Cyndi Turner's Blog, page 15

Depression and Addiction

It’s natural to wonder if depression and addiction are connected. Frequently, when one condition is present, the other follows. However, it’s not very useful to expend energy attempting to figure out which came first or which condition caused the other. The key when dealing with depression and addiction to treat both conditions simultaneously, so the individual fully heals. When a depressive disorder (or any mental health issue) is present with substance use disorder or addiction, medical professionals refer to this as having a co-occurring disorder. The best way to deal with co-occurring disorders is through dual diagnosis treatment, which addresses addiction and the underlying mental health issues an individual is enduring.

At Insight Into Action Therapy, our counselors and therapists are experts in helping clients address their mental health issues while also working through their substance abuse. Our methods can help clients identify and resolve their problems before substance use disorder worsens, requiring residential treatment.

Depression and Addiction

Depression is more than merely feeling sad or disappointed. Rather, it is a mood disorder characterized by a persistent sense of hopelessness lasting for several weeks or months, affecting every aspect of life. Some signs of depression include:

Irritability
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies and activities
Restlessness
Difficulty concentrating, remembering, or making decisions
Sleep issues like insomnia or unexplained fatigue
Thoughts of death or suicide

These signs will vary from individual to individual, and not everyone will evince every sign or symptom. However, the discomfort from these symptoms frequently leads individuals to look for relief. Often, this self-medicating takes the form of abusing drugs or alcohol. While substance use can mask the pain or discomfort arising from depression, it allows the mental health condition to worsen. This prompts people to abuse drugs or alcohol more, putting them at extremely high risk of developing an addiction.

Once an individual is addicted, they need treatment for substance use disorder. However, leaving the underlying depression untreated means the individual will most likely relapse. Both conditions must be treated for the individual to heal. To do so, clients need a dual diagnosis treatment program to address their co-occurring disorder.

How Dual Diagnosis Treatment Helps

Upon entering dual diagnosis treatment, clients will be evaluated by our team fo compassionate and experienced counselors and therapists at Insight Into Action Therapy. Together, we’ll develop a treatment plan with clearly defined goals and discuss the appropriate therapeutic approach. For some, this may mean cognitive-behavioral therapy (CBT), and for others, it may be acceptance and commitment therapy (ACT) that would be most effective. Similarly, some individuals respond best to group therapy, while others prefer the intimacy and confidentiality of one-on-one individual therapy. No matter the approach, our experts will help clients identify the triggers of both their addiction and mental health issue. Clients will learn techniques to confront and overcome their issues, create a healthier environment for themselves and others, and practice positive coping mechanisms.

Insight Into Action Therapy

When someone struggles with mental health issues like anxiety or depression, it is very easy to abuse drugs or alcohol to self-medicate. Often, this happens unwittingly, and individuals discover they have a substance use disorder. Similarly, when an individual struggles with a substance use disorder, they are at a higher risk of developing a mental health issue. Depression and addiction are two conditions that spring from one another and worsen each other. Therefore, it’s vital when someone shows the signs of either to seek professional help to heal. Fortunately, at Insight Into Action Therapy, our dual diagnosis treatment, as well as our other treatment programs, can give individuals the support they need to heal from both conditions and prevent either from arising. Reach out to us today at 703.935.8544 to learn more about our programs and treatments so you or a loved one can begin the healing process.

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Harm Reduction Techniques for the Spectrum of Alcohol Use Disorders

Fri Oct 16th 1:00pm – 4:30pmSubstance-UseAlcohol-ModerationMental-HealthSmith College of Social Work – Virutal 

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Cyndi Turner and Craig James will offer a half day Smith College of Social Work Professional Education Course on October 16, 2020. This presentation will review the findings of the major research studies on alcohol use disorders, describe assessment techniques, predict who is a candidate for moderation using the Alcohol Moderation Assessment, develop and monitor an Alcohol Moderation Plan, and share practical strategies for using harm reduction tools with clients. For more information: https://ssw.smith.edu/academics/professional-education/professional-education-seminars/harm-reduction-techniques-spectrum

The post Harm Reduction Techniques for the Spectrum of Alcohol Use Disorders appeared first on Insight Into Action Therapy.

Ways to Manage Anxiety

It can be quite a challenge for individuals who struggle with anxiety disorders to learn how best to manage anxiety. Fortunately, anxiety is one of the most treatable mood disorders people face. Millions of Americans every year seek anxiety treatment for issues ranging from generalized anxiety disorder (GAD), social anxiety, obsessive-compulsive disorder (OCD), panic disorders, and post-traumatic stress disorder (PTSD). At Insight Into Action Therapy, we understand how daunting anxiety can be, how it can affect personal and professional relationships, and sometimes lead individuals to self-medicate with drugs or alcohol. We offer several anxiety treatment programs that provide clients with the resources and support they need to manage anxiety and eventually overcome it.

