Showing posts with label treatment. Show all posts
Showing posts with label treatment. Show all posts

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You want to do what?!?! The importance of informed consent in treatment





By Gail  A. Edelsohn, MD, MSPH





We come across ads in print, on television
and on the Internet for medications and therapies that promise to make your child
do his homework without a screaming match, behave better and generally restore
harmony to home life. Not so easy, taking a medication raises a host of
questions:  How long does the therapy
take? Should I as the parent sign off on this? What about the possible serious
side effects, such as significant weight gain, thoughts about suicide, risk of
diabetes or a life-threatening condition?








Parents and legal guardians make
decisions about psychosocial therapy and medication treatment for children and
adolescents every day. But who should give permission and sign informed
consent?  What should parents, advocates,
guardians be looking for or consider before signing informed consent? Is
signing a form enough?  What about the child
or teen - do they have a voice regarding their own treatment?


What is Informed Consent?


Psychiatric informed consent
involves a parent or legal guardian giving
permission for his/her child to undergo evaluation and treatment.  It is a
process which partly involves receiving sufficient relevant information about
the condition, prognosis, risks and benefits of treatment to be given and other
types of treatment available. Informed consent is NOT simply a signed and dated
form. Parents and guardian should expect informed consent to include:




  The purpose of the treatment


  • To address a specific condition or diagnosis?



  • To lessen symptoms?



  •  To change behaviors?


  The effects of treatment


  • How will you know if it is working?



  •  How long till you see an effect?


  Risks of treatment


  • Side effects of medications



  • Consequences of psychosocial treatment (e.g., therapy
    can be emotionally difficult)


  Risks of NO treatment


  • Will symptoms improve over time without
    treatment?



  • Will things get worse or lead to other
    consequences? (e.g., Untreated individuals are more likely to use substances,
    get into legal trouble)


  What alternative treatments are available?
  

For medication


  • Is it FDA approved for this age and condition?
    (i.e., prescribed FDA on label)



  • If it is prescribed off-label, why?



  • Are there any FDA warnings about the medication
    and what do they mean?



  • What is the plan for stopping or phasing out the
    medication?









     Parents and legal guardians are
asked to give legal permission or informed consent for treatment.  If a child is in foster care, it may be the
parent or it may be child welfare service or court that can give consent.   Where a child is living (home, out of home
placement) does not tell you who the legal guardian is.  In some states an adolescent may give
informed consent for psychiatric treatment depending on the state’s legislation
about mental health procedures. Ideally the parents/guardians and the child
should be involved in treatment decision making.



Children also have a voice in
this process.  Children and youth should
be involved in giving assent.  Assent involves providing the child or teen
with information about the therapy or medication in terms appropriate to their
age and stage of development. The assent process should include opportunities
for the child/adolescent to ask questions and have their concerns addressed.






Gail A.
Edelsohn, MD, MSPH, is senior medical officer with Community Care Behavioral
Health, clinical professor of psychiatry and human behavior,  Jefferson
Medical College, and clinical professor of psychiatry and behavioral science,
Temple University School of Medicine.

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Spreading Hope!

By Matt Goldenberg
D.O.

@docgoldenberg 

“You treat a disease, you win, you lose. You treat a person,
I guarantee you, you'll win, no matter what the outcome.” 






I whole-heartedly agree with that statement. However, I
cannot take credit for those words. Those are the words of Robin Williams, or
more specifically, the words of his character in Patch Adams.



I want to discuss the disease called depression. I will start by first
discussing the diagnosis and the signs and symptoms of depression. I will then
follow up with my thoughts on the various treatment options for depression and
the strategies I employ with my patients to improve their outcomes. None of my
thoughts and suggestions should serve in place of a formal consultation with a
mental healthcare provider. However, I hope shedding light on mental health
diagnoses like depression will lift the veil and social stigma on these chronic
diseases that impact so many people.



