Drugs and the Brain | National Institute on Drug Abuse

Drugs and the Brain | National Institute on Drug Abuse

Nice. Please, Please check this out! Just an excellent discussion on how your brain works and why addictions are diseases and not about identity, character flaw, will power etc., etc., etc. Addictions are mental illnesses that should be treated by psychiatrists. It's your brain stupid!

Get over it!

This last month President Obama stated that we Americans need to get over the stigma of mental illness. Since then, there has been a shooting here in Santa Monica, right down the street from my office at Santa Monica College.

As a psychiatrist, I’m with the Pres on this. Life is hard but it shouldn't be that hard. If it is, there might be a mental issue that is affecting you and is easy to treat.

Often I see patients with a constellation of symptoms like poor sleep or nervousness or feeling stuck in some ground hog day mode. People think it's crazy;  no matter what they do, they are not performing at work or school or meeting realistic goals. I do very little of CRAZY. Seriously.

If your heart was skipping a beat you might notice headache, light headiness and feeling out of breath. Your doctor might tell to you to start an anti-arrhythmic drug to restore a normal heart beat. Your brain is no different. The medications I use restore normal brain functions, which are normal thoughts, emotions and behaviors. There are no artificial states. All medications work, it’s a matter of finding something that works and has no side effects for you.

Medications just alleviate symptoms. Once you can sleep, think and stop crying, I then get you involved in psychotherapy whether it’s with me or a therapist to learn better coping skills. The skills you learned 10 years ago might not be working now. So we get new skills. It’s always about the skills, not the meds.

So get real, get a grip and get WELL.

Intervention Everyone?

Watching celebrities on T.V. being confronted by involved family and friends in staged interventions makes for great theater. Watching these people detox in front of our eyes is gratifying; they have f.+++ed up lives too. We rejoice and feel better when they at the end are clean and sober. Their redemption is our salvation, we are all well again.

The reality is only about 40,000 people in the U.S. die from drug overdose each year. This includes not only deaths from the use of legal or illegal drugs but also poisoning from medically prescribed drugs. If we subtract these accidental poisonings, the figure is lower.

In the same year, 31,000 people died from suicide, plain and simple; no exceptions. Why isn't anyone doing suicide interventions on T.V.? Why isn't anyone talking about more people dying every year from suicide than routine drug overdose? Don't get me wrong, drugs are a serious problem. Suicide from depression is a serious problem.

The symptoms of Major Depressive disorder are:                

         -Sadness
         -Loss of interest or pleasure in usual activities
         -Changes in weight, up or down
         -Sleeping, under or over 8 hours
         -Restlessness or slowness
         -Fatigue
         -Feeling worthless, hopeless or guilty
         -Poor concentration
         -Thoughts of death or suicide

I've listed some of the symptoms above in red because most people who have no clue about anything else, can recognize these symptoms. While patients are in my waiting room, before I've even seen them, I can make the diagnosis by just noting these physical observations. Even my dog (a Chug) jumps on my bed when I'm over sleeping; she notices the changes in my behavior. If you notice these symptoms in any person you know and these symptoms have gone on for over 2 weeks, do an intervention. Get these people to their regular medical doctor ASAP. Most primary doctors can start treatment and make other arrangements that might be necessary. Yes, Major Depressive disorder is a medical illness that can be treated.

I'm sure you've recently heard to look for other symptoms of depression and suicidal intent like making a will, making a plan for suicide, etc, but come on, are you really going to ask your loved one "do you feel suicidal?" No, our own shame and horror keeps us from asking. God forbid, if they say yes. Focus on the above observable behaviors and behavioral isolation. This keeps our thoughts and conclusions out of the mix. It's not so personal but you've saved a life.

Look around you folks, think intervention. Suicide just shouldn't have to happen.

National Suicide Prevention Lifeline 1-800-273-TALK (8255)

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Soroya Bacchus M.D. specializes in all aspects of psychiatry, geriatric psychiatry and addiction medicine.

310-829-4640

2730 Wilshire Blvd., Suite 660

Santa Monica, CA 90403



What is Psychosomatic Medicine?

Recently a doctor friend of mine asked me, "What is psychosomatic medicine?" When my answer was more vague than concrete, I realized clarification was in order.

Psychosomatic Medicine is a subspecialty of psychiatry. The American Board of Psychiatry and Neurology gives the following definition:

Subspecialization in the diagnosis and treatment of psychiatric disorders and symptoms in complex medically ill patients. This subspecialty includes treatment of patients with acute or chronic medical, neurological, obstetrical or surgical illness in which psychiatric illness is affecting their medical care and/or quality of life such as HIV infection, organ transplantation, heart disease, renal failure, cancer, stroke, traumatic brain injury, high risk pregnancy and COPD, among others. Patients also may be those who have a psychiatric disorder that is the direct consequence of a primary medical condition, or somatoform disorder or psychological factors affecting a general medical condition. Psychiatrists specializing in Psychosomatic Medicine provide consultation-liaison service in general medical hospitals, attend on medical psychiatry inpatient units, and provide collaborative care in primary care and other outpatient settings

  
I glazed over just trying to type this out. In a nutshell it's medical psychiatry. It's understanding and practicing a healthy mind, healthy environment and healthy personality mean physical health, mental health and well being. It is a holistic concept of disease management leading to mind and body wellness. I literally assess the psychological, neurological, endocrine and immune status of the individual. I assess the medical disease status of the individual. I understand personality, genetic and environmental factors that affect homeostasis or wellness. I evaluate and can improve patient function mentally and physically using evidence based medical treatment and psychotherapy techniques. The approach is integrative, where the bio, medical, psycho and social aspects of wellness are considered. Psychosomatic medicine is the new field of integrative psychiatry.