Approaches to Anxiety Treatment

In individual or group therapy, individuals struggling with anxiety can learn how to best manage the condition. One-on-one therapy helps individuals learn how to accept things out of their control. This can involve focusing on the present moment an individual is in through mindfulness therapy or meditation. Anxiety treatment using cognitive-behavioral therapy helps individuals learn to identify their triggers. Once these triggers are known, they can be avoided, but, more importantly, individuals can learn how to develop healthy coping mechanisms. Doing so reduces the risk of substance abuse.

In group therapy, individuals benefit from hearing how others have dealt with their anxiety. This can be an excellent way to discover that one isn’t alone. Building a support system can be key to learning how to manage anxiety.

How Exercise Can Help Manage Anxiety

Perhaps the best way to manage anxiety when outside a therapy program is exercise. However, exercise doesn’t have to anything too straining. Rather, simply keeping one’s body active and moving can help diffuse anxiety. Exercise has been proved to release endorphins through the body. This reduces the effects of anxiety. Also, exercise provides individuals with a sense of immediate control that turns one’s mood more positive. Simple exercises or activities can help alleviate the tensions springing from anxiety.

Jogging, walking, biking, or dancing daily for at least 30 minutes can be an excellent way to manage anxiety and reduce stress. The key is consistency. Rather than designing the perfect workout or having the perfect equipment, individuals need to simply get their body moving. Sometimes sticking to a schedule is made easier with a companion who will help you stick to a routine and whom you can encourage to stick to it also. This reciprocity not only makes maintaining a new exercise routine easier, but it also makes the process more enjoyable.

Insight Into Action Therapy

It doesn’t matter what kind of anxiety disorder you or a loved one is struggling with; it can cause severe disruption to everyday life. No one has to endure anxiety alone. At Insight Into Action Therapy, we’re prepared to help guide clients through how to manage anxiety. Aside from anxiety treatment, we offer other programs to address both mental health disorders and substance use issues such as:

Relationship repair counseling: Personal and professional relationships become strained for numerous reasons. Our counseling program examines how individuals can repair and improve intimate relationships, family relationships, and work relations by addressing any substance use issues or mental health concerns.
Dual diagnosis treatment: Often, individuals with mental health issues also struggle with the early stages of substance abuse. This program addresses both conditions, so clients maintain holistic wellbeing.
Play therapy for children: Children require a unique approach when dealing with environmental and social pressures that cause them emotional distress. A good way to improve and keep a child’s mental health positive is through our play therapy program.
Medication-assisted treatment: Some individuals benefit from the strict administration of medications to overcome withdrawal and cravings when in treatment for substance use disorder.

Learn more about managing anxiety and maintaining good mental health by contact Insight Into Action Therapy us at 703.935.8544.

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The Fallacy of the Quick Fix for Psychiatric Medication and Crisis Management

The fallacy of the Quick Fix for Psychiatric Medication and Crisis Management

The above title may have you agreeing that there is no such thing as a quick fix when it comes to psychiatric medication for psychiatric disorders such as anxiety, depression, and bipolar disorder. Yet, for all the education and advice that is doled out in sessions, clinicians we will inevitably get called by our patient who is in an emotional crisis. How then do we “fix” that?

As a physician, my aim is to relieve suffering and not to see my patients in either physical or emotional pain. I readily admit that I do prescribe pills to relieve anxiety in such moments. However, from a psychological vantage point, the patient’s crisis is also a window for me into their world: what they are thinking, feeling, and expecting, and how they are coping. This is valuable because inevitably I will uncover distorted, habitually unhealthy thinking, beliefs, expectations, and ensuing behaviors.

Therein for me lies the gold, so to speak: the likely reason for the crisis in the first place and how my patient’s current way of coping with it may even be perpetuating it. At such times, it is understandable that my patient may become the victim of their own deep-seated core dysfunctional thinking. The unfortunate consequence is that such thinking ultimately disempowers patients, and makes them see medication, hospitalization, or other service as the rescuer that they believe they need in order not to drown.

My approach to crises has always been one of being empathic but practical. If someone feels like they are drowning, they deserve to feel like a lifeline is available to them. For me, that means my making myself accessible to my patient and them knowing when I will be at the end of the phone if needed. I know such symbolism goes a long way with my patients, and just their knowing that has actually meant that my phone does not actually ring off the hook. However, as I also explain to my patients, they will need to prepare themselves for those times when both their therapist and/or psychiatrist are not available. Is that when the quick fix, anxiety-relieving medications can come in handy? Yes, but with caveats as detailed below.

As I often explain, while medication can calm nerves and take the painful edge off the intensity of angst or even the rush of thoughts in the midst of a crisis, it can never change thinking patterns or dysfunctional beliefs that give rise to anxiety, panic, or depressive moods. That is why I have always viewed medication as a top-down approach, whereas greater and more lasting relief comes from the bottom-up approach of addressing distorted beliefs so that they no longer have the power to create depressed mood, anxiety, or panic. This would typically occur before or after a crisis has been managed, so the patient has time to reflect upon and challenge their own thinking in the interim. Thus, they are better prepared to manage next time.

