Hi Dr. Raj,

My father was diagnosed Schizophrenic; does this mean I will be Schizophrenic?

ANSWER:

Let’s begin with what Schizophrenia is; Schizophrenia is a mental illness that presents as a few different subtypes; it belongs to the group of disorders we refer to as “Psychotic Disorders”; what psychosis simply means is “a break with reality”; thus, if someone is experiencing auditory hallucinations (hearing voices without any stimulus in the enviornment) or believes that the FBI or CIA is following them when they are not, we would say that he or she is “psychotic”; Schizophrenia has an incidence rate of 1% world wide; what this means is you can take 1% of any population and estimate what the expected number of individuals with Schizophrenia would be; thus, it a very serious and not so uncommon mental illness.

Now, let’s turn to understanding how it works if your parents have certain diseases and what that means for you; we inherit 50% of our genetic material from each of our parents; the body uses this as a blueprint to build proteins that the body needs similar to how an architect uses a blueprint when building a house; you can imagine that if there is an error in the blueprint that then will carry over to an error in the house and cause a problem; well, in the same way, if we have an error in the blueprint that the cells of our body use, it can cause a problem as well; so, in regards to Schizophrenia, there are problems in the “blueprint” that the body is uses; however, just having the error in the blueprint does not seem to always cause the disease; if you take two identical twins (same exact blueprint) that have parents with Schizophrenia, you will find about 50% of the twins get the disease even though they both have the exact same blueprint.

Thus, what this means is that you need both the problem with the blueprint as well an environmental factor which then triggers the disease; we are not clear as to the exact nature of the triggers but stress in general seems to bring out our vulnerabilities; so to answer your question, you do have a genetic risk or predisposition greater than someone who does not have a Schizophrenic parent; however, even with the genetic predisposition, you are not necessarily going to get the disease; I would suggest developing a good working relationship with a therapist with whom you can learn coping strategies to prevent stress in your life from building up.

Do you remember, that old question about which straw broke the camels back; the usual answer is “The last one”; but if you really think about it, it’s the SUM TOTAL of all the straws. Thus, don’t let the straws of your life accumulate.

Hi Dr. Raj,

I’m having a bit of a problem finding the right psychologist for my problem. I’m 21 and have been self-injuring since I was 12. Do you know of any good resources in the New York area for people suffering with this issue? Thanks for your time.

ANSWER:

First of all let me acknowledge your commitment to wanting to learn how to better manage your mental and emotional life; as you know, it’s anything but simple; I think some of the most powerful individuals are those who are seeking insight into understanding themselves and why they do the things they do; thus, your ahead of many in that you seem committed to wanting to learn about yourself and how to manage your feelings.

With that said, I would suggest that the most important thing to monitor for anyone who has thoughts of self-injury is their safety; if anyone feels that they are not going to be able to control their urge of wanting to self injure, then they must check into a hospital to make sure that they stay safe; remember that a 3-5 day stay in the hospital is not a huge amount of time in the big picture.

The next issue to address is why people self injure; one reason they do so is in moments they feel emotionally overwhelmed; in fact there is a specific type of therapy that has been developed called DBT to help teach skills that help in such moments; DBT stands for Dialectical Behavior Therapy; this is a psychosocial treatment developed by Marsha Linehan specifically to treat individuals who have difficulty managing their emotions.

The basic idea is that at one end of the spectrum is emotional mind where at the other end of the spectrum is logical mind: those individuals that have difficulty managing their emotions and sometimes engage in self injurious behaviors live on the emotional end and have a difficult time accessing the logical parts of their mind; thus, DBT is designed to help access the logical mind and achieve the state of mind referred to as mindfulness.

Logical Mind————————-Mindfulness—————————-Emotional Mind

It has been shown to help manage one’s emotions which in turn can lead to a decrease is self injurious behaviors.

With regards to resources in NYC, I know that Roosevelt Hospital in NYC has a DBT based program that you may find helpful; they are located at 59th and 10th; their number is 1-212-523-6983; remember that as you learn to manage your emotions more efficiently, it will get easier; we can overcome unhealthy behaviors as long as we seek support and treatment by the right individuals.

