Can We Talk

Can we Talk?

We live in a world that is constantly changing technologically, and as it does so, it is changing how we as people interact. In previous generations, in order to obtain anything- food, shelter, clothing, information- you had to speak to another person. All of these transactions required interactions. And that meant you would have to converse with people. But things have evolved, and are continuing to evolve, every day. Obtaining those normal life needs I mentioned above has been revolutionized to the point that they no longer require person to person interactions. I talk to and listen to people all day, everyday, and I have seen some repercussions from the decline of personal interactions. These days, people really suck at the art of conversation. And it is an art. But now that the advent of technology has made it unnecessary to converse, it’s clear that its gone downhill. Look at texting. Most people choose to communicate by text rather than by voice/ phone whenever possible. The problem with that is that when people actually do talk to others, it sounds sort of like a text, with all the appropriate jargon and acronyms. Even the way we entertain ourselves has changed. You can entertain yourself alone now. You don’t even need a friend to play a game. For that matter, you don’t even need to make friends in person. You can have electronic friends to play video games with. If you’re in school and you need to do research, you can do it all online. There is no seeking out of experts and sitting down in person for a discussion. You don’t comb through giant reference texts; hell, you don’t even need to go to a library, you just need a laptop. When I tell millennial patients that I spent a lot of time in the library when I was in school, they’re amazed. They can’t wrap their minds around using microfiche (“Duuuude, like what is that microfish Doc?”) to look at newspaper articles from years past. They don’t even understand what the Dewey Decimal system is, and would have absolutely no clue as to how to find and check out a book. While today’s ability to get all the information you need online sounds totally fantastic, there are some pitfalls to be aware of. For all the information on the superhighway, there is a lot of misinformation. You have to be able to weed that out, which can be difficult. There are plenty of people with their own nefarious agendas posting crap online and taking no accountability. There is no monopoly on information.  Good, bad, or indifferent, everything is shared online. Social media has radically changed interactions between people. It used to be that to find a date, you actually had to leave your house. Not so anymore. Now you can find dates and vet them without even getting off your couch, and that first awkward conversation is had in text rather than in person. Facebook, Instagram, Twitter, Tinder, Match, JDate, Farmer’s Only, DateUrDog, yada yada- there are crazy sites for every segment of the population- these sites allow people to share information and give the illusion of socialization. 

What about some basics of just feeding yourself? When going “out to dinner,” people would normally socialize. But that does not happen anymore. Uber Eats, Delivery Dudes, DoorDash, you can get virtually any restaurant food delivered, whatever you want, whenever you want it. As a result, there are no more random interactions where you would meet people for dinner or run into people you know while you’re out. Money management is another area that has drastically changed. Banking, stock trading/ dealing, investment management, everything has gone online. There is no more going to the bank, gossiping with a teller friend, or running into people at the bank. Doesn’t happen much any more. I remember when I was a kid, people used to say that a banking job had good security, because people would always need money. I wonder what they think now, when everything is done electronically. Another major shift has been online shopping. I hate making comparisons that start with “When I was a kid…” but when I was a kid, a teenager, a big place to hang out and see cute girls was the mall. That’s where most people bought their clothes and it was the place to be seen wearing them. But now, shopping is done online…Amazon, Walmart, Rakuten, Wish, on and on. Every store has a website; it’s a virtual mall to buy clothes, shoes, decor, jewelry, whatever you could possibly want. You don’t need to go out every week to grocery shop either. Now you can join Amazon Prime and get Whole Foods groceries delivered to your doorstep. These days, we don’t have to do many of the errands that our mothers and grandmothers did. Dry cleaners pick up dirty laundry and deliver everything perfectly pressed the next day, dog food is delivered, pharmacies deliver medications, groceries are delivered with the frozen goods still frozen, and there is even an increasing trend of doctors doing more telemedicine. I have one patient, Eileen, who tells me she leaves the house just twice a month- to get her hair done, her nails done, spa treatments, or to see a doctor or dentist. That’s all she’ll leave the house for. She even gets her dog groomed from a mobile dog groomer that comes to her house.  Since everything we need can be delivered to the home, there is very limited interaction where we see others, and social interactions are even more limited. There becomes only one reason to interact, and that is that we as humans need to socialize or risk damage to our psyche. Think about what you hear about most serial killers…they were quiet, they were loners, never seen with others. Socialization is healthy. But now, instead of making and nurturing all these relationships through the chores we used to do, we have to create a social world, a place in which we choose to make time to socialize, where we choose to interact with people. It’s like socialization by appointment.

This information applies to all generations. I have talked a lot about millennial this, millennial that, but this is all generations. Yes, our young people have been raised on a diet of electronics and have not learned to communicate with one another, but our older generations that were taught and practiced social skills are now losing those skills as they age. I’ll put it this way…with any learned skill, if you do not use that skill for seven years, you will lose that skill. I have elderly clients who never leave their homes; everything is ordered in and delivered. Their social skills are inadequate. One of my long time patients, Albert, comes to mind. He was a vastly different person when he was going out to dinner with friends, when he went grocery shopping or played cards with friends. Now he doesn’t get out much and his social skills suffer for that. I feel very strongly about the need for socialization; I would say if we do not socialize, we do not exist.  I think we need to come to the point where we recognize that a lack of interaction between people is a problem. Not just not socializing with people but also “electronic friends” from social media that are not real friends. People whose lives revolve around these “friends” on social media and videogames have to see that these virtual relationships aren’t fulfilling. There is no intimacy in those relationships. And when I say intimacy, I’m referring to physical and emotional intimacy. You can’t see a facial expression, read body language, or touch, feel, or smell over the internet or through text or anything other than an in-person interaction. Another problem with electronic online relationships is that there are no checks and balances on behavior. You can say or do whatever you want, and you can dress, smell, and look any way you want and it really doesn’t matter. You can even be a predator or a catfish trolling online…or you could be a victim of those people when you are interacting on the internet. There is no one to say hey, that was dumb, or that was funny, or that was great, or you are pretty, or you are dressed inappropriately. So, without outside interaction, behaviors can become more bizarre in the technological vacuum. You also limit group interactions that nurture skills that are good, as in leadership, speech,skills of social interaction, the ability to make a case for yourself and sway opinion. These are critical in terms of group behaviors.

