Simon Downes is a psychologist and medical student who has been in living in Japan since 1992. He interviews Japanese doctors to learn more about medical practice in this country.

Noriko Noguchi, MD, is an OB/GYN physician in Japan.

Simon R. Downes: Is there a need for more OB/GYN physicians in Japan? Why would students not choose this specialty?

Yes, there is a great need. Students do not choose this specialty because it is very hard. Deliveries of babies, in particular, are difficult to predict, so students find themselves often staying overnight in the hospital. Compared to other specialties, we spend more time staying overnight in the hospital.

When do students decide their specialty?

First, a resident must rotate through all of the specialties for two years. We average three months per rotation, but it depends on the hospital. Then, the student may choose a specialty.

What made you chose this specialty?

When I was a med student and resident we were able to see many departments. I was interested in this specialty for two reasons. First, we can take care of women throughout their whole life. Second, our specialty includes many sub-specialties. Therefore, we can handle many issues within our department. For example, we can do surgeries such as cesareans, hysterectomies, cancer operations, myomectomies, etc. The patient does not need to change to a different department.

Please tell me more about the sub-specialties.

The four main specialties within OB/GYN are Cancer, Obstetrics, Endocrinology and Women’s health. While most OB/GYNs can do all of these, we chose one area. In my case, while I rotated in general surgery, and learned how to do these types of surgeries, I focused on endocrinology.

In conclusion, please summarize why you chose this specialty.

OB/GYN is a specialty that covers all areas, from birth to death…we take care of all women’s health needs from internal medicine to surgery – that is why I love this specialty!

Thank you, Dr. Noguchi.

I am afraid I might have a social anxiety disorder. I am not a very timid person, but I feel uncomfortable if I am the center of attention, such as speaking in front of a large group. I turn bright red and begin sweating and I can’t keep eye contact. It doesn’t happen when I am around friends. Because of that, I try to avoid those types of situations. My mom was diagnosed with OCD/schizophrenia. Is it a possibility that I can have this?

Hello and thank you for your question about whether you have either/both social anxiety disorder or OCD/schizophrenia. Before I answer your question, I would like to say that while I can provide you with basic information, to be properly diagnosed, you will need to see a psychologist or a psychiatrist.

Although some psychiatrists will be more likely to prescribe medication, psychologists tend to prefer non-pharmacological treatments such as cognitive behavior therapy (see below).

That being said, there is a great deal that you can learn and do without visiting a doctor. First, let’s talk about social anxiety disorder. 

If you are diagnosed with social anxiety disorder, your doctor may prescribe either therapy only such as cognitive behavioral therapy, or drugs, or a combination. 

Example drugs used are selective serotonin reuptake inhibitors (SSRIs) such as Paroxetine (Paxil) or Sertraline (Zoloft). However, drugs are for very persistent social anxiety.

I prepared a number of links and videos that will help you understand this disorder more. 

1. This is what psychiatrists and psychologists look at to decide whether you fit into their category for diagnosis: DSM-5 Definition of Social Anxiety Disorder

2. Mayo Clinic on social anxiety disorder basics and treatment

VIDEO LINKS

1. Professional definition of social anxiety disorder and treatments

2. Types of social anxiety

By your own definition – you are not a very timid person. Therefore it may be possible that you do not have a severe form of social anxiety. It would be a good thing for you to consider trying cognitive behavioral therapy, which can be offered by psychologists (online, or in person). Another way to tackle this would be to search for video links on youtube that deal with the subject and see which works for you best. If none do, then you will need to see a professional.

Next, let’s consider OCD/schizophrenia. While OCD and schizophrenia are two distinct disorders, recent research has described them as being related. In addition, there seems to be some evidence that it runs in families.

1. Obsessive Compulsive Disorder Runs in Families

2. OCD Patients & Their Kids at Greater Risk of Schizophrenia By Traci Pedersen
~ 1 min read

Again, to properly diagnose this, you will need to visit a professional. However, I would like to share with you a video series that I think offers excellent advice and techniques on dealing with OCD.

Cognitive Behavioral Therapy for OCD (set of 15 videos)

Thank you for your question.

I think I have a problem. I think my arm is not a part of my body. I feel as if my arm isn’t mine. I talked to psychiatrists about this and they tried to figure out my problem but it has been months and I still feel this way and seen no improvement. It drives me insane having to look at my arm. I’m looking at it and its attached to me, but it doesn’t feel like it is my arm. I don’t really know how to explain it. What can I do?