During a crisis, clinicians commonly do crisis intervention: an intervention designed to help the patient mobilize their own inner resources in order to deescalate anxiety, anger, panic, substance use, or out control eating, for example. That may something as simple as deep breathing, stepping out for air, or going for a walk. Whatever it is, it can only be effective if practiced, otherwise, all the talk in the world is of no use if it is not implemented when it matters.

As part of crisis intervention, I advise my own patients not to feed the crisis, in what they do, or what they think.

For example, if my otherwise healthy patient has an established anxiety /panic disorder, I would tend to discourage them from feeding panic by going to the emergency room every time they have a panic attack, convinced they are having a heart attack. Instead, I would first recommend distracting themselves from such self-fulfilling thoughts. Otherwise, they might needlessly dramatize the crisis because of adrenaline and other stress hormones kicking in to complicate the picture. This can ratchet up such unhealthy thinking, given how powerfully emotions drive thoughts and vice versa. Sometimes such thinking will even create the very symptoms the patient is fearful of. This can make it particularly hard to tell the difference between a heart attack and a panic attack. All the more reason to re-evaluate once anxiety is soothed, and not simply assume the worst.

A non-addictive/non-dependency forming medication like Vistaril® can certainly be of particular value here in calming things, However, imagine if that was the default answer to any upticks in anxiety? That begs the question of whether physicians should keep prescribing these types of medication, lest they convey a quick-fix mentality, leaving the patient beholden to a medication for life, bereft of any self-soothing skills in the long term.

Could such chronic, as needed, prescriptions also mean that some patients continue to live in crisis or merely leap from one crisis to another? The short answer is yes. The interesting reason typically lies in the origins of their way of thinking and coping, usually dating back to a traumatic upbringing and what they themselves may have been modeled by adults in their family of origin. There often has been dramatic and unhealthy ways of coping with high intensity of emotions and few problem-solving skills. In part, it can also be attributed to our quick fix and prescription advertising culture, whereby instant results are all too regularly promised. When it comes to psychiatric and psychological disorders, nothing could be further from the truth, as such messages tend to set patients up for unhealthy expectations for their own recovery.

As a practicing psychiatrist, I have always believed in equipping my patient with the appropriate long-term knowledge and tools to manage their chronic anxiety, eating disorder, substance use disorder, or mood disorder. One of the most important things I try to do is set realistic expectations for recovery: how recovery will look (not fast like a flip of a switch), the usual course/pattern of their disorder (up’s and downs), and how they can empower themselves on the way to recovery, with the help of appropriate, long-term medications (to make the bumps less bumpy along the way). That way they know my role, their therapist’s role, and most importantly, their own role in the process.

Of the many ways I try to help my patients meaningfully, I try to communicate regularly with my patient, and to encourage regular communication between myself, my patient, and their therapist. I have found this goes a long way in preventing crises, resolving issues before they escalate to crisis point, and conveying the importance of reaching out to others, as well as the regular work that is required on the part of all in properly managing psychiatric disorders in the long term.

After de-escalating the crisis, my aim would be to say goodbye to the quick fix, and hello to the real work of recovery.

Dr. Anand is a Psychiatrist with Insight Into Action Therapy

Dr. Anand is available in both the Ashburn and Fairfax locations for evaluations and medication monitoring appointments. You can reach Dr. Anand at 703-646-7664 or sanand@insightactiontherapy.com

For direct questions about Insight into Action Therapy and our services, call us at 703.935.8544 today.

The post The Fallacy of the Quick Fix for Psychiatric Medication and Crisis Management appeared first on Insight Into Action Therapy.

Problems with Piecemeal Prescribing

Problems with Piecemeal Prescribing

 

Sumit Anand, MD

As a practicing psychiatrist, I see many patients. Many have psychiatric symptoms such as anxiety, insomnia, depressed mood, low energy, and irritability. My first task is to address the symptoms that trouble my patient the most in the safest, most practical way possible.

Unfortunately, many are increasingly presenting with a list of medications that appear to contradict the basics of the way physicians are trained to prescribe. It’s as if the prescribing manual was thrown out the window. People are taking one medication for this, that for another, and one more for an additional symptom. That is not the intention in training, yet it has become all too common in practice.

 

Physicians are trained to look at the big picture of symptoms in order to arrive at a diagnosis, so that the best, most tolerable medication can be prescribed for the underlying disorder that is causing the symptoms.

People naturally look for relief of unbearable symptoms like anxiety or insomnia. In such cases, certain medications with sedative properties would be ideal. Alternatively, prescribing a sleeping medication and a non-sedating antidepressant would also be appropriate. However, there can be unintended consequences to the second approach like creating dependence on a habit-forming medication in a patient with a substance use disorder history. It doesn’t make it wrong. However, as the list of medications grows longer, so does the risk of more interactions between them.

 

Such a prescribing approach may unintentionally convey a quick fix or piecemeal mentality, whereby the link between different symptoms is not properly made like anxiety leading to insomnia. In reality, most anxiety and depressive disorders that cause insomnia are actually chronic, fluctuate in time, and require a comprehensive treatment strategy including therapy as well as education about sleep habits and medications combined, all of which take time to fully appreciate. The aim should be to tie these seemingly disparate symptoms together so that patients themselves can embrace the notion of treating their disorder as a whole.