I spend most of my time with the above evaluations particularly in chronic pain management and addiction medicine. I am able to improve mental function and outcomes in the setting of medical complications such as drug withdrawal and detoxification. My treatments are aimed at achieving wellness without relapse. I minimize polypharmacy and lifelong medication use. Polypharmacy and lifelong medication is antithetical to the definition of psychosomatic medicine.

I know this definition seems long. One of my teenage patients said just call yourself an uber psychiatrist. I think I like that!

Announcing Online Video Sessions!

PSYCHIATRIC TREATMENT FROM YOUR OWN COUCH WITH ONLINE VIDEO SESSIONS.

 

 

All you need is your computer with an internet connection to get the same psychiatric treatment as an office visit. Logging into my secure website for psychiatric care as a new or existing patient is easy. Most medications including those used for substance abuse and dependency can be prescribed through your local pharmacy. Online psychotherapy is also available. 

 Please contact us if you have further questions. I am excited about offering this new service! I look forward to our video encounters.

Soroya Bacchus M.D. specializes in all aspects of psychiatry, geriatric psychiatry and addiction medicine.

310-829-4640

2730 Wilshire Blvd., Suite 660

Santa Monica, CA 90403



Narcotic Abuse, Dependence and Treatment

Currently in the United States, 7 million people are addicted or physically dependent to some form of opiate or prescription pain killer. Substance abuse disorders are at epidemic proportions. In my practice, I have seen many patients suffer with various addictions and/or other mental illnesses. Often these disorders are not adequately treated at rehabilitation and sober living programs where you can spend thousands of dollars to get well for 30 days; only to leave and relapse. Not only is this a waste of time and money but the experience of more failure leads to depression and anxiety aggravating more substance abuse.

A recent study, The National Center of Addiction and Substance Abuse at Colombia University, highlights the lack of care that most American’s who seek this treatment experience. It’s not enough to detox, treatment should focus on relapse prevention. Usually this should be done in the context of an outpatient office or clinic where patients not only learn to function in their environment but also thrive. Leaving a sober living in Malibu and going back home with a few skills learned over 30 days, almost always ends in relapse.

In my office as a psychiatrist, I am able to address all aspects of substance abuse including detox as well as managing other problems like anxiety, depression, mood disorders or other mental illnesses which cause people to use drugs in the first place. It is a rare person who uses and abuses narcotics in a vacuum. Most people who are suffering dependency issues are usually drug abusing in an attempt to self medicate these underlying disorders. Detoxification from all substances is usually the starting point. If there has been a history of relapse in the past, maintenance treatment is often discussed. These highly individualized treatment plans include Suboxone/buprenorphine to achieve full functioning in all aspects of your life. Usually when this goal has been attained, further sobriety and prevention of relapse can continue where medications like Vivitrol/naltrexone injectable and psychosocial support, including psychotherapy, are arranged. An essential focus of the treatment plan at this point is also treating any underlying illnesses like depression or anxiety and any debilitating symptoms like insomnia, pain, restlessness or difficulty with attention. Most rehabilitation centers or physicians who do this kind of treatment are unable to provide all these aspects of care.

Setting an appointment is easy where the initial evaluation is an hour long with weekly treatment thereafter for the first 30 days. Other collateral treatment modalities are utilized including psychotherapy, drug testing, supportive groups, meditation, yoga, or anything else that promotes your wellness. Arrangements with other health care providers and medication assistance is usually for a period of 6 months or more with continued monthly psychiatric visits. In addition to saving money, patients can get well in the quickest and easiest way possible.

If you're suffering with narcotic dependency, know that there is help that is effective and simple. You are not a drug addict. Addiction is treatable.

Drugs, Alcohol and Blood?

I think the Twilight movies and cast of characters are kind of dumb. They are an interesting take on vampirism, being addicted to blood. I won't even get into the psycho-sexual aspects that make these movies popular but as an addiction specialist, I started to think, how would I detox a vampire from blood? Slow taper? Placebo blood type? Blood Suckers Anonymous meetings-1 less human at a time??

For my human patients, there are a lot of simple choices. Psychiatrists are best able to medically detox, stabilize and provide the psychosocial treatment and support necessary to achieve sobriety and prevent relapse. 8.9 million adults in 2009 were either chemically abusing or dependent. That's a whole lot of suffering for something that is fairly easy to treat. Below, I have listed treatments that I use, that are highly effective.

Alcohol--I use tranquilizers/benzodiazepines to detox and prevent withdrawal. Sometimes, I have to add anti-seizure medications or mood stabilizers if withdrawal is complicated. After detox, I stabilize sobriety with naltrexone pills or the new FDA approved Vivitrol injection. Generally the medication regimen is simple and short term. Campral/acamprosate during FDA trials was seen to be effective for alcohol sobriety maintenance therapy. However, the recent COMBINE study found acamprosate no better than placebo. I have found Antabuse/disulfiram helpful and do prescribe this as well.

Opiates--For office based treatment, Buprenorphine is the easiest and quickest way to sobriety and maintenance with minimal to NO withdrawal symptoms--seriously. I use this strategy for all opiate detox including methadone, which a lot of my pain patients take. Tapering off this medication, within 7-10 days or over 30 days can be easily achieved. Using other medications to prevent rebound pain, insomnia or depression is also something I can add that is different from other addiction specialists. All medications can usually wind down within 8 weeks of treatment. This new standard of less medication to achieve more health is my philosophy of mental health overall. Vivitrol injections used monthly after detox prevents relapse: yes PREVENTS. If there is a history of relapses, I maintain patients on buprenorphine to prevent further relapses. Safe, easy daily maintenance is ALWAYS better than relapsing and is EVIDENCED BASED FACT. I don't care what anybody else tells you. Tapering off when you're functional and well, is NOT the big deal everyone makes it out to be.

