January 10, 2013

Antidepressant Medication

Filed under: anxiety disorder,decreased energy,depression,Frustration,guilt,helplessness,Restlessness,sadness,worthlessness — Tags: , , , , , , , , — admin @ 3:59 pm

As described previously, depression has neurovegetative signs. These include:

  • sleeping too little or too much
  • problems with poor concentration
  • low energy
  • problems with memory
  • feeling hopeless, helpless and/or worthlessness
  • feeling suicidal or violent
  • getting no pleasure from life
  • having decreased sex drive
  • being withdrawn

In this first blog on medication I will talk about SSRIs, or serotonin reuptake inhibitors. (The SSRIs are a group of medications that block the reputake of serotonin, a neurotransmitter.) This has the effect of improving depression after 5 to 6 weeks. In the depressed state, the level of serotonin is low, and by blocking the reuptake, it increases the perceived amount.

These medications include:

  • Prozac (fluoxetine)
  • Zoloft (sertraline)
  • Luvox (fluvoxamine)
  • Celexa (citalporam)
  • Lexapro (escitalpram)
  • Paxil (paroxetine)

All of them are now available in generic form, and a decision to choose one would be made between the doctor and the patient.

In each case, the medication works as follows:

  • In the first 2 weeks, sleep and appetite improve
  • In the third, fourth, and fifth weeks, concentration, energy, and memory improve
  • In the fourt to twelfth weeks, anxiety and depression begin to improve. So other symptoms get better before the mood and anxiety improve.

This is true with the entire class of medication.

June 4, 2012

Frustration

Filed under: Anger,anxiety disorder,depression,Frustration,Irritability — Tags: , , , , — admin @ 6:34 pm

Frustration is a perennial and ubiquitous problem that we all face every day. It is largely characterized by not being able to get what we want and the attendant feelings, which give rise to anger and irritability. In general, we are frustrated when we cannot have what we want when we want is.

An approach to dealing with these feelings is to get perspective and accept the need for delayed gratification. To delay gratification is the ability to postpone having one’s desires met until a more appropriate time or place may occur. The delay of gratification comes from our ability to tolerate not having our desires met immediately. This is expressed in terms of using the more mature parts of our mind to compensate for the childlike part of our mind.

For example, if a two-year-old wants a piece of candy, and he is denied, he cries and has a tantrum. This is not unusual behavior at this age; however, the same behavior in a twenty-year-old would be unacceptable. One must look for more mature ways to cope with the frustration of desires. One way is to accept that we do not always get what we want. The second is to look for ways to obtain gratification by other means. In the above-mentioned example, the twenty-year-old can accept that he or she needs to go without a treat and look for satisfaction in other areas, such as exercise or gardening, that do not involve candy but do give satisfaction.

In my practice, my patients experience the problems of frustration everywhere. People have trouble tolerating it. One of the hallmarks of my work with people is to help them identify the nature of the problems and develop the abilities to cope more effectively with these problems.

In seeking treatment for depression, anxiety, and stress, people are often frustrated if I cannot provide an immediate answer or cure. I reassure them that while I may not be able to work magic in one session, there are satisfactory resolutions, but it requires time and effort to obtain them. The ability to tolerate frustration successfully is one of the features of adulthood as is the ability to understand that immediate gratification seldom occurs in reality.

April 27, 2012

Irritability: A Potential Symptom

Filed under: ADD,anxiety disorder,bipolar disorder,depression,Irritability,Narcissistic character disorder,Personality disorder — Tags: , , , , , , — admin @ 10:09 pm

     Irritability is defined as a state of extreme or marked sensitivity to criticism or insult from internal or external sources. It typically comes about as a result of stress and is characteristically found in a number of psychiatric disorders.

     It is important to understand that irritability is often ignored or overlooked because people think or are told they are just being overly sensitive. In actuality irritability can be a symptom of a psychiatric disorder for which treatment should be sought.

     Irritability often leads to anger and sometimes extreme anger. The person is said to have “a short fuse” and can lash out at those whom he or she believes are criticizing him or her.

     Irritability can be a symptom of several psychiatric disorders. They include:

  • Major depressive disorder
  • Adjustment disorder with anxiety
  • Bipolar disorder, especially in a manic or hypomanic state
  • Intermittent explosive disorder
  • Attention deficit disorder
  • Personality disorders, especially borderline personality and narcissistic character disorder

     Major depressive disorder can include people who have symptoms of anger and irritability as well as depression. Again, this disorder is well treated with medication and therapy.

     In adjustment disorder a person experiences some stress related to his outside life, whether it is work, home, or family. Irritability can be prominent.

     Bipolar disorder is characterized by mood swings. The range frequency varies from anger to depression. People often think that mood swings generally involve going from being grandiose and happy to being depressed and sad; however, in my experience the scope is more often from anger and irritability to sadness. (Note: Bipolar disorder is frequently misdiagnosed as a form of character disorder, which may or may not be present as well and is best treated with therapy and medication. Irritability is a psychophysiological response to the mental disorder.)

     Intermittent explosive disorder is as the name suggests. It is best treated with medication.

     Attention deficit disorder is also characterized by difficulty focusing and concentrating and extremely noticeable irritability coupled with inability to stay on task.

     Borderline personality disorder is characterized by rejection sensitivity, that is to say being hurt by someone saying something or doing something they do not like, and becoming unhappy and angry very, very quickly.

     I will cover narcissism in the next blog.

March 27, 2012

On My Mind

Filed under: ADD,anxiety disorder,bipolar disorder,depression,obsessive-compulsive disorder,post-traumatic stress disorder,social phobia,Uncategorized — Tags: , , , , , , — admin @ 7:16 pm

Welcome. My name is Dr. Michael Madow, and this is the launch of my blog.

This blog will contain topics pertinent to various aspects of the practice of adult outpatient psychiatry. It will also address the nature of the many types of mental and emotional illnesses for which people seek psychiatric help. Although not everything is currently understood about these illnesses, science and medicine now offer a tremendous array of therapeutic agents and strategies to achieve the reduction and in some cases elimination of troubling symptoms.

This blog is intended for informational purposes only. It is not designed to be a substitute for seeking assistance from a licensed mental-health professional. It will be interactive, but it will be closely monitored, and I will respond to appropriate comments and questions.

In upcoming posts I will address such issues as: the diagnosis and treatment of depression; anxiety disorders; stress; bipolar disorders; ADD; post-traumatic stress disorder; social phobia; obsessive-compulsive disorder; and many others. This site is intended to be user friendly. I look forward to answering questions as well as providing psychiatric care to people in the greater Las Vegas area, including Boulder City, Henderson, and Summerlin.

Welcome aboard.