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Dream a Little Dream

It is common practice in psychoanalysis for the patient to report the content of dreams as part of treatment. Sigmund Freud believed that dreams were a window into the unconscious mind. Therefor, by understanding and interpreting the content of dreams the patient would reveal thoughts and images that would possibly clarify current or past experiences, feelings and actions.

Dream analysis, once in vogue for both patients and doctors, has given way to what is termed cognitive-behavioral therapy, or CBT. A CBT approach to treatment might view dream content as random neural activity. However, if one considers the complexity of our dreams and the fact that there are repetitive themes and images,frankly, that hardly seems “random.” CBT examines cognition,our manner of thinking about issues. It also evaluates and treats behavioral concerns, like nail biting, smoking or other compulsive behaviors. Dream analysis is more within the realm of psychotherapeutic approaches that incorporate a deeper analysis of the complex developmental issues, or psychodynamics, which are the causal basis of personality and cognitive concerns.

The dream is divided into two components. The first level of analysis is the manifest content ( which is the actual experience of the dream). “I was driving my car down a mountain road and I had no brakes!” The second level is the latent content of the dream,( what the dream really means). In this case it might be a feeling of loss of control or an inability to control something. We dream in symbols. If we identify certain people in the dream that image could be a “stand-in” for someone else. Dreaming about snow could represent depression or a desire to “cover up” something or jus a pleasant memory of childhood.. So, how do we know the “correct” interpretation? The symbolic items in the dream can be better understood if interpreted within the context of that particular person. Freud suggested that we dream in symbols to “protect” our sleep. If we see through the symbolic process it can cause anxiety and would awaken us, possibly identified as a nightmare.

Dreams can be viewed as the dreamer’s attempt to “work through” or resolve some conflict that they are experiencing in reality. Another aspect of the dream is “wish fulfillment.” Within a dream one can see themselves mastering a task or problem. Apparently, we experience dreaming several times on most nights, even if we do not recall the experience. However, some medications can interfere with neurological function and inhibit dreaming. Interestingly, we seem to have a need to dream.In a classic study people were awakened as they began to dream.It was easy to identify the dream state since dreams are accompanied by rapid eye movements that can be identified and recorded. This procedure occurred for several days. Finally when the subjects were allowed to sleep, their number and frequency of dreams increased. Deprived of dreams, people began to dream more; possibly to make up for the deficit. Dream deprivation increases dreaming when subjects are permitted to have normal sleep.

Finally, dreaming is the only time that we can really “time travel.” One can be a young child in the dream and instantly become a teen or young adult. While the meanings in dreams may be elusive, they can provide meaningful thoughts and ideas that can help the patient to overcome the challenges and the demands of life that have brought them to treatment.

The Columbia Counseling Center offers an eclectic and integrated approach to treatment. The doctors on our staff are trained in the use of multiple techniques and strategies to relieve anxiety, improve mood and effectively modify coping strategies.

You can call 410 992 1949 for the first available appointment.

The Serotonin – Depression Connection

Recent articles( such as this piece from have posited the notion that serotonin is not a significant component of the depressive process .Further, that drug companies, having developed serotonin enhancing medicines, began an advertising campaign to “convince” the public that serotonin was the “cure” for depression.The idea that drug companies would conspire to mislead the public is quite questionable ( although I do enjoy a good conspiracy theory). One of the problems is that we cannot measure serotonin in the brain directly. Further, if we manipulate serotonin with an SSRI (selective serotonin re-uptake inhibitor), this also disturbs the balance of norepinephrine and dopamine- two of the major neurotransmitters. Now, it is really more complicated than this. There are many sub-types of each of these substances so it is not a simple matter of manipulating one of these chemicals.There are also many sub-types of receptor sites in the brain. The more we learn about the chemistry and structure of the brain, the more complicated it becomes.

The data from numerous studies indicates that psychotropic medications may only work about 50% of the time. In addition, psychiatrists may have to try a number of different medications in order to gain a positive effect. Of course, patient compliance is always a problem. It is not a good idea to wash your Prozac down with scotch whiskey – but I have had a number of patients who have done just that!

