Alprazolam

Alprazolam

Welcome to a brand new blog, people! Last week we talked about mindfulness, so I hope everyone has been trying to practice that in at least some small ways everyday, especially when stressed. If not, the topic of the new series I’m introducing today may be a bit of foreshadowing, as you might need it. Trust me when I tell you that it’s far easier, not to mention more rewarding, just to live a more mindful life. The new topic is alprazolam, which you might better recognize as Xanax, a drug used nearly solely for anxiety, at least when used as intended, but we’ll get to that. 

Today as an introduction, I’ll give you an overview on what you should know about alprazolam if you’re thinking about taking it. But my advice? Don’t, because while it works, it can be so sneakily addictive, in a way that seems almost sinister. Insidious. It took me a second to get there, people. My point is, it will creep in and take over anyone’s life if given the smallest opportunity to do so. We’ll talk more about that later. For now, suffice it to say that it’s so abused by so many people, it’s literally become a threat to public health. I hear stories everyday about how it ruins the lives of good people with only the best of intentions. For that reason, plus more that I’ll get into, everyone should really know the basics about alprazolam. 

Alprazolam belongs to a group of medications called benzodiazepines, aka benzos. Other meds in this group include Valium, Klonopin, and Librium.  You may have seen my YouTube video on benzodiazepines, barbiturates, and alcohol. If not, I’ll put the link at the bottom so you can check it out. Alprazolam, aka Xanax, has a lot of slang names as well, mostly referring to its shape and color. Bricks, zanny bars, blue footballs, and z-bars are the ones that come to mind right now, but there are others used on the street. Speaking of, alprazolam is pretty cheap in the pharmacy. On the street, it’s pretty damn expensive when you consider it can easily cost you your life, but it usually goes for around $3 to $5 per bar or pill, depending on strength. What a bargain. 

Alprazolam, like other benzos, is most commonly prescribed for people with anxiety disorders or panic disorder. Sometimes it’s also used short term for treating severe insomnia, alcohol withdrawal, and prolonged seizures. I myself prescribe it for these indications- very short term and as low dose as possible- because it works well and it’s so fast acting. For anxiety and panic attacks, I almost universally try other meds and methods first, because of its aforementioned insidiousness, but occasionally I might use it as a bridge while the other meds and methods start to work. 

How Alprazolam Works

Like all other benzodiazepines, alprazolam works by binding to specific receptors in the CNS called GABA (gamma-aminobutyric acid) receptors. GABA is an inhibitory neurotransmitter, meaning it works to decrease nerve activity. The simplified pharmacological mechanism looks like this: when alprazolam binds to the GABA receptors, it enhances GABA’s inhibitory activity. This pumps up the GABA, which greatly reduces neural stimulation. This decreased neural activity produces general CNS depression, and elicits the anti-anxiety and sedative-hypnotic effect that’s felt by the person ingesting it. It’s important to note that alprazolam doesn’t affect everyone in the same way. There can be other factors involved, including the person’s mental state at the time the drug is taken, the dose taken, the person’s age, weight, and individual variances in the metabolism of the drug. 

How Alprazolam Feels

Captain Obvious says that this depends on the dose, which I’ll get into next, but when taken as prescribed for anxiety or panic disorders, the idea is that you should feel “normal” after your first dose. The sedative effect should help alleviate the symptoms of anxiety, and calm your body’s response to the anxiety or the stressor. If you take it recreationally, aka without a prescription, the effects you feel would still be dose dependent, and if you take a small dose, in theory you would have the same effects. I say in theory because that would depend greatly on where you get it. If you buy it on the street, you’re probably not taking actual alprazolam. Fake alprazolam is a huge, lethal problem, and I’ll be dedicating an entire blog to that topic in this series. You’ll be shocked. Hint: if you want to live, don’t buy Xanax on the streets! Unlike stimulant drugs like cocaine, which produce a euphoric “high” feeling, recreational alprazolam users describe feeling more relaxed, quiet, and tired, often to the point of passing out for several hours at a time. Some people have memory lapses or amnesia or black out periods, where they can’t remember anything that happened for several hours, even if they’re awake at the time. Equally important is what you should not feel when you take alprazolam, and I’ll cover that below, when I talk about side effects.

Alprazolam Dosing

Alprazolam is available in multiple milligram strengths, 0.25 mg, 0.5 mg, 1 mg, and 2 mg. 

The effects become more significant as the dose increases, so first-time alprazolam users should absolutely start with the lowest possible dose and let your prescribing physician know exactly how it affects you to determine if the dose needs to be adjusted. You don’t ever get to play doctor here, people. Don’t increase the dose on your own, even if you’re an experienced user. This is because higher doses can be fatal for everyone- from first-time users all the way up to people who’ve used it as prescribed for many months or years. Again… don’t take a higher dose than what’s prescribed by your doctor. 

In addition to instant death, high doses are associated with a counterintuitive complication known as the “Rambo effect.” This unusual side effect can happen out of the clear blue sky in anyone taking alprazolam, prescribed or not and experienced or not, and generally presents as the user beginning to display behaviors that are very unlike them. These might include aggression, theft, or promiscuity, but can really be any unusual legal or illegal behavior- the key is that it’s very atypical and seems to occur suddenly. It’s not clear why some people react this way, or how to predict who it will happen to, so it adds a very unwelcome guest to the alprazolam party. 

Alprazolam Metabolism

How alprazolam is broken down and affects you also depends on those aforementioned factors of age, weight, and individual variances in metabolism, but can also be impacted by the presence of other substances and/ or  medications you may be taking. When taken by mouth, alprazolam is absorbed quickly by the bloodstream, so it’s very fast acting. Some people can begin to feel its effects within 5 to 10 minutes of taking the pill, but almost everyone will feel the effects within an hour. One of the reasons why it’s so effective for treating panic attacks and anxiety is that the peak impact from the dose comes so quickly. But, fast acting meds wear off fast too, so the effects are brief. Most people will feel the strongest impacts from the drug for two to four hours, though lingering effects or “fuzzy feelings” may stretch out beyond that for several more hours. Some people even report a hangover type effect as well.

The length of time that alprazolam stays in the body before being excreted also varies person to person by those aforementioned factors. The half-life of alprazolam in a healthy adult averages about 11 hours, meaning that it takes the average healthy person 11 hours to eliminate half of the dose from the bloodstream. Typically speaking, that time would generally be a little shorter for younger people, and longer for older people. It’s important to recognize that you will stop feeling the effects of the alprazolam long before you reach half life.  

It is possible, even likely, to build up a tolerance to alprazolam, and this can happen very quickly. If that happens, you may begin to notice it takes longer to feel the sedative effects of the drug, and that feeling will wear off more quickly. As alprazolam wears off, most people will stop feeling the calm, relaxed, lethargic sensations that the drug is associated with. If you take this medication to relieve symptoms of anxiety, like a racing heart, those symptoms will begin to return long before it’s half-life. If you don’t have these symptoms, you’ll begin to return to feeling “normal.” However, some people who take alprazolam for reasons other than anxiety may find they actually begin to experience feelings of depression and/ or anxiety, even if they’ve never had an issue with these conditions, as the chemicals in their brain adjust to the lack of the drug. This rebound anxiety or depression is usually temporary, but will often happen each time it’s taken. I have a Huntington’s patient who never had any anxiety or depression until his specialist put him on alprazolam for severe muscle spasm, and now it’s a real problem. Sometimes it’s hard to tell what’s worse, the disease or the “cure.”

Alprazolam Side Effects

Captain Obvious says that being aware of potential side effects is very important when considering taking any drug. He also says that should you experience any of these, stop taking it and contact your prescribing physician immediately, or seek emergency medical attention if appropriate. Possible side effects of alprazolam include sleepiness, dizziness, headache, confusion, muscle cramps, decreased appetite, weight loss or weight gain, diarrhea, nausea or vomiting, manic symptoms, difficulty walking, dry mouth, irregular heartbeat, low blood pressure, and blurry vision.

How it Shouldn’t Feel 

When taken properly at prescribed doses, the effects of alprazolam should be mild, but detectable, and the symptoms for which it is prescribed should be decreased. If the drug appears to be having a significant negative impact, seek emergency medical attention and then contact the prescribing physician later. It should go without saying, but don’t take it again. Symptoms to watch for include extreme drowsiness, muscle weakness, confusion, fainting, loss of balance, and/ or feeling lightheaded. You should also seek emergency medical attention if you experience signs of an allergic reaction. Signs may include swelling of the face, lips, throat, and tongue, and difficulty breathing.

Alprazolam Special Considerations

Some people should avoid alprazolam entirely because they may be more sensitive to its side effects, or it could potentially harm them in some other way. This includes pregnant women, older patients, children and teenagers, people with a history of alcohol or drug abuse, and people with certain medical conditions such as respiratory illnesses.

Alprazolam Tolerance, Abuse, Dependence

I cannot overstate the potential for misuse, abuse, dependence, and addiction associated with alprazolam. And it doesn’t “just happen to junkies” people. Some folks without any reason take it recreationally just because they like the way it makes them feel. Others have undiagnosed anxiety disorder, so they start buying it or taking it. Others are prescribed it for anxiety, insomnia, seizures, or severe muscle spasm, but begin to need higher or more frequent doses of it to achieve the same effect; this is known as tolerance. 

Though the routes to get there vary widely, without any intervention, all of these situations usually lead to the same place: dependence and addiction. This happens when the body begins to rely on alprazolam to function normally. Over time, we’ve collected scientific data and anecdotal reports to determine that certain people/ groups are at greater risk for abuse, tolerance, and dependence on alprazolam. These include non-hispanic whites, young adults 18 to 35 years old, people with a current psychiatric disorder, and people with a personal or family history of substance abuse. For these people, taking alprazolam is like playing with fire. If you’re one of them, don’t risk getting burned. 

Alprazolam: Synergistic Interactions

A synergistic interaction occurs when the combined effect of two drugs or substances is greater than the sum of the individual activity of each. As a CNS depressant, alprazolam has synergistic interactions with other CNS depressants, and there are lots of those out there. The biggest example is also the most commonly overlooked one: alcohol. Good ole EtOH. Other examples include: other benzos (duh), opioid analgesics ie OxyContin, Vicodin, morphine etc, barbiturates ie Seconal and Nembutal, hypnotic drugs ie Ambien, heroin, methadone, neuroactive steroids ie estrogen and testosterone, and intravenous and inhalational anesthetics. If you take alprazolam and any of these substances, the alprazolam intensifies the effects of that substance and vice versa, so when taken together, they literally become exponentially more potent than if you used either of them on their own. 

This is because all of these substances also increase neurotransmitter GABA activity in the CNS, slowing the activity of the nervous system, causing the sedative effect. When alprazolam is mixed with any of these substances, because the effects are synergistic and exponentially more potent than just the two combined, you’re at risk of excessive sedation, extreme confusion, prolonged memory loss, seizure, loss of consciousness, respiratory depression, cardiac problems, dangerous accidents from increased clumsiness and sedation, and unintentional death. Please note that these synergistic interactions occur whenever the substances are mixed- even if it is at prescribed doses. 

However, there are some drugs that cannot be combined with alprazolam that you wouldn’t even think about. This includes some oral contraceptives, antifungals, antidepressants, antibiotics, and heartburn drugs. These drugs can affect the pathway that’s responsible for eliminating alprazolam from the body, so that the alprazolam isn’t removed as quickly as it should be. Over time, this can lead to a toxic buildup of the drug, and eventually an overdose. Always speak with your doctor to review meds and discuss potential interactions. In addition, your pharmacist is an excellent resource for any questions about med interactions. Some specific meds that may interact with alprazolam include cimetidine (Tagamet), fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), carbamazepine (Tegretol), diltiazem (Cardizem), isoniazid (Laniazid, Rimifon, Hyzyd, Stanozide, Nydrazid), and cyclosporine (Sandimmune). 

Also, not a medication, but important to remember is… grapefruit juice! Grapefruit juice can block the action of CYP3A4, which is a critical enzyme in the body. Mainly found in the liver and the intestine, it oxidizes small foreign organic molecules, like toxins and drugs, so that they can be removed from the body. When CYP3A4 is blocked, instead of being metabolized, more of the drug enters the blood, and stays in the body longer. The result is too much drug in the body. I should add that there is some controversy surrounding this. The FDA says grapefruit juice does slow alprazolam metabolism, but some studies have published results that indicate it is “unlikely to affect the pharmacokinetics or pharmacodynamics of alprazolam, due to its high bioavailability.” Translating this geek speak to plain english, they’re saying their studies found that grapefruit juice had no effect on how alprazolam was metabolized and cleared from the body, because so much alprazolam is absorbed and available for biological activity in the cells and tissues where it’s metabolized. I say err on the side of caution and avoid alprazolam, or grapefruit juice if you just can’t. I should add that CYP3A4 is involved in the metabolism of other meds as well, so if you drink grapefruit juice, keep that in mind- tell your docs and pharmacist.  

Stopping Alprazolam

I touched on the dependence issue associated with alprazolam, but I’m going to discuss that and withdrawal in more detail in next week’s blog. Regardless, even if you have only taken alprazolam exactly as prescribed, and you’re sure you’re not dependent on it- if you want to stop using it, you must do so with the guidance of your prescribing physician or another healthcare provider, because stopping alprazolam abruptly can lead to serious, medically dangerous withdrawal symptoms and rebound anxiety. Don’t stop alprazolam on your own! Depending on how long you’ve been on it and how much you take, your physician will need to taper your dose, meaning step you down on the dosage until you stop it altogether. This is the only way to go. Withdrawal is no picnic, but stepping down makes it so much easier, and it eliminates the dangers associated with cold turkey. Rebound anxiety from abrupt alprazolam withdrawal is no joke- people who experience rebound anxiety report that their anxiety symptoms are at least at the same level, but usually worse, than they were before starting alprazolam- so not only are they not better, they’re worse. You want to avoid this if at all possible, so don’t stop alprazolam abruptly. 

Speaking of stopping abruptly, that’s it for this week. Next week I’ll talk in depth about alprazolam addiction and withdrawal. And we may have a guest blogger situation. We’ll see. 

I promised you a link to my YouTube video that covers a lot of this information, so here that is. Lots of other vids to check out there too. 

Benzodiazepines, Barbiturates, and Alcohol

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Working Remotely,Part Trois

Working Remotely, Part Trois

Hello, people! The last couple of weeks we’ve been discussing working remotely. I was prompted to do this series after noting the ways some of my patients evolved, or devolved, after working remotely in a ‘rona world. When I did some research, I read studies and reports from years BR, before ‘rona, and saw that remote workers regularly reported higher stress levels than their office worker counterparts. According to a 2017 United Nations study involving 15 countries, 41 percent of “highly mobile” employees (defined as those who “most often,” or “more often…worked from home” as opposed to “in office” or “onsite”) rated themselves “highly stressed,” as compared to only 25 percent of the office and onsite cohort. This was of obvious interest to me, given what I’d been seeing in my patients, so I thought it warranted further investigation and discussion. And a baby blog was born. Awww…

Captain Obvious says that mental health and work are intertwined, because work is such an integral part of our lives. Remote work has a somewhat unique ability to get to people, even the mentally healthiest of individuals, because when you work from home, you may feel like you live at work. The work-home and work-life lines can blur, especially if the switch is abrupt and unavoidable. Thank you, ‘rona. Last week I talked about some of the issues that can come along with this type of remote arrangement, and the fact that they generally present as some level of SADness, so you may find you feel stressed, anxious, and even depressed as a result. You may feel these impacts within a widely variable range as well as pattern; acutely, chronically, or as more of a cumulative or building phenomenon. Just to make it more complicated, you can also have a pink cloud situation as well. After making a switch, the novelty of the setting can alter how you value certain associated factors. You may find that any negative impacts you feel from one issue are offset by the positive impacts of another. But this can be a little insidious if you’re not careful, because it’s a transient phenomenon. Once the novelty wears off, that pink cloud goes **poof-bye bye** and suddenly, the equation is altered again! It’s not really worth it anymore, and that can make you SAD. 

Sometimes the effects can be so low level, you might just generally feel blah, or ‘some kind of way,’ as the kids say, but you can’t seem to put your finger on why. There are nearly innumerable ways that stress can manifest, regardless of where you work, and it usually doesn’t just affect your work. It often seeps over into your private life as well, but this is especially true when you’re working from home, because of those annoying blurred lines. 

So if you’re a remote worker and feeling some kind of way, how would you know that it might be your remote work at the heart of it? Clearly it’s difficult to pinpoint it exactly in a generalized blog setting, because each person is different; but there are some ways stress can manifest in both your personal and professional life, some things you may start to notice. The most common things can include: insomnia and poor sleep patterns, an inability to ‘switch off’ from work, headache, feeling disconnected from other people, an increase or decrease in appetite, having difficulty concentrating, having difficulty becoming and/ or staying motivated, having difficulty prioritizing workload and daily tasks, and feeling insecure or unsure of standing or spread too thin/ pulled in too many directions in your work and/ or personal life. 

Last week I likened work, and life, to an equation. Everything has a value, and you decide what’s worth what, give and take, in order to decide what works for you. Last week I focused on the negative side of said equation, so this week will focus on the more positive side. Today will be about addressing issues I brought up last week, presenting some additional factors, and suggesting some steps you can take if you think that working remotely is having a negative impact on your life. Clearly, you don’t have to wait for that to happen, and everyone knows what they say about an ounce of prevention, people. When we’re talking about stress, it all comes down to minimization and mitigatation. I’ll try to address each issue in the same order I did last week, and make some strategic suggestions for solutions. Some of these may have been mentioned in the first blog of this series, so people that might’ve missed it can still follow along. If you didn’t miss it, please bear with me. 

Awesome Office

I’ve joked about how many patients I’ve seen in bed during facetime appointments, but I think far too many people are both working and sleeping there. Seems like a lot of people’s morning routine is just rolling over to grab the laptop. But there are good reasons why this is concerning to me. Humans need sleep, and studies show that working from home, just in and of itself, can already interfere with sleep. But this is especially true for people who find it difficult to switch off from work. Working from your bed, or even bedroom, makes it very difficult to do just that. Not only does it encourage the late night blue light exposure that has been shown to interfere with sleep, but it also makes your brain associate that place with being alert, awake, and switched on. And that’s not the association you want- your bedroom should be the place you rest and recharge. 

If you find yourself working remotely full time, you want the best possible experience. You’ll certainly be more comfortable and productive, not to mention a lot happier, if you create a dedicated space to work. Preferably, a separate room with a door you can close for privacy, and to minimize distractions and physically separate your work from your home life. If you just don’t have a separate room, find a corner or nook in your house that you can commandeer, and transform it into your home office. The goal is to make it feel detached from the rest of your house, so if it’s a small space, consider a room divider, or think about using just an area rug as a means of creating a division. Once you have “the office” location, be it a separate room or just a corner, set yourself up for success. Buy new- or check out used shops or thrift- for a desk that’s wide enough to support your wrists, arms, and elbows to keep carpal tunnel at bay while you’re tapping away at your keyboard. Better yet, go tetherless and get a wireless mouse and keyboard. Also look for a comfortable, ergonomic chair that supports your lumbar back, neck, and spine. Few paychecks are worth an orthopedic problem. Big bonus points if you can kit out your space with a sound system and other creature comforts. Try to also get some life into the space. Consider some plants and maybe even a little fish tank if you have room- they’re very soothing. If you’re only working remotely temporarily, and you just don’t have the space at home for an office, even going to a local library or cafe to work may be better than just converting your bed to one. When you have a clearly defined working space and time, it’s far easier to finish your tasks for the day, and leave work at “the office.” That way home remains home, and you avoid being “on” all the time. 

Tech No!

Once you’ve done what you can to create a dedicated work space, make sure to do what you can in the way of technological assistance. If you need a new laptop, smartphone, wi-fi, or cell booster, communicate that with your employer, if appropriate. If they provide the equipment, or some sort of assistance in purchasing it, then score! If not, investing in tech that will save you time and aggravation is always a good move, so do that as soon as is feasible. If you’re all set up and ready to roll and find you’re still having technical difficulties, most definitely communicate that with your company’s IT department, if that’s not you, to fix the issue. If that is you, take the time to deal with it as efficiently as possible, call a “geek” to come out for a diagnosis. The sooner your systems are running smoothly, the fewer the tech migraines you’ll have later. 

Coming at this from a different direction, once you’re properly setup, working from home can give you an opportunity to be proactive, learn something useful, and make friends with technology. There are apps out there that do all sorts of cool things that can be helpful in a remote work environment. You can set timers and reminders for break activities, track your social media usage, like if you need some help to use it less, remind yourself to get back to work when you become distracted for too long, and you can create to-do lists and schedules galore to help stay on top of things, simplify tasks, avoid frustrations, and be more productive. There’s nothing more encouraging than getting your mundane tasks done as quickly and efficiently as possible, so check out all the options available and learn to use tools like these to your advantage. 

And just as the expansion of the internet has made remote work possible from nearly all corners of the globe, novel programs and platforms have also been developed specifically for remote workers. If you work for an organization, they may offer access to automated online courses that will allow you to keep honing your skills, so contact human resources and make some inquiries. If those opportunities don’t exist, you can always look for other free or paid online courses for virtual and remote workers. When I searched it, the number of them available was impressive. There are courses designed to give you the skills necessary to start a new career, or to grow an existing one. Remember that any time you work to broaden your horizons, you further your personal identity and make yourself more valuable in every professional application. 

Management

A significant issue revolving around working remotely involves its management. How do you adequately supervise- and support- multiple employees, when they’re potentially thousands of miles away? Both managers and employees face a different set of challenges when working remotely. From what I hear from remote worker patients, the decreased feedback from managers and supervisors boils down to making some employees feel insecure. As I mentioned last week, it makes them feel mistrusted, and as though they have to prove that they’re actually working from home and not goofing off. I think the remoteness gives them no benchmark to judge their own progress, and that leads to increased anxiety and concerns about being up to standards. In short, they may not be getting the attaboys they did in the office, and that makes them wonder if they’re doing a good enough job. Obviously, employees need to adequately document the hours they work, and maintain regular communication with supervisors to keep them up to date on what they’re working on. More on communication later. 

On the supervisory side, I think the solutions to these issues requires an open mind. Remote companies need to start thinking about how they can ensure that employees aren’t overworked, and also utilize management courses for remote team leaders to help train them for this new working environment. They should set aside more traditional ideas that no longer work, in favor of developing more flexible policies that better correspond with a more modern arrangement. Maybe implement the concept of management by objectives accomplished instead of by time. I can tell you from years of listening to people that helicopter monitoring- actually helicopter anything- and micromanagement won’t work. Management should consider allowing some employee input into the creation of novel management methods as well. Employee happiness and engagement increases productivity by 31 percent, so getting them involved in making suggestions benefits everyone. 

Some other simple steps that management can take include encouraging employees to communicate amongst themselves, to take PTO days, to stay out of their “office” after hours, and to enjoy a hobby that does not involve a computer screen or technology of any kind. Also, performing technology and work station audits to confirm reasonable working conditions, and giving regular updates regarding organization standards and plans for future work performance will help alleviate a great deal of employee insecurity. Management also needs to be proactive in helping remote employees avoid undue stress, and allow them to feel comfortable reporting stress without worrying about repercussions. Two psychologists created the Yerkes-Dodson Law, which points out that stress can be productive up to a point, and then it results in reduced productivity. Being overly stressed without the ability to report it is detrimental, as pressure will eventually outweigh an individual’s ability to cope over time. Contrast that with the findings of one recent study, which reported that colleagues who spend just 15 minutes socializing and sharing their feelings of stress had a 20 percent increase in performance. Clearly, this demonstrates how it behooves management to implement measures for employee stress sharing and reporting. 

Given the negative impact of stress in a remote work environment, management should also avail themselves of training to learn the warning signs that signal that remote employees are feeling workplace stress. Opening up a line of communication is a good first step, so that when they are starting to experience burnout, they’ll be comfortable discussing how they feel. Management should learn to ask questions about how they’re feeling and listen closely to the answers. Do they mention having a difficult time concentrating? How about their interests in things they used to like? Are they experiencing any feelings of frustration, irritability, or hopelessness? These would all be indicators of stress that management needs to catch before employees reach a breaking point. An increase in negative language is another indicator. The use of phrases such as: “there are no options,” “I can’t do anything,” or “this is impossible” are examples of catastrophizing, and should be red flag indicators of employees having more workplace stress than they know how to deal with. There are other signs as well. Make sure to speak with employees that are starting to make mistakes, missing deadlines, or getting sloppy, as they are often the first signs of struggle. And instead of cracking down on staff that’s having a hard time, organizations must offer support through stress management initiatives in the workplace. In my opinion, management and employees making all of these efforts would result in big strides on the road toward improving the remote work experience for everyone.

Isolation and Loneliness

The solitude of working remotely can be a double-edged sword. It can be easier to focus when you’re in your own home, with no annoying coworkers randomly stopping by your desk, or your boss breathing down your neck. Aah…sweet freedom! But when there’s no social interaction during a full workday, that also means there’s no one there to ask a work related question to, or bounce an idea off of, or un-stick you at a crucial point. Social isolation was another factor associated with increased stress levels mentioned in the UN study. In addition, without personal communication, more emphasis is placed on deadlines and routine information, so remote workers can feel like a cog in a machine, rather than an essential part of a team. This just adds to the sense of isolation that naturally comes with working remotely, and the two together can make it difficult to have as much energy to be productive. In addition, it can be very unpleasant, if not impossible, to sustain this for the life of a career. A top priority should be to maintain relationships with coworkers and managers, especially if you are one who is energized by these relationships. It is critical not only to work performance, but to emotional and mental wellness. 

Technology can serve as an assist, and there are plenty of platforms like Slack, Zoom, and even good ole facetime to facilitate this. Lots of companies have established ‘virtual coffee breaks’ and even ‘watercooler’ channels to encourage break-time chatter during work hours, to foster collaboration and create a more comfortable work environment. If your company has outlets like these, take advantage of them. If they don’t, then maintaining connections is essentially up to each individual. Because everyday encounters with colleagues don’t spontaneously happen when working from home, you need to be proactive to maintain positive relationships. Think about scheduling a few minutes for informal banter at the start and end of video calls to emulate the normal casual talks you would have with coworkers when walking by their desks, or in the kitchen at the office. It may not seem productive, but it helps build internal relationships and boost morale. These connections will help you feel less isolated, reduce stress levels, and stay productive. 

You can always facetime, Zoom, message, and email people, but that’s not the same as having face-to-face interactions with them. So make it a point to meet with coworkers or friends for lunch, coffee, or drinks a couple of times a week. If you find you’re still feeling isolated and lonely while working remotely, consider meeting other digital nomads at a coworking space, or work together from one of your home offices twice a week, or more often if it’s helpful. But remember what all work and no play did to little Johnny. Make social commitments with friends and get outside of the house at least once a week. Ultimately, if you work from home and feel isolated or lonely, it’s important that you take responsibility for your own social interactions. The key is to make an effort and be proactive to do things to decrease the isolation that can come from the remote work setting. 

Burnout

One of the biggest challenges in working remotely is finding a healthy work-life balance to avoid blurring those lines I mentioned earlier. Surveys show that 51 percent of employees report stress and burnout as a result of working at home. Just as an interesting aside, the most often cited reasons for burnout are, surprisingly, the very things that made remote work seem attractive to most people. The dressing! Or not. The surveys indicated that when people dress in sweats because they are not seeing anyone, they then find that comfort makes it difficult to fully engage. Their clothing signals fun chill time, while their tasks are anything but. And while remote work seemed liberating, many employees relied on supervision and structure to manage their workday. Without it, many people fing it hard to be as productive, and are stressed about not completing tasks in a timely manner, and these cause them to overwork and risk burnout. 

Not all people can achieve proper work-life balance when they work from home, and in fact, the UN study also noted that this is one of the many negative impacts of the remote work arrangement. For some, working from home feels like a special privilege that’s been granted to them, so they feel like they should work harder, and that’s how stress and burnout are escalated. I’ve noted that some patients, who definitely seemed to have a solid, healthy work-life balance when they worked in an office, suddenly started to become work obsessed after going remote. They work ridiculous hours at home, unable to even define the end of a day, much less switch off at it. I’ve seen it happen- watched it happen- to people who had a previously healthy balance, so imagine what happens to someone with workaholic tendencies when they go remote. From what I’ve observed, working remotely is to workaholism what bar hopping is to alcoholism. If you’re in a place that facilitates a bad habit, that’s a bad place to be. In other words, workaholics probably need not- or should not- apply for a remote position.

When working in an office environment, there are often clear signs and symptoms if somebody is burning out. These commonly manifest as increased emotional reactions to situations, a general lack of motivation, and the appearance of small, seemingly minor mistakes. There are also some visible physical signs, such as bags under the eyes and even weight loss, that can be seen. When working from home, there isn’t anybody to notice these telltale signs, apart from family members or friends. But if that person lives alone or is isolating themselves, then they’re not even there to see them. So remote workers have to be able to police themselves to avoid burnout.

Flexibility is a double edged sword. It can be liberating to set your own times as to when you need to get up, when you go to bed, when you need to start work, and when you need to stop. But this feeling of freedom can gradually morph into a feeling of being out of control, especially if you don’t expect it. It sounds great to eliminate a structured office setting, but once that structure is gone, where it might have felt stifling before, it can start to feel like the scaffolding on which your whole life was built. When there’s no one there to monitor or guide you, and structure has to be self-imposed, it can be difficult to create. It can also be more challenging to function as efficiently without it.

The solution is to set a schedule and put it on a calendar. Look at it as an opportunity to exercise the flexibility that is a prime benefit of working remotely. It can be vital to not only save you from burnout, but also from distractions that will swallow up your time. More on that in a bit. There are several useful tricks for creating a schedule, and you can always use an app to help you to make one in a format that suits you. If you are free to set your own hours, meaning it doesn’t matter when you work, then decide when you work best. Many people find that working in the morning when they feel rested can provide a more productive experience than beginning work halfway through the day after cleaning the house and doing other non-work-related activities. This isn’t true in all cases, so feel free to experiment if this advice doesn’t seem to ring true for you. If it were me, I would not only start work first thing in the morning, but I would also prioritize the most challenging tasks first. Rather than letting unpleasant or difficult tasks hang over your head and create stress when you think about them, pushing yourself to get the most difficult jobs done first will give you a sense of accomplishment and increased energy to get you through the day.

To be productive and avoid burnout, you not only have to set a schedule for balance, but you have to stick to it. Make sure to maintain reasonable office hours. As I mentioned last week, your home is now your office, so you’re not technically ‘leaving’ work unless you turn off all communication platforms. Sign out of your email, close the laptop, put the phone down at the end of the day, then leave “the office.” Make sure to include time to step away from your desk to take a lunch break, and eat something sensible to avoid being distracted by hunger later. If you have children or family at home, this is a good opportunity to spend some time with them. Since you probably spend a lot of time indoors, try to have lunch outside. 

In addition to a lunch break, schedule short breaks during the day. Scheduled breaks are better than just working until you lose focus, then randomly giving in to distractions. Everyone is different, so the length and number of breaks can vary slightly, but within reason. Some people would do better taking 15 minutes mid-morning, and then again mid-afternoon, while others would rather two shorter breaks in place of one longer one. During these breaks, try to step away from your desk to disconnect for a few minutes; this is a very effective method for avoiding/ managing stress. Go outside to get some fresh air, maybe take the dog out to get the mail. The idea is to use these times to clear your head to help you focus on work when you come back. 

When you take time off, take it completely off. If you’re guilty of working on PTO days or of bringing your laptop on vacation, you’re missing the point and need to disconnect more fully. It might seem like bringing work with you means you’ll have less to catch up on, and therefore less stress, when you get back, but in reality, you aren’t allowing yourself to recharge. This goes for weekends too. Keep the laptop closed, resist the urge to check emails, and concentrate on the life part of the work-life balance during your time off.

Focus, Motivation, Distraction

Creating structure and setting boundaries are critical in a remote work setting, not only to avoid blurring the lines between work life and home life, but also those between productivity and leisure time, and socializing time and working time, in order to avoid distractions. But this can be more challenging than many people expect. If you live with family, setting boundaries with others can be difficult when people expect that you should have time to talk when they do. You may feel pulled between competing loyalties and overwhelmed by the responsibilities of your various roles. Not only is it difficult to set and communicate boundaries, but in some situations, such as when there are children in the home, those boundaries may also be constantly challenged. If you live with other people, especially children, make sure to have set office hours and communicate them to everyone. You can even show small children your schedule, and explain that you have break times and lunch time scheduled, and you’ll see them during those times. Also clearly communicate what circumstances warrant an interruption of work time in order to avoid random needless interruptions. Apparently some companies actually provide employees with do not disturb signs to hang on their office doors in order to remind others you’re actually working. It’s not the worst idea ever. I say if you have kids, and your company doesn’t provide you with one, get out the markers, glue, and glitter and them involved- ask them to create a sign for you. If they make it, they’ll be more lilely to respect it when they see it hanging on the door. 

Setting and sticking to boundaries with yourself may be even more difficult than with others, especially when you are feeling a lack of motivation. Without other coworkers around to hold you accountable, you may have a little tougher time motivating yourself, but resist random distractions in favor of taking your scheduled breaks. In addition to sticking to your schedule, you can avoid distractions by not taking personal calls during the middle of the day and avoiding the endless rabbit hole of social media. Turn off notifications and/ or mute your devices while you’re working. Just don’t go on social media if you don’t want to be Alice. It’s easy to lose sight of tasks and deadlines, especially when your superiors can’t physically see you, but you can monitor your own productivity by planning ahead of time and using time management techniques. At the end of each day, make a list of tasks to be done for the following day. On the next day, review your priorities and tackle high-value tasks first. By following this, you’ll stay organized by keeping your schedule and calendar straight, and learn how to prioritize to get your work done. It should also help you learn one of the golden rules to working remotely: don’t procrastinate! If you need more help with time management techniques, google it. There are methodologies available on the interwebs to help maintain your focus throughout the day, and I’m sure there are apps for that, as well. Aren’t there for everything?

To keep your motivation up, it’s a good idea to break big tasks down into smaller, workable goals. You can also setup project milestones, working with a manager to establish objectives when needed. Sometimes communicating those goals out loud to others can help to motivate you, so consider sharing those goals with coworkers or family members, because sometimes making public commitments to others about what you will accomplish that day helps hold you accountable. If you need to really pump up the motivation factor, you can always reward yourself for accomplishing goals as well. But this doesn’t mean a food reward, people. Maybe schedule a massage, a special lunch with a friend, or an ice cream with the kids. Okay, I guess that’s technically a food reward… so make it a yogurt if you’re trying to be healthy. At any rate, put planned rewards on the calendar so you can see it as a motivator. It doesn’t even have to be a real reward that costs anything. Sometimes it’s rewarding enough to imagine something you’re working toward, and reward yourself by taking whatever the next step is in attaining it. Maybe you want a new kitchen; you can go to the tile store and get different samples to bring home and mull over. The point is that it’s up to you to be productive, while also making your work experience pleasant. Try to keep yourself feeling appreciated, even if you yourself are the only one who appreciates you. 

Freelancing

If you’re freelancer, your monthly workload and income can be unreliable and constantly changing. This is an obvious source of anxiety and stress, as sometimes you may be swamped with too much work, while at others, not have enough; it can be very difficult to find that middle ground. And because jobs aren’t usually long-term, you need to spend much of your time searching for new opportunities, while simultaneously completing the work you have. Not only are these conditions stressful, but freelancers are independent contractors that usually have to handle everything, so switching hats from sales to service to invoicing and bookkeeping adds to the stress. Not every personality is well suited for this variability. While researching this blog, I found a lot of resources available- job boards, apps, communities, and blogs for freelancers that look like they would make their lives quite a bit easier. One blog I came across had a list of various applications with descriptions of exactly what they do, along with links to everything. If anyone is interested, the blog was called skillcrush, and can be found here: https://skillcrush.com/blog/useful-resources-for-freelancers/

Communication

Communication can be very sensitive territory, and learning how to navigate it is an essential skill to avoid misunderstandings and misinterpretations in every work situation, but especially in a remote work setting. With electronic communication methods that don’t allow for visible body language, it’s difficult to convey the true meanings of messages, leaving them open to individual interpretation. Misunderstandings can lead to hurt feelings, decreased productivity, and issues with your corporate culture. For these reasons, it’s best to have an assortment of communication and collaboration tools at your disposal for use in different circumstances. Email and instant messaging are convenient, but more complicated communications should always take place using some sort of video interface, such as Zoom or Skype, as it allows people to interact with each other in a format that provides body language and non-verbal cues that other forms of correspondence don’t express. 

When communicating with a group, make sure that any messages you share are very easy to understand. On that note, if you receive a message that isn’t understood, don’t be shy about asking for clarification. For collaboration to work properly, the right information needs to be passed along efficiently and comprehensively, so this makes proofreading especially important. 

Keep in mind that etiquette matters in all communication. Jokes and sarcasm have their place, but that is not in professional group applications. Also, remember to check your tone. Without that face-to-face connection, tone is important, so take the time to double check your phrasing before hitting send. Spending a few extra seconds to go over what you’ve written to make sure that there aren’t mistakes, omissions, or other factors to get in the way of what you’re trying to say helps keep you from having to backtrack and explain things again later. This can also keep incorrect presumptions from influencing the results of your efforts. Given that your coworkers could be located anywhere around the world these days, try to be extra aware of time zones, and remember that waking up to 20 Slack notifications/ instant messages is stressful! Try to be respectful of the different time zones that your team are working from, and keep communication to those hours whenever possible.

Conduct regularly scheduled video chat meetings to maintain good communication with your colleagues and managers. This is the best way to keep lines open and make sure everyone is on the same page about whatever projects you’re currently working on. Make sure the video chat platform includes features such as file sharing, screen share, and multiple user interfaces in one chat. Be sure to always “show up” to your organization’s online meetings and be heard. If you need to communicate with your manager about sensitive topics, such as evaluations, progress reports, or even workplace stress levels, always do it over a video conferencing platform. It’s much easier to connect and fully emote how you’re feeling when your manager can see you. 

Stressbuster Tip: Mobile Devices

Probably the biggest overall culprit common to all remote workers in causing stress is device use, especially smartphones. I’ve been yelling about this forever. While all of the sources of stress I’ve mentioned are significant, the UN study that prompted this blog found that frequent use of mobile devices appeared to be a “significant source” of added stress. Part of the reason has to do with blue light exposure from device use late at night, which remote workers are more prone to, and the serious impact it has on sleep schedule. In fact, this study found that it was linked with frequent waking at night: 42 percent of those who work from home report frequent night waking, while only 29 percent of office workers reported the same. This is especially important because poor sleep can add a significant amount of stress throughout the day. 

Research has also connected higher levels of stress to the habit of constantly checking one’s phone. Remote workers certainly check their phones often, but what else might make people constantly check their phones? Hello, social media. Not only that, but surprise, social media use itself can also lead to stress, because of increased social comparison. I’m sure I’ve mentioned that before. Ultimately, the increased use of devices, and the constant checking of devices- whether for work or social media silliness- is absolutely associated with higher stress levels, insomnia, and ironically, social isolation. Okay, rant over. The solution for this one is pretty simple: limit the number of times you check your phone for non-work reasons, ie social media, each day, make it a point to put the devices down at the end of the work day, and declare a minimum 90 minute moratorium on all device and screen use, for any reason, before bed.

Stressbuster Tip: Make it Routine

Just as you create a schedule to keep you on track at work, design a morning and evening routine unrelated to your work, to tell your brain when it’s time to work, and when work is over for the day. This will help your brain create a distinction between work and home, which helps you switch off and decompress. Yet another good reason to get dressed for work, even though no one will see you- it helps you create that division. If you have young children at home, seeing you “dressed for work” will also help them to understand the distinction. Be sure to use time spent away from work for yourself, for family time, exercise, and self care.

Stressbuster Tip: Get Comfortable Saying No

Working from home, you’ll be faced with many requests, many of which you may need to refuse if you want to have enough time to get everything done. It can be surprisingly difficult to say no to people you don’t really owe your time to, simply because most of us can find reasons why a “yes” is a perfectly reasonable answer. We may think of their needs and see ourselves as a great answer for them, and not realize that saying yes to them means saying no to ourselves. We may also have our egos involved in having a solution for them. Whatever the challenge, realize that saying no to the time drains you didn’t plan for often means saying yes to the healthy life you truly want and need. For freelancers, learning to say no is an especially important skill. You may want to take on as much work as you can, but there’s only so much you can complete in a day. Know your limitations, set boundaries based on your schedule and workload, and don’t extend yourself beyond them. Be assertive, yet courteous, and your clients will still respect you. 

Stressbuster Tip: Protect Your Sleep

A good night’s sleep rejuvenates the body so you can tackle the day ahead and can help lower the effects of stress during your workday. Because healthy sleep is vital for your productivity, do what you need to do to get it. It may sound like kindergarten time, but this includes setting a bedtime for yourself and sticking to it. Believe it or not, keeping a sleep schedule is one of the hardest things for most of my patients, even the ones I lecture to about it. In any case, when you do it for a while and feel the effects of getting adequate sleep, you’ll see that it’s well worth the effort. You already know that this is a no-no, but it bears repeating, as so many people blow it off: using screens and devices late at night alters your sleep patterns; it makes it very difficult to not only get to sleep, but to stay asleep at night, because it elicits brain patterns of wakefulness. So skip the screens before bed for a minimum of 90 minutes.

Stressbuster Tip: Accentuate the Positive

Another cause of work-related stress is focusing on the negative, and all of the things going on that are beyond our control. The best cure for stress is to concentrate on what is going right and the progress that is being made. I’m sure I’ve mentioned in various blogs that laughing and smiling lowers stress hormones like cortisol, epinephrine, and adrenaline, and can act sort of like a natural antidepressant that releases healthy hormones. When you’re working remotely, learn to take a few minutes to concentrate on positive things, and do what makes you feel calm and happy, even if these things may not be so productive and useful all the time, you’ll find you’re less stressed.

Stressbuster Tip: Slow Down

Life can come at us way too fast at times, and while you can’t just stop, you have to learn to pace yourself if you want to be a great remote worker. Slow down and remember that the best decisions are never made in a rush, and rushing is never the best decision. When you’re stressed, take a few minutes to breathe and clear your head. Try inhaling for five seconds, holding five seconds, and exhaling with another five. Do this a few times in succession if necessary. This will help you stay calm and focus, like a 90-minute yoga class, but in three minutes or less. 

