Tag Archives: mental-health

Straight, No Chaser: The Holiday Blues – Tips to Deal with Depression and Stress This Time of Year

November 28, 2013Mental HealthDepression, Disorders, health, Major depressive disorder, Mental disorder, Mental health professional, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Suicidal ideationJeffrey Sterling, MD

I don’t mean to bring anyone down during what is supposed to be the ‘most wonderful time of the year’, but in reality there are many people hurting. For some, life’s tragedies happen this time of year the same as they might any other time. For others, this may have already happened, and this time of year is a permanent reminder of an unfortunate experience. For others still who struggle with depression, anxiety and mental illness all year, the holiday season can exacerbate these feelings and may make holidays especially long, depressing and potentially dangerous times.
My goal today is not to drag you into the dumps but to empower you with tips to assist you in the event this is a difficult time for you. By the way, I’m extremely thankful that you’ve chosen to give me moments of your day and life. I take that gift seriously and hope you continue to find it a worthwhile use of your time.
Here’s five tips for your holiday mental health:

Remove yourself from stressful environments and avoid situations you know will create conflict, mental duress and/or danger. I can not emphasize this enough. If you put yourself in a bad situation, you can not be surprised when bad things happen.’
Find support. Specifically, have ‘go-to’ friends and family that provide you comforting support. There’s a time and place for tough love, but in the midst of depression or suicidal ideation, ‘buck up’ is not good advice. Know where your support lies and be sure (in advance) that it will be accessible if you need it.
Find success and happiness where it is. During the holidays, people tend to lament what isn’t. That’s not a formula for success. Yes, all of your family may not be around, but celebrating happy memories with the ones you can often fills the room with the joyous presence of loved ones not around. Enjoy the pleasures and successes you do have access to, whether big or small. Focusing on the positive keep you positive.
If you’re struggling, admit it. You already know you’re hurting. Often the first step to getting past it is acknowledging it. Once done, then you can put coping mechanisms in place to address your feelings.
Avoid holiday activities that will create post-holiday angst. This applies to eating, drinking, shopping and personal interactions. Some use the holiday as an excuse to overindulge as if the consequences won’t be there afterwards. Reread #1 above.

Know when you need professional help. If your support system doesn’t sufficiently address your needs, and you’re feeling severely depressed, can’t function or are suicidal or homicidal, find a physician or mental health professional ASAP. Of course, you can always contact your SterlingMedicalAdvice.com expert. If you type mental health, depression or other keywords into the search bar above, you can access many other Straight, No Chaser blogs on behavioral health concerns that may provide you the support you need. I wish you all the best today and throughout the year, and hopefully the picture below will reflect the only type of blues you’ll have to deal with this year.
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Straight, No Chaser: When Eating Goes Wrong, Part I – Anorexia

