Printed with author's permission from myleftunsaid.com/category/doctoring/

11 Things Your Psychiatrist Wants You to Know

There are a lot of misconceptions about Psychiatrists and the way we practice, mainly because our sphere of medicine is so vastly different from that of any other medical specialty (and yes, I have an MD!) Here are a few thoughts I hope will help you understand us and our field a little better.

1) Yes, we all have clocks in our offices. We watch the time to pace ourselves, not because we want the session to be over. Many times I am checking the clock to make sure I have enough time left to cover all the things we need to before the session ends.

2) We are only slightly weirder than you are. The main thing that sets us apart from “normal people” is our ability to tolerate long pauses in conversation. It can feel awkward, but it’s also what makes us good at our job.

3) Most of us are not pill pushers, and we do not get any sort of kick back or perks for prescribing meds. Trust us, we don’t want anyone taking medications if they don’t need to. That being said, there’s usually a reason people come to see us, and we do have treatments that are effective.

4) Psychiatrists’ schedules are very different from other medical specialties, and there is a reason we like you to show up on time (and why we try very hard not to run late). We have longer and more frequent appointments because developing a trusting relationship takes time, and being punctual maximizes the time we can spend working together. We also use time management as a way to model appropriate boundaries, as well as demonstrate for patients how to successfully learn to contain their own emotions in an adaptive way.

5) We feel awful that the wait to get in to see us is so long. If we had it our way, we could see everyone as soon as they called for an appointment. Unfortunately, there is a vast shortage of psychiatrists in this country and an increasing need for us as our society becomes more aware of mental illness. Furthermore, we see less patients than other medical specialties because of our longer appointment times and frequent follow up (see #4 above).

6) Unless you are seeing a psychoanalyst, we won’t ask you to lay down on the couch. Ever.

7) We put a lot of thought into our office décor. If you’re interested, please feel free to ask about the significance of anything that catches your eye.
8) We don’t analyze anyone outside of the office. We are more than thrilled to hang up our work hats at the end of a long day, and again, I promise we are more normal than you think (see #2 above).

9) Most of us think benzodiazepines are overprescribed. We don’t want you to taper off of them because we are mean, but rather due to the many harmful side effects and it’s “band aid” effect.

10) We aren’t miracle workers. Your problems didn’t develop over one day, so we won’t be able to “fix” you in one session. Sometimes it can take awhile to get back on track, but your psychiatrist should be there to help you along the way.

11) If you don’t feel comfortable opening up to us, then we encourage you to find someone else. Patients have the best outcomes when they feel a strong connection with their therapist. Our main goal is for you to feel better, so if we aren’t the right one, please tell us so we can help you find a better fit.

Most importantly, psychiatrists are very passionate about helping those with mental illness and improving the stigma and misconceptions surrounding mental health conditions.
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Getting Through Winter by Judith Snyder Kastenberg, MD  215-545-2145

After the winter holidays and their associated joys and challenges, people often feel the short days and long dark evenings of winter.  Do you:

feel tired?
crave another cookie?
hit the snooze button each morning?

Even January’s resolve to commit to new resolutions can feel tougher to accomplish than you had thought.

Why does this happen?

Humans are wired to feel more like hibernating than hitting the gym this time of year.  And with good reason.  Consider your cave person alter ego.  Years ago, finding food in the winter was much harder than driving to the local market.  It required heading outdoors to find game or vegetation.  And heading outdoors was life threatening in inclement weather.

So we are programmed to move less, store up calories, and sleep until Spring.  Except that now we need to get to work, get the kids to their activities, and try to stay healthy and active.  But how?

Doing what feels impossible helps.  

-Keep regular hours as much as possible.  Try to go to bed the same time most evenings and get up the same time most mornings.

-Open the window shades and get natural sunlight.  Better yet, get outside.  If you cannot get to Florida each month, then take a walk outside during your lunch break.  Noonday sun is better than morning or evening sun.  The higher the sun is in the horizon, the better the meaningful light exposure.