Stressbuster Tip: Eat Right

Diet does matter. Eating poorly will stress your body out, while eating right will restore balance and reduce pressure. Sometimes working remotely can be a recipe for a snack attack when you get distracted or don’t eat properly, so that’s double trouble. When you work remotely, make sure to eat three decent, well balanced meals each day. 

Stressbuster Tip: Share Stress

Remember the two kinds of stress, good and bad, how they work for and against you, and the Yerkes-Dodson Law. Share your stress with coworkers to lighten everyone’s load. I’m not saying concentrate on it, just spend a few minutes each day releasing it, and then keep it moving. 

Stressbuster: Keep it Moving

Speaking of which, you should absolutely be doing something to move your body everyday, so incorporate exercise into your non-work routine. I personally exercise every morning, first thing, to get my blood pumping; and I also use that time to think about what I have coming up in my day. You don’t have to spend two hours at the gym, even just 30 minutes of walking per day can help boost your mood and reduce stress levels, and you can do that on a treadmill if you have one, or just in your neighborhood if you don’t. That way you also get some fresh air and kill two birds with one stone. In addition, a pre- or post-work workout will help enforce those divisions in your brain to keep your work life separate from your home life, and prevent those lines from blurring. 

Mental Health Benefits of Flexible Work

Yes, remote work can cause and exacerbate mental health issues, but it can also act as a support mechanism. I read a survey of over 3,000 professionals conducted in 2018 on flexible work options, which includes remote work, flexible hours, and reduced schedules; and the results were interesting. It demonstrated that flexible work options have a lot to offer in supporting mental health at work, and in life in general. In fact, the impact that work flexibility can have is so great that 97 percent of people surveyed said that having a more flexible job would have a “great,” “positive” impact on their quality of life. That same survey also found that work-life balance and commute-related stress are two of the top factors that make people want a job with flexible options. For people with mental health concerns, caregivers, and professionals at large, flexible work options appear to support efforts to improve the mental health of everyone. It should be noted that this study included people who self-identified as living with a chronic physical or mental illness, making up 16 percent of those surveyed; and also included people who were caregivers of someone with a physical or mental health issue, making up 10 percent of those surveyed. 

There other notable way flexible work can positively affect mental health is directly related to commute-related stress. Even if a person loves their job, sometimes what they have to go through to get there is so stressful that it can negate that positive impact and result in added stress. The average commute time in the U.S. is approximately 26 minutes each way. But according to this survey, people who are most interested in flexible work options have even longer commutes, with 73 percent of respondents reporting commutes exceeding one hour. And 71 percent said they’d like to work from home just to eliminate commute-related stress, so this is clearly a huge factor in the appeal of remote work.

Other interesting findings from the survey on specifically how remote work could help respondents “reduce stress and improve productivity” included: 75 percent indicated by generally reducing distractions during the work day; 74 percent indicated by eliminating interruptions from colleagues, 65 percent indicated by keeping them out of office politics, 60 percent indicated by allowing for a quieter work environment, 52 percent indicated by giving them a more comfortable work environment, and 46 percent indicated by a giving them a more personalized work environment.

Remote work also provides more job opportunities in economically disadvantaged areas. Living through the decline of an industry or long-term high unemployment can negatively affect mental health. High rates of depression and anxiety are found in rural areas, especially among older adults who have often had their lives greatly affected by their community’s economic decline. Those living in rural or economically struggling areas may miss a key piece of the human experience: engaging in the workforce in a meaningful, long-term way. Remote work may be an solution to all of these issues by providing options to people in economically disadvantaged areas that may have mental health issues. It shows huge promise in bringing people in these situations back into the workforce, and there are partnering programs established to help spread the awareness of these opportunities.  

Another population that would reap great benefit from flexible work options are neurodivergent individuals. For example, employees on the autism spectrum and people with mental disorders like OCD can benefit from more time working from home, as loud noises, distractions, and pressure to appear “neurotypical” in front of colleagues and coworkers takes an emotional toll and impacts performance. By working remotely, they can benefit greatly, both professionally and personally. 

All professionals put a huge amount of time, energy, and focus toward work each day. By offering flexible work options, companies are signaling to their employees that they can, and should, devote more time to health and wellness. And that’s never a bad thing.

The other top factors that make people want a flexible job, in addition to better work-life balance and eliminating commute related stress, were family time savings. The constant pull that people feel between time spent with family versus time spent at work can negatively affect mental health, and flexible work options allow those priorities to coexist more peacefully. But this isn’t just a benefit for employees, because companies also benefit when their workers are healthier. Multiple studies have demonstrated that employees in unhealthy workplaces are likely to experience higher stress levels and lower engagement, and that these feelings actually spread throughout the workplace, negatively affecting productivity and corporate culture. Companies that give employees more control over when, where, and how they work by offering flexible work options, are supporting the health and wellness of their workers and enhancing the company’s culture and productivity, all at the same time.

The only demonstrable good thing ‘rona did was to reveal the opportunities that working from home poses for many companies that may not have considered it an option otherwise. Maybe it helped them realize how important health, both physical and mental, is as well. Nothing like a pandemic to set your priorities straight. Ultimately, mental health at work must remain a priority for employers, regardless of whether that takes place at the office, or at the employee’s home. 

The news that remote work can actually be as stressful as working from an office, if not more so, may have come as a shock to many people who considered a work-from-home lifestyle to be one that’s less stressful just because it offers more personal freedom and eliminates a commute. Part of the stress experienced by remote workers may be due to the fact that those who work from home face a host of challenges that are unique to this particular setup. While there are certainly pitfalls, there are also a number of benefits. As remote working becomes more popular, it’s very important that companies adapt and put the right policies in place to ensure their employees don’t experience any undue stress or burnout, and still feel like a valued part of a team. The right kind of communication is key to overcoming the challenges, as is being proactive about using it. Everyone involved in the remote work equation, top to bottom, needs to think about what makes them productive, happy, and successful in everyday life, and try to replicate those things in a remote setting. When you implement ways to mitigate and manage the stress associated with working remotely, then you’re free to enjoy all of the many benes.  

Hopefully now that you know how common some of these stressors are, you may feel less isolated in what you face, and more energized in tackling these challenges in the remote work environment. While employers should make the mental health of their employees an important priority, remember that ultimately, we’re all responsible for monitoring our own mental health, so if the simple exercises and routine changes I’ve suggested here are not enough, and workplace stress becomes too much for you to handle, it’s important to talk to somebody about it, so please seek professional help if that’s the case. 

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Migraines;Strategies to Treat It and Bear It

Migraine: Strategies to Treat It and Beat It

Last week, I talked all about migraine. What do I hope were the takeaways? Well, there are roughly 10,000 known human diseases under the sun… of allll those diseases, I hope you learned that migraine is a very unique beast, thanks to a very unusual constellation of facts surrounding it: its striking capacity to debilitate (ranked first in neuro and sixth overall) and staggering prevalence (ranked third overall) despite a frighteningly high (60%-70%) rate of misdiagnosis really make it a beast of a neurological disease. 

This week, the focus will be on how to manage and/ or prevent migraine. I’m going to cover some basic suggestions and nonprescription ways to avoid or prevent migraine, and I’m also going to discuss some prescription medications and procedures to treat migraine when it occurs. Spoiler alert: one of the very new migraine meds has been like a miracle in my life people. So read on to find out how you might be able to avoid getting a migraine as well as some ways to deal with it once it rears its ugly head. 

First, a few more takeaways from part 1: 

– Migraine is more than a bad headache. 

– Proper and early diagnosis by a specialist physician with specific neuro symptoms is very important. 

– Episodic migraine occurs once or twice a month while chronic daily migraine is minimum 15 days per month. 

– There are several migraine types classified mainly by presence or absence of neurological aura. 

– Migraineurs often have identified triggers that will cause attack. 

– All migraines suck, but some more so than others (hello cluster, rebound, and status migrainosus) because of the extreme pain, but also because of the extreme neurological disturbances that come along for the ride. 

– Exact cause of migraines still unknown, but thought related to a combination of genetics, neurotransmitters, and/ or hormones. 

– There are medications to prevent, abort, and rescue from migraine.

Why isn’t there an obvious known way to prevent and treat migraine?

When people find out I have cluster headaches or when I’m asked by a fellow migraineur or a patient why we don’t already have a foolproof way to prevent and treat migraine, the answer is intensely unsatisfying, especially considering that migraine affects zillions of people, and has done so for a looong time. For the love of Pete, why haven’t we figured it all out by now? Well, even though it is the world’s most common cause of neurological disability, researchers are only just beginning to understand what really causes migraine. I say ‘really’ because unfortunately, the common and long accepted vascular explanation for migraine had to be thrown out relatively recently. The vascular theory was proposed in 1938 and claimed that pressure changes in the vascular system near the brain, and in the brain, caused migraine. More specifically, that vasospasm and vasoconstriction narrowed the blood vessels, slowing and restricting blood supply in and around the brain and causing visual aura and other neuro symptoms; then vasodilation occurred, and those vessels rebounded and widened, allowing too much blood to course through too quickly and causing pain. Eventually, the vessels came back to their normal size and state and the migraine ended…until the next time. This vascular explanation had considerable intuitive appeal because alteration in blood flow seemed to fit the pulsating pain quality that migraine headaches often possess. But now after extensive testing, this theory no longer has any validity. We now know for sure that migraine is a gene-related neurological disease, not a vascular one. So we lost a lot of valuable time looking at the wrong culprit and screwing around with the vascular theory.  

Current research shows that a variety of genetic mutations are at least partly responsible for migraine, with the TRESK gene being identified as one such genetic mutation site. The TRESK gene provides the blueprints for a potassium ion pump channel that is believed to help nerve cells rest. When mutations occur in this gene, they may cause nerve cells to become overexcited, making them more responsive to a smaller pain stimulus or less pain. Personally, I would call that over-reactive rather than overexcited, but that’s just me. Either way you get the idea. Even though genetic mutations tell part of the story, migraine initiation is enormously complicated. It relies on several processes which either result in a visibly changed brain structure or are caused by these changes in structure. In fact, it seems that most scientists believe as I do, that there isn’t just a single cause. In my thinking, there can’t be- there are so many different systems and senses affected that there have to be multiple causes in play. Obviously, lots of research is still needed before we know the whole story. 

Treating Migraine: Natural Remedies

When a migraine does strike, you’ll do almost anything to make it go away. There are ten natural remedies and at-home treatments that may help prevent migraines, or at least help reduce their severity and duration. 

1. Know and avoid triggers, esp in diet

Diet plays a vital role in preventing migraines. Many foods and beverages are known migraine triggers, such as:

-Foods with nitrates, including hot

dogs, deli meats, bacon, and sausage

-Chocolate

-Naturally-occurring tyramine compound, such as blue, feta, cheddar, Parmesan,

and Swiss cheese

-Alcohol, especially red wine

-Foods that contain the flavor enhancer monosodium glutamate (MSG) 

-Foods that are very cold such as ice

cream or iced drinks

-Processed foods

-Pickled foods

-Beans

-Dried fruits

-Cultured dairy products such as

-Buttermilk, sour cream, and yogurt

-Caffeine: a small amount of caffeine may ease migraine pain in some people, and a small amount of caffeine is found in some migraine medications. But too much caffeine may also cause a migraine and/ or may also lead to a severe caffeine withdrawal headache.

**Track yourself! As Migraine Warriors, we tend to think of the occasions when attacks occur and the major symptoms that go along with them. Always keep a diary or list of things that act as warning signs or triggers of an oncoming migraine, including foods or environmental triggers, how much sleep have you had, what the weather is like, what you ate and when, etc.  To figure out for the first time which foods or beverages may trigger your migraines, keep a daily food diary. Record everything you eat and note how you feel afterward. All information may be very important and will likely help you to avoid future attacks.

2. Apply lavender oil

Inhaling lavender essential oil may ease migraine pain. According to a 2012 study, people who inhaled lavender oil for 15 minutes during a migraine attack experienced faster relief than those who inhaled a placebo. Lavender oil may be inhaled directly or diluted and applied to the temples.

3. Try acupressure or acupuncture

Acupressure is the practice of applying pressure with the fingers and hands to specific points on the body to relieve pain and other symptoms. While there are no recent scientific studies, according to some sources, acupressure is a credible alternative therapy for people in pain from chronic migraine and other conditions, and may also help relieve migraine-associated nausea. And although there may not be any definitive  scientific studies on acupuncture, some migraines may respond well to acupuncture, the Chinese method of inserting needles into specific body locations to reduce or stop pain. Because the results are so variable, some doctors do not recommend this treatment. But because some patients report headache relief, it is another treatment method to consider.

4. Look for feverfew

Feverfew is a flowering herb that looks like a daisy, and according to some, is a folk remedy for migraines. According to some sources, there’s not enough evidence that feverfew prevents migraines, but many people still claim it helps their migraine symptoms without side effects.

5. Apply peppermint oil

The menthol in peppermint oil may stop a migraine from coming on. A 2010 study found that applying a menthol solution to the forehead and temples was more effective than placebo for the pain, nausea, and light sensitivity associated with migraine. 

6. Go for ginger

Ginger is known to ease nausea caused by many conditions, including migraines, and it may also have other migraine benefits. One study claimed that ginger powder decreased migraine severity and duration as well as the prescription drug sumatriptan, and with fewer side effects.

7. Sign up for yoga

Yoga uses breathing, meditation, and body postures to promote health and well-being and may relieve the frequency, duration, and intensity of migraines. It’s thought to improve anxiety, release tension in migraine-trigger areas, and improve vascular health. Although researchers conclude it’s too soon to recommend yoga as a primary treatment for migraines, they believe yoga supports overall health and may be beneficial as a complementary therapy.

8. Try biofeedback

Biofeedback is a relaxation method that teaches you to control autonomic reactions to stress. Biofeedback may be helpful for reducing migraine triggers like stress and early migraine symptoms such as muscle tension.

9. Take vitamins and supplements

Some vitamins and supplements (collectively known as nutraceuticals) may be useful therapies. One of the nutraceuticals that has shown some evidence of relief in preliminary testing is magnesium. Magnesium deficiency is known to be linked to headaches and migraines and studies show magnesium oxide supplementation helps prevent migraines with aura, and may also prevent menstrual-related migraines. Adding magnesium to your diet may be helpful. You get magnesium from foods like nuts and nut products, including almonds, sesame seeds, sunflower seeds, Brazil nuts, cashews, peanut butter, eggs, oatmeal, and milk.

10. Book a massage

A weekly massage may reduce migraine frequency and improve sleep quality, according to a 2006 study. The research suggests massage improves perceived stress and coping skills and also helps decrease heart rate, anxiety, and cortisol levels.

The Takeaway

If you get migraines, you know the symptoms can be challenging to cope with. You might miss work or not be able to participate in activities you love. Try the above remedies to possibly find some relief… they can’t make it much worse!

It might also be helpful to talk to others who understand exactly what you’re going through. There are lots of websites, support groups, and apps to connect you with real people who also experience migraines. You can ask treatment-related questions and seek advice from other people who totally “get it.” So do some googling for migraine support. 

Calculate your Headache Burden

Another good idea… Some doctors like to estimate how much migraine disrupts your normal activities before establishing a treatment regimen. A questionnaire may be given to the patient to estimate how often they miss various functions (school, work, family activities) because of their attacks. You can also commonly find other surveys and tools online meant to be filled out, printed, and brought to a primary care physician to broach the subject of headache and/ or to discuss migraine types with specialist physicians to help define headache/ migraine type and zero in on the best treatment regime.

Treating Migraine: Medications

There are many types of medications for people with migraine headaches. Some help to reduce symptoms of acute migraine as they occur, while others prevent episodes from occurring. Captain Obvious says that taking any drug can have side effects, and that some are safer than others.

Two primary ways that medications treat migraine headaches: Acute medications aim to treat symptoms of migraine headaches as they occur. Preventive medications aim to reduce the risk of migraine headaches occurring in the first place by reducing migraine frequency and severity.

Over-the-Counter (OTC) Medications

-Acute medication to treat migraine

-A range of migraine medications are available without a physician’s prescription. 

-These include analgesic medications like aspirin, acetaminophen, naproxen, or ibuprofen, may help to reduce pain. 

-Many of these analgesic medications are nonsteroidal anti-inflammatory drugs (NSAIDs). This means that similar to steroids, they reduce inflammation which may help with migraine symptoms. 

-It is best to take these medications when the first signs of an episode occur. The medicines will take time to enter the bloodstream, and taking them too late means that the headache will likely last longer and possibly won’t be susceptible to the medication; in other words it may not help. 

-The risks associated with using OTC analgesics are relatively low. 

-May cause mild side effects in some people, such as rashes.

When over-the-counter (OTC) medications do not work, a doctor may recommend stronger prescription drugs. There are several different types of prescribed migraine medications.

Prescription Medications: Treat Migraine

As opposed to preventing migraine

Ergot Alkaloids: Treat Migraine

-Medication to treat acute migraine

-I want to point out that ergot drugs are really old school. The American Migraine Foundation wants to point out that doctors don’t commonly prescribe them any longer, but they may recommend them in severe cases if someone doesn’t respond to other analgesics.

-Two main types are dihydroergotamine (DHE)  and ergotamine (Ergomar)

-Ergot alkaloids may cause blood vessels to narrow, which can have serious side effects for people with cardiovascular disease issues.

-Other potentially serious side effects: nausea, dizziness, muscle pain, unusual or bad taste in the mouth, vision problems, confusion, unconsciousness, in addition to many drug interactions.

-These side effects and the drug’s interactions are so problematic that physicians typically severely restrict use of ergotamines except in very rare cases.

-Fun fact: many scholars claim that the behavior of Salem’s “witches” was actually due to a fungal infection in the grain used at the time; ergotamines are essentially a mimic of this grain infection. So maybe don’t take it unless you look good in black and like the pointy hat look. Yikes people! Because of the side effect profiles and lack of efficacy, this class is definitely not as commonly used as newer and more effective triptans and more novel compounds.

Triptans: Treat Migraine

-Acute medication to treat migraine

-Approved to treat moderate to severe migraines: headaches where the symptoms interfere with the ability to perform daily tasks.

-Triptans act on the symptoms of a migraine headache in its early stages. -They will not stop the migraine headache, but they can help with some symptoms, such as nausea, pain, and light sensitivity. 

-Several triptan medications exist:

sumatriptan (Imitrex)

zolmitriptan (Zomig)

rizatriptan (Maxalt)

-A person should take these drugs as soon as migraine symptoms start. 

-They may not work if taken during a migraine aura. 

-They are available in several forms: pill, orally disintegrating tablet, nasal spray, or injection.

-Triptans can cause side effects: dizziness, fatigue, nausea and vomiting, pain in the throat, chest, or head, numbness, dry mouth, burning or prickly feeling on the skin, indigestion, hot flashes, chills.

Antiemetics/Antinausea: Treat Migraine

-Acute medication for migraine symptoms

-Also known as antiemetic drugs, these can help people with migraine, even if they don’t feel nauseous. 

-Don’t reduce pain, so some people take them alongside pain relief medication.

-Examples of antiemetic drugs:

chlorpromazine (Thorazine)

metoclopramide (Reglan)

prochlorperazine (Compazine)

promethazine (Phenergan)

CGRPReceptor Antagonist: Treat Migraine

-The FDA has recently approved several drugs that block calcitonin gene-related peptide (CGRP) receptors for the immediate treatment of migraine.

-CGRP is a molecule typically involved in migraine episodes.

-Examples of recently approved CGRP receptor antagonists include ubrogepant (Ubrelvy) and rimegepant (NURTEC).

Ubrogepant (Ubrelvy): Treat Migraine

-First drug in the class of oral CGRP (calcitonin gene-related peptide) receptor antagonists approved for the acute treatment of migraine with or without aura in adults

-Similar to Rimegepant (Nurtec ODT)

-Most common side effects that patients in the clinical trials reported were nausea, tiredness, and dry mouth. 

-Contraindicated for co-administration with strong CYP3A4 inhibitors such as ketoconazole, clarithromycin, and itraconazole.

-Your doctor may change your treatment plan if you also use: nefazodone; an antibiotic – clarithromycin, telithromycin; antifungal medicine – itraconazole, ketoconazole; or antiviral medicine to treat HIV/AIDS – indinavir, nelfinavir, ritonavir, and saquinavir.

Rimegepant (Nurtec ODT): Treat Migraine

-CGRP receptor antagonist used for acute treatment of migraine with or without aura in adults. 

-Similar to ubrogepant (Ubrelvy)

-Orally Disintegrating Tablets (ODT) for sublingual or oral use.

-Side effects include: nausea and

hypersensitivity, including shortness of breath and severe rash

-Important: like Ubrelvy, Nurtec will interact with other medicines such as: strong CYP3A4 inhibitors and moderate CYP3A4 inhibitors such as ketoconazole, clarithromycin, and itraconazole. Will also interact with inhibitors of P-gp or BCRP.

**This is the new medication for treating migraine that works like a miracle for moi people!

Lasmiditan (Reyvow): Treat Migraine

-First in a brand-new class of drugs (Ditans) that stimulate the serotonin 1F receptor found in different brain regions and believed involved in causing migraine

-Slows body’s pain pathways

-Used for acute treatment of migraine with or without aura in adults. 

-Not useful for migraine prevention. 

-Taken by mouth 

-Common side effects: sleepiness, dizziness, tiredness, numbness

-Reduces inflammation that arises in the nervous system. 

Prescription Medications: Preventing Migraine

-For people who get migraine headaches regularly, some medications can help to reduce the number and severity of episodes, ie prevent migraine.

-Most drugs for preventing migraine headaches are relatively low risk.

-May cause side effects such as constipation, muscle spasms, and cramps.

-Several categories of preventative medications:

Antihypertensives

-Antihypertensive drugs lower blood pressure, usually in people with high blood pressure. 

-There are many different types of antihypertensive drugs that might help to prevent migraine headaches, such as: beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors

Anticonvulsants

-Anticonvulsant drugs treat seizures in people with epilepsy by reducing activity in the brain- and this can also reduce the risk of a migraine headache.

-Examples of anticonvulsants for treating migraines include topiramate (Topamax) or valproic acid (Depakene).

Antidepressants

-Antidepressants often work to increase the availability of serotonin in the brain. -Because of this mechanism, some of these drugs could also help to prevent migraine headaches, such as amitriptyline (Elavil).

CGRP inhibitors

-Calcitonin Gene-Related Peptide

-CGRP inhibitors are preventive migraine treatments that disrupt a protein called CGRP, which is particularly active in people with migraines.

-They block the flow of CGRP to the brain, disrupting signals that cause migraines.

-Unlike traditional migraine meds, such as sumatriptan (Imitrex), CGRP inhibitors don’t constrict blood vessels, so they’re safe for people who’ve had a stroke, heart attack, or vascular disease.

-Three new CGRP inhibitors are injected once a month to prevent migraines:

erenumab (Aimovig) 

fremanezumab (Ajovy) galcanezumab-gnlm (Emgality)

-So new: may cause unknown side effects, and consequences of long-term use are still unknown. 

Eeptinezumab-jjmr (VYEPTI)

-FDA 2020 approval, migraine prevention in adults

-First drug for migraine prevention via IV infusion.

-Treatment involves doctor administering this drug intravenously for 30 minutes every 3 months.

Devices: Treat/ Prevent Migraine

-There are three new noninvasive medical devices currently available:

Cefaly

-Placed on the forehead to stimulate a nerve that impedes migraine pathways. 

-Used as prevention or for treating when a migraine strikes.

-SpringTMS

-Magnetic stimulator placed on the back of the head to disrupt migraine signals in the brain.

-Used as prevention or for treating when a migraine strikes.

gammaCore

-Third device

-Used for treating when a migraine occurs, cannot prevent migraine

-Placed at front of the neck to stimulate the vagus nerve. 

Procedures: Preventing Migraine 

There are two profedures used in an attempt to prevent migraine by reducing frequency and severity.

SPG Nerve Block

The sphenopalatine ganglion (SPG) is a group of nerve cells linked to the trigeminal nerve. 

-Applying local anesthetics to this group of nerve cells can reduce sensations of pain related to migraines.

-Doctors can apply medication to this area through the use of small tubes called catheters. They can place these tubes inside the person’s nose, then insert numbing medication through the tube using a syringe.

Botox Injections

-OnabotulinumtoxinA (Botox) injections for people with chronic migraine headaches. 

-Doctor might prescribe Botox if a person has experienced at least 15 headaches per month for 3 months, eight of which must have included migraine symptoms.

-Doctors tend to recommend two or three other types of medication before trying Botox injections.

-Comes as injection only, can have many side effects.

-Progress carefully monitored, treatment may be stopped if there is no response after 8–12 weeks or if migraine episodes fall to less than 10 per month for 3 months.

-Can also have many possible side effects, including numbness or mild nausea. -Some other side effects are more serious, such as gallbladder dysfunction, visual problems, and bleeding.

Your Migraine Treatment: Is it Working?

-Sometimes initial treatments for migraine either do not reduce the symptoms or only marginally reduce them. 

-If, after trying prescribed treatment(s) about two or three times and getting little or no relief, you should ask your doctor to change the treatment.

-Patients are strongly urged to treat migraine attacks early: some references indicated to take it within about 2 hours of the start of headache to get full benefit of treatments.

-Taking it earlier is better: as early as possible.

Migraine Treatment: Medication Limits

-Some chronic headaches are due to overuse of medicine

-Avoid using migraine-prescribed medicines more than twice per week. -Using and tapering medicine for migraine should proceed under your doctor’s supervision. 

-Narcotics are a bad idea except used only as a last resort for migraine because they are addictive and very easily cause rebound headache pain. For example, only in an emergent situation, an ER visit.

Migraine: When to Seek Emergent Care

Most people know the pattern of their attacks (triggers, auras, and headache pain intensity). However, new headaches, in people with or without a migraine history, that last two or more days should be checked by a doctor. However, if a headache develops with symptoms such as fever, stiff neck, confusion, or paralysis, the person should be examined emergently and should be taken to an Emergency Medicine Department for scans and thorough evaluation.

Okay people, now you know pretty much everything about migraine… I hope it’s information you don’t need for yourself, and that you can tuck it away in your brain for the who knows when future. If you learned something, great! If you’re interested in a blog about a specific topic, please feel free to leave that in this comments section and I’ll see what I can do. And don’t forget about the sex and orgasm survey people! We need people to agree to be contacted once we finish it, so leave that in the comments too if you’re willing to takw it. Please pass this blog on to friends and fam. And definitely check out my YouTube channel for all of my videos and please like, comment, and share those too. As always, my book Tales From the Couch is available on Amazon and in the office. 

Thanks people!

MGA

Learn More

Migraines,Part 1

Migraines, Part I

This is a very personal topic for me, as I have had cluster headaches and migraines my entire life. While I was double checking a statistic for this blog, I came across a term that I’d never heard before: migraineur. Such a romantic sounding word to define a person with migraines. But when in Rome… As a migraineur, at times my headaches dictated my entire life, what I did and when I did it; or more accurately, if I did it. My cluster headaches are horribly disabling, like fireworks going off in one side of my head; bunches of them exploding at random intervals- in clusters- hence the name. Best medical intel indicates this barrage lasts 4 to 72 hours, though mine have always been a helluva lot closer to the latter than the former. And I swear that migraines and clusters somehow alter the spacetime continuum, tearing a hole in the fabric of time such that every minute lasts an hour. In any event, suffice it to say that every minute of a cluster or migraine is the Longest! Minute! Of! Your! Life! If you’re having difficulty imagining what that pain might feel like, consider yourself lucky. Most people (physicians included) don’t realize how consequential and life altering migraine can be. Migraine is the 3rd most prevalent illness on the planet and the 6th most debilitating illness on the planet, yet also the most misunderstood, underestimated, mis-/un-diagnosed, and mis-/under-treated neurological disorder, especially in relation to its symptoms and ability to incapacitate afflicted people, people. While most migraineurs have “attacks” or episodes once or twice a month, more than 4 million adults experience chronic daily migraine, which is defined as having at least 15 migraine days each month. Though it’s usually unintentional, medication overuse in treating episodic migraine is one of the most common reasons why episodic migraine becomes chronic daily migraine. 

Migraine Fast Stats

-Affects 12% of the US population = 39 million people in US, 1 billion globally.

-Affects 18% of all American women, 6% of all men, and 10% of all children.

-Onset can occur at any time, but most commonly falls between ages 18 and 44.

-Approximately 90% of migraine sufferers have a family history of migraine.

Migraine and Gender

-Migraine disproportionately affects women, as 85% of chronic migraine sufferers are female, affecting 28 million women in the US.

-Fluctuations in estrogen levels are often responsible for increased severity and frequency of migraines.

-Before puberty, boys are more affected by migraine than girls, but adolescence sees an increase in the risk and severity of migraine in girls such that by adulthood, three times more women suffer from migraine than men.

Pediatric Migraine

-Very often undiagnosed or misdiagnosed

-Evidence suggests association with infant colic, possibly an early form of migraine.

-Occurs in kids as young as 18 months.

-50% of first migraine attacks occur before age 12.

-Occurs in 10% of school-age children 7-14 and 28% of adolescents 15-19.

-Migraines are hereditary: studies have shown that a child with one parent who suffers from migraines has about a 50% risk of developing migraines, but if both parents have a migraine diagnosis, a child’s risk of developing migraines jumps to 75%. If just a distant, non-parent relative suffers from migraine headaches, the risk for any genetically related offspring to also develop migraine is 20%. 

-Childhood aged boys suffer from migraine more often than girls, but as adolescence approaches, the incidence rate increases faster in girls than in boys, and by adulthood, females with migraine outnumber males by three to one.

Costs of Migraine

-Migraine is a public health issue with major social and economic consequences.

-More than 157 million workdays are lost each year in the US due to migraine.

-US industry loses $36 billion per year due to absenteeism, lost productivity, and medical expenses caused by migraine.

-US headache sufferers receive $1 billion worth of brain scans each year.

-Over 90% of sufferers are unable to work or function normally during migraine, claiming at least a 50% reduction in overall productivity.

-24% of people living with migraine disease report headaches so severe that they have sought emergency room care.

-Medical costs of treating chronic migraine itself equal approximately $6 billion annually, but sufferers spend nearly seven times that treating the conditions often associated with it including depression, anxiety, and sleep disturbances. 

-Healthcare costs are 70% higher for a family with a migraine sufferer than a non-migraine affected family.

Headaches vs Migraines: Who’s Who?

Headache refers to any pain within the head, face, or neck. This pain may be centralized to one focus or area, or it may be diffuse and emanating throughout all areas. While many people consider all “bad” headaches to be migraines and/ or use the two terms interchangeably, this is inaccurate. As I’ll explain next, migraines are a type of primary headache, so that means that all migraines are headaches. But the reverse, that all headaches are (or can be) migraines, is not true. 

Headaches: Three Main Categories

Category 1) Primary Headache

Category 2) Secondary Headache

Category 3) Painful cranial neuropathies and other (facial) pain

Primary Headache: Refers to a headache that occurs on its own. The three major types of primary headaches are migraine, tension, and cluster.

Secondary Headache: Refers to a headache that is caused by something else, such as ‘medication overuse headache’ which is caused by using migraine medication over a long period of time. This is also known as rebound headache, a very disabling headache that is basically the result of taking meds for frequent migraines over an extended time period, even when taken as directed. I have a chronic daily migraine patient that at one time had 22-plus migraine days per month, and she got locked into a gnarly rebound headache. They’re super painful and the only way to treat them is to discontinue the causal migraine med… and that’s a problem if that’s the only thing that’s ever helped. Thankfully, these days we have more options for both preventing migraine and treating it when it rears its ugly head. But I’ll tackle all of that next week. For now, continuing on with migraines.

Painful Cranial Neuropathies and Other Facial Pain: Refers to headaches/ pain arising from, or related to, nerve abnormalities in the upper part of the head and neck. For example: a whiplash injury or disk injury with nerve damage (ie neuropathy) leading to inflammation and pain.

As opposed to “bad” headache, migraine is a neurological disorder whose accurate diagnosis requires the presence of specific symptoms and certain qualities.

Requisite Migraine Symptoms

Migraine attacks are accompanied by one or more of the following disabling symptoms: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch, and smell, and/ or numbness/ tingling in extremities or face.

Migraine Qualities

-(Mostly) occuring on one side of head

-Pulsating pain quality

-Moderate to severe pain intensity

-Made worse with physical activity

-Nausea and/ or vomiting

-Sensitivity to light (photophobia)

-Sensitivity to sound (phonophobia)

Migraine: Ancillary Symptoms

The presence of one or more disabling symptoms (listed above) are required for diagnosis of migraine, but many other ancillary symptoms can be (but aren’t required to be) associated with migraine. These can include abdominal pain, fever, dizziness, and fatigue.

Migraine: Triggers

Many things under the sun can trigger a migraine. Triggers are very individualized, they’re not the same for everyone; what’s more, what causes or triggers a migraine in one person could relieve it in another. 

Migraines are commonly triggered by environmental factors, and these can be external factors like eating certain foods or taking certain medications, or internal factors like stress or blood sugar changes. 

Triggers may be hormonal, behavioral, physical, emotional…they vary, but there are common themes. Below are some of the usual suspects, along with ways to avoid them. 

Certain light patterns, loud sounds or strong smells

Alcohol: Red wine is a common and well recognized migraine trigger, but other alcoholic drinks can also cause migraine.

Weather changes: Even small changes in barometric pressure can cause migraine, especially those associated with storms and hurricanes. If weather is a trigger for you, ask your doctor about the possibility of taking medication at the first sign of atmospheric change.

Bright light: It’s believed that light “turns on” certain cells that can trigger pain. Wearing sunglasses indoors can increase your eyes’ sensitivity to light, so save your shades for outside. You can also try wearing FL-41 boysenberry-tinted lenses, which have been shown to minimize the triggering effect of light.

Caffeine: Caffeine is unusual in that both its presence, and its withdrawal, can trigger a migraine; and it is a common component of prescription and over the counter migraine remedies. If you have migraine, your best bet is to not vary your regular coffee/ tea routine and caffeine intake, even on weekends.

Processed meats and cheeses: Some people may be sensitive to tyramine, a substance found naturally in some foods: especially aged and fermented foods like some cheeses, kimchi, smoked fish, soy sauce, caviar, cured meats, and some types of beer. 

Computers: Poor ergonomics and the screen’s bright light can combine to trigger a migraine. Practice good posture and take frequent stretch breaks.

Dehydration: Not consuming enough liquids causes blood volume to drop and decreases blood flow to the brain, which can trigger migraine. Low electrolyte levels and/ or the loss of electrolytes are also common culprits. Aim to drink at least eight 8-ounce glasses of water a day.

Hormonal changes: Migraines affect women disproportionately, which could be partly due to fluctuations in estrogen levels. Talk to your doctor about whether you should take NSAIDs a few days before menstruation.

Hotter temperatures: The risk of migraine jumps almost 8% for every 9-degree Fahrenheit increase in temperature. Stay hydrated and consider avoiding outdoor activities during the hottest seasons and/ or times of the day if you’re sensitive. 

Anatomical Migraine Triggers

Rather than an environmental trigger, these are four distinct external sensory nerve regions in the neck and face that can act as anatomical migraine triggers. Patients who are subject to one or more of these triggers will feel as if migraines are emanating from these specific areas.  The common trigger areas are 1) the area above the eye/ forehead, 2) the neck, 3) the nose (felt behind the eye), and 4) the temple(s).

Two long term treatment options act against these trigger points: 

-Botox injections will relax all of these trigger sites except for the nose. 

-Trigger point surgery will physically release these nerves. 

More on these next week.

Migraines: Diagnosis

Nearly one in four American households includes someone with migraine. This exceptionately high incidence rate means that every American knows someone who suffers from migraine (whether they’re aware of it or not) or they themselves struggle with it. Despite this high incidence rate, migraine is misdiagnosed more frequently than it is accurately diagnosed, most often as tension headache or sinus headache. Seriously? Misdiagnosed as often as it’s accurately diagnosed?! Scary, no? Blows my mind… but check out this this cute little factlet: 60% of women and 70% of men with migraine are misdiagnosed… period, end of story. But getting an accurate diagnosis is critical for arranging the right treatment, as some medications indicated for specific migraine types can actually be dangerous to people with other migraine types. 

The science behind migraines can get complex people… we are dealing with the brain after all. But understanding exactly what’s occuring during a migraine can help in receiving the proper diagnosis and treatment options, as when it comes to migraine, it’s always better to err on the side of caution. Why? Aside from the fact I mentioned above, about how certain type-specific medications can be dangerous if utilized incorrectly… Well, if a migraine is not properly diagnosed and treated, an individual will typically experience recurrent and increasingly severe symptoms, including extreme head pain, fatigue, nausea, vomiting, and increased sensitivity to light and sound. Not only do the symptoms of the migraine become more severe when left untreated, the migraine tends to become more difficult to treat as it becomes more prolonged. In addition, the neurological disorder as a whole tends toward the progressive, such that subsequent instances of migraine and associated symptoms generally become more severe with time. But even setting aside the health and medical implications, there’s simply no reason to suffer pain needlessly and allow your life to be totally disrupted in the (horrifyingly) special way that only migraines can. Primary care physicians are often responsible for a preliminary diagnosis of migraine headaches, but it is strongly suggested that patients suspected of having migraines see a neurologist for a full workup, including a neuro evaluation and imaging studies if/ when indicated. Knowing exactly which type of migraine you have is essential to finding the safest and most effective treatment for you.

What’s Up with the Migraine Brain?

What’s happening in the brain to create such an excruciating storm? A migraine typically starts with a trigger, which is often incoming sensory information that wouldn’t bother most people… maybe opening the door to a bright sunny day or walking into Starbucks with the intense smell of coffee beans roasting. But a migraine brain is essentially damaged, so it doesn’t respond to stimuli the way a “normal” non-migraine brain does. So during a migraine, these incoming stimuli feel like an all-out assault.

Simple mechanistic view of a migraine brain: upon presentation of a trigger, the migraine prone brain produces an oversize reaction to that trigger, and its electrical system immediately starts (mis)firing on all cylinders. All of this electrical activity causes a change in blood flow to the brain, which in turn affects the brain’s nerves, causing pain and other associated symptoms. About 25% of migraine sufferers have an associated visual disturbance called an aura, which usually lasts less than an hour. In 15-20% of migraine attacks, other disabling neurological symptoms occur before the actual head pain, while in some other cases of migraine, these neurological symptoms occur without any actual head pain. More on these specific phenomena to come. 

Migraine: Progression of Stages

Migraine attacks can progress through four distinct stages: prodrome, aura, attack, and post-drome. It’s important to note that not everyone with migraine goes through any or all of these stages.1) Prodrome Stage

Beginning one to two days before a migraine, some subtle changes that may warn of an impending migraine include:

-Constipation

-Mood swings, depression to euphoria

-Food cravings

-Neck stiffness

-Increased thirst and urination

-Frequent yawning2) Aura Stage

Reversible symptoms or sensations of the nervous system that might occur before or during migraines or other neurological events. They’re usually visual symptoms, but they can also include other types of disturbances as well. Each symptom usually begins gradually, builds up over several minutes, and lasts for 20 to 60 minutes before fading away.

Examples of migraine aura include: 

-Visual phenomena, ie bright spots, flashing lights, and zigzag lines

-Vision loss

-Pins & needles sensations in extremities

-Weakness or numbness in face or single side of the body

-Difficulty speaking

-Auditory symptoms: noises/ music

-Uncontrollable movement,shakes/jerking3) Attack Stage

A migraine usually lasts from 4 to 72 hours, depending on its severity and if/ how it’s treated. Migraine frequency varies from person to person; may occur rarely or strike many times each month.

During a migraine, you will likely have:

-Pain on one side of your head, but can occur on both sides.

-Pain that throbs or pulses

-Sensitivity to light, sound, smell, touch to varying degrees.

-Nausea and vomiting4) Postdrome Stage

After a migraine attack, you might feel drained, confused, hung over, and moody for up to two days. Some people report mood swings from elation to despair. Sudden head movement may briefly bring on pain once again.

Migraine: Treatment

Traditional migraine treatment involves a combination of medications, lifestyle changes, and potentially, alternative therapies like acupuncture. Migraine medications are usually divided into three groups: preventative, abortive, and rescue. 

Preventative medications: Captain Obvious says that preventative meds are generally taken daily in an effort to avoid getting (aka prevent) a migraine, as they are intended to reduce the frequency and severity of migraine attacks.

Abortive medications: Abortive meds are generally the first-line, acute medications meant to be taken when someone gets a migraine. Unlike pain medications that only mask the pain for a few hours, abortive medications work to stop the migrainous process itself and end the associated symptoms, and they are most effective when taken as early as possible in a migraine attack. 

Rescue medications: Rescue meds are often pain medications, and are intended to be used if and when abortive meds fail, or when abortive meds might be contraindicated due to allergy, side effects, or pregnancy in some cases. Other types of rescue meds can be used to help people relax and get through a migraine by reducing nausea for example. Rescue meds don’t have the ability to abort a migraine, but the idea is they may mask the pain for a few hours while the migraine runs its course. 

While most migraineurs experience “attacks” or episodes once or twice a month, more than 4 million adults experience chronic daily migraine, which is defined as having at least 15 migraine days each month. Though it’s usually unintentional, medication overuse in treating episodic migraine is the most common reason why episodic migraine becomes chronic daily migraine. About 25% of migraine sufferers have an associated visual disturbance called an aura, which usually lasts less than an hour. In 15-20% of migraine attacks, other disabling neurological symptoms occur before the actual head pain, while in some other cases of migraine, these neurological symptoms occur without any actual head pain. More on these specific phenomena to come. 

Migraine Types

Migraines are like ice cream… they come in a variety of different ‘flavors’ that ‘taste’ different to each of us. The basic ingredients may be the same, but the symptoms and severity vary widely by person, age at time of attack, and length of time they’ve been experienced. It’s always possible to have multiple migraine types, so talk to your doctor about your symptoms if you’re uncertain.

According to the ICHD-3 the International Classification of Headache Disorders, there are seven types of migraine, with diagnostic criteria based on scientific evidence. It should be clear by now that not everyone will have ‘typical’ migraine, so please view this information as a guide only, and not as a replacement for physician evaluation. Note that some references created different divisions.

