You’re in your favorite recliner watching the game, and then comes a “word from our sponsors.” You may not bet on the game, but you can bet there’ll be a commercial for a pharmaceutical drug during that break. For today’s purposes, I’ll refer to a fantasy medication named ‘Druguall.’ The Druguall commercial shows a couple at the beach, walking hand in hand along the shore as the announcer explains the indications for Druguall, ending with the requisite side effect statement “…Druguall may be habit forming, and has been shown to cause an inability to make a left turn, an impulse to chew toenails, and a compulsion to repeatedly beat your head against a wall. If symptoms worsen or become problematic, contact your physician immediately. If you are allergic to Druguall, do not take Druguall.” Duh! That last one always kills me. Does the American public need to be told to not take a drug they’re allergic to? Apparently so, because pharma companies have been held liable for idiots taking their drug (despite being allergic to it) in numbers sufficient enough to spend the extra commercial time and money to make the statement to cover their corporate posteriors. But enough of the woes of big pharma. What am I writing about today? Side effects! Every drug’s got ‘em, and they range from comical to serious…even downright deadly. The point of this is so that you’ll ask your doctor when he or she starts you on a new med, especially if you’re already taking other meds…you need to know if they’ll play nice together.
Here’s the ugly truth that your doctor probably doesn’t want you to know. When it comes to taking most drugs, it’s a crap shoot. He or she can know the side effects, but there’s no way to predict if you’ll experience any of those side effects, what they may be, and if they will have a minor/major affect on your life. When it comes to prescribing, there’s a lot of ‘throw this out there and see if it sticks’ going on. Granted, good physicians know the published side effects of the drugs they prescribe. I certainly do. But even though I know these drugs inside and out, there’s still some trial and error, because everyone reacts to different medications differently. If you’ve ever seen the PDR, the Physician’s Desk Reference, it is chockablock full of side effects. And it’s big enough to be used as a weapon. Nowadays it’s really just for show…everyone just checks the internet. Anyway, when a drug is tried in humans, everything that happens is noted. If the test subject happens to fart ten minutes after taking a trial medication, that medication is labeled with a side effect of flatulence, even though the guy probably just had broccoli for dinner. So if you look at any given drug, there are multitudes of side effects. Today, I want to talk about some of the weirder and wilder ones.
Lots of medications get a bad rap for having yucky and unpleasant side effects, and most have earned them. Almost every drug on the market has side effects of upset stomach, dizziness, and headache. Borrrring!!! Instead, I want to look at some not-so-common side effects. The big note here is that just because a certain medication can cause a certain side effect doesn’t mean it will cause that side effect.
Hallucinations happen when you sense something that’s not actually there. I’m talking little green men here, people. But hallucinations can be seen, felt, heard, and even smelled. They are some freaky and frightening side effects. Most people associate them with illegal psychadelic drugs like shrooms and acid, but prescription drugs can also cause hallucinations. The sleep aid eszopiclone and a common medication for depression called escitalopram have been known to cause hallucinations. Even a drug to treat malaria called mefloquine can cause hallucinations. I’ve seen more cases of people hallucinating than I could ever count and ordered lots of four-point restraints. I’ve seen super heroes with broken bones they received learning that they actually couldn’t fly from multi-story buildings. I’ve seen lots of people who say they’re God, and lots who say they’re Satan, but no proof from any of them.
Now we’ll go from freaky to funny. There are plenty of meds that will turn your urine different colors. Even some non-drug food items can do it…beets can turn it pink, asparagus can turn it green (and stinky!) and carrots can turn it bright yellow. As for meds that change pee color, every woman probably knows that pyridium for UTIs makes it bright Tang orange. Even OTC Azo will do that too. But can you imagine seeing your urine turn green or bright blue? This can be a side effect of taking the antidepressant amitriptyline or the common pain reliever indomethacin. An antibiotic called metronidazole can even cause your urine to turn black. That would freak me out. The anesthetic drug propofol can also make your urine turn blue. Michael Jackson could’ve told you about that one. Well, if he weren’t dead from abusing it.
Big word alert for the Scrabble set: anosmia; the loss of smell. This side effect actually has a huge impact on a patient’s life, because the loss of smell goes along with the loss of taste, so patients have no desire to eat, and that becomes a problem. Sometimes patients even have to be put on IV feeds. Some examples of drugs that can cause this side effect include the blood pressure drug enalapril, the antipsychotic drugs chlorpromazine and prochlorperazine, and the antibiotic metronidazole. And just a side note, prolonged use of OTC decongestants like Sudafed can also cause loss of smell.
