NO MORE SHOPPING MY WAY THROUGH LIFE!!!

One of my dear patients today described for me how she feels when she goes shopping. "Lonely," she said, "that's how I feel. I feel there is a whole in my heart that I need to fill. I have been trying to fill it with 'things' that I can buy for years. It doesn't work. Ten minutes after I get home, take the new clothes' tags and hang them in the closet, the happiness that buying them has given me, has already evaporated. The hole in my heart is still there, gaping at me once more. Then, there is this griping guilt taking over me, that I spent way too much money, and for nothing. I will have to watch the mailman again to intercept the bill before my husband sees it."

It's just like someone who is thirsty but has only food and no water. No matter how much food he eats, he will never be satisfied because it isn't the food that he needs. So it goes with using shopping for happiness.

Talking in more detail with her about her shopping "obsession," we both realized that it isn't an obsession at all. She feels the urge to shop only when she is alone without much to do. Being alone makes her feel unloved. Not having something to do makes her feel useless. So it's beginning to look more and more like an escape from loneliness and meaningless activities.

I know she is very talented in decorating her house. She has showed me pictures and she often told me how her friends admired her taste. I asked if she would consider taking a class in interior design. It would give her something meaningful to do, with other people and it will feel natural to her because she has this natural ability to decorate. She thought about it and seemed excited for a moment. Then she turned down the idea. "I am terrified to start something new" she said sadly, "Ever since I was in school I couldn't take any initiative on my own. Even is I try to do something, I come very close then I run in the opposite direction."

I told her we can work out a plan for that, and following that plan, she will be able to take the class if she wanted to. She is to think about it, do the research and sign up for it and then we'll meet in few days to discuss and implement the rest of the plan.

My patient then, inspired by our dicussion, held her head high and declared: "I refuse to shop my way through life! I will find that class and sign up for it, but you better come up with an awfully good plan to do it because the whole idea still scares me to death."

(To be continued)

HEALTHY CHOICE 1: Use your vacation days

Perhaps you didn't know, I too found this out very recently, that the United States is the only industrialized country where it is not illegal not to use your vacation every year. In all other industrialized countries, not only it is illegal not to take a vacation a year, but there their vacations are much longer compare to ours. They are taking about a month in the summer and two weeks in the winter minimum. Many well documented research studies have shown that people who take a vacation every year live longer, have less incidence of hypertension, anxiety and depression and keep their weight better under control.

To get all these healthy benefits from your vacation is not absolutely necessary to go to far away places, although that would be more exciting, but creative recession driven people have come up with creative ideas to have fun while staying at home on your vacation. It's called "staycation" and it is all the rage.

The fact is, it doesn't matter what you do on your vacation/staycation, as long as you are able to disconect: from the work e-mail, from your boss and co-workers, from the annoying things you normally do everyday. Change the pattern, wake up late, take a hike, explore the parks and the museums you have never visited because they are in your own city, and have as much fun as you can. Doctor's orders!!!

That "prevention is better than the cure" is also true for mental health

According to a new report from the Institute of Medicine who did a nation wide study on the fact that the prevention of an emotional crisis is possible for children and adolescents if their emotional environment is improved. This is true, by extension, for adults as well: if you know how to handle stress, make healthy choices, eliminate toxic people from your life, etc., you are working not only on having a better life, but also on preventing an episode of anxiety or depression.

But making healthy choices implies you know what works for you and you also know what kind of animal this "healthy choice" is. For example, it is healthy to sit back, take a deep breath for few times and allow your thoughts to go free. When you have a tense day at the office and you find yourself frantically flying from task to task completely overwhelmed and able to accomplish nothing, this would be precisely a good time to try this simple "healthy choice". You will see that in less than 20 seconds, you feel more relaxed and when you get back to work, you will be able to take things one at the time and be more efficient.

WHAT ROLE DOES MEDICATION PLAY WHEN USING BETTER THAN CURED

The psychiatric medications do work. The way in which they are used is responsible for the side effects and negative reactions from the patients, as well as for the successes. Used carefully, they can truly change people’s lives. But using them carefully and correctly requires creativity, knowledge and a good communication between the patient and the psychiatrist.

Better than Cured has a unique way of addressing this relationship. The patients are not, or should not be, passive recipients of the psychiatric medication. The communication between the doctor and the patient needs to flow in both directions openly and trustingly. As a psychiatrist, I have the duty to explain to my patients why I believe a medication would be better than another for their particular form of depression. I have the duty to educate them about the medication’s benefits and its possible side effects.