-Eat vegetables and fruits and proteins.  Minimize or eliminate simple carbohydrates.  Avoid cakes, cookies, processed sugars, and especially alcohol.  These items make us feel tired.

-MOVE your body.  Walk, run, dance.

Talk to your doctor and get a full physical if these simple changes do not help.  Your doctor might recommend lab tests or suspect “seasonal affective disorder” in which case you might need more formal treatment.

Read more here.

Adapted from an interview on August 7, 2014 at www.wee-wander.com.

Real Talk: Baby Blues and Postpartum Depression A no-b.s. Q&A with Perri Shaw Borish, psychotherapist and perinatal mood disorder specialist. Plus: Local resources for moms by Christy on Aug 7, 2014.

While most of us have at least a baseline understanding of postpartum depression these days (most doctors are doing a good job educating us, no?), it’s also true that the whole world turns upside down in those weeks and months after you give birth. Suddenly, things you might know intellectually don’t necessarily translate into your new reality, and so It’s easy to question your feelings, to feel overwhelmed about reaching out to someone, and to just worry about the logistics of dealing with your own anxiety, depression, or mood issues. In short: There can be so many questions about everything, including your own feelings.

So. We hit up Wee friend, mom of three and psychotherapist Perri Shaw Borish (Perri specializes in anxiety and perinatal mood disorders: you can read about her private practice here), and asked the nitty-gritty detail things that we never really thought to ask until we were moms with new babies. 

***

Q:  I mentioned to my pediatrician that I was a bit more irritable with my husband in the few months after having the baby. She startled me by suggesting I might have been suffering from a bit of postpartum depression. This makes me think that as much as most of us think we know the symptoms, maybe there’s some confusion between baby blues, postpartum depression and postpartum anxiety?
A:  Yes, that is true. The “baby blues” are very common (about 85 percent of women experience them), and it is a temporary state. Symptoms of the “blues” — which might include (but aren’t limited to) weepiness, a lack of energy, negative thoughts, feeling sad — that last longer than 2-3 weeks should be referred to for assessment and treatment.

Postpartum Depression is best defined on a continuum. There is a large spectrum of postpartum mood disorders which range from mild to severe and usually occur within the first year. Some examples of symptoms of PPD might include feelings of anger, sadness, irritability, guilt, lack of interest in baby, changes in eating and sleeping habits, thoughts of hopelessness and even sometimes, thoughts of hurting oneself or the baby.

Symptoms of Postpartum Anxiety usually manifest as extreme worries or fears – often over the health or safety of the baby. Some women have panic attacks, a feeling of loss of control, racing thoughts and often disturbance of sleep.

Q:  If a mom does go to you — or any professional — to deal with anxiety or depression, what does she do with the baby for the duration? I ask this because I think some moms might find trying to find the time and the energy to take care of themselves stressful in a moment when they’re also learning to deal with a new baby.
A:  I always encourage women to bring their babies (up to a certain age). If they have childcare and can come alone, that’s great, but that’s not always possible. Additionally, I really like to see how a woman engages with her baby – it helps give me a better sense of her attachment to the child and therefore where she may be on the continuum.

Q:  Are there long-term effects of not being treated? Do some people just snap out of it?
A:  There can be major risks to the mental health of the mother and the child if Postpartum Depression/Postpartum Anxiety goes untreated. Again, it depends where on the continuum you are. For example, we know that children of depressed mothers have been found to have impaired cognition and emotional abilities, and bonding with the baby can become an issue. Anxiety Disorders that go untreated can lead to impaired functioning, panic and agoraphobia, to name a few. If you feel you may be suffering from some type of Postpartum Depression, the important thing to remember it is not your fault. You are not to blame and with help, you can feel well again. Even if it’s just a mild case, you can still benefit from talking to someone. In fact, mild cases especially are treated quickly once people seek professional help. 

