In my practice I often see patients self referred or sent in by their general practitioner who tell me that he or she has Major Depressive Disorder. Problem is, medications and therapy have had little success so my expert advice is needed.
When evaluating a patient it is crucial not to miss the diagnosis of bipolar depression. A recent article in a Chilean medical journal (Rev Med Chili 2010 Jun) identifies suggestions of how a proper diagnosis can be achieved. This information resonates with my practical experience seeing patients through the years.
First it is important to use standardized diagnostic criteria such as the DSM-IV or ICD 10 manuals. Second it is important to check whether certain clinical features are present. These features tend to be less known to the general practitioner and population. These criteria include whether there are previous episodes of mood elevation. Mood elevation can include times when mood is either positively elevated as in euphoria or high energy that is distinct from other times, or it can be negatively elevated. An example of the latter would be “road rage”. One is driving and the person in front of him lingers a little too long at the stop sign and the drivers gets unusually angry and wants to punch the guy out. We all have heard of that happening.
Another lesser known criteria is current or past episodes of psychotic depression which are episodes of depression that are so severe and debilitating that a person has great difficulty getting out of bed in the morning and functioning.
Recurrent depressive disorder before the age of 25 and a strong family history of mood disorder and suicide are other red flags for Bipolar Disorder.
Finally there are the signs related to past antidepressant usage that can be valuable information in proper diagnosis. If a patient has had a lack of response or “wearing off” to well conducted antidepressant treatment, or an unusually fast response to antidepressants with features of elation these are all red flags of Bipolar Disorder.
Finally, it is important that the proper professionals are utilized in making the diagnosis. While it can be a starting place, it can not be adequately done by self-diagnoses through the internet!
Cognitive Behavioral Therapy improves ADHD Scores
This month a very interesting research study was recorded in the journal of JAMA. It addresses Cognitive Behavioral Therapy as an ADHD treatment
Cognitive Behavioral Therapy, also known as CBT, is most successfully used in conjuction with medication in my opinion, but often the medication does not offer complete relief of all bothersome symptoms. This study compared CBT with relaxation and educational support. Please note that all the subjects were already on medication but all had symptoms that remained.
Results of this study showed CBT to be superior to relaxation and educational support in the lessening of ADHD symptoms.
I love and highly recommend CBT and find it very effective for many types of mental health conditions from depression, anxiety, bipolar, and psychotic types of illnesses. I am glad to hear that it shows promise with ADHD as wel
I get a lot of questions about concerns patients and family members have about troublesome symptoms of memory loss when I am treating them for Depression and Anxiety. They wonder whether they have Alzheimer’s Disease and not Major Depression.
Memory loss—and that is short-term memory loss—is very common with Depression. Depression affects the brain in a way that impairs the storage of information into long-term memory. What I mean by short-term memory is the memory of what you had for dinner the night before or what you discussed with a friend earlier in the day. People with Depression often lose some short-term memory but not memory from when they were a child (or long-term memory).
It is normal for people to have some trouble with memory when they are stressed from time to time. But if it is happening every day and creating embarrassment in your life, i.e. forgetting 3 days in a row your preschooler needing to be picked up at a certain time or repetitively forgetting appointments, then I would suggest you go get an evaluation from your Psychiatric Mental Health Nurse Practitioner. You may be depressed or anxious and could be helped with some therapy and possibly medication.
Years ago, I suffered from a bout of Post Partum Depression after my last child. My older daughter who was about 14 at the time felt the brunt of it. One day she called me from school and asked me to bring her term paper that she forgot. She had called me in the middle of the day to bring it at the end of the day. A half hour before she needed it, she called me again to remind me because she knew I had an issue with that. I reassured her that I would be there. Then I get a third call from her after I didn’t show up 10 minutes after I should have been there. She was very upset with me and distressed. I was so embarrassed! I felt bad knowing that I had let her down and how she must have felt thinking that her own mother didn’t put her needs on a higher priority than what I was doing at the time. I’ve always wondered if I scarred her for life during that very dark time for me. Hopefully, she has forgiven me…
Please don’t let this happen to you! Get help if you see some concerns with memory—particularly short-term memory.