Stimulants--Really easy to detox from. The real problem here is the crashing mood after detox. I'm able to use mood stabilizers combined with antidepressants like Bupropion, Amoxetine and Modafinil, where patients are comfortable and functional without the white knuckles. These medications also help in preventing relapse.

Tranquilizers, Sedatives and Hypnotics--Taper strategy combined with medications to allow patients to sleep and stay comfortable during detox and to regain and maintain function.

Cigarettes--Chantix, Wellbutrin, e-cigarettes and nicotine patches or nasal spray are helpful. Cognitive Behavioral Therapy with support is the gold standard. Most of my patients have been able to stop within a few months. I often use other psychotropic medications aimed at symptom relief.

Caffeine--Yes, this is a drug I've often seen abused. If you're slamming energy drinks or coffee, wean off. Caffeine should be enjoyed like alcohol, occasionally, a few times a week. Caffeine is highly metabolic and is a major cause of anxiety that complicates detoxification of other drugs. With decaf coffee, you can get the lift without the physical effects. Placebo coffee is psychosomatic medicine at it's best and is what I do.

Now detoxing from blood...um mm. Oh I know, blood thinners! Call it aversion therapy for vampires.

It's time...

Mental disorders are characterized by abnormal thoughts, emotions and behaviors. Last year 36,000 people died from drug overdoses associated with obsessive thoughts and impulsive behaviors. Last year 36,000 people died from suicide associated with depression and other emotional disorders. Last year about 20,000 people died from gunshot wounds associated with emotional disorders and impulsive behaviors. That's 100,000 people who died from treatable and preventable causes. It's time to talk about gun control laws and mental health for everyone. Sandy Hook is in my prayers. Who will it be the next time?

Common Drug Interactions You Don't Know About

Just a quick blog about some common drug interactions you probably don't think about.

Caffeine and Psuedoephedrine: With hay-fever season here in California, short term nasal decongestants are a way of life at this time of the year. Mixed with lots of caffeine from gallons of ice tea with the hot weather, it's easy to become wired and not even recognize it. Caffeine and sudafed potentiate each other. If you do need to use nasal decongestants, use for the short term and limit your caffeine so you can sleep and not become some wired maniac.

Melatonin with Tramadol or Antidepressants: I see this all the time; people taking over the counter melatonin for sleep with their antidepressants or Ultram. These drugs mixed together in any combination can cause a life threatening illness called serotonin syndrome. It is a very common reason why I don't see people responding to their antidepressants as they should. All antidepressants by themselves help sleep. If you are not getting relief, discuss this with your doctor before you begin self medicating.

Steroids (Prednisone, Birth Control, Testosterone): These medications should be generally taken in the morning. I see people who have various immunological diseases on these medications complaining of insomnia. I usually see this in patients who take these medications at night. All of these drugs are known to cause insomnia. In fact high doses of all these drugs can cause mania and psychosis. Keep your doses for the morning hours.

Dementia medications (Aricept) with bladder medications (Vesicare): I see this commonly as a prescribing error by most primary care physicians. The two drugs essentially negate each other. Dementia medications increase acetylcholine in the central and peripheral nervous system. Bladder agents work by blocking this chemical in the same central and peripheral nervous system. I suggest you decide which is the issue causing the most loss of function and start there first, dementia or incontinence. Incontinence medications when used by themselves can cause a drug induced dementia, and might be worth stopping in elderly patients to see if their mental status improves before adding extra medications.

NSAIDS and Antidepressants: All nonsteroidals such as aspirin and ibuprofen thin the blood. So do antidepressants. In fact I frequently tell surgeons in my pre-op evaluations that antidepressants should be stopped 5 days before surgery if they are worried about a bleeding risk. Recently a patient of mine who was on an antidepressant had a complicated outcome with her liposuction because she forgot to mention this to her surgeon. I have many career actresses and models as patients where I advise using Tylenol for pain while on their antidepressants to minimize bruising.

I always tell my patients to inform me about medication changes including OTC's and supplements. It is one of the reasons I advocate using less medications overall. People are so worried about psychiatrists over medicating them. Be careful not to over medicate yourself.

Less is MORE

Last week at the end of our session my patient told me, "I'm glad I found you". He had earlier seen an "addiction medicine" doctor who detoxed him off of opiates, i.e., 20+ Norco's per day. This doctor used a Suboxone taper with Tramadol and detoxed him over 5 days. The Suboxone was appropriate;  the Tramadol was not. My patient then stated that for 4 to 5 months he did not feel well. He couldn't sleep, he kept having racing thoughts, and he felt quite dazed. He was probably in a manic delirium exacerbated by his "successful" detox. My patient thought that he was still having drug withdrawal symptoms. I told him, "No, although your detox was successful this most likely triggered a bipolar mood cycle". It is not necessary to wait a year of sobriety to make this diagnosis. In fact my patient was so impaired during this time he almost lost his job.

