Why Testing Routinely Patients for Drug Use?

Practicing good medicine at the present time requires psychiatrists to maintain a high index of suspicion in order to rule out SLID intoxication, when treating conditions as anxiety, depression and psychotic disorders.

SLID stands for synthetic legal intoxicating drugs, that have been banned in US but continued to be manufactured at an worrisome rate with just slightly modified variants.

The sad part is that most regular urine drug screens do not test for synthetic marijuana, therefore a patient who complains of severe anxiety, panic attacks not responding to the usual treatment could be very well showing the symptoms of SLID. These patients are willing to take a regular urinary drug screen while denying the use of marijuana. The psychiatrist is left with a puzzle to solve, sometimes with no hope for an answer, unless he is aware of this increasing trend.

How about ‘ bath salts’? The most common compound in them is mephedrone or 3,4- methylenedioxypyrovalerone (MDPV), producing effects similar to those of methamphetamines. The most common symptoms that should alert the clinician to the possible use of bath salts are : agitation, aggression, anxiety, confusion, and acute psychosis. The urine drug screen should be testing for cathinones, or otherwise the clinical picture could be misdiagnosed as another case of ‘ resistant to treat’ mental illness.

If you like this article on drug use testing, or have questions, schedule your first session by calling us at 713-426-3100.

How Much Media Coverage of the Tragedies is Too Much

When a tragedy strikes, like the recent one in Aurora, Colorado, adults and children alike are faced with a lot of questions. Media coverage of the traumatic events helps communities to come together in showing support for people who lost dear ones in tragedies.

However, another question arises for the mental health professionals, psychiatrists, psychologists and counselors. What is the impact of watching traumatic images on children and adolescents who are not necessarily the direct victims of the tragedies? Is this indirect exposure to the trauma having an impact on the psychological development of children and adolescent watching the news at home, in a remote location from the tragedy?

In general, the research shows a positive correlation between exposure to media coverage of tragedies and symptoms of post-traumatic stress disorder (PTSD) in children. Children who witness violence, directly or indirectly, may experience a disruption of the normal developmental trajectory of childhood, depending on the different age groups. Repeated television coverage of the disaster may perpetuate panic, fear, despair and a potential re-experience of trauma with each viewing.

What do experts recommend in order to minimize the negative effects of media coverage?

  1. Monitor the amount the child watches new shows
  2. Watch the news with the kids
  3. Allow appropriate amount of time to discuss feelings or questions elicited by the show
  4. Ask the child what he/she has heard and what questions does he/she may have
  5. Provide reassurance regarding his or her own safety, emphasizing that the adults in his/her life are going to keep him/her safe
  6. Look for signs that the news may have triggered fears or anxieties such as sleeplessness, fears, bedwetting, crying, or talking about being afraid.
  7. If there are serious concern, the parent should contact a child and adolescent psychiatrist for a consultation and assistance.

If you like this article on How Much Media Coverage of the Tragedies is Too Much, or have questions, schedule your first session by calling us at 713-426-3100.

The Biology of Depression

Understanding depression through the bio-psycho-social model requires a review of all factors needed to make an accurate diagnosis. A skilled psychiatrist should be able to elicit through the patient’s interview several areas that would need to be addressed in a comprehensive and individualized treatment plan.

The Factors of Depression

The biological factors that predispose to depression include the genetics of an individual that codify an unique biological response to external as well as internal

factors, also known as precipitating factors. The psychological factors include the cognitive abilities of each individual, his or her ability to appraise and give meaning to perceptions, as well as a particular learned behavior through which each person copes with illness.

The social part of the model is represented by the social support, customs, values that surrounds the life events. When somebody afflicted with a mental illness looks for a psychiatrist or a comprehensive evaluation, all of the above have to be taken into account. Why, one could wonder… because the treatment should address each and everyone of these factors.

Let’s Look At The Biology of Depression…

Usually the depression or affective disorders, such as bipolar disorder, or anxiety disorders run in families, because of the genetic load that gets to be distributed between members of the same family. Mental illnesses are usually polyfactorial, no one single gene has been identified to be the culprit but a multitude of them. A careful family history needs to be discussed and afflictions identified in the immediate and extended family. It might be a good idea to talk to other family members before an appointment with a psychiatrist and ask questions about the psychiatric history to help narrowing down the diagnosis.

Depression Diagnosis

Several medical conditions can have symptoms of depression as part of their presentation, therefore a lot of patients with mental illness are diagnoses first by their internist or primary care physician.

Low vitamin D, low B 12, low testosterone levels hypothyroidism and blood dyscresias ( i.e. anemia) have sadness, decreased energy, fatigue, lack of interest, problems sleeping, as presenting problems. A comprehensive diagnosis of an affective condition has to exclude medical conditions as their cause. Sometimes depression, anxiety or bipolar disorders are comorbid with medical illness and need separate treatment.

Brain imaging is not used yet in the diagnosis, but might be in the future shows brain changes. These methods of imaging, such as MRI, functional MRI have been widely used in research but not considered cost-effective yet, for the clinical practice. Few of the brain changes noteworthy to mention are decreased left prefrontal cortex blood flow and metabolism, basal ganglia abnormalities, increased amygdal activity and abnormalities in hippocampus.

Case Studies: Integrative Treatment In Psychiatry

How To Treat the Patient AND Address the Diagnosis


The Integrative Treatment Model

integrative treatment

When James came to see me for the first time he was accompanied by his wife. When an adult brings their spouse with them at the first visit with the psychiatrist, it almost always means that things are not going well. As they sat on the couch next to each other, I knew James’ wife, Mary, was a strong emotional support for him and that she was there to make the message to me more compelling: James needed help, and he needed it fast!

