Dr. Lisa Diane Fairweather, D.O.

Please seek counseling in order to learn to set appropriate boundaries with your son. As difficult as it may be, you need to look at your part in how your son's life turned out. What type of lifestyle have you modeled for him? Who purchased (and continues to purchase) the foods he learned to love as a child Who has allowed him to live a sedentary lifestyle? Who continues to provide him with a roof over his head and food to eat, despite his unwillingness to get a job? Do you also pay for his car, cable TV, gas, and food? If any of these are true, why would he change anything? He's got it made (in his head, anyway)... In reality, he's been crippled by whatever enabling has gone on for the last 27 years. I apologize if that sounds harsh, but the truth is what his enablers need to hear, as well as ways to stop the enabling, which can only be done by a professional. Neither the enabled (your son) nor the enablers are bad people; rather, they've got unhealthy coping and relating skills. There is hope, but it will take a lot of work and it will require both you and your son to do things that you find difficult and/or uncomfortable.
I wish you the very best. Please don't hesitate...find a therapist TODAY and get started on the path to recovery.

At twelve, he is incapable of purchasing his own food; therefore, you are in complete control of his food choices. If you do not purchase fast food, and if you stock your house only with healthy foods, your problem will eventually work itself out. Will he escalate bad behaviors in order to get you to buy him the foods he wants? Absolutely. Is it worth it to resist his bad behaviors and do what's right for him, no matter how difficult it is for you? Absolutely. And are you modeling good habits for him? Children often model the behavior of their parents. Do you eat a healthy diet? Do you exercise regularly? Please act now, and do so with the assistance of a therapist or coach. Once he's of driving age, you'll have much less control over his habits.
I wish you the best of luck.

First, I would get a second (or even third) opinion about your diagnoses, as many other diagnoses (including anxiety disorders and substance abuse/withdrawal disorders) can masquerade as Bipolar. Your next step would be establishing a close patient-provider relationship with a psychiatrist, who should be able to diagnose you within the first one or three sessions. What we're trying to avoid here:

1. A missed diagnosis of bipolar disorder (very common), or
2. A premature diagnosis of Bipolar Disorder.

Either of the above can put you at risk of a Bipolar Spectrum Disorder that can make your disease A) more difficult to treat in the future, and B) a disease that is increasingly difficult to treat with time.

Best of luck!

I recommend finding a child psychiatrist, and having your daughter evaluated for ADD/ADHD. If she does suffer from an attention deficit disorder and it goes untreated, it will have negative effects on many areas of her life, some that may surprise you.

Untreated ADD/ADHD results in: poorer school performance and therefore limits career opportunities as an adult; behavioral issues that can result in poor conduct grades, in-school suspension, and difficulty getting along well with peers; lower self-esteem; the development of social anxiety disorder, which is typically a lifelong disorder and significantly limits both social and occupational opportunities.

There are many other potential negative consequences of untreated attention deficit issues, so it is critical that your daughter receive a full and proper psychiatric evaluation to rule in or out ADD/ADHD and/or other psychiatric disorders that may co-occur with, exacerbate, or mimic ADD/ADHD.

I hope you find this helpful, and I wish you and your daughter the best!

Sincerely,

Lisa Fairweather, D.O.

Unfortunately, there is no cure for Schizophrenia, and medication treatment needs to be lifelong. The good news is that there are many effective medications currently available for the treatment of Schizophrenia--several of which are available in injectable forms--and new medications for Schizophrenia are coming down the pipeline each year. Injectable medications for Schizophrenic patients are important, as these patients are notoriously medication-noncompliant with oral medications (pills), which has dire consequences as outlined below.

The key to successful treatment of Schizophrenia--and avoidance of progression (permanent worsening over time) of the illness--is to treat early and to treat aggressively. The longer a Schizophrenic patient is symptomatic prior to the initiation of treatment, and or if treatment isn't sufficiently aggressive (thereby allowing some symptoms to persist), the poorer the long-term outcome for the patient. There is a concept known as the "kindling effect" which refers to the fact that the more symptomatic a psychiatric patient remains, and the more time the brain spends in any pathologic psychiatric state (including Schizophrenia/psychosis): the more quickly and severely the illness will progress (irreversibly), and the more treatment-resistant the illness will become.

It is unfortunate, but many Schizophrenic patients do not receive the treatment they need, either due to lack of resources, or an unwillingness to participate in treatment. A large proportion of these patients wind up incarcerated, where they are treated with older, less-effective medications (if they're treated at all), and where they're often severely victimized by other prisoners.

If you suspect a person may have any type of mental illness, including Schizophrenia, please do what you can to help them get a complete psychiatric evaluation performed by a qualified psychiatrist. All psychiatric illnesses have a significantly better long-term prognosis if treated early and appropriately. Just waiting a few months can make a significant difference in a patients long-term prognosis, and thus quality of life.