ICHD-3 Seven Migraine Types:

1. Migraine without Aura

-Formerly called common migraine

-First & most widespread type of migraine 

-Main symptoms: throbbing pain that starts on one side of your head (as opposed to starting behind the left eye where most migraines tend to start), moving around tends to make the pain worse, and it’s normal to feel nauseous, dizzy, and sensitive to light and sound.

-Duration 4 to 72 hours

-Prodrome brings: difficulty speaking or reading, increased urination, irritability and depression, food cravings, frequent yawning, muscle fatigue or tight or stiff muscles in the neck and shoulders, nausea, constipation, or diarrhea, poor concentration, sensitivity to light, sound, touch, and smell, and trouble sleeping.

-After the 4 to 72-hour headache attack,  hits, postdrome with “migraine hangover” can make you: feel moody, feel sensitive to touch, especially in areas where the headache was focused, feel tired, have stomach issues

Here’s some more info about how the common migraine progresses.

2. Migraine with Aura

-Formerly called classic migraine, focal migraine, complicated migraine, aphasic migraine, migraine accompagnee.

-Main symptoms: visual disturbances before migraine begins, followed by common migraine symptoms

-Duration of visual disturbances: ranges from a few minutes to a full hour, usually before the actual migraine attack starts.

-Duration of migraine: 4 to 72 hours.

-25% of people with migraines also experience aura. 

-Aura can cause visual disturbances, neurological symptoms, and unpleasant feelings like a numb face or tongue, or pins and needles that spread across body.

-ICHD3 breaks these down even further into four types: typical aura, brainstem aura, retinal aura, and hemiplegic aura.- ICHD-3 Subtype 1: Typical Aura

-Typical aura brings visual symptoms, inc temporary blind spots, geometric patterns, zigzag lines, stars or shimmering spots, and flashes of light. – ICHD-3 Subtype 2: Brainstem Aura

-Brainstem aura involves symptoms that seem to originate in the brainstem, like difficulty speaking, double vision, ringing ears, or vertigo.- ICHD-3 Subtype 3: Retinal Aura

-Retinal migraine (a.k.a. ocular migraine and optical migraine) differs from a typical migraine with aura in that you typically only have visual disturbances in one eye. Because they cause visual issues, they’re sometimes called “ocular migraines” or “optical migraines.”- ICHD-3 Subtype 4: Hemiplegic Aura

-Hemiplegic migraine involves symptoms like motor weakness or a loss in the strength of your muscles, usually on one side of your body; you may also struggle with language and feel confused or tired.

-Like with typical aura migraines, these symptoms usually last only minutes, and usually for no more than an hour, though may be longer for some; but memory loss and problems with your attention span can linger for weeks or even months. -Sometimes, hemiplegic migraines can cause more serious issues, like seizures, coma, and long-term problems with brain function and body movement. 

-These facts might be frightening to read, but these types of migraines are rare and the extreme side effects are uncommon.

3. Menstrual Migraine

-Also called “hormonal migraines.”  

-Pretty much as they sound: migraines in women triggered by hormonal changes.

-Duration: 4 to 72 hours

-ICHD-3 notes that menstrual migraines can happen with aura or without, and usually strike just before or at the beginning of your period. 

-If you experience migraines during this time in two out of three periods, they are likely to be menstrual migraines.

-According to the US Office on Women’s Health, menstrual migraines might be triggered by the quick drop in the hormones estrogen and progesterone that happens before your period starts. -Affect about 7% to 19% of women 

-Most women who usually get menstrual migraines also have other migraine types at other times.

-Frustrating but good-to-know: menstrual migraines tend to last longer than your average non-menstrual migraines, and might be more painful.

4. Vestibular Migraine

-Main symptoms: vertigo, dizziness, and trouble with balance

-Duration: ranges from a few seconds to a few days

-Surprisingly common, affecting 30%-50% of migraine sufferers. 

-Vestibular migraines can give you sudden bouts of vertigo, where you see the world spinning or feel like you’re moving when you’re not. 

-These bouts of vertigo might not always occur like aura symptoms, ie right before a headache sets in…

-These vertigo bouts may happen for just a few random seconds or may even happen intermittently for a few days.

-Sometimes this occurs when you move your head too quickly or when you see something particularly stimulating. 

5. Migraine without Headache

-Main symptom: no actual headache pain, thank you Captain Obvious.

-Duration: each aura symptom can last 1 hour or less

-If you get aura symptoms but never get the telltale splitting pain in your head, you might have a migraine without a headache, sometimes known as a “silent migraine,” “painless migraine,” or “acephalgic migraine.”  

-ICHD-3 simply calls them a “typical migraine with aura without a headache”

Whatever!

-An acelphagic migraine, or a migraine with no pain, can have all the same symptoms of migraines with aura, except the headache just never shows up!

-Interestingly, migraines without headaches become more likely as you get older. Something to look forward to!

6. Abdominal Migraine

-Main symptom: stomach pain instead of a headache

-Duration: 1 to 72 hours

-Migraine can cause extreme pain in your abdomen rather than your head; this is an abdominal migraine.

-Causes pain near the belly button, can make you feel nauseous, give you no appetite, cause vomiting, and make you look pale.

-This is more common in children than adults, but 2/3 of the children with a history of abdominal migraine actually end up developing migraine headaches as adolescents.

-Just like common migraines, abdominal migraines can be triggered by things like stress, bright lights, and food additives like monosodium glutamate (MSG). -Typically treated using the same medications as standard migraines with headaches.

7. Status Migrainosus

Main symptoms: a migraine that that lasts more than 72 hours

Duration: 72+ hours

-Basically a migraine (with or without aura) that lasts longer than the standard max of 72 hours. 

-ICHD-3 recognizes status migrainosus, and points out that overusing migraine medications could be a likely cause

-Other triggers can bring on Status Migrainosus, like: changes in food and sleep habits, changes in medication, changes in weather, head and neck traumas, hormones, illnesses like the flu or a sinus infection, sinus, tooth, or jaw surgeries, and stress.

-Status migrainosus can be extremely frustrating; called a “trick candle on a birthday cake,” because the headache might briefly respond to medication, just to flood back randomly after a break.

Next week I’ll get into more specifics on these seven migraine types, along with the various medications used to treat the specific types and why they’re used. Also lots of intel on non-pharma methods of managing migraine, including devices. 

That’s all for today folks. Please make sure to share my blogs and YouTube vids with friends and fam, and like, subscribe, and comment people! As always you can find my book Tales from the Couch on Amazon.com.

And don’t forget that Dawn and I are going to need everyone’s help to take a simple, anonymous, sex and orgasm survey coming up here before too long. The more people that take it, the more meaningful the data, and the better the book will be! And you want it to be good, right people?  

Thanks and be well!

MGA

Learn More

Sex Toys, Part 2 of 3

Sex Toys: Much Ado About Something

I hope everybody enjoyed last week’s marathon blog on sex toys and learned something new. I know I definitely learned a few things in researching it. So now that we know all about the categories of sex toys and their illustrious histories, today we’ll move on to who’s using sex toys and why, and go over some important things you should take into consideration if you’re thinking of joining them. So once again, open your minds, set aside your preconceived notions and biases, and read more about sex toys, people… 

Part deux sur trois!

Out of the Closet… and the Nightstand

Sex toys are so much more mainstream and accepted- appreciated, even- more now than in previous generations, and the proof of that is in studies being published in notable medical journals. These studies on sex toy use are important for the contributions they make to an understanding of the sexual health and sexual behaviors of adults in today’s society.

Indiana University conducted survey studies on the use of sex toys among nationally representative samples of adult American men and women. I looked at surveys on vibrator use where they sought responses specifically from 2,056 women and 1,047 men, ages 18 – 60, and the results were published in the Journal of Sexual Medicine, a leading peer-reviewed journal in the area of urology and sexual health. These are the first studies to document many insights into sexual health, including: how and why people use vibrators, the side effects of use, and how use is associated with sexual health behaviors, sexual enjoyment, and quality of life. The results showed that vibrator use is in fact fairly common, with approximately 53% of women and 45% of men responding positively, indicating vibrator use. Among the men included in the survey, there was no statistical difference between the rates of vibrator use among men who identified as heterosexual and those who identified as homosexual or bisexual.

Of the 53% of women that reported using vibrators, 70% of those indicated that they never experienced any side effects associated with use. Those side effects that were reported were typically rare and of a short duration, and included mild genital numbness, irritation, or inflammation. 

Vibrator users were significantly more likely to perform genital self-examination and have regular gynecological exams as well. In addition, the 53% that reported using vibrators also reported better sex- including increased sexual desire, arousal, and orgasm- though there was no significant difference in general sexual satisfaction between the female vibrator users and the non-users.

The 45% of men (which included heterosexual, homosexual, and bisexual men) that reported using vibrators were more likely to record participation in sexual health promoting behaviors like testicular self-exam, and also scored themselves higher on four of the five factors used to measure sexual function, including erectile function, intercourse satisfaction, orgasmic function, and sexual desire. Of the 45% of men that reported using vibrators, approximately 17% said they did so for solo masturbation. Of the heterosexual constituent of the 45% of men that reported using vibrators, 91% of those reported most commonly doing so during foreplay or intercourse with a female partner. 

Though often thought to be covered in dust and dog/ cat hair, hidden under beds, or buried deep in sock drawers, these studies demonstrate that vibrator use is actually more common than most think. In addition, these groundbreaking results demonstrate that the use of vibrators is associated with a fulfilling sex life, positive sexual function, and being more proactive in caring for one’s sexual health. This affirms what many doctors and therapists have known for decades- that using sex toys is common, linked to positive sexual functions of desire and ease of orgasm, and rarely associated with any side effects of note.

Who’s Using Sex Toys and Why?

I hope you’re getting the point that sex toys aren’t just for sluts and freaks and ridiculous shades o’ grey. All kinds of people may choose to use sex toys, and for any of many different reasons. For some people, using sex toys is the easiest- or only- way they can have an orgasm, especially in vulva owning (female) people. Sometimes people use sex toys to help them masturbate Han Solo, or during sex with their partner(s). 

For transgender, nonbinary, or gender nonconforming people, using certain sex toys may help positively affirm their gender identity or help relieve gender dysphoria.

Some people with disabilities or limited mobility use sex toys to make it easier to masturbate, have sex, or perform certain sexual activities using positions that would otherwise be difficult- or impossible- for them. 

Sex toys can also help treat the symptoms of certain disorders, like erectile dysfunction, genital arousal disorder, hypoactive sexual disorder, and orgasm disorder/ anorgasmia. And some people find that sex toys help them deal with the sexual side effects of certain medications, health conditions, or menopause, ie low sex drive or decreased genital sensation.

Put simply, it’s not only totally normal and acceptable for any/ every consenting adult to use sex toys, but it’s also often a component of a fulfilling sex life and a sign of positive sexual health. Having said that, it’s also totally normal to not want to use sex toys. It’s a personal decision… everyone’s different and therefore entitled to their own opinion. As long as you’re using sex toys safely, there’s nothing harmful in it and no big down side. How do do you use sex toys safely? I’m glad you asked. I’ll tell you…

Safe Sex (Toys) People

Sex toys are big business- serious business- and big money. Yes, they should be for fun; and yes, they can be fun, but if you’re a newbie considering exploring the great sex toy universe, you need to seriously consider some things. Let me ask, would you eat something poisonous? What about something that smelled wrong- like chemicals- or looked off- like maybe it had little black dots on it or was discolored? How about something you’re allergic to- would you eat it? You probably answered ‘no, no, and no.’ We’ll assume you did. But why? Why no? ‘Well, Dr. Agresti, because those things are bad for the body… if it smells bad or it’s growing stuff, I don’t want to eat it. I don’t put bad things in my body.’ Okay, great. Does that apply to sex toys? Because in some situations, those go in the body too, right? 

Exactly. 

Sharing sex toys with other people can spread STD’s- Sexually Transmitted Diseases. If someone with an STD uses a sex toy, the bodily fluids on that toy can spread the infection to the next person who uses it. So if you’re using a sex toy with a partner, unless and until you exchange clean test reports, it’s important to take steps to help prevent STD’s, essentially by behaving as if they have one. How? Read on. 

Wash sex toys thoroughly with antibacterial soap and hot water after you use them if it’s a single user situation. It’s always better to sanitize toys, and you must sanitize toys that are shared, before you share them. Always sanitize before they touch another person’s genitals. In addition, if you put a condom on the sex toy, that will help keep them clean and prevent the spread of STD’s, but just make sure you change condoms before the toy touches another person’s genitals. It’s best to sterilize your sex toys whenever possible, and washing doesn’t equal sterilization. If your toy is heat stable, you can wash it in the top rack of your automatic dishwasher on the sterilize setting. It’s an important feature, so consider putting the ability to sterilize on your sex toy wish list.

Throwing back to last week again, remember that if you enjoy “backyard” play, make sure you use lots of lube. That area doesn’t lubricate itself the way other areas do, so putting something in your butt without adding lube can be painful and medically unsafe. And never put a sex toy that’s been in the anus directly into the vagina without sanitizing it and changing the condom first. If germs from the anus get into the vagina, it will most likely lead to a serious case of vaginitis. Basically, when referring to single person orifice swapping, the rule of thumb is this: toys are fine to go from vagina to anus, but never the reverse- never anus to vagina- that’s a no go people. And if you’re dealing with a multiple player situation, the toy should always be sanitized and the condom changed when toys pass from one person’s parts to another’s.  

Another throw back, remember that if you are a penis owner into the back door, it’s important to make sure that any sex toy you use in your anus has a wide base to keep it from going all the way up and in the backside. If a sex toy goes so far into your anus that you can’t reach it to pull it out, you’ll need to see a doc to get it out. By the way, if you’re wondering… a sex toy cannot be lost in the vagina because the cervix stands in the way, blocking the end. So vulva owners are off the hook for that bit.

Don’t use silicone lube with silicone sex toys-  unless you put condoms on them- because silicone lube can react with the solid silicone of your toy and damage it. Some people disagree- it seems to be a grey area- but the safe play is usually the best one. Water-based lube is a safe bet to use with any sex toy, and any condom for that matter. So just make it a point to keep only water based lube around so that if you’re a little too deep in the heat of the moment, you don’t accidentally reach and grab for the wrong tube. 

Toxic Toy = No Joy

It wasn’t all that long ago that most people didn’t care about what their sex toy was made of, or even ever thought it could pose an issue. It’s only been in the last 15-ish years or so that people have realized the toxicity issues and the market has offered more access to all-silicone sex toys.

I hate to be a killjoy, but knowledge is power people, so let’s get down to brass- more accurately, plastic- tacks. 

There are body safe toys and “non-toxic but not body-safe” toys…. There are shades of tres grey when it comes to the dangers of sex toys. Some people seem to experience no obvious side effects, no problemo. Some people break out and get very sick, and it’s a nightmare. For those people, there can be very specific materials that they cannot be exposed to, but it’s not like sex toys come with a list of ingredients. So if you’re one of those people that are prone to sensitivities, how do you make sure you’re not using something that can make you sick? Read on. 

The first sex toy tests after people started becoming aware (at least publicly) of important issues, reactions, and infections from the use of sex toys were run by the Danish EPA in 2006. Do you understand the implications of that, people? The EPA monitors threats to the environment first and foremost, not people’s health. Evidently, after people became aware of reactions and infections and such, I can only speculate that some concerned Danish person (environmentalist?) must’ve looked into what might be in these toys to cause these illnesses, and that they were possibly so alarmed by the components- more accurately, the making of said components- they ultimately made enough noise and garnered enough backing that the Danish EPA ran material safety testing. That’s a big deal. And the results weren’t good… By September 2014, figuring the sex toy industry had come a long way in eight years, Smitten Kitten and Badvibes.org did another round of testing, and the results were better, but there was still some room for improvement. I imagine that will always be the case, and not just for the sex toy industry. But why does this industry seem so fraught with problems? The biggest reason is the total lack of oversight and regulation. Nobody’s minding the store, and it’s all about the bottom line… pun intended. I believe I read that up to 80% of toys are manufactured in China, and we know there’s not much tlc involved. Hey, we run out of component xyz, we’ll add more of abc, of course. No time to halt production. Besides, who’s gonna know? 

So I want to make sure you have information on toxic toys and “non-toxic but not body-safe” (say whaaaat?) toys. There are so many shades of grey when it comes to the issues here, and admittedly of course, some people will experience no obvious side effects. But others surely will, and that’s an important issue that I’d like to attempt to change. A sex blogger and toy reviewer named Dangerous Lilly is all about DIY home sex toy “tests” that aim to ferret out toxic toys, expose blatant material lies, and dispel some myths about silicone sex toys. She’s even done these jar tests to prove that toys made of compromised garbage materials are dangerous. You’ll have to check it out at http://dangerouslilly.com/ and go near the top, under the header where it says in little letters “New? Start Here!” and then click on Toxic Toys. There’s also a search site option and it’s very easy to navigate. It seems that she hasn’t posted in maybe a year, but her very extensive blog is still available, and it’s an excellent resource. These details are also in the references at the end of this blog. 

Anyway, she did these jar tests where she took two giant glass jars; one was filled with a bunch of toys of questionable materials, and the other was filled with a bunch of 100% silicone toys. She sealed both and documented what happened over the course of a couple of years. Suffice it to say that it absolutely demonstrated that cheap garbage toys off-gas, leaking chemicals and softeners and all the crap they’re made from, they get tons of little black dots which are spores, and these lead to fuzzyold/ mildew growth and yuck and all the pieces deform and glop up (technical term) onto each other, all swimming in five inches of toxic goo and chemicals- and almost all of it actually happens in the first three months. In jar two, with the 100% silicone toys touching each other, there was nothing doing. No oozing, no melting, no spores, nada. And that does demonstrate that silicone can be stored safely with silicone, although experts still say that after use, proper care dictates that toys must be sterilized and thoroughly dry before being placed in individual baggies. And you should always inspect your toys before using them: look for little black spots and examine any ‘things that make you go hmm.’ Better safe than sorry people.

There are still sex toys on the market that contain gnarly stuff, like phthalates (pronounced phay-lates) Have you heard of phthalates? A tidal wave of research has documented the wide-ranging negative health impacts of phthalates on pets and people, so they’ve been demonized and (theoretically) excluded from children’s toys, then dog toys, and now sex toys, among many other things: cosmetics, personal care products, hair combs, even earring backs. Basically manufacturers use them to make anything that’s made of plastic less breakable, really. For this reason, they’re referred to as plasticizers, ie, substances added to various plastics to increase their flexibility, transparency, durability, and longevity. And they’re often used primarily to soften PVC (polyvinyl chloride) and other plastics to make them less brittle and less likely to break with use… sounds like it would be great to use in sex toys, right? Maybe in theory. But manufacturer’s want ’em to be tough, so bring on the phthalates! Not.

Clearly, it’s a good idea to limit your exposure to phthalates, as studies are demonstrating that exposure can lead to organ failure and possibly cause cancer. Phthalates are present in lots of sex toy materials, but they’re not found in pure silicone toys, which is why it’s ideal to buy 100% silicone toys. 

But phthalates aren’t the only harmful chemical being used; other chemicals have been found, stuff like latex- helll-ooo- so many people find they’re allergic to latex… how’d you like to learn that way, with itchy fire orifices? No thank you. Another issue is that companies can (and do) lie about their material claims. Often, “phthalates-free” is more like a wishful tagline that doesn’t mean jack. So ultimately, we’re left totally in the dark about the safety of a sex toy unless you buy only from a company that’s demonstrated a history of honesty. Like many sex bloggers and toy reviewers, Dangerous Lilly still has a list of approved manufacturers and retailers, and it’s worth going over. To help you out, I’ve included it in the references section at the end of this blog. I’m a giver.

Another issue is that there are sex toy materials that have not been proven toxic yet, but they’re still softened with mystery oils (grades and types unknown), the materials are very unstable, they break down quickly, and are so porous that they harbor a lot of bacteria and mold. So even if (and that’s a big if) the material is ‘non-toxic’ when you first buy it, that changes as you expose it to air and lube chemicals and… other stuff. As you use it over time, even if you take exemplary care of it, it breaks down. That’s a simple fact people. Chemical changes will occur and oils will release, along with new volatile compounds VOCs, and who knows what else. Yet another issue revolves around the colorants and paints that tint and/ or paint these toys. Materials are especially questionable when derived from other countries… like China. Where maybe 80% of these toys come from. Ya think they care about what’s going into them? That there’s any oversight or quality control? Ah haeelll no! Especially to be sent to us! It’s about producing the cheapest possible junk they can possibly squeak by with… and if they can use garbage that shaves off an eighth of a cent per piece- even way less than that- that translates to more money for them, and that’s the name of the game. 

One particular group of offenders are the Jelly toys. Sometimes spelled jelly, or gelle, or gels. Whatever it’s called and however they spell it, it’s cheap garbage. Dangerous cheap garbage. Using Jelly products for oral, vaginal, or anal stimulation is going to introduce phthalates and other toxic solvents to be absorbed into the mucous membranes of the body. That bit happens quickly, but you may or may not know immediately. But you will know. Headaches, cramping, and nausea are just some of the proven side effects that result from exposure at the levels found in the study… normal levels from normal use. Regardless of whether you sheath the thing in condoms every time you take it out of its box, it’s still going to off-gas, degrade, begin to dissolve, release a greasy oil stain, fuse to its packaging, and stink like old tires. Is any part of that sexy? Doesn’t do it for me people.

Again, I can’t stress enough that a company can and will have the Chinese manufacturing plants put anything on the box and/ or label- any tagline or buzzword you might be looking for when buying a toy. “Phthalates Free!” “All Silicone!” More like All Crap. Nothing and no one can stop them. Nothing dictating that their packaging has to hold a grain of truth. No regulation, people.

A Magic Word

Now I think we’ve established that you can’t always trust the manufacturers. So only buy from a reputable source, and if you have any doubts about it- any smells, strange changes in the finish, development of little black dots- do not use it. Note that manufacturer’s name and you can research their reputation, maybe consider asking someone in the know about it, and don’t buy from them again. 

But how do these manufacturers get away with it? Aside from everything I mentioned before about how it’s a penny pinching free for all in China, even if you could complain, they’ve got you beat anyway… First, you really can’t complain because there’s the ‘lost in translation’ feature. They no speaky de englees don’tcha know. But regardless, the magic word comes into play: for Novelty use only. Yep. That 9 inch flesh toned realistic dildo that’s falsely stamped ‘All Silicone!’ that you bought from us is a novelty (betchur bippy they know that word…) we didn’t think you were going to use it there! Yeah. Riiighhht. So there’s that. 

We’ve discussed some sex toy lab tests over the years and things have changed for the better. In the mid-2000’s the Danish EPA tested many sex toys, and found very poor toxicity results. And while the sex toy industry has come a long way since then, and more recent tests were actually found to be improved, the big issue remains: better results still fail to explain why so many people still get chemical burns, allergic reactions, and/ or chronic infections and related issues from using certain sex toys, lubes, and accoutrements. Here’s a for instance that I want to serve as a word of warning, people…

Doc Johnson ‘Sil-a-Gel’ Products: 

Burn, Baby, Burn!

One brand to avoid that I’ve read about in several places with multiple references is Doc Johnson ‘Sil-a-Gel’ products. Don’t know what Doc Johnson is doing with these specific products made with this specific stuff, but I don’t want to find out the way some people have had to. Sil-a-Gel isn’t actually a material, it’s an additive. They claim it is an antibacterial agent that is mixed in with very porous PVC to inhibit bacterial growth in the pores of the material. Sounds pretty harmless… but note that they’re using PVC in these toys, and that’s not all silicone. The extreme reactions people have reported are cause for great concern, and many folks in the know recommend a complete boycott of any Doc Johnson products containing this ‘Sil-a-Gel’ additive. It’s worth noting that I’ve seen plenty of good reviews on other Doc Johnson’s toys, so if you just buy 100% silicone you should be safe. But ‘Sil-a-Gel’ boycott… That’s what’s up Doc!

There are so many sex toys out there… I mean, I know they say variety is the spice of life, but that’s a spicy meataballa! Navigating the sex toy universe to choose the right toy is a potential minefield, especially the first time! It’s not like you can google “world’s best sex toy” and come up with a reasonable list of safe quality toys to look at. So, what to do? Thankfully, there are plenty of people in the know, so I’ll pass along their advice. 

Choosing Sex Toys: It’s a Material World

Clearly the first thing you should consider when choosing a sex toy is material. The material the toy is made of dictates everything about how you can safely use it and how you care for and clean it. 

When you’re talking about the best sex toy materials, you want to consider material safety, durability, and hygienic properties. The best sex toys are nonporous and phthalates free. You want a toy to be nonporous because that means you can sanitize it. Nonporous materials literally have no pores, meaning no microscopic holes in them for bacteria to get into- or, at the very least, the pores are so small that nothing can get in there. To repeat: porous material= bad, invite bacteria to accumulate, reproduce, and spread. Nonporous material= good, no pores or pores too small for bugaboos to get in and colonize. 

This means that toys made of nonporous materials can be safely shared, only after being sanitized between users. It also means the toy can be used vaginally and anally, but only in a specific order if not sanitized between orifices. Going from vagina to butt in the same person is okay without sanitizing, but the opposite direction, from butt to vagina is a no go people. If you go from butt to vagina, you’re ass-king for an infection if you don’t sanitize the toy. You can also use a condom on the toy in lieu of sanitizing, but if you’re in a multi-player scenario, you must change the condom and/ or sanitize the toy whenever it goes from the first person’s genitals to the other person’s. Remember, vagina to butt is OK in a solo situation. Butt to vagina is not- ever. Also, no matter the material, a new sex toy needs to be thoroughly washed with antibacterial soap and warm water prior to its first use. If it were me, sanitize sanitize sanitize people!

That said, I’ll start with the best choices for sex toy materials first, based on everything:

Silicone: All Silicone.

If you want a more pliable toy, then 100% silicone (not a blend) would be the best choice. Silicone actually comes in a wide range of firmness and finishes. For high quality silicone sex toys, I understand from lots of sex bloggers that you can’t go wrong with the company Tantus. As mentioned before, silicone is phthalates free and nonporous. 

Being nonporous and heat resistant, you can sterilize silicone toys in a number of ways, including: boiling for a few minutes (making sure that the toy never touches the sides or bottom of the pot), washing in a 10% bleach solution, or washing in the top rack of your dishwasher set on sanitize cycle. I saw where some said you could simply lather it up really well in antibacterial soap and rinse it clean, but I’m not totally sold on that, especially if you share it. That’s not sterilizing it. And Captain Obvious says if your silicone toy has an electronic vibrator inside then don’t boil it or put it in the dishwasher.

Usually manufacturers and most sex toy reviewers will tell you to only use water-based lube with silicone toys. This is because some silicone lubes can damage some silicone toys. As I mentioned before, there are some differences in opinion on this, but better safe than sorry. So it’s best that if you’re going to keep lube around, make sure it’s water-based, especially if you’re sort of in the heat of the moment, you don’t want to worry about grabbing the wrong lube. 

Many people believe that you can’t store silicone toys where they are touching each other, but again, this is another grey area. Some people say you can and some say you can’t. From what I’ve read, many sex toy reviewers have stored their high quality silicone toys piled together in drawers without any issues, but a good rule of thumb is to have some kind of individual ziplock storage bag for each of your silicone toys. Then you can put all of them in some sort of storage box and put that by your bed or wherever. A lot of toys evidently come with their own pouches and it seems fine to store them in there. Just make sure that after using your toys that you thoroughly wash and sanitize them and make sure they’re totally dry before you seal them up in plastic bags. Any moisture left in there can lead to mold growth.

Stainless Steel

If ever there was a durable sex toy material, stainless steel would definitely be it. Seems like it would be bullet-proof. The polished finish on these toys makes it so you can use any type of lube you like, and you can also disinfect steel toys really easily by boiling or on the top rack of the dishwasher on the sanitize cycle. For routine cleaning, an antibacterial soap is good to use. About the only way you can harm steel toys is if you use something abrasive to clean them that will mar the polished finish.

Glass

Understandably, many people are skeptical of using glass sex toys, but evidently it’s considered a great material to make toys out of. Glass toys are nonporous, phthalates free, and are compatible with any type of lube, so no worries there. It’s cleaned in all the same ways you would clean steel or silicone, but if you decide to boil a glass toy,  you might want to put a hand towel in the pot to cushion it and keep it from hitting against the sides and possibly chipping. But if it does get chipped, you must stop using it. Be sure to thoroughly inspect the glass toy for chips or cracks prior to every use. I did read about annealed glass toys vs not, and annealed seems to be better, as it’s evidently stronger. There is a DIY test to suss that out. The only other issue may lie with any tinting in the glass or painting on the glass, so awareness is key. If it’s painted here in the US, say by an artist, chances are good it’s safe, but everywhere says to use a condom over it anyway. 

Wood

Wood sex toys are sealed with a finish that is nonporous and body safe, and wood itself is a nonporous and phthalates free material. A company called Nobessence is a reputable manufacturer of wood toys. You should not put wood toys in the dishwasher or boil them, but antibacterial soap and a 10% bleach solution can be used to sterilize. Solvents of any kind should not be used on wood sex toys, as they will damage the finish, but all types of lube are compatible with wood toys.

Aluminum

Aluminum is nonporous, body safe, and phthalates free. It can be cared for just like stainless steel, and any lube can be used with it. An advantage it has over steel is its lighter weight.

If you choose a sex toy made of quality materials from a reputable retailer, take proper care of it, and observe safe sex toy practices, toys should be expected to last a long time. I would emphasize staying away from cheap novelty stuff of questionable origin and dubious materials- we don’t often consider the non-monetary cost of things we purchase, even though those are usually the highest priced items in life. I’m reminded of a fitting saying I heard ages ago, don’t even remember where; but a variation on it just popped into my head. It’s a little crude, but it says “a hard prick has no conscience.” I would argue “neither do the toy companies that make ’em that way.”  

Some toys might be okay if the labeling on the box is honest and accurate and if you adhere to proper hygiene. But there’s just too much uncertainty with these materials- too many cases of reactions and infections. It’s so insidious, because the people most affected with these things almost never even consider that the root of the issue could lie in their sex life, so when they finally go to a physician and begin the long road to eatablishing cause, they don’t think ‘oh yeah, I introduced a new toy’ and the doctor doesn’t think to ask them ‘have you used a new lube or introduced a new toy?’ Definitely keep that in mind if you should ever have a reaction or issue. But fingers crossed, you won’t.

If you know you have sensitivities or allergies in your life, just don’t mess around with cheap mystery toys- or lube- same thing. Remember the potential non-monetary costs, so research, research, research… and go with quality 100% silicone. 

Perusing the Great Sex Toy Universe

There’s a lot of information out there on how to choose a first toy- be it a dildo, vibrator, butt plug, cock ring- you name it. Clearly I don’t have the time to go over all of it for every single thing, but I’ve included a list of resources at the end of this blog, and all or most are fully searchable. If you’re interested in entering the great universe of sex toys, I really encourage you to do a lot of research and ask questions; a lot of bloggers seem happy to help people with it if you send a question. Dangerous Lilly is one; even though she hasn’t posted recently, you might still want to ask since that was kind of one of her specialties and she is super detailed. But there are many sex bloggers out there… Google ‘sex toy reviewer’ or ‘blogger’  and see what I mean. Again, I’ll list some in the resources section at the end of the blog. If you’re a newbie interested in a toy, research, research, research. Absolutely ask a blogger- one of the people I’ll list at the end. Don’t be embarrassed, they’re into this stuff and are in the know. But once you’ve done some serious due diligence, I’d say take a field trip or a research expedition: go, see, and touch things; you’ll be more able to compare what’s what and make a better decision. If you’re planning on using it in a couple situation, make it a good time!

Buying for Others: Gift Trip

Now if you want to buy something for a lover, spouse, committed partner, or nebulous ‘I hope I get to use this with (insert name here)’ it makes the process of choosing sex toys even more complicated, especially if it’s the first one! Dangerous Lilly has a set of several questions that she says the buy-er must know about the buy-ee before buy-ing a toy, people. They entail accurately measuring members, maybe some comparisons to vegetables… and some deep introspection. One thing I definitely can say that’s frowned on is “Surprise!!” sex toys, especially if they’re a new introductory type deal to one or more partners. They’re fraught with potential pitfalls from the jump. So I’d suggest no “Surprise!!” sex toys. If you want to introduce the topic, or you’ve talked about it but nothing further, try a “Surprise, this is a gift certificate for us to go to (wherever) to do some shopping, baby/ honey/ sweetie pie, I thought it would be better to shop together” gift; it’ll be much better received. You can make the shopping excursion into an experience to bring you closer together and make some serious sparks fly, people. 

What else have I learned? When you’re talking about dildos, size does matter. As patients, I have seen lots of men and penis owners feel threatened by the introduction and/ or use of dildos, where they feel absolutely in competition with them, especially if it’s “bigger” than they are. This is a very real and potentially serious issue that can undermine an otherwise amazing relationship, especially because people don’t find it easy to open up about it. Any problem is a problem as it is, but a problem wrapped in shiny shame is a monster. That said, it seems an unspoken agreement that a ‘mere’ ¼ inch increase in the width of a dildo is enough to make some ladies leave a room… and others to run screaming from it. Well, you must understand one big factor: it’s not living human flesh, so evidently it equals a lot more in the fullness aspect. Because they’re not living human flesh, toys don’t have any give at all. Whereas living human flesh can be compacted in certain areas, causing it to be more expanded in others, a dildo is going to be what it is, everywhere it is. And I can imagine how that could be uncomfortable when you’re dealing with a sensitive area in the center of a body. To give you an idea: I’ve even read accounts of dildo ‘aficionados’ (unclaimed by them, just my estimation only) that refuse to use anything wider in girth than 1.25 inches, which by the way is considered a size small. They do come smaller though… and larger… up to porn starlet size. I’m just saying that there’s no reason to remain insecure about allowing a partner to explore the use of any toy, whether a dildo or anything else. Note I said remain insecure. I said that because people are allowed to feel whatever they feel; but I have seen patients that have felt that way, and they tell their partner, get assurances, and let it go. Or, they internalize it, build resentment, get miserable, stay miserable, distance themselves, then end up in my office with some major issues. With all the patients I’ve seen, I’ve never come across a situation where the person asking for and/ or using the dildo is actually doing so to cause their partner to shape up or engender a sense of competition. And by the way, there is a size designation for dildos: length and girth. The easiest one to follow was on a blog called Betty’s Toy Box. The direct link to it is here:

https://www.bettystoybox.com/blogs/bettys-buzz/betty-s-guide-to-dildo-size-how-to-get-the-right-length-and-width-for-you

Hopefully that will stay active after I post this, and I’ll include it in the references section at the end as well. If all else fails, just Google Betty’s Toy Box Dildo Size Guide.

Another note on a first dildo that I noted was on several sites… if you’re a vulva virgin and haven’t experienced any penetration; or if you have a vulva and maybe you’re built on the smaller side and have difficulty or pain on penetration; or you have medical issues that prevent penetration or make it too painful, all the cool kids say to ease into things, and get a silicone dilator set before you consider anything else. And get a lot of lube. As a physician, I definitely second that. You can actually do some damage, so medically speaking, lube and very gradual dilation would be the way to go. I saw two references to a Sinclair Institute dilator set on SheVibe I believe. Link is below in the references section. Gotta walk before you run, people.  

Don’t Go Here… or There

I’ve never seen so many ridiculous material and product names in my life! So many -skins and -gels and -luxes, -future this and that. It’s ridiculous! And they do it on purpose! They figure you won’t take the time to Google what it is if it sounds interesting enough. Also remember you usually get what you pay for, and that a bad decision may cost you more than money. So for the love of all that is holy, avoid some things like the plague people! 

Just say ‘NO!’ to: 

-Jelly, Gelle, Jels, Gelz or anything like that 

-Rubber anything (helll-ooo latex!)

-PVC

-Cyberskin

-UR3

-Futorotic

-Any ultra-realistic dildos, especially when painted, and if they smell funny. They’re guaranteed to have phthalates in them, and they’re porous so they can’t ever be fully sanitized, so they also can’t be shared. 

Some Takeaways

-You get what you pay for…

-But if something is waaay crazy overpriced, it’s likely to be a rip off, because 100% silicone is 100% silicone. A toy can’t be siliconi-er people.

-If you stick with brands that reviewers trust, you’re much more likely to make the best purchase and be happy with whatever you bought. Some reviewers actually offer discount codes as well, so look for those while you’re researching. 

-Your best bet is all silicone, but it is more expensive, so it may be out of your range. If you decide you absolutely can’t get silicone right now, go for glass, but not cheap, un-annealed glass; and/ or cover it with a polyurethane condom. Other cheaper options that are (usually) non-toxic include TPR / TPE / Elastomer, but it’s porous so it’s hard to sanitize, and it’s softened with mineral oil-based ingredients most of the time. Oil isn’t compatible with latex, as in latex condoms, so you can’t use that type of condom with it. So that’s a minor little detail to keep in the forefront of your mind.

-If you do choose a porous material, please examine it very carefully before each use; look for any discoloration, odd odors, and black dots anywhere on it. And it is recommended that you toss it after six months to be safe, even if it’s not growing crap like a petri dish… yet.

It seems sex bloggers generally advise  avoiding buying sex toys from Amazon and Ebay. Counterfeit sex toys are definitely a major problem as bullshit seems to reign in this industry. You can easily get ripped off and pay for something that you think is silicone but actually isn’t. Some people have reported good experiences buying from Amazon, but the risk of getting a fake sex toy is high enough that people in the know advise against it. Stick with well-known sex toy retailers like Shevibe, Early to Bed, and Smitten Kitten. They say in Canada, use Come As You Are, but I’m sure they’re online and these days they must ship. I also saw the name Tantus mentioned several times on different sites when talking about good quality all-silicone stuff, but then they specify that they’re a manufacturer. I still think you could find a way to buy directly from them. I haven’t tried personally, but I’m betting you can… 

References

Unsure that links will remain active people!

Dangerous Lilly

https://dangerouslilly.com/

-Hasn’t posted since 2019, but all previous posts available with excellent information

-Very interested in toy safety and materials

-Former sex toy retailer 

-Very good with instructing in “Surprise!!” sex toy gifts. But just don’t do it- a certificate if you must, but no “Surprise!!” sex toys. Take your partner shopping and make it fun people!

Betty’s Toy Box

https://www.bettystoybox.com/blogs/bettys-buzz/betty-s-guide-to-dildo-size-how-to-get-the-right-length-and-width-for-you

-This is the direct link to the Dildo Size Guide on Betty’s blog, which is another great resource.

Toy Meets Girl

https://toymeetsgirlreviews.com/about-me

-A no bull middle-aged woman started a blog due to problems with hyposexual drive secondary to medical/ medication issues

-Lots of great info on everything, including toxic toys, tells it like it is. 

The Smitten Kitten

https://www.smittenkittenonline.com/blogs/news

-Blog and a trusted retailer 

-If you do a Google search, be aware there are crazy cat lady blogs and cat retail stores and boarding services as well, very different!

-Also interested in toxic toys- talks the talk

Bad Vibes

BADVIBES.ORG

-This is an organization est in 2005

“Creating radical change in sex toy manufacturing and consumer awareness around sex toy material and usage.”

-Tons of resources

-Worked with Smitten Kitten to do second round of sex toy material safety testing

Sexational!

http://www.sex-ational.com/blog-1

-Any semi sex-related topic you can imagine

-They describe it best

-As their home sign-in page says: 

“Keep Abreast”

It’s “Whatever I feel like, once a week–and at least one breast.”

Then: “GET ON IT” and “I’m not kidding about the breast.”

Trusted Suppliers

SheVibe   

https://shevibe.com/

“The most competitive prices for the highest quality products available.”

Early to Bed   

https://www.early2bed.com/

“Chicago’s feminist sex shop. Helping all kinds of folks have great sex since 2001. We ship discreetly and quickly!”

Smitten Kitten

https://www.smittenkittenonline.com/

“Non-Toxic and Body-Safe Sex Toys”

Also have guides to sex with disabilities

Come As You Are Co-op (Oh Canada)

https://www.comeasyouare.com/

“World’s only worker-owned co-operative sex shop … a fundamentally anti-capitalist and feminist approach to sexual pleasure, health, and education.”

I’m not absolutely positive if they ship outside of Canada, eh?

Tantus

https://www.tantusinc.com/?rfsn=3563776.b20e70

“Founded on the belief that each person has the right to a healthy sex life. We believe that our products should be driven by passion and integrity, and inclusive to everybody.”

-They highlight their “Ultra-Premium Silicone”

-And yes, you can definitely buy direct!

AND…

Next week… Last of Sex Toy Blog Series

Smart and App’d Couple Toys- For long distance love… or love in the time of Covid!

Sex Toys of the Future

The last sex/ toy blog- for now- so stay tuned!

I hope you enjoyed this blog and found it to be interesting and educational. If you did, let me know. If you didn’t, let me know that too!

Please feel free to share the love! Share blogs and YouTube videos with family and friends. 

Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, and share those vids too! 

And if you like what you see and want more of it, or if you want a specific topic, leave it in the comments- I love reading them! 

As always, my book Tales from the Couch has more educational topics and patient stories, and is available in the office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Sex Toys:Not Too taboo

Sex Toys: Not Too Taboo

Usually I write my blogs and record my vids right off the top of my head with basically zero preparation required. Today’s topic is a little outside my usual scope, but I’m man enough to admit that I did some research- and believe me when I tell you that there is a freaking metric ton of info on sex toys out there! As a physician, I’ve seen more than my fair share of kink and way-out-there sex practices in hospital ER’s all over this great country, but I found that toys these days go from “wow…now that sounds interesting” to “they want you to put that there?” to “dammit, why the hell didn’t I think of that??” Some of it is totally blush-worthy, but set aside your hang-ups and preconceived notions, open your minds, and get ready to get really up close and personal here, people! And fair warning: prepare for plenty of innuendo and double entendre – and any time you read something and think to yourself ‘oh wow, did Dr. Agresti realize what he wrote there, what that word choice kinda sounds like in a blog about sex?’ The answer is yes and yes…I did and I do. So I hope you like it and share it.

