RAISING CHILDREN; IS THIS TOO LOUD? Art Smukler MD

Recently we attended a performance of kindergarten to third grade children who had attended an acting camp for a week. There were about a hundred family and friends waiting expectantly in the high school auditorium.

Just as the performance was about to begin, a 3 year-old boy sitting next to me, on his father’s lap, began crying, “It’s too loud. I want to leave. It’s too loud!” His father, trying to soothe him said, “There’s nothing to be afraid of. You’ll like the show. Your sister’s going to be in it.” The little boy became more and more frantic and tried to pull out of his father’s grasp. “It’s too loud! It’s just too loud!”

At that moment, the head of the acting program, a slim, athletic woman dressed in leotards, came off the stage and approached the little boy. “Is this too loud?” she asked, in a voice just above a whisper. The little boy nodded. The director whispered even softer, “Is this too loud?” The little boy shook his head. “This voice is okay, then?” she asked in a whisper. He nodded, transfixed by her smiling, calm face.

“Would you like to come and help me?” she whispered. The little boy nodded, took the director’s hand, and walked with her up on the stage. He then played the piano with her, started laughing, and was the absolute hit of the pre-show. Then he happily came back to his seat, and laughed and smiled throughout the entire performance.

All the little boy needed to calm down and handle his fear was validation. His feelings and observations were respected and fear and trauma were averted.

I sat in awe as this whole process unfolded. The director was just masterful — gentle, sweet and so effective. If only all our parents could have been this way…   Thanks

THE BEST ANTIDEPRESSANT IS…by Art Smukler MD

Antidepressants are medications that are prescribed mainly for depression, anxiety disorders (including panic attacks) and obsessive compulsive disorders. They are also used in pain syndromes, smoking cessation, premenstrual dysphoria and many other off-label disorders. They are BIG BUSINESS — 11 billion in sales in 2010 in the US alone. One in ten Americans are on an antidepressant!

Antidepressants were first discovered in the mid-fifties when researchers were trying to find a cure for schizophrenia. What they found was Tofranil, a tricyclic antidepressant. Sadly, it made schizophrenia worse, and happily, depression better. For the first time, psychiatrists had a tool other than psychotherapy, tranquilizers or electroconvulsive therapy (ECT) to treat the depressed patient. This discovery started the snowball effect, and quickly other drug companies followed suite with Elavil, Norpramin and Trazadone. The problem with this generation of antidepressants was the severity of the side effects.

In 1988, when Eli Lilly introduced Prozac, it was an absolute game-changer — less side effects and more effective. By 1990, annual sales of the “miracle drug” topped 1 billion. It wasn’t perfect, but compared to the competition it was fabulous.

Now there are over a dozen newer antidepressants: Zoloft, Paxil, Paxil CR, Celexa, Lexapro, Luvox, Luvox CR, Wellbutrin SR, Wellbutrin XL, Cymbalta, Pristiq, Viibryn…

So which one is the best? The answer is much less exciting than the question. NONE and ALL. It depends which one works for a particular person, and which has the least side effects for that person. Choosing a particular drug is often a litany of trial and error. There are no blood tests to help us choose the right one.The only real clue we have is if a family member did well or poorly on the chosen drug.

My feeling is that drugs alone are often not the best treatment for depression, anxiety or OCD. What seems to work best is often a combination of medication and psychotherapy. It’s a dual approach that addresses both the physiological and the underlying psychosocial issues. This is a great time to be depressed! Often it’s fixable.

Please feel free to ask any questions and I’ll do my best to answer them.  Thanks!