In medicine, the prescribing of several medications simultaneously is called polypharmacy. It is usually discouraged as medicines can interact with one another, causing more side effects or reducing the effectiveness of each added medicine.

 

On the other hand, the reality is that psychiatrists may need to add to the effectiveness of one medication with another when the first has only been partially helpful. An example of this is adding a mood-stabilizing agent to an antidepressant for treatment-resistant depression. However, the original medication dosage needs to be maximized before the augmenting agent is added. This is called rational polypharmacy. The good news is that the addition of a lower dose of another medication in such a case can actually achieve a faster result.

The practice of irrational or piecemeal prescribing is common in healthcare. By this, I mean the chronic prescription of, for example, a sleeping medication, when in fact, the underlying problem is a depressive disorder.

 

Another example would be two hypnotic medications – one supposedly for sleep, the other for nightmares. This is where the science contradicts such a practice because the combination of different sleeping medications can prove risky and even fatal. This was famously highlighted by Michael Jackson’s death when it came to light that he was receiving several sedative medications simultaneously.

It also makes little sense to duplicate sedative medications. When I see this in practice, I question why one medication was never maximized. Unfortunately, I see this all too commonly in intakes with patients who complain how unsatisfied they are with their current medication combination. They are usually exasperated that they have not had adequate explanation along the way for this either.

 

Another common example I have seen is the chronic prescription of “as-needed” addictive medications for years on end. The doctors have not focused on treating the underlying anxiety disorder or explained why this approach is not ideal in the long term.

Thus, a patient is prescribed (as needed or PRN, the technical term) benzodiazepines for panic attacks. The person struggles from one episode to the next, without a proper strategy for treating the underlying anxiety disorder that has given rise to these and other symptoms of anxiety in the first place.

Physicians need to be cognizant of what medications are indicated for short term and long-term treatment of, say, an anxiety or depressive disorder, and what the research literature is recommending as to when to use them.

 

Let me cite another example: Prazosin has acquired an increasing reputation for treating nightmares for those with Post-Traumatic Stress Disorder. However, I would typically not prescribe it before I had first tried a mainstay SSRI antidepressant like Prozac® or Zoloft® to reduce the other associated symptoms that might be driving the nightmares. In addition, therapy is also a valuable intervention that would be included in my comprehensive plan to address the content of these nightmares.

Of course, if somebody comes to me on a medication I would not recommend, I wouldn’t just abruptly stop it. I would assess if it is actually helping and know that any abrupt cessation in medication is always considered unsafe. A delicate balancing act is required in tidying up even a haphazard prescription medley of medications. The decision must be driven by what’s in the patient’s best interest, including an awareness of the patient’s persisting symptoms—all with the aim of providing symptom relief, while using the simplest, most effective medication combination possible.

 

All of these examples hopefully illustrate the importance of sound prescribing principles, in order to treat any patient’s psychiatric condition safely and effectively. In my own training of medical students, I use the adage “start low, go slow” for initiation of a new medication. Another would be “primum non nocere” which means: first…do no harm.” If I wanted to dismantle what appears to be an overly complicated medication combination, I would go about it in a safe and prudent way.

To my dismay, I am noticing less and less use of these well-established prescribing principles over the years. I appreciate that there may be good reason for a particular medication combination and that prescribing is as much an art as it is a science. Nonetheless, I am increasingly noticing over my years of practice is that there is a dearth of adequate explanation and documentation, typically leaving myself and the patient in the dark as to what has been going on in their medication history.

 

My own conclusion is that there are currently overriding forces in our current healthcare system that have successfully undercut such principles and approaches. I do not blame fellow individual physicians for this trend. Those forces include the current healthcare system’s emphasis on digitization, speed, and turnover. Treatment has become checking of boxes rather than quality of care, connection with the patient, or even basic explanations of why a medication is being prescribed to them.

 

It’s as if the world has been caught in an endless race, just trying to jump through hoops to get to the end of the day. This opens up a larger discussion as to how doctors and hospitals are paid. I am seeing corners being cut in order just to financially survive. However, this drive-through approach for medication management is ineffective and dangerous.

I end this discussion with the above concepts only to illustrate that forces larger than just the individual have unduly shaped our collective cultural approach and mentality in healthcare. I just hope as physicians we are able to hang on to what I have always known to be true: focus on your craft and your patient above all else!

Dr. Anand is a psychiatrist with Insight Into Action Therapy.
He is available in both the Ashburn and Fairfax locations for evaluations and medication monitoring appointments. You can reach Dr. Anand at 703-646-7664 or sanand@insightactiontherapy.com

For direct questions about Insight into Action Therapy and our services, call us at 703.935.8544 today.

The post Problems with Piecemeal Prescribing appeared first on Insight Into Action Therapy.

