QUESTION

I am a twenty eight year old female who is suffering from extreme anxiety and depression. I’m always jittery and I just never feel content.  My therapist recommended that I see a psychiatrist for some anti- anxiety and antidepressant medication. However, I’m afraid that this will affect my decision to build my family in the next couple of years.  Is medication harmful during pregnancy? Will I be able to have a healthy child while on meds? Is there any possibility of abnormal fetal development due to effects of meds?
Thanks for your time.

ANSWER

Dear Jolene,

Let’s begin with understanding that there are three aspects to your anxiety and depression.  The first is the biological, which is the genetic predisposition we inherited from our parents (50% from mom and 50% from dad).  Now keep in mind, if your parents and family history is negative for anxiety and depression, then this may not be playing a hugh role in understanding your symptoms.  However, if you have a strong family history of anxiety and depression, then it would be more appropiate to think that biology is playing a bigger role in your symptom presentation.

Second, is your psychological make up.  What this suggests is that your personality and the multiple facets it’s composed of plays a part of how you view and interact with the world around you.  We’ve had millions of experiences growing up and have formed very intricate belief systems that guide us through our day-to-day lives. I like to think of these belief systems as a software equivalent on a computer.  As we all know, software systems run on rules (beliefs) and inevitably contain errors.  The only way to fix the error is to look at a presenting problem (set of symptoms) and begin exploring the possible causes.  Once we have identified the suspected cause, we go and closely examine and change that part of the software (beliefs).  You can think of this as updating your software.

Lastly, it is important to understand the Social aspects of one’s life and it’s role in our day-to-day lives.  We all have varying family structures, it is becoming more rare in western civilization to see a nuclear (father, mother, children) families and more and more often we are seeing single parents raising their children.  Clearly, this has impact on the child’s beliefs systems which then later the adult utilizies to navigate through life.  Maybe, someone has a serious medical illness in the family; maybe someone’s parents died; or maybe there are financial stressors; or maybe someone is just overwhelmed by her or his chldren and the stress being a parent carries; you can see there are millions of permutations that give each one of us a unique idenity and a social frame in which to function.

Going back to understanding your depression and anxiety; you have to examine the amount of contributions from each of these 3 areas; how much biological load is involved (genetic predispositon); how much of the symptoms are understood by the your particular psychology?  Lastly, what social aspects are involved in your life that could be amplifing your symptoms?

This is what we refer to as the Bio-Psycho-Social model of any presenting problem.  I think it is critical in addressing all of these attributes when dealing with a medical problem in order to get the best treatment of the illness.  Also, keep in mind that some problems are more biologically determined while others are more psychologically driven.  Thus, medication managment may be more appropriate in some situations and therapy in others.  Usually, a combination is best.

About your question to pregnancy and the use of medications.  The FDA has established 5 categories to indicate the potential of a systemically absorbed drug for causing birth defects. The key differentiation among the categories rests upon the degree (reliability) of documentation and the risk vs benefit ratio. Pregnancy Category X is particularly notable in that if any data exists that may implicate a drug as a teratogen and the risk vs benefit ratio does not support use of the drug, the drug is contraindicated during pregnancy. These categories are summarized below:

I would suggest talking to your physican about any concerns that you have in reference to risks during pregnancy so that he or she may specifially address your needs.

QUESTION

Dear Dr. Raj, I am currently struggling with my mental health. Following many years of taking anti-depressants and anti-anxiety meds I decided it was time to detox, and in Jan. discontinued taking Effexor XR and buspar.  I weaned myself with physician guidance, but not necessarily approval.  I’m sure you are aware that discontinuing the Effexor w/o the proper guidelines is awful.  It was difficult enough…since that time I have undergone, treatment by an accupuncturist for my depression.  However I feel like as hard as I try to be “happy” I continually struggle.  I’ve listened to Oprah’s “The Secret”, recently read The Four Agreements, constantly tell myself, I am enough, I have enough, I do enough.

My question and concern are if I do have altered brain chemistry can I correct it through will power, and positive thinking? How do I avoid my dark side?  Should I go back on meds?  If so what’s out there that doesn’t cause sleep disturbances or sexual side effects?  Since currently I feel like my system is clean are there herbs or supplements that you might suggest?  Thank you so much for your time and consideration.

ANSWER

Dear Cara,

It seems that you are committed to overcoming your depression which I commend you on; sometimes making the commitment to getting treatment can be one of the hardest steps.

First, it will be important for you to identify and understand what gives rise to your “unhappiness”; it is through this understanding and insight that you will eventually find “Happiness”.  The first question that comes to mind is, what is happiness to you?  It will be important to know what this word exactly means to you, as we all have different definitions. It is important to note that one can be satisified and “happy” with certain aspects of one’s life while simultaneously discontent or “unhappy” in other areas.  It does not have to be mutually exclusive.

