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While being diagnosed with the correct mental health disorder is critical for development of a treatment plan which includes medication, thousands of patients receive an incorrect plan, often continuing to struggle through life for years to come. The National Institute of Mental Health estimates that in the U.S. 1.6% of the population is diagnosed with BPD or Borderline Personality Disorder compared with 2.6% of the population that have bipolar disorder.

Is it Bipolar or BPD?

When comparing bipolar disorder, which may also be referred to as bipolar affective disorder, manic depressive disorder or manic depression — BPD or borderline personality disorder rivals the deterioration of psychiatric and physical health that is also present in those diagnosed with bipolar disorder. In addition, those with either bipolar or BPD present with co-occurring mental health illness symptoms that overlap each other make it difficult for even those with experience to ascertain which disorder (bipolar or BPD) is actually present.

Bipolar and BPD Share Similar Symptoms

Science Daily reports that clinical comparisons and study have intimated that BPD is as disabling as bipolar disorders. Data from psychiatric patient samples show that BPD is seen as frequently as bipolar disorder and share many of the same overlapping issues. Both bipolar and BPD patients typically suffer from depression, anxiety disorders, substance abuse, eating disorders and suicidal behaviors.

Bipolar versus BPD

People with bipolar disorder may experience the same mood or phase of their cycle for weeks at a time while those with BPD find themselves dealing with intense bouts of anger, depression and anxiety that are relatively short in duration. Both disorders have similar symptoms such as extreme mood swings, displaying reckless behavior, and being impulsive. While a major defining factor of bipolar disorder involves extreme highs and lows in mood, those with BPD have significant difficulty regulating their emotions and thoughts, at times finding themselves at the extreme destructive ranges of mood.

Diagnosing Bipolar or BPD Correctly

The correct diagnosis is often confusing and tricky for mental health professionals with limited experience. While they may have similar and overlapping symptoms they are completely different disorders that require their own unique treatments and therapeutic plan. Having a correct diagnosis early allows for providing effective treatment more quickly. Misdiagnosis and delay of proper treatment brings with it a higher risk of complications, worsened symptoms, or even risk of suicide.

Dr. Hege, a highly respected psychiatrist in the Atlanta area has more than 25 years of experience providing correct diagnoses and successful treatment plans for those that have sought him out for the help they needed to get their lives back on track. If you too need help, call the office for an appointment.

Treatment for Bipolar and BDP

If Dr. Hege diagnoses bipolar disorder, he is very experienced in providing medication management. He usually also recommends a therapist for supporting and/or insight oriented psychotherapy to enhance the response to treatment. If he diagnoses borderline personality disorder, he refers patients for the most scientifically proven treatment, DBT. DBT is a structured treatment provided by a specially trained therapist. These therapists work in the same office in collaboration with a psychiatrist to provide the most effective, integrated treatments.

The picture you may have in your head when hearing someone is depressed, or has been diagnosed with depression is typically not a true “picture.” People are often surprised to hear that a friend or family member is depressed as they do not “act the way a depressed person should act.”

Depression Facts versus Depression Truths

So just what is the real truth about depression? Having a better handle on what depression looks like may let you give help and support where it truly is needed. Being able to come to terms with one’s own depression with the help of friends and family is the first step in seeking treatment.

• “Depressed people are usually miserable and prefer to be left alone.” Fact? Truth? Very often people with depression feel their best when they are socializing, being the “life of the party,” attending events and activities and staying very active within their community of friends and family. Party goers are seldom viewed as depressed and may go their entire lives without the treatment they so desperately need.

• “Depression and life’s problems fade into the background of living the high life.” Fact? Truth? Staying fun loving and in the lime-light keeps the sadness, fear and panic away — at least for a short while. Moods may change and there may be times when you feel better alone and miserable around friends, however these mood swings may just occur at random times with no discernible pattern.