November 26, 2013Mental HealthAnorexia nervosa, Diet, Disease, Disorders, Eating, Eating disorder, health, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Our society doesn’t do the job it should in promoting a normal image of health. The typically promoted American ideal of beauty sets standards that lead many to pursue unrealistic means of meeting that ideal. In the setting of an actual American population that is obese by medical standards, this becomes even more of a problem, as individuals give up on realistic goals and settle into unhealthy eating habits that lead to disease due to obesity.
Most people are aware of two eating disorders–on the low side (obesity is another conversation): anorexia and bulimia. It is important to note that eating disorders are real medical and mental diseases. It is equally important to understand that they can be treated. It is vitally important to understand that when left untreated these disorders lead to a much higher incidence of death than in those without these conditions. These diseases cause severe disturbances in one’s diet, so much so that individuals spiral out of control toward severe disease and death in many instances. Sufferers of eating disorders often have a distorted self-image and ongoing concerns about weight and appearance. (This is as true for those pathologically overweight and in denial as it is for those pathologically underweight.)
Today, I’ll discuss anorexia. Anorexia nervosa is an eating disorder with nearly a 20 times greater likelihood of death that those in the general population of a similar age. Why, you ask? Simply put, they’re suffering the consequences of starving themselves. Anorexics have a maniacal and relentless pursuit of thinness, even in the face of being extremely thin. They couple an unwillingness to maintain a healthy weight with an intense fear of gaining weight. They possess a distorted view of their bodies and severely restrict their eating in response. They are obsessed.
Other symptoms and habits of anorexics include a lack of menstruation (among females, though men suffer from anorexia, too), binge-eating followed by extreme dieting and excessive exercise, misuse of diuretics, laxatives, enema and diet medications. The medical manifestations of anorexia are serious and can include osteoporosis or osteopenia (bone thinning), anemia, brittle hair and nails, dry skin, infertility, chronically low blood pressure, lethargy and fatigue, and heart and brain damage. It’s worth noting again that people die from anorexia. It is to be taken seriously.
The key components of treating eating disorders in general are stopping the behavior, reducing excessive exercise and maintaining or establishing adequate nutrition. The pursuit of adequate nutrition is vital enough that when patients develop dehydration and chemical imbalances (i.e., electrolyte abnormalities), they need hospitalization to correct deficiencies.
Specific management of anorexia involves addressing the psychological issues related to the eating disorder, obtaining a healthy weight, and consuming sufficient nutrition. This may involve various forms of behavioral therapy and medication. Regarding medication use, although some (such as antipsychotics or antidepressants) have been effective in addressing issues related to anorexia such as depression and anxiety, no medication has been proven effective in reversing weight loss and promoting weight gain back to a healthy/normal level. Similarly, behavioral therapy has been shown to assist in addressing the roots causes of anorexia but insufficient in addressing the medical issues that the disease contributed to or caused. Ultimately, it appears that a combination of medications, other medical interventions and behavioral therapy is the most effective course. As is the case with most illnesses, the earlier treatment is initiated, the better the outcome tends to be.
Please maintain a sufficient sensitivity toward those with anorexia. It’s a life-threatening condition, not the punch line of a joke about someone’s appearance.
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About SterlingMedicalAdvice.com: What's Next?

November 1, 2013General Health and WellnessFacebook, Limited liability company, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser (composition), Twitter, WordPressJeffrey Sterling, MD

SterlingMedicalAdvice.com is creating a virtual healthcare universe. You can look forward to the following offerings.

Nov. 1: The launching of www.SterlingMedicalAdvice.com, including the Sterling Advice plan and the Sterling Advice Plus plan. The Sterling Advice plan offers you personalized, immediate 24-hour advice and information from physicians and other medical specialists covering all medical specialties. The Sterling Advice Plus plan incorporates the offerings of the Sterling Advice plan and expands it to include pharmacy, mental health, dentistry, nutrition and personal training.

Dec. 1: The launching of SterlingMedicalAdvice.com’s Wellness and Smoking Cessation Programs. These modules will allow you to follow a best-practice program to improve your health over the long-term. This is a perfect addition to your employee benefits program. Employers, take note!

Jan. 1: The launching of SterlingMedicalAdvice.com’s Spanish language platform. All of the offerings of www.SterlingMedicalAdvice.com will be available in multiple languages for multiple audience.
Hablamos español!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Straight, No Chaser: Save a Life, Save a Trip, Save Your Cash!

November 1, 2013Public HealthEmergency department, health, Limited liability company, mental-health, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, United States, WordPressJeffrey Sterling, MD