Sex toys are clearly no longer the taboo subject of generations past, as ever increasing numbers of men and women, cis and trans, L, G, B, and Q, individually, and in couples and fill-in-the-blank-somes, are incorporating toys into their sex lives. As a result, it’s no surprise that the sex toy business is banging. Not a shock if you recall my wildly popular orgasm blog and some of the not-so-fun facts I had to reveal: 

-10% to 15% of all women are anorgasmic, meaning they cannot or do not orgasm…like at all. Bummer days people.

-75% of women will never (Hey, you hear that? Never…ever…ever…ver…ver…err…errr) reach orgasm from straight up intercourse alone, without a toy. Like wow people. 

-Captain Obvious says that means that only 25% of women will reach orgasm from vanilla sexual intercourse alone, ie without a toy.

-Only 29% of women regularly reach orgasm with their partner, while 75% of men will always reach orgasm with their partner (“yeah, or a hole in the wall” as added by someone who will remain nameless that’s giving me the stink eye at this very moment because for some reason she thinks that when I’m typing on my laptop I somehow magically become blind to everything else.) Anyway, the moral of this story is that women are far more likely to orgasm when they’re all by themselves than when they’re with a partner. Ouch people.

So…why should you care, you ask? Well, numero uno is that you might have a vagina. Duh. And if you’re an owner of said vagina, you are statistically much more likely to be among that 75% that can’t orgasm from vanilla intercourse, or the 71% that don’t orgasm with your partner at all! Or you could even be both. Or, maybe you have a penis, but you care about someone that has a vagina…like you really care, to the point where you want to have sex with them and please them…both at the same time I mean. This would be good intel then, no? Because then you could even introduce a sex toy (surprise, honey!) and explain that you got it just because you’re so concerned that she may be a member of the “no orgasm club.” But don’t call it that- use big words and quote the statistics in an effort to make yourself sound smart- they’ll appreciate that. Oh, and because you’re a giver. Throw that one in there too. No… really, in all seriousness, emotional intimacy and pleasure from physical intimacy are truly very important parts of a love relationship. And emotional intimacy is at its best when everybody involved derives pleasure from engaging in physical intimacy. To simplify: make your partner’s orgasm at least as important as yours. They’ll be much more inclined to like you and give you more opportunities to make their orgasm at least as important as yours… it’s a positive feedback loop.

There are a lot of myths surrounding sex toys, and one of the most ridiculous is that they’re unnatural and unhealthy. In reality, that couldn’t be farther from the truth. Sex is one of the most natural things a body does; it’s a gross comparison, but sex is right up there with peeing and pooping. Anything that promotes sex and pleasure is absolutely natural and completely healthy! In fact, people who abstain tend to have more instances of anxiety and depression. Facts people. Women that use sex toys report greatly increased levels of sexual desire, much more frequent orgasms, far greater sexual satisfaction, and happer, better, and more complete intimate relationships. I can’t find a negative in any of that. 

Why are sex toy sales on the rise?

While they were once seen as depraved and belonging to a certain line of work, these days they are totally socially acceptable. Now there are even more sex toy parties than Tupperware parties, and women enthusiastically compare notes about the latest sex toys in their collection. The hype surrounding the film Fifty Shades of Grey has played a part in this, along with the fact that today’s women are no longer ashamed about satisfying themselves. On the contrary, self-assured modern women are open about their sexuality, and this includes the fact that they don’t necessarily need a man to be sexually satisfied. That said, couples are also incorporating sex toys into their activities at an ever increasing rate. In particular, couples in long-term relationships are using sex toys to spice up their love lives, allowing them to explore new sexual experiences together. I’ll be talking all about this in part three of this sex toy series, and you don’t want to miss it- it is hot stuff people!

But before we get that deep, today I’m going to start with the basics on sex toys: what they are, how they started, and what they’re all about. Then next week in part two, I’ll talk about who’s using sex toys and what you should consider if you decide to join them. As I said before, part three will be about partner toys and ways to spice up long-term relationships. And at the end, I’m going to paste some links to articles and sites where you can find more information about different types of toys, how to choose a first toy, and where you can find and purchase any and every toy you could ever want. Look, if you’re into playing fingerpuppet five-on-one or downstairs DJ and it works for you, I certainly have no objections your honor, but some new toys could put a new smile on your face; so keep reading my blogs and if anything strikes your fancy… be adventurous and go for it!

What are sex toys?

As if you don’t know… Sex toys, aka adult toys, aka “marital aids”… all are terms for objects that people use to have more pleasure during partner sex or masturbation. Sometimes sex toys can also have medical uses, as in cases of sexual dysfunction, although that seems to be something of a point of contention. There are many different types of sex toys, and people use them for any of many different reasons, but the general idea and end goal is basically the same for everyone across the board: to get off. I’m pretty sure that’s the technical term.

Here’s a quick overview of some of the most common categories of sex toys:

Vibrators

AKA vibes or buzzers

AKA “personal massagers” (yeah…riiiight) 

-Objects that vibrate or buzz to stimulate internal and/ or external genitals.

-Most commonly used on the clitoris and/ or other parts of the vulva and vagina, especially the G-spot.

-Can also stimulate the penis, scrotum, testicles, nipples, anus, and the male P-spot. 

-Come in endless shapes and sizes, waterproof or not, for inside the body and/ or out, and for all genders.

Dildos

-Objects that go inside a vagina, anus, or mouth. 

-Come in many shapes and sizes, but they’re often shaped similarly to a penis. 

-Some look realistic, others more abstract.

-Can be slightly curved to help stimulate G-spot or prostate,  the P-spot.

-Can be made out of lots of different materials: silicone, rubber, plastic, metal, or

glass (freaking yikes – not for butterfingers!)

-Dildo Fun Fact #1: Ever wonder where the term dildo came from? Constantly, right? Let’s get in the Wayback Machine to find out!

-Turns out, like so many words, dildo is thought to be a bastardization of terms taken from other languages.

-IMO, the winner is diletto, taken from the Italian which means ‘a woman’s delight.’ This seems a very likely place where the word we know and love today got its start, however there are a couple of other contenders. 

-My next personal choice would be dill-doll, which is the ye olde English translation for the old Norse word ‘dilla,’ a verb meaning ‘to soothe.’ So literally, a dill-doll would be a soothing doll, as in…a penis! Of course! Or an intimidating giant rubbery effigy of one, anyway. 

-Dildo Fun fact #2: Did you know that there’s an actual place called Dildo? I heard that’s where Waldo was… Waldo in Dildo. But seriously, there’s a town in the maritime province of Canada called Dildo, and Dildo Island is located just offshore don’tcha know. The tourism marketing folks there are fighting one hell of an uphill battle. Check out these tags that I came up with: 

‘Dildo~ The Weather is Here…Wish You Were Beautiful!’ 

‘Come to Dildo…See the Sights!’ 

‘The Isle of Dildo…Get On It!’

Anal Toys

-Captain Obvious says these are toys made specifically to stimulate the anus. 

-Includes plugs (aka butt plugs), anal beads, prostate massagers, and wide base/ flared dildos. Yeah people…pay special attention to that wide base/ flared part- if you don’t, these suckers are prone to take an accidental detour waaay up the hershey highway, and then you’ve got to go to an ER to have it pulled out, and that’s not embarassing at all. I’ve seen this all up-close-and-personal-like more times in the ER than my poor brain can block people.

-You must use lube to use anal toys (especially anal toys) safely. An overarching theme on these toy sites is basically this: lube is cheap, so use lots and lots of lube when you play with toys.

Sleeves

-AKA masturbation sleeves

-AKA penis sleeves 

-AKA strokers

-Soft tubes designed to put the penis into.

-Come in all shapes and sizes, and with different textures on the inside for more sensation. 

-Some feature vibration or suction. 

-These are cool because there are strokers specially designed for a larger clitoris or smaller penis, particularly for intersex or trans people.

Penis Rings

AKA cock rings 

AKA erectile dysfunction rings

AKA constriction rings  

-Shockingly, these are rings that go around your scrotum and/ or penis (must be prior to arousal people!)

-Work by slowing the blood flow out of the penis once it’s erect, thereby increasing sensation and/ or making the erection harder and longer-lasting. 

-The safest penis rings are made from soft, flexible materials that can be easily removed in case of emergency: silicone, rubber, or leather with snaps for the biker set. 

-Some penis rings have little vibrators on them to stimulate the wearer and/ or their partner during intercourse. 

-Penis rings restrict blood flow, so don’t wear one for longer than 10 to 30 minutes, and take it off right away if it becomes even slightly painful: kind of defeats the purpose. 

-Talk to a nurse or doctor before using penis rings if you have a bleeding disorder or are on blood-thinning medicine. See, just the fact that they mention that leads me to believe that there could be blood shed associated with using this toy…so for me, this is a pass and a no freaking way, people!

Pumps

AKA penis pumps

AKA vacuum pumps

AKA vacuum erection pumps

-Vacuum-like devices that use a hand or battery-powered pump to create suction around the penis, clitoris, vulva, or nipples. -Pumps drive blood flow to the area, which helps increase sensitivity and sensation. -Penis pumps can help you get an erection, but they won’t make your penis permanently bigger. Sorry people.

-Some pumps are designed to help treat erectile dysfunction, genital arousal disorder, and orgasm disorder. 

-For more information about these pumps, contact a nurse or doctor. You can also go to your local Planned Parenthood health center. -Most of the pumps you buy in sex stores or adult shops are not medical devices, they’re just meant to enhance pleasure during sex and masturbation. 

-Make sure to follow the instructions on the packaging, and don’t pump for longer than the instructions dictate.

-Once again, talk to your doctor before using a pump if you have a blood disorder, or are on blood-thinning medication.

Ben Wa Balls

AKA Kegel balls

AKA Kegel trainers 

AKA Vagina balls

AKA Orgasm balls

-I’m sure you’ll all be shocked to learn this first part: that these are round objects; but maybe a little more surprised by the second part: that they’re designed to be inserted inside the vagina, and definitely shocked by the last part: some women keep them in for an entire day. Like on purpose. Whoa people. Don’t mind me, I’ll just be crying in the fetal position over in the corner. 

-They can assist in exercises that tone and strengthen the Kegel muscles. 

-Kegel balls are usually weighted so that the vagina must be squeezed to keep them inside the body, strengthening the pelvic floor muscles. 

-You don’t need these balls to do Kegel exercises, and not everyone uses them for that purpose; many women just like the way they feel inside the vagina.

-Fun Ben Wa Balls fact: female prisoners could use these to enlarge their “God purse,” which is what they call their vaginal cavities, especially when they hide illegal items from cops and/ or smuggle contraband into jails and prisons. Wonder if a female inmate came up with them… after all, necessity is the mother of invention.

-Some are hollow with smaller balls inside that roll and bounce when you move, making a jiggling sensation. And probably a jingling noise too, right? Can you imagine that? I’ll do it for you: you’re a man in an elevator, you’ve just pushed the button for eleven, and just as the doors are about to close, you hear the familiar sound of jingle bells getting louder as you see a woman is running to catch the elevator, and as she jumps inside at the last second and lands in her spot, there’s one final loud jingle as she smiles and says “five please,” then silence. Internal thoughts as you push five: Hmmm, those were bells. Like jingle bells? Huh. But kind of… quiet-ish… almost muffled (? you ponder this as you clean your right ear with a pinky finger). Funny, it’s May, not December. I don’t see any bells tied to her stilettos. Odd. Well, maybe she’s one of those people that keep that holiday spirit all year long. Freaks. Ugh so annoying! Or, she’s got ’em in that purse. It’s really small; didn’t see that on her other shoulder before. That’s it. They’re in that purse. Gotta be. Mystery solved. Good job. 

Meanwhile, her internal thoughts after you pushed five: Sheese…this ass monkey moron heard my bell balls. Ha! He’s trying to figure it out right now…I can see the gears working overtime in his pea brain. Can practically smell the burning as he’s inspecting me. No moron, they’re not tied to my Manolo’s…what am I, four? Doesn’t he- oh, he just saw my purse. Yep, he thinks I’ve got them in there. Oh yeah, he thinks he’s got it all figured out…he looks so proud of himself. Little does he know this silly little purse won’t even hold my bell balls! But my God purse does…juuust fine. Later loser.

Right after his mental pat on the back, the elevator stops, the door opens, and she’s gone… jingle all the way.

Harnesses

-AKA straps 

-AKA strap-ons

-These are garment systems that hold a packer, dildo, or other sex toy against the body. 

-Some can be worn like underwear or jock straps, while others can go around other parts of the body, such as the thigh.

People still have a hard time talking about sex and orgasm, but make no mistake: these are integral components of life, and even the ancients knew it. The desire for a good, satisfying, old-fashioned orgasm is timeless. Our ancestors, while they were making hair combs out of bone and forming and firing clay pots, they didn’t neglect their sexual needs… quite the opposite actually. Need proof? To date, the oldest dildo recovered is a big curved stone phallus found in Germany. How old was it? 28,000 years old people!

Turns out, historical men (and women, maybe even more so) were light-years ahead of us in the pleasure department; we have proof positive of this, thanks to their inventions, all of which are still used today. Here are the backstories on some of the most recognized sex toys and paraphernalia that’s still out there in one form or another. 

Blow-up Dolls

-Invented in 1904

-“Lady substitutes” are recorded as far back as the seventeenth century, when French sailors devised the Dame de Voyage: a collection of curvaceous rags (say whaaat?) that could only ever resemble a woman to a very homesick and horny Frenchman. But it wasn’t until some time after vulcanized rubber was patented that the more familiar model came about, which was in 1904. Boy, that must’ve been a Goodyear… and a good year! At that time, they marketed them as  “inflatable dolls for discerning gentlemen.” Would’ve been a hell of a lot easier than marketing tourism to Dildo.

-Less than four years later, German sexologist Iwan Bloch was marvelling over mass-manufactured versions that could ‘imitate ejaculation’ for sale in Parisian catalogues. Rating super creepy was a firm that offered a custom doll resembling “Any actual person, living or dead,” which has to be the single most disturbing tagline in the history of marketing and advertising. Except maybe of course for ‘The Isle of Dildo…Get On It!’ 

-Now they make those “real life girls” which are waaay too (sur)real for me, but devotees talk to them, eat with them, and live with them like they’re real humans. Some medical show I saw followed these men that preferred these dolls, and one guy had four of them, and he actually detailed conversations between himself and the “girls,” including arguments between them about how they would get jealous when he chose to “spend time” with someone other than them. And I’ll never forget when they filmed him opening a door with a smile and saying something like “Yeah, the girls hate to be put in the closet,” and the camera focuses on the closet and there are his three other girls all sprawled out haphazardly. Here he was explaining how he loved each of them, combed and styled their hair, shopped for hot outfits for them, and here they were, all crumpled up in some dingy little closet, waiting for their next date with him or whatever. It was patently ridiculous while absolutely hilarious! There was a movie on this same storyline, I think it was called Lars and the Real Girl. I’m sure you could find it if you were so motivated. 

Butt Plugs

-Invented in 1892

-An English dude named Frank E. Young was a man with a vision, and that vision evidently involved things being inserted up other people’s rectums. Because that happens everyday, right? 

-Developed in 1892, but not marketed until the turn of the century, his ‘Rectal Dilator’ was a terrifying 4 1/2-inches of pain, designed to go not just where the sun don’t shine, but where the sun can’t, and won’t ever, shine. At the time, it was billed as a cure for piles, a gussied-up term for hemorrhoids. 

-The devices were hawked to doctors and even advertised in respected journals. And people might well have gone on believing they were medical devices too, were it not for the ridiculously suggestive instruction manual included with each order. 

-For forty years, these Victorian butt plugs managed to jump the pond to be sold all across the US of A, before they fell afoul of the 1938 Federal Food, Drugs, and Cosmetics Act, which banned them for “false advertising.” Given that it looks like it does, I don’t see how that’s possible, but we are talking about our federal government here. 

Vibrators

-Invented in 1869

-That date is the officially accepted one, but legend has it that Cleopatra actually developed the first version of a vibrator. She was said to keep a jar of live bees on her bedside table, and when she was needing some personal attention, she had her servants fill a hollowed-out gourd with them. She then pressed that against her lower Mesopotamia, using the angry vibrations emanating through the gourd to pleasure herself.  

-She had to stimulate her own self after all four of her husbands died… I guess a girl’s gotta do what a girl’s gotta do. And evidently she did, quite regularly.

-Back to the Victorian vibrators of 1869… this period was a different time… a time when “robots” were steam-powered and doctors treated hysterical women by masturbating them to climax. Of course. I also covered this in my orgasm blog.

-Female hysteria was supposedly a genuine illness, and its treatment involved a qualified medical professional rubbing the female patient’s private parts until orgasm was achieved. Because nothing about this practice could be logical, doctors often complained of boredom and pain-in-the-wrist, probably the very first cases of repetitive motion injury. 

-One of said qualified medical professionals, George Taylor, came to the rescue and invented the first steam-powered vibrator. Because what could possibly go wrong with that… a metal device powered by steam… which is hella hot people!

-Although (shock of shocks) that version failed to catch on, J. Granville’s 1880 ‘electrochemical’ design really did, much to the delight of housewives everywhere, as they went bonkers for them. 

-Even Good Housekeeping magazine started running monthly reviews of these marvelous wonders. So what happened? Well, society accepted the ‘massager’ as long as devotees could tell themselves that it was a medical device, rather than a sexual aid. Yeah, riiight…whatever gets ‘ya through the night people. 

-Now, I should note something I learned while doing research for this blog: that supposedly, while this practice of medical professionals using a vibrator to bring women to climax was common, it was not done for a female hysteria diagnosis, as there supposedly was no such animal. So there ‘ya go, now ‘ya know.

-After these vibrators made their debut in the earliest porn films, husbands soon realized what their wives were up to all the time, and they put a stop to it. Of course they did! Because as every man of that era knew, the last thing you wanted was a sexually satisfied wife… total bullshit. 

-Trust me people, I’m a doctor: a partner that’s satisfied in every aspect of life is actually the thing you should want more than anything else in the history of things in the whole wide world. If you’re wondering why, (re-)read my orgasm blog. 

Condoms

-Depends on whose history books you read, but the accepted invention date was around 1560-ish.

-Going by a strictly modern definition, the first reliable record of condom use doesn’t appear until 1564.

-Regardless, in Japan and China, ‘condoms’ made from various animal membranes were in use before the 15th century. I use ‘quotes’ because there’s really no telling what they were called.

-Japan favored tortoiseshell, but then later thin leather, to make them. In China they were made out of oiled paper or lamb intestines. Neither differed much from condoms in later centuries that were made out of linen or animal intestine.

-They were typically one-size-fits-all – sorry “Magnum” men – and they had to be dipped in water before use to make them pliable. Hmmm… pleasure fit.

-In the 16th century, condoms were used primarily to prevent STD’s like syphilis, as it was typically fatal. So whatever they called them, they may have saved some lives. That is until…  Duhn Dun Duuuhhhnnn!!!

-The discovery of spermatozoa in the 17th century changed everything forevermore. -The Church became outraged over the use of any barrier that could impede the progress of men’s little swimmers as they attempted to reach and fertilize a golden egg. 

-As a result, by the 18th century, the condom’s reputation amongst medical professionals had been firmly cemented as a tool for philanderers, prostitutes, and the immoral.

-Despite this condom condemnation, they actually proved to be quite popular among the upper and middle classes of the day. The beleaguered working classes finally gained access to them after the vulcanization of rubber, round about 1839… another Goodyear and good year. And also what undoubtedly led to the ubiquitous term recognized ’round the world… ‘rubbers.’

Penis (Cock) Rings

-Invented in China in about 1200 A.D.

-These have undergone few changes or innovations in their history. If it ain’t broke…

-Evidently, being ancient Chinese nobility was not an easy job. Not only did you have to put up with assassination plots and Mongol invaders, you were also expected to service your wife, mistresses, and concubines… all on a regular basis. 

-While it sounds like fun and games, there was an urgent reason behind it: if you didn’t produce an heir, you could be pretty sure some obscure prince was going to step up to take his shot at a coup. 

-In stressful circumstances, performing can become… well… difficult, people!

-But have no fear – penis rings are here! -First made from the upper and lower eyelid rings of a goat, with the eyelashes still attached (freaking ouch!) it helped the wearer get on with the business of impregnation for hours on end, even if he was secretly crying on the inside. And I’ll bet he was.

-While primarily made for purposes of sexual enhancement, they were later made from carved ivory and jade to also be worn for aesthetic adornment. No matter how pretty it is, I betcha they still hurt like hell.

-For a brief period inspired by sexual repression, these rings were also designed specifically for the purpose of preventingerections and sexual exploits by inflicting pain with constriction or spikes. 

-This is interesting, because it really demonstrates the clear link between pleasure and pain, even waaay back in dynastic China… tres 50 Shades. Interesting though it may be, I’ll take a hard pass on the pain part of that equation, thank you very much people. Debbie and I have no Christian and Anastasia tendencies at all.

-In reality, the basic form and function of these rings have remained quite unchanged, though they are now made in softer, less painful materials and in adjustable models as well. 

Geisha Balls

-AKAs: Ben Wa Balls, Burmese Balls

-Origins are uncertain and incomplete

-What we know: they appeared in the Orient sometime around A.D. 500 and were originally used to pleasure men. 

-Women soon (somehow) caught on to the benefits (?) of the device, and the balls went supernova. 

-Recorded across most Asian cultures, Geisha Balls were the “Rabbit” of their day: a toy that could heighten pleasure during sex, or simply facilitate some good old-fashioned self-pleasure.

Penis Enlargement

-Popularized in Third Century A.D.

-The Kamasutra was many things: a manual for living, a treatise on sex, and likely the earliest recorded scam. Why? I’m glad you asked: because in it, they describe a method for making a penis larger. How? I’m glad you asked: by catching wasps, and- stingers and all- rubbing them all over the penis, being very careful not to crush and kill them before they angrily sting the entire shaft and head of the penis. Or, some people say you could also simply grasp each wasp and apply its stinger to the skin of the penis- and then repeat that action until you’ve managed to cover it completely. Does it work? I’m glad you asked: technically, yes… but the enlargement you get would only be courtesy of the swelling caused by the poison stinger, and I’m quite sure that using the penis for intercourse in that condition would be painful as hell, certainly sufficient enough to prevent you from doing so. In reality, the efficacy of this “treatment” in making the penis larger is questionable at best, and lethal at worst, if that’s how one discovers they happen to have a severe anaphylactic reaction to wasp stings, and would be very temporary in any case… So it would only work about as well as the tub o’ enlargement cream that Junior High boys buy online after sneaking dad’s credit card. 

-There is an alternative of sorts, to increase the girth of a penis. What is it? I’m glad you asked: Apadravyas. What the hell are those? I’m glad you asked: apadravyas are a type of deep penis shaft piercing. *Warning: cross your legs, penis people!* These piercings pass through the penile shaft at certain specific points and apparently function to make the penis feel larger as it enters the vagina – or so devotees claim. 

-These girth piercings come in other forms based on where they are placed through the shaft.

-In addition to apadravyas, other forms of these piercings are called ‘deeply placed ampallangs’ and ‘reverse shaft Prince Alberts.’ Well hell, that clears it right up… not!

-These deep penis shaft piercings are fairly rare piercings due to (helll-ooo!!) their associated pain, difficulty, bleeding, and long healing times. 

-Common placement is directly behind the head of the penis, but they can be placed farther back if the (completely batshit crazy) man so desires.

-In the interest of research (heh heh) I had to ask Debbie if she would have intercourse with a dude with an apadravyas. I can’t describe the look she gave me, because words just can’t go there, and I can’t tell you exactly what she said… but it sounded a lot like “what the muck is a applegravys and what does it have to do with mucking some dude?!” After I enlightened her, I repeated my question: “…so would you have intercourse with a dude with an apadravyas?” I can’t tell you what she said, because she didn’t say anything… she just set her face in an ‘ewww, what the hell stinks?’ expression and shivered… an impressive, full body-length shiver, starting from the blonde hairs on the very top of her pretty head and carrying down to the very tips of her perfectly manicured pink toenails. After this shiver response, she started to turn and walk away, but then turned back to add “Just to be clear… I would never (word that sounds like muck) a dude with an applegravys in his (word that sounds like lick) – not even after a tetanus shot! I love my wife, so it’s my duty to keep her on her toes, however I find it fit to do so. That’s how I see it anyway… can I get an amen?! Anyway, so it was for her own good that I asked (read: yelled after her as she left) in my very best Austin Powers voice “…so you’re saying it really turns you on, huh baby?” And what did I get for all of my concern? A Debbie triple: an eye roll-tongue tisk-whut-everrr! As you can imagine, it’s a classic at my house. 

‘Lube

-Sometime and somewhere – evidently, actually everywhere in Ancient Greece.

-Given their reputed penchant for orifices that don’t naturally lubricate, it should come as no surprise that the Greeks were into lube. 

-While no record exists of its earliest use, we do know that by 350 B.C., olive oil was big business… and it wasn’t just for salads, o-kaaay? 

-Aristotle makes a passing reference to this olive oil love in his History of the Animals, implying that smoother sex was best because it made pregnancy less likely. Suurre…

-Two centuries later, physician Soranus echoed Aristotle’s views on olive oil as lube. Seriously?! A Greek dude named Sore-anusthat’s into olive oil lube? Duh! This has got to be a joke. Albeit a hilarious one!

-Sore-anus’ friends- Herodotus, Plutarch, and Ovid- evidently agreed wholeheartedly, and all maintained that Athens got its name because the goddess Athena herself gifted its founders with an olive tree… that’s how much they loved olive oil.

-Greeks were clearly keen on material innovations. In an effort to upgrade from hard (not to mention dangerous and so very uncomfortable) materials like stone, dried tar, and wood, the Greeks developed olisbokollikes- these were essentially dildos baked out of bread. They basically made breadsticks, people. Breadstick dildos…a whole new take on “food porn.” 

-I don’t know why, but whenever I think about Greeks, I automatically think Romans, so I don’t want to leave them out… the Romans were innovators as well during this time. They’re actually known for creating the double-ended dildo, which was regularly used between partners and friends, but was also even used during certain public ceremonies. Roman exhibitionists… that’s amore, people!

….And speaking of dildos

-Archaeologists discovered an eight inch stone behemoth in Germany, dated at 28,000 years old, people!

-The dildo may well be humanity’s most durable invention, as only fire, weapons, clothing, and beads appear to have been around longer. 

-Evidently, archaeologists find dildos on digs all the time: it’s almost as if people in the prehistoric era found sex to be a natural and enjoyable thing that they didn’t have to be ashamed of. No shame in their game people. 

…And speaking of no shame: Pornography

-Years ago, archaeologists uncovered a decidedly pervy prehistoric statue carved from a mammoth tusk. Who knew that archeology could be so titillating?

-It was basically a female torso with… hmmm- how to put this… ‘exaggerated’ sexual parts on top and bottom. 

-It was a toy- a sex toy- and it was also functional pornography! A two-fer people!

-The exact age of it is uncertain, but the best guess places it at over 35,000 years old. 

-That means it may even pre-date religion. That’s big, people. 

-Obviously, the history of religion is essentially educated guesswork, so lots of eggheads argue about it, but if you assume it’s true- that this pervy porno sex toy pre-dates religion- can you understand the implication of that?

-In case you can’t, I’ll help you out: that would mean that before humans bothered with their ‘trivial’ thoughts on the meaning and creation of life, they had already figured out all the things that turned them on and got them off, and were producing toys and paraphernalia to make it easier and more gratifying to do so. Talk about priorities, people. 

Clearly, human beings have been exploring sexuality since the dawn of time, and as it turns out, sex toys and sex paraphernalia have been around for just as long. The above glimpse at their design histories offers a strange and often hilarious look at humans’ constant quest for innovation and better…. connection, let’s say. 

Okay people, this blog has been a long one, but you hung in there (hahaha I’m on a roll here!!) and I like to reward good behavior. So, speaking of hilarious, I found a page from a UK-based global sex toy company called Lovehoney (Lovehoney.co.uk) where they sell stuff that might blow your mind…but the following will sooner bust your gut: it’s their list of the 101 funniest Lovehoney site searches (look for occasional commentary from me, MGA people!)

101 Funniest Searches on our Sex Toy Site

https://www.lovehoney.com/blog/2018/03/08/101-funny-sex-toys-searches-lovehoney/

Quoted from Lovehoney page:

There have been 6.9 million unique searches on Lovehoney.co.uk in the year to date. Most of the words that are typed into the search box at the top of our site are pretty straightforward: cock rings, vibrators, and all the other types of sex toys we sell. And when customers type in a phrase, we try to present them with the product or page they’re looking for. Simple. But!!! Some of the searches are not quite what you’d expect…

“Anal cockroach”???

Ummm… Sorry, no page for that!

Or any of the below, which are just 101 of the funniest, weirdest, and ‘whoops you’re on the wrong website’ searches we’ve found!

Typos and epic auto-correct fails…

1. make your duck longer

2. election enhancer (MGA: we’ll all need this come November people!)

3. cockfosters extension

4. pension extender (MGA: where can I sign up for this?)

5. masterbakers for male

6. master storyteller sleeves

7. prostate lasagne (MGA: not what your Italian grandma serves for Sunday supper, thank you God) 

8. blowtorch stroker

9. extra quiet clitoris

10. quiet rabbi

11. g spotify

12. large g snot rabbit

13. vibe eating butt plug

14. king clock dildo

15. breaded dildo (MGA: ditto last comment)

16. jelly bilbaos

17. rubber dodos (MGA: and scientists claim they went extinct)

18. nipped pasty

19. nipple gardening cream

20. or gasman creams

21. pies for woman to get horny (MGA: we need to introduce this lady to Mr. 5 ^)

22. parents ribbed and dotted

23. bondage ape (MGA: our ASPCA would never allow those here)

24. lego restraints (MGA: I remember looking for that set. People really snapped ’em up at Christmas time!)

25. clint clamp

26. sexist enhancer (MGA: ‘Ah-hem, I’m afraid I couldn’t purchase these again for you, Mr. President’)

27. £3 sex tits (MGA: that’s only $3.75 USD…can’t be very BIGsex tits)

Somebody’s got the sex toy blues…

28. argue dildo

29. be warned balls

30. begging set

31. bitterly kiss

32. bleak lace lingerie

33. blue worthless knickers

34. fifty shades of greed

35. cock extinction

36. fleshlight insults

37. handcoffins

38. hate based lubricant

39. male sick vibrator

40. male wasterbators (MGA: masturbating stoner guys)

41. vaginal fighting cream

42. ben war balls

43. very berating pants

44. misery bundle

45. pensive sleeve

46. performance kills

47. remorse egg

48. repent rabbit

49. undead wear

50. ruthless panties

51. sorry panties

52. worthless dispenser panties

We do NOT sell these…

53. bishop vibrator

54. barman vibrator

55. cricket vibe

56. turnip vibrator (MGA: for the very strict vegan)

57. parsnip vibrator (MGA: okay, somebody clearly thinks they’re a comedian. I make the jokes here, people!)

58. vibrators with noodles

59. bike saddle dildo

60. pogo stick dildo

61. glasses with testicals snaped to them

62. Darth vader condom

63. extra sting condoms

64. pickled onion condoms

65. chicken tikka masala condoms (MGA: it’s past somebody’s dinnertime)

66. lovehoney wine

67. extra wine vibrator

68. make-up sperm coconut

69. paperami lube

70. Love twiglets

71. family guy sex doll

72. Japanese dancing pants

73. loyal pyjamas

74. machine guns

Going somewhere? You’re on the wrong site… (MGA: if I had captioned this, it would’ve been: “Sorry – we’re all about coming, not going…”)

75. gloucestershire bus timetables

76. london to whitehaven train times

77. meeting point in bangkok airport

78. walking trails in east falmouth

79. bike rack inside caravan

80. staying in a hotel in alton towers

81. is drinking allowed on coaches

82. parrot sale in india

83. North Korea (MGA: there’s a Kim dynasty joke in there somewhere)

Nope, we’re not a grocery store…

84. andrex supreme quilted toilet roll tissue paper

85. fairy non bio pods sensitive skin washing capsules

86. gaviscon double action mint tablets

87. roasted cauliflower with parmesan cheese

88. serrano ham

89. Ragu

90. Absinthe

Just plain weird…

91. Peter from gravesend – timewaster

92. hide your drink in bra

93. mild penis

94. mild vagina

95. outpouring vegan

96. room of priests

97. scrotal parachute (MGA: I know they stretch as we age, but wow…that’s gotta be impressive)

98. the loo of love (MGA: must’ve missed that position in the Kamasutra)

99. Wednesday

100. Dave

And finally this person, who clearly knows exactly what they want…

101. a silicone butt plug for beginer one my wife can leave in her ass n get on with housework shaped without risk of it falling out

(MGA: alert the media people… I’m speechless!!)

   _______________________________

That’s some of the history and background on sex toys. In the next couple of weeks, I’ll be covering more interesting details and specifics on sex toys that you won’t want to miss, so be sure to come on back for more, people. 

I hope you really enjoyed this blog and maybe even found it to be slightly more titillating than the usual fare. If so, please feel free to spread the love and share it with family and friends…. and lovers of course! And be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more fabulously educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Opiate Addiction and Detox: Buprenorphine vs Methadone

Opioid Addiction and Detox: Buprenorphine vs Methadone

Last week, I went over the history of opioids, and it really highlighted the trend of addiction that has always been linked with them. According to the World Health Organization, more than 15 million people are suffering from opioid dependence today. It’s clear that the opioid epidemic isn’t a new phenomenon; for as long as the opium poppy has been in existence, so has addiction. Historically speaking, what is relatively new is that physicians and pharma companies are recognizing the need for more effective ways to combat this epidemic, whether through prevention or treatment. As a result, we have some novel compounds that present different options for people who are addicted to these drugs; these include non-narcotic options for pain relief to prevent addiction, as well as medications to help addicted people on their road to recovery from opioid dependence. In a future blog, I’ll talk about a non-narcotic compound currently in patient trials that is showing a great deal of promise in the chronic pain arena. If you’re interested now, I posted a video on it on my YouTube channel, so check it out. But for today, I’m going to talk about the latter: two drugs, one relatively new and one not so much, that are being used to detox opioid addicts and give them a shot at a clean life. These two drugs are buprenorphine and methadone, and one of these is definitely not like the other. I’m going to compare and contrast them: the good, bad, and the ugly. By the end, you’ll not only know my opinion on the matter, but why I’m passionate about it. 

What is Buprenorphine?

On the market for nearly twenty years, buprenorphine is a Schedule III drug used to help treat the physical ramifications of opioid withdrawal. Given as a simple medicine that dissolves under the tongue, buprenorphine satiates the opioid receptors that cause dependent people to crave opioids. It can be prescribed in its solo form, or as a branded compound product with naloxone, which is the familiar ‘resurrection’ drug Narcan. It is the most strictly regulated drug by DEA, and available only from physicians that have been specially certified in its use, a fact that has been the nexus of some controversy. Why? Some physicians and policy makers feel that the hoops that physicians must jump through in order to receive the ‘X Waiver’ required to prescribe it present a barrier to its use; that if certification requirements were relaxed or eliminated, more opioid-dependent people would have access to this option for detox. The objective of someone taking buprenorphine is to help them remain safe and comfortable as they go through detox from opioids so that they can focus on treatment and recovery. While some data claims that buprenorphine may create some feelings of well-being when a person takes it, it does not cause a euphoric high. It’s also worth noting that while it can be used safely long term, the duration of use of buprenorphine tends to be more short-term, which clearly verifies the absence of a high and it’s low potential for addiction. Buprenorphine’s binding action to opioid receptors in the brain blocks the narcotic effects of traditional opioids, so if a drug-dependent person takes buprenorphine and an opioid together, there’s still no “high,” thus eliminating the reason for taking said opioid. And, buprenorphine also has a ceiling effect, meaning that beyond a specific dose, its effects remain unchanged. This essentially does away with the “if one is good, four are better” phenomenon, so overdose is very rare. 

What is Methadone?

Methadone is a drug that some physicians believe can be used to “help” opioid-dependent people as they try to stop using drugs. But that’s about where the similarities end. Old as the hills, methadone is a Schedule II opioid medication that’s been used for detox for 60 years. Methadone has a similar chemical structure to morphine; as such, methadone can, and does, make someone feel high. In theory, methadone doesn’t make people “as high” as some other opioids, and it can take longer for that high to occur, which proponents say translates into less potential for abuse. I say this is total bullshit. Why? Because we’re talking about drug-dependent people here, people! We’re dealing with people that, despite any good intentions they may have, their brains and bodies tell them they must get high. Remember that “if one is good, four are better” phenomenon I mentioned? Yeah. Bottom line is that methadone is a very strong opiate, so when a dependent person takes it, their addicted brain gets a taste of that high, and it’s like a tease…it tends to make them want more. Helllooo! There’s almost nothing that will stop a drug addicted brain from getting what it wants. There’s no blocking action and no ceiling with methadone, so overdoses are not unusual. Regardless, for over sixty years, methadone has been given as a “short-term” treatment to help people stop using opioids. That’s bad enough, but what’s worse is that it’s even more often used as a long-term maintenance drug for the “management” of opioid addiction. In reality, it’s replacing one bad drug with an even worse one. In fact, methadone is also known as “liquid handcuffs” by the people who have managed to successfully get off of their methadone “management” programs. 

While the general objectives of buprenorphine and methadone use may be similar to one another, there are clearly many significant differences.

Methadone is almost exclusively dispensed by clinics on a per diem basis, meaning that people have to head to the clinic every day and line up to get their “medicine.” In contrast, a physician with an X waiver can write for a 30-day supply of buprenorphine. It is less problematic than methadone, largely because it’s less dangerous and less addictive than methadone, thanks to the ceiling effect precluding overdose, and the fact that it doesn’t cause a high. That said, people must keep in mind that buprenorphine is a powerful drug, and not one to be taken (or prescribed) lightly. Saying that it’s less dangerous than methadone, while absolutely true, is sort of like saying that rattlesnake bites are less dangerous than cobra bites. Me personally, I’d just rather not be bitten…but if I have to be bitten, bring on the freaking rattlesnake. 

Buprenorphine vs. Methadone

It’s Science, People!

Both humans and animals have opioid receptors in the brain and spinal cord. Biologically speaking, these receptors facilitate the binding and effect of naturally produced pain-relieving chemicals. Externally sourced opioids like methadone belong to the opioid agonist class of drugs. They work by binding to these specific receptors in the brain and mimicking the effects of those naturally produced pain-relieving chemicals. As a result, the perception of pain is blocked, producing feelings of well-being and euphoria, but also side effects such as nausea, confusion, and drowsiness. While opioid drugs are often very effective in treating pain, people can eventually develop a tolerance, so they require higher doses to achieve the same effects. It’s a vicious cycle, so people become dependent, and will experience symptoms of withdrawal if they decrease or stop opioid dosing. That means that when it comes time to taper off of methadone, it’s intrinsically difficult, and withdrawal is unavoidable. Symptoms of opioid withdrawal can include anxiety, muscle aches, irritability, insomnia, runny nose, nausea, vomiting, and abdominal cramping. It’s seriously un-fun at best.

Buprenorphine belongs to the opioid agonist-antagonist class of drugs, and it is a partial opioid agonist. As such, it activates only a portion of an opioid receptor, so it only causes a portion of the effects of an opioid, specifically eliminating the euphoric effects of opioids like methadone. It has lower potential for causing respiratory depression than methadone, and that translates to little potential for overdose death. And it also effectively blocks the effects of other opioids, including heroin and prescription pain medications like fentanyl and oxycodone, so it’s much more likely to discourage relapse in recovering patients. Buprenorphine prescriptions can be filled and taken home, eliminating the need to go line up at a nasty clinic every single day. And because it’s much longer acting than methadone, buprenorphine doesn’t need to be taken every single day anyway, so patients aren’t tied to it; they have the freedom to spend more time doing activities that are more positive for their recovery. When it comes down to tapering off of buprenorphine, it’s far easier than methadone, with essentially zero physical withdrawal symptoms. All of these factors make a big difference, people.  

Buprenorphine Pros vs Methadone

Newer, safer, more effective 

Long acting, easy taper

Safe for use during pregnancy

Low overdose potential

Prevents opioid usage- blocks euphoria

Covered by most insurance carriers

Typically excluded from employment drug screening

Buprenorphine Cons vs Methadone

Can be more expensive out of pocket

Unpleasant taste sometimes reported

Requires specialized physician

In my practice, I treat a fair number of opioid addicted people, and I do not and will not ever use methadone to treat them…it makes zero sense, when there’s an alternative that is more effective, safer, and easier to use. Methadone doesn’t solve a problem, it creates a bigger one. If I have a new patient that is on methadone, I switch them to buprenorphine as a matter of course. It’s not easy on them, but I use every weapon available in my arsenal. 

Methadone to Buprenorphine

In order to start taking buprenorphine, a patient must be in withdrawal, another un-fun fact. This is because buprenorphine is a bully. When you take it, it preferentially binds to those opioid receptors we talked about before. That means it kicks the true opioid off the receptor and replaces it. Doesn’t sound so horrible in theory, but it’s a very different thing in practice. The opioid addicted brain without its favorite thing- opioids- leads to a brain in withdrawal, which leads to a body in physical withdrawal…shakes, sweats, nausea, vomiting, diarrhea, muscle aches, and joint pain, just to name a few of the symptoms to be expected. 

The patient must be in a state of withdrawal for a proscribed amount of time before you can dose them with buprenorphine, because it can be dangerous to give it sooner. The longer they can tolerate that withdrawal prior to dosing buprenorphine, the better the buprenorphine will work and the easier the process will be. The length of the ideal withdrawal time is based on the half-life of the opioid the patient is addicted to. The half-life of a drug is roughly the amount of time it takes for half of the drug to be metabolized by the body, ie that 50% of it is left. For most opioids, 24 to 36 hours is the ideal withdrawal time. But methadone’s half-life is crazy long; in some people, it can be between 88 and 59 hours. But wait…it gets worse. That’s just for half of the drug to be metabolized. It generally takes six or seven half-lives to fully metabolize out a drug so it is no longer biologically active, so in methadone you need to have ten days off before you can safely introduce buprenorphine. Again, this is because that buprenorphine is a bully, and if you introduce it too soon, when methadone is still parked on the opioid receptors, it’s going to kick that buprenorphine off and throw the person into instant, severe withdrawal, which is not only dangerous, but intolerable to patients. Coming off of methadone requires high doses of buprenorphine for the first 24 to 48 hours, even after waiting for it to metabolize out. Otherwise, you can precipitate major withdrawal where that person starts kicking their legs uncontrollably, sweating, flinging sheets off the bed, and having terrible muscle spasms and cramping- it’s a horror to watch, let alone experience. I had a new patient that had become addicted to strong opioids secondary to chronic, severe pelvic pain and a series of several consecutive pelvic surgeries for ovarian tumors. The whole thing lasted for years and culminated in a hysterectomy. Immediately upon release from the hospital after the hysterectomy, she checked herself in to rehab to detox, and they put her on buprenorphine way too soon. Her withdrawals were very severe, to the point where she vomited so hard that she tore 19 of her abdominal sutures open and had to be taken back to the operating room emergently. Needless to say, she wasn’t too keen on the possibility of that ever happening again.  

