Reflections on Psychiatry & Psychology

OCD is often diagnosed late (6–10 years) due to varied symptoms and stigma. Depression frequently co-occurs and may obscure OCD. Standard treatment is ERP plus SSRIs; other medications may be added. Emerging evidence suggests ketamine may help treatment-resistant OCD.

Psychosocial treatment for bipolar disorder includes psychoeducation, CBT, social rhythm therapy, family therapy, and group work. These target stress, routines, cognition, and relationships to reduce relapse. Early intervention and stress prevention—especially after childhood adversity—may improve course and outcomes.

Treatment The treatment of BD is complex.   Psychosocial treatments are necessary but rarely sufficient for controlling relapse or acute symptoms.  From my observations, the treatment of BD is as much of an art as it is a science, with different researchers and clinicians having different ideas as to what is the appropriate formulation.   Critically important is the assessment of suicide throughout the treatment.  Suicidal ideation and suicide completion is a very real possib

Stress is closely linked to bipolar disorder (BD), though its role in causation is unclear. BD is highly heritable. The Kindling theory suggests early stress triggers first episodes, after which episodes may become autonomous or stress-sensitized. Early trauma predicts earlier onset, greater severity, and poorer outcomes.

The Comorbidity of Bipolar Disorder and Stress disorders   Comorbidity is common in BD, further complicating the diagnosis.  In one study, a comorbid disorder was found in all of the samples, and in 59% the condition preceded the onset of BD symptoms (Kessler, Rubinow, Holmes, Abelson, & Ahao, 1997).  Common among the comorbid disorders are anxiety, substance abuse, ADHD, Oppositional-Defiant Disorder, Bulimia, Social Phobia, Panic Disorder, and Obsessive Compulsive Disorder 

It is generally agreed in the literature that stress affects the course and severity of Bipolar Disorder. Diagnosis is particularly difficult, because those with BD often do not recognize their episodes and so do not report their presence.

Zurzuvae, the first FDA-approved oral pill for postpartum depression, is taken for 14 days and can reduce symptoms within days. Costing about $15,900, access may be limited despite its rapid action compared with traditional antidepressants.

The “988 Lifeline” service was launched in July 2022, progressing from the narrow focus on suicide prevention as the “National Suicide Prevention Lifeline” to a wider attention of forms of acute distress (and also requiring a much simpler dial code).  A recent study on 988 Lifeline reveals that while it has received millions of calls, texts, and online messages, it might not be living up to its full potential. The researchers found that people dealing with severe psychologic

In areas where cannabis is legal, more young people are driving under its influence than alcohol. Misconceptions about impairment, lack of clear THC limits, and normalization of use raise road safety concerns, highlighting the need to balance legalization with prevention.

Zuranolone (Zurzuvae) is the first oral GABA-modulating antidepressant for postpartum depression. Taken for 14 days, it can improve symptoms within 3 days; benefits may last weeks. Common side effects include drowsiness and dizziness.

Nutraceuticals—herbs and vitamins like ashwagandha, kava, chamomile, and CBD—may ease mild anxiety but aren’t a substitute for professional treatment. Consult a healthcare provider.

Cocaine blocks dopamine reuptake in the brain’s reward pathway, causing short-lived euphoria and repeated dosing. It raises heart rate and blood pressure and can cause paranoia, psychosis, heart attack, stroke, and overdose. Mixing with alcohol forms toxic cocaethylene.

Drugs disrupt brain homeostasis by hijacking the dopamine-based reward system, producing powerful reinforcement and cravings. Repeated use causes brain adaptations, impaired impulse control, and stress-driven relapse. Genetics and environment increase risk, but recovery is possible through strengthened top-down control.

Bipolar II disorder alternates between depression and hypomania but is hard to diagnose because patients often enjoy or fail to recognize hypomania and seek help only during depression. Recollections may be distorted, so collateral history from others is often crucial for accurate diagnosis.

Moderate caffeine (2–3 cups/day) is usually safe, but heavy use (>500 mg) can cause anxiety, insomnia, GI issues, and heart problems; withdrawal may trigger headaches and fatigue.

Biofeedback uses tech to monitor body signals like heart rate and muscle tension, helping you gain awareness and control, reducing stress, pain, anxiety, and other conditions.

Winston, long prone to anxiety, feared ALS after a referral. Therapy and meds eased his health anxiety and he thrived—until ALS was confirmed. He chose to focus on family, stayed positive, and kept in touch for refills until his death about 14 months later.

Research shows a two-way gut–brain link: gut bacteria shape brain development and influence mood. Dysbiosis may contribute to anxiety and depression. Probiotics show mental health benefits, but aren’t yet FDA-regulated or reliable stand-alone treatments.

Cravings for drugs or alcohol are controlled by a variety of brain chemicals, including norepinephrine, dopamine, and glutamate.  Many people describe their cravings as coming out of nowhere, as if these chemicals pop into their brains and create a cravings spontaneously. These chemicals and the manifestations of cravings are actually triggered by stimuli from external environmental cues and internal mood states, particularly anxiety, irritability, and dysphoria.  Environment

After 20 years of depression, Jack improved in 2 weeks on Paxil. But feeling better upended his “depressed” life—job, friends, marriage—causing crisis. Lesson: patients with chronic illness must prepare for change and continue therapy when they improve.