I told my patient that this "addiction specialist" he saw was not trained to recognize why he was abusing prescription drugs in the first place. His attempt at self-medicating his unrecognized bipolar disorder was the problem. An internist or any other physician who does detox but is not a trained psychiatrist is going to drop the ball.  WHY?  It is a rare person who uses drugs in a vacuum. Usually there is some underlying issue that leads to the abuse or dependency. I applaud doctors who detox patients successfully. I can tolerate physicians who miss identifying Major Depression, Anxiety, Bipolar and ADHD disorders. But when they start taking the initiative to treat these disorders, I get mad as hell because it is dangerous! 

An addiction doctor I know put a patient on Lithium after his "successful detoxification". To make a long story short, he eventually came under my care after relapse. Lithium is a serious drug that has serious side effects. I discussed this with my patient and decided to discontinue Lithium. I evaluated him later and noticed continued hyperactivity and poor attention. After starting him on Stattera (Amoxetine) his ADHD is much better. We went from "bipolar disorder" to ADHD where my patient is now happy, functional and thriving.

The moral of the story? See a psychiatrist who can perform your detox AND who will not miss a serious underlying diagnosis that would prevent your optimal recovery and health. All psychiatrists who are recently trained can perform detox and treat psychiatric disorders. More so if they are board certified.

Seriously?!?  Make it easy on yourself. Start with a psychiatrist and get it all done at one time. Why see several providers? As a board certified, sub specialized psychiatrist all of this is pretty easy for me to do. Less is MORE.

Paranoid Schizophrenia in Aurora, Colorado

I am sad thinking about the Colorado shootings. Victims and survivors. It makes me think about my college days. I can't imagine dying in my 20's. When I was in school, the only time I really went out was to see a movie. I couldn't afford much else. When I was in med school, 2 of my classmates 1 in my first year and 1 in my third year had psychotic breaks. Both were struggling during exams and both became very isolated. One of these classmates I knew well. I even escorted him to the dean's office when he had come to my apartment obviously acting odd. As a psychiatrist I now know both of these men suffered from paranoid schizophrenia. Thinking back I remember how two bright young men seemed isolated at first, then talking very little, then what appeared as an odd way of listening to things that weren't there. We call this in psychiatry responding to internal stimuli, another way of saying "listening to auditory hallucinations". Both men were in their early 20's. Both men had no prior psychiatric history. I don't know their family histories except to say they were from families who were very proud that their sons were going to be doctors. There was probably no legal history. You really can't get into med school if you have one.

Paranoid Schizophrenia is a disease that strikes young people and usually becomes apparent after some initial stressor. It is characterized by delusions, particularly paranoid delusions which are fixed false beliefs that would not make sense to you or me. This is a thought disorder that then includes changes in emotions and behaviors. The affect or emotional expression becomes blunt, flat or inappropriate. For James Holmes the Colorado shooter, the affect was blunted and is now described as inappropriate (his grin).

I am pretty sure now Mr. Holmes is suffering from paranoid schizophrenia. I don't know the particulars, I have made no examination. Drug abuse although a possible issue and co-occurance, does not present in this fashion. There are no strange behaviors after intoxication wears off. In fact, Mr. Holmes had a very clear sensorium during the shootings. Having seen many such patients, the description of events so far is enough to make the diagnosis as a physician/psychiatrist. The treatment is actually fairly simple. Depending on the severity, the prognosis is good with medication and psychotherapy that emphasizes treatment compliance.

I am angry thinking about the Colorado shootings. 1 in 4 Americans, right now suffers from mental illness. Yet people continue to minimize mental health issues. I hear statements like, "oh, he'll grow out of it, it's just a phase" or "it's normal to feel like this, it's a part of life". I am tired of psychiatrists and mental health professionals being vilified and scapegoated because of people's refusal to understand their own suffering. Insurance companies don't want to pay for treatment, stereotypes about medications and treatment abound, etc., etc., etc. Even other physicians I know don't understand the value of treatment. Once I see their kids for management and they thrive; all of the sudden I'll get a ton of patient referrals from them. WAKE UP ONE AND ALL. IF THERE HAS BEEN A CHANGE IN HOW YOU OR SOMEONE ELSE IS BEHAVING, THINKING OR FEELING FOR MORE THAN 1 MONTH, GET HELP. PLEASE. PLEASE. PLEASE. JUST ASKING A PROFESSIONAL "IS EVERYTHING OK?" CAN SAVE A LIFE. MAYBE YOURS.

I can't imagine dying in my 20's.

Can't Sleep? 10 No Medication Tips!

  

Sleep difficulties are the most common complaints that I encounter in my practice. Often the reasons for poor sleep include anxiety disorders, mood disorders and a myriad of medical disorders. Although treatment often requires medications, treatment plans always include learning how to sleep correctly. We call this sleep hygiene and it sort of means the same as brushing your teeth correctly as in oral hygiene.

Try these 10 tips below and see if you get immediate relief from your sleep disorder:

1. No caffeine 10 hours before you go to bed. It actually takes that long for caffeine to metabolize and be completely out of your brain. Even if you think caffeine doesn't affect you, it does disturb all the biological processes that your brain performs during sleep including your REM or dream sleep.

2. Same goes for alcohol: because alcohol is a vasodilator and disinhibits brain control centers, sleep can be difficult. It usually takes 2-3 hours to metabolize 1 glass of wine out of brain tissues.

3. Get a good pillow Neck tension can disrupt sleep and cause restlessness. Pillows are now made for side, back and face down sleepers. The same concept goes for getting rid of and replacing that 20 yr old bed with that huge sag in the middle.

4. Unplug the TV in the bedroom for 7 days; yes unplug. When I did this I was surprised how many times I tried to turn on the TV forgetting that I unplugged it. For most of us, TV is a bad habit that keeps us from going to bed on time. Sleeping with the TV on actually keeps some unconscious centers of the brain hyper alert preventing good sleep.

