As prescribers for Providers for Healthy Living, we strive to practice evidence-based medicine (EBM). What is evidence-based medicine? EMB is the conscientious, explicit, judicious, and reasonable use of modern, best evidence in making decisions about the care of individual patients (1). This means that each time we evaluate a patient, we integrate our patient's wishes, our own clinical experience and expertise, and the best modern evidence before making a treatment recommendation.
Sometimes, this recommendation may include pharmacologic therapy (medication), and sometimes it may not. For example, current evidence suggests that pediatric patients with anxiety benefit from a 12-week course of Cognitive Behavioral Therapy (CBT) for anxiety prior to trying any medication. Research also shows us that insomnia is often best treated with CBT for Insomnia rather than with medication. And, sometimes behavioral changes to correct unhelpful behaviors are necessary and medications won't make a difference. In these instance, we might recommend individual and/or family therapy to address the concerning behaviors. Should therapeutic interventions fail to provide relief of symptoms, we then will turn to possible pharmacologic options.
In all cases, our goal is to find the best-fit treatment while using as little medication as possible.
REFERENCE - (1) Masic I, Miokavic M, Muhamedagic B. Evidence Based Medicine - New Approaches and Challenges. December 2008. Acta Inform Med.
What is genetic testing for medications?
Providers for Healthy Living uses GeneSight to provide genetic testing services for patients. GeneSight is a laboratory-developed genetic test that uses DNA collected from a cheek swab to analyze genetic information and match it with information about available treatment options. It is available for children, adolescents, and adults.
Who qualifies for genetic testing?
In order to have insurance consider paying for genetic testing, patients must show a history of treatment failure with numerous medications, bothersome medication side effects with previous medication trials, or both.
Will insurance cover genetic testing?
This, like all insurance-related services, is patient-specific. Patients can call their individual insurance plans to ask about genetic testing coverage. However, GeneSight requires each patient to pay a nominal fee for genetic testing, regardless of what insurance will or won’t pay.
Does genetic testing help with my treatment?
The information obtained from genetic testing can streamline the process of medication management as it gives a guideline for treatment. Although this kind of testing is relatively new, four published, peer-reviewed studies confirm that GeneSight can double a patient’s odds of getting on the right medication.
How often is genetic testing necessary?
Since genetic material doesn’t change, it is only necessary to have genetic testing done once in a lifetime. Obviously testing profiles improve and more medications are added, but the results obtained are good for a lifetime and should be kept in a safe place and shared with all treatment providers.
If you meet the above criteria and would like explore genetic testing, call your insurance company and discuss it with your medication provider at your next visit.
It seems like we are hearing about mindfulness all of the time, but what is mindfulness exactly? “Mindfulness is moment-to-moment non-judgmental awareness. It is cultivated by purposefully paying attention to things we ordinarily never give a moment's thought to (Full Catastrophe Living, Jon Kabat-Zinn).” There are many great benefits derived from practicing mindfulness; these range from relief of stress, depression, and anxiety, to improvements in learning and memory, to boosting our immune function and relief of chronic pain.
According to Marsha Linehan, we can begin to understand mindfulness with these three concepts:
How do we practice mindfulness?
Mindfulness is an internal resource that all of us already have within us. We just need to practice! We can engage in formal practices such as yoga and stretching, or breathing and meditation. We can also use informal practices including mindful eating, awareness of pleasant moments, awareness of unpleasant or stressful moments, awareness of falling into old habits, and awareness of emotional reactions.
Try some of these mindfulness tips:
Give words to feelings:
Identify the trigger to their emotion:
A study published in 2017 has found that depressed people who also use marijuana are less likely to recover from their depression. It has been shown that marijuana use is associated with poor physical health, worsening of depression, anxiety, and an overall decline in mental health functioning.
Although marijuana may produce instant euphoria, there are potential consequences including:
Some persistent effects of marijuana include:
Some longterm effects of marijuana include:
While there are no current medications FDA approved to treat marijuana use disorders, research indicates that effectively treating (if present) the underlying mental health disorder with both medication management and therapy may help reduce use and improve functioning.
Some medications have shown promise in early research studies which include the anti-anxiety medication, buspirone and the anti-epileptic medication called gabapentin. Both buspirone and gabapentin have been shown to improve sleep and executive functioning during the withdrawal period from marijuana. In early studies, N-acetylcysteine has been linked with reducing withdrawal effects by inhibiting the breakdown of cannabinoids.