You are saying that psychiatrists have not been able to make you feel your arm is yours / or classify you with a certain disorder. 

If this is a recent feeling, eg a few months, and psychiatrists have ruled out a psychological disorder, I would recommend you see a neurologist. It could be that a nerve injury or neurotransmitter problem is causing you to feel your arm is not yours. 

Another possibility is a brachial plexus injury that may have caused temporary muscular or nervous injury. 

One thing is for sure: something is not right. You need to rule out everything so you can come to a conclusion. TV depicts medicine as an exact science but in reality, it is not. 

In medical school, we learn how to fit patients into particular categories by ruling out things and considering differential diagnoses for a particular set of symptoms. 

In your case, you will need to come to your own conclusions based on seeing a number of specialists. 

The final diagnosis may be one you will not like – but could be one you could deal with.

One possible diagnosis could be that it is psychosomatic – a real physical condition brought on by an internal conflict or stress. But this is not something to be taken lightly. 

Please learn all you can and come back if I can be of more help.

I suffered from very severe insomnia and anxiety relating to relationship issues about 5 years ago. I have pretty much recovered from the anxiety now but I still experience insomnia. I have gone days without sleep before. I feel tension and aches throughout my body. I feel headaches and slowness. I thought my problems were related and if I got better from anxiety, I would get better from insomnia because both derived from the same issue. What can I do?

Thank you for your question regarding your severe insomnia and anxiety. This is a serious issue so I am glad you have contacted me. 

I’m glad to hear that you have recovered from your anxiety concerning the relationship issue. It sounds like the experience was particularly traumatic. Before I discuss some possible options to address your insomnia, I would like to say I am concerned about your physical symptoms – they must be worrisome to you. 

Physiologically speaking, your headaches and slowness and tension may be related to lack of sleep – your body calling out to you to rest. But the fact you are unable to sleep may mean either your anxiety is still causing you issues or you have a physiological imbalance. 

To rule out a physiological cause I would suggest you see an endocrinologist. The doctor may check thyroid functions, respiratory or neurological causes. I know it is not desirable to have to go through this, but you will feel relieved to know some major illnesses have been ruled out. 

Some medications cause insomnia but you have not listed any in your profile. 

If we can assume there is no chemical imbalance, we should consider other causes of your insomnia and what should be done about them. 

Firstly, you would be well advised to learn all you can about insomnia. Physicians may look at a reference such as the one below. 
Types of insomnia 

In order to help you more, I would like to ask you to provide more information about your relationship that was the origin of your anxiety. Please tell me why you think you have overcome this anxiety. 

I am 45 years old and I think I am going through a midlife crisis. I had a reunion with some college friends from my past this weekend and after seeing how everyone else has grown, I feel like I haven’t. I started to think of all the things I’ve done, and none are noteworthy. I am not sure that I am the man who I thought I was. I am not sure who I am anymore. I feel depressed. I’ve been drinking alone at night till I passed out. What can I do to get over this?

Hello and thank you for your question about whether you are in a mid-life crisis.

It seems that recently, the idea of a ‘mid-life crisis’ is being replaced with an understanding that focuses more on the natural changes that happen around the middle of life and why this may be a welcome transition, perhaps leading you to realize that you are not doing what you were born to do, or wanted to do.

Firstly, I liked this article which explores some of the feelings experienced in a mid-life crisis:

Recognizing and responding to a mid-life crisis

For many, this is an opportunity to take steps to change your life for the better. The downside is some become depressed, which may call for talk therapy (eg, cognitive behavioral therapy) or temporary medication or both.

A clear understanding of what a ‘mid-life crisis’ is will be helpful. The hope here is that you will come to realize that this time does not have to be a crisis, but an opportunity for change.

WebMD offers a more detailed explanation which is up to date summarizing how psychiatrists and psychologists help patients with a mid-life crisis. The second page goes into more detail about why this stage can be considered ‘normal’. 

Midlife Crisis: Transition or Depression?

Lastly, I would like to suggest that you have a physical to look at your basic lab results (blood work etc) and to possibly visit an endocrinologist to confirm you do not have a hormone imbalance.

Please take care of your body. The negative effects of alcohol (even 1-2 glasses a night are well-documented).

Thank you for your question. I hope you will find that the second part of your life will be as fun (or better) than the first part.

