Health and Psychology

A friend of mine went to a psychiatrist recently to look into getting medication for his depression and was surprised when the psychiatrist referred him to therapy instead.  "Medication for mild to moderate depression, just isn't that helpful, but therapy is far more effective."  

That's true, for the most part.  It depends on the type of therapy being offered.  It also depends on making sure the actual diagnosis is depression.  Supportive psychotherapy, where a therapist is listening but doing virtually nothing besides that isn't very helpful.  So if you are having therapy and the treatment doesn't seem much different from what you would be doing if you were seeing a barber or hairstylist and they casually talked with you about your life, then it's not really therapy.  It's support.  There are several types of therapy that are effective and have good evidence to support the fact that they are effective.  This includes some short term dynamic psychotherapies, cognitive behavioral therapy, acceptance and commitment therapy, mindfulness therapy, and brief behavioral therapy. Medication may help with severe depression, and may be needed with moderate depression in addition to therapy.

I often see people who report depressive symptoms but also report other symptoms which suggest a medical illness.  The most common medical illness that causes depressive symptoms is long term untreated infection.  This often presents as very severe chronic abdominal pain in addition to depressed mood.  Endocrine disorders can also cause symptoms associated with depression such as difficulty sleeping, weight problems and fatigue.  Darkening of the skin around the neck, also known as Acanthosis nigricans, is a symptom of endocrine disorders and needs to be evaluated by an appropriate medical specialist.  Swelling of the fingers and ankles, or erectile dysfunction in men needs to be referred to a cardiologist because those types of symptoms may be associated with cadiac problems and those can cause symptoms of depression as well.

I routinely refer clients for medication with any conditions that have a genetic, neurological or a medical basis to them.  These are conditions where medication is often not only useful but required for symptom relief.  These include conditions like attention deficit disorder, bipolar disorder, and psychotic disorders.  In some cases, behavior problems are so severe that a short term course of medication to get symptoms under control may be needed.  This includes some personality disorders.  In some of the cases of personality disorders medication may be required for long term stability.  Differential diagnosis by psychological testing can help to determine a diagnosis when multiple conditions may be present.  Screening questionnaires are relatively inexpensive, and can refine and clarify diagnostic symptoms.  

In some cases a history is all that is required.  I met a man indicating he had panic attacks.  His symptoms of panic attacks were that he had temper tantrums where he yelled and threw things.  This isn't a panic attack.  This is a behavior problem and can easily be treated with behavior therapy.  I met another man who thought he had schizophrenia because following being shot at gunpoint he kept reliving the incident as if it was occuring again.  This isn't schizophrenia. This is a description of post-traumatic stress disorder and can be treated with psychotherapy.  Simple rating scales and checklists can differentiate these kinds of conditions.  More formal psychological testing may be needed to assess types of psychotic disorders, types of attention disorders or executive dysfunctions, and differentiate conditions like bipolar disorder from behavior disorders or personality disorders.  Some people confuse sleep disturbances with hallucinations.  One is a dream state, which can occur even if the person is awake, the other is a sensory disturbance.

If you have a question about your diagnosis please feel free to call our office for an assessment.