FAQ – Frequently Asked Questions from My Patients and The General Public About Mental Health & Psychiatry
I thought this would be a very interesting page on this website because I hear so many questions and concerns from my patients as well as comments from friends and acquaintances who are not medical professionals and might have some misinformation about psychiatry, psychotropic drugs, medication management; and general questions about how a psychiatrist sees mental illness and treats it. As a psychiatrist in Scottsdale I have been practicing since 2001 and I treat a nearly every illness and noticed some questions that are common to all of my patients.
1. How long can I be on medication before it hurts my body?
Answer: Indefinitely – lifetime, most mental illnesses are treatable and not curable. Depending on the underlying illness, sometimes we can lower the dose as the individual learns to cope; however, medication management is a long-term treatment plan. Most medications are not toxic or harmful to the body, yet we always run full blood work on a regular basis to ensure that the liver and kidneys are functioning properly. These are run frequent enough so that if we detect abnormalities in the tests we can stop or change medications before any damage is done. Medication management must be weighed against the symptoms of the illness. I am not sure that medications of any sort (except those used in chemo therapy and the ones we know are taxing on the body such as some of the anti-psychotics) have any more of an impact on your liver or kidneys than the food and substances we consume. Vitamins, aspirin, soda, beer, wine, processed food, candy, coffee; the human body is quite remarkable and can process much more than natural fruits and vegetables. You should always speak with your psychiatrist or medical doctor before you plan to get pregnant because some of the medications will have an effect on the child. Read more on the benefits of medication.
2. What medication do you see as the fastest working drug today in 2014?
Answer: Remeron (Mirtazapine). This medication often alleviates the symptoms of depression in as few as 3 days.
3. What illness responds fastest to medications?
Answer: ADHD, patients have often told me that they get relief from the symptoms of ADHD in just hours after taking the medication.
4. What happens to someone who takes a Methamphetamine who doesn’t have ADHD?
Answer: Methamphetamine’s were developed to treat ADHD and not as a recreational drug. For patients with ADHD these stimulants have an inverse effect in that they help them focus and calm down. Even at night if one has ADHD the stimulant will help them sleep. If one doesn’t have ADHD they will concentrate better and become hyperactive and experience more energy and possibly become psychotic if they are taking too much of the medication. We advise that most if not all patients check with their family practice doctor or cardiologist before going on stimulants.
5. What is the most common mental illness?
Answer: Social Anxiety disorder. This is a form of anxiety and not merely a phobia, we can treat it with anti-anxiety medication, anti-depressants, or beta-blockers that were developed for hypertension.
6. What percentage of your patients are male?
Answer: I would hate to put a percentage on this since my practice is a small sample size; suffice it to say I am treating more men today than I did 5 years ago. I think this might be due to the de-stigmatization of mental illness, which has been and is a goal of my practice. Often patients will suffer with their symptoms for up to 10 years before seeking treatment due to the stigma of mental illness. In the past I “believe” it was much more socially unacceptable for men to seek psychiatric help than women – this is changing! Read more on this topic or here on post-menopausal depression
7. Do Woman suffer from depression more than men?
Answer: Yes the figure is still about 2 to 1 in the general population, much of this is hormonal, genetic, and possibly because women have a tendency to hold their feelings in whereas men are expected to voice their aggression through sports and their demonstrative behavior. But this is just a guess on my part and we really don’t know why that figure is 2 to 1. Maybe women are more open to seeking help thus skewing the statistics?
8. What are the most common side effects of the anti-depressants?
Answer: reduced libido, weight gain, increased anxiety, read more on the side effects.
9. What is the latest medication(s) that has impressed you the most?
Answer: The anti-depressant Latuda (Lurasidone HCL). This drug is used to treat bipolar depression and does a great job with little weight gain. Nearly 68% of people with bipolar disorder suffer chronic depression. Cymbalta (Duloxetine HCL) is another new drug that is excellent in that it treats depression, fibromyalgia, diabetic neuropathy, peripheral neuropathy, and this one drug treats several illnesses or what we call comorbid illnesses.
10. What are the most common comorbid illnesses?
Answer: Co-morbidity means that two or more illnesses will occur together, and this is very common with mental illness. The most common comorbid illnesses that I see are: Anxiety/Depression, Anxiety/ADHD, Depression/ADHD. With Anxiety/ADHD; ironically once the ADHD is treated with a stimulant (which you would think promotes anxiety) the anxiety is alleviated as well.
11. What percentage of your patients have spouses that have a mental illness?
Answer: I would estimate 25%, and with family members this is even higher because of the genetic transfer from parent to child. Another illness that is “Catchy” is OCD; often spouses will pick up on some of the habits of the one suffering from OCD. If the husband has a habit of driving home to check to see if he closed the garage door, the wife will often find herself doing the same thing, and the children as well. Read more on OCD
12. The Methamphetamine stimulants have gotten a bad rap due to abuse, why continue to prescribe them?
Answer: The Methamphetamines were developed for treating ADHD and do an excellent job. My patients tell me that this drug is a miracle and they wish they were on them earlier in life. Unfortunately there will always be those that abuse medications that have wonderful medicinal value; especially the pain killers. But we shouldn’t stop prescribing them we just have to monitor and control the use of these medications.
13. Insomnia seems to be epidemic, how is it treated today?
Answer: Sleep to the brain is as important as insulin to the pancreas and insomnia is not a illness but usually a symptom of depression, anxiety, ADHD, or many other mental illnesses. Usually of the 75% of my patient population that come to me with sleep disorders, 50% of them will get relief from the insomnia once the underlying illness is treated. Read more on sleep disorders.
14. Do you still prescribe Prozac and the older medications?
Answer: Yes, often if the newer first line medications aren’t effective we will use the older SSRIs, Tricyclics, and the MAOIs, and even ECT. We do this especially when we encounter treatment resistant depression. Read more on treatment refractory depression.
15. What do you do when someone comes to you and is abusing drugs and alcohol?
Answer: I don’t treat addictions and refer these patients out; however, if someone is “self medication” and able to abstain from drug and alcohol use for several weeks, we can then get an idea of the underlying illness and treat it. Sometimes the substance abuse will dissipate once the underlying illness is treated. But the patient has to want help and must work with the doctor or it is all for naught.
16. What percentage of your patients do you co-treat with a counselor or psychologist?
Answer: 80%, I focus on medication management and have a fully integrated team to work with the other aspects of treatment.
17. How long do your patients need to see you, or what is the typical treatment plan?
Answer: This of course is on a patient by patient basis, but if I had to generalize I would say our treatment begins with the initial evaluation. Then I will see the patient every 2 to 4 weeks until we have stabilized them, and after that usually I will see them on a quarterly basis or as needed basis. My goal is to “do no harm” to the patient or his/her pocket book. Treatment is a joint effort and often the patient will help in determining when they feel stabilized enough to allow for longer intervals between appointments.
18. What causes mental illness?
Answer: This requires a protracted answer and you will find this by clicking here. The short answer is genetics, hormones such as a lack of testosterone or pre and post menopausal changes, head injuries, other physical illnesses such as diabetes, and the environment plays a large role as well. Studies have shown that fetal stress can change the genes of the fetus thus creating a propensity for an anxiety disorder later in life. We must distinguish between mental illness which is usually biological and no different from any other organ not functioning properly and personality disorders which are in a class of their own.