Dr. Scott Ispirescu, MD

I would say that generally, psychotherapy is unlikely to harm you. However, there are some amazing therapists out there, then there are mostly mediocre ones, and then there are some really bad therapists too. So, it pays to get a personal referral from a friend or physician. Also, you can look at psychology today.com and get information about areas of speciality, education, and what sort of insurance a particular therapist takes.

As you may know alcoholism is a life-long condition, and so the treatment will likely need to be life-long by attending AA meetings and maintaining sobriety. Typically alcohol detox where you go to a facility and they medically supervise and treat alcohol withdrawal is about 30 days. Of course, all this depends on how much you drink, for how long, and also on how motivated you are to quit.

The short answer is yes. However, there may be some additional things to think about. For example, do you have any suicidal thought and would you consider acting on them? If yes, consider going directly to an emergency room. On the other end of the spectrum, if you feel that your depression is mild, you may also consider going to talk therapy first. There are also some over the counter supplements such as Mood Joy which is available on Amazon for about 20 dollars which may help if your depression is mild. Andrew Huberman in his podcast on Dopamine recommends cold water exposure as a way of boosting your dopamine to 2.5 times baseline.

This is a very interesting question. My opinion is that yes, obesity can cause depression, but in an indirect way. That is, in order to become obese, people often eat unhealthy foods which serve as excitotoxins which contribute to depression. Examples of excitotoxins are High Fructose Corn Syrup (found in soda and other processed foods), MSG, aspartame, and many other food additives. Additionally, obesity can impair your ability to exercise, and we know that exercise contributes to making you happy (not depressed). Some suggestions that would improve both your depression and your weight are to eat natural unprocessed food, exercise every morning, end your showers with cold water, get 8 hours of sleep each night, and try intermittent fasting (eat in an 8 hour window).

The newer multimodal antidepressants such as Trintellix and Viibryd work well for depression and anxiety, and they overcome some of the side effects typically encountered with the SSRI class of medications (Prozac, Lexapro, Zoloft) which generally fall into three categories: emotional blunting, weight gain, and sexual side effects. These newer agents overcome those side effects, but cans still have some GI (gastrointestinal) side effects such as nausea. The nausea generally can be avoided by a slow start. There are some other antidepressants that may help which have different side effect profiles. For example, Remeron (mirtazepine) avoids the sexual side effects and the emotional blunting, but it tends to make people sleepy and hungry. Those side effects may be benefits to certain people (depressed elderly person who is not eating and has trouble falling asleep) but may be liability to others who already have too good of an appetite. MAOI's are also very effective, and they are low on their side effects, but they require careful attention not to combine them with other antidepressants, stimulants, opiates and certain tyramine containing foods. Hope this helps answer your question.

The short answer is no. Divalproex is used to treat epilepsy, but taking it will not increase your chances of becoming epileptic. However, there are some other side effects of divalproex which may be of concern such as weight gain, hair loss, liver toxicity, and also has the possibility of Stevens Johnson's which is a sever but rare rash. Lamictal has only the possibility of the Stevens Johnson's but not the other side effects and may also be effective in treating bipolar. Also, please be aware that you need to reduce Lamictal dose by 50% if you are adding it to Depakote, and this means you will need to double it once the transition is complete. Olanzapine works great, but it also has a weight gain tendency, so consider one of the newer atypical antipsychotics if that is a problem.

Tapering off diazepam or any benzodiazepine can be challenging, especially if the anxiety which was the reason for taking the diazepam is still there. You may consider increasing the other two meds you have, which are the Buspar and the paroxetine which also treat anxiety. Also, tapering very slowly is helpful. Additionally, I believe natural supplements/vitamins, a healthy lifestyle that includes exercise, adequate rest (8 hours of sleep, vacations), and a healthy diet that avoids processed food are beneficial to reducing anxiety and making it easier to come off the diazepam.

Hello, the answer to your question is that what is a good substitute depends on your diagnosis (why you are on the meds), what other meds have and have not worked for you in the past, which side effects would be least problematic, and also on how much work you are willing to invest in improving your lifestyle. Having said that, there may be some general things to say about newer meds to replace clomipramine for the treatment of OCD or Depression. All of the SSRIs work for both diagnoses, though some are FDA approved for one or the other diagnosis. Prozac is the least sedating, and some would even call it mildly activating of the SSRI category. There are also the newer multimodal agents such as Trintellix and Viibryd which are only approved for depression and have fewer sexual side effects, less sedation, and no weight gain. However, they are pricy, and you have to check your individual plan to see whether they are covered. They only have an indication for depression, but not OCD. As far as the Seroquel, what could be used to replace it varies greatly on why you need it in the first place. For example, if you were using Seroquel as an adjunctive treatment for OCD or it would be a different story than if you were using it to treat depression, which would also be different if you were using it to treat insomnia. As an adjunct for depression, you may consider Wellbutrin. For OCD, you may consider a less sedating atypical such as Geodon. For Bipolar, you may want to consider a less sedating atypical such as Vraylar which also has an FDA indication for Bipolar, while if you were taking the Seroquel for sleep, you may want to try some natural supplements such as Melatonin 1 mg and Magnesium L-threonate 500 mg ninety minutes before bedtime. In short, you should really get a second opinion if your doctor is not willing to work with you on finding some alternatives that have less of an impact on your lifestyle.

Depression is a subtype of a mood disorder. Mood disorders include Depressive disorders, as well as Bipolar Disorders.

Our office is able to help you with Suboxone or Subutex prescriptions if you are ready to stop using any other opiates. You may contact us by email at helpdesk@ocpsychiatry.com or find our website www.ocpsychatry.com [6].

This is a very interesting question about the most energizing antidepressant. There may be different ways of answering this question. The most energizing among the SSRIs is Prozac. The newer multimodals such as Trintellix and Viibryd also boast of improvements in cognitive performance, no emotional blunting, no weight gain, no sexual side effects, and may also improve energy. However, they are more expensive and may also require authorization from insurance company. If anxiety is not a problem, then Wellbutrin is also on the energizing side, and also does not have sexual side effects, and may also help people quit smoking if that is a problem. Of course, the most energizing of them all would be to take a stimulant, such as Ritalin (methylphenidate).

SSRIs generally would be a possible option for controlling sexual desires. An example of an SSRI is Prozac or fluoxetine, but there are 5 more medications in this category. SSRIs may work in two ways: 1) They are indicated for the treatment of OCD (obsessive-compulsive disorder) and a sexual compulsion may be considered a type of OCD, 2) they have sexual side effects which decrease sexual desire. Most of the time, we are trying to avoid sexual side effects, but in this case, we may welcome them.

First, let me begin by saying that I am not a fan of the vaccine for 18 year olds. The risks may outweigh the benefits. However, having said that, I have never heard of the vaccine affecting the appearance of your thighs or anyone else's. This is likely related to your body dysmorphia, and I would seek treatment for the body dysmorphia such as psychotherapy and possible pharmacologic intervention. Specifically, CBT ( Cognitive Behavioral Therapy) and SSRIs have been found to be useful in the treatment of your condition.

Treatment for anxiety can include both psychotherapy and/or pharmacotherapy (medication treatment). Generally it takes about 3 months or 90 days to have the treatment work. Of course, each individual is different, and response times may vary depending on the severity of the depression, how well the individual responds to treatment,