Cynthia Benton MD

Eating Disorders – Bulimia

CynthiaBentonMD — Wed, 08 Dec 2010 14:53:07 +0000

I am a psychiatrist in Austin, Texas specializing in the treatment of adults, including adults with eating disorders such as bulimia. The only medication which is FDA approved for the treatment of bulimia is Prozac. In clinical trials, Prozac was found to reduce the frequency of binge-eating and purging episodes in patients with bulimia; these trials compared Prozac at doses of 20mg or 60mg to placebo and found that only Prozac 60mg was effective. Patients who had more severe symptoms (as measured by engaging in more frequent episodes of binging and purging) had a greater reduction in symptoms with Prozac. Patients who continued taking Prozac were more likely to maintain their improvements than those who discontinued Prozac.

Notably, although some patients had a complete remission of bulimic symptoms with Prozac, for the majority the benefit was a reduction in the frequency of binge-eating and purging. It has been shown that the combination of Prozac and brief psychotherapy (usually 16-20 sessions) yields better results than medication alone in terms of seeing an initial response, eliciting higher recovery rates and lowering level of symptoms. Because of this, medication should be incorporated as one component of the treatment plan for a patient with bulimia. It is important that patients with significant bulimic behaviors meet regularly with a team of providers that includes: a primary care physician for monitoring of physical health, a therapist to help explore what thoughts and emotions underlie the bulimic behaviors, and a dietician to develop a plan for healthy eating.

Treatment with Prozac may provide an additional benefit for patients with bulimia who are also depressed. In some estimates, about half of patients with bulimia have another co-morbid psychiatric disorder such as depression, and Prozac is also FDA approved for the treatment of major depression.

Call 512-239-8943 to schedule an appointment.

Disclaimer: The information in these posts is not guaranteed to be accurate or complete. It is not meant to serve as medical advice, and your reading of it does not establish a physician-patient relationship with Dr. Cynthia Benton. If you have any questions about this information, please contact your doctor.

Depression

CynthiaBentonMD — Wed, 08 Dec 2010 14:52:22 +0000

I am a psychiatrist in Austin, Texas specializing in the treatment of adults, including adults with depression. Sometimes people with depression are reluctant to take an antidepressant. Common concerns include being worried that the antidepressant will have intolerable side effects. It is certainly true that antidepressants, like all medications, have many potential side effects. However, not all patients will experience adverse effects; generally only a minority of patients taking a particular agent will experience adverse effects to that drug. Some side effects, such as headache or nausea, occur early in the treatment course and tend to resolve after one to two weeks. The goal is to find an antidepressant that has minimal side effects for that person and to match any likely side effects to the symptoms the patient is experiencing. For instance, a patient who has a decreased energy level during the day may do better with an antidepressant that tends to be more activating; whereas, this may be a poor choice for someone with anxiety. Sometimes a patient may have to try a couple of medications before finding one that is a good fit. What I tell people is that you cannot tell whether any side effects that you might experience are worse than your depression until you try the medication for a month. If you do find that the side effects are intolerable, you can stop the medication. If you find the medication gives you relief from your symptoms of depression but causes side effects, we can work together to manage that side effect. But if you never try the medication, you won’t have the information you need to make an informed decision.

Another concern that I hear from patients is that they worry that taking an antidepressant will decrease their motivation to change situations in their life that they are unhappy with. I suppose that is possible, but on the other hand, the symptoms of depression often prevent people from being able to address problems in their lives. One example might be a woman who is depressed and has a boss at work who is critical and difficult to work with. During her depression, she might feel worthless and feel the boss’s criticism is accurate and that she would never be able to find another job anyway. After her depression is treated, she might feel more positive about herself and have the energy and motivation to find another job or to address her boss in a manner which improves her ability to work with him. I also recommend that people with depression utilize a combination treatment of therapy and medication because therapy can also help people start to explore and change factors in their lives that are contributing to their depression.

Call 512-239-8943 to schedule an appointment.

Anxiety/Panic Disorder

CynthiaBentonMD — Tue, 07 Dec 2010 22:37:07 +0000

I am a psychiatrist in Austin, Texas specializing in the treatment of adults, including adults with Panic Disorder. One of the most helpful classes of medications for anxiety is the SSRI medications (Celexa, Lexapro, Paxil, Prozac, Zoloft). Once a patient has been on a therapeutic dose of an SSRI medication for a month, many will experience a decrease in their overall level of anxiety along with a reduction in frequency and intensity of panic attacks. However, for some people with Panic Disorder starting a new medication can be difficult. People with Panic Disorder can become so sensitized to their body’s own sensations, that normal sensations such as an increase in heart rate with exercise can trigger a panic attack. For these people, taking a new medication which may potentially have side effects can feel very frightening; sometimes to the extent that taking the first dose can trigger a panic attack. There are a couple of techniques that can help with this. One possibility is to have the patient take the first dose of their SSRI medication along with a dose of a mild sedative medication like Ativan or Klonopin. The Ativan or Klonopin helps to reduce the sensations of anxiety and prevent a panic attack. Another possibility is to start the medication at an extremely low dose and titrate up as the patient feels comfortable. Some SSRI’s such as Lexapro actually come in a liquid formulation so that the dose can be increased as slowly as one drop at a time to the target dose. Often during the first month of medication therapy, a patient may have to rely on taking Ativan or Klonopin to treat panic attacks as they occur but as they stabilize on their SSRI medication, they will have fewer instances where they need to take Ativan or Klonopin for panic attacks. The goal is that the SSRI medication will decrease or eliminate panic attacks and decrease the severity of any panic attacks that do occur, and also decrease anticipatory anxiety about having panic attacks and help the person feel more comfortable to be in situations or places they previously avoided due to fears or having panic attacks.

Call 512-239-8943 to schedule an appointment.

Adult ADD/ADHD

CynthiaBentonMD — Tue, 07 Dec 2010 22:34:52 +0000

I am a psychiatrist in Austin, Texas specializing in the treatment of adults, including adults with ADD/ADHD. One common question that many of my patients have is whether they should switch to Vyvanse for treatment of their ADD/ADHD. Vyvanse is closely related to the medications Adderall and Adderall XR. Adderall and Adderall XR are a mix of amphetamine salts; whereas, the active component in Vyvanse is d-amphetamine. Vyvanse is also formulated to have a more gradual onset of action and more even blood levels throughout its duration of action. This may result in Vyvanse having fewer side effects, and some patients report that they feel less jittery or anxious with Vyvanse. Conversely, some patients feel Vyvanse does not feel as strong or potent. Another important difference is that Vyvanse must pass through the digestive tract to become active; it will not produce a high when snorted or injected. This may mean that its abuse potential is less. However, it is important to remember that all of these medications are considered to have a high potential for abuse and addiction. Of these three medications, Adderall has the shortest duration of action (6 hours) which may result in the inconvenience of having to take 2 doses during the day but also gives greater flexibility for people who do not need to concentrate all day. Both Adderall XR and Vyvanse have a similar duration of action (10-12 hours). One final difference is cost; Adderall is the cheapest of the three medications because there are a variety of low cost generic alternatives. Adderall XR is also available in generic form although the cost is higher than that of Adderall, and Vyvanse which is only available in brand name is the most expensive.

Call 512-239-8943 to schedule an appointment.