SPRAVATO An Alternative For Treatment-Resistant Depression

An Alternative For Treatment-Resistant Depression- SPRAVATO

Spravato Brochure

SPRAVATO™ is the only NMDA receptor antagonist approved in conjunction with an oral antidepressant for treatment-resistant depression. It contains esketamine, an alternative for treatment-resistant depression, and is a schedule III-controlled substance, related to ketamine, an anesthetic that also has been studied to help in the treatment of depression.

What Is Treatment-Resistant Depression?

The depression is considered resistant to treatment after failing to respond to two trials of antidepressants. About 30 percent of the patients suffering from depression do not respond to the standard treatments. Ketamine and esketamine are similar but not identical. They are enantiomers, meaning that their chemical structures are mirror images of each other. Both can be used as anesthetics but esketamine has more potency acting on the brain receptors.

Research On Ketamine And Esketamine

Ketamine IV has been extensively studied and there are numerous clinics throughout the US offering ketamine IV as a treatment for depression even though it does not have an FDA approval. The administration is done over a period of 40 minutes, at a subanesthetic dose.  We prefer to use Eskatemine Spravato because of its improved safety and FDA endorsement.

Administration Of Esketamine And Possible Side Effects

Esketamine can be administered intranasally, it is FDA approved and has less potential for dissociation and hopefully will be covered soon by the insurance carriers, has less potential for dissociation and hopefully will be covered soon by the insurance carriers. Because esketamine, like ketamine, has abuse potential, there are very strict rules related to its administration. It must be done in the doctor’s office, under direct supervision, followed by a period of two hours of observation. Following the administration, dissociative episodes can happen; therefore, the patient should not engage in driving or operating any machinery. The most common side effects are feeling dissociated from one’s body, dizziness, nausea, sedation, vertigo, anxiety, increased blood pressure, vomiting and feeling drunk.

Learn More

If you’d like to learn more about SPRAVATO for treatment-resistant depression and esketamine- call us to set up an appointment at 713-426-3100. If you’d like a brochure click here.

Learn more about Spravato here.

Psychiatrist For Anxiety and Depression Houston

Psychiatrist For Anxiety and Depression Houston Shares Facts About Mental Illness

psychiatrist for Anxiety and depression

Research On Anxiety and Depression

Research on mental illness shows that mental illnesses are common in the United States.  According to the National Institute of Mental Health, tens of millions of people experience depression and anxiety each year. In fact, some research even suggests that mental illnesses are so common that almost everyone will develop at least one diagnosable mental disorder at some point in their life. However, estimates indicate that only half of those with mental illnesses receive treatment.

Facts About Anxiety Disorders

According to the World Health Organization (WHO), 1 in 13 people, globally, suffers from anxiety. The WHO reports that anxiety disorders are the most common mental disorders worldwide. Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year.

Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment.

People with anxiety disorders are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders.

Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

Feelings of anxiety can interfere with daily activities such as work performance, school, and relationships.

There are several different types of anxiety disorders such as social anxiety disorder, panic disorder, generalized anxiety disorder, and specific phobias.

Anxiety and Depression Can Occur Together

It is common for someone with an anxiety disorder to also suffer from depression and vice versa. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder. Accordingly, there is significant overlap in symptoms between anxiety and depression. Comorbid anxiety and depression are often more resistant to pharmacologic treatment, and patients with coexisting disorders have a poorer medical prognosis than do patients with either mental illness alone.

Facts About Depressive Disorders

Depression is believed to be the leading cause of disability worldwide. Almost 75% of people with mental disorders remain untreated in developing countries with almost 1 million people taking their lives each year.


Major Depressive Disorder (MDD)

Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15 to 44.3.  MDD affects more than 16.1 million American adults or about 6.7% of the U.S. population age 18 and older in a given year. While major depressive disorder can develop at any age, the median age at onset is 32.5 years old. Only 61.7% of adults with MDD are receiving treatment. The average age of onset is 31 years old. (Source: National Institute of Mental Health).

Depressive Disorders are more prevalent in women than in men.

Persistent depressive disorder or PDD, (formerly called dysthymia) is a form of depression that usually continues for at least two years.


Treatment Options

Anxiety and Depressive disorders are treatable, and the vast majority of people with these disorders can be helped with professional care. Several standard approaches and lifestyle changes have proved effective:

  • Therapy
  • Medication
  • Complementary and alternative treatment
  • Self-Help or Support Groups
  • Exercise
  • Diet
  • Stress-Management Techniques
  • Transcranial Magnetic Stimulation(TMS)*Note that TMS has been researched and shown effective for anxiety but it’s not FDA approved or covered by insurance for anything except Major Depression.


Get Help As Soon As Possible

It is crucial for those who experience depression and anxiety to seek treatment as soon as possible. Aggressive and professional management of depression, as untreated or inadequately treated patients are more likely to have negative medical consequences of their depression, including a substantial risk of suicide and longer, more treatment-resistant episodes of depression.

Fortunately, many new medications are available to help. The newer antidepressants, in particular, are playing an increasingly important role in the treatment of both depression and anxiety disorders alone as well as comorbid anxiety and depression.


The Challenge of Diagnosis

Thus, the challenge for clinicians is to make a quick and accurate diagnosis and then to ensure proper and effective treatment.

One reason it is essential to obtain a diagnosis from a medical professional is so they can rule out any medical issues that might be causing physical symptoms as we know that somatic complaints can affect an individual’s mood and emotional state. In conjunction with your primary care doctor, a psychiatrist for anxiety and depression can help rule out any physical causes of mental illness.

Our Psychiatrist For Anxiety and Depression Houston, Daniela White, MD, is located at Midtown Psychiatric and TMS Center, a mental health clinic located in Houston, Texas. All of the clinical staff at Midtown Psychiatry are caring and knowledgeable professionals who are committed to using the most up-to-date treatments for anxiety and depression and other mental health disorders. Give us a call at 713-426-3100 or visit our website at https://www.midtownpsychiatrytms.com to learn more.