But ultimately, it is the patient himself who must choose the medication he feels most comfortable with. As a physician, I am committed to give my patient support and up-to-date information. But my patient has to commit to working with me as a team, giving me the feedback I need in order to help him to the best of my abilities. Usually the dose of the medication needs to be adjusted or even changed and tailored to fit each patient’s needs. My patient is the barometer I need in order to know how to make these changes.
Not surprisingly, shortly after I started involving my patients in choosing their own treatment path, I realized how much they liked this model. They did not feel overwhelmed or flooded with information as some of my psychiatrist colleagues feared. Just the opposite happened. The patients were very interested in asking questions about how the antidepressants work and welcomed feeling empowered and actively involved their own treatment and healing process.
One common fear patients have in using the psychiatric medication is that “it will transform me into a zombie.” I am often called in for a second opinion consultation for patients for whom “nothing works.” From my experience, this can happen when the medication dose is too high for that patient, when it is not the right medication or when the diagnosis is incorrect all together.
If there is a problem with the medication, it can be troubleshot. There is no need for patients to suffer major inconveniences due to the medication, in addition to their original problem—depression. And depression is treatable. I think the readers need to understand these issues, so they will not shy away from using options available to them, only because they are not well enough informed.

Medication plus Therapy

Less than 50% of psychiatrists nationwide provide combined treatment, psychotherapy and psychiatric medication, according to the American Psychiatric Association.
Intuitively, it only makes sense that the combined treatment has superior results than either component by itself. Still, no formal research study has been able to demonstrate this concept.
Why? Perhaps because it is very difficult to quantify the effect of the “human element.” It’s like trying to measure happiness. The scientific world does not yet have adequate means to do it. On average, it takes about 10 to 15 years for a clinical fact to be proven by formal research. The readers in need should try therapy in combination with medication to improve their outcome.

This can be done by finding a psychiatrist that does both, or by working with a psychiatrist and a psychotherapist. I have often seen how beneficial it is for patients to have a therapist with whom they can “talk through” their problems, while the medication treatment eases the intensity of the worse depressive symptoms—hopelessness, helplessness, insomnia, etc.
All psychiatrists or psychotherapists are not created equal. If the mental health provider’s personality or practicing style is not congruent with the patient’s personality, the patient would be better served to work with another mental health provider with whom that the patient feels more compatible.

The simple truth is that all of us, patients, doctors and the public at large can work together to limit the damage depression causes to people’s lives. Depression is not only a treatable condition, but it is also preventable.

HOW DOES BETTER THAN CURED WORK?

The three components of Better than Cured, psychotherapy, psychiatric medication and life coaching, play different roles.
Psychotherapy includes replacing old patterns that have caused problems in the past with new behaviors; looking at the world with less fear and more courage; taking apart painful situations and ill-advised decisions of the past to learn from them so as to adopt healthier thinking and attitudes based on newly found confidence, knowledge and wellness. One exercise I often do with my patients is reframing the problem by creating a paradigm shift. For example, I suggest they watch financial guru Suze Orman’s shows and substitute the word “emotions” for the word “finances.” This gives them a crash course in how to avoid an emotional crisis, not just a financial one. Here’s how this may work. Orman talks about how to build financial (emotional) capital, how to make good choices with your finances (emotions), how to look at the financial (emotional) environment to make the best decisions which will influence their short and long term financial (emotional) health.
The “manage finances: manage emotions” analogy is just one example of reframing. Finding that “angle,” weighing various choices and mapping out steps to solve even the most complicated emotional predicaments, usually shift my patients’ psyches from passivity to action, from powerlessness to a sense of control. Approaching life’s challenges logically implies a new way of thinking and a more progressive, imaginative, and open frame of mind. This is what Better than Cured method provides.
People who have mild to moderate depression and/or anxiety may be able to use therapy to improve their lives without the additional help of anti-depressants or anti-anxiety medications. However, those who experience more severe depression—a deep sense of hopelessness, helplessness and lethargy--may not be able to heal using therapy alone. In addition, those who suffer from severe panic attacks, inescapable obsessions and compulsions and other paralyzing irrational fears need more help to get over the hump. That is where medication can play an important role in healing. Once these symptoms begin to improve with a carefully modulated program of medication, the life-coaching work begins.
And, once the symptoms of depression and anxiety are significantly improved, people realize they can ask much more from life. The old barriers—guilt, shame, depression, anxiety—have fallen as if a sculptor had chiseled them away. A newly empowered self emerges. Now patients realize that they can do so much more with their lives. The next step is developing strategies for them to become the person they were meant to be. This involves life-coaching: the establishment of long and short-term goals and pursuing them with a step-by-step strategy that’s developed in partnership with the patient. The Better than Cured method nurtures in people qualities buried deep within them--so deep, they’d forgotten they had them--qualities like courage, enthusiasm, initiative, playfulness, endurance and joie de vivre--thus placing them on a sure track to happiness.