Get Help For Bipolar Disorder

A Psychiatrist for Bipolar Disorder Discusses Symptoms and Treatment

psychiatrist for bipolar disorder

Do You Have Bipolar Disorder?

A number of people come to me suspecting they have bipolar disorder. These patients often report extreme emotional highs and lows, as well as some other common symptoms such as feeling sad or manic. However, not everyone who experiences these symptoms has bipolar disorder. I wanted to write this article to provide some information so that people can learn more about bipolar disorder, and can get the help they need.  Although this information will be helpful-nothing is more effective than an in-person session with a trained clinician so that you can be properly screened, and make sure that you can explore all possible treatment options.


Bipolar Disorder Defined

In laymen’s terms, Bipolar disorder (often called manic depression) is a mental health condition whereby people experience extreme highs (mania), as well as intense periods of sadness or depression. The phases of depression and mania are known as “episodes,” and they can shift quickly.

Bipolar Disorder and the Brain

Bipolar disorder is a brain disorder that causes unusual shifts in energy, mood, activity levels, and can affect the person’s ability to carry out daily tasks.


Types of Bipolar Disorder

There are four basic types of bipolar disorder. Each of these types involves distinct changes in energy, mood, and activity levels. These moods range from manic episodes (periods of extremely “up,” elated, and energized behavior), to depressive episodes where the client presents as “down,” very sad, or hopeless. Less severe manic periods are known as “hypomanic episodes.”


Commonalities in Bipolar Disorder

What is common in all types of bipolar disorder is that people with bipolar disorder experience periods of unusually intense emotion, changes in activity levels and sleep patterns, as well as unusual behaviors. These distinct periods are known as “mood episodes.” What is different with bipolar disorder, is that these mood episodes are drastically different from the behaviors and moods that are typical for that particular person. When people experience these mood episodes, we typically see extreme changes in the person’s activity, energy, and sleep patterns.

Sometimes a mood episode includes symptoms of both manic and depressive symptoms. This is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.

Bipolar disorder can be present even when mood swings are less extreme. For example, some people with bipolar disorder experience hypomania, a less severe form of mania. During a hypomanic episode, an individual may feel very good, be highly productive, and function well. The person may not feel that anything is wrong, but family and friends may recognize the mood swings and/or changes in activity levels as possible bipolar disorder. Without proper treatment, people with hypomania may develop severe mania or depression.


Diagnostic Criteria for Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing bipolar and related disorders. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.  Diagnostic criteria for bipolar and related disorders are based on the specific type of disorder:

For Bipolar I disorder, you have to have had at least one manic episode. The manic episode may be preceded, or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis).

For Bipolar II disorder, you have to have had at least one major depressive episode lasting at least 2 weeks and at least one hypomanic episode lasting at least four days. People with Bipolar disorder II have never had a manic episode. Major depressive episodes or the unpredictable changes in mood and behavior can cause distress or difficulty in areas of your life.

For Cyclothymic disorder you must have had it at least two years, or one year for children and teenagers, where you have had numerous periods of hypomania symptoms (this is the less severe episode than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode). During that time, symptoms occur at least half the time and never go away for more than two months. Symptoms cause significant distress in important areas of your life.

There are other types of Bipolar disorder, which include bipolar and related disorders caused by another medical condition, such as Cushing’s disease, stroke, or multiple sclerosis.  There is an additional type called substance and medication-induced bipolar and related disorder.

Note that Bipolar II disorder is not a milder form of Bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be dangerous and severe, individuals with Bipolar II disorder have been known to be depressed for longer periods of time, which can lead to significant impairment in their daily functioning.


Bipolar Disorder Treatment

With proper diagnosis and treatment, people who have bipolar disorder are able to lead healthy and productive lives. Speak with your doctor or a licensed mental health professional if you think you might have Bipolar disorder. We cannot stress enough that you should have a physical exam to rule out other conditions.  Some Bipolar disorder symptoms are similar to other illnesses, which can make it hard for a doctor to make an accurate diagnosis.

If the problems are not caused by physical illnesses, a mental health evaluation should be done with a trained mental health professional, such as a psychiatrist, social worker, or psychologist who has experience in diagnosing and treating bipolar disorder.

Bipolar disorder can sometimes co-occur with another illnesses such as an anxiety disorder, eating disorder or with substance abuse. In addition, some people with Bipolar disorder are at higher risk for obesity, diabetes, thyroid disease, heart disease, migraine headaches, and other illnesses.


Want Help? Call Us

If you would like to set up an appointment for an evaluation call us at 713.426.3100.



