Depression & Bipolar

Have you been feeling sad, sluggish or unable to focus? Are you wondering if this is something that should be treated with therapy or medication? Or maybe you are currently on medications that are not effective, or causing side effects?

Major depressive disorder is a medical condition comprised of some combination of the following symptoms:

persistently depressed mood or irritability
inability to enjoy things
low energy, sluggishness
inability to concentrate
increased feelings of self blame
suicidal thoughts
uncharacteristic sleep patterns
changes in appetite

Sometimes you are able to do the things you need to do. Sometimes the symptoms make even the idea of getting out of bed overwhelming.

If this is you, there is hope. Treatment is often multifaced with common interventions including dietary and other lifestyle changes, medical workup, therapy, and medication. There are many therapy modalities proven to be helpful for depression including cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) or interpersonal therapy (IPT). Common medications we turn to first include selective serotonin reuptake inhibitors (SSRI), serotonin norepinephrine reuptake inhibitors (SNRI) or atypical antidepressants.

Maybe you have already tried some of the first line options above, and still do not feel better. My job is to a deep dive into your stressors, history, and relationships to understand the nuances behind your illness and treat accordingly. Perhaps a second or third line option is appropriate for you, such as transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT) or ketamine.

Do you experience times in your life when you inexplicably feel euphoric, or cannot control your irritation for days on end? Are you sometimes unable to sleep for days but do not feel tired?

Untreated bipolar disorder can be quite debilitating, and you may feel that your mood is controlling you rather than the other way around. You may feel frustrated with the unpredictability of what you feel day to day. In the height of mania, perhaps you make impulsive decisions that you later regret or significantly impact your life (spending too much money, or doing something risky that you would not normally do). In this way, people with bipolar disorder may have a difficult time trusting themselves.

It need not be this difficult. Bipolar disorder is a treatable illness. Depending on your symptoms, you may benefit from certain medications designed to put you back in control of your emotions and your life, such as a mood stabilizer (like lithium).

This can all be overwhelming, and we would love to guide you through.

In the meantime, here are some resources we have compiled that will provide you deeper understanding:

National Institute or Mental Health: https://www.nimh.nih.gov/health/topics/depression
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
American Psychiatry Association: https://www.psychiatry.org/patients-families/depression/what-is-depression

Still not sure?

Psychiatrists use a questionnaire called PHQ-9 to determine if you need to be treated for depression. You can find it here. Follow the instruction to determine illness severity

Anxiety & Panic Attacks

Do your thoughts turn to the same set of worries over and over, even if you know your fear is not rational? Or perhaps you have a rational fear that leaves you unable to focus on your work or family?

Anxiety can be an adaptive sensation. After all, its original function was probably to keep us safe. However, sometimes anxiety can be disproportionate to the threat, and sometimes it can detract from our day to day quality of life and functioning so much that it becomes the most central thing in your life. Sometimes it can progress to panic, which can lead to you avoiding doing basic things. When quality of life and functioning are impaired, it may be time for treatment.

Common symptoms of anxiety include feeling on edge, irritable, fatigued, restless, having difficulty sleeping, and/or muscle tension. Panic is a physical reaction caused by anxiety that includes sweating, chest pain/tightness, heart beating wildly, fear of dying, and feeling hot/cold. Panic attacks can be so bad that you may even be afraid to leave your house or drive your car.

Similar to the other mental health diagnoses, anxiety and panic are highly treatable with lifestyle changes, therapy, and medication. Supportive therapy, cognitive behavioral therapy, and dialectical behavioral therapy may be helpful for anxiety. Medications that we initially use to treat anxiety usually include the selective serotonin reuptake inhibitors (SSRI), serotonin norepinephrine reuptake inhibitors (SNRI), or atypical antidepressants. Together, we will unearth the roots of your anxiety and find the best treatment modality for you.

Here are some resources that may be helpful to you:

National Institute or Mental Health: https://www.nimh.nih.gov/health/topics/anxiety-disorders
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961

Still not sure?

Psychiatrists use a questionnaire called GAD-7 to determine if you need to be treated for anxiety. You can find it here. Follow the instruction to determine illness severity

Obsessive compulsive disorder

Do you have intrusive thoughts that will not go away, no matter how much you try to ignore them? Do you sometimes feel you have to do things a certain way for fear that something bad will happen? Are you unable to cope if something is just out of place?

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed in an attempt to alleviate anxiety or prevent a feared event. OCD can significantly impact daily functioning and quality of life. Sometimes these thoughts can be quite scary and difficult to understand. You may not even recognize the thoughts as your own, which can make you feel out of control of your own mind.