So what’s a guy like me to do when a methadone-addicted patient comes in? If they’re committed, there are a couple of ways to handle it. Neither is fun nor risk free. One, you can step down from methadone to another opioid substitute like oxycodone in an incremental ratio for three days or so, stop the substitute for 24 hours, and then start buprenorphine. Or two, stop the methadone, wait as long as you can, which is usually two days, three max, of total misery, while using ancillary drugs like clonidine, benzodiazepines (like Klonopin, Ativan, and Xanax), muscle relaxants like Robaxin, and Mirtazapine to sleep. Basically using every drug possible to make the patient more comfortable, hold off on the methadone for as long as possible, and let the methadone metabolize out. Then put them on high dose buprenorphine for 48 hours, then drop to moderate dose for whatever time period is required. 

In addition, there are some dietary type changes that are helpful. Taking high-dose vitamin C acidifies the urine, enhancing the secretion of methadone out of the system. Taking 1000 mg of vitamin C twice a day, drinking slightly less water if possible, and eating a lot of protein will help further acidify the body and constipate the system, which sounds like hell, but is actually a good thing for withdrawal. 

The best way to deal with the situation is not to, meaning avoid becoming addicted in the first place. But, if you do find yourself addicted, do not choose a methadone detox, and definitely do not choose a methadone maintenance program. There’s just zero reason to do that when we have buprenorphine fairly readily available. 

The clear consensus is that buprenorphine is the gold standard treatment for patients suffering from opioid addiction. As a provider, I’ve had the privilege of seeing patients reclaim their lives with the help of a buprenorphine detox regimen; it allows them to focus on their jobs, their families, and their own well-being, instead of physically, mentally, and emotionally battling their addiction every minute of every day, to the exclusion of all happiness.

So boys and girls, the moral of the story is…

Coming off methadone is not fun, and I have had patients who are still depressed, anxious, and unable to sleep- six months, eight months, even a year- after transitioning from methadone to buprenorphine, to the point where they still require medications to deal with it. Xanax and methadone are my two least favorite pharmaceuticals in the entire world, each for their own specific reasons. Clearly, for patients looking to switch from methadone to buprenorphine, it’s a tough row to hoe; the symptoms can be excruciating, especially if mismanaged, but don’t let that stop you from making the switch. My first and best advice is to avoid becoming an addict, but if you do become one, never go on methadone, for any length of time, ever. It’s a trap, pure and simple. 

I hope you enjoyed this blog and found it educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Opiates:History,Use,Abuse,Addiction

Opioids: History, Use, Abuse, Addiction

How Did We Get Here?

Anchored in the history, culture, religion, mythology, biology, genetics, and psychology of the earliest civilizations to the societies of present day, humans have long tried to balance the positive medicinal properties of opioids with the euphoric effects that have so often led to their use and abuse.

Before we get into their history, first a quick fyi lesson in the semantics of the terms opiates vs opioids vs narcotics. While the terms are often used interchangeably, they are technically different things. 

The term opiate refers to any drug that is derived from a naturally occurring substance, ie from opium alkaloid compounds found in the poppy plant. Types of opiate drugs include opium, codeine, and morphine. The term opioid is broader, and refers to any synthetic or partially synthetic drug created from an opiate. Examples of opioid drugs include heroin, methadone, oxycodone, and hydrocodone. Narcotics is an older term that originally referred to any mind altering compound with sleep-inducing properties.

For the general public, only the term opioid is really necessary, as it includes all opi- substances. In my practice and in my blogs, I sometimes make a distiction between the terms, but if you’re looking for a safe bet, or maybe a trivia win, the term opioid is the best and most accurate choice. Regardless of the word used, one is not any safer than the other; any opiate or opioid has the potential to treat pain, to be abused, and to cause dependence.

Following are some of the most common opioids and their generic names, listed in order of increasing strength.

Codeine

Hydrocodone (Vicodin, Hycodan)

Morphine (MS Contin, Kadian)

Oxycodone (Oxycontin, Percocet)

Hydromorphone (Dilaudid)

Fentanyl (Duragesic)

Carfentanyl (Wildnyl)

History of Opiates

A long, long time ago, opiate use began with Papaver somniferum, otherwise known as the opium poppy. Native to the Mediterranean, it grew well in subtropical and tropical regions fairly easily, a fact that contributed to its historical popularity. Unripe poppy seed pods were cut, and the milky fluid that seeped from the cuts was scraped off, air-dried, and treated to produce opium. 

In case you’re wondering… today, legal growing of opium poppies for medicinal use primarily takes place in India, Turkey, and Australia. Two thousand tons of opium are produced annually, and this supplies the entire world with the raw material needed to make the medicinal components. Papaver somniferum plants grow from the very same legal and widely available poppy seeds found in today’s many seed catalogues. But, planting these seeds is less legal, with the DEA classifying them as a Schedule II drug, meaning that technically, they can press charges against anyone growing this poppy variety in their backyard. You can ask this one dude in North Carolina about it, as he was busted for having one acre of these big blooming beauties behind his house. At about 9 feet tall and topped with big red blooms, they’re not exactly inconspicuous. Another grow was discovered after an Oregon state patrol officer stopped to look at a field of beautiful “wildflowers,” wanting to cut a bouquet for his wife… a story that I personally find totally hilarious. Evidently, when he cut the first one, he was surprised by the sap that got all over his hands, so instead of taking some home to his wife, he took one to a fellow cop friend that was big on horticulture, and she enlightened him on what it was. Good thing too, because he had even thought about how cool it would be to dry the “wildflowers” to seed and plant them in his side yard! You just can’t make this stuff up.

Archaeologists have found 8,000 year-old Sumerian clay tablets that were really the earliest “prescriptions” for opium. The Sumerians called the opium poppy “Hul Gil,” meaning the “Joy Plant,” which was regularly smoked in opium dens. Around 460-357 B.C. Hippocrates, known as the “Father of Medicine” acknowledged opium’s usefulness as a narcotic, and prescribed drinking the juice of the poppy mixed with nettle seed. Alexander the Great took opium with him as he expanded his empire- it’s surprising that he was so great, because some accounts seem to suggest that he was a raging addict. Arabs, Greeks, and Romans commonly used opium as a sedative, presumably for treating psychiatric disorders. In the 15th and 16th centuries, Arabic traders brought opium to the Far East. From there, opium made its way to Europe, where it was used as a panacea for every malady under the sun, from physical ailments to a wide variety of psych issues. Biblical and literary references, and opium’s use by known and respected writers, leaders, and thinkers throughout history, including Homer, Franklin, Napoleon, Coleridge, Poe, Shelly, Quincy, and many more, made opium use perfectly acceptable, even fashionable. 

19th Century Opiates to Opioids

There was a lot of unrest and violence around the globe throughout the 1800’s. Wounded soldiers from the American Civil War, British Crimean War, and the Prussian French War were basically allowed to abuse opium. And sure enough, beginning in the 1830’s, one-third of all lethal poisoning cases were due to opium and its opiate derivatives, and this really marked the first time that a “medicinal” substance was recognized as a social evil. Yet, most places around the world still really turned a blind eye to opium and opiate use. But, so many soldiers developed a dependency on opiates that the post-war addiction state was commonly known as “soldier’s disease.”

In 1806, German alkaloid chemist Friedrich Wilhelm Adam Sertürner isolated a substance from opium that he named “morphine,” after the god of dreams, Morpheus. The prevailing wisdom for creating morphine was to maintain the useful medicinal properties of opium while also reducing its addictive properties. Uh huh, sure. In the United States, morphine soon became the mainstay of doctors for treating pain, anxiety, and respiratory problems, as well as consumption and “female ailments,” 

(that’s old-timey for tuberculosis and menstrual moodiness/ cramps) In 1853, the hypodermic needle was invented, upon which point morphine began to be used in minor surgical procedures to treat neuralgia (old timey for nerve pain). The combination of morphine and hypodermic needles gave rise to the medicalization of opiates.

Well, morphine turned out to be more addictive than opium, wouldn’t ya know it. So, as with the opium before it, the morphine problem was “solved” by a novel “non-addictive” substitute. Of course… I mean, what could possibly go wrong? Your first clue is that this novel compound was the first opioid, and was called heroin. See where this is going? First manufactured in 1898 by the Bayer Pharmaceutical Company of Germany, heroin was marketed as a cough suppressant, a treatment for tuberculosis, and a remedy for morphine addiction. Well, as you can probably guess, that worked great, until heroin proved to be far more addictive than morphine ever thought of being. So what to do? Hmmm… what…to…do… I know! Let’s make a “non-addictive” substitute for the heroin! That’s the best plan, definitely. 

20th Century: Opiates to Opioids

By the dawning of the 20th century, the United States focused on ending the non-medicinal use of opium. In 1909, Congress finally passed the “Opium Exclusion Act” which barred the importation of opium for purposes of smoking. This legislation is considered by many to be the original and official start of the war on drugs in the United States. Take that, Nancy Reagan! In a similar manner, the “Harrison Narcotics Tax Act of 1914” placed a nominal tax on opiates and required physician and pharmacist registration for its distribution. Effectively, this was a de-facto prohibition of the drug, the first of its kind.

In 1916, a few years after Bayer stopped the mass production of heroin due to the dependence it created, German scientists at the University of Frankfurt developed oxycodone with the hope that it would retain the analgesic effects of morphine and heroin, but with less physical dependence. Of course they did, because this worked out so swimmingly before. What could possibly go wrong? 

Well, we know how this story turns out.

First developed in 1937 by German scientists searching for a surgical painkiller, what we know today as methadone was exported to the U.S. and given the trade name “Dolophine” in 1947. Later renamed methadone, the drug was soon being widely used as a treatment for heroin addiction. But shocker… unfortunately, it too proved to be even more addictive than its predecessor heroin. Captain Obvious says he’s sensing a trend here.  

In the 1990’s, pharmaceutical companies developed some new and especially powerful prescription opioid pain relievers. They then created some equally powerful marketing campaigns that assured the medical community that patients would not become addicted to these drugs. Gleefully, docs started writing for them, and as a result, this class of medications quickly became the most prescribed class in the United States- even exceeding antibiotics and heart medications- an astounding statistic. Well, we now know that the pharma co’s were full of crap: opioids were (and still are) the most addictive class of pharmaceuticals on the planet… and so in the late 90’s, the opioid crisis was born. 

Opioids: True and Freaky Facts

The real fact is that 20% to 30% of all patients who were/ are prescribed opioids for chronic pain will misuse them. Further, studies on heroin addicts report that 80% of them actually began their addiction by first misusing prescription opioids. That’s a big number people, but I think it’s actually higher. Food for thought for all the pill poppers out there saying ‘I’ll never use a street drug like heroin.’ And speaking of that, by the turn of the 21st century, the mortality rate of heroin addicts was estimated to be as high as twenty times greater than the rest of the population. Twenty times, people.

Opioid Addiction and Overdose

Opioids produce a sense of wellbeing or euphoria that can be addictive to some people. Opioids are often regularly and legitimately prescribed by excellent, well-meaning physicians when treating patients for severe pain. The problem is that even when taken properly, many people develop tolerance to these opioids, meaning they need more and more to get the same effect and relieve their pain. That’s just one factor that makes them so insidious. In addition, we cannot predict who will go down this tolerance and potential addiction path, because it can happen to anyone who takes opioids. However, there are some factors that make people more susceptible to addiction, such as the presence/ prevalence of mood disorder(s) and especially a genetic/ familial history of addiction, which contributes to nearly 50% of abuse cases.

When people become addicted to opioids, they begin to obsessively think about ways they can obtain more, and in some cases they engage in illegal activities, such as doctor shopping, stealing prescriptions from friends and family, and/ or procuring them on the street. 

Another insidious facet of tolerance is that the tolerance to the euphoric effect of opioids develops faster than the tolerance to the dangerous physical effects of taking them. This often leads people to accidentally overdose as they chase the high they once felt. In this attempt to get high, they take too much and overdose, dying of cardiac or respiratory arrest. Drug overdose is the leading cause of accidental death in the United States, and there are more drug overdose deaths in America every year than deaths due to guns and car accidents combined. According to the CDC, 2019 drug overdose deaths in the United States went up 4.6% from the previous year, with a total of 70,980 overdose deaths, 50,042 of which were due to opioids. 

There’s a kahuna in Opioidland that’s so big and so bad that it bears a special mention… fentanyl. Referencing the above statistics, of the more than 50,000 opioid overdoses, fentanyl is specifically indicated in more than 20,000 of those fatalities. Again, I think it’s way higher than that. Regardless, I think we can all agree that it’s deadly. Fentanyl is so crazy dangerous because it is 50 to 100 times more potent than morphine, so it takes the teeny tiniest amount to overdose. A lethal dose of fentanyl for adults is about two milligrams- that’s the equivalent of six or seven grains of salt people! 

Obvi, there are tons of chilling statistics about fentanyl, but here’s another one for you: in one-third of fentanyl overdoses, the individual died within seconds of taking it. Get this- they died so quickly that their body didn’t have enough time to even begin to metabolize the drug, so no metabolites of fentanyl were found on toxicology screens at the time of autopsy. The moment you ingest or inject any drug/ pharmaceutical, the body immediately begins to break it down into components called metabolites. After a certain period of time (which varies according to many different factors) the drug is completely metabolized by the body, so a toxicology screen will pick up those metabolites rather than the complete molecule(s) of the drug. Every drug has a known rate of metabolism, so tox tests can tell how long ago a drug was used or ingested. This data is saying that in one-third (33%) of fentanyl overdose deaths, tox screens pick up zero metabolites, because the body had no time to even begin to start the process of making them. The screens detected the presence of the full complete molecule(s), but no breakdown products. It’s a very significant and scary hallmark of fentanyl use/ abuse/ overdose: the fact that you may not live long enough to regret using it.  

How did fentanyl become such a big part of the opioid epidemic? Around 2010, docs were getting smart to the use and abuse of opioids and the ensuing crisis, and many stopped prescribing them. This left a lot of addicted people, including many who legitimately required relief from pain, unable to get prescriptions and SOL. At the same time, buying prescription drugs on the street was crazy expensive due to increased demand and decreased supply. But also, heroin had became so abundant that it suddenly became cheaper than most other drugs, so addicts started to switch to heroin. In one survey, 94% of people in treatment for opioid addiction said they used heroin only because prescription opioids became much more expensive and harder to obtain. 

Next, to make things exponentially worse, drug cartels discovered how to make fentanyl very cheaply, so huge quantities of fentanyl started flooding the market. Because fentanyl is easier to make, more powerful, and more addictive than heroin, drug dealers recognized the opportunity, and began to lace their heroin with fentanyl. People taking fentanyl-laced heroin are more likely to overdose, because they often don’t know they’re taking a much more powerful drug. Fentanyl can be manufactured in powder or liquid forms, and it can be found in many illicit drugs, including cocaine, crack, and methamphetamine. And let’s face it folks, the people making this garbage aren’t exactly rocket scientists, so all of these drugs can (and usually do) contain toxic contaminants and/ or have different levels of fentanyl in each batch, or even varying levels within the same batch. These facts just add to the lethal potential of this stuff. 

Now fentanyl has found its way onto the street in yet another form: pills. When fentanyl pills are created for the street, they’re pressed and dyed to look like oxycodone. Talk about insidious! If you go looking to buy oxy’s on the street and the dealer is selling them dirt cheap because they don’t know any better, or care is probably more accurate, you’ll probably think ‘Wow- these oxy’s are cheap! Let me get those!’ If your body is accustomed to using real oxy’s and you unknowingly take fentanyl, you will absolutely overdose. Like see ya later, bye overdose.

But believe it or not, it gets worse… A new variation of fentanyl is finding its way into the drug trade. Carfentanil is 100 times stronger than fenatanyl, which makes it 10,000 times more potent than morphine. While it was originally developed as an elephant tranquilizer (hel-looo??!!) the powdered form of carfentanil is now commonly used as a cutting agent in illicit drugs like heroin, cocaine, and methamphetamine.

Opioid Withdrawal

Opioid withdrawal can be extremely uncomfortable. But an important thing to remember is that opioid withdrawal is not generally life threatening if you are withdrawing only from opioids and not a combination of drugs. This is because each drug class is pharmacologically different, so withdrawal is different for each one. FYI, the most dangerous withdrawls are from benzodiazepines (Valium, Xanax, etc) and alcohol, even though alcohol isn’t technically a drug, it reacts, is metabolized, and physically withdraws from the body like any drug. Individually, either can be lethal in withdrawl and require medical supervision. 

Opioid Withdrawal Symptoms

Withdrawal typically includes the following symptoms to varying degrees:

Low energy

Irritability

Anxiety

Agitation

Insomnia

Runny nose

Teary eyes

Hot and cold sweats 

Goose bumps

Yawning

Muscle aches and pains

Abdominal cramping

Nausea

Vomiting

Diarrhea

Stages of Opioid Withdrawal

-The first phase (called acute withdrawal) begins about 12 hours after the last opioid use. It peaks at around 3 – 5 days, and lasts for approximately 1 – 4 weeks. This acute stage has mostly physical symptoms.

-The second phase (post-acute withdrawal) can last for a long time, with some references documenting up to two years. The symptoms during this phase are mostly emotional, and while they are considered less severe, they last longer.

Symptoms include mood swings, anxiety, variable energy, low enthusiasm, variable concentration, and disturbed sleep.

But, don’t let concern over withdrawl symptoms keep you from getting off of opioids. There are medications that can significantly decrease all of these. Two of the most common are methadone and buprenorphine. Being that drug detox is one of my specialties, in next week’s blog, I’ll outline both of these and tell you my reccommendations.

Until then…

Now that we’ve covered the history and background on opioids, if you think you might have an opioid addiction, I have a separate quiz that will bring some clarity to you on that question. I will upload a more detailed assessment as a separate blog, but for now, here’s a short generalized screen to take first. 

Do You Have an Opioid Addiction?

Answer yes or no to each of the following questions. If you answer yes to at least three of these questions, then you are likely addicted to opioids and should definitely take the detailed addiction self-assessment test which follows. I also suggest that you print the assessment and answers and take them with you for a professional evaluation.

Addiction: Basic Screen1) Has your use of opioids increased over time?2) Do you experience withdrawal symptoms when you stop using?3) Do you use more than you would like, or more than is prescribed?4) Have you experienced negative consequences to your using?5) Have you put off doing things because of your drug use?6) Do you find yourself thinking obsessively about getting or using your drug?7) Have you made unsuccessful attempts at cutting down your drug use?

Again, if you answered yes to at least three of these questions, then you are likely addicted to opioids and should take the detailed addiction self-assessment test which follows as a separate blog. Be sure to print both with you for a professional evaluation. 

I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon. 

Thank you and be well people!

MGA

Learn More

Drug Abuse Screening Test – DAST-10

To determine if you may have an addiction to drugs, please answer the following questions regarding the last 12 month period with a yes or no. An answer of yes is scored as 1 point. An answer of no is scored as zero. Once completed, add the number of points together and follow the corresponding recommendations listed at the bottom. Be sure to print this to take with you for a professional evaluation when indicated. 

In the past 12 months…

No (0)

Yes (1)

1. Have you used drugs other than those required for medical reasons?

2. Do you abuse more than one drug at a time?

3. Are you unable to stop abusing drugs when you want to?

4. Have you ever had blackouts or flashbacks as a result of drug use?

5. Do you ever feel badly or guilty about your drug use?

6. Do your spouse/ parents/ friends ever complain about your involvement with drugs?

7. Have you neglected your family because of your use of drugs?

8. Have you engaged in illegal activities in order to obtain drugs?

9. Have you ever experienced withdrawal symptoms or felt sick when you stopped taking drugs?

10. Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding)?

Your Score & Recommendation

3 ‐ 5 = Probable drug problem/ addiction; see professional for evaluation. The quality and length of your life likely depend on it. 

6 ‐ 8 = Substantial drug problem/ addiction; see professional for evaluation at earliest convenience.The quality and length of your life depend on it. 

9 ‐ 10 = Severe drug problem/ addiction; see professional for evaluation ASAP. The quality and length of your life seriously depend on it. 

No single test is completely accurate. You should always consult your physician when making decisions about your health.

Learn More

Edinburgh Postnatal Depression Scale

This 10-question self-rating scale has proven to be an efficient way of identifying patients at risk for “perinatal” or postpartum depression. While this test was specifically designed to be administered by a medical professional, to a woman who is pregnant or has just had a baby, it can be used as an effective at-home guide to determine if you or someone you care about has postpartum depression. Just make sure to follow all of your score’s corresponding action(s).

For each of the 10 questions, please check mark the answer that comes closest to how you have felt in the past 7 days. Scoring is explained after the questions.1) I have been able to laugh and see the funny side of things.

____  As much as I always could

____  Not quite so much now

____  Definitely not so much now

____  Not at all2) I have looked forward with enjoyment to things.

____  As much as I ever did

____  Rather less than I used to

____  Definitely less than I used to

____  Hardly at all3) I have blamed myself unnecessarily when things went wrong.

____  Yes, most of the time

____  Yes, some of the time

____  Not very often

____  No, never4) I have been anxious or worried for no good reason.

____  No not at all

____  Hardly ever

____  Yes, sometimes

____  Yes, very often5) I have felt scared or panicky for no very good reason.

____  Yes, quite a lot

____  Yes, sometimes

____  No, not much

____  No, not at all6) Things have been getting on top of me.

____  Yes, most of the time I haven’t been able to cope at all

____  Yes, sometimes I haven’t been coping as well as usual

____  No, most of the time I have coped quite well

____  No, I have been coping as well as ever7) I have been so unhappy that I have had difficulty sleeping.

____  Yes, most of the time

____  Yes, sometimes

____  Not very often

____  No, not at all8) I have felt sad or miserable.

____  Yes, most of the time

____  Yes, sometimes

____  Not very often

____  No, not at all9) I have been so unhappy that I have been crying.

____  Yes, most of the time

____  Yes, quite often

____  Only occasionally

____  No, never10) The thought of harming myself has occurred to me.

____  Yes, quite often

____  Sometimes

____  Hardly ever

____  Never

SCORING VALUES AND GUIDE

Grade each of your checked answers with the specifically stated score, then add the scores together. Take that sum and apply to the interpretation/ action scale and follow the stated suggestion.1) I have been able to laugh and see the funny side of things

0 As much as I always could

1 Not quite so much now 

2 Definitely not so much now 

3 Not at all 2) I have looked forward with enjoyment to things

0 As much as I ever did 

1 Rather less than I used to 

2 Definitely less than I used to 

3 Hardly at all 3) I have blamed myself unnecessarily when things went wrong

3 Yes, most of the time 

2 Yes, some of the time 

1 Not very often 

0 No, never 4) I have been anxious or worried for no good reason

0 No, not at all 

1 Hardly ever 

2 Yes, sometimes 

3 Yes, very often 5) I have felt scared or panicky for no very good reason

3 Yes, quite a lot 

2 Yes, sometimes 

1 No, not much 

0 No, not at all 6) Things have been getting on top of me

3 Yes, most of the time I haven’t been able to cope 

2 Yes, sometimes I haven’t been coping as well as usual 

1 No, most of the time I have coped quite well 

0 No, I have been coping as well as ever 7) I have been so unhappy that I have had difficulty sleeping

3 Yes, most of the time 

2 Yes, sometimes 

1 Not very often 

0 No, not at all8) I have felt sad or miserable

3 Yes, most of the time 

2 Yes, quite often 

1 Not very often 

0 No, not at all 9) I have been so unhappy that I have been crying

3 Yes, most of the time 

2 Yes, quite often 

1 Only occasionally 

0 No, never 10) The thought of harming myself has occurred to me 

3 Yes, quite often 

2 Sometimes 

1 Hardly ever 

0 Never 

EPDS Score Interpretation/ Action

Score of 8 or less: depression not likely, but continue to seek support.

Score of 9 to 11: depression is possible, continue seeking support and re-screen in 2 to 4 weeks. Seriously consider appointment with primary care provider or established mental health professional.

Score of 12 to 13: fairly high possibility 

of depression. Continue to monitor and seek support. Make appointment to see primary care provider or established mental health professional.

Score of 14 and higher: this is a positive screen for probable postpartum depression. Diagnostic assessment is required to determine appropriate treatment. See mental health specialist or primary care provider for referral to same. 

Note: if there is any positive score (a rating of 1, 2, or 3) on question 10 (suicidality risk) definite immediate discussion and possible emergency management is required. Refer to primary care provider, mental health specialist, or emergency resource for further assessment and intervention as appropriate. The urgency of the referral will depend on several factors, including: whether suicidal ideation is accompanied by a plan, whether there has been a history of suicide attempt(s), whether symptoms of a psychotic disorder are present, and/ or if there is concern about harm to the baby.

Learn More

Postpartum Depression,Signs,Symptoms,and Treatment

Postpartum Depression: o

Signs, Symptoms, New Treatment?

Last week, we talked about sex and orgasms, so it seems only fitting that this week, I talk about the potential ‘homework’ that may come after the sex and orgasms: pregnancy… and the postpartum depression that may accompany it. 

It is one of life’s greatest joys, and for me personally, the proudest moment of my entire life: the birth of a child. But no matter how much you love that baby or how you’ve looked forward to its arrival, having a baby is stressful on both parents for many reasons. However, there are specific reasons that make it more physically and emotionally taxing on mom. Captain Obvious says that there are many physical, emotional, and chemical changes in a woman’s body that allow them to (help) create, carry, and birth these little miracles. And add to that the onset of new responsibilities, sleep deprivation, and lack of time for any personal care, it’s not a big shock that lots of new moms get overwhelmed and feel like they’re on an emotional rollercoaster from hell. In fact, the mild depression and mood swings that are so common in new mothers have earned them a name, “the baby blues.” But how do you know if what mom is feeling goes beyond the blues? What should you look for, and when should you seek help? 

The majority of women experience at least some symptoms of the baby blues immediately after childbirth. Why? It’s all down to female hormones: specifically, progesterone and estrogen, the big kahunas in the female hormone universe.

Progesterone’s role in pregnancy is so vital that it’s referred to as the “pregnancy hormone.” Actually, progesterone comes into play long before pregnancy, as it is one of the hormones secreted by the ovaries that governs ovulation and menstruation in post-pubescent women. Then upon conception, it gets the uterus ready to accept, implant, and maintain a fertilized egg, and it also prevents the uterine muscle contractions that would otherwise cause a woman’s body to reject it. During fetal gestation, it helps create an environment that nurtures the developing baby. It makes it sound like progesterone is in there painting, hanging curtains, and fluffing pillows, but its role goes way beyond that. The placenta, which is the structure inside the uterus that provides oxygen and nutrients to a developing baby, will itself begin to produce progesterone after about 8 to 10 weeks of pregnancy. At this point, the placenta increases progesterone production to a much higher rate than the ovaries ever thought about making. Those high levels of progesterone throughout the pregnancy cause the mom’s body to stop producing more eggs, as well as prepare her breasts to produce milk. 

Also produced by the ovaries when not pregnant, and then later by the placenta during pregnancy, estrogen helps the uterus grow, maintains the uterine lining where the budding baby is nestled, steps up blood circulation, and activates and regulates the production of other key hormones. In early pregnancy, it also helps mom develop her milk-making machinery. And baby benefits too, as estrogen triggers the development of those teeny tiny organs and regulates bone density in those cute little developing arms that wave and legs that kick. 

The increased levels of progesterone and estrogen during pregnancy actually make mom feel good and feel bonded to baby, even though she may be crying her eyes out for virtually no reason (sorry ladies) in the beginning. Levels of both hormones continue to increase as the pregnancy advances, and mom’s body actually gets used to these high levels. Then when the baby is born, there’s no more placenta, so mom’s progesterone and estrogen levels drop suddenly and precipitously, in a matter of hours. So mom goes essentially cold turkey from high hormone levels to comparatively no hormone levels. Sudden hormonal change + stress + isolation + sleep deprivation + fatigue = tearful + overwhelmed + emotionally fragile mom. Generally, these feelings can start within just the first day or so after delivery, peak at around one week, and taper off by the end of the second, third, or maybe up to the fourth week postpartum; that’s if it’s the baby blues. 

These baby blues are perfectly normal, but if symptoms are extreme, don’t go away after a month, or get worse, mom may be suffering from postpartum depression and likely needs help.

Postpartum Signs & Symptoms

Though they share some symptoms, postpartum depression is a much more serious problem than the baby blues, and should never be ignored. Shared symptoms of the two include mood swings, crying jags, sadness, insomnia, and irritability.      

Postpartum depression is the most common complication of childbearing, and it occurs in 10% to 20% of all moms after delivery. It is different from the baby blues in that the symptoms are more severe and longer lasting. It is an issue that can’t be blown off or underestimated, because it begins at a critical time, when mom is caring for a helpless infant and needs to be bonding with them. 

Symptoms of postpartum depression can include suicidal thoughts, an inability to care for the newborn child, and in extreme cases, even thoughts of harming the baby. Postpartum can be extremely debilitating, and certain signs can put the lives of mom and/ or baby in jeopardy.

Beyond the Blues

Common Red Flags for Postpartum:

-Mom withdraws from partner

-Mom’s unable to bond well with baby

-Mom’s anxiety gets out of control, preventing ability to sleep and/ or eat

-Mom feels guilty, worthless, useless, overwhelmed

-Mom seems preoccupied with death or wishing she were no longer alive

There’s no single reason why some new moms develop postpartum depression and others don’t, but a number of interrelated causes and risk factors are generally at play.

Postpartum Causes/ Triggers

Hormonal changes after childbirth cause fatigue and depression:

 -Progesterone/ estrogen levels drop

 -Thyroid levels can drop

 -Changes in blood pressure, immune system functioning, metabolism

Numerous physical/ emotional changes after delivery: 

 -Physical delivery pain

 -Difficulty losing baby weight

 -Insecurity, especially in physical/ sexual attractiveness

Significant stress of caring for a newborn:

 -Mom is sleep deprived

 -Mom is overwhelmed/ anxious about her abilities to properly care for baby

 -Mom has difficulty adjusting

All of the above factors are especially true in first time moms, as they must also get used to an entirely new identity at the same time. 

Postpartum Risk Factors

Several factors can predispose a mom to suffer from postpartum depression:

  -History of postpartum depression

A prior episode can increase the chances of a repeat episode by 30% to 50%.

  -History of non-pregnancy related depression and/ or family history of mood disturbances

  -Social stressors, including lack of emotional support, abusive relationship, and/ or financial uncertainty 

  -Significantly increased risk in women who discontinue medications abruptly for purposes of pregnancy.

Postpartum Psychosis

Postpartum psychosis is an even more rare, and more extremely serious disorder that can also develop after childbirth. Characterized by a loss of contact with reality, postpartum psychosis poses an extremely high risk for suicide or infanticide, and hospitalization is nearly always required to keep both mom and baby safe. Postpartum psychosis develops suddenly, usually within the first two weeks after delivery, and sometimes within a matter of 48 hours. 

Postpartum Psychosis Symptoms

Postpartum psychosis is considered a medical emergency requiring immediate medical attention.

  -Hallucinations: seeing things and/ or hearing voices that aren’t real 

  -Delusions: paranoid, irrational beliefs

  -Extreme agitation and anxiety

  -Suicidal thoughts or actions

  -Confusion and disorientation

  -Rapid mood swings

  -Bizarre behavior

  -Inability or refusal to eat or sleep

  -Thoughts of harming or killing baby

There is a screening tool that can be used to detect postpartum depression, called the Edinburgh Postnatal Depression Scale. I will put the questions and explain the scoring of this scale at the conclusion of this blog. It can be helpful if mom or partner isn’t quite sure if symptoms are the baby blues or true postpartum depression. 

Coping with Postpartum Depression

Four Tips for Moms:

1) Create a secure attachment with baby.

The emotional bonding process between mom and child, known as attachment, is the most important task of infancy. The success of this wordless relationship enables a child to feel secure enough to develop fully, and affects how he or she will interact, communicate, and form relationships throughout their entire lives.

A secure attachment is formed when moms respond warmly and consistently to baby’s physical and emotional needs. When baby cries, quickly soothe them. If baby laughs or smiles, respond in kind. In essence, the goal is for mom and baby to be in synch, and to be able to recognize and respond to each other’s emotional signals.

Postpartum depression can interrupt this bonding. Depressed moms can be loving and attentive at times, but at other times may react negatively or not respond at all. Moms with postpartum depression are generally inconsistent in their care, and tend to interact less with their babies; they are also less likely to breastfeed, play with, and read to them. Postpartum is sinister in this way, as learning to bond with baby not only benefits the child, it also benefits mom by releasing endorphins that make mom feel happier and more confident. By its very presence, postpartum makes the bonding process difficult, and therefore mom is less likely to produce those endorphins that would make her feel better. It’s a vicious cycle.

If mom didn’t experience a secure attachment as an infant, she may not know how to create a secure attachment as a mom. However, this can be learned, as human brains are definitively primed for this kind of nonverbal emotional connection that creates so much pleasure for both mom and baby.

2) Lean on others for help and support.

Human beings are social creatures. Positive social contact relieves stress faster and more efficiently than any other means of stress reduction. Historically, and from an evolutionary perspective, new moms have typically received help from those around them after childbirth. In today’s world, new moms often find themselves alone, exhausted, and lonely for supportive adult contact. 

Ideas to better connect with others:

 -Make relationships a priority. When feeling depressed and vulnerable, it’s more important than ever to stay connected to family and friends, even if you’d rather be alone. Isolating will only make the situation feel even bleaker, so make adult relationships a priority. Let loved ones know your needs and how you wish to be supported.

 -Don’t hide feelings. In addition to the practical help that friends and family can provide, they can also serve as a much-needed emotional outlet. Share experiences- good, bad, and ugly- with at least one other person, and preferably face to face. It doesn’t matter who mom talks to, so long as that person is willing to listen without judgment and offer reassurance and support.

 -Be a joiner. Even if mom has supportive friends, she may want to consider seeking out other women who are dealing with the same transition into motherhood. It’s very reassuring to hear other mothers share the same worries, insecurities, and feelings. Good places to meet other new moms include support groups for new parents or organizations such as ‘Mommy and Me.’ Pediatricians can also be excellent neighborhood resources.

3) Take care of yourself. One of the best things moms can do to relieve or avoid postpartum depression is to take care of themselves. The more moms care for their mental and physical well-being, the better they’ll feel. 

Simple lifestyle changes can go a long way toward helping moms feel more like themselves again.

 -Skip the housework. Make yourself and baby the priority, and give yourself the permission to concentrate on just that. Remember that being a 24/7 mom is far more work than holding down a traditional full-time job.

 -Ease back into exercise. Studies show that exercise may be just as effective as medication when it comes to treating depression, so the sooner moms get back up and moving, the better. No need to overdo it: a 30-minute walk each day will work wonders. Stretching exercises, like those found in yoga, have shown to be especially effective.

 -Practice mindfulness meditation. Research supports the effectiveness of mindfulness for making moms feel calmer and more energized. It can also help moms become more aware of what they feel and need.  

 -Don’t skimp on sleep. A full eight hours may seem like an unattainable luxury when dealing with a newborn, but poor sleep makes depression worse. Moms must do whatever they can to get plenty of rest- from enlisting the help of the partner or family members, to catching naps at every opportunity.

 -Set aside quality time for yourself to relax and take a break from mom duties. Find small ways to pamper yourself, like taking a bubble bath, savoring a hot cup of tea, lighting scented candles, or getting a massage at a day spa, or even calling a masseuse to come to you.

 -Make meals a priority. Nutrition often suffers during depression. What mom eats has an impact on her mood, and also the quality of breast milk the baby requires, so always make the best effort to establish and maintain healthy eating habits, for yourself and baby.

 -Get out in the sunshine. Sunlight lifts the mood, so try to get at least 10 to 15 minutes of sun each day.

4) Make time for your relationship with your partner. More than half of all divorces take place after the birth of a child. For many men and women, the relationship with their partner is their primary source of emotional expression and social connection. The demands and needs of a new baby can get in the way and fracture this relationship, unless couples put time, energy, and thought into preserving their bond.

 -Don’t scapegoat. The stress from nights of no sleep and new or expanded responsibilities can leave parents feeling overwhelmed and exhausted. It’s all too easy to play the blame game and turn frustrations onto your partner. Instead of finger pointing, remember that you’re in this together. If you tackle parenting challenges as a team, you’ll find that you’ll become an even stronger unit.

 -Keep the lines of communication open. Many things change following the birth of a baby, including roles and expectations. For many couples, a key source of strain is the post-baby division of household and childcare responsibilities. It’s important to talk about these issues, rather than letting them fester. Don’t assume your partner has a crystal ball or knows how you feel or what you need, because you’re bound to feel perpetually disappointed and frustrated if you do. 

 -Carve out couple time. It’s essential to make time for just the two of you when you can reconnect. But don’t put pressure on yourself to be romantic or adventurous, unless you’ve discussed it and found you’re both game. And you don’t need to go out on a date to enjoy each other’s company. Just spending even 15 or 20 minutes together, undistracted and focused on each other, can make a big difference in how close you feel to each other.  

Treatment for Postpartum Depression

If, despite self-help and the support of family, mom is still struggling with postpartum depression, it’s best to seek professional treatment.

 -Individual therapy/ marriage counseling A good therapist can help moms deal better with the adjustments of motherhood. If moms or partners are experiencing marital difficulties or are feeling unsupported at home, marriage counseling can also be very beneficial.

 -Antidepressants. In postpartum cases where mom’s ability to function adequately for herself or baby is compromised, antidepressants may be an option, though they are more effective when accompanied with psychotherapy. Obviously, medication must be closely monitored by a physician.

 -Hormone therapy: Estrogen replacement therapy can sometimes be helpful in combating postpartum depression, and is often used in combination with an antidepressant. There are risks that go along with hormone therapy, so moms must be sure to talk to their doctor about what may be best, and safest, for them.

Helping New Moms with Postpartum

If your loved one is a mom experiencing postpartum depression, the best thing you can do is to offer support, give her a break from her childcare duties, provide a listening ear, and always be patient and understanding. But, be sure to take care of yourself too. Dealing with the needs of a new baby is hard for the partner as well as mom. And if your significant other is depressed, that means you are dealing with two major stressors.

Tips for Partners:

 -Encourage mom to talk about her feelings. Listen without judgement and without making demands. Instead of trying to ‘just fix’ things, simply be there for mom to lean on.

 -Offer help around the house. Chip in with the housework and childcare responsibilities, and don’t wait for mom to ask… trust me on this one!

 -Make sure mom takes time for herself. Rest and relaxation are even more important after a new edition. Encourage her to take breaks, hire a babysitter, or schedule some date nights.

 -Be patient if she’s not ready for sex. Depression affects sex drive, so it may be a while before mom’s in the mood. Offer her physical affection, but don’t push it if she’s not up for anything beyond that.

 -Getting exercise can make a big dent in depression, but it’s hard for moms to get motivated when they’re feeling low. So do something simple, like going going for a walk with mom. Better yet, make walks a daily ritual for just the two of you, or for the whole family.  

There is a fairly new breakthrough drug called Zulresso (brexanolone). Approved in 2019, Zulresso is a neuropathic drug, and first in its class. So what is it? Basically, it’s an aqueous (water-based) solution of progesterone products. They have taken the component product of progesterone and put it into solution; it is then administered to a new mom with postpartum depression. And then a miracle happens… seriously! This lifts postpartum depression like a kid does candy. It is a scientific breakthrough; never before have we had a drug that treats postpartum depression faster than any drug for any type of depression, ever. That’s the good news, but guess what comes next… the bad. While we know it works, very well and very quickly, there are some major disadvantages of this drug. The first one is that it can only be administered by IV infusion. So that means that you have to place an IV map into mom’s vein and drip the drug in with IV fluid. That brings me to the next big disadvantage: it can only be administered in a hospital setting. Why is that? Well, studies show that during administration, which takes place over about 60 hours, two and a half days, some moms can become very dizzy and faint, can lose consciousness, and can even stop breathing. For all of these reasons, moms must be medically monitored with an oximeter and telemetry for two and a half days, during which time they must be checked on every two hours. And they cannot be in charge of baby during this hospital stay, because they may be in and out of consciousness and/ or have severe respiratory issues. While that’s no bueno, the last disadvantage is muy loco, people. Are you ready? The drug costs $34,000. Yep. But wait, it gets better, which in this case, actually means worse. That little $34K is just for the drug! The hospitalization and monitoring costs more… a lot more. And to add insult to injury, you have to shell out the cash to pay for a sitter to watch baby, as mom could potentially be very busy losing consciousness and going into respiratory distress.  

Needless to say, Zulresso is not used very much, even though it is an amazing breakthrough product, essentially curing the notoriously difficult-to-treat postpartum depression in a mere 60 hours. There are some other anti-depressants that work pretty well. Effexor (venlafaxine, desvenlafaxine) and Wellbutrin (bupropion) with antipsychotics like Abilify help to speed up the treatment process generally show some progress in about a week. 

So while I’m very impressed with Zulresso as a novel, first-in-class drug, you can see my practical issues with it. Although, I suppose that everything is relative: if my wife were suffering from serious postpartum depression, to the point that she was suicidal, or the baby’s life was in danger, and it was refractory, meaning all other treatment options had been tried and failed, I would find a way to get the Zulresso treatment; I’d make it happen, by contacting the manufacturer for patient support options. Or maybe by selling a kidney. Whatever it took.

Edinburgh Postnatal Depression Scale

This 10-question self-rating scale has proven to be an efficient way of identifying patients at risk for “perinatal” or postpartum depression. While this test was specifically designed to be administered by a medical professional, to a woman who is pregnant or has just had a baby, it can be used as an effective at-home guide to determine if you or someone you care about has postpartum depression. Just make sure to follow all of your score’s corresponding action(s).