• “Depression really just means that you are sad.” Fact? Truth? While being depressed may feel like a heavy weight of sadness is weighing down your every thought and move, depression may also take on other less recognizable forms. Depression may make itself known through making one irritable and easy to anger – often to make others feel bad so you can feel better about yourself.

• “Depression makes you sleepy.” Fact? Truth? Contradictory symptoms often makes depression so hard to detect. Depression may affect your sleeping patterns – you may find you have trouble falling asleep, waking up on time or sleeping away most of the day. Loss of weight may be a welcome change, but not because you become so fidgety and anxious you find you can’t sit still long enough to enjoy a meal. Memory issues may develop where you find you are not able to remember simple or routine events on a week to week basis. Your libido or sex drive may dwindle away to nothing or you may become super active sexually. Depression has so many faces that it really is a diagnosis that can go undiagnosed for years and years.

• “Antidepressants will not work.”Fact? Truth? Many people believe that taking antidepressants will not work for them as they may have known friends who took them to no avail, or watched news reports on the millions of people on antidepressants that may or may not make a difference in their lives. It is true that depression rates are rising; however this needs to viewed in the light of mental health professionals becoming better at making the correct diagnosis than in previous years, rather than people being diagnosed with depression for the lack of a better diagnosis. It is true that some antidepressants are not effective for everyone. Individual treatment plans make for better strategies and regimens in a multifaceted treatment process.

Depression – Help a Phone Call Away

Give the office a call to set up a convenient time to meet.

A study published in the June 2015 Journal of Psychopharmacology reports widespread cognitive decline of menopausal women.  The areas of cognitive decline affect executive functions, most notably difficulties with time management, organization, memory, attention and problem solving. With approximately 90 million post-menopausal women in the U.S. with an average age of 52 at onset, these women live in a post-menopausal state for almost 1/3 of their lives.

Prior to this study, I hadn’t seen objective studies of ADHD like syndrome emerging during menopause, but I had seen numerous women presenting with suspected ADHD during menopause. My history taking with these women almost always reveals a history of pre-existing ADHD or sub-threshould multiple ADHD like symptoms. Regardless of the origin of the ADHD like symptoms, Vyvanse and other psychostimulants typically are quite helpful.

ADHD Vyvanse Dual Use

The medication Vyvanse primarily used in the treatment of adult ADHD, has also successfully treated cognitive issues of menopausal women promoting healthy cognitive aging as a major public health goal.  ADHD Vyvanse research data shows a 41% overall improvement in executive function deficits compared to those receiving a placebo medication.

Benefits of Vyvanse Treatment

Vyvanse, also known as lisdexamfetamine or LDX, not only improves executive function in menopausal women, the medication has also been proven to show significant improvements in rating four out of the five subscales used in mental health evaluation and diagnosis which include:

• Organization and motivation for work
• Attention and concentration
• Alertness, effort, and processing speed
• Working memory and accessing recall

Comprehensive Evaluation Critical for Correct Diagnosis

Study results show that ADHD Vyvanse, LXD or lisdexamfetamine, show significant positive results. It is crucial however to confirm that the complaints of cognitive changes including loss of memory, or issues with executive function abilities are tied to the transition to menopause and do not point to another pathological cognitive impairment. Working with a psychiatrist experienced in this field is mandatory for a correct diagnosis or diagnoses to build the proper medication and treatment plan upon.

Call Dr. Hege for a confidential and comprehensive evaluation to determine the best course of treatment to meet your needs.

Many adults on ADHD medication look to take a medication “holiday” or “vacation” for two days, a week, or even for the summer. For those that do take a break from their ADHD medication many report that they want a break from the side effects, others may feel that they want an option to be “control free” where they choose to stop taking their prescriptions at various times during the year. Still others may take a med vacation wanting to see if it is the medications that have made a positive difference in their life or if their ADHD has resolved or become a non-issue.