Q:  Is there an alternative to seeing a therapist ? Hotlines? Support groups? Phone calls with a therapist instead of in person visits? I’m just curious if there are varying levels and methods of support for varying levels of need.
A:  There are alternatives to seeing a therapist, and depending on the person’s situation and needs, the alternatives may or may not be recommended … or they may be used as complements to other therapies. It’s best to first at least talk to a qualified therapist or doctor to determine what’s going on. Once that happens, some alternatives to therapy might be medication (prescribed by an M.D., of course), exercise, massage, meditation, good nutrition, adequate rest, and social interaction. (Exercise, massage, meditation, good nutrition, adequate rest, social interaction and support are always recommended, and for some new moms that might be enough, however, for many moms, much more clinical work is needed.) There are also hotlines and support groups (depending where you are – many of the support groups are peer groups run by other moms).

Sometimes these types of alternatives can make a difference, however that’s often not the case, and seeking professional help with a qualified therapist can make a huge difference. Often people don’t seek professional help because they feel ashamed or because they think they should “be able to handle it on their own,” but the quickest way to feel better is to talk to someone. Also, one thing to remember when seeking professional help is that you have the right to ask about the therapist’s qualifications, training, and approach and confidentiality policies. It’s your treatment and you need to be comfortable with whomever is going to treat you.

Q:  Are there any preventative steps a new mom can take so she doesn’t feel anxiety or depression?
A:  Yes, there are lots of preventative steps that may help — although there is a lot we can’t plan for, such as what kind of birth one might have. Working with a therapist trained in Perinatal Mood and Anxiety Disorders before the birth can actually help with this, too. If, for example, you have a lot of worries going into the birth, or there is unresolved trauma or loss (since those things put you at higher risk for PPD), it can be very helpful to process those things before the baby arrives with a therapist. Also if you’ve had any kind of postpartum mood disorder before, going to a therapist when you’re planning for a second child or when you’re pregnant with a second or third child can help tremendously to cut down on potential risk for that postpartum period.

Other examples of preventative steps include working on letting go and being okay with not doing everything perfectly once baby comes home; making sure the lines of communication are open between mom and her partner, or whomever her support people are; working on processing any major losses and any parenting issues before the birth; having a plan in place for taking care of oneself; and divvying up responsibilities once the baby comes home so mom can find pockets of time to rest and nurture herself. Also, have your thyroid checked within first few months postpartum, because thyroid disease often looks like Postpartum Depression. Sometimes OB/GYNs miss it because they often only see a postpartum mother once or twice in first year postpartum.

Q:  Aside from you, any other thoughts on where Philly folks can turn for help, even if it’s just an initial phone call to ask a question? 
A:  Postpartum.net is a really great, free, local resource that includes free weekly chats for moms, and also monthly chats for dads, and they have a map of local coordinators who can help connect women with local resources.

And there’s the Penn Center for Women’s Behavioral Wellness, which is great (215-573-8886), and they take most insurance providers. There are loads more locally; you can also ask your OB/GYN office for a list of local professionals who take your insurance.

There is also the very helpful Postpartum Support International Warm Line: 1-800-944-4773, as well as the suicide prevention hotline: 1-800-273-TALK (8255).

And you might remember the Hall Mercer Parent Child Center, which isn’t specifically for postpartum issues, but they have groups for new moms and their babies, which is a great way to get support in your own community and meet new moms who are potentially going through similar things.

How Do You Care for Yourself in a Crazy World?    by Lisa Seufert, MD 267-882-6251

First turn off the TV.  And walk away from the computer. 

It is important to slow down and check in with yourself both physically and emotionally when the world turns upside down.  Then thoughtfully tend to the physical, mental and emotional aspects of your health.  Doing so not only promotes healing, but also allows you to better care for the other people in your life.

To slow down, check in with yourself in a kind non-judgmental way, as if you were talking with a dear friend, child or pet. You can ask, “What am I feeling in this moment:  in my heart, in my mind, and in my body?”  Are you weary, angry, overwhelmed, or drained?  Are you sick or in pain?  Are your thoughts going too fast?  All of these experiences are understandable.

Tend to your physical health as best you can.  Eating healthy meals and avoiding alcohol and fast food if possible helps center your body.  Exercise can help discharge difficult feelings. Getting fresh air and being in nature can nourish and relax us, even in the midst of unpleasant feelings and physical sensations. Sleep can help restore and rejuvenate the body as can listening to relaxing music or breathing in a relaxing scent like lavender.

