Help and Homeopathy for Anxiety

Anxiety disorders affect 40 million adults in the United States, making it the most common mental health condition in the country. Untreated anxiety can affect every facet of life, making it difficult to relax, to achieve success in a work environment, to have fulfilling hobbies, and to maintain close relationships with family and friends. While there is no cure for anxiety, there are ways to manage it. While there are many prescription anxiolytics, today I want to talk about some behaviors, supplements, vitamins and homeopathic remedies that you can use to help deal with anxiety and release the hold it may have on your life. 

Let’s start with some simple stuff. Some behaviors that you should stop and some you can start to help quell anxiety. 

Behaviors to stop

Alcohol: If you think consuming alcohol would help ease anxiety, you would be wrong. While alcohol relaxes the body, it clouds the mind, and a clouded mind actually increases anxiety. And though you might feel relaxed for an hour or two, once you stop drinking, your mind and body are affected as the alcohol leaves your system, so the other 22 hours of your day will only be filled with more anxiety. Not only that, if you have chronic anxiety and drink in a misguided attempt to help it, you’re going to be consuming alcohol in quantities that can end up in your developing alcoholism. 

Smoking tobacco: Again, you may think that cigarettes might help anxiety. When a smoker gets stressed, they often say they want to smoke to chill out. So why does smoking seem to help smokers relax? Smoking cigarettes interferes with certain chemicals in the brain. When smokers haven’t had a cigarette for a while, the craving for another one makes them feel irritable and anxious. These feelings can be temporarily relieved when they light up a cigarette, so smokers associate the improved mood with smoking. In fact, it’s the effects of smoking that are likely to have caused the anxiety in the first place, as nicotine raises blood pressure. Additionally, many studies have shown that cutting out the cancer sticks improves mood and thereby reduces anxiety.

Caffeine: This one is a no-brainer. Caffeine is actually a psychoactive drug, and like many of its kind, it is a stimulant. When you consume it, caffeine stimulates your “fight or flight” response, and studies show that this not only increases anxiety, it can even trigger an anxiety attack. If you’re anxious, consuming caffeine is pretty much the worst idea ever in the history of ideas.

Poor diet: Like it or not, what you eat can make a difference in how you feel, physically and mentally. You should not be on a first name basis with the Dominos delivery dude and the Mickey D’s drive-thru girl. Fact, Jack! Cut out the high carbs, the high fats, the processed foods and sugars. Remember: garbage in, garbage out.

Electronics: Surfing the net, watching YouTube vids, online shopping, and anything done on a screen can lead to an increase in anxiety by affecting your sleep. How? Exposure to the blue light of a screen anytime within four hours of sleep disrupts the natural circadian rhythm, and may even disrupt the natural production of melatonin, resulting in poor sleep. Functioning normally while tired can increase anxiety. 

No news is good news: If you are anxious or prone to anxiety, stop watching the news. Stop reading the news. Stop listening to the news. Why? The press is categorically tailor-made to incense, aggrevate, enrage, and incite. All of these roads lead to Anxiety City. So think again before feeling guilty for not keeping up with current events. A national survey conducted by (oddly enough) NPR and a bunch of other eggheads found that watching, reading, or listening to the news caused people greater stress and anxiety. It’s like the old saying goes…what you don’t know can’t hurt you. And clearly, what you do know can. 

Anti-Social media: The advent of social media has completely changed the way humans interact on a global scale. Just stop and think about that. It literally changed the entire planet. Now you can interact with anyone on the face of the earth that has a cellphone on a 24/7 basis. It sounds like the greatest thing ever, but it can cause an incredible amount of anxiety in a number of ways. Trust me, I see it day in and day out. So, how does social media cause anxiety? It has brought the concept of keeping up with the Jonses to a whole new level. Used to be the Jonses just lived down the street. Now they’ve moved. To everywhere! There are billions of electronic Jonses to emulate, be jealous of, to love, to hate, and to outdo. From posting the perfect picture that took 2 hours to take on Fakebook to likes and hearts and wow! faces, everyone gets to weigh in and hate on. All of these things are so anxiety producing. But social media can also be addicting. It’s a like-seeking quest, and every like reward is a dopamine hit. Dopamine is a happy chemical. A hit gives a little high, akin to any drug high. And just like with drugs, there can be an actual withdrawl if you separate that person from their source, their cellphone. Some people check social media 20 times or more in a day. They must check for likes, they must see what all their “friends” are doing, what all those electronic Joneses are up to. Keeping up with them and always being on the hunt, all are naturally anxiety producing. If you find that social media becomes stressful, makes you feel jealous, or mad or sad as a result of trolls or the presence or absence of positive comments, silence the alerts, put the damn phone down, and do something more positive with your time. If you feel anxious when you do this, go visit your parents or a friend in real life. You’ll get through the anxiety and be better for it. Then do whatever you have to do to set and stick to limits on your social media use. Be electronically anti-social and personally social. 

There are also tons of behaviors that you can add to your life to help with anxiety.

Behaviors to start

Exercise: You don’t have to turn into a gym rat, just spend at least 15 minutes a day doing something that moves your body.

Meditation: Spend 5 minutes a day centering yourself. Clear your mind and the rest will follow.

Breathing: Dr. Andrew Weil deveoped a breathing exercise called 4-7-8. It goes like this: exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to a mental count of 4. Hold your breath for a count of 7. Exhale completely through your mouth, making a whoosh sound to a count of 8. You’ll likely find this is very helpful in reducing anxiety. 

Reading: This is great for distracting yourself from stressors occupying your mind and causing anxiety. Open a book and immerse yourself in someone else’s story.

Routine: Establishing and following a routine forces behavior modification and can be stress reducing.

Positive affirmations: Practice saying all the good things about yourself to yourself.

Connect with nature: Take a walk in the woods or get some sand between your toes. Try to lose your worries and yourself in a place that’s bigger than you. 

Eat healthy: Eat lots of fresh fruit and veggies and eat only lean meats. There are some natural food components that can help with anxiety. Omega-3 fatty acids make up the basic building blocks of the brain and nervous system. They are essential for cognitive functioning and have also been shown to improve symptoms of depression, which is often closely linked with anxiety disorders. These brain-boosting amino acids are found in a wide variety of fish species, including salmon, tuna, mackerel, herring, sardines and anchovies. They are also found in supplement form. Probiotics are also helpful. Probiotics are microorganisms known for their digestive health benefits. But recent research has revealed that probiotics can also have a profound impact on mental health. A healthy balance of bacteria in the body can boost the body’s ability to cope with stress, improve overall mental health, and bolster cognitive functioning. Probiotics can be found in direct supplement form but are also found in a wide variety of foods and drinks. Some of the most common sources include sauerkraut, yogurt, kimchi, kombucha, miso, and pickles. Put good stuff in, get good stuff out.

Talk: Whether to a therapist, friend, family member or clergy, find someone to talk to and share worries and anxiety with. The support of others can do wonders.

Be grateful: Count your blessings; think about the good things in your life: a home, support of family and friends, a place to sleep, food to eat, a vehicle, whatever the positives may be, be happy that you have them.

Take action: If you have something you need to do that’s weighing on your mind, do it. If you have a bunch of things to do, make a priority list and start doing them. As you finish the items, literally cross them off the list. This way the list isn’t overwhelming and it will feel really good to mark things off. 

Sauna: Heat is amazingly relaxing and wonderful in combating anxiety. Relax the body to relax the mind. 

Massage: A great massage is fabulous in reducing tension and anxiety.

Accupuncture: The Chinese haven’t been wrong for thousands of years. Accupuncture is one of the most relaxing, stress and anxiety reducing activities. Don’t be scared of the needles. Almost a must if you have anxiety. 

Spirituality: If you have it, use it. Prayer can be centering, almost meditative. 

Supplements and vitamins: If you live with anxiety, one measure you can take to reduce your symptoms is to include supplements and vitamins for anxiety in your diet. These can be taken directly in an oral pill form and in the consumption of various foods and drinks. Before taking any of these, check with your physician first, especially if you already take any prescription medications. 

Some of the best supplements and vitamins for anxiety include:

B Vitamins: B vitamins are vital to healthy nervous system functioning, so they play an important role in various aspects of mental health. They also have a significant impact on stress management and mood. Because of these benefits, many people with anxiety take B-complex vitamins and/or incorporate B vitamins into their diet through a variety of foods, including wild salmon, shrimp, tuna, halibut, yogurt, eggs, cheese, lamb, venison, turkey, grass-fed beef, carrots and green, leafy vegetables.

L-Theanine: L-theanine is an amino acid that can improve focus, reduce stress and promote relaxation. You pretty much have to take this as an oral supplement because it’s not commonly found in many foods or drinks. You can take 400mg of the supplement three times a day.

Chamomile: Chamomile has been used as a traditional medicine for thousands of years to calm anxiety and settle stomachs. Chamomile is best known as an ingredient in herbal tea, but is also available as capsules, liquid extracts, tinctures, and topical creams. Adults can take it in capsule form, 400 to 1600 mg in divided doses daily; as a liquid extract, 1 to 4 ml three times daily; in a tincture, 15 ml three to four times daily; or as a tea, 1 to 4 cups per day.

Lavender: Lavender is an herb that has been proven effective by leading researchers as a natural remedy for treating signs of anxiety. In one published study, lavender oil was shown to be just as effective as the pharmaceutical drug lorazepam, but without sedative effects or potential for drug abuse or dependence. Other studies have confirmed the anti-anxiety properties of lavender as well as many other medicinal benefits. Lavender oil capsules can be taken by mouth, 800mg three times a day. Tea can also be made by using 1 to 2 tablespoons of whole, dried flowers for each cup of boiling water. Steep for 10 to 15 minutes using a tea infuser or strain before drinking. You can also add six drops of lavender oil extract and 1/2 cup of dried lavender flowers to bath water for a great anxiety relieving soak. 

GABA: Gamma-aminobutyric acid is a neurotransmitter located in the brain that is crucial to serotonin production. Serotonin is one of the nervous system’s most “feel-good” neurotransmitters, so GABA plays a significant role in reducing anxiety, regulating mood and in relaxation, aka “feeling good.” I’m told this is very effective. When I tried it, I noticed that my skin tingled. An unual and somewhat unpleasant side effect.

