Shrinks In Sneakers

Tag: Mental health advocate

  • Doctor’s Near-Death Experience: The Truth Behind Antidepressant Withdrawal – Fact or Fiction

    Doctor’s Near-Death Experience: The Truth Behind Antidepressant Withdrawal – Fact or Fiction

    These sensational headlines about near-death experiences coming off antidepressants are becoming far too common. While we must be cautious with prescribing, it’s equally important not to dissuade people from trying medications that could help them.

    Yes, some patients experience withdrawal symptoms if medications are stopped abruptly without proper tapering. But many patients do not, and I’ve seen countless cases where people discontinue their antidepressants without any issues. Some may require prolonged tapers, while others can taper off much faster than alarmist articles would suggest.

    It’s crucial to remember that while discontinuation can be uncomfortable, it’s rarely life-threatening. We do need to be mindful of how long we prescribe these medications, given they manage symptoms but don’t modify the underlying disease, and the long-term benefits are still debated.

    Guidelines for deprescribing are helpful, but dramatic headlines about “nearly dying” when coming off these medications are not only inaccurate but harmful to those who could benefit from treatment. Let’s promote balanced, evidence-based discussion on this topic, focusing on proper discontinuation without sensationalizing the risks.

    Link to article: https://www.theguardian.com/australia-news/article/2024/jul/31/australian-doctor-mark-horowitz-who-almost-died-writes-landmark-guidance-on-how-to-safely-stop-using-antidepressants

  • Surge in Antidepressant Overdoses Alarms Health Experts Across the U.S

    Surge in Antidepressant Overdoses Alarms Health Experts Across the U.S

    Rising Antidepressant Overdoses: A Growing Concern in the U.S.

    Recent data reveals that antidepressant overdoses in the U.S. have been steadily increasing from 1999 through 2022. According to a CDC report released last month, there were 5,863 overdose deaths attributed to antidepressants in 2022—numbers comparable to heroin-related fatalities, which claimed 5,871 lives. While these figures represent a small fraction of the over 100,000 overdose deaths that year—most of which involved fentanyl—they signal a troubling trend that demands attention.

    Potential Causes for the Rise in Antidepressant Overdoses

    Understanding the root causes of this increase is challenging, given the complexity of overdose data and the lack of detail on the exact substances involved. However, there are several factors worth considering.

    First, many individuals with opioid use disorder (OUD) also suffer from co-occurring mental health conditions like depression and bipolar disorder. These patients are often prescribed antidepressants, sometimes too liberally, in my experience working in community mental health. When opioids are mixed with antidepressants, opioids are often the primary cause of death in overdoses. Yet, I’ve also encountered numerous patients who have attempted suicide using antidepressants alone.

    Newer antidepressants are generally safer in overdose compared to older drugs, such as monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). While these older medications tend to be more effective, they come with significantly higher risks in overdose situations. This is something I frequently emphasize to residents: older drugs are more dangerous, but the newer ones, though safer, can still have serious consequences.

    Chronic pain patients, who are often prescribed opioids, are another vulnerable group. Their risk of suicide is heightened by the constant pain they endure, and many of these individuals are also prescribed antidepressants like duloxetine, which is indicated for pain management, or more dangerous TCAs such as amitriptyline and nortriptyline. Additionally, gabapentin—another drug commonly prescribed to these patients—has been known to increase the risk of death when taken with opioids.

    Overprescription of Antidepressants: A Contributing Factor?

    There has also been a sharp rise in antidepressant prescriptions across the U.S., which I believe warrants scrutiny. Antidepressants are, at best, symptom management tools, with a modest effect size of 0.33 in many studies. Given these limited benefits, we should be more judicious about who we prescribe these medications to and for how long.

    Withdrawal symptoms from long-term—and sometimes even short-term—use of antidepressants can be severe, increasing the risk of suicide. I’ve personally seen this with a family member who experienced debilitating headaches and vertigo after stopping sertraline. She was unable to work or function for nearly two weeks, highlighting how challenging withdrawal can be for some patients.

    Balancing Risks and Benefits in Mental Health Treatment

    Any population for whom antidepressants are considered a treatment option is inherently at high risk for suicide. That said, there are many confounding factors in the overdose data, and mainstream mental health reporting often glosses over the nuances of psychiatric research and treatment. When prescribing medications, it’s crucial to weigh not only the pros and cons of the drugs themselves but also to tailor treatment to each individual’s unique needs.

    I continue to prescribe antidepressants to patients whom I’ve carefully evaluated and believe will benefit, even if only in the short term. However, I am transparent with them: antidepressants are unlikely to resolve deeper psychological conflicts or “problems of living.” Mental health is rarely black and white, and much of this uncertainty stems from our incomplete understanding of the brain.

    In short, we need to acknowledge the complexity behind the rise in antidepressant overdoses and respond with a more nuanced, patient-centered approach to prescribing these medications.

