Episode #109
How Do Psychiatry & Medication Fit In Therapy?
ft. Dr Gail Fernandez, MD
Psychiatry and medication can be powerful tools in helping you reach your mental health goals.
How do you know when you should see a psychiatrist?
How do you know when medication could be helpful?
And do they both fit into mental health therapy?
Join me, Dr Julie Osborn, and my special guest, Dr Gail Fernandez, as we share with you how psychiatry and medication can be used as tools to improve your mental health.
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Full Episode Transcript
Dr Julie
Hi, this is Dr. Julie Osborn. I'm a Doctor of Psychology and a licensed clinical social worker. Welcome to My CBT Podcast. I'm here to help you bring the power of CBT into your life. So today I am thrilled to have a colleague and a very good friend of mine that I'm going to be interviewing. You guys are going to learn is Dr. Gail Fernandez, who's a psychiatrist. I just know she has so much to offer us, and I think she'll be able to answer a lot of questions that you have, maybe you didn't know you had. It's going to be a really great podcast. Welcome, Dr. Fernandez.
Dr Gail
Thank you. Pleasure to be here.
Dr Julie
Why don't you first start and share with the audience your background and what you do with a psychiatrist and all those good things?
Dr Gail
Sure. First of all, psychiatry is a medical specialty. Psychiatrists are doctors of medicine. They go to medical school for four years, and then a psychiatry residency is four years, and then an additional two years if you specialize in child psychiatry, like I did. My main practice originally was University of California, Irvine, where I was the program director for child and adolescent psychiatry. Then I left there about 10 years ago, and now I'm the chief psychiatrist at California Institution for Women. A lot of the women that we work with do have childhood issues, a lot of trauma, a lot of anxiety. The child training comes in very well. Psychiatrists mainly diagnose psychiatric disorders and treat patients with medications. We are trained in therapy, but we tend to be rather expensive and very busy because it's an underserved specialty, meaning there's not enough of us. So we generally focus on medication management, and the best psychiatrists work very closely with therapists to help their patients.
Dr Julie
Yes. Which doesn't happen enough. I don't think it's enough. So me and Dr. Frennis met at UCI. And the one thing I do miss when I left there was that collaboration. We would bump into each other, or we would refer people and, Hey, what do you do with this? Oh, I just changed their meds. I'm doing this. And it was so easy because we were under the same roof.
Dr Gail
Correct. And one thing that I really enjoy, believe it or not, about the prison environment is that mental health collaboration is required. And in fact, we have what's called a complete care model, meaning that the entire spectrum of medical, mental health, and psychiatric care is collaborative. So from medical to nursing, to therapist, to psychiatrist, to recreation therapist and even custody all work together. And I think that is the best way to help your patient.
Dr Julie
Oh, for sure. Especially, hopefully, they will get out of prison one day and they will have some foundation.
Dr Gail
One would hope!
Dr Julie
Yes. I want to share with the audience a complaint I guess I would get or I hear often with my clients is people do assume, like you mentioned a minute ago, that psychiatrists do therapy. They go in, and they get their initial evaluation, and then they go for a checkup. A lot of times there's these 15 minute med checks, they call them, especially in bigger places like universities. My clients come like, Oh, we didn't do any therapy. Just because they don't know, right? They're not educated in what that means. And I think like you do. I didn't think you mentioned it, you also have a small private practice?
Dr Gail
Correct. And I think the difference between someone like myself who does a concierge, I know that word sounds boogie, but it really means that you're being paid for your service, regardless of who you are or what your insurance is. So you're going to provide the same service to every person. And most psychiatrists, they serve people based on time when they do a private practice, it doesn't accept insurance. Whereas insurance based practice, there really is an emphasis on volume because the reimbursement is so low, sadly. When I'm doing a private practice patient, I'm going to give each patient one half hour, or they could ask for an hour, but it gets pricey. But they get a half an hour, and during that half an hour, I do have the ability to spend more time exploring more deep issues than current symptoms.
Dr Gail
Okay. So as a private practitioner who's paid by their time, each patient will get one half hour. And I like that because I can also spend time exploring other issues. And that allows me, for example, to refer for cognitive behavioral therapy because I see that maybe their thinking is distorted and they have a lot of unrealistic beliefs. And that is triggering their anxiety or their depression. And I can say, Hey, based on what you're telling me, I think you need to see Dr. Osborne for some cognitive therapy because you have some really irrational thinking. If I would just had a very brief med check, I wouldn't have time to see those patterns and.