Psychiatry has come a long way in the last decade. This is a time of continued
discovery and increasing public awareness. The leaders of our professional
organization, the American Psychiatric Association (APA), have suggested that we
as mental health professionals are under a microscope. I agree that we are
and I also strongly believe that we are up for the challenge. School shootings
and celebrity suicides and overdoses have increasingly put a focus on mental
health. Psychiatry has significantly improved the outcomes, treatment options
and the prognosis of patients with mental illness. However, we still are unable
to decrease the prevalence of the diseases we treat or prevent them. We know that
the brain changes during an episode of depression and our treatments help it to
return to normal (see the image below). Although we are getting closer, we
still currently do not have widely accessible blood or imaging tests that can
confirm our diagnosis or localize the area of disease.




I can say with certainty, however, we are able to accurately
diagnose patients. We are able to identify medications, psychotherapies and
other treatments that patients with a specific diagnosis or cluster of signs and
symptoms often benefit from. There is strong evidence that our treatments
decrease symptomatology and disability and improve quality of life, clinical
outcomes and a patient’s prognosis.



Psychiatrists are trained to view the patient as a “whole person”. Psychiatry
is a field of medicine whose assessment by definition includes all of the
biological, psychological and social aspects of a patient’s life. We listen for
the psychological and social factors that can contribute to disease.
Oftentimes, the “whole story” can be more telling than only focusing on
specific symptoms of a given disease. There is a saying, throughout all fields
of medicine, that “most patients have not read the textbook.” In other words,
patients usually do not present exactly as the textbook says they should.
Stress and psychological factors can mimic chest pain, shortness of breath,
gastrointestinal problems and a whole host of other diseases. If we do not step
back and get the whole story, we can miss the root cause or the exacerbating
factors of many manageable diseases which are of the mind.



Many of the diseases we treat, such as depression, are chronic illnesses which
require lifelong treatment. Our treatments can improve a patient’s mental
health and coping skills and decrease their symptomatology and substance use.
We know through decades of research that these are modifiable risk factors for
suicide. Therefore, Psychiatrists have the training and tools necessary to
decrease a patient’s risk of attempting suicide. Our treatments have the
potential to not only significantly improve the lives of our patients, but also
the lives of their families and everyone who comes into contact with them.
Anyone who tells you otherwise is misleading, misinformed or both.





I
hope this information and the blogs to follow will give you hope. Mental
illness can include symptoms which can be devastating and complications which
can be life-threatening.
However, it is important to state again, these are treatable diseases. If you
or someone you know, would like to talk to someone, call your primary care
doctor or your insurance company for a referral to a Psychiatrist. A true
multi-disciplinary team also includes therapists, psychologists, nurses and
social workers. You are never alone. You can call the national suicide helpline
24 hours a day, seven days a week (1-800-273-TALK (8255) or visit www.suicidepreventionlifeline.org).
There are also local crisis lines likely available in your area and are an
internet search away. If you are ever feeling unsafe, or fearing for the safety
of a loved one, you can call 911 or go to the nearest emergency department.


It is time for everyone to understand that there is no shame in getting help
for depression, much as there is no shame in getting help with diabetes or high
cholesterol. Even if you have never suffered from depression, there is
a lot you can learn.








Together we can raise awareness and spread truth and hope. I know that if we
spread knowledge, and ignore the misinformation, we will overcome the
complacency and ignorance that is so pervasive today. That is how we can best
honor those we have lost. That is how we can best prevent the next death from
mental illness and addiction.





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Depression & Cancer

By Brad Zehring, DO @DrZehringDO






“Cancer can take away all of my physical abilities. It
cannot touch my mind, it cannot touch my heart, and it cannot touch my
soul”  - Jim Valvano




But, what
happens when it does?



Depression
is a multifactorial disorder that requires acknowledgement of the biological,
psychological, and social aspects of a person’s life. Professionals in the
mental health community describe this as the biopsychosocial model. It provides
an understanding of the factors influencing a person’s mental and physical
state of being.




When mental health professionals talk about depression they
often do so in regards to Major Depressive Disorder (MDD). According to DSM 5
(Diagnostic and Statistical Manual of Mental Disorders), 5 out of 9 criteria
are needed to diagnose MDD. It requires a depressed mood or anhedonia (lack of
enjoying what was previously enjoyed) for greater than 2 weeks including:
disturbances in sleep, guilty/hopeless/worthless feelings, poor concentration,
low energy, changes in appetite (weight loss or weight gain), psychomotor
agitation or retardation, and suicidal ideation.