Beware of Dr. Google

As a practicing clinician, I am regularly told by patients about what they have read on the internet. My clinical colleagues have referred to the internet as “Dr. Google.” Why do people give more weight and authority to something they have read on the internet than what we have discussed in the office?

I suspect this comes from a place of anxiety: If I knewthe answerto my worries, they would be solved, right? I don’t think so. In reality, I have found that the internet tends to confuse and distort far more than it educates. But then if it is in readable, printed form, then it has got to be right, right? Wrong I say.

Information from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), package inserts of medication side effects, what the latest study proves,  and horror stories and gripes are all posted on the internet. Where are the success stories? Why do people focus more on what might go wrong that what did go right?

All in all, the consequence of such a plethora of information is usually more—not less— anxiety. As a result, people tend to hone in on the one negative thingthey read, rather than on the big picture. That’s precisely what anxiety makes us do! When people turn to Dr. Google for answers they are usually concerned about a problem. The internet is not only unhelpful, but potentially harmful for anyone concerned about their mental health.

There is such a thing as too much information or even the wrongtype of information. The internet tends to be riddled with mere lists of things. The information then completely loses context and is not helpful. For example, a tumor discovered in rats is listed plainly alongside dry mouth as a potential side effect. Can you guess which one is more common but is more talked about?

Even with a side effect such as hypotension (low blood pressure), there can be huge variation in its severity. On the simple end of the spectrum, it is just getting up slowly from a lying down position or drinking regular fluids while intravenous fluids need to be given in a hospital setting at the more severe end of the spectrum. Sometimes, merely lowering the dose of the medication is all that is required. Without a proper discussion with the treating physician as to how common or rare, as well as how severe the side effect usuallyis, a patient might otherwise be entirely dissuaded from even considering the particular medication—all out of an exaggerated fear of such a side effect. This is where the internet can cause far more harm than good.

These examples reiterate the main point: information that cannot be adequately explained to or digested by the patientis equivalent to a distortion of the truth. Earlier this year, a prominent political commentator posted DSM-5® criteria for Narcissistic Personality Disorder on his Twitter feed. He did so as a naïve ingester of that information. This is the exact opposite of the experience and training that is required to interpret and applythese criteria to one’s own patient.

I am not an expert in search engine optimization technology but I think the internet is getting it wrong. In my view, websites that post package inserts of medication that list rare side effects are because of defensive litigation motive rather than to properly educate the patient. People tend to believe other patients’ experiences and good patient experiences somehow don’t find their way onto the internet.

Unfortunately, stories with the most dramatic horror rather than the results of rigorously designed studies get the most traffic. Perhaps that is because study designs are hard to interpret and their findings tend to be dry, overdetailed, and riddled with terminology that the average person will not understand. Such studies rank lower on Google® searches or are only in specialized search engines such as Google Scholar®.

No matter what is written about a particular medication on the internet, nothing trumps the experience of a physician and patient actually going through the process of prescribing and taking of a medication. An experienced and prudent clinician will have to make a judgment call as to which medication is best for their patient, discuss the patient’s unique medical history and vulnerabilities, and start at a reasonably tolerable dose. Then, like any new venture in life, we wait and see what happens.

It may surprise you to know that, in the aftermath of the suicide and antidepressants controversy in the early 2000’s, the suicide rate jumped in subsequent years in adolescent patients. This was because physicians were more reluctant to prescribe antidepressants in this age group. From subsequent research that the media didn’t give publicity to, the original studies were found to be flawed in their design, thus generating false findings linking suicide and antidepressants. To date, not a single suicide has ever been proven to be caused by antidepressants.

For myself, and many other psychiatrists, we found ourselves having to explain this media debacle in order to undo the damage that the media perpetuated by jumping on the bandwagon. By the internet hijacking something that a public health issue was worsened in more ways than was ever intended.

Now when I advise my patients, I have told them to take what they read on the internet with a huge sack of salt, as it tends to lack credibility an educational resource. By virtue of its fragmented, list-driven, search engine design, the internet has turned into its own beast. One that alarms people to the point that whatever else is going on, anxiety should be at the top of their concerns. Beware of Dr. Google!

Dr. Anand is a psychiatrist with Insight Into Action Therapy. He is available in both the Ashburn and Fairfax locations for one-hour evaluations and half hour medication monitoring appointments.  He will not rush  your diagnosis or treatment. You can reach Dr. Anand at 703-646-7664 or sanand@insightactiontherapy.com

