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Therapist

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Blog

This is a collection of information I believe is helpful for client's and the community to better understand concerns related to our mental health.

Is Medication Right For Me?

Todd Swagler

As a licensed psychotherapist, I’ve seen client’s struggle with the concept of taking medication to support the hard work of therapy. For those who already use medication to support their treatment, I’ve had the opportunity to learn of some very trigger-happy prescription-writhing behavior by mental health professionals in New York City. While I am neither a psychiatrist, nor a clinical psychologist (who in a few states can prescribe medications), as a mental health provider I would like to apologize if you have had a similar experience. It is crucial as a mental health practitioner to discern the need for medication as medically, clinically, and ethically necessary. We will discuss the importance of evaluating, as a patient/client, your rights and how to make the most informed decision for yourself and your treatment.

Psychotropic Medication

Medication, or more important psychotropic medication, are drugs that are prescribed by licensed and trained professionals to alter your mind, emotions, and behavior. These drugs are often used to elevate, alter, or correct neurological concerns. For example, Clonazepam (brand name Klonopin) used to treat panic, anxiety, and seizure based disorders, can impact your ability to operate and function effectively. This drug is a benzodiazepine, a group of medications, responsible for slowing down the nervous system and ultimately impacts your behavior.

According to the 2012 National Conference on Health Statistics, apart of the Center for Disease Control and Prevention (CDC), the primary drugs prescribed were for anti-depressants, followed by ADHD and anti-anxiety. Additionally, Kathryn McHugh and colleagues highlighted “The past 10 years have seen substantial increase in the prescription of antidepressant medications, which surpassed all others as the most commonly prescribed class of medication in the US in 2005. There is also evidence of a concurrent decrease in patients receiving psychological treatment. However, the available data on patients preference, efficacy, and cost-efficacy for depression and anxiety do not support this trend, and imply that many patients are not engaged in their preferred psychological treatment” (p. 7).

So we have seen an increase in prescription medication for mental health concerns, but does that mean it’s helping us? This is a little less clear, however, there is a growing body of research and evidence that medication alone is highly ineffective, without psychotherapy to support the deeper work that must be achieved for successful treatment of any diagnosis. Between 1998 and 2007 the American Psychological Association (APA), there was an increase from 44% to 57% for the prescription of medication of the only treatment for mental health disorders—no psychotherapy—that’s a huge increase! This is important information because drugs alone can not heal all psychological concerns without treatment through “talk-therapy.”

What are my options? 

This is the best part of my job! I have the freedom in this platform of letting clients know they have options in how they tailor their treatment and gain insight into their healing process. It can be highly discouraging if mental health progressional are not on the same page as you. Lissa Rankin, MD argues there are more than just the medication options to help you feel better, particularly in regards to depression.

  1. Speak with your psychiatrist, psychologist (if they are prescribing medication), therapist, or life coach. There is significant research that states talking out your feelings, beliefs, and thoughts with a person you trust can be highly effective and healing.
  2. Ask about psychotherapy treatment to support your medication. (Refer to number 1)
  3. Try meditation or guided imagery. While it may seem “too simple” to meditate, research and data has proven this is an effective mood booster and a host of other mental health benefits.
  4. Try mood-enhancing supplements (DISCLAIMER: based on my research these are the recommended holistic options to support your mental health, but I would always recommend speaking with a medical professional before integrating these supplements into your daily diet).
    1. 5-HTP
    2. St. John’s Wort
    3. SAMe
    4. L-Theanine
    5. Fish oil
  5. Expose yourself to sunlight, which can boost your mood and vitamin D levels. This is seen throughout the northeast, we’re sad in the winter and happy in the summer. The sun plays a huge role in our happiness and mood (See previous blog post: It’s getting sunny, but why do I still feel sad?).
  6. Avoid caffeine which lowers serotonin levels.
  7. Never skip a meal. Keeping your body and sugar levels balances.
  8. Move your body. Exercise and moving your body releases happy-feeling endorphins. That’s easy right?
  9. Eat a serotonin-enchanting diet. Serotonins-Enhancing foods include:
    1. Foods high in omega-3 fatty acids
    2. Healthy fats like coconut oil
    3. Eat high protein diet

References:

McHugh, R.K., Whitton, S.W., Peckham, A.D., Welge, J.A., & Otto, M.W. (2013). Patient Preference for Psychological vs. Pharmacological Treatment of Psychiatric Disorders: A Meta-Analytic Review, J Clin Psychiatry. 2013 June ; 74(6): 595–602. doi:10.4088/JCP.12r07757.

