you mentioned just not caring coupled with times of intense irritability it reads more like Bipolar Disorder.
You state you've attended NA- which I assume is Narcotics Anonymous. If you have a drug problem then obviously this needs to be treated and addressed first. I can't diagnose your situation without a complete history, but what I can say is that you most certainly need an evaluation.
Frequently in a case like this, medications can make an amazing difference in your life. All the books, self help groups and projects won't treat a true chemical imbalance. So, schedule an eval with a psychiatrist ASAP. With proper treatment you could truly change your life and start completing all things you've left undone.
Dr. Archer
I don't want to do anything anymore, please help...
Dear Dr. Archer,
I saw you on CNN and went to your website...I feel at ease talking to you. I'm having so many problems, I hardly know where to start. As long as I can remember I've had difficulties in social situations. In school I would keep to myself...the thought of having to speak in front of the class or sit in the lunch room with all the others would send me into a panic. I had a few close friends, but without them by my side I felt like everyone was staring at me.
I'm now 39 and still battling this. I think that maybe I also have some depression or maybe bipolar issues. I find myself avoiding even the people I love, with exception of my husband and children. I stress over situations where I have to be around others.....birthday parties, school functions, etc. I try really hard to overcome these fears, recently I volunteered at my daughters school because I want so badly to be a good mother. My stomach was tied in knots the whole time.
If I see an old friend out somewhere, I avoid them if possible....at the grocery store I will go hide down another aisle. When my phone rings, I usually only answer if it's my mom or husband. The weird thing is that sometimes, but not very often, I feel normal and will answer the phone and talk for quite awhile with friends.
I have these days where I feel good and want to be with others, but they are few and far between. I also have become very irritable with my family, snapping at my husband and kids over the simplest things. When in large crowds such as at the mall, I feel like I'm just going to explode. I always get irritable and nervous in these situations, it's so bad that I've snapped at my mother when we are out somwhere. I don't mean to be this way, but I just get so nervous and in a panic.
I find myself not enjoying things I used to love, such as gardening and decorating. I stay home even when my kids are in school, when I could be out doing something. I don't keep my house up the way I used to, it's almost like nothing matters. I said when my daughter started school that I would get a job. She's now in kindergarten and the fear of actually going to ask for a job, have an interview and have to be around new people is more than I can bear.
I know I have a problem and need to get help, my mother is so worried about me. The thing is, I'm unsure of what to expect at the Dr's visit, and uneasy about going. I don't know what to say or which Dr. to see. How do you diagnose chemical imbalances? Any help would be great. Thanks for taking the time to read my ramblings.
Dee
Hi Dee,
It sounds like you've had a case of Social Anxiety Disorder (anxiety about social situations) for years, which has gradually developed into a more serious psychiatric condition. My best guess is that you have Bipolar disorder, though it's impossible to make a definitive diagnose over the internet.
Plain and simple, you need a psychiatric appointment immediately. Your condition is getting worse and needs to be evaluated and treated NOW! A chemical imbalance is diagnosed based on your clinical symptoms. This will be determined by an in depth psychiatric interview.
Please don't delay Dee, the longer you wait and the more severe the symptoms, the more difficult it becomes to treat your condition.
Dr. Archer
Can a hysterectomy cause a chemical imbalance...
Dear Dr. Archer,
I am wondering if you could shed some insight on a problem I am having. For almost 2 yrs I have been battling chronic lightheadedness and crashing fatigue, with no indication as to why. 4 months ago I had a partial hysterectomy (ovaries intact) and about 1 week after surgery I started having anxiety attacks (adrenaline rushes), severe chills, sweats and severe lightheadedness.
My family Doctor thinks it is all stress related and wants to put me on Effexor; he funny thing is before the surgery I never had these attacks. My Doctor put me on Ativan which helped, but now I am working my way off it. The anxiety attacks are getting better but the lightheadedness is awful!! Also when I get these adrenaline rushes they mostly happen during sleep or first thing in the morning. I have started back on the birth control pill to stabilize my hormones and that has helped quite a bit. The crashing fatigue is completely gone.
Is it possible for surgery like a hysterectomy to cause a chemical imbalance? Can my body repair itself without going on medication? If that is not possible what is your thought on Effexor? I feel right now like my body has too much adrenaline; will the Effexor make it worse? I would appreciate any insight you can give. Thank you.
Brenda
Hi Brenda,
You bring up several questions, so let's answer them one at a time. First, hormonal changes whether due to surgery, meds, menopause or some other cause can indeed trigger a psychiatric condition. It sounds like this was at least partially responsible for what you are calling “adrenaline rushes”. The diagnostic term for this is 'Panic Attacks' and both Ativan and Effexor can help treat this condition. You indicated that the Ativan was effective so I'm not sure why you are tapering your way off this med when it's working?
Next, your crashing fatigue also appears to be related to a hormonal imbalance since the birth control pill has treated this completely. This leaves the lightheadedness, which has me concerned. I'm not sure exactly what you mean by this, but if you are having 'fainting spells' along with the lightheaded feelings then you need a full work up for what we call syncope (temporary loss of consciousness). Your family Doc could do this or he may refer you to a neurologist or a cardiologist.
If it's determined that there is no medical cause for your lightheadedness, then the next step would be to keep working with your Doctor to adjust your meds until your symptoms are under total and complete control. Good Luck.
Dr. Archer
Do I need to stop my medication to have a baby...
Dear Dr. Archer,
I have a question about combo medications prescribed for Bipolar Disorder and the potential harm they might cause to a fetus during pregnancy. It doesn't seem like there's a lot of research out there, and I am on a mix of different medications. I thought maybe you have some experience treating patients with bipolar disorder who eventually want to have a child.
My list of medications are these: Lamictal (300mg per day); Seroquel (25 to 50mg per day for insomnia); Celexa (40mg per day for depression); and Klonopin (as needed for anxiety and panic attacks). I feel as if I might be able to do without the other meds, but I do not feel like it would be safe for my health or the baby's health if I totally stopped all meds, especially the Lamictal. I might be able to reduce my dosage to 200mg, which is what I was on for a year until recently. I also feel like maybe I could get through my first trimester, but not through the entire pregnancy without any medications at all.
Have you ever worked with a patient in a similar situation? I realize you have to look at each case specifically to decide the best treatment with the OB-GYN. I am primarily looking for some general advice or an opinion as to the prognosis.
Thanks
BP Mom
Hi BP Mom,
I have worked with potential Moms in this type of situation and you are correct; there is no set answer and every case is different. Here are some general thoughts on the subject:
First, this must be a team effort involving you, your Psychiatrist and your OB-GYN. All parties need to understand the risk/benefit of treatment vs. no treatment. Ideally you should not be on meds during your pregnancy. Of course, this is not always possible and you are absolutely right that a full blown manic episode while pregnant could be devastating to your unborn child.
Next, work with your Psychiatrist ahead of time to get off all meds that are not absolutely necessary. The fewer number of meds you’re taking, the less the potential risk. I try to start far in advance of a planned pregnancy and work with a patient to see which meds are needed. Occasionally, but only in mild cases, I’ll even do a trial to see how long this patient can go without meds. Sometimes they do better than expected and this is a good indicator they can go without meds during the pregnancy. Also important to note is that the first trimester often represents the greatest danger in many cases and sometimes if you can’t stop your medications long term then a good compromise is to take no meds during this period.
Finally, I suspect in your case, as in most Bipolar patients that the mood stabilizing drug (in this case Lamictal) is indeed the most important. The manufacturer of the drug states: "Lamictal should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus". Exactly what the risks are has not been definitively determined, but one study showed a significant increase in cleft lift/palate, but this needs to be verified.
This is never an easy decision, so take your time to get the facts, discuss it with your Docs and then as a team come up with a game plan. Take care and good luck BPMom! I’ve dealt with hundreds of women in these circumstances and it’s not as tough as you think. The overwhelming majority of my patients have done well and ended up with happy and healthy babies.
Dr. Archer
My new doctor won't prescribe my medication...
Dear Dr. Archer,
My insurance company told me I had to change my psychiatrist. I did that, but I could not get an appointment for 3 months. I had to go to my family doctor for medication refills but she REFUSES to fill my Xanax even though I’ve been on it for years and was doing well. I feel horrid and I know it's the withdrawal from the Xanax. What do I do?
Christine
Hi Christine,
This is a concerning situation which I’m starting to hear more about: Doctors refusing to prescribe certain drugs that may have the potential for abuse. Xanax is a fantastic med for many conditions including anxiety and panic attacks. It also works well in combo with other drugs for many additional chemical imbalances.
Unfortunately, Xanax does have the potential for abuse and addiction, so the prescribing Doc needs to take steps to ensure the patient is using it properly. This can be as simple as prescribing only enough medication to last until the next appointment. I can quickly figure out which patients can be trusted and then, if the patient is stable, the visits can be stretched out over a longer time frame. My concern is that patients are being denied excellent treatment options by their Docs because of this fear of abuse, which is something that can be easily monitored.
As for your situation, Christine, I’m not sure you are just suffering from withdrawal. It could be that your original symptoms have returned now that you are off the meds. It may be worth calling your original Psychiatrist for a 3 month extension of your original prescription. Otherwise, you need to find a Doc that will listen to you and understand how well the Xanax worked and then be willing to prescribe it. You need to get a copy of your medical record from your original Psychiatrist to document this. You could then tell the new Doctor that you only need enough refills to last 3 months until your appointment with your new Psychiatrist.
In addition, it may be worth asking your family Doc if she could get your appointment moved up with the Psychiatrist or recommend another with a shorter wait time. Good luck, I know you are really suffering.
Dr D
I'm pulling out all my hair...
Dear Dr. Archer,
I have a hair pulling disorder called Trichotillomania. I have read all about it. I am looking for a cure. I have been doing it for 4 years and have not been able to conquer it. I am retired, but I started pulling my hair when I was still working under a tremendous amount of stress. I am looking into HairPullingCure.com and StopPulling.com to find an answer. The first is a 9-minute cure by looking at videos. The other one is an on-line behavioral program to help manage the problem.
lease check out these programs and I would appreciate your thoughts to guide me in the right direction. I wear a wig constantly to cover up my problem. Thank you.
Madeline
Hi Madeline,
Trichotillomania is considered an impulse control disorder but it also has some traits in common with OCD, repetitive habits and even addiction. The disorder consists of repetitively pulling out chunks of body hair, mainly from the head but also from the eyebrows and body. Patches of baldness can result. There appears to be a genetic link which would implicate an underlying chemical imbalance.
Treatment consists of medication and/or therapy. I’ve had good luck in treating this with Luvox which is a med mainly used for OCD (Obsessive compulsive disorder). A type of therapy called Habit Reversal Training (HRT) is also reported to work. This therapy teaches patients to recognize when an impulse arises, then to redirect that impulse to a more benign behavior. It is performed by a trained therapist. I really can’t comment on whether a video would work as well as a therapist, since I haven’t seen any scientific studies on the effectiveness of that type of treatment. My advice would be to get an eval by a psychiatrist and to give medication a try.
Dr. Archer
My OCD is causing Panic Attacks...