There are other things that are lost without an in-person social interaction. It is tough to have humor online. It’s hard to convey certain thoughts, without voice inflection and facial expression. In effect, you lose your sense of humor and the ability to make people laugh. It’s also difficult to have or convey empathy. You can’t understand what is going on in other peoples’ heads or what they’re feeling or thinking. The internet can cater to people looking to hurt others, bully people, and be mean; they can say what they want while remaining anonymous. Social etiquette is lost.  The ability to speak and interact using your voice, your speech and your body language to communicate a message is lost in electronic interactions, as is understanding nonverbal cues, group dynamics, and the art of conversation, as I mentioned above. You actually become dulled when you have limited true life interactions, so you lose the ability to pick up on social cues. Another thing lost to limited true life interactions are shared experiences. You are always alone with only electronics, no personal interactions, so there’s no one to motivate you or challenge you. By severely limiting real life interactions, you lose exposure to everything outside of you. There are no new things, new tastes, smells, places, people, and travel…you just don’t get that from your electronic internet- bubble life. 

Whenever I present a problem, I like to present a solution as well. So, if you’re living an electronic/ internet existence, what can you do about it?  It sounds cliche, but the first thing is to recognize that there is a problem, and that you want to change your reliance on electronics and improve your social skills. This is big, because most people do not even realize there’s a problem. They don’t realize how much they are depending on electronics/ social media to communicate. 

Then two, once you realize the problem, you have to commit to doing everything possible to increase interactions with real people in the real world. To do this, you’ll have to begin to desensitize yourself, because there may be anxiety early on when interacting with other people. But don’t let the anxiety prevent you from doing it. Go out and talk to people, same or opposite sex, maintain a conversation, and try being funny. Definitely make sure to be appropriately dressed in something you feel good about wearing, and make sure your hair and/or makeup is on point. Be aware of non-verbal cues like your body posture and your natural facial expression. If you have Resting Bitch Face, find and frequently practice a more open expression in the mirror. Essentially, you want to enhance your positives and interact appropriately. Before you know it, you’ll be less terrified by personal face to face interactions. Another way to meet people and increase real social skills is by doing errands, especially if you previously had them done and delivered for you. If you like certain products, go where they sell them and interact with salespeople or other customers and buy them. If you see someone buying something you haven’t tried before, tell them that and ask them what they think of it. Also, make it a point to expand your world by involving yourself with hobbies, your family, sports, academics, whatever piques your interest. Make an effort to seek out new things and try them. As you go to new places, the goal is to make new friends, to start real relationships in the real world. You can do this by starting a conversation based around whatever activity you’re both doing. For example, if you’re taking a cooking class, ask someone in the class what dish they really want to learn to cook or what restaurants they go to when the dinner they make is inedible. A common denominator is a great place to start a conversation. It may take a minute to psych yourself up to start a conversation, but don’t get stuck there- It’s not a big deal to start a conversation, so don’t spaz out and make it into one.

If you want to have real relationships,function properly in the real world, and learn how to interact appropriately and carry on a conversation- with co-workers, bosses, friends, family- the key thing you have to do is to put down the electronics, the phone. Turn it off and don’t carry it for a day and see how your social interactions change. 

So, you’ve admitted there’s a problem with your social interactions, that you have trouble making in person friends and starting real relationships with real people, and that you really only interact with people electronically on the phone. And you’ve said that you’ll do whatever it takes to learn how to make real friends in real life and stop relying on electronic friends; that you will put the phone down and get hobbies or try sports or whatever you can find to meet people in person and not online. That’s all great. But I have a couple of tips for you. First tip: when you go out now to wherever and whatever it might be and you’re making efforts to interact with people, observe successful people and copy them. When I say successful, I don’t necessarily mean someone who has money (though that doesn’t hurt lol) I just mean successful in that they are clearly holding people’s interest, or it could be someone who oozes charisma to you, someone that you’d like to be or hang out with. So locate that person and look at how they interact with others and pick and choose the qualities you like and can integrate with your unique personality. You don’t have to  reinvent how to interact with people, you just have to find someone you think is successful at it and copy it into your personality. And the second tip is that it’s perfectly fine to talk to people about how to meet people, and it’s okay to ask for help. No one is born knowing everything there is to know about everything. So while you will be better at some things, there will be some people who could be role models or instructors for you who are maybe wiser or more capable in this communication area, and you could learn skills from them on how to break the ice, how to interact face to face, and how to hold conversations. 

When I asked ‘Can we Talk?’ I asked it literally, because every day I see that the spoken word is being usurped and replaced by the texted/ transmitted word, a fact that I find unsettling at best.

As technology advances, I’m certain that robotics will continue to take over an ever-expanding pool of tasks that require skilled labor, jobs that are currently filled by humans. In the future, we will have to learn to live with robots, to interact with them on a daily basis. I wonder what that will be like, if they will have the ability to have real conversations given that they would not have hearts and souls. I worry that artificial intelligence will take over and possibly eliminate human intelligence, human feelings and interactions, just as many human jobs will surely be eliminated. Even after robots, life will continue to evolve, it has no choice…but I think it’s going to be a bumpy ride. 

