Shrink Rap

Many people come for psychiatric/psychological help when the pressures and problems of life are overwhelming. Usually, life stress causes people to experience various symptoms of anxiety, depression, and insomnia. The psychiatrist can diagnose a mood or anxiety disorder and prescribe medications that are often quite effective for symptom relief. However, it is important to be aware that although a person may feel better, there is still a disease process taking place. Similarly, if a person leads an imbalanced or dysfunctionally stressful life and develops high blood pressure, medications can surely bring the blood pressure down. But the cause may continue to exist, damaging the body.

In these days of instant gratification and our extremely fast-paced lives, many people place unrealistic expectations on what psychiatric medications can do for them. Often, the prescription of one drug is insufficient for results, or causes side effects necessitating the prescription of several more drugs. People with extremely chaotic, out of control or situationally sad lives frequently expect to feel “normal” with the right combination of medications. Yes, there is the concept of chemical imbalances which medications do correct, but no medication will correct the underlying cause. And it is the correction of the cause that promotes real healing.

Sometimes, medication can “numb” reactions and reduce symptoms that are the body’s natural response to stressful situations. Without symptoms, we lose the awareness that certain situations may need to be fixed. I have seen instances where people who are medicated become complacent or resigned to life situations which can be altered. With the help of a well-trained therapist, people often find their own solutions to problems and begin to take control of their lives. Once life becomes more under control, a lot less medication is needed.

Medications can be life saving and there is often no substitute for them during a crisis. However, the long-term use can cause side effects that adversely affect quality of life. In the end, each person must make an informed decision about their treatment based on personal preferences and goals.

A selfish idea? YOU come first? Hardly. The literature of all faiths urges believers to care for themselves. For instance, the cliché “Love thy neighbor as thyself” assumes that you first are able to “love” yourself. Perhaps “love” is the wrong word these days. The concept, however, is still valid. You can only care for others as well as you know how to care for yourself.

Think for one moment. How many people rely on you? How many people are affected by how you feel every day? Spouse, children, in-laws, employees, co-workers? Even the check-out worker at the grocery is influenced by how you feel as you pass through his or her life. If you have not taken care of you, then all these interactions can be negative or even hurtful.

Somehow we have in our society come to believe that to be a good person, we must give, give, give. Time, energy, affection, money. It’s all expected to flow out from us to others. Endlessly. The more we do, the more we give, the better person we are. Or so we’ve been trained to believe.

But emotional energy is like a bank account. One cannot continue to make withdrawals and not expect the amount to shrink. What can we do if the account is emptied? Then there is nothing left for all those people who need that piece of us.

Only one person can make deposits in that emotional energy bank. You! That is why YOU come first. You are responsible for keeping that emotional bank full. Only you.

“YOU COME FIRST” urges a new concept: mental wellness. Most people think of psychiatry as an experience to be had after a crisis. That’s wrong. These days we eat healthy and exercise to avoid a heart attack. We lose weight and stop smoking to prevent the stroke. We should also exercise our emotions to determine how we can be as emotionally healthy as possible. If we truly recognize how important we are in our families and our communities, then we will take the steps to examine the emotional side of our lives. Counseling, massage, relaxation therapy, sleep assistance and other tools are all a part of helping you understand that you come first. This is not selfish a thought. It is, in fact, the way you can guarantee that you will always be there to give to those who need you.

FDA confirms some antidepressants increase suicide risk in some children. In February of 2004, two advisory committees of the U.S. Food and Drug Administration recommended that the FDA warn practitioners about the possible risk of suicide potential associated with antidepressant treatment in children. The information was obtained from clinical trials of medications with children, expert witnesses on suicide research, testimony from families of suicide victims, as well as from those whose children had benefited from antidepressant medication.

At a second meeting last year, improvement on antidepressant study designs and monitoring for suicide risk was discussed. Now, federal officials are preparing stronger warnings giving some antidepressants to children after new analyses back a suspected link to suicidal thoughts and behavior. FDA and Columbia University psychiatric specialists have re-evaluated 25 studies involving more than 4,000 young people and eight antidepressants. When all the results were lumped together, young antidepressant users were about 1.8% times more likely to have suicidal thoughts or behaviors than patients given dummy pills. Risk varied widely from drug to drug and among studies of the same drug, but studies of Effexor showed particular risk.

At present, changes have been made in the labels for Effexor, Serzone,Wellbutrin, Celexa, Lexapro and Paxil indicating warnings which apply to both adults and children with major depressive disorder. The warnings recommend that patients be observed closely for clinical worsening and the emergence of suicidal ideation and behavior, particularly when they begin treatment and when the dose is changed. The warnings also advise families and caregivers of patients to be alert to those and other symptoms, including agitation and irritability, and to immediately let health care providers know about them.

Despite the warnings and possible risks, it should be noted that Major Depression is a serious mental illness which often responds favorably to medication, in both children and adults.

Dear Reader,

Hello, and welcome to Shrink Rap, my first venture into the brave new world of blogging. For those of you who don't know me, I'm a psychiatrist located near Fort Lauderdale, FL. I've been in private practice (General Psychiatry) for more than sixteen years. I received my MD from the University of Miami and am board-certified by the American Board of Psychiatry and Neurology. If you're interested, more information is available on my website: www.doctorgorin.com.

The purpose of Shrink Rap is to provide topical and useful information on a variety of mental health issues. It's my hope that you find this weblog both informative and helpful. I plan to update the information on this site as frequently as time allows, and I encourage feedback, questions, and suggestions for new topics.

So, here goes rap #1...


Depression is a disorder marked by sadness, low energy, impaired concentration, and feelings of dejection. Some people believe that depression is normal. Hectic daily activities and the conflict between family and career cause constant stress. Yet depression and anxiety as a response to stress are not normal. They can be signs of illness, which may worsen and result in physical symptoms or an inability to function.

Life was much simpler for the last two generations. Father worked; mother stayed home. This is no longer the model. Some now view families as an “endangered species.” There are more single mothers working than ever before. There is greater stress and competition for well-paying jobs. The result: long hours at work, away from the family. Children are raised with limited supervision. Thus we see more children with emotional problems derived from a lack of knowledge as to who they are and what their role is in today’s society. Similarly, adults suffer from the loss of nurturing that family time should provide.

Until recently, mental health was not discussed openly. However, there is a growing awareness that choosing therapy can be helpful, even necessary, to cope with today’s life. Psychiatric help is often sought for the entire family. Today, being healthy means not only having a sound body, but also a sound mind and spirit.

People exercise their bodies daily, yet they neglect to “exercise” their feelings and emotions. Young men are taught to hide and deny emotions. Women are reluctant to seek help in coping with their depression, anxiety, or distressed relationship. The same fitness fanatic who exercises daily, eats right and has two physicals a year will neglect the mind until a crisis is reached. Emotional problems don’t just happen, but are cumulative and they can be avoided at times with the same “daily fitness” and “annual physical” approach we use when caring for our bodies.

The Chinese say “the journey of a thousand miles begins with a single step.” Just like it’s better to maintain a healthy heart than recover from a heart attack, dealing with emotional issues is easier before the chaos of a crisis breaks. Think about “exercising your emotions" and give your mental health professional a call.