Dr Julie
Thought processes. So for those of you looking for psychiatrists, that's something to ask is how long are the appointments? Correct. And hopefully at least have, say, 20, 30 minutes where they can talk and know what's going on. Because I've had many times where I'll call a psychiatrist just to do some follow up. We're both seeing the same client, and they just don't even know. I'm like, basic stuff. I'm like, oh, this is going on in their life. And they're like, Oh, I didn't know that because they're just checking for the medicine and they just miss so much. So that would be something to ask for when you guys are looking. Do you do at least, say, 20 or 30 minutes? You guys have the time to talk, not just about.
Dr Gail
The medication. I have to say that even psychiatrists that are insurance based, they could spend more time, but they have to be willing to do so. Not to get too technical, but there are some coding that they can do that would allow them to be reimbursed. To be honest, some of the reimbursement by insurance for psychiatry is pretty poor. I have some empathy for them. And again, my private practice, I'm not relying on that income. So I have the luxury of being able to do a little more time based interventions. Yeah.
Dr Julie
Okay, great. And then I want to talk to you, too, about... So with medicine. There's some people out there that don't want to take medicine. Some people just want to take a pill and have it be the answer and never do any therapy. So I have met more psychiatrists lately also that when patients call for an appointment, they actually say, Do you have a therapist? Because I'm not just going to give you medicine. I expect you to also have a therapist because they see the bigger picture is medicine can definitely help. It's not a cure. And you need to be working on whatever is creating the problems in your life. If that's, say, the depression, anxiety. So if you could share your thoughts about medicine, explaining how it helps and how the person can get in the way sometimes as well.
Dr Gail
Correct. So you have the two sides of it. The person who wants to take only meds and not do anything else and be fixed. And that, in my experience, isn't as common. But the other hand is I either don't want to do therapy because it's too difficult, or I don't want to do meds because I'm going to get addicted or it's a crutch. So what I try to do is educate. The medications are an important tool. There is no psychedelic medications, which we call the psychiatric medicines, psychedelic. There is no medication in our field that cures any illness. Some illnesses are not curable. For example, schizophrenia and bipolar disorder. So you probably will need medications most of the time for your lifetime. But therapy is still helpful. Certain other illnesses, like certain cases of depression, because there are some very severe depressionsthat need medications long term. But depression and anxiety can be actually cured, meaning your rewiring your brain circuits through therapy. The medication temporarily allows your brain neurotransmitters to be, we don't understand it really, but rebalanced in the sense that they're not being increased by the medication, but redistributed in your brain by the medication.
Dr Julie
And how do you see the people that are... They're going to go on it, but they're stubborn about it. How do you see that gets in the way sometimes? We were chatting before we started taping here, and we're talking about the placebo and the other...
Dr Gail
Correct. So the placebo effect is well known in medicine all throughout medicine, and in fact, probably throughout every topic in the world. And basically, if you believe something will work, it is more likely to work. It's very high in psychiatric medications. Depending on the study, somewhere in the 35 % range, maybe higher for children. But to me, that just means how powerful your mind is. That you believe in something is going to make it more likely to work. However, the medications have been proven to be effective despite the placebo effect. The flip side is people who are very pessimistic and negative about medications, they can have, I just coined it the reverse the placebo effect. I don't know if there's an official term, but basically they come in and say, There's nothing will work for me. It will not work. And sometimes they say, Well, anything I try is not going to work either, because you're already convinced it won't. You have to have an open mind. The mind is very powerful. For example, in conversion disorder, an illness where you're so stressed that your brain can shut off parts of your body, even though they're fully functional and you can think that your arm doesn't work or that you're blind shows how strong the brain is.
Dr Gail
So having a positive attitude, both towards medication and therapy is really just part of the treatment plan, I think.
Dr Julie
I just thought of this, you were sharing that, that I tell my clients, if you're not sure you want medicine, just go have an appointment and get educated. Because there's all these fears and assumptions and things you hear on the internet and all these people share their nightmare stories. I say, just because a psychiatrist gives you prescription, nobody's going to make you take it. But go get educated and see what is out there for you and how does it actually work. How do you go up in dose? And side effects, I always say, are possible. Not that you're going to have them. Because I've seen with the placebo, I think this might fit in where clients read every single possible side effect and then they get them. Because I think your brain is just creating them a lot of the times.