Sexual side effects are always of interest to patients. The most common sexual side effect is the loss of the ability to either perform during sex or the ability to enjoy sex. The usual culprits of these types of sexual side effects are certain drugs that treat depression. These medications are called selective serotonin reuptake inhibitors (SSRIs), and they include common drugs like Prozac (fluoxetine), Celexa (citalopram), and Zoloft (sertraline). I always consider this side effect when choosing what to prescribe. I find that men aren’t willing to trade mental health for sexual satisfaction, but interestingly, women are more willing to do so.
On the flip side of the sexual side effect coin is priaprism, which is a painful, permanent erection. A variety of medications can lead to this condition, one which patients who’ve experienced it will never forget. This unfortunate side effect lasts for more than four to six hours and may be caused by antidepressants like trazodone, fluoxetine, sertraline and lithium. An anti-anxiety medication called vistaril and the blood thinner coumadin are also known offenders. Priapism due to a medication side effect (as opposed to from taking a little blue pill) often goes away without treatment, though putting ice packs on the affected area might help speed up recovery. Cringing.
This one sort of goes along with the above discussion. There are several medications that cause the side effects of unusual urges for sex and gambling, though hopefully not at the same time. Common culprits include Requip, which is a medication for restless legs, and the antidepressant Abilify. These meds may cause uncontrollable urges to gamble, binge eat, shop, and have sex. Interestingly, a Parkinson’s medication called carbidopa/levodopa also carries a warning of intense urges for gambling and sex. I’ve had cases where men don’t want to leave their homes because they want to masturbate, as well as cases where they’re caught masterbating in public. As for the gambling…I’ve had patients lose a lot of money gambling in casinos, betting on horses, and even at the dog track. The sexual and/or gambling compulsions just drive them.
It’s common knowledge that drugs affect dreams, but not always in a good way. Medications that affect neurotransmitters in the brain commonly cause bad dreams and nightmares. The Alzheimer’s medications donepezil and rivastigmine, as well as the Parkinson’s medication amantadine, are all reported to cause vivid dreams, often being of a sexual nature. Nightmares are also a commonly reported adverse effect of blood pressure medications called beta-blockers. These include propranolol, atenolol and labetalol. There are also reports of steroids like methylprednisolone and prednisone causing nightmares. Varenicline, the medication often prescribed to help people stop smoking, is known to cause dreams that are super strange and very vivid. Not only does varenecline cause bad vivd dreams, I’ve seen patienta think it’s okay to stab themselves repeatedly or to kill themselves. Varenicline is a scary strange drug. Even stranger? The prescription sleep aid zolpidem doesn’t keep many users sleeping in bed. In fact, many who take it have been known to get up at night and go for a drive, maybe talk on the phone, or even have sex…all without remembering anything in the morning. You can ask Elon Musk about zolpidem. He tweeted that he was going for an IPO for $423 a share after taking it. His advisors had a fit the next morning, but he found it amusing and shrugged it off. But Roseanne Barr wasn’t laughing when she lost her eponymous show after a discriminating tweet. She apologized, but the damage was done. Maybe she should’ve called Elon for help.
Another big word for the Scrabble set: Akathisia. The word comes from the Greek for “inability to sit,” so this side effect invokes feelings of unease and an inner restlessness. Unfortunately, this is another adverse reaction that folks who experience it never forget. They describe it as wanting to crawl out of their skin. The triggers for this horrible sensation are the anti-nausea medications prochlorperazine and metoclopramide, as well as some SSRI antidepressants, and an anti-anxiety medication called buspirone. Thankfully, this terrible feeling goes away when the medication wears off.
What if taking a medication made you pack on the pounds? How about if it caused you to gain 20 plus pounds in only three months? Some people who take the medication olanzapine for bipolar disorder have done just that. Some common medications used to treat depression, like paroxetine, can also cause unintended weight gain. Weight gain is enough to cause depression in and of itself, so I’m always cognizant of that when I prescribe. Other drugs that can pack on the pounds include steroids, birth control pills, hormone replacement therapies, and some diabetes medications. The bottom line on that is that if you must take one of these drugs, you also must watch what you eat.
File this under the creepy side effect column. And yet another big word for the Scrabble set: Onycholysis. This is the medical term to describe when nails separate from the nail bed. You may not think that’s so bad, but trust and believe that patients who experience it do, and you would too if you had it. It can be super painful and may result in infections under the nails. Believe it or not, there are quite a few meds that can cause this: acne treatments tetracycline and fluoroquinolone, antibiotics like ciprofloxacin and levofloxacin, oral contraceptives, and some chemotherapy medications…all may cause your nails to separate from the nail beds.
