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Friday, December 14, 2012

Why Is Life So Hard?

Question: Why is life so tough?  Do all people always have a happy ending?

Answer: People are suffering every day. It's often hard to find any meaning to life. It's often hard to find joy when all we see is tragedy. Then our thoughts take over and we worry about what may happen to us, to our loved ones. What if we can't pay our bills, what if we get sick, what if we have a tragic accident, what if we lose our job. All these what ifs lead to anxiety and depression. How do we get personal control over this? How do we achieve happiness?  How do we maximize our safety in this world?

While psychiatry continues to attempt to find a niche in the medical world as a legitimate physiological and scientific disease process, it is just these types of philosophical questions that plague so many of us and that ultimately lead to mental distress.  So is it really a chemical thing gone awry in your brain, or is it a philosophical conflict about our place in this world.  

Of course I prescribe psychiatric medications and at times, the medicine relieves a person's suffering. But I prescribe medications at the same time I initiate therapy.  So is it the medication or the therapy and philosophical exploration that eases a person's mental pain?

My style of therapy is really philosophy. And although the field of psychiatry won't admit it, most of the therapeutic techniques used today are really old world philosophies rewritten.  Philosophers have always suggested that it is important for us to examine our beliefs. Your feelings and actions are a consequence of your beliefs. So, if you believe the world is a bad place full of evil...then that's what it is for you.  The great philosopher Pyrrho said, "Always be quick to question and slow to believe. We too easily become convinced of things that trouble our minds and disturb our souls...withhold judgment."

Your feelings, desires, hopes, and dreams are an important part of who you are. But they are all results of your beliefs or dependent on those beliefs. We are all on a quest for certainty. We want to"know" everything without any doubts. We want to "know" that our life is real and not a dream, we want to "know" that we are safe, we want to "know" that our religious belief is the right one.  All this doubt and uncertainty cause anxiety and depression. We are greedy for control.  And in the end....we will never have control.

The only certainty is that nothing is certain." - Pliny The Elder

So is happiness possible? 
Most of the great philosophers agree that the only moment we really have is the present, right now. But the past and future are always trying to pull us away from the moment. Most people miss the present moment because they are thinking about the past or future. Worrying about past and future. You can't change the past and you can't predict the future. The goal to happiness is working hard to relieve yourself of the past and future. It takes work to constantly redirect your mind to the here and now. Happy and content people work toward goals involving other good people in objectives using love and creativity to make a difference in the world. To help other people.

We can't always understand the suffering that we see. But we can respond to it better. You can control your response and your intervention. You can help people.

He knows not his own strength who has not met adversity. -Ben Johnson.

Thursday, November 22, 2012

Klonopin(Clonazepam) Questions

Question: I am on 1 mg. of Klonopin, twice a day. I tried to find an alternative anxiety med with less side effects, and discovered Grandaxin (tofisopam), a benzo derivative that does not cause sedation, memory loss or dependence. http://en.wikipedia.org/wiki/Grandaxin  The only problem is, this med is not available in the U.S., so I can't seem to find any info on switching to it from benzo's. I have found a reputable dose equivalent chart online [http://www.non-benzodiazepines.org.uk/benzodiazepine-names.html ], but is it safe to switch directly from a benzo like Klonopin to a benzo derivative like Grandaxin, as long as the doses are equivalent?  Grandaxin does not act on GABA, like benzo's, and I know you are supposed to taper off of benzo's to avoid withdrawal symptoms. Will I go into withdrawal, or  will the Grandaxin simply work like the Klonopin without the nasty side effects, like I hope it will, if I switch? Or, would it be better to taper off the Klonopin onto the Grandaxin, since it is safe to combine them? Thank you.