References and further reading:






Can Magnets Really Help Depression? TMS Therapy Results

TMS Therapy and Depression Treatment

TMS and Depression Treatment

If you are suffering from major depression, you know that every day can seem difficult and hopeless. And you are not alone. The Latest Statistics on Major Depression from the National Institute of Mental Health(NIMH) in 2016 show that:

  • In the United States, an estimated 16.2 million adults in the United States had at least one major depressive episode. This number represents almost 7% of the United States population.
  • The prevalence of adults with a major depressive episode was highest among individuals aged 18-25 (10.9%).
  • The prevalence of major depressive episode was higher among adolescent females (19.4%) compared to males (6.4%).

Symptoms of Major Depressive Disorder

There are many different types of major depressive disorder. Each type can have a different cause, however, they all involve the same feeling of disinterest in activities you once enjoyed and feelings of hopelessness, sadness or anxiousness as well as other symptoms. See a mental health professional for a formal diagnosis, but to have a formal diagnosis of major depressive disorder you will need to experience a primarily depressed mood for two weeks or more, as well as other symptoms as outlined below.


Although the number and intensity of symptoms will vary for each individual, they are typically as follows:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment


Major Depression Can Cause Severe Impairment

In 2016, an estimated 10.3 million U.S. adults aged 18 or older had at least one major depressive episode with severe impairment. Severe impairment was indicated if their depression caused severe problems with their ability to manage at home, manage well at work, have relationships with others, or have a social life. Those adults who had major depression with severe impairment represented 4.3% of all U.S. adults.

For adolescents aged 12 to 17, approximately 9.0 percent had a Major Depressive Episode with severe impairment. Adolescents were defined as having a Major Depressive Episode with severe impairment if their depression caused severe problems with their ability to do chores at home, do well at work or school, get along with their family, or have a social life.


Depression Treatment Options

Common treatments for a major depressive episode may include antidepressants,  psychotherapy, exercise, TMS and electroconvulsive treatment (ECT). A prescribing psychiatrist can provide both psychotherapy services and prescribe antidepressants, which may differ for each person based on their individual considerations. However, ECT is generally avoided, except in extreme circumstances, in favor of both psychotherapy and antidepressants. ECT is generally avoided because the patient typically needs to be in the hospital and receive anesthesia. ECT may also cause some side effects, including confusion, disorientation, and memory loss. Unlike the TMS treatment that is noninvasive and done with the patient being awake, without any need for anesthesia.


Depression Treatment With TMS Therapy

What Is TMS Therapy?

tms machine depression treatmentTranscranial magnetic stimulation (TMS) is a non-invasive method for using a magnetic field to cause an electric current to flow in a small region of the brain via electromagnetic induction, which causes the excitation of neurons in the brain. During a TMS procedure, a magnetic field generator, or “coil”, is placed near the head of the person receiving the treatment. The neuron excitation is caused by the electric currents induced in the tissue by the rapidly alternating magnetic fields, a process called electromagnetic induction. The TMS machine triggers activity in the brain without applying electrodes on the brain and without surgery.


Who Is A Good Candidate For TMS?

A doctor can help decide if NeuroStar TMS Therapy is right for you. TMS Therapy has been approved for the treatment of Major Depressive Disorder in adult patients who have failed to receive satisfactory improvement from prior antidepressant medication in the current episode.

NeuroStar TMS Therapy is only available by prescription.


What Happens In A Typical TMS Procedure?

A typical TMS session lasts approximately 30-50 minutes and does not require anesthesia. Patients come to the office five times per week. The treatment goes on for six to eight weeks, for an average of 20-30 total treatments. The TMS treatment is time-intensive, but research shows it can provide long-lasting improvements.


What Happens During The TMS Procedure:

An electromagnetic coil is held against the forehead near an area of the brain that is thought to be involved in mood regulation.

Short electromagnetic pulses are administered through the coil. The magnetic pulses easily pass through the skull, and causes small electrical currents that stimulate nerve cells in the targeted brain region.

Generally, the person feels and hears a slight knocking or tapping on the head as the pulses are administered.


Side Effects of TMS

For those who experience side effects, the most common side effect they have reported is a headache and/or pain or discomfort (tenderness) on the scalp, at or near the treatment site. However, this is usually transient; it occurs typically during the TMS treatment course and does not occur for most patients after the first week of treatment. There is a rare risk of seizure associated with the use of NeuroStar TMS (less than 0.1% per patient).


Who Is Not A Candidate For TMS

NeuroStar TMS Therapy should not be used with patients who have non-removable conductive metal in or near the head. NeuroStar TMS Therapy has not been studied in patients who have not received prior antidepressant treatment.


How To Pay For TMS Therapy Treatment

Insurance Coverage For TMS Therapy

Insurance coverage for TMS is expanding due to the increasing recognition by the insurance companies of the effectiveness of TMS. In Texas, TMS treatment is covered by Blue Cross Blue Shield, Cigna, and Optum (formerly United Behavioral Health).

If you don’t have these carriers, TMS Therapy® may be covered by your health insurance provider on a case-by-case basis.  Currently, insurance coverage for the TMS procedure varies and individual carriers and plans may determine coverage on a case-by-case basis.

Most insurers will only cover members after they have tried 3 or 4 medications without success, although this may change in the future, as was seen with Medicare when they changed this approval to 1 failure of medication. Although anyone can pay for the treatment out of pocket. Research shows that taking fewer medications before TMS can reduce the number of side effects of these medications, and increase the success rate of the TMS treatment.


Success Rate Using TMS With Major Depression

Repetitive transcranial magnetic stimulation, known as rTMS, may produce long-lasting changes in electro-cortical function. According to researchers, the pulses are thought to increase blood flow and encourage the growth of connections between brain cells. TMS can also cause the release of the neurotransmitters dopamine, serotonin and norepinephrine, which are chemicals that help send signals between cells. The magnetic field is about the same strength as that of a magnetic resonance imaging (MRI) scan.