Visual disturbances can also be a side effect of certain meds. These disturbances can include blind spots, distorted vision, blurred vision, or halos around lights. Medications that can affect your vision include antihistamines, high blood pressure medications, and medications taken for malaria or tuberculosis. For men on the little blue pill, a truly weird and whacky side effect can be tinting of the vision, as through tinted glasses. And of course it tints the vision blue. I wonder if that might be a promotional idea…to see blue like their little pill.
Most people are familiar with the hair loss that goes along with some types of cancer treatments, but there are also several other common medications that cause hair loss, including blood thinners, birth control pills, antidepressants, and medication used to treat gout. But hair growth can also be a drug side effect. Women may experience unwanted hair growth from steroid medications and from the drug danazol, which is used to treat endometriosis.
Have you ever torn a tendon? It isn’t always just from a sports injury. Believe it or not, a common medication used to treat urinary tract infections could cause you to rupture your Achilles tendon. The U.S. Food and Drug Administration (FDA) has issued a warning for just that for the class of antibiotics called fluoroquinolones. According to the FDA, pain, swelling, and tears of tendons in the heel, shoulder, and hand are more likely to occur when taking these drugs. Common medications in this class include the often prescribed antibiotics ciprofloxacin and levofloxacin. So maybe it’s best to warm the bench when you’re taking these antibiotics.
All jokes aside on this one. No list of side effects would be complete without mentioning side effects causing birth defects. Obviously, birth defects are a very serious medication side effect, and this is why pregnant women are told not to take any drugs before checking with their doctor first. Types of drugs that can cause birth defects include high dose vitamin A, some blood pressure medications, and some antibiotics. Two drugs that are especially dangerous and potentially fatal for developing babies are Accutane (isotretinoin) and Thalomid (thalidomide). Accutane is used to treat severe acne and Thalomid is used to treat a type of white blood cell cancer. When pregnant, all side effects are serious. But pregnant or not, isotretinoin is a nasty, scary, dangerous drug. It’s used most commonly by dermatologists for severe acne. I’ve heard of patients flying planes into buildings, thinking they’re invincible and jumping from buildings, and just acting in an exceedingly dangerous way. It’s like they’re without fear.
Rather than a condition, this one is about a drug called Interferon. Interferon is used to treat certain cancers, leukemias, and Hodgkin’s Disease. I’ve seen some pretty bizarre things with Interferon. People become suicidal, openly so. They’ll talk about suicide like it’s an acceptable option. Sometimes they cut themselves and make themselves bleed. It’s very odd and very scary. Interferon can also cause bizarre thoughts, and people become psychotic. Also, they can have anosmia. Remember that? That’s the loss of smell that I discussed above. Interferon can be useful in cancer treatments, but people have to be closely monitored for side effects.
I’ve saved the weirdest of the weird, the most bizarre side effect I’ve ever seen, for last. At the time, I was in medical school but working in the ER. What I saw looked straight out of The Exorcist. The side effect is called an extra-pyramidal oculogyric crisis. Oculo- refers to eyes, which fix upward and to the side during the crisis. In severe attacks, there can also be involvement of the head and neck and structures within the neck. There are several drugs that cause it, and the crises or attacks can happen in varying degrees, from minor reactions to major emergencies requiring intubation for airway control. Oculogyric reactions are caused by neuroleptic drugs, antipsychotics, antiemetics (anti-nausea drugs), and antidepressants. Cases involving other drugs have been reported, including methylphenidate and carbamazepine. In this case, the patient’s head was turned sideways and backward at an impossible angle, with her eyes fixed very strongly to the opposite side. Her face was frozen in a grimace and her neck was so flexed that she was unable to speak and her airway was compromised. She needed to be intubated for airway support, but doctors were unable to straighten her neck to insert the tube. They were considering a tracheostomy, making a hole in her throat, to buy some time because they didn’t know what was happening. Because she was unable to speak, she couldn’t tell the ER doctor that she had taken an antiemetic, a medication for nausea, which had caused the episode. The doctors were puzzled as to what was happening because of how extreme the episode was, and several were gathered around her bed in the ER. A nurse just happened to stick her head in the room to see what the commotion was, and she mentioned in passing that she had seen something similar in someone who had taken compazine. At that word, compazine, the patient snapped her fingers and pointed at the nurse; the doctors asked if she had taken compazine and she snapped her fingers again and the mystery was solved. They gave her IV Benadryl and five minutes later her neck and eyes relaxed to midline and in another five minutes, she was able to speak. I’ve seen oculogyric crises since, but none like that. The whole Exorcist thing is the craziest side effect I’ve ever seen, but I will forever remember extra-pyramidal oculogyric crises.