Answer: So here's the thing...there is a reason grandaxin is not FDA approved in the USA. You have put a lot of research and effort into finding an alternative to the clonazepam(klonopin).  You say you are having side effects from the klonopin. But it sounds like the klonopin has been controlling your anxiety. If you were my patient, I would explore with you the side effects and how your typical day goes. Do you have worse anxiety in the morning, evening, or night? Do you have side effects shortly after taking the klonopin? Do you have other symptoms such as difficulty focusing, insomnia, poor appetite, no motivation?  Maybe you have more than just simple anxiety or maybe it is just anxiety. I would change your klonopin dosing to 0.5mg three times a day. I would discuss with you adding on another medication that will help your symptoms and while we give the new medication time to work, I would slowly taper you off the klonopin. You need to cross taper if you truly want to come off the klonopin.  I don't recommend a complete switch. And, it is very dangerous to stop the klonopin abruptly. You can have terrible withdrawal such as panic and seizures. There is a very specific equivalency chart of how much klonopin equals how much valium and so on. 1mg of klonopin does not equal 1mg of valium or xanax or ativan.  There are many options. It is all about me listening to exactly what symptoms you are having at what times of day in what kinds of situations. That's how we(me and you) would pick a medication for you. If you feel like your prescriber is not helpful in this way, time for a new prescriber.  I happen to use klonopin quite a bit. It is a medication to be used short term while you explore what's at the root of your anxiety. Sometimes, I prescribe klonopin at the same time I do intensive cognitive therapy and then ween off the klonopin and the person is able to adequately control their anxiety with new coping skills and behavioral techniques. It's time to put all that energy into evaluating yourself. Stop looking for a magic pill. Your "magic pill" is your mind, you are in control of your thoughts and feelings and behaviors. Buddha says: "All that we are is the result of what we have thought."   Good luck!

Monday, September 3, 2012

Procrastination Is How We Control Our Lives

Question: (I'm an adult with A.D.D)  I have trouble doing what I know needs to be done, but if something arises that is more urgent that I want to do even less, I have no problem doing the first thing.  I was wondering how I might be able to use this principle somehow in my self talk/thinking so that I could do what really needs to be done more often.

Answer:  There are many philosophical and psychological theories regarding procrastination. What I have uncovered with my clients suffering with procrastination is that it's all about control. When we are obligated to do something...the best way we can control it is to procrastinate! It's not that you have trouble doing the task, it's that you need to control what's going on in your life. When we feel out of control with our thoughts and emotions, we unconsciously begin to control everything else around us. So when we can't control our thoughts and feelings, we control our tasks and obligations. It may be time for you to consider what feels out of control for you right now... Maybe a relationship, or your eating habits, or some other vice like smoking or drinking?

It is better to conquer yourself than to win a thousand battles. Then the victory is yours. It cannot be taken from you, not by angels or by demons, heaven or hell. - Buddha

Sunday, August 19, 2012

Calm Your Mind Without Drugs

Question: I always feel like a thousand things are running through my mind. I have anxiety severe and have for many years, I have suffered addiction and overcame it twice! I have chronic pain due to lumbar problems, although I can handle most of the pain with nsaids to avoid relapse, I feel a constant need to remove myself from the real world to avoid my problems, I live in VA and know that pot is illegal, although I feel like it would slow me down and bring back my happiness. When I was in high school I had the same feelings and experimented with it and all my previous issues was gone. Now they have returned, and I need help!

Answer: Many people "self-medicate" in an attempt to calm themselves down or in an attempt to "make" their feelings and emotions go away. It is those of us who are unable to self-sooth, those of us who did not learn the art of calming our minds, those of us who have little to no tolerance for uneasiness who often turn to substances to relieve our perceived pain.  It takes much diligence and work to change your thought process. You have the insight, you know your mind is racing with thousands of "worries" and "what ifs."

It is here where I must insert my belief that it is a parent's duty and obligation to teach their children self-soothing and how to calm the mind. If you continuously sooth your child and "rescue" your child...your child may end up like this young man who presents our question today.