I hope you find this information helpful.

Sincerely,

Lisa Fairweather, D.O.

A change in appetite, be it increased or decreased, is normal for someone experiencing grief or sadness, so a lower appetite that began after your father's death is very likely due to grief (which is depression stemming from a loss). Although grief is often self-limiting, some people never fully recover from a significant loss. Although she likely won't feel like doing so, your mother may benefit from seeking treatment from a therapist to help her move through the grieving process in the most healthy and expeditious way possible.
I'm sorry for your loss, and wish both you and your mother the best.

Sincerely,

Dr. Lisa Fairweather

Without knowing your daughter's age or her interests, it's difficult to ascertain the reason for her distractibility; however, she may be suffering from Attention Deficit Disorder, or ADHD. Children with ADHD can often focus on things in which they're interested, but simply cannot sustain focus for any length of time on any other tasks. They often daydream, have trouble comprehending new concepts or what teachers are saying, and they tend to be more forgetful than their peers. I recommend that you find a skilled child/adolescent psychiatrist and have her evaluated for ADHD, as well as other psychiatric or medical disorders that can masquerade as ADHD.
I wish you the best!

Sincerely,

Dr. Lisa Fairweather

Overall, Prozac is generally considered to be a "weight-neutral" medication, meaning that a small proportion of patients lose weight, a small proportion gain weight (typically very little, but occasionally a significant amount), and most neither gain nor lose weight. If your treating provider believes Prozac would be a good medication choice, it would be worth trying. If it was going to cause you to gain weight, you would likely have a noticeable increase in appetite. In that case, the medication could be discontinued before any weight gain occurred. Another factor to consider with antidepressants and weight gain or loss is this: Most people with anxiety -- and some with depression -- endorse a decreased appetite. When their antidepressant causes remission of their mood symptoms, their appetite normalizes (increases), causing weight gain. This type of weight gain is often incorrectly blamed on the antidepressant.
As you can see, there is no simple answer to your question, but I'll try to sum it up: Prozac is unlikely to cause weight gain, but if your appetite spikes after starting Prozac, inform your physician so that they can change your antidepressant.
I hope that helps.

Sincerely,

Dr. Lisa Fairweather

The severity of your somnolence sounds more like that related to a sleep disorder such as OSA (obstructive sleep apnea) than to a mental/psychiatric disorder. Sleepiness due to the latter is milder and varies throughout the day. If your primary care has truly ruled out every possible physical cause for your excessive daytime somnolence, you may benefit from a sleep study. In addition to OSA, there are other sleep disorders that can prevent a person from getting sufficient restful sleep, and there are wake-promoting medications for patients in whom they're appropriate.

Without knowing the age at which she first experienced depression, or what other symptoms she has, it's difficult to know. She may have been misdiagnosed (e.g., she may have Bipolar or another psychiatric disorder), she may not have been compliant with her medications, she may not have been prescribed the right medications at the right doses and or in the right combinations, or her depression may truly be extremely treatment-resistant. In the latter case, there are treatments such as Ketamine therapy, TMS (Transcranial Magnetic Stimulation), ECT (Electroconvulsive Therapy), and Vagal Nerve Stimulation. She may benefit from an evaluation at a major medical center--such as the Mayo Clinic--if no treatments have been effective; or she may need a second or third opinion. I champion those who, despite treatment failures, continue trying to get help.
I wish her the best.

Sincerely,

Dr. Lisa Fairweather

Your symptoms were mild enough that therapy would be sufficient, and medications would not be necessary. In mild cases of some psychiatric illnesses, therapy (or counseling), including CBT, is often the appropriate first-line treatment for such symptoms. If, however, therapy proves insufficient, the next step in treatment is an evaluation by a psychiatrist, as medications in combination with therapy are likely what is necessary at this point in treatment. I hope that gave you some clarity, and I wish you the best!

Lisa Fairweather, D.O.

Most often, when patients come to me with issues similar to yours, one of the following situations has occurred:

1. The patient has been misdiagnosed all along, which explains why the previous treatments have been unsuccessful.

2. Only some of the patient's psychiatric and or medical diagnoses have been addressed, while others have been missed or ignored, thus rendering the overall treatment regimen ineffective.

3. The patient has been correctly diagnosed, but treatments have been ineffective. This most commonly due to having been under-medicated, over-medicated, given incorrect medications and or doses of those medications, not having had appropriate ancillary treatments (counseling, etc.) added to their treatment regimens, or some series or combination of these events.