Dr Gail
I think so. It's the power of a self fulfilling prophecy. A side effect is a possible, maybe a probable. For example, if you take Benadryl, it will probably make you sleepy because it is a very sedating antihistamine, but not everyone will be sleepy, so it isn't cause and effect. Some of the more rare side effects are scary. For example, when you look at the medication commercials and they start rolling off, this will kill you in 50 different ways. That's probably one in a million people, but they have to list it. So you have to take that into context and look at the risk versus the benefits. And hopefully your psychiatrist is honest about that, that here are the risk, here are the benefits. I say if you have a very bad side effect, we're going to stop the medication immediately. If it's tolerable, then let's see, it should only last a week or so. By starting lower doses, I think it's less likely. And sure, it may take a little more time to get better, but at least we got you through that initial rough period where you're not sure if it's going to work with you or not work.
Dr Julie
With you. And do you find with people, say with the depression, anxiety symptoms, they worry about they have to stay on it forever?
Dr Gail
Did they talk to you about that? Correct. And just for example, depression, most psychiatrists recommend, and the studies recommend staying on medication for about a year once you're doing well. And the reason is that depression is a very long illness. It can last years, but the average is two plus years. So we're just treating it, not curing it. So let's get the symptoms under control. Let's get you learning new skills in therapy. Let's rewire some of those tracks that have been worn in negative ways. And you have this negative tunnel you're stuck in. And then let's try to get you off the medication. And then you try it to get off it. And for depression, about 50 % of people will never need medication again. That's great to know. There's about half that will need.
Dr Julie
It again. And I have found, especially with anxiety, I would say, I've met some clients where I say to them, you need to go get on medicine because you're so anxious, you can't even do therapy yet. So that's a starting point. And I explained it. It gets you out of that black hole to a place where you can read a workbook, do some homework, show up, have some insight. So that's where I really find medicine helpful on my side, working with clients. That sometimes when it's so bad, they can't really even do the therapy or use the tools to help them get better.
Dr Gail
I 100 % agree. My analogy for people that don't quite understand that is being anxious and trying to do a task is like trying to do a math problem on a train track while a train is coming at you. It's not going to happen. You're just going to be running for your life. And therapy is a lot of hard work, especially cognitive therapy. It requires a commitment, it requires homework, it requires practice. If your anxiety levels 10, or if you're so depressed you can't really think through a problem, it's not fair to ask you to do that without relieving some of the symptoms. Right.
Dr Julie
And another argument, I guess, or concern people throw out is they think they're weak if they need to go on medicine. Because the half thought, the cognate thought is, I should be able to do this on my own. Or, Weak people go on medication. Do you hear that, too?
Dr Gail
I do. And it depends a bit on cultural and ethnic lines. There tends to be certain cultures and ethnicities that it's still very high stigma, and it's seen as a sign of weakness. But my analogy is the medical model. We now know that psychiatric illnesses are equivalent, and not even equivalent, they are medical illnesses. So the comparison would be, if you have type 1 diabetes, are you weak because you need insulin? You just need it. And my second argument for people is that everybody has something. Nobody is completely perfect in every way in terms of their health or their abilities. So you're going to need something sometime, whether it be high cholesterol or hypertension or anxiety. It's all, in a way, genetics and environment, something eventually is going to happen. So when you have those incidences, use the resources that you have to get better. It's not weak. It's actually very brave. And in fact, there's a book and a movie that just won an Academy Award called The Boy, the Mole, the Fox, and the Horse. And in this book, there's one line that I just love. The boy asked the horse, what's the bravest thing you've ever said? And the horse answers, Help.
Dr Julie
Wow.
Dr Gail
So actually accepting that help, medications, therapy, medical treatment is brave.
Dr Julie
Totally, yes. I say to my clients all the time, because you're here shows me the strength you have. That you're willing to say, what do I need to do? And I'm going to take suggestion, I'm going to do the work and see where it goes.