5. Exercise. Even exercise late at night does not disrupt sleeping, in fact you sleep better. This is probably the best thing you can do to sleep well. Walks outside in the morning are the best, see below

6. Bright daylight particularly in the blue or green spectrum inhibits melatonin production during the day. Complete darkness at night allows full release of brain melatonin for sleep. The pineal gland located behind eye retinal nerve cells regulates how this gland responds and produces melatonin. If you're taking a 5 to 10 minute walk in the morning daylight, you're setting up your melatonin production to be good that same night; with exercise you've got 2 birds with one stone.

7. No heavy meals before sleep and conversely don't go to bed hungry. Heavy meals pull blood flow from the brain and disrupt all the important functions the brain accomplishes during sleep. Your brain is a highly active organ during sleep and sleep is an evolutionary process to accomplish these tasks. Not eating enough also robs your brain of needed nutrients for biologic sleep functions.

8. No liquids 1 hour before bed and also void before going to bed. Waking up to pee in the middle of the night disrupts sleep. Trying to fall back to sleep delays your sleep cycle and ruins your sleep for the next night.

9. No internet, Facebook, or other social media devices when you get into bed. Try instead, reading or laying in the dark and allowing your conscious mind to relax. Think about all the good stuff that happened during the day and actively suppress the negative. Reliving the things you can't change sets you up for anxiety and depression.

10. Keep a note pad next to your bed. That way if any to do things come to mind, write them down in the dark and let your mind go and relax. I can't believe how many of my patients keep themselves awake trying to remember things at night. Also this is a great way to learn how to remember your dreams by scrawling out in the dark anything that seemed vivid. You'll find as you remember more, you won't be able to wait to go to bed!

Any other ideas you can think of? Let me know and sweet dreams. Seek a professional psychiatrist if you have more concerns about your sleep disorder.

Stressed out?

Yesterday while out with friends, I was asked what was the most common disorder that I treat. Without thinking twice I answered anxiety disorders. Yes, most people suffer with anxiety (including myself) that for the most part, is normal. Anxieties that interfere with your day to day activities or impair your ability to function should be evaluated. I find that if these conditions continue, patients often end up self medicating with either prescription drugs or illicit drugs to get relief. The problem with self medicating is that it always worsens the condition in the end.

  

Anxiety Disorders include the following conditions:

• Generalized Anxiety Disorder
• Panic Disorder
• Social Phobia and other specific phobias
• Obsessive Compulsive Disorder
• Post Traumatic Stress Disorder

During my evaluations I am careful to rule out any other causes for anxiety symptoms such as endocrine, vascular or acute drug withdrawal syndromes. I also have to rule out other psychiatric diseases such as depression, somatoform disorders and personality disorders. This is no small task but is very doable after the first or second session. Often I have to obtain labs and clarify health history from a primary care physician. Actually, a lot of my referrals come from primary care physicians who have already ruled out the medical causes for presenting anxious symptoms.

Medications used for the treatment of anxiety disorders usually includes antidepressants. Let me repeat, THE TREATMENT FOR ANXIETY IS AN ANTIDEPRESSANT. Benzodiazepines are helpful but they are not the first line drugs of choice. I usually use these for a short period of time (less than a month) or until I have an antidepressant working. Because these drugs rapidly calm anxiety, they often psychologically reinforce and cause more anxiety in the long run. I prefer using SNRI antidepressants but also routinely use SSRI's. Often alpha or beta blockers can be helpful, especially for acutely anxious situations.

After I have obtained control and resolution of most anxious symptoms, I then focus on coping skills. My preference is CBT (cognitive behavioral therapy). Addressing irrational fears and developing strategies to reduce fear in real time is curative. Once successful strategies are developed and can be automatically used, I can taper most of my patients off medications. Conflict resolution of past traumas rather than dwelling on them or being victimized by them is my treatment goal orientation.

Patients are then given assignments to be social and practice their skill set. Social phobia? Anonymous meetings present great opportunities here. OCD? Talking out loud your anxiety with a confidant is better than hiding it in some ritualistic behavior. Panic Disorder? No, I don't push you out of a plane parachuted but you can gradually be challenged with a progressive set of social exercises.

Addressing the biopsychosocial aspect really works with anxiety disorders. If you are suffering personally or professionally, treatment is easy and provides a tremendous amount of relief in a few weeks. There really is no need to keep worrying after all, don't you think?

Understanding Anorexia - How to deal with this Eating Disorder

Understanding Anorexia is very important in managing this disease. Without the proper knowledge about it, it won’t be taken seriously as a life threatening medical condition. The incidence of anorexia has become alarming. We often hear this disorder affects those in the entertainment and modeling industries where many women think when they’re skinny, they’re beautiful. In fact, there are already celebrities who have died from anorexia. Yes, it’s not wrong to look beautiful but beauty and health are synonymous. Anorexia is not healthy. You are not beautiful if you’re not mentally and physically healthy, plain and simple. You should face and not take your health for granted.

Anorexia often first appears among teenagers. Understanding anorexia nervosa is the first step in order to deal with it properly. If you suspect that you are suffering from this eating disorder or someone whom you care is, here are some tips on how to deal with anorexia nervosa:

Do your Homework. Research about Anorexia

Search online for articles written by people who had this eating disorder and check on the bad effects it had to their bodies. This way you’ll get a better view of anorexia. Stay away from people who are practicing improper eating habits or websites that promote anorexia so you won’t be influenced into doing the same thing. You may even try to start blog writing about your condition to share your experience and help other people who are struggling with anorexia.