Dear Dr D,
Organization and I have had a tight knit relationship from the get-go. I was going to say a love affair, but certainly more of a marriage than affair. To put it in simple terms, I like things done my way. Not your way, my friend’s way, my housekeeper’s way, but my way. The phrase "my way or the highway" means a great deal to me. Let me give some examples.
My desk at work: open a drawer and you will find everything lined up in little rows. Pens grouped by color and type. Envelopes and papers stacked by shape, size, and color. Not a big deal right, the way an office should look?
My apartment: my bed is like a display from Bloomingdales. 6 pillows arranged in order, sheets under a blanket, under a comforter, folded with a certain amount of sheet folded over and showing. (Better yet: when I sleep I only use ONE of those pillows! Ha!) My friends/family know not to sit on my bed- it drives me crazy. Not so much the sitting, but the fact that you on my bed will certainly wrinkle, crease or plain "mess up" what I think my bed is supposed to look like. When I see people going to sit on my bed a slow motion "NOOOOOOOOOOOOOO" is coming your way. Even when my partner rolls over in their sleep I find myself saying "stop messing up the bed!" Once again, no cause for concern, right?
I guess it’s in recent years that these traits have become more and more heightened. For example, when someone passes me the TV remote and says "here you find something" I have to start at channel 1. I simply can't channel surf from any other number. My TV volume has to be set on the same setting every time.
I bought a new couch a few months ago and have only sat on it a handful of times because I’m terrified it might get dirty, or crease the fabric. I am a very social person and have avoided having a housewarming party at all costs because I can't imagine the stress and anxiety of potentially dirty rugs, spilled drinks, a dropped cracker or a god forbidden errant chip with salsa! I love to cook, but almost entirely only for myself because I know that when I eat I don't drop or spill things.
The few times I've entertained people the process of watching them tear a roll in half makes me wince in pain because all I can think of is the explosion of crumbs it just created. Let me help you in the kitchen? How about more harm than good! If you mix whatever is in that bowl too fast a drop might escape! My father has been talking about visiting me in my new apartment and all I can think of is him leaving coffee grounds on the counter and granules of sugar EVERYWHERE! Not to mention every towel in my bathroom dirty and water dripping from the ceiling.
On top of this I have experienced panic attacks, my most recent one a few weeks ago. So my question is does my behavior enable panic attacks to happen? Does my borderline OCD (let’s face it, I’m not washing my hands 50 times a day and counting cracks in the sidewalk) contribute or even create panic attacks?
Trip
Hi Trip,
True Obsessive Compulsive Disorder (OCD) is a serious psychiatric condition which consists of obsessive thoughts, impulses or images which reoccur frequently throughout the course of a day. These are coupled with compulsions which are repetitive behaviors or mental acts that are performed to block out the obsessions. I’ll illustrate this by describing a patient of mine I’ll call Sam.
Sam was obsessed with cleanliness and germs. He thought about contamination, viruses, germs and staying “clean” for hours each day. Everything that had not been personally scrubbed and disinfected by him was considered contaminated. He couldn’t shake hands or grab a door knob, push an elevator button or handle any object that had been touched by others, because of all the germs. He carried a large supply of clean paper towels with him which he used whenever he needed to touch anything. After using a towel he would throw it away. He showered numerous times a day and always used ant-bacterial soap. He washed his hands dozens of times daily and carried hand sanitizer with him everywhere. In addition, he frequently wiped his house, car and desk down with Lysol and couldn’t go anywhere in public where he might bump into others. His life had turned into a total nightmare. Fortunately, he finally visited me after several years (and after getting fired because of this behavior) and medication turned his life around.
OCD has become a vogue term to describe someone who is extremely neat and organized as well as excessive when it comes to order in their personal life (See my blog on OCD). Though you clearly take this to an extreme, you are quite aware of your traits. Most importantly you note: “I am a very social person”; this indicates you get along with people and are able to have successful relationships with friends and with your partner. A good rule of thumb when deciding on treatment for a mental health issue is: Does it affect the way you would like to lead your life? In this case the answer appears to be no. What you are really describing are mild obsessive personality traits which I can promise you that many folks would love to have. This is your personality; plain and simple.
I agree with you that this is no cause for concern. My advice is to keep being very honest with yourself and your friends/loved ones about your organizational and tidiness traits. Make light of it and even be willing to joke about it with others. If it gets worse, or if it is really bothering you more than it ppears to me, then you may wish to see a therapist for some counseling related to control issues and letting go. Medication does not seem to be necessary at this point.
As for the panic attacks: your mild obsessive behavior does not predispose you to panic attacks. If you have one every few weeks and you know what they are, that probably does not require medication either. If these attacks begin to interfere with your life, then a psychiatric eval would be advised. Good luck, Trip. Enjoy your life and your quirkiness. That’s what makes you who you are and I’m sure your friends love you for it!
Dr D
My ex-girlfriend is nuts...
Dear Dr. Archer,
I just broke up with a girl and I think she might be nuts. Like really nuts. One day she is so angry and upset and I am the worst person on the planet, and the next morning she wakes up happy and singing like nothing ever happened. But I can't switch back and forth like that and finally I gave up.
A friend of mine told me she might have Dissociative Disorder, but I don't know what that means. They tried to explain it to me. It sounds sort of like what she is, but I don't know. Her father abandoned her when she was little and I think it has something to do with that. She's just so extreme, it's like she can never be happy, and that makes me sad. Thanks for your help.
Andy Hi Andy,
A Dissociative Disorder can be defined as a condition that involves a breakdown and disruption of memory, awareness, identity and perception of self, others and reality. Things don't quite seem normal to these individuals, but rather fuzzy and unreal. You haven't given me enough info to consider this diagnosis, but the symptoms sound more like Bipolar Disorder (previously known as Manic-Depression) to me. This would explain the mood swings.
All you can do at this point, Andy, is to explain your concerns to her and request that she get help from a psychiatrist. I can tell that you still care; you wouldn’t have bothered to write to me otherwise. Most chemical imbalances of the brain can be treated. So, it is possible that if she gets a professional diagnosis and treatment, the two of you could make things work. Take Care.
Dr D
I was manic for months...
Dear Dr. Archer,
I was FINALLY diagnosed with Bipolar Disorder II (BP II) in 2006 after going through 6 misdiagnoses for depression over a 20 year period. To say my life was a chaotic nightmare for all those years would be an understatement. However, I was able to earn graduate degrees never having made anything less than a 4.0. My diagnosis was a relief and I became a huge advocate of BP treatment. However, during that time I had a complete meltdown, even on medication.
I was trying to maintain my 4.0 while working a 35 hour a week internship, I had a complete breakdown. It scared me so much that I live in fear of going back to that place every day. I am currently taking Lamictal (mood stabilizer), which has changed my life in such a positive way I can't even begin to explain. I quit taking it after a year to try to get pregnant. I did and lost the baby, but we were going to start trying a couple months later.
I went totally manic for MONTHS and it was so bad I could swear that I am not longer BP II but BP I. Does that happen? My only depression symptoms are physical, where my body feels like 1000 lbs and I can't even get out of bed, but I feel mentally fine. The manic episodes WAY out-number the depression and this manic episode lasted months and was just awful. I was so confused I didn't even know who I was anymore.
I am working in a professional job now and love it. I have made it an art not to have to work long hours by being extremely efficient, because I can’t handle it. It's a skill that I've developed over the years to keep my sanity. I am able to get twice as much work done in 40 hours than most people working 60.
Recently, however, my organization, in preparation for a strike, is requiring all management in the company to train for the laborious jobs that are essential to running the company. So, in addition to my very stressful regular job, they are making us train nearly 150 hours in 1.5 months and, if there is a strike, we have to travel to other states and MUST work 72 hours a week.
I am petrified. In a week of doing the training and my real job, I have almost told my boss off, I have been crying every night, I have been thinking about quitting my job - which I LOVE, by the way! Quitting has never crossed my mind until now. And this is only the beginning of something that could last for months! I know that I will absolutely fall apart and may not even come back able to perform the job I was hired to do.
I have recently submitted a claim with the organization's disability support group to request a job accommodation to get out of it. I feel guilty. Am I being silly or lazy for not feeling like it would be good for my mental health to perform all those duties? I am so scared. I come home everyday nearly in tears and wake up dreading the day ahead. Do I have a legitimate concern? Sorry so long, I just wanted you to understand the whole story behind my very, very real fears.
Thank you!
Scared
Hi Scared,
Bipolar Disorder (mood swings from manic highs to depressed lows) is a mood disorder which is closely related to the mood disorder Major Depression. Many folks previously diagnosed with Depression really have Bipolar Disorder. We now consider any type of mood cycling at all (even if the predominant mood is depressed) to be a Bipolar condition. Psychiatrists are also more in tune to mild mood swings and are much more inclined to give the Bipolar diagnosis rather than a pure Depression diagnosis.
It doesn't surprise me that you were initially diagnosed with Depression. This was common until very recently. Bipolar Disorder is broken down into Bipolar I (BP I: full fledged manic symptoms) and Bipolar II (BP II: mild manic symptoms). You must understand that these conditions are a continuum; it’s not unusual for the diagnoses to overlap. Your symptoms sound more like BP I, but I don't place a lot of stock in deciding if a patient has Bipolar I or II. I treat the symptoms that are present, regardless. Typically Bipolar I requires stronger meds, higher doses and a greater number of medications, but otherwise the treatments are similar.
In terms of treatment, you must understand a few things. First, Bipolar disorder often requires a lifetime of treatment, so don’t ever stop your meds without discussing this with your Doc. Next, stress is a trigger for relapse, so it doesn’t surprise me that you’ve worked out a system to minimize stress in your job. Now that you are under increased stress, it sounds like you may be starting to relapse- this is common. Stress is a huge relapse trigger.
My advice is: you must talk to your Doc ASAP! You may need a med adjustment due to the increased stress you’re facing. They will also be able to help you out with respect to your disability claim. Next, talk to your Employee Assistance Program (EAP). They may be able to help with modifying your duties based on your psychiatric condition. If you feel comfortable and have an understanding boss, then discuss the situation with him as well.
Finally, you absolutely have no reason to be ashamed of your condition or this situation. I wonder how your company would treat someone with a heart condition that couldn’t work the long hours required in this strike environment. I bet they would be very understanding.
Bipolar Disorder is a medical condition caused by a chemical imbalance in the brain. It’s not your fault; you didn’t choose to have this illness. Hopefully your company will show you the same respect that they would to an employee with any other medical issue. Good Luck.
Dr D
I need to feel better about myself so I can date...
Dear Dr. Archer,
I'm from Texas and stopped in Lake Charles for lunch on the way to Baton Rouge. When we were leaving, I saw your picture on the cover of Lagniappe, so I took the magazine with me. I read some of your article, which was very interesting. I know you were speaking of other people's problems, but it was like you had spoken directly to me. You're right, we pretty much all have the same issues.... but it does help to ask someone from the outside that doesn't know us on a personal basis to give advice, and I would like an honest answer even though it might not be the one I want to hear.
So this is my question... Okay I'm going to be 43 in February, and I'm a single parent . I get on the internet looking for my wishful boyfriend. Yes I know that its only a 10% chance or maybe even smaller than that ... but its a chance and I haven't had any luck. My self esteem has lowered; I've gained some weight, and kinda feel hopeless. I know I'm depressed, so how can I overcome this feeling without medication? How can I start to feel good about myself again and go out there and enjoy life ?
