Friday, February 15, 2008

Depression III: Heart Disease

Besides the fact that depression just sucks and makes you miserable, here’s a discussion about another reason that helping people to get better matters.

Depression II: Music therapy

There’s this review in Cochrane about the use of music therapy for depression. While it is inconclusive, it’s worth a look, I think.

Depression I: Overmedicated?

I’ve read several articles lately about depression, which is an area of particular personal and professional interest. For several years I have been under the influence of "Against Depression" by Peter Kramer, MD, which makes an impassioned and persuasive case for the treatment of depression, and particularly the legitimacy of pharmacologic treatment of depression. It is a perspective and explanatory model that I am still informed by in my treatment of depression.

The question of excessive medication is something I also ponder frequently both in the context of mental health treatment, and generally. I therefore was interested to read this this article in the NYT by Judith Warner. One of my core values is moderation, and avoidance of polarization, so I like the basic thrust of this article. Like Kramer, Warner recommends, and I agree, that we look a little closer at our beliefs about “designer drugs” for depression and other mental health disorders. I followed the links to the articles in SLATE by Peter Kramer, which I recommend if you’re interested in walking the line between the poles in the treatment of depression and the place of pharmacotherapy in the treatment of it and various other diseases.

Warner’s article alone is a bit too dismissive of those who allege overmedication. While I agree that patients very rarely accept the use of chronic daily medicine blithely, an example of overuse is found in the marketing and use of sleep aids (Ambien, Sonata, Lunesta, anyone?), and there are others. I have also seen innumerable patients for whom anti-depressants have been recommended, though often not accepted, in scenarios accompanied by lines such as “well, there’s nothing really wrong with you but you don’t feel well, so you must be depressed.”

Saturday, February 09, 2008

Progressive Muscle Relaxation (PMR)

I was talking with my brother and sister this morning, and the topic of progressive muscle relaxation came up. It is based on early work by Edmund Jacobson, who first wrote about it in Progressive Relaxation in 1929, and the premise is that one can't simultaneously experience warm well-being and psychological stress. There are innumerable ways of accomplishing the relaxation response, and there are times when it helps to use the body and/or breath - when the mind is so uneasy that it can't be used to calm itself. Duh!

Anyway, you can find the instructions, including an audio-file here. I also recommend the book The Relaxation and Stress Reduction Workbook by Martha Davis, PhD, et. al. which includes information about PMR and a number of other related topics.

(A Spoonful of) Sugar

Kids are on my mind this week, I think because of some very special infants I saw in my practice. Two of them were in for 6 month shots. The issue of pain and infancy is one I remember well from residency, when during obstretrics rotation we were required to perform circumcisions. The question then was whether anesthetizing injections decreased pain associated with the procedure. I always anesthetized, and had also heard that some sucrose (table sugar) also helped, so I would let the infant suck a little sugar off of my little finger before the procedure. A familiar sound to any pediatric or family practice office is that of children getting, or preparing to get, immunized. A recent article in pediatrics affirms the helpfulness of sucrose in decreasing pain associated with this procedure.

Tuesday, February 05, 2008

Innerweave update

After a very positive initial program in our "Positive Psychology" series, our second and third programs were postponed. "Mind your Heart" will take place on March 8, and "Healing with your Stories" will take place on March 15. Please call 518.456.5951 or e-mail us at for more information and to register. We're also currently working on launching the 12-week program, including arranging for insurance coverage if possible.

On-line house calls

I'm very interested in the use of internet technology in primary care and also have some misgivings about it. Approaching this topic, one can quickly get mired in the sometimes dreary state of primary care and family medicine in general. I'll save that for another time. Suffice it to say that medicine continues to value technology over intellect, testing over talking, doing over discussing.
My greatest satisfaction in my work comes from well-paced, thoughtful, personal dialogues face-to-face with my patients. As a result of the energy I dedicate to these many encounters daily and my own personality style (or limitations, you might say), phone-calling is a dreaded task of mine. All of us know the satisfaction that it gives our patients to get the personal attention of a doctor phone call. The demands of the "modern" primary care doctor are overwhelming, however. There simply will need to be some means of compensating us for the time required to continue to give you, the patient, that personal touch, that both of us deserve and crave.
Here's an article about on-line house calls which describes a trend in frequent trendsetter (for better and for worse) Kaiser Permanente in California.