How To Learn With ADD

How to Learn Best with ADD/ ADHD

I want to talk about learning with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). I have been working with patients with ADD/ ADHD for over 30 years. In that time, I have helped people pass exams of all sorts: the bar, CPA exam, medical boards, police entrance exam, lieutenant exam, marine captain exam, ACT, SAT, MCAT’s, LSAT’s, marine captain’s license, firefighter exams, pilot exams, GED’s, on and on. It’s a unique situation, because people with ADD/ ADHD have specific study methods that work, but may not be the conventional way. They have a distinct problem with concentrating while sitting. They cannot just sit there and read and incorporate the information they read, it just won’t work. They also do not do well sitting and listening, so sitting in a lecture will do little to no good. Large groups are virtually impossible. Sitting in a group of 500 people listening to a professor during a freshman English lecture is useless for someone with ADD/ ADHD, it’s a waste of time. Studying and learning may be more challenging for those with ADD/ ADHD, but it’s definitely doable, so if you have either of these diagnoses, don’t use it as an excuse! Based on my experience listening to literally thousands of patients with ADD/ ADHD, I’ve come up with 15 guidelines on study methods and the do’s and the don’t’s that will help to process, incorporate and recall information in preparation for any test.

Before I get to those, a quick note. Your diagnosis is your business, but if you do choose to inform your teacher(s) or prof(s), you may find they’re willing to help you by possibly giving you more exam time, giving you extra materials (like questions or even practice tests) or by giving you one-on-one time to guide you as to what topics or ideas are most important. This may not be possible in professional exams or standardized exams, but if it’s a grade 1 to 12 school or even a college situation, it’s very likely they’ll assist you. Often they have policies in place already, so if you do have the diagnosis, don’t be afraid to tell them and ask for help. You certainly can’t be penalized in any way for doing so. If you do feel comfortable disclosing the diagnosis, a guidance counsellor is a great place to start. Now for my guidelines.

1. Do not just sit and read, do not just sit for lectures unless they’re required, and do not just sit (get my drift?) and watch something being done and expect to learn from it the way others might. It won’t necessarily hurt you, but your time might be better spent learning in a different way. If you do go to lectures, maybe use that time to create questions on the material as the teacher or prof drones on about it….insert Charlie Brown teacher soundbite here….wahn wahn waaahhhn waahnn wahhnnn wahn…. More on questions later.

2. With ADD/ ADHD, you will learn best by using interactive methods. Tutorswork very well whether you have ADD/ ADHD or not. Group interaction works well too, so start a study group. Better yet, combine the two- start a study group and have everyone pitch in to pay a tutor to help study for exams. Working with an interactive computer program would be great, a program where it asks you a question and you choose an answer and enter your choice. Some textbooks have those types of study aids online, so check out whatever resources exist at the end of chapters in your textbook, whether it’s online or printed.

3. Never cram for a test! Study over a prolonged period- this will allow you to “sleep on it,” which will help you retain more of the material. During sleep, the brain rehashes the information you’ve learned. Reviewing it over several days will increase the odds that you will better understand the material and remember more of it. And always do a before bed blitz… Studies show that you remember more when you take 10 to 15 minutes to review material you’ve studied or learned just before you go to sleep. Obvi, don’t do all of your studying at bedtime, just do a quick review so the brain processes the information as you sleep. And be sure to catch enough shut eye. Experts say that most people need to sleep eight to nine hours a night to remember what they’ve learned, and teens need even more than that.

4. Study the material, not the clock. When you sit down to study, note the time you start, but do not study by the length of time spent studying. Instead, study by the amount of material you cover; ie decide to cover x number of chapters, and do not stop until you know that material. And while your goal is to cover x amount of material, do try to make your study sessions last as long as the time allotted for the exam. This will start habituating your mind to be active for (and be able to sit for) a 2- or 4-hour exam or whatever the case may be.

5. When you sit down and study, treat it like it is an exam, don’t get lazy and knock off early. When you sit down and study, you sit down and you rock and roll, you pretend like you are in an exam situation. If you’re not willing to sit down and put your mind in an exam situation, then studying is a waste of time. Train your mind to be in the exam. Pretend you are in the exam so that when you do get in the actual exam, you are well practiced, your body is habituated for that situation, and everything comes more easily.

5. Learn to study anywhere, anytime. You don’t know the exam situation: if the person next to you will be coughing, if the clock on the wall will be ticking, ifthere will be noise outside, if you can hear the sound of the street, if the overhead lights are buzzing, if the fan is clicking rhythmically, etc. Break up your study locations or study in different situations so that you learn to adapt. Plus, you can get superstitious if you always study in the same place…I’ve had patients tell me they can only learn in one particular place- their room, kitchen, or the library. Also, you may find that you increase your focus and motivation for studying by seeking out locations outside of your house or room, like a Starbucks. 

6. When you read questions, read very carefully! This is key. If you have study questions, read carefully to prepare yourself to do so in the actual exam, because obvi, that’s where it matters. Remember to pay very close attention to words like yes and no and phrases like the most, the least, which one is, which one is not. Also pay close attention to absolutes in questions, words like never and always. Take it from a physician who is dual board certified: critical reading of the question is the most important thing in exams. Focus! Do notread the question quickly and always read it twice to make sure you understand exactly what is being asked. If some key words in the test question are familiar from studying, you might be inclined to just skim the question when you see the words, assuming it uses those words in the same context as they were in the book or study materials. Don’t make that assumption- pay attention and read the question again, even if you’re sure you got it the first time. Maybe the question only has a minor difference, like ‘is’ instead of ‘is not.’ Sometimes your brain can trick you….and sometimes the test maker can too! 

7. Work out every day. Thirty minutes of aerobic exercise a day improves focus and executive functioning skills, especially in students with ADD/ ADHD. It doesn’t matter what you do: sit ups, pushups, squats, planks, running…do it for half an hour every day.

8. Be mindful with socialization. You can study in a work group, but as for going to parties the day before a test, that’s a negatory! Your brain will not have time to regroup before the exam. Actually, it’s better to rsvp no to all parties during the entire study period- not only do you lose that study time, but you won’t be able to redirect your thought processes back into the study mode the next day. Save the party for after the exam, when you hopefully have something to celebrate…knowing you did well! 

9. Drugs. Caffeine helps bigtime, so have coffee and tea on hand when studying and learn to love it. Caffiene and studying are like an AmEx card- you shouldn’t study without it. Other amphetamine stimulants like Adderall are very helpful. Patients I’ve placed on stimulants see a dramatic difference in their ability to study and retain information. It’s a tool for them, just like a number 2 pencil, which btw, don’t forget to have at least three sharpened number 2 pencils and a good eraser so you can fully erase mistakes. This is especially important in scantron tests! If you’re struggling in exams and school and you haven’t tried a stimulant like Adderall, maybe you should ask your physician about trying it. And on the topic of drugs, Captain Obvious says don’t drink or smoke pot because it makes your brain discombobulated for a looooong time! If you do drink and smoke pot, don’t bother wasting time studying. It would be pointless.

10. Set goals. Tell yourself ‘I will get through x amount of material today,’  ‘I will do so many questions today,’ ‘I will be able to recite so much material today.’ Set goals that challenge you, but are attainable. If you have a tutor or are in a study group, it’s much easier to stay on track and stick to goals like these, so if that’s difficult for you, consider going that route.