Bipolar Disorder Treatments and Drugs

Bipolar Disorder Treatment Options

The good news is that treatment for Bipolar Disorder helps many people-even those with the most severe forms of bipolar disorder, to gain better control of their mood swings and other bipolar symptoms. A typical, effective, plan for treatment includes a combination of psychotherapy (also called “talk therapy”), and some type of medication.

No Quick Fixes

Bipolar disorder is a lifelong illness. Unfortunately, episodes of depression and mania often return over time. However, typically, many people with bipolar disorder are free of mood changes between episodes. Some people may have lingering symptoms. In the long-term, most people with bipolar disorder need continuous treatment to help to control any symptoms that arise.


Use of Medications for Bipolar Disorder

Bipolar Disorder Treatments and Drugs

Different types of medications are available that can help control symptoms of bipolar disorder. Oftentimes, those with Bipolar Disorder may need to try several different medications before finding ones that work best for them.

Medications generally used to treat bipolar disorder include:
  • Mood stabilizers
  • Atypical antipsychotics
  • Antidepressants


Those taking these medications should:

Make sure they take the time to talk with their pharmacist or doctor so they can understand the benefits and risks of the medication.

Do not suddenly stop taking a medication without first  talking to your doctor, because doing so may lead to “rebound” or worsening of the symptoms of bipolar disorder, and other uncomfortable or potentially dangerous withdrawal effects.

Immediately report any side effects or concerns to their doctor. The doctor may want to try a different medication, or adjust the dosage of the medication.


When done in combination with medication, psychotherapy (also known as “talk therapy”) can be an effective treatment for Bipolar Disorder. A professional therapist trained in helping people with Bipolar Disorder can offer support, education, and guidance to people with Bipolar Disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

  • Cognitive behavioral therapy (CBT)
  • Family-focused therapy
  • Interpersonal and social rhythm therapy
  • Psychoeducation

Other Treatment Options

Electroconvulsive Therapy (ECT)

This form of treatment has been proven to provide relief for people with severe bipolar disorder who have not been able to recover with other treatments. Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make taking medications too risky. Some short-term side effects can be seen with ECT such as confusion, disorientation, and memory loss. We recommend you discuss with your doctor the possible benefits and risks of using ECT.


Sleep Medications

Those with bipolar disorder who have trouble sleeping typically find that treatment is helpful. And in the case where sleeplessness does not improve, your medical provider may suggest a change in medications. If the problem continues, the doctor may prescribe sedatives or other sleep medications.



We do not recommend the use of supplements as there is not enough research done on natural or herbal supplements and their effect on bipolar disorder.

If you are taking any supplements we recommend that you let your primary care doctor or psychiatrist know about these and any over-the-counter medications because certain supplements taken together with medications may cause drug interactions that can be dangerous.


Getting Help For Bipolar Disorder

Your primary care physician or family doctor is the best resource to start so that any medical issues which may be impacting you can be ruled out.

They will typically refer you to a mental health practitioner. Ideally, if you suspect you have symptoms of Bipolar Disorder-you should request any provider you see has this specialization. In addition, to exploring medications through a psychiatrist, as mentioned above, some form of talk therapy have been shown to be helpful through the treatment process.

If you, or a loved one is in crisis- call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255), available 24 hours a day, 7 days a week. The service is available to anyone and all calls are confidential.

If you would like to make an appointment to see our Integrative Psychiatrist for Bipolar Disorder and learn more about Bipolar Disorder Treatments and Drugs, call us at 713.426.3100.



How Do Stress, Emotion, and Diet Affect the Gut?

Stress, Emotion, Diet and the Gut


photo by Shira Gal

The Gut – Brain Connection

It has becoming more accepted in the psychiatric literature as well as in the functional medicine that there is a bidirectional connection between the brain (central nervous system) and the gut (the gastrointestinal tract) through endocrine pathways.

Stress Affects The Gut

Stressors of various nature, either psychological or physiological, can alter the gut microbiota’s composition and the changes in the microbiota, represented through metabolic activities can influence the brain response.1

Emotion and the Limbic System

The limbic system plays a central role in regulating emotion and also is the center of the gut control.2 The generation of emotions and attached physiological reactions are most likely generated at this brain level (a very primitive part of the brain).

Depression and The Gut

In more recent scientific communications it has been suggested that depression can promote intestinal permeability as a result of chronic inflammation leading to a condition known as ‘leaky gut’. Leaky gut is another name for intestinal hyper-permeability that allows different substances (such as toxins, microbes and undigested food particles) to pass into the blood stream.