In the last 20+ years of caring for patients in emergency rooms (ERs) in communities all over the country, and in 12 years of healthcare consulting in 36 states and countries, my team and I have had the unique privilege of serving all age groups, genders, and health conditions, from sprains to strains, moans and groans, sniffles and whistles, trauma and the flu.
However, in the ER setting, well over half of the people we see every single day would say they could have saved themselves the trip and the cost “…if I only knew.” Straight, No Chaser has given me the privilege to talk with you in a relaxed environment about urgent and non-urgent issues that concern you. It has been fun for me, especially because you have responded in a way that lets me know that my goal of empowering you with knowledge to make your own healthcare and financial decisions for you and your family is being realized. Because this works for your health and your wallet, I have expanded the service from Straight, No Chaser to http://www.SterlingMedicalAdvice.com. Not only will you have access to thousands of tips, fun facts, and frequently asked questions about the full spectrum of health topics, you will also have access to your own personal healthcare consulting team. That’s right, you can chat 24/7 with experts in medicine as well as fitness, dentistry, nutrition, mental health, pharmacy, and other healthcare entities.
So, when the time comes that you need to make an informed decision for yourself and/or your family member, we’re here for you. If this turns out as we desire, this service will become part of the national healthcare system and may be covered by your current insurance interests or as an employee benefit. Beginning today, November 1 at 12 noon Eastern Daylight Time, join me and hundreds of other healthcare experts who have signed up to turn the tide in our country by putting the power of your health back in your hands and saving you the time and costs of unnecessary visits to the emergency room and pharmacy. A subscription counts as payment toward your deductible (if you have insurance) and equates to less than a third of what Americans pay out-of-pocket EVERY YEAR for ER and doctor visits. Try us, and discover the difference having a team at your fingertips will make in your health. We at SterlingMedicalAdvice.com are looking forward to keeping the knowledge flowing,
Jeffrey Sterling, MD
President and CEO
SterlingMedicalAdvice.com
Your Personal and Immediate 24-Hour HealthCare Consultants

Straight, No Chaser: Keys to Mental (Un)Health and (Un)Happiness

October 23, 2013General Health and Wellness, Mental HealthDepression (mood), Disease, health, Limited liability company, mental-health, Sterling Medical Advice, Straight No Chaser (composition), Twitter, WordPressJeffrey Sterling, MD

Everyone has thoughts about the keys to happiness, but we can objectify the conversation and identify what’s most likely to make you unhappy and lead to depression. You may find this hard to believe, but outside of medical causes of psychiatric illness and factors outside of your control, there are actually three choices we make that most commonly adversely impact your happiness and good mental health. Take it for what you will, but the data is what it is. Stay away from these circumstances, and you’re less likely to be unhappy. Sometimes it’s about addition by subtraction.
Health Problems: People who are sick or have significant illness in their families generally aren’t happy. Although this may seem obvious and perhaps unfair, given that some illnesses and conditions are inherited or occur haphazardly, be mindful of the things you can control. Of course, this gets to the negative effects of obesity and smoking. More so than any other health-related activities/conditions, these will eventually lead to deteriorating health and subsequent unhappiness.
Job Problems: You don’t have enough to do with your time? Yep, an idle mind is the Devil’s workshop, as the saying goes. It should be pointed out that neither too much work nor the wrong type of work (i.e., low job satisfaction) seems to promote happiness. On average, people change careers seven times during their lifetimes. It’s often due to a search for happiness and actually is a good thing to do to avoid being stuck in a bad situation. Follow the job you love, and you’re more likely to be both happy and successful.
Relationship Problems: You make bad relationship choices? Well there’s one specific choice that is shown to be most likely to reduce your happiness—choosing a neurotic partner. What’s neurotic? For one particularly disruptive example, think about the so-called Drama Queen/King. A neurotic partner responds emotionally to events that wouldn’t affect most people, and their reactions tend to be more intense than normal. They’re more likely to interpret minor frustrations as hopelessly difficult. Their negative emotional reactions persist for unusually long periods of time. In short, if you want to be really unhappy, become attached to such a person. They will negatively affect your world, keeping you embroiled in drama and unhappiness, no matter how good the financial, physical, or other parts of your relationship.
Now your results may vary but probably won’t. I’m not make judgements, just sharing the data. Life choices have consequences. Choose wisely!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
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From the Health Library of SterlingMedicalAdvice.com: “What are some warning signs of mental illness?”

October 18, 2013Mental HealthDisease, General practitioner, health, Mental disorder, mental-health, Oceania, Policy and Advocacy, Sterling Medical AdviceJeffrey Sterling, MD

Symptoms of mental illness vary, but immediate and drastic changes in mood, thinking, and/or behaviors are common indicators. Should any such symptoms develop, seek medical attention immediately.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

“What should I look for as an indicator of poor mental health in children?”

October 16, 2013Mental Health, Pediatrics/Kids Health, Health Prevention844-SMA-TALK, Behind the Curtain, Disorders, health, Mental health professional, mental-health, SMA, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Symptom, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

Today’s questions related to mental health in children.