11. Never ‘kind of’ know something. If, after you have studied and done questions and practice tests, you can close the book and recite what you have just learned, you should be golden. If you can teach the material to a total stranger, you should be golden. Be careful testing that theory though- it would suck to miss the exam because you’re in jail.

12. Always study with a computer or an iPad next to you so that you can look things up if you don’t know the definition of a word or understand a concept. A question may hinge on the definition of a key word, and it would suck to get it wrong because you thought you knew the definition when you studied so you didn’t bother to look it up. That would be the definition of dumb.

13. Questions, questions, questions! Here it is. I’m all up in your grill with questions because they’re the best way to learn if you have ADD/ ADHD. The best way to create questions is to make a practice test. Try to predict what your teacher may ask on the exam. If they give a review in class, you definitely want to be there, because they’re not giving a review just to hear themselves talk. If they give out a study guide, know it, because they didn’t take the time to make it just for funsies. Study old quizzes, making sure you’re using the right answers, and ask classmates what they think is importantenough to be on the test. And then create a practice test. Obvi, that doesn’t mean you should only know the material you put in your practice test. If you study in a group, which you should, have each person create a practice test, and then make copies and distribute to everyone in the group for a better variety of topics. Then go over every test as a group and study those questions. The very best way to prepare for a test is to get a tutor, join a study group, and do questions. That would be the winning trifecta for exam preparation. 

14. Keep a positive attitude. If you have ADD/ ADHD, chances are you beat yourself up throughout your whole life, and people may have even put you down, saying you’re not that smart blah, blah, blah. Well, screw them. You are smart. Study and get excellent grades as a big F.U. to anyone who ever put you down. Know your stuff and stay positive.

15. You must be determined. Have a can do attitude. You must say ‘I will do this at all cost.’ Make success the only option. Yoda said it best: “No try. Do.”

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How To Get People To Like you In Ten Minutes

Through the years I’ve had lots of patients ask me how to interact with people and how to be social, the mechanics of it, so I want to give some rules of the road, social skills 101 if you will. First, let’s talk about why social skills are important. Social skills are the foundation for positive relationships with other people: friends, partners, co-workers, bosses, neighbors, on and on. Social skills allow you to connect with other people on a level that is important in life, a level that allows you to have more in-depth relationships with others rather than meaningless surface relationships that have no benefit to anyone. Once you understand the value of having good social skills, you need to want them for yourself and commit to working on them, because that may mean doing new things that may be uncomfortable at first.  So, how would you start to improve social skills? Well, socialization is an interaction, so you need at least one other person to socialize with. So  the first step is to put yourself among other people. Basically, you have to suit up and show up to socialize. You might feel wierd or shy at first, but don’t let anxiety stop you. If you’re not around other people to socialize with, you’re obviously not going to improve your social skills. So take a breath and dive in.

Step number two, put down the electronics. If you’ve put yourself in a social situation, you may be tempted to fiddle with your phone to avoid the awkwardness of just standing there, but when you’re around people, turn the phone off.  You shouldn’t be disrupted, you can’t be distracted, and you can’t be checking email, messages, notifications, etc. Those things will get you to exactly nowhere. When you’re distracted, you won’t pay proper attention to the social setting you’re in, and since that’s kind of the whole point, put it away and keep it there.

So you’re in a room with plenty of folks to socialize with, your phone is tucked away, so what’s next? Well, if you want to interact with people, socialize with people, you have to look like it. You can’t put yourself in a corner with your arms crossed and a disinterested look on your face. Step three is to demonstrate an open, friendly posture. You need to be inviting to others who may want to talk to you. Put on a friendly face – you’ll be surprised at how many people approach you when you look approachable. 

As they say, the eyes are the entries to the mind. Step four is to always maintain good eye contact. This is hugely important when conversing, but fleeting eye contact also comes in handy when you’re just circulating in a room or looking for someone to strike up a conversation with. Eyes can entirely change a facial expression and easily convey mood and interest. Without eye contact, there is limited communication, and social skills are compromised without appropriate eye contact. Eye contact is so integral to communication that some people say they can tell if someone they’re talking to is being honest or lying by their eye contact, or the lack thereof. 

To communicate well, you must pay attention to your equipment…your speech. So step five is remember your speech: the tone, the pitch, the volume, the tempo, the accent. Right or wrong, people will judge and label you by your voice. A man’s voice that’s too loud is a turnoff, he comes off as a blowhard. A woman’s voice that’s too soft is annoying because people have to try too hard to hear her, and people may say she’s a sexpot, a la Marilyn Monroe. If she speaks at too high a pitch, she’s a bimbo. To some, a southern accent means you’re dumb and a northern accent means you’re a hustler. Speaking too slowly or too fast is annoying, too monotone and you’ll put people to sleep. On the flip side, a singer or actor with perfect pitch or an especially unusual or dulcet tone can build a legacy based just on their voice, a voice that will be instantly recognized for all time. When it comes to the way you speak, be aware and make alterations to be distinct and easily understood. Remember voice inflection, because monotone is a tune-out and turnoff. Speech should be like a story, with highs and lows, ups and downs to hold people’s interest.

After reading step five above, you might think that developing good social skills hinges on everything you say, but that leaves out a key factor…listening. Step six on the path to developing good social skills is to be a good listener. Just listen. Eazy peazy lemon squeazy. Now, if you’ve ever in your entire life enjoyed speaking to someone who clearly wasn’t listening to anything you said, raise your hand. Any takers? Anyone? I thought not. It is annoying AF when it’s so obvious that someone’s not listening to you speak. And you don’t want to be annoying AF, do you? I thought not. Social skills aren’t just about what comes out of a person’s mouth, so listen. 

A great way to deal with nerves that may accompany you when you put yourself in a social situation and talk to people is to find commonality, so this is step seven. When you first meet someone, a sense of commonality is a great way to establish a quick rapport with them. Commonality is something you share. It could be something as simple as going to the same school, a shared interest in sports, same places where you’ve lived or hobbies in common. Step seven is to find commonality with someone; something simple to break the ice and establish a conversation. 

Once you’ve begun a conversation with someone and you want to further it, you need to go beyond just commonalities. You need to relate to the person on a deeper level. How do you do that? Through step eight, empathy. Empathy is the ability to relate to someone by putting yourself in their position in order to understand them better. If someone has a dying parent, has just lost their job, if someone is lonely, has ended a relationship, didn’t get a promotion, or experiences anything that elicits an emotional response, being empathetic is the ultimate understanding of their pain, their sorrow, or their disappointment. Step eight in improving social skills is the ability to put yourself in someone else’s shoes in order to have genuine empathy for that person. A key word here is genuine. As a general rule, good social skills are genuine. Lip service is not part of good social skills.

Step nine is a pretty simple concept, though not so much in practice. Respect. In order to learn good social skills (and have anyone to practice them on) you must respect what other people say. I did not say agree. You can completely disagree with their opinion, but step nine is that you must respect their right to have it and include it in the conversation.  