Diet and the Gut

Diet plays an important role in addressing the condition, such as ingestion of probiotics and prebiotics. Probiotics are beneficial forms of gut bacteria that helps the intestine to function properly. Examples of probiotic foods include: yogurt, kefir, sauerkraut, dark chocolate, microalgae, miso soup, pickles, tempeh (made from soy, a great source of vitamin B12 too), kimchi (an Asian form of pickled sauerkraut), Kombucha (fermented tea). For those who don’t find any of these appealing, tablets of probiotics are also good.

Prebiotics and the Gut

The prebiotics are enzymes that help the good bacteria to grow in the intestine. They are found in asparagus, Jerusalem artichokes, bananas, garlic, onions, oatmeal and legumes. They are also available in forms of supplements.

Non-Celiac Gluten Sensitivity

Another source of interest in affective disorders as well as in autism, and schizophrenia has been the Non-Celiac Gluten sensitivity (NCGS). The literature and studies are limited on the subject but it has been suggested that there is a relationship between the NCGS and neuropsychiatric disorders. Some studies point at the inflammation triggered by the gliadin in people sensitive to it and the ‘leaky gut syndrome’ associated with it.  The IgA detected in affected individuals suggest an inflammatory response to the gliadin that is found in wheat, barley, rice, and an exclusion of these products could reduce the neuropsychiatric symptoms associated with the “leaky gut” (migraines, Irritable Bowel syndrome, tiredness, chronic fatigue, etc).3

Listen To Your Body

Because research on diet and gut is still in it’s infancy it is important that you monitor how you feel after you eat certain foods. Obviously, if a food makes you feel bad you can reduce or eliminate it and see how you feel.

Integrative Treatment in Psychiatry

We take an integrative treatment approach with all our clients because we believe that any treatment that we recommend should be based on a very thorough history, questionnaires, targeted laboratory testing, and results from a physical exam.

Examples of core imbalances we assess for include:

  • Structural, boundary, and membrane imbalances
  • Genetic Mutations
  • Psychological and Spiritual
  • Hormonal and neurotransmitter imbalances
  • Oxidation-reduction imbalances and mitochondrial dysfunction
  • Detoxification, neurotoxicity, and biotransformation imbalances
  • Immune imbalances (Cytokine hypothesis)
  • Inflammatory imbalances
  • Digestive, absorptive, and microbiological imbalances

If you like this article on How Do Stress, Emotion, and Diet Affect the Gut, or have questions, schedule your first session by calling us at 713.426.3100



1 Inflammation:Depression Fans and Flames and Feasts on the Heat: Kiecolt-Glase PhD, and colab, Am J Psychiatry, 172:11, November 2015, pg 1075-1091

2 Brain–gut connections in functional GI disorders: anatomic and physiologic relationships: Jones, MD and colab, Neurogastrointestinal Motil, 2006, 18, 91-103.

3 Non-Celiac Gluten Sensitivity: The New Frontier of Gluten Related Disorders,  Catassi and colab, Nutrients 2013, 5, 3839-3853.

ADHD Symptoms in Children

Does Your Child Have ADD OR ADHD?


 Attention deficit hyperactivity disorder (ADHD) is a disorder that affects behavior. A recent national study reported by the CDC found that 11% of school aged children are now being diagnosed with ADHD. Three main symptoms that define ADHD including inattention, hyperactivity, and impulsivity. To have a diagnosis of ADHD, the symptoms must be severe enough to affect the child’s behavior in social situations and at school. If you are a parent then the school may have brought some of these symptoms to your attention.

There are some things mental health professionals look for when we are determining whether a child has ADHD (Attention Deficit Hyperactivity Disorder), sometimes referred to as ADD. Three primary characteristics of ADHD are hyperactivity, inattention, and impulsivity. In order for a professional to make a diagnosis of ADHD, the symptoms the child presents with need to be inappropriate for the child’s age and also have a negative impact on the child’s ability to function on a daily basis.


Different Types of ADHD

Children with ADD or ADHD may appear to be one of these types:

  • Inattentive, but not necessarily hyperactive or impulsive
  • Impulsive and hyperactive, but is able to pay attention
  • Inattentive, hyperactive, and impulsive (the most common form of ADD or ADHD)


Not All Children Have Hyperactivity 

Children who only have inattentive symptoms of ADD/ADHD are often overlooked in school or other settings, because they are not typically disruptive. But oftentimes, parents and teachers notice the symptoms of inattention when the child is struggling because they don’t follow directions; do not turn in homework, get bad grades in school,  or have difficulty with other kids over not playing by the rules.


Attention Deficit is a Misnomer 

When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. But this is not the only possible picture. Some kids with ADHD can concentrate for long periods of time if interested in an activity.