Ivan’s Addiction:Alcohol Detox

Ivan’s Addictions: Alcohol Detox

I want to discuss what people can expect when detoxing off of alcohol, inspired by my patient Ivan. He was a long-time patient, though I hadn’t seen him in a while. He was big time addicted to opioids years ago, and he had dragged his sorry butt into my office, barely coherent, begging for help. That’s how we met. I managed to get him clean off of the oxy’s he so dearly loved, but I would learn that Ivan had a very addictive personality…this guy could get addicted to oxygen. Anyway, that’s where it started with Ivan, and over the subsequent years I saw him in the office here and there. Now fast forward twenty years and in walks Ivan. It looked like the years had not exactly been kind to him. He looked like an alcoholic. Red swollen nose, check. Ruddy grey skin, check. Blood shot eyes, check. Balance just slightly off kilter, check. Gaunt frame with distended belly, check. I could go on, but suffice it to say that after so many years of doing what I do, I can spot an alcoholic from 50 yards. He said he was still clean, off opiates, but admitted to drinking in excess for many years. I burst his bubble with a sharp prick of  cold harsh truth: he was an alcoholic. When I said it, he might’ve flinched, but he didn’t argue. 

I asked him what he was doing for work. He said he was rehabing properties. He had inherited some money, bought a bunch of properties, fixed them up and rented them out. He collected the rent paychecks every month from his “magic money mailbox.” That sounded great, but the down side of this equation was that he wasn’t expected to be anywhere at any given time. And that left a lot of time for drinking. When I asked how much he was drinking, he admitted to drinking at least ten of those 2 ounce airline mini bottles a day. He had found some place where they only cost a buck a bottle. I was floored. That is an incredible deal. But I digress. I told him that we would have to do a medical detox, and he was on board. What follows are all of the things I told him.

To start, I explained that he needed to hydrate. Even though alcohol is liquid, it is very dehydrating, so there must be copious amounts of water during detox. As I told Ivan, drink water until you think you’ll burst. Next, start eating healthy foods. This is critical, getting food in your system, because alcohol causes irritation of the walls of the stomach and intestines. Also, you have to kick start the digestive tract, because alcoholics don’t eat well, if they eat at all. Next, start taking an over the counter stomach proton pump inhibitor like Prilosec or Prevacid. This will help to decrease the acid in the stomach as well as heal the stomach wall and the esophagus. Next, start taking B complex vitamin and multivitamin to replenish the system. He said he understood as he dutifully wrote all of this down. 

Next, I explained the important warnings about detox, the reasons why it’s important to medically detox. We have to use a type of drug called a benzodiazepine to prevent severe alcohol withdrawal. Without it, you will start shaking, you can become delirious and confused and have grand mal, full body seizures. There is a possibility of death: up to 25% of people actually die from severe alcohol withdrawl when they don’t use the benzodiazepines. I use medications liberally to prevent the withdrawl and safely detox. My goal is to keep patients comfortable with meds, but never nodding out. I wrote a scrip for 2mg alprazolam and told him to take one 2 or 3 times a day. I also gave him one to take immediately in the office because it had been 16 hours since his last drink and he was really starting to feel it. He had all of his instructions, so I told him I’d call him at 8pm that night as well as every six hours thereafter, and that he could call my cell phone anytime with questions or problems. With that, he left.

That night when I called, he said he was feeling not so great, but that he had eaten, was drinking lots of water, and taking the vitamins. When I called him the next morning, he said he woke up feeling very uneasy, very tense, and with some slight tremor. I told him to take the alprazolam right then and to take another in the afternoon around 2 or sooner if he felt tremulous. He repeated the alprazolam schedule on day 2 and also took it that night. When day 3 came, I explained that this is the most dangerous time. While seizures and delirium can happen at any time, they are most likely to happen on day 3. It’s also the worst day. It was really tough for Ivan. He was sweating. He had tremors. He was a little confused. His girlfriend came over and made him chicken soup, served with some TLC, and checking to be sure he was hydrating and taking the vitamins. He took the alprazolam three times that day, but didn’t sleep much. I gave him a drug called mirtazapine for sleep, and this helped. The fourth day dawned and Ivan saw the light at the end of the tunnel. Day 4 was better than day 3, but he was still feeling tremor, still sweating, and still needed 2 alprazolam that day. On day 5, he had no tremor. The sweating had lessened, but he still felt restless. He took just 1 alprazolam that day. As of the 6th day, he didn’t need the alprazolam at all. The detox was done. I told him to continue the vitamins and the Prilosec stomach meds for 2 months, keep up the improved diet, and keep hydrating. 

Ivan followed all of my instructions and he came out the other side and did pretty darn well. He got in great shape by walking his dog Malcom for a minimum of 3 hours a day, and he felt better every day. In fact, Ivan had dodged some serious bullets in that he had no major organ damage from the alcohol. There are several very common things that go bad with alcoholism. Most didn’t happen to Ivan, but let me caution you what can happen with alcohol abuse. Pancreatic issues are common. The pancreas is the most important organ for blood glucose regulation and digestion. You become a diabetic if your pancreas shuts down.  Gastritis quickly becomes a potentially lethal problem. Gastritis is extremely dangerous, it is irritation or bleeding of the stomach, leading to bleeding ulcers. Aspiration pneumonia is a concern: where you are so drunk that you throw up or cough up stomach contents and you breathe the stomach contents into your lungs, causing a serious and life threatening infection. A very common issue with alcoholics is that they get drunk, fall, and break a bone or hit their head, causing subdural hematomas of their brain. And you can’t forget liver disease. One of the key features of chronic alcohol abuse is liver failure and liver cirrhosis. The liver shuts down and so the body diverts the blood flow around the liver because the liver is so scarred and gnarly that it no longer accepts blood. As a result, you get big vessels forming in the esophagus and rectum, and they explode, causing hemorrhage and death. Ivan was lucky… he didn’t have any of those things. But he didn’t get off scott free. The most common thing I see with alcohol- that no one escapes- is cognitive damage. The brain slows down. It is permanently damaged. As a result, you cannot think straight. You are not as coordinated as you were. You become less active so there can be muscle wasting. These had happened to Ivan. As I said, no one escapes this. So Ivan was little bit slower, a little less coordinated, legs a little weaker. But he’s not drinking, and that’s a major accomplishment. I’ll continue to follow him in his clean and sober life. If you are abusing alcohol, Ivan would advise you to medically detox, as would I. If you would like to read more about alcohol withdrawl, medical detox or more patient stories, check out my book, Tales from the Couch, available on Amazon.com.