Because most patients have no way of knowing which, if any of the above, may be the cause of their treatment failure, my advice is this:

Before exploring other outlets of treatment besides psychiatry, I recommend that a patient in this situation give psychiatry another chance. Seek out (online reviews are helpful) a reputable, highly experienced psychiatrist who will do the following: evaluate you both psychologically and medically; provide you with accurate diagnoses (if appropriate); craft a comprehensive, whole-person treatment plan tailored specifically to you; and make subsequent changes to that plan as necessary to optimize your wellness over time. You may have to make a few calls and interview staff of local psychiatrists in order to find out if their treatment philosophy matches what's listed, but it's worth the time invested.

I wish you the best!

~Lisa Fairweather, D.O.

Your husband would benefit from a complete psychiatric and medical evaluation by a professional with expertise in trauma and associated anxiety disorders like PTSD, or Post-Traumatic Stress Disorder.

Fortunately, there is hope for PTSD sufferers, as there are several medications that specifically target many of the core symptoms of PTSD, including depression, anxiety, hypervigilance (or "jumpiness"), nightmares, flashbacks, insomnia, panic attacks, and other symptoms that can severely limit the quality of life of PTSD patients. These medications are typically used in combination with routine therapy (counseling), with promising outcomes.

It's important that both the prescribing psychiatrist and the therapist have in-depth experience in properly diagnosing and effectively treating PTSD. Untreated, PTSD can reduce life to a series of continuous flashbacks, nightmares and panic attacks. With proper, ongoing treatment, many PTSD patients are able to resume previous levels of functioning and quality of life.

Your fears are certainly understandable, but may not be justified.

It's unclear if you fear (A) starting an antidepressant because your body will become dependent on the medication, thus making it difficult for you to stop the antidepressant, or (B) if you fear seeking evaluation because you may be advised that you're a good candidate for long-term treatment with antidepressant therapy.

If you fear (A), fear not! Although antidepressants can cause discomfort if improperly discontinued, a skilled clinician can discontinue any antidepressant with minimal or no discomfort to the patient.

If you fear (B) above: whether or not you remain on medications long-term is--firstly--your choice. A psychiatrist's job is to educate you about your illness, as well as the potential risks and benefits of various treatment options (including no treatment), then to help you decide upon a course of treatment. No one should pressure you to decide either way.

The likelihood that a given patient will need antidepressant therapy long-term depends upon several factors. One factor predictive of a need for long-term (sometimes lifetime) treatment with antidepressants, for example, is the number and severity of mood episodes that have occurred in the past.

A very general rule of thumb for depressed patients, for example, is: if a person has had three or more major depressive episodes, they are likely to do best on long-term medication maintenance treatment. The data is very clear regarding these patients: those who do not remain on maintenance antidepressant medication have a high likelihood of having additional--and often increasingly disabling--major depressive episodes in the future, with each major depressive episode predisposing that patient to additional future episodes, sometimes worsening in severity.

Not every patient diagnosed with depression is an appropriate candidate for antidepressants, as many patients are more suitable for counseling or therapy.

I hope that helps, and I wish you luck!

Again, that is a very general rule of thumb. Only after a thorough evaluation and discussion with your provider can a reasonable outlook be formed and appropriate treatment recommendations made.

First, let me explain what each can do for you. Both are experts at diagnosing and treating psychiatric illnesses. The primary difference lies in how each profession treats mental illnesses.

A Psychologist is a type of doctor--a PhD--who is an expert in psychotherapy or counseling, but does not prescribe medications.

A psychiatrist is a medical doctor--a D.O. or M.D.--who focuses on both the medical and psychiatric components of mental illness, and who treats these illnesses with medications when appropriate. Most psychiatrists do not provide therapy or counseling, but instead refer patients to other mental health professionals--like PhDs--for non-medical therapy.

When a patient's symptoms are mild and are not disabling or causing any significant distress, starting with a psychologist is often recommended. For patients whose symptoms are more severe, an evaluation by a psychiatrist should be considered.

Often, when patients report issues similar to yours, one of the following situations has occurred:

1. The patient has been misdiagnosed all along, which explains why previous treatments have been unsuccessful,
2. Only some of the patient's psychiatric or medical diagnoses have been addressed, while others have been missed or ignored, thus rendering the overall treatment regimen ineffective, or
3. The patient has been correctly diagnosed, but treatments have been ineffective. This most commonly due to having been over- or under-medicated, given incorrect medications, not having had appropriate ancillary treatments (counseling, etc.) added to the treatment regimen, or some combination of these events.

Because most patients have no way of knowing which, if any of the above, may be the cause of their treatment failure, my advice is this:

In addition to exploring other outlets of treatment, find a reputable, highly experienced psychiatrist who will do the following: evaluate the patient both psychologically and medically; provide them with accurate diagnoses (if appropriate); craft a comprehensive, whole-person treatment plan tailored specifically to that patient; and follow that patient's progress carefully, making changes to the treatment plan as necessary over time.

You can often tell a lot about what a physician will and won't do by reading their reviews. I wish you the best in finding a psychiatrist who is a great fit for you.