Beware of Dr. Google

As a practicing clinician, I am regularly told by patients about what they have read on the internet. My clinical colleagues have referred to the internet as “Dr. Google.” Why do people give more weight and authority to something they have read on the internet than what we have discussed in the office? I suspect this comes from a place of anxiety: If I knewthe answerto my worries, they would be solved, right? I don’t think so. In reality, I have found that the internet tends to confuse and distort far more than it educates. But then if it is in readable, printed form, then it has got to be right, right? Wrong I say. Information from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), package inserts of medication side effects, what the latest study proves,  and horror stories and gripes are all posted on the internet. Where are the success stories? Why do people focus more on what might go wrong that what did go right? All in all, the consequence of such a plethora of information is usually more—not less— anxiety. As a result, people tend to hone in on the one negative thingthey read, rather than on the big picture. That’s precisely what anxiety makes us do! When people turn to Dr. Google for answers they are usually concerned about a problem. The internet is not only unhelpful, but potentially harmful for anyone concerned about their mental health. There is such a thing as too much information or even the wrongtype of information. The internet tends to be riddled with mere lists of things. The information then completely loses context and is not helpful. For example, a tumor discovered in rats is listed plainly alongside dry mouth as a potential side effect. Can you guess which one is more common but is more talked about? Even with a side effect such as hypotension (low blood pressure), there can be huge variation in its severity. On the simple end of the spectrum, it is just getting up slowly from a lying down position or drinking regular fluids while intravenous fluids need to be given in a hospital setting at the more severe end of the spectrum. Sometimes, merely lowering the dose of the medication is all that is required. Without a proper discussion with the treating physician as to how common or rare, as well as how severe the side effect usuallyis, a patient might otherwise be entirely dissuaded from even considering the particular medication—all out of an exaggerated fear of such a side effect. This is where the internet can cause far more harm than good. These examples reiterate the main point: information that cannot be adequately explained to or digested by the patientis equivalent to a distortion of the truth. Earlier this year, a prominent political commentator posted DSM-5® criteria for Narcissistic Personality Disorder on his Twitter feed. He did so as a naïve ingester of that information. This is the exact opposite of the experience and training that is required to interpret and applythese criteria to one’s own patient. I am not an expert in search engine optimization technology but I think the internet is getting it wrong. In my view, websites that post package inserts of medication that list rare side effects are because of defensive litigation motive rather than to properly educate the patient. People tend to believe other patients’ experiences and good patient experiences somehow don’t find their way onto the internet. Unfortunately, stories with the most dramatic horror rather than the results of rigorously designed studies get the most traffic. Perhaps that is because study designs are hard to interpret and their findings tend to be dry, overdetailed, and riddled with terminology that the average person will not understand. Such studies rank lower on Google® searches or are only in specialized search engines such as Google Scholar®. No matter what is written about a particular medication on the internet, nothing trumps the experience of a physician and patient actually going through the process of prescribing and taking of a medication. An experienced and prudent clinician will have to make a judgment call as to which medication is best for their patient, discuss the patient’s unique medical history and vulnerabilities, and start at a reasonably tolerable dose. Then, like any new venture in life, we wait and see what happens. It may surprise you to know that, in the aftermath of the suicide and antidepressants controversy in the early 2000’s, the suicide rate jumped in subsequent years in adolescent patients. This was because physicians were more reluctant to prescribe antidepressants in this age group. From subsequent research that the media didn’t give publicity to, the original studies were found to be flawed in their design, thus generating false findings linking suicide and antidepressants. To date, not a single suicide has ever been proven to be caused by antidepressants. For myself, and many other psychiatrists, we found ourselves having to explain this media debacle in order to undo the damage that the media perpetuated by jumping on the bandwagon. By the internet hijacking something that a public health issue was worsened in more ways than was ever intended. Now when I advise my patients, I have told them to take what they read on the internet with a huge sack of salt, as it tends to lack credibility an educational resource. By virtue of its fragmented, list-driven, search engine design, the internet has turned into its own beast. One that alarms people to the point that whatever else is going on, anxiety should be at the top of their concerns. Beware of Dr. Google!

Dr. Anand is a psychiatrist with Insight Into Action Therapy. He is available in both the Ashburn and Fairfax locations for one-hour evaluations and half hour medication monitoring appointments.  He will not rush  your diagnosis or treatment. You can reach Dr. Anand at 703-646-7664 or sanand@insightactiontherapy.com

The post Beware of Dr. Google appeared first on Insight Into Action Therapy.

We are the collective creator …. Healthy Covid-19 Habits

We are the collective creator of our own agony. It is time for a re-awakening of consciousness when we recognize the best in ourselves and overcome the worst. ~Lawrence Overmire

Americans are increasingly housebound and left to their own devices as the Covid-19 quarantine stretches into months. Measured reactions to the stress, boredom, and loneliness reveal that people are drinking more booze, vaping more cartridges, toking more weed, watching more porn, and smoking more cigarettes.

Self-medicating is all the rage. Online alcohol sales in the United States rose 243% in the week ending March 21st, according to the market research firm, Nielsen. Responding to the need, Instacart offers delivery of alcohol in 14 states and Washington, DC. Drizly an alcohol distribution website advertises beer, wine and liquor delivered in under 60 minutes. According to Flowhub, sales of cannabis in California, Colorado, Oregon, and Alaska increased by 50% from March 16th to March 22nd.

The virtual sex-trade that profits from human trafficking, isolation, and addiction has also gotten a lift from the pandemic. Pornhub.com, the leading adult entertainment website, saw a 12% increase in global traffic from February 24th to March 17th. Social distancing is also proving profitable for makers of vibrators. Sex toy sales in the United States were up 75% since the first week of March.