Passionflower: This is a calming herb commonly used as a household treatment for anxiety. It has been shown to alleviate nervousness, promote positive moods, and improve sleep quality. Passionflower can be consumed as an extract and tablet, or can be added into teas and tinctures.

Valerian Root: This has been used for a variety of medicinal purposes since the time of ancient Greece. While most commonly known as a sleep aid, this herb can also be helpful for reducing anxiety. Valeric acids found within the herb convert to calming, “feel-good” neurotransmitters in the body, regulating stress and relaxing the mind and body. Valerian root extract is available in both capsule and liquid form, as well as a tea.

Licorice Root: This herb carries many health benefits for people with anxiety because of the effects it has on the adrenal glands, which produce the stress hormones adrenaline and cortisol. Licorice helps regulate the production of these hormones, relieving stress and reducing anxiety symptoms. Licorice root can also soothe gastrointestinal upset, which is common in many people with anxiety. Be aware that most drinks and candies that claim to contain licorice only contain flavoring, which has no benefits. It’s best to consume licorice in an extracted, purified form. Deglycyrrhizinated licorice (DGL) is the safest and most effective variety of medicinal licorice root available. DGL is sold in capsule, powder, tea and chewable tablet forms.

Ashwagandha: Ashwagandha is a plant native to India and North Africa that has been used for centuries to reduce anxiety, combat the effects of aging, and improve energy. In natural medicine, the root is considered to be an “adaptogen,” or a compound that helps regulate the body’s natural processes and promote overall wellness and health. Today, many people use Ashwagandha to improve mood and reduce anxiety symptoms. While the benefits of Ashwagandha are gained by eating the fruit, seeds and shoots of the plant it is derived from, Ashwagandha is most commonly consumed in capsule form, 600mg a day.

CBD products: Cannabidiol (CBD) is a type of cannabinoid, a chemical found naturally in marijuana and hemp plants. Unlike THC, tetrahydrocannabinol, another type of cannabinoid, CBD doesn’t cause any feelings of intoxication or the “high” associated with cannabis. Several studies point to the potential benefits of CBD for anxiety. It can be found in many forms: oil, gummies, teas, tinctures, vape pens, and more. As for where to begin, consider trying a sublingual (under the tongue) CBD tincture first. They have high bioavailability, meaning the body easily absorbs them. If you’ve never used CBD before, be sure to do some research and get it from a reputable place…not from the gas station around the corner. Start by taking the dropper and placing the liquid under your tongue and allow it to sit for about 2 minutes so it absorbs into your bloodstream before you swallow it. Figuring your ideal dose is tricky. Most packaging will have guidelines, but dosing is still a guessing game, as CBD affects everyone differently. You can try one dropper full and go from there. You’ll have to see how you feel to determine how much works best for you. 

Rhodiola: Also referred to as “golden root,” Rhodiola has a long history of medicinal use in traditional Chinese and Siberian medicine. Like Ashwagandha, Rhodiola is considered to be an adaptogen, meaning that it promotes physical and mental health while improving mood and resilience to stress. It is typically taken in capsule form, but it is also available in extracts and teas.

While the above homeopathics, supplements, and vitamins can be beneficial for anxiety, it’s important to check with your doctor before adding them to your diet. Taking this precaution can help prevent any potentially dangerous side effects or drug interactions. Keep in mind that while vitamins for anxiety can be helpful, they are not a substitute for prescription medications or doctor-approved therapies. It is especially important to speak to a medical professional if your anxiety co-occurs with another mental health condition. 

The supplements, vitamins and homeopathics discussed above can be found on Amazon. I discuss anxiety and other mental health issues in my book Tales from the Couch, also available on Amazon.

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Marianne asks “how can I get off klonopin’’

A woman named Marianne messaged me wanting to know how to get off of Klonopin, which is a benzodiazepine, or benzo for short. She has been taking them regularly for more than twenty years, which is a very long time to be on a benzo. That will certainly complicate things. Before I go into how to stop taking benzos, I want to tell you what they are and what they do. 

What are they?

Benzos are medications designed to treat anxiety, panic disorders, seizures, muscle tension, and insomnia. Some of the most commonly prescribed benzos include: Xanax (alprazolam), Klonopin (clonazepam),Valium (diazepam), Restoril (temazepam),
Librium (chlordiazepoxide), and Ativan (lorazepam). A 2013 survey found that Xanax and its generic form alprazolam is one of the most prescribed psychiatric drugs in the United States, with approximately 50 million prescriptions written that year. Unfortunately, this class of drug is also highly abused. Another 2013 survey found that 1.7 million Americans aged 12 and older were considered current abusers of tranquilizer medications like benzos. When abused, benzos produce a high in addition to the calm and relaxed sensations individuals feel when they take them. 

How do they work?

Benzos increase the levels of a chemical in the brain called GABA. Meaningless trivia: GABA stands for gamma amino-butyric acid. GABA works as a kind of naturally occurring tranquilizer, and it calms down the nerve firings related to stress and the stress reaction. Benzos also work to enhance levels of dopamine in the brain. Dopamine is the feel good chemical, the chemical messenger involved in reward and pleasure in the brain. In simple terms, benzos slow down nerve activity in the brain and central nervous system, which decreases stress and its physical and emotional side effects.  

Why can using them be problematic?

Benzos have multiple side effects that are both physical and psychological in nature, and these can cause harm with both short-term  and extended usage. Some potential short-term side effects of benzos include, but are not limited to: drowsiness, mental confusion, trouble concentrating, short-term memory loss, blurred vision, slurred speech, lack of motor control, slow breathing, and muscle weakness. Long-term use of benzos also causes all of the above, but can also cause changes to the brain as well as mental health symptoms like mood swings, hallucinations, and depression. Fortunately, some of the changes made by benzos to the different regions of the brain after prolonged use may be reversible after being free from benzos for an extended period of time. On the scarier flip side of that coin, benzos may in fact predispose you to memory and cognitive disorders like dementia and Alzheimer’s. They’re many studies currently focusing on these predispositions. A recent study published by the British Medical Journal (BMJ) found a definitive link between benzo usage and Alzheimer’s disease. People taking benzos for more than six months had an 84% higher risk of developing Alzheimer’s dementia, versus those who didn’t take benzos. Long-acting benzos like Valium were more likely to increase these risks than shorter-acting benzos like Ativan or Xanax. Further, they found that these changes may not be reversible, and that the risk increased with age. Speaking of age, there are increased concerns in the elderly population when it comes to benzo usage. Benzos are increasingly being prescribed to the elderly population, many of which are used long-term, which increases the potential for cognitive and memory deficits. As people age, metabolism slows down. Since benzos are stored in fat cells, they remain active in an older person’s body for longer than in a younger person’s body, which increases the drug effects and risks due to the higher drug concentrations, like falls and car accidents. For all of these reasons, benzos should be used with caution in the elderly population. 

A big problem with taking benzos for an extended period is tolerance and dependency. Benzos are widely considered to be highly addictive. Remember that benzos work by increasing GABA and dopamine in the central nervous system, calming and pleasing the brain, giving it the feel goods. After even just a few weeks of taking benzos regularly, the brain may learn to expect the regular dose of benzos and stop working to produce these feel good chemicals on its own without them. Your brain figures, “why do the work if it’s done for me?” You really can’t blame the brain for that! It has become dependent on the benzo. But as you continue to use benzos, you develop higher and higher tolerance, meaning that it takes more and more of the drug to produce the regular desired effect. This tolerance and dependence stuff really ticks off your brain. It’s screaming “why aren’t these pills working anymore?!” The answer is that it has become dependent and tolerant, so it needs more. Just to prove its point, it makes you feel anxious, restless, and irritable as it screams “gimme gimme more more more!!!” The problem is that the body is metabolizing the benzo more quickly, essentially causing withdrawl symptoms, and a higher dose is needed. The longer you’re on a benzo, the more you’ll need. It’s a vicious cycle and it’s sometimes tough to manage clinically. 

The most severe form of physical harm caused by benzos is overdose. This occurs when a person takes too much of the drug at once and overloads the brain and body. The Centers for Disease Control and Prevention (CDC) cites drug overdose as the number one cause of injury death in the United States. A 2013 survey reported that nearly 7,000 people died from a benzo overdose in that year. Since benzos are tranquilizers and sedatives, they depress the central nervous system, lowering heart rate, core body temperature, blood pressure, and respiration. Generally, in the case of an overdose, these vital life functions simply get too low.  

When combining other drugs with benzos, obviously the risk of overdose or other negative outcome increases exponentially. But mixing benzos with alcohol is a special case, deserving of a strong warning as it is life-threatening. BENZOS + ALCOHOL = DEAD. One of the most common and successful unintentional and intentional suicide acts in my patient population is mixing benzos with alcohol. The combo is lethal, plain and simple. The body actually forgets to breathe. People pass out and just never wake up. If you’re reading this and you take benzos with alcohol and you’re thinking that you don’t know what the big deal is, you do it all the time and have never had a problem, then my response to you is that you’re living on borrowed time, and I strongly suggest you stop one of the two, the booze or the benzos, take your pick. 

What about withdrawl from benzos?

Benzo withdrawal can be notoriously difficult. It is actually about the hardest group of drugs to get off of. The level of difficulty is based on what benzo you’ve been taking, how much you’ve been taking, and how long you’ve been taking it. Obviously, if you’ve been on benzos for 25 years, it’s not going to be a walk in the park. To be honest, it’s going to be a rough road. Sorry Marianne. But it can be done. The first and most important thing is that you should never just stop benzos on your own, as it can be very dangerous and can include long or multiple grand mal seizures. Withdrawal from benzos should be done slowly through medical detox with a professional. It is best done with an addiction specialist like myself, because a specialist has the most current knowledge and experience. This is the safest way to purge the drugs from the brain and body while decreasing and managing withdrawal symptoms and drug cravings. As for the symptoms of withdrawl, these can include mood swings, short-term memory loss, seizure, nausea, vomiting, diarrhea, depression, suppressed appetite, hallucinations, and cognitive difficulties. Stopping benzos after dependency may also lead to a rebound effect. This is a sort of overexcitement of the nerves that have been suppressed for so long by the benzos, and symptoms can include an elevated heart rate, blood pressure, and body temperature. There may also be a return of the issues that lead you to take the benzos in the first place, insomnia, anxiety, and panic symptoms, and they can possibly be even worse than before. 

