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Saturday, July 30, 2011

We Should Pick Our Next President From Match.com!

Well the last few years speak for themselves. Our country is getting all out of sorts! It's time to break-up with Obama and pick a new partner!  I sent B.O. a break-up text, it's kind of a lame way to break-up, but I just couldn't take his begging to stay together speech anymore! I just couldn't figure him out...one day he liked me the next day he ignored me! Then he got too pushy...telling me what to eat and what to buy and how to act! Then...the deal-breaker for me...he actually had the nerve to ask me for money! I can't be in a relationship with someone like that! So I broke up with him and I just joined match.com! There are hundreds and hundreds of people we can pick from to be our next president!

Take a guy named "Mike" from North Dakota. He has pictures of himself standing in front of his car, in a business suit, and at the gym in a tank top! He likes dogs, he owns his home, he has a 401K, he has two children that he enjoys spending time with. He likes going to the movies, yoga, and Indian food! He sounds perfect right??? Or maybe "Crystal." She has 5 cats and lives in a condo on the beach! She has pictures of herself on the beach and of herself with all her cats. She drinks green tea and likes to jog at 5am every day! She sounds motivated right?

There are so many qualified people on match.com! We should definitely pick our next president off match.com! And...maybe we should pick our congress peeps off of there too!  Cause you know what...we would NOT have picked Senator Wu if he had a picture of himself in that tiger suit posted on his match.com profile! 

Friday, July 29, 2011

Chronic Pain and Severe Depression

Question: My question is how can I get over this severe depression that goes along with my chronic pain?

Click on comments to read Laura's advice

Wednesday, July 20, 2011

Medications For Insomnia

So you're having trouble sleeping and you went to your psychiatric clinician for help. And somehow you left their office with a prescription for remeron (also called mirtazapine). And you're thinking that this remeron medicine is for insomnia, to help you sleep because that's what the clinician said right!? And why oh why wouldn't you believe what a licensed professional tells you!?

Well guess what...remeron is an antidepressant, not a sleep aide! So if you happen to suffer with insomnia AND you're depressed, remeron may be the right medication for you. But if your only issue is a sleep problem...don't you want a medication that's only job is to put you to sleep!? Of course!

First, some effort needs to be put into developing good sleep habits. Sure all the other psych websites give you long lists and long articles of how to magically turn yourself into sleeping beauty! But here's the low-stress version:

* standardize your wake time
* limit amount of time awake in bed
* limit napping
* remove the clock from your vision
* avoid caffeine after 12noon and avoid alcohol after 6pm
* avoid stressful activities in the evening

Second, find a clinician whose not afraid to give you a thorough evaluation and an appropriate sleep medication if your primary diagnosis turns out to be insomnia. Remember, sometimes a sleep problem is really a symptom of some other medical or psychiatric diagnosis. Make sure you ask exactly what kind of medication you are being prescribed. Too often clinicians are prescribing medications that have a side effect of sedation to treat insomnia. Like the remeron...which is an antidepressant with a side effect of sedation. Trazodone is often prescribed for insomnia but it is an antidepressant with a side effect of sedation.  And seroquel is an antipsychotic but sometimes prescribed for insomnia because its side effect is sedation! Don't expose your body to these medications just for insomnia.

As a Nurse Practitioner, I always ask myself..."Is this a medication I would prescribe for myself for this particular problem?" And guess what! I would NOT prescribe remeron or trazodone or seroquel for my own insomnia! I would prescribe ambien or restoril or lunesta. Take care of yourself. Don't accept second rate service. It's your body! And next time you see your clinician...ask them if the medication they are prescribing for you is something they would prescribe for themselves. http://www.eleventhhourllc.com/online-advice/default.aspx

Saturday, July 16, 2011

Bath Salts May Kill You

My job here is to give you the straight story. All my followers out there know I tell it like it is. And as I go to work in the Emergency Room day after day, I see you guys coming in completely freaked out on bath salts. Some of you come in DOA....that's DEAD ON ARRIVAL in case you didn't know.

You are snorting, smoking, injecting, eating these bath salts and you are getting suicidal, homicidal, psychotic. You are dangerous to yourself and all of us around you. You bite, kick, scream, punch, hit, spit at those of us trying to help you. You end up with five officers on top of you as we tie you to a bed with restraints so we can pump your veins full of medications and fluids in an attempt to save your life. You look near death as you scream about wanting to kill yourself, as you scream about seeing and hearing things that aren't there, as you beg us to help you. And we do help you. But please help too...DON'T USE BATH SALTS!