Midtown Psychiatry Experience With TMS

At Midtown Psychiatry and TMS Center, Dr White has been using TMS to help people with Major Depression since 2014. She has seen a success rate of  54% percent for patients who’ve tried TMS at her office that have seen improvements in their depression symptoms.

“For the people who do see an improvement, it can be life-changing, as many of those patients have suffered from Major Depression for years,” Dr. White says. The success stories of those helped using TMS can be seen in the note cards that Dr. White has posted on a bulletin board in her office.

The results Dr. White has seen in her office are similar to studies announced at the American Psychiatric Association meetings, which report that 53 percent of patients with medication-resistant depression who were treated with TMS reported no or mild depression following six weeks of treatment, according to results.

The TMS patients achieved better results than depressed patients who tried a different medication after failing to improve from past medication. Among patients trying a new medication, 38 percent saw improvements, according to study results.

However impressive the studies are, the studies and Dr. White caution that TMS does not work for everyone. In more serious cases of major depression, intensive outpatient treatment or hospitalization may be required.


TMS For Other Conditions

Research is ongoing into whether transcranial magnetic stimulation, or TMS, can help people with autism, schizophrenia, tinnitus, and a host of other conditions involving the brain. Although the FDA has approved TMS only for medication-resistant depression, the treatment has been approved in Europe for bipolar disorder, post-traumatic stress disorder, chronic pain, obsessive-compulsive disorder and adult ADHD, according to transcranialmagneticstimulation.com.


Integrative Treatment And Major Depression

Dr. White uses what she calls Integrative treatment, which, after a comprehensive evaluation, may include a combination of various therapeutic modalities such as relaxation, psychotherapy, yoga, medication, meditation, exercise, TMS therapy, nutritional supplementation, herbal medicine, vitamins, dietary changes, light therapy, and others. If you find yourself experiencing any of the symptoms of a major depressive disorder, you should seek assistance from a medical professional. Thankfully, in recent years, there is much less of a stigma for a major depressive disorder, and there is plenty of in-depth information available about depression online that you can discuss with your doctor.


What Our Patients Are Saying About TMS Treatment At Midtown Psychiatry

We have a bulletin board in our office which has note cards posted from people who have experienced TMS treatment in our Houston TMS Psychiatrist Office. Here are a few:

“As someone who has struggled with depression on and off my whole life and struggling with another long term episode I was excited to find a new treatment. After completing the TMS treatment I’ve been able to climb out of that depressive state and start doing the things I need to do to continue to enjoy my life. I would recommend the treatment.”

“My experience with TMS was very helpful. I went from being tired all day and not finding much pleasure in life to seeing hope for the future.”

“TMS help with my depression symptoms better than any medication ever has with no side effects. I would definitely recommend TMS to those suffering from depression and/or anxiety.”




You can hear from some of our patients as they discuss the real impact of TMS on their lives by watching Dr. White in a television video interview about TMS.


About Midtown Psychiatry & TMS Center

Midtown Psychiatry and TMS Center was created to provide the best possible mental health care available. With each patient, we strive to identify and treat the underlying causes of distress and symptoms of anxiety, depression, and other mental health issues. We work closely with patients and their families to create a treatment plan that addresses any imbalances we find. This may include addressing nutritional, lifestyle, and other core imbalances. Our treatment team, directed by Dr. Daniela White, MD, is dedicated to providing the best in diagnosis and treatment possible for a wide range of psychiatric issues, using an integrative treatment approach that improves the quality of life for our patients.

To that end, Midtown TMS and Psychiatry Center works in partnership with our patients and their families, advising them on options for treatment, such as psychotherapy, medication, TMS therapy, nutritional supplementation, vitamins, dietary changes, light therapy, yoga, meditation, exercise, herbal medicine, and others.

To learn more about TMS and our integrative treatment approach–make an appointment using the button or form on this page or call us directly at 713.426.3100.












The Best Treatment When You Have Both Anxiety and Depression

When To Get Help For Anxiety and Depression

Best Treatment When You Have Both Anxiety and Depression

Anxiety is a normal reaction to the stress and worry that is part of modern-day life. One can feel “stressed out,” nervous, or fearful, at times, given the demands of everyday life. If, however, it lasts for a long time or if it becomes severe, it could be suggestive of an underlying mental illness. Depression, on the other hand, can appear as sadness, hopelessness, and loss of interest in life. Some surveys show that 50% of those with anxiety also have depression, and a slightly greater number of those with depression have clinical symptoms of anxiety. The distinguishing attribute of these conditions is that they can last a long time and are likely to get worse if not treated.


Causes of Anxiety And Depression

Some people are more at risk of getting anxiety attacks, as well as depression. A history of either of the conditions in the family can predispose you to also be affected. Sometimes, anxiety is triggered by an event outside the control of the affected person. A terminal illness or death of a close friend or relative can cause a high level of anxiety and later, depression. Other situations like a serious illness, an accident, divorce, separation or drug abuse can also lead someone to experience anxiety and depression.

Clinical depression can be expressed in anxiety attacks. Continuous anxiety can also lead to depression. This has led some psychiatrists to view the two conditions as different sides of the same coin. With anxiety, one will live in fear of bad occurrences happening in the future; whether in an hour or year to come. Depression, in some cases, can manifest itself as a feeling of giving up because you do not think you can cope. This can sometimes lead to self-destructive behavior whose consequence could turn out tragic as in the case of suicide.


What Is Comorbidity?

Comorbidity refers to a situation where a person has both anxiety and depression. An example is persons suffering from Post-Traumatic Stress Disorder (PTSD) whose anxiety attacks could develop into depression.


Signs And Symptoms Of Anxiety And Depression

  • Unrelenting, irrational fear and worry
  • Insomnia
  • Erratic eating habits that could include bingeing and self-starvation
  • Memory difficulties, erratic decision-making, difficulties with attention
  • Feeling tense
  • Panic attacks
  • Constant fatigue and irritability
  • Loss of interest in social activity and hobbies
  • Sadness and feeling of loss of worth
  • Physical symptoms include headaches, rapid heartbeat, sweating, abdominal pain, and labored breathing


Because depression and anxiety are related conditions, the two conditions require a treatment regimen that addresses both. A suggested treatment often entails a combination of medication, exercise, therapy, relaxation techniques, and support groups.