I noticed that James moved very slowly, with reduced balance of his arms while walking, but as he sat down, he started moving his right leg in a fast, tapping motion.

I heard from James that he was highly functional until three years ago, when he started declining, feeling depressed and losing his ability to enjoy things. His wife Mary told me she noticed a marked change from his usual bubbly personality. During the last three years he had two psychiatric hospitalizations, tried ‘many medications’ and was engaged in weekly therapy.

Referral for Transcranial Magnetic Stimulation (TMS)

Due to his lack of response to medications, his therapist referred him to me to evaluate James for possible Transcranial Magnetic Stimulation (TMS) treatment. His therapist told me on the phone that James was so depressed and that nothing seemed to help him and she did not know what else to suggest.


Integrative Treatment Model Assessment

For all my patients, I do a thorough assessment that looks at many physical and mental health issues, so that I can rule out possible medical and health issues that could be contributing to symptoms. This approach is called an Integrative Treatment Model. As part of my integrative treatment assessment, I began to explore whether there was an organic cause to any of his symptoms. Both James and Mary assured me that he was recently evaluated by his Primary Care Physician, who told him that everything was normal, and prescribed him Xanax to help him manage his anxiety. Mary was very concerned that for a period of time, James was taking three of them every day, and she was concerned that he was developing an addiction because he was waking up in the middle of the night to take more pills. James on the other hand, told me that the Xanax was the only thing that was helping him to stop his leg from moving. James reported being very bothered by the fact that his leg would start shaking uncontrollably the moment he woke up in the middle of the night. To prevent him from abusing the Xanax, Mary and James decided she would dispense the Xanax as prescribed. James medication was Prozac 20 mg once daily, Seroquel 100 mg once daily and Xanax 1 mg twice a day.


The Correct Diagnosis Leads To The Best Treatment

My initial thoughts in regard to his correct diagnosis were multiple and varied covering different areas, including a neurological condition, a possible bipolar disorder, or a withdrawal from benzodiazepines.

I began to explore a detailed history with James to try to understand what might be causing his symptoms. The more I learned about James‘ depression, the more I believed that it fit the diagnosis of bipolar disorder. This diagnosis was communicated to him in the past, by previous treatment providers, but his current treatment regimen was not adequately addressing his depression.

His cognitive abilities, as seen by a mental exam were too impaired for his age, and for somebody who was very successful in sales, and I was extremely concerned about an early onset of a neuro-degenerative disorder.

I also explored a possible correlation I observed with bipolar disorder or major depression disorder, which results in a highly inflammatory state. This inflammation has been reported, more and more in the recent research and scholarly journals, and so I requested a blood test that would help us understand what might be going on.


Treatment Based On The Assessment

Both James and Mary felt very pressed by time because James’ poor performance at work was jeopardizing his job. They were convinced that if his condition were not addressed correctly he would soon become unemployed. They really wanted him to try Transcranial Magnetic Stimulation, but that intervention did not seem to be indicated given the fact that James’ diagnosis was not Major Depressive Disorder, the only diagnosis for which there has been FDA approval for TMS treatment.

My decision was instead to initiate Lithium treatment as a good mood stabilizer. James had not tried this medication in the past, and it is a good antidepressant for bipolar disorder, especially in the depression phase. I also ordered more lab work to rule out some other issues I observed. The blood work came back with very low levels of testosterone, very low levels of vitamin D, high cholesterol, and Triglycerides, high homocysteine levels, and very low therapeutic level of Lithium.

Over the next month, with regular visits every couple of weeks, and numerous calls to my office requiring reassurance, James received testosterone supplementation, vitamin D supplementation, folate, zinc and magnesium supplementation ( to address the high homocysteine levels). I also made adjustments of his lithium dosage until James got to the best therapeutic level of lithium. At the same time, I treated his anxiety by increasing his Prozac dosage to 60 mg per day.

At his third and last visit, six weeks after his initial visit, James reported that he was back to work full time, that he was sleeping well, and had reduced his Xanax use to only one pill at bedtime to help him sleep. He also reported that his leg movements had stopped completely. James reported that he was feeling well, and his concentration was back on track. When he came for his follow up visit, he came without his wife, and told he that he felt that I had saved their marriage and conveyed Mary’s appreciation for bringing him back to his normal self.

If you are concerned about yourself or a loved one who may need help- give us a call to set up an appointment at 713-426-3100.


TMS For Depression

An Alternative, Proven Non-drug Treatment for Depression Is Available

depressed woman

If you suffer from depression, you are not alone. The National Institute of Mental Health(NIMH) estimates that in the United States alone, 16 million adults had at least one major depressive episode in 2012. That equals almost 7 percent of the United States population.


Worldwide, according to the World Health Organization (WHO), there are over 350 million people who suffer from depression.


The National Survey on Drug Use and Health offers some data that highlights the problem among young adults. There found that more than 8 percent of young adults between the ages of 18 and 22, from 2008 to 2010, reported a major depressive episode in the previous year. They also found that women are more likely to be diagnosed with depression than men.


NeuroStar TMS Therapy® may be able to help, with a non-drug treatment for depression that has proven effective in people with major depression.


NeuroStar TMS Therapy is an FDA-cleared safe and effective treatment for patients with depression who have not benefited from prior antidepressant medication. It works by stimulating areas of the brain that are underactive in patients with severe depression.


Because it is not a depression drug, NeuroStar TMS Therapy does not have the same side effects that patients experience when they take antidepressant medication.


NeuroStar TMS for depression therapy is not right for everyone.


Contact us at 713-426-3100 to set up an appointment to ask our NeuroStar Certified Psychiatrist, Daniela White, M.D., if TMS Therapy is right for you.

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