And so it is, I recommend cognitive behavioral therapy. You can change your thought process...and when you change your thought process...your feelings will change...and when your feelings change...your behaviors will change.  Find a therapist who specializes in this type of therapy. You will be successful, but you must work at it! It is far easier to smoke a joint and escape the worry for a few hours, than to complete a thought diary and analyze the links between how your negative thoughts create your anxiety. You must train for the marathon of life, there are no short cuts or quick fixes.

Consider reading the book, Buddha's Brain by Rick Hanson. It will guide you through mental practices that may change your reality and bring you peace and wisdom.  Here is a quote from the book that applies to your very situation:
"Only we humans worry about the future, regret the past, and blame ourselves for the present. We get frustrated when we can't have what we want, and disappointed when what we like ends. We suffer that we suffer. We get upset about being in pain, angry about dying, sad about waking up sad yet another day. This kind of suffering-which encompasses most of our unhappiness and dissatisfaction-is constructed by the brain. It is made up. Which is ironic, poignant-and supremely hopeful.   For if the brain is the cause of suffering, it can also be its cure."

Friday, August 17, 2012

Mirtazapine Side Effects

Question: I have been taking mirtazapine 30 mg for about 3 weeks.  I felt that it was helping at first with my depression and anxiety. I have been on many other antidepressants but have not been able to tolerate the side effects, mostly nausea.  I was able to tolerate the mirtazapine for a while and felt it was helping, but for the past week I have been experiencing lightheaded feelings that come and go everyday.  It's like bad sinus pressure in my head.   It is very difficult to function like this.  Is this something that will go away or should I discontinue the med.

Answer: Mirtazapine is an antidepressant. Some people do well on mirtazapine 15mg daily, or 30mg daily, or 45mg daily. The key with mirtazapine is to take your dose in the evening before bed.  Some of the side effects may be mild or very serious. They include: drowsiness, dizziness, anxiety, confusion, weight gain, increased appetite, dry mouth, constipation, nausea, vomiting, flu-like symptoms, chest pain, fast heart beat, seizures. What you are experiencing may be from the medication. It is possible for this symptom to subside, but it is best to discuss it with your prescriber. You will have to review the risks and benefits of this medication and decide, in conjunction with your prescriber, whether to continue taking your current dose, change dose, or discontinue the medication. Good Luck, and don't forget the benefits of therapy!

Wednesday, August 15, 2012

Why Do You Do Drugs?

Question: This is a question about drug interaction.  I've smoked marijuana before with no unexpected problems, just the usual dizziness and mild euphoria.  I have never been a frequent user.  Recently, someone gave me a prescription Marinol pill, and when I took it, I had the most awful experience of my life - a seriously intense high that was in no way pleasurable, hallucinations, a feeling that my mind was continually "spinning," and what felt like electrical pulsing throughout my whole body.  I thought I was going to have a seizure, but I didn't.  The worst of it lasted just over 4 hours, and it took me 24 hours to stop feeling tingly, depersonalized, and altogether weird.  I am currently taking Klonopin at a prescribed dose of 0.5 mg/day as needed (usually 2-3 times per week), and although I didn't take it the same day as I had the Marinol pill, I'd taken it the day before.  My question is:  could my weird trip have been a reaction between Klonopin and Marinol?  And now that it's been over a week (today is August 14th, and I had this reaction on the 6th), is it safe to take my Klonopin again?

Answer: The first order of business is to do some self-reflection regarding why it is necessary for you to do drugs.  Perhaps you use drugs to medicate some emotion or feeling you don't like having or dealing with. I suggest therapy. The second order of business is why in the world you believe what you are buying illegally is actually what the seller says it is!?! What if the seller gave you methadone or some other downer even though they told you it was marinol and it caused you to stop breathing because you took it with your klonopin and then you are accidentally dead. Truth is...that happens all the time!!  Marinol is sort of the synthetic version of marijuana. Marinol's most common adverse reactions are associated with the central nervous system - and can cause anxiety, confusion, depersonalization, dizziness, euphoria, dysphoria, somnolence, and "weird" thinking. It is the synthetