Marks Psychiatry

We in psychiatry have always said it took 3-4 weeks for an antidepressant to show a clinical effect.  Those who showed improvement in the first 2 weeks were thought to be having a placebo effect.  In the past 2 years, there have studies that have shown that patients can have a “real” response to antidpressants as early as 1 week after starting the medication.

When Lexapro became available in 2002, pharmaceutical reps said it was supposed to show effect in the first week.  At that time, that was the first antidepressant that made that claim.  I find the literature still unclear about what is an expected response time.  This is probably because there are other factors such as lack of support, ongoing stressors, variability in how drugs are metabolized that affect response time.

Also, another source of confusion may be in how we define “working”.  A clinical response is not the same as a full recovery, so a person may experience some lifting of their depressed mood in the first week, but still have considerable irritability, insomnia, anxiety, etc. for several more weeks.  Bottom line, I think the current literature supports early responses in the first week as being real and possible, but we still need to give the medications 4-6 weeks at a therapeutic dose to show a full response.

Popularity: 22%

Sometimes it’s difficult for bipolar patients to tell when they are in a depressed mode or if they have simply lost their manic high.  For many, mania can be a very destructive phase, but for some, mania or hypomania (milder form of mania) can feel very good and be a very productive time.  Sometimes this loss of the elation can make patients not want to take their mood stabilizer.  Some will say they experience the non-manic period as being flat or as if they are living a generic version of themselves.  They may then conclude they are “depressed” when in fact, they may not be depressed, they are just experiencing the middle ground.

Some patients may swing between cycles so often that they may not know how to recognize the middle ground.  This is why it is important for patients with bipolar disorder to stay in regular contact with their health care provider so they can have someone keeping an eye out for their mood states.  It’s not always as easy to recognize the beginning of a manic state as it is to recognize depression.  A person who is hypomanic may appear happy, upbeat and busy.  On the surface, that doesn’t seem so bad.  But it is usually the people close to them that recognize the more destructive behaviors such as functioning on little sleep, making impulsive decisions, etc.   So, although the hypomanic state may seem desireable and some even try to prolong the state (by avoiding medication), mania can spiral out of control.  Therefore it is important to keep a careful watch and welcome periods of non-mania and middle ground.

Popularity: 24%

The short answer is yes. Anabolic Androgenic Steroids are the steroids used by those wanting to increase muscle mass usually in the context of sporting competitions. We hear about athletes being penalized after they are caught testing positive for these substances. This topic has gained much attention recently with former professional wrestler, Chris Benoit who killed himself as well as his wife and son in Fayetteville, Ga. He was found to have anabolic steroids in his home.

The term “Roid Rage” has been around for a while and even used as a defense in some cases where someone claimed to have harmed someone under the influence of anabolic steroid use. Non-anabolic steroids such as prednisone are commonly prescribed for many inflammatory conditions or other conditions such as asthma.  However, they can have mental health consequences such as psychosis, depression and mania. Androgenic anabolic steroids are testosterone-based and in addition to psychosis, depression and mania, can also cause increased aggression. Some athletes who use these performance enhancing drugs, will notice changes such as being more easily angered or irritable. Some athletic activities that involve contact, can be a natural outlet for the increased aggression.

Some criticize the wrestling community for lending itself to athletes abusing these drugs unchecked. As an activity that is a mix of sports and entertainment, the participants are not monitored in the same way as professional athletes.

Perhaps this recent death of a wrestling heavy weight and the deaths of several other wrestlers will bring more attention to the issue of anabolic androgenic steroid use.

Popularity: 17%