Dr Gail
And mental health is still pretty much in its infancy. It's been maybe 100 to 200 years at the most that there's even been a thought about mental health or mental illness. So it takes a while for the generational mind to accept it. And I think the younger people of today understand that it's an important part of evolving as a person. Some of the older generations, it was shameful to have a mental health issue. And so out of that sense of shame, they thought asking for help was a weakness. And there's been a lot of old fashioned thinking that has had to be debunked and moved on from. It's just part of it's evolving.
Dr Julie
And the stigma is still so strong, which is.
Dr Gail
Really sad. It's very sad. And there's so many lives that could have.
Dr Julie
Been saved without the stigma. And because of the stigma, I think even if you are taking medicine, then you don't tell anybody and you don't share. And I tell my clients, I say, First of all, look at the amount of prescriptions that are written. It's a good chance your neighbor or your coworkers on the same medicine as you. And I've had clients come in saying, Something came up and I share with my coworker. We're both taking Zoloft. And I'm like, Exactly. It's super common. And if we can find good people we trust to share, then it can help take that stigma away. This is something we're doing for ourselves and to get that support instead of feeding into that isolation. And so it's just me, nobody's going to understand, and there's something wrong with me.
Dr Gail
That being said, unfortunately, there are certain professions and different types of fields where it will be countered against you. For example, if you were in law enforcement and you said you had depression and needed to be on medication, that might be the end of that career, sadly, because they can't differentiate. There's not enough sophistication to know the well treated person with depression is probably as high or higher functioning than the person that doesn't go and get treatment and hides a severe mental health issue. But hopefully with time, it'll be continuing to be a very important part of options for treatment.
Dr Julie
And also I share, and you know this better than me, understanding medicine is, I've told some clients that struggle with it that to maybe look at it in a way of being grateful, what we do have, because even, you know what, 60, 70 years ago, people were just locked up in psych hospitals, and they didn't have the correct medicine or it was really... People were having, you know, lobotomies. I mean, horrible stuff. And now we have so many medicines that really help it. I'm grateful for what we have today in really a short amount of time.
Dr Gail
It is. And again, they're not curing the illness and they're not the most perfect ideal, but they're the best that we have. There's been a lot of research, a lot of safety data. For example, people will come to me and say, Why can't I take this herb instead? It says it helps depression. And my answer is, maybe it does, but if it was that great, some company would have grabbed it up and researched it. Number one. Number two, we don't know the safety data. At least we know the risks and benefits of an antidepressant. And sure, there might not be one that pops up in 20, 30 years, but for example, fluoxetine or Prozac has been around for more than 50 years. And there's no one in the age of 75 that's saying, I suddenly have this huge health problem from taking it when I was 25 years old. So the data looks good on the things that we do know. Is there a possible long term risk? Sure. But the risk of severe depression or anxiety is extreme, and it's now.
Dr Julie
Then let's touch also want to touch on ADD medicine. A lot of people take it as needed. If they're going to study or they need to get through a test, and they don't take it on a regular basis. So you want to take it based on what your doctor tells you. But I wanted you to share with our listeners what you told me that made total sense about how it affects your brain when you take it on a regular basis.
Dr Gail
Correct. So by definition, ADD and ADHD, same thing. It requires impairment in more than one setting. So this is a hard wiring issue. It's not an emotional problem. It's just the way your brain is wired. So it's going to affect you everywhere you go. Now, for studying, sure, if you take it, it's going to help. And if you don't have a homework, you could think you don't need it. But as we see more and more social media, people talking about all the ancillary issues that happen with ADHD is the issue of, I call it inertia, inability to start moving forward to get a task done. The issue of procrastination, the issue of the amount of time it takes to complete a task, and some other habits that develop secondary to it. What I think for most people, it's important to take it daily at the same time because it's helping your brain be at its best so that you can start developing better, more productive habits. You can't develop new habits without time and effort, so you want to be in an optimal state of mind to be able to do that. I think when you take it only for homework, sure, it helps for that homework, but it's not helping you with the longer term changes.
Dr Julie
And what about the aspect... I don't know if this is even an issue, but if you take it regularly, like the same time every day, is your brain or I don't know if balance is the word, but instead of up and down, up and down, taking it at different times, the stimulant.
