Ep. 012 - How to reverse weight gain from antipsychotic medication?
Ask A Psychiatrist
This episode deals with the question of weight gain from antipsychotic medication: I'm on 20 milligrams of olanzapine. It's helping me and I don't want to change it. The only thing is that I've gained a lot of weight that makes me feel very unattractive. I’ve spoken to my psychiatrist about it, but I haven't gotten any guidance on the matter. Are there any solutions to weight gain from this kind of medicine? Modern antipsychotic medications can be very helpful for some people. And they are less likely to cause neurological side effects, compared to their first-generation predecessors....
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Ep. 011 - What is akathisia, and how to stop it?
Ask A Psychiatrist
What is akathisia? Akathisia is a relatively common medication side effect. Akathisia is a feeling of restlessness that many people find difficult to describe. Many people with akathisia say that it makes them feel like they would like to crawl out of their skin. What does akathisia feel like? Akathisia can be just an uncomfortable feeling. But for many people that feeling of restlessness translates into not being able to sit still. (Akathisia comes from Greek words that mean “not able to sit down”). It can involve fidgeting, or not being able to sit down or lie down for very long...
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Ep. 010 - Lack of insight into mental illness: Are there any new leads?
Ask A Psychiatrist
This week’s listener question was “is there any new research about curing anosognosia?” Anosognosia is a medical term derived from Greek root words that mean “lack of disease knowledge.” Although anosognosia started off as a neurological concept, it's also very common for people with psychiatric conditions to have no awareness that their symptoms are unusual, or that they could indicate the presence of a mental illness. Emerging data suggest that impaired insight in mental illness might -- like neurological anosognosia -- involve those outer layers of the right side of the brain. It...
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Ep. 009 - Can Antidepressants Reduce Self-Harm?
Ask A Psychiatrist
Can Antidepressants Reduce Self-Harm? Self-harm is a common behavior. About 1 in 8 children and up to 1 in 5 adolescents will deliberately injure themselves without suicidal intent. But even without suicidal intention, self-harm is an alarming and potentially dangerous behavior. Self-harm is a sign that something is wrong… but what’s the best way to help? It’s not uncommon for someone with self-harming behavior to be prescribed an antidepressant. Most of us would think that someone who is repeatedly harming themselves is very sad or depressed. So, it’s not surprising that doctors might...
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Ep. 008 - What is Cannabinoid Hyperemesis Syndrome?
Ask A Psychiatrist
Cannabinoid Hyperemesis Syndrome (also called CHS) is the topic of this week’s episode. Melissa and Dr. Erik answer the question “How can something that’s an anti-vomiting medicine be the cause of a vomiting illness”? Cannabinoid hyperemesis syndrome involves symptoms like loss of appetite, stomach pain, nausea, and vomiting. Vomiting attacks come in waves or cycles. A vomiting attack can last many hours or several days and can be severe enough to cause dehydration or a host of other serious complications. Cannabinoid hyperemesis syndrome affects some people who use...
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Ep. 007 - Is it possible to prevent Alzheimer’s disease?
Ask A Psychiatrist
In this episode, Melissa and Dr. Erik discuss Alzheimer’s disease and address the question of whether it’s possible to prevent Alzheimer’s disease. What is Alzheimer’s disease? Alzheimer’s disease is one of several causes of dementia. The American Psychiatric Association has renamed “dementia” and now refers to this type of condition as “Neurocognitive Disorder.” Either name refers to a decline in cognitive performance. “Cognition” is a broad term which can include things like: attention, decision-making, recognition of language, faces, or situations, learning, or...
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Ep. 006 - Are There Any Medications to Treat Alcoholism?
Ask A Psychiatrist
At least 1 of every 20 adults has an alcohol use disorder. The average life expectancy of a person with alcohol use disorder is shortened by about 29 years.
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Ep. 005 - What is borderline personality disorder?
Ask A Psychiatrist
This week’s podcast episode focuses on borderline personality disorder. Borderline personality disorder is a common condition Borderline personality disorder is relatively common. It’s a condition that currently affects about 1 out of every 60 people (). Up to 1 of every 20 people may be diagnosed with borderline personality disorder at some point in their lives (). “Borderline personality disorder” is a terrible name Dr. Messamore starts off by pointing out that the name of this condition – “borderline personality disorder” – is long overdue for change. It is based on...
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Ep. 004 - What is psychosis?
Ask A Psychiatrist
Psychosis is a word that gets spoken a lot, but that gets discussed very little. About 1 of every 11 people will experience psychosis at some point in their lives. But even though it’s a common experience, we hardly ever talk about it. In this episode of Ask A Psychiatrist, Dr. Erik Messamore and Melissa Xenophontos discuss psychosis. Dr. Messamore explains what psychosis is, how it happens, and what to do about it. We learn that it’s easier to understand – and probably more accurate – to think of psychosis as a misperception syndrome. Psychosis by itself is not a standalone diagnosis....
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Ep. 003 - Does therapy help?