Depression affects your entire body. But, the physical
aspects of depression are often overlooked. It is common for people with
depression to experience weight changes, digestive problems, headaches, back
pain, muscle and joint pain, and disruptions in sleep cycle. Many symptoms that
are present in cancer.




Depression has been linked with many health problems,
including cancer. Cancer is a heavy word. The enormity of the word brings many
images to the forefront of our imagination: radiation, chemotherapy, losing
hair, sickness, weakness, and death - among others. There is so much symptom
overlap between cancer and depression it can be hard to recognize the etiology
of the symptoms.






It is important that health care professionals, family
members, and other caretakers
are vigilant with a person’s mental well being after they are diagnosed with
cancer. Even if a person has never experienced depression previously, their
risk of depression is increased when they find out they have cancer. Research
shows that the incidence of depression increases proportionately with the
cancer’s progression. It is believed those with depression have increased
likelihood of depression because of increased immune response (cytokines)
within the body.




It is important not to assume that someone with cancer has
an appropriate depressed mood due to his or her circumstances.  This is why it is important to screen for
depression in those diagnosed with cancer. Screening for depression can help
“tease out” symptoms related to depression and symptoms related to the cancer. Treating
depression in patients with cancer can help them focus on their treatment and
have the motivation to do everything needed to possibly achieve remission.
Proper treatment gives them the ability to focus on their future. Cancer alone
is enough, but when combined with untreated depression the results can be
deadly.




After recognizing depression in someone with cancer, there
are ways to treat depression in parallel with cancer treatment. There are two
forms of treatment. One involves medication and the other involves
psychotherapy, or talk therapy. The typical medications for depression are
antidepressants like Selective Serotonin Reuptake Inhibitors (SSRI) and
Serotonin and Norepinephrine Reuptake Inhibitors (SNRI). These medications have
been around for a long time and are generally well tolerated. They take
anywhere from 2-6 weeks for clinical efficacy. These medications should be
monitored with cancer treatment, as there can be drug interactions and side
effects that may not be present in someone taking these medications without
cancer. In addition to medications, psychotherapy can be effective. More
specifically, Cognitive Behavioral Therapy (CBT) can help people change their
negative thoughts about cancer and their future. For the most efficacious
treatment a combination of both should be implemented.




Cancer is a serious illness and a well-developed
multi-disciplinary approach is necessary to best treat the patient. Cancer can
cause a lot of different disturbances in physical and mental health. It is
important to have health professionals, like psychiatrists
and psychologists, part of the treatment team to ensure proper treatment of the
whole patient.





















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Effective Addiction Treatments are Available




By John Renner, MD and Frances Levin, MD






We are all saddened by the death of Philip Seymour Hoffman and the many other
individuals who have died because of overdoses of heroin or pain
medications.  For all of those individuals who struggle with opioid use
problems, it is important to realize that help is available and that effective
treatment can restore them to productive lives.  Some 4.7 million people
in the U.S. have used heroin at least once in their lives.  It is estimated that nearly a quarter of
people that use heroin become dependent on it.



Whether it be through mutual support programs such as NA, long-term residential
treatment, or addiction pharmacotherapy with buprenorphine, methadone or ER
naltrexone, no individual need fear that their condition cannot be
treated.  Friends and family members also need to be educated in the use
of intra-nasal naloxone for the reversal of opioid overdoses.  



APA has long fostered the development of addiction focused training programs
for psychiatrists.  Many psychiatrists have been specifically trained
to provide office-based addiction pharmacotherapy and to manage the
co-occurring psychiatric disorders that often complicate recovery from
substance use disorders.  