Digital Addiction Disorder

Time to Log Off?

Technology addiction, electronic addiction, digital addiction, social media addiction, internet addiction, mobile phone addiction…. No matter the name, the common thread in these addictions is that they’re all impulse control disorders that involve the obsessive use of mobile phones, internet, and/or video games, despite the negative consequences to the user of the technology. For simplicity, I’ll combine all of the above names together and refer to the phenomena as a digital addiction.

*** A new special called “Digital Addiction” will air on the A&E Network (Comcast HD ch 410 / SD ch 54) on Tuesday, September 17th at 9pm. There will be stories of people addicted to video games and social media and discussion on how people are trying to recover from digital addiction. It should be very interesting, so check it out. 

Do you play video games in excess? Are you compulsively shopping or gambling online? Do you spend hours taking the perfect picture to post or ‘Gram or tweet? Do you feel a need to constantly monitor all of your social media outlets to look for likes and loves and to track people to see what they’re up to? Is your excessive use of all of these things interfering with your daily life- family, relationships, work, school? If you answered yes to any of these questions above, you may be suffering from a digital addiction disorder. These disorders have been rapidly gaining ground as they are more recognized as truly debilitating, and as a result, they are recently receiving serious attention from many researchers, mental health counselors and doctors. The prevalence statistics vary wildly, with some reports stating that the addiction disorder affects up to 8.2% of the general population, but others state it affects up to a whopping 38%. In my opinion, it affects far more than 8.2%, but not quite 38%, so my educated guess is about 20%. That’s one-fifth of the population… a staggering number of people. And we have the explosion of the digital age to thank. Advancing technology is the ultimate double-edged sword. One of the most troubling things about this disorder is that we are endlessly surrounded by technology. Most of what we do is done through the internet. And we’re enticed to do things online. Take Papa John’s as an example- if you place your order online, you get an extra discount or a free small pizza. Lots of company sites offer similar discounts. And if you do buy online, most companies then include you in their email blasts with info on sales and discounts. Even if you’re just doing research on something online, not shopping, you’ll get little photo pop-ups from online stores you’ve ordered from before. Gamers make up a huge subset of the digitally addicted. Ask any mother of a male child aged 10 and up if she and her son argue about his spending too much time playing games, and chances are she’ll tell you that it happens all the time. Of course, to the developers of these games, that’s a total eargasm! These game developers have a strategy to keep people, especially kids, glued to their seats with eyes on the screen. Many games, especially the huge multiplayer roleplaying games like World of Warcraft and Everquest, may lead to a gaming addiction because as players play together, they spur each other on. In addition, these games have limitless levels, so in effect, they never end.

Just because you use the internet a lot, watch a lot of YouTube videos, shop online frequently, or like to check social media often does not mean you suffer from a digital addiction disorder. It only crosses over into the trouble zone when these digital activities start to interfere with, or even negate, your daily life activities. Every tweet, every phone alert DING! is an interruption in your thoughts, your psyche, and your day. I have a handful of patients that struggle with just turning their phones off during a session with me. They literally get anxious being without it, being unable to check it. They have to hold it, have it in their hands. I have one patient that couldn’t turn it off but agreed to put it in her purse. That stupid thing dinged and blipped and bleated every freaking 5 – 10 minutes, I swear. And every time, I could see her leave the appointment….it interrupted her train of thought with every stupid, annoying noise it made. I told her that next time, and for every time thereafter, the phone would be off and in my drawer. She grudgingly agreed, but she regularly panicked without it, so I had to begin every session by talking her off the edge.

Like many disorders, it can be difficult to pinpoint an exact cause of digital addiction disorder, but there have been some risk factors identified. These include physical impairments, social impairments, functional impairments, emotional impairments, impulsive internet use, and dependence on the internet. The digital world can be an escape for people with various impairments, so they are at higher risk. 

Digital addiction disorder has multiple contributing factors. Some evidence suggests that if you have it, your brain makeup may be similar to those of people that have a chemical dependency, such as drugs or alcohol. Some studies even report a potential link between digital addiction disorder and brain structure- that the disorder may physically change the amount of gray and white matter in a region of the brain associated with attention, remembering details, and planning and prioritizing tasks. As a result, the affected person is rendered unable to prioritize their life, so the digital technology takes precedence over necessary life tasks.

Digital addiction disorder, as in other dependency disorders, affects the pleasure center of the brain. The addictive behavior triggers a release of dopamine, which is the happy, feel good chemical. Note the name dopamine. Drugs of all sorts are often referred to as dope, and this is not happenstance; they are called dope because drugs elicit the release of dopamine as well, causing the pleasurable high. So chemically speaking, the high that gamers or internet surfers or Facebook hyper-checkers get from indulging their addiction is exactly the same as when a drug addict takes drugs. Win a game or get a like or love on Fakebook, get a dopamine hit. And, just like with drugs, people develop a tolerance over time, so more and more of the activity is needed to induce the same pleasurable response that they had in the beginning. Ultimately, this creates a dependency. 

