The ADAA 2020 40th Annual Conference (March 19-22, San Antonio, Texas) will bring together clinicians and researchers who want to improve treatments and find cures for anxiety, depression and related disorders. Join more than 1,400 peers from across the US and around the world. Connect, share and collaborate. Choose from 160+ sessions, hear engaging keynotes, learn about cutting-edge thinking in research and clinical practice, and earn continuing education credits (CEs and CMEs). Find your professional home and leave more connected to your peers, and better able to integrate research, practice, and community. #ADAA2020

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
More than 1in 6 Americans take a psychiatric drug (such as an antidepressant or a sedative). according to a 2013 Medical Expenditure Panel Survey (MEPS), which gathered information on the cost and use of health care in the United States. Antidepressants were the most common type of psychiatric drug in the survey, with 12 percent of adults reporting that they filled prescriptions for these drugs, the study said.
Reach out to other people. Isolation fuels depression, so reach out to friends and loved ones, even if you feel like being alone or don’t want to be a burden to others. The simple act of talking to someone face-to-face about how you feel can be an enormous help. The person you talk to doesn’t have to be able to fix you. He or she just needs to be a good listener—someone who’ll listen attentively without being distracted or judging you.
Beware of drug interactions. You should avoid drinking alcohol when taking SSRIs since it can lessen the effects of the medication. Dangerous drug interactions can occur when SSRIs are taken with antihistamines, found in many over-the-counter cold and allergy medicines and sleep aids, or with prescription painkillers. Always talk to your doctor or pharmacist before combining medications.
People who are depressed may reject your help because they feel they should be able to help themselves, and feel worthless when they can’t. Instead, they may withdraw or start an argument in an effort to resolve their difficulties. In addition, people with depression may have negative thoughts and feel so hopeless that they do not see recovery as a reality.
The future is very bright for the treatment of depression. In response to the customs and practices of their patients from a variety of cultures, physicians are becoming more sensitized to and knowledgeable about natural remedies. Vitamins and other nutritional supplements like vitamin D, folate, and vitamin B12 may be useful in alleviating mild depression when used alone or more severe degrees of depression when used in combination with an antidepressant medication. Another intervention from alternative medicine is St. John's wort (Hypericum perforatum). This herbal remedy is helpful for some individuals who suffer from mild depression. However, St. John's wort being an herbal remedy is no guarantee against developing complications. For example, its chemical similarity to many antidepressants disqualifies it from being given to people who are taking those medications.
The pattern of symptoms may fit a pattern within any type of depression. For example, a person who suffers from persistent depressive disorder, major depressive disorder, bipolar disorder, or any other illness that includes depression can have prominently anxious, melancholic, mixed, psychotic, or atypical features. Such features can have a significant impact on the approach to treatment that may be most effective. For example, for the person whose depression includes prominent anxiety, a focus of treatment is more likely to be effective if the sufferer's pattern of repeatedly going over thoughts is a major focus of treatment, versus an individual with melancholic features, who may need more intensive support in the morning when the intensity of depression tends to be worse, or versus a person with atypical features, whose tendency toward weight gain and excessive sleeping may require nutritional counseling to address dietary issues.
For some people, the reduced daylight hours of winter lead to a form of depression known as seasonal affective disorder (SAD). SAD affects about 1% to 2% of the population, particularly women and young people. SAD can make you feel like a completely different person to who you are in the summer: hopeless, sad, tense, or stressed, with no interest in friends or activities you normally love. SAD usually begins in fall or winter when the days become shorter and remains until the brighter days of spring.

Despite the popularity of social media platforms and the rapidity with which they’ve inserted themselves into nearly all facets of our lives, there’s a remarkable lack of clear data about how they affect us personally: our behaviors, our social relationships, and our mental health. In many cases, the information that’s available isn’t pretty. Studies have linked the use of social media to depression, anxiety, poorer sleep quality, lower self-esteem, inattention, and hyperactivity — often in teens and adolescents.
Mahableshwarkar AR, Jacobsen PL, Serenko M, Chen Y, Trivedi M. A randomized, double-blind, parallel group study comparing the efficacy and safety of 2 doses of vortioxetine in adults with major depressive disorder. Program and abstracts of the 166th Annual American Psychiatric Association Meeting; May 18-22, 2013; San Francisco, California. Poster NR9-02.
The SSRI antidepressants can cause sexual dysfunction. SSRIs reportedly decrease sex drive (libido) in both men and women. SSRIs reportedly cause inability to achieve orgasm or delay in achieving orgasm (anorgasmia) in women and difficulty with ejaculation (delay in ejaculating or loss of ability to ejaculate) and erections in men. Sexual dysfunction with SSRIs is common though the exact incidence is unknown. Newer SSRIs like vortioxetine and vilazodone have little to no negative impact on sexual functioning. Furthermore, patients have reported sexual side effects with the use of other antidepressant classes such a MAOIs, TCAs, and dual-action antidepressants.
People living with high-functioning anxiety and depression usually do not fit the stereotype of either disorder. In fact, many appear to be overachievers. The anxiety can serve as an energizer, driving the person towards achieving his or her goals. It’s later, when in private, that the symptoms of depression tend to emerge. Feelings of self-doubt and self-criticism, fatigue, helplessness or guilt, moodiness, and a desire to avoid interaction with others become intensified. Because the stereotypical image of depression or anxiety doesn’t match up with what people living with high-functioning anxiety and depression “look like,” it is hard to spot, even for sufferers to recognize in themselves. However, the symptoms of high-functioning anxiety and depression are the same as for non-high functioning anxiety and depression. The main difference is the ability to suppress or diminish the appearance of disruptions in life activities.
Serotonin syndrome: Serotonin syndrome is a serious medical condition that can occur when medications that alter the concentration of serotonin in the brain are taken together. Symptoms of serotonin syndrome may include anxiety, restlessness, sweating, muscle spasms, shaking, fever, rapid heartbeat, vomiting, and diarrhea. Examples of medications that can cause serotonin syndrome include antidepressants, some pain relievers such as meperidine (Demerol) or tramadol (Ultram), St. John's wort, medicines used to treat migraine headaches called triptans, and some street drugs such as cocaine.
A key feature of depression is inactivity. People find that they are doing less and then feel even worse because they are doing less. Behavioural strategies for depression aim to identify and change aspects of behaviour that may worsen depression. People are encouraged to act against the depression by increasing activities, even though this is the last thing that they feel like doing. Relevant behavioural strategies include activity scheduling, social skills training, structured problem solving, and goal planning. One of the advantages of this form of treatment for depression is that once acquired, these new behavioural styles can be applied throughout life, minimising relapse or recurrence of depression.

Understanding the main pharmaceutical options requires becoming familiar with a number of acronyms: SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), NDRIs (norepinephrine–dopamine reuptake inhibitors), TCAs (tricyclic antidepressants), and MAOIs (monoamine oxidase inhibitors). These represent categories of drugs, grouped together because of their effect on various neurotransmitters (chemical messengers) in the brain.


The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.
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