More information:

·        
Information on addiction

·         Opioid Overdose Prevention Toolkit (SAMHSA)

·        
Substance
use treatment locator (SAMHSA)

·        
Buprenorphine Physician
and Treatment locator (SAMHSA)

·        
For psychiatrists:  Providers
Clinical Support System for Medication Assisted Treatment






Blog
contributors:




John
Renner, MD

Member, APA Council on Addicition Psychiatry (Past Chair)
Director of Addiction Fellowship Program,

Professor of Psychiatry,  Boston University School of Medicine



Associate Chief of Psychiatry, VA Boston Healthcare System


















Frances Levin, MD



Chair, APA Council on Addiction Psychiatry
Kennedy-Leavy Professor of Psychiatry, Columbia University Medical Center

Director, Addiction Psychiatry Fellowship,

New York Presbyterian Hospital

New York State Psychiatric Institute










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APA Releases List of Five Uses of Psychiatric Medication to Question


Continuing
the Conversation about Choosing Wisely:
The American Psychiatric Association Releases List of Five Uses of Psychiatric Medication to Question





Joel Yager, MD, 


Professor, University of Colorado School of Medicine


Chair of the APA Council on Quality Care





Recently the APA released a list of
“Five Things Physicians and Patients Should Question” in Psychiatry as part of
the Choosing Wisely®
campaign, led by the ABIM Foundation. The list
identifies five specific evidence-based recommendations that can help
physicians and patients make wise choices about their care.





The APA list contains the following
five recommendations:


  • Don’t
    prescribe antipsychotic medications to patients for any indication without
    appropriate initial evaluation and appropriate ongoing monitoring.

  • Don’t
    routinely prescribe two or more antipsychotic medications concurrently.
     

  • Don’t
    prescribe antipsychotic medications as a first-line intervention to treat
    behavioral and psychological symptoms of dementia.    

  • Don’t
    routinely prescribe antipsychotic medications as a first-line intervention
    for insomnia in adults.   

  • Don’t
    routinely prescribe antipsychotic medications as a first-line intervention
    for children and adolescents for any diagnosis other than psychotic
    disorders    .



Why
was this list created?


This list was created to help
clinicians and patients reduce the number of times that certain medications are
routinely prescribed in situations where other initial treatments might be
preferable, and where risks of these medications’ harmful side effects could be
decreased or avoided. 





Does
this list apply to the care of children or adolescents?


For
any indication and for any patient, the potential harms of treatment must be
weighed against the potential benefits. For the Choosing Wisely campaign, the APA recognizes that for some young
patients in some circumstances an antipsychotic medication may turn out to be an
appropriate choice of treatment if the clinical benefits are judged to outweigh
potential harms after the patient receives appropriate initial evaluation and will
receive ongoing monitoring. However, the APA advises physicians and patients to
question the routine use of
antipsychotic medications in children and adolescents for clinical
circumstances where these medications are not endorsed by available clinical
practice guidelines or lack explicit FDA approval indications for their use.





Why
the Choosing Wisely Campaign?


The facts driving the Choosing Wisely effort are well known: Current
health care practices in America spend too much money on unnecessary tests and
procedures that do not benefit patients and that may even cause unintended harm.
According to a report from the Institute of Medicine, up to
30 percent of health care delivered in the United States is wasteful. Providers
and economists agree that these costly unnecessary practices threaten America’s
ability to provide the highest quality of care possible to all patients.





Choosing WiselyThrough the Choosing Wisely campaign and by publishing this list, the APA hopes
to spark conversations between its members and patients about whether certain
tests and treatments are really necessary or the best ones to choose. The APA joined
the campaign because it recognizes
that physicians have professional, moral and ethical responsibilities to take
the lead in addressing these challenges.





While the APA has taken a bold step in
identifying and developing the list, our work doesn’t stop here. Over the
coming months and years, the APA will be working with the ABIM Foundation,
Consumer Reports, and a variety of other Choosing
Wisely campaign stakeholders to raise awareness of these lists and to make
them available to patients and the public at large.     





Learn more about Choosing Wisely and read all the lists released to date at www.choosingwisely.org.







www.choosingwisely.org

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What You Should Know About Binge Eating Disorder: 3 Doctors Discuss


By Arshya Vahabzadeh, M.D. Follow @VahabzadehMD



Holly Peek, M.D., MPH Follow @PsychGumbo



Mona Amini, M.D., MBA Follow @MonAmiMD





What Causes Binge Eating Disorder? 