Some children with ADD or ADHD are hyperactive, while others sit quietly—often labelled daydreamers, with their attention  somewhere else. Some put too much focus on a task and have trouble changing gears to focus on something else. Others are only mildly inattentive, but overly impulsive.

ADHD Symptoms in Children may include:

  • Excessively talkative
  • Frequently fails to finish schoolwork, chores or other tasks
  • Often has trouble waiting for his or her turn
  • Easily distracted
  • Difficulty staying seated and seems to be constantly in motion
  • Difficulty paying attention
  • Frequently daydreaming
  • Oftentimes forgetful and loses needed items, such as toys, pencils, books
  • Frequently squirms and fidgets
  • Difficult time following through on instructions and appears to be not listening
  • Frequently has problems organizing activities or tasks
  • Frequently intrudes or interrupts others’ conversations or games

Because of the importance of this diagnosis it is essential that ADHD  be diagnosed by a specialist. There are a number of tests for ADHD that can determine whether it is ADD/ADHD or another issue that might be causing symptoms of ADHD in children.  Before medication is considered we recommend you consider all your options due to the risks involved.

Check out a more detailed list of symptoms of ADHD in Kids.

To learn more, call us to set up a consultation at 713.426.3100

To learn more about ADHD and Sleep issues check out this website

Is Seasonal Depression Affecting You?

What To Do About The Holiday Blues?

seasonal depression

What are they and how do they affect us?

Many factors can lead to what we describe as the holidays blues: headaches, insomnia or sleeping too much, excessive worrying, difficulties concentrating, decreased interest in things that are normally enjoyable. They are usually transitory but sometimes they can trigger periods of feeling anxious and depressed that needs to be addressed with a therapist or psychiatrist. Many factors can lead to what we describe as the holidays blues: headaches, insomnia or sleeping too much, excessive worrying, difficulties concentrating, decreased interest in things that are normally enjoyable. They are usually transitory but sometimes they can trigger periods of feeling anxious and depressed that needs to be addressed with a therapist or psychiatrist.

Below, are some of the most common causes of these sad or anxious feelings around the holidays that affect what is supposed to be a time of joy and celebration. Below, are some of the most common causes of these sad or anxious feelings around the holidays that affect what is supposed to be a time of joy and celebration.

    1. Anniversaries of losses such as deaths, departures and breakups. Most people who lost the dear ones, either to death, illness, breakups or departures, anticipate the holidays as a time that instead of being happy, reminds them that their loved ones will not be around this time of the year. Family gatherings are vivid reminders of the person who is not present. Especially the first year after the loss, each holiday becomes an acute reliving of the painful feeling of separation and longing.

We recommend to our patients that they use these times to celebrate the life of their loved one, and reflect on the way they positively impacted the people that they left behind. By focusing on celebrating their lives rather than on the sad separation could help make the holiday times more bearable. We recommend to our patients that they use these times to celebrate the life of their loved one, and reflect on the way they positively impacted the people that they left behind. By focusing on celebrating their lives rather than on the sad separation could help make the holiday times more bearable.

    1. Remembering the happy times that are gone from the present is more common with people whose present lives are not ‘as happy’ as in the past with their departed loved one. Economic hardship, changed family dynamics and transitions through later stages of life can make these times difficult.

What we recommend is to try to spend as much time as possible with the remaining loved ones, focusing and cherishing the warmth and benefit of having healthy relationships, and on the positive light and influence in their lives.

    1. Seasonal depression is mostly seen in the parts of the world further away from the Equator. Some people are more sensitive to the diminished light during the winter months, which appears to decrease the internal brain production of serotonin.

We often suggest “light therapy” or phototherapy which is administered through light boxes which give off specific wavelengths of light, and are administered for a prescribed amount of time. Exposure to this light can result in reduced symptoms of decreased energy, increased appetite and drowsiness associated with this form of depression.  Providing light therapy through light boxes can reduce the symptoms of decreased energy, increased appetite and somnolence associated with this form of depression.

    1. Dealing with dysfunctional families. Some people anticipate with almost despair spending time with members of their family that they simply do not like, or have had previous, unhealed conflicts.

What we recommend is to attempt controlling only the things that can be controlled, such as the time and place where the gathering happen, keep any statements made to ‘I’ without assigning blame, and actively listening and avoiding ‘hot’ topics.

    1. Breakdown of routines during the holidays. Most people’s schedules becoming hectic and disorganized during the holidays, and neglect healthy routines such as exercising, eating healthy and allocating time for themselves.

What we recommend is to treat yourself first with a healthy regimen; avoid excessive consumption of alcohol or unhealthy foods, and keep a regular exercise and sleep schedule.