A good number of people who come to see me have already tried a number of the non-medication alternatives and have not received enough relief from symptoms. Medication can be used to manage the symptoms of anxiety or depression. Often, the same drugs are used for both conditions. The main effect of the medication is to help you to relax and not feel so sad or anxious.

An experienced psychiatrist will prescribe the best pharmacological treatment in addition to the lifestyle changes recommended. Ruling out biological causes of the presentation, such as thyroid disorders, vitamin deficiencies, or inflammation should be part of an initial evaluation so they can be addressed as part of a comprehensive treatment. The pharmacological treatment requires frequent visits at least initially to determine what are the best options since there are different classes of agents that can be used in addressing anxiety and depressive symptoms. Some of the medications used to treat anxiety could be addictive and need consistent monitoring to detect early signs of developing tolerance. In that case, the psychiatrist will discuss further options for treatment.

Medication for both depression and anxiety symptoms include SSRI (selective serotonin reuptake inhibitor) and SNRI (serotonin-norepinephrine reuptake inhibitor). Your psychiatrist can review with you the advantages and possible side effects of various medications to come up with a treatment that is best for you.


Therapy For Anxiety And Depression

There are a number of treatments for these conditions. Interpersonal therapy improves your ability to relate to other people through developing your communication and other social skills. Problem-solving aims to give you the skills needed to handle your symptoms. Exposure therapy aims to have a person confront their fears by being exposed to the situations or people that trigger their anxiety attacks. This is done gradually so that you can develop coping mechanisms.
Cognitive behavioral therapy (CBT) involves the therapist helping you to change your thoughts and actions. By taking charge of your emotions, you are empowered to control your fears and anxieties since you learn to identify what causes them. The CBT approach is one of the best treatment options if performed well and in accordance with a set of procedures. People who get treated using this method are also less likely to relapse because of the sense of responsibility it develops.



It is well known that exercise leads to a change in your mood. It can also bolster your self-esteem and confidence, which in turn can have a positive impact on how you relate to others. Endorphins, the feel-good chemicals in the brain can be released by exercise. For this reason, mild to moderate depression can be impacted by the use of workouts. The best approach is to have a regular high energy exercise program. Joining a group or friends for exercise can also be beneficial in offering support and motivation.


Relaxation Techniques

Meditation is a good way to cope with anxiety attacks. Learning yoga and deep breathing can help one keep anxiety under control. Meditation can also help you to replace the images that cause your anxiety with more calming and self-soothing alternatives. Other people find repeating mantras (usually any repeated word or phrase) helpful in gaining more control of their response to anxiety. Mantras are sacred statements, sounds or group of words in Sanskrit that practitioners believe to bear spiritual and psychological powers.


Diet And Mental Illness

A healthy diet and a regular meal plan are important for your physical and mental health. Anxiety or depression can manifest in seeking comfort from eating. Eating any foods you like can activate the release of endorphins in the brain, and can lead to compulsive eating so it is important to be on a regular schedule and maintain a healthy diet. The other extreme is where depression makes you think that you look overweight and unattractive. If you have feelings of worthlessness, shame, and sadness directly coming before or after binges you may want to seek help and be evaluated for an eating disorder.


Get Support

Family and friends can be helpful in facing the challenges stemming from anxiety or depression. It can sometimes help to inform them of your condition if you feel they can offer support and encouragement. Some people also opt for support from the community, such as church groups, clubs. If your depression is linked to drug or alcohol addiction, groups such as the Alcoholics Anonymous can also provide support.

What You Can Do

Other than the assistance you receive from professionals, you can also carry out some activities to lessen your depression or anxiety. These could include:

    • De-cluttering your life and physical surroundings. This will help keep the feeling of being overwhelmed to a minimum.
    • Get involved in a purposeful activity. A purpose helps you focus your energies and can remove the hopelessness.
    • Set new achievable goals to keep your mind away from thoughts of failure. Create a plan that can be broken down into achievable steps.
    • Creative activity such as painting, writing, crafts, or even reading is also constructive and can improve your self-worth.

If you are experiencing any of the symptoms mentioned above we recommend you speak to your primary care doctor to rule out a medical condition and get a referral to a trained mental health professional. If you live in the Houston area and need any assistance, feel free to contact us at 713-426-3100.



How Anxiety and/or Depression Comes With ADHD

Comorbidity of ADHD and Anxiety or Depression

ADHD Depression

People often picture a person with ADHD as someone who is extremely hyperactive. They rarely picture someone who is anxious or depressed. However, a person who suffers from ADHD and anxiety and/or depression is a common scenario. Anxiety and depression are often comorbid with ADHD, which means they often occur in conjunction with ADHD. Adults with ADHD are mostly the ones who suffer from anxiety and/or depression simultaneously. The symptoms of ADHD in adults include:

• Impulsiveness
• Trouble listening and focusing
• Interrupting other people’s conversations or activities
• Excessive talking
• Restlessness
• Getting easily distracted
• Fidgeting
• Forgetfulness of important information
• Losing essential items
• Has a strong disdain of work, school, driving, or other activities that require extensive focus and sitting.

Diagnosing Anxiety and/or Depression with ADHD

Diagnosing someone who has ADHD with anxiety and/or depression can be complicated because anxiety and ADHD share many symptoms. When mental health professionals are questioning whether an ADHD patient is suffering from anxiety and/or depression in conjunction with ADHD, they need to consider two factors:
• Whether or not the patient’s symptoms are severe enough to be indicative of a coexisting disorder.
• Whether or not the patient’s symptoms will improve if treated for anxiety and depression.