I’m sure that just about everyone currently taking benzos is thinking “I’m NEVER stopping!” right about now. It is not easy to do, but there is a way to manage all of this, to come off of the benzo and deal with all of the physical and cognitive aspects of withdrawl. I do it everyday. I set up a tapering schedule to lessen the specific benzo dosage over time, sometimes over a period of months. I will also often add or switch to a long acting benzo, which can be very helpful. I use several drugs to deal with the withdrawl symptoms: clonidine for tremor and high blood pressure, neurontin for pain and to help prevent seizures, anti-psychotic like seroquel for sleep, and an anti-depressant for depression, thank you Captain Obvious. The drug regimen varies from patient to patient. I also utilize psychotherapy to help work out the psychological kinks associated with withdrawl and rebound effect symptoms. Another trick I strongly recommend to many of my patients, not just those withdrawing from alcohol or any drugs, is transcranial magnetic stimulation or TMS. This is a non-invasive procedure done in the office that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression and anxiety, and I’ve found that it seems to calm the nerves and offer relief to some people in withdrawl. Electrodes are placed on the forehead and behind the ears and painless stimuli are passed into certain regions of the brain for 40 minutes in each daily session for about a month. Many patients say it’s the best 40 minutes of their day.

I’d like to wish Marianne good luck. Please feel free to call me at the office at 561-842-9950 if you have any questions. 

To everyone else: If you can avoid ever having to take benzos, I strongly suggest that you do. If you’re currently taking them, give some serious thought to finding an alternative medication. I can help with that. For more information and stories about benzos, other drugs, and the process of medical detox, check out my book Tales from the Couch on Amazon.com.

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What is Schizophrenia? A man named Eugene Bleuler coined the term schizophrenia. If you break the word down to its parts, “schizo” and “phrenia,” it literally means split personality. But that’s not what schizophrenia is. There are so many misconceptions about schizophrenia that I want to explain more about it. Schizophrenia is a psychotic disorder, a severe and often debilitating brain and behavior disorder. It affects how a person thinks, feels, and acts, because they have breaks from reality. Basically, that means they have hallucinations and delusions, and can have trouble telling the difference between reality and fantasy. Their thought processes, behavior, and speech can become disorganized. Disorganized basically means abnormal. Disorganized speech is generally gurgly speech, it makes no sense. Disorganized behavior is basically a decline in daily functioning. This can range from a person not taking care of their hygeine, not bathing or brushing their teeth, to catatonia, where they are unable to move at all. They freeze and look like a statue, and this is called posturing. There can be something called “waxy flexibility” which is where their body can be placed in any shape in a fixed position, like a wax figure, hence the name. Disorganized thinking is basically when someone cannot “think straight.” They are unable to connect thoughts into logical sequences, so their thoughts become disorganized and fragmented. They often have unpredictable or inappropriate emotional responses, and hear imaginary voices and believe others are reading their minds, controlling their thoughts, or plotting to harm them. These are delusions and hallucinations; the two are very different. A delusion is a false fixed belief, often involving thoughts of others monitoring or threatening them or reading their thoughts. The most common type of delusion is a paranoid delusion. “The CIA is tracking me,” “The FBI is coming to get me,” “My neighbor is watching me.” These are common delusions in people with schizophrenia. Hallucinations cause a patient to hear, see, feel or smell something that is not there. The most common type of hallucination is an auditory hallucination, meaning the person hears something not actually there. These auditory hallucinations can be dangerous if they are what are called “command hallucinations,” because they can tell the person to kill themselves or someone else. Obviously, this is not good, and must be taken very seriously. Anytime you have someone experiencing hallucinations, it is in your best interest to explore these with a mental health practicioner to find out what they are and take appropriate measures. Schizophrenia can be cyclical. There can be remission and relapse cycles; a person can get better, worse, and then better again repeatedly over time. As a result, people with schizophrenia suffer from symptoms either continuously or intermittently throughout their entire lives, and they are often severely stigmatized by people who do not understand the disease. Contrary to popular belief, people with schizophrenia do not have “split” personalities or multiple personalities, and as long as they receive appropriate treatment and are compliant with medications, most pose no threat to others. However, the symptoms are sometimes so terrifying to those experiencing them that they can become agitated, withdrawn, and depressed. Sadly, people with schizophrenia attempt suicide more often than people in the general population, and it is estimated that up to 10 percent of people with schizophrenia will complete a suicidal act at some point within the first 10 years of the illness. This is particularly true in young men with schizophrenia. While schizophrenia is a chronic disorder, it can be treated with medication and psychological counseling, and this can substantially improve the lives of people with the condition. Schizophrenia can have very different symptoms in different people. The way the disease manifests itself and progresses in a person depends on the age of onset and the severity and duration of symptoms, which are categorized as positive, negative, and cognitive. Positive symptoms don’t mean symptoms that are good, they mean symptoms or actions which are added to the person’s behavior. Examples of positive symptoms are delusions and hallucinations, and these can be severe or mild. Negative symptoms don’t mean they are especially bad, they mean symptoms or actions which are taken away from the person’s behavior. They reflect a loss of functioning in areas such as emotion or motivation. Examples of negative symptoms are loss of motivation, aimlessness, poverty of speech, a blunted or flat affect, and inability to express emotion or find pleasure in life. They often lead to social withdrawl and apathy, and can be mistaken for laziness or depression. Cognitive symptoms involve problems with attention and memory, especially in planning and organizing to achieve a goal. These cognitive deficits are often the most disabling for patients trying to lead a normal life, as they make it very difficult to keep up with peers in the big wide world. All three types of symptoms- positive, negative, and cognitive- reflect problems in brain function. Schizophrenia affects men and women equally. Symptoms such as hallucinations and delusions usually start between the ages of 16 and 30, though men tend to experience schizophrenia symptoms earlier than women. Schizophrenia rarely occurs in children, but awareness of childhood onset schizophrenia is increasing in the psychiatric community. It can be difficult to diagnose schizophrenia in teens. This is because the first signs can include behaviors commonly exhibited by normal teenagers, such as a change in friends, a drop in grades, sleep problems, and irritability. Despite this, there are a combination of factors that can predict schizophrenia in up to 80 percent of youth who are at high risk of developing the illness. These factors include isolation, withdrawing from others, an increase in unusual thoughts, paranoia and unusual suspicions, and a family history of psychosis. Currently, schizophrenia is diagnosed by the presence of symptoms or their precursors for a proscribed period of time. There must be at least six months of deteriorating function where the illness is present. Additionally, two or more positive symptoms, such as hallucinations, delusions, and/or disorganized speech, as well as negative symptoms, must be significant and last for at least one month to make a diagnosis. In some cases, only one symptom is required for diagnosis if the delusions are bizarre enough or if dangerous auditory command hallucinations are present, or if there are two or more voices “conversing.” Social or occupational problems can also be taken into account in diagnosis. What causes schizophrenia is still unknown. Scientists are working to understand the genetic and environmental mechanisms that combine to cause schizophrenia. It is not purely genetic, because one of a pair of identical twins may have it while the other does not. In terms of environmental issues, when a baby is in utero, it can be exposed to bacteria, viruses, environmental toxins, poisons, and contaminants, which may also play a role. Trauma at birth and decreased oxygenation may play a role. Some psychological and social issues may also contribute. Sexual abuse, physical abuse, a neglectful family, a stressful life, parents that have died, people raised or living in rough urban areas, and people who move from their home country- are more prone to schizophrenia. As more is discovered about chemical circuitry and structure of the brains of people with the disease, better diagnostic tools and early intervention techniques can be developed. This is crucial for schizophrenia, as it is believed that with every psychotic episode, increased damage is done to the brain. It doesn’t go back to it’s previous place. Speaking of the brain, their can be some differences in the schizophrenic brain. In general, but not always, people with schizophrenia may have less intracranial volume, which basically means their brains are small. They have less white matter and their grey matter decreases over time. There is an increase in ventricular volume, meaning that the ventricles that house the brain get larger, but the actual brain itself gets smaller. As mentioned before, schizophrenia can be cyclical, with periods of remission and relapse, but no cure exists for schizophrenia. However, it is treatable and manageable with medication and behavioral therapy, especially if diagnosed early and treated continuously. Those with acute symptoms, severe delusions or hallucinations, suicidal thoughts, or the inability to care for themselves may require hospitalization. Schizophrenia treatments typically include antipsychotic drugs as the primary medication to reduce the symptoms of schizophrenia. They relieve the positive schizophrenia symptoms by impacting the brain’s neurotransmitters. Other treatments for schizophrenia include cognitive and behavioral therapy that can then help “retrain” the brain. These approaches improve communication and motivation, and can teach coping mechanisms so that individuals with schizophrenia may attend school, hold down a job, and socialize properly. Obviously, patients who are compliant with medications and therapy do better than those who are not. Social networks and family member support have also been shown to be helpful. Unfortunately, there are sad cases, people that for whatever reason(s) don’t do well. Life is difficult for them. You may have seen them, wandering the streets aimlessly, making bizarre movements, having an argument with someone who is not there. It is very hard to treat these people who are socially withdrawn. They’re going nowhere in life. They usually live in an assisted living facility, if they’re lucky. Many live on the street. They are sedentary. They usually neglect their hygiene. They don’t eat a healthy diet. They chain smoke cigarettes. Believe it or not, nicotine may be helpful for the treatment of schizophrenia. It sort of calms them down. They drink soda and eat sugary foods. They eat too much and very poorly. They’re prone to developing diabetes because the treatments, the medications, on top of the smoking and the sedentary lifestyle can cause coronary artery disease, diabetes, and fatty liver. They do not live healthy lives due to their illness. In general, schizophrenics live an abbreviated life, about 20 years less than the norm. The most common issues are delusional beliefs and command hallucinations to kill themselves. Disorganized behavior in public may result in them being victims of crime. They usually have violent ends because they are victims of crime. Substance abuse is often rampant in schizophrenics seeking an escape from the chaos inside their heads. Non-compliance with treatment is another factor. Also, the much higher incidence of smoking cigarettes, poor diet, poor exercise habits, and poor self-care contribute. All of these separately or together in some form or fashion is what usually causes their longevity to be dramatically decreased. But with full compliance, patients can have a good life. There are famous people with schizophrenia. John Nash, the Nobel Prize winning mathematician. The great author Jack Kerouac. Peter Green, guitarist for Fleetwood Mac. Syd Barrett founder and member of Pink Floyd, and Beach Boy Brian Wilson. For case studies of schizophrenia as well as other psychiatric diagnoses, check out my book, Tales from the Couch, available on Amazon.com.