The bottom line is that the holidays do not have to be a time that causes you anxiety and sadness. Although some of this is natural, there are things you can do to lessen the severity.

For some people, taking the above steps is not enough, and there are other options that you can explore which include counseling, medication and other forms of intervention.
If you’d like to get some help in coping-please call us to set up a time to talk at 713.426.3100

Homocysteine and Depression: What You Need To Know

Ask your psychiatrist if Homocysteine could be contributing to your depression…

homocystein and depression

What is HCY?

Homocysteine (HCY) is an amino acid that is destructive to cell integrity and DNA, and is a risk factor for the development of vascular and neuropsychiatric pathologies.

HCY has been linked to cardiovascular diseases, but when it passes the blood-brain barrier, it contributes to other chronic disorders such as depression, dementia, bipolar disorder, schizophrenia, and acute events, like strokes.

Where do these amino acids come from? HCY is not obtained from the diet – it’s not present in a naturally occurring protein. An amino acid found in a normal diet, called methionine, is broken down to either cysteine (a ‘good’) amino acid or homocysteine (the ‘bad’ form).

What causes HCY Toxicity?

The mostly commonly suggested mechanisms are oxidative injury, direct vascular damage, impaired methylation and impaired DNA synthesis. Another possible mechanism is the possibility of a heightened the inflammatory process, which is associated with depression.

Causes for elevated HCY can be genetic, epigenetic, and environmental and lifestyle-related.

The most common causes of elevated HCY:

  • smoking
  • excessive alcohol consumption
  • lack of exercise
  • obesity
  • some medications
  • psychological stress

Exercise helps distribute the HCY more evenly throughout the body, facilitating metabolism.  Poor vitamin intake makes it impossible for the metabolism of homocysteine to a ‘good’ form (cysteine). Decreased magnesium levels also slows down the metabolism of HCY. Lipid lowering medications or anticonvulsants impair the HCY metabolism as well. Genetic predisposition, like a mutation in the MTHFR enzyme can also decrease the ability of the body to metabolize HCY efficiently (TT and CT are the most variants shown to be associated with depression).

Why and how is this important for the treatment of depression?

Based on the theory of impaired metabolism of HCY, the low monoamines levels (serotonin, dopamine, norepinephrine) are related to the lack of important coenzymes that are necessary for the metabolism of HCY and the synthesis of neurotransmitters.

The coenzymes necessary for the HCY reduction are fully metabolized B vitamins. If a patient with depression is genetically predisposed to not be able to metabolize them (such in CT and TT variants of MTHFR) then they will have high levels of HCY, which may cause a higher level of inflammation and neurotoxic effects on the brain.

How can we individualize the treatment of depression?
  1. Check for the MTHFR mutation. Although it is not the only etiological factor, it can suggest a polymorphism contributory to the inflammation and depression.
  2. Supplement treatment with antidepressants by adding metfolate at 15 mg/day. Depression has been associated with reduced metfolate. Supplementing can help the HCY metabolism, reducing its toxic effects on the brain.
  3. Supplement with complex B vitamins and other necessary micronutrients. Maximizing methylation with reduced complex B and micronutrients necessary in the metabolism of HCY. Many patients can benefit from this supplementation even in the presence of HCY and because they are safe, they should be more largely used as a routine addition to the antidepressant treatment.

If you like this article on Homocysteine and Depression, or have questions, schedule your first session by calling us at 713.426.3100.


  1. Homocysteine and Neuropsychiatric Disease: Angela Pana, MD, Psychiatric Ann. 2015;45(9):463-468.
  2. Inadequate Homocysteine Metabolism: A theory of Depression, Andrew Farah, MD. Psychiatr. Ann. 2015;45 (9): 469-472.
  3. Theory into Practice-Addressing the Homocysteine Basis of Depression. Andrew Farah, MD Psychiatr. Ann. 2015;45(9):473-477.


Depression and Inflammation: What You Need To Know

Ask your psychiatrist if inflammation could be contributing to your depression…

depression and inflammation

In the last few years there has been an increased interest in the link between depression and inflammation. More and more research has been done to understand depression better and find other ways to combat it besides using antidepressant medications. Depression is the most widely spread cause of disability in the world, and these medications do not always work for everybody.


Inflammatory Disorders and Depression

One of the many things pointing to the relationship between depression and an inflammatory process is the fact that depression is frequently associated with other inflammatory disorders such as autoimmune diseases, cardiovascular disorders, diabetes and cancer.