Comfort eating is again in vogue. Surveys from several New York State Whole Food Markets during the beginning of the lockdown revealed that snack foods were the first to sell out. Popcorn, chips, doughnuts, and candy were flying off the shelves in the first three weeks of quarantine. Nestle boss, Mark Schneider, remarked that the $310 billion candy maker was struggling to keep snacks in markets.

Current behaviors may temporarily alleviate the anxiety, worry, and monotony of the stress of lockdown, but at what costs to our future health? As we emerge from the Covid-19 pandemic with pornography addiction, liver disease, obesity, diabetes, cancer, and cardiovascular disease, the long-term impact is not lost on market predictors. Porn Hub and the makers of Novo Nordisk, the world’s biggest diabetes treatment, stand to benefit well from the virus.

We owe it to ourselves to pause and think about how the pandemic is affecting us individually. Some of my clients report giving themselves a “pass” to engage in unhealthy behaviors during the quarantine. As a mental health and addictions counselor, that presents a troubling solution that can lead to addiction and hard habits to break.

The best predictor of the way we respond to triggers and temptations tomorrow is the way we are responding today. Reaching out for help during this difficult time may be the best way to insure a healthy future.

Below are resources for online and telephonic help.  Each group has a website and listings of meetings:

Moderation Management moderation.org
Smart Recovery smartrecovery.org
Celebrate Recovery celebraterecovery.com
Overeaters Anonymous oa.org
Gamblers Anonymous gamblersanonymous.org
Sex Addicts Anonymous saa-recovery.org
Sexaholics Anonymous sa.org
Sex and Love Addicts Anonymous slaafws.org

Crisis Text Line or Text 741-741

If you or someone you love is struggling with unhealthy coping skills, there is help. You can prevent a problem from developing into an addiction. Please call 703-646-7664. Therapists are available for in-person, telephone, and video sessions.

Nancy Kirk, LCSW, CSAC, CSAT-Candidate is a therapist with Insight Into Action Therapy. She specializes in both chemical and process addictions, specifically sexual.  She is available in both the Ashburn and Fairfax locations.  You can reach Nancy at 703-646-7664 or nkirk@insightactiontherapy.com

 

We are the collective creator …. Healthy Covid-19 Habits

We are the collective creator of our own agony. It is time for a re-awakening of consciousness when we recognize the best in ourselves and overcome the worst. ~Lawrence Overmire Americans are increasingly housebound and left to their own devices as the Covid-19 quarantine stretches into months. Measured reactions to the stress, boredom, and loneliness reveal that people are drinking more booze, vaping more cartridges, toking more weed, watching more porn, and smoking more cigarettes. Self-medicating is all the rage. Online alcohol sales in the United States rose 243% in the week ending March 21st, according to the market research firm, Nielsen. Responding to the need, Instacart offers delivery of alcohol in 14 states and Washington, DC. Drizly an alcohol distribution website advertises beer, wine and liquor delivered in under 60 minutes. According to Flowhub, sales of cannabis in California, Colorado, Oregon, and Alaska increased by 50% from March 16th to March 22nd. The virtual sex-trade that profits from human trafficking, isolation, and addiction has also gotten a lift from the pandemic. Pornhub.com, the leading adult entertainment website, saw a 12% increase in global traffic from February 24th to March 17th. Social distancing is also proving profitable for makers of vibrators. Sex toy sales in the United States were up 75% since the first week of March.

Comfort eating is again in vogue. Surveys from several New York State Whole Food Markets during the beginning of the lockdown revealed that snack foods were the first to sell out. Popcorn, chips, doughnuts, and candy were flying off the shelves in the first three weeks of quarantine. Nestle boss, Mark Schneider, remarked that the $310 billion candy maker was struggling to keep snacks in markets. Current behaviors may temporarily alleviate the anxiety, worry, and monotony of the stress of lockdown, but at what costs to our future health? As we emerge from the Covid-19 pandemic with pornography addiction, liver disease, obesity, diabetes, cancer, and cardiovascular disease, the long-term impact is not lost on market predictors. Porn Hub and the makers of Novo Nordisk, the world’s biggest diabetes treatment, stand to benefit well from the virus. We owe it to ourselves to pause and think about how the pandemic is affecting us individually. Some of my clients report giving themselves a “pass” to engage in unhealthy behaviors during the quarantine. As a mental health and addictions counselor, that presents a troubling solution that can lead to addiction and hard habits to break. The best predictor of the way we respond to triggers and temptations tomorrow is the way we are responding today. Reaching out for help during this difficult time may be the best way to insure a healthy future. Below are resources for online and telephonic help.  Each group has a website and listings of meetings:

Moderation Management moderation.org
Smart Recovery smartrecovery.org
Celebrate Recovery celebraterecovery.com
Overeaters Anonymous oa.org
Gamblers Anonymous gamblersanonymous.org
Sex Addicts Anonymous saa-recovery.org
Sexaholics Anonymous sa.org
Sex and Love Addicts Anonymous slaafws.org

Crisis Text Line or Text 741-741 If you or someone you love is struggling with unhealthy coping skills, there is help. You can prevent a problem from developing into an addiction. Please call 703-646-7664. Therapists are available for in-person, telephone, and video sessions.