Dr Gail
I think it depends on the stimulant. The longer acting stimulants are supposed to last up to 12 hours. They don't have as much of an up and down so that you have a peak blood level after about two and a half hours, and then it gently goes downhill. And then by the end of the day, it's completely out of the system. So later in the day, it's probably less effective. So you don't have a big up and down. But if you're taking the short acting, in about an hour and a half, you have a big peak, and then a couple of hours later, you have a big drop. And this is one of the reasons they started studying this is one of the reasons they started studying ways to make them longer acting, because those peaks and troughs created all kinds of problems like rebound hyper activity or emotional fallout where kids would get very moody and irritable in the evening. So yes, the ups and downs of the short acting stimulants can be quite significant. Okay.
Dr Julie
So that's a great way to look at it, you guys. It's not just taking the medicine to be able to focus, but it's taking it so that you can not be procrastinating, right? You're feeling like I can take on this task and not feeling so overwhelmed with things. That's where the medicine can make a difference. It's not just for the specific task that you want to do.
Dr Gail
And I can give you another example that completely sounds like non sequitur, but it's along the same lines. So for people who are very depressed and have suicidal thoughts, they're often very surprised when their mood gets better, they still have the suicidal thoughts. And so what I explain is that there's two factors in those. One is you really have those thoughts because you're depressed, but the second one is like your habit. Whenever things get tough, you go to that. In the ADHD, you have these habits of, like I said, not doing the work, procrastinating, being unproductive, doing 50 other things all at the same time and getting none of them done. Right. So again, you got to work on those habits, and you can't do them if you're not medicated.
Dr Julie
Excellent. This is great information. I hope you guys are loving it. I'm learning at the same time with you. So can you share also your thoughts on how you feel the CBT can help with recovering depression, anxiety, as well as using the medication and the whole treatment plan?
Dr Gail
Yeah. I think if I had my wish, every person on the planet would do some cognitive behavioral therapy. The reason is because in all of my training, which you were a big part of because you taught the CBT course and did so many groups. So I had so many patients I sent to you. And in my training, I was learning so much about CBT. You just start giving it to yourself in every situation. And I tell people, if you go through a CBT course, it's not going to just help you with your anxiety or your depression. It's going to help you when you're waiting in line and the line is going too slow, or if you're in a phone call and it's very irritating, or the meeting is boring. There's always a way to use those skills to get yourself through these tough moments. And in fact, I taught myself to like traffic because it's the only time that I can call friends and have an extended conversation because otherwise, I'm on the go. I used to be so angry if I had to be stuck in traffic for 45 minutes. And now it's like, who can I call? And that's CBT? It is. I reframed it and now found a way to enjoy something I once hated. So unfortunately, not every person is a candidate for CBT. And I think, unfortunately, people think that that hard work is too difficult, or they're too busy, since it does require some written work most of the time.
Dr Julie
Always homework. So when you said some people aren't a candidate, meaning the ones that are willing to do.
Dr Gail
The homework? That aren't willing to do the work. And honestly, there are some people that maybe cognitively don't have the skill set. I do see some people with developmental disabilities. Those people some of those people. But I think even a simplified version could be effective for those people.
Dr Julie
Because I've worked with people with schizophrenia that high functioning, but they knew they had to see schizophrenia and accepted it. So we're able to address, say, the paranoid thoughts, right? Obviously, bipolar. And I've worked with a handful of clients with Asperger's, and they've been able to really do well with the CBT. And you're always adjusting it for your client anyways, right?
Dr Gail
Correct. I think that the mindset has to be a sense of wanting to be responsible for your own self. I love that. Some people want to be fixed. Those are the people that would just like to take a medication and get it over with. I would challenge people to be willing to explore themselves. It might be difficult. It might be challenging. It might be painful. But the analogy I use, it's like cleaning out an affected wound. It's very painful, but then the wound heals and you don't even think about it. So for those people who are anxious, for example, working through CBT to discover where the anxiety comes from and what irrational thoughts. And don't forget, CBT also helps you examine your rational thoughts that make you anxious and then help you address those rational thoughts. So it's not magically saying everything you're thinking is unreasonable or irrational. It's saying, let's separate out the rational from the irrational. The irrational will rethink it and challenge it. But the rational, we have to help you with it. So it's win win because it helps you out of problem solve.