Another important finding is that inflammatory markers are associated with major depressive disorder (MDD). One in five persons with cardiovascular diseases experiences MDD. Up to 70% of patients with autoimmune disorders experience MDD. About 15-20 % of cancer patients also have depression. Diabetes doubles up the rate of depression. Many meta-analyses studies show that individuals with MDD have significant increase in inflammatory markers like TNF-alfa and IL-6.


Stress and Inflammation

Since depression can develop in the absence of other inflammatory diseases, one theory is that stress (acute and chronic) is associated with the increased availability of proinflammatory citokines. Psychological stress can activate inflammation; however, depressed patients have difficulty controlling the body’s inflammatory response to stress. When the inflammatory pathway is initiated, a cascade of reactions results that decreases the serotonin level and boosts the glutamatergic response; thus creating depressive symptoms.


How Does This Apply to Depression Treatment?
  1. This medication helps decrease immunotherapy-induced depression, reduce the inflammatory response, and lower the pro-inflammatory factors.
  2. Stress Management. Managing stress effectively and proactively decreases inflammation.
  3. Healthy Diet. A diet rich in vegetables, fruits and Omega 3 is helpful in reducing inflammation.
  4. Exercise. Aerobic exercise has a well-documented impact on reducing inflammation and acts as one of the best destressors.

If you like this article on Depression and Inflammation, or have questions, schedule your first session by calling us at 713.426.3100.

  1. Depression and Inflammation: Examining the link: Maria Almond, MD, MPH Current Psychiatry, vol 12, no 6, 25-32.

Alternative Medicine For Depression: Beware of False Advertising

Can You Beat Depression Without Medication?

depressiontreatmentI am always unpleasantly surprised when I listen to some of the advertising done by some clinics on radio shows claiming that they can treat depression without medication.

The Real Definition of Depression

I cannot stop but wonder if they are confused about what the word ‘depression’ means for psychiatry versus the meaning that it has in the vernacular language. One of the most frequent claims is that alternative treatment can be a substitute for antidepressant treatment for depression, but they fail to specify the kind of depression helped by that treatment.

Medication Is Often Medically Necessary

While I truly believe that integrating all modalities of treatment, (or as many as possible) creates a more effective approach in addressing all types of mental illness, including depression- I think it’s a mistake to suggest eliminating medication when it is oftentimes medically necessary, or to claim that it’s not needed when the alternative treatment has not been proven to be an effective substitute.

The Prevalence of Depression Worldwide

Depression, in its medical sense, is a chronic, multifaceted illness, that has plagued humanity from the beginning, and has a higher than ever prevalence worldwide. By 2030, it will be the most common cause of disability. Out of 14 million Americans, only 7.2 million are adequately treated, leaving at least 7 million or more struggling with this chronic disorder. Depression needs, first and foremost, a correct diagnosis, followed by an individualized treatment approach.

Diagnostic Criteria for Depression

Somebody complaining of feeling ‘depressed’, meaning feeling sad because of a recent or anticipated loss, doesn’t mean that he or she suffers from depression, in its medical understanding, but that she or he has an appropriate emotional reaction. If the sadness persists and becomes associated with cognitive impairment, changes in appetite, weight, and sleep patterns, then they could have either an Adjustment disorder, acute or chronic, or even Major Depressive Disorder when suicidal thoughts are associated. Chronic Depressive disorder, or Dysthymia, defines long periods of time of less than optimal mood, and other symptoms, including lack of energy, and changes in sleep patterns.

Strategies for Managing Depression

In mild and moderate states of depression, exercise and implementing good sleep hygiene and a healthy diet could help stabilize the mood to a normal level. However, in patients with severe depressive states, while these changes could be helpful, they can rarely be initiated by the depressed patients because of their lack of interest, energy and self-worth, as well as their feeling that life is not worth living which is characteristic of this level of depression. In these situations, it is more effective for the patient to try using medication to at least improve the drive and the energy level, This will help them initiate lifestyle changes that they could not maintain in the more depressed state.

Integrative Psychiatry Practice And Depression

In my practice as a integrative psychiatry provider, I do a comprehensive evaluation to assess if there are other factors that may impact a person’s mental health. Sometimes by addressing any vitamin or mineral deficiencies one can make a positive impact on relieving symptoms of depression. For example, when I discover that someone is deficient in certain vitamin or has endocrine disorders, I might recommend supplements that can address that deficiency. The research shows that individuals with deficits in vitamins D, and B12, can present with symptoms characteristic of depression.

Depression and Genetic Testing

In recent years, deficits in methylation that can now be easily diagnosed with genetic testing ( to determine the MTHFR mutation) that assesses the ability of the individual to properly utilize folic acid ( vitamin B9) which can also be associated with symptoms of depression. In the presence of this mutation, the organism has limited ability to eliminate homocysteine, creating, in time, a chronic state of inflammation that has also been correlated with depression.