After working in psychiatry for the past 30 years, I’ve seen time and time again that when you put a drug in the human body, you don’t know what you’re going to get. It’s like Forrest Gump’s box of chocolates, but not as tasty. For more patient stories, be sure to read my book Tales from the Couch, available on Amazon.com.Learn More
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
Inability to live independently
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.Learn More
Anxiety disorders affect 40 million adults in the United States, making it the most common mental health condition in the country. Untreated anxiety can affect every facet of life, making it difficult to relax, to achieve success in a work environment, to have fulfilling hobbies, and to maintain close relationships with family and friends. While there is no cure for anxiety, there are ways to manage it. While there are many prescription anxiolytics, today I want to talk about some behaviors, supplements, vitamins and homeopathic remedies that you can use to help deal with anxiety and release the hold it may have on your life.
Let’s start with some simple stuff. Some behaviors that you should stop and some you can start to help quell anxiety.
Behaviors to stop
Alcohol: If you think consuming alcohol would help ease anxiety, you would be wrong. While alcohol relaxes the body, it clouds the mind, and a clouded mind actually increases anxiety. And though you might feel relaxed for an hour or two, once you stop drinking, your mind and body are affected as the alcohol leaves your system, so the other 22 hours of your day will only be filled with more anxiety. Not only that, if you have chronic anxiety and drink in a misguided attempt to help it, you’re going to be consuming alcohol in quantities that can end up in your developing alcoholism.
Smoking tobacco: Again, you may think that cigarettes might help anxiety. When a smoker gets stressed, they often say they want to smoke to chill out. So why does smoking seem to help smokers relax? Smoking cigarettes interferes with certain chemicals in the brain. When smokers haven’t had a cigarette for a while, the craving for another one makes them feel irritable and anxious. These feelings can be temporarily relieved when they light up a cigarette, so smokers associate the improved mood with smoking. In fact, it’s the effects of smoking that are likely to have caused the anxiety in the first place, as nicotine raises blood pressure. Additionally, many studies have shown that cutting out the cancer sticks improves mood and thereby reduces anxiety.
Caffeine: This one is a no-brainer. Caffeine is actually a psychoactive drug, and like many of its kind, it is a stimulant. When you consume it, caffeine stimulates your “fight or flight” response, and studies show that this not only increases anxiety, it can even trigger an anxiety attack. If you’re anxious, consuming caffeine is pretty much the worst idea ever in the history of ideas.
Poor diet: Like it or not, what you eat can make a difference in how you feel, physically and mentally. You should not be on a first name basis with the Dominos delivery dude and the Mickey D’s drive-thru girl. Fact, Jack! Cut out the high carbs, the high fats, the processed foods and sugars. Remember: garbage in, garbage out.
Electronics: Surfing the net, watching YouTube vids, online shopping, and anything done on a screen can lead to an increase in anxiety by affecting your sleep. How? Exposure to the blue light of a screen anytime within four hours of sleep disrupts the natural circadian rhythm, and may even disrupt the natural production of melatonin, resulting in poor sleep. Functioning normally while tired can increase anxiety.
No news is good news: If you are anxious or prone to anxiety, stop watching the news. Stop reading the news. Stop listening to the news. Why? The press is categorically tailor-made to incense, aggrevate, enrage, and incite. All of these roads lead to Anxiety City. So think again before feeling guilty for not keeping up with current events. A national survey conducted by (oddly enough) NPR and a bunch of other eggheads found that watching, reading, or listening to the news caused people greater stress and anxiety. It’s like the old saying goes…what you don’t know can’t hurt you. And clearly, what you do know can.
Anti-Social media: The advent of social media has completely changed the way humans interact on a global scale. Just stop and think about that. It literally changed the entire planet. Now you can interact with anyone on the face of the earth that has a cellphone on a 24/7 basis. It sounds like the greatest thing ever, but it can cause an incredible amount of anxiety in a number of ways. Trust me, I see it day in and day out. So, how does social media cause anxiety? It has brought the concept of keeping up with the Jonses to a whole new level. Used to be the Jonses just lived down the street. Now they’ve moved. To everywhere! There are billions of electronic Jonses to emulate, be jealous of, to love, to hate, and to outdo. From posting the perfect picture that took 2 hours to take on Fakebook to likes and hearts and wow! faces, everyone gets to weigh in and hate on. All of these things are so anxiety producing. But social media can also be addicting. It’s a like-seeking quest, and every like reward is a dopamine hit. Dopamine is a happy chemical. A hit gives a little high, akin to any drug high. And just like with drugs, there can be an actual withdrawl if you separate that person from their source, their cellphone. Some people check social media 20 times or more in a day. They must check for likes, they must see what all their “friends” are doing, what all those electronic Joneses are up to. Keeping up with them and always being on the hunt, all are naturally anxiety producing. If you find that social media becomes stressful, makes you feel jealous, or mad or sad as a result of trolls or the presence or absence of positive comments, silence the alerts, put the damn phone down, and do something more positive with your time. If you feel anxious when you do this, go visit your parents or a friend in real life. You’ll get through the anxiety and be better for it. Then do whatever you have to do to set and stick to limits on your social media use. Be electronically anti-social and personally social.