Dr Julie
Totally, yeah. And I always tell everybody, it's not just cognitive therapy, it's cognitive behavioral. We're going to do things. We can change our thoughts. We have to actually go experience. If you're afraid to fly, I can help you change your thoughts and find ways to feel safe. But you're going to have to go get on that plane to prove to yourself like, Oh, I can't handle this and I'm okay. Correct. Yeah. So it is a lot of problem solving within that for sure.
Dr Gail
And for depression, a lot of depression surrounds terrible self esteem and self image and worrying excessively about what other people think and a sense of worthlessness. And if you don't challenge those thoughts, the medications may be taking away some of the symptoms, but those core beliefs are going to just bring you right down as soon.
Dr Julie
As you go off the medication.
Dr Gail
So you really need to change your... And again, it's not saying you're just a wonderful person because you're human. Maybe you are and you need to work on some of your issues and some of your behaviors. But most people are pretty good people and are very unfair to themselves. And maybe it's based on childhood issues. And what's great about CBT is it's got a course. It's not forever. And you don't have to sit and talk about your childhood endlessly. It's very proactive.
Dr Julie
Yes. I tell people, yeah, it's short term. A lot of people say, How long is going to take? And I said, That's up to you. The more you put into it, the quicker you're going to get better.
Dr Gail
Correct. And it's like mastering any art. The more you practice, the better you get. you get it. And case in point, I now like traffic.
Dr Julie
That's pretty amazing. Especially here in California. And one thing I want to add, too, that I thought of is that I have a lot of clients that will be on meds, and I always say, Oh, who's giving you meds? Oh, my general practitioner. So I say, Okay, that's fine. You got started. But like Dr. Ferdinand has shared her training, her years of training, it is a specialty. So I ask my clients, Please, I know you got started and you can stay on it, but go talk to a psychiatrist.
Dr Gail
I think that's a really good idea, especially if you're ready to start going off the medication. You need guidance. I don't know if a primary care doctor really is trained. Most primary care doctors, whether it is internal medicine or family practice, maybe get six weeks of psychiatry training in their entire residency as opposed to we get 4 to 6 years. We call it know a little bit about everything. Let's say you're run at the mill, anxious or depressed and your doctor started an SSRI and I had a presence. That's fine. But when do you go off it?
Dr Julie
When do you increase?
Dr Gail
When do you increase it? That's when it would be helpful. Unfortunately, it's hard to find a psychiatrist and get an appointment. There are some nurse practitioners who specialize in psychiatry that can handle those things, and they're filling in some of the gaps.
Dr Julie
I used to get like any specialty. If you have a medical issue, you're not just going to always see your general practitioner. You're going to go see a allergist. You're going to go see maybe GI doctor. I want to go see somebody that really knows what they're talking about, and how's it affecting maybe other medicines? There's just so much to know that I won't get into details with you guys, but I've learned a lot from working with Dr. F renan, being in the hospitals about other things that can cause symptoms that other people might not even look at.
Dr Gail
Correct. That's one of the things a psychiatrist does. They rule out other causes. And it's not common. So some people get their hopes up. Maybe it's a thyroid problem and not depression. Probably not. It's probably depression. But it's good to get a good general workup. And there is a rare case where it is a low thyroid or it is severe anemia that's making you feel sick. You're so exhausted. So a good medical workup is always on our mind before we diagnose something. We want to make sure it's not.
Dr Julie
Something else. Medical, right. And not every doctor might look at it that way, where they just say, Oh, this is what I think it is. And they just prescribe this. So that's just my advice for my clients is I always say, I'll help you. I've had my clients email me their insurance portal and I'll say, Oh, I know this psychiatrist, to get in once you've started some medications or if you haven't. So I just like knowing how psychiatrists think and how they work by being with them for so many years, I think it's just a good way to go. And again, if you're on the fence, what should I do? Don't be afraid to just go meet and just say, Can you educate me? And what would you prescribe me? How would that affect me? How long would it be on? Write down your questions and just, again, we all should be educated on any pills that we're taking, period. Just don't take something because the doctor gives it to you. Ask questions and then you stay working with your doctor closely. This is good. This is good, this isn't. I think of some when we used to work at UCI closely, and there was more like some teenagers.I remember two teenagers come to my mind, and they both had really bad OCD. One was put on Prozac and was phenomenal. It worked so help. The other person got nothing. I mean, it didn't help at all, sorry. Then that person took Zoloft and it was great. But the person on the Prozac took Zoloft, it didn't help at all. I was learning one medicine can really work for somebody and not for the other person.