Why Anxiety and Depression Tend to Be Comorbid with ADHD

The distress caused by ADHD symptoms can often lead to anxiety and depression. Though hyperactivity tends to cease once an ADHD sufferer reaches adulthood, many of the symptoms such as impulsiveness and trouble focusing linger if the ADHD is untreated or improperly treated, which will cause an ADHD sufferer to struggle with everyday life. An example of ADHD symptoms causing anxiety is a college-aged ADHD sufferer being anxious about their academic performance because he or she has trouble focusing on studying and has trouble remembering important details. An example of ADHD symptoms causing depression is an ADHD sufferer being depressed because he or she does not have any friends due to struggling with interrupting others and talking a mile a minute.

People can easily be misdiagnosed with ADHD when they actually have anxiety and/or depression because ADHD, anxiety, and, depression because of the similarity of the symptoms. In addition, anxiety and/or depression can give the illusion of a more severe form of ADHD. Once it is established that a patient has anxiety and/or depression that is comorbid with ADHD, it is possible that it will be discovered that his or her case of ADHD is not as severe as previously thought.

The Best Treatment for Anxiety and/or Depression that is Comorbid with ADHD

A mental health professional will take one of two approaches to treating anxiety and/or depression that is comorbid with ADHD, depending on the patient’s unique case:

• If the anxiety and/or depression is caused by ADHD symptoms, the mental health professional will focus on managing the ADHD before addressing the anxiety and/or depression.

• If the person was misdiagnosed with ADHD or the anxiety and/or depression significantly worsens the case of ADHD, the mental health professional will focus on managing the anxiety and/or depression first. If the person still has ADHD, the mental health professional will address the ADHD after the anxiety and/or depression is under control.
ADHD and anxiety treatment or ADHD and depression treatment can consist of a medication and other methods of treatment. The best treatment for comorbid ADHD and anxiety and/or depression is an integrative approach that combines medication and non-medication methods. Medication is helpful in the short-term while the person is learning non-medication methods to managing their ADHD, anxiety, and/or depression for the long-term. The different treatments for comorbid ADHD and anxiety and/or depression consist of:

• Medication (benzodiazepines, anti-depressants, serotonin, beta blockers, stimulants)
• Cognitive Behavioral Therapy (CBT)
• TMS Therapy
• Relaxation techniques (deep breathing, yoga, meditation, etc.)
• Hypnosis
• Journaling
• Identifying triggers
• Lifestyle changes (getting enough sleep, adhering to a schedule, diet, and exercise).

Proper Treatment is Key to Treating Comorbid ADHD and Anxiety and/or Depression

Mental health issues can be just as painful and serious as physical health issues. Living with ADHD by itself is a battle; therefore, living with comorbid ADHD and anxiety and/or depression is double the battle. Approximately eight million adults are living with ADHD in the United States of America. Sixty percent of those eight million adults have a comorbid condition, so sufferers of comorbid ADHD and anxiety and/or depression are not alone.

Proper ADHD and anxiety treatment or ADHD and depression treatment offer sufferers a chance of living a successful, fulfilling life. Effective treatment is the key to success, and effective treatment comes from an effective mental health professional. In addition, a strong support system of family and friends is helpful. Sufferers of comorbid ADHD and anxiety and/or depression are not different, less, or mentally ill; they simply have a struggle just like everyone else in the world. Recovery is possible for those struggling with comorbid ADHD and anxiety and/or depression.

Midtown Psychiatric and TMS center is a mental health clinic that is located in Houston, Texas. Our staff is a group of knowledgeable, caring individuals who are committed to using the best treatment for ADHD and other mental health disorders. Give us a call at 712-426-3100 or visit our website at https://www.midtownpsychiatrytms.com if you think we can help you.




Get Help For The Warning Signs Of Depression And Suicide In Children And Young Adults

Suicide Is The Number One Cause Of Death In Young People


Sadly, suicide is the number one cause of death in young people, 15-24 years old, and by 2020 depression will become the number one cause of disability worldwide. It should be noted that 1 in 5 teens will suffer from depression before they reach adulthood. And In 2014, around 15.7 million adults age 18 or older in the U.S.A had experienced at least one episode of major depression in the past year. This represented 6.7 percent of all American adults.

Communicate With Your Child Openly

It is a common belief that if you ask someone if they are considering suicide, you may actually instill that idea in them. However, it has been found that being open and unafraid of inquiring about it when somebody seems depressed might be the only way to get help, and therefore, be more likely to prevent suicide.

A Window Of Opportunity

In the mind of the patient suffering from depression, there is a window of opportunity that allows for intervention. It is during this time that a decision to do something to kill themselves has not been made yet. Teenagers, as we all know, have a more difficult time to talk about how they feel than adults. The most common answer to the question ‘how was your day?’ is typically ‘fine’. That is a normal response from a teenager who is preoccupied with his or her own developmental challenges. However, that should not discourage parents to ask questions which can create opportunities for a dialogue to occur. Just because your teen might signal that he or she does not want to talk about things that preoccupy them- does not mean that you, as a parent, must accept the notion that there is nothing to talk about.

Your Attitude About Psychiatric Treatment Makes A Difference

Before I review several signs that could alert parents that something more serious than normal development may be happening with their teen, I have to share some of my concerns about parents’ attitude with regard to psychiatric treatment.  More often than not, your child will mimic your attitude about mental illness, and model your understanding and acceptance of it. When you, as a parent, have been disparaging about people with mental illness and/or treatment of it, either denying its existence or denigrating those with mental illness who seek help as weak- do not be surprised to learn that your child might not be forthcoming with their feelings or concerns.

Young Adult Body And Mind Changes

Because young adults are still growing and developing, many teens and young adults do not have the language necessary to discuss their emotional states in words. Especially with their parents, teens are even more unlikely to talk about their insecurities or feelings for fear of being considered ‘crazy’, or ‘weak’ or ‘not worthy’ of your love.