Michael Greger points out that diet ( whole food plant based nutrition) and exercise may be just as effective as some anti-depressants. While there is merit to this assertion, trying to get a depressed patient to exercise and eat properly is quite challenging – to say the least! It is my impression that “comfort foods” carbohydrates, potatoes, bread, mac and cheese act as “comfort foods” because they do, in fact, raise serotonin levels along with a number of other “calming” chemicals (such as tryptophan) that do cross the blood-brain barrier. Unfortunately, a bag of potato chips only increases serotonin levels for a couple of hours.

It does appear that cortisol is a precipitating chemical in the depressive process and influences a decrease in certain neurotransmitters. Indeed, being in a stressful situation for two to six weeks can trigger a depressive episode. This is chemistry, not “psychological” weakness. The notion that neurotransmitters are the causal factors in the depressive process is strengthened by the apparent genetic relationships within families. If we examine the family of origin of a depressed patient we will find both genetic and psychogenic factors that contribute to the depressive process. Further, it is interesting to note that if a particular antidepressant medication is effective for a “blood relative” ( biological parent or sibling) there is a high probability that the medicine will be effective for the patient.

The “holy grail” of treatment for depression will not be easily discerned. Light therapy can be effective. Likewise, trans-cranial stimulation shows promise. Various approaches in psychotherapy can be quite effective. However, anti-depressant medicines will continue to be a major component of treatment.Columbia Counseling Center’s integrated treatment protocol carefully evaluates the multiple causal factors in depression and provides both pharmacological and psychotherapeutic approaches for maximum effective treatment of depression.
Call 410 992 9149 for the next available appointment.

The Most Powerful Treatment for Depression

The title of this 2008 study says it all: “Faster remission of chronic depression with combined psychotherapy and medication than with each therapy alone”. The study of over 650 patients with depression compared medication treatment alone to medication treatment plus psychotherapy. The results were clear: patients on medication and therapy recovered from chronic (meaning repeated episodes of) depression faster than patients on either treatment alone.

Many studies over the years have identified both cognitive-behavioral therapy and interpersonal psychotherapy as being just as effective as medication in reducing symptoms of moderate depression. Other studies have shown that the improvements gained in therapy alone can last longer than the improvements gained from medication alone.

In my opinion, it’s the minority of cases that improve on just medication. The job of antidepressant medicine is to reduce the most immediate and troubling symptoms that interfere with your ability to function at home, at work, and socially: low energy, loss of interests, poor concentration, crying spells, hopelessness, and suicidal thoughts. The job of therapy is to identify the life issues that have led to depression and make changes in how you deal with those issues so they stop depressing you.

Therefore, we have two powerful and effective tools to treat depression. Use them together and you are likely to get the fastest and most enduring relief from your symptoms. At Columbia Counseling Center, the psychiatrists and therapists are all under one roof and we work with each other to ensure that your treatment is coordinated and efficient.

Written by: Dennis Glick, M.D. Board Certified Psychiatrist at The Columbia Counseling Center

Worried and tense every day? It could be Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is a common and recurring condition. Typical symptoms include near-daily worry, anxiety, tension, feeling on edge, irritability, and sleep disturbance. Features of panic attacks and/or social anxiety may also be present. Your primary care doctor may have already ruled out medical causes such as thyroid, electrolyte, cardiac, or nutritional abnormalities.

Cognitive-behavioral therapy (CBT) is a very effective form of treatment, typically requiring 6 to 12 weekly sessions that may include the use of workbooks and homework. The SSRI and SNRI antidepressant medications (Prozac, Paxil, Zoloft, Celexa, Lexapro, Effexor, Cymbalta, and Pristiq) are highly effective and should be continued for a period of 6 to 12 months following symptom reduction. Benzodiazepines such as Xanax, Ativan, and Klonopin are best used on a temporary basis due to the risks of addiction, memory impairment, physical incoordination, and potentially endangering combinations with alcohol and pain killers. Other medicines such as Buspar, Vistaril, Gabapentin, and Seroquel are occasionally used but are not specifically approved for treatment of GAD.

Many patients will benefit from the combination of CBT and medication. The Columbia Counseling Center is uniquely able to provide coordinated treatment as our staff includes both psychiatrists and psychologists specifically trained to diagnose and treat GAD and other anxiety and mood disorders. Your clinicians work together to ensure you are receiving the most effective treatments for your condition.

