Our amazing Dr. Tammoima explains anxiety

Anxiety involves feeling uneasy, anxious or nervous, due to stress or trauma, real or imagined. Typically, anxiety is a normal health issue that goes away once a negative situation is completed. Anxiety can even be positive, helping to improve coping or alertness. But when anxiety remains, this mental illness is called an anxiety disorder. Typically lasting for at least six months, these disorders can affect mental health, relationships and quality of life.

Anxiety is actually a group of disorders that all share some level of excessive, persistent, irrational panic and dread. Generalized anxiety disorder (GAD) involves ongoing excessive worry and tension, often with no apparent reason. With obsessive compulsive disorder (OCD), irrational, reoccurring thoughts and uncontrollable compulsions can occur. Post-traumatic stress disorder (PTSD) develops after trauma or terrifying events. PTSD patients may have frightening, long-lasting thoughts and memories. Phobias, excessive, inappropriate fear of an object, situation or activity, are uncontrollable. A phobia can cause extreme stress and anxiety, as people try to avoid their fear. Those with social anxiety disorder worry and feel self-conscious about normal social situations. With separation anxiety disorder (SAD), children have anxiety when separated from loved ones. Panic disorders (anxiety attack, panic attack) are sudden episodes of intense panic or fear, often without reason. A panic attack rarely lasts more than 30 minutes, but can be severe, and you may be worried that another anxiety attack will occur.

Causes and Risk Factors of Anxiety

The exact cause of anxiety and mental illness is not completely understood. Mental health researchers suggest a combination of several factors, including environmental stress, trauma and heredity, may be at fault. Severe or long-lasting stress may actually cause chemical imbalances to the brain and its structures, altering memory and mood. But other underlying health issues shown may also cause anxiety, including: muscle cramps/spasms, thyroid conditions, tingling and burning sensations, tumors, asthma, diabetes and heart disease.

Stress is a major risk factor for anxiety, whether due to illness, big events or smaller life situations. Women are twice as likely to be diagnosed with anxiety. Children who have endured abuse or trauma have greater chances of anxiety, as well. Your risks may be higher if blood relatives, including one or both parents, have an anxiety disorder. While drug and alcohol use causes anxiety, it also masks mental health issues, and should be treated first. If anxiety goes untreated or advances, insomnia, headaches, grinding teeth (bruxism) and digestive or bowel problems can develop. Nearly half of all anxiety patients are diagnosed with depression, as well.

Symptoms, Signs and Testsof Anxiety

Often, anxiety symptoms and signs first indicate physical or mental health illnesses. Anxiety symptoms may include: feeling apprehensive or powerless, increased heart rate, rapid breathing, feeling weak or tired, sweating, dizziness, stomach discomfort, chest pain, startling easily, muscle tension, sleep issues, nightmares and sexual problems. Anxiety disorders may have specific symptoms, such as panic attacks unreal, disconnected feelings and emotional numbness, or recurring, upsetting thoughts and compulsions occurring with obsessive compulsive disorder (OCD). As anxiety may have a medical cause, doctors give physical exams and blood tests. Patients fill out psychological questionnaires, and discuss medications or alcohol/drug use. Mental health professionals diagnose stress, trauma and anxiety with criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Anxiety disorders are diagnosed, along with other mental health problems. Depression is diagnosed in about half of anxiety patients.

Treatment, Drugs and Preventionof Anxiety

When anxiety remains, it becomes a mental issue requiring treatment. Typically, anxiety is treated with psychotherapy, medications, or both. Effective drugs enable patients to lead productive, fulfilling lives, although doctors may need to determine optimal treatments. Doctors typically prescribe antidepressants, such as fluoxetine (Prozac) and paroxetine (Paxil, Pexeva). These medications, which influence brain chemicals (neurotransmitters), are thought to play a role in anxiety disorders. Doctors may also prescribe benzodiazepines (sedatives), such as clonazepam (Klonopin) or diazepam (Valium), but they can be habit-forming. Beta-blockers can prevent the physical symptoms of social phobia and other anxiety disorders, as well.