Rosie
Hi Rosie,
Here's the deal: Depression can often become a vicious cycle. You feel depressed with low self esteem, so you stop doing things and and avoid getting out. The less you do, the worse you feel; the worse you feel the less you do. Eventually you end up with a chemical imbalance depression.
I know you don't want to take meds but I think you should at least see a psychiatrist for an evaluation, as I suspect you are indeed clinically depressed. Often, treating the depression with meds can make a huge difference!
My advice for online dating is this: You need to be happy with yourself before you can ever be happy in a relationship. So many people look for a partner that will make them feel better when in reality they need to focus on their own inner happiness.
So, Rosie, look inside yourself. Think about who you are and what you like. Think about your child and focus on their life, analyze your work and see if that's fulfilling, start an exercise program and diet to lose some weight. When you become content with who you are then you can revisit the dating sites and give it another try. All the best.
Dr. Archer
I think my wife is bipolar...
Dear Dr. Archer,
I believe my wife has Bipolar Disorder. She has a severe gambling problem which I think is the cause. She displays these symptoms: wide mood swings that go from being very nasty-down right mean and verbally abusive to very nice and caring. These mood swings come whenever she wins/loses. Winning brings "rewards" and losing brings verbal abuse.
As a result of her gambling problem, our family is on the verge of bankruptcy and divorce. She was very nice and caring before, but now she has become a monster. What would you suggest? Solve her gambling problem first or the bipolar disorder? Thank you.
Mike
Hi Mike,
Bipolar disorder does indeed consist of mood swings from being very down and depressed to being high, irritable, mean and impulsive. There are often periods of nice, caring, normal moods in between these swings. What you need to know, Mike, is that during a manic phase impulsive activities such as promiscuity, alcohol/drug abuse and gambling are frequently seen.
The answer here is very simple: Treat the Bipolar first! This could totally correct the gambling addiction. Get your wife in to see a psychiatrist as soon as possible for an evaluation to see if she does indeed have Bipolar Disorder. This is a very treatable condition with the proper medication. If the gambling addiction persists after diagnosis/treatment then your Doc can re-evaluate at that time. Take care.
Dr. Archer
I have battled Xanax addiction for years...
Dear Dr. Archer,
I have battled with a Xanax addiction since 1989, and have been through rehab three times, the last being this past November. After this last treatment, the Dr. prescribed Neurotin for cravings. I gained 15 pounds in 5 weeks, stopped taking it and now can't get the weight off and the cravings came back.
I went to the Dr. today and explained to him what was happening. Now he has put me on Topomax 25mg for 2 weeks in conjunction with the Cymbalta that I've been on for the past 3 years for arthritis symptoms (which has helped). What do you think!?
Pam
Hi Pam:
Xanax is a wonderful drug for a variety of psychiatric conditions, especially panic attacks. The downside is anyone who takes this drug will develop some degree of dependence. In addition, withdrawal symptoms can occur if the dosage is stopped abruptly. Unfortunately, like you, some people become addicted. There is no approved medication treatment for Xanax addiction at this time. Many doctors are using medications like Neurontin and Topomax to help control cravings. Topomax can also help with weight loss.
Cymbalta is an anti-depressant with no addictive roperties, so I doubt that's an issue here. Please remember, Pam, that addiction is a lifetime disease. Of course, total abstinence is the goal and there are many therapies, groups and medications that may work - depending on the individual. My suggestion is to stick with your doctor and let him try the medications and therapies that he thinks will work in your case. Patience is key here, and every patient is different. Hang in there Pam!
Dr. Archer
Now I know what a panic attack feels like...
Dear Dr. Archer,
I just watched your video on panic attacks, and had one while watching. I'm still shaking! I have experienced these since I was assaulted by my ex in 2004. I have often been told to just get over it. I have moved and am in hiding in a safe place. But, try as I might, I still can't "just get over it". I have them just driving ten miles from one town to the other on the back roads. I have them while in the house for no reason.
I’ve often wondered what to call them or how to explain how I feel during them. Your video hit them dead on. I did go to the women’s shelter to seek some help with this, but they said I was manic depressive and too mental...besides they don't have counseling. So, now armed with this video, I have a chance for my friends to kind of understand what I'm going thru and that I am not crazy. For this I thank you!
Jade
Hi Jade,
It really sounds like you've had a tough time lately, but I'm so glad you are safe now. I have to say that the video I get the most comments on is by far the panic attack video in the
"See Dr D" section of this website. My intention was to let others know just how devastating this condition really is. I'm certainly sorry you had a panic attack, but now at least you now know what you are up against.
The most important thing for you to understand now, Jade, is that this disease can be evaluated medically and treated with medication! Schedule an appointment with a psychiatrist as soon as possible for a formal diagnosis and treatment. Good luck!
Dr. Archer
I have suffered from depression and no medication seems to help...
Dear Dr. Archer,
Hello from Scotland. I have suffered from depression for ten years now. I have no known triggers or any cause I can think of. I don't understand why I feel like this. I have been on so many antidepressants over the years. I have just started a new one 4 weeks ago and have increased my dose as advised by my psychiatrist, but I don't feel at this stage that it is going to help! Do you have any advice for me? I'm fed up living like this and no medication seems to help. Many thanks.
Greg
Hi Greg,
There are dozens of antidepressants on the market. There are also medications that augment the effects of antidepressants. Sometimes we use combinations of antidepressants and sometimes we combine antidepressants with medications like anti-psychotics, mood stabilizers, anti-anxiety drugs and other meds. There are literally hundreds of different possible ways to medically treat a chemical imbalance depression.
The one thing I tell my patients is that we will never give up! We will keep trying medications and combinations until something works. My advice to you, Greg, is to keep working with your psychiatrist (yes, you can also request a second opinion) as he tries different treatment strategies. I will tell you that I have gone through numerous regimens with hard to treat patients and nothing feels better (for patient and docs alike) than finally finding a treatment for a difficult depression! There is no scientific strategy on how to do this (at least not yet). It is trial and error; every person is different. Believe me, this condition can be treated! So hang in there and keep a positive attitude. Good luck.
Dr. Archer
My 11-year old son takes medication for anxiety...
Dear Dr. Archer,
Over the past couple of years my 11 year old son has been complaining of chest pains, stomach problems and most recently breathing problems. At times he feels like he is unable to take deep enough breaths to fill his lungs. His pediatrician thinks that it is anxiety because he is a very healthy child and he sees no other problems. He has prescribed a very low dose of Prozac for him. After thinking about this I am unsure that I want my child taking this type of medication.
There are a few possible mild stresses in my childs life right now, however, over the past three years he has experienced a lot of changes. His father and I have divorced and each remarried, we've moved, he has started middle school this year, he was on a school bus that was involved in an accident and I have been suffering with migraines recently which seems to have him worried. He loves both of his new step-parents and all four of his parents get along very well. Both households are stable and happy and he lives with me but sees his dad and step-mom weekly.
He plays football, has absolutely no discipline problems at home or school, makes average grades, is mature for his age, well liked by his teachers and peers and is overall a very happy child. He is a joy to have as a son and I just want him to feel good and not be worried. If it is anxiety that we're dealing with I feel that it is mild and was hoping that you could suggest some alternative ways that I might be able to help my child through these incidents without medication. Thank You!!
Sherrie
Hi Sherrie,
The first thing I think of here is asthma, so make sure your son has been evaluated for this. Sometimes a mild case can mimic anxiety and is difficult to diagnose. If there is no medical condition present, then these symptoms could be anxiety, but they don't sound like a classic case at all.
The key to the Prozac is whether it's working or not? The fact that you wrote to me indicates it's not. Here's the deal Sherrie, mild cases of anxiety often respond to either medicine or theapy. If you would prefer your son not be on meds then talk to his pedeatrician about stopping the med. If he agrees then get a recommendation from him for a therapist. It could be that the new school, your migraines, the divorce, move to a new house, school bus accident, etc... have been more stressful for him than you realize and counseling could do the trick.
Dr. Archer
My girlfriend wants to treat my depression with alternative remedies...
Dear Dr.D,
Here's a story for you, perhaps you have some advice. When I was a teenager I had real trouble feeling happy or being enthusiastic about anything or feeling like I fit in, this is pretty common. At 16 I started smoking dope as this was the first time anything really gave me relief. To cut a story short, time went by, 15 years and all the time I had the same feelings.
I found a website which described how I felt by chance and apparently I was suffering from the symptoms of depression. So I went to a doctor and he prescribed some medication and after a few weeks I started to feel relief for probably the first time in my life. The knot went from my stomach, I felt relief, I have always ached, stress I don't know, but my life isn't very stressful, anyway the pain went away, life stopped being hard work and just normal. I was taking the medication for a couple of years, don't get me wrong, antidepressants aren't a magic fix which make you feel you walk on a cloud, I guess they make you feel normal, and trust me normal is good!
So I met a girl, we are to get married, about 6 months ago I stopped my medication and well its not really good because now I'm suffering from the same symptoms I suffered prior to the medication. The problem I have now is my girlfriend is a very positive person and believes most problems are in the head even to the extent that if a cancer suffer believes they well get well there is a good chance. I believe in the medical imbalance and I believe my father and brother suffer the same, why its the males I don't know? (they both takes medication). So for me to get back on the medication I need to educate my girlfriend about condition, she believes in alternative healing methods.
Anyway after my rambling what I'm trying to figure out is how to get someone who doesn't have the condition to understand it more without ramming it down her throat and support me, the reality if I can't we're not going anywhere, but I also understand how hard it is for someone to comprehend a condition they don't suffer from or goes against their belief system.
John
Hi John,
Clinical depression such as you describe is caused by a chemical imbalance of the brain. You are fortunate that you found a medication that works for you. The fact that you stopped the med and now have relapsed means that you may need to be treated long term for this condition- maybe even for life.
So, the first thing you must do is return to your Doc and talk to him about the symptoms of your particular case. Major Depression can become more and more difficult to treat the longer it is left untreated. Also, when not treated, there is even a theory that it may be a risk factor for Alzheimer's disease.
As for your girlfriend, she absolutely needs to understand that this is a medical condition that can be evaluated medically and treated with medication, just like diabetes, high blood pressure and asthma. Have her read this response and then have her talk to your treating Doc.
Next have a talk with her. Tell her how much the medicine helps you and also how you bad you feel when not taking it and how normal you feel when you do. Tell her there is no scientific proof that alternative medicines work for this disorder and that supplements are not FDA approved and even worse they are not even regulated as to what actually goes into them. She doesn't have to agree with you or take meds herself, but she needs to support you and your treatment. If she refuses to support you on this then you have a major life decision to make.
Dr D
I think my friend is suffering from Post Traumatic Stress Disorder...
Dear Dr. Archer,
I think a friend is suffering from PTSD. He is a young male with a history of manic depression from childhood. HE was clinically diagnosed in early adolescence. Various medications were prescribed. No therapy was mentioned as part of treatment plan. He said meds made him feel "strange" not "better". Ultimately he refused meds and sought no further treatment; neither medical nor therapy.