Conflict Resolution vs Separation

By Dr. Susan Minsky

Couples often believe the easiest solution to frequent arguments that appear unresolvable is to threaten separation and divorce. Divorce is the last choice to resolve what initially may appear as unreconcilable differences. Marriages require the willingness on both parties to rebalance needs, expectations, hopes, on a consistent basis at various stress points and change which occur throughout a long term relationship. Clear, direct communication, hearing each other in an accurate manner is necessary to produce effective changes for both parties. Couples often require refresher courses and new skills to promote a growth oriented exchange during stressful times, in particular.

Come join the Columbia Counseling Center team who provide an integrated approach to promoting and strengthening the bonds between partners in relationships. Individual and couples therapy are offered simultaneously to promote more rapid and productive identification of issues that require resolution to enhance the lost intimacy and positive communication and interaction between partners.



Overweight and Mental Health

According to the Centers for Disease Control more than a third of American adults—over 72 million people—were obese in 2005 and 2006 and they predicted that, unless we change our eating and exercise habits, 86 percent of the American population will be overweight or obese by the year 2030. People who are obese are more susceptible to serious health problems, such as high blood pressure, type 2 Diabetes, heart disease, orthopedic problems and stroke. But being overweight or obese doesn’t just affect your physical health. You may also have feelings of guilt, embarrassment, low energy, isolate yourself socially, and feel depressed. These feelings can definitely impact your physical health and even shorten your lifespan.

The Social Consequences of Being Overweight

While being fat was once seen as a sign of wealth and comfort, most people almost automatically assume that someone is overweight or obese because they overeat on pizza, cheeseburgers and ice cream. But it’s not that simple. We live in a society in which you can get great tasting, high-calorie, high fat foods at any time of the day or night. They actually have a name for this: “the obesogenic society.” Some obese people may have jobs that require them to work seated for long hours and just don’t have the time or energy to exercise. And, food is ALWAYS THERE. This results in eating many more calories than their level of activity can burn off and leads to constant gain weight.

Overweight and obese people may feel strongly stigmatized and experience discrimination because of their weight. Discrimination usually begins during early school years, when overweight persons are not chosen for school teams, and this discrimination extends into adult life. In schools and colleges, obese students face harassment, rejection from peers, and biased attitudes from teachers. At work, obese people commonly report they have experienced humiliation and discrimination related to their weight – such as not getting promotions. Obese employees are often viewed as less competent, sloppy, and lacking in self-discipline by co-workers and supervisors.

What can be done to reduce the stigma of obesity?

You have a voice at work and at home. You don’t have to accept discrimination in school or in your workplace. It’s okay to share with your co-workers that YOU ARE NOT YOUR WEIGHT.  Also, if you are trying to lose weight you should be sure to surround yourself with supportive, caring friends and family members. Be open about your weight loss goals and ask explicitly for a helping and motivating hand. Supportive friends and family are a vital part of your weight loss program

Finally, take the word “diet” out of your dictionary and vocabulary. Diets don’t work. Lifestyle change does. Eat healthier foods…eat smaller portions…exercise at least 30 minutes a day. And think happy thoughts.

Columbia Counseling is here to help you on your journey to a natural, healthy weight. Our caring therapists and medical staff can help you to look at your lifestyle and help you understand what you might do to successfully achieve your weight loss goals. Call us  at 410- 992 – 9149 for an initial appointment to begin a rational, sustainable and effective weight loss program.

Winter Depression

My favorite season is winter. My wife calls me “a bear with furniture,” and like a bear, in winter the cold weather and shorter days give me the opportunity to slow down, pull my energy back into myself and prepare for spring. However, many men and women in winter have low energy, become irritable and gain weight because they eat too much, especially foods that contain a lot of carbohydrates. They don’t exercise as much, lose interest in getting out of the house and being with other people, sleep more and just stay “tired” all the time. In reality, all of these symptoms may be signs of depression. Some people get depressed because they lose their job or don’t like their job, get a divorce or there is a death in the family. There may also be a genetic basis for depression because it seems like everyone in the family is depressed. But some people get depressed every winter even without experiencing a stressor that would make any of us feel depressed and without a family history of depression.