Some treaters may sit here and try to explain to you what exactly the chemical compounds are in these bath salts and how they affect your brain. How they are a stimulant sort of like meth and cocaine and ecstasy all rolled into one. How if you inject them with a dirty needle, you can also get hepatitis, HIV.   But none of that matters if you're dead....

Thursday, July 7, 2011

Antidepressants, Serotonin, You and Me

Just wait a minute! Don't take that pill just yet! So you were at your primary care clinician's office getting your annual check up and you mention to your practitioner that you've been "out of sorts, kind of depressed, not myself." And before you know it, without further investigating your feelings, your clinician hands you a prescription for paxil or prozac or celexa or lexapro or zoloft or luvox. All these medications are antidepressants and known as SSRIs (Selective Serotonin Reuptake Inhibitors). Sounds fancy right? Sounds like a sure bet for happiness right? Well let's do a little more investigation.

Dr. Axelrod won the Nobel prize in 1970 for his research that led to the development of the SSRIs. The discovery of serotonin was a very cool thing because psychiatry became hopeful that they could now "cure" depression. Psychiatry thought they would be accepted as a legitimate arm of medicine because depression was actually a "medical illness," a "deficiency of serotonin." So quickly, the pharmaceutical companies got to work developing the SSRIs, medications that affect serotonin. The SSRIs simpy put, inhibit the reuptake of serotonin, thus allowing a build up of the serotonin.

Serotonin is in your blood. It works in your central nervous system. Serotonin affects mood, emotion, sleep, and appetite. But guess what...90% of your serotonin supply is in your digestive tract and in your blood platelets!  So when we look at the side effects of the SSRIs, we can understand it.

The side effects from too much serotonin include insomnia, rash, muscle pain, bleeding, sweating, anxiety, and GI distress like nausea, diarrhea, vomiting, upset stomach. Well these make sense now that we know that serotonin works in the belly and works in the brain on mood, emotion, sleep, and appetite! In other words...too much serotonin can make you sweat, can make you anxious, can make you bleed, can make you have diarrhea, nausea, vomiting. And...the most annoying side effect...decreased sexual interest, desire, and performance.

There's a cool study that found migraine patients have a higher sex drive. Hmmm...you say?? Yup, it's true! People who suffer from migraines have low levels of serotonin. And people with low levels of serotonin have normal or higher than normal sex drives. So if you increase your levels of serotonin with an SSRI, you will decrease your sex drive!  I bet your primary care clinician didn't explain that to you!

Well all the hype about serotonin seems to only be good news for some of the people some of the time. Some people don't need more serotonin and some people can't tolerate having increased serotonin.  

So what should you do if you feel depressed? Should you try an SSRI? Well you should definitely try meeting with a psychiatric nurse practitioner. Because there just isn't a magic happy pill out there. And what may work for one person, may not work for another. Do you think low levels of serotonin cause depression or does depression cause low levels of serotonin?  I sure don't know! But what I do know, is that when I meet with a client, together, we take the time and seriously examine all aspects of your health, your activities of daily living...what makes you tick.  Sometimes the SSRIs work and sometimes they don't. Well how is that possible? If all those science and doctor dudes said serotonin is the thing that makes people depressed...why doesn't it work all the time for all the depressed people? Because maybe you have a dopamine issue. Or maybe you have a specific life event that's caused you emotional difficulties. Or maybe you have a norepinephrine issue. So maybe depression isn't just a serotonin problem.

Dr. Axelrod gave us a good start.  But I think each person is unique and has very specific reasons and chemistry's and histories... that together, may cause mood disorders. So be good to yourself, don't just take that prescription from your primary care clinician, ask for a referral to a psychiatric nurse practitioner and explore what's really going on in your mind and body.

Monday, July 4, 2011

Why isn't the Adderall working?

Question: My doctor has recently decided that his initial diagnosis of schizophrenia was incorrect. He has decided that I actually have ADHD and has put me back on medication I had been taking previously, Adderall IR.

The problem is that I'm not feeling the effects of the medication. I was on the Risperdal Consta injection for a little over a year, and it's been seven weeks since my last shot, which is the time required for elimination. However, I still feel nothing; I don't notice a difference when I take the Adderall.

I used to feel focused and calm when I took Adderall, but now... nothing. Is this a side effect of the Risperdal? When will the Risperdal stop having an influence on my body? My doctor said it would go away after eight weeks, but it hasn't. I don't understand. Thank you so much.

Click on comments to read Laura's advice.