There are also some biological predispositions to digital addiction disorder. If you have this disorder, your levels of dopamine and serotonin may be naturally deficient as compared to the general population. This chemical deficiency may require you to engage in more behaviors to receive the same pleasurable response that individuals without the addiction have naturally. 

Another predisposition to digital addiction disorder is anxiety and/or depression. If you already have anxiety or depression, you may turn to the internet or social media to fill a void or find relief, maybe in the form of online retail therapy for example. In the same way, people who are very shy or socially awkward may turn to the internet to make electronic friends because it doesn’t require actual personal interaction.  

The signs and symptoms of digital addiction disorder can present themselves in both physical and emotional manifestations. 

Emotional symptoms may include:

Depression
Dishonesty
Feelings of guilt
Anxiety
Feelings of euphoria when indulging 
Inability to prioritize tasks

Problems with keeping schedules
Isolation
No sense of time
Defensiveness
Avoidance of work
Agitation
Mood swings
Fear
Loneliness
Boredom with routine tasks
Procrastination

Physical symptoms may include:

Backache
Carpal tunnel syndrome
Headaches
Insomnia
Poor nutrition: not eating or junk food

Poor or zero personal hygiene 
Neck pain
Dry eyes and other vision problems
Weight gain or loss

Digital addiction disorder impacts life in many ways. It affects personal relationships, work life, finances, and school life. Individuals with it often hide themselves away from others and spend a long time in this self-imposed social isolation, and this negatively impacts all personal relationships. Trust issues may also come up due to the addicts trying to hide, or lying to deny, the amount of time they spend online. Sometimes, these individuals may create alternate personas online in an attempt to mask their online behaviors. Serious financial troubles may also result from the avoidance of work, as well as bankruptcy due to continued online shopping, online gaming, or online gambling. They may also have trouble developing new relationships, and they often withdraw socially, because they feel more at ease in an online environment than an actual physical one.

One of the overarching problems with the internet is that there is often no accountability and no limits. You are hidden behind a screen, so you may say or do some things online that you would never consider doing in person. To some, that can be a very attractive proposition. One iissue that happens in digital addiction is that people who may be shy or awkward or lonely may create a new identity for themselves. They find that on the internet, they can be the person that they can’t be in real life. They develop this perfect fantasy world where everything goes their way. The problem is that the more they get into that fantasy wotld, the more distant they become from the real world. The results can be a disaster emotionally when they’re forced into the real world; they find they can’t function there and desperately need help. There’s a flip side to a created persona, where it’s done to intentionally hurt others. By now, I’m sure most people are familiar with “catfishing” from the eponymous movie and television program. For those who are not familiar, catfishing is the purposeful act of luring someone into a relationship by means of a fictional online persona. Catfish steal pictures of an attractive person, usually from that person’s social media, and they create a fictional persona and post it online with the stolen pictures to see who bites. If they get an attractive bite, they message that target to begin a relationship for their own devious purposes, which is usually just to get their rocks off, to hurt someone because they hurt, to get nude pictures, or to weasel people out of money. Catfish often do this with multiple people, leading them on, and are usually pretty proud of themselves for it. I think they’re lowlife cowards. My point is that the internet is full of people that feel brave online but who cower in real life. Online and social media digital addicts are more likely to be targeted, simply because they spend so much time on their devices, on the internet, or monitoring their social media. 

As for diagnosis, because it was only very recently added to the Diagnostic and Statistical Manual of Mental Disorders as a disorder that needs more research, a standardized diagnosis of digital addiction disorder has not been developed. This is likely due to the variability of the different digital applications that people may become addicted to, as well as the fact that digital addicts can have anxiety and/or depression as well, and therefore would have difficulty, or may be averse to, seeking help.  

As to treatment options for digital addiction disorder, the first step in treatment is the recognition that a problem exists. If you don’t believe you have a problem, you’re not likely to seek treatment. 

Developing a compulsive need to use digital devices, to the extent that it interferes with your life and stops you from doing things you need to do, is the hallmark of an addiction. If you think you or a loved one may have a digital addiction, you should definitely see a psychiatrist, because there may be an underlying issue like anxiety and/or depression that is treatable with talk therapy and/or medication. I specialize in addiction, and I work with many patients with digital addiction with a great deal of success. There is a right way to utilize technology without it running and ruining your life, so please seek help.  

Digital addiction disorder has become such a common theme in my practice that I cover this topic in several stories in my book, so check out Tales from the Couch, available on Amazon.com if you’d like to read patient stories and get more information on the digital addiction phenomenon.

How To Know If Someone Is Schizophrenic

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,

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.

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.

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.  

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. 

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.

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. 

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.

Choosing The Right Separation Anxiety Treatment

Many individuals across the country are looking for an effective separation anxiety treatment to help them deal with severe separation anxiety. Before looking for a treatment method for relief, most of these individuals have experienced numerous instances of separation anxiety, and the condition might be worsening as the days pass.

The selling of separation anxiety treatment has actually become a multimillion dollar industry, and continues to grow each year as more and more treatments are added, and more individuals feel the need to purchase the products.

There are lots of different sorts of treatments for separation anxiety available, developed by several different manufacturers]. A separation anxiety therapy can be natural, consist of medicines, or be a restorative approach that modifies the way the body is working to ease the symptoms of the condition.

The sort of treatment technique chosen depends on the individual’s personal choice, the intensity of their symptoms, and the level of disruption that separation anxiety is causing in their life. Cost may also be a factor in selecting a separation anxiety treatment, as some treatment methods are more costly than others.

The most typical sort of separation anxiety treatment used today is a treatment that contains a drug to help the person manage their separation anxiety. These medications can be bought from a pharmacist at lots of different places with a prescription from the individual’s physician. These medicines can be very strong, so they can only be purchased with a prescription to avoid abuse and dependency to the medication. Lots of people do not want to use a separation anxiety treatment which contains medication, because of the risk of dependency.