How best to take care of your emotional health?  Sometimes talking with a trusted person or writing down your feelings can be useful.  In addition, thinking of one or two things for which you are grateful can often lift your spirits. 

Stay well and breathe.

Staying Healthy During the Holidays  by Judith Snyder Kastenberg, MD  215-545-2145

The pressure is on.  No matter what winter holiday you celebrate - if any at all, the holiday season can make people feel rushed, under pressure, and tired.

There are time and obligation pressures.  Where to find time for gift getting, gift giving, work still to get done, children’s concerts to attend, homes to clean, and relatives to care for or contend with?  There can be pressure to perform.  How to measure up to expectations at work?  How to measure up to expectations of family members?

Many of us push through this time, stay up too late, put aside exercise, and eat easy and usually carbohydrate laden foods to get by.

As a result, we often view our obligations and time spent as chores rather than enjoy the season and appreciate the people and traditions we love.  How can we counter this tendency to grouse?  By taking care of ourselves.

Picture this: you are a pitcher full of clear quenching water ready to fill up the glasses of the people you love.  But if your pitcher is empty, you cannot fill anyone’s glass.

So fill your own pitcher.  Get a good night’s sleep.  Take a walk during lunch.  Breathe.

Post-Partum Depression by Perri Shaw Borish, MSS, LCSW, BCD 215-840-3554

"The only thing that seems eternal and natural in motherhood is ambivalence.” – Jane Lazarre, novelist.

There is a tremendous societal pressure on mothers to see the period after their child's birth as a time of bliss.  But for many mothers this is not the case. Rather, it is often a time of ambivalence, irritability, anxiety and hopelessness.

“I just want to sleep. I feel terrible and I’m afraid I’m going to drop my baby. Sometimes I imagine my arms may just give out and the baby will fall to the floor. I can’t speak to anyone about this so I pretend that everything is fine but sometimes I wonder if everyone would just be better off if I weren’t here.”

These thoughts are typical among new mothers I have treated.  Many do not realize that they suffer from a common and treatable condition. Postpartum depression may appear to be the baby blues at first -- but the signs and symptoms are more intense and longer lasting, eventually interfering with a mother's ability to function.

Postpartum Depression affects 15-20% of new mothers and ranges in severity from mild anxiety to major depression. Here we will focus on the most common form, that of major depression.

Patients and caregivers often overlook the symptoms of postpartum depression.  Like most types of major depression, postpartum depression is characterized by: depressed mood, irritability, anxiety and loss of interest in general.

In addition, women who suffer from postpartum depression often express ambivalence toward their newborn child and commonly doubt their ability to care for the child.

How should women suffering from Postpartum Depression be cared for?

Ideally, women at risk - those who have been depressed in the past either post partum or otherwise or have a family history of depression - should meet with a therapist to create a wellness plan to be prepared for her child's arrival.

Once a mother shows symptoms of postpartum depression, she and her doctor should review her medical history and consider a physical exam and lab tests to rule out reversible causes of depression such as thyroid dysfunction or anemia. Then they can make a treatment plan based on the severity of the symptoms and the degree of functional impairment experienced by the new mother.

For mild to moderate depression, non-pharmacologic options such as psychotherapy can be helpful.  A healthy diet and plenty of sleep are essential.  The human brain needs continuous sleep to recharge.

Friends and family can lend a hand and offer emotional support and encouragement and provide hands-on help taking care of the baby.

At night, a loved one (partners need to pitch in if there is one) can help feed the newborn with a bottle so the mother can sleep. During the day, a loved one or friend can take the baby for a walk, hold the baby, or do household chores to give the new mother much needed time for herself.

Believing the myth that “new mothers love each and every moment with their babies” can push some mothers to ignore their own needs. When we are depressed it can feel as though the walls are closing in around us. A few minutes of exercise, a short walk outside and a breath of fresh air can go a long way to help the recovery process.