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The Dangers Of Alcohol

As an addiction specialist, I see patients abusing substances of all kinds. Today I’d like to talk about alcohol. It is so ingrained and accepted in our society. Pop culture would have you believe that you can’t have any fun or lead a fulfilling life without alcohol. During nearly every commercial break on television, there is an advertisement for alcohol, full of smiling people having the time of their lives like they’re on a permanent vacation. As a matter of fact, as I write this, I have a television on in the background, and there was just a commercial for a Mexican beer. It was a fiesta, with women in bright costumes dancing around and people cheering and cheersing with cold cervezas. The message: you’re clearly missing out if your life doesn’t resemble the lives of these people, but if you drink their beer, your life can be as awesome as theirs.  

Fermented grain, fruit juice and honey have been used to make alcohol for thousands of years. Even early Greek writings warned of the perils of alcohol. In our modern world, the dangers of alcohol are well studied and well known. Despite this fact, alcohol is the most common drug used and abused by people. Here are some sobering facts and figures: an estimated 15 million Americans suffer from alcoholism, and nearly 90,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. 40% of all car accident deaths in the United States involve alcohol, claiming approximately 10,000 lives a year. According to the Institute of Alcohol Studies, consuming larger amounts of alcohol can cause more than 60 different health issues and hundreds of physical conditions.

Day in and day out, I witness the ravages of alcoholism, and it’s not pretty. Alcohol in any amount affects every part of a person, inside and out. It’s just a matter of degrees. 

What are these effects? Let’s start with the outward appearance. While drinking moderately may not have immediate disadvantages, over time you’ll start to notice them- especially when you look in the mirror. Drinking alcohol dehydrates you, which makes hair follicles dry and brittle and more likely to cause hair to fall out. What hair you have will look crispy with split ends. Heavy alcohol use can lead to permanent damage to the health of your hair. It can also cause hormonal issues like increased estrogen, which can cause problems with hair growth and loss, particularly in men.   

Drinking too much also dehydrates and deprives the skin of vital vitamins and nutrients. Instead of being soft and hydrated, your skin will begin to look cracked and wrinkled. This will leave others thinking you may be older than you actually are. Excess alcohol also alters blood flow to the skin, leaving an unhealthy appearance for days.Alcohol can also cause your face to look pale, bloated and puffy.Sometimes the blood vessels on your face burst and the capillaries break, causing a chapped look. Not only can your face become red, but the tiny blood vessels in your eyes become irritated and rupture, causing bloodshot eyes. Not cute. 

Over time, drinking heavily can have other, more permanent, detrimental effects on your skin. Rosacea, a skin disorder that starts with a tendency to blush and flush easily is linked to alcohol consumption. Continued alcohol consumption can eventually lead to a condition called rhinophyma, a facial disfigurment that is a subtype of rosacea, where large, red, pus-filled bumps develop on the face, commonly on the cheeks, chin, and especially the nose, where it can cause severe bulbous distortion. If you have rosacea, I strongly urge that you google rhinophyma and that you don’t drink. 

Let’s not forget that alcohol is fattening, high in empty calories. A couple of gin and tonics and a pint of beer equal about the same calories as a big fast food burger. You might be surprised to find out what the junk food calorie equivalents are for your favorite drinks. Alcohol also bloats your stomach. “Beer belly” is real people, but not only caused by beer. And then there’s cellulite; many believe the toxins in alcohol contribute to its build up. 

A less often discussed result of drinking heavily is B.O. Yes, the bad odor emanating from the body after a long night of drinking is directly related to the alcohol seeping from it. According to the Institute of Alcohol Studies, over 10 percent of alcohol consumed leaves the body unused through your sweat, breath, and urine. While pretty much everyone can smell it, non-drinkers are generally especially susceptible to the odor. And it is gross. Keep that in mind the next time you wake up after a bender. Your body odor could leave a lasting impression.

Let’s move from external effects of alcohol and go inside the body, starting with the brain. Obviously, when you’re drunk, your brain is impaired. There is loss of inhibitions, confused or abnormal thinking, and poor decision-making. But I want you to understand the chronic effects of alcohol on the brain and cognition, the long term effects. So, how does alcohol impact cognitive ability? Clearly, the impact is directly related to the frequency and quantity of alcohol consumed. 

Occasional and moderate drinkers:
– Memory impairment
– Blackout
– Recklessness
– Impaired decision-making

Heavy and/or chronic drinkers:
– Diminished gray matter in the brain
– Inability to think abstractly
– Loss of visuospatial abilities

-Memory loss

-Loss of attention span

In general, heavy alcohol use causes the brain to shrink. Any alcohol use causes clouded thinking, slow thought process or delays in cognition. If you drink at night – even two drinks – the next day, your thoughts aren’t as fluid, you’re not as clear, you’re not as creative. Alcohol use changes behavior. You may develop psychological issues,  personality issues. It is well established in the mental health field that alcohol consumption can exacerbate underlying mental health disorders. People become more irritable, anxious, and depressed when they drink. So why do it? People use it as a coping skill. It lowers inhibitions, gives “liquid courage” and allows us to do things we wouldn’t normally do. Some people use it to keep a job they hate, or to stay in a miserable marriage. It numbs pain, it’s an escape hatch for the psyche. It becomes a solution to a problem, or a way to mask the problem. Just as we are all different, the way alcohol affects us all differently. 

The following factors have been shown to influence how alcohol impacts a person’s brain functioning over time:
-The volume a person drinks
-How often a person drinks
-The age at which drinking began
-The number of years a person has been drinking
-The person’s sex, age, and genetic factors
-Whether the person’s family has a history of alcoholism
-Whether the person was exposed to alcohol as a fetus
-The person’s general health 

One of the biggest problems with alcohol that I see is trauma, people getting hurt. When you drink alcohol, your decision making is impaired. The brain that usually protects you is suddenly impaired, so you fall, you fight, you drive a car recklessly, and your coordination is off. You’re going to fall or make a bad decision and get hurt. So many accidents and deaths are attributed to alcohol. It’s especially disturbing because they’re preventable.

There is no bodily system that alcohol does not affect. What are other physical dangers of alcohol? Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, liver, and breast. The common thing that everyone understands is liver damage with alcohol. It causes fatty liver and cirrhosis of the liver which eventually kills you. There are a host of digestive problems with alcohol consumption: peptic ulcers, bleeding ulcers, diarrhea, pancreatic cysts/disease/failure. Alcohol can lead to diabetes, a compromised immune system, lung infections, stroke, and heart disease. It can be associated with memory issues, learning disorders, and neurological problems, where you have numbness in your arms and legs, lack of coordination, and slurred speech.   

Alcohol plays a role in other issues as well. Family problems, legal problems, and social problems. One of the biggest concerns with drinking frequently is (or should be) dependency, becoming an alcoholic. Right now, I’m sure almost 100% of you are thinking ‘I‘d never become an alcoholic.’ There’s a television show called Intervention that documents the trials, tribulations, lifestyles, and consequences of alcoholics and drug addicts. None of them planned on becoming alcoholics back when they drank socially or just had a few drinks at night. The great news is that if you never make alcohol a part of your life, guess what? You’ll NEVER have to be an alcoholic or deal with all of the issues that come with it. I can’t stress enough how strongly you should take this to heart. 

By now I’m certain that you understand the ravages and damages of alcohol use and abuse. But the dangers are minimized and we’re desensitized to it by pop culture; it’s so ubiquitous that we accept it as a part of life. If you tell someone that you don’t drink, they look at you like you have three heads. It is ingrained in every aspect of our society in terms of weddings, funerals, bars, restaurants, hotels, public events, private events, and clubs.  

Have you ever noticed how glorified alcohol is? They put it in these beautiful bottles. I admire alcohol bottles. The artistry and sculpture of the bottles…they’re just beautiful. They look like there must be something very good inside, so you want to find out. When you go to a restaurant, the first question is always, “Would you like a drink?”  Now, children’s birthday parties even serve drinks to the adults. If it’s so safe, why don’t we serve it to children? It’s because we know it’s poison, we know it’s dangerous, but it’s minimized. It’s socially acceptable. I’m not for prohibition; I think there is a place for alcohol in our society, but it shouldn’t be so glorified and so easily accessible. We need to acknowledge it’s dangers and be more restrictive with it. Take all-you-can drink mimosa or bloody mary brunches or happy hours for example, where drinks are two-for-one. These things encourage drunkenness, and then people leave with alcohol-induced poor decision skills and car keys in hand. These sorts of events need to be seriously restricted. There should be no event where we encourage people to get drunk. We should not condone its overuse or extoll its virtues. 

With all of that said, how does an individual stop drinking alcohol? It’s a simple theory. You make a decision to stop, and then you stop. There is no other way. If you’re not in control of stopping, then who is? I’ve spent more than thirty years medically detoxing and working with people with alcohol and drug addictions, and I assure you that there is no other way to stop other than the person making the decision to stop and living with it. I’m not saying it is easy, especially with alcohol all around us in grocery stores, restaurants, on television, on billboards…it is everywhere. But it can be done. I see it every day, people living fulfilling lives without alcohol. If you want to be one of those people living without alcohol, make an appointment. I can help you. I talk more about this in my books, A Chance to Change and Tales from the Couch, both available on Amazon.