Psychotherapy with mental health professionals is effective, allowing patients to identify stress sources. Its also helpful to discuss mental health issues with trusted friends or loved ones. Anxiety and related mental illnesses can be treated through lifestyle changes. Physical activity is important, and regular exercise incorporating healthy, fun activities reduces stress. Proper sleep and relaxation, along with daily leisure time, eases anxiety and stress. A well-balanced, healthy diet, including vegetables, fruits, whole grains and fish, reduces anxiety, while fried, sugary and processed foods should be avoided. Those with anxiety should limit caffeine, and completely avoid alcohol (and other sedatives), nicotine and drugs. Discuss with your doctor whether any drugs or medications you’re taking may cause anxiety.



Tammoima Gichana PharmD, MBA, MB(ASCP),RPh.


Causes, Risk Factors and Complications of ADHD

ADHD stands for attention deficit hyperactivity disorder and is a condition of mental health that provides the individual with difficulty in holding attention combined with hyperactivity and behavior that is impulsive in nature. Though the condition is most associated with children, it is also common to find the condition in many adults. The condition and symptoms can persist into the adult years, and in some individuals the disorder is not diagnosed until later years.

Causes, Risk Factors and Complications

Often ADHD is passed down from one generation to the next making it a hereditary disorder. The individual suffering with the condition might express signs early on in life that are missed or misdiagnosed as bad behavior or laziness. Some of the things that might put a person at risk for developing the disorder include things such as drug or alcohol abuse during the woman’s pregnancy, exposure to toxins like lead paint or pipes, or if you are born prematurely. You have a greater chance of suffering from ADHD if you have other family members with mental illness or ADHD.

There are many complications involved for those individuals dealing with ADHD in their lives. Performance in school and work can be hindered because of the inability to focus on the topic at hand and follow through to the end. Poor relationships can also become a result of ADHD in adults and children. It is also easy to see how a person with ADHD can be in trouble with the law, suffer from drug or alcohol abuse and go through severe financial stress. In addition, individuals with ADHD are often at greater risk for mental and physical health that is poor in nature.

Signs, Symptoms and Tests

It can be easy to misdiagnose ADHD, particularly in children, as the symptoms appear to be similar to basic childhood actions and laziness. It is important to note that many adults suffer from ADD which is attention-deficit disorder without the hyperactivity. Some of the symptoms include trouble with focus on daily tasks, difficulty completing projects or tasks, disorganization in general, restlessness, mood swings, impulsivity, low frustration tolerance, inability to cope well with stress, quick temper and inability to sustain stable relationships.

A doctor can provide you the individual with a number of tests that will give them feedback to be used in the evaluation of ADHD. This information is broken down into sections of inattention and hyperactivity/impulsivity. The individual should answer yes to six or more signs and symptoms that are designated by the Diagnostic and Statistical Manual of Mental Disorders (DSM) put out by the American Psychiatric Association. If six in each category of the questionnaire ring true to the individual they can be considered ADHD.

Treatment, Drugs and Prevention

There are a series of approaches to take when dealing with treatment of ADHD in children and in adults. These often include a medication such as a stimulant combined with psychological counseling. The medication choices often include Concerta, Metadate, Exedrine, Ritalin and some others newer to the field. These stimulants work to balance the brains neurotransmitters. Some other options for treating the ADHD with medications is the use of atomoxetin, better known as Strattera and Wellbutrin. There are some individuals that can not take the stimulants because of health problems or because of past drug addiction.

Counseling will help the individual learn how to cope with some of the things that can trigger the behavior. In addition, you will learn how to prevent or reduce such things as impulsive behavior and how to be better organized, handle time management better, improve self-esteem and improve relationships with those around you. This is all important for developing a lifestyle free of ADHD symptoms and drama.



Tammoima Gichana PharmD, MBA, MB(ASCP),RPh.


What is depression?

