I'm an expert at medication management. I'm really good at prescribing medication and I recommend my patients receive psychotherapy or counseling from therapists. There is so much expertise involved in psychotherapy that I would never want to consider myself an expert in psychotherapy. While I will devote several hours a year to learning about new psychotherapy skills, I spend the majority of my free hours each year updating myself on the latest medication management information. I utilize multiple sources of information to inform how I co-make decisions with my patients. I utilize trusted sources such as the United States government and other esteemed resources to remain up-to-day with the latest in pychopharmacology. I say co-make because I let my patients know all options available so that I'm not forcing treatment onto anyone. After all, patients and their lives are so unique that each person requires individualized care. My patients have much say in what I prescribe.
I always place a big emphasis on encouraging my patients to report side effects to me as soon as possible (I'm on call 24/7!). I do not like to see people suffer from taking medication that is supposed to help them feel better. Furthermore, some side effects can be dangerous. Sometimes psychiatric medications can cause nausea, disruptions in sleep or appetite, headaches, rashes, or can make someone feel like a "zombie" as many would describe it. The goal of psychiatric medication management is to maximize the benefit of the medication and minimize or eliminate side effects. Strange side effects can happen that can scare people such as hand tremors or problems with memory. The first step is to try to avoid side effects by safe medication prescribing and good decision making. The second step is careful monitoring by asking if someone is experiencing common side effects or anything out of the ordinary. Finally, my duty is to be there along the way to help people get rid of side effects as quickly and safely as possible so that people can continue on their road to recovery!
About once month I get a request for a letter for an Emotional Support Animal (ESA). While I firmly believe in having a pet for emotional support, I have to admit I believe my patients probably know more about ESAs than I do. ESAs do not have the same protection as a service animal, but they can still provide many benefits. ESAs can add to a person's quality of life by helping calm someone's anxiety or soothing their depression. I typically have patients who own dogs or cats as ESAs. Typically my patients request letters of support for the owner's living environment (such as an apartment or dorm room) or for plane travel. There is training available for ESAs in San Antonio (for a cost) but not all owners go through formal training for their pet. As a dog and cat owner myself I totally understand the companionship pets can provide. I look forward to discussing ESAs each time! Pets are welcome in my clinic!
NAMI San Antonio is the local chapter of the larger NAMI non-profit organization. I think my patients have found their family and individual support groups to be the most helpful resource that they offer. Check them out for yourself and gather some pearls!
Treatment of insomnia starts with your morning routine! When most people think of sleepy hygiene they think of their bedtime routine, however, one of the strongest recommendations for treatment of insomnia occurs in the morning and not at night. The eye's exposure to natural sunlight in the morning starts the body's circadian rhythm (the body's internal clock). Light tells the body that it is time to wake up and sets the timer to tell the body to go to sleep later on. Daylight savings time is here! This is the perfect time of year to be exposed to lots of bright natural sunlight each morning. On the contrary, it also means you must block out bright light from your windows at night because the body's clock needs the absence of light to cue it's sleep time (also hence no electronic devices 1-2 hours before bedtime). But there is a second runner up when it comes to morning sleep hygiene! Physical activity also helps start the body's circadian rhythm in the morning. This is where I digress for a second. Physical activity is not just good for the circadian rhythm but also for heart health and emotional well-being. Physical activity too late in the day may cause some people to experience insomnia. However, one has to balance the pros and cons of the effects of physical activity late in the day on their health versus no physical activity at all. It is generally thought that if one can only exercise in the evening that they exercise in the evening. However, the best time to exercise for the circadian rhythm's sake is early in the morning upon awakening. In summary, physical activity and the retina's exposure to sunlight are two morning sleep hygiene recommendations that can help improve sleep quality. I hope this helps you get a better night's rest!
Here is a link to a government website on sleep hygiene.
There are times when an anti-depressant stops working. First of all, what does that mean? It is largely a subjective experience, one that each individual describes differently, but we clinicians can use our skills to evaluate a change in someone's symptoms. For example we may ask about any changes in the intensity or frequency of someone's sadness. And we may also ask about any changes in one's capacity for interest in pleasurable activities. However the conclusion is drawn most patients are asking for help when they feel their anti-depressant stops working! When an anti-depressant stops working it can be called anti-depressant poop-out! It can feel devastating! Techniques such as those taught in Cognitive Behavioral Therapy can be useful during this time, but what I want to focus on in this blog is anti-depressant augmentation or adding another medication to help the anti-depressant work again. Most importantly, when patients feel their anti-depressant has stopped working, patients should seek help and do not wait until depression worsens to the point of suicidal thoughts.
Scenario two: an anti-depressant doesn't completely help with feelings of sadness or loss of pleasure. Or it doesn't help completely with other related things such as sleep, feelings of guilt, energy, concentration, or appetite. Again, anti-depressant augmentation to the rescue! Don't get me wrong, other things can be done such as switching anti-depressants or adding supplements or alternative remedies, etc., but this blog focuses on augmentation. I'm not one to prescribe in a one-size-fits-all fashion nor am I one to stick to old practices nor am I one to prescribe based on the latest trend. Each one of my decisions is carefully weighed against risks, benefits, and patient preference and situation. So what I'm recommending in this blog is adding an FDA approved medication to the anti-depressant that either stopped working or that is not working completely. I've seen wonderful success with this approach. Like all medications in psychiatry it is not guaranteed and it is not meant for everyone, but I want people to know that they have this as an option. It is a terrific option for those who have experienced this approach's success! So if you feel like your anti-depressant has stopped working or is not working completely then ask about anti-depressant augmentation!
This article is not intended to give medical advice. No one can diagnose your condition from email or other written communications, and communication via our website cannot replace the relationship you have with a physician or another healthcare practitioner.
It's so common for people to dread Mondays! But the dread of Mondays can be amplified for people who have anxiety or depression. Here are some tips to break the Monday blues! I love this picture above. It illustrates a variety of ways to ease into Monday. I recommend easing into Monday by using Sunday to plan the next weekend. Reflect on your weekend. What worked, what didn't work. What did you like, what would you do differently? Then, plan next weekend like there's no tomorrow. Plan to live in the moment. In this picture above, there are many activities going on that would spike most people's pleasure and reward brain pathways! First of all, there is nature. Being in nature away from the hustle and bustle of city life can really get your feel-good brain chemicals going. Also, in the picture there is food, which can be used, in moderation, to promote a good time. Then, we have music. Adding background music while one is cleaning, doing chores, or just hanging out can fire up that pleasure center. But most of all, this picture highlights FACE-TO-FACE social connectivity which is necessary to fire your brain up and get those feel-good chemicals really flowing! So one of my solutions to the Monday blues is to use Sunday to plan ahead and have something FANTASTIC to look forward to the next weekend! Some studies have shown that sometimes more pleasure can actually be gained from planning compared to the actual experience! Now, go have fun and fire your brain up! Have a great week and happy planning!
Mental Health Care for Children, Adolescents, and Adults