A natural separation anxiety treatment will contain natural herbs and minerals found in nature to help individuals handle the stress that occurs with separation anxiety. These treatments are not as strong as the medications, but, they have a decreased danger of dependency, and many individuals believe that they are safer for mild to moderate cases of separation anxiety. A natural separation anxiety treatment can be purchased at locations such as grocery stores, drug stores, or stores that sell natural products.

Therapeutic methods that are utilized as a separation anxiety treatment teaches the person physical techniques to ease the stress that goes along with separation anxiety. These methods have the ability to ease the person’s separation anxiety within a matter of minutes without the person having to take medicine. There are lots of different separation anxiety treatment methods available to assist an individual in easing the symptoms of separation anxiety, and a few of them can be very effective at treating separation anxiety for good.

What Is One of the most Effective Methods To Relieve Separation Anxiety?

If you are attempting to relieve separation anxiety and its accompanying symptoms, there are lots of different alternatives for you to select from. A few of the remedies are natural, while a few of the other treatments are manufactured by companies and sold commercially. So how do you determine which remedies are the most effective method to relieve separation anxiety? There are a few things that you should consider.

When trying to find a treatment that will be utilized to alleviate separation anxiety, you will want to search for a solution that is simple to use. If the procedure for taking the remedy is too complicated, you might resist utilizing the remedy for a longer period of time, allowing the anxiety to gradually worsen as time passes, and you resist taking the remedy. For a remedy to alleviate separation anxiety effectively, you cannot be resistant to making use of the remedy, nor have a remedy that is so complicated to take, that it is much easier to just suffer through the stress and anxiety.

The ease of finding the remedy may likewise be very important for how effective the remedy can be to relieve separation anxiety. Lots of people have home remedies that are constantly available, and can be taken quickly to alleviate separation anxiety before it becomes too bad, while other individuals chose a remedy that is always in their favorite stores for their separation anxiety remedy, because it can quickly be located whenever it is required. If a remedy is too tough to find, people will stop taking it to ease their separation anxiety.

The strength of the separation anxiety remedy is another aspect of how effective the remedy will be to relieve separation anxiety. Prescription remedies are more powerful than nonprescription remedies or home remedies, however, the fact that you require a prescription from a doctor to purchase them make them more difficult to obtain.

The remedies to relieve a separation anxiety disorder that can be acquired over the counter in stores are available in a variety of various strengths, so it is easier for a person to find a strength that is effective, but is not so strong that it might trigger other issues when taken.

The speed at which the remedy can alleviate separation anxiety is essential too. A few of the remedies available work for a longer time frame, but takes longer to work, while some other remedies begin to work within a few minutes, but only last for an hour or two. For immediate relief, the fast acting remedies are normally chosen to stop the separation anxiety fast, and prevent it from worsening in time.

Where To Discover The Best Social Anxiety Assistance

If you are dealing with separation anxiety or serious social anxiety, you will want to find social anxiety help that works fast, and deals with the issue efficiently. However, how do you know where to find the very best sort of social anxiety help for your needs?

Social anxiety assistance can be discovered in a number of different locations, and the type of assistance that is used for your circumstance will depend on how serious the issue is, and what caused the social anxiety in the first place. It is very important to try to determine what is causing the social anxiety to happen so that you can discover a remedy that will prevent it from coming back at a later date.

Among the best places to find social anxiety help is at your local retail store or grocery store where there will be a variety of different medications and stress relievers offered. These treatments are frequently used when the social anxiety cannot be controlled with stress relieving methods are ineffective, or social anxiety occurs with some regularity to the individual.

The social anxiety assistance in pill form that is purchased from these facilities can be natural treatments that contain no medication, over the counter medicines, or strong prescription medicines that are intended to be used sparingly when the individual is suffering from social anxiety.

The various kinds of medications that can be taken for social anxiety help can come in a variety of various forms. Some individuals like medications that come as a drinkable solution, while some others like chewable tablets that can be carried with them at all times.

There are thick liquid syrups offered that can be used for social anxiety assistance, and pills that can be taken once a day to prevent the event of social anxiety for twenty four hours or more. The kind of social anxiety help that is chosen will depend upon which ones are easier for the individual to take, and which brands are the most effective.

If the social anxiety is returning regularly, or the problem is too serious to be dealt with by nonprescription treatments, then the person may want to consider obtaining social anxiety assistance from a therapist. The assistance obtained from the therapist is usually a lot more intensive and long ranging than anything that can be accomplished with medicine.

Some insurance companies might require the person to get a referral from their physician prior to starting treatment, however, oftentimes, the therapist sessions will be covered by the insurance company. This sort of social anxiety assistance is normally the most costly approach of acquiring assistance, and has to be done on a regular schedule for the therapy to be effective.

What You Need To Understand About Social Anxiety Medicine

Individuals that experience social stress and anxiety are always looking for solutions to eliminate the symptoms of the condition so that they feel relaxed in social situations. There are a number of different treatment techniques that can be utilized for treating social anxiety, however, the most popular method appears to be using a social anxiety medicine. The number of people that are helped by social anxiety medicine increases each year as more and more individuals decide that medication is their best choice.

A social anxiety medicine is typically a medication that is identified as an anti-depressant or anti-anxiety medicine. Since depression and stress are commonly pinpointed as 2 of the main reasons for the condition, treating it with these medicines reduces the intensity of the symptoms and helps them weaken the stress of many different sorts of social situations. Some social anxiety medication can be acquired over the counter, while some others are strictly obtained by a physician’s prescription.

Most sorts of social anxiety medicines work by altering the amount of the chemical serotonin present in the brain which controls the individual’s mood, and minimizes the amount of stress that they are feeling. Reducing the amount of anxiety the person is feeling can help the person manage the stress in their life. The levels of the chemicals in the brain likewise impact the person’s mental skill, and if the levels are imbalanced, other mental conditions may be the result.