“What should I look for in my child as an indicator of mental health issues?”

Today’s question is simple. The answer certainly is not. Be aware of changes in your child’s emotional, behavioral, and/or mental functioning. Remember that children often express sadness and feelings of depression in the form of anger, through outbursts, tantrums, etc. If the symptoms persist for more than a month, seek evaluation from your child’s doctor or a mental health professional. Sooner is better than later.

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Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK. Likewise, please share our page with your friends on WordPress! Also like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.

From the Health Library of SterlingMedicalAdvice.com: How Do I Cope?

October 14, 2013Mental HealthAustralia, Coping (psychology), Disease, health, Mental disorder, mental-health, Oceania, Policy and AdvocacyJeffrey Sterling, MD

What should I do if I’m having a hard time coping with recent changes in my life?
Adjusting to change or coping with a recent traumatic event is a difficult process and can lead to some of the same symptoms as mental illness if left unaddressed. Short-term treatment is often very effective to help prevent long-term distress, especially when you seek help sooner than later. Difficulty coping with change is normal, and talking with a professional to help make a healthy transition does not indicate you have a mental illness.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) will offer beginning November 1. Until then enjoy some our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Straight No Chaser: The United States of Obesity – The Crossroads Between The Pursuit of Health and Happiness

September 4, 2013Cardiology/Heart, General Health and Wellness, Health PreventionBMI, Body mass index, health, heart health, mental-health, Mexico, Obesity, Overweight, overweight and obesity, physical attractiveness, United States, Weight Management, WordPressJeffrey Sterling, MD

obesity4

Obesity in the United States places many at a crossroad between self-esteem and health. Often, larger frames are celebrated as more desirable. Other times, they are celebrated because we must learn to ‘love ourselves’, which is seemingly easier than laboring to diet and exercise. Of course, our culture embraces and contributes to obesity. Consider the ramifications of “As American as Apple Pie” or “Coke Adds Life” or the size of our favorite athletes in our most popular sport. I’ve previously discussed the calorie counts of soft drinks and desserts and their contributions to obesity. At the end of the day, we now have a culture that views what’s physiologically most healthy for our hearts as visually less desirable and a culture where one can ‘reasonably’ (i.e. based on evolved cultural norms) make the decision that having a permissive attitude toward obesity is a more desirable state of being than the pursuit of health.
Odds are, you’re overweight. It was a both a joke and a cause for celebration that Mexico just overtook the US as this hemisphere’s fattest country, but it did bring attention to the fact that more than one-third of U.S. adults (35.7%) are obese, and nearly two-thirds are overweight. Over the next three days, we’ll review various components of obesity that affect your health. To be clear, this is not about your perceived physical attractiveness (and while we’re at it, just because you’re slim, that doesn’t mean you’re anorexic). It’s about your health. If you’re sensitive about your size or have made an educated decision to ‘love yourself as you are’, you don’t have to read through this. If you’re at all interested in how your body is affected by weight, and if you can handle a little truth, proceed. As always, the goal is to educate and stimulate thought, discussion and action.
Let’s start today with making it clear what obesity is and who’s obese. Be reminded the heart is only a pump meant to move blood around the body, carrying oxygen and nutrients to cells in different parts of the body. The heavier you are, the more work your heart has to do and the more likely it becomes that this pump will not function ideally and will functionally ‘give out’ over time. It is this functional failure that produces many diseases.
Let’s start with Ideal Body Weight (IBW). For humans (not ‘Northerners’ or the ‘Small-Boned’ or the ‘Non-Athlete’ or ‘Women Who Haven’t Had Children’), the formula for calculating IBW is as follows:

Women: 100 lbs for the first 5 feet, then 5 lbs. for each additional inch.
Men: 100 lbs for the first 5 feet, then 6 lbs. for each additional inch.

Ideal body weight refers to health, especially heart health, not ‘grown and sexy’ or any other concocted notion of what looks good. So as an example, if you’re a 6 ft tall male, your IBW is 172 lbs. If you’re a female and 5’5”, your IBW is 125. Now before those of you ‘in the know’ tell me there are limitations to IBW and BMI considerations, I’ll stipulate the point and note that doesn’t change the point of this conversation one bit.