While in theory you have the right to say anything you want in your social circle, you should watch what you say. Step ten is to consider the content of your conversation. There are certain things that shouldn’t be brought up in some situations. As they say, religion and politics are big no no’s for sure. Gossiping is also on the no list, because it’s really toxic to a conversation and leaves people scratching their heads. If you’re talking about Mary to Connie, Connie’s bound to wonder what you say about her when you’re speaking to Shelly. So it’s best to just not talk about people. But I think it was First Lady Dolly Madison who said “If you don’t have anything nice to say, sit next to me” Some people do like gossip, the jucier the better. But you have to be prepared to pay the piper. A conversation can be like a minefield, with certain subjects as the mines. You have to navigate through the whole conversation without blowing yourself to smithereens.  

In order to have appropriate social skills, you must consider the non-conversational parts of social interaction. If you’re so drunk that you can’t speak or no one can understand what you’re saying, obviously you can’t use good social skills. Same goes for drugs. If you take a Xanax to calm your nerves before the company mixer, you will not have appropriate social skills. You may not think people can tell, but you’d be wrong. Step eleven is  about intoxicants like alcohol, marijuana, benzodiazepines, and Adderall… they all make you act weird and affect your social interactions, and people pick it up right away. They may not know what drug you’re on, but they’ll know you’re on something for sure, because your social interactions will be inappropriate. Rule eleven: you cannot interact appropriately when using drugs or alcohol, so cut both out if you want to have good social skills.

If you follow these steps, you’ll definitely learn better social skills. And a breath mint wouldn’t hurt. Like with anything else, practice makes perfect when it comes to social graces. Be positive, open, honest, empathetic, clear, respectful and sober, and you’ll never be at a loss for people to talk to. You’ll navigate the waters of conversation deftly with give and take, and all included will come out feeling positive about the interaction.

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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.

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Autism Spectrum disorder

Comedian Dan Aykroyd, children’s author Hans Christian Andersen, movie director Tim Burton, naturalist Charles Darwin, poet Emily Dickinson, scientist and mathematician Albert Einstein, chess grandmaster Bobby Fischer, Microsoft founder Bill Gates, actress Daryl Hannah, late Apple CEO Steve Jobs, painter Michelangelo, music composer/ pianist Amadeus Mozart, and artist and cultural influencer Andy Warhol, just to name a few…  

What do all of the above people have in common? Given their fame and success, I bet you’ll never guess. They all have islands of extreme expertise, but all also have social limitations in terms of their abilites to interact with others and their ability to communicate. What does that sound like? What diagnosis do they share? Autism.

Autism spectrum disorder (ASD) is a condition related to brain development that affects how a person relates to and socializes with others, and which also causes problems in communication and social interactions. Replacing just the single word autism, the term “spectrum” in autism spectrum disorder refers to the wide range of symptoms and potential severity of the disorder of autism.

Autism spectrum disorder is said to be a “developmental disorder” because symptoms generally appear in the first two years of life. The disorder extends into adulthood, causing problems with functioning in society, in school, and at work. Children often show symptoms of autism within the first year of life, though signs may be subtle at first. Sometimes children appear to develop normally in their first year, but then exhibit regression between 18 and 24 months of age as they develop autistic symptoms.

Symptoms of ASD

Children can show signs of autism spectrum disorder in early infancy. These include reduced eye contact, lack of response to their name and/or indifference to caregivers. Some children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose the language skills they’ve already acquired. Fairly definitive signs of ASD are usually seen by age two. 

Each child with ASD will have difficulty with social interactions and will exhibit unique patterns of behavior and levels of severity, from low functioning to high functioning.
Some children with autism spectrum disorder may have difficulty learning, and some have signs of lower than average intelligence. Other children may have normal to high intelligence and learn quickly, but have difficulty communicating and applying what they know. Because of the unique mixture of signs and symptoms exhibited in each child, the severity of ASD can sometimes be difficult to determine. It’s generally based on the level of impairment and how that impairment impacts the ability to function.

A child or adult with ASD may have problems with social interactions and communication skills, including any of these signs:

Failure to respond to his/her name or appearing to not hear you at times

Resists cuddling and holding as child

Lacks facial expression

Prefers playing alone, retreats into his/her own world

Exhibits poor eye contact 

Doesn’t speak/ has delayed speech/  loses previous speech ability 

Can’t initiate or further conversation 

Speaks with abnormal tone or rhythm; may use a singsong voice or robot-like speech

Repeats words or phrases verbatim, but doesn’t understand meaning

Doesn’t appear to understand simple questions or directions

Doesn’t express own emotions/ feelings and is unaware of others’ feelings

Inappropriate aggression or disruption to social interactions of others 

Difficulty recognizing nonverbal cues, interpreting other people’s facial expressions, body postures, or tones of voice

A child or adult with ASD may exhibit limited and repetitive patterns of behavior, including any of these signs:

Performs repetitive movements, such as rocking, spinning or hand flapping

Develops specific routines or rituals, becomes disturbed at the slightest change

Performs self-harming activities, including biting or head-banging

Is unusually sensitive to light, sound, and/or touch, yet can be indifferent to pain or temperature

Has problems with coordination or exhibits odd movement patterns, such as clumsiness, walking on toes, and odd, stiff, or exaggerated body language

Is fascinated by small details of an object without understanding the overall purpose or function of the object. Ex: spinning wheels of a toy car

Doesn’t engage in imaginative or make-believe play

Fixates on an object or activity with abnormal intensity or focus

Has very specific food preferences: eats very few foods/ refuses certain textures

A child or adult with ASD may exhibit other signs and symptoms, such as:

Unusual Touch and Sound Sensitivities: They may recoil when touched, and/or may be extremely hypersensitive to certain sounds

Seizures: Approximately four out of ten people with ASD suffer from seizures; most commonly occurs in childhood or entering teenage years and in those with more severe cognitive impairment.  

Bowel Disorders: People with ASD tend to have more gastrointestinal symptoms such as abdominal pain, constipation, and diarrhea than peers

Placing Inedible Objects in the Mouth: While it is common for babies and toddlers to put toys or other inedible objects in their mouths, older kids with autism may continue to do this even as they age. Some children have been known to put items like soil, chalk, and paints into their mouths, which means supervision is a must to prevent them from eating something toxic or choking on an object.

Sleeping Issues: Getting a child to sleep at an assigned time can be hard, but children with ASD often have different sleep patterns. ASD interferes with the “working clock” that regulates sleep patterns. Many children with ASD with sleep problems will have the problem in adulthood as well. 

As they mature, some children with autism spectrum disorder become more engaged with others and show fewer behavioral disturbances, but some, usually those with the least severe problems, may end up leading normal or near-normal lives. But others continue to have difficulty with language or social skills, and for them, the teen years can bring even worse behavioral and emotional problems.

When to see a doctor

Babies develop at their own pace…they don’t necessarily follow the developmental timelines that Dr. Spock or other parenting book authors lay out. But children with autism spectrum disorder usually show some signs of delayed development before they are two years old. If you’re concerned about your child’s development or suspect that your child may have ASD, discuss your concerns with your pediatrician, as some ASD symptoms can look like other developmental disorders.