There are also tons of behaviors that you can add to your life to help with anxiety.
Behaviors to start
Exercise: You don’t have to turn into a gym rat, just spend at least 15 minutes a day doing something that moves your body.
Meditation: Spend 5 minutes a day centering yourself. Clear your mind and the rest will follow.
Breathing: Dr. Andrew Weil deveoped a breathing exercise called 4-7-8. It goes like this: exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to a mental count of 4. Hold your breath for a count of 7. Exhale completely through your mouth, making a whoosh sound to a count of 8. You’ll likely find this is very helpful in reducing anxiety.
Reading: This is great for distracting yourself from stressors occupying your mind and causing anxiety. Open a book and immerse yourself in someone else’s story.
Routine: Establishing and following a routine forces behavior modification and can be stress reducing.
Positive affirmations: Practice saying all the good things about yourself to yourself.
Connect with nature: Take a walk in the woods or get some sand between your toes. Try to lose your worries and yourself in a place that’s bigger than you.
Eat healthy: Eat lots of fresh fruit and veggies and eat only lean meats. There are some natural food components that can help with anxiety. Omega-3 fatty acids make up the basic building blocks of the brain and nervous system. They are essential for cognitive functioning and have also been shown to improve symptoms of depression, which is often closely linked with anxiety disorders. These brain-boosting amino acids are found in a wide variety of fish species, including salmon, tuna, mackerel, herring, sardines and anchovies. They are also found in supplement form. Probiotics are also helpful. Probiotics are microorganisms known for their digestive health benefits. But recent research has revealed that probiotics can also have a profound impact on mental health. A healthy balance of bacteria in the body can boost the body’s ability to cope with stress, improve overall mental health, and bolster cognitive functioning. Probiotics can be found in direct supplement form but are also found in a wide variety of foods and drinks. Some of the most common sources include sauerkraut, yogurt, kimchi, kombucha, miso, and pickles. Put good stuff in, get good stuff out.
Talk: Whether to a therapist, friend, family member or clergy, find someone to talk to and share worries and anxiety with. The support of others can do wonders.
Be grateful: Count your blessings; think about the good things in your life: a home, support of family and friends, a place to sleep, food to eat, a vehicle, whatever the positives may be, be happy that you have them.
Take action: If you have something you need to do that’s weighing on your mind, do it. If you have a bunch of things to do, make a priority list and start doing them. As you finish the items, literally cross them off the list. This way the list isn’t overwhelming and it will feel really good to mark things off.
Sauna: Heat is amazingly relaxing and wonderful in combating anxiety. Relax the body to relax the mind.
Massage: A great massage is fabulous in reducing tension and anxiety.
Accupuncture: The Chinese haven’t been wrong for thousands of years. Accupuncture is one of the most relaxing, stress and anxiety reducing activities. Don’t be scared of the needles. Almost a must if you have anxiety.
Spirituality: If you have it, use it. Prayer can be centering, almost meditative.
Supplements and vitamins: If you live with anxiety, one measure you can take to reduce your symptoms is to include supplements and vitamins for anxiety in your diet. These can be taken directly in an oral pill form and in the consumption of various foods and drinks. Before taking any of these, check with your physician first, especially if you already take any prescription medications.
Some of the best supplements and vitamins for anxiety include:
B Vitamins: B vitamins are vital to healthy nervous system functioning, so they play an important role in various aspects of mental health. They also have a significant impact on stress management and mood. Because of these benefits, many people with anxiety take B-complex vitamins and/or incorporate B vitamins into their diet through a variety of foods, including wild salmon, shrimp, tuna, halibut, yogurt, eggs, cheese, lamb, venison, turkey, grass-fed beef, carrots and green, leafy vegetables.
