Frequently Asked Questions

Does having a mental illness mean you have something wrong with your character?

How long should I take an antidepressant?

Do eating disorders eventually get better?

How does a doctor decide which antidepressant to prescribe?

Do psychiatrists still do therapy or just prescribe medicine?

How common is bipolar disorder?

How common is dementia?

Does attention deficit disorder occur in adults?

Question: Does having a mental illness mean you have something wrong with your character?

Answer: No, mental illness is not character weakness. Human behavior is based on many components of choice related to personality and character. These components involve complex interactions between self-will, spirituality and environmental influences. The brain and nervous system have physiological components, too – also complex - that can malfunction in many ways, just as a pancreas can malfunction in diabetes or a thyroid can malfunction in Grave’s disease.

There is sometimes a fine line between normal and abnormal function, with an often subtle movement from one side to the other. Each of us responds uniquely, based on both choices and our own individual physiological wiring. This can lead to confusion over what is and isn’t in our control, and may invite judgmental responses from others. That will likely always be a part of human behavior, too, but can be countered with education and compassion. Response to treatment can be an impressive form of education to others, as individuals regain access to their character strengths.

Question: How long should I take an antidepressant?

Answer: Treatment of mental health issues should involve a comprehensive approach. Medication can often be a valuable component and today we have many choices of single medications and combinations of medications with the expectation that treatment will result in full remission of symptoms. However, medications are not trivial treatments and caution should be taken to monitor short- and long-term side effects, as well as the need for continuation of treatment. After remission, additional treatments (such as exercise routines, lifestyle changes) may allow reduction of medication and discontinuation of medication. Most medication treatment courses last a minimum of 6 months. Ideal goals are treatment to complete remission, lowest effective dose(s) and minimal side effects.

Question: Do eating disorders eventually get better?

Answer: Logically, it would seem that abnormal eating (or starving) behaviors would be self-limited – like holding your breath, but that is not the case with anorexia and bulimia. They have a broad range of presentation with regard to type and severity of symptoms. What may start out as a goal of losing 5 pounds can become a medical disorder in vulnerable individuals, seeming to take on a life of it’s own that has no endpoint. Since it usually is initially linked to a positive goal, it can be difficult to identify and treat through individuals asking for help until it has caused significant problems.

Eating disorders have the highest mortality rate of any mental illness. Most common causes of death are suicide and heart problems. The mortality rate associated with anorexia nervosa is 12 times higher than the death rate of ALL causes of death for females 15 – 24 years old. And while more common in females, it can be equally as serious in males. The majority of treatment needs respond to outpatient medical management and therapy, but sometimes hospitalization and residential programs are necessary. Vulnerable individuals are typically high achievers, bright and highly motivated. There is often great potential once they get reconnected with healthier functioning. The earlier an intervention is made, the better the prognosis.

Question: How does a doctor decide which antidepressant to prescribe?

Answer: Mood and anxiety disorders often respond to antidepressant medication. These disorders cover a wide spectrum of symptoms. A good assessment includes both listening and questioning about symptoms, functioning and stressors.

Knowledge of the different nervous system targets and the side effect profiles of each antidepressant, along with an individual’s medical history, family history and concurrent medications are then used to make the best clinical choice of medication.

Each medication has a unique chemical shape, along with its known mechanism of actions in the body, leading to a great deal of variability in individual response and tolerance of any one antidepressant. It is important to have regular follow-up when starting an antidepressant and good communication with your prescriber. It is not uncommon to add a second medication with a different mechanism of action or to switch medications, depending on how well the person is doing and/or if side effects are a problem.

Question: Do psychiatrists still do therapy or just prescribe medicine?

Answer: Yes - psychiatrists are trained as medical doctors and then complete a specialty residency training which includes obtaining skills in different types of psychotherapies. Clinical experience is also an important factor. There are different forms of individual therapy; there are also group and couples therapies.

A psychiatrist can combine therapy with medication management, if drugs are indicated, or only focus on the medication component. Psychiatrists frequently work in collaboration with other therapists. There are also times when a patient does not wish to participate in formal therapy. Regardless of the arrangement, it is a goal to understand the whole person and establish a relationship of trust and communication.

Question: How common is bipolar disorder?

Answer: Current research estimates that about 1% of the adult population (2 million people) meet criteria for a diagnosis of bipolar disorder. Bipolar disorder usually develops in late adolescence or early adulthood, though symptoms can present first in childhood or late in life.

Bipolar disorder has a spectrum of presentations. Type I is defined as having distinct episodes of depression that last two weeks or longer and mania (elevated or irritable mood) that last one week or longer. Type II also has depression, but with less severe swings of mood (hypomania). There is a rapid cycling form of bipolar disorder, which can present with mood variation throughout even a day, but it is rare and usually presents late in the course of the illness. Mood symptoms changing throughout the day are more often the result of depression or anxiety disorders.

It is important to spend time determining the correct diagnosis for the patient to receive the appropriate treatment with medication and therapy, as well as have the correct education for understanding his or her individual functioning.

Question: How common is dementia?

Answer: It is probably worthwhile to first define what is and is not dementia. A clinical definition of dementia requires a decline in memory and impairment in at least one other area of mental functioning. Examples include difficulty with aspects of language, impaired ability to perform motor tasks (in the absence of physical disability) and difficulty in what is termed executive function of the brain (planning, organizing, sequencing, abstracting). The impairments must represent a change from baseline functioning and interfere with daily life (social and/or occupational areas). The incidence increases with age. Current data estimate dementia occurs in 15-20% of individuals over the age of 65 and up to 45% after the age of 85. Dementia is further categorized by symptom presentation and etiological factors. Alzheimer’s disease is the most common type of dementia (up to 70% of cases).

There can be normal age-associated decline in memory. It does not interfere with work or social abilities and is usually stable over time.

Question: Does attention deficit disorder occur in adults?

Answer: Based in our current terminology, attention deficit hyperactivity disorder (ADHD) is estimated to occur in 3-5% of school-age children. There is limited data on the prevalence in adolescence and adulthood, but with some consensus that approximately 33% of those diagnosed in childhood will have symptoms that persist into adolescence, and 33% of that group will have symptoms that persist into adulthood.

However, as research in brain functioning continues to expand our knowledge in understanding and treating emotional and behavioral problems, there is a movement toward treating symptoms and neurological pathways. Attention, motor activity and impulse control can be problems in various spectrums of dysregulation.

A “reverse attention deficit disorder” may be a sign of our times – a recent study completed at the University of London found that constant distractions (ringing phones, pagers, incoming emails) can cause temporary drops in IQ functioning of up to 10 points. Effects on concentration and problem solving occur.

Appropriate treatment requires thorough diagnosing.