With up to 4 million Americans having binge eating disorder, it's a significant health issue for our nation.  Binge eating disorder has a wide variety of causes, and sometimes it can be caused by several different reasons, even in the same individual.


To understand why someone develops binge eating disorder, we need to recognize binging triggers. These triggers often result in binging behavior, and they are often negative feelings or thoughts toward body shape, weight, or food. Triggers to binging may also include worry, anxiety, difficult relationships with loved ones, or even boredom. Some people binge eat because it helps them numb these feelings in the short term. But later, they find the binge eating to be harmful to their own self-perception.




Sometimes dieting may be a major factor for binge eating. While dieting tends to happen after binge eating disorder has started, missing meals or not eating enough can lead to binging episodes. If left untreated, binging behaviors become more and more ingrained and harder to control.


Depression has also been linked to binge eating disorder. People who have depression or have been depressed in the past are more at risk. Binge eating is also higher in people who have bipolar disorder or anxiety disorder. Some evidence suggests that it may be more common in people who have addictions to recreational drugs.


Binge eating disorder may be more common in families where the condition is already present. Therefore it seems that our genetics are also an important factor to consider. Researchers continue to explore more scientific explanations on why binge eating disorder happens including studying the neurochemicals and pathways of the brain. 


How is Binge Eating Disorder Treated? 





The treatment goal for binge eating disorder focuses on binge eating and weight control. Treatment also addresses conditions that commonly occur with binge eating disorder, including depression, difficulty in work or relationships, and distortions in body image.


Treatment outcomes are generally good with psychological treatment often being more helpful than medication based management, although in some cases both are used. There is evidence that cognitive behavioral therapy (CBT), a type of talk therapy, is successful in treating binge eating disorder. Multiple research studies point to benefits with its use. CBT works by disrupting the “binge-diet cycle” by promoting healthy and structured eating patterns, improving body shape and weight concerns, and encouraging healthy weight-control behaviors.


Another type of talk therapy used in treatment is interpersonal psychotherapy (IPT). IPT helps people express and manage their negative feelings without turning to food to cope. Research shows that 20 sessions of CBT and IPT can provide improvements for more than 70% of people with binge eating disorder.


Reading self-help guides like Overcoming Binge Eating by Christopher Fairburn in combination with therapy sessions can also have substantial benefits.


Medications may also be used to ease binge eating disorder symptoms. Serotonin selective reuptake inhibitors (SSRIs), commonly used for anxiety and depression, have been found effective for reducing some binge eating disorder symptoms as well. SSRIs can help with depression often occurring in people with binge eating disorder. Continued research will examine how other medications, including anti-obesity medication and mood stabilizers, may also treat people suffering from binge eating disorder. 



What Should I Say to My Friend / Family Member Who is Suffering?




It is important to take the approach of talking to your loved one with serious intent. Though some people can overcome eating disorders, seeking professional help usually has more lasting positive results. In seeking the care of a professional, both the patient and his/her family benefit from the information presented by the doctor. The first step to talking to someone you care about who has an eating disorder may feel nearly impossible.



  • Patience is key. Being patient and learning facts about eating disorders will guide you (and your loved one). Due to the complexity of binge-eating disorders, communicating your concerns regarding their eating habits and other behaviors will initiate a cumulative effect.

  • Be prepared for a range of responses. Rejection, denial, anger, and shame are just some of the emotions that your loved one may express when you approach her/him for the first time.

  • Avoid judgment, criticism, and simple solutions to disorder. Instead, you should provide encouragement and compassion regarding their feelings and relationships. Your concern and support may be enough for them to seek professional help but know that this is not guaranteed.

  • Recognize binge eating may be just tip of the iceberg. Understanding that binge eating disorder, or any eating disorder, involves food and weight issues as mere symptoms of a deeper and more complex behavioral problem will help your loved one realize they need to acquire healthier coping tools.

  • Know when to ask for assistance. Don't forget that health professionals can alleviate some of the imminent issues that may need to be treated before full recovery is possible. 