Understanding Anorexia as a disorder of Thoughts, Emotions and Behaviors

 You should learn to acknowledge that the problem with anorexia is medical, physical and mental dysfunction. The most difficult part in suffering with an eating disorder is admitting you have a problem. Most people with anorexia are fascinated in becoming thin and not taking into consideration their health. Try to ask a trusted person that you know to give an honest opinion about your current weight or your physical appearance as a whole. Upon knowing the reality, this can be the starting point to your healing and recovery.

Make your Day fun and exciting

When you’re socially engaged, this will distract your mind from thinking of being fat. Try to avoid being alone so you’ll not feel sad and lonely. Isolating allows you to engage in harmful behaviors. Start exercising and socializing instead of starving yourself.

Set an Appointment with a Board Certified Psychiatrist

It would be a wise decision to pick up the phone and call a professional health care provider if you think you are suffering from anorexia. Ask for your family and/or friend’s support in getting treatment for this eating disorder. If you know someone who has anorexia, offer to accompany them on their next visit to the doctor so you can give them your moral support. Knowing that you’ll get the full support of your love ones is very important in dealing with this disorder. To prevent serious consequences it is advisable to address this disorder as early as possible.

Anorexia Nervosa is a mental health issue and eating disorder where a person is obsessed in losing weight through not eating. This disease will definitely affect the health of the person suffering from anorexia. It may lead to malnutrition and can be deadly if not treated right away. You should discover ways on how to deal with this eating disorder. Treatment includes medical management, medications, nutritional support and psychotherapy to get rid of it for good. It may not be an easy task but when it is detected early, it can save you from suffering and permanent complications.

Understanding Anorexia is important. Take control of your life if you want to stop anorexia nervosa. It can be very challenging but control of your life instead of your food is healthy and life saving.

Mental Health Issues in the Black American Community

Whitney Houston’s “I’m Every Woman” was my banner song during the last year of my psychiatric residency training. She gave me a sound track that became part of my identity. Watching the Grammy Awards Night was tremendously painful; we lost an American Treasure…a Black American Treasure. 

As a Black American myself, we should learn and recognize that taking care of ourselves is very important. It is clear that Whitney Houston suffered from mental health issues that sadly most people ignore.

Why? Because…

·       Mental health treatment is a taboo subject to Black Americans because of fear and misunderstanding. No one would like to admit that their family member or family is seeking psychiatric treatment(s).

·       Instead of seeking professional mental healthcare, Black Americans often rely on religious institutions, family members, or self diagnosis. This prevents the community as a whole from accessing available programs and treatments.

I am not saying that it is wrong to seek spiritual help, but when mental health issues are involved, this should be in conjunction with psychiatric and psychosomatic medications to recover from the problem. It is not a sin to use drugs, to feel suicidal, to not sleep, to not take care of your family, and to behave improperly. These are mental issues that are highly treatable and can be rapidly treated and resolved. 

A recent published poll revealed Black Americans in response to emergency situations, call a family member first rather than 911. These kinds of health care decisions and fears of healthcare professionals keep us from being a vibrant and healthy community.

Gone is our collective history of sacrifice, adversity, and talent. We must learn how to take care of ourselves and not to just run to a preacher who might be less than helpful. We must use all available resources including mental health services, primary medical care, and social institutions like our churches and faith based groups. 

Culturally competent minority physicians can be hard to find, but we are here. Word of mouth and Google searches are a good start. Get help for your mental health issues if you need one and know that we can take care of our own.

Rest in peace…Whitney.                       

L.E.A.R.N. -- A Strategy for a Happier Life

I guide my patients towards a happier life using a simple acronym: L.E.A.R.N. L.E.A.R.N. stands for Live in the moment, Examine your thoughts, Acquire new coping skills or strategies, Relax, and “No” when to say no. This strategy can apply to all psychological and psychiatric issues, particularly as an aftercare maintenance protocol and can help patients achieve success various elements of everyday life.

Live in the moment: It’s human nature to think about our past and future, but the topic becomes unhealthy when we overly obsess. I encourage my patients to think about what they are doing at the moment and focus on the benefits and consequences about the decision they make at this specific moment.

Examine your thoughts: Are your thoughts a true reflection of what is truly going on around you? Try to gain insight into what you are really thinking. Examples of thoughts that are harmful to a person are: All or nothing thinking, over generalizing, dwelling on the negative and ignoring the positive, over assuming, and fortune telling.

Acquire new coping skills or strategies. The decision-making process will not work for everyone, every time. When you are having difficulties dealing with a certain situation, change your approach. 

Relax: To live a healthier life you need both physical and emotional relaxation. I find that it’s important not to take yourself so seriously. Set aside some personal time after a stressful day to kick back and relax as to avoid maladaptive coping mechanisms.

No. One of the hardest things to tell our loved ones or coworkers is No. For many, pleasing everyone around us is an overwhelming goal that is rarely achieved. I tell my patients to be conscious about their personal needs when evaluating their time, and if you want to say no, then do so and reschedule when you have more time.

Knowing how to set healthy boundaries and having the ability to respect one’s personal needs is the key to maintaining one’s personal space and creating a healthy and sane lifestyle.

...and the Rest of My Diet Tips

Life has been busy, but I have managed to lose 5 pounds without a lot of effort. In fact, that should be the point, without a lot of effort. Even my husband has lost weight and he never thinks about his weight. He's been grabbing my protein bars for breakfast, leaving me speechless. At least he knew better not to give me chocolate on Valentine's Day. The flowers I got instead, reminded me of the warm weather coming.