With regards to depression, it has both a biological and a psychological basis and can be a part of a variety of clinical presentations; again, the key is to have a good understanding to what’s giving rise to your symptoms. Medications may be necessary if your symptoms interrupt your normal function; I would suggest you to discuss this with your psychiatrist; if you feel that your psychiatrist does not spend an ample amount of time with you, find another one who will; you deserve to have one that is interested in listening to you and one that is genuinely committed to finding the right diagnosis and treatment.

Remember, prescription medications must be taken under the care of a physician and should be monitored closely for any side effects as well as efficacy; as a category, the Selective Serotonin Reuptake Inhibitors (SSRI’s) have a high association of sexual side effects; this doesn’t mean that they will all cause this as each individual is different; one SSRI may cause sexual side effects in one person and not in the next; there are anti-depressant medications that do not have a high association of sexual side effects; one such anti-depressant is Wellbutrin; again, the decision to be on Wellbutrin should be made with a physician and be taken under his or her guidance.

As far as herbal preparations for mild depression, please read the answer I posted for a question on homeopathic medications for mild depression (on May 27th; you can click on medication? under categories).

Your question about thoughts changing our brain function is an area in which there as been a great deal of interest recently; research has shown that talk therapy does change brain function and hence structure. I find it fascinating that after every conversation we have with someone, our brain has changed in some way; this then means that after every session in therapy, our brain has changed; now keep in mind that talk therapy is more time consuming and requires a great deal of effort but I believe that it gets to the deeper causal layers (psycholigically speaking) and is tremendously important to include in a treatment plan.

Thus, I highly recommend finding a good psychiatrist and therapist who you can work with in understanding the biological and psychological underpinnings of your “unhappiness”; this will be fruitful in the long run.  Remember, you are enough, you always have been and you always will be. Healing will take time and will happen as long as you are committed and stay in treatment; if your need support, please send in any questions that I can help you with.

QUESTION

I hear a lot about depression and bipolar disorder on TV commercials.  I feel very sad sometimes.  How do I know if I may have bipolar disorder or just depression?

ANSWER

The NIMH describes a Depressive Disorder as “an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression”. Depressive disorders come in different forms that include Major Depression, Dysthymia and Bipolar Disorder.  When someone is depressed, they may experience symptoms which include:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Dysthymia is a mild to moderate depression versus a Major Depression is a severe depression.  Dysthymic Disorder lasts longer than a Major Depressive Episode but is not as disabling with regards to work, school and pleasurable activities.  The third type of Depressive Disorder is Bipolar Disorder.  In Bipolar Disorder, not only does the individual experience the symptoms of depression (lows) but also experiences symptoms of mania (highs).  Symptoms of mania include:

• Abnormal or excessive elation
• Unusual irritability
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire
• Markedly increased energy
• Poor judgment
• Inappropriate social behavior

A few gender differences that I think are worth mentioning: depression is twice as common in women than in men; about 6 million men in the US are affected by depression and many go undiagnosed; depression in men may not present with feelings of hopelessness but rather irritability and discouragement; lastly, depression has shown to be associated with a higher risk of coronary artery disease both in men and women.

If you feel that you have symptoms of depression or mania, make sure you discuss it with your physician to properly formulate a working diagnosis and treatment plan.  There is good treatment available and you don’t have to suffer needlessly.

QUESTION

Stressed Writes:

Hi Dr Raj, I’ve recently been feeling overwhelmed by the difficulties of work, school and family life. My doctor had me taking ambien and zoloft for quite some time but the ambien started to make me binge eat!! Weird right? Also I would have conversations on the phone after taking it and not remember what I said. Now he switched me to klonopin at night but I’m not sleeping… it just relaxes me? any suggestions

ANSWER

Dear Stressed,

Being overwhelmed in our personal and/or professional life is not so uncommon; in fact, I think one can feel overwhelmed at times of challenge and growth (i.e. work, school and family life); with that said if one finds themselves experiencing significant mood symptoms such as depression and/or anxiety, it is important to understand it’s cause.

Remember that both the biology (our genetic predispositions) as well as our psychology (our internal belief systems, conscious and unconscious) are giving rise to our reality mentally and emotionally. Thus, it is critical to carefully explore one’s history in order to identify clues as to what the underlying cause is.

I think psychotherapy is an excellent modality to a detailed exploration and can be very supportive in resolving feelings of being overwhelmed; medications have their place as well and have been shown to be effective in treating a variety of anxiety and mood disorders. In reference to the Binge eating with the Ambien, it’s not listed as a side effect (which doesn’t mean it’s not possible) and is intended for short term use; you being confused about the contents of the conversations you had while taking the Ambien is not uncommon and is listed as a side effect; Klonopin is also habit forming and should be used with caution; I would suggest speaking to a Psychiatrist or a therapist to understand the exact nature of what the cause of your sleep disturbance is.

Also, look under categories “sleep problem” to view comments I had made about sleep to a different question on April 25th.