Dr. Michele Casoli-Reardon, MD

Core symptoms of depression include:
Sad, irritable or bored mood, loss of interest in things that give you pleasure, changes in sleep, appetite, energy and concentration [typically worse], feelings of hopelessness, helplessness, guilt, worthlessness. In more serious cases, it can be associated with thoughts of death, suicide and some patients even experience auditory hallucinations [typically of their own voice telling the negative things about themselves]. I would follow up with you PCP- he can complete a simple questionnaire that can assess your level of depression and talk to you about options.

Compulsive skin picking [called excoriating disorder] is a form of obsessive compulsive disorder and responds to the same treatment as OCD. Connecting with a therapist who specializes in treating OCD [treatment is Exposure Relapse Preventive Therapy] and starting one of the Selective Serotonin Reuptake Inhibitor antidepressants such as Prozac or Zoloft in combination, has the greatest efficacy and success rate.

Yes, feels of being disconnected from others, isolation, withdrawal are all core symptoms of depression. I would suggest that you encourage your friend to follow up with a therapist. Although he may also need an antidepressant, therapy is very effective in addressing core symptoms of depression.

Yes. Deficiencies in Vitamin D [which tend to be prevalent in northern states] is associated with cognitive/memory issues, depression and anxiety. Would have your PCP check your Vitamin D levels as you may need supplementation. Additionally, Folate [type of Vitamin B] is an important vitamin in helping our brain make neurotransmitters and hormones necessary to mood, sleep, thoughts and cognition. Would add an over the counter supplement of 4-25 mg a day.

If you are taking any of the benzodiazepines such as Xanax, Klonipin, Valium, then yes, you can absolutely be dependent [physically] on these medications if using them regularly. These medications work on the same receptors in your brain as alcohol does. So, like alcohol, you build up tolerance, need to use more over time and when you stop experience [sometimes life threatening] withdrawal symptoms. I would talk to your doctor about weaning slowly off your medication or sending you to a treatment center that can help do this safely. There are much better options for anxiety including the antidepressants [particularly ones that work on serotonin in your brain such as Prozac/Zoloft], Buspar, Neurontin, Clonidine. All of these are safe, do not cause tolerance or withdrawal and are more effective than taking a short acting benzodiazepine for your anxiety.

The best therapist to see for anxiety is one who specializes in a form of therapy called cognitive behavioral therapy. This works by helping you identify irrational and distorted thoughts, challenging them and reversing learned [usually avoidant] behaviors as a result of them.

In studies the antidepressants as a group are weight neutral. Meaning that if you gain or lose weight when you start them, your weight at the end of a year tends to stabilize to baseline. However, about 5% of patients on antidepressants do experience weight gain that persist. Weight gain typically ranges around 10-15 lb but can be higher. If your friend has experienced weight gain with her current antidepressant then I would have her talk to her provider about switching over to another one. Different antidepressants have different side effects even though the work the same way for depression and anxiety. So it is not uncommon that patients gain weight with one of the antidepressants but not another.

If you have noted recent moodiness, then it may be related to your medication and I would discuss with your physician switching to another. Anxiety itself will cause irritability so addressing it properly with the right medication is key. The best treatment for anxiety are the antidepressants and should be the first line.

The antidepressants- typically with young children we use Zoloft- are safe. You can also use clonidine in children as young as 3.