Dr Gail
Exactly. And what is the logic of that? We don't know because they have the same mechanism of action. And I do want to say that for both anxiety and depression, the first medication you try works in about 65 % of cases, which is pretty good. It's better than maybe hypertension or high cholesterol. But the second medication, so that one didn't work, so you try a different one. Now you're up to about 80 %, which is pretty amazing data. The last 10, 20 %, maybe you have to play around. Maybe it's a different diagnosis. Those are a little bit more challenging.
Dr Julie
That's good.
Dr Gail
To know. It's very successful. But again, you have to be open minded and believe in the process because otherwise, you'll prove yourself right. And that's a hollow.
Dr Julie
Victory, right? Exactly.
Dr Gail
I knew it didn't work and it didn't. It's like, Okay, well, what did you get out of that?
Dr Julie
Nothing. Just proving myself right, I suppose. But then you're still probably depressed and anxious, right? Exactly.
Dr Gail
And then the mindset of nothing will ever help me. And those people with that mindset are unlikely to be open minded in therapy either. Right. That's why I like to challenge people to be willing to self evolve or get help to evolve because no one is perfect. No one has no medical problems or no psychiatric problems. Nobody is great at everything. It may seem so, but it's.
Dr Julie
Not true. Not true. Yeah, not true. My last thing I say to my clients, too, is when they're like, Should I get medicine? I don't know. I say, You know what? Why don't we start with the therapy? A gain, CBT, short term. If you're using the tools, you're really working and you're still feeling that level of depression, anxiety, then go see the psychiatrist. It doesn't have to be your first thing if you don't want to do that. You can try some other things. And if you're still struggling, maybe that will help you be a little more open to go talk to somebody.
Dr Gail
I agree with that as long as you're safe to do so. And especially with children and adolescents, that being my specialty, I think it's reasonable to try therapy first if they're functioning. Now, because psychiatry is so in high demand, we often end up seeing the kids is the most severe because they've already been through a therapist and through probably an adult psychiatrist and maybe the family doctor and maybe their cousin knows somebody. And so by the time we get them, they've already been refusing to go to school for six or eight weeks and they're not eating. So at that point, I can't say, Let's try some more therapy because we've run out of time. But in a higher functioning scenario, give it X amount of time and agree that if there's no improvement after this time, be more open minded to the idea because, again, you're making your own life unnecessarily difficult by saying, I'm going to do this all by my own. Taking the medication means you still did it on your own.
Dr Julie
Yes, very true. There's a good, cognitive, different way of looking at it.
Dr Gail
And going back on that same vein for people with ADHD, I tell kids this all the time, the medication can allow you to focus better and be more productive and efficient, but you have to choose to do so. You can still bomb out of school and talk to your kid neighbors all day long and tap your pencil and interrupt people. You have to choose that you want to let that medication effect benefit you.
Dr Julie
Yes, that's a great point, too. Excellent. Oh, you guys could see we could talk forever here. There's so many aspects to cover, but I love that we've had this opportunity. I hope Dr. Finanis gave you a better idea, different way of looking at what psychiatric medication is, maybe answer some questions. If they'd love to reach out and maybe connect with you, if that's what you're looking for a psychiatrist and they're in the California state, how could they reach you?
Dr Gail
Most likely way to reach me is my email, which is GailSheeksMD@gmail.com.
Dr Julie
Excellent. Okay. And as always, you guys can reach me on my website at my CognitiveBehavioralTherapy.com. All of my information about my emails on there, you can find me on Instagram, on My CBT Podcast, and Facebook is Dr Julie Osborn. So thanks again for being with us. And thank you for your time, Dr. Fernandez. It was so fun.
Dr Gail
Yes. I had a great time. Thank you.
Dr Julie
So again, I feel privileged. You've been such a great influence in my career. First meeting you and one of the psychiatrists I made to trust the most. And I'm so happy when my clients do get to see you because I know how much time you take with them and she's super smart. And she's the psychiatrist you want to see. She really looks at things in a big picture, which I really love.
I appreciate it again, you guys being here. Pass this along to anyone you think might be helpful. Keep sending me your emails and questions.
And remember, make decisions based on what's best for you, not how you feel.