‘Overweight’ and ‘Obesity’ are about your risks for disease. We’ll talk about those risks tomorrow, but here are the definitions of each.
Being Overweight is defined as a body mass index (BMI) of 25 or higher; Obesity is defined as a BMI of 30 or higher. BMI gives you an indication if you’re over/underweight or at a healthy weight for your height.
If you’re interested in your BMI, use the following calculator:
http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Let’s talk about it. This is important for your health and longevity.
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Straight, No Chaser – The Week In Review

August 25, 2013Medical Treatment, Public Health, Health PreventionAmerican Academy of Pediatrics, Circumcision, health, mental-health, No Chaser, Oral rehydration therapy, Straight No Chaser (composition), Syncope, Texas, Vision loss, WordPressJeffrey Sterling, MD

I hope this was another week of good health for you. Let’s review how Straight, No Chaser tried to contribute to your health and wellness. Don’t forget to click on any of the underlined topics for links to the original posts.
On Sunday, we reviewed eye emergencies. Don’t forget that even transient vision loss could be a stroke in progress, and certain causes of vision loss have a limited window of time in which treatment must occur. Act quickly! By the way, I didn’t mention this information that occurs more commonly than you’d think: If you ever have eye discharge so copious that it seems like you’re tearing pus, this is probably gonorrhea. Get it treated, lest you could lose an eye. Now that I have your attention…
On Monday, we reviewed syncope (aka fainting) in two parts, talking about the entity (click here) and the life-threatening conditions associated with faints. You’re way too cavalier with faints; please get them evaluated. Faints can either be the result of significant disease or can secondarily produce significant head and neck injuries from the falls. Stop going to the bathroom (with all the hard stuff in there) when you’re feeling dizzy. That’s not a good place to black out!
On Tuesday, we discussed suicide and depression in-depth, reviewing demographic information, information for your self-assessment, and tips on how to recognize when help is needed (and how you can avoid depression). I’m pleased that you’ve made these topics the most read topics yet, and I sincerely hope this information helps some of you.
On Wednesday, we reviewed the overuse of the emergency room, which will become a major theme of this blog. Those creature comfort visits are 8 times more expensive than the same visits done at a primary care physician’s office. In Texas, the average ER cost is $1020. Just because you’re not necessarily paying up front doesn’t mean the hospital won’t ensure you’ll pay eventually. Remember, hospital bills are the #1 cause of personal bankruptcy in the U.S. Straight, No Chaser was created to point you toward better options. Stick around, and we’ll get you there. Wednesday also brought a review of vomiting and diarrhea (viral gastroenteritis). Learn about oral rehydration therapy. Viral gastroenteritis is a good example of something that feels really… bad but is usually self-limited and will go away on its own, as long as you stay hydrated.
On Thursday, we reviewed end of life decision-making. I know this struck home for a lot of you, bringing back not so fond memories. That said, you must begin to think about how you want to be treated in your last days. There are many tragedies during this time that tear families apart. Use the tools discussed on the post on living wills, power of attorney designations and DNR considerations to make sure your interests are the only consideration being addressed when the time comes.
On Friday, we seemed to prick a nerve or two (no pun intended) discussing circumcision. If nothing else, be an educated consumer. Even now, considerations are perhaps best summed up by the posture of the American Academy of Pediatrics, which declines to recommend routine circumcisions for all newborns but notes that if you are inclined to get the procedure (which should be a big if), the benefits outweigh the risks. Friday afternoon, we reviewed hearing loss and the damage the activities of daily living produce. This is a pretty good example of how we take our health for granted. Just a little bit of protection and prevention over the first 40 years of your life will make a big difference later on.
Saturday, we discussed two different types of sounds that come out of you. First, we discussed snoring (which is always annoying but never boring) and gave you some Quick Tips to overcome it. We also discussed hiccups, which everyone gets at some point, but no one ever wants. We also gave you Quick Tips on hiccup cures here. Remember those ABCDEs!
We continue to listen to your comments and feedback, and over the next few months, some major changes will be occurring. Please continue to forward your topic requests. I promise I’ll get to them all eventually. Maybe I’ll start doing reader submission posts. As we continue to grow, your support, referrals and follows are much appreciated. Have a happy and healthy week.
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Straight, No Chaser: Depression Quick Tips – How to Avoid It, When to Get Help