Using a medicine for social anxiety can be dangerous, because of the threat of dependence on the medicine. Some individuals discover that they end up being unable to be a part of any social situations without taking the medicine first, while others discover that they are taking more and more of the medicine to attain the desired effects. If an individual discovers that they are becoming dependent on the medication, they ought to stop taking it and consult their physician immediately.

The adverse effects connected with using a social anxiety medication can vary, much like taking various other sorts of medications. The most typical side effect linked to taking a social anxiety medicine is a feeling of grogginess during the day, or a decrease in the reflexes of the body. Other side effects include congestion, headaches, and loss of balance. In many cases, the negative effects will begin to disappear over time if the person uses the medicine on a regular basis.

Social anxiety medicine can only be effective if the reason for the development of social anxiety is stress or worry. If the social anxiety is triggered by something else, like a medical condition or a different medicine, then this treatment approach might be ineffective. It is necessary to understand what triggers the social anxiety prior to deciding on a treatment approach for the condition. A social anxiety medicine will only be effective in specific cases.

Handling Social Anxiety Disorder

Dealing with social anxiety disorder can be incredibly painful for a lot of people. It is often difficult for an individual to come to terms with social anxiety, and getting treatment for it can be unpleasant.

That is because the person may have to put themselves in an undesirable circumstance in order to face the problem. This can be done through group counseling sessions, or even with the aid of a prescription prescribed by a doctor. Everyone may require a range of various approaches to help them conquer social anxiety.

Thankfully, there are a variety of things a person can do by themselves to help relieve the symptoms of social anxiety disorder. By taking advantage of these pointers, it might just be enough to take the edge off of those awkward social situations that you could be fearing.

The first thing that everybody can do to help themselves deal with social anxiety disorder is to get lots of rest. By getting a great night’s rest every night, you can help your body feel more rested and at ease. This can enable you to handle social situations much better. Lack of rest can cause tiredness, which might intensify the symptoms that social anxiety disorder could cause.

If you are dealing with social anxiety disorder and you also happen to be a cigarette smoker, consider stopping. Most people nowadays understand that cigarettes have a powerful ingredient called nicotine inside of them. Nicotine is a stimulant which is the last thing somebody struggling with social anxiety needs. The object is to remain tranquil when handling social anxiety, not excitable.

Coffee enthusiasts could also suffer in the very same way that a smoker does in public circumstances. This is since coffee includes a lot of caffeine which is likewise a stimulant. Consider drinking an alternative drink in the early morning that will enable you to avoid consuming the caffeine, or think about switching to decaffeinated coffee. As soon as you remove the additional caffeine that you consume, you will hopefully notice that the symptoms of social anxiety disorder ease up a bit.

Lots of people think drinking alcohol is an excellent way to calm the nerves. In fact, people may even consider drinking prior to having to deal with a public scenario that could be incredibly uncomfortable. This is not a good idea, as alcohol can worsen the feelings of social anxiety disorder and should be avoided to help relieve the burden.

Finding out about Stress and Anxiety Drug Treatment

If you or someone you know suffer from anxiety, then no doubt the greatest thing on your mind is discovering some sort of treatment that is going to provide you the results and relief that you are trying to find. For people who do not have stress and anxiety themselves, it is quite hard to comprehend, but, when an individual is dealing with stress and anxiety, it can be one of the most devastating sensations ever.

Anxiety produces a feeling of constant panic, where the flight or fight response of the body kicks in. To put it in terms that the average person can comprehend, picture a scenario that would frighten you. Let’s say your house was getting broken into in the middle of the night.

Your heart would start racing, your mouth would go dry, you would be shaking and afraid; this is the fight or flight response, and it is the feeling that anxiety sufferers have all the time. They may likewise suffer from panic attacks, which are bouts of panic that often have them feeling as though their heart is going to beat out of their chest or make them feel as though they are going to have a heart attack.

Stress and anxiety can be exceptionally hard to deal with. The individual will feel totally stressed and troubled, but they feel too embarrassed to do anything about it. That is where treating anxiety comes into play, and although there are numerous different alternatives here, one of the most sought after is the anxiety drug therapy.

Among the major reasons that stress and anxiety drug therapy is so popular is since it works almost immediately. Although the full results of stress and anxiety drug treatment may not be seen for approximately six weeks after the individual begins the stress and anxiety drug therapy, they will normally see at least a remote difference within the first week or so.

Nevertheless, there are also specific problems that may occur which you are going to want to be aware of. For one, some medicines may end up making you feel even more anxious, and some individuals are so anxious to start with, that they feel as though they might die if they take the medicine they were given.

It is really all a matter of starting on the right anxiety drug therapy, and this means working closely with your physician and seeing to it that you keep them abreast of your condition, and whether you are making any improvements.

Natural Treatments For An Anxiety Attack

Dealing with an anxiety attack is essential and must not be taken for granted. Many people who struggle with anxiety think that the issue will solve itself and will not need any follow up. Treating an anxiety attack is of utmost importance to decrease any development of psychological issues which could be detrimental to the person’s wellness, both mentally and physically.

In many cases where stress and anxiety does not take place often, this could hold true however in cases where attacks boost in frequency your focus ought to count on efficient anxiety treatments and therapies. Dealing with an anxiety attack will be dependent on the intensity or the extent of the case. Moderate cases of anxiety could require simply some self help or self realization for the individual to manage or handle it, or to completely eliminate it.

There is no certain root of why people deal with stress and anxiety. Many researchers blame bodily hormones that act up when the individual is confronted with a situation that could be out of his/her control. This is the reason treating anxiety attacks can be tough, especially for severe cases. Dealing with stress and anxiety attacks of the serious or extreme range may need some professional help. There are many experts who can attend to conditions like these.

