Saturday, September 27, 2014

If You Really Want to Get Better with Your Anxiety...

The treatment for all ANXIETY DISORDERS if you want the most rapid and complete outcome is medication; antidepressants to bring down the symptoms quickly and cognitive behavioral therapy to unlearn the anxiety you learned. I typically see people much better in 6 weeks or less. Everyone suffers from anxiety but if it is getting in the way of your life that's when it's time to get help. These are the most common disorders that I treat.

Talk therapy -- not medication -- best for social anxiety disorder, large study finds
Published: Saturday, September 27, 2014 - 05:51 in Psychology & Sociology
While antidepressants are the most commonly used treatment for social anxiety disorder, new research suggests that cognitive behavioral therapy (CBT) is more effective and, unlike medication, can have lasting effects long after treatment has stopped. Social anxiety disorder is a psychiatric condition characterized by intense fear and avoidance of social situations and affects up to 13 percent of Americans and Europeans. Most people never receive treatment for the disorder. For those who do, medication is the more accessible treatment because there is a shortage of trained psychotherapists.
The findings of the study, a network meta-analysis that collected and analyzed data from 101 clinical trials comparing multiple types of medication and talk therapy, are published online Sept. 26 in The Lancet Psychiatry.

"Social anxiety is more than just shyness," says study leader Evan Mayo-Wilson, D Phil, a research scientist in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. "People with this disorder can experience severe impairment, from shunning friendships to turning down promotions at work that would require increased social interaction. The good news from our study is that social anxiety is treatable. Now that we know what works best, we need to improve access to psychotherapy for those who are suffering."

The research was a collaboration between the Johns Hopkins Bloomberg School of Public Health, Oxford University and University College in London, where Mayo-Wilson formerly worked.
For the study, Mayo-Wilson and his colleagues analyzed data from 13,164 participants in 101 clinical trials. The participants all had severe and longstanding social anxiety. Approximately 9,000 received medication or a placebo pill, and more than 4,000 received a psychological intervention. Few of the trials looked at combining medication with talk therapy, and there was no evidence that combined therapy was better than talk therapy alone.

The data compared several different types of talk therapy and found individual CBT was the most effective. CBT is a form of treatment that focuses on relationships between thoughts, feelings and behaviors. It helps people challenge irrational fears and overcome their avoidance of social situations, Mayo-Wilson says.
For people who don't want talk therapy, or who lack access to CBT, the most commonly used antidepressants -- selective serotonin reuptake inhibitors (SSRIs) -- are effective, the researchers found. But they caution that medication can be associated with serious adverse events, that it doesn't work at all for many people, and that improvements in symptoms do not last after people stop taking the pills.

The researchers acknowledge that medication remains important but say it should be used as a second-line therapy for people who do not respond to or do not want psychological therapy. The group's analysis has already led to new treatment guidelines guidance in the U.K. and, Mayo-Wilson says, it could have a significant impact on policy making and the organization of care in the U.S.

Social anxiety disorder typically begins in adolescence or early adulthood, and it can severely impair a person's daily functioning by impeding the formation of relationships, by negatively affecting performance at work or school, and by reducing overall quality of life. Because it strikes people at critical times in their social and educational development, social anxiety disorder can have important and lasting consequences.

"Greater investment in psychological therapies would improve quality of life, increase workplace productivity, and reduce healthcare costs," Mayo-Wilson says. "The healthcare system does not treat mental health equitably, but meeting demand isn't simply a matter of getting insurers to pay for psychological services. We need to improve infrastructure to treat mental health problems as the evidence shows they should be treated. We need more programs to train clinicians, more experienced supervisors who can work with new practitioners, more offices, and more support staff."

Source: Johns Hopkins Bloomberg School of Public Health

Sunday, September 7, 2014

Tipsheet: Bipolar Depression Versus Unipolar Depression

Tipsheet: Bipolar Depression Versus Unipolar Depression
Published on Psychiatric Times  (
Tipsheet: Bipolar Depression Versus Unipolar Depression August 19, 2014

Milder forms of bipolar disorder are something that I see frequently in my office. Most of my patients become quite concerned and even alarmed when I discuss this diagnosis with them. Chronic recurrent depression is often bipolar II. As a board certified sub-specialized psychiatrist, I can tell if certain symptoms and history are important in making this diagnosis; see if any of these items sound familiar to you. Most of my patients think I'm talking about a disorder that involves crazy. Instead, it really is a disorder of mood variation which is important to diagnose. Diagnosis means a treatment plan which is very different from the treatment plan for major depressive disorder. Clarification of the diagnosis is treatment that allows my patients to become well, possibly for the first time in their lives.

Given the greater frequency of depression than manic episodes in bipolar disorder, what clues
indicate bipolar disorder rather than unipolar depression? The Tipsheet below lists factors that may
help identify bipolar depression.

■ Prepubertal onset of symptoms
■ Brief duration of depressed episodes
■ High frequency of depressed episodes
■ Seasonal pattern
■ Postpartum symptom onset
■ Multiple antidepressant failures
■ Nonresponse to antidepressant treatment
■ Rapid response to antidepressant treatment
■ Erratic response to antidepressant treatment
■ Dysphoric response to antidepressant treatment with agitation and insomnia
■ Family history of bipolar disorder
■ History of unstable interpersonal relationships
■ Frequent vocational problems
■ Frequent legal problems
■ Alcohol and drug use

■ Bipolar I disorder, with episodes of full-blown mania, is usually easier to diagnose than bipolar II disorder, with episodes of subtler hypomania
■ Recognizing that the primary mood state may be irritability rather than euphoria increases the likelihood of diagnosis
■ Focusing more on overactivity than mood change further improves diagnostic accuracy
■ Bipolar disorder is associated with a significantly elevated risk of suicide
■ Bipolar patients often use highly lethal means for suicide

■ Early age at disease onset
■ The high number of depressive episodes
■ History of antidepressant-induced mania
■ Traits of hostility and impulsivity

Further reading:
•Effective Personalized Strategies for Treating Bipolar Disorder," by Stephen V. Sobel, MD, from
which this Tipsheet was adapted.
•Successful Psychopharmacology: Evidence-Based Treatment Solutions for Achieving Remission, by
Stephen V. Sobel, MD (New York; WW Norton; 2012).

See also psychiatryuplugged: Bipolar Disorder, It's a Mood Thang