Folate is a B vitamin found in a variety of foods and over the counter/prescription supplements. It is metabolized by the body into a form called L-methylfolate. This form of folate can cross the blood brain barrier where it aids in the synthesis of neurotransmitters like serotonin, dopamine and norepinephrine. These neurotransmitters serve as pivotal players in regulating our mood and anxiety.
Recent research links L-methylfolate deficiencies to depression, noting that there is an inverse relationship
between low mood and this metabolized form of folate. Furthermore, research indicates there maybe as a high as 70% of individuals with depression are inadequately metabolizing folate to L-methylfolate, all of which could
detract from antidepressant medication/therapeutic interventions.
Please talk to your current prescriber about folate conversion testing if you feel L-methylfolate is something that
could benefit your current treatment plan.
One of the most common issues discussed in therapy with children and teens is appropriate discipline. Many parents struggle with this, especially parents whose children have mental health and behavioral difficulties. Effective discipline can significantly help children and teens improve their behavior, while ineffective discipline can cause chaos in families. Below are four principles that can help parents discipline effectively.
Effective discipline should be...
In today's fast-paced world, parents and children are busier than ever! It seems increasingly difficult these days to plan quality time with our families. However, the results of strengthening family relationships last for a lifetime. Research has shown that if a child has a strong bond with their caregiver(s), the child will exhibit higher levels of achievement, increased emotional regulation, and reduced chances of delinquency.
But, how can you fit this into your schedule? Here are some suggestions to improve parent-child bonding that work for busy families.
1) Create a schedule with your child/children that includes a designated time for family time or one-on-one time with each of your children. Discuss with child(ren) what activities they want to do or what they want to talk about during this one-on-one or family time.
2) Setting up a nightly routine that involves reading or telling silly stories to each other.
3) Putting down electronics and communicate. Repeating back what one has said with phrases like “I hear you...” is important in helping you and your child know that each other has been heard.
4) Ask each other what the other needs from the relationship. To improve mutual respect, it is important to hear and understand what your child needs from you and what you need from your child.
5) Set up family rules. It is very important for children to have rules but it is also important to have family rules that everyone including the adults have to follow. This allows children to understand that they have to respect the rules of the house but so do the adults in the house. Examples: No yelling from anyone, eye contact with the person you are speaking to, everyone has to say “I hear you” after someone has spoken, when going to sleep hug everyone in the household.
6) Be silly! The most important aspect of bonding is the ability to let your guard down. Don't be afraid to be silly with your child. Playing games, making silly faces or having a dance party are simple activities that will promote fun and silliness.
Day after day I hear people tell me that they are “stressed out”, “exhausted”, “at the end of my rope” and even “about to lose it”. Then, in the same breath, these same people tell me that there is nothing they can do about it, because, “I have to take care of my kids; they come first”. While I agree that kids are at the top of most priority lists, I disagree that there is nothing these parents can do about their stress and exhaustion.
I fully believe that parents have to take care of themselves first. Many of you will argue this point with me saying that you “don’t have time” because there is too much to do for the kids. I’m here to tell you that if you continue to ignore your own needs and focus only on others, you will eventually “lose it”.
Have you ever tried to pour water from an empty pitcher? It doesn’t work! You are the pitcher. If you have nothing in you, then you have nothing to give. Self-care is the key! You have to “refill” yourself before you can give to your children or to anyone else. Self-care is not the same thing as being selfish. It is okay to take time for yourself. It doesn’t have to be anything big or spectacular, and it doesn’t have to take a lot of time.
Here are some simple ways you can engage in self-care in order to fill yourself back up with the energy you need to continue being the great parent you are:
There are a thousand more things you can come up with on your own, but I hope these are a few ideas to get you on your way to better self-care so that you can be the parent you want to be!
Alcohol use disorders are common and have a strong genetic component; however, less than a third of patients receive any treatment. FDA-approved medications with proven efficacy are available but less than 10% of patients are treated with them. As addiction develops, brain circuits change and treatment should address these
Three available medications are Naltrexone, Acamprosate, and Disulfiram. Naltrexone reduces heavy drinking and craving, and may improve abstinence from alcohol. Acamprosate helps maintain abstinence in patients who have already stopped drinking. These are usually tried before Disulfiram because of their better safety profiles. Disulfiram interacts with alcohol to cause an unpleasant reaction that causes an aversion to drinking.
The earlier these medications are considered the better, because treatment is most effective early in the course of the disease.