Tag:

mental health

Personal Independence Day

{Malibu, California}

I recall previous 4th of July holidays spent working in the hospital, or on-call with my pager held tight as I nibbled on barbecue anxiously anticipating a flurry of calls regarding the behavioral management of alcohol-intoxicated patients. This year, however, I am free from the responsibility of being on call, free from the hospital, free from clinic, but NOT free from the mentality that I SHOULD be productive and get items A-Z done on my to-do list. Doctors tend to be perfectionists, overly self-critical, driven, competitive, which usually means that putting their “workaholic” tendencies aside in order to relax can be quite difficult. Well, at least that’s how I feel, but I’m working on it.

So, today after 12pm I intend on putting my computer, to-do list, and anything work-related aside for the sake of my own health and sanity. I think it’s about time to enjoy the traditions of this historic event in America, especially since barbecue and the beach sound far more appealing than doing paperwork and organizing my house.

Thought of the Day: Any other workaholics with me on this? Do you allow yourself to put work aside during holiday weekends?

July 4, 2015 9 comments

Medicine Psychiatry

The Drug Rep Dilemma

written by freudandfashion

I attend pharmaceutical dinners every once in awhile because: 1) I like to stay up to date with all the new drugs (or just a slightly modified version of the generic, but with a much fancier name and packaging); 2) Though I’m several years out of med school/residency, one thing I have maintained from those formative years is the mentality where I’d never pass up a free meal. I know that pharmaceutical sales representatives (also known as drug reps) have been banned and limited in several institutions, and I completely understand the reasoning (it has been shown that drug reps’ marketing tactics influence physicians to write prescriptions they typically would not write, thus boosting pharmaceutical sales). However, I also think it’s important for physicians to be self-aware of their existence and influence in order to make conscious decisions on their own.

A few months ago, I attended a pharmaceutical dinner sponsored by the manufacturer of one of the newest psychiatric medications. These dinners always feature a physician, who describes the medication (the pharmacology, indications, side effects, etc), explains the existing research in support of the medication, and leads a discussion and answers clinical questions. My initial impression of the night’s presenting physician: charming, and since his introduction boasts the research he conducts at a prestigious university, he must be highly reputable and intelligent. But, as his talk progressed, I realized how narcissistic and full of sh** he was. I sat in the very front, yet chuckled to myself and assumed every other clinician in this room picked up on his suave, yet unconvincing tactics. I mean, who was this guy trying to fool by flaunting his European accent and stories of trips around the world??

However, I looked around the room and the entire audience of doctors and other clinicians were laughing and smiling in awe. I tried to hide my disdain and cringing facial expressions, but I sat at the very front of the room, so I’m sure others noticed. Or maybe not…I mean, everyone in the room was mesmerized by this guy! I figured that I should refocus my thoughts and give him another chance and caught up just in time to hear about his trip to Europe. I shook my head and thought to myself, “wow, can you believe this guy? And he gets paid tons of money to attend this dinner and talk about himself?” I smirked and assumed his current, pointless story-telling (aren’t we supposed to be discussing the medication?) would be convincing enough to prove his bullsh**, fake persona, so I turned to look at the audience assuming others would catch on. Still, all smiles.

At the end of the dinner, I found myself in a dilemma as I had to pass this man on my way out as I left the dining room. I contemplated whether I should act just as fake as his schmoozing and say something along the lines of “hey, great presentation” or should I challenge some of the comments he made? I settled for a more neutral comment and told him “thanks, you are very entertaining” as I shook his hand and smiled.

Then, I realized at that very moment I became just like everyone else in the audience who commended and complimented him. For a temporary, quick second I even contemplated prescribing the medication. The thought of prescribing the medication was short-lived, for, after I left the restaurant, I snapped out of it and wished I gave him a piece of my mind.

I thought, “oh well, instead I’ll just stick with my guns and won’t be overly influenced to prescribe the med, unless clinically indicated.” (I’d never deprive my patients of a medication that might possibly help). I now realize even more why pharmaceutical companies used to frequently provide fancy trips, extravagant dinners, and expensive novelties before policies/rules became more stringent. The speakers and drug reps can be quite hypnotic and mesmerizing, but it’s our duty not to be fooled by any marketing tactics.

Or have I already been swayed?