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When recovery from depression seems hopeless, are there other options? A patient's perspective


By Andy Behrman, Guest Blogger





My experience with electroconvulsive therapy (ECT) began in 1995, when I opted for ECT as a last resort for treating my bipolar disorder. For so many people who were termed medication resistant and suffering with depression or bipolar disorder, ECT was the “last stop” when it came to treatment. But the variety of medications and other treatments now available to patients suffering from depression has expanded dramatically over the last 17 years.





I recently became extremely curious about a treatment for depression called TMS (transcranial magnetic stimulation). I was surprised to discover that even though TMS is a non-invasive outpatient procedure with few side effects, does not require anesthesia, and was approved by the FDA as far back as 2008, it is still very much “under the radar” and is a treatment which many patients are not very familiar.





According to Kira Stein, M.D., psychiatrist and medical director of Los Angeles-based West Coast TMS Institute, “In a recently published multicenter naturalistic study, 58% of patients significantly responded to TMS treatment, with 37% undergoing complete remission."





Today, TMS is primarily being used to treat those of us suffering with depression. The statistics for depression are alarming: 1 in 6 people experience it in their lifetime, which means that more than 50 million Americans are likely to struggle with clinical depression. Unfortunately, of this population, only 1 in 4 people get adequate treatment. One of the biggest concerns is the risk of suicide, as more than 36,000 people in the United States take their lives every year. Untreated depression, which causes disability at work and disrupted family and interpersonal relationships, can also lead to self-medication with drugs and alcohol. Depression has reached epidemic proportions and has become a silent killer.





When I speak to audiences about mental illness, I always encourage people who suffer from depression to seek advice from a mental health professional. Sometimes, getting people to overcome the stigma of suffering from depression is one of the hardest jobs I have to do. It is often the patient who resists seeking help, often because of the stigma, who really ends up at risk. But today, there are more treatment options than when I was ill. Technology is giving doctors more tools, and patients much more hope, for recovery.





Andy Behrman is the author of “Electroboy: A Memoir of Mania,” a personal story about his bipolar disorder, his experience electroconvulsive therapy (ECT), and his recovery from drug and alcohol addiction. Behrman advocates for mental health awareness and suicide prevention. He speaks to college audiences, health care professionals, and local and national mental health support groups working to stop stigma surrounding mental illness.

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Addiction: A Real Disease with Effective Treatments


By Amanda von Horn, Medical Student





For September's National Recovery Month, let's discuss recovery from alcohol / drug addiction. Odds are that you or someone you know has struggled with addiction, whether it be alcohol, street drugs, or prescription medications. Unfortunately, many believe that those who struggle with addiction are simply weak, lacking morals, or don’t have the desire or will-power to stop using. The fact is that addiction is a chronic brain disease with real physical and psychological symptoms. People may voluntarily use drugs or alcohol initially, but the drugs themselves can change the brain and make it extremely difficult to stop using, even if they have a strong desire to quit. 








This post answers some commonly asked questions about the disease of addiction. Hopefully you will share the information so others understand that with treatment and support, people do recover.





What actually is addiction?


Addiction is a long-term, often relapsing brain disease that results in repetitive and compulsive substance use despite harmful effects or consequences. 


 


Why is it so hard to stop using drugs/alcohol?


With long-term drug/alcohol use, there are significant changes in the “reward” pathways of the brain. These changes can result in needing more and more drugs just to feel normal. Stopping the drug often causes withdrawal, with symptoms such as intense nausea/vomiting, fevers and chills, horrible depression and/or anxiety, and in some cases even life-threatening seizures. 





Why does addiction affect some people more than others?


Addiction can be caused by many factors, and it is hard to predict individuals who are more vulnerable to the disease. A person’s biology and genetics can play a big role; for example, if a parent abuses drugs/alcohol, the child has a higher chance of having the same problem than does a child of parents who don’t use. 





I am struggling with addiction. What kind of treatment is available?


No one treatment is appropriate for everyone. Effective treatment often involves a combination of medication, counseling, behavioral therapy, and 12-step programs such as Alcoholics Anonymous and Narcotics Anonymous. In many cases, a person may need hospitalization to treat the physical symptoms of withdrawal in the early stages of recovery. 



