SMARTer CARE Newsletters
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Light Therapy
Light therapy is a non-pharmacological treatment that is best studied for seasonal affective disorder (SAD) but has also been found to be useful in other depressive disorders. It can be tried as the primary treatment for mild depression or for antepartum or postpartum depression and as an adjunctive treatment for moderate-severe depression. It has been […]
Treating Anxiety in the Primary Care Setting: A Case Review
A recent case consultation highlighted medication treatment for an anxiety disorder in the primary care setting. This is a 33 year old male with Generalized Anxiety Disorder and Panic Disorder. He has some benefit from Celexa 40 mg qday, but continues to engage in avoidance behavior, which makes it difficult to sustain work and social […]
Guidelines for Tapering Benzodiazepines
Psychological and physiological dependence on benzodiazepines can occur in as little as two weeks of daily moderate use. It can occur in the most benign of clinical situations, and it is important for providers to be aware of the risk for dependence when prescribing this class of medications. If a patient has been on a […]
Advantages and Disadvantages of Currently Available Treatment Options for Generalized Anxiety Disorder (GAD)
Type of Treatment Advantages Disadvantages SSRIs*/SNRIs*: paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac), citalopram (Celexa), venlafaxine(Effexor), duloxetine (Cymbalta) Recommended first-line treatments in GAD Effective against comorbid depression Slow onset of action Sexual dysfunction, other side effects limit compliance Tolerability/withdrawal issues/”start low, go slow”. Maximize dose over time, as tolerated. Psychological Therapies/Counseling: Concurrent with possible medications; All patients […]
Appropriate Use of Benzodiazepines
Millions of prescriptions are written every year for benzodiazepines. In a large percentage of these cases, the provider is uncomfortable with the prescription. For this reason and many others, it is important to have a good understanding of when it might be appropriate to prescribe a benzodiazepine for a patient. This is also becoming particularly […]
Treatment for Anxiety in Children and Adolescents
The presenting symptoms of anxiety in children and adolescents were discussed in last week’s edition and today’s focuses on treatment in pediatric populations. Primary care pediatric providers can play a major role in diagnosis, treatment planning, prescribing and, as needed, referring for consultation or specialty intervention. Treatment options include therapy or a combination of therapy […]
Anxiety in Children and Adolescents
Up to one in three children and adolescents experience clinically significant anxiety, and it is often under-recognized and under-treated. It is particularly important for primary care providers to be aware of the symptoms of anxiety in pediatric patients, because patients typically present first in this setting. Often the presenting complaint is a physical symptom, rather […]
May Is Mental Health Awareness Month
May 2016 marks the 67th time the United States has observed Mental Health Awareness Month. One in four American adults lives with a diagnosable, treatable mental health condition. As many as 50 percent never seek or receive help due to stigma, lack of information, cost or lack of health care insurance coverage. Primary care providers […]
Depression related to pregnancy
Depression related to pregnancy is a common and potentially serious concern. Therefore, it is important to understand the various conditions and when it is important to have a clinical intervention. Postpartum Blues: Symptoms of mood lability, irritability, interpersonal hypersensitivity and tearfulness are common in the postpartum period and are commonly known as the postpartum “blues”. […]
Long Term Effects of Childhood Bullying
A recent article in JAMA Psychiatry brings to the forefront an ongoing important topic – the long-term effects of childhood bullying, particularly on a person’s mental health. Bullying at a young age puts people at a higher risk for developing depression and other psychiatric conditions requiring treatment by young adulthood compared to people who were […]