July 2, 2015 11 comments

Personal

Brighter Days

written by freudandfashion

{Napa, California}

I am so appreciative of the supportive comments I received after sharing my personal experience of physician burnout. I’ve had similar experiences, especially during medical school and residency, but never felt comfortable enough to share until recently. In my practice, I work with so many patients who suppress their emotions. I identify with them wholeheartedly because I am just like them. During residency, I made excuses to avoid meetings with my supervisors because rather than discuss patient cases, the meetings would somehow turn into therapy sessions where I’d cry and feel embarrassed for exposing my vulnerabilities. At the time, suppression and isolation were the only ways I knew how to cope, but it’s a pattern I am actively trying to break ever since I started seeing a psychotherapist during my fourth year of residency.

A common phrase that I mention to my patients (which was told to me by my amazing sister, who is a marriage and family therapist) is that “if you suppress yourself, you depress yourself.” We all suppress ourselves to some degree, but once able to overcome the barriers {our own internal barriers (i.e. cultural, self-criticism, etc), in addition to external barriers (such as the immense pressures and expectations placed on physicians)}, then we have a better chance at achieving wellness and exerting more control in our lives and our careers.

June 27, 2015 6 comments

Medicine Psychiatry

Out of Isolation

written by freudandfashion

{Calistoga, California}

I noticed that my latest posts convey far less emotion than usual. My reserve for tolerating stress had reached maximum capacity, which I realized upon my first day back at work from vacation three weeks ago as exhaustion immediately erased any sense of relaxation from my trip. Perhaps I should have requested two weeks off instead of one? Either way, I’ve felt numb in the past (as I wrote in previous posts), but my current state of numbness also included fatigue and the need for multiple naps throughout the day. At first, I blamed my tiredness on multiple potential causes (overexerting myself during workouts, not eating enough, lack of sleep). I returned to clinic with a massive inbox full of emails, prescription refill requests, and patient messages, but the one message that impacted me the most was a note documenting that one of my patients (whom I least expected to have a suicide attempt) was in the psychiatric hospital due to an attempted suicide by overdose. Normally, I’d breathe a sigh of relief knowing that my patient was alive, safe, and receiving care in a secure environment, however, something triggered me at that moment to feel even more anxious than usual, which led to a massive headache. Did I develop a headache because my mind can’t tolerate the thought of experiencing even more patient loss and grief?

Fatigue continued to hit me on a daily basis. And how ironic that I recently wrote a blog post on tiredness and neither of the reasons I listed seemed to fit my case. However, I neglected two important, plausible causes (one that I even listed in my post) — Burnout & Depression. One of my closest friends asked if I might be depressed and I quickly replied, “no, I just need to eat better.”

I thought to myself, “How can I be depressed? I make a good living, I chose to enter this field, people respect me and tell me I’m a great doctor, I have amazing family and friends…”

Yet, after fighting the idea that I may in fact be burned out and depressed, I became more accepting and relieved at finally pinpointing the cause — yes, I was burned out and depressed. I was experiencing loss of interest, fatigue, poor concentration, lack of motivation, and increased naps during the day. How dumb of me not recognize the signs, especially since I’m a psychiatrist??? (Depression obviously impacts cognitive abilities as well)

Later that day, I randomly thought of one of my patients whom I haven’t seen in clinic for quite some time. He missed his last two appointments with me and never returned follow-up calls. I quickly searched for his name and confirmed my biggest fear once I saw the word “obituary” next to his name. Tears filled my eyes, which led to uncontrollable sobbing. I seriously wanted to quit my job that very moment.

My attempt at self-care and setting healthy boundaries:

Whereas in the past, I would’ve dealt with the news by isolating, throwing myself into work as a form of distraction, or having several glasses of wine once I came home, I knew that I’d eventually hit rock bottom unless I sought help from others. I reached out to my close friends, sought support from my clinic manager, opened up about my issues in my therapy group, and talked to other staff members who knew my deceased patient. I allowed myself to cry rather than holding in the tears.

Feelings of detachment had also replaced my propensity to engage with others, which made practicing psychiatry and being fully present for my patients much harder. I scheduled a trip to visit my family in northern California for Father’s Day because I knew that visiting home would alleviate my detachment and make me feel like myself again. Also, in further effort to prioritize self-care, I requested a two-week long vacation in the following month because I knew that more time off was necessary to fully recover my emotions, energy, and drive.

Why am I sharing my experience? We may read research, statistics, and articles about physician burnout, yet the majority of people in the medical field still do not feel open nor comfortable enough to share due to fear of stigma, criticism, and feelings of guilt and shame. A part of me even feels somewhat embarrassed posting this, but if someone out there can identify with my experience, then why not share? Physician burnout is more common among physicians than other workers in the United States and has been linked with the following: negative impact on patient care, more likely medical errors, depression, and increased risk of suicide among physicians and medical students.