My primary care doctor prescribed Prozac for me but I am afraid to take it. What are the side effects that I should be worried about when taking this medication?

ANSWER:

Prozac belongs to a class of medications that are based on their mechanism of action; medications belonging to this class are called selective serotonin reuptake inhibitor’s or and SSRI’s; low serotonin levels in the brain are thought to play a significant role in mood and anxiety disorders; this group of medications increase serotonin levels in the brain by selectively inhibiting the uptake of serotonin after it has been released; bottom line, serotonin levels are increased which in turn is correlated to an improvement in symptoms related to depression and anxiety disorders.

The most common side effects of this class are:

• Allergic or Toxic – Rash, Pruritus (skin inflammation)
• Neurological – Headache, Tremor, Dizziness, Asthenia
• Behavioral – Insomnia, Anxiety, Nervousness, Agitation, Abnormal dreams, Drowsiness and fatigue
• Autonomic – Excessive sweating
• Gastrointestinal – Nausea, Disturbances of appetite, Diarrhea
• Respiratory – Bronchitis, Rhinitis (inflammation of the nasal mucous membranes), Yawning
• Endocrine – Weight loss
• Musculoskeletal – Muscle pain, Back pain, Joint pain
• Urogenital – Painful menstruation, Sexual dysfunction, Urinary tract infection, Frequent micturition
• Miscellaneous – Chills

Keep in mind that not all SSRI’s cause all the above side effects and that different individuals respond differently to different SSRI’s; your doctor and you have to work together to see which medication suits you the best; always check with your doctor if you have any side effects (symptoms that were not present prior to starting a particular medication) and ask him or her if other options are available; also, keep a small journal of how you feel when starting any new medication; note down any changes in mood, appetite or energy; be sure to bring your notes to your visits with your physician; make sure to address your questions during your follow up visits; don’t be afraid to ask questions related to your working diagnoses and treatment plan; you have a right to ask questions of your health care providers and deserve answers if they are known; Lastly, only take prescription medications under the supervision of a physician. Take care of your self and keep the lines of communication open.

Dr. Raj,

A close friend of mine has been seeing the same psychologist every other week for over 4 years.  This friend is college educated and intelligent. He does not abuse drugs or alchohol.  He has a problem with anger management, often reacting out of proportion to events.  His reaction can range from melancholy to temper tantrums that include shouting insults.  He can go up to six weeks without having what I call a “melt down”.  How do I know this?  Because I have actually tracked his mood swings on a calendar over 12 months.  The melt downs can last 2 days, 1 week or he may have one very few days for 2 weeks.  Then, he will recover and appear happy and content for 2 to 6 weeks.  I know this is probably bipolar disorder.  Or maybe it is post tramatic stress, since he grew up with domestic violence between his parents.  The point is…my friend does not appear to be “getting better” in light of all the therapy he has gotten.  I can see no changes in his behavior!over the 3 1/2 months I have known him.  I know my friend speaks openly to his doctor and is honest to a fault.  He does realize he has problems with self esteem, depression, mood swings and handling his anger.  I know not every doctor is the same caliber, too.  What type of therapy shoud my friend be getting? Talk therapy? Cognitive behavior therapy?  What strategies can you suggest?

ANSWER

Dear iNTj,

It does seem that you have alot of insight into your friends problems and that you genuinely care about his well being.  You mentioned that he see’s a therapist every two weeks, how often is he seeing his psychiatrist?  What is the working diagnoses that his psychiatrist is treating?  Is he on any psychiatric medications and have any helped?

We now know that the most effective treatment will address the Biological-Psychological-Social domains individually.  What this means is that once, the presenting problem is understood, a health care practioner should address each of these domains to get the most effective treatment response. The Biological domian usually involves medicaton management, the Psychological involves getting into psychotherapy and the Social domain involves looking at and understanding social facotrs that are contributing to the persons presenting complaint(s) i.e. family dynamics.

Remember that it takes time to corrently diagnoses and understand the dynamics of human behavior.  I know this can be frustrating for many individuals but the number of diagnostic tests in psychiatry are limited.  Our most useful tool is obtaining a through history from our patients and their families in order to come up with a working diagnoses and over time it is verified or adjusted.  Many times I hear from people, “My Psychiatrist only spent 2 minutes with me, how could he have correctly diagnosed me?”  My response to them is usually to find somone else who will spend the time obtaining the proper history to properly formulate a treatment plan.