He then entered military and served extended duty on frontline combat overseas. He was up for discharge or reenlist. He took a short leave to visit family and friends and intended to reenlist and return to combat with his buddies. When he returned to the military to reenlist; he was denied for personal reasons. Since, he's fought feelings that he's let his buddies down. They are there fighting and he's here - worthless and powerless to protect them. He's extremely depressed. He needs treatment...and he is receptive...what should he do?
I hope I gave you enough info so that you can at least piece together a loose assessment and maybe give a little direction if you can. Thanks Dr D,
Betty
Hi Betty,
There is not enough information here to make a diagnosis of PTSD (Post Traumatic Stress Disorder) however the key to me is that he was previously diagnosed as Manic Depressive (Bipolar Disorder). Bipolar Disorder can be a lifelong illness and it may be that these symptoms have resurfaced and this definitely needs to be assessed.
So the first thing to do is to get an evaluation as soon as possible by a psychiatrist to determine if this is a Bipolar Disorder relapse (my guess is yes), PTSD, a combination of the two or some other disorder. Fortunately he is receptive to treatment, but don't delay an instant Betty, he needs a professional evaluation immediately.
Dr D
Panic attacks are ruining my life...
Dear Dr. Archer,
I am a 26 year old mother of 4, housewife and small business owner. I also have had Lupus for close to 6 years, which is about the time I had my first Panic attack [the worst thing ever]. I truly thought I was dying or having a stroke or losing my mind needless to say I went to the ER where they told me that it was anxiety.
I went for several years without this attacks and after my number 4 child in March I have had severe bouts with these attacks sometimes lasting all throughout the day. I have been on Zoloft 50mg for nearly 6 years. This year I have tried Lexapro which helped the attacks but made me extremely lazy and also Pristiq which made the attacks more. Also my rheumatologist has prescribed me Nirivam the lowest dose which I take if the attacks are too bad. I try my hardest to fight them off usually to the point where the walls are closing in and the mind is wondering out of my body. This is the most debilitating illness to me and I just want my life back.
The part that gets me the most is that nothing I can tell brings them on they just happen and i begin to obsess over something - an ache, a twitch, something losing my mind.....etc. I do avoid some places and usually large crowds and I also have lately had a lot of trouble driving because it brings them on. I am 26, very healthy for having lupus and a mommy to four very active kids....where do I go from here? Also I am just wondering what your take on Panic Disorder is? Is this common? I feel so alienated. Thanks for your time and knowledge.
J
Hi J,
First I would like my other readers to understand the fact that you have Lupus! BUT, you consider your panic attacks to be the "worst thing ever". This clearly shows how devastating this condition can be.(Note: for those of you who want to understand what a panic attack is, see my Panic Attack video in the See Dr D section). Many times the first diagnosis for a panic attack occurs in the emergency room when the patient thinks they are having a seizure, stroke or hear attack.
The cause is definitely a chemical imbalance in the brain and you are correct, they usually come out of the blue without warning. OK, as for treatment: Many meds can be used but the absolute key is to treat the attacks aggressively until they are gone- not controllable but gone. Sometimes this will require long term treatment with higher than average doses. This also means a scheduled regimen of meds, not just holding on as long as you can and then taking something. There is some evidence now that the more attacks you have and the longer this goes untreated the harder it becomes to control.
So J, you need to see a psychiatrist who specializes in psychopharmacology (chemical imbalances of the brain) ASAP. Then work with the Doc closely to find out what meds work for you and adjust the doses accordingly. Your Rheumatologist would probably be a good source for a recommendation. Please don't delay J, this condition is highly treatable and you shouldn't have to suffer like this. Good luck.
Dr. Archer
I get depressed every year at this time...
Dear Dr. Archer,
I get depressed every year at this time. It starts in November and goes to February. Everyone tells me it's holiday depression but I don't feel like I have any big problems related to the holidays. I have a husband, 2 kids and a good job I like and we're ok financially and don't argue or fight very often. This seems to be getting worse every year. What can I do?
Thank you,
Danni
Dear Danni,
Though I can't give a definitive diagnosis based on an email, it sounds like you have a classic case of seasonal affective disorder (SAD). Also known as the winter blues, this is a depression that comes on in the winter months and is related to light. As the days grow shorter and the amount of sunlight exposure decreases this can trigger a chemical imbalance depression in some folks. The further north you live (or south in the southern hemisphere) the greater the incidence of this diagnosis. Finland reports a rate of almost 10% of the population. The symptoms typically recur year after year and can vary in severity from mild feelings of sadness associated with low energy all the way to severe depression with suicidal thoughts requiring hospitalization.
Treatment can be antidepressant medication, a mood stabilizer or light therapy (exposure to bright lights which mimic sunlight). So Danni, you need to see a psychiatrist for an evaluation. If you do indeed have SAD then the good news is that this condition is very treatable. Take care.
Dr D
He often states he 'just doesn't care' ...
Dear Dr. Archer,
My younger brother who lives in Lake Charles suffers from diabetes and chronic liver disease. He's been depressed for years. He's not suicidal but has no interest in getting up in the morning, bathing or grooming, or caring for his daily needs. He often states that 'he just doesn't care'. His medical problems are getting the best of him and he 'shuts down' when we start to lecture him about caring for himself. We've tried everything, but we just can't get through to him to realize we can't force him to seek counseling, but I think he may improve if someone talks to him. Any ideas or suggestions would be greatly appreciated.
Thank you, Lin
Hi Lin,
Although most people don't realize it, medical illness is one of the primary stressors which cause a chemical imbalance of the brain. I recommend a psychiatric evaluation as soon as possible to determine if medications may be effective. After that counseling could also be helpful.
So Linda, you must tell your brother that a chemical imbalance of the brain is a medical condition just like diabetes and liver disease and it can be evaluated medically and treated with medication. If he absolutely refuses to see a psychiatrist then you could talk to the medical doctor about your brother (assuming he gives you permission) and he could assess and start a trial of medication if indicated. Though you can't make someone get help against their will you can certainly be gently persistent in terms of urging him to give it a try. Sometimes the difference in the quality of life can be remarkable when a depression is treated in a case such as this. Good luck and don't give up!
Dr. Archer
She stays out partying and claims it's part of her illness ...
Dear Dr. Archer,
My wife has bipolar disorder which does well when treated with medication. However, sometimes she stops taking it and becomes completely wild. She says it makes her feel fuzzy and she needs a break at times. The biggest problem is her sexual promiscuity. She stays out partying and sleeps with anyone. She claims it's part of her illness and not her fault and that she has a sexual addiction. I'm trying to be understanding and patient but I've had enough. What's your opinion?
Rick
Dear Rick,
First of all impulsivity is indeed a hallmark of Bipolar Disorder. This impulsivity can be in the form of alcohol or drug abuse, excessive shopping or gambling and even sexual promiscuity. So, yes her numerous sexual indiscretions when manic are potentially caused by the illness.
However the key here is that her condition is being treated by medication. She chooses to stop these meds and therefore must take full responsibility for her actions when she's not taking them. No doubt these meds do have side effects and they may need to be adjusted, but typically a bipolar patient will need to be treated for life.
So here’s what you must do Rick, tell your wife that you want to make this work but that you will not tolerate her manic behavior anymore. Offer to go with her to her doctor and discuss the side effects of her meds. There may be other meds or a different combo which she would be more willing to take. But let her know that not taking her prescribed meds is no longer an option and you will not tolerate her sexual indiscretions since this is totally under control IF she takes her meds. Also there are 12 step programs available to treat sexual addiction and she may be interested in looking into that as well. Good luck.
Dr. Archer
My daughter doesn't seem to care about anyone any more...
Dear Dr. Archer,
I found your site on the web and am hoping you can give us some advice. We are parents of a 20 year old daughter who was recently diagnosed with bipolar disorder. She used to be a very kind, caring individual but now seems to have lost all of that. She doesn't seem to care about anyone else's feelings and has alienated most of her family and friends.
Is it common for people with bipolar to push their loved ones away and be mean to them? Will the medication she was just prescribed make her kinder and take her meanness away? Will she be the way she was before? We are new to this so any help is much appreciated.
Daniel
Hi Daniel,
Bipolar disorder is another name for manic depression. As the name implies this is comprised of mood swings from hyper high energy, irritability and impulsivity to severe depression. Understand Daniel that your daughter has not chosen this illness and the meanness you see is really just a manifestation of the condition.
Bipolar disorder is caused by a chemical imbalance of the brain and must be treated with medication. The good news is that this condition is very treatable. But remember Daniel that this is harder for her than it is for you and it takes time for a complete remission of the symptoms. Try to be patient and supportive as she works on her recovery. As she becomes symptom-free, her normal personality should re-emerge, but keep in mind, anything you go through in life changes you. These changes forge and mould our personalities as we grow and mature.
You can't turn back time and expect her to be exactly the same person she was before she became ill. But with treatment, she should go on to live a normal, happy life and you will be part of it. Take care.
Dr. Archer
My daughter's divorce has changed her completely...
Dear Dr. Archer,
I'm worried about my daughter. She went through a very ugly divorce almost two years ago and has not seemed the same since then. Some days she is so depressed she can't even get out of bed. She's lost two good jobs because of this.
At other times she seems to have pulled it all together and is extremely happy and overflowing with energy. For example, when I went to check on her last week, she had repainted all the rooms in her house in one day, and was cleaning out all the closets. This sounds great, but just a few days later when I called her she sounded like a different person, very sad again and not leaving the couch.
I've tried to get her to see a doctor for these mood swings, but she just tells me to leave her alone and she'll be back to herself soon. This can't be normal, can it?
Mary Ann
Hi Mary Ann,
No, this is absolutely NOT normal! While it is common to go through a phase of adjustment and depression after a traumatic event like divorce, there is definitely something more serious going on here.
The symptoms you describe are classic signs of manic depression, which is now called bipolar disorder. The hallmarks of this illness include a manic phase characterized by hyperactivity and impulsivity, which is exemplified here by your daughter repainting the whole house in a short time. At the other end of the spectrum is a severe depression and the inability to carry out normal activities. Even getting out of bed can seem like an overwhelmingly difficult task. While at times she may seem totally normal, this is temporary before the vicious cycling starts again.
Manic depression is caused by a chemical imbalance in the brain's emotion center (limbic system). You can think of this emotion center as being similar to a thermostat in the central air unit that cools and heats your home. For most of us, this thermostat fluctuates between up and down depending on a variety of factors and regulates our mood to keep it relatively stable. However, in bipolar disorder it's broken and can get stuck in the high position which leads to mania, or in the low position which leads to depression.
The good news is that this condition can be treated with medication. So Mary Ann, you have to take charge here and convince her that this is definitely a chemical imbalance and that she needs to see a psychiatrist ASAP. Don't delay! The longer the cycling continues unchecked, the harder it becomes to control the mood swings, If she refuses, then maybe she'll agree to see your family Doctor and you can take it from there. Good luck.
Dr. Archer
I have had mood swings for five years...
Dear Dr. Archer,
I was recently diagnosed with bipolar disorder. My mood swings have been going on for about five years and have caused numerous problems with many of my friends and family. Now that I'm on medication, I feel much more like myself again, but am not sure how to explain my condition to others. I can't change or erase the way I've behaved in the past, but I'd like them to understand why I acted the way I did. Any suggestions?