I think I am depressed. I have never been diagnosed by a doctor. I am not on any medication. I don’t have any allergies that I am aware of. I don’t have any defining point that caused the depression. I don’t cut myself or think about suicide. I’m not really sure what I feel. I don’t really feel anything. When I think logically about my situation, I think I am depressed, but I don’t feel depressed. Do these seem like symptoms of clinical depression? What tips do you have to deal with this?

Hello and thank you for your question about depression. In particular, you are asking whether what you describe may be clinical depression or not, and how to deal with these feelings.

It is a good thing to contact a professional rather than just searching the internet because professionals are better able to curate what is useful information and what is not.

In your symptoms information area, you did not indicate a duration, but in general, the indication of a depressive disorder is continued feelings of depression for at least two weeks.

That being said, you should be able to tell which category you fit into by looking at both Dysthymia and Major depression. Both are serious conditions, but treatment varies depending on which one you have (if you think your symptoms match those in the list). 

However, please remember that professionally trained psychologists/therapists and psychiatrists are the only ones who may diagnose you, regardless of whether you think you fit into a particular category. 

The links below are very well prepared. They are based on the definitions for depressive disorders listed in the DSM5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition). Please take the time to read them and also watch the videos presented on Depression TV.

Dysthymia

Major depression

Depression TV (Web MD)

To answer your question based on the information you have provided, I would say that you probably do not meet the definition of major depression, but more likely match dysthymia or a more temporary form of depression.

You mentioned that you ‘don’t feel anything’ … so I recommend that you also read about Anhedonia.

Lastly, I would like to recommend that you consider seeing a therapist or psychiatrist to consider options for dealing with these feelings you are having.

One of the most successful therapies is cognitive behavioral therapy (CBT) which will help you to look at your feelings and actions, and to learn coping mechanisms that will improve your life.

Thank you, and I hope you can find some answers in my suggestions.

I have been on Effexor for about 2 months to help with my social anxiety disorder. My doctor started me on 35.5mg a day for a week, then eventually upped to 75.5mg a day. At this point, I was feeling fine. Eventually, my doctor increased the dosage to 225mg and then 300mg. Oddly enough when the dosage increased, the effect was decreased. I am also taking Risperidone (2-4 tablets) before bedtime, could this be countering the effect of the Effexor?Hello and thank you for your question about whether Risperidone is countering the effect of the Effexor.

Firstly, it is important to say that I am not a medical doctor (still in medical school), so I cannot comment on your medications. As I was trained as a psychologist, I first recommend non-pharmacological approaches to social anxiety disorder such as cognitive behavioral therapy.

Sometimes CBT plus a medication temporarily can be helpful. But ultimately, as the psychiatric drugs are so strong and unpredictable, I generally do not recommend them.

However, as I am now in medical school, and have experienced first-hand the positive effects of psychiatric medications with patients, I can admit their efficacy in certain severe cases.

If this is working for you, that is great. But I would like to ask you to become an expert on the medications you are taking. You can learn a great deal through certain web pages.

To learn more about the drugs you are taking and possible interactions through video, I recommend ‘Doctor Mind’ Dr. Mark Viner in Nevada. He is so honest about the drugs and you will learn a great deal that psychiatrists will not tell you.

1. Doctor of Mind talks about Effexor Venlafaxine/Effexor

Please watch the whole video.

He says it can be a good antidepressant, but watch what he says about taking too much….never above 225mg…(1:25)

it is mainly for depression – not good for anxiety: (6:20)
 He says it can make you anxious…so that may explain the weaker anti-anxiety effect as the dosage becomes higher.

Here is another on Venlafaxine by him!

2. Please be aware that Risperidone can have very serious side effects:Compare both drugs:

Effexor vs Risperidol

Dangers of the interaction of these drugs

I do not know whether you have tried SSRIs, but they are often the first type of medication for symptoms of social anxiety (eg Paroxetine (Paxil) or Sertraline (Zoloft)). Risperidone, sold under the trade name Risperdal among others, is an antipsychotic medication. It is mainly used to treat schizophrenia, bipolar disorder, and irritability in people with autism.

If this doctor is not prescribing the right balance for you, I recommend that you try another. You will find the right balance. However please be careful about altering the dosage of Effexor suddenly – make sure you have a psychiatrist’s guidance, for whatever changes you make. 

Lastly, if you are looking to reduce your anxiety speaking in front of others, or to boost your social confidence, I recommend Toastmasters; It worked wonders for me!Thank you