https://www.psychologytoday.com/blog/fulfillment-any-age/201507/psychotherapy-vs-medications-the-verdict-is-in

https://www.psychologytoday.com/blog/owning-pink/201103/11-natural-treatments-depression-md-s-tips-skipping-the-prozac

https://www.psychologytoday.com/blog/why-we-worry/201401/overprescribing-drugs-treat-mental-health-problems

http://pgxmed.com/wp-content/uploads/2014/03/drugsinhand.jpg

http://www.apa.org/monitor/2011/09/psychotherapy.aspx

http://integrativeholisticdoctors.org/wp-content/uploads/2014/09/holistic-natural-foods.jpg

It's Getting Sunny, But Why Do I Still Feel Sad?

Todd Swagler

It’s April in New York City, and most of the country, which means many things are just around the corner, i.e. summer Friday’s at work, weekends spent on the beach with family and friends, longer days of sunlight, warmer weather, and upcoming vacations just to name a few. While these are terrific things to look forward to, many people around this time begin to notice they are not quite as “happy” as their friends and family around them. “What does that mean?” “Am I depressed?” What you may have written off as seasonal affective disorder, or low feelings in mood from the lack of sunlight and Vitamin D during the winter months, may be lingering symptoms of depression. You may be asking yourself at this point, “How do I know if I have depression or I am just sad?” or “How do I get better?” Both of these questions I would like to address in this article.

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But what is depression, anyway?

Depression is a painful, complex diagnosis that, according to the Depression and Bipolar Support Alliance and the National Institute of Mental Health affects 14.8 million Americans each year (6.7% of the U.S. population 18 years and older). Additionally, depression impacts women more often than men. This issue may have less to do with men not feeling depressed, but a failure to report due to social stigmas, rules surrounding men expressing emotions, and the differences of how depression manifests within the men. While depression impacts a large percentage of our U.S. population, it is important to understand what are the symptoms. These feelings and experiences may look like any of the following:

  • Sadness, despair, sense of loss
  • Apathy, indifference, low or no motivation
  • Inability to experience excitement or pleasure across all spheres of one’s life
  • Low self esteem, lack of confidence
  • Irritability, easy frustration, anger
  • Feelings of guilty, self-blame, self-hatred
  • Feelings of hopelessness and/or helplessness

While these symptoms represent the most common experiences, this list only highlights a few of the many symptoms of depression. Depression is complex, painful, and difficult to recover from without the right knowledge and support. While many of us may experience one or more of these symptoms on any given day, it is also important to highlight how clinical depression differs from general sadness:

  • More intensely painful
  • Lasts longer
  • Interferes with day-to-day functioning
  • Destructive emotions
  • Interferes with one’s social interactions, behavior, thinking, and biological functioning.

Getting Help

While gaining help is not simply a one size fits all process, there are many forms of treatment that is evidence and best practice approaches. I will walk through several of the modalities that are highly recommended.

Self-Help

There are loads of texts published today on the topic of depression and cognitive behavioral techniques individuals can challenge their thinking, depression, and feelings to self help. While some of these books may not be helpful for everyone, they can be very insightful components to any of the following treatment modalities.

Pharmacological Medication

The treatment of depression through prescription anti-depressants can be highly effective. Many anti-depressants are also known as selective serotonin reuptake inhibitors (SSRI). There are dozens of SSRI’s prescribed today, including Paxil, Prozac, and Zoloft Medication, SSRIs and the like, are particularly important if your depression feels biological, not stemming from anything acute or chronic within your environment.

Psychological Support

If you are able to identify with these issues of clinical depression or you know someone who does, the most effective treatment for clinical depression is seeking a mental health provider for support. This may take the form of psychiatrists (MD - both medication able and non-medical psychotherapist), Clinical Social Workers (LCSW or LMSW), Marriage Family Therapist (LMFT), or Mental Health Counselors (LMHC). These professionals are specific to NY state and may vary if you live in other states.

Sources:

http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml

http://www.dbsalliance.org/site/PageServer?pagename=education_statistics_depression

http://i.telegraph.co.uk/multimedia/archive/03265/depressed-man1_3265726b.jpg

http://static1.squarespace.com/static/520bf8d3e4b04d4779439a98/t/52228c56e4b062b4a5cde0f1/1377995866281/bigstock-Problems-20872742.jpg

Preston, John. You Can Beat Depression: A Guide to Recovery. San Luis Obispo, CA: Impact, 1989. Print.