L-Theanine: L-theanine is an amino acid that can improve focus, reduce stress and promote relaxation. You pretty much have to take this as an oral supplement because it’s not commonly found in many foods or drinks. You can take 400mg of the supplement three times a day.
Chamomile: Chamomile has been used as a traditional medicine for thousands of years to calm anxiety and settle stomachs. Chamomile is best known as an ingredient in herbal tea, but is also available as capsules, liquid extracts, tinctures, and topical creams. Adults can take it in capsule form, 400 to 1600 mg in divided doses daily; as a liquid extract, 1 to 4 ml three times daily; in a tincture, 15 ml three to four times daily; or as a tea, 1 to 4 cups per day.
Lavender: Lavender is an herb that has been proven effective by leading researchers as a natural remedy for treating signs of anxiety. In one published study, lavender oil was shown to be just as effective as the pharmaceutical drug lorazepam, but without sedative effects or potential for drug abuse or dependence. Other studies have confirmed the anti-anxiety properties of lavender as well as many other medicinal benefits. Lavender oil capsules can be taken by mouth, 800mg three times a day. Tea can also be made by using 1 to 2 tablespoons of whole, dried flowers for each cup of boiling water. Steep for 10 to 15 minutes using a tea infuser or strain before drinking. You can also add six drops of lavender oil extract and 1/2 cup of dried lavender flowers to bath water for a great anxiety relieving soak.
GABA: Gamma-aminobutyric acid is a neurotransmitter located in the brain that is crucial to serotonin production. Serotonin is one of the nervous system’s most “feel-good” neurotransmitters, so GABA plays a significant role in reducing anxiety, regulating mood and in relaxation, aka “feeling good.” I’m told this is very effective. When I tried it, I noticed that my skin tingled. An unual and somewhat unpleasant side effect.
Passionflower: This is a calming herb commonly used as a household treatment for anxiety. It has been shown to alleviate nervousness, promote positive moods, and improve sleep quality. Passionflower can be consumed as an extract and tablet, or can be added into teas and tinctures.
Valerian Root: This has been used for a variety of medicinal purposes since the time of ancient Greece. While most commonly known as a sleep aid, this herb can also be helpful for reducing anxiety. Valeric acids found within the herb convert to calming, “feel-good” neurotransmitters in the body, regulating stress and relaxing the mind and body. Valerian root extract is available in both capsule and liquid form, as well as a tea.
Licorice Root: This herb carries many health benefits for people with anxiety because of the effects it has on the adrenal glands, which produce the stress hormones adrenaline and cortisol. Licorice helps regulate the production of these hormones, relieving stress and reducing anxiety symptoms. Licorice root can also soothe gastrointestinal upset, which is common in many people with anxiety. Be aware that most drinks and candies that claim to contain licorice only contain flavoring, which has no benefits. It’s best to consume licorice in an extracted, purified form. Deglycyrrhizinated licorice (DGL) is the safest and most effective variety of medicinal licorice root available. DGL is sold in capsule, powder, tea and chewable tablet forms.
Ashwagandha: Ashwagandha is a plant native to India and North Africa that has been used for centuries to reduce anxiety, combat the effects of aging, and improve energy. In natural medicine, the root is considered to be an “adaptogen,” or a compound that helps regulate the body’s natural processes and promote overall wellness and health. Today, many people use Ashwagandha to improve mood and reduce anxiety symptoms. While the benefits of Ashwagandha are gained by eating the fruit, seeds and shoots of the plant it is derived from, Ashwagandha is most commonly consumed in capsule form, 600mg a day.
CBD products: Cannabidiol (CBD) is a type of cannabinoid, a chemical found naturally in marijuana and hemp plants. Unlike THC, tetrahydrocannabinol, another type of cannabinoid, CBD doesn’t cause any feelings of intoxication or the “high” associated with cannabis. Several studies point to the potential benefits of CBD for anxiety. It can be found in many forms: oil, gummies, teas, tinctures, vape pens, and more. As for where to begin, consider trying a sublingual (under the tongue) CBD tincture first. They have high bioavailability, meaning the body easily absorbs them. If you’ve never used CBD before, be sure to do some research and get it from a reputable place…not from the gas station around the corner. Start by taking the dropper and placing the liquid under your tongue and allow it to sit for about 2 minutes so it absorbs into your bloodstream before you swallow it. Figuring your ideal dose is tricky. Most packaging will have guidelines, but dosing is still a guessing game, as CBD affects everyone differently. You can try one dropper full and go from there. You’ll have to see how you feel to determine how much works best for you.