Your pediatrician may recommend developmental tests to identify if your child has delays in cognitive, language and social skills, or if your child doesn’t meet certain timelines:

Doesn’t respond with a smile or happy expression by 6 months

Doesn’t mimic sounds or facial expressions by 9 months

Doesn’t babble or coo by 12 months

Doesn’t gesture, point or wave by 14 months

Doesn’t say single words by 16 months

Doesn’t play “make-believe” or pretend by 18 months

Doesn’t say two-word phrases by 24 months

Loses language skills or social skills at any age

Causes of ASD

Autism spectrum disorder has no single known cause. Given the disorder’s complexity and the fact that symptoms and severity vary, there are probably many causes, with genetics and environment likely playing larger roles.

Genetics: Several different genes appear to be involved in ASD. For some children, ASD can be associated with another genetic disorder, such as Rett syndrome or fragile X syndrome. For other children, genetic mutations may increase the risk of autism spectrum disorder. Other genes may affect brain development or the way that brain cells communicate. Some genetic mutations are inherited, but others occur spontaneously.

Environmental factors: Researchers are currently exploring whether factors like viral infections, medications, complications during pregnancy, or air pollutants play a role in triggering autism spectrum disorder.

Not from childhood vaccines: One of the biggest controversies in autism spectrum disorder centers on whether childhood vaccines can cause ASD. Despite extensive research, no reliable study has shown a link between autism spectrum disorder and any vaccines. In fact, the original study that ignited the debate years ago has been retracted due to poor design and questionable research methods. Not only do vaccines not cause ASD, but 
avoiding childhood vaccinations can place your child and others in danger of catching and spreading serious diseases, including whooping cough (pertussis), mumps, and/or measles. So don’t let the fear of ASD keep you from allowing your child to have their vaccines. 

Risk factors for ASD

The number of children diagnosed with autism spectrum disorder is rising. It’s not clear whether this is due to better detection and reporting or a real increase in the number of cases, or a combination of the two.
Autism spectrum disorder affects children of all races and nationalities, but certain factors increase a child’s risk. These risk factors may include:

Your child’s sex: Boys are about four times more likely to develop autism spectrum disorder than girls are.

Family history: Families who have one child with autism spectrum disorder have an increased risk of having another child with the disorder. It’s also fairly common for parents or relatives of a child with autism spectrum disorder to have minor problems with social or communication skills themselves or to engage in certain behaviors typical of the disorder.

Other disorders: Children with certain medical conditions have a higher than normal risk of autism spectrum disorder or autism-like symptoms. Some examples include fragile X syndrome, tuberous sclerosis, and Rett synsyndrome.

Extremely preterm babies: Babies born before 26 weeks of gestation may have a greater risk of autism spectrum disorder.

Parental ages: Children born to older parents may be more likely to develop ASD, but more research is necessary to fully establish this link.

Complications of living with ASD

The problems that come with ASD in terms of social interactions, communication, and behavior can lead to issues in life, including:

Problems in school and successful learning

Employment problems

Inability to live independently

Social isolation

Stress within the family

Victimization and being bullied

Prevention of ASD

There is no way to prevent autism spectrum disorder, but there are some treatment options. Intervention is helpful at any age, but early diagnosis and intervention is the most helpful to improve behavior, skills and language development. While children don’t usually outgrow autism spectrum disorder symptoms, with work, they may learn to function well within their environment.

Diagnosis of ASD

Your child’s doctor will look for signs of developmental delays at regular checkups. If your child shows any symptoms of autism spectrum disorder, you’ll likely be referred for an evaluation to a specialist who treats children with autism spectrum disorder, such as a child psychiatrist/ psychologist, pediatric neurologist or developmental pediatrician.

Because autism spectrum disorder varies widely in symptoms and severity, making a diagnosis may be difficult. There isn’t a specific medical test to definitively diagnose the disorder. Instead, a specialist will make observations. These may include:

Observing your child’s development, social interactions, communication skills and behavior; done over time to determine if there have been changes.  

Give your child tests which will cover hearing, speech, language, developmental level, and social and behavioral issues.

Score your child’s social and communication interactions.

Include other specialists in order to definitively determine a diagnosis.

Recommend genetic testing to determine if your child also has a genetic disorder such as Rett syndrome or fragile X syndrome.

Treatment for ASD

While there is no cure for autism spectrum disorder, early and intensive treatment can make a big difference in the lives of most children with ASD. The goal of treatment is to maximize your child’s ability to function by reducing ASD symptoms while also supporting development and learning. Early intervention during the preschool years can help your child learn critical social, communication, functional, and behavioral skills that will make a huge impact on their adult lives.

The range of ASD “therapies” you’ll find on an internet search can be very overwhelming. If your child is diagnosed with autism spectrum disorder, talk to experts about creating a treatment strategy and build a team of professionals to meet your child’s needs.

Some ASD treatment options may include:

Behavioral and communication therapies: Many programs address the range of social, language, and behavioral difficulties associated with ASD. Some programs focus on reducing problem behaviors and teaching new skills. Other programs focus on teaching children how to act in social situations or how to communicate better with others. Applied behavior analysis (ABA) can help children learn new skills and apply these skills through a reward-based motivation system.

Educational therapies: Children with ASD often respond well to very structured educational programs. Successful programs typically include a team of specialists and a variety of activities to improve social skills, communication and behavior. Earlier intervention is better, and preschool children who receive intensive one on one behavioral intervention show more progress.

Family therapies: Parents and other family members can learn how to play and interact with their children in ways that promote social skills, manage problem behaviors, and teach communication and other daily living skills.

Other therapies: Depending on your child’s needs, they can have speech therapy to improve communication skills, occupational therapy to teach activities of daily living, and physical therapy to improve movement and balance. Any and all of these may be beneficial. Adding a psychologist to address problem behavior is also beneficial.

Medications: There are no specific medications to improve the core signs of autism spectrum disorder, but some medications can help control specific symptoms, including hyperactivity, behavioral issues, and anxiety. Always keep all health care providers updated on all medications or supplements your child is taking, as some can interact and cause dangerous side effects.

Some ASD takeaways

Autism spectrum disorder is a developmental disorder that causes problems with communication and social interactions. There are no specific tests for autism spectrum disorder, the diagnosis is made by observation and process of elimination. There are no one-size-fits-all therapies for autism spectrum disorder. Early detection and intervention are of utmost importance and make a greal deal of difference in determining the person’s likely functional level in adulthood. If your child exhibits some of the characteristics defined above, it is best to see your pediatrician for an evaluation.

For information on other psychiatric diagnoses and patient stories and experiences, please check out my book, Tales from the Couch, available on Amazon.com. 