    Link to the article:

    https://www.theguardian.com/science/article/2024/sep/03/antidepressants-overdose-deaths-increasing

  • Enlarged Brain Networks: A Hidden Signature of Depression from Childhood Onward

    Enlarged Brain Networks: A Hidden Signature of Depression from Childhood Onward

    The article “Frontostriatal salience network expansion in individuals in depression” highlights new research findings showing that individuals with depression have enlarged brain networks associated with emotional processing. The study, conducted on both children and adults, reveals that specific brain regions linked to depression display structural differences, with these regions being larger than those in non-depressed individuals.

    The researchers particularly focused on the amygdala and hippocampus, which are key to emotions and memory. This enlargement appears to start in childhood, suggesting early neurodevelopmental factors might contribute to the onset of depression later in life. The findings could lead to better understanding of depression’s biological roots and improve early detection and treatment strategies.

    Link to the article: https://www.nature.com/articles/s41586-024-07805-2

  • Hidden Dangers: Unveiling the Link Between Medical Conditions and Suicide Risk

    Hidden Dangers: Unveiling the Link Between Medical Conditions and Suicide Risk

    The article “Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder” published in JAMA examines the association between various medical conditions and suicide risk, highlighting the influence of pre-existing mental disorders. Key findings include:

    1. Increased Suicide Risk in Certain Medical Conditions: The study identifies a significant rise in suicide risk among patients with specific conditions, such as cancer, chronic pain, neurological disorders, and respiratory diseases. Chronic illness often contributes to emotional distress, exacerbating the risk of suicide.
    2. Impact of Mental Health History: Individuals with a prior mental disorder are at an even higher risk of suicide when diagnosed with a medical condition. The presence of a mental disorder can amplify feelings of hopelessness, increasing vulnerability.
    3. Interconnected Nature of Physical and Mental Health: The research emphasizes the need for integrated care that addresses both the physical and psychological aspects of health, particularly for individuals with complex medical histories.

    The article advocates for more robust screening for suicidal ideation in patients with both medical and mental health conditions and suggests collaborative treatment approaches to reduce suicide risk.

    Link to article: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2822967

  • Suicide Prevention: A Personal Commitment to Hope and Healing

    Suicide Prevention: A Personal Commitment to Hope and Healing

    I thought I would share one of my favorite songs (Eminem Beautiful) as I reflect on what suicide prevention means to me. 

    link to song if you haven’t heard it: https://www.youtube.com/watch?v=SBb11rmHLIY

    This past year has been one of the most challenging times of my life. I watched my 20-year relationship fall apart, missed crucial professional opportunities, and questioned nearly every decision I’ve ever made. To say I was struggling would be an understatement. What stung even more was the silence from people I thought were my friends—they never reached out, never asked how I was doing. It left me feeling hollow and alone.

    But instead of letting that break me, I took this as a chance to reflect on who my real friends are, and I focused on building myself—mind and body—stronger than ever. I refused to let this hardship define or defeat me.

    When patients tell me they’re at their breaking point, I understand that feeling. But I also know they’ve only tapped into a fraction of their strength. There’s so much more to give, more life to live. During dark times, it’s easy to feel unheard and invisible, but I promise you—I’m here, I’m listening, and we can get through anything.

    If you or someone you love is in a dark place, please reach out for help. You are not alone, and your story is far from over. Don’t ever let anyone tell you that you’re not beautiful—because you are.

  • Inpatient Psychiatry: Sanctuary for Healing or Profit-Driven Trap?

    Inpatient Psychiatry: Sanctuary for Healing or Profit-Driven Trap?

    The New York Times typically does a good job of investigating and reporting on mental health topics, but in this case, it seems they missed the mark, especially in representing inpatient psychiatry. Inpatient psychiatry is a challenging environment for both patients and physicians like myself. We never want to keep anyone in the hospital who doesn’t need to be there. In fact, when patients accuse me of holding them for financial gain, I tell them that I’m paid the same regardless of the number of cases I manage, and my life is easier with fewer patients. No physician working in inpatient care would ever keep someone confined without a legitimate safety concern for the patient or the community. While no one defends poor practices, and Arcadia may indeed have its issues, the broader implications of articles like this one deserve closer scrutiny. The article lacks detail, avoids expert input from professionals in the field, and fails to account for the fact that dangerousness might emerge during hospitalization, potentially converting a voluntary patient to involuntary status or necessitating a more cautious discharge approach that could save lives.

    Here’s the reality: people are admitted to inpatient psychiatric units for a variety of reasons. We can talk all day about the broken U.S. healthcare system and the lack of access to quality outpatient psychiatric care, but fundamentally, there are two main reasons someone ends up on an inpatient unit. First, they are a danger to themselves, and without close monitoring and treatment, they are at high risk of suicide. Second, they pose a danger to others, and without inpatient care, serious harm could come to someone else. We see plenty of cases that meet these clear criteria, and I believe that without our services, many of these individuals would either be dead or in jail. However, there are also other reasons why patients seek inpatient care, and the article’s example of a woman with bipolar disorder needing a medication adjustment is worth exploring.