For each of the 10 questions, please check mark the answer that comes closest to how you have felt in the past 7 days. Scoring is explained after the questions.1) I have been able to laugh and see the funny side of things.

____  As much as I always could

____  Not quite so much now

____  Definitely not so much now

____  Not at all2) I have looked forward with enjoyment to things.

____  As much as I ever did

____  Rather less than I used to

____  Definitely less than I used to

____  Hardly at all3) I have blamed myself unnecessarily when things went wrong.

____  Yes, most of the time

____  Yes, some of the time

____  Not very often

____  No, never4) I have been anxious or worried for no good reason.

____  No not at all

____  Hardly ever

____  Yes, sometimes

____  Yes, very often5) I have felt scared or panicky for no very good reason.

____  Yes, quite a lot

____  Yes, sometimes

____  No, not much

____  No, not at all6) Things have been getting on top of me.

____  Yes, most of the time I haven’t been able to cope at all

____  Yes, sometimes I haven’t been coping as well as usual

____  No, most of the time I have coped quite well

____  No, I have been coping as well as ever7) I have been so unhappy that I have had difficulty sleeping.

____  Yes, most of the time

____  Yes, sometimes

____  Not very often

____  No, not at all8) I have felt sad or miserable.

____  Yes, most of the time

____  Yes, sometimes

____  Not very often

____  No, not at all9) I have been so unhappy that I have been crying.

____  Yes, most of the time

____  Yes, quite often

____  Only occasionally

____  No, never10) The thought of harming myself has occurred to me.

____  Yes, quite often

____  Sometimes

____  Hardly ever

____  Never

SCORING VALUES AND GUIDE

Grade each of your checked answers with the specifically stated score, then add the scores together. Take that sum and apply to the interpretation/ action scale and follow the stated suggestion.1) I have been able to laugh and see the funny side of things

0 As much as I always could

1 Not quite so much now 

2 Definitely not so much now 

3 Not at all 2) I have looked forward with enjoyment to things

0 As much as I ever did 

1 Rather less than I used to 

2 Definitely less than I used to 

3 Hardly at all 3) I have blamed myself unnecessarily when things went wrong

3 Yes, most of the time 

2 Yes, some of the time 

1 Not very often 

0 No, never 4) I have been anxious or worried for no good reason

0 No, not at all 

1 Hardly ever 

2 Yes, sometimes 

3 Yes, very often 5) I have felt scared or panicky for no very good reason

3 Yes, quite a lot 

2 Yes, sometimes 

1 No, not much 

0 No, not at all 6) Things have been getting on top of me

3 Yes, most of the time I haven’t been able to cope 

2 Yes, sometimes I haven’t been coping as well as usual 

1 No, most of the time I have coped quite well 

0 No, I have been coping as well as ever 7) I have been so unhappy that I have had difficulty sleeping

3 Yes, most of the time 

2 Yes, sometimes 

1 Not very often 

0 No, not at all8) I have felt sad or miserable

3 Yes, most of the time 

2 Yes, quite often 

1 Not very often 

0 No, not at all 9) I have been so unhappy that I have been crying

3 Yes, most of the time 

2 Yes, quite often 

1 Only occasionally 

0 No, never 10) The thought of harming myself has occurred to me 

3 Yes, quite often 

2 Sometimes 

1 Hardly ever 

0 Never 

EPDS Score Interpretation/ Action

Score of 8 or less: depression not likely, but continue to seek support.

Score of 9 to 11: depression is possible, continue seeking support and re-screen in 2 to 4 weeks. Seriously consider appointment with primary care provider or established mental health professional.

Score of 12 to 13: fairly high possibility 

of depression. Continue to monitor and seek support. Make appointment to see primary care provider or established mental health professional.

Score of 14 and higher: this is a positive screen for probable postpartum depression. Diagnostic assessment is required to determine appropriate treatment. See mental health specialist or primary care provider for referral to same. 

Note: if there is any positive score (a rating of 1, 2, or 3) on question 10 (suicidality risk) definite immediate discussion and possible emergency management is required. Refer to primary care provider, mental health specialist, or emergency resource for further assessment and intervention as appropriate. The urgency of the referral will depend on several factors, including: whether suicidal ideation is accompanied by a plan, whether there has been a history of suicide attempt(s), whether symptoms of a psychotic disorder are present, and/ or if there is concern about harm to the baby.

So that’s all the news on postpartum depression. If you liked this, please share with friends and family. Look for new blogs here every Monday, and check out my book, Tales from the Couch, for more education and patient stories, available on Amazon.com. See my YouTube channel for new lectures- I post them all the time. And I’d appreciate it if you hit that subscribe button, people! Thanks everybody, be well. 

MGA

Learn More

Double your Pleasure:the Health Benefits of the Magical Mystical Orgasm

Double your Pleasure: the Health Benefits of the Magical Mystical Orgasm

Once a topic strictly relegated to hushed conversations, research has taken the orgasm from bedroom to clinic, elucidating the many positive benefits of these happy endings. Great news, right? But before I get into that, I want to talk about the definition and history of the orgasm. What you don’t know might surprise you. 

Because it’s hilarious, my favorite clinical description of orgasm is ‘a temporary state of neuromuscular euphoria and paroxysmal climax, often accompanied by vocalization, and generally with the ejaculation of semen in the male and vaginal contractions in the female.’ 

If you’ve ever wondered, the sensation of an orgasm is basically the same for men and women. This is because the penis and clitoris are homologous organs, meaning they arise from the same tissue in a developing embryo. Whichever part you have is connected to the spinal cord, and hence the brain, through a pair of nerves called the pudendal nerves. It’s a horrible name for the same nerves in males and females, so it makes perfect sense that we have the same perfect sensations of pleasure.

From fascination to repulsion and everything in between, orgasm has been the subject of speculation and debate since the Big Bang. Aristotle actually wrote about orgasm and female ejaculation in the first-century BC… and you thought he was just into philosophy! By the way, that’s not a typo: women can ejaculate, though research estimates that only 10% to 50% of women do; actually a small number considering that the woman must reach orgasm in the first place in order to ejaculate. The moral of that story? Don’t let the pornos fool you- it’s a pretty rare event whose presence or absence says nothing of a male’s or female’s sexual prowess. 

In ancient times in Western Europe, women could be medically diagnosed with a disorder called “female hysteria,” during which they exhibited symptoms of nervousness, insomnia, irritability, loss of appetite for food/ sex, and “a tendency to cause trouble.” (this elicited a what-ever! and an eye roll from my wife Debbie) Women diagnosed with the condition would sometimes undergo the proscribed treatment of “pelvic massage” by a medical professional until they experienced “hysterical paroxysm,” which immediately, but not permanently, “cured” them. Captain Obvious says that this diagnosis is no longer recognized as a medical condition. In the early 1900’s, the first electric vibrators hit the market- a decade before vacuum cleaners and electric clothes irons! Evidently, women had gotten their priorities straight. And the rest, as they say, is history. 

Thankfully, we’ve clearly come a long way in narrowing the orgasm perception gap. But questions persist: how long does it last, does a woman need one to get pregnant, can all women have them, can men/ women have multiples, what’s the G-spot, where’s the G-spot, do women fake it and how to tell??? Time for answers.

I’ll just get the less pleasant news out of the way first. 10% to 15% of all women are anorgasmic, meaning they cannot orgasm… at all. It can be global, meaning there is no means by which she can orgasm, or it can be situational, meaning she can only orgasm under certain circumstances. In some cases, age and circumstance are factors in the ability to orgasm for both women and men. (Un)Fun fact: Marilyn Monroe was actually anorgasmic until the age of 36, when she reported to her psychiatrist that she had finally had her first orgasm. A sadly ironic circumstance for America’s biggest sex symbol was that her first orgasm, and possibly last, had been just months before her death. In men, anorgasmia typically manifests in an inability to ejaculate, called anejaculation, and usually occurs as part of erectile dysfunction, which can be organic or a side effect of medication.

Fast facts from peer-reviewed studies:

-75% of women never reach orgasm from intercourse alone. 

-75% of men and 29% of women always reach orgasm with their partner. 

-Women are far more likely to orgasm alone than with a partner. Ouch.

Are orgasms like potato chips? Experts say that if women can have one, they can have more than one. In fact, studies have shown that most women are not only capable of multiples, but they are actually capable of two different types of multiples: sequential and serial multiples. Sequential multiples are a series of orgasms that come fairly close together. Usually from 2 to 10 minutes apart, sequential orgasms have a drop-off in arousal in between; they’re like a roller coaster, with a dip after the first hill before a climb back up the next. According to studies, women report that the most common scenario for sequential multiples is an oral sex orgasm followed by another orgasm during intercourse. In contrast, serial multiples are orgasms that come one after another and are separated by just seconds; with no interruption in arousal, serial orgasms are more like a set of waves breaking on a beach. It’s a different story for men, who have what’s called a refractory period. This is the time needed for a break- and sometimes a nap- between orgasms, but given the right amount of time, male multiples aren’t entirely unusual.

The average length of a man’s orgasm is approximately 10 seconds, though it is possible for them to last up to 30 seconds. A woman’s orgasm may last slightly longer or much longer than a man’s, with an average length of 20 seconds, but possibly up to 30 seconds or more. There is a very rare and misunderstood disorder called Persistent Genital Arousal Disorder (PGAD) found in women. PGAD is spontaneous, persistent, unwanted, and uncontrollable genital arousal in the absence of sexual stimulation or sexual desire, and which is typically not relieved by orgasm. Women with this disorder report feeling constantly and uncomfortably on the brink of orgasm for weeks or months at a time. If you’re thinking that would be cool, you’re wrong; for the sufferer, it is a very debilitating and embarrassing disorder with no cure and little potential for future therapeutic intervention. There is concern that the word ‘arousal’ in the title may be misleading, because it connotes pleasure, and having PGAD is the polar opposite of pleasure. Though vastly more common in women, PGAD is considered an analogous version of priapism, and is called such; this is when men have persistent and often painful erections for various reasons, the most well known being a side effect of the ‘little purple pill’ Viagra.

According to a published study, straight women only have orgasms 62% of the time they have sex, while lesbians orgasm 75% of the time they have sex. I guess there’s something to be said about being familiar with the tools you’re working with.  

G-whiz! There’s much ado about the female G-spot, and most people don’t even have a clue what the G in G-spot stands for. The Gräfenberg Spot was named for German gynecologist Ernst Gräfenberg, who unknowingly started a furor when he characterized an erogenous area of the vagina that, when stimulated, can lead to strong sexual arousal, powerful orgasms, and potential female ejaculation. While some people think the G-spot is as real as a unicorn, most say that every woman has one, but that it’s not necessarily the magical button of fable and lore. So for reals, what is it? The G-spot is a quarter-sized area in the vagina that swells with blood when women are aroused, and some “experts” say it is directly connected to the ‘orgasm center’ in the brain. For the record, I call bullshit on this ‘orgasm center’ stuff- it sounds like it comes from a Cosmo article. Being board certified in psychiatry and neurology, I know a few things about the brain, and there isn’t an ‘orgasm center.’ In reality, orgasms are not localized, discrete events. Researchers have used PET-scans and functional-MRI’s to show that up to 30 major brain systems are activated during orgasm, so it’s more like a wave that washes over the brain in a global manner. There is an analogous male G-spot called the P-spot, where P stands for prostate. This organ is located internally, between the base of the penis and the rectum, and produces pleasant sensations on stimulation.  

Though an orgasm isn’t strictly necessary to feel pleasure, most people will admit that reaching the big “O” with a partner or ‘Han Solo’ is a great added bonus. But beyond just feeling great, an orgasm also brings with it a host of unexpected health benefits, from lowering stress levels and heart attack risk to giving skin a fabulous natural glow. Read on to learn all the good stuff that comes from the fun stuff.

Several hormones are released during orgasm in both males and females, including oxytocin and DHEA. Studies suggest that these hormones could have protective qualities against cancers and heart disease. Oxytocin and other endorphins released during male and female orgasm have also been found to work as relaxants, in both a physical sense and psychological sense, as a mood elevator. Oxytocin is the bonding and cuddling chemical, aka the ‘tend and befriend’ chemical, and makes both sexes feel a desire to be closer to their partner during and after sex. Women actually release four times the normal amount of oxytocin on orgasm. In fact, evidence shows that the bonding and cuddling mechanism is so reliable and predictable that if a woman doesn’t feel cuddly after sex, it is strongly suggestive that she faked her orgasm. Whoa, people.

Orgasms can help lower the risk of prostate cancer in older men. Ward off prostate cancer by having sex? True story! A decade-long and well-reviewed study demonstrated that regular and frequent ejaculation (defined as at least four times per week) in men over age 50 can lower the risk for prostate cancer by up to 30%. One of the authors of the study said, “We know that having sex and orgasms is beneficial for every aspect of male health. The male reproductive system fares best with regular use, and the prostate belongs to that system. The more ejaculations, the better off he’ll be.” Hey, no argument here. 

Orgasms can help regulate the female menstrual cycle, even during times when women are not actively on their periods. According to a published and peer-reviewed scientific journal, the mechanism is linked to the apparent circadian rhythm of ovaries and their response to inflammation. Regular orgasms in females lower inflammation, improving immune health, mental health, and circadian health, which fosters regular cycles.

Orgasms can also help boost female fertility.

Regular sexual activity triggers physiological changes in the body that increase a woman’s chances of getting pregnant, even outside the window of ovulation, meaning that orgasms bring benefits at any and all points in the fertility cycle.

An associated concept is that female orgasm appears to improve the odds of conception. Now, I’ve been surprised and frightened by the prevailing ignorance on this topic, so let me be clear here: a female orgasm is not required for a woman to get pregnant; all that is required is the male’s sperm (part of the ejaculate) to meet the female’s egg(s), which is/ are released automatically and independently each month during ovulation. The basic premise of orgasm improving the odds of conception centers on the vaginal and cervical contractions during orgasm. It is believed that the ligaments involved in the muscular pulsations and contractions from the female orgasm cause the cervix to dip down and pull in any semen pooled in the vagina. That brings in more sperm, and more sperm means it’s more likely for one or more of those wiley guys to win the race to any unsuspecting egg that may be hanging out up there. This is all borne out by findings in women who have had intercourse with orgasm having more sperm in their cervical mucus than women who have had intercourse without orgasm. The moral of this story is that orgasmic pulsations are some next-level shit, and those baby-making parts have minds of their own, grabbing around in the dark to continue the genetic line. Science, people! 

Orgasms as the next homeopathic treatment for colds and flu? Consider going to the bedroom instead of the drugstore. Orgasms are killer for your immune system, no pun intended. A small German study found that immediately after sexual arousal and masturbation to climax, men showed increased levels of leukocytes, which are the white blood cells that help protect the body from illness and infectious disease. But the ladies haven’t been left out here. Another study demonstrated a correlation between female sexual activity, and therefore female orgasm, and levels of Helper T cells, which help to activate the cells the body needs to fight off foreign invaders that cause disease and illness. In addition, orgasm in both males and females releases those feel-good hormones called endorphins, and these are known to reduce general inflammation, the arch enemy of the immune system and other biological pathways. Reduction of inflammation, wherever it may be, does a body good. 

In both men and women, orgasm is shown to help alleviate pain and increase one’s threshold for pain. This is also due to the release of those feel-good endorphins and their ability to reduce inflammation. Studies have shown a direct link between sexual activity and migraines, with 60% of participants reporting some improvement of their migraine attack, and 70% reporting moderate to complete relief. It is believed that orgasm impacts perceived pain through the down-regulation of pain sensitization pathways and by modulating the immune system to reduce levels of inflammation, thus reducing pain levels. Orgasm as an anti-inflammatory once again… O-lieve?

Evidently, orgasm is also useful for relieving the pain of menstrual cramps. In addition to the reduction of inflammation for general pain relief, the pleasurable muscular pulsations and contractions of the female orgasm also use up specific lipid compounds called prostaglandins, which are the cause of menstrual cramps. Lower concentrations of free prostaglandins translates to less cramping-type muscle pain, which is a very good thing.   

Orgasms can help keep your brain sharp. The flood of hormones released in both male and female orgasm sends a ton of messages throughout the body, increasing brain activity. This is particularly true in women. An imaging study of brain function and orgasm showed that while masturbating and upon orgasm, women’s brains light up with activity in the cortical, subcortical, and brainstem regions. The researchers stated that these benefits are more powerful than doing challenging crossword puzzles. Hmmm… Sunday New York Times puzzle, roll in the hay; New York Times, roll in the hay… Frustration, satiation… Duh- this one’s what you call a no-brainer. At least, that’s the technical term.

Orgasm reduces levels of stress and anxiety in males and females. Though an orgasm initially releases a flood of stress hormones, studies have shown that the end-game effect is stress reduction. Experts have long agreed that the post-coital payoff in terms of anxiety reduction is also major, as during an orgasm, the parts of the brain that process fear shut down. All of this is thanks to our friend oxytocin, the bonding, snuggling, tend and befriend chemical.  

What makes for a happy heart can also make for a healthy heart. Since any sort of physical activity helps your heart pump more efficiently, it’s no surprise that sex can too. But published studies indicate that regular sexual activity seriously benefits heart health, helping to lower cardiovascular risk in older men and women. More specifically, they demonstrated that frequent sex and orgasms reduced instances of cardiovascular disease, hypertension, and rapid heart rate among those over age 65, especially in comparison to those that don’t have frequent sex and orgasms. This study didn’t define “frequent,” so take away from that what you will. Or what you can get away with.

Orgasm as the mystical fountain of youth? That radiant flushed look is post-coital glow; it’s for reals, and all thanks to the increased blood flow from your orgasm. The skin is the body’s largest organ, and also the biggest tell. If you’re under stress, it shows by way of a sallow, stressed out complexion. But when men and women climax, blood vessels throughout the body open up, allowing them to carry greater quantities of blood, which is the source of the flushed and blushed look. The increased blood flow also helps to stimulate the production of collagen, a protein that keeps skin looking plumped and youthful, which is why orgasms may be the quickest- and cheapest- way to gorgeous skin. Some British shrink did a survey of 3,500 people, including both men and women, and determined that regular orgasms were the second most common factor/ cause for people looking younger, the first being regular exercise. Nobody called me, so I don’t know who appointed this guy the chief judge of orgasm and youngness, but it is what it is. 

Orgasms can help boost your self-esteem and well-being. When your desires are being satiated, it makes sense that you would feel better about yourself, but it turns out that there’s a proven and demonstrable link between sexual health and self-esteem. So say researchers at Johns Hopkins (well…la tee da) as they found that sexual pleasure among young adults (ages 18-26, both male and female) is linked to healthy psychological and social development. They specifically looked at measures of self-esteem, autonomy, and empathy, and found that sexual pleasure increased all three of these measures in both males and females. However, they also found that the level of increase was not uniform: measures of self-esteem increased the most in young women particularly, while young men showed higher levels of empathy. The explanatory hypotheses for these findings are similar: that the effect of a female’s orgasm on self-esteem is circular, so the ability to easily achieve orgasm increases a woman’s self-esteem, which, in turn, better facilitates her achieving orgasm, which again feeds her self-esteem, and so on. In an analogous way, empathetic males are more responsive to their partner’s needs, and this initiates a positive feedback cycle: being more responsive to their partner’s needs increases the male partner’s ability to reach orgasm, which feeds the male’s empathetic nature and makes them more responsive to their partner’s needs, and so on… Now, I can’t say that I’m calling bullshit on this, but it seems to me that this is back-asswards: while I totally buy that orgasm in both men and women would lead to increases in all three measures, I would think that levels of self-esteem would be more increased in men, resulting from a sort of evolutionary caveman pride ‘look what I can do’ kind of thing. And I would think that greater empathy levels would be higher in women, because of the super intensive release of oxytocin that results in the huggy cuddly ‘oh how I love this person’ feelings. Then again, maybe it’s that women have a higher increase in self-esteem because their orgasm assures them that they are sexually attractive, and men have a higher increase in empathy because their partner has had a simultaneous orgasm? I’m not sure, and you probably don’t care, so we’ll just step away from this one for now.

Orgasms can help you live longer, so say some experts. Additionally, the health benefits of orgasm increase with age, and extend throughout a person’s life. Some Brits studied men between the ages of 45 and 59, and found that those with “high orgasmic frequency” lowered their mortality risk by as much as 50%. The men that had two or more orgasms a week died at a rate that was half the rate of the men who had orgasms less than once a month; in other (less confusing) words, the men that had fewer than one orgasm per month died twice as fast as the men that had eight or more orgasms per month. Like wow, people! These findings prove that sexual activity and orgasm have a protective effect on men’s health. As for the ladies: over the course of an eight-decade study on married, heterosexual couples, researchers found a demonstrable link between orgasms, health, and longevity: specifically, results indicated that women who orgasmed frequently lived longer than their female counterparts who didn’t, though they did not disclose a longevity estimation or definitive ratio of the number of orgasms required to attain greater longevity. 

Orgasms aren’t exactly a miraculous method for weight loss, but getting there might be a different story. Sex is an aerobic activity; it gets your heart rate up, and there’s no better way to burn calories than when your heart is pumping. Beats a treadmill, stairclimber, or pilates any day of the week. Researchers have attempted to measure the number of calories burned during sex for many years and on numerous occasions, but the results have varied wildly. Accepted averages indicate that most people burn about 150 to 200 calories each time they have sex, but there are some really fun ways to set that number on fi’ya… a heated make-out session can burn as many as 85 calories per hour in a 150-pound person, while 15 minutes of heavy foreplay will burn about 25 calories. So, figure you make-out for 15 minutes, then another 15 minutes of foreplay, followed by intercourse, will burn about 250 calories- that’s the same number burned in a 30-minute run, but it’s way more fun than a run. If that’s not enough burn for you, add in a sensual and arousing massage at a burn rate of 80 calories per hour. Or, employ the magic of multiples: reaching a second orgasm can burn an additional 60 to 100 calories, depending on the amount of work required to get there; and since it’s a bonus score, why stop after just one? The ultimate formula for burning more calories during sex is fairly simple: just pour on more heat and more passion for a longer period of time. 

You have probably always known that orgasms are awesome, but now you know the why and how of everything orgasmic, and are all set to impress and amaze your friends with your dazzling sexual intellect at the next cocktail party.

And even though I wrote this blog on the benefits of orgasm, I don’t want to contribute to society’s historical relationship with sex and orgasm: typically seen as goal-based, a skill to be practiced and reward to be achieved, rather than something to explore, experience and enjoy. So go forth, explore, experience, enjoy, orgasm, and spread the word, people! 

But first, google ‘Dr. Mark Agresti YouTube’ to check out my videos, leave comments, like, and subscribe to my YouTube channel. As always, you can find tons of content and patient stories in my book, Tales from the Couch, available in office or on Amazon. Thanks people.

Learn More

steroids:Seductive Today,Sinister Tomorrow

Steroids: Seductive Today, Sinister Tomorrow

An Appointment and Cautionary Tale

I got a new patient who came into my office- we’ll call him Rocky- and he said to me, “Ya know, I’m here because I’ve been having trouble with rage.” And then he just looks at me expectantly. After eleven words, he’s waiting for me to open my desk drawer and take out my magic wand. Bing! You’re cured! He’s clearly never been to a shrink. We talk here. 

In all honesty, I didn’t even need a magic wand at that point, because between those eleven words and my eyes, I had already diagnosed him. I should’ve waved my pen at him like a wand and said “Stop using steroids. You’re cured.” Instead, I said, “Let’s explore this a bit.”  

He says “I’m worried, I might be bipolar….” How did I just know he was going to say that? It is so typical. At 32 years of age, Rocky’s a big boy, unnaturally bulky, looks like he’s been lifting a lot of weights. Compared to his trunk, his head looks like somebody washed it in hot water. His face is oily, pock-marked with acne and scars. I’m noting all these things, jotting them down on my pad, jot jot, as he goes on. “…and I like to go to the gym to blow off some steam…” Rages jot. Acne jot. Oily skin jot jot. Bacne jot. Receding hairline jot jot. “…and lately everybody just pisses me off and I can’t…” Angry jot jot.“…I mean, I can bench a lot. So the other day, I was with my buddy and I finally figured it out; I realized that he’s jealous; that’s his problem with me…” Paranoia jot jot. “…and I know I’m his competition. I undercut him all the time. He would love to see me fail and close up shop, but…” Ah ha. Psychotic? jot jot. All of this is very typical with steroid use and abuse. “…so anyway, I can push harder, lift more, ya know? I work at it! The steroids help, but the work is all me.” Bingo! Finally! Now we’re getting somewhere. 

So tell me about that…the steroids. Who’s prescribing? “Oh no, I am buying it at the gym.” Well, how much are you using? “I’m doing 200mg every two days.” Injecting testosterone cypionate, 200mg Q 2 days jot jot jot jot jot. Buys at gym jot jot. And how long have you been using them? “Uhh, maybe about three years?” Times 3+ years jot jot jot. Do you think maybe you have a problem? “Oh, no. No.” Denies problem jot jot. I explain that he’s at a max dose for someone who has virtually no gonad function. Confusion jot. I explain that means someone who produces no natural testosterone. I spell it out. You’re taking the max dose that a person with no gonad function, zero testosterone would take, and that’s on top of your normal testosterone levels. Or I should say your natural testosterone levels. So you would be way above normal- ten times normal levels or more. And you’re wondering why you’ve been having these rages? Losing control? Loses control jot jot. Banging on s÷=%t at home jot jot jot. Screaming at wife jot jot. Have you ever hit her? “No. I haven’t hit her. But I’ve wanted to hit something. My fists are clenched and I want to tear something apart with my bare hands.” Denies hitting wife jot jot. Clenched fists jot jot jot. Believes he’s bipolar jot jot. I tell him that he’s not bipolar. Steroids are the problem here. He says, “No, it’s not. Can’t be.” No. It’s the steroids, I’m sure. Rocky says, “Ya know, I’ve been reading, and I’m saying it’s probably bipolar.” He’s just holding on to the bipolar excuse. Addicted jot jot. I mean, he would rather be bipolar- actually fight to be bipolar- than admit that his precious steroids are the sole root of his many issues. Denial jot. Steroids don’t cause a typical high, it’s more of an exhilarating positive feeling, an energized, almost super power feeling. For dudes like Rocky, with his temperment, he is all about that musclebound feeling of power. 

Have you noticed your hairline is receding. “Oh. You can tell?” Umm, yeah, I can tell- it’s like three inches back from where it should be- that’s why I mentioned it. That’s what steroids do. “Really?” Really. Bipolar doesn’t do that. Have you noticed your oily skin and acne on your back? “Yeah, I have.” Yeah. Bipolar doesn’t do that either. Guess what does. You get really argumentative and pissy. Some people actually become psychotic. “Oh, I’m not psychotic, man.” Really?  But, you know, in our conversation, you said you’re always worried about people at the gym being jealous and giving you side eye and you said people are trying to destroy your business. You know, maybe you’re getting a little paranoid. “Oh, I am not paranoid.” Uh huh, yeah. I tried to explain. When you’re getting paranoid, you don’t know you’re getting paranoid. He saw all these deep meanings and he was making these deep connections, why people would be tracking him and why government agencies would be interested in monitoring his business. Rocky is in the nursing home business. He’s not even actually running a nursing home, he just provides services to nursing homes. It’s not like he’s involved with any government agencies. He’s contracted to bring in ancillary services to nursing homes. It’s a fairly big business and he’s been pretty successful financially, but there was no root in reality for the paranoia he was demonstrating. 

I asked him if he noticed anything else, like maybe breast enlargement? “Ahh, maybe a little bit, but no big deal.” Mmm hmm. + breast development jot jot jot. He says, “You know, my muscles got bigger, I got leaner, and my endurance increased. I felt trimmer, more energetic.”   You said your endurance went up, how much cardio do you do, Rocky? He says, “Well, I used to do more, but man, I’ve gotten so much bigger that it’s hard to breathe when I do heavy cardio, you know?” No, I don’t know, because I don’t abuse steroids. Androgenic erythrocytosis jot jot jot. That means that you have increased the number of red blood cells in your blood, so your blood becomes thick and viscous like oil. You have so many red blood cells, it’s tough for your heart to beat, it’s tough for your lungs to get oxygen, because there’s drag from the increased viscosity, so when you do cardio, you can’t breathe. “Yeah, yeah. I can barely run. I used to do triathlons. I can’t do them anymore, but I can lift way more weight.” Yeah, because not only are the steroids making your blood thick like oil with RBCs, the thick blood makes the left heart ventricle- the one that does most of the pumping of the blood- thick. It’s a muscle, so the thick viscous blood overworks it as it tries to pump that thick gross blood through, so it makes that left ventricle wall thick, really thick. So instead of having a thin elastic pump that pumps blood in and out easily, you get this thick, wide left ventricle wall that cannot pump effectively. It enlarges the left ventricle wall, so you can’t pump good oxygen rich blood through. It’s called hypertrophy. With all those factors going on, it’ll cause hypertension. “Oh, yeah, I take medicine for that.” Like no, big deal. Aah, I just take medicine for the damage that I’m causing myself. Duh! + hypertension jot jot jot. + medication jot jot. And did you tell the doctor that prescribes that med that you’re using steroids? “No.” Nice. Prescribing Dr. unaware of illicit steroid use jot jot jot jot jot. Do you know that hypertension leads to kidney disease? “Really? My kidneys work good I think.” I’m thinking ‘maybe for now’ to myself. You think you look good on the outside, although you’re balding, your skin is oily, you have pitted acne scars on your face and acne on your back and you’re growing boobs like a teenage girl and your testicles are microscopic and you have low to no sperm and your penis doesn’t work… and you can’t breathe with any amount of exertion because your blood is thick and gross so your heart is all enlarged and your blood pressure is so high you have to take medication like a man more than twice your age. And you’re causing all of it! Through your steroid addiction. And as if the physical side isn’t bad enough, now it’s affecting you mentally. You’re paranoid, on the verge of psychosis…really you’ve got a toe or two over that line if you want the truth. So no matter how big your muscles are, no matter how good you think you look (and my raised eyebrows were clearly saying that was debatable) you are destroying your body. “Um, like what? How?” Now he’s really listening. I continued. Do you understand what hypertension actually is and does? Cause and effect? How about atherosclerotic plaques. What are those? What do they mean? The arteries in your heart become lined with plaques that are basically made of fat. These fat plaques are sticky, so as your thick gross blood slogs through the arteries, the fat plaques gather and narrow the arteries, so you cannot push blood through the arteries. Eventually, they clog off. It’s like a tunnel being filled with more and more muck, so there’s not enough room for blood to flow through and you get a heart attack and die. But before that happens, you’re incapacitated with high blood pressure because your thick oversized left ventricle is trying to push your thick gross blood through arteries that are filled with fatty muck, athersclerotic plaque filled arteries. “I didn’t know all that.” I’m sure you don’t, but I’m not done educating you yet. It gets better. Well, actually worse. 

Education jot. Steroids decrease HDL, which is the good cholesterol that helps keep your arteries open. And it also raises the LDL, which is the bad cholesterol that causes the fatty plaque to build up. So lowers the good while raising the bad. Got that? “Yep. Got it.” So that causes hypertension, and makes you prone to heart attacks and strokes. Did you know that hypertension also makes your kidneys malfunction? I didn’t think so. Right now, your kidneys are trying to pump under hypertension, and that kills them. The gross viscous blood thick with red blood cells kills them. So your kidneys shut down. Do you like to be able to take a piss? To be able to clean your thick slaggy blood of all the toxins you make? He nodded that yes, he rather liked to be able to take a piss and clear his thick slaggy blood of all the toxins he makes. I thought so. Enjoy it while it lasts. Before long, a machine will do that for you: four hour sessions, three times a week…if you’re lucky enough to live that long. If the massive heart attack doesn’t kill you first. Honestly, Rocky looked like he was about to have a heart attack right now. I know I’m hitting him pretty hard with all of this at once, but this guy was in a romantic relationship with his precious steroids, and I need him to break it off, clean and quick like. But wait, there’s more!

Now, with all this bad stuff going on, the little vessels throughout your body do not pump blood as well because they are clogged and they are hypertensive. So all those tissues, joints, and bones are starved of nutrients and oxygen. You get something called avascular necrosis. Avascular means without vasculature- blood vessels- and necrosis means death. It’s everywhere, but especially in the hips, with the ball and socket joint. The little vessels that feed the balls of your hip joints, where the femur meets your hip? Hello, the blood supply gets occluded- it gets starved- and then it gets dead. So you can recognize all the steroid abusers out there: they’re the 40 year olds using wheelchairs and walkers, whining about the pain in their hips. Balding, acne, boobs, erectile dysfunction, heart problems, kidney issues, disability, chronic pain. On and on. Oh yeah, it’s pretty bad, but it gets worse. His face fell. I couldn’t let up now. You enjoy being able to lift weights? You enjoy being physically capable? Like a zombie, he mumbled on a sigh “Yes…” I’m glad you do. But don’t get too used to it. Because if you keep this crap up, keep injecting that garbage, you’ll build your muscles up beyond what your body can handle. You’ll build them up- your muscles will get bigger- but your ligaments and tendons can’t be built up, and they can’t support these unnaturally large muscles. Do you know what muscles without ligaments and tendons do? Not much. Without healthy ligaments and tendons, big muscles are useless for anything but causing pain, debilitating pain. When you’re pumping iron, lifting really heavy weights, your ligaments and tendons get damaged. In no time, the muscle size supercedes the ability of the damaged ligaments and tendons, so you get irreversible chronic muscle pain. Sounds great, right Rocky? Oh, wait, and to top it all off, now you’re having psychological effects. You’re having rages. You want to tear something apart with your bare hands. You said that. What’s scary is that right now, at this moment, you have the physical ability to do that. If somebody pushed you too far on a bad day, you might go there. You could kill someone. I’ve seen it happen to a patient. A guy a lot like you. He came in here young and dumb and I explained everything to him, just like I’ve done with you. For several years, I begged him to stop. He refused to listen; didn’t believe me. Ultimate in denial. He’s in prison now for the next 30 years; that equals a life sentence for him. It’s scary. What’s even scarier is that if you keep this crap up, keep sticking yourself with that needle, you won’t be able to tear somebody apart for long. You might want to, but you’ll be too debilitated. That guy in prison? He’s in a wheelchair now 90% of the time. He uses a walker sometimes- when he can stand the pain- which isn’t often. 

I’ll make this very plain. You are addicted to steroids. They are physically wrecking your body, the body you seem to worship. Oily skin, acne, bacne, boobs, receding hairline, balding, teeny tiny testicles, a penis that you can’t get up…and no sperm to come out of it anyway. And that’s just the stuff on the outside that people can see! Your insides get wrecked too. Thick slaggy gross blood, hypertension, atherosclerosis, heart attack, stroke, kidney dysfunction, erectile dysfunction, avascular necrosis, chronic pain. And now you’re raging, scaring the crap out of your wife, you’re paranoid, becoming psychotic. You have nothing positive happening in your life. So it’s your call, Rocky. I can help get you off the train here before it runs your ass over. He was nodding very slowly, but clearly shell-shocked. Look, how about this. Don’t use for two weeks and see me again. You’ll have some time to digest all of this. Can you do it? If you can’t- if you feel like you’re gonna hit that needle- I’ll see you sooner. Here’s my cell number. Call me anytime, but especially if and when you’re tempted to use. Deal? “Deal.” We shook on it.  

Dx: steroid addiction, assoc features jot jot jot jot

Pt agrees to d/c use jot jot jot

F/up 2 weeks, will call/ see sooner prn jot jot jot jot jot

Here’s the bottom line on steroids people. Your body just does not like these drugs in excess. There may be some use for them in people with anemia, in people who have wound healing problems, a temporary use in people with HIV or cancer who do not want to eat, and in muscle wasting diseases for short periods of time and in very regulated doses, okay…fine.  

But, for my Olympic athlete patients, my professional athlete patients: you all know who you are. All of my Rocky’s out there: cut it out! You’re sterile, can’t get it up, scared everyone’s gonna see your breasts, hello, they are! I know you’re saying ‘but I cycle them on and off, doc!’ I say bullshit. No, it causes permanent damage to heart, kidneys, tendons, and ligaments. Not to mention the cosmetic aspects: the oily skin, the acne on your face and back, the balding, receding hairline… and you say ‘oh, but to minimize the breasts I use an estradiol’ (an anti-estrogen, because testosterone breaks down to estrogen, so if you use an anti-estrogen in someone who is abusing testosterone or testosterone-like drugs, you will not get the breast enlargement) Yes, that’s true. I’ll give you that. But, you still get all that other crap, guys! Hellllo!! All my elite athletes, you all whine like ‘No, no, no, I need it to stay competitive, because everybody else is doping!’ Whatever! You are addicted to the high, the performance, and the cosmetic enhancement. You get big muscles, tiny balls, and tinier brains. You also get limp and sterile, permanent damage to the ventricles, the heart, and the kidneys, hypertension, and its host of other problems. You are predisposing yourself to coronary disease, heart attack, and stroke. You become delusional, and you fly into rages when the wind blows.  

As you are my patients, I’ve probably told you about other patient stories. For those that haven’t heard them: one steroid abuser was very paranoid and psychotic, but of course didn’t know it, because you will not see yourself becoming psychotic. He was stopped at red light. I don’t know what he was doing, but when the light changed green, he didn’t go right away. So the car behind him honked. He started ticking like a time bomb, and the car kept honking, but for whatever reason, he still didn’t go. Instead, with the light still green, he got out of his car. With a golf club. He went off, banging on the guy’s car with the golf club, and he just didn’t stop. Eventually, they called the police.  The police came and they had to subdue him with a tazer because he was out of control. When he was transported to the emergency room, he continued there, even continuing to spit and scream, even after being put in four-point restraints. Finally, he had to be pharmacologically restrained with a freaking rhino dart. Unbelievable. I mean, he was all black and blue, like he had been beaten, but he did it by thrashing, all by himself. His whole affect was totally inappropriate. I know that some people are beaten by police for no reason; they don’t deserve it, but this maniac was taking every opportunity to hit the police officers for absolutely no reason. In the hospital, he was arguing with nurses, disturbing the entire emergency department for no reason. His wife finally came in, but even she couldn’t calm him. He just lost it, in every sense. He was (or had been) on the road to being Mr. Olympia or some such title. He was 190 pounds, and bench pressing over 450 pounds. It was just crazy. Eventually, but not long after, he went into kidney failure. But it wasn’t from the steroids. Yeah, right. Denial!! jot jot

You know, it also causes immune suppression, so you don’t fight off pathogens like viruses, like COVID-19, like any bacteria. I had someone who had a heart attack and died. He was 25. Another stroked out in his late 30’s. These patients are Olympians, professional athletes, and really elite level people. They’re so hyper-disciplined about their diets and their training and supplements and sleep patterns and all of that. But they’re abusing steroids. It’s a crazy dichotomy. Some have made it. Big success stories that stopped and then did it the right way. But many don’t. Right now I have a 45-year-old man who is just going into kidney failure. And the one with psychosis that killed the guy that set him off. He’ll die in prison. Now I have Rocky. I hope I opened his eyes. 

Remember, people… just because you cannot see what’s going on doesn’t mean the steroids aren’t destroying you. They are. But you can get there without them. And PS, for those that are wondering, there is a steroid withdrawal: headaches, drowsiness, decreased appetite, weight loss, fatigue, depression, dizziness. It’s a mess when I get them off, especially when they do high dose. It takes two to four weeks, and they are miserable, cranky, irritable, and obnoxious people to deal with when they are in withdrawal. I use benzodiazepines, things to help them sleep; I sometimes add anti-psychotics because they can’t see themselves drifting to the psychotic lane, sometimes hearing voices and seeing things. It’s a spectrum. And lots of misreading events in reality… “Those people are talking about me. They’re plotting against me. Those police officers are here to get me, or that group of people talking over there are planning something against me or these workers are not working because they are all in a grand plot against me. They are very faint signs and forms of psychosis. Hearing voices and seeing things, disorganized speech and behavior is the extreme. But there can be the unextreme, the misreading, the over-emotional abnormal response to normal events, thinking people are plotting.  

Probably from age 10 to 30 is when most people started and abused the steroids. And too often, it’s a one way trip, once they start, they get lost in it. You know, “I am superman now” and they don’t stop, and then they stroll into my office and then I deal with them when they are 45 to 50 and that’s when their kidneys shut down, when they get a heart attack, when they are debilitated with degenerative disk disease from lifting too heavy weights, their ligaments and tendons go, they become sterile, they cannot have kids, they’re in constant horrible chronic pain. They have heart problems and kidney problems, and that’s what gets them. If they have heart and kidney failure, to the point where the organs have just given up, that’s what kills them.

Hopefully not Rocky jot jot jot

Learn More

Sociopath or A-hole How To Tell The Difference

Sociopath or A-hole?

How to Tell the Difference

When you think of a sociopath, you probably picture someone like Dr. Hannibal Lecter in Silence of the Lambs, or Annie Wilkes in Stephen King’s Misery. But like most mental health conditions, sociopathy- otherwise known as antisocial personality disorder, or ASPD for short- exists on a spectrum. And clearly, kidnapping and hobbling your favorite author or enjoying a cannibalistic dinner with a nice chianti would be pretty out there on that spectrum. 

Before I get started on the details of recognizing sociopathy, I want to quickly remind you about last week’s blog topic, the differences between sociopathy and psychopathy. Both disorders are considered ASPD’s, but people tend to use the terms sociopath and psychopath interchangeably, though they mean different things. Typically, sociopaths are a product of their childhood environment or upbringing. Disturbed and unhinged, they’re not always big planners, so they’re more prone to impulsive behavior. They’re very likely to break rules and/ or laws without thinking twice, but as for going on a murderous rampage? Not so much. On the other hand, psychopaths are essentially born, and have an innate disdain for others coupled with a compulsive need for violence. They are cold and calculating, and can even be charming when it suits their purposes, a la Ted Bundy. Psychopaths are at the most extreme end of the antisocial personality disorder spectrum, and while all psychopaths are antisocial, not all antisocials are psychopaths. 

There are many people with difficult personalities out there, all of which can impact your life to varying degrees. These are your garden variety a-holes, and they’re usually pretty simple-minded and relatively harmless if you don’t pay them much attention. But sociopaths have one of the most hidden personality disorders, as well as one of the most dangerous. They often slip under the radar because they put so much energy into deceiving people. In my vast experience with sociopaths, most people don’t know what to watch out for, and they’re generally shocked at how easily they can be manipulated. In truth, anyone can be a target. The point of this week’s blog is to explain sociopathic behavior, help you identify potential sociopaths in your life, and share how to deal with them once you do. 