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Let’s Talk About Ambien

Ambien, generic name zolpidem, is the most commonly prescribed sleep aid, accounting for 85% of prescribed sleeping pills. It also ranks in the top 15 on the list of most frequently prescribed drugs in the country. Its popularity is clearly due to its efficacy. Zolpidem works as a hypnotic drug, meaning that it induces a state of unconsciousness, similar to what occurs during natural sleep. How does it do that? Zolpidem affects chemical messengers in the brain called neurotransmitters, specifically a neurotransmitter called GABA. By affecting GABA, it calms the activity of specific parts of the brain. One of the areas in the brain that is affected is the hippocampus. Along with other regions of the brain, the hippocampus is important in the formation of memory. Because of this hippocampal involvement, 

zolpidem can cause memory loss, especially at higher doses, an effect colloquially referred to as “Ambien Amnesia.” If you take it and do not go to bed immediately as recommended, this is more likely to occur. When you get right in bed after taking it, a loss of memory is inconsequential…it doesn’t matter if you can’t remember lying awake for a few minutes before falling asleep. But there are many reports of people taking it and remaining awake and out of bed, and they commonly experience an inability to recall subsequent events shortly after taking it. Because of its effects on memory, there is some concern that zolpidem could affect long-term memory and contribute to the development of dementia or Alzheimer’s disease, though there has been no research to prove or disprove these possible associations. Zolpidem comes with a host of known side effects that range from weird and wacky to illegal and downright dangerous behaviors. Included are hallucinations, decreased awareness, disinhibition, and changes in behavior. Very serious problems may occur when someone who has taken zolpidem gets up during the night. They may exhibit very complex sleep-related behaviors while under the influence of zolpidem. These might include relatively innocuous sleeptalking, sleepwalking, sleep cleaning and sleep eating, to more disturbing behaviors like sleep cooking and sleep sex, to potentially deadly sleep driving. While in a confused state, a person on zolpidem may act in a way that is different from their normal waking behavior. This can lead to legal consequences, such as driving under the influence (DUI) or potentially even sexual assault charges stemming from disinhibited sexually charged behavior. 

I have a long time patient named Deanna that takes zolpidem and regularly sleepwalks, also known as somnambulation for the Scrabble set. It happens that she has been a sleepwalker ever since she had the ability to walk, so being on the zolpidem now makes her nocturnal activities and behaviors really way out there. Just flipping back through her chart, I see she mentions: taking apart electronics and trying to put them back together with no success. Dumping all of her shoes out of their boxes onto her closet floor. Taking all of her clothes off their hangers and throwing them over her dining room chairs. Gathering all sorts of disparate items together, evidently whatever catches her eye at the time, and putting them in her oven. She said she learned that particular lesson the hard way. This one is whacked. She started “painting” a wall in her house….with a purple sharpie. She showed me a picture of that. She once found several pages of her stationery scrawled in words she knew she didn’t consciously write in a letter to someone, she didn’t know who. She brought that in. She said she would evidently clean in her sleep; she put shower gel all over the tile in her shower and “put things away” in odd places they didn’t belong in. She also sleep eats. Cereal, bread, ice cream, whatever she sees that looks good I guess. She regularly wakes up to a mess in the kitchen and destruction in the house. It used to really freak her out to see the evidence of activities she didn’t remember, but now she just feels unsettled as she surveys the damage from her night time escapades. But since it hasn’t ever been anything dangerous and because zolpidem works well for her, she doesn’t want to change it. 

How is it that a person on zolpidem can achieve these complex behaviors while unconscious and asleep? It’s because the parts of the brain that control movement still function, but inhibition, consciousness, and the ability to create memory is turned off. Because of this, the person is disinhibited, and that can lead to unintentional actions and behaviors as discussed above.

Beyond zolpidem’s effects on memory, awareness, and behavior, there may be additional issues associated with its use. Some other common side effects include:

– “Hangover” or carry-over sedation,               especially in women

– Headaches

– Loss of appetite
– Impaired vision
– Slow breathing rates
– Muscle cramps
– Allergic reactions
– Memory loss
– Inability to concentrate
– Disorientation
– Emotional blunting
– Depression and/or suicidal thoughts
– Anxiety
– Nightmares
– Sedation
– Confusion
– Dizziness
– Delirium

– Aggression
– Back pain
– Diarrhea or constipation

– Sinusitis (sinus infection)
– Pharyngitis (sore throat)
– Dry mouth
– Flu-like symptoms
– Seizures

– Breathing difficulties
– Palpitations (irregular heartbeat)
– Rash
– Rebound insomnia

Any of these side effects could be bothersome and may interfere with the continued use of the medication. Sometimes the benefits of zolpidem outweigh the risks and/or side effects. If a symptom is particularly bothersome, discuss this with your prescribing doctor to see if an alternative treatment may be a better option for you.

If you take zolpidem, use it exactly as prescribed and get in bed immediately after taking it. It’s best to allow yourself at least 7 to 8 hours of sleep to help ensure avoidance of morning hangover effects. Keeping a regular sleep-wake schedule will also help. Taking zolpidem with other drugs that depress the central nervous system such as alcohol, opioid pain medications, or tranquilizers intensifies the sedative effects of zolpidem and increases the risk of overdose as a result of respiratory depression. Zolpidem is an abusable drug. Individuals who take it for non-medical reasons or at more than prescribed doses are at risk of experiencing intensification of adverse side effects, including the following:

– Excessive sedation
– Confusion and disorientation
– Lack of motor coordination
– Slow response times
– Delayed reflex reactions
– Dizziness
– Hallucinations
– Impaired judgment
– Aggression
– Seizures

– Withdrawl

Men and women don’t metabolize zolpidem in the same way. Women metabolize it much more slowly, so they often wake up with a zolpidem hang over and feel cloudy in the morning. So an important note for women taking zolpidem is to be extra cautious about allowing at least 8 hours of sleep after taking it and to take lower doses of it due to the potential effects on morning function, especially driving. 

Actor Roseanne Barr had probably taken a little too much when she “Ambien tweeted” a racist statement comparing an Obama aid to an ape. She admitted that she had taken zolpidem shortly before the 2am tweet that caused her eponymous show to be cancelled. Elon Musk, Mr. Tesla, can feel her pain. He shocked investors when he tweeted he was considering taking Tesla private at $420 a share and that funding was secured. He said he sometimes takes zolpidem because it’s either that or no sleep. Good thing he has people to protect him from himself when he’s in a zolpidem daze.

Zolpidem can be a safe and effective medication to treat insomnia, but if it affects your memory or causes sleep behaviors or other adverse side effects, you should probably consider alternative treatments for your insomnia. Hello Roseanne and Elon…that means you!!

I talk more about drugs for sleep like zolpidem and a host of other psychoactive drugs in my book, Tales from the Couch, available on Amazon.com.

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Marianne asks “how can I get off klonopin’’

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

What are they?

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

How do they work?

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

Why can using them be problematic?

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

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

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

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

What about withdrawl from benzos?

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

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

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

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

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The Dangers Of Alcohol

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

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

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

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

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

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

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

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

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

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

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

-Memory loss

-Loss of attention span

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

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

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

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

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

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

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

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

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Attention Deficit Disorder and Attention Deficit Hyperactive disorder

Attention Deficit Disorder

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

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

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

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

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

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

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

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

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Depression…What can you do to help yourself?

Let’s talk about depression. First, understand that like most things in life, depression is a spectrum; it is not black and white. Some people have situational depression or very mild depression and do really well with therapy and making some simple life changes. Others might need medication to assist them. Some unfortunately suffer from major depression and find it hard to cope with life.

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Handling Clinical Depression Symptoms

Individuals often speak of feeling depressed. Indeed, it is common to feel periodic sadness due to life’s
disappointments. Clinical depression, on the other hand, is quite different from those times when we experience
unhappiness or despair.

Clinical depression is a serious disease caused by a brain disorder, and its effects on the individual’s ability
to perform in daily situations is profound. The condition can impact moods, thoughts, habits, and physical
wellness.

According to the National Institute of Mental Health (NIMH), depression strikes about 17 million American adults
every year. This is more than the amount of cases related to cancer, AIDS, or coronary heart disease. What makes
it even worse is that an estimated 15 percent of people dealing with depression ends in suicide.