Staying silent about our struggles and trying to cope on our own does not solve the problem, especially since the rate of physician burnout is on the rise. If we can’t advocate and stand up for ourselves, then who will?

June 25, 2015 26 comments

Personal

Reconnect

written by freudandfashion

{Miami Beach, Florida}

Lately, my ability to write and stay connected via my blog and social media requires far more effort than usual. I’ve written in previous posts that when life gets overwhelming, one of the first things that fall to the wayside is my blog. I’m trying hard to stay consistent on posting because the last time I put my blog aside, I ended up taking a one year hiatus from September 2013 through September 2014. I sound like a broken record when I find myself regularly struggling with life balance, though I’m well aware that the ability to find balance is an ongoing process.

This weekend, I’m headed to northern California to visit my family for Father’s Day and am looking forward to reconnecting again. I also have group therapy today before catching my flight, so i hope to get some feedback from my therapist and group members regarding my disconnect and self-critical self.

I know that I am human, “nobody’s perfect,” and we’re entitled to our good and bad days. Yet, I just can’t help getting frustrated when I don’t feel like myself. I’m sure several of you out there can relate?

June 20, 2015 8 comments

Psychiatry Travel

Coping With Travel Anxiety

written by freudandfashion

{Miami Beach, Florida}

With the summer season fast approaching, many have upcoming plans for vacation, which may trigger high levels of anxiety related to travel. Several of my patients request medications to alleviate anxiety to have on hand for their upcoming trips (mostly a small supply of anxiolytics such as benzodiazepines or sleep aids). Though I travel often, I also experience feeling anxious with each trip and have a routine that I religiously perform a few days before in effort to minimize my anxiety. My routine seems pretty standard to me, but I’ve traveled with several people who are either much more last-minute and disorganized or plan everything months in advance and arrive at the airport 2-3 hours early. Long story short — everyone’s different, so find out which techniques/strategies work best for you.

In effort to find the most common causes of anxiety related to travel, I performed a literature search (the number of studies are limited and all of them pretty old before the year 2000) and discovered a research article titled “Anxiety and Health Problems Related to Air Travel,” a study led by Dr. Iain McIntosh which identified frequency of perceived anxiety at certain stages of travel and use of strategies to reduce the anxiety. The results are summarized as follows:

Stages of air travel with highest frequency of perceived anxiety:
- Take-off and landing
- Flight delays
- Customs and baggage reclaim
Strong relationship between overall anxiety and frequency of reported health problems
- Women have slightly more health problems related to air travel than men
Most frequently used anxiety-reduction methods:
- Alcohol use (one third of the surveyed participants)
- Distraction or relaxation techniques
- Doctor-prescribed or over-the-counter medication (5%)

Since I’m always on the lookout for resources to provide my patients, I found the following links useful:

Articles on tips to cope with travel anxiety: “10 Tips For Nervous Flyers,” “How to Relieve Flying Anxiety,” “10 Foolproof Tricks to Beat Flight Anxiety.”
Apps specifically for anxiety: 5 Apps To Help You Cope With Anxiety
Travel Apps: App For That!, Best Travel Apps for 2015
- I personally use the following apps, which decrease my anxiety about traveling to new places: specific airline carrier apps (to check flight status, etc), Uber, Yelp, Instagram (several travel bloggers have accounts & may even respond to any questions you post to their account), Skype, Kayak, Hotel Tonight

And, in conclusion, I personally recommend the following techniques to make sure your anxiety doesn’t get the best of you:

Don’t put too much pressure on yourself to have the PERFECT trip. I used to be guilty of this and would feel bummed if I forgot to do something on my “must-see/must-do” list. Putting too much pressure on yourself creates more stress rather than being present and fully enjoying each moment of your vacation.
Take some time-out to re-energize yourself. Especially to the introverts out there — visiting the most touristy places means LOTS of people and crowds, which can be manageable, yet in small doses. If you find yourself feeling exhausted after being around hoards of people, then give yourself permission to take some time for a solo activity right after (ie, chill and watch tv or do some reading once you get back to your hotel, etc).

Thought of the Day: Does travel make you anxious? And if so, which strategies help relieve your anxiety/stress?