Sociopathy occurs in nearly 4 percent of the U.S. population, which works out to about one in 20-ish people. There is a clear link between ASPD and sex. You are 3 to 5 times more likely to be a sociopath if you own a Y chromosome; and only 25% of sociopaths are female. Obvi not all men are sociopaths, but being male can be one clue in identifying them.

Whether someone has intentionally deceived you for their own perverse pleasure, or you’ve had a college roommate eat the last of your mom’s famous homemade lasagna without asking before or apologizing after, you’ve experienced sociopathic behavior. Fortunately, your selfish roommate’s sociopathic behavior probably doesn’t make him an actual sociopath… it just makes him rude AF. 

So that begs the question: how can you differentiate between an a-hole and a sociopath? It’s not always as easy as it seems, because sociopaths can be masters of deception, and some traits might be hidden by their frequent lies. Remember too that they can be intelligent and good at manipulating people into doing what they want, so they may come across as friendly and outgoing when it’s really all a ruse.

That said, here are some of the general themes to be on the lookout for:

Sociopaths can be highly effective at getting you to overlook any warning signs you see or sense. That’s why they’re called con artists: they take you into their confidence, and you trust them. You will doubt yourself before you doubt them. They are narcissistic, believing they are better, smarter, cuter, funnier, and more interesting than anyone else. 

In a dating relationship, a sociopath may be the most loving, charming, affectionate, and giving person you have ever met. But, if it seems too good to be true, it usually is. They are likely to be secretly dating several other people. They can be very promiscuous and are loyal to no one. They’re also very quick to anger. If you dare to question them, their anger response is totally outside the scope of what would be considered ‘normal’.

They can be fast talkers and bull$#&t artists. They’ll say anything to cover up their secret activities, no matter how ridiculous it sounds. I have a patient that was actually living with 3 different women in 3 different houses, at the same time- and the women were happy and had no clue about his deception. I actually had him bring each of them (in separate appointments, of course) for a couple’s session, because I had to see it for myself. Get this…he would tell them that he did contract work for the CIA, so he couldn’t give them any details about it. When he would leave a woman to be with one of the others, he’d just say that he’d be gone all the next week on a secret mission. And then he would lament about how much he wished he could tell them all about it, but he just couldn’t, so they must never askhim about it. And they bought it, hook, line, and sinker! 

They quickly lose interest in a girl-/ boy- friend, but they’ll keep them hanging on with a few words of love, so that they can still have sex with them, borrow money from them (which is never returned) and maintain access to their house or car. They have no empathy, so they’ll use them until they’re not useful anymore, and then leave, feeling no remorse for any damage they’ve left in their wake.

They are secretive. They may pretend they are going to work at the office everyday, when they’re actually going out to deal drugs. Or gambling away their paycheck, then saying they were robbed. They’re often impulsive and irresponsible, and unable to maintain a job, so they don’t have money and need to find a reason to cover that up. They like to see how far they can control a situation, what they can get away with. Everything is done for their personal gain, and they have a greatly exaggerated sense of self-worth.  

Sociopaths love to play the victim. They’ll tell you a story about how someone else took advantage of them, or how life circumstances treated them very badly. This is a calculated tactic to get you to feel sorry for them, so that you’ll want to help them. This ploy works, because normal, healthy people naturally care about others, even strangers. Ted Bundy tore a page out of the sociopath’s play book and used to put a fake cast on his arm or leg, then drop a bunch of books near an isolated young woman on a college campus. Then he would ask her to help him carry his books back to his car, and when they leaned into his car to put the books in the back seat, he would shove them inside. And the rest was history.

I’ve seen firsthand how all of these kinds of activities have gone on under the radar for so many people in relationships with sociopaths. The targets are always shocked, because the sociopath was so good at living a lie. But as I tell the victims, that’s what they do. 

Officially diagnosing someone as a sociopath using the DSM-IV isn’t always as simple as you might think. But, if someone has three or more of the tendencies listed below, as Jeff Foxworthy would say, they might be a sociopath:

-Failure to conform to social norms (i.e, they break the law)

-Repeatedly lie or con others for profit or pleasure

-Fail to plan ahead or exhibit impulsive behavior

-Repeated irritability or aggression (i.e, they always get into fights)

-Reckless disregard for the safety of themselves or others

-Consistent irresponsibility (i.e, they can’t hold down a job or meet financial obligations)

-Lack remorse (i.e., they rationalize their actions or are indifferent to other people’s feelings)

Following is more information on some of the red flag symptoms of sociopaths to watch out for, based on criteria listed in the DSM-IV.

Symptom: Lack of empathy

Perhaps one of the most well-known signs of a sociopath is a lack of empathy, particularly an inability to feel remorse for their actions. When you don’t experience remorse, you’re basically free to do any horrible thing that comes to your sick mind. That’s a problem. 

Symptom: Difficult relationships

Sociopaths find it hard to form emotional bonds, so their relationships are often unstable and chaotic. Rather than forge connections with the people in their lives, they might try to exploit them for their own benefit through deceit, coercion, and intimidation.

Symptom: Manipulativeness

Sociopaths tend to try to seduce people and ingratiate themselves with the people around them for their own gain, or just for sheer entertainment. While some are charming, this doesn’t mean they’re all exceptionally charismatic. I’ve seen plenty that I would not call charming in any way, shape, or form. But they think they are of course; this can be an important distinction. 

Symptom: Deceitfulness

Sociopaths have a reputation for being dishonest and deceitful. They often feel comfortable lying to get their own way, or to get themselves out of trouble, whatever motivation they may come up with. They also have a tendency to embellish the truth when it suits them. 

Symptom: Callousness

Some sociopaths can be openly violent and aggressive. Others will cut people down verbally. Either way, they tend to show a cruel disregard for other people’s feelings.

Symptom: Hostility

Sociopaths are not only hostile themselves, but they’re more likely to interpret others’ behavior as hostile, which drives them to seek revenge. Revenge is a primary goal when a sociopath feels wronged.

Symptom: Irresponsibility

Sociopaths often have a deep disregard for financial and social obligations. Ignoring responsibilities is extremely common, which can include not paying child support when it’s due, allowing bills to pile up, and regularly taking time off work. Their needs and wants supersede everyone else’s, no matter who they are, even including their children. 

Symptom: Impulsivity

We all have our impulsive moments: a last minute road trip, a drastic new hairstyle, or a new pair of shoes you just have to have. But for sociopaths, making spur of the moment decisions with no thought for the consequences is part of everyday life. They find it extremely difficult to even make a plan, much less stick to it.

Symptom: Risky behavior

Combine irresponsibility, impulsivity, and a need for instant gratification, and you get risky behavior. It’s not surprising that sociopaths get involved in risky behavior, because they tend to have little concern for themselves, let alone the safety of others. This means that excessive alcohol consumption, drug abuse, compulsive gambling, unsafe sex, dangerous hobbies, and criminal activities are all on the sociopath’s to-do list.

Can sociopathy be cured or treated?

There’s no cure for sociopathy, and there isn’t a lot of evidence that it can be successfully treated. Typically, the main issue in treating it is that it’s unusual for a sociopath to seek professional help. One of the curious things about this disorder is a general lack of insight on the sociopath’s part. They may recognize that they have problems, might notice that they get into trouble on the job, and may recognize that their spouses are not happy with them. But they tend to blame other people, and other circumstances, for the trouble; this is part and parcel of the diagnosis. The good news is that symptoms of sociopathy and other ASPD’s seem to recede with age, especially among milder cases and in people that don’t do drugs or drink to excess. Cognitive behavioral therapy isn’t very helpful for treating the disorder itself, but it can help people to stop certain devious behaviors. Sociopaths might not really develop actual empathy or learn to feel badly about their actions, but they could possibly learn to stop eating their roommate’s lasagna.

So now you know the symptoms of sociopathy to look for and you’re better prepared to recognize a sociopath. But if you suspect that you’re dealing with a sociopath, what should you do?

The best and simplest answer is to get far away from them, to permanently extricate them from your life. If you don’t, they will seriously complicate that life. Unfortunately, that isn’t always possible. If it’s your boss or a relative, you might not be able to just cut ties and bolt, but you can learn how to deal with their sociopathic behavior and still remain true to yourself and your own mental health.

First, trust your instincts. A person doesn’t need a DSM diagnosis to be a manipulative a-hole who’s causing you harm. If they don’t care about your feelings, repeatedly lie to you, and manipulate your emotions for their pleasure, they aren’t someone you should be around, sociopath or not.

Secondly, remember that you cannot change this person. They may not realize that what they’re doing is abnormal, and they definitely don’t give a flip if it hurts you. You must let go of any illusions that you can fix them or get them to be a better person.

As you distance yourself from them, the sociopath might try to make deals with you. Do not go along with it! They don’t care about your feelings and they don’t obey any rules, so they will never honor any deal they offer. And even worse, when it fails (because it will) they will say that you were the one that ruined the deal; they’ll try anything to put any and all blame on you. So your best bet is to just avoid that crap all together.

If you’re not sure how to distance yourself from this person, or you need other tools to deal with them, talk to a therapist. They’re far better able to spot the true tendencies of a sociopath, and they can help you learn how to set boundaries or remove yourself from the situation. They can also help you cope with the harm the sociopath inflicted and the damage they left in their wake.

If the person seems like they’ll cause extreme harm to themselves or others, you can call an emergency mental health line. SAMHSA (Substance Abuse and Mental Health Services Administration 1-800-662-4357) is a good one. And If you are, or anyone else is, ever in any physical danger, call 911 immediately.

Now you know all the hallmark behaviors of a sociopath and what to do when you realize there’s one squirming around in your life. There are a bunch of sociopaths out there, so by all means, share the knowledge with your friends and family. 

For more information and patient stories on sociopathy and other personality disorders, you can read my book, Tales from the Couch, available on Amazon. And you can also check out my lectures and subscribe to my YouTube channel by searching under Mark Agresti. 

Learn More

Psychopaths and sociopaths Tomato Tomato or Tomato Potato

That dude in the little blue speedster flying down I-95 and using all three lanes to cut everyone off and pass them… what a total psycho! The captain of the high school cheerleading squad who’s demanding that her boyfriend work extra hours to pay for her hair and nails to get done every week… that chick is such a self-centered sociopath! We pin these labels on people easily, and often jokingly, but psychopathy and sociopathy are pretty serious states of being, sometimes far from a joking matter. 

Do you know someone who seems to have no understanding of what it means to show empathy or concern for others, someone who has no regard for right or wrong, or someone who actually seems to derive pleasure from hurting others? To you, this behavior and personality seem calloused and unreal, maybe even impossible to believe; but believe it…if the above characteristics sound familiar to you, you’ve probably crossed paths with a psychopath or sociopath. 

A lot of people use the labels psychopath and sociopath interchangeably when referring to a person who exhibits a wide array of creepy, odd, or dangerous behaviors. But while the two do share some common traits, there are other points that separate them as well. Both sociopaths and psychopaths have a patent disregard for the safety and rights of others, and manipulation and deceit are central features to both personalities. Contrary to popular belief and what you see in the movies, psychopaths and sociopaths are not necessarily bloodthirsty or violent. Surprised? Violence is actually not a necessary requirement for a diagnosis of psychopathy— but it is often present. In this blog, I’ll shed some light on sociopathic and psychopathic traits, go over why they’re grouped together, and also what sets them apart from one another.  

In actuality, neither psychopathy and sociopathy are official diagnoses on their own, but The Diagnostic and Statistical Manual of Mental Illness puts them under the heading of antisocial personality disorders, meaning that people with psychopathy and sociopathy have a diagnosis of antisocial personality disorder, hereafter ASPD. 

ASPD is a mental health diagnosis characterized by a lack of empathy, ie an inability to care about the needs or feelings of others. Approximately 3 percent of the US population qualifies for a diagnosis of antisocial personality disorder. It is more common among males and more often seen in people with an alcohol or substance abuse problem, or in forensic settings such as prisons. People with antisocial personality disorder are usually master manipulators and absent of moral conscience. The exact cause of ASPD is not currently known, but environmental factors, genetics, and possible changes in the function and structure of the brain are believed to be factors that contribute to its development. Other contributing factors may include having a family history of mental health disorders or a history of living in an unstable or violent family in an abusive or neglectful environment. In both cases, some signs or symptoms are nearly always present in a person before the age of 15, so that by the time that person is an adult, they are well on their way to becoming a full fledged psychopath or sociopath.

The common features of a psychopath and sociopath lie in their shared diagnosis and key characteristics of ASPD:

Lack of empathy toward others

Constant deceitful or manipulative behavior

Little regard for the safety of others

Difficulty with all relationship types

Aggression or irritability

Criminal history

Lack of remorse or guilt for actions

Reckless and/or dangerous behavior

Laws/ Rules don’t apply to them

Regularly breaks or flouts the law

Impulsive and doesn’t plan ahead

Prone to fighting and aggression

Irresponsible, can’t meet financial obligations

As with many things in life, there are different levels of both psychopaths and sociopaths.

Some might be thieves or cheaters, while others could be actual killers. The most concerning difference between psychopaths and sociopaths is that when someone is a psychopath, you’ll probably never know it, never have the faintest idea… which is what makes them even more dangerous.

You’re probably familiar with some famous fictional psychopaths and sociopaths. How about psychopath Hannibal Lecter from Silence of the Lambs, or the psychopathic detective Dexter from the primetime crime drama of the same name. Or sociopathic pop culture hero, King Joffrey from Game of Thrones, and the sociopathic Joker in The Dark Knight. These characters all had ASPD and lacked empathy, broke laws and disregarded rules, ignored others’ rights, exhibited violent tendencies, and never felt an iota of guilt for their behavior, if they even knew they behaved badly and hurt people in the first place. Which they probably didn’t.

Traits of a Psychopath

Psychology researchers generally believe that people are born psychopaths, as it’s likely associated with genetic predisposition. The flip side is that sociopaths tend to be a product of their environment, perhaps as a result of abuse. But that’s not to say that psychopaths may not also suffer from some sort of childhood trauma. 

Research has shown that psychopathy might be related to physiological brain differences, as psychopaths often have underdeveloped areas of the brain in regions that are responsible for emotion regulation and impulse control.

Generally speaking, psychopaths are superficial, egocentric, and emotionally shallow. They’re practiced and smooth operators, and they will compliment you, make you feel good, and say all of the right things, until you find out later they’ve been playing you for their own purposes, using you, stealing money from you, or plotting some kind of crime…like your murder. 

They’re extremely manipulative and pros at gaining others’ trust. They have a hard time forming real emotional attachments with others, so they intentionally form shallow, artificial relationships designed to be manipulated in a way that most benefits them. They see people as pawns to be used to forward their own goals and agendas, and rarely, if ever, feel any guilt regarding how they treat others or how much they hurt them. 

Psychopaths can often be seen by others as being charming and trustworthy, as they hold steady, normal jobs. They tend to be very successful and well liked, much like master con artists. They may even have families and seemingly-loving relationships with a partner. And while they tend to be well-educated, they may also have learned a great deal on their own, living in and experiencing the real world. They are the princes most charming of all…until they aren’t anymore. Legendary psychopath Ted Bundy comes to mind here. Women found him smart and attractive, and they took him at face value; and that was their undoing.

When a psychopath engages in criminal behavior, they tend to do so in a way that minimizes risk to themselves. If that means they must implicate an innocent party in the behavior, so be it. They will carefully, and even obsessively, plan criminal activity to ensure they don’t get caught, having contingency plans in place for any and every possibility.

While psychopaths are like chameleons, seamlessly blending into their environment, sociopaths are easier to spot. The cool, calm psycho attitude is replaced by the hot-headed sociopathic one. They are rage-prone, and if things don’t go their way, they’ll get angry and aggressive, with emotional outbursts.

Traits of a Sociopath

Researchers tend to believe that sociopathy is the result of environmental factors, such as a child or teen’s upbringing in a very negative household; or in any situation that resulted in physical abuse, emotional abuse, or childhood trauma.

In general, sociopaths tend to be more impulsive and erratic in their behavior than their psychopath counterparts. While they also have difficulties forming attachments to others, some sociopaths may find it easier to form an attachment to a like-minded group. Unlike psychopaths, most sociopaths have a difficult time holding down a long-term job, fitting in properly with some social situations, and presenting a normal family life to the outside world.   

When a sociopath engages in criminal behavior, they may do so in an impulsive and largely unplanned manner, with little regard for the risks or consequences of their actions. They may become agitated and angered easily, sometimes resulting in violent outbursts. These kinds of behaviors increase a sociopath’s chances of being apprehended.

Who is More Dangerous?

As with many things in life, there are different degrees of severity in psychopaths and sociopaths. In reality, both pose risks to society, because they must constantly, 24/7-365, find ways to cope with a way of thinking and a way of life that is different from society’s accepted norm, and this can make them edgy. But, that said, psychopathy is the more dangerous disorder, because people with it experience far less guilt connected to their actions. Also, a psychopath is better able to dissociate from their actions, meaning they can easily separate emotional feelings from any actions they undertake. Without this emotional involvement, any pain that other people suffer is completely meaningless to a psychopath. All of the most famous serial killers have been psychopaths.

Psychopath v Sociopath: Childhood Clues

Clues indicative of later psychopathy and sociopathy are usually available in childhood. Most people who are diagnosed with sociopathy or psychopathy have had a previous pattern of behavior in which they violated the basic rights of others or endangered their safety. They also often have a childhood history of breaking rules and laws, as well as societal norms too. These kinds of childhood behaviors are recognized as a conduct disorder. 

Conduct Disorders:

Four categories of problem behavior

Aggression to people and animals

Destruction of property

Deceitfulness or theft

Serious violations of rules or laws

If you recognize any of the above four symptoms or any of the specific childhood clues of conduct in a child or young teen, they’re at much greater risk for having antisocial personality disorder. We’ll talk about what to do with that next week. Also next week, we’ll get deeper into how to spot a sociopath. 

Check out my website for more blogs at dragresti.com/blog/ and pass them around to friends. Search my name on YouTube to see all of my lectures there and subscribe to my channel, people. And share with your friends! Also, as always, my book Tales from the Couch is available on Amazon.com.

Learn More

The 15 Scariest Mental Disorders of All Time

The 15 Scariest Mental Disorders of All Time

Imagine having a mental disorder that makes you believe that you are a cow; or another that you’ve somehow become the walking dead. Pretty freaking scary, eh? Well, while relatively rare, these disorders are all too real.

Worldwide, 450 million people suffer from mental illness, with one in four families affected in the United States alone. While some mental disorders, like depression and anxiety, can occur organically, others are the result of brain trauma or other degenerative neurological or mental processes. Look, having any mental illness can be scary, but there are some disorders that are especially terrifying. Below, I’ve described the 15 scariest mental disorders of all time.

‘Alice in Wonderland’ Syndrome

In 1865, English author Lewis Carroll wrote the novel Alice’s Adventures in Wonderland, commonly shortened to ‘Alice in Wonderland.’ Considered to be one of the best examples of the literary nonsense genre, (seriously, who knew they even had a nonsense genre?) it is the tale of an unfortunate young girl named Alice, who falls through a rabbit hole into a subterranean fantasy world populated by odd, anthropomorphic creatures. That’s your vocabulary word for the week… anthropormorphic. Popular belief is that Carroll was tripping when he penned it. Regardless if that’s true or not, what is true is that one of Alice’s more bizarre experiences shares its characteristics with a very scary mental disorder. Also known as Todd Syndrome, ‘Alice in Wonderland’ Syndrome causes one’s surroundings to appear distorted. Remember when Alice suddenly grows taller and then finds she’s too tall for the house she’s standing in? In an eerily similar fashion, people with ‘Alice in Wonderland’ Syndrome will hear sounds either quieter or louder than they actually are, see objects larger or smaller than what they are in reality, and even lose sense of accurate velocity or textures they touch. Described as an LSD trip without the euphoria, this terrifying disorder alters one’s perception of their own body image and proportions. Fortunately, this syndrome is extremely rare, and in most cases affects people in their 20’s who have a brain tumor or history of drug use. If you need yet another reason to not do drugs… well, there ya go. 

Alien Hand Syndrome

While most likely familiar from cheesy horror flicks, Alien Hand Syndrome isn’t limited to the fictional world of drive-in B movies. Those with this very scary, but equally rare mental disorder experience a complete loss of control of a hand or limb. The uncontrollable body part takes on a mind and will of its own, causing sufferers’ “alien” limbs to choke themselves or others, rip clothing off, or to viciously scratch themselves, to the point of drawing blood. Alien Hand Syndrome most often appears in patients suffering from Alzheimer’s Disease or Creutzfeldt-Jakob Disease, a degenerative brain disorder that leads to dementia and death, or as a result of brain surgery separating the brain’s two hemispheres. Unfortunately, no cure exists for Alien Hand Syndrome, and those affected by it are often left to keep their hands constantly occupied or use their other hand to control the alien hand. That last one actually sounds even worse- one unaffected arm fighting against the affected arm that’s trying to tear into the person’s own flesh. Yikes. 

Apotemnophilia

Also known as Body Integrity Disorder and Amputee Identity Disorder, Apotemnophilia is a neurological disorder characterized by the overwhelming desire to amputate or damage healthy parts of the body. I recall a woman with Apotemnophilia making worldwide news ages ago when she fought with her HMO to cover the amputation of one of her otherwise healthy legs. Good luck; they don’t even cover flu shots. I remember I was pretty shocked that she found a surgeon to agree to do the amputation in the first place, as it seemed to me that might violate that little thing called the Hippocratic Oath us docs took when we got our medical degrees, specifically that part about ‘do no harm’… and sparked a debate about the ethical dilemma of treating or “curing” a psychiatric disorder by creating what is essentially a physical disability. Though not a whole heck of a lot is known about this strangely terrifying disorder, it is believed to be associated with damage to the right parietal lobe of the brain. Because the vast majority of surgeons will not amputate healthy limbs based purely upon patient request, some sufferers of Apotemnophilia feel forced to amputate on their own, which of course is a horrifying scenario. Of those who have convinced a surgeon to amputate the affected limb, most say they are quite happy with their decision even after the fact.

Boanthropy

Those who suffer from the very rare- but very scary- mental disorder Boanthropy believe they are cows, and usually even go so far as to behave as such. Sometimes people with Boanthropy are even found in fields with cows, walking on all fours and chewing grass as if they were a true member of the herd. When found in the company of real cows, and doing what real cows do, people with Boanthropy don’t seem to know what they’re doing when they’re doing it. This apparently universal finding has led researchers in the know to believe that this odd mental disorder is brought on by possible post-hypnotic suggestion, or that it is a consequence of dreaming or a sleep disturbance, sort of kin to somnambulism, aka sleepwalking. I can buy the sleepwalking thing. I have a patient that is a lifelong sleepwalker who sleep-eats, sleep-cleans, sleep-cooks, sleep-destroys, sleep-online-shops, sleep-everythings. Some mornings she wakes up to very unpleasant findings of the house in total disarray, electronics dismantled and improperly and ridiculously fashioned together, every piece of furniture moved or a sink full of dishes and pots and pans with dried up food in them. Before setting up prevention measures, she even had single episodes of adult sleep-driving, and even sleep-biking at (eek!) age 9. In the middle of the night, her mother awoke to what she thought was the big garage door opening, and when she went to check, she saw her coasting out of the driveway on her bright yellow bike, heading right toward a very busy highway. She always has zero recall of the events afterwards. If she can do all of that while essentially sleeping, it would be comparatively easy to wander out to a pasture on all fours and stick around to munch on some grass. Curiously, it is believed that Boanthropy is even referred to in the Bible, as King Nebuchadnezzar is described as being “driven from men and did eat grass as oxen.” Or was it King Nemoochadnezzar? No? Okay, moooving on…

Capgras Delusion

Named after Joseph Capgras, a French psychiatrist who was fascinated by the effective illusion of doubles, Capras Delusion is a debilitating mental disorder in which a person believes that the people around them have been replaced by imposters. As if that’s not bad enough, these imposters are usually thought to be planning to harm the sufferer. It really sounds like a bad Tom Cruise movie. Oh, wait; that’s redundant. Anyhoo, in one case, a 74-year-old woman with Capgras Delusion began to believe that her husband had been replaced with an identical looking imposter who was out to hurt her. Fortunately, Capgras Delusion is relatively rare, and is most often seen after trauma to the brain, or in those who have been diagnosed with dementia, schizophrenia, or severe epilepsy.

Clinical Lycanthropy

Like people with Boanthropy, people suffering from Clinical Lycanthropy also believe they are able to turn into animals; but in this case, cows are typically replaced with wolves and werewolves, though occasionally other types of animals are also included. Along with the belief that they can become wolves and werewolves, people with Clinical Lycanthropy also begin to act like the animal, and are often found living or hiding in forests and other wooded areas. Didn’t Tom Cruise play a werewolf in one of his many (vapid) movies? Or was it a vampire? Werewolf, vampire – tomato, potato.

Cotard Delusion

In a case of life imitating art, or life inspiring art, we have Cotard Delusion. In this case, the ‘art’ is zombies, a la The Walking Dead. Oooh, scary! For ages, people have been fascinated by the walking dead. Cotard Delusion is a frightening mental disorder that causes the sufferer to believe that they are literally the walking dead, or in some cases, that they are a ghost, and that their body is decaying and/or they’ve lost all of their internal organs and blood. The feeling of having a rotting body is generally the most prevalent part of the delusion, so it doesn’t come as much of a surprise that most patients with Cotard Delusion also experience severe depression. In some cases, the delusion actually causes sufferers to starve themselves to death. This terrifying disorder was first described in 1880 by neurologist Jules Cotard, but fortunately, Cotard’s Delusion, like good zombie movies, has proven to be extremely rare. The most well-known case of Cotard Delusion actually occurred in Haiti, circa 1980’s, where a man was absolutely convinced that he had previously died of AIDS and was actually sent to hell, and was then damned to forever walk the earth as a zombie in a sort of pennance to atone for his sins. 

Diogenes Syndrome

Diogenes Syndrome is a very exotic name for the mental disorder commonly referred to as simply “hoarding,” and it is one of the most misunderstood mental disorders. Named after the Greek philosopher Diogenes of Sinope (who was, ironically, a minimalist), this syndrome is usually characterized by the overwhelming desire to collect seemingly random items, to which an emotional attachment is rapidly formed. In addition to uncontrollable hoarding, those with Diogenes Syndrome often exhibit extreme self neglect, apathy towards themselves or others, social withdrawal, and no shame for their habits. It is very common among the elderly, those with dementia, and people who have at some point in their lives been abandoned or who have lacked a stable home environment. This is likely because ‘stuff’ never hurts you or leaves you, though most people with the disorder are unlikely to be able to make that connection. Fortunately or unfortunately, depending on how you look at it, this disorder is much more common than some of the others I’ve mentioned here.

Dissociative Identity Disorder

Dissociative Identity Disorder (DID), is the mental disorder that used to be called Multiple Personality Disorder. Another disorder that has inspired a myriad of novels, movies, and television shows, DID is extremely misunderstood. Generally, people who suffer from DID often have 2-3 different identities, but there are more extreme cases where they have double digit numbers of identities. There was a “reality” show a few years ago that centered on a young mother of two that supposedly had like 32 distinct personalities. All of them had names and ranged from a five-year-old child to an old grandpa; and according to her, a few of them were homosexual while the rest were not, so she was required to be bisexual. She claimed that many of the personalities knew everything about all of the others, and they would get mad at or make fun of the others at various times. What’s more, she would “ask” other personalities to come forward so that producers could ask them questions for the camera’s sake, and her voice and mannerisms changed, depending on the different characteristics of the personalities. It was all pretty difficult to buy to be honest, because I’ve seen a lot of people with DID, and none seemed like they were having as much fun with their illness as she did. In true DID cases, sufferers routinely cycle through their personalities, and can remain as one identity for a matter of hours or for as long as multiple years at a time. They can switch identities at any time and without warning, and it’s often nearly impossible to convince someone with DID that they actually have the disorder, and that they need to take medications for it. For all of these reasons, people with Dissociative Identity Disorder are often unable to function appropriately in society or live typical lives, and therefore, many commonly live in psychiatric institutions, where their condition and their requisite medications can be closely monitored. 

Factitious Disorder

Most people cringe at the first sniffle indicating a potential cold or illness, especially these days, but not those with Factitious Disorder. This scary mental disorder is characterized by an obsession with being sick. In fact, most people with Factitious Disorder intentionally make themselves ill in order to receive treatment; and this is what makes it different than hypochondria, a condition where people blow mild symptoms into something they aren’t, kind of like if you cough once and automatically think you have covid-19. Sometimes in Factitious Disorder, people will simply pretend to be ill, a ruse which includes elaborate stories, long lists of symptoms, doctor shopping, and jumping from hospital to hospital. Such an obsession with sickness often stems from past trauma or a previous genuinely serious illness. It affects less than .5% of the general population, and while there’s no cure, psychotherapy is often helpful in limiting the disorder. 

Kluver-Bucy Syndrome

Imagine craving the taste of a book or wanting to have sex with a car. That’s reality for those affected by Kluver-Bucy Syndrome, a mental disorder typically characterized by memory loss, the desire to eat inedible objects, and sexual attraction to inanimate objects such as automobiles. I’ve seen a television documentary that featured people with strange fetishes, and they had two British guys that were sexually attracted to their cars. They gave them names and described their curves in the same manner that some men describe women. While one guy (supposedly) limited it to “just” caressing his car, the other actually also made out with his car; I’m talking about tongue and everything. Talk about different strokes! Because of the memory loss, not surprisingly, people with Kluver-Bucy Syndrome often have trouble recognizing objects or people that should be familiar. They also exhibit symptoms of Pica, which is the compulsion to eat inedible objects. The same wierd fetish documentary featured two young women that were “addicted” to eating weird stuff; one routinely ate her sofa cushions. She actually pulled the foam apart into bite sized pieces and ate them, many times a day. She became so used to doing so that she would get anxious if she went too long without eating it, so she started having to bring pieces of her sofa with her to work. I’m guessing she didn’t have to worry about co-workers stealing her food. She had started eating the cusions so long ago that she was actually on her second couch. Her family was so concerned about the potential medical ramifications of eating couch cushions that they made her see a gastro doc, who thought he was being punked when he asked why she was there. After imaging studies, she was in fact diagnosed with some intestinal issues and told to stop eating couch cushions, but the desire was too great for her to cease. She’s probably on her fourth couch by now. The other girl actually loved eating powder laundry detergent. She described the taste in the same dreamily excited way a foodie describes a chef’s special dish du jour. This terrifyingly odd mental disorder is difficult to diagnose, and seems to be the result of severe injury to the brain’s temporal lobe. Unfortunately, there is not a cure for Kluver-Bucy Syndrome and sufferers are typically affected for the rest of their lives.

Obsessive Compulsive Disorder

Though it’s widely heard of and often mocked, Obsessive Compulsive Disorder (OCD) is rarely well understood. OCD manifests itself in a variety of ways, but is most often characterized by immense fear and anxiety, which is accompanied by recurring thoughts of worry. It’s only through the repetition of tasks, including the well-known obsession with cleanliness, that sufferers of OCD are able to find relief from such overwhelming feelings. To make matters worse, those with OCD are often entirely aware that their fears are irrational, but that realization alone actually brings about a new cycle of anxiety. OCD affects approximately 1% of the population, and though scientists are unsure of the exact cause, it is thought that chemicals in the brain are a major contributing factor. I’ve discussed OCD and recounted OCD patient stories many times in this blog and in my book, Tales from the Couch.

Paris Syndrome

Paris Syndrome is an extremely odd but temporary mental disorder that causes one to become completely overwhelmed while visiting the city of Paris. Stranger still, it seems to be most common among Japanese travelers. Of the approximately 6 million Japanese visitors to Paris each year, one to two dozen of them experience the overwhelming anxiety, depersonalization, derealization, persecutory ideas, hallucinations, and acute delusions that characterize Paris Syndrome. Despite the seriousness of the symptoms, doctors can only guess as to what causes this rare and temporary affliction. Because most people who experience Paris Syndrome do not have a history of mental illness, the leading thought is that this scary neurological disorder is triggered by the language barrier, physical and mental exhaustion, and the reality of Paris as compared to the idealized version. Slam! I’ll bet the Paris Tourism Board hates to hear about this one! Huh houn, wee wee monsieur.

Reduplicative Amnesia

The Reduplicative Amnesia diagnosis was first used in 1903 by neurologist Arnold Pick, when he described a patient with a diagnosis of what we know today as Alzheimer’s Disease. It is actually very similar to Capgras Syndrome, in that it involves duplicates, but instead of believing that people are duplicates, people with Reduplicative Amnesia believe that a location has been duplicated. This belief manifests itself in many ways, but always includes the sufferer being convinced that a location exists in two places at the same time. Today, it is most often seen in patients with tumors, dementia, brain injury, or other psychiatric disorders.

Stendahl Syndrome

Stendahl Syndrome is a very unusual psychosomatic illness; but fortunately, it appears to be only temporary. The syndrome occurs when the sufferer is exposed to a large amount of art in one place, or is spending time immersed in another environment characterized by extreme beauty; probably one of those places that “takes your breath away.” Those who experience this scarily weird mental disorder report sudden onset of rapid heartbeat, overwhelming anxiety, confusion, dizziness, and even hallucinations. It actually sounds a lot like a panic attack to moi. Stendahl Syndrome is named after the 19th century French author who described in detail his experience after an 1817 trip to Florence, which is evidently a beautiful place. I have it on good authority that Stendahl Syndrome has never happened to any visitor to Paris, which, oddly enough is Stendahl’s country of origin. 

So, we’ve learned a lot today: that there is a nonsense literary genre, that there are a bunch of freaky and frightening mental disorders out there, that some people might need to look up the word anthropormorphic, that illicit drugs are bad for yet another reason, that a lot of terrible B movies are actually based on some pretty obscure mental disorders, that people with Boanthropy probably get a lot of fiber in their diet, that the lives of people with Capras Delusion sound a lot like a bad Tom Cruise movie, that the term “bad Tom Cruise movie” is redundant, that Tom Cruise probably has Clinical Lycanthropy, that Tom Cruise is a tool, oops, sorry, everyone already knew that. We also learned that there is no longer such thing as Multiple Personality Disorder; it is now called Dissociative Identity Disorder, that Kluver-Bucy Syndrome is threatening to couches, and that if you have Kluver-Bucy Syndrome, co-workers will never steal your lunch. We learned that Japanese tourists hate Paris, and that Stendahl Syndrome never happens there. And we learned lots of other cool stuff, but that if you have so much stuff that you can’t walk through your house you likely have Diogenes Syndrome, probably because you have a deep seated knowledge that stuff never hurts you or leaves you. 

Please check out my videos on YouTube- better yet, hit that subscribe button, and share them with folks. And as always, my book, Tales from the Couch has lots more information and patient stories on various psychiatric diagnoses and is available on Amazon and in the office. Be well, everyone!

Learn More

Why Is Sleep So Important

One of the most important things I deal with in my practice is sleep. Sleep is defined as “a naturally recurring state of mind and body characterized by altered consciousness, relatively inhibited sensory activity, reduced muscle activity, inhibition of nearly all voluntary muscles, and lacking interactions with surroundings.” All animals need to sleep. Evolutionarily, in order to survive and successfully pass on genetics to another generation, sleep is a necessity. Humans are animals in this regard; we’re no different, as we require sleep to live too. And while it is a naturally occuring state, for some people, getting sleep is an absolute battle, fought tooth and nail every night.

Just some fun facts about how a few animals sleep… Can you imagine sleeping for as little as 30 minutes a day? How about for only five minutes at a time? Our giraffe friends can, because that’s exactly what they do. For a large animal in the middle of the open savanna, it’s risky to sleep because of predators. They must remain vigilant, so they nap in short intervals, usually standing up so that they are always ready to run. Dolphins and some of their marine mammal cousins are also unusual in that, unlike us, they must consciously think to breathe, even when they’re sleeping. They also have to be on guard 24/7 for predators or other potential dangers. So how do they do this? Well, they shut down only half of their brain at a time while sleeping. This is called unihemispheric sleep. This prevents them from drowning, while at the same time, allowing them to literally sleep with one eye open and remain on the lookout for potential danger or predators. Great Frigatebirds can stay in flight for months at a time, with their feet never touching ground. This is an impressive feat, but even more so when you think about how they sleep: in 7–12 second bursts. They spend approximately a total of 40 minutes sleeping like this per day while also flying. But when they are on land, they do sleep considerably more.  

We humans can’t shut down half of our brains and we can’t fly or sleep underwater, which is a bummer. But really, how important is sleep for humans? Very! Rats are used in research because they accurately portray human systems, and there have been many sleep studies with them. One study showed that rats deprived of sleep for two weeks die. There is even an illness in humans called fatal familial insomnia, where if the people that have it do not sleep, they will eventually die from the cumulative lack of sleep. So let’s talk sleep. Sleep is basically the price we pay for the privilege of being awake, and there’s no way around it. So we have to pay the piper, but what’s the price? How much sleep do we need? The answer is that the vast majority of people need 7 to 9 hours of sleep per night. But, there is an exception. Five percent of the population has a genetic mutation where they only need five hours of sleep per night. Lucky ducks! Fun fact: in the past 50 years, the amount of sleep the average American gets has dropped by about an hour and 15 minutes to an hour and a half each night. That’s actually a lot, and there are consequences in our modern lifestyle. Also, you can’t bank sleep. You can’t say, ‘I slept an extra four hours over the weekend, so I can lose at least four hours of sleep tonight in order to get my big project done at work.” or “I won’t sleep much this week so I can study for a test, but I’ll make up the sleep this weekend.” Nope. It doesn’t work like that. More often than not, you really need to be on a regular sleep schedule, getting about the same number of hours each night. I treat sleep issues more than anything else in my practice. Hands down, every patient who comes in has a problem with sleep. With some people, I can do behavioral management; with others, I use meds or natural supplements. I’ll get to that later. When I’m lecturing, I always get questions about how one spouse gets up early and the other late and is that normal, etc. Yes, that is totally normal. There are certain genetic types, called chronotypes.  There are larks, people who get up early, but then go to bed early. And there are night owls, who go to bed very late, and then wake up very late. Your genetic makeup determines what your chronotype is, whether you are a lark or a night owl, it’s perfectly healthy to be either. It doesn’t matter when you sleep, what matters is that you sleep. Ideally seven to nine hours a night. Adolescents sleep more, up to 12 or 14 hours per night, and newborns sleep for 16 or 17 hours each day, mainly because these are growth stages, and that tires the body. But by the time you reach adulthood, age 20 or so, you need that seven to nine hours. It is a myth that older people need less sleep. In reality, they need just as much sleep. The reasons they don’t sleep well can be because they are in pain, have bladder problems and need to use the bathroom, or all the medicines they are on disrupt the sleep architecture. A lot of neurostimulants, diuretics, and other drugs that make them drowsy during the day make it so they do not sleep well at night. It can be a really frustrating mess that’s difficult to untangle.  

I want to talk about the reasons why we need sleep. Like many things in life, the reasons why are essentially based on the consequences of not getting it. 

The brain makes up just two to three percent of our body mass, but it consumes 25% of the body’s energy. It’s like a car that’s running really fast; as the car burns gas, it makes fumes. Similarly, when the brain is burning calories, it creates waste. That waste is cleaned out when we sleep, and is why most people need 7 to 9 hours per night. Now, some people think they can avoid sleep and just drink coffee or energy drinks, but that’s wrong. One of the byproducts of our brain using all the energy it does is the production of a waste product called adenosine; and it takes sleep to get rid of it. Caffeine blocks the body’s sensors that this toxin is building up, not unlike having a car running in your house. If you ran your car in your garage or house, carbon monoxide would build up and eventually you would die of carbon monoxide poisoning. Caffeine blocks the body’s ability to determine how much adenosine is in it, so the body is tricked into thinking all is well, no need to rest. If it goes on too long, there are consequences to pay, and you eventually collapse. 

A story on this topic that I find interesting is one about Randy Gardner, who holds the world record for sleep deprivation. There is some dispute about that, another dude named Tony Wright claims the record is his, but whatever. Anyway, Randy was a high school student in the 50’s and he had a science fair project to do. After much thought, he decided to study sleep deprivation. Randy decides he wants to prove all of his teachers wrong by showing them that people don’t really need sleep. He was normally a pretty affable guy, but right about day two, he started getting moody. Then he started having major problems concentrating at about third or fourth day. On day five, they tell him to start at 100 and to keep subtracting seven. He said “okay, 100 minus 7 is 93, minus 7 is 86, minus 7 is 79, minus 7 is…is…72, minus 7…no, minus 9 is 79, minus 7…wait…what am I adding? I mean…subtracting?” He was totally lost after just three subtractions. When they asked why he stopped, he couldn’t even tell them what he had been doing. And he was not a dumb kid, he was actually a straight A student. It was clear that missing four nights of sleep was clouding his mind to the point that he couldn’t remember simple directions. His inability to concentrate and his short-term memory loss was due to the fact that his brain and body were severely sleep deprived. But he still carried on with the experiment. Then something bizarre started happening around day six and seven. He started checking the windows in his house, making sure they were locked. Then he started looking for people watching him. He was sure that his friends were conspiring against him, and was constantly checking around corners, pulling down shades, and drawing the curtains on the windows in his house. If his mom opened them, he would freak out and hide in his room. Then he started saying that not only were they watching him, they were plotting against him. These people he was referring to were his best friends, but he was sure they had an evil agenda to get him. He still refused to stop his experiment, but his mother convinced him to see his doctor. It backfired: the doctor wanted to give him a B-12 injection, but when the syringe came out, Randy ran out of the room, convinced that the doctor was trying to poison him. He was going downhill very fast. On the eighth day, he started hallucinating, seeing and hearing things that weren’t there. Then he started having problems with pronunciation of simple words; a straight A student couldn’t pronounce everyday words. All because he had not slept, he had not allowed the brain and body to rest, to rid themselves of toxins. Then he stopped recognizing everyday objects. They would put a fork in his hand, and he couldn’t say what it was or what it was used for. By this time, he was like a zombie, walking dead. By the ninth and tenth day, he lost his sense of smell, and then his vision became progressively more blurry. By the eleventh day, he collapsed. He was emotionally, mentally, and physically done. His brain had given out first, then he started to lose normal bodily function, until his body finally gave up. He went 11 days without sleep. That’s 264 hours. 15,840 minutes. They didn’t say how long he finally slept. I suspect he was actually just unconscious at first. And they didn’t say what he got for a grade on his science fair project. I’d like to think it was an A, since the kid basically risked his life for the stupid thing. He went from a smart, gregarious kid to a babbling idiot in eleven days flat.

