Archives for Health Matters Blog

Bill is a 27-year-old physicist with bipolar SAD, type A. He agreed to take lithium, which eliminated his springtime hypomania, but only partially alleviated his winter depression. Light therapy was added with good results. After three years, Bill married, and two years later he and his wife decided to move to a farm, which is at the same latitude, essentially, as his home of origin (the frequency of SAD goes down as one moves toward the equator and sunlight increases, and vice versa). I will never forget the conversation Bill and I had after his second year on the farm,
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The Importance of Context and the Limits of Medication Every health care provider has had experiences that were so powerful that they have forever transformed his or her thinking and approach to patients. The following was such a case. It demonstrated a number of things to me, including the importance of context, the limitations of medication, and the failure of psychiatrists – myself included – to educate their nonmedically trained therapist colleagues in the rapidly progressing biological realm. At a time when the secrets of the brain are being unraveled, and research in the brain sciences is burgeoning like few
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High Functioning Businesswoman When Janine first came to see me she was 35 years old, and had just delivered her third child. As a former businesswoman, her transition to full time mom had been very rocky. One of the first things she said to me was, “I was high functioning until 3 years ago.” I was glad she told me this, for it gave me a baseline sense of who Janine was as a person in this regard. Pregnancy Complications, Depression, and Panic Attack She went on to detail her medical history: “During my pregnancy with my son, my third child, I
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Severe OCD since 4th Grade John was a very bright young fellow who was heading off to an Ivy League university in the fall. He was suffering from very severe OCD since 4th grade. He had tried Cognitive Behavioral Therapy, however it didn’t help. He refused exposure and response prevention therapy. Eventually, his OCD became so severe that he refused to extend his elbow because of his belief that such an action would cause harm to someone he loved. He also refused medication. Headaches, GI Problems, and Weight Problems His Yale-Brown Obsessive Compulsive scores was= 29 (obsessive=12, compulsive=17). He complained
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19 Year Old with Depression and Panic Attacks Brody had a recurrence of panic disorder after 20 symptom-free years. Brody was a funny really warm-hearted young man. When I first met him, 29 years ago, he was 19. He was sent to me after he had been hospitalized for depression and panic attacks. He was given Nardil in the hospital and I then treated him with Cognitive Behavioral Therapy [CBT] and group therapy. Stabilized When Prozac came out, in 1988, I put him on it. He was stable and so soon I was seeing Brody three times a year. Destabilized
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1985 after being in practice for just a couple of years, a patient I will call Joanne, came to me for treatment of a panic disorder. I figured it was a pretty straightforward case that the literature, my experience, and my training indicated should respond to therapy or medication. Joanne was a 50-year-old woman in a bad marriage and her youngest daughter was going off to college. I assumed that Joanne was having panic attacks because of the threatened separations both from her daughter and the possible break up of her marriage. Multiple Medication Approach Failed I thought that a
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Top Student Sidetracked by OCD Despite being handsome, tall, personable, and a top student at Yale, Mark was silently struggling with an intense need to count to 100 every time he had a “bad thought”. This he told himself, reduced the thoughts from taking over. What’s more, he had difficulty socializing with his friends, without unobtrusively washing his hands for fear of contamination. And the back of his head had a patchy baldness—the result of years of nervous hair pulling (a tic like behavior), so he always wore a large baseball cap. As his life was grinding to a halt,
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