Play It Safe-Take Your Child Seriously

Unfortunately, I see way too many parents who do not take seriously their children’s complaints of sadness, lack of interest, energy or extreme worries. These symptoms need to be evaluated by a professional to explore their seriousness so that, if needed, they can be addressed in treatment; either with medication, therapy, or both. Since parents are the decision makers in the administration of their children’s treatment- they need to keep in mind that they are not the ones who are directly experiencing the pain of depression, anxiety or other mental illness.

Resources That Can Help Your Child

A good resource for understanding when to become concerned about your teen is the ‘Facts For Families,’ guide which details the signs that could alert a parent about the possibility of a suicide. These are as follows:

  • change in eating and sleeping habits
  • withdrawal from friends, family, and regular activities
  • violent actions, rebellious behavior, or running away
  • drug and alcohol use
  • unusual neglect of personal appearance
  • marked personality change
  • persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork
  • frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc
  • loss of interest in pleasurable activities
  • not tolerating praise or rewards

As it is noted in the ‘Facts for Families’ guide, the above are also signs of depression and the parents should attempt to get help to prevent a suicide attempt by getting the teen or young adult to participate in a psychiatric consultation.

Other Signs To Look For In Your Child

There are some other changes to look for in your child that may signal imminent danger. These include teen or young adult communicating the following thoughts:

  • complain of being a bad person or feeling rotten inside
  • give verbal hints with statements such as: I won’t be a problem for you much longer, nothing matters, It’s no use, and I won’t see you again
  • put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc.
  • become suddenly cheerful after a period of depression
  • have signs of psychosis (hallucinations or bizarre thoughts)

There Is Hope If You Take Action

What is important to know, and to remember, is that depression is a treatable disorder, and so is suicidal ideation, as long as we act fast. As I mentioned above, we must act within the window of time that precedes the decision to move from suicidal ‘idea’ to ‘plan’.  As also previously stated, once the teen has made the decision to kill himself or herself, their mood usually lifts, becomes less obviously gloomy and more peaceful. This is not an unusual behavior for people, adults or teens alike, who shift their mindset from ‘contemplative’ or more ‘passive’ thoughts of death to an actual active plan for completion of the suicidal act. The bottom line here is that you don’t have to make this decision as to what is safe or not by yourself. It is better to err on the side of caution and discuss with your child the decision to have them evaluated, not as a punishment, but, as a way to help them sort out their thoughts and feelings and begin to find ways to make them feel better.





Same Sadness, So Why Different Types Of Depression?

If It’s The Same Sadness, Why Are There Different Types Of Depression?

And How Does This Affect Your Treatment?

By Daniela M. White, MD

 depression treatment houston


It Is The Same Illness, So Why Different Medications?

I’m sure that some of you wonder that after seeing your psychiatrist that you received a different medication than your friend, coworker, or even family member. You have many of the same complaints of feeling sad, lacking interest and the energy to do much, isolating, crying at the drop of a hat and having ruminating bad thoughts that sometimes life is not worth living. You appear to have the same feelings, the same complaints, but are receiving different treatments and sometimes, a different diagnosis. This article describes why this might be the case.
From the beginning, it is worth noting that feeling sad, and crying when something bad and unexpected happens is perfectly normal, and oftentimes is expected.  Feeling of sadness by themselves, does not result in a diagnosis of clinical depression, unless several conditions are met at the same time.


Different Types of Depression

Even if the criteria for clinical depression is met, there are different types of depression, and they need to be approached with different treatments to obtain a response and eventually remission.

Response, in clinical terms, means that the treatment provides some relief.

Remission means that the symptoms become absent.


What is The Commonality Within A Depression Diagnosis?

In all the different types of depression, sadness is the main complaint, usually associated with low self-esteem, sometimes irritability and difficulties enjoying life and increased tendency to cry very easily. However, there are differences in duration, intensity and severity as well as the way these episodes are triggered that make the diagnosis and therefore treatment, different.

According to the Mayo Clinic, to get a diagnosis of clinical depression, one must meet the symptom criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association. The DSM is also used by mental health providers to provide a diagnosis of mental health conditions and by insurance companies to provide reimbursement for mental health treatment.

To get a diagnosis of clinical depression, you must have five or more of the following symptoms over a two-week period, most of the day, and nearly every day. At least one of the symptoms must be either a depressed mood or a loss of pleasure or interest. Signs and symptoms may include the following:

  • Depressed mood, such as feeling sad, empty or tearful (in children and teens, depressed mood can appear as constant irritability)
  • Feelings of worthlessness, or excessive or inappropriate guilt
  • Fatigue or loss of energy
  • Significantly reduced interest or feeling no pleasure in all or most activities
  • Insomnia or increased desire to sleep
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected)
  • Either restlessness or slowed behavior that can be observed by others
  • Trouble making decisions, or trouble thinking or concentrating
  • Recurrent thoughts of death or suicide, or a suicide attempt

For a diagnosis of clinical depression, your symptoms must be severe enough to cause noticeable problems in relationships with others, or interfere with your day-to-day activities, such as school, work, or social activities. Symptoms may be based on your own feelings, or on the observations of someone else.

Clinical depression can affect people of all ages, including children. However, clinical depression symptoms, even if they are severe, can usually get better with counseling, antidepressant medications or a combination of the two.


Types of Depression Diagnoses

The following list of diagnoses that most mental health clinicians might choose from when determining a diagnosis. The diagnosis is important because proper treatment depends on an accurate diagnosis:

  • Persistent Depressive Disorder (or dysthymia): 
  • Major Depressive Disorder, unipolar
  • Bipolar disorder, Depressed (bipolar disorder I, II and cyclothymia
  • Postpartum Depression
  • Premenstrual Dysphoric Disorder
  • Adjustment Disorder with depressive symptoms
  • Bereavement
  • Depression secondary to medical conditions
  • Substance Induced Depression

As an example of the difference between two types of depression, a lot of times people who have bipolar disorder spend most of their sick time depressed and not hypomanic, or in a state of elation. However, the treatment for a depressed episode of a bipolar disorder is typically a mood stabilizer and not an antidepressant that might make symptoms worse.  Having one episode of mania or hypomania, indicates a diagnosis of bipolar disorder and the treatment should focus on that, avoiding as much as possible an antidepressant without a mood stabilizer to start with.