Depression is a medical condition, which includes continued feelings of sadness, despair, hopelessness and loss of interest in daily life. It is a serious illness that can affect the body’s functions, behavior, physical health and ones thoughts and feelings. There are three different types of depression major depression, clinical depression and major depressive disorder. This chronic illness requires proper treatment in order to recover fully from its effects on the body and mind. Each year nearly 25 million Americans will suffer from depression. It typically occurs 70% more in women than that of men; mostly likely because women are more willing to seek treatment for the condition.

Causes, Risk Factors and Complications

While it isn’t known exactly why depression occurs, there are many factors into the development of this illness. For some patients, it is caused by changes within the brain or neurotransmitters that researchers suggest are a direct link to depression. Hormones can also trigger depression because of the body’s imbalance. For others, certain life events may trigger depression in their life as well as trauma such as death or abuse.

Some common risk factors for developing depression include:

  1. Being a woman;
  2. Experiencing trauma as a child;
  3. Having family history of depression;
  4. Stress;
  5. Being introverted;
  6. Recently having a child;
  7. Having a chronic or serious illness such as cancer;
  8. Addicted to drugs or alcohol;
  9. Low self-esteem;
  10. Taking certain medications

Untreated depression can lead to dangerous consequences. Some complications include: alcohol or substance abuse, anxiety, conflict, suicide, self-mutilation or premature death. Researchers suggest that nearly one-half of all people who die by suicide were depressed.

Signs, Symptoms and Tests

For outsiders, its hard to detect from the outside as most of the symptoms are fighting internally. This contributes to ones feeling of being alone. Depression symptoms are not the same for every person inflicted, but can include:

  1. Changes in sleep habits (difficulty falling asleep, waking up at weird hours or sleeping longer than normal);
  2. Inability to concentrate;
  3. No energy;
  4. Hopelessness;
  5. Moodiness;
  6. Low self-esteem;
  7. Lack of interest in normal activities;
  8. Weight gain or loss;
  9. Loss of appetite.

Its extremely important to be treated for depression when symptoms are experienced. Not only because it is unhealthy to live in such a state of hopelessness, but also because other medical conditions mimic the same symptoms of depression. Some of these diseases include: anemia, neurological disorders, hypothyroidism and infectious diseases.

During a typical doctors visit concerning depression, a physician may ask questions about ones thoughts and mood. A physical exam will be administered where vital signs such as blood pressure and heart rate are measured. A CBC or complete blood count may also be administered in order to test if the body is functioning properly. A thyroid test may also occur to make sure that the symptoms felt are not because of an under-active thyroid. A psychological evaluation may also occur where behaviors, feelings and thoughts will be explored. This is where any self-harm or suicidal thoughts will be discussed.

Typically, in order to diagnose someone with major depression, a patient must meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders. A patient must have five or more symptoms (including loss of interest in life) in a two-week period. A doctor will explore other options that may be causing these symptoms including bipolar disorder, adjustment disorder, dysthymia, post-partum depression and seasonal affective disorder, to name a few.

Treatment, Drugs and Prevention

A patient will be treated in regards to their specific case or type of depression. There are many different types of treatment that can include medication and psychotherapy. For mild cases, a doctor may prescribe an anti-depressant that can lesson symptoms. However, for many counseling allows one to talk about these feelings, work through them and learn how to change them and understand them properly. Experts believe the best treatment is a combination of both. Some antidepressants prescribed include: Selective Serotonin reuptake inhibitors (SSRIs), Serotonin and Norepinephrine reuptake inhibitors (SNRIs), Tricyclic antidepressants, anti-anxiety medications or antipsychotics.

In terms of psychotherapy, cognitive behavioral therapy is typically the most commonly-used therapy for depression patients. This therapy helps patient to understand and identify negative thoughts and behaviors and learn how to replace them.

For extreme cases of depression, electrocution therapy may be used where the neurotransmitters in the brain are affected in order to provide immediate relief to severe depression sufferers. Typically this treatment is used in patients who do not receive any changes from medications or who are at a high risk for committing suicide. Others may be hospitalized and offered psychiatric treatment.



Tammoima Gichana PharmD, MBA, MB(ASCP),RPh.