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On May 16, 2017 from 1:00- 2:00 pm EST, ADAA hosted its first live "Ask the Psychiatrist and Psychologist" event on the community platform.

ADAA members Dr. Debra Kissen (Psychologist, Clinical Director of the Light on Anxiety Treatment Center of Chicago) and Dr. Karen Martinez (Psychiatrist, Principal Investigator at University of Puerto Rico and the Director of the Center for the Study and Treatment of Fear and Anxiety at the University of Puerto Rico) hosted the event and answered questions for an hour. They also answered questions that were sent in prior to the live event. We have listed the questions and answers below. Stay tuned for information on our next live event!  

Q. What is the predominant trait that people with depression and anxiety have in common?

A. (Dr. Martinez) Both anxiety and depression are mood disorders, so the predominant trait seen in both is that there is a change in normal mood. Normal mood is that your mood should change depending on everyday events but when there is depression or anxiety, your mood will be anxious or depressed most of the time for most days for a few weeks or months.

Q. What is the best way to help a family member or loved one who has anxiety and depression?

A. (Dr. Kissen) The best way to help a loved is to be there unconditionally, without judgment. Those struggling with anxiety and depression are not looking from answers or tips from loved ones but just to know there loved ones are there for them. You can also direct them to ADAA.com to find a provider who can be of assistance to them.

Q. Why are stimulants not widely considered for treatment of fatigue or low energy in PTS with major depression disorder?

A. (Dr. Martinez) Stimulants, which are medications like Ritalin and Adderall, can be used to be added on to more traditional medications used for major depression disorder (MDD). It is not considered a first line therapy for MDD since there are many other medications that work on all symptoms of MDD not just fatigue and energy problems.

Q. Fatigue is on symptom of depression that many anti-depressants don't seem to address. what are possible options available for pts on anti-depressants who still struggle with this symptom, and are these options known and accepted in the mental health community or are pts left on their own?

A. (Dr. Martinez) Stimulants, which are medications like Ritalin and Adderall, can be used to be added on to more traditional medications used for major depression disorder (MDD). It is not considered a first line therapy for MDD since there are many other medications that work on all symptoms of MDD not just fatigue and energy problems.

Q. What happens when the patient is already on bupropion and another antidepressant yet still complains of fatigue? Is the doctor then supposed to try stimulants? I get this sense that many are afraid to try stimulants. I have so far not been able to get at least 4 psychiatrists to try adding stimulants to my cocktail, even for ADHD, this 2017. I am.still unable to work because I'm too tired to do most anything yet none would even try stimulants to help and not that I'm even new to them.

A. (Dr. Martinez) Like I was just mentioning in the above post, stimulants are medications that can be used to treat fatigue and loss of energy in depression. There is also a first line treatment for depression, bupropion (Wellbutrin in the USA), that can address those symptoms. Stimulants are usually used in addition to other medications.There are also psychosocial interventions that can be used to treat energy and fatigue problems like targeting sleep problems and engaging in lifestyle changes such as diet and exercise regimens that increase energy.

Q. Would like to know if I should see a psychologist instead of psychiatrist? I don't really understand the difference.

A. (Dr. Kissen) The short answer is that a psychiatrist prescribes medication and a psychologist provides behavioral therapy.

Q. Is Hypnotherapy good for severe social anxiety?

A. (Dr. Kissen) There is no study that I know of that lends empirical support for the use of hypnotherapy for social anxiety but that does not mean it is not worth "a shot". What I do recommend is CBT for social anxiety with an emphasis on EXPOSURES. Teach our brain it is not dangerous to do something embarrassing or to be judged.

Q. As a spouse of a person who is in the middle of a depressive episode that started 6 months ago, how do I keep myself healthy? I am feeling very lonely and invisible. There is no natural need for him to want to connect with me on any level at all. Is this normal?

