Dr. Danya Lewis

Absolutely, no question about it. You can start with your primary doctor. They should not only screen you for acute MDD (which requires only 2 weeks symptoms), persistent depression (less severe sx over 2 years), other mood/anxiety/safety issues, but also onset at 40yo, screen for underlying medical or medication causes. Not to worry you as risk is low, but depression can be triggered early on by colon or pancreatic, autoimmune, insomnia, vitamin D deficiency (not unusual postmenapausal) and other conditions. Your PCP may feel comfortable starting you on medications (which I’d probably do if 2 months severe sx) and may recommend some type of psychotherapy (esp if there are life stressors or a significant anxiety component). If sx is complicated or sx resistant to therapy, they may want to refer to a psychiatrist. Don’t delay, treating early leads to a faster and stronger response to lower doses of meds. Depression is harmful to the brain, increases dementia and other risks. I sent my daughter to a therapist right away after her father died and periodically after that. She has been amazingly resilient, kept a positive outlook on life and remained engaged socially, in sports and academically very successful. I viewed therapy as preventative. No one needs to know, they’ll just see your doing better.
Good luck.

Yes, both on a physiological and psychological basis; opioids are also depressants. That doesn’t mean medications are required. You need to see a psychiatrist, MD who can assess your case and offer you appropriate options of treatment. It’s likely that will involve some type of psychotherapy such as cognitive behavioral, meditation, etc., and maybe medications for insomnia/anxiety/depression (at least initially it may help you engage in psychological/physical therapy and social activities etc to optimize outcome). They can review your pain management and may make additional consultations and coordinate care. Chronic conditions require team approach and with minimal delay as chronic issues change the brain and are more resistant to treatment over time. While 3 years is delayed, it’s not as bad as 5 or 10 or 15. Get a referral after doing some research, see if you can find some one who subspecializes/has more experience with similar things. Maybe your pain specialist works with someone, are there any cross trained/certified IM Psychiatrists in your area? This not an uncommon problem. There is hope, but you must seek help.

Good luck,

Dr Lewis

YES. Clearly, you already know you are deeply depressed and you should be seen immediately given your suicidal thinking and severe impairment. Go to an ER now where they will check out possible medical causes and get a psychiatrist to evaluate you right away. There is no reason for you to suffer this way. Please get family or a friend to take you or call 911.

Any distress that persists or is overwhelming, interfering with emotional state, social, occupational or academic function may benefit getting a check up, even if it's just with an attuned general practitioner. It doesn't mean medication is required, maybe not even therapy. There are a variety of approaches, exercise, sleep, diet, social activities, thyroid/medical considerations, and maybe nothing at all is required. Sometimes a sentinel event may suggest preventative care. My husband died and I put my 9yo in therapy even though she was coping amazingly well. It got in the way and she stopped going for 18 months, but we moved and I noticed some little things and got a good referral. She sees her therapist periodically as she wishes and it's not generally about her dad. Just a teen who doesn't always want to talk to mom. No harm done and hopefully she'll be in charge of where her life goes by understanding where her emotions come from and being able to direct her thoughts and behaviors in a constructive way.
Nobody needs to know you get a little confidential advice.

I’m afraid there are no guarantees in life. Treatments have advanced over the years with improved outcomes and broadly speaking are more tolerable. Most likely Schizophrenia is clinical result of multiple different causes. This is why treatments have variable effectiveness. The important thing to do is find a good psychiatrist and start the process of looking for the best medication for you. There is no way to control Schizophrenia without medication. Studies show the sooner treatment starts the better the outcome and the lower the amount of medication required. Noncompliance with medication worsens the outcome. You should also optimize treatment by living a clean lifestyle to protect your brain: no illicit drugs and caution with prescription drugs, low stress environment, exercise really makes everything in our body work better, good sleep, healthy nutrition, no alcohol or MARIJUANA-it worsens psychosis, appropriate animals/pets can be very helpful reducing stress. Be clear: none of these things substitutes for medication and no alternative herbs will either, they can do a great deal of harm. Discuss any such “supplements “ with your doctor. Talk Therapy can help too.
Let me reassure you, many of my patients have good outcomes but this is a lifelong illness. The key is to develop a good working relationship with your doctor and communicate clearly. Journaling symptoms and side effects can help direct your treatment and community mental health support groups are really wonderful resources. I wish you the best.
NIH, National Institute of Health and American Psychiatric Association are some good resources.

Yes you should take him to a counselor. But do a little research to find one who is experienced working with kids his age and divorce situations and people who think they work well with kids. My husband died and I’ve taken my very resilient daughter to counseling to PREVENT serious psychological problems developing and everyone thinks she’s amazing. It can help you both negotiate very stressful circumstances and teach healthy communication and coping skills. Promote a healthy relationship with his father and avoid getting your son involved in your conflict with his father, regardless of how his father behaves (within reason and safety). Make VERY clear that the divorce is NOT his fault but the difficulty of adults getting along. Definitely get a good counselor and frequently they may engage the parents too. Good Luck

Yes, a psychiatrist can evaluate your mother for possible reasons causing memory loss. You may also start with your Primary Practitioner. You can also be referred to a memory clinic, if appropriate - often run by a psychiatric specialist or see a Geriatric Psychiatrist.

There are a multitude of possibilities including psychiatric, such as Depression or Dementia, which can be reversible early on if caused by nutritional deficiencies such as B12. There are many neurological and medical causes which any of the named practitioners can screen for: thyroid, cancer, insomnia, strokes, medications especially etc. I would start with my PCP, get some blood work and/or medical evaluations and mental health screening, then get appropriate referrals.

Given that you are noticing a change, this could be a symptom of depression, which doesn't require a trigger.
However there could be other explanations. I would suggest you speak to your regular doctor who can do some screening and refer you to appropriate professionals (psychologist, psychiatrist or others) indicated.
Your doctor should also check for obvious medical causes such as thyroid disease, nutrition or even cancers according to your demographics or risk factors. Regardless of the etiology, there is a lot of wonderful positive mindedness research to show its benefits in all aspects of health, mental & physical, and in coping with daily life stressors. You can work on this on your own, not to discourage psychotherapy. NY Times magazine had a special edition on mental wellness this summer and a lovely review of resilience and how anybody can learn positive mindedness, regardless of personality or traumas. You could easily google up a plethora of articles on this. Nevertheless, you should still go and discuss this with your primary doctor.
I wish you well,
Dr Lewis, MD Psychiatrist