When a mom shows signs of more severe postpartum depression or does not respond to non-psychotropic treatments, antidepressant medications taken along with psychotherapy have been proven to be effective. For nursing mothers, antidepressant medications must be chosen with the safety of the baby in mind. When a mother presents with severe postpartum depression, particularly for patients who are at risk for suicide, inpatient hospitalization may be considered.

Recognize the Symptoms and Know What to Do

New mothers and those who surround them should be made aware not only of the symptoms of postpartum depression but also that it is a common and highly treatable condition.

There is no reason for a new mother to suffer in silence and shame.  Getting help from a trained professional helps develop a game-plan to lessen the depression and anxiety and enable the mother to enjoy this time.

I have found that the simple act of talking about feelings often helps to alleviate symptoms in my patients. As a therapist, often the most important thing I can do for my patients is to listen to them, encourage them, and normalize what a difficult and challenging time this is for new parents. With proper treatment and care, the process of becoming a mother can truly be an exciting time, full of new adventures, growth and a tremendous amount of love.

Resources if you are struggling with Postpartum Depression:

Postpartum Support International  http://www.postpartum.net

Center for Postpartum Health  http://www.postpartumhealth.com 

American Psychological Association  http://www.apa.org 

Talking to Yourself by Judith Snyder Kastenberg, MD  215-545-2145

There are too many things to do these days to fit into the time available.  But we try our best.  

We juggle.  We fit a lot into too few hours.  We run.  We add to our to do list.  We do more than one thing at once.  We sleep a little less.  We end dinner before we have all had time to talk about our days.  

Where does that get us?  

It gets us sleep deprived and driving distracted and missing out on great conversations with our loved ones and with ourselves.

Yes, we miss out on conversations with ourselves.  Taking time to talk to ourselves - in the best sense - lets us check in.  Check in on where we have been, where we are, and where we want to go.  Some formal rituals allow this time.  Sitting with your doctor at an annual physical lets you do this.  “So how has the last year been?”  Even if you think your doctor only cares about your cholesterol or the numbers on the scale, you can treat the question philosophically.

So, how has your last year been?

Where have you been?  Where are you?  And where do you want to go?

I Can't Sleep by Judith Snyder Kastenberg, MD  215-545-2145

You can't sleep.  You grumble at work, with your significant other, with your kids. You can hardly concentrate on the task at hand because you feel irritable and tired.

No matter if the problem is falling asleep, staying asleep, or getting up too early, the results are the same. You are unable to contribute to your world in the way you want and are capable of doing.

Scientists do not understand why humans need to sleep. But they all agree that we do need to sleep. How much depends largely on your age. Newborns and teenagers need the most sleep, the elderly less. Somewhere between 7 and 9 hours of restorative sleep at night seems best for most adults.

Sleep can be life sustaining for people with psychiatric and other medical problems. Maintaining a happy and even mood depends heavily on regular and good quality sleep. Losing sleep can trigger not only depressed moods, but also manic ones in people who are at risk for that. Lack of sleep makes healing of all kinds take longer. Most of us have experienced this phenomenon when our bodies are sick with a virus and drive us to stop everything and rest. And if we ignore those signals? Then we drag through those activities we feel we "must" do and take longer to recover from the illness.

What interferes with the chance of getting 7-9 hours of restorative sleep a night? Traditional things that interfere are stress, taking care of kids, laundry, cleaning, work, not to mention a snoring bed partner or a sick child. In modern life, add in caffeine, television and computer time at night.

How can we promote restful and restorative sleep? Our bodies want to get up when it is light out and wind down when it gets dark. Not many of us can or want to live like farmers without electricity. But we can help things along.