    Why not see an outpatient psychiatrist for medication management? Why seek inpatient care from a doctor who doesn’t know your case? This situation can be dissected further. Suppose this patient, who doesn’t pose a threat to themselves or others, voluntarily enters an inpatient unit for treatment. Medication changes are made, lithium is increased, and as the treating physician, you would need at least 3-5 days for observation and lab work to monitor the effects. Given that this patient could have pursued outpatient treatment, it becomes your responsibility as the inpatient doctor to ensure proper monitoring and follow-up. But let’s say, after admission, you learn that the patient had been suicidal the week prior and had a plan to overdose. Now, there’s new information indicating a greater level of risk. If, after 24 hours, the patient suddenly wants to leave, as the physician, you must consider this new information. You ask to speak to the patient’s family to gather more context, but the patient refuses and demands discharge. In my state, the patient would file a formal 48-hour notice, which allows me 48 hours to assess if they pose an imminent danger. If so, a two-physician commitment process can be initiated.

    The point is that treating physicians must weigh numerous safety concerns—such as unfinished medication adjustments, potential emerging risks, and patients’ misunderstanding of the inpatient process. Mental health treatment often takes weeks to months to see full results, and if patients feel significantly better after just a few days, it’s either due to electroconvulsive therapy (ECT) or the placebo effect of being in a hospital setting. I believe it’s crucial for people to understand the role of inpatient psychiatric facilities, and I make it a point to educate my patients about why hospitalization is necessary and what they can expect. Many arrive with false assumptions about what can be accomplished in an inpatient setting.

    Link to New York Times Article: https://www.nytimes.com/2024/09/01/business/acadia-psychiatric-patients-trapped.html

  • Mastering the Mind: Strategies for Tackling Anxious Depression

    When treating anxious depression, SSRIs and SNRIs may not always provide sufficient relief. In such cases, I consider adding medications like quetiapine, which has a significant effect size for generalized anxiety disorder (GAD) and is FDA-approved as an augmentation strategy for depression at doses of 150–300 mg. However, due to its side effect profile, it’s advisable to limit the duration of quetiapine use when possible.

  • Breaking Free: What to Do When Anxiety Won’t Let Go

    The tried-and-true approach of recommending Cognitive Behavioral Therapy (CBT) along with a serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) doesn’t work for everyone. So, what are the alternatives? One often-overlooked option is hydroxyzine, which has effect sizes (0.4–0.5) similar to benzodiazepines but with a lower risk, particularly in older adults. For those seeking natural remedies, Silexan, available over the counter, is another possibility. Other medications that have shown efficacy in treatment-resistant depression include pregabalin, quetiapine, and eszopiclone. When it comes to social anxiety disorder, I’m a bit old-fashioned but still favor MAOIs in this area.

  • The Power of a Comeback: My Time is Now, and So is Yours

    The Power of a Comeback: My Time is Now, and So is Yours

    Life is a journey full of ups and downs, and sometimes, we find ourselves at a low point, feeling defeated and uncertain. But remember, it’s not about how many times you fall; it’s about how many times you get back up.

    A comeback isn’t just about bouncing back—it’s about bouncing forward. It’s about using your setbacks as a setup for a stronger, wiser, and more resilient version of yourself.

    1. Believe in Yourself: Trust in your abilities and your potential. You have everything within you to overcome challenges and achieve greatness.
    2. Set Clear Goals: Define what success looks like for you. Break down your goals into manageable steps and tackle them one by one.
    3. Learn from the Past: Reflect on what led to the setback. Embrace the lessons learned and use them to fuel your growth.
    4. Stay Positive: Surround yourself with positivity. Cultivate a mindset of gratitude and optimism, even in the face of adversity.
    5. Take Action: Don’t just dream about your comeback—take concrete steps towards it every day. Consistency and perseverance are key.
    6. Seek Support: Lean on friends, family, or mentors who believe in you. Their encouragement can be a powerful motivator.
    7. Celebrate Small Wins: Acknowledge and celebrate every small victory along the way. Each step forward is progress.

    Remember, the greatest comebacks are born from the greatest setbacks. Your story is far from over, and this is just the beginning of a new, exciting chapter. Keep pushing, keep striving, and watch as you rise stronger than ever.

  • Breaking Barriers: Streamlining Clozapine Access for Patients in Need

    Breaking Barriers: Streamlining Clozapine Access for Patients in Need

    Happy Friday Everyone, todays post is a topic near and dear to my heart

    Clozapine is the most effective medication available for treating schizophrenia. In my work in community mental health, many of my patients could greatly benefit from clozapine, but significant barriers make access difficult. A large portion of my patients are homeless and frequently lost to follow-up, which complicates the already burdensome REMS (Risk Evaluation and Mitigation Strategy) program. To ensure access to this life-saving treatment, adjustments to the REMS program are necessary. One solution could be eliminating the requirement to report completed monitoring and post results on a central database. Additionally, restrictions that delay pharmacies from distributing clozapine should be removed. Finally, we need to reevaluate the frequent and, quite frankly, excessive monitoring of absolute neutrophil counts (ANC). These changes could significantly improve access for patients who need this critical medication.