Anxiety and Bipolar

For many people with bipolar anxiety is a bigger problem than mood swings. It is not that unusual for someone with bipolar to report that their first “symptom” of a psychiatric nature was the onset of anxiety early in childhood. Let’s take a look at this information again… 90% of people with bipolar have an anxiety disorder diagnosis. 2/3rds have had …

Potential Catastrophe

What to do when catastrophe seems to loom just around the corner? Many people are having trouble getting to sleep these days.  They’re worried about a possible catastrophe emerging after the US Presidential Election. This seems like a good time to review what we know about situations where there is the potential for something really bad to happen but the magnitude and …

Acceptance and Commitment Therapy Part 1: Acceptance and Willingness

I recently attended the Anxiety and Depression Association of America conference in Philadelphia, where I offered a two-hour workshop on Acceptance and Commitment Therapy (ACT) and deepening experiential practices in ACT sessions (largely based on the book The Big Book of ACT Metaphors: A Practitioner’s Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy*). This post is Part …

Mood Charting for Complicated Problems

Lucy is a single woman who is a professor of anthropology at a local university. She is in her late 30s and she was referred to me for a consultation because of a complicated set of potentially interrelated problems with cognitive impairment, sleep disruption, anxiety, depression, a seizure disorder, and migraine headaches. She’s an interesting person and I really wanted to help her figure …

Centering

Feeling scattered and distracted is such a common experience in our lives these days. Rick Hanson talks about getting centered in today’s post in his Just One Thing series. If you are feeling scattered, take one moment to be aware of your body as you take a long, slow breath, or think about something you feel good about. In that moment …

St. John’s Wort for Depression

A recently published study raises questions about whether the natural supplement St. John’s wort is actually associated with fewer adverse effects than commonly prescribed SSRIs. Living in the Bay Area it is common for me to run into a strong conviction that any natural supplement is bound to be safer than any manufactured medication. Perhaps the most problematic of these …

Herd Instinct in Humans: The Source of Anxiety and Depression?

Jeffrey Kahn has written a fascinating book (Angst: Origins of Anxiety and Depression in Oxford Press) suggesting an evolutionary source for much of human psychopathology. He gave a Grand Rounds presentation at UCLA in February of 2015 that outlined some of his theories and that presentation has been the subject of a vigorous discussion online. In essence, Jeffrey argues that …

Treating Anxiety – An Update by Kelsey

Treating anxiety is an important part of working with people with depression or bipolar. This update focuses on changes that have taken place in the field in the last five years that might be relevant to many people dealing with depression and anxiety. Imagine that you are taking a nice, peaceful walk in the woods. It is a lovely, warm, clear …

Accepting Uncertainty

We are often trapped more by what we think about how things should be, or “have to be,” than by the reality of the challenges we face.  This week I have been noticing how often the phrase “I can’t stand.XX” precedes a statement that is quite obviously not true.  Someone who has been living with the uncertainty of multiple sclerosis for …

Quitting Smoking Improves Mood

A study published in the British Medical Journal reports that quitting smoking had a simillar positive effect on mood as an antidepressant. The researchers did an analysis of 26 studies using a technique called a “meta-analysis” and looked at changes in mental health (anxiety, depression, mixed anxiety and depression, quality of life, positive affect, and stress) at ≥6 weeks’ post–smoking cessation …

Medications for Anxiety

A writer we have been seeing for about a year for depression and bipolar sent me an email yesterday – “I need something for my anxiety…” Often anxiety is the symptom that is of greatest concern to people who have bipolar or depression. Working through my thought process as I tried to come up with an answer for the woman …

Media Makes PTSD Much Worse

  It was a sunny October day in 1989. Game 3 of the Battle of the Bay baseball World Series between Oakland and San Francisco. Then the largest earthquake in almost a hundred years hit the bay area. I was, as it happens, in my therapist’s office, my wife was at work. I rushed home to make sure that all …

Therapy for Anxiety in Bipolar

Anxiety is very common in people with bipolar moods. In fact, anxiety is typically the first sign of mental health problems (often it is present in childhood) for people who later develop bipolar. As a psychiatrist, I am aware that we have fewer useful long term treatments for anxiety in bipolar than we do for the mood swings of the …

A Deep Shadowy Fear

Most of us have had the feeling that, deep in the recesses of our brain, there lurks some terrible secret or event, some deeply frightening, or even terrifying memory or experience. For some of us there may, indeed, be a past trauma and a repressed childhood memory. But the rest of us are left to wonder, if nothing seems to …

Experience a Sense of Plenty

Nothing can seem more urgent, important, and real than the sense that there is not enough for us. Not enough love. Not enough food. The sense of scarcity may not even connect to any clear sense of what is missing. But that doesn’t take away its power. Regular readers of this blog know that we appreciate the insights of Rick …