References for "Alternatives to antidepressants during pregnancy"

Cohen LS, et al. "Treatment of Mood Disorders During Pregnancy and Postpartum," Psychiatric Clinics of North America (June 2010): Vol. 33, No. 2, pp. 273–93. Cooper WO, et al. "Increasing Use of Antidepressants in Pregnancy," American Journal of Obstetrics and Gynecology (June 2007): Vol. 196, No. 6, pp. 544.e1–5. Dimidjian S, et al. "Nonpharmacologic Intervention and Prevention Strategies for Depression During Pregnancy and the Postpartum," Clinical Obstetrics and Gynecology (Sept. 2009): Vol. 52, No. 3, pp. 498–515. (Locked) More »

References for “Pathological gambling”

Dadayan L., et al. "For the First Time, a Smaller Jackpot," Fiscal Studies (Sept. 21, 2009), pp. 1–20. Dannon PN, et al. "Topiramate versus Fluvoxamine in the Treatment of Pathological Gambling: A Randomized, Blind-Rater Comparison Study," Clinical Neuropharmacology (Jan.–Feb. 2005): Vol. 28, No. 1, pp. 6–10. Frascella J, et al. "Shared Brain Vulnerabilities Open the Way for Nonsubstance Addictions: Carving Addiction at a New Joint?," Annals of the New York Academy of Sciences (Feb. 2010): Vol. 1187, pp. 294–315. (Locked) More »

References for “Stress and the sensitive gut”

Blanchard EB, et al. "The Role of Stress in Symptom Exacerbation Among IBS Patients," Journal of Psychosomatic Research (Feb. 2008): Vol. 64, No. 2, pp. 119–28. Bloom F, et al. Brain, Mind, and Behavior (Worth Publishers, 2001). Drossman DA, et al. "Cognitive-Behavioral Therapy versus Education and Desipramine versus Placebo for Moderate to Severe Functional Bowel Disorders," Gastroenterology (July 2003): Vol. 125, No. 1, pp. 19–31. (Locked) More »

Pathological gambling

Problem gambling behavior was first mentioned in the medical literature in the early 1800s, but the American Psychiatric Association did not classify pathological gambling as a psychiatric disorder until 1980, in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). An ongoing discussion in the mental health community is whether gambling is an impulse control disorder — as it is currently classified in the DSM-IV — or whether it is better understood as an addiction, as the DSM-V proposes (see "Symptoms of pathological gambling"). Epidemiological studies have found that pathological gambling often occurs in conjunction with dependence on a chemical substance. While roughly 1% to 3% of people in the general population develop a pathological gambling disorder at some point in their lives, as many as 5% to 33% of people with substance use disorders will do so. One national survey found that pathological gamblers were five times as likely as those in the general population to be dependent on alcohol, and nearly seven times as likely to be dependent on nicotine. The DSM-V work group cited other evidence to support its proposal that pathological gambling be considered an addiction. Genetic studies suggest that people who develop pathological gambling or a substance use disorder are more likely than those in the general population to have particular gene types (alleles) associated with impulsive behavior. Brain imaging studies have reported that both substance use disorders and pathological gambling create similar types of dysfunctions in a neural circuit involved in reward processing and decision making. Regardless of how pathological gambling is eventually classified, however, many of the strategies for treating it are based on those used for substance use disorders. Although there is no consensus yet about which therapies are best, several have emerged as the most promising. (Locked) More »

Alternatives to antidepressants during pregnancy

Although pregnancy is a joyful time for many women, others struggle with depression and other mood disorders. The limited data available suggest that 7.5% of women who become pregnant develop major depression, and another 7% have minor depression, before giving birth. Consensus is growing that depression during pregnancy should be treated, for the sake of both the mother and the developing fetus. Among other risks, untreated depression during pregnancy increases the likelihood that a woman will have postpartum depression and give birth to a lethargic, irritable baby whose weight is lower than normal. Medication is one option for treating prenatal depression (see "Medications for prenatal depression"). In 2003, 13% of pregnant women used antidepressants at some point during pregnancy. But anecdotal reports from clinicians suggest that many women prefer not to take antidepressants during pregnancy, mostly because of concern about exposing the developing fetus to any type of drug. Guidelines issued jointly in 2009 by the American Psychiatric Association (APA) and the American College of Obstetricians and Gynecologists (ACOG) offer detailed advice for clinicians. In general, the APA-ACOG guidelines recommend psychotherapy for pregnant women with mild to moderate depression, and medication for patients with severe depression, psychosis, bipolar disorder, a history of suicide attempts, or a co-occurring psychiatric disorder that requires drug treatment. Unfortunately, scant research exists on alternatives to medication — whether psychotherapy or other modalities. As such, a decision about how best to proceed is an individual one and depends on clinical experience and the patient's preference. (Locked) More »

Stress and the sensitive gut

Functional gastrointestinal disorders affect 35% to 70% of people at some point in life, women more often than men. These disorders have no apparent physical cause — such as infection or cancer — yet result in pain, bloating, and other discomfort. Multiple factors — biological, psychological, and social — contribute to the development of a functional gastrointestinal disorder. Numerous studies have suggested that stress may be particularly important, however. The relationship between environmental or psychological stress and gastrointestinal distress is complex and bidirectional: stress can trigger and worsen gastrointestinal pain and other symptoms, and vice versa. This is why psychological therapies are often used in combination with other treatments — or even on their own — to treat functional gastrointestinal disorders. More »

Ask the doctor: What is the choking game?

I was half listening to the television the other night and heard something about kids dying from the choking game. What is that? How can I tell if my child might be playing this game? (Locked) More »