• Go to bed roughly the same time each night and wake up roughly the same time each morning. Staying up late on the weekends and then sleeping in create jet lag without the benefit of having travelled.
• Have a getting ready for bed routine. Changing out of work clothes, brushing teeth, reading and other evening rituals tell your body to wind down because bedtime is near.
• Make sure your bedroom is comfortable. How is your mattress? How is the temperature? The linens? Do you like your windows opened or closed? Do you like silence or ambient noise?
• Does you or your bed partner snore? If the answer is yes, please talk to your physician. There are non-invasive ways to help snorers sleep quietly and healthily thereby helping themselves and their bed partners sleep better.
• Do you use caffeine after mid-day? Caffeine after noon can interfere with the ability to sleep for some people.
• Do you use alcohol to help fall asleep? Alcohol can help people fall asleep, but inevitably awakens the person in the middle of the night after it wears off.

Trouble sleeping can be a sign of depression or anxiety. Treating depression or anxiety directly with talk therapy or medication can clear the trouble sleeping.

Take any questions about your sleep to your primary care physician so that you and your doctor can get you back to bed.

Understanding Depression by Judith Snyder Kastenberg, MD  215-545-2145

Feeling down? Is getting through the day more like slogging through peanut butter? Have no energy?  At any given time, nearly one out of five people experience symptoms of depression. However there is hope and help out there for you. 

What does depression feel like? It is more than feeling bummed after a break up or sad after a relative has died. It's strong and it's not "shakable." When you know someone with depression, you may want to grab him or her and tell them, "Pull yourself up by your boot straps. Get out of bed!" But they just don't seem to be able to control their sad state. 

For two weeks or more, the person may have a depressed mood or loss of interest and pleasure in nearly all of his or her activities. A depressed person may also have one or more of these symptoms: unintentional weight loss or gain, change in appetite, too little or too much sleep, fatigue, inappropriate guilt, trouble concentrating or making decisions, and recurrent thoughts of death, even suicide. 

Who gets depressed? We are all vulnerable at different times of our lives, but some more than others. Women report being depressed twice as often as men. Other at risk groups include those who are divorced or separated and individuals aged 18 to 44 who suffer depression at higher rates than any other age group.

What causes depression? A variety of factors may be involved, including genetics (i.e. family history of depression), early childhood experiences (such as loss or trauma), environmental factors (like recent stressors or lack of social support) or medical conditions (such as hormone imbalances, infections, cancer, or just having had a baby). 

Sometimes people are told to "Just get over it." A depressed person, however, really can't. Left untreated, depression can last for several months, leaving the sufferer unproductive or even out of work and with disrupted relationships. But with treatment, symptoms of depression can start to clear in weeks and enable people to continue being productive and happy.

What treatments are out there? Medications. Psychotherapy. Bright light lamps. Herbals. What is the first step? Get a complete physical and set of blood tests from your internist, family doctor, ob-gyn, or psychiatrist. There is no blood test for depression, but there are reversible causes of depressive symptoms like low thyroid levels or anemia and there are physical consequences to having been depressed like poor nutrition and lack of sleep that can make you more vulnerable to other illnesses. 

After your complete physical, your doctor may recommend treatments you can do for yourself like getting regular and adequate sleep and exercise, or treatment with psychotherapy and/or medications to jump start your recovery. 

Therapy helps people pinpoint triggers for their depression and deal with the consequences of living with depressive symptoms like trouble at work and in relationships. 

If medication is needed, most medications that treat depression have few or no side effects. You and your doctor can pick one that is right for you by exploring the medication's side effect profile. For example, if one medication makes people sleepy and you experience restlessness at night because of depression and anxiety, that particular medication may work well for you. 

Don't want to take prescription medication? Some herbals may have good anti-depressant properties like St John's Wort or SAM-e. One should know, however, that not enough studies have been done to know for sure how effective herbals might be. Be sure to tell your doctor what herbals you take, or would like to take, since herbals can affect the metabolism of other drugs making them more or less effective or even building toxic levels. Also, the amount of active ingredient in an herbal preparation can vary from pill to pill so one day's dose may have enough ingredient, while another day's dose may not. 

Bottom line to getting better? TALK. Talk to your spouse. Talk to your friends. Talk to your doctor. You are not alone and you can get better with help. 

Also, educate yourself and your loved ones. Here are some good websites to help you start: 

• American Psychiatric Association
• Depression & Bipolar Support Alliance 
  
  

You can feel better.