16. Forget the Supplements. Most supplements don't work and there is no evidence that they do. OK, so Zinc was reported as helpful for a cold by shortening the duration of symptoms, so what? I think it's better to use hand sanitizer and not get sick in the first place. Most people don't realize that a lot of supplements and over the counter pills have a side effect of weight gain. A patient I saw last year was taking OTC benedryl for sleep. Problem is, benedryl has a side effect of weight gain. I instead started her on an antidepressant that improved her sleep and had a side effect of weight loss. Within 2 months she lost 15 pounds without dieting. It was obvious she was having side effects to her OTC's. Keep your supplement a simple daily multivitamin that's geared to your age or medical condition, like a prenatal vitamin for pregnancy or an age appropriate vitamin that's made for 55 and over, etc. Save your money and buy something else, instead of buying guilt for not making a few simple lifestyle changes from the get go.

17. Weigh frequently. Most people who are over weight avoid the scale. It's a mini-traumatic event that's like PTSD. Actually, weighing yourself most days keeps you from gaining 10 pounds overnight. If you see yourself up a few pounds, it's a lot easier to calibrate and lose a few later. There are scales now that don't show the weight number, they just show if your plus or minus from your normal weight. My scale does this; I love the positive reinforcement when it says minus 5 pounds!

18. Consider fasting. I mentioned in point number 12 that splurging on one meal a week is a god-given right that keeps you sane and normal. My splurge time is Saturday when anything goes: I eat whatever I want for one meal. On Sunday, I sleep in late and by the time I eat anything it's already afternoon. A light breakfast and/or light dinner feels healthy and cleansing. It's also fasting. My Sundays are spiritual, relaxing days to cleanse emotionally and physically. Because the day is shorter and relaxed, fixing a healthy brunch or dinner is easy. Find a day of the week when it's easy to fast and cleanse. You'll be able to keep your weight under control much easier.

19. Use your social media for support. When I was shopping for Valentine's Day, the chocolate cupcakes with pink icing looked so good. I texted my husband that the cupcakes were "looking at me". He texted me back, "are they looking at you or your fat ass?" Crude, but effective. I was able to keep walking and not look back. Use your Facebook, Twitter, smartphone, whatever, to martial up support for your weight loss endeavor. A Facebook group of 20 people looking at your weight loss pictures feels good, it's like your own private sponsor and addiction group rolled into one. Use your devices and media to get a support system that works for you.

20. Deep breathe, relax and smile. It's no surprise that most people don't know how to relax. Our lives revolve around doing something all the time. The problem is meditation, insight and relaxation are imperatives that most people don't take the time to learn, or were never taught. Chronically anxious states affect the hypothalamus thermostat that I mentioned in earlier posts. The hypothalamus compensates for stress by releasing the anti-inflammatory hormone cortisol which causes weight gain and insomnia. Learning how to relax turns off compensatory brain functions. Meditation is not some fancy technique that takes hours a day. 10 minutes is enough, but it has to be 10 minutes of doing absolutely nothing else, including driving or listening to music or any other activity. While sitting quietly, breathe in through your nose and let out through your mouth. Repeat. Feel the healthy air go into your chest, your core, your being, your essence. Relax. Let your mind center on your chest and your internal thoughts. Experience your insight or your ability to look inward. After 10 or so minutes you're done. Then smile at yourself, literally smile. When you smile and laugh at yourself you smile down your stress hormones. You also learn not to take yourself so seriously. After 10 minutes of thinking about how silly you are, shaking it off with a smile makes you human and gets you out of that stressed superman mode.

Well there it is; 20 simple steps. Spring is almost here. Get ready!

...and Still More Diet Tips

Because I'm a psychosomatic medicine specialist, weight issues are frequently a focus of attention especially when underlying illnesses like anxiety and depression are under control. Last week, my first patient of the day told me she was just starting to eat healthy, now that her anxiety was much better. She rattled off, "I had yesterday for breakfast oatmeal with no sugar, a subway sandwich for lunch, and brown rice with broiled chicken and a salad." I told her that her diet yesterday was healthy for someone who had a BMI of 25 or less. Hers, a BMI of 32, meant to me the food she ate yesterday wasn't all that healthy and she probably wouldn't lose any weight. This brings me to my next set of tips.

11. If it's white, it ain't right. This means if you're eating foods made from grains whether refined (white flour) or whole (brown flour); your body won't kick into weight loss mode. All grains are carbohydrates just like sugar, pastas, bread, cookies, pastries, muffins, tortillas, oatmeal, cereal and rice, white or brown. These are white foods. You can even include bananas and other light colored fruits and vegetables. If your eating more than 1 of these servings a day, you won't lose weight. Try to limit your carbs to 7 servings or less per week. No more 3 servings per day. My patient's diet above would have been better if it had been a protein bar with a peach; a lettuce wrap sandwich with a low fat yogurt, broiled chicken with a salad, a separate side of green beans, and cherries for dessert. Soups at dinner are great too, if excess salt is not an issue for you. When in doubt about whether it's a carb or not, if it's a light colored food (white or beige) eat less of it. Chicken and fish are exceptions.

12. Splurge once a week socially. A few years ago when I ended up having an emergency appendectomy, I remember before the anesthesia thinking about all my loved ones. What if I died? I also remember thinking about the 3 Der Wienerschnitzel hot dogs I had the day before. I love hot dogs. It was nice to know I got to eat my favorite food before I die. Do the same for yourself. Eat whatever food you like once a week. Substitute one meal only and make sure you eat like this socially with other people. After doing this a few times, you will enjoy the social context of the event more than the food. You'll see, you'll actually pig out less. Instead of 3 hot dogs, it'll probably be only one.