The reason why it is essential to concentrate on dealing with stress and anxiety attacks is due primarily to how one sees oneself. Without treating a stress and anxiety attack, the individual might be less positive and prone to worried breakdowns, state of mind disorders or mental concerns. This is highly feasible because not dealing with stress and anxiety attacks can speed up the development of psychological illnesses along with promote reduced self esteem. Dealing with an anxiety attack is very important for the development of an individual’s personality and self confidence.

Exactly how a specific indivisual acts in society can likewise be impacted by having a stress and anxiety condition. The way he or she associates with other individuals and deals with others can be hampered by a stress and anxiety condition.

There are many means of treating an anxiety condition, including natural and organic therapies. Massage is one way of dealing with stress and anxiety attacks and minimizing their incidents. Massage combined with aromatherapy is also a terrific way to unwind and to keep your mind in balance. Other optional therapies are plain aromatherapy to calm the nerves and to unwind the mind. Acupressure and acupuncture are also recommended although massage is more reliable given that there is less trepidation with it.

Unique Mindcare offers a safe and efficient drug-free non-invasive treatment choice for people experiencing stress and anxiety or anxiety attacks. With our partnership with Nexalin Technologies we supply an FDA accepted treatment system called transcranial electric stimulation which has shown terrific success in the effective therapy of anxiety disorders. Contact our Houston office today to find out more on this amazing development in natural anxiety therapy.

General Anxiety Disorder: What It Is, Its Causes, And Treatments

General anxiety disorder (GAD) is among the most usual types of anxiety disorders, and it is a condition that is defined by continuously worrying, in addition to feeling panicky about nothing worse than ordinary and simple daily occurrences.

The worry, which to a logical person is wholly unjustified is so severe that it will considerably degrade the quality of life of the sufferer. It is essential to understand what general anxiety disorder is, what its symptoms are in both psychological as well as physical terms, and how the condition can be treated.

Common general anxiety disorder symptoms consist of feeling lightheaded and experiencing headaches, as well as observing that the heart has actually begun palpitating, and there is also a particular amount of tiredness felt as well. In addition, the signs of general anxiety disorder include profuse sweating, in addition to becoming an insomniac and the muscles may also begin to twitch uncontrollably.

Doctors will have to first look at the symptoms of general anxiety disorder, and take note of the frequency, and the condition will only be diagnosed as GAD in case specific symptoms continuously happen over a period of six months at the very least. When the medical diagnosis has been made, the doctor will then recommend appropriate general anxiety disorder treatment that commonly involves the taking of anti-anxiety medicine consisting of sedatives, and there is also a need to go through cognitive behavioral therapy. Even yoga, along with various other relaxation methods, can help to get rid of general anxiety disorder.

It is disheartening to note that in the United States alone, an estimated, it is believed, over six million Americans suffer from general anxiety disorder, and the actual figure might in fact be even higher. What’s more, GAD can frequently be misdiagnosed, and even undiagnosed, meaning that in truth, the numbers of Americans affected by this condition could be as high as tens of millions of individuals. Also, GAD affects adults in addition to children in equal numbers.

Though the specific cause of general anxiety disorder is yet to be discovered, it is presumed that the trouble takes place due to hereditary factors, and also because of certain sorts of lifestyles. Thankfully, there are numerous treatment methods available that can help control and minimize the symptoms of GAD.

Anxiety disorder signs generally manifest themselves as behavioral, along with physical indicators that are noticed right away, as well as during an attack of anxiety disorder. They manifest themselves in the form of the inability, along with the fear of being able to interact effectively with others.

Different Kinds of Anxiety Disorders

Stress and anxiety helps individuals face threats, along with challenging circumstances, and it also helps individuals to deal with external threats. Nevertheless, some people are not so lucky as you and I, because they have to suffer from anxiety that persists over time, and which is also mostly irrational.

Such individuals are considered to be suffering from a condition known as an anxiety disorder which has a variety of causes, as well as causes that in turn, when studied, helps physicians identify the sort of anxiety disorder an individual is experiencing.

The most common kind of anxiety condition is the one that is described as general anxiety disorder (GAD), which has characteristics such as lengthy durations of anxiety that is unjustified, but still present over a time frame. GAD is a condition in which the person experiencing it is incapable of describing their stress and anxiety, and which is an issue that also seems to affect women more than men. Typically, this form of anxiety disorder lasts for about six months, and it continues and causes the sufferer to experience dizziness, headaches, as well as become insomniacs, and there is also some amount of palpitation of the heart felt also.

Some people establish particular fears, and this type of anxiety disorder is unique in that the sufferer is not able to find a reason for their irrational fear of specific objects or scenarios. It is not the same as regular fears that most people experience, as the fear being felt in this case is intense, and causes nauseous sensations, along with shortness of breath, hand shaking, and a palpitating heart.

Another kind of anxiety disorder is the one described as post-traumatic stress disorder that occurs in individuals that have suffered a severe and emotionally upsetting, traumatic experience such as having undergone a threat to their lives, or even having experienced somebody’s death. Occasionally, such people come into contact with particular stimuli that cause them to link the stimulus with the past distressing activity and this in turn will cause a post-traumatic stress disorder.

Other forms of anxiety disorder consist of obsessive-compulsive disorders, panic disorders, and social fears. Individuals that are affected by obsessive-compulsive disorders will have a continuous fixation and/or compulsion, where undesirable thoughts and images preoccupy their minds, and any attempt to suppress these thoughts will lead to the exacerbation of the thoughts, rather than the suppression of the disturbing thoughts.

Panic disorders have certain traits such as the reappearance of panic attacks that happen suddenly. Social fears cause a person to believe that they are the center of everyone’s attention, even when that is not the case.