Lockup Doc

Assume for a minute that you do not have an underlying psychiatric or neurologic condition. You’re healthy. If you could take a pill that would significantly improve your memory, help you to concentrate through great distractions, keep you full of energy even though you’ve slept little, help you to be more social, or keep you from worrying much, would you take it?

That’s really the issue at stake with the concept of cosmetic psychiatry. Is it okay for psychiatry to evolve beyond simply treating disease and relieving suffering to the point where the goal is also enhancement of “normal” functioning? Read more…

As a psychiatrist who has now been practicing for over a decade, I think back to the days of residency and fellowship and realize how much my approach to prescribing benzodiazepines has changed.

One of the key faculty members in my psychiatry residency program was considered an expert in treating anxiety disorders. He was very liberal with his prescription of benzodiazepines, the anti-anxiety class of medications including diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax) and others.

Having no other frame of reference, I naively adopted his unsparing prescription-writing habit of these not-so-benign medications. I unquestioningly steered down this path for the first couple years of my post-training practice.

Then I had the good fortune of working with a very competent group of experienced psychiatrists who were in full-time clinical practice. Regularly collaborating on cases with them helped to initiate my transformation to more conservative, and in my opinion, more appropriate,  prescribing habits.

My prescription style inevitably evolved further when Read more…

Clinical Psychiatry News (Nov. 2009) published an article by Drs. Jan Leard-Hansson and Laurence Guttmacher entitled, “Treating Peginterferon-Induced Depression.” In order to determine the best evidence-based antidepressant treatment, the authors reviewed 170 studies but ultimately narrowed these down to 4 to include only randomized controlled trials.

Chronic hepatitis C virus (HCV) infection is not an uncommon health condition among prison inmates. The three most common HCV genotypes that occur in North America are 1, 2, and 3. Genotype 1 is treated with a 48-week course of weekly IM peginterferon and daily oral ribavirin. Types 2 and 3 are treated with a 24-week course. Approximately 1/3 of patients undergoing peginterferon treatment develop depression. Of this 1/3 who develop depression, 3/4 become depressed within the first 8 weeks of treatment.

Anecdotally I have found that citalopram works well for most patients. I have found it fascinating to treat patients with no mental health history who have abruptly developed Read more…

All psychiatrists have worked with patients who were unhappy or dissatisfied with their life circumstances but did not have a diagnosable psychiatric illness. They may or may not have had an adjustment disorder, but they were not clinically depressed. They were functioning about as well as usual. In my own non-clinical term, they were in “emotional pain.” They were emotionally uncomfortable, restless, unfulfilled, and resisting whatever life circumstances they despised.

Sometimes they were dealing with situations over which they had no control, but other times they very much could make needed changes, but they were “stuck” and afraid to move into the unchartered territory of the unknown.

Generally speaking, psychotherapy is likely to be the most helpful intervention in these cases. However, beyond psychotherapy, I want to point out what I believe psychiatrists should not do when working with such patients, Read more…