A. (Dr. Martinez)  Part of the symptoms of depression include isolation and not feeling a need to connect socially- so your spouse is presenting a normal reaction within the disorder. It is really important to think about what you need to keep yourself healthy as it is common for family members to get burnout. Make sure you take time to have a healthy diet, enough sleep and an exercise routine. If you also start having depressive or anxiety symptoms, therapy can also help.

(Dr. Martinez) Good question! When your loved one is struggling with anxiety or depression you deserve and requires a good amount of self care. Connect with other loved ones, eat healthy, get good sleep, exercise...do whatever you need to do to nourish yourself because right now your loved one is running on empty and does not have the internal resources to be there for you (for the short term...not for forever).

Q. I'm on 3 different medications for anxiety and depression Im also told I have a mood disorder should I be on all of these at one time? My medications are zoloft 50mg,buspar 5mg, geodon 80mg.

A. (Dr. Martinez) You can be on these three medications at once since they all work differently. Zoloft is a medication that is prescribed for anxiety and depression and works through the serotonin networks in your brain. Buspar is a medication specific for anxiety and although it also works on those serotonin networks, it does so differently than zoloft. Finally, geodon is a medication that is used for psychosis and mood stabilization. Both Buspar and geodon can be used to augment the response of the Zoloft. It is recommended to first try the highest dose of Zoloft and then use augmentation medications, but sometimes, if the mood disorders is very severe or includes marked anxiety, psychosis or mood changes, more than one medication is used initially.

Q. How can the science of psychology and psychiatry move forward if patients are not effectively engaged in the finding of best treatment for their own situations. Psychiatrists readily admit that no two patients are the same yet the way some of them approach treatment is as if every case is the same. Why the contradiction?

A. (Dr. Kissen) Mental health consumers have a right to high quality care. You are the expert on you and if your information is not valued and seen as a critical piece of the treatment plan, it is time to find a new provider.

(Dr. Martinez) A high quality psychiatrist and psychologist with adapt an evidence based treatment protocol to address the specific needs of their patients. If you feel like you are receiving "cookie cutter" treatment, and not being seen as a human being, with unique attributes and strengths, it is time to find a new provider. One of the most interesting things about being a psychiatrist is that contradiction. Symptoms that usually occur in clusters that are similar enough between individuals are classified as a disorder. But that disorder will manifest itself differently in every individual because the symptoms will depend on culture, age, religion and other social characteristics. So, as a psychiatrist, the diagnosis serve as a guide to understand the reasons for the symptoms and determine a treatment plan but then you need to tailor that diagnosis and the treatment to the individual manifestation. A very clear area where this contradiction is key is in terms of language. Most people do better in therapy when it is conducted in their native language and when the therapist speaks the native language. So even though I might be using cognitive behavioral therapy techniques that are used across any individual, I would tailor the language to that specific patient.

Q. I would like to know what is being done for treatment resistant depression. ECT, TMS, all meds have been tried. I was hoping deep brain stimulation would help but my psychiatrist told me the results were iffy. I don't understand why the classification of TRD is for those that have only tried a few meds. This is a slap in the face to those of us who have tried everything out there over a 30 year span. Why is this categorized this way?!

A. (Dr. Martinez) Treatment resistant depression is an area that has only been gaining research and clinical attention for the last 10 years and that is why we still have more questions than answers. There are several areas of promise such as the use of rapid onset antidepressants, like ketamine, and the use of anti-inflammatory medication. There are also several new studies on combining medications with several therapeutic interventions.

Q. Antidepressants work different in individuals. why then aren't some symptoms of depression considered syndromes to allow for their proper treatment in the case that anti-depressants alone aren't enough to treat all the symptoms of depression suffered by pts?

A. (Dr. Martinez) Antidepressants work differently in people for various reasons. First, depression is a heterogenous disorder with some people suffer depression as a response to a loss or trauma while in others is caused by inflammatory processes. At this time, we do not have the tools to identify if a specific individual has a specific type of depression so it is difficult to target treatments. Antidepressants also work differently because each individual has a different way of processing the medication in the liver. We are starting to have test to identify if a specific person might respond better to one antidepressant than another depending on this last issue.