When ADHD Becomes Symptom Free

Adults with ADHD who are taking prescription medication for the disorder may begin to notice that their old symptoms have significantly decreased or find they have been symptom free for several months. The decision to not only take a holiday from the medications but to discontinue their prescribed med regime is a common road that thousands will travel down every day. Of the thousands with adult ADHD who do decide to “just stop” their daily dosage, the majority do so without the help and guidance of an experienced ADHD psychiatrist or mental health practitioner.

Management of Drug-Free ADHD with Doctor 

While taking a break or “holiday” from ADHD drugs can be fine for most, it is important to work with your psychiatrist for follow-up appointments and good management of any symptoms or problems that may occur by discontinuing the ADHD medications. What may work could be a medication reduction without totally discontinuing your routine meds. Keeping your ADHD doctor in the loop is a crucial component to properly managing your behaviors, personality changes, or annoying symptoms.

Potential Risks of Stopping ADHD Drugs

Taking a vacation from ADHD medications does not typically turn into a dangerous situation, but there are some potential risks that need to be considered. Some of the most common risks are:

• Side effects from stopping and then restarting medications too quickly without the guidance of a qualified practitioner
• Development of problems at work or school
• Problems cropping up that affect relationships, friends, or family
• Social alienation
• Reckless or impulsive behaviors start to occur

ADHD Benefits with Consistent Use

Numerous studies have shown evidence that adults with ADHD who take their medication regularly build and improve their executive functions and higher level cognitive processing as well as performing better socially than those with ADHD who do not take medication. In addition the ADHD drugs deliver improved attention, focus, and the ability to self-control hyperactivity and impulsive behaviors.

Make the call to Dr. Hege to discuss your situation and determine the treatment plan that fits your lifestyle the best.

Thousands of people every day wonder if their behavior or emotional state is normal or not. Unfortunately, someone can needlessly suffer for years before their actions or symptoms become out of control and psychiatric help is finally sought.

Mental Health Diagnoses

With more than 200 classified forms of mental health illness, the organization Mental Health Awareness reports that mental health disorders often share similar symptoms. When multiple diagnoses are present, it takes a skilled professional to make an accurate assessment to design an individual treatment plan for recovery.

Following are some of the numerous symptoms and problematic behaviors that indicate further mental health appraisal is in order.

• Exhibiting frequent and dangerous sexual acting out: The issue may be psychological, emotional or trauma based and include sexting, acting as a prostitute, having sex with multiple partners or wanting an open relationship without boundaries.

• Displaying frequent physical and/or verbal aggression: Having a “quick temper” or a “difficult personality” does not automatically point to a mental health disorder. Behaviors alerting you to a possible mental health disorder include frequently lashing out in anger at others, being abusive to others (verbal, physical, or sexual abuse), or acting in a manner that jeopardizes your job or living conditions.

• Planning to harm yourself or commit suicide: All suicidal threats need to be addressed. Threats with a plan need immediate attention.

• Finding yourself extremely fatigued or depressed: Many have experienced being “worn out” from a hectic work or family week, or feeling sad and depressed about their job, financial situation or relationship. A mental health evaluation may be in order if you suffer for example from chronic sleep disturbance, feel hopeless or helpless, do not care about previously enjoyed activities, have weight gain or weight loss, find yourself irritable with others for no real reason, or finding it more and more difficult just making it through the day.

• Preoccupation with physical appearance, money or crime: Many in our society may display narcissism yet still be within “normal” ranges. Clinical narcissism on the other hand, interferes with one’s daily life routine. Examples include acting impulsively, gambling beyond your means, displaying risky sexual behaviors including infidelity, substance abuse / addiction, or being extremely vain.  It is time to make an appointment with a psychiatrist for therapeutic intervention.

• Flashbacks or night terrors: After experiencing or witnessing a traumatic event, it is not uncommon to experience flashbacks or night terrors. Flashbacks about such a traumatic event is known as Secondary Trauma which can often be just as upsetting as or more so than the original event.