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COUPLES AND CONFLICT

Couples and Conflict

One of my foremost jobs as a psychotherapist is to be a listener. All day, every day people come to me to talk about their problems. As you can imagine, many times patients want to talk about their spouses, specifically how they fight with them. So I want to talk a little bit about couples and fighting. Whether it’s about money, children, career, housework, all couples fight. Nobody gets along 100% of the time without some conflict. It’s all a matter of how you resolve that conflict. I had a patient named Roxanne come in for her session yesterday, and she told me that she and her husband Bill fight all the time. One yells at the other and the other yells back louder until it reaches a terrible crescendo and both storm off in opposite directions. She said she had no choice in this, he just made her so angry and they just didn’t get along. I told her that the first thing that had to happen for the relationship to move forward was to decide that it wasn’t his fault and wasn’t her fault, it was both of them. She immediately recoiled and told me I was dead wrong. That it was all Bill’s fault. He was never home, he didn’t want to be a part of the family, he this, he that, ad nauseum. I asked her about how they fight, her yelling and screaming…was it working? Was it resolving anything? She launched in again, saying it wasn’t her fault, it was his fault because he made her yell. He antagonized her. I told her that she didn’t have to go to every fight he invited her to, she had the choice. This is a point that I think a lot of couples miss. Just because your spouse may be baiting you, looking for a fight, it doesn’t mean you have to give them what they’re looking for. You don’t have to respond at all. You have a choice in how you behave.

I explained to Roxanne that the only way to start to resolve an issue is to not yell and scream, not raise a voice. Once you express anger, you’ve made the situation worse. I suggested to her that the only way to make the situation better when Bill is yelling and screaming is to fall silent. Until the yelling stops, nothing productive can be accomplished. A conflict cannot be resolved through warfare. Once people raise their voice, no interaction happens. For instance, if you raise your voice at a child, they shut down. They will hear nothing you say. The same happens in couples. If one raises their voice at the other, from that moment forward, nothing constructive happens. So, if you’re married or in a relationship and you find you are having problems or there is fighting, and yelling, you are responsible for your response, and your response should be to not yell back, fall back. All yelling does is put fuel on the fire. If you fall silent, eventually they will stop yelling, and once the yelling stops, resolution can start. You can begin a conversation by discussing what the problem is, why you keep arguing, and what you can each do to make things better. That’s the only way these things will really be resolved. But you have to be willing to change how you respond to conflict and how you fight. Learn to fall back if baited. Talk should replace screaming matches. 

I hear so often in my office “it’s not me, it’s him, it’s her, they’ll never change, we tried that” blah, blah, blah, blah. If you really want to effect change in your relationship, change your own behavior and then the reaction you get back from your spouse or partner will change. Stop yelling and start conversing. Focus on what you can each do to make the relationship better. To resolve conflict, cooler heads should always prevail over heated emotions.

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Attention Deficit Disorder and Attention Deficit Hyperactive disorder

Attention Deficit Disorder

ADD, Attention Defecit Disorder is a chronic condition marked by issues with attention. It is most often seen in childhood, but can persist into adulthood, and there are 3 million US cases per year. Due to it’s high prevalence, I want to take the opportunity to discuss the diagnosis, symptoms, and treatment of ADD.   

ADD has a sister disorder called ADHD, Attention Defecit Hyperactivity Disorder. What’s the difference between them? It’s pretty simple. ADHD includes the symptom of physical hyperactivity or excessive restlessness. That’s what the “H” is for. In ADD, the symptom of hyperactivity is absent. 

What are the hallmarks of this disorder?  Basically, it is a disorder of concentration, marked by problems concentrating and the inability to stay on task. These individuals are easily distracted and readily bored. They move from project to project without finishing and start projects without all of the appropriate tools needed to complete them. This all leaves them very anxious. In cases of ADHD, they are also impulsive, intrusive, disruptive, and hyperactive, often constantly fidgeting. 

What percent on the population are we dealing with here?  Roughly 20% of boys and 11% of girls have some type of attention deficit disorder. 

What are the causes of attention deficit disorder? While we don’t know exactly, there are several suspects. Maternal use of alcohol or cocaine while in utero is an extremely common finding. Brain infections when pregnant or during early childhood, head trauma, and any birth defects that affect child development are also suspected. Exposure to enviromental toxins and pesticides are suspect. Excessive video games alter brain chemistry, as does a diet of processed foods and sugar, and these are also suspected causes for attention deficit disorder. I would say the number one cause of ADD is most likely genetic, inherited from mother or father. 

What is the result of having attention deficit disorder? How does it affect one’s life? It results in having problems fitting into the academic world or the job world. People with attention deficit disorder don’t fit into a regimented or organized educational or work environment. They can be very intelligent and productive people, but they don’t fit into what we would consider the stereotypical or standard type of academic setting or work setting. Also, due to their impulsivity and their disorderly conduct, they can wind up getting in trouble in school and in trouble with the law. They can be unsuccessful at work, not because they aren’t smart enough, but because they cannot stay focused. In terms of lifestyle, they also have a much higher rate of obesity. This is likely due to lack of impulse control, causing them to overeat. They have problems in relationships, and their divorce rates are much higher. Their propensity toward domestic violence may also be higher. They may also be more prone to Alzheimer’s disease. Because of all of these failures and shortcomings in the stereotypical organized worlds of education and career, they have much lower self-esteem. There are studies that report that up to 52% of people with attention deficit disorder have drug or alcohol problems. 

So how can we help these people? How do we treat these illnesses? The number one treatment is behavioral training with a mental health professional. The gist of that is educating them to focus on one thing at a time. They are not able to handle instructions with multiple levels at once, but they can focus on one thing at a time and have success with that. Pharmacologically, ADD and ADHD are generally treated with amphetamine stimulants. Some antidepressantants may also benefit people with attention deficit disorder. Essentially, a combination of behavioral therapies, special education programs and medications show the most promise in the treatment of attention deficit disorder. But a diagnosis of ADD or ADHD isn’t all future doom and gloom. Eventually, people find their niche in the world and can become successful. The actor Ryan Gosling takes medication for his ADD and says that it may take him longer to read his scrips than other actors, but he manages to get the job done. Uber successful comedian Howie Mandel has successfully done just about all there is to do in Hollywood. I have met a lot of CEO’s with ADD, and they function well because they have people around them to take care of all the boring mundane tasks, giving them the chance to think freely and create business opportunities. They are creative and capable people. They are another example of why you can’t judge a book by it’s cover…you can’t assume that someone with a psych diagnosis will never make it in the world. Ask Richard Branson. I think he’s done pretty well for himself in the corporate world despite his ADD. Justin Bieber has ADHD and has managed to record a few hit songs. Olympian Michael Phelps has ADD, depression and anxiety, and that hasn’t stopped him.These are some examples of people that have adapted and overcome their diagnoses rather than be labeled by them. If you have ADD or any psych diagnosis, I’d suggest you follow their lead. 

For more patient stories, check out my book Tales from the Couch, on Amazon.com.  

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How To Manage Stress

Rather than just introducing you to today’s topic, I want to play a little game of ‘Who am I?’ I’ll give you ten clues and let’s see if you can guess who I am. And no looking down below and cheating!

1. Everyone has me, either intermittently or constantly.

2. I am an unwelcome guest.

3. Some people deal with me better than others do.

4. I keep lots of people up at night.

5. I make some people physically ill.

6. I can shrink your brain. 

7. Some people take drugs to deal with me.

8. I can make some people binge, purge, or starve themselves.

9. I can cause a whole host of medical problems.

10. I have a good side, but nobody ever gives me credit for it!

Last clue: 

I am defined as “a physical, mental, or emotional factor that causes bodily or mental tension.”

So who am I? 

I am STRESS! 

I see so many stressed out people every day that I thought I’d do a little educational primer on stress.

Stress is a normal psychological and physical reaction to life’s everyday demands. A small amount of stress can be good. Positive stress is officially called eustress, and it can motivate you to perform well. But multiple challenges throughout the day such as sitting in traffic, meeting deadlines, managing children, and paying bills can push you beyond your ability to cope.

What’s going on in your brain when you feel stress? Your brain comes hard-wired with an alarm system for your protection. When your brain perceives a threat or a stressor, it signals your body to release a burst of hormones, especially cortisol, that increase your heart rate and raise your blood pressure. This is part of the fight or flight mechanism. But once the threat or stressor is gone, your body is meant to return to a normal, relaxed state. Unfortunately,some people’s alarm systems rarely shut off, causing chronic stress. When chronic stress is experienced, the body makes more cortisol than it has a chance to release. This has been shown to kill brain cells and even reduce the size of the brain. Chronic stress has a shrinking effect on the prefrontal cortex, the area of the brain responsible for memory and learning. So it’s very important to find effective ways to deal with stress. Stress management gives you a range of tools to reset your brain’s alarm system. Without managing stress, your body might always be on high alert, and over time, this can lead to serious health problems and contribute to mental disorders such as anxiety, depression and post-traumatic stress disorder. So don’t wait until stress damages your health, relationships, or quality of life…start practicing some stress management techniques. 

To help combat the negative effects of stress and anxiety, here are five tips to help manage stress in your daily life…

1. Follow a Regular Sleep Routine
It may seem like simple advice, but often the simplest advice is the best advice. Following a regular sleep routine can help you decompress, recharge, and rejuvenate your body and mind after a stressful day. Try going to bed at the same time every night and aim for 7 to 8 hours of sleep. Resist the urge to stay up late watching TV. In fact, avoid screen time altogether before bed, including tablets and smart phones. Studies have proven that reading on a backlit device before bed interrupts the body’s natural process of falling asleep. These devices also impact how sleepy and alert you are the following day.

2. Use Exercise to Combat Stress
Exercising regularly can have an enormous impact on how your body deals with stress, and it is one of the most recommended ways doctors instruct patients to reduce stress. The endorphins released while exercising can help improve your overall health, reduce stress levels, regulate sleep pattern, and improve mood. The key to exercising is to choose something that you truly enjoy. Whether it’s going for a walk, taking an exercise class at the gym, going for a swim, or lifting weights, exercise keeps us healthy. Make sure to mix up your exercise routine to prevent boredom and stay motivated. 