Some of the common fears/obsessions are (not an exhaustive list):

fears of contamination/disease
doubts about safety
fear of harming oneself or others
repetitive washing of hands
mental rituals
repetitive counting

There are evidence-based treatments for obsessive compulsive disorder that can help control the symptoms. These employ a combination of psychotherapy and medications. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed, as they help regulate neurotransmitter levels in the brain, reducing the severity of obsessive and compulsive symptoms. Tricyclic antidepressants may also be considered in certain cases.

Cognitive-Behavioral Therapy (CBT) is the most established psychotherapeutic approach for OCD. Specifically, Exposure and Response Prevention (ERP) is a subtype of CBT that involves gradually exposing individuals to situations that trigger obsessions while discouraging the corresponding compulsive rituals. Through systematic exposure, individuals learn to tolerate the anxiety triggered by obsessions without engaging in compulsions, leading to symptom reduction over time.

Still not sure?

Psychiatrists use a questionnaire called Y-BOCS to determine if you need to be treated for depression. You can find it here. Follow the instruction to determine illness severity

We have compiled a few resources to expand your understanding of this disorder:

National Institute of Mental Health: https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432
American Psychiatric Association: https://www.psychiatry.org/patients-families/obsessive-compulsive-disorder/what-is-obsessive-compulsive-disorder
National Library of Medicine: https://medlineplus.gov/obsessivecompulsivedisorder.html

Women's Health

Are you a woman undergoing a life change? Do you have a new or old diagnosis and plan to become pregnant?

A woman’s life is marked by several biological transitions that can affect mood. Menses, fertility, pregnancy, childbirth and menopause are all life-affirming landmarks that are primal and a source of great joy and identity. At the same time, they are all times of transformation, a loss of previous identity and a time of growth. These times can prove to be vulnerable for many women. As a female-owned practice, we love working with women through these challenges and helping to maintain stability.

According to MGH Center for Women's Mental Health, 85% of women experience some type of mood disturbance & about 50 to 85% of women experience postpartum blues during the first few weeks after delivery. While these symptoms are mild and do not interfere with the responsibility of motherhood, in some cases where there is history of mental illnesses or if these symptoms last longer than a few weeks, they may need to be treated.

Postpartum psychiatric illness is typically divided into three categories: (1) postpartum blues (2) postpartum depression and (3) postpartum psychosis. It may be useful to conceptualize these disorders as existing along a continuum, where postpartum blues is the mildest and postpartum psychosis the most severe form of postpartum psychiatric illness. Typical symptoms of postpartum depression are:

Tearfulness
Loss of interest in usual activities
Feelings of guilt
Feelings of worthlessness or incompetence
Suicidal thoughts

In severe cases, you may even have scary thoughts about harming your baby that are highly distressing.

If you are unsure if you might benefit from treatment, we can together elucidate what is going on and use evidence-based treatments to help you feel better. Studies have shown that when mom feels better, bonding with baby is easier. Improvement in postpartum depression has immediate and downstream benefits to you and your child. We are comfortable guiding you through the pros and cons of different combinations of therapy and medication through pregnancy planning, birth, and postpartum.

Still not sure?

Psychiatrists use a questionnaire called EPDS to determine if you need to be treated for depression. You can find it here. Follow the instruction to determine illness severity

Here are some resources that may be helpful:

MGH Center of Women's Health: https://womensmentalhealth.org/specialty-clinics-2/postpartum-psychiatric-disorders-2/
Mother to Baby: https://mothertobaby.org/pregnancy-breastfeeding-exposures/depression/
Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/24152-postpartum-psychosis
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/postpartum-depression/symptoms-causes/syc-20376617

Psychosis

Do you sometimes have difficulty keeping track of your own thoughts? Have odd things been happening to you lately, and you are trying to make sense of them?

Psychosis is more common than you think, and can be an unsettling sensation. It can manifest in many ways. The essence of psychosis is that you may believe things that are not really true, or you may hear or see things that others cannot. You may also act in a way that is very uncharacteristic for you, or have thoughts that are difficult to keep track of.

Many things can cause psychosis, including a medical condition or medications. Sometimes psychosis is inherited genetically, and may be diagnosed as schizophrenia, schizoaffective disorder, or bipolar disorder with psychotic features. Regardless, there is treatment available to manage psychosis which can dramatically improve quality of life. This often includes an antipsychotic medication and cognitive behavioral therapy for psychosis. We are here to talk to you about things that may be uncomfortable to talk about with friends or loved ones. Education is also extremely helpful for your and your family in how to talk about the psychosis, and how to be less afraid of it.

Further resources include:

National Institute for Mental Health: https://www.nimh.nih.gov/health/publications/understanding-psychosis
Cleveland Clinic: https://my.clevelandclinic.org/health/symptoms/23012-psychosis