Shawn
Hi Shawn,
We all have times in our life that we'd like to R.A.D. (rewind and delete) but unfortunately it doesn't work that way. So let's analyze this.
First, I'm so happy that you had the courage to seek and receive treatment (many don't) and that your condition is under control. Next you must understand that we're all responsible for our life and actions - no exceptions.
So now you need to look at this as a wonderful opportunity to not only reach out to friends and family and explain your behavior but to also become an advocate to explain bipolar disorder and chemical imbalances of the brain to others.
OK, Shawn, here's what you tell each and every person; one on one AND face to face; "I'm sorry for my actions over the last 5 years. I know I've done things to hurt you and push you out of my life. I'm not making excuses for what I've done, but I've recently been diagnosed with bipolar disorder. This is a chemical imbalance in the emotion center of the brain and I've been living in hell with this illness for a long, long time.
Now, I'm being treated with medication and I feel normal again for the first time in years. Please forgive my past actions and understand that I consider you a valuable part of my life and would like to remain your friend/son/father/brother/husband etc... Again, I'm so sorry and ask your acceptance and understanding.' Take care.
Dr. Archer
I'm developing the 'baby blues'...
Dear Dr. Archer,
I would like to make an appointment to see a psychiatrist if possible. The only problem is that I am within my last trimester of pregnancy and I am not sure they are willing to counsel a pregnant woman.
I would really appreciate it if you could advise me because I seem to be developing the ‘baby blues'. I'm not quite sure why I'm feeling this way because I really do have a wonderful family that is thrilled about the new baby. They just don't know that I'm still not sure about how I feel. Thank you.
Natalie
Hi Natalie,
Congratulations! How exciting to be expecting your first baby. Here's a few things you need to know: first of all, depression during pregnancy affects almost 20% of women so you are not alone! The cause of this condition is related to hormonal changes that occur during pregnancy and the effect this has on your brain chemistry.
As for the uncertainty, it's perfectly normal to be scared and overwhelmed when facing the unknown especially with the upcoming birth of your first baby. I think this is all related to a mild chemical/hormonal imbalance. Medication is very effective for this condition, but of course, I would prefer that no drugs are taken during pregnancy unless absolutely necessary, but depression can also represent a risk to the unborn child, so it's a judgement call based on risk versus benefit.
So Natalie, talk to your OBGYN about your condition and the need for medication treatment/counseling for depression. If he sees fit then he can refer you for an appointment with a psychiatrist at that time. Take care.
Dr. Archer
My wife has post-partum depression...
Dear Dr. Archer,
My wife was diagnosed with post-partum depression. Can this affect our new baby?
Shane
Hi Shane,
Congratulations on your new baby! Post-partum depression is a chemical depression that occurs to varying degrees in over 10% of women that give birth. It is probably caused by hormonal changes and their complex interaction on brain activity.
Shane, this can definitely be harmful to your wife and it can be harmful to your baby. Your newborn needs constant love and attention and with a clinical depression your wife may not have the energy, focus or happiness to be able to meet your babies needs. Remember though Shane, this is not her fault! She didn't choose this condition, so you need to be very supportive of her and the baby during her recovery.
The good news is that her condition is very treatable with anti-depressants and the response time is usually rapid. I assume she's already on medication, but if not then you need to get her assessed immediately. Once she's recovered she'll be back to her old self in no time. There is indeed a light at the end of this tunnel! Take care.
Dr. Archer
Having a baby while taking antidepressants...
Dear Dr. Archer,
I've been on antidepressants for a few years and am doing fine. My husband and I have decided we're ready to have a baby. Can I keep taking my antidepressant while I am pregnant or trying to get pregnant?
Shelly
Hi Shelly,
Obviously your Doctor knows your condition better than I do so everything I suggest must be carefully discussed with him and closely supervised. In general with depression and pregnancy there are two possibilities. If this is your first episode of depression and you have been symptom free for years then it would be worthwhile to consider slowly tapering and discontinuing your medication under the supervision of your physician.
First, it's always preferable to be on no medication during pregnancy and secondly, if you do it now, then you will see how things go BEFORE you become pregnant. Thus, if you do relapse you will probably need medication during the pregnancy and it's better to know this upfront. So discuss this with your doctor and good luck. Take care.
Dr. Archer
Can pain cause depression...
Dear Dr. Archer,
Can physical pain be caused by depression? I've been depressed ever since my husband died last year and it seems to be getting worse. At the same time, I started having back pain that is also getting worse, although several specialists have not been able to find a reason for the pain. I did recently see a doctor for the depression but did not mention the pain to him. My daughter thinks it could all be connected. Is this possible?
Sherry
Hi Sherry,
Absolutely! Let's analyze this: if you have a constant chronic pain how could this NOT cause you to be depressed? Conversely think about the times when you're feeling sad and down and you'll notice that every ache and pain seems to hurt just a little more. Any stress, including pain can make depression worse and depression can make pain worse; it's a vicious cycle. There is even some research to suggest that pain and depression may share common transmitters and pathways in our brain.
Now what to do? Well the key is that you must treat both conditions. Generally this means an antidepressant and some type of treatment for the pain rather it be surgery, medication or physical therapy. Also, remember this Sherry, just because they can't find a cause for your pain doesn't mean it isn't real.
So, two things you must do. First, on your next visit make sure you tell the doctor treating the depression about your pain. Also, you must let him know that your depression is getting worse so that a medication adjustment can be made. Take care.
Dr. Archer
My akathisia is driving me bananas...
Dear Dr. Archer,
I am currently experiencing severe akathisia, A little history: I am 7 months pregnant and 34 years old. I have fought anxiety for 20 years without medication. I struggled to get pregnant for 2 years and wanted it more than anything in life. Once I finally conceived I began to panic. This got worse in my first trimester.
During my second trimester I began to experience painful and prolonged contractions which only served to heighten my anxiety. After about 6 weeks of this, I went into a sustained panic attack after being given a narcotic in the hospital to "relax" me. That panic attack lasted for 9 days, during which I only slept for one or two hours each night. Suddenly I became psychotic and was committed to a psychiatric hospital. There, I was dosed into a catatonic state on Haldol (or Helldol). They started me on a low dose which seemed to actually work well, but inexplicably, they increased it markedly.
My husband finally lobbied them to reduce the Haldol and they let me out after 13 days. I was then admitted to another hospital by my OB for observation and detox from Haldol. I was experiencing incredibly miserable EPS and akathisia. I was put on a routine of Ativan and Benadryl. This was carried on for 4 days inpatient. The symptoms began to improve dramatically.
After I was discharged, I stayed on the same dosing. About 2 weeks later I began to experience a relapse of the akathisia, manageable though. At 3 weeks my psychiatrist put me on Zoloft. Now, 2 weeks later, my akathisia is back in full force and it's driving me bananas. I am afraid that this will drive me over the edge again. My psychiatrist says it's probably anxiety, but as I said, I've had anxiety for almost 20 years and it never felt like this. This feels similar to what Haldol did to me. Now he wants me to raise my Zoloft.
PLEASE HELP ME! I need a second opinion! I've read articles about Zoloft and akathisia and it worries me. Please let me know what I should do. I would be very eager to get another opinion.
Kristin
Hi Kristin,
Congratulations on your pregnancy and even though it's been tremendously difficult you'll get through this. Obviously it's difficult for me to give advice with only a limited history, but I can offer some observations.
First, I must assume that you had a psychotic episode since Haldol is usually prescribed only for severe psychosis, not anxiety. Psychosis is characterized as a break with reality and is comprised of hallucinations, delusions (often paranoid in nature), or a thought disorder.
Anxiety by itself seldom leads to psychosis. Your experience could have been caused by your sleep deprivation or triggered by the pregnancy. Haldol is usually prescribed only for severe psychosis. A common side effect of this drug is an inner restlessness and the inability to stay still called AKATHISIA.
Zoloft has been reported to cause akathisia but this is rare; and it's unclear if you are still taking the Haldol. Akathisia can often be severe and debilitating, as you have experienced. Treatment for the condition can include Cogentin, a benzodiazepine like Ativan, Benadryl, or beta blockers like Inderal. Often, a dosage reduction helps. Many times, a switch to a different medication can decrease or eliminate the problem.
Anti-psychotics with a lower incidence of akathisia include the newer drugs Geodon, Seroquel, Zyprexa and Invega. But because they are new, their safety in pregnancy has not been determined. More importantly, being 7 months pregnant is not the time to switch psychiatrists. Every drug used in pregnancy should be discussed with your Obstetrician and the risk/benefit must be evaluated.
So Kristin, I suggest you discuss changing meds with your psychiatrist to see if you can find one that works with fewer side effects. Take Care.
Dr. Archer
Is it possible to have anxiety and depression...
Dear Dr. Archer,
My sister-in-law lives far away and has had various problems in her life for years. She called last week and said she had been diagnosed with anxiety and depression. Is this possible? I thought they were two separate conditions?
Mike
Hi Mike,
Back in the day we thought that all psychiatric conditions were separate and distinct. But now I view these conditions as a continuum with many overlaps. Typically anxiety is less severe than depression but it can actually turn into depression if left untreated. Also the two diagnoses are very often seen together.
Remember Mike that these conditions are caused by a chemical imbalance in the brain and the key to treatment is to address any and all symptoms. Fortunately, most modern medications treat both depression and anxiety so often only one drug is needed. Take care.
Dr. Archer
A long list of tragedies and traumas...
Dear Dr. Archer,
I have faced a long list of tragic and traumatic circumstances in my life and am suffering from severe depression as a result. My symptoms over the last 6 months have almost totally disabled me from a normal life. Friends and family don't understand.
On the other side of the deep depression is that when I feel good, I seem to feel too good. All of a sudden, I can fix everything. The fog fades and I have false perfect clarity. I call it a false clarity because I really can't do the things I have imagined I can. These times do not last very long, maybe a couple of days at the most. Then I plummet from the top of Mount Everest again. I can't even put on a "happy face" in public anymore, so I avoid it as much as possible. It feels like I have been on the front lines of a war for 10 years with no reinforcements or R & R and the enemy just keeps on coming. I feel like I'm about to lose the war.
All too often lately I sense that I can't go on even another minute. My Christian beliefs are very strong and I would never take my own life. I wouldn't intentionally harm anyone, either. But, I must confess that I have prayed that if my kids were well taken care of, that God would pluck me off this earth.
I am asking for help in any way you can. I have tried to handle all of this by myself for far too long. It isn't something I can change or fix on my own. I respect you and appreciate the fact that you have this forum; otherwise, I would still be waiting, not asking for help, hoping that someone would just rescue me.
CJ
Hi CJ,
You have a chemical imbalance of the brain which is causing a severe depression. This needs to be treated IMMEDIATELY! Don't delay, call now for an appointment with a psychiatrist.
The good news here is that this condition is totally treatable, but the longer you delay the tougher the condition becomes to get under control. One other note here is that your mood swings could indicate bipolar disorder but this can be further assessed after your depression is treated.
So again CJ, pick up the phone book, Google psychiatrist in your hometown or ask your family doctor for a recommendation. But DO IT NOW! Take care.
Dr. Archer
Prescribing antidepressants...