As far as therapy goes, I think going every other week is not as effective as going every week.  In my opinoin, much happens in two weeks and the session usually becomes about “catching up” versus working on insight.  Their are also many different types of therapy that range from working on supporting the individual to working on insight around internal conflicts.  Their are also therapies that focus on one’s thoughts (Cognitive Behavioral Therapy) as well as being more mindful about one’s behaviors (Dialectic Behavioral Therapy).  Which approach is best is dependent on the individual who is entering it.  As a genral rule of thumb those in treatemnt do better than those who are not in treatment.

Thus, I commend your efforts in understanding your friend’s current challenges but remember that he must make the committment to find the appropiate answers.  You can not do his work for him but only support him along the journey.  He’s lucky to have you in his life.

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.

I hear about people who say they take a “xanax” pill when they fly so they fall to sleep. What is this and can anyone get it?

ANSWER

Xanax is a medication that belongs to the class known as benzodiazepines.  The benzodiazepines are considered to be minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties.

I think great caution should be taken when using a medication from this class of drugs because of it’s addictive potential.  However, in an individual with minimal abuse potential short term use can be appropriate.  In some situations, such as in your question, some individuals can become very anxious when they fly and require a minor tranquilizer to be able to tolerate the flight.

One aspect that I find very concerning is inappropriate use of this class of medications.  Many persons will go to their physician due to situational anxiety (an anxiety related to a particular stressor in ones life) and want something to relieve their symptoms.  What often happens is the person will find effective symptom relief and begin to psychologically become dependent on the medication.  I have seen many cases in which “pill popping” becomes a coping strategy.  Remember, I said that this class of medications is addictive.  Thus, what would have been a good short term strategy has turned into something that the person is now dependent.

What I suggest is asking your physician about addictive potential for any medications that are prescribed to you (Benzodiazepines are only available by prescription from your physician).  Make sure you ask the questions up front so that you don’t find yourself with a bigger problem down the road.

If you take a lot of psychiatric medication, like zoloft or prozac, will it affect my sex drive?

ANSWER

Zoloft and Prozac fall under the category of Selective Serotonin Reuptake inhibitors.  SSRI’s as a group have been associated with sexual side effects.  There is no way to tell if one agent will necessarily cause it while a different agent won’t.  The only way to know if you will or will not have sexaul side effects if to have a trial of a given medication.  It will be critical to monitor and communicate any sexual side effects that you may experience with your prescribing physician .   If sexual side effects present they usually present as ejaculatory dysfunction and/or decreased libido.

When thinking about if one should take a medication or not based on possible side effects, I think it becomes about close evaluation of the risk to benefit ratio.  If the benefits out weigh the risks (i.e. side effects) and if the individual is willing to accept them, then it may be appropriate to continue the medication as prescribed under the guidance of your physician.  Of course, if other medications are available, one could be put on a trial of a different medication to determine how well it is tolerated.

Remember to always communicate to your physician about side effects that you may be experiencing (sexual or any other) to determine the best course of action.

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.

My parents ignored me when I was growing up, and I just want someone to love me. If I have a baby to love me, will that satisfy my need, even though I am only 18?

ANSWER

First of all, the answer is not searching for something to “love you” but to understand why it is that you don’t feel loved; my understanding of the mind says to me that your lack of feeling loved is based on your experiences in early childhood; the question now becomes, “Would a child be the vehicle to love?”

My answer to this would be no.

You must learn to love yourself even though at times you don’t understand yourself; in my opinion, you can never find love outside of yourself.

Having an infant is not about wanting to be loved by him or her; it’s about providing unconditional love TO THEM; this will difficult if you are looking for the same thing the infant is looking for, which is essentionaly “wanting to be loved”.

I would suggest to you to explore (with a therapist) just how your parents ignoring you impacted you; understanding this will allow you to heal the place that you don’t feel loved and will one day lead to a life that most importantly will be more fullfilling.

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.