August 20, 2013Medical Treatment, Health PreventionAddictions, Articles and Research, Depression, Disorders, health, Major depressive disorder, mental-health, Mood, Recreational drug use, Suicide, Support GroupsJeffrey Sterling, MD

As a physician, I’m not willing to advise you on how to ‘care’ for yourself at home if you’re clinically depressed. I can discuss how to avoid depression (to the extent possible) and what warning signs should prompt emergent access to care. If you’re good at accomplishing the items listed below, you have less of a chance of being unhappy and clinically depressed.

Avoid alcohol and other mood-altering drugs.
Eat healthily.
Exercise regularly.
Get enough sleep.
Remove yourself from negativity, including your choices in friends, mates and work environments.
Surround yourself with positivity, including your choices in friends, mates and work environments (Please note this is a different consideration than the previous bullet point.).
Learn how to relax and where to go to relax (These considerations include such things as yoga, meditation and your religion/spirituality, not the business end of a bottle or drug use.).

Look out for these potential warning signs for suicide: Remember that approximately 30% of suicides are preceded by the individual declaring intent. Be alert for the following additional considerations:

Increasing levels of depression, withdrawal, reckless behavior, alcohol and other drug use, and/or desperation.
Notice activity that could be a prelude to a suicide attempt, such as obtaining knives, firearms or large quantities of medication.
Changing one’s will and settling one’s life affairs in the midst of depression
Ongoing comments about lack of worth and desire to end it all.

The following considerations should prompt an immediate visit to an emergency room or other treatment facility.

You have a compelling, overwhelming feeling that you want to hurt yourself, with or without an actual plan.
You have a compelling, overwhelming feeling that you want to hurt someone else, with or without an actual plan.
You hear voices or see things or people who are not there.
You find yourself crying often and uncontrollably for no apparent cause.
Your depression has affected your activities of daily living (work, school, consistent forms of recreation or family life) for longer than 2 weeks.
You think your current medications are affecting you abnormally and are possibly contributing to making you feel depressed.
You have been told or believe that you should cut back on drinking or other drug use.

I wish you and your loved ones all the best in avoiding and/or dealing with this disastrous condition. I welcome any comments, thoughts or questions.

Straight, No Chaser: Are You Depressed and/or Suicidal?

August 20, 2013Mental Health, Health PreventionDepression, Disorders, health, Major depressive disorder, mental-health, Mood, Suicide, Toni BraxtonJeffrey Sterling, MD

I have a strong distaste for do-it-yourself websites that want to ‘screen’ you for depression. Folks, if you’re wondering whether you’re clinically depressed, you don’t need validation from some makeshift online questionnaire. That said, if you’d like to learn something, go ahead and find one. More importantly, seek assistance immediately from a qualified counselor or therapist. They do wonderful work and can get through to you before you get to yourself. Instead of a quiz, I will simply give you common signs and symptoms consistent with the diagnosis. Note the progression in the symptoms. The bottom line is: odds are, you already know if you need help. Yes, there are different depression syndromes; I’m not getting into that. You and a psychiatrist or therapist can sort that out. Don’t be reassured by a quiz when you already know better.
You may be depressed if…

You feel sad, hopeless, empty, or numb to the point where you wallow in these emotions, and they dominate your existence.
You have a loss of interest in your normal activities of daily living. It’s not just that you don’t enjoy things. You don’t even want to be bothered with them. You don’t want sex. You don’t enjoy your friends. You don’t want recreation. You can’t eat. You can’t sleep, or you can’t stop sleeping. You can’t breathe (because of your crippling anxiety). You might actually be depressed if you have these symptoms and didn’t get the ideas from listening to the lyrics of a Toni Braxton song.
You find yourself exceedingly irritable and/or anxious. These feelings are explosive and over the top. You’re waiting, ready and looking for a reason to embrace gloom, doom or anger.
You have difficulty moving forward and making decisions. This occurs for many reasons. Your attention may be shot. Your interests aren’t there. You’re overwhelmed. Stuck in a rut is not only where you are, it’s where you want to be.
You feel worthless and blame yourself for any and everything. Again, these feelings are explosive, dramatic and over the top.
You have thoughts of death and suicide. This is where things get beyond scary. You may simply have a passive wishing that things would end and a belief that your friends, family and the rest of the world would be ‘better off’ without you. You may have fleeting voices that aren’t your own suggesting or commanding suicide as an option. You may see visions of people telling you to harm yourself. You may have an active plan. When depression gets to this point, nothing good is going to happen without intervention. Never allow someone to make such comments and then pretend as if they were insincere.