3. Learn How to Meditate
One of the simplest ways to help alleviate stress is to practice deep breathing and meditation. There’s no secret to this, and you don’t have to chant and burn incense or any of that. It’s just about finding a quiet space without distractions. It only takes a few minutes every day, either before bed or first thing in the morning. Breathe in through your nose, letting your abdomen expand. Hold your breath for a count of three, then breathe out slowly through your mouth. Repeat this three times. Focus on your breathing and your heart beat to prevent thinking about everything that you need to do. If doing it in the morning allows stressful thoughts of the upcoming day to intrude, try it at night. Deep breathing is especially important when your stress levels are high. Aim for meditating for at least 15 to 20 minutes, but if you’re feeling pressured during the day, a quick 5-minute meditation session can help you chill out.

4. Take Care of Your Skin
It may not seem like skin care and stress prevention are linked, but they are. Have you ever noticed that your skin is more prone to break out when you’re stressed out? How many times have you gotten up for work all stressed out about a presentation and looked in the mirror only to see a big zit on your nose? For crying out loud…why the heck is that?!!? How does your skin know you have a big presentation? Well, stress causes a chemical response that makes your skin more sensitive. And as we discussed, your body produces more cortisol when stressed, which causes your sebaceous glands to produce more oil. More oil means oily skin that is prone to acne. So it’s important not to neglect your skin care routine, especially when you’re stressed out. This goes for both guys and girls. You may be exhausted at night and want to go straight to bed, but taking an extra few minutes to wash your face and remove daily dirt and any facial products or makeup you’ve worn during the day will make a world of difference. And if you’re prone to oily or dry skin, always choose skin care products that are specifically designed for your skin type. Your skin will thank you for it by surprising you with big red zits less often. 

5. Ask For Help When You Need it
Asking for help may not always be easy, but when you need a shoulder to cry on or someone to listen, it can help put things into perspective.  Seeking support from family and friends or a professional isn’t a sign of weakness. In fact, it takes courage to admit you need help. Many patients that I see for the first time have been needlessly suffering for so long. I feel terrible for them. There is no reason not to seek help for any ailment affecting your health, especially your mental health. Patients who wait until they start to develop multiple physical and psychiatric issues before seeking help have a much harder time recovering than those who seek help sooner. Remember that friends and family are great support, but if you develop any signs of anxiety or depression or other mental health issues, get help from a licensed mental health professional immediately. In my experience, some patients may need medication, but some do not, they find relief through simple talk therapy with me. It’s very much an individualized assessment. While not a replacement for professional help, you can also look for online support groups for stress management. You’re not the only person who’s ever dealt with a specific stressful situation, so why not discover how other people managed their stress and overcame a potentially frustrating situation.

Hopefully after reading this you have a better understanding of what stress is, how it can impact your physical and mental health, and what you can do to start dealing with it effectively to minimize its role in your life. If you feel you need help, call my office for an appointment. I can help you. For more mental health topics and stories, check out my book Tales from the Couch, available on Amazon.com or for purchase in my Palm Beach office. 

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How To Sleep Better At Night

Slumber, shuteye, repose, siesta, snooze…Sometimes we have a love-hate relationship with it…we love it when it’s good and curse it when it’s bad, but we all need it. Whatever you call it, one complaint I hear from patients day in and day out is that they have difficulty sleeping. It’s so prevalent that I want to discuss how to  get better sleep. In my 30 years of practice, I’ve compiled a list of 14 things in no specific order that you can do that should have you snoozing at night night in no time. 

Rule 1: Bright light during the day.  Your body has to have bright light during the day; sunshine is best, but even sitting in a bright room, like by a window, is helpful. Bright light tells your brain that it is day time, time to be awake. Darkness or the absence of bright light tells the brain it is night time, time to sleep. If you’re in a dark room all day, you probably won’t sleep well at night. So remember, in the day time, bright light is right. 

Rule 2: Limit blue light. What is blue light? Blue light is what is emitted from your computer, laptop, and smartphone. The more blue light you are exposed to, especially at night, the more disruption you’ll have in sleep, as it disrupts circadian rhythm. Lots of people climb into bed with their cell phone or iPad, and that’s the worst thing to do. You should avoid looking at bright screens beginning two to three hours before bed. There are apps you can install on your phone that filter out the blue light. There’s also something called “F. Lux” that you can put on your computer or iPad which will block out the blue light. You never hear about it, but blue light exposure, especially at night, is a major factor in hindering sleep. 

Rule 3: Captain Obvious here with a newsflash. Caffeine will keep you up at night. Don’t think you’re going to have coffee or tea after dinner or before bed and expect to sleep. And if you’re drinking sodas, coffee, or iced tea all day, it’ll still disrupt your sleep. I tell patients to limit caffeine consumption to under 250 – 300mg a day. As a guide, an 8oz cup of coffee has about 100mg caffeine, the same amount of tea has 24mg, a 12oz can of soda has 34mg, and those gnarly energy shots have 200mg of caffeine! I strongly advise against consuming caffeine after lunch if you plan on a bedtime between 10pm and midnight.  

Rule 4: No naps! Boo! Hiss! Why is it that as kids, just the word nap sent us into a tizzy tantrum, but as adults we love naps? If anyone has an answer, please let me know. Anyway, as satisfying as it is, napping disrupts your sleep-wake cycle, temporarily resetting it to where you’re not likely to be able to go to bed between 10pm and midnight. Bummer. 

Rule 5: Melatonin. I recommend 2 to 4mg of melatonin at bedtime; it really seems to help a lot of my patients. I do find that some patients get daytime hangover from it though, so you’ll have to see where you fall on that one. But it’s definitely worth a shot if you’re suffering from insomnia. 

Rule 6: Get up at the same time every day, and go to bed at the same time every day. Yeah, it’s kind of a drag not sleeping in on weekends, but a sleep routine can make a big difference in your relationship with Mr. Sandman. You can’t regulate when you’ll fall asleep, but you can regulate when you wake up. So set your alarm and get up at the same time every day, no matter how tired you are. Don’t nap and go to sleep between 10pm and midnight, and you should fall asleep. If sleep still eludes you, stick to the same plan, and you should surely sleep the second night. You can’t decide when you’ll fall asleep at night, but you can regulate your sleep-wake cycle by deciding when you wake up. Stick to setting your alarm for the same time every day, and hopefully your brain will get the idea. 

Rule 7: I recommend taking a glycine or magnesium supplement at night as well as L-theanine and lavender. They don’t make lavender teas, pillow sprays, lotions, and sachets for nothing. I have heard from people that swear by lavender as part of their wind down routine before bed. You can find these supplements on Amazon.com. Shameless plug: handily enough, you can also find my book, Tales from the Couch for sale there too. Check it out. 

Rule 8: This is the Mac Daddy, numero uno, absolute, not-to-be-broken rule. Alcohol. If you consume alcohol before sleep, you will not sleep. Why? As the body metabolizes the alcohol, it goes into a withdrawl-like reaction and disrupts sleep. I know what you’re thinking. You’re thinking that a little nightcap helps you sleep. Wrong. Some people will tell you differently, but trust me…alcohol and sleep do not play well together. 

Rule 9: A comfortable bedroom. Your bedroom should be an oasis of calm serenity. There should be no office or desk in the bedroom. It should be uncluttered. Anything not conducive to sleep should be out. Make sure it’s dark and quiet at bedtime. The weight of multiple blankets can help sleep. You can even purchase weighted blankets expressly for this purpose. The weight is comforting and relaxing to the body. 

Rule 10: This sort of goes hand in hand with #9 above. Try a low temperature in the bedroom. I personally make sure my bedroom is at 70 degrees. The blankets from rule number 9 come into play here too. There’s something very comforting about burrowing under fluffy blankets to go to sleep. I mean, they’re called comforters for a good reason. 

Rule 10: No eating late at night. People seem to mostly make terrible food choices at night, all in the name of snacks…chips, candies, baked goods. Sugary foods are especially bad. When you eat, the body goes into digestive mode, not sleep mode; it is very interfering to sleep. Sugars especially are no bueno. Evening or night snacking is one of the worst things you can do If you want to sleep.  

Rule 11: Relax and clear your mind. There’s an older pop song that has a lyric, Free your mind and the rest will follow. It’s true. We all have problems and stresses throughout the day, and they seem to pop up when your head hits the pillow. You have to come to some resolution on how you’re going to handle the problems in your life and put them to bed so that you can put the rest of you to bed.  

Rule 12: Spend money on a comfortable quality mattress. You’re going to spend a third of your life in your bed. Just suck it up and spend the money on the mattress. Don’t cheap out. Another place to spend money is on good linens. Few things are as inviting as a comfortable mattress covered in minimum 1,000 thread count all-cotton sheets. If you’ve never had nice linens, try them.You can pick them up on a white sale or online. You can thank me later. 

Rule 13: No exercising late at night.  When you exercise late at night, you raise blood pressure and heart rate, which will hype up the body, which is the antithesis of what you want when it’s time to sleep.  

Rule 14: No liquids prior to sleeping. No rocket science here. If you put liquids in, you’re going to need to get liquids out. In other words, you’re going to have to get up in the middle of the night to pee. And you’re probably going to stub your toe. Not good. 

This is my handy dandy guide on the do’s and don’ts when it comes to sleep. Anything is better than counting sheep. I don’t know who came up with that, but I would like to inform them that I have never in 30 years heard of it working. I’ve never before wanted people to fall asleep as a result of reading something I wrote, so this is a first! I hope you’ve learned some things here that will put you out like a light.

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Warning Signs Of Bipolar

As a psychiatrist practicing in Palm Beach Florida, I come across a lot of bipolar patients.  What are the warning signs of bipolar disorder? How can you recognize if someone you love or even yourself has bipolar disorder? You can’t get through an hour television program without at least 2 commercials for bipolar medications, so I thought it would be a good idea to talk about it. 

First, what is bipolar? Bipolar disorder is a mental health disorder more commonly found in women that can cause dramatic changes in mood and energy levels. The term bipolar refers to the two poles of the disorder, the extremes of mood. Those two extremes of mood are mania and depression. The symptoms of bipolar can affect a person’s daily life severely as their mood can range from feelings of elation and high energy to depression. There are two types of bipolar, type 1 and type 2. Type 1 is more serious and disruptive than type 2, which can also be called hypomania. 