Dealing with depression could appear like a daunting task. Some people don’t even comprehend the real nature of
the disease. “Many people still believe that depression is a character defect, or caused by bad parenting”, says
Mary Rappaport, a spokeswoman for the National Alliance for the Mentally Ill. It needs to be noted that taking
care of depression does not merely involve willpower. It requires proper medical attention.

The good news is that depression is treatable. In fact, among the initial steps of taking care of depression,
consists of making use of either of the two major treatment options available; medication or therapy. First, a
proper medical diagnosis must be obtained before one can go on with dealing with depression.

When identifying and dealing with depression, it is necessary to keep in mind that that there are three primary
classifications of the condition. These are major depression, dysthymia, and bipolar depression (otherwise known
as manic depression).

The symptoms for each category of depression can differ, depending upon the person. And there are numerous
factors that serve to increase the risk of depression. According to the American Psychiatric Association’s
Diagnostic and Statistical Manual, the following are the typical symptoms of depression as noted in the DSM-IV:
depressed mood, loss of interest or pleasure in nearly all activities, changes in appetite or weight,
interrupted sleeping patterns, slowed or restless movements, fatigue, loss of energy, feelings of worthlessness
or extreme guilt, difficulty thinking, focusing, or making decisions, and even recurrent thoughts of death or
suicide.

Antidepressant medicines are often prescribed as a step in dealing with depression. These medicines, such as
tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin re-uptake inhibitors, work by
modifying particular chemicals in the brain, such as serotonin. This leads to improved symptoms of depression,
and can assist in taking care of depression.

Alternatively, persons dealing with severe depressive episodes may not be responsive to medication alone. In
order to offer long term relief, psychiatric therapy is required.

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Managing A Depressive Disorder

At some point in our lives we might experience depression. Depression is described as a feeling of unhappiness,
dissatisfaction, loneliness, or having negative thoughts towards oneself or to other people. Nonetheless, if the
feelings become overwhelming and continue to appear, which can substantially impact your health and your
everyday routine, immediate care and attention needs to be sought.

In fact, the level of depression that every person experiences might range from mild, moderate, to serious,
depending upon the symptoms related with each condition and the degree the condition disrupts everyday
activities. Managing depression is also, like the level of depression, different from one person to another.
Some individuals might realize the condition to be really disabling, and that they cannot seem to overcome it,
while others manage to undergo effective treatment. It is very difficult to comprehend exactly how extreme the
feelings of a depression sufferer.

We may be able to understand if we know what the possible causes are, and the symptoms of the depression.
Dealing with depression might not be as easy as you think, but, we can offer help to depressive individuals by
letting them know that we always have an ear to listen to their problems. Loss of something or somebody
essential. Loss of control over your own life or things around you.

Most likely, the person who feels this, in some way, senses that nothing can be done to alter the undesirable
events in life, and that handling depression is an impossible job. I should state this one is a great factor why
an individual feels depressed in the first place, as a negative attitude can cause self-defeat.

Here are some of the typical symptoms of depression, mostly grumbled by depression victims. A person with
depression might feel a strong sense of unhappiness, anxiety, guilt, anger, hopelessness, mood swings, and
helplessness.

An individual having depression might commonly sleep too much or too little, experience loss of hunger or
overeating, constipation, irregular monthly period, lose interest in sex, and experience weight loss or gain.

Considering that a depressive person deals with down feelings, crying without reason can occur. Also, withdrawal
from other people or the world in general, irritability, loss of interest in activities, and loss of interest in
physical appearance, no set objectives, and resorting to abuse via drugs and alcohol are simply some of the
things you’ll notice with a depressive person.

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Clinical Depression, Mood Disorder Symptoms

Depression is a mood disorder that manipulates every part of daily life. The illness impacts all sectors of the
population in each socio-economic group, from kids, adults, and the elderly. This frustrating illness controls
the mind, behavior, body, emotional state, and can even conclude the ability to maintain relationships. Clinical
depression is a medical finding, and is different from the common connotation of being depressed. According to
the DSM-IV-TR criterion for identifying a major depressive disorder or clinical depression, two aspects need to
be present, which is depressed mood or anhedonia.

It is satisfactory to have either of these clinical depression symptoms in combination with five other clinical
depression signs over a two-week period, which includes; mental or physical fatigue and loss of energy feelings
of guilt, hopelessness, stress and anxiety, fear, or helplessness, decreased amount of interest or enjoyment in
all, or almost all, day-to-day activities practically every day, changing appetite and visible weight-loss or
gain, psychomotor agitation or retardation nearly every day, feelings of overwhelming sadness, or the seeming
inability to feel emotion.

Other symptoms include difficulty concentrating or making decisions, or a generalized slowing of cognition
consisting of memory, disrupted sleeping patterns such as excessive sleep or hypersomia, insomnia, or loss of
REM sleep. Repeated thoughts of death, not simply the fear of dying, but persistent suicide ideation with a
specific plan, or a specific plan of committing suicide or suicide attempt.

Various other clinical depression symptoms sometimes reported but not usually taken into account in medical
diagnosis consist of inattention to personal hygiene, fear of going mad, decrease in self-esteem, change in
perception of time, sensitivity to noise, physical pains and aches with the belief that these may be indications
of a severe illness.

Clinical depression symptoms in youngsters are not as apparent as in grownups. Some of the signs that children
may reveal are irritability, loss of appetite, learning or memory problems where none existed in the past, sleep
problems such as reoccurring nightmares, and substantial behavioral changes such as social isolation,
aggression, and withdrawal.

An additional indicator could be the excessive use of alcohol or drugs, where depressed teenagers are at a
particular risk of further critssical behavior such as eating disorders and self-harm.

Among the most extensively used instruments for measuring the extent of depression is the Beck Depression
Inventory, which has twenty-one multiple-choice questions. For people who have not experienced clinical
depression, either personally or by regular exposure to individuals who struggle with it is hard for them to
comprehend the emotional impact and seriousness. It could be similar to as having the blues or feeling down.

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Sorts of Depression Medicine

There are a bunch of different sorts of depression medicines which are now available for the treatment of
depression. More recent depression medicines have become accessible that are safer and more effective than the
older depression medicines, and have fewer adverse effects. It is essential to take note though, that all types
of depression medicines, even the newest and most well-known, present specific risks, and can still trigger
unpleasant negative effects. It is smart to educate oneself in order to find suitable alternatives such as Selective Serotonin Reuptake Inhibitors (SSRI).

These sorts of depression medicines are the newest and most popular, and works by increasing the levels of a
mood-related neurotransmitter called serotonin, in the brain. These medications normally present a lesser risk
of side effects than other types of depression medications, but it does not imply that they are completely safe
or free of negative effects.

The most difficult adverse effects caused by SSRI depression medications are sexual dysfunction and weight gain.
It is not unusual for men taking this medication to end up being nearly impotent, and females to gain thirty
pounds. A lot of people look to natural options to prescription depression medicine in order to eliminate these
nasty negative effects. The first SSRI medicine introduced in the United States in 1988 was Prozac (fluoxetine),
since then, numerous SSRI medications have been released, including Paxil (paroxetine), Lexapro (escitalopram),
Luvox (fluvoxamine), Celexa (citalopram), Zoloft (sertraline) and Tricyclic Antidepressants (TCA).