Rhodiola: Also referred to as “golden root,” Rhodiola has a long history of medicinal use in traditional Chinese and Siberian medicine. Like Ashwagandha, Rhodiola is considered to be an adaptogen, meaning that it promotes physical and mental health while improving mood and resilience to stress. It is typically taken in capsule form, but it is also available in extracts and teas.
While the above homeopathics, supplements, and vitamins can be beneficial for anxiety, it’s important to check with your doctor before adding them to your diet. Taking this precaution can help prevent any potentially dangerous side effects or drug interactions. Keep in mind that while vitamins for anxiety can be helpful, they are not a substitute for prescription medications or doctor-approved therapies. It is especially important to speak to a medical professional if your anxiety co-occurs with another mental health condition.
The supplements, vitamins and homeopathics discussed above can be found on Amazon. I discuss anxiety and other mental health issues in my book Tales from the Couch, also available on Amazon.Learn More
Couples and Conflict
One of my foremost jobs as a psychotherapist is to be a listener. All day, every day people come to me to talk about their problems. As you can imagine, many times patients want to talk about their spouses, specifically how they fight with them. So I want to talk a little bit about couples and fighting. Whether it’s about money, children, career, housework, all couples fight. Nobody gets along 100% of the time without some conflict. It’s all a matter of how you resolve that conflict. I had a patient named Roxanne come in for her session yesterday, and she told me that she and her husband Bill fight all the time. One yells at the other and the other yells back louder until it reaches a terrible crescendo and both storm off in opposite directions. She said she had no choice in this, he just made her so angry and they just didn’t get along. I told her that the first thing that had to happen for the relationship to move forward was to decide that it wasn’t his fault and wasn’t her fault, it was both of them. She immediately recoiled and told me I was dead wrong. That it was all Bill’s fault. He was never home, he didn’t want to be a part of the family, he this, he that, ad nauseum. I asked her about how they fight, her yelling and screaming…was it working? Was it resolving anything? She launched in again, saying it wasn’t her fault, it was his fault because he made her yell. He antagonized her. I told her that she didn’t have to go to every fight he invited her to, she had the choice. This is a point that I think a lot of couples miss. Just because your spouse may be baiting you, looking for a fight, it doesn’t mean you have to give them what they’re looking for. You don’t have to respond at all. You have a choice in how you behave.
I explained to Roxanne that the only way to start to resolve an issue is to not yell and scream, not raise a voice. Once you express anger, you’ve made the situation worse. I suggested to her that the only way to make the situation better when Bill is yelling and screaming is to fall silent. Until the yelling stops, nothing productive can be accomplished. A conflict cannot be resolved through warfare. Once people raise their voice, no interaction happens. For instance, if you raise your voice at a child, they shut down. They will hear nothing you say. The same happens in couples. If one raises their voice at the other, from that moment forward, nothing constructive happens. So, if you’re married or in a relationship and you find you are having problems or there is fighting, and yelling, you are responsible for your response, and your response should be to not yell back, fall back. All yelling does is put fuel on the fire. If you fall silent, eventually they will stop yelling, and once the yelling stops, resolution can start. You can begin a conversation by discussing what the problem is, why you keep arguing, and what you can each do to make things better. That’s the only way these things will really be resolved. But you have to be willing to change how you respond to conflict and how you fight. Learn to fall back if baited. Talk should replace screaming matches.
I hear so often in my office “it’s not me, it’s him, it’s her, they’ll never change, we tried that” blah, blah, blah, blah. If you really want to effect change in your relationship, change your own behavior and then the reaction you get back from your spouse or partner will change. Stop yelling and start conversing. Focus on what you can each do to make the relationship better. To resolve conflict, cooler heads should always prevail over heated emotions.Learn More
January 6, 2018 THE RIGHT APPROACH TO THE OPIOD CRISIS
As a practicing doctor with certification in psychiatry and having worked in Palm Beach County for the past 25 years, my views on the current opioid epidemic are the result of my daily contact with addicts, their families, the medical community, law enforcement and the judicial system. My work has taken me from the E.R. to the inpatient treatment centers and rehabs to the courts to our psychiatric hospitals and to our coroners offices. I have watched this epidemic from its earliest stages to its current existential threat status. As a result I have come to the following conclusions about this tragic situation our community and communities across the country find themselves faced with. WE MUST CHANGE THE WAY WE THINK ABOUT THIS AND TREAT THIS PLAGUE.
1.) Move away from the concept of a war on drugs. Move towards providing an aid package for these vulnerable and impaired individuals.
2.) Move away from concepts of criminalization, imprisonment, and that they are deserving of severe punishment. Move towards treatment and therapeutic interventions. View individuals with OUD as impaired and of need of help.