Bipolar is sort of the Jekyl and Hyde of psychiatric disorders, with cycling of mania and depression. Manic episodes and depressive episodes have very specific signs and symptoms associated with them.

When someone is manic, they do not just feel very happy. They feel euphoric. Key features of mania include, but are not limited to:

– irritability 

– having a lot of energy
– feeling able to achieve anything
– having difficulty sleeping
– using rapid speech that jumps between topics.
– inability to follow through with ideas or tasks

– feeling agitated, jumpy, or wired
– engaging in risky behaviors, such as reckless sex, spending a lot of money, dangerous driving, or unwise consumption of alcohol and other substances
– believing that they are more important than others or have important connections
– exhibiting anger, aggression, or violence if others challenge their views or behavior
– in severe cases, mania can involve psychosis, with hallucinations that can cause them to see, hear, or feel things that are not there.

People in a manic state may also  have delusions and distorted thinking that cause them to believe that certain things are true when they are not. While I have many patients that get delusions of grandeur, I have one patient that comes to mind. Her name is Felicia. Felicia is a 32-year-old receptionist. She was diagnosed with bipolar type 1 when she was 25, which happens to be the typical age of diagnosis. Felicia is on two medications for her bipolar with mixed results. She still cycles occasionally to a manic state. Sometimes that’s a clue that she may not be compliant with her meds. Like many bipolar people, Felicia loves loves loves her manic state. When Felicia is manic, she is on top of the world. Her house is pristinely clean, the meals she makes for her family are total gourmet, and her appearance is perfect. Sounds great, right? You may be thinking ‘Where’s the downside, Dr. A?’ Well, in this manic state, Felicia absolutely positively believes that she is descended from “the true” royalty. She believes that the father of the current Queen of England, the previous King George VI, actually stole the monarchy and the crown from her father. As a result, she believes that she should be the rightful current monarch. In reality, her father is a semi-retired urban planner living just outside of Topeka Kansas. Regardless, when Felicia is super manic, she will relay this story with a voice full of indignation and a perfectly straight face. She will tell anyone this story, so people think she’s totally nuts. 

A person in a manic state may not realize that their behavior is unusual, but others may notice a change in behavior. Some people may see the person’s outlook as eccentric or sociable and fun-loving, while others may find it unusual or bizarre. The individual may not realize that they are acting inappropriately or be aware of the potential consequences of their behavior. In some cases, they may need help in staying safe when they are completely out of touch with reality. Bipolar type 1 patients can be some of the most dangerous patients in my practice, as they can be violent, prone to rage and acting out on that rage. They are chaotic. If you have an untreated or ineffectively treated bipolar 1 person in the household, you will know. One big problem is that patients enjoy the manic state of their disorder. They feel such increased energy and euphoria that they are prone to stop taking their meds. Once that happens, all hell breaks loose. 

But eventually, that mania will cycle into deep depression with all of the symptoms that go with it, and may end with suicidal thoughts or acts. Key features of depressive episodes may include, but are not limited to:

– feeling down or sad
– having very little energy
– having trouble sleeping or sleeping a lot more than usual
– thinking of death or suicide
– forgetting things
– feeling tired
– losing enjoyment in daily activities
– having a flatness of emotion that may show in the person’s facial expression
– In very severe cases, a person may experience psychosis or a catatonic depression, in which they are unable to move, talk, or take any action.

Bipolar type 2, also called hypomania, is a disorder which is sort of like type 1-light. It features episodes of depression and hypomania. Symptoms of hypomania are similar to those of mania, but the behaviors are less extreme, and people can often function well in their daily life. But if a person does not address the signs of hypomania, it can progress into the more severe form of the condition at a later time. I see type 2 patients more often in my practice, and I see them as generally being much calmer than type 1 patients. They do not get as violent, do not hear voices, do not have hallucinations, and are not disorganized in their speech or behavior. However, they are usually irritable. They talk quickly. They have trouble sleeping. They have trouble concentrating. They have trouble getting things done. They have relationship issues. They have trouble sleeping. These periods of hypomania can last anywhere between minutes to days to weeks.

So what can be done for a patient suffering from bipolar disorder, whether type 1 or 2? There are multiple drugs which can be used to balance the patient. I find my go-to drug would be lamotrigine, as it is minimal in its side effect profile, is mood stabilizing, does not put on weight, does not make you drowsy, and does not have many drug interactions. There are other drugs which can be used,  oxcarbazepine and divalproex, which are antiseizure mood stabilizers. These have some effectiveness and have various side effect profiles. In some cases, antipsychotic drugs like lurasidone are useful. Many times I put patients on at least two drugs, one to treat mania and one to treat depression. I can prescribe all the drugs in the world, but they won’t do any good if patients are non-compliant in taking them. So the biggest and most important key feature in treating bipolar is having a relationship with the patient and making sure they are compliant with medicine, because the manic state is so enjoyable to them that they may choose non-compliance. That’s really the biggest barrier to treatment. I always explain to my manic patients that while they may like the mania, they will have to pay the piper, because guess what? Next they’ll be hopelessly depressed and unable to get out of bed.

In my practice, I see many female patients with mood disorders. The way I approach treatment is to find the best tolerated drug. This may not be the best drug on the market, but may be the best drug for that patient because it is better tolerated and has a better side effect profile for that patient. If the drugs cause weight gain, make them drowsy, or cause sexual dysfunction, they won’t take them. And who would blame them? So I work very hard to explore all available pharmaceutical treatment options for each patient as an individual. The goal is to have a drug regimen which is the least invasive in that person’s life and to combine that with psychotherapy. Because bipolar disorder is a lifelong disease, treatment should also be lifelong. If you suspect that you have bipolar or a loved one has bipolar, contact a physician for referral to a mental health professional like myself. For more information, check out my book, Tales from the Couch, available on Amazon.com. 

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What Ever Happened To Dating

Whatever happened to dating? I’m part of a lot of talk on this particular topic. Day in and day out, patients tell me about their trials and tribulations in the dating world, and the dialog has definitely changed over the years. So, as an unofficial-official expert, I want to talk about dating. There are discrepancies as to who hit on the idea first, but computer-assisted dating sites came into play as personal computers gained popularity in homes everywhere. Remember the Tom Hanks movie You’ve Got Mail? That romanticized the idea of online dating and spawned sites like Match in the early 2000’s. The advent of Facebook kept people checking for “friends” as a hobby, linking people all over creation. However and whomever launched what doesn’t matter much anymore, dating sites and dating apps are here to stay. The list goes on and on and on, and now sites and apps are getting more specific. They target groups: SilverSingles, OurTime, JDate, BlackPeopleMeet, and Farmers Match…if you can be grouped into a subset, you will be. So what’s the impact of dating sites and apps? They’ve changed the game. If you listen to your grandparents tell their love story, it often includes a meeting of eyes, maybe across a crowded bar or restaurant, hence love at ‘first sight.” Now, if you manage to find love, it may be more like at “first site” or “first swipe.” 

Whole movies are made of dating in the modern world. The process of meeting someone has now moved away from social contact, which is sort of oxymoronic in the age of ‘social’ media. The old rules don’t apply anymore. It used to be that to get a date, you got all gussied up to go out and attract a date. Now you can sit home on your couch in your boxers or fat pants and dangle an electronic lure to attract someone. Sadly, romance is now largely a thing of the past, replaced by an electronic algorithm. You have to be a wordsmith to get a date, not a romantic. Pickup lines aren’t spontaneous. Now someone trolling an app for a date can use a line that it took them a month to come up with, and they can use it over and over until the payoff, the date. Social media can also be very manipulative as well. When my patients tell me about failed dates arranged through social media, one of the most popular reasons they give me is that the person didn’t look like their picture. Blah blah blah… I hear that ALL the time. My only reply is usually “Duh!!! It took that guy / girl three hours to take that picture!” I marvel at how they’re shocked by not getting what they were expecting! And these sites and apps are too easy. Going out to attract a date used to require a little effort and forthought. Where am I going? What should I wear? How’s my hair? Is my breath okay? On sites and apps, it doesn’t matter. They’re a numbers game. Send a line out to enough people and you’re bound to hit on a date at some point. And what happens on that date? Social media has stripped away the art of conversation. It’s been reduced to memes, a series of easily textable phrases and lines. Those aren’t conducive toward building the foundation of a relationship. And there can be a darker side to the use of these sites and apps. Some people believe that participation on these dating sites and apps is essentially implied consent or positive acceptance of sexual advances. If you met someone In the real world, not all advances are welcome. The same is true with participation on an app or site. But the flip side of that coin are the apps where advanves are welcome. There are an increasing number of mobile apps that will let you know when a person of like mind is in the vicinity. Of like mind on these apps usually means down to hook up, which has inherant risks in and of itself. These transactional apps seeking sexual relations really take the human touch out of the whole equation. They’re all about the easy hookup, people as commodities. Phone on, date out. Social media has really changed the idea of participating with one’s community. Now you see young people with no interests beyond their phones. What’s going on in their electronic world takes precedent over what’s happening right in front of them. I discuss this at length in my book, Tales from the Couch. People miss so much of what’s going on around them because they’re buried in their phones. Human interaction goes by the wayside. Another consequence of social media is the downfall of commitment. With more relationships being non-committal, I’ve seen marriage rates among my patients go down. When I ask people about that, they essentially tell me that they’re not into commitment because why should they be? Why settle down and buy one cow when you can have all the milk from all the cows on the internet for free? 

Some of these issues can be troubling. I especially wonder what happens to the people who don’t have profiles posted everywhere, who don’t want to swipe right or left to get dates and find companionship. Are they doomed to forever be single? Will they miss out on their happily ever after? Maybe.They may need to bite the bullet and throw a line into the electronic world of dating. For all it’s foibles and downfalls, social media doesn’t seem to be going anywhere anytime soon. Good, bad, or indifferent, that’s dating today. For more on the world of social media, check out my book Tales from the Couch, available on Amazon.com.