Now consider these most common precipitants for suicide:

Problems with one’s intimate partner
Problems with one’s physical health
Problems with one’s job
Problems with one’s finances

You will have a lot better chance getting someone help at a warning stage than preventing someone from doing something once they have a weapon in their hands. Approximately 30% of suicides result after the individual has expressed an intent to do so. Listen up… Take the signs of depression and any expressed thoughts of suicide seriously.
I welcome your comments, thoughts or questions.

Straight, No Chaser: Suicide Data – Understand the Threat

August 20, 2013Mental Health, Public HealthBipolar disorder, Death, Disorders, Gia Allemand, health, List of causes of death by rate, Major depressive disorder, mental-health, Molecular Psychiatry, Religion, Suicidal ideation, Suicide, Suicide preventionJeffrey Sterling, MD

There are amazing, shocking and saddening facts about suicide. It is equally amazing that we aren’t discussing this as an epidemic. Consider the following information provided by the Centers for Disease Control and Prevention:
There were an average of 105 suicides a day in the U.S. (over 38,000 for 2010).
An estimated 8.3 million adults reported having suicidal thoughts in the past year.
Suicide is the third leading cause of death among those aged 15-24, the second among those aged 25-34, the fourth among those aged 35-54, and the eighth among persons aged 55-64.
For those committing suicide:

33.3% tested positive for alcohol.
23% tested positive for antidepressants.
20.8% tested positive for opiates (such as heroin and prescription pain killers).
There is one suicide for every 25 attempts.

Females are more likely than males to have had suicidal thoughts, but suicide among males is four times higher than among females (in other words, females think about it and try more often, but males complete the act more often.).
Among Native Americans aged 15-34, suicide is the second leading cause of death, fully 2.5 times higher than the national average.
There are some topics that aren’t amenable to Blogs. Depression and suicide are among them. They can’t be done justice. What I can try to do is break components of the conversation into bite size pieces and give you information to work with. I’ll do this in three parts. Above, I’ve shown you the magnitude of suicide. In the next post, I will help you understand what clinical depression looks like, then finally, I’ll review some Quick Tips to help you prevent falling into the deepest levels of depression and to help you know when immediate attention is required. Just remember: this isn’t the type of depression that involves having a bad day. I’m talking about when your downward mood interferes with your activities of daily living. I’m describing depression that introduces suicide and homicide as an option. If you don’t read these for yourself, read them for knowledge. Someone you know may be affected.
I welcome any questions, comments or thoughts.

Straight, No Chaser: The Grief of it All

August 15, 2013Mental Health, Public HealthAcceptance, Anger, Bargaining, Death, Delayed grief, Denial, Depression, Emotion, Grief, Grief Loss and Bereavement, Kübler-Ross model, mental-health, MourningJeffrey Sterling, MD

It’s never easy discussing death. Bereavement is the state of mourning and sadness we endure after the death of a loved one. Grief is that process we endure, either in anticipation of death or in bereavement. Humans have been shown to systematically show grief in a predictable way. This Kubler-Ross model famously describes the response of those dying.

Denial, accompanied with simultaneous emotional numbness
Anger over the loss
Bargaining, as if the possibility of staying alive exists
Depression and intense mourning
Acceptance

The real point of bringing up the grieving process is to point out that the loss of a loved one is an extremely dangerous time for those left behind. In fact, the death of a spouse is the single highest risk factor for one’s own death. I’m sure many of us can think back to an elderly couple who died months apart.
The period of bereavement is a time when people need to come together, provide support and take care of each other. It’s very important that you and your loved ones know that the emotions you will experience are universal and normal. Try to keep that in mind when the time comes. Be reminded that normal grief can last over a year. Don’t feel abnormal because of the difficulties you may be having moving on. It’s healthy to work through your pain.
Common psychological thought describe four trajectories we take in bereavement.