Dear Dr. Archer,
Do all psychiatrists prescribe all anti-depressants? The reason I'm asking is that I've heard that some doctors only prescribe one type of antidepressant. I would like to switch psychiatrists for personal reasons but I'm concerned they will change my medication which is working wonderfully well.
Suzan
Hi Suzan,
First of all any legitimate psychiatrist should be familiar with and use a wide variety of anti-depressants. Different meds work for different people - period! Also a crucial rule of thumb in psychiatry is that if you find a medication that works for a condition then you don't ever even think of switching(i.e. if it ain't broke don't fix it) unless it stops working or an unwanted complication occurs.
Find a psychiatrist you would like to see and discuss the situation with the receptionist over the phone. Make it clear that this medication works for you and that you don't want to switch. If you don't feel comfortable with the response then call another Doc. Unfortunately there are many ‘Dr. Gods' out there who are caught up with their own huge ego and feel they have to make a change just to prove they're better than the other guy. Personally I'm thrilled when I get a transfer and the patient can tell me exactly what works. That makes my job so much easier.
Finally, remember Suzan, you're the client and you pay the bills. You already know what works, don't settle for less. Take care.
Dr. Archer
Can I drink alcohol and take antidepressants...
Dear Dr. Archer,
If I take antidepressants, does this mean I can never have an alcoholic drink? What is the effect of alcohol on my medication?
Brian
Hi Brian,
Most authorities discourage drinking alcohol while taking an anti-depressant. But here's the straight scoop: millions of people take anti-depressants every day and I can guarantee you that all those individuals haven't stopped drinking.
So Brian, let's look at some sensible rules: when first starting an antidepressant it's a good idea not to drink until you see how the medication affects you. Also remember that it takes time for your chemical imbalance to resolve and alcohol may delay the benefits of the med. Further there are some antidepressants (in particular the Monoamine Oxidase Inhibitors) that may have a dangerous reaction when mixed with alcohol.
In addition your physical health can play a huge role in your alcohol tolerance and interaction with any medication. The bottom line: you should ALWAYS discuss your particular case and medication(s) with your doctor before drinking. Depending on all the above circumstances I allow most of my patients on antidepressants to drink in moderation. Take care.
Dr. Archer
Could I be addicted to antidepressants...
Dear Dr. Archer,
If you use anti-depressants and stop taking them, are there withdrawal symptoms, and does having symptoms mean you are addicted to the medication?
Sally
Hi Sally,
Withdrawal symptoms may occur if an anti-depressant medication is abruptly discontinued after taking it for an extended period of time. Signs and symptoms of withdrawal may include irritability, anxiety and sadness, as well as physical symptoms such as headaches, dizziness, fatigue, nausea, vomiting and diarrhea. To minimize withdrawal I always gradually reduce the dosage over about a week to allow brain chemistry to adapt to the absence of the drug. However, antidepressants are not addictive and it's important to understand that withdrawal symptoms are not the same as addiction
. Addiction represents long-term abnormal chemical changes in the brain. Symptoms of addiction, in addition to withdrawal symptoms, include tolerance (a need for a higher drug dose to maintain the same effect), physical dependence and uncontrollable cravings for the drug.
Withdrawal caused by abrupt discontinuation of an addictive substance is a much more severe condition than withdrawal resulting from the sudden discontinuation of a medication designed to restore normal chemical balance in the brain. One final note is that there are drugs that we use in psychiatry that have addiction potential, for example Xanax, so these need to be monitored very closely. Take care.
Dr. Archer
Should I see my doc or a psychiatrist...
Dear Dr. Archer,
I sought psychiatric care years ago and I ended up with a highly qualified doctor who provided outstanding care. The problem: I suffer from severe depression. I was diagnosed with Post Traumatic Stress Disorder due to problems experienced in childhood.
My question is somewhat complex. I stopped seeking care. I began to feel better and I thought I could continue on without the medication. Of course, this led to problems with my frame of mind and I quit treatment altogether. Afterwards, I struggled through several years, drank heavily and used illegal drugs. I continued to work but eventually the problems affected my job as well as my family life. I became afraid to seek help again. I dropped so low that my family set up an appointment for me with a doctor at a local clinic. It took everything that I had to show up for the appointment.
The physician listened closely to my problems and I was so grateful. Medication was prescribed and my life is opening up. The doctor prescribed a six-month supply and after four months of medication, my life has changed dramatically. I would like to continue the medicine. However, I do not know what options are open to me at this point. I have no medical insurance. The cost of the medication has gone up since my previous care and I want nothing more than to continue on it. I feel like a person again. However, I feel somewhat embarrassed to re-visit this physician and ask for a refill of the medication. Would this be out of line? Should I seek care from a psychiatrist?
I want help and am willing to pay for help. I can't afford to let the medicine run out and continue on the route of being afraid to ask for more. Is it normal for MD's to prescribe psychiatric medications or am I asking too much of their service? Your qualified opinion is extremely appreciated.
Judie
Hi Judie,
Any medical doctor can prescribe a psychiatric mediation and this is very common in conditions such as yours that respond quickly to treatment. So it is completely appropriate for you to return for follow up with this physician for a refill. But Judie, here's what's absolutely crucial for you to understand: You have suffered from two distinct episodes of major depression. This means you will need to have long term treatment for your chemical imbalance, possibly for the rest of your life. If you stop taking the medication again you are at extremely high risk of another relapse, and each one typically gets worse.
So, call for a follow up appointment immediately and let the Doctor know how well you're doing and that you want to continue with your treatment. If he feels uncomfortable doing this then seeing a psychiatrist would be your next step. Take care.
Dr. Archer
I am terrified of another hurricane...
Dear Dr. Archer,
As the next hurricane season approaches, I have developed an almost paralyzing fear of another hurricane hitting here. My home suffered major damage but we have rebuilt and have a better home than before. I know that many people are much worse off than me but I can't seem to shake off this irrational fear. How can I overcome this and try to get my life back to normal?
Pat
Hi Pat,
You are suffering from a mild case of post-traumatic stress disorder (PTSD). This is very common and often occurs after severe stress, i.e. the hurricane that hit your region, so you are not alone. Symptoms consist of flashbacks, extreme anxiety, actually re-living the event in your mind, depression, nightmares, irritability and anger.
Now Pat, it's important for you to realize that the threat of a direct hit again by a major hurricane is extremely slim. Also, most mild cases of post-traumatic stress disorder, such as yours, resolve without treatment. So, here's what you must do: monitor the symptoms I listed above carefully. If they start interfering with how you wish to lead your life, then medication treatment is indicated and you must see a psychiatrist. In this case, I think if you make it through the next hurricane season unscathed you should be fine. Take care.
Dr. Archer
Can high stress lead to depression...
Dear Dr. Archer,
Can consistent high levels of stress lead to depression?
Denise
Hi Denise,
Yes, absolutely, stress is a major trigger for depression. I like to compare the risk for depression to the risk for heart disease. I'm sure Denise, that you understand that a problem with your heart can be related not only to your genetics but also to your lifestyle habits. Some people can over-eat, drink heavily, smoke and not exercise and yet never have a problem with their heart.
On the other hand, others can have a completely healthy lifestyle with no vices and yet have a heart attack in their twenties. Most of us fall somewhere in-between, with our risk for heart disease increasing the more we abuse our bodies. Depression is very similar. There is a genetic component such that some can be exposed to tremendous stress, whether it is from fighting in a war, a natural disaster, or a personal tragedy, and yet never experience a problem with depression. Others will suffer a depression at a very young age, even when their life is going perfectly. I have patients plead with me, “Dr. Archer, I don't understand it. I have a great job, wonderful family and no stress - but I'm so depressed that I want to die, please help me!”
Again, most of us fall somewhere in-between. The more stress we face, the greater likelihood that it will serve as a trigger for a chemical imbalance depression. But, you have to understand that stress is not all bad. First of all, completely banishing stress from your life is impossible. The way you grow as a human being is to be able to face stress, deal with it and overcome it. Every time you face a difficult situation and come out the winner, you gain self-esteem and become a better and stronger person. However, you also have to constantly be on guard for an overload of stress, especially chronic stress. This can be a compilation of many things, which over time, will gradually wear down your ability to cope. You have to know your limitations.
The important key here Denise, is to recognize when stress is turning into a chemical imbalance. Warning symptoms include: poor sleep, change in appetite with weight gain or loss, uncontrolled anxiety, low energy level and feeling hopeless, helpless, guilty and worthless. If these are present for an extended period of time a psychiatric assessment is indicated.
Take care.
Dr. Archer
My mother changed when my father died...
Dear Dr. Archer,
Since my father died late last year, my mother seems to have withdrawn from the family. She seems distracted and more forgetful also. How can I tell if she is suffering from depression, or could it even be dementia? She is 84.
Helen
Hi Helen,
Typically, the sudden onset of a condition like this after a loss is depression and should be treated as such. Dementia is usually a gradual progression over time. So, an evaluation by a psychiatrist and anti-depressant medication is the first step. Once the depression is completely treated a dementia work-up can be performed if other symptoms, such as memory loss, persist. Also, if the depression doesn't respond to the meds then a full dementia screen should be performed. Take care.
Dr. Archer
What comes first, depression or illness...
Dear Dr. Archer,
If someone has both, does a physical illness cause depression or does depression cause the illness?
Bree
Hi Bree,
Yes! Not to be glib, but the true answer is they go hand-in-hand, and if both are present, then they both must be evaluated by a physician. I believe that depression can weaken the entire body and make us more susceptible to an illness, and a physical illness is a stress that certainly can trigger depression. So, what to do Bree? The answer is very simple. I don't worry about which came first the depression or the illness, they both need to be treated. Take care.
Dr. Archer
Which antidepressant is best for me...
Dear Dr. Archer,
How do I determine which is the best anti-depressant for me? I was on Prozac several years ago and it seemed to work fine. After several years, I switched to Wellbutrin because my husband thought my sex drive was non-existent. I really didn't like taking those as I felt ‘very strange.' So, mistakenly, I just quit taking them altogether.
Several months later, I started on Lexapro. I was on that for about a year. I felt like they weren't working and asked by OBGYN to give me a higher dosage but he switched my to Cymbalta. I'm still having bouts of depression, weight gain and general disinterest. Would it be harmful if I switched back to Prozac?
Sherrie
Hi Sherrie,
I find this statement interesting “My husband thought my sex drive was non-existent'. What did you think, Sherrie? OK, here's the deal: different meds work for different folks but the good news is that when an anti-depressant works for you it will typically always work down the road. Thus, there should be no harm in switching back to Prozac and I would expect it to be as effective as it was the first time you took it.
A decreased sex drive is indeed a possible side effect, so the question is what to do? I would discuss resuming Prozac with your Doctor at least until your depression is once again in remission. At that point Sherrie, IF the side effects are still a problem, then you have two choices to consider with your Doctor.
First, attempt to treat your low libido. Meds such as Estrogen, Testosterone, Wellbutrin and even Viagra are being prescribed and studied in women, but as of now, none of these are approved by the FDA.
Next, is to systematically try other anti-depressants to find one that works well with no side effects. This needs to be done in an organized and documented fashion with your Physician so you know exactly what works, at what dose and with what side effects. Take care.