• Frequent mood changes: Those that suffer from emotional lability, changing moods, engaging in risky behaviors without restriction, and having intense emotional reactions to normal everyday situations would find receiving the correct mental health diagnosis or the more common dual or combination mental health diagnoses and treatment life changing.

With the multitude of disorders and mental health illness where symptoms may be identical or overlap, a mental health evaluation by a specialist in the field will find the correct diagnosis so that proper treatment can be started.  Call the office for an appointment today.

Research data by the National Center for Biotechnology show that many patients initially prescribed antidepressant medication do not report a timely remission of their depression. Studies have shown that only 33% of those diagnosed with major depression get better with the initial antidepressant medication. Another 30% achieve depression relief after taking a combination of different medications, or through a combination of medicines and cognitive behavioral therapy.  The final roughly 30% of patients do not respond to numerous treatment attempts and may have treatment resistant depression (TRD).

Depression by the Numbers

Clinical depression affects more than 15 million adults in the U.S.  It is being predicted that in the years to come depression will become the second most common illness in the world. For those 30% that do not respond to various treatment options, an experienced psychiatrist may find them to have treatment resistant depression – the diagnosis that is one of the most challenging conditions a psychiatrist may face.

What is Treatment Resistant Depression?

The answer is often hard for mental health professionals to explain or agree upon. Some questions you may ask yourself before calling to set up an appointment with a local psychiatrist experienced in TRD follow:

• Has your depression treatment / medications failed to make you feel better?
• Do you feel your treatment has helped with the depression but you still do not feel like your old self?
• Have you found that your medication’s side effects have been hard to handle?

If you said “yes” to any of the above questions get a specialist involved to develop a treatment plan that “fits” you. Whether or not you have treatment resistant depression, it is important to talk with your mental health professional to examine how your life can become a joy that feels worth living.

Living with Undiagnosed TRD

Depression treatments do not always work. Those with undiagnosed treatment resistant depression may become disheartened when their treatment plan keeps changing but no positive results are seen.  Living with TRD can leave one feeling hopeless, discouraged, and even demoralized. Months and years can go by without finding any relief for your depression. It can take time to work through, but an experienced psychiatrist can help.

Finding the Right Doctor Key to Success

Primary care doctors do treat depression and prescribe 60% to 65% of antidepressants in the U.S.  If you have not had success with the medications prescribed for your depression or think you may have treatment resistant depression it is time to see a TRD specialist.

Call the office for a confidential assessment. Evening and weekend appointments are available for your convenience.

Having been a bully or the victim of a bully is generally thought to be a problem of childhood and adolescence which becomes virtually non-existent with the passage into adulthood. A research study published in the Journal of American Medical Association – Psychiatry (JAMA Psychiatry) reports that effects of bullying continue well into adulthood significantly increasing the risk for psychiatric problems such as depression, social anxiety disorder, and suicidal thoughts as well as the development of substance abuse of illegal drugs and/or prescription medications.

Types of Bullying Behaviors

Bullying defines a group of repetitive, aggressive behaviors used to abuse or intimidate others and establish psychological or physical dominance over its victims. Bullying may take place in person or online. Bullying behaviors include physical intimidation or actual assault, verbal intimidation, or social intimidation.

In adulthood bullying may be seen in work and social settings, where the victim is teased, threatened, punched, kicked, pushed, excluded from the group, or where hurtful rumors are spread. In the “virtual world” bullying can come via text messages, public or shared videos, Facebook posts, private e-mails, or in online group forums.

Bullying versus Victim Statistics

Research studies have looked at three main subgroups related to bullying. One group contained those who admitted to bullying others, a second study group was for victims of bullying, and a third group was for those that were bully-victims. Bully-victims are those that have been both a victim and a bully, picking on others in response to being picked on themselves. The statistics of each subgroup follows:

• Bullies display 4 times the risk of developing antisocial personality disorder than their non-bully social peers. Bullies tend to be the most socially adept and may use their bullying skills to assist them in rising up through social tiers and interactions.
• Victims show 4 times the prevalence of generalized anxiety, agoraphobia and panic disorder as adults when compared to those adults who were not bullied growing up. Victims of bullying report the greatest anxiety problems overall.
• Bully-victims have 14 times the risk of developing panic disorder, 5 times the risk of being diagnosed with depressive disorders and 10 times the risk of having suicidal thoughts and behaviors. Overall bully-victims have the most significant emotional issues which includes suicidal actions.