Resilience – the attempt to ‘stay strong’ through it all
Recovery – evolution toward an healthy honoring and appreciation of the life of the lost
Chronic dysfunction – the unfortunate circumstance of being stuck in the mourning process such that it cripples your existence
Delayed grief or trauma – the subsequent release and expression of those suppressed emotions

Grief is to be considered a necessary and healthy part of a recovery process that we should learn to embrace.

Quick Tips on Elderly Falls

August 3, 2013Health PreventionEpidural hematoma, Grab bar, Head injury, health, Hip fracture, Intracranial bleed, Journals of Gerontology, mental-health, Old age, Osteoporosis, Scalp laceration, Subarachnoid bleed, Subdural hematomaJeffrey Sterling, MD

Introduction

This post is about elderly falls

Are all of you DIYers (do it yourself) ready for a weekend project to help a loved one? Here you go. First, let’s start with some not so fun facts.

Every year, one of every three adults older than 65 has a fall.
Falls are the #1 cause of injury death in senior citizens.
Falls are the #1 cause of nonfatal injuries and trauma hospitalizations.
Typical injuries include lacerations, hip fractures and head injuries (including intracranial bleeds). These injuries occur in approximately 20-30% of falls.

Quick Tips

How can older adults prevent falls and the complications of falls? Here are six Quick Tips I hope you’ll share with your loved ones.

Start by doing some home improvements to accommodate the shortcomings of your elderly relatives. Consider railings and grab bars – near the bed, on the stairways, shower, tub and toilet. Improve lighting. Clear out and widen walking paths. Consider using a walker.
Exercise regularly. It keeps the brain sharp and the leg muscles strong. Inactivity promotes bad outcomes when activity is attempted. Have their doctors arrange for home health care and physical therapy if indicated.
Have your loved one and your family review medications with their physician. You need to know which medications and drug interactions can promote loss of balance, dizziness, drowsiness, and/or mental status changes, all of which can lead to falls.
Keep those eyes checked. This should be happening at least once a year. Be diligent in changing prescriptions as needed. Could you imagine being a little confused and not being able to see? What would you expect to happen?
Pay attention to diet. Nutritional needs are even greater in those with health issues, which is always the case in the elderly. Supplement Vitamin D and calcium for bone strength.
Of course, get screened and, if needed, treated for osteoporosis.

The key is to pay attention. You don’t have to let your loved ones wither into oblivion. Simple quick fixes and some love and attention can go a long way to preventing falls and the injuries that accompany them. My mother fell and suffered a massive intracranial bleed with herniation 2 years ago. I’m pleased to note that she’s made a full recovery, and these tips I’ve offered you make a world of difference. Good luck.

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Straight, No Chaser: Why is Life so Traumatic? (aka Human Shark Week!)

July 28, 2013Trauma, Health PreventionAnxiety, Centers for Disease Control and Prevention, Conditions and Diseases, health, mental-health, Post-traumatic Stress, Shark Bites, TraumaJeffrey Sterling, MD

Introduction

If there were a human equivalent to shark week, it would be TRAUMA WEEK! That’s right. Trauma has all the drama, excitement and tragedy as shark bites and often makes about as much sense as exposing yourself to a shark.

Trauma is the #1 cause of death between ages 1 and 44. In fact, according to the Centers for Disease Control and Prevention, trauma accounts for more deaths during the majority of life than all other causes combined, checking in at just over 50%. Traumatic causes of injury are so common and avoidable that it’s worth looking at the top entities separately. This week we will do just, informing you of where the danger lies and offer simple tips to keep you alive.

So buckle up (literally). We’ll get into motor vehicle collisions, brain injuries, domestic abuse, suicides and homicides, drownings and other home/recreational injuries. Trauma. Unfortunately, it’s for everyone.

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