How To Get The Most Out Of An Appointment With Your Care Provider

The best thing that a patient can do is to be as open as possible during the psychiatric evaluation and be willing to work with your doctor without leaving information out that might be essential not only in treating the symptoms but to avoid causing new ones.


Diagnoses Can Change Over Time

It is also worth remembering that your initial diagnosis is a working one that can evolve over time as more clinical information becomes available from the sessions. It is also important to see your psychiatrist often before the diagnosis is fully defined and until remission is achieved.


See Your Doctor And Psychiatrist Regularly, Even If You Are Feeling Better

Your primary health care and mental health care should be given in a coordinated manner. That is to say, your primary care doctor and mental health provider should be aware of the care the other is providing.  If you haven’t already done so, and you are feeling sad or depressed, we recommend that you first speak with your primary care doctor and get a complete physical exam. The goal of the physical exam would be to try and rule out a physical cause for your depression. During the physical exam, the doctor typically will focus on the most likely causes of depression, the endocrine and neurological systems of your body. The doctor will look for any health concerns that may be contributing to clinical depression symptoms. For example, hypothyroidism is typically caused by an under-active thyroid gland. The under-active thyroid is the most common medical condition that is associated with symptoms of depression. Other endocrine disorders that are associated with depression include hyperthyroidism, caused by an overactive thyroid, and Cushing’s disease, which is a disorder of the adrenal gland. Oftentimes, treating these issues can alleviate symptoms of depression. Also, your doctor might look at other medications that you are taking to see if any of the side effects include depression.

Not seeing your treating physician and mental health care provider regularly can leave side effects unaddressed or allow symptoms to progress or worsen.


Monotherapy Vs. Combination Drug Therapy

There are multiple medications and therapies now available. In psychiatry for bringing mental illness to remission, and it is not uncommon to try several medications before finding one or more that are effective. Combination drug therapy is a type of treatment that many doctors and psychiatrists have been increasingly utilizing during the past decade, especially for Major Depressive Disorder, where there is some research to suggest that taking antidepressants from multiple classes may be the best way to treat Major Depression.



Combination of Antidepressant Medications From Treatment Initiation for Major Depressive Disorder: A Double-Blind Randomized Study   Pierre Blier, M.D., Ph.D., Herbert E. Ward, M.D., Philippe Tremblay, M.D., Louise Laberge, M.D., Chantal Hébert, R.N., and Richard Bergeron, M.D., Ph.D.  March 1, 2010, American Journal of Psychiatry March 2010, Vol. 167, No. 3, pp. 281 – 288


http://www.webmd.com/depression/guide/depression-tests – 1

Can Antioxidants Help Treat Depression and Anxiety?

Antioxidants Depression and Anxiety

When it comes to stress-induced psychiatric disorders, anxiety and depression are the most common. I see this often in my practice. We know that stressful life events can produce a state of vulnerability to depression and anxiety in some people. The mechanisms that contribute to vulnerability of mental illness is an area which needs further study. Although promising research has been done in the past few years that indicates that there are biochemical changes that occur in the body as a result of stress that can be addressed.  For patients suffering from stress-induced psychiatric disorders, it is essential to understand the role of antioxidants on stress-induced psychiatric disorders so a plan can be created and implemented to help cope with the effects of stress.


Stress and Nutrition

Research has shown that stress places a demand on the body in terms of nutrition. During a period of stress, it has been discovered that there is an increase in adrenal production and mobilization. There is also an increase in vitamins and minerals, such as vitamin C, vitamin E, magnesium, potassium, and micronutrients, This further accelerates the metabolism of proteins, fats, and carbohydrates which produces quick energy that is needed to overcome the stress response.


Antioxidants and Stress

To combat the biochemical changes which occur as a result of stress, there is something researchers call “antioxidant defence” in the biological system. The research on this states that “primary defence is by enzymatic antioxidants such as superoxide dimutase, glutathione peroxidase, catalase, nicotanamide adenine diphosphate, glutathione transferase and glutathione reductase, while secondary defence is by the non-enzymatic antioxidants such as vitamin E (alphatocopherol), vitamin C (ascorbic acid), β-carotene, minerals, and trace elements like zinc.” This indicates that stress and vitamins are related and we need to replace any vitamins that are depleted in order to maintain healthy functioning.


What Are Antioxidants?

The term “antioxidant” was originally used to refer to a chemical which prevented the consumption of oxygen. We now use the term “antioxidant” to describe small molecules that interact with free radicals and neutralize them ensuring proper function of all physiological functions of the body. Free radicals and oxidants can play a dual role as both beneficial as well as toxic compounds. As such, they can either have a helpful or harmful effect on the body. Free radicals are continuously generated by our bodies through internal processes, exposure to different external pathogens or stress. The best sources of antioxidants come from richly colored fruits and vegetables. Different colors characterize different types of antioxidants.


Green Vegetables

Brightly colored green vegetables such as kale, broccoli, peas, zucchini celery, collard greens, asparagus, Brussel sprouts, and spinach are rich in lutein and zeaxanthin, antioxidant nutrients deposited in the retinas of your eyes. It is believed that eating an adequate amount of these green vegetables can help prevent the vision loss caused by macular degeneration.

The cabbage family is rich in B vitamins, needed to properly convert glucose to ATP.


Yellow and Orange Vegetables and Fruits

Carotenoids are yellow and orange vegetables and fruit, such as butternut squash, carrots, pumpkin, yellow and orange bell peppers, and sweet potatoes. The body converts carotenoids to the nutrient vitamin A which benefits your skin, bones, immune system, vision, bones, and heart.


Red Vegetables

Red vegetables also contain flavonoids called anthocyanins, which have properties of antioxidants and may help your memory, boost immunity, protect urinary tract and reduce your risk of disease. These include vegetables such as radishes, beets, red onions, and tomatoes. Many foods with natural red pigments also contain lycopene, which is an antioxidant phytonutrient which may help protect against cancer of the prostate.