Q. How can I help bipolar people?

A. (Dr. Kissen)  Be a source of calm in the storm. Offer structure and routine and get support to work on your own emotional reactions to the chaos that your bi polar loved ones may create.

Q. My kid has some symptoms of anxiety/depression, but not all of the symptoms. When and how do you know if its normal or an actual disorder?

A. (Dr. Martinez) The most important aspect to evaluate is determining if the symptoms cause dysfunction. If the anxiety and/or depression are causing your kid to have trouble at school, with friends or at home, then it might be a disorder.

Q. What are the major differences between ADHD that's causing self-esteem problems and is hard to cope with, vs. actual depression? Second, is it possible to have depression even though there are things in life that you still truly live for and you like doing, but you still feel little to no motivation to get out and do anything?

A. (Dr. Martinez) Depression frequently occurs in people with ADHD because it is a disorder that leads to interpersonal, study/work stressors that can lead to depression. If a person with ADHD is sad or with decreased interest for most of the day for a period of two weeks of more, it is possible that they also have depression. A lot of people with depression still have many good things in their life that they enjoy and, as therapist, we focus on that as part of the treatment of depression.

(Dr. Kissen) It is always helpful to consult with a mental health provider (ADAA find a therapist link) to review your concerns. Even if someone does not meet full criteria for an "actual disorder", it is always helpful to address challenges proactively before they become a bigger problem.

Q. I have depression and trauma and am going to counseling as well as taking medication. But for a month now, I have been experiencing several mental crashes every day. Whenever I do anything from talking to people including talking to my counsel or doing everyday tasks, my body crashes.
I am wondering why this is occurring.

A. (Dr. Kissen) It is hard to provide a full, clinical answer through this format but I would recommend talking to your counselor and psychiatrist about these "mental crashes". What are the sensations, feeling, thoughts and behaviors associated with these episodes. It could be that through your counseling work for the trauma, some of the pain memories from the past may be surfacing as you are working your way through them.

Q. I would like to know how to get rid of these scary intrusive thoughts. I take sertraline but that doesn't help. I have also had other antidepressants and counselling and cbt but nothing has helped.

A. (Dr. Martinez) Intrusive thoughts are one of the most difficult symptoms to treat in anxiety. In terms of medications, these intrusive thoughts usually only respond to high doses (for example, 200 mg Zoloft). In addition, there are certain medications that work specifically for these symptoms such as clomipramine and fluvoxamine.

(Dr. Kissen) Hmm...I would be interested in learning more about the CBT you are receiving. Part of the CBT treatment protocol for intrusive thoughts should be imaginal exposure as well as other forms of exposure to "scary thoughts". It can be amazingly freeing to repeatedly expose yourself to intrusive thoughts, with the help of a well trained provider, to teach your brain that they are simply "spam mail" and need not be addressed or taken seriously. It is not what you think but the behaviors you engage in that define your life.

Q. Why is Anhedonia is still considered a mere symptom of major depression disorder and not a syndrome in itself. I would also be interested in learning what other medication helps there are for pts already taking anti-depressants and anti-anxiety medications that still do not address the issue of anhedonia.

A. (Dr. Martinez) Most studies have shown that anhedonia (lack of pleasure in activities) only occurs in the context of depression. It is important to state that anhedonia can be present in itself (without sadness) in order to diagnose depression. We have talked previously in the feed about treatments for low energy that will also work for anhedonia.

Q. Will these docs be discussing the role that "natural factors" (bad gut health/enteropathy, nutrient deficiencies, environmental/food pollution, etc.) play in triggering anxiety & panic?

A. (Dr. Martinez) Psychiatric disorders are caused by several factors interacting to produce symptoms- so any factor that can affect the body (diet, other illness, pollution) will definitely have a role in the development and maintenance of anxiety and panic. It is also important to address these factor in treatment. All treatment plans should address diet, exercise, sleep and any other factors that can lead to wellness.

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