Ask A Psychiatrist
There are so many forms of therapy today that it can be hard to decide which is best for you. One of these types is “psychotherapy,” which sounds a lot scarier than it is. In this episode of “Ask a Psychiatrist” we learn about what psychotherapy is, how it can benefit your thought life, and why fears about undergoing psychotherapy still persist. Dr. Erik Messamore explains the history of psychotherapy and how Freud’s findings dominated professional psychiatric thinking for decades. After about the 1960s or so, Dr. Messamore explains, psychology underwent enormous strides to get us to...
info_outlineWhy do anti-depressants seem to work well for some and not at all for others? In this episode of Ask a Psychiatrist, Dr. Erik Messamore takes on this question, offering practical information about the multi-faceted nature of depression and factors to consider in choosing from a range of treatment options.
A clinician has more than half a dozen pathways to think about the cause of high blood pressure, each with its own family of medications available as possible treatments.
But when it comes to depression? It’s treated as a one-size-fits-all monolith – as if there are no variants or factors specific to the affected individual.
Dr. Messamore has a different take, explaining the range of biological, environmental, social, and even spiritual variables that are relevant to mood.
As a first step, Dr. Messamore underscores how important it is for patients, their families and most of all clinicians to put on a Detective’s Hat: Keep track of symptoms and the progression of treatment; consider having a personality assessment done to better understand the individual’s unique psychological landscape and tendencies; take a pro-active approach to researching and considering alternatives to a bio-chemical approach.
When it comes to treatment options, they are as diverse as the nature of depression itself, which is why this episode of Ask a Psychiatrist not only describes some common types of depression but also an array of clinical strategies to augment or replace anti-depressant medications. Dr. Messamore also breaks down how drugs affect particular neurotransmitters and why Evidence-Based Psychotherapy can be a highly effective tool for responding to depression – especially those that are not genetically based.
With the incidence of depression on the rise nationally, generation over generation, it’s very likely that you or someone you love will encounter the complex and constantly evolving field of psychiatry. Dr. Messamore is here to answer questions and provide information about mental illness and general wellness.*
*Advice provided by the host is not addressed to any specific person or personal situation. If you are experiencing a health emergency, please consult a physician.
Click here to view a relevant video in which Dr. Messamore offers additional thoughts on this topic.
Click here if you’d like to ask a question or suggest a topic to address in a future episode.
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KEY TAKEAWAYS:
- (01:40) – Depression is not a single disease as defined by one set of symptoms or a single remedy. It’s has many causes, and many treatment options.
- (06:31) – Some people respond to anti-depressants because they’re experiencing a genetic deficiency in one of their neurotransmitters, but anti-depressants might also be curative because they increase a general feeling of well-being that encourages resilience.
- (10:10) – Why is it that – even with all the enhanced treatment options – the rates of depression keep going up and up?
- (13:34) – Dr. Messamore cites some of the many contributory components of depression and some of the interventions available, such as:
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- Anti-depressants targeting specific neurotransmitters such as serotonin, norepinephrine and glutamate.
- Transcranial Magnetic Stimulation
- Electro-Convulsive Therapy
- (15:50) – It’s very important for people to know that serotonin isn’t the only treatment option out there.
- (16:20) – Anti-depressants given at the right dose for the right period of time should lead to improvement. If the overall trendline is not towards relief, it’s worthwhile to revisit the treatment with your provider.
- (18:28) – About Evidence-Based Psychotherapy and the use of personality or temperamental assessments in pinpointing/responding to depression.
- (20:35) – Two symptom clusters that are typical in depression and can help guide bio-chemical treatment approaches:
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- Melancholic Depression: Loss of appetite, sleep disturbance, mood variation that tends to improve as the day goes on.
- A-Typical Depression: Tendency to sleep a lot, eat a lot (especially carbs) and respond with unusual sensitivity to relationship stressors.
- (25:11) – Dr. Messamore highlights some of the factors that can trigger a biological response and also play a role in the failure of bio-chemical treatments.
- (29:29) – Some strategies to consider if you’re not getting the results you’d like from your anti-depressant medication:
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- Establish what you’re looking for in terms of quality of life and track your moods to determine if progress is being made.
- If multiple treatment options have failed, assess which drugs have been tried, to what degree they’ve been effective and whether there are external environmental factors that might be affecting outcomes.
- Consider undergoing an assessment to see whether you’re one of a large subset of people whose personality or temperamental make-up undermines the efficacy of anti-depressants.
QUOTABLE:
“We’re living in a time where we have more medication treatment options for depression than ever before … yet depression rates are growing. They’re going up and up.”
“It’s important if you’re not getting good results from Treatment A or Treatment B to press the pause button with your doctor and talk about all the options.”
“The specific symptom cluster that we call Melancholic Depression might tip the scales in favor of assuming that biological factors are more relevant.”
“The thing about perfectionism is that you can never achieve it. You can always envision something better than what you’ve currently got.”
“It’s really important for everybody involved – patients, their families and especially clinicians – to put on a Detective Hat as well as a Doctor Hat.”
About the Host:
Dr. Erik Messamore is a board-certified psychiatric physician and PhD-level pharmacologist. He’s a consultant psychiatrist, researcher, lecturer, teacher, and solution-focused scholar currently affiliated with the Northeast Ohio Medical University in Rootstown, Ohio. He is joined on this podcast by Melissa Xenophontos, a journalist, radio producer and longtime mental health advocate.