Winter depression is sometimes called Seasonal Affective Disorder (SAD) and affects between 5 to 10 percent of the U.S. population. Another 10 to 20 percent of the population may suffer from more mild winter “blues.” SAD is more common in women, between the ages of 20-50, and is thought to be caused by the shorter hours of daylight the winter brings during its colder months of the year January and February.  Although the specific cause of this disorder isn’t known, some biological factors such as the circadian rhythm, which helps regulate the body’s internal clock, may be disrupted with the decreased amount sunlight in fall and winter. Also, the decreased amount of light may also cause a biochemical imbalance of the neurotransmitters serotonin and the sleep-related hormone melatonin in the brain.

As a psychiatrist I usually treat winter depression with antidepressant medication and individual or group psychotherapy, but I also use “light box therapy.”  Light box therapy uses a very strong source of broad-spectrum light for a half-hour or hour each day during the winter months to replace the missing hours of daylight. Research has shown that some people with SAD who are exposed to bright light treatments experience relief from depression because the light therapy mimics outdoor light and is thought to cause a biochemical change in the brain that improves mood.

Tips for Coping with Seasonal Affective Disorder

Besides using anti-depressant medication, individual group and light box therapies there are other very effective ways to deal with SAD and other types of depression.

Exercise – Physical exercise has huge health benefits. It’s one of the most powerful ways to prevent and treat depression. One of the first things I ask my patients is to become more active, “just start moving.” For example, instead of eating lunch at your desk, take a midday walk to get as much sun as possible (there’s that light thing again) and to breathe in fresh air.

Work space-try to locate where you sit in your office so that you are next to a window and are exposed to sunlight during the workday.  One of the things I’ve always put high on my priorities is to always have a window in my own office. Open the window for fresh air even in winter.

Sugar-Cut back on the amount of sugar and high fructose corn syrup (HFCS) in your diet. They have been shown to cause increased swings in mood and directly impact your brain function. All of us have experienced a “sugar rush” and “sugar crash” as your body uses up the sugar in your blood.

Foods-Eat protein and complex carbohydrates such as whole grains, fruits, and vegetables at every meal. Less sunlight means less Vitamin D and you can get Vitamin D from milk, most whole grain cereals and fish, especially cod, herring and sardines.

Greyhound Therapy- If it’s in your budget, get out of town and go someplace sunny. Just a change of scenery by itself can help you feel better.

Seek Professional Help-if the depression gets so bad that you find it difficult to get through the day, it’s important that you talk with someone about your struggles and depression. You are not alone and we can get through this working together.

Remember, if you have SAD, unless you live in Alaska or Greenland, the sun will shine, the air will get warm and you will feel better and more alive as the depression melts away with the snow.

Choosing the Correct Weight Loss Pill

If you have a headache…you take a pill and it goes away. If you have an upset stomach…you take a pill and it goes away. If you are overweight…well, you can’t just take a pill to lose weight even though there are thousands of advertisements on television and in magazines that promise to help you lose weight and “it takes no work at all!” I bet you wonder if there ARE weight loss pills that really work, or are they just a waste of time and money.

Why can’t just take a pill and lose weight?

The pharmaceutical companies are in a desperate multi-BILLION dollar race for an effective and safe “weight loss pill”. But they have failed in their search because feeling hungry or feeling full is based upon hormones in your body. The hormone levels constantly change depending on how much energy your body needs and how much and what type of foods you eat.

The most important hormones that control when and how much you eat are called Ghrelin and Leptin. There are other hormones such as Peptide YY, Adiponectin, Cholecystokinin, and Pancreatic polypeptide which are all involved in this energy balance but the main hormones are Grehlin and Leptin.Grehlin and leptin act together, but in opposite ways, to control your urge to eat or to stop eating. Grehlin tells your body to eat because it needs energy and Leptin lets your body know when it is full so you stop eating.