Nancy Kirk, LCSW, CSAC, CSAT-Candidate is a therapist with Insight Into Action Therapy. She specializes in both chemical and process addictions, specifically sexual.  She is available in both the Ashburn and Fairfax locations.  You can reach Nancy at 703-646-7664 or nkirk@insightactiontherapy.com

 

The post We are the collective creator …. Healthy Covid-19 Habits appeared first on Insight Into Action Therapy.

Life of a Quarantined Teen

If you asked just about anybody, they would probably tell you that a teenager would love being at home, away from school and other responsibilities. That has proved itself not to be the case. Not even a quarter way through this and I am dying to go back to school and have life unpaused. Being home without having to go anywhere might have sounded appealing at first but it definitely hasn’t turned out that way. Everything I was looking forward to has been canceled including a funeral, ceremonies, field trips, swim meets and practices, hockey season, and vacations. I can’t hang out with my friends or even see my extended family. Many of the places that my friends and I like to hang out at have been closed as well.

So far the days without school and my normal interactions have been slow but can turn out to be little adventures. With every bad thing there is an upside. I try to make this time count so I spend more time doing things I claimed “I never had the time for” when we weren’t quarantined. I have developed my love for certain hobbies: things like playing the piano, cooking, going on long walks, sewing, and reading. I have spent a lot of time with my family and together we have deep cleaned most of the house. Now that we have more time together, we have also started family game nights which turn out to be loads of fun. We play our favorite games Sequence, Five Crowns, and mahjong. Well, it helps the days feel more meaningful when we are together.

Then again there are so many that we are missing out on. Now that the governor issued a Stay at Home Order, we aren’t allowed to interact with any of our friends. Even before that, most families had started practicing social distancing so it has been awhile since I’ve seen anyone but my mother, father, or sister. The only form of communication with friends and the outside world is online. Oftentimes communication is through face timing, snap chatting, and texting each other to keep ourselves sane. Nowadays, most teenagers are feeling very lonely and we resort to the media to cure our loneliness. Social media apps like TikTok are full of teenagers voicing their thoughts and feelings about this pandemic and it is nice to hear how others are handling it. Sometimes it can be really funny too.

Another thing that is difficult about being stuck at home is the whole birthday situation. My sister just had her 18th birthday and we tried our best to give her a fun and safe party but it wasn’t as grand as we had hoped. Every year on our birthdays my sister and I are lucky to get a “friend party” as we call it, so we can celebrate our birthdays with our closest friends. That didn’t happen for my sister this year. It sucks that she missed out on that on such a special birthday. Because this will be going on for months, many others aren’t getting to celebrate their birthdays as well. My birthday is all the way in June, which seems so far away, but this quarantine is supposedly ending two days after my birthday. That means my sister, my mom, and I will be celebrating our birthdays at home. It’s different but we make the best out of it. So far it is kind of a fun change of pace with the birthdays. We can order our favorite foods, create gifts, and order great presents online for each other.

Nobody likes missing out on things that they have waited a long time for. Something I am really sad about is the fact that I’m 13 years old and I have already had my last day of middle school. It ended unexpectedly. I was excited to graduate from middle school as the first class to go through all three years but school ended so suddenly and we won’t be able to go back. It’s a scary thought that the next time I physically go back to school, it will be at my new high school.As much as I dislike this, things are definitely worse for my sister. She is a senior in high school and doesn’t get all of the special events she earned. She returned her dress and shoes for prom and it’s unlikely that she gets a normal graduation. She got into college but we aren’t even sure if move in day will get postponed. I feel terribly for all of the seniors who worked so hard to get to their senior year and then they can’t even finish it off the right way. I just hope that they will end up getting the farewell they deserve.

Unfortunately, the future’s uncertain and that is one of the worst parts about this whole thing. Not knowing when this will be over and things can go back to normal is terrible. Even if the deadline for staying at home is pushed back, things will take awhile to go completely back to normal. I sometimes wonder if when this is all over, will handshakes stop being a thing? But the cancelation for all of these major things is for a good reason. Which is to keep us all safe. And that is what we all need to remember.

There are many things that parents can do to help their teens during this time. Parents should make an effort to spend more time with their kids since they are the only people they can talk to face to face. Little things like playing games and going on walks together are really good ways to make this pandemic easier on families. This is a chance to enjoy family time and learn more about each other. Sure things can get tense when you’re cooped up at home with your families, but when it gets that way just try to give each other space and revisit family time.

I can’t think of anyone who likes missing out on all of these important milestones, but at least we know that we are all going through it together. It’s awful but we’ve got to do our part to keep this virus from spreading and keeping ourselves and others safe. This time spent at home is what you make of it so my recommendation during this dreadful time is to not to think of it as a monthly thing but rather take things one day at a time.