Bring Me A Higher Love!

Dear Dr. Guterson - how can I love my wife better? A: Marriage and love are all about giving to your spouse - her needs are more important than yours. The famous lyricist, Alan Jay Lerner, wrote the lyrics of a song in the musical ‘Camelot’ that went like this: “How to handle a woman?.. simply love her, love her, love her” And then Lerner himself was married eight times! Why? I can’t say for sure but the phrase ‘handling’ a woman to me smacks of selfish desire. So then ‘loving her’ was more about Lerner than her. Obviously, I was never Lerner’s psychiatrist but just a thought. My basic answer is that it starts with true empathy. Active listening; putting yourself in her shoes; connecting with her inner world as best you can. Knowing her love language (touching; quality time; words of affirmation; gifts; acts of service) is always a good place to start. Then you are truly “loving her, loving her, loving her.”

Which AntiDepressant??

Dear Dr. Guterson - I’m depressed. Which medication would you recommend?

A: The first question to ask is: am I really depressed, or am I just going through a hard time. Because everyone goes through hard times, it’s part of life. And sometimes the feelings of depression or sadness can be a necessary step in one’s journey toward growth. It’s called ‘the healthiness of depression’. I’ve often wondered if this was the case with Abraham Lincoln, who went through some profound depressions.

Next, medication is not always the way to go. Daily exercise (within reason, as authorized by your PCP or cardiologist) can be a huge antidepressant.

As can therapy; real good therapy, therapy that helps us understand our inner world so that we can navigate life in a more healthy and joyous way.

And then there’s spirituality, having an awareness and connection with our soul, a purpose and mission in life. To wake up every morning with a sense of this can be a huge life changer.

But - getting to your question - there is no set answer, no special antidepressant that fits everyone. The general rule is to focus on the main presenting symptoms of depression:

If anxiety and/or irritability are major additional factors of depression, then the Serotonin medications (likes Prozac, Zoloft, Celexa, and Lexapro), especially in high dosages, would be my top choice.

With lethargy and/or poor concentration, choose Wellbutrin, which can also help with smoking cessation and ADHD.

With poor appetite and/or insomnia, choose Remeron.

With fibromyalgia and diabetic neuropathy, Cymbalta is a good bet. The tricyclic antidepressants (like Amitriptyline and Nortriptyline) also can help with pain syndromes and sometimes migraines.

All these are of course general rules. Nothing is set in stone, as each of us is wonderfully unique. One also has to consider side effects.

And of course, there’s always family history - if a particular antidepressant has worked well for one family member, that might be a good direction to go.

Obviously, for all of my above suggestions, you must ultimately consult with your own psychiatrist before making any decisions.

When all is said and done, knowing that difficulties are an intrinsic part of life is a great mindset to have. When we work through our struggles, and don’t avoid them, we become better people.

Wishing you the very best,

Dr. John Yaakov Guterson

No Closed Doors

Dr. Guterson: I have all these lusts and fantasies streaming through me. Help!

Answer: I’m reminded of President Jimmy Carter who once said “I have lusted in my heart.” I imagine we all have lusts; that’s what helps propagate humankind!

One need not fall into guilt about one’s desires. The problem is when we act on our desires in ways that are ultimately destructive.

Infatuations can be extremely seductive and enticing. As a psychiatrist, I have witnessed the sad and tragic result of a spouse who gets caught up in an infatuation - which then leads to adultery. Soon comes divorce and then estrangement from one’s children.

There is wisdom to those who say one should never be behind a closed door with someone other than your spouse. And that includes emails and texts.

So, yes, live life with passion, lots of passion. Accept that you may have some "unkosher" thoughts from time to time. Just don't put those thoughts into action.

And then compliment yourself that you were able to push those thoughts to the side and control yourself! That way you turn lustful thoughts into a positive.