These types of depression medicines are the older group, and due to the fact that they can cause adverse effects
such as constipation, dry mouth, bladder issues, blurred vision, sexual dysfunction, drowsiness, and
lightheadedness. They are no longer frequently prescribed, and have fallen out of favor. Some TCAs consist of
Tofranil (imipramine), Anafranil (clomipramine), Elavil (amitriptyline) and Monoamine Oxidase Inhibitors (MAOI).
These depression medications are currently the rarest sorts of depression medications, due to the fact that they
pose serious safety risks, can cause extreme side effects, and require a restricted diet plan.

Because of the expensive cost and negative effects of depression medicines, people in the United States are
increasingly more turning to natural depression medicines. Nonetheless, numerous natural supplements are of poor
quality, and do not work as well as prescription medicine. Some high-quality natural depression supplements do
exist though, and the best natural depression supplements include ingredients that have actually been proven to
work as well as depression medication, but with fewer side effects.

In a natural antidepressant medication called Amoryn, the major ingredient is hyperforin, which is an effective
treatment for anxiety and depression. Scientific research reveals that it eases depression as successfully as a
great deal of prescription medicine, but the good thing is, it has fewer negative effects.

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Treatments for Depression

Among the most common mental issues impacting almost everyone, whether on a personal basis or through a family
member dealing with the condition, depression is an illness identified by bouts of melancholia, despair, or
feeling emotionally down in such a way that disrupts the normal functioning of a person. Individuals with
depression might experience problems with work, social and family adjustment. If left without treatment,
depression can be a strong risk factor for suicide.

Luckily, therapies for depression are offered, and the majority of them work in dealing with the condition,
along with its symptoms. The treatments for depression are likewise extremely varied, so to list them all here
would be almost impossible. Suffice to say, that therapies for depression are generally divided into two
significant classifications; medications and therapy. Some individuals with depression respond to therapy
better, while others can go on normally with their lives by routinely taking antidepressant medicine.
Nonetheless, there are also others that can only respond to treatment after taking antidepressants. Hence, the
two methods of treatment for depression may be utilized alternatively or in combination with some health
specialists, depending on the individual response of the patient.

The first thing to remember about depression medicines is that they do not treat depression. Just as aspirin can
lower a fever but without clearing up the infection that causes it, antidepressants only help control the
symptoms, but do not treat the condition itself.

Furthermore, depression medications do not produce the same effect in everybody. Some individuals might
experience side effects, and factors such as age, sex, body size, body chemistry, and so on, can impact exactly
how the drug works on a patient. Many people do however respond well to antidepressants as treatment for
depression. How long the person should take antidepressants depends upon the kind and severity of the
depression.

A different approach to providing treatment for depression is therapy. Therapy is where the depressed individual
is given support in lots of different ways, consisting of supportive counseling, cognitive therapy, and
problem-solving therapy.

This sort of intervention helps alleviate the pain of depression. Among the most common symptoms of depression
is the sensation of hopelessness that a depressed individual experiences. The function of supportive therapy is
to directly address this feeling of hopelessness and despair.

All pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression are
taken care of in this phase of intervention. The key right here is to help the depressed individual recognize
which life problems are important and which are minor. In understanding this, the individual can now develop
more positive life goals.

Depression may be created because of certain troublesome areas in an individual’s life. The purpose of problem-
solving therapy is to directly address these crucial areas that create considerable stress.

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Major Depression

Each year, about 9.9 American adults deal with it. That is roughly five percent of the overall adult population,
give or take a few. Extreme depression is unlike the normal feelings of sadness, loss, or passing mood states
that many people have.

The condition is more persistent, and because of that persistence, it might significantly disrupt your thoughts,
habits, mood, activity, and even physical health. According to the World Health Organization (WHO), extreme
depression is set to become the second leading cause of disability in the world, after heart disease. The onset
of severe depression might be gradual, so the symptoms are not obvious right away.

Nonetheless, a few of the indications to keep an eye out for to identify whether you are suffering from severe
depression or not consist of the following: persistently sad state of mind or high irritability,
marked shifts in regular routines, consisting of sleep and appetite. Noticable changes in energy such as
frequently low energy practically daily. Feelings of being slowed down or agitation such as loss of interest in
previously pleasant activities. Relentless sensations of shame, unimportance, hopelessness, and emptiness may
also occur.

Other symptoms that are brought on by depression are reoccurring ideas of death or suicide, consistent physical
signs like headaches, intestinal disorders, and persistent pain without any known cause, and do not respond to
therapy. If you experience a number of of these symptoms of major depression, and they happen at the same time
for approximately longer than two weeks, and in such a way that they interfere with normal functioning, then do
not think twice to ask for expert treatment.

The reasons for severe depression are different, and the events that led to the development of the condition,
are in some cases too numerous to determine a single one as the clear-cut cause. There are typically lots of
aspects involved such as physical, biological, and even environmental aspects that all play a role.

According to scientific research, however, extreme depression is mainly a brain disorder. The problem could be
traced back to three chemicals or neurotransmitters, which function as messengers that transfer electric signals
between brain cells. These are norepinephrine, serotonin, and dopamine.

A person suffering from major depression often exhibits a chemical imbalance between these three
neurotransmitters, thus, producing a clinical state where depression takes place. In order to make up for the
imbalance, antidepressant drugs are introduced. These drugs work by increasing the availability of
neurotransmitters, or by changing the level of sensitivity of the receptors for these chemical messengers.

It is not enough however, to deal with major depression with psychotherapeutic drugs alone. Some individuals may
respond better to cognitive therapy, wherein they are given assistance in managing the problem areas of their
lives that add to depression. Additionally, individuals with severe depression may react to treatment
incorporating both approaches of medication and therapy.

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Teenager Depression

Everyone feels down at some time. It’s common to feel sad. If you are feeling sad most of the time, and the
feeling is starting to impact your grades, relationships, and your behavior in many ways, then the issue might
be more than just the blues. It might be teen depression, a major health problem that approximately four out of
a hundred teenagers suffer with each year.

The signs of depression are many, so there is typically no hard and fast guideline to identifying all the
symptoms of teen depression. However, the most vital thing to keep in mind is that there are typically two sorts
of teen depression.

Under the first kind, you will discover two other sorts of depression which differ only in their intensity, as
major depression or clinical depression (severe) and dysthymia or chronic depression (moderate, but lasts for a
longer period).

The second type of teen depression is referred to as bipolar depression, the depressive state of manic-
depressive disorder, a condition wherein the subject suffers periodic bouts of mania or elevated mood and
depression, where the subject is commonly too low in energy that he would not have the ability to move. It would
take a health specialist to distinguish the sort of teen depression.

It is a good idea that you speak with expert assistance when you see any of the following indications of teen
depression. Consistent feelings of sadness or crying a lot for no evident reason is an indication of teen
depression. Consistent feelings of guilt, once again, for no actual reason and the feeling like you are no good
or are worthless are also indications.

Symptoms of depression can include loss of confidence or low self-esteem, you feel as though life is
meaningless, and that absolutely nothing good will ever come out of it. You constantly appear to be tired, and
you do not feel like doing things that you used to take pleasure in a lot, like music, sports, being with pals,
or going out. Most of the time, you simply want to be left alone.