The recovery plan must address not only the patient’s addiction but all aspects of his or her life in order for treatment to be effective long-term. Since relapse is often a part of the recovery process, it is important to identify “triggers” (people, places, or things that set off an alcohol or drug craving for someone in recovery) and how to cope with these triggers without the use of alcohol or drugs. 





If you or someone you know is struggling with addiction, please consult a physician for evaluation. Recovery is possible, and there is no better time to ask for help than now.





For more information on addiction, visit http://psychiatry.org/addiction. 




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What to do about side effects of antidepressant medications?


By Felicia K. Wong, M.D.





There are various treatment options for depression including therapy and medication. Antidepressant medications can be extremely helpful to the recovery and healing process of someone suffering from depression. However, sometimes medications that are meant to help may cause unpleasant side effects. The most common symptoms my patients report include headache or upset stomach. These typically improve after a few days and go away within a few weeks. If such side effects remain, you should discuss other options with your doctor / psychiatrist. He or she can try a different medication or treatment option; just be sure to stay in touch with your physician to find the best treatment choice for you.





If the side effects seem intolerable, you may be tempted to stop taking an antidepressant or to reduce your dose on your own. Don't do it. Stopping your antidepressant suddenly may cause your symptoms to return and could cause an unpleasant withdrawal-like reaction. That’s why it’s so important to talk to your doctor.



The Mayo Clinic provides a wonderful resource with practical tips for coping with some of the most common side effects of antidepressant medications that includes explanations for the side effects. For example, sometimes people may gain weight because of fluid retention or lack of physical activity, or because appetite returns or improves when depression symptoms ease up. The resource also presents coping strategies such as cutting back on sweets and sugary drinks, avoiding fast food, and getting regular exercise most days of the week – since exercise is also known to help with depression.





Find more tips at Mayo Clinic online.

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Fight for Your Right to Behavioral Health Benefits


By Carol McDaid, Co-Chair of the Parity Implementation Coalition





In 2008, Congress passed a law that requires health plans to provide benefits for addiction and mental illness that's equal to other medical benefits. Unfortunately, many people still don't know about this law called the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (named after two bipartisan senators who experienced addiction/mental illness in their families).





Parity is personal to me. Did you know that 23 million people have a diagnosed substance use disorder but fewer than 10% receive any help for that condition? I am one of the lucky ones who got the treatment I needed to recover. When my insurance failed twice to provide the coverage promised in my employer-provided health benefit package, I got support from family and employers to help pay for the care I deserved.





When my insurance company refused to pay for any of my last residential treatment (after years of failed attempts at outpatient programs), I fought back. I used all of my internal and external appeals rights. It took me three years and a blizzard of paperwork, but one day a check for half of my treatment appeared in the mail.





Sadly, the average American family with a loved one suffering from addiction or mental illness lacks the resources to fight a three year battle with their insurer to get benefits they are entitled to - by law. Often afraid to discuss their illness with employers, they suffer in silence rather than using their behavioral health benefits promised by insurers. These victims become sicker and even unemployable – causing the burden of paying for their treatment to be shifted to the public sector, where taxpayers like you and me are forced to pick up the bill for health plans that simply will not pay their fair share.





Today, I use my skills as an advocate and former employee benefits analyst to fight for the rights of those coping with addictions and mental illnesses. I'm driven by the passion of my personal parity experience with insurance discrimination and my sense of justice and equality. Help for these conditions should not be limited to those who can afford to pay out-of-pocket or have the fortitude to fight long battles with insurers.





If you or a loved one have been unable to get your insurance to pay for addiction or mental health treatment, please share your story. 





I've been in the halls of Congress fighting this fight since 1993. I realize that laws and regulations are complex and often take many years to be fully implemented. I intend to fight this fight as long as it takes to end insurance discrimination against people suffering from addiction and mental illness. But, to be successful, we need your stories and a collective sense of outrage.





Join me. Share your personal parity story by sending an email to hsf@psych.org. Fight for your rights. Every 15 minutes in the U.S., someone dies from suicide. The clock is ticking.





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