Successful Treatment of Social Anxiety Disorder

The treatment of social anxiety disorder related to bullying may include a combination of medications, cognitive behavioral therapy and a variety of adjunct therapies dependent upon the severity of social anxiety, other co-existing mental health issues such as depression, suicidal thoughts or substance abuse.

The memory of being a bully or a victim of bullying may have been repressed, yet the suffering continues. Working closely with experienced mental health professionals can lead you through the healing process to a productive life without the fear, anxiety, or depression of your current situation.

Bullying – Victims Social Anxiety Doctor

Call Dr. Hege’s office for a confidential appointment and comprehensive evaluation.

Research has found that sleep problems which used to be viewed as a symptom of mental health disruption may actually be a contributing factor for psychiatric disorders. Studies at Harvard Medical School confirm that sleep problems affect between 10% to 18% of adults in the general U.S. population; the percentage of adult patients seen in psychiatric practices with chronic sleep issues jumps to 80%.

Sleep Problems Point to Increased Risk for Psychiatric Disorders

Patients with a diagnosis of anxiety, depression, bipolar disorder and ADHD commonly report being plagued with sleep problems. While sleep dysfunction was once viewed as a symptom, clinical data supports the hypothesis that adult sleep problems raise the risk for developing a psychiatric disorder. In long term studies it was found that adults who reported a history of insomnia were four times as likely to develop major depression on re-evaluation three years later, indicating the sleep disruptions developed before the mental health disorder.

Sleep Problems versus use of Antipsychotics

Sleep issues and insomnia began to be more closely looked at in the 1970’s. The sleep problems were thought to be directly tied to use of antipsychotics at the time; however, data indicates a long history of sleep disturbance complaints long before use of antipsychotics began. Today it is more widely believed that chronic sleep problems puts one more at risk for the development of psychiatric issues and that treating the sleep disorder can actually assist in alleviating symptoms of a co-occurring mental health problem.

Sleep Disorders in Psychiatric Patients

Of the more than 70 types of sleep disorders the most common problems are insomnia, obstructive sleep apnea, unpleasant sleep movement syndromes and narcolepsy. The University of Brazil Medical School reports the type and impact of the sleep problems vary by the psychiatric diagnosis with examples noted below:

• Up to 90% of adults with major depression experience a sleep problem
• One-in-five adults with depression suffer from obstructive sleep apnea
• Depressed adults with insomnia less likely to respond to treatment, at a higher risk for relapse and are more likely to die by suicide
• Up to 99% of adults with bipolar disorder experience insomnia or restless sleep
• In adults with bipolar depression up to 78% sleep in excessive amounts
• More than 50% of adults with anxiety disorders have dysfunctional sleep patterns
• Sleep problems precede anxiety disorders 27% of the time
• Sleep dysfunction precedes depression 69% of the time
• 68% of adults with PTSD report sleeping problems
• Long term studies indicate that insomnia or other sleep disruptions worsen before a manic episode or bipolar depression

Sleep and mental health are interconnected though not yet completely understood. Neurochemistry studies do indicate that having a good night’s sleep promotes a healthier outlook, while chronic sleep problems can set up an arena for negative thought processes and emotional vulnerability. Call the office for a comprehensive evaluation with Dr. Hege who will work with you to get your sleep patterns and mental health issues back into functional ranges.