Other symptons consist of you continually getting sidetracked and you can’t seem to focus. You likewise forget
things, or you do things without any recollection of doing them. Little things make you lose your temper. You
get aggravated very easily, or you overreact. Your sleep pattern changes. Either you sleep more or you sleep
less, or you cannot seem to fall asleep or remain asleep. You get up too early most mornings, and have problems
falling back to sleep.

Insomnia (inadequate sleep) or hyposomnia (too much sleep) sets in. Your eating routines likewise change. You
have lost your appetite or you eat a lot more. Weight gain or weight-loss is extreme. You think about death, or
feel like you are dying, or you have thoughts committing suicide, whether or not you have the energy to actually
harm yourself.

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Signs of Depression

A very typical condition, depression is believed by numerous professionals to be the leading cause of disability
in the world. In the United States alone, studies show that 17 % of the population will experience the symptoms
of depression eventually in their lives. Currently, there is an estimated 19 million people experiencing
depression in the United States. Additionally, research shows that females are more vulnerable to struggle with
the symptoms of depression than males.

Often classed as a mental condition, depression is as much an illness of the body as it is of the mind. You
cannot wish it away and you can not simply snap out of it. Neither is it a sign of weak character. The good news
about depression is that virtually everyone experiencing the symptoms of depression can be helped with
appropriate therapy. That is why it is essential to identify the signs and symptoms of depression as early as
possible in order to prevent the condition from worsening.

The U.S. National Institute of Mental Health, or NIMH, has developed a list of the primary signs and symptoms of
depression. The following symptoms can be seen on the list; persistent feelings of sadness, anxiety, or
emptiness, feelings of hopelessness, despair, and pessimism, feelings of shame, worthlessness, and helplessness,
loss of interest, even in basic pleasures such as hobbies or activities that were once enjoyed, consisting of
sex, decreased energy, tiredness, being slowed down, difficulty concentrating, remembering or making decisions,
sleeplessness, early-morning awakening, or oversleeping, appetite and/or weight loss or overeating and weight
gain, thoughts of death or suicide, suicide efforts, restlessness, irritability, consistent physical symptoms
that do not respond to therapy, such as headaches, intestinal disorders, and chronic pain.

If you have any of these symptoms of depression, and have been struggling with them for a number of weeks, and
to a degree that they have actually hindered or impacted your life, have a talk with your doctor. She or he can
help you find out whether you are dealing with depression or not, and then help you create a treatment and
recovery strategy.

The symptoms of depression can differ from person to person. In addition, an individual’s response to various
medicines may also vary. That is why it is rather possible that you may have to check out a number of different
drugs in order to find out which one works best for you.

Your physician can recommend you some anti-depressant medicines. These drugs are relatively quick-acting, so you
may begin to feel better after just a few weeks of taking them. Nonetheless, unless your physician says so, do
not stop taking the drugs. It might be that you are only experiencing the initial impact of the drugs, but the
complete results have yet to take place.

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Signs of Depression in Children

If depression is considered a severe condition to adults, exactly how would you think about depression in kids?
Actually, depression in kids is the same as in adults with just a few exceptions. Therefore, this only suggests
one thing, depression in children must be given immediate attention and care, particularly if they can’t make
out the precise words to express their condition. This is why you have to always keep a closer look on the
possible indicators of depression in children in order for you to take specific action about the problem.

To say that children have clinical depression, they need to have five of the 9 most common symptoms of
depression, which can cause disturbance of their functioning or behavior, for a duration of at least two weeks.
Below is a list of some of the symptoms that could be possible signs of depression in children. These signs may
be helpful to you if you sense your youngster or some children you know are dealing with depression.

Irritable mood most of the day, virtually everyday, having problems sleeping or sleeping too much practically
daily, tiredness or loss of energy, decreased ability to think or concentrate, significant loss of appetite
causing loss or gain of weight, loss of interest in things once enjoyed, restlessness, or slowness.

Various other physical symptoms, such as serious headaches, which may not be really common, have actually been
experienced by children for at least once a month. There are actually many other warning signs of depression in
children that you need to know and be aware of. Early indicators of depression in children can easily be missed,
due to the fact that it is typically associated with various other behaviors. Abrupt changes in behavior,
aggressiveness, angry or agitated behavior, increased interest in risk-taking, lower self-confidence, resulting
in withdrawal from other people.

When you hear young people discussing hurting themselves, or even suicide, don’t let it go by. In case you have
no idea, hurting one’s self or suicide is not new to depressive individuals. They have the tendency to commit
suicide because of the many aspects such as feelings of unimportance, unhappiness, helplessness, and many more.
Anyhow, none of the signs of depression in kids should be taken lightly. As soon as indicators of depression in
youngsters are observed, see to it to talk to your child and have him or her talk about what they are feeling.

It’s no use to comfort your kid, so don’t try and seek professional assistance immediately, as physicians are
the only ones who can identify depression. Fortunately, depression is treatable, and can be treated only with
psychotherapy and medicine. Except for depression, you and the whole family, and good friends can still show
your support to other emotional and physical difficulties of your children.

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Depression

Victims of depression describe it as a black curtain of despair coming down over their lives. In truth, lots of
people diagnosed with depression have perpetual spells of apathy, where they feel like they have no energy to do
anything, or they can’t concentrate. Others might experience sensations of irritation, although there seems to
be no reason for feeling so.

The symptoms of depression vary from person to person. So, occasionally, it is challenging to diagnose. However,
if you have been feeling down for more than two weeks already, and these emotions are starting to interfere with
your life, it is time for you to see a physician who specializes in mood disorders to identify if you have what
they call clinical depression.

It has been observed that people who have gone through depression have the tendency to experience another
episode sooner or later. It is possible that you have one episode today, and the next few weeks, and then you
experience some of the symptoms once again before the next full-blown episode. If you learn to spot these very
early causes or symptoms, then you might be able to keep the depression from worsening.

Working with your doctor can help you learn how to manage depression. There are lots of medications used to
treat this mood disorder, and you may need to try a few different ones to discover which works best for you. In
addition to that, your doctor may also suggest a specialist for you, and suggest that you make a couple of
lifestyle changes.

Whatever medication you select in the end, always the initial step to improving and remaining better is taking
your medicine precisely as prescribed by your physicians. It might also help if you remember the following
treatment tips.

It takes some time for anti-depressants to work, so do not be impatient. Some antidepressants may start to make
you feel much better in just a few weeks. Nonetheless, the full anti-depressant impact of the drug might not be
seen until the passage of numerous weeks.

Even if you feel much better, keep taking your anti-depressant for as long as your physician tells you to. Your
doctor may suggest that you continue using the anti-depressant in order to help lower your chances of becoming
depressed once again.

There are some individuals who only become depressed once. However, there are others who have actually been
depressed before, or have a number of risk factors, in which case, they might need long-term treatment with
medicine.

 

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Keeping the News in Perspective

Dr. Mark Agresti discusses the importance of keeping the news in perspective. By doing so, one allows themselves to minimize the impact that negative news can have.

Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist, Psychiatrist

Call (561) 842-9550 or email: info@206.189.200.158 Dr. Agresti today to get psychiatric help.

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