Dr. Archer
Can antidepressants cause suicide...
Dear Dr. Archer,
My wife has been taking anti-depressants for the last year and I do not feel they help her. In fact, I recently saw a news report that said anti-depressants cause suicide. I've tried to explain this to her, but she won't listen. What do you think?
Bob
Hi Bob,
Depression can lead to suicide. In fact, depression is the number one risk factor for suicide. The FDA has issued a warning that there is a POSSIBLE increase in suicide in those under 25 years old who take anti-depressants. This has lead to a decrease in prescribing these drugs especially in children and teens and a resulting INCREASE in suicide in this age group. So, I don't agree with the warning and I think it's actually harmful NOT to give an anti-depressant when needed. Also, there was no risk or warning in the over 25 year old population.
The key here Bob, as in most cases of chemical imbalance, is risk versus benefit and the treating Doctor must always keep this in mind. Anti-depressants have helped millions recover from their illness and lead normal lives and I think they are hugely beneficial.
So, gently have a talk with your wife about her depression. Try to understand exactly what her symptoms are and share your concerns about the meds not working. Perhaps you should attend the next medication visit with her Doctor and talk to him as well. We have dozens of anti-depressants on the market and sometimes several have to be tried in order to find just the right one for any given patient, but this illness can be treated! Finally and most importantly Bob, support your wife in her struggle with depression. Good luck.
Dr. Archer
My family member has Borderline Personality Disorder...
Dear Dr. Archer,
Recently, after a moderate amount of research, I have realized that a family member definitely appears to meet all the criteria for Borderline Personality Disorder. It seems that this condition is not that well known. Could you give characteristics of BPD and advice on how I might be able to get this family member the help they need?
Michelle
Hi Michelle,
Borderline Personality Disorder is a controversial diagnosis that some experts, including myself, don't believe exists as a separate entity. I personally think it's a variant of bipolar disorder (manic depression).
First, I'll give the list of symptoms for Borderline Personality Disorder: 1) frantic efforts to avoid real or imagined abandonment 2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation 3) identity disturbance: markedly and persistent unstable self-image or sense of self 4)impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating) 5) recurrent suicidal behavior, gestures or threats, or self-mutilating behavior 6) affective instability due to a marked reactivity of mood (e.g. intense episodic dysphoria (sadness), irritability or anxiety usually lasting a few hours and only rarely more than a few days 7) chronic feelings of emptiness 8) inappropriate, intense anger or difficulty controlling anger (e.g. frequent displays of temper, constant anger, recurrent physical fights) 9) transient, stress related paranoia or severe dissociative symptoms (feeling an out of body experience).
As you can see Michelle this is a very serious illness and it's a difficult diagnosis even for an expert to make so don't do this at home! Many of these symptoms are common in bipolar disorder, depression and ADHD (Attention Deficit Hyperactivity Disorder) and these are very treatable conditions, unlike Borderline Personality Disorder which really has no definitive treatment other than counseling. So, I always prefer to think that a chemical imbalance bipolar disorder is the underlying cause and treat with the appropriate medication. I can say in all my years of psychiatry I've never had a patient sent to me as Borderline Personality Disorder that didn't respond at least somewhat to bipolar medication.
As for getting help for your family member, start with a psychiatrist, but keep an open mind as to the possible diagnosis. Also, understand you can't make someone get help who doesn't want it, so be prepared for resistance. Good luck.
Dr. Archer
Can schizophrenics have children...
Dear Dr. Archer,
My husband has been struggling with schizophrenia for the last two years. We would like to have children soon but have heard about genetic links for mental illness. Is genetic testing available to find out ahead of time the risk of passing along a mental illness to your children? If not, what would be the risk that our child would develop schizophrenia?
Sharon
Hi Sharon,
There are absolutely genetic links to schizophrenia, a chemical imbalance that consists of hallucinations, delusions (especially paranoia) and disordered, illogical thoughts. The normal occurrence rate in the population is 1%. One parent with the illness raises the risk to 10% and both parents raise it to almost 50%!
The problem Sharon, is that there is no one gene or genetic test YET which will determine risk. Rather there is a group of defective genes that are CONTRIBUTORY to the condition. There are, however, actions YOU can take to reduce risk which include: good pre-natal care, a loving and caring environment for your child, solid nutrition and avoiding infections. So Sharon, have your baby and hope for the best!
The good news is that even if schizophrenia develops, early recognition and treatment can tame the long-term consequences of the illness by the use of medication. No one can predict the future; my advice is to go for it! Good luck.
Dr. Archer
Can I stop my medication...
Dear Dr. Archer,
I was recently diagnosed with anxiety disorder and am taking medication. It seems to be working, but I was wondering if I could stop the medication to see if I still needed it?
Rachelle
Hi Rachelle,
I advise my patients to take their medication for the first episode condition of clinical anxiety for approximately one to two years.
Now Rachelle, if there was a stress factor that caused the problem that has since been resolved then this time frame can be shortened. However, when it's time to stop, make sure you consult with your Doc who may recommend a slow taper of your medication to make sure that no symptoms re-emerge. If you've had more than one discrete episode of this condition then you will definitely be looking at longer term treatment, maybe even for life. Evidence now indicates that an untreated chemical imbalance may cause damage in the emotion centre of the brain and make the illness much harder to control. Take care.
Dr. Archer
I have to avoid some foods because of my medication...
Dear Dr. Archer,
My doctor recently prescribed a monoamine oxidase inhibitor for my depression. He told me to avoid foods that contain tyramine. What is tyramine?
Linda
Hi Linda,
A monoamine oxidase inhibitor (MAOI) is a medication which does exactly what it's name implies. It inhibits the oxidation of monoamines which are brain chemicals that have a link to depression. Thus, these drugs are effective anti-depressants. Tyramine is an amino acid that occurs naturally in your body, but it is also found in certain foods. A side effect of monoamine oxidase inhibitors (MAOIs) is that tyramines breakdown is inhibited. Thus, foods containing tyramine could lead to a marked increase in blood pressure, or even a stroke.
To avoid this serious side effect when taking a MAOI you must avoid or limit certain foods that contain high levels of tyramine, such as certain types of: alcohol, cheese, fruit, processed foods, smoked fish, soy, nuts, chocolate and others. It's very difficult to quantify the exact amount of tyramine in food based on various factors, but aged food has the highest levels. Also, note that certain drugs may interact with MAOIs.
Now Linda, I recommend getting a complete list from your Doctor based on your particular medication and you should also go to the drugs website for an exact rundown on what to avoid. Symptoms such as severe headache, chest pain, increased blood pressure, dizziness or any type of numbness, weakness or paralysis may indicate a serious drug-tyramine interaction. Ask your Doctor in advance what to do if these symptoms occur. I tell my patients to go immediately to the nearest Emergency room!
One final note is that these are wonderful mediations when used properly and for some patients they work better than anything else, so don't be afraid to take the medication. Take care.
Dr. Archer
I think St. Johns Wort is great...
Dear Dr. Archer,
I believe that St. John's Wort is very helpful for depression and much safer than prescribed anti-depressants. What is your opinion, do you believe in this drug?
Bill
Hi Bill,
No, no, no! The approval process for drugs in the United States is one of the most stringent in the world, and it is in place to protect consumers. The FDA requires numerous studies to not only look at the effectiveness of the drug but also to identify any potential side effects.
The problem with most herbal supplements is that they have not been through this tremendously regimented process. First, their effectiveness hasn't been proven by scientific, double-blind studies (a study which compares the drug to a placebo). Next, there could be harmful side effects which are not documented or even known at this time. Finally, there is no validated testing to control the purity of these supplements.
My opinion is that, at this time, there are no studies definitively showing benefit for St. John's Wort. Look Bill, depression is a complicated biochemical condition in the brain that needs to be evaluated and treated like any other medical condition. Don't complicate the problem by trying to self-medicate with a supplement of unknown origin, purity or benefit. Take care.
Dr. Archer
Panic attack...
Dear Dr. Archer,
What is a panic attack?
Bob
Hi Bob,
Rather than giving a long technical list of symptoms and diagnostic criteria, I'm going to describe a typical panic attack.
Picture this: You've had a stressful day at work and you're driving home. You have a list of to-do projects racing through your mind, including a deadline for tomorrow. As usual you're keyed up fighting the rush hour traffic.
You finally see the high bridge ahead that signals the last part of the commute that you've completed 1,000 times before. As you approach, you feel a strange anxious feeling and you begin to sweat. Your hands have a tremor and you can feel your heart starting to pound in your chest. Your mouth feels dry and it's hard to swallow, you feel like you're choking! You can't take a deep breath, there's a roaring sound in your ears and waves of fear wash over you as you wonder "What the hell is going on with me?" You see the bridge ahead full of traffic and notice how narrow it suddenly looks.
You feel like you're staring down a long tunnel with the cars on both sides getting closer and closer and closer! Your breathing is rapid, choking, heart racing; sweat pouring and worst of all is a feeling of terror that keeps getting worse and worse and worse! You're in a panic, mind on overload! Now the symptoms are overwhelming: Is it a heart attack? A seizure? A stroke? You may be dying! You look ahead and see the road the bridge, the traffic all closing in around you. Your mind screams, "Somebody, please help!"
Finally, in desperation, you reach for the phone...... This is a panic attack Bob, and some patients have them several times a day. The good news is that this condition can be evaluated and fully treated with medication. If this sounds familiar then call your Doctor. Take care.
Dr. Archer
Are schizophrenia and bipolar the same...
Dear Dr. Archer,
Are schizophrenia and bipolar the same thing? If not, what is the difference?
Trenton
Hi Trenton,
No, they're very different, even though both are caused by a chemical imbalance in the brain. Schizophrenia is a psychotic disorder and is characterized by psychotic symptoms, including hallucinations, delusions and disorganized thoughts, speech or behavior.
Bipolar disorder is a mood disorder and is associated with drastic mood swings, from severe depression to manic highs. Bipolar disorder is generally easier to treat and has a better prognosis than schizophrenia. With modern medications most cases of bipolar disorder can be completely treated with the mood stabilized; as long as the patient is compliant with their meds.
Schizophrenia on the other hand, is much more difficult to manage. Even though many symptoms can be controlled with medications, there are often residual and/or breakthrough symptoms, and it is very difficult for people with this condition to lead a completely normal life. Now Trenton, the key is the diagnosis. Sometimes patients are misdiagnosed as schizophrenic when they are actually bipolar. In these cases it is extremely important to correct the diagnosis since the treatment is not the same. Take care.
Dr. Archer
Holiday season blues...
Dear Dr. Archer,
During the holidays, when most people are celebrating, I am fighting the blues. It has happened every year of my adult life. I'm 46 and I can never get into the spirit of the season no matter how hard I try. I dwell on happier times and dread the hectic pace, spending and just about everything to do with the holidays. The way I am, needless to say, puts a damper on the holidays for the rest of my family, but I can't seem to change the way I feel. Can you help?
Kelly
Hi Kelly,
You are not alone; the fact is that for many the holidays are not a good time. In fact the US Mental Health Association issues a warning every year on holiday depression. So, why is this so? Well let's see: there's over-eating, over-partying, over-spending, over-commercialization, less sleep, increased alcohol use, house guests, family reunions..... the list goes on and on.