Depression and the Brain

Folic acid in its methylated form is also essential in the production of the serotonin and norepinephrine that are two key mediators whose low concentration in certain area of the brain underlie the symptoms of anxiety and depression.

Medication and Depression

In this particular situation where there is a high level of depression and there is a biological condition that could be addressed- exercise and lifestyle changes alone are not sufficient. Also, when there is a genetic predisposition for depression, as seen in families who have multiple members afflicted with affective disorders, these cases cannot oftentimes be addressed with lifestyle changes only, but with an integrative approach that would include medication, and/or Transcranial Magnetic Stimulation (TMS), a non-invasive neurostimulation technique.

TMS As Alternative to Depression

TMS uses electromagnetic induction to produce weak electric currents using a rapidly changing magnetic field. These electric currents cause activity in specific or general parts of the brain with little discomfort, enabling the medical provider to study of the brain’s functioning and interconnections. TMS uses magnets instead of an electric current to activate the brain. An electromagnetic coil is held against the forehead and short electromagnetic pulses are administered through the coil. The magnetic pulse which can easily pass through the skull, produces small electrical currents which stimulate nerve cells in the brain region that is targeted.

If you like this article on alternative medicine for depression, or have questions, schedule your first session by calling us at 713.426.3100.


Can Exercise Help Depression?

Physical Activity and Lifestyle Changes as Adjunctive Treatment for Mental Illness

exerciseanddepressionWhen it comes to helping people cope with depression, the most commonly recommended treatments for most are usually either therapy alone, or counseling combined with prescription medications. These forms of treatment are often effective in helping people to manage the symptoms.

Research on Depression: What Works?

However, research on depression, anxiety, and exercise shows that the psychological and physical benefits of exercise can also help reduce symptoms of depression and anxiety, and even help people manage other conditions such as diabetes, high blood pressure, and arthritis.

A study by S. Rosenbaum et al. published in the Journal of Clinical Psychiatry (Sept 2014) showed that physical activity reduced depressive symptoms in people with mental illness. Physical activity has been researched more in recent years showing that when incorporated in a holistic approach to the treatment of mental illness it has the result of augmenting the action of the antidepressants, and speeding up the response to treatment.

What I See In My Practice In Patients With Depression

While some studies suggest that exercise can be a substitute to the pharmacological treatment, what I found in my clinic is that only a certain subset of patients with depression respond to physical activity only; those with depression that is milder in severity. However for moderate to severe depression I find that the addition of exercise to the medication regimen and other changes in lifestyle, make the recovery more robust and sustainable.

Physical Activity Defined

Physical activity was defined for the purpose of the above study as ‘any body movement that is produced by the contraction of the skeletal muscles that increases body energy expenditure’ and exercise as ‘a subset of activities that is planned, structured, and deliberate’. The simplest form of regular exercise that could still make a change in the treatment of depression is walking at a brisk pace, for at least 25 minute a day for a minimum of five days per week.

Challenges for People With Depression

People who struggle with depression know that what may seem to be a simple task, taking a walk, or working out, becomes a difficult one. Especially those with moderate to severe depression, due to the fact that some of the common symptoms include: lack of initiative, decreased energy, difficulty making decisions, thoughts of life not being worth living, etc. These symptoms make taking that first step toward regular exercise extremely difficult.

More Challenges Seen In Depression

Another common form of resistance for those with depression is the reluctance to initiate a change, even one that could potentially be helpful. I hear a recurrent complaint of ‘the lack of time’. For the depressed patient in the midst of their depression, it becomes increasingly difficult to attend to the required activities of going to work, attending to the children, cleaning the house, and taking care of themselves. Usually, they are the last ones to take care of themselves, especially if they are feeling mentally tired and physically exhausted.

Ways to Break Through The Challenges of Depression

Get Support and Encouragement


Rather than add exercise as one more task to add to the ‘to do list’, what I find the most helpful is to ask the patient to rely on a friend or a family member to support and encourage them to set a goal and start working towards it.

Schedule Exercise; Start Small And Build

Usually, I recommend people start with just allocating 10 minutes a day in their daily schedule for ‘exercise’. Even for a short distance of 100 yards is enough to start, but keep the mind aligned with a final goal of walking 25 minutes at a brisk pace every morning, if possible. I ask them to start with this small step, dividing the main goal into smaller ones that are more easily attainable. Accomplishing a small task becomes rewarding, and initiating it is less overwhelming. What I found is that when the window of time allocated for exercise exists in one’s schedule, increasing the amount of time or the intensity of the exercise is easy to adjust in a stepwise approach.