The National Institute of Mental Health is evaluating research data on insomnia and depression from major U.S. schools such as Stanford, Duke, the University of Pittsburgh, as well as Ryerson University in Toronto. The research from all schools conclude that while it has been long held belief that depression causes insomnia, insomnia can actually precede and directly contribute to causing depression. The link between depression and insomnia works in both directions, however treating both can make a huge difference in curing both depression and insomnia.

Common Signs of Insomnia with Undiagnosed Depression

Some of the most common signs reported for an insomnia diagnosis include:

• Fatigue during the daytime with loss of energy
• Irritability with others
• Difficulty concentrating and focusing
• Feeling like you never get “enough” sleep
• Trouble falling asleep
• Difficulty going back to sleep after waking up during the night
• Waking up at all hours of the night
• Waking up before the alarm clock goes off

Common signs of Major Depression

Some of the most common symptoms of major depression also include signs that point to insomnia:

• Change in sleep patterns
• Fatigue or loss of energy
• Impaired concentration with complaints of poor memory
• Insomnia or its reverse hypersomnia (excessive sleeping)
• Difficulty falling asleep
• Problems staying asleep all night

While there is cross-over of symptoms between insomnia and depression it does not mean you have one or both of these two diagnoses. Only an experienced psychiatrist can correctly diagnosis and successfully treat either insomnia, depression, or a combination of the two discovering if it was insomnia that preceded the depression or vise-versa.

Combination Treatment Effective

Depression and insomnia do respond to use of one or a combination of medication and cognitive behavioral therapy (CBT). While pharmacological and CBT can be used to treat both depression and insomnia, treatment of insomnia or sleep problems are typically an integral component used in the treatment of depression.

Getting Help

Self-diagnosis or incorrect diagnosis and treatment may cause more harm than good, delay proper treatment, and risk developing other physical, medical or mental health issues.

Call Dr. Hege for a confidential day, evening or weekend appointment.

Smoking or chewing tobacco can quickly become a nicotine addiction where outside help is often sought in order to successfully quit the habit. While hundreds of thousands try to stop their nicotine addiction “cold turkey,” by using nicotine patches, gum, or through use of relaxation and bio-feedback techniques, almost 30 million nicotine addicts a year find themselves making unsuccessful attempt after attempt to break their nicotine addiction.

Nicotine Withdrawal Symptoms Sabotage Success

More than half of those trying to break their nicotine addiction exhibit at least four of the following symptoms noted below. Having multiple symptoms sabotage success by “attacking” both physiological and psychological components that together work to turn those nicotine cravings into another failed attempt to end the addiction.

• Depression, loss of motivation and energy
• Increased appetite, feeling like you “need” to eat
• Weight gain and the fear of gaining weight
• Insomnia, tossing and turning in bed, night sweats
• Feeling drowsy and sleepy with decreased concentration or focus
• Feeling irritable, angry, or agitated with no apparent reason
• Feeling anxious, stressed, or like you would like to “crawl out of your skin”
• Headaches that may stay with you for hours on end
• An intense craving for nicotine where you must satisfy the urges

Nicotine withdrawal symptoms can begin as soon as the last cigarette is put out – prescription medication in combination with cognitive behavioral therapy or other adjunct therapy has proven the most successful in stopping nicotine addiction.

Nicotine Withdrawal Symptoms Manageable with Medications

Medications prescribed may include Chantix, Zyban, Wellbutrin or buproprion. Your psychiatrist may also add over-the-counter products to your regime such as nicotine patches, inhalers, gum, or nicotine nasal spray. Treating the whole person and their unique needs make for a successful outcome in ending nicotine addiction.

Chantix New Nicotine Addiction Medication

Chantix is a relatively new medication for nicotine addiction. Chantix studies indicate that the 3 month abstinence rates are almost 50% compared to other medications that have 30% success in nicotine abstinence. Looking at abstinence rates at 1 year shows Chantix at 23% and other medication falling far below at 14-16%.

Stopping nicotine addiction is hard. Working with an experienced nicotine addiction psychiatrist gives you the best opportunity for success and freedom.  Call the office today.