I have lived for some time with depression. Most of the time, it is nagging in the background, helped by exercise, family and friends. But a few times, despite my best efforts, it has gotten out of control. At the middle of my chief year in November, it came to a head. I was under tremendous pressure to apply for fellowship when I didn’t think it was what was best for ...

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She didn’t seem obviously depressed as I entered the room. “So, we have you taking a good dose of both antidepressants now,” I said. “How are you doing?” “I feel about the same.” “Have you done anything lately that could have made you feel a little better?” “I’m not sure …” “I’ll give you some examples. They can be different things for different people. It could be reaching out to a friend, helping a neighbor, ...

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During my two years off from medical school, I’ve been volunteering as a court appointed special advocate for children in the foster care system. And I’ve spent a lot of time reading about how these kids’ experiences could affect the rest of their lives. The seminal research on this happened in the late 1990s using data from more 17,000 Kaiser patients. What the researchers found was that patients ...

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In a world of diverse mental health treatments and treatment settings, psychoanalysis and psychodynamic psychotherapy have lost their former prominence.  Only a small fraction of patients have the time, money, and interest to engage in long-term, open-ended mental exploration -- even if doing so would get to the root of their problems and lead to lasting improvement. More commonly, emotional distress is dealt with in emergency departments, in crisis clinics, on the medical and surgical floors of hospitals, in ...

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No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it's some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight. That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali ...

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A few weeks after I started residency, two of my peers killed themselves in New York City. No one I knew was surprised. Intern year is hell, and everybody knows it from TV shows like "Scrubs" and books like "House of God." Old doctors tell tall tales of working a million hours without sleep before training standards got “soft,” limiting residents’ monthly work hours to 320 and requiring four days off. ...

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Those of us who work in pediatric intensive care have frequent encounters with the problem of suicide and attempted suicide. It has seemed to me for some years that the numbers are increasing, and this has been shown to be the case. After years of declining, the suicide rate in our country has been increasing, now at about 125 percent of the rate of several decades ago. This increase ...

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I’ve known since I was very young that I just experienced life differently than did my extroverted family members and friends. During parties, they seemed to truly enjoy the loudness and chaos of get togethers and the seemingly endless small talk, while I would secretly yearn to return home so that I could read my latest novel in peace. An older family member once told me that I would eventually ...

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My cohort graduated from our psychiatry residency almost ten years ago. The level of frustration and disappointment we’ve all experienced within the past two years is striking. Some have taken leadership roles, only to relinquish them because of fatigue from fruitless discussions with administrators. Others have tried to alert senior managers about dangerous and irresponsible clinical practices. Their efforts were unsuccessful because concerns about finances trumped concerns about clinical services. With ...

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Many patients are referred to me as a psychiatrist to treat their depression.  The new patients that come to me for depressive symptoms usually expect that I will be recommending and prescribing an antidepressant for their depressive symptoms because that is what a psychiatrist does, right?  Not always. Often times these patients come to me having gone through several antidepressant trials without any successful resolution of their depressive symptoms.  Well, sometimes ...

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