3.) The concept of opiate-dependent individuals as merely addicts that are weak, self-indulgent, hedonistic, and who are scorned by all is not helpful in resolving this national issue. There certainly is a volitional component to this illness. While personal responsibility and accountability is the only path to a healthy life, opiate-dependent individuals need a support system and tools to help get them on that path. Individuals suffering from OUD hate themselves, the behaviors in which they engage, and the resulting consequences. People with OUD are reckless with their lives because they feel their lives have little or no value. The mind-set of the opiate-dependent individual is one in which it doesn’t matter if they live or die. These vulnerable individuals are also prone to abuse and exploitation.
4.) Society must track these individuals and intervene when necessary.
5.) Society as a whole must be educated about opiates and all aspects of drug dependency, starting in grade school. Opiates come in pill form, patches, lollipops, and can be snorted and inhaled. Drug dependency can begin after one dose. Five days of continued use of opiates can result in drug dependency. Individuals who are genetically predisposed to dependency are more affected.
Like many drugs, over time the same amount of opiates has less and less affect which results in individuals increasing the drug dose and decreasing time between doses. This is the concept of drug tolerance. People spend more time getting the drug and doing the drug, and it becomes a vicious cycle. OUD individuals start to live a life of lies to cover their drug use. They spend a majority of their time planning to get money and make time to use drugs. They become psychologically consumed by thoughts of procuring opiates, using opiates, and disregarding everything else, including family, friends, job, health, and finances. All that matters to them now is getting high. When in withdrawal, these individuals can become very desperate and dangerous. They will go to great lengths to get high.
What can we do in terms of how society should deal with the problem? When treating an OUD patient, both incentives and consequences need to be geared towards keeping them off the drug of abuse. These five areas are conceptual changes needed towards resolving the national opiate use crisis and treating patients with Opiate Use Disorder:
1.) There needs to be a massive education campaign similar to the education campaign against tobacco including the danger of opiates and treatment options for OUD individuals. Explain the dangers of opiates, what opiates are, how they affect our brains, and, importantly, how easily it is to become dependent. The potential of overdose and death needs to be underscored. For example, the opiate called fentanyl, in amounts barely visible to the human eye, can cause individuals to stop breathing. Fentanyl is measured in micrograms. There are 100 milligrams in a gram. There are 1000 micrograms in a milligram. There are 100,000 micrograms in a gram. Two hundred micrograms or maybe less is lethal, which hardly covers the tip of a needle.
2.) The streets must be flooded with Narcan inhalers. One to three sprays in a nostril can revive an opiate overdose.
3.) The streets must be flooded with test kits to determine what is in the drugs and how much is in them. People make better decisions when they know what is in the drug they are taking. For example, if someone makes a street purchase of a drug with fentanyl or methadone in it, they need to be extra careful because those drugs can easily kill you. Methadone is dangerous not only because it is so potent but because it lasts so long. There is an even more dangerous drug on the street called carfentanyl which is 100 times more potent than fentanyl! Note: methadone has been useful in the treatment of OUD, however, it is so dangerous that the dose must be given out on a daily basis. While methadone blocks cravings, it provides a high so can still be abused and lead to an overdose. Buprenorphine is another drug used in treating OUD, and it has been found to be safe enough to prescribe on a monthly basis. The negatives and stigma associated with methadone should not be associated with buprenorphine.
4.) Laws need to be changed. Instead of charging people with accessory to murder when a friend overdoses and dies, give them immunity. Give complete immunity to people in the presence of someone who overdoses if they call 911 during the overdose. Encourage people to call 911 and save lives, not run and hide fearing prosecution.
5.) The court system for individuals with OUD must change. Once in the system, these individuals must be tracked with drug testing and given treatment when needed. Criminal records for possession or use can be wiped away if the individual stays sober. Incarceration should be a last resort. Charging people with felonies for drug possession scars people for life. Once labeled a felon, re-entering society becomes very difficult. OUD individuals are not sociopaths or criminals, they are ill with a disease. Treat the illness and there are no criminal problems.
This perspective demands basic changes in our societal and individual thinking about opioid dependency. Equally as important is the way the established medical community regards and treats this diagnosis and it is just that….a medical condition.
I have many thoughts for my peers and given the opportunity, I would welcome the chance to share them.
No matter what our circumstances in life, we are all touched by this epidemic in some way. We all have skin in this game. Time is precious, costly and limited. Soon may become later and it is already too late to wait.
More comprehensive explanations about how to deal with addictions in my book Tales From The Couch on amazon.com
Mark Agresti, M.D.Learn More