June 17, 2015 5 comments

Personal

Reset, Recharge

written by freudandfashion

{Miami Beach, Florida}

I talk A LOT about mental health (in case you haven’t noticed), so I’ve appreciated the opportunity to put psychiatry-related thoughts aside for the last week while on vacation. And I haven’t psychoanalyzed one thing while in Florida, which is a record for me! I recognize how burned out I was getting, especially since I slept a whole lot during my first few days of vacation. In the past, I probably would’ve felt guilty about saying I was tired of talking about mental health, but sometimes taking a break from your interests and passions makes you appreciate them even more. I intend on using my final days of vacation to soak up more sun, take a boat ride along the bay, shop, enjoy delicious Cuban dishes, and anticipate feeling fully recharged by the time I return to work next week. Hope you have a relaxing weekend!

Beautiful lanterns at the Shore Club

June 6, 2015 10 comments

Medicine Psychiatry

Why Am I So Tired?

written by freudandfashion

{Rancho Cucamonga, California}

As I struggled to get up this morning and hit the snooze button multiple times then proceeded to turn off my alarm clock on accident (thus waking up several hours later), I contemplated reasons why I’m feeling so tired today. I’m sure several of us try to diagnose ourselves, and sometimes jump to the worst conclusions as to the causes of our tiredness. But before you start self-diagnosing, here are a few potential causes that I generally explore with my patients before resorting to lab tests and referring back to their primary care doctors:

1. Are you getting enough sleep? Lack of sleep is an obvious cause, but you’d have no idea how many people actually believe they’re inhuman and should be able to get by on less sleep without crashing.

2. Is your schedule constantly changing? Our circadian rhythm acts as an internal clock that guides our sleep-wake cycle. Any disruption as a result of a change in schedule or activity (ie, I have several patients whose job schedules constantly change, such as firemen, dispatchers, etc; or college students studying late night for exams; or recent travel to a different time zone) can disrupt your cycle, thus causing you to feel more tired than normal during the day.

3. What type of food do you eat? If you start your day with a meal chock full of refined carbs (bagel, doughnuts, croissants, etc), your insulin levels skyrocket, thus feeling sluggish. Also, not eating enough food is an obvious reason for low energy levels.

4. Do you rarely exercise? Just turning up your current level of activity up a notch (ie, if you’re sedentary, start walking, etc) has been shown to increase your energy levels.

5. Do your workouts involve exercises that your body’s not quite yet conditioned to? I, myself have tried various types of workouts programs and generally struggled to adjust when I first started, which is to be expected. In the past, I’ve done boot camps and Crossfit, which I truly enjoyed, yet my recovery times were quite long (in addition, I also had to change my nutrition to adequately fuel my body). Thus, I had several days where I’d want to nap or veg on the couch all day (leg days tend to be the worst!). I have several patients who feel abnormal because they’re making great efforts to drastically increase their physical activity, yet don’t realize that feeling tired during the recovery phase is normal.

6. Did you forget to take your medication? Thyroid medications (such as levothyroxine), stimulant medications (such as those used to treat ADHD), antidepressants (such as buproprion) can drop your energy levels if not taken regularly.

7. Is it a medication side effect? If you were recently started on new medications and notice that you’re feeling more tired lately, then check with your doc (or search online as most people do) to check if lethargy is a possible side effect.

8. Did you cut back on your regular caffeine intake? Somnolence is a common symptom of caffeine withdrawal (in addition to headache, irritability, decreased concentration, etc).

9. Did you overexert yourself with activity recently? Work, running errands, planning a big upcoming event, etc — it’s normal to feel exhausted and need time to regroup after a busy day (or days) of activity. Know your limits as to how much activity you can handle, or go easy on yourself if you’re not as productive on subsequent days.

10. Are you working on some difficult material in psychotherapy? Since I am a psychiatrist, I usually explore this possibility. Processing difficult emotions can be draining. I’ve experienced this firsthand and used to take naps after my Saturday sessions with my therapist.

11. Is tiredness a sign of depression? If tiredness is also accompanied with symptoms such as loss of interest in activities you normally enjoy, isolation, sadness, etc, then lack of energy might be a sign of depression. Reach out to your doctor, especially if symptoms don’t improve and start impacting your ability to carry out your daily activities.

If the cause of tiredness is not apparent, then make sure to contact your medical doctor to discuss your symptoms. However, more often the cause of tiredness is not a major medical issue. In my practice, I find that the most common cause of lethargy is related to schedule and unrealistic expectations that we place on ourselves to be superhuman (I’m definitely guilty of this) and accomplish so much in one day without allowing adequate time to rest and refuel, thus leading to excessive stress, insomnia, poor eating habits, subsequent depression, etc. Listen to your body — if rest is needed, allow yourself enough time to reset, relax, and gain your energy back.