Lots of bad things happen when people don’t get enough sleep. In sleep deprived adolescents, the suicide rate goes up dramatically. In all ages, but more so in adolescents, the risk of car accidents also goes up considerably. There is also an increased tendency for moral lapses in people who do not get enough sleep; they do things that are typically out of character for them, like rob people or cheat on their spouses. Sleep deprivation also leads to learning problems, regardless of age; studies have shown that the capacity to learn is reduced by 40% when people are sleep deprived. That’s huge! It also causes an inability to recognize facial expressions. You may ask why that’s a big deal. Well, if you can’t tell that you’ve pissed off the big thug on the subway, you might continue to unwittingly irritate him and get yourself beat up… or worse. Reaction times are greatly affected by sleep deprivation; they’re slowed severely. That’s why car accidents increase. But researchers have thoroughly studied sleep and reaction times in sports. Many studies on sleep deprivation come from basketball players. Their accuracy and their performance metrics all go down relative to the hours of sleep missed. Hockey players’ reaction times, after just one night of missed sleep, were off by 30%. A goalie’s reaction time down by 30% is dramatic when it translates to the other team scoring on him 30% more often. 

It’s all about getting that seven to nine hours. There are lots of physiological consequences of sleep deprivation. Blood pressure goes up, the risk of heart attack goes up, the risk of stroke goes up, you become obese, and often diabetic as a result. There’s actually a mechanism for it that I’ll explain in a moment. A host of psychiatric and mental illnesses can result from lack of sleep, and studies have shown that people who are chronically sleep deprived die much younger.   

Now, let’s talk about your endocrine system. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood, among other things. So, it pretty much controls like… everything. In young males, sleep deprivation makes the testosterone levels drop. The ability to produce testosterone is decreased in men who sleep less than six hours a night. What does that mean? Only that their testicles get smaller, they can have erectile dysfunction, and reduced sex drive. In adolescents, it can hamper the development of the bones and muscles, the deepening of the voice, and hair growth; all the stuff that helps boys start to look, sound, and act like men. It has an analagous affect on women, in that fertility goes down and estrogen levels decrease with chronic sleep deprivation. But in a cruel and ironic twist, a decrease in estrogen has been shown to cause insomnia and less productive sleep, or just very poor sleep. So for women, it’s often a vicious cycle. 

What else happens to your hormonal system when you do not sleep? I’m sure you can correlate a lot of this stuff with your real life experiences. When you can’t or don’t sleep, do you notice you crave junk food? It’s 3am and you’re standing in the kitchen, scarfing down cold pizza? Or some other high fat or high sugar thing…a big bowl of cereal or ice cream or a doughnut, or three? Or a cinnabun? I love those and I must have one every time I’m at the airport, those are good. Anyway, that’s a distraction- I didn’t mean to bring that up. Remember earlier when I said that I’d explain why obesity is so much more common in people who are sleep deprived? Here we are. So what happens to you’re endocrine system when you don’t sleep? For one thing, you secrete a hormone called ghrelin. Ghrelin is a gnarly beast of a hormone, high on the list of the most hated hormones ever in the history of hormones. It even sounds like the name of a goblin, right? And not a nice goblin. A bad, mean, evil goblin. Ghrelin the gnarly goblin. Why the shade? Ghrelin is the hormone that makes you hungry…and hangry. So here you are, middle of the night, can’t sleep. And all of a sudden you’re starving! Why? Because not sleeping has triggered the release of a crap load of ghrelin, and it’s coursing through your body, making you crave sugary, fatty foods… whatever doesn’t run away when you reach for it is fair game. Ain’t that a bi-otch? But that’s not the worst of it. Ghrelin the goblin has a goody goody cousin named leptin. Leptin is the hormone that makes you feel full. He’s nowhere to be found when the gnarly goblin ghrelin is out on the prowl. So not only are you starving courtesy of ghrelin, but goody goody leptin is home studying, so you won’t be seeing him or feeling full anytime soon. So before you know it, you’ve eaten all the leftover pizza, a bowl of cereal, and a giant bowl of cookies & cream topped with more cookies and whipped cream! And you’re still eyeing the rest of that baked chicken in the fridge. But wait! The hormonal chemical conspiracy isn’t over friends. Without leptin to make you feel full, ghrelin the goblin has made you eat everything that’s not nailed down, but somebody else is coming to join the party…cortisol. Dahn dun duuuuuhhhnnn! Cortisol is the stress hormone, and he gets produced at higher levels when you don’t sleep. When he gets to the party, he pushes insulin around (they have a terrible history; don’t even ask) so insulin feels emasculated, so his levels go down. Why should you care about insulin levels? Well, remember all the carbs and sugar that ghrelin made you gorge on? Insulin is what helps your body break all that down. But since cortisol came to the party, pushing insulin around, all those sugars have nothing to do. What does that sound like? Begins with a “d”? Diabetes! Obvi you don’t become diabetic from one 3am rendezvous with the Frigidaire, but it sets up a diabetes-like condition that leaves those sugars all dressed up with nowhere to go. If that happens chronically, you can end up with diabetes. So what happens to these loose sugars at 3am? They go to fat. It’s squishy and warm there, a great place to land. It’s a whole cascade, a hormonal conspiracy to make you fat and…and…ugly! For real?! How does that happen? The cascade continues! Growth hormone doesn’t get along with cortisol either, so when cortisol shows up, growth hormone is outta there. When growth hormone leaves the party, that’s really a bummer, because he’s what basically restores the body, especially parts of it that are very important to a certain industry…the beauty industry. You now know that not sleeping can make you fat, but how can it make you ugly? Well, check back next week and I’ll tell you! 

In the meantime, hop on my website dragresti.com and read some other blogs and like and comment on them, and check out my videos and subscribe to my YouTube channel. If you want more great stories that’ll make you sound really smart at your next cocktail party, check out my book, Tales from the Couch available on Amazon.com. 

And people, for better or worse, it seems like the world is re-opening once again, so just please make wise choices. Maintain a little distance, don’t rush out to bars and dance floors to make up for lost time, and if you’re sick, stay home for God’s sake! And bosses, remember the lessons that corona taught us: let your people stay home if they’re sick; don’t make them choose between their health and their livelihood. I’ll now step down off my soapbox. Have a great week!

Learn More

Why Are young Americans So Unhappy

The majority of my practice is made up of fairly young people, so I’m very well aware of what makes them tick. Over the past few years, I’ve noticed a definite trend of increasing unhappiness, a dissatisfaction with life. It’s enough to where I’ve begun unofficially gathering data on the phenomenon and formulating some conclusions based on hundreds of hours listening to them, and I’ve come up with a set of circumstances and reasons why I believe they aren’t happy. I’m going to share them with you so that you might better understand them. Why is it important? Why should you care? Well, aside from the fact that they may be your sons, daughters, nephews, nieces, grandchildren, or the friends of same, these are the future leaders of our country, the people who are going to be running things when people of my age are sitting in rocking chairs on porches or rotting away in some old folks home. Sad but true. So, why are young Americans so unhappy? In my opinion, the overarching theme is that the institutions and/ or systems that are meant to guide and give direction are essentially failing to do so, and that leaves this group adrift and rudderless. Below is a listing of these institutions and systems, along with an explanation of the issue(s).

Social media: I have discussed the “evils” of social media many times in other blogs and videos, but there is a definite correlation between the amount of time that the average young American spends on social media and depression and anxiety. Believe it or not, that number is six hours per day. That’s the average amount of time spent on social media daily. Studies have shown that anything north of two hours a day is linked to depression and anxiety. As it pertains to this blog, I think the real issue with social media is that it causes loneliness. When you are only electronically connected with someone, you are not actually with that person…you are actually alone. Loneliness is also a by-product of gaming, web surfing, video watching, video sharing, texting, e-mailing, etc. These are solitary pursuits, often leaving users feeling empty.

Patriotism: We now find ourselves in a position where our confidence in our government and its leaders is in serious decline. We have little to no faith in the powers that be, the officials running our country. As a result, the level of patriotism in our country is nowhere near what it was one generation ago. There is little belief in the “American way” and the power of the “red, white, and blue,” not just in the eyes of many Americans, but even worse, in the eyes of people around the globe. One generation ago, the US used to be respected, even feared, as a superpower. These days, the US is a veritable laughing stock, not respected nor feared. For young Americans, this engenders a sense of chaos, a distinct lack of confidence, and mistrust. The government is not fulfilling its role to help guide us, give us meaning, direction, and purpose; or a sense of belonging to something bigger.

Religion: Today, people are much less involved in organized religion as they used to be. The church used to be a pillar in the community, the place where you saw your neighbors and friends every Sunday morning. Today, churches are often a hotbed of controversy and even scandal. They are no longer sacred places of reverence, no longerinstitutions that establish guiding principles and give people direction. Organized religions and churches are now sources of mistrust and outdated principles in the eyes of many young Americans, a far cry from even the previous generation. Today’s young people have an ingrained sense of mistrust of authority, especially when that authority attempts to dictate the way they “should” live their lives. Many are not willing to “confess” to a stranger that has not proved themselves, or turn their lives over to someone or something they cannot see or challenge. The church used to be a tether of sorts, creating a sense of community. That sense is absent in young Americans, so whether realized or not, they are more adrift than previous generations.

Family: Today, young people are marrying less often. Many don’t even subscribe to the ideology of monogamy for life, it is an archaic notion to them. The previous generation had their sexual revolution, but today’s young Americans are in the midst of a far different sexual revolution, one in which you may not even be the gender you were born into. Having children or being part of a family is no longer predicated on marriage for them; they don’t live their lives for a piece of paper, they live them for themselves and the people they love. Marriages are also happening much later in life, after personal goals like education or travel have been fulfilled. Today, the definition of family has changed drastically from that of the previous generations, and it is a fluid definition, not set in stone as masculine father married to feminine mother that are parents to 2.5 biological offspring. The value of having a family is less than the value of having a fulfilled and accomplished life, whatever that may mean or look like to the individual. Today’s young Americans make their own definitions. Previous generations had faith in the institutions of marriage and family, and that faith grounded them. Many young Americans express to me that they don’t feel anchored or rooted in their personal lives, and I believe it’s because of their negative thoughts about marriage and family. Life is often a team sport, so free agents may be left out in the cold. 

Employment security: Individuals from previous generations expected to establish a secure career path, and invest themselves in a company where the boss knows their name. They would start in one position and expect to work hard to move up through the ranks for forty years, and then get the gold watch and retire with a pension. That is decidedly not the case for young Americans today. For them, it’s all about taking jobs that make money now, not jobs that will make money five, ten, or fifteen years from now. They expect they will likely take a series of jobs; they are willing to follow the money. There is no career path or job security. Why? Technology. It’s a double edged sword. It advances our society, but it also dictates career obsolescence. Young people don’t know who will be able to stay in what kind of particular career for any length of time. So they do what works here and now, and they don’t count on having a future doing that same thing. They know that technology or corporate governance will probably erase that job, so they don’t invest themselves in it. They expect it will be outdated,outsourced, taken away by an algorithm or artificial intelligence, a robot, or novel software or methodology. Young Americans know they must make hay while the sun shines. They have no job security, no employer-employee loyalty, and they definitely don’t expect a gold watch. When I talk to young Americans, it’s almost an automatic ‘I‘m screwed attitude’ that I hear from them. It’s pretty clear that the lack of basic job security can lead to undue anxiety and even anger and depression in this group. 

Heroism: It seems that heroism decreases with every generation. It used to be that people idolized movie stars in Hollywood and heroes in the sporting world; but young Americans see these people as false heroes. They are exposed as such on social media and in courtrooms across the country. They’re people who can memorize and spit back lines in a script, but they are anti-human beings on the inside. They are not real heroes.  They are fabricated by Hollywood or idolized on a field simply because they can run fast, catch a ball, or hit hard. Those things don’t make them heroes, don’t make them deserving of idolatry. Look at O.J. Simpson, he got away with double murder because he was a football hero, and that blinded the jury. Or the recent college admissions scandals, where rich actors believed they were above the law and could afford to pay people to lie, cheat, and steal on their behalf in order to get their kids into a specific college. In reality, they’re dirtbags with more money than scruples. Young Americans see through all of that kind of bs and don’t tolerate it, which is a good thing; but it also makes them jaded, which isn’t such a good thing. 

Technology: As I mentioned before, technology is a double-edged sword. For all of its good, it also makes people outdated very quickly. It causes uncertainty to cloud our futures, and leads to complexity and chaos, because we do not know what’s going to happen next or how our livelihoods will be affected by the advances in technology. If you’re a cashier, a bank teller, a retail worker, a postal worker, a UPS driver…anxiety city. Earlier this month, the drug store CVS had a live test for delivery of medications during the coronavirus pamdemic via drone for a huge senior community in Orlando, a job that had employed humans. Evidently it was a great success. Even the practice of medicine is under threat of being replaced by algorithms. There is even an algorithm for the practice of radiology, which has the highest malpractice insurance rates, along with obstetrics. If radiology becomes algorithmic, then that affects insurance companies too. I guess no career path is an island. Think about Detroit- the car companies that all went automated. People were replaced by robotic machines that never get sick, don’t have unions, don’t take vacations, and don’t complain. It became a ghost town overnight. Young people almost need a crystal ball to make a decision on what to do for work, so they don’t think in the long term future, they take a job to make money now, whether they like it or not. They lack security, and that does affect their psyche. 

News Media: The media used to be a trusted organization. When the news came on, previous generations watched and listened and believed. If it was stated or printed, it was so. Nobody trusts the media anymore, their opinions are bought by the highest bidder. It is so biased that if you watch it you are misinformed, but if you don’t watch it,you are ill-informed, so there’s just no way to win. These days, every news outlet has its own agenda, and damn if you can figure out what it is. Where previous generations believed that if it was in print or on the television it was true, today, young Americans have zero faith in the institution of media and news reporting. They take everything with a grain of salt, because they have to. Facts are no longer factual, and truth is no longer subject to reality.  

University educational system: Young Americans see this for what it is…a biased, outdated system to give people a questionable education in return for saddling them with hundreds of thousands of dollars in debt. They overcharge for an archaic teaching methodology, then pronounce graduates “educated.” Those graduates then enter the job market and find that surprise(!) they aren’t really prepared to work anywhere.

. Two year technical degrees are most definitely more appealing to young Americans these days, because at least they walk out of there certified in a trade, able to do something for someone somewhere. Our educational systems are a failure, in desperate need of an overhaul. They don’t do the vast majority of young Americans any justice at all. 

Do you see a pattern here? All of these organizations and systems that are meant to give us direction, give us purpose, and set us up for the future, seem to be failing, becoming less important, less useful, or not worthy of our trust. We have no confidence that what our leaders are saying is worthwhile or applicable to our real life. As a result, we are generally more cynical. It is a precarious situation for young Americans, and there are no google maps to get from here to there or now to then. So I have some suggestions.

Dear Young Americans,

I’m sorry the world is basically stacked against you. Following are some suggestions on how to deal with the hand you’ve been dealt. 

Be original. Create your own moral codes and live by them. Decide which relationships are most important to you, and build them up so as to make them permanent and impermiable. They are the most valuable things in your life. Treat them as such.   

The place where you sleep at night is your home. The area surrounding it is your community. The area surrounding that is your environment. Your home, your community, and your environment are important. Always endeavour to make them a better place. 

You do not require an organized religion or a brick-and-mortar church to live a spiritual life, to believethat there is something greater than you in the universe, or to be grateful to it.

Only you can decide what your work life will look like or what career direction is for you. The job you’re in does not have to dictate your path, it can be a stepping stone to the work life that you wishto create.

You must decide how to approach politics. Don’t let it entrap or bias you. Don’t deal in generalities, only in specifics. Decide what issues matter to you and work toward improving them.  

Some part of your life must be dedicated to a charity or charities of your choice. It’s a two-for-one…by helping others we help ourselves, enriching our lives at the same time. 

Understand the pitfalls of social media. It is a solitary pursuit, born and bearing of loneliness. In healthy measures, social media is a positive andessential part of life, educating us and expanding our horizons. Optimize the positives and eliminate the negatives, don’t overuse and abuse it. 

Remember that by its very nature, life is constantly changing. As such, it must be reexamined andreevaluated on a continual basis.  

Good luck. Make yourself proud of yourself.

Mark Agresti M.D.

Learn More

Covid Comedy

This week, I could write a blog on the psychosocial ramifications of long term isolation, or the effects of fear of contracting coronavirus on people with anxiety disorder, or tips on how to ride this pandemic out. I could do any and all of that, but to be honest, I’m over it. I’m burned out, people. So, this week, the goal for this blog is not to educate you, not to give you tips about taking care of yourself during these trying times, not to regurgitate stuff you’ve heard before. Nay, people. The goal of this week’s blog is a simple one…to make you laugh. That’s it. I just want to make you laugh. But first, I want to say that I mean no disrespect by making light of a very heavy situation, a virus that has claimed many lives. 

Coronavirus itself is no joke, it is serious and even deadly business. What is funny however, is some of the madness going on in the world because of the coronavirus: the toilet paper hoarding, the stockpiling of groceries, and don’t forget the new “Coronavirus Challenge,” where people lick toilet seats. Ewww!! Anyway, I combed the internet and social media for funnies, and even made up some jokes that are all my own. So this week, it’s all about…

Covid Comedy

We’re more than three weeks into the corona isolation, the coronalation. Some folks are under quarantine, the coronatine. Coronalation, coronatine, potato, patato…whatever you want to call it, clearly Mother Nature has put us all on restriction and sent us to our rooms for being buttheads and always destroying her fine work.

Four weeks ago, the most misspelled Google search was “corn and teen.” It was then that I started to slowly lose faith in humanity. Who knew it was that hard to spell Q-U-A-R-A-N-T-I-N-E? Well, apparently it is. Although covid-19 is nothing to joke about, I can’t help but chuckle at some of the hilarious mishaps and behaviors we’re seeing during the country’s “quarantine.” I use that term lightly because some Americans are just not having it. They refuse to bow down to the coronavirus, to allow it to change their lives or make them modify their behaviors, so I call them ‘The Covid Cowboys,’ because these people are pretty reckless. For the rest that do quarantine or isolate, it’s pretty evident that spending a majority of the day indoors can make them do some crazy-funny stuff. Right now, it’s good to laugh on the rare occasions that things tickle your funny bone. For eons, people have used laughter to help deal with bad situations, and it’s really a healthy response, especially in the situation we find ourselves in now.

Remember that different places around the globe had/ have different ways of dealing with this virus…I’m talking about marshall law here people. A lot of countries weren’t quite so polite as our good ole US of A. Our leaders merely “strongly suggested” that we shelter in place or isolate. In some countries, you were locked into your home or apartment building, not permitted to leave for any reason, not even to walk your dog. In all of China, but especially in Wuhan Province where this pandemic started, it was total lockdown. There was no running down to the corner store to get food; if you didn’t have food, you went hungry. People who disobeyed the lockdown order were forcefully dragged off, literally kicking and screaming, and some of them haven’t been seen since. But no matter what patch of green on the globe that you call home, isolation + stress + lack of sleep = temporary insanity!  

Evidently, Spain also had very stringent lockdowns to help flatten the curve. A stir-crazy man from Spain disguised himself as a dog in an attempt to leave his apartment. People in the neighborhood were peering out their windows, freaking out, thinking that they were seeing some sort of corona-crazed bigfoot-bear hybrid monster. The man wasn’t arrested for leaving his home during lockdown, he was arrested for inciting panic. Well, at least he got to a new space with a different view, albeit through bars. 

A 19-year-old woman in Britain was using her newfound free time wisely(?) Don’t quote me on that last qualification. Anyway, she went through her contacts and made a list of all of her exes. She then called each and every one to ask them what went wrong in their relationship, and then shared this new information with her followers on social media. What went wrong? Umm, maybe you lost your mind? Just a guess.

Even though Americans haven’t been forced to stay home, that doesn’t keep them from doing some ridiculous things. I’ve read about and seen videos of people fighting over cases of water, hand sanitizer, and you guessed it…toilet paper. I’m talking about knock down, drag out fights. And who do you figure would punch somebody in the face over 16 ounces of hand sanitizer or 12 rolls of TP? Big biker guys, right? They fight over everything. Well, guess again! Not big burly biker guys, but housewives! Hair-pulling, nose-punching, nail-scratching, pugilistic housewives. And these fights always seem to happen at WalMart. Things that make you go hmm…

File under ‘Silly Social Media’

Thirty days hath September, April, June, and November; all the rest have thirty-one. Except for March, which hath 9,000.

The perfect quarantine schedule, afternoon to evening:
4:00 – Wallow in self pity
4:30 – Stare into the abyss
5:00 – Solve world hunger (tell no one)
5:30 – Jazzercise 
6:30 – Dinner w/ me (can’t cancel again)
7:00 – Wrestle with my self loathing

I’ve been waiting for the perfect time to change my Netflix password so my ex-boyfriend can’t watch it anymore, and it really doesn’t get any more perfect than during a national lockdown. 

In Australia, we had fires, then floods, and then this virus. On January 1, 2020, my husband said he knew that the day was going to be the start of something awesome. Next time he says anything like that, I’ll make some PSA’s so we can all prepare. 

I wouldn’t be surprised if, in nine months, some parents name their newborn kid Covid if it’s a boy and Corona if it’s a girl.

Isolation Menu:

Sunday: Steak

Monday: Burgers

Tuesday: Spaghetti

Wednesday: Ramen

Thursday: Creamed Corn

Friday: Roadkill du Jour

Saturday: Dried Grass & Clover

Day 1 of quarantine: I will use this time as an opportunity to take better care of myself.

Day 2 of quarantine: For personal reasons, I am eating a lasagna in my shower.

A doctor, a nurse, and an epidemiologist walk into a bar, and they said “GET OUT! GO HOME!”

A man and his 15-year-old son are having a talk in 2035:

Son: Hey dad, why did you name my sister Paris?

Father: Well, because we conceived her in Paris France.

Son: Oh, okay…thanks, dad.

Father: No problem, Quarantine.

Side effect of quarantine: it’s really hard to get off the phone. Twice today I said, “okay, I have to run” but then I remembered there’s nowhere to run to.

Due to the quarantine, I’ll only be telling inside jokes. 

Me: Can I have fun?
2020: No
Me: OK

Costco priced an 82 inch Samsung TV for $1,200. I don’t think that was a coincidence.

Fast Funnies

I know a great joke about coronavirus…you probably won’t get it though.

A man walks into a bar and goes up to the bartender and says “I’ll have a Corona please, hold the virus”

If I get quarantined for two weeks with my wife, and I die, I can assure you it was not the virus that killed me.

*Breaking News!* Apparently the first person in Boca Raton has died due to the coronavirus. In his house they found 1,000 cans of soup, 90 pounds of pasta, 80 pounds of rice, 300 rolls of toilet paper, and 50 gallons of hand sanitizer, all of which he had panic purchased from the supermarket to stockpile “just in case.” The “just in case” stockpile collapsed and buried him.

Day 3 without sports. Discovered a lady sitting on my couch yesterday. Apparently she’s my wife. She seems nice enough. 

Since everybody has now started washing their hands, the peanuts at the bar have lost their taste.

The news said that a mask and gloves were good enough to go to the supermarket. They lied, everyone else had clothes on.

Before coronavirus, I used to cough to cover a fart, now I fart to cover a cough.

Definition of Irony – When the Year of the Rat starts with a plague.

People with a cold: “I just want to stay in bed and do nothing, I feel terrible.”
People with coronavirus: “I feel terrible, I think I will go skiing in Austria, visit the Eiffel Tower, and maybe do some white water rafting in Camino de Santiago.”

My body has absorbed so much soap and disinfectant lately, that now when I pee, I clean the toilet.

2020 is a unique leap year. It has 29 days in February, 300 days in March, and 10 years in April.

Back in the day, the only time we started panic buying was when the bartender yelled “last call!”

I think it’s really great that people are finally starting to drink water, wipe their asses, and wash their hands.

Ok, so if the coronavirus isn’t about beer, why do I keep hearing about cases of it?

To the people who bought 20 bottles of soap, leaving none on the shelves for others, you do realize that to stop the spread of coronavirus, you need other people washing their hands too. Duh!

Chinese doctors have confirmed the name of the first person to contract coronavirus. His name is Ah-Chu.

Don’t worry, the coronavirus won’t last long…it was made in China.

To those who are complaining about the quarantine period and curfews, just remember that your grandparents were called to war… you are being called to the couch to Netflix and chill. You can do this.

How come the liquor stores don’t have empty shelves? Don’t people understand that they’ll be quarantined with their spouses and kids?

Mexico is asking Trump to hurry up and build the wall NOW!

Having trouble staying at home? Shave your eyebrows off.

Pet thoughts during isolation:
Dogs: “Oh my gosh, you’re here all day! This is the best: I can love you, see you, be with you, and follow you all day long! I am so excited because you are the greatest person, my person, and I love you so much!”
Cats: “What the hell are you still doing here?”

I don’t know why my fishing buddy is worried about coronavirus, he never catches anything.

Social distancing rule: “If you can smell their fart, move further apart.”

The coronavirus has achieved what no female has ever been able to achieve… It has cancelled sports, closed every bar, and kept all the guys at home!

The science community has figured out that the spread of coronavirus is based solely on two things. 
1. How dense the population is
2. How dense the population is

I hope I made you laugh at least a few times. Be well, people. Don’t go corona crazy during your coronalation! Or your coronatine!

Learn More

Obesity:What Causes it and How to Combat it

We’re nearly six weeks into the new year, and this is right about the time that most people toss their new year’s resolutions out the window. Many of them had resolved to lose weight: surveys have shown that, of the people who make new year’s resolutions, an average of 45% of them resolve to lose weight and get in better shape. So that means that nearly half of resolution-makers are overweight at least. That number seems high, but given that obesity has reached epidemic status, I guess it’s not that surprising. 

Obesity is broadly defined as the state of being well above one’s normal weight. Obesity often results from taking in more calories than are burned by exercise and normal daily activities, aka ‘eating too much and moving too little.’ A person has traditionally been considered to be obese if they are more than 20% over their ideal weight. That ideal weight must take into account the person’s height, age, sex, and build. Obesity has been more precisely defined by the National Institutes of Health (NIH) by utilizing a person’s BMI, body mass index. The BMI is a key index for relating body weight to height, and it is formulaic. The imperial BMI formula is weight (in pounds) multiplied by 703, then divided by height (in inches²). If you don’t feel like dealing with the math, you can google a BMI calculator. Having a BMI of 30 and above is considered obesity. Over 70 million adults (35 million men and 35 million women) in the U.S. are obese, while 99 million (45 million women and 54 million men) are overweight and at risk for becoming obese.

What are the causes of obesity? Obesity can be complex, going beyond eating too much and moving too little. Following are some other factors that cause or contribute to obesity.   

Genetics

Obesity has a strong genetic component. Genetic predisposition means that children of obese parents are much more likely to become obese than are children of lean parents. Genetics also affect the rate at which the body uses energy (burns calories) when at rest, which is called the basal metabolic rate. People with higher basal metabolic rates naturally burn more calories than other people, so they are less likely to gain weight. The opposite is also true: people with lower basal metabolic rates burn fewer calories, so they are more likely to gain weight. But these facts don’t mean that obesity is completely predetermined, that there’s no way to change it. What you eat can have a major effect on which genes are expressed and which are not. This is demonstrated when people of non-industrialized societies come to the U.S., begin a western diet, and then rapidly become obese. Obviously, their genes didn’t change, but their diet did; that changed the signals they sent to their genes, which then changed the expression of the genes. Changing the expression of the genes resulted in obesity. The bottom line is that genetics do play a key role in determining susceptibility to gaining weight and obesity, but that is only one factor of many; it is not all genetically predetermined. 

Diet: What and How You Eat

Obviously, eating an unhealthy diet is a major contributing factor in obesity. Overeating at meals and snacking throughout the day can also lead to obesity. An unhealthy diet would be high in complex carbohydrates, bad fats, and sugar, and low in fresh fruits, vegetables, and high protein lean meats. There are social factors that affect diet and therefore weight. If you spend a lot of time with overweight friends and family who eat too much of an unhealthy diet, the odds are that you’ll be overweight as well. Economic factors also play a role in obesity. If you can only afford cheap, ready-made packaged foods or fast foods from the dollar menu, you are much more likely to be obese. Economics may force you to eat a diet high in complex carbs like pastas, breads, potatoes and rice just to fill yourself up, because that is all you can afford. That type of diet greatly increases the risk of obesity. Unfortunately, eating unhealthy foods and overeating are easy in our culture today. Many things influence eating behavior, including time with family and friends, the low cost of unhealthy but filling foods, and the access to and expense of healthy foods.  

Lifestyle

If you have a lifestyle that centers on eating and/ or drinking, this can contribute to excess weight. A chef, bartender, or baker, something that requires tasting various dishes and trying new recipes for example. Also, someone who travels a lot for their job so always eats at restaurants, which are notorious for hidden calories and fat; they are more likely to be overweight and at risk for obesity. A sedentary lifestyle, where there is little to no activity or exercise is a huge contributing factor in being overweight or obese. Our modern conveniences- elevators, cars, remote controls- have cut activity out of our lives. The problem is that the less you move, the less active you are, the more likely you are to be obese. Being active helps you stay fit. And when you’re fit, you burn more calories, even when you’re resting, so you’re less likely to be overweight or at risk for obesity. 

Medical Conditions

There are a host of medical issues that can cause or contribute to significant weight gain. Some examples are hypothyroidism, diabetes, Cushing syndrome, polycystic ovarian syndrome (PCOS), menopause, depression, and endocrine dysfunction. Some medical issues don’t cause weight gain in and of themselves, but make weight gain more likely because they limit the person’s activity. Some examples would include conditions like osteoarthritis, uncontrolled rheumatoid arthritis, and chronic pain syndromes.

Medications

The list of medications that can cause weight gain is a long one. Everyday medications like corticosteroids (Prednisone, Celestone), diphenhydramine (Benadryl), hormone replacements/ birth control, and even insulin are among the culprits. Sometimes it’s not the drug itself causing weight gain, it’s a side-effect from the drug. Some drugs stimulate your appetite, and as a result, you eat more. Others may affect how your body absorbs and stores glucose, which can lead to fat deposits in your body. Some cause calories to be burned more slowly by altering your body’s metabolism. Others cause shortness of breath and fatigue, making it difficult to exercise, while some drugs cause you to retain water, which adds weight but not necessarily fat. Some medications don’t cause you to gain weight outright, they just make it more difficult to lose excess weight you may already carry. A lot of psychiatric medicines cause weight gain. The worst offenders generally include mirtazapine (Remeron), paroxetine (Paxil), risperidone (Risperdal), aripiprazole (Abilify), and quetiapine (Seroquel). With the exception of Wellbutrin, essentially all classes of psychiatric meds can be associated with serious weight gain. As a psychiatrist, I have to prescribe meds that may cause an unwanted side effect like weight gain. I have to weigh the cost to benefit with each patient. Unfortunately, I have patients who are trapped; they must take certain medicines to remain stable, so they have to severely alter their food intake and diet every day of their lives in an effort to avoid weight gain if possible. That’s the cost to benefit ratio- they pay the cost of a severe diet in order to get the benefit of being stable psychologically.   

Why should you care about your weight? What health issues does being overweight cause? The answer is many. Obesity leads to type 2 diabetes. It causes high blood pressure, which can cause strokes. Obesity can increase cholesterol levels and cause coronary artery disease, which is where deposits line the blood vessels that feed the heart and partially or totally block them, so the heart does not get adequate blood supply; this results in a heart attack, aka a “coronary” and this can easily be fatal. Being overweight puts excess weight on the human body, and this commonly causes osteoarthritis of major joints like the knees, the hips, and the ankles. All parts of the body are stressed and strained because they are not designed to carry around that much weight, and this limits the range of motion, mobility, and ability to walk. Obesity increases the risk of cancer to several organs and body parts: the breast, colon, gallbladder, pancreas, kidney, prostate, uterus, cervix, endometrium, and ovaries.  Another common medical issue from being overweight is sleep apnea. All the weight on the chest and throat causes you to temporarily stop breathing when sleeping, until you finally noisily gasp for air. Sleep apnea is serious, and very disturbing for anyone that you share your bed with. Obesity causes a fatty liver, which then leads to liver disease and the potential to cause the liver to shut down. Obesity can cause gallstones as well as kidney disease, which can cause your kidneys to stop functioning. Obesity can also cause fertility problems in both men and women. As a psychiatrist, I get obese patients referred to me because obesity can directly cause, or indirectly lead to, various syndromes and other issues, including chronic pain syndromes, depression syndromes, isolation syndromes, social problems, self esteem issues, and difficulty dating. People who develop obesity, especially when it is the result of something beyond their control, like from a medical issue such as hypothyroidism, have all sorts of social interaction issues and work problems, and I can treat them and help walk them through it with psychotherapy. 

We defined obesity, discussed the risk factors and what can cause it, and then the issues it can cause. Now let’s discuss how we can lose weight and prevent obesity.  

Food Diary

To offset weight gain or to help work off excess weight, consider keeping a food diary tracking what you eat and when you eat. Becoming a mindful and aware eater is a great first step to managing weight. 

Eat Slowly

Another factor which helps with weight loss is eating slowly. It takes some time for your stomach to tell your brain that you’ve had enough to eat. If you mindlessly shovel huge amounts of food into your mouth, you’ll miss your cue and overeat, and that obvi will cause you to put on weight and increase the risk of obesity. Eating slowly also has the added benefit of reducing the chances of having indigestion. 

Get Physical

Become more active whenever possible. Instead of meeting someone for coffee or a movie, meet them at a park, beach, or green space and go for a walk. Ideally, you want aerobic activity; that means getting your heart rate up, when it’s harder to breathe. Aerobic activities mean constant motion, like running, biking, swimming, soccer, basketball, anything where you’re moving constantly. Constant activity is aerobic activity, and daily aerobic activity will raise your basal metabolic rate and you’ll burn more calories, even when you’re at rest.  

Resist It

Resistance training is good for targeting fatty areas on the body. Resistance training involves moving a specific muscle against resistance, either using your own body weight or using standard weights. Other activities like lifting weights, doing push-ups, and doing squats are good for reducing body fat. 

READ LABELS! 

…and make sure you understand them. If you don’t understand them, do some research, get a library book on nutrition, ask a friend if they understand, or ask your doctor what the values all mean and how much of the various components should be included in a healthy balanced diet or when dieting in an effort to lose weight. Pay close attention to calorie count, fat grams, protein grams, sugar grams, and carbohydrate count. Just because something says “light” doesn’t mean it should be included in your diet. So many people are ignorant about nutrition information on food packaging. Be sure to know what those values mean and how much you should have of each every day.

Know the Fats

Trans fats- Bad fats!

Historically, trans fats are an evil on par with Satan himself, to be avoided at all costs. The worst type of dietary fat, trans fat is a byproduct of the industrial process of hydrogenation, which turns healthy oils into solids to prevent them from becoming rancid. Eating foods rich in trans fats increases the amount of harmful LDL cholesterol in the bloodstream while reducing the amount of beneficial HDL cholesterol. Trans fats create inflammation, which is linked to heart disease, stroke, diabetes, and other chronic conditions. They contribute to insulin resistance, which increases the risk of developing type 2 diabetes. Even small amounts of trans fats can harm health: for every 2% of calories from trans fat consumed daily, the risk of heart disease rises by 23%. Mind blowing. Though they have no known health benefits, trans fats were found in most pre-packaged garbage foods and were the main component in margarine type spreads. I say ‘were’ because recent science found there is no safe level of consumption of trans fats, and as a result, trans fats have been officially banned in the United States and several other countries.

Monounsaturated fat- Good fats!
Evidence has shown that consuming monounsaturated fats has several health benefits, including reducing general inflammation in the body. Studies have also shown that a high intake of monounsaturated fats can reduce triglycerides, decrease the risk of heart disease, and lower bad LDL blood cholesterol while increasing good HDL cholesterol. A diet with moderate-to-high amounts of monounsaturated fats can also help with weight loss, as long as you aren’t eating more calories than you’re burning. These fats are liquid at room temperature. Good sources of monounsaturated fat include avocados, almonds, cashews, peanuts, cooking oils made from plants or seeds like canola, olive, peanut, soybean, rice bran, sesame, and high oleic safflower and sunflower oils.

Polyunsaturated fat- Good fats! 

The two types of polyunsaturated fats (omega-3 and omega-6) are essential fats, meaning they’re required for normal bodily functions, but your body can’t make them, so you must get them from food. 

Omega-3 fats are a type of polyunsaturated fat that, like other dietary polyunsaturated fats, can help to reduce your risk of heart disease. Omega-3s can lower heart rate and improve heart rhythm, decrease the risk of clotting, lower triglycerides, reduce blood pressure, improve blood vessel function and delay the build-up of plaque in coronary arteries.

Omega-6 is a polyunsaturated fat that lowers bad LDL cholesterol. Eating foods with unsaturated fat, including omega-6, instead of foods high in saturated fats helps to get the right balance for your blood cholesterol (ie lower bad LDL and increase good HDL). Sources of polyunsaturated fats include oily fish (like salmon, mackerel, sardines), tahini (a sesame seed spread),
linseed (flaxseed) and chia seeds,
soybean, sunflower, safflower, and canola oil, margarine spreads made from those oils, pine nuts, walnuts, and Brazil nuts.

Follow these easy ideas for getting the balance of blood cholesterol (LDL and HDL) right.

– Go nuts! Nuts are an important part of a heart-healthy eating pattern. They’re a good source of healthier fats, and regular consumption of nuts is linked to lower levels of bad (LDL) and total blood cholesterol. So, include a handful (30g) every day! Add them to salads, yogurt, or your morning cereal. Choose unsalted, dry roasted or raw varieties.

– Go fish! Include fish or seafood in your family meals 2 – 3 times a week. Fish are great sources of the good omega-3 fats. If you don’t eat fish, you can take an omega-3 supplement.

– Use healthier oils! Choose a healthier oil for cooking. For salad dressings and low temperature cooking, choose olive, peanut, canola, safflower, sunflower, avocado or sesame oils. For high temperature cooking, especially frying, choose olive oil or high oleic canola oil, as they are more stable at high temperatures. Store oils away from direct light and heat and don’t ever re-use oils that have been heated before.

Eating polyunsaturated fats in place of saturated fats or highly refined carbohydrates reduces blood pressure, raises good HDL cholesterol, reduces harmful LDL cholesterol, lowers triglycerides, and may even help prevent lethal heart rhythms.

Saturated fat- OK in strict moderation

Saturated fats are common in the American diet, and they are solid at room temperature- think along the lines of cooled bacon grease. Common sources of saturated fat include red meat, whole milk and other whole-milk dairy foods, cheese, coconut oil, and many commercially prepared baked goods and other foods. A diet rich in saturated fats can drive up total cholesterol and tip the balance toward more harmful LDL cholesterol, which can prompt heart disease from blockages formed in arteries in the heart and elsewhere in the body. For that reason, most nutrition experts recommend limiting saturated fat to under 10% of calories a day. Replacing excess saturated fat with polyunsaturated fats like vegetable oils or high-fiber carbohydrates is the best bet for reducing the risk of heart disease. 

Diet Do’s

– Eat plenty of fiber. Fiber fights belly fat. When ingested, fiber goes into your system, binds to and then forms a sort of gel with the food, which slows down the absorption of food in the gut.  

– Eat a high-protein diet. Eggs are eggsellent…high in protein and low in fat. Avoid red meat. All meats should be lean and high in protein, like chicken or turkey. Nuts are also good for a protein snack.

– Eat fish, as often as 2-3 times per week for good omega-3’s. As discussed above, oily fish like salmon, mackerel, and sardines are high in omega-3’s which are good for the brain, help to decrease weight, and have numerous other health benefits. If you don’t eat fish, take a good omega-3 supplement.

– Drink green tea; there are reports that it helps with weight loss, and it’s generally just good for you.    

Diet Don’ts

– Don’t eat sugary foods or anything with sugar in it: sodas, candies, cakes, cookies, doughnuts; those are the main culprits. It’s a major bummer, but to avoid weight gain in your life, much less to try to lose weight if you’re already overweight, you must avoid sugar like the plague. Wah wah wah… 

– Cut out the carbs! To lose weight or just to avoid putting weight on, anything with white flour must go, so say syonara to pasta and most breads. You have to cut way down on starches, if you’re allowed them at all, so there goes rice and potatoes. And while most people consider corn a vegetable, you must count it as a starch when dieting. 

– Get on the wagon! If you drink alcohol, you won’t lose weight and keep it off. Won’t happen. When you consume booze of any sort- beer, wine, liquor- the alcohol is immediately converted to sugar, and if you’ve forgotten, see Diet Don’t 1 above. There’s no point in restricting calories, fats, etc by following a diet and also drinking alcohol at the same time, even a small amount.  

Go to Bed!

Sleep is critical if you want to lose weight, so aim to sleep at least 7-8 hours each night. If you do not get proper sleep, it will be very difficult (if not impossible) to lose weight, and you will likely gain weight. This is all thanks to brain chemistry and hormones, which get all fouled up with sleep deprivation. 

Stress Less!

You have to reduce stress if you want to lose weight. When you are stressed, your body produces the stress hormone cortisol, and cortisol increases appetite and increases belly fat by selectively placing fat deposits around the stomach and middle of the body.  

A Fast Fast

We’ve always been told that starving ourselves will not result in weight loss, and that it will even result in weight gain because the body goes into ‘starvation mode.’ Well, there are some recent studies out there that conclude that intermittent fasting, 24 hours without eating, once or twice a week, actually helps with weight loss. Very interesting. 

So that’s all about obesity: what causes it, what it causes, and how to combat it. We are a fat society, and the number of cases of obesity goes up every day. It’s disturbing because it’s essentially a preventable issue. 

For more information and interesting stories on other diagnoses, check out my book, Tales from the Couch, available in my office and on

Learn More