Dheeraj Raina is a psychiatrist.

Hospice didn’t stop suffering. But what it did for us was priceless.

Physician
March 27, 2019

My wife Uzma died peacefully at home. She didn’t take any painkillers for her last three days. Our kids, my parents, and I were next to her. In the weeks leading up to her death, many old friends visited her. Others sent her flowers, cards, and food. It was a good death. Yes, in the last five years cancer and its treatment took a physical and emotional toll. Yes, she left us a …

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Hospice didn’t stop suffering. But what it did for us was priceless.

Depression causes a drop in productivity at work

Conditions
October 5, 2011

According to a recent study, depression causes an 23% drop in productivity at work. The drop is almost 45% for treatment resistant depression, defined in that study as depression that has not responded to 2 adequate trials (i.e. adequate dosage for adequate duration) of antidepressants.

My gut, based on clinical experience, tells me that even when depressed, people devote lot more of their emotional resources to trying to not let …

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Depression causes a drop in productivity at work

Neurotransmitters and the side effects of antidepressants

Meds
July 22, 2011

We  certainly wish that antidepressants in particular, and all psychiatric medications in particular were free of side-effects. It would be a boon to our patients, and their families. Sadly, there is no such thing as a medication without any risk of side-effects. Even over-the-counter medications such as Tylenol, Benadryl an aspirin can have pretty serious side-effects.

Some side-effects of medications are related to dose — the higher the dose, the …

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Neurotransmitters and the side effects of antidepressants

How to be heard by your psychiatrist

Patient
April 26, 2011

How do I get my concerns heard about the direction of my treatment?

On the surface, it seems easy. Just tell your psychiatrist what you want him to pay attention to.

On the other hand, there are many reasons why it not so simple.

  • Many psychiatrists diagnose a patient’s illness after a 45-50 minute interview, without doing any tests to rule out potential medical causes of …

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How to be heard by your psychiatrist

What makes a good, competent psychiatrist?

Physician
February 16, 2011

A reader recently asked, how does someone find a good psychiatrist?

Stated another way, the questions are:

  1. What qualities make a good, competent psychiatrist?
  2. How do I find a good, competent psychiatrist?
  3. How do I get my concerns heard about the direction of my treatment?

I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe …

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What makes a good, competent psychiatrist?

Solving treatment resistant depression

Conditions
December 13, 2010

About 60% of patients suffering from depression do not find any benefit from their first antidepressant. Up to 20% of patients find depression impossible to overcome even after 1 year. Assertive treatment of depression from the get go is essential to helping recover from depression.

Psychiatrists don’t have a shared definition of treatment resistant depression. However, most would agree that your depression may be treatment resistant if it has not resolved …

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Solving treatment resistant depression

How an antidepressant can hurt your patient

Meds
October 27, 2010

Patients want a quick fix. Society wants patients to have a quick fix, so that they can quickly return to their usual performance at work and home.

Patients still have shame about seeking help from a psychiatrist or other mental health professional. So they ask help for their depression from their primary care physician. The PCP feels an emotional pressure to provide the quick fix in that 15-minute appointment – the …

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How an antidepressant can hurt your patient

What is an adequate trial of an antidepressant?

Conditions
September 10, 2010

Since there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an “adequate trial” of an antidepressant.

However, it’s worth looking at some guidelines.

A 2003 study from the Journal of American Medical Association found that only 21.7% of Americans diagnosed with depression received “minimally adequate treatment” in the past 12 …

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What is an adequate trial of an antidepressant?