21 Paths

Chemicals, Depression, and the Mythos of Natural

Usually by the time a depressed person comes in to see me, it’s because what they’re doing hasn’t been working. Therapy hasn’t been helping, or they don’t have the time or finances to do therapy. So as a psychiatrist, I offer an antidepressant. And almost every day, people hesitate. They don’t hesitate because they doubt whether the medications work (a separate debate). They hesitate because they want to follow a “natural” lifestyle or philosophy. Now I follow a principle of using as little medication as needed, recognizing a propensity in many colleagues to use more and chase every symptom with

Is it Bipolar, or not?

Jesse, a 27-year old guy comes into my office because he had a “rage” attack at his boss. He might lose his job. He’s overweight, not particularly self-conscious with a receding hairline and dressed like he’s still in college. He got upset when his boss criticized his work, so of course he lunged at him and punched. “But that was just my Bipolar.” No, it wasn’t. Because you don’t have Bipolar. Of course I don’t say that. Directly challenging doesn’t often serve the situation or help them to understand what’s happening with them. It would only put them on the

Well maybe it’s like physics. Kinda.

I was at a party once of non-medical people. A woman we’ll call Jill comes up to me. She’s a teacher, 28 years old, and talks to me about her teaching middle schoolers. I mention what I do, and I get a surprised look. She’s intrigued, but then brings up all the complaints she’s heard. “My friend went to a psychiatrist, and they were horrible… And isn’t it true that the DSM is run by drug companies?” “So you’re pushing pills all day?” “Why can’t psychiatry figure it out better?” Where do I start in addressing so many myths? Ultimately

But I’m not crazy, right?

“But I’m not crazy, right?” I get asked this question at least weekly. There’s a person, let’s say twenty years old. Or forty. Or eighty. Or fifteen. Doesn’t really matter the age. And they’ve reached some point where they’re actually starting to question their own sanity, wondering if they’re about to “lose it.” So they come to someone for help. Are they really at risk? Maybe. If so, it’s probably being driven by the fear itself. Of course there’s that old colloquialism that if you think you’re crazy, you’re not crazy. That has a grain of truth. One of the

Yes, Your Doctor Should Be Blogging

And so it begins… A new blog. Another amongst thousands. Is there particular utility or reason to follow this one? I’d like to imagine that this will have usefulness to your life. This is more than just thoughts on psychiatry, but really the thoughts of a psychiatrist who is both enamored with and annoyed by his own field. And with modern culture. So everything. Which raises the question – should a doctor really be blogging? Within medicine there’s a culture of secrecy. We protect our own, not letting on about our problems. Our venues of criticism fall into “peer reviewed