Photo by Marlon Santos

June 3, 2015 5 comments

Lifestyle

Much Needed

written by freudandfashion

{Miami, Florida}

I’m constantly testing my limits as to how long I can continue working before I become extremely stressed-out and less pleasant to be around, which usually indicates I’m overdue for a vacation. When I scheduled my vacation months ago, I had a feeling I’d be overexerting myself having too large of a time gap in between breaks. Well, I definitely learned my lesson this time around (yet again). Part of self-awareness and good self-care is recognizing when you’re in need of a break. Therefore, for the next ten days, I’ll be catching up with some much needed sleep, laying out on the beach, and doing nothing work-related. Next week I plan to head to Miami, which is the city I fondly remember as providing the most fun during my medical school elective rotations. Actually, I do have one task: learning how to use Snapchat and hopefully posting snaps during my vacation (if you’re on Snapchat, add me @freudandfashion and follow me on my journey towards wellness, balance, and self-care!).

Have a wonderful weekend!

May 30, 2015 14 comments

Psychiatry

7 Ways Exercise Improves Mental Health

written by freudandfashion

{Rancho Cucamonga, California}

Not a day goes by where I don’t ask myself the following question: Should I, or shouldn’t I go to the gym today?

You don’t have to be lectured by a doctor to know that exercise is good for you. We all recognize that exercise provides positive benefits on our overall health and mood, yet do we religiously incorporate physical activity into our regular routines? Trust me, even as a physician who preaches the importance of incorporating non-medication alternatives such as exercise into wellness plans, I empathize with the struggle to prioritize physical activity in our busy schedules. Yet, if you’re interested in even more specific ways that exercise can enhance your mental health, I compiled a list of information that I often provide to my patients:

1. Target your mood. Exercise has been shown to be just as effective as antidepressants for the treatment of depression. A study led by Dr. James Blumenthal found that an exercise program provided equal benefits in mood as regular doses of Zoloft (a commonly prescribed antidepressant). Also, a Cochrane review (which is a systematic review of all high quality research relevant to a specific research question) found that exercise is associated with a greater reduction in depression symptoms compared with no treatment.

2. Alleviate anxiety. I can attest to this, for my ability to manage stress (especially when in clinic) declines after missing several workouts, though my coworkers say I mask my anxiety fairly well (which is hard for me to believe!). Aerobic exercise has been shown to be an effective treatment for several anxiety disorders. One study found that exercising at 70-90% of maximum heart rate for 20 minutes 3 times a week has been shown to significantly reduce anxiety sensitivity.

3. Boost concentration. Exercise elevates the brain’s levels of dopamine and norephinephrine, which are important chemicals involved with focus, attention, and our executive functions (planning, analyzing, prioritizing, organizing, initiating, and completing tasks/activities). Some people with ADHD are able to manage their symptoms with exercise alone, though many find the ideal treatment regimen includes medication plus exercise. For more helpful info, I often refer my patients to ADDitudeMag.COM.

4. Sleep better. Though the most common method utilized to treat insomnia is via pharmaceuticals, I am always on the lookout for ways to improve sleep without the risks of dependency and tolerance that many sleep aids have. Regular, physical exercise raises core body temperature, which can benefit the initiation and maintenance of sleep.

5. Improve heart health. People living with mental illness tend to have higher risks of cardiovascular disease. Over 50% of adults with serious mental illness are obese. Among individuals who are overweight, losing 5% of body weight can improve risk significantly and one way to accomplish this is through lifestyle modifications such as increased exercise.

6. Connect with others. Social connectivity has been found to be one of the factors that contributes to happiness and well-being. Whether you have a walking buddy, join an exercise class, or join a meet-up group for hiking, etc, physical activity may provide an opportunity to socialize and engage with others.

7. Sharpen your memory. Studies on exercise and prevention of dementia were mostly limited to studies performed on rats, but I did find one promising study which found that older adults involved in a 6-month aerobic training program positively impacted cognitive functioning.

I often tell my patients that they don’t have to be marathon runners to experience the benefits of exercise. The most important aspect to keep in mind when choosing your preferred form of exercise is sustainability — your chosen form of exercise should be something congruent with your interests, goals, and can be easily incorporated into your routine, whether it’s walking, running, playing basketball, yoga, dancing, etc.

Thought of the Day: Which type of exercise have you found to improve your mental health?

Photo by Marlon Santos

May 28, 2015 10 comments

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