Purple and Blue Vegetables

Purple and blue vegetables such as purple cabbage, purple onions, eggplant, purple peppers, and purple potatoes contain phenolic flavanoids and ellagic acid which are anti-inflammatory compounds. Eating these color vegetables may improve cognitive function, prevent some types of cancer, and reduce your risk of cardiovascular disease.


Oxidative Stress, Free Radicals and Illness

Researchers believe that a balance must be maintained between free radicals and antioxidants within the body for healthy functioning. If this balance is not maintained, the free radicals may exceed the body’s ability to neutralize them, which can change different proteins, molecules, DNA, lipids, and carbohydrates, resulting in illness. Antioxidants must be present in the body in order to stabilize the reaction by-products (free radicals), otherwise, it is believed that they damage the cellular tissue.

We get these needed antioxidants from our food. We know that if we eat a diet which is lacking proper nutrients our mitochondria cannot properly process glucose. This results in free radical by-products which can cause ongoing damage to cells and proteins. This, in turn, may accelerate the aging process, increase the risk of auto-immune diseases, degenerative diseases, cancer, and other illnesses.

The term of oxidative stress refers to this imbalance between the free radicals that become excessive to the antioxidants defenses, resulting in molecular changes and eventually illness.


Oxidative Stress and Mental Health

Oxidative stress has been shown to be an important contributor to inflammatory conditions, and in recent years has been implicated in the underlying mechanisms that result in depression and anxiety. One of the proposed pathway in developing depression has been the increased oxidative stress which pairs up with inflammatory mechanism leading to cellular aging, and possibly depression and anxiety. Studies that look at the common factors that underlie depression, cellular aging, cancer and dementing illnesses seem to find the oxidative stress a common denominator.


Alternative Treatment and Depression

There is an ongoing research in finding “out of the box” modalities to help in the treatment of depression, and most of the alternatives to the traditional pharmacological treatment try to address the inflammation through moderate exercise and a noninflammatory diet. A diet that has anti-inflammatory properties is rich in flavonoids or  ‘nutraceuticals. ’  These seem to have good antioxidative properties, and are primarily found in brightly-colored fruits and vegetables. Others kinds are also found in food, the vitamins such as vitamin C (ascorbic acid), Vitamin E (tocopherols), or B carotenes.


Research On Antioxidants, Anxiety and Depression

In a study exploring the role of antioxidants in generalized anxiety disorder (GAD) and depression, it was observed that patients with GAD and depression had significantly lower levels of vitamins A, C, and E in comparison to healthy controls. The study results reported that after dietary supplementation of these vitamins for a period of 6 weeks, a significant reduction in anxiety and depression scores of patients was observed (P<0.001). A significant increase in the blood levels of antioxidants was observed in patients (P<0.05) except that of vitamin E in the group of depressed patients.


The Reality of Diets

We know that while the amount of antioxidants needed could be obtained through good nutrition, it would be necessary to eat between 6-10 servings of fruits and or vegetables daily. Oftentimes, that is not possible.  Therefore, we recommend supplementing with good multivitamin/antioxidants called nutraceuticals which gives you a better chance of ensuring that you are getting enough antioxidants and helps with good absorption and bioavailability.


Diet and Illness

Although further study on the effects of nutrition is needed to maximize the potential of nutrition on health, the research, to date, demonstrates clearly that diet can play a huge role in preventing or ameliorating illness. As can be seen from the research detailed above- having a diet rich in different colored vegetables, and supplementing with nutraceuticals can be a great start in getting the antioxidants your body needs.


Below is a list of references that can help you in your journey to feeling good both physically and mentally.  Click here to schedule a mental health consultation.



Role of antioxidants in generalised anxiety disorder and depression.

Gautam M, Agrawal M, Gautam M, Sharma P, Gautam AS, Gautam S.
Indian J Psychiatry. 2012 Jul;54(3):244-7.


“Minding My Mitochondria: How I overcame secondary progressive multiple sclerosis” By Terry Wahls, MD


Dr Wahls’ super-nutrient paleo diet, that reversed her Multiple Sclerosis


Phytochemical and Pharmacological Profile: A Review. … Lobo, V., A. Patil, A. Phatak, and N. Chandra. 2010. “Free Radicals, Antioxidants and Functional Foods: Impact on Human Health.” Pharmacognosy Reviews 4 (8): 118–126.


Free radicals, antioxidants in disease and health.

Pham-Huy LA1, He H, Pham-Huy C.
Int J Biomed Sci. 2008 Jun;4(2):89-96.


Depressive and Anxiety Disorders Showing Robust, but Non-Dynamic, 6-Year Longitudinal Association With Short Leukocyte Telomere Length.

Verhoeven JE1, van Oppen P1, Révész D1, Wolkowitz OM1, Penninx BW1.
Am J Psychiatry. 2016 Jun 1;173(6):617-24. doi: 10.1176/appi.ajp.2015.15070887. Epub 2016 Mar 4.


Psychiatrist for Depression Treatment

Psychiatrist for Depression Treatment Houston


Are You Feeling Anxious, Depressed or Struggling with Low Self-Esteem?

Feeling sad, discouraged, down, or irritable?

Life does not have to feel this bad.

At Midtown Psychiatry and TMS, we specialize in helping people manage their depression and get back their peace of mind.

Get the Right Help to Feel Better

We offer a free Phone Consultation

If you need a Psychiatrist for Depression Treatment Houston Psychiatrist Daniela White should be on the top of your list. She cares and offers the latest depression treatment.

Her integrative treatment model offer a wide range of holistic treatment options including medication and non-medication related choices.

Depression can affect all areas of your life and can really limit your potential and relationships- so we encourage you to get help right away to get things back on track.

Modern Depression treatment methods can be very effective in helping people feel more in control of their life and feelings.

Learn more about How to Cope with Depression

Call today for an appointment at 713.426.3100.


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.