Couple this with the fact that you are supposed to be happy and enjoying the spirit of the season and you have the perfect set-up for Bah, Humbug! Now understand some individuals love the holidays and everything they stand for, but in one survey almost 50% do not and report stress and depression! OK, what to do: first discuss your feelings, you'll be pleased to find others just like you.
Next: pace yourself with respect to parties, alcohol, shopping and sleep. Also, lower your expectations and know your limitations. I think the biggest problem here is that we are programmed to think this should be the happiest time of the year. What a set-up for a disappointment! Finally, it is what it is; accept who you are in this situation. You can even find humor in how many revel in the over indulgences of the season.
One word of warning : IF your blues develop physical symptoms like poor sleep, change in appetite, low energy level, crying spells and feelings of hopelessness, helplessness or worthlessness you may have a chemical imbalance and need an evaluation for medication. Take care.
Dr. Archer
Is my sister delusional...
Dear Dr. Archer,
My sister is experiencing paranoia and I'm not sure it's real. What are the symptoms? I'd like to help her figure out if she can trust anyone or if she is delusional.
Melody
Hi Melody,
In psychiatry a paraniod disorder is a mental condition characterized by systematic delusions (fixed false beliefs) due to the supposed hostility of others. Sometimes this may progress to a disturbance of consciousness and aggressive acts may be performed in self defense or as a mission.
Alternatively paranoia may be as mild as baseless or excessive suspicion about the motives of others. As you can see the term "paranoia" can range from being suspicious/distrustful with good cause, all the way along the spectrum to outright psychosis. It is often difficult, even for a professional, to determine if paranoia is justified or imagined.
So Melody, here's what you need to do: take specific examples of her paranoid thinking. If you can come up with DEFINITIVE proof that her thoughts are not justified and yet she still won't change her view then this is a psychiatric chemical imbalance condition that needs to be evaluated by a professional. On the other hand, if you find proof that what she believes is true then you need to be supportive and let her know that you believe her and want to help solve the problem. Take care.
Dr. Archer
My medication caused me to gain weight...
Dear Dr. Archer,
I've been going through a rough patch and have been prescribed an antidepressant. i guess it's working because I feel a lot better, but I've gained about 12 pounds since I started the medication. Is that a common side effect?
Debbie
Hi Debbie,
The good news is that you found a drug that works for your depression. The bad news is that weight gain may indeed be a major problem with these meds. Tell your doctor about your concern and ask to try a different anti-depressant. Sometimes a med switch can make a huge difference. You just need to make sure that with a new medication a) to make sure it's still treating your depression and b) to evaluate any new side effects.
Anti-depressants with a lower incidence of weight gain include Cymbalta, Effexor and Wellbutrin, but remember that it all depends on the individual and their sensitivity. You may control the weight gain only to have some other unwanted effect crop up. So Debbie, this is a case where you must work closely with your Doc to maximize benefits and minimize side effects. Take care.
Dr. Archer
Can a lack of sleep cause depression...
Dear Dr. Archer,
Can a lack of sleep cause depression? I've been working a lot of overtime and have just been feeling down and depressed. I was wondering if these feelings could be the result of getting only a few hours of sleep on most nights for the past few months.
Darren
Hi Darren,
In those with the potential for a chemical imbalance of the brain, any stress can serve as a trigger. Sleep is one way our brain recuperates from stress, so not getting enough can indeed cause symptoms of depression. Coupled with your overtime hours at work, I think there's no doubt lack of sleep is part of your problem. Whether you have a true chemical imbalance at this time is hard to say, but if you keep going at this pace you will almost certainly develop one.
So Darren, change your schedule, get more sleep and see if the problem resolves. If you can't change your hours, then take vacation time and see how you feel after a week of rest. If you feel better, yet can't reduce your hours at work, then you may need to make a choice between your job and good mental health. If you don't feel better even with more sleep, then you need an evaluation for depression. Take care.
Dr. Archer
Help! I am totally isolating myself...
Dear Dr. Archer,
I need help. I'm totally isolating myself now. My problem is what I consider “audio terrorism.” I can't walk in a park, eat at a restaurant, attend a funeral, attend a class, without being assaulted by extremely loud exhausts and loud speakers. There is no quiet left. I know the noise is illegal but the police can only do so much. I've dropped out of life.
Constructive noises don't bother me like leaf blowers, airplanes, etc. With my apologies to the deaf community, if I could have my eardrums removed tomorrow, I would. I desperately need help. Antidepressants don't help this matter. I've almost given up on life....the quality is no longer there. The noise even comes through my walls at home. Thanks.
Chris
Hi Chris,
Your condition sounds much more serious than depression. Often an increase in noise sensitivity is an early sign of either a developing psychotic disorder (such as schizophrenia) or a neurological problem such as a mini-stroke, seizure disorder or tumor.
So, first you need to have a full evaluation including CT scan, MRI, EEG and blood work. Don't delay, see your Doctor immediately. The good news Chris, is that if your brain work up is normal, early intervention with the appropriate psychiatric medication can make a huge difference in the course of an illness such as this. Also, from the symptoms that you describe, it doesn't surprise me that the anti-depressants were not helpful, there are other medicines which, based on your medical evaluation, would most likely be more appropriate. Take care.
Dr. Archer
My son has changed since his terrible accident...
Dear Dr. Archer,
I cannot write all I need to tell you about a situation I have in my family. Briefly, my son was hurt in a terrible accident and has been very ill as a result of the injury. He will no longer be a physically productive individual and has become a stranger to us and a tyrant to his children, ages 4, 6 and 8. I am very concerned about them and what he is doing to them mentally.
His wife is "waiting" for the settlement (she is a gambler). My son and daughter in law have cut off all communication with his dad and I and they have recently moved back to their house which is 3 houses down from us. My husband and I have always been the "stability" in the children's lives but my son and daughter in law are punishing the children by not letting them visit unless it's convenient for her.
I know depression and pain alter one's life and I also know that he needs help along with my daughter in law, but my biggest concern is for the little people. Their lives as they knew them are no longer the same.
Katherine
Hi Katherine,
There are two separate issues here. First, there is no doubt that a severe accident which results in a disability is a huge stressor on an individual and you and your family have my sympathy. Chemical imbalance symptoms and personality changes are common in such circumstances and seem clearly present in your son. These can be treated but first your son must realize that there is a problem and really want to get help. In treating mental health conditions it's virtually impossible to treat anyone who doesn't think they have a problem. I frequently hear: "Dr. Archer, why should I see a shrink when I'm totally fine?"
So, unfortunately there's not much you can do for your son except to be supportive and offer to be available whenever he gives you the opportunity. Hopefully one day a light will go on and he'll realize he does indeed have a problem.
The next, and most important issue is the welfare of the children. Here you can and must take action. If you have any suspicion Katherine about any type of abuse or neglect at all, then call your local child protection hotline (every community has one, though the names vary) immediately and report your suspicion. They will do an in home evaluation and determine if the parents are properly caring for the children. They have the power to recommend treatment for the parents and/or if needed move the kids to a safer environment which could be your home or that of another family member.
I know this is terribly stressful Katherine, but hang in there and do the right thing by putting the children's welfare first. In fact, it could be the very children themselves with the involvement of child protection that could be the trigger for your son to finally realize he really needs treatment. Good luck.
Dr. Archer
My husband had a manic episode...
Dear Dr. Archer,
My husband of 17 years was diagnosed bipolar in May 2006 following a manic episode that included very extreme spending, sexual promiscuity, alcohol abuse, delusional thoughts, rage and insomnia. I finally got him to see a psychiatrist.
Over the next 2 years he was prescribed several psych meds with very little result. He was hospitalized because he was suicidal. They began Lithium and he responded a little. The doctor put him on Abilify and he started having Parkinson type symptoms. The local psychiatrist said we were running out of options and he suggested Shock therapy.
We went to another psychiatrist to inquire about Shock therapy. He referred us to a internal medicine doctor who sent us to a neurologist. The neurologist diagnosed him with Parkinson's disease and prescribed Sinemet. They stopped the Abilify and began Cymbalta. He stayed in bed for basically the next 2 months sleeping as much as 17 hours per day. I called and reported this to the doctor and they prescribed Provigil, but it did nothing. The Parkinson's symptoms gradually disappeared. We went to the 90 day follow up at the neurologist and he said he felt the Parkinson's symptoms were caused by the Abilify and to stay on the Sinemet and come back in 6 months.
Presently he is still depressed, very flat, still sleeping quite a bit, no interest in activities, can't make decisions, fatigued, lack of motivation, lack of empathy and affection to our son and myself, he seems intimidated and lacks assertiveness in his relationship with his brother, who is his business partner. He is currently taking Zoloft, Lithium, Xanax, Restoril and Sinemet.
I don't know what else to do! Marriage therapy was suggested last year by the local psychiatrist after I discovered a sexual indiscretion involving a prostitute. We went to the appointment, I went in to talk to the counselor but he chose to sit in the waiting room! Do you think there is anything you can do to help him? I have tried everything I know to do. The only reason I am still trying is because I fear what would happen to him if I left. Would he commit suicide? How could I live with the guilt?
I am now entering into the "no longer my problem or responsibility" phase of the marriage and I think our son and myself would be better off if we were out of this situation. It isn't mentally or physically healthy for us to continue living in this environment. The stress factor is off the chart. I feel an obligation to him but the love is so thin I don't think I could ever get it back. All the trust is gone with the affairs and the ugly things he has said and done. I have tried to forgive but it is very hard. Maybe I need counseling?
Thanks for your time. I'm sorry this is so long. Maybe it is a lost cause, I don't know anymore.
Denise
Hi Denise,
This is indeed a tragic, but all too common, story of a bipolar patient and the havoc they wreak on those who love them. First you must understand that Bipolar Disorder is a chemical imbalance of the brain that causes mood swings from irrational, impulsive highs all the way down to suicidal lows.
As for treatment: I really can't comment about his medications as these often depend on trial and error with the individual patient - different meds work for different folks. Also Shock Therapy (Electro Convulsive Therapy) may be a last ditch effort for some cases but all of this depends on working closely with your husband's Doctor and his recommendations.
Now let's analyze this. Though he has Bipolar Disorder this is not your husband's fault as no one would willingly choose this condition. On the other hand, we all must take responsibility for our actions even if a mental illness is present and it's concerning that he wouldn't see a marriage counselor with you. The number one rule in treating a psychiatric condition is that it's very difficult to help anyone if they don't want to be helped and it seems to me that you've gone overboard to try to get treatment for your husband.
So Denise these are the facts and here's what you must do. Wait until your husband is in a stable mood and have a talk. Tell him how difficult this is and that you want to be there for him but you don't feel like he is trying to help himself. Let him know that his condition is absolutely treatable but that sometimes it takes time to find the right combination of medications. Make sure he feels comfortable with his Doc and ask him to commit to following up with the medication management sessions for as long as it takes.
As for you, yes - you definitely need counseling to help you better understand his condition and how to cope with it. I sense you are trying to decide whether to stay or go but I urge you to give it one last chance to make this work. I have seen many cases where a simple switch to the right combo of meds can make all the difference in the world. Good luck.
Dr. Archer