Take Time For Yourself

We all know that we can best help others if we take care of ourselves- so it is important that we make the time for ourselves a priority. Walking is really helpful in increasing the sense of planning, and actually doing something for one self which is extremely healing for the depressed patient who perceives him/herself as not worth it, a burden, and contemplating death.

Take Time To Reconnect With Others

Walking can also provide distraction from our negative thoughts- especially when done with a companion. It helps create a sense of connection with people and with our surroundings as well.

Physical Effects of Exercise

When done at a fast pace, exercise increases the heart rate high enough to provide aerobic benefits, including the production of the endorphins that often help you feel happier and more relaxed. When exercising regularly, people also begin feel better about their appearance which can boost confidence and improve self-esteem. And most importantly, exercise improves your chances of living a longer and healthier life.

Holistic Approaches to Treatment; Other Ways to Manage Depression

In addition to exercise, I encourage my patients to consider other lifestyle changes that can help manage depression. These include healthy nutrition practices, getting good sleep, increasing their social support, and practicing stress reduction techniques. I will talk more about these practices in future articles. So to answer the question can exercise help depression, yes it can, but also explore other options to maintain improvement in mood, energy level, and overall health.

Contact us to learn more about can exercise help depression and treatment options by calling us at 713-426-3100.




Integrative Treatment In Psychiatry: A Path To Wellness


Case Study N.Y.

Main Symptoms

When N.Y. 20, came in for an evaluation with her family, her main complaint was that she could not retain information and was worried about starting school and her performance in college. Her family noticed that she was also very tired, slept a lot and did not seem to follow through on her goals. She complained of very low energy and increased appetite, and was concerned about the weight that she gained and could not lose. She felt sad and worried most of the time- especially about her starting school again and not feeling up for it.


N.Y. was never seen by a psychiatrist before and was not aware of any mental illness running in her family. She had been a good student in her country of origin, came to United States when she was in 9th grade and once here, her academic performance gradually deteriorated. She found that she needed more time to accomplish her tasks; she was easily distracted in class, and seemed that she worked twice as hard as her peers to achieve the same results.


During the first meeting with her-it became clear that based on the clinical history and the self-reported questionnaires that she was suffering from significant depression and anxiety symptoms. At the same time, while her concentration could have been impaired by the presence of an affective disorder, I considered the presence of a comorbid ADHD. At the same time, her lethargy, decreased energy and mental cloudiness could have been explained by an atypical form of depression but I was also concerned about the possible comorbidity with a thyroid deficiency, vitamins deficiencies, or anemia.

I created a customized treatment plan and discussed the plan with N.Y. and her family and decided to start the treatment for the most obvious complaint, the low depressed mood, and test for ADHD when the mood was better through a Continuous Performance test. At the same time, I recommended we run a set of lab tests to address possible biological causes of her symptoms.

The laboratory results confirmed my clinical suspicions by showing signs of microcytic anemia, and significant deficits in Vitamin D, B12, and folate, with an increased homocysteine level that is a marker for a generalized inflammatory state.

The Continuous Performance Test (CPT) test for ADHD showed that she was having a lot of difficulties with maintaining attention, and increased distractibility.

Integrative Psychiatric Treatment For N.Y.

We created a customized Integrative psychiatric treatment program which began to help N.Y. see improvements. N.Y. showed significant improvements on a combination of a medication (an SSRI) for her depressive symptoms and anxiety, Strattera (for ADHD) and targeted supplementation including Vitamin B12, Vitamin D, folate(Vitamin B9), and B-Complex. She was also referred for further testing and follow up with her primary care physician for her microcytic anemia. I also recommended that she start exercising by going for a walk regularly, at least 25 minutes a day at a fast pace. To help her lose the extra weight she wanted to lose we talked about her trying a low-glycemic index diet.

It is possible that with an improved regimen of regular exercise, improved nutrition and supplementation with the appropriate vitamins she might be able to get off the antidepressant in about 6 months. At that time- we plan on repeating the CPT test to assess her ability to concentrate on and off medication, and decide if further treatment is necessary.

Integrative treatment in Psychiatry is becoming more and more popular and effective because it provides a more comprehensive analysis of the potential factors that may influence an individual’s health and mental health. It also provides a more customized plan of treatment that incorporates the interplay of body, mind and spirit and therefore can be much more effective than traditional medicine which takes a narrower view.

If you like this article on integrative treatment in psychiatry, or have questions, schedule your first session by calling us at 713.426.3100.