13. Sleep. Remember the hypothalamus I talked about earlier? This area of the brain also regulates sleep. It appears if one of these functions of the hypothalamus is out of sync, so are all the other functions it regulates, like hunger and eating. Think of the hypothalamus as a thermostat. If the thermostat senses your not sleeping enough, it turns up compensatory mechanisms like hunger and eating. This is all unconscious, you can't will your hypothalamus into anything. Keep the thermostat from kicking in and get most nights 8 hours of sleep. That's why limiting your caffeine is important. It takes 10 hours for caffeine to completely be gone from your system. That means the last cup has to be 10 hours before you go to bed. Also, caffeine increases the surge of insulin hormone which doesn't help you lose weight.

14. Eat and drink while you walk. Those short little walks I described earlier? Enjoy them with your favorite healthy beverages and snacks. When I walk my dog, I drink a bottle of water or snack on some nuts. It feels healthy, I feel cleansed physically and emotionally. The eating with the walking reinforces each other. Use the brain's natural powers of association to connect your physical with your emotional self. This is the definition of psychosomatic.

15. Keep snacks with you. While traveling last week, I got stuck at the airport. It was great to pull out my protein bars instead of binge on pastry at the food vendor in front of me. When I was about to go there, I reached for 2 bars and drank some water. No breakdown. In fact I felt so full with the bars, it was easy to pass up the plane food service; just tea instead. Always carry healthy snacks. Protein bars and fruit is easy. My colleague keeps protein shakes in her refrigerator at work. Find what works; what you can keep in your car, your desk or your handbag.

Next week I'll finish the rest of my tips.

...and More Diet Tips

As I mentioned in my last post, this is a New Year and new you. There are simple ways to lose weight if you think about the unconscious thoughts that undermine your success. I have 13 year old boys whom I see, that are able to manage these few tips and lose weight easily.

6. Water. We've all heard that drinking lots of water is good for you, so what? At the base of your brain is the hypothalamus that regulates hunger, thirst, body temperature, all your hormones and more. The hypothalamus functions like a thermostat; it moves up and down to keep all your body processes balanced. The brain has a hard time telling the difference between hunger and thirst mediated by the hypothalamus. If you feel hungry, drink a glass of water first to correct dehydration. Your hypothalamus will probably shut off and you won't feel hungry. You'll probably eat less. Drink plain, flat water whenever you feel hungry and before every meal. I don't care about 8 glasses a day. Plain water absorbs faster and doesn't have to undergo any metabolism. Drink all the other kind of drinks you want in addition, but no calorie drinks. Diet drinks are just fine. The sweetners used in these drinks are safe and taste fine, get used to them. Remember drinking 150 extra calories every day (a coke) equals 15 more pounds, per year, that is more unhealthy and will shorten your life faster than any artificial sweetner. Don't make irrational decisions.

7. Protein bars. Find protein bars that you can eat every morning. Make sure these bars contain minimally 10 grams of protein. Remember no milk, means no cereal, which means no insulin spikes during the day. Insulin is a hormone that stores sugar in your body. Extra sugar stored, later becomes fat stored on your thighs. There are protein granola bars which are good, too. Add a fruit or whatever else you like for a full breakfast. If your not a breakfast person, protein bars are easy to eat while driving to work. My adolescents love these and protein bars are easy to get in grocery stores now.

8. Walk. Go out the door 5 minutes in one direction, then walk back. That's 10 minutes a day and 1 hour total a week. I don't care how fast you walk, time is the measure. My dog loves a 10 minute walk, she doesn't need 30 full minutes, and I don't have the time for that. Where I work, I park my car the farthest I can from my office door. The walk in the morning and evening when I leave, totals to 15 minutes. 10 + 15 equals 25 minutes of walking, everyday, that I don't even have to think about. Take the stairs. All these daily movements add up even if your too busy for a work out schedule. Plus, you don't feel guilty for not having a work out schedule.

9. Throw out your weaknesses. My husband brought home a chocolate cake he got from one of his patients. This cake was superb, gorgeous, rich and chocolate. I lovvvve chocolate. He put it in the middle of the refrigerator shelf where the refrigerator light beamed it's full glory when you opened the door. When he came home and he opened the refrigerator door; it wasn't there, I had already thrown it away in the outside trash can so he wouldn't try to salvage it from the kitchen garbage pail. "Whyyyy?" He whined, "I wanted that cake." I told him, "I did too, and neither of us needed to go there." After sulking, he said "You're right, at least you had the guts to throw it out." Poignant as this story was, we both felt better and in control when we took control of our refrigerator and our cupboards. If you're the grocery shopper in the house, take control and get rid of the junk that shouldn't be in the house in the first place. Trust me, your family will get used to it. Keeping food you shouldn't eat is obsessive and is called hoarding.

10. Healthy snacks within reach. When I get home, I have the fruit bowl right next to where I put my keys. I'm always hungry when I get home and this prevents me from reaching for something else. Lite popcorn already made in a big bowl also works. Trying to pop 3 minute corn in the microwave is enough time to tear through every cabinet and find the the junk you shouldn't eat. Also, waiting those 3 minutes when you are hungry is agonizing and setting you up for a binge. Find healthy snacks that you can leave around that work for you. Have your kids take control and do the same for their own snacks.

Next week I'll share a few more tips.