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Help me… I need to Lose Weight and Get into Shape

I’ve been a psychiatrist in Palm Beach, Florida for the past 30 plus years. Being that Palm Beach is all about beautiful people and seeing and being seen, I have a constant stream of patients worrying about their their image. Botox, fillers, face lifts, tummy tucks…the list goes on and on, but there’s only so much a plastic surgeon can do, especially when it comes to the appearance of the body. Obese patients can have a lap band or gastric bypass to lose a lot of weight, but not everyone requires such drastic measures. A lot of patients complain of being just a little heavy, a little out of shape, and they come to me asking what they can do to lose some weight and get in better shape. The first thing I do is ask them about alcohol intake and smoking habits, and how much they indulge in these activities. Then in order to get an idea of how physically fit they are- or aren’t-  I ask them to tell me their activities of a single weekday, from the time they wake up to the time they go to bed. What I typically hear is that they get up, shower, go to work (often skipping breakfast), eat something quick for lunch at work, go home from work, make dinner, eat, and relax in front of the television until they fall asleep. Most never include any physical activity.     

I then educate them in terms of diet and physical activity. I explain that while a minimum of 30 minutes a day is ideal, even spending 15 minutes a day exercising is beneficial. I’m generally concerned with three areas: stretching, cardio, and strength/resistance training. Stretching really should be done each and every day prior to exercising to improve flexibility and decrease the chances of hurting yourself. Cardio and strength training are also important to your workout regimen if you want a fit, lean body. These can be done on alternating days. 30 minutes of cardio increases your heart rate and pulmonary capacity, building endurance. Strength training using weights builds muscles and definition. Along with a healthy diet, all of these things are key components of a fit body and healthy lifestyle. 

But don’t think that you need a gym membership to start down this road. I always tell patients to start at home. Why? There are always persuasive excuses that win the “going to the gym” battle: too far away, too nice out, too cold, too tired and so on. Working out at home makes it easier to incorporate a workout into your daily routine. It makes excuses to not work out much harder to find. It’s really only upside: the commute time to the extra bedroom only lasts 14 seconds, you can blare whatever music you want, you can watch last night’s show on Netflix, and you don’t have to wear those rubber shower shoes for your post-workout shower. Bonus!

So what kind of a workout can you get at home? If you’re intereated in fancy toys, you can buy the latest state of the art exercise machine. If you use it, it’s a great workout, but it seems to me that it ends up being a very expensive clothes hanger. What can you do without any of that. The answer: everything you need to. There are even exercise programs on demand from most cable companies. These are great if you need more guidance to work out at home. But when you get down to the basics, you can still get a good workout at home with little or no gym equipment. I suggest that after stretching, go for cadio; try running in place and jumping jacks to increase your heart rate. Then do some floor exercises like squats, pushups and situps. These are erecises that strengthen your core and define muscles. I’ve found that those stretch bands are great to incorporate into floor exercises. Tou can pick them up on Amazon. While there, check out my book, Tales from the Couch. It’s a great read, and full of interesting and educational patient stories I’ve gathered in my 30 year career.

We all know that exercise is beneficial, but in case you need extra motivation, I want to discuss a few of the benefits of exercise. 

Heart health: The heart is a muscle like any other. Cardio strengthens the heart and helps protect against heart related illness. By getting your heart pumping at a faster rate on a regular basis, you’ll keep it healthy and in shape.

Good vibes: Workouts release positive endorphins. These “feel good” hormones have considerable impact on your overall health. They help alleviate the symptoms of depression and fatigue as well as releasing hormones that will suppress your appetite. These stress-relief hormones can be extremely beneficial to your overall outlook on life, simply because of the positive effect these hormones have on the system.

Better sleep: Half of the world’s population suffers from some sort of sleep disorder. A study published by The National Sleep Foundation found that individuals who performed cardio exercises at least 3 times a week fell asleep 54% faster and slept 37% longer than individuals who did not. Most of us know the importance of getting enough sleep at night. It’s iimportant for productivity, mood, and overall health. So getting your sweat on during the day should make for a much easier lights out.

Metabolic boost: Not only does cardio speed up your heart rate, but it also increases the rate of different processes throughout the body…your metabolism being one. The more intense your cardio session is, the more noticeable increase you’ll see in your metabolic rate. An increased metabolism also means an easier time maintaining your weight or losing weight.

In general, people who exercise regularly are more mindful of their health and their bodies. They tend to smoke and drink less and to live longer, more functional lives. 

I subscribe to the KISS method when starting out a new exercise program. Keep it Simple Stupid. Don’t think that a boot camp type workout is a good place to start. You’ll just end up pulling something and hurting yourself, and that will set you way back. The number one rule in exercising is not to get hurt. KISS would be the number two rule. If you break the number one rule, then see number two.

So if you want to get in better shape or to lose a few pounds, start a little program at home. Start slowly and take baby steps and you’ll surely see a return on your physical investment. 

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January 6, 2018 THE RIGHT APPROACH TO THE OPIOD CRISIS

As a practicing doctor with certification in psychiatry and having worked in Palm Beach County for the past 25 years, my views on the current opioid epidemic are the result of my daily contact with addicts, their families, the medical community, law enforcement and the judicial system. My work has taken me from the E.R. to the inpatient treatment centers and rehabs to the courts to our psychiatric hospitals and to our coroners offices. I have watched this epidemic from its earliest stages to its current existential threat status. As a result I have come to the following conclusions about this tragic situation our community and communities across the country find themselves faced with. WE MUST CHANGE THE WAY WE THINK ABOUT THIS AND TREAT THIS PLAGUE.
1.) Move away from the concept of a war on drugs. Move towards providing an aid package for these vulnerable and impaired individuals.
2.) Move away from concepts of criminalization, imprisonment, and that they are deserving of severe punishment. Move towards treatment and therapeutic interventions. View individuals with OUD as impaired and of need of help.
3.) The concept of opiate-dependent individuals as merely addicts that are weak, self-indulgent, hedonistic, and who are scorned by all is not helpful in resolving this national issue. There certainly is a volitional component to this illness. While personal responsibility and accountability is the only path to a healthy life, opiate-dependent individuals need a support system and tools to help get them on that path. Individuals suffering from OUD hate themselves, the behaviors in which they engage, and the resulting consequences. People with OUD are reckless with their lives because they feel their lives have little or no value. The mind-set of the opiate-dependent individual is one in which it doesn’t matter if they live or die. These vulnerable individuals are also prone to abuse and exploitation.
4.) Society must track these individuals and intervene when necessary.
5.) Society as a whole must be educated about opiates and all aspects of drug dependency, starting in grade school. Opiates come in pill form, patches, lollipops, and can be snorted and inhaled. Drug dependency can begin after one dose. Five days of continued use of opiates can result in drug dependency. Individuals who are genetically predisposed to dependency are more affected.

Like many drugs, over time the same amount of opiates has less and less affect which results in individuals increasing the drug dose and decreasing time between doses. This is the concept of drug tolerance. People spend more time getting the drug and doing the drug, and it becomes a vicious cycle. OUD individuals start to live a life of lies to cover their drug use. They spend a majority of their time planning to get money and make time to use drugs. They become psychologically consumed by thoughts of procuring opiates, using opiates, and disregarding everything else, including family, friends, job, health, and finances. All that matters to them now is getting high. When in withdrawal, these individuals can become very desperate and dangerous. They will go to great lengths to get high.

What can we do in terms of how society should deal with the problem? When treating an OUD patient, both incentives and consequences need to be geared towards keeping them off the drug of abuse. These five areas are conceptual changes needed towards resolving the national opiate use crisis and treating patients with Opiate Use Disorder:

1.) There needs to be a massive education campaign similar to the education campaign against tobacco including the danger of opiates and treatment options for OUD individuals. Explain the dangers of opiates, what opiates are, how they affect our brains, and, importantly, how easily it is to become dependent. The potential of overdose and death needs to be underscored. For example, the opiate called fentanyl, in amounts barely visible to the human eye, can cause individuals to stop breathing. Fentanyl is measured in micrograms. There are 100 milligrams in a gram. There are 1000 micrograms in a milligram. There are 100,000 micrograms in a gram. Two hundred micrograms or maybe less is lethal, which hardly covers the tip of a needle.
2.) The streets must be flooded with Narcan inhalers. One to three sprays in a nostril can revive an opiate overdose.
3.) The streets must be flooded with test kits to determine what is in the drugs and how much is in them. People make better decisions when they know what is in the drug they are taking. For example, if someone makes a street purchase of a drug with fentanyl or methadone in it, they need to be extra careful because those drugs can easily kill you. Methadone is dangerous not only because it is so potent but because it lasts so long. There is an even more dangerous drug on the street called carfentanyl which is 100 times more potent than fentanyl! Note: methadone has been useful in the treatment of OUD, however, it is so dangerous that the dose must be given out on a daily basis. While methadone blocks cravings, it provides a high so can still be abused and lead to an overdose. Buprenorphine is another drug used in treating OUD, and it has been found to be safe enough to prescribe on a monthly basis. The negatives and stigma associated with methadone should not be associated with buprenorphine.
4.) Laws need to be changed. Instead of charging people with accessory to murder when a friend overdoses and dies, give them immunity. Give complete immunity to people in the presence of someone who overdoses if they call 911 during the overdose. Encourage people to call 911 and save lives, not run and hide fearing prosecution.
5.) The court system for individuals with OUD must change. Once in the system, these individuals must be tracked with drug testing and given treatment when needed. Criminal records for possession or use can be wiped away if the individual stays sober. Incarceration should be a last resort. Charging people with felonies for drug possession scars people for life. Once labeled a felon, re-entering society becomes very difficult. OUD individuals are not sociopaths or criminals, they are ill with a disease. Treat the illness and there are no criminal problems.
This perspective demands basic changes in our societal and individual thinking about opioid dependency. Equally as important is the way the established medical community regards and treats this diagnosis and it is just that….a medical condition.

I have many thoughts for my peers and given the opportunity, I would welcome the chance to share them.

No matter what our circumstances in life, we are all touched by this epidemic in some way. We all have skin in this game. Time is precious, costly and limited. Soon may become later and it is already too late to wait.
More comprehensive explanations about how to deal with addictions in my book Tales From The Couch on amazon.com

Mark Agresti, M.D.

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