But it gets even more complicated. The level of Ghrelin, which is also called the ‘hormone of hunger,” is affected by many factors such as the type of food you eat, sleep deprivation, being overweight and drinking sweetened soda. Almost everyone drinks soda but grehlin levels don’t decrease after meals if you drink a lot of soda so you still feel hungry. The next time you buy a soda don’t buy the 64 ounce size or even better, drink water with your meals. Because it takes about 20 minutes for the hormones to interact and for you to feel full after you start to eat, always stop eating before you feel full.

When the pharmaceutical companies first discovered Leptin they thought it might be the “anti-fat” miracle drug and they spent an enormous amount of money on research and advertising. But it quickly became obvious that taking leptin or ghrelin as a pill does not control appetite or help people normalize their weight. Because of the difficulty in isolating these hormones and using them in a weight loss pill, don’t expect to see them in the ingredients listed on the pill boxes any time soon.

Prescription weight loss pills

But if we don’t have a pill that can specifically raise and lower the levels of Grhelin and Leptin (and the other appetite hormones) in our bodies, then what kind of pill CAN we take for weight loss? Most weight-loss medications you buy at drug stores, groceries or get by prescription are “appetite suppressant” medications and usually come in tablets or extended-release capsules. Appetite suppressants promote weight loss by tricking the body into believing that it is not hungry or that it is full by increasing brain chemicals, such as serotonin and norepinephrine, that affect mood and appetite.

Fat absorption inhibitors, another type of weight loss pills, work by preventing your body from breaking down and absorbing fat from the foods you eat. The fat which your body can’t digest goes out of your body in bowel movements and many people complain of oily stools, gas and frequent bowel movements. These side effects are especially bad with a high fat diet and can really be embarrassing. Fat absorption inhibitors also reduce the absorption of fat soluble vitamins A, D, E and K so you should take supplements containing these missing nutrients along with the fat absorption inhibitor.

But what about other side effects besides the oily stools? Luckily, the side effects of most weight loss medications are usually mild and become less bothersome the longer you take the medication.

Some of the common side effects of the different medications include increased heart rate and blood pressure, sweating, constipation, problems sleeping, excessive thirst, lightheadedness, headaches and anxiety. But some serious and even fatal outcomes from taking weight loss medications have also been reported. The most tragic example is the use of the appetite suppressor “phen-fen” which caused severe damage to the heart and lungs.

There is still little information on how safe and effective weight-loss medications are if you take them for more than just a few months.You should not expect to reach a “normal” body weight using just medications because most people have individual reactions to any most types of medications, and some people lose more weight than others.

Most people who take weight-loss medications lose about 10 pounds more than people who don’t take weight loss pills. Most weight loss occurs within 6 months of starting the medicine and then your weight will level off or even increase. Sadly, most people will regain the weight they lost when they stop taking weight-loss medications.The best weight loss pills on the market can be a big help for people who are struggling with losing weight.

If you combine weight loss pills with an exercise program and a healthy diet, prepared in a natural way, of fresh meats, fish and whole grains, you’ll see even faster results than you would without them.

Even if you don’t take weight loss pills, because obesity is a chronic disease, you should definitely include regular physical activity and a healthy diet to improve health and to reach and maintain a normal weight. A weight loss of even 5 to 10 percent of your body weight, for example from 200 pounds to 180 pounds, can markedly improve your health.

Conflict Resolution vs Separation by Dr. Minsky

Couples often believe the easiest solution to frequent arguments that appear unresolvable is to threaten separation and divorce. Divorce is the last choice to resolve what initially may appear as unreconcilable differences. Marriages require the willingness on both parties to rebalance needs, expectations, hopes, on a consistent basis at various stress points and change which occur throughout a long term relationship. Clear, direct communication, hearing each other in an accurate manner is necessary to produce effective changes for both parties. Couples often require refresher courses and new skills to promote a growth oriented exchange during stressful times, in particular.

Come join the Columbia Counseling Center team who provide an integrated approach to promoting and strengthening the bonds between partners in relationships. Individual and couples therapy are offered simultaneously to promote more rapid and productive identification of issues that require resolution to enhance the lost intimacy and positive communication and interaction between partners.

National Eating Disorders Awareness Week is Coming Up!

February is National Eating Disorders Awareness Month. Eating disorders effect 1 or 2 out of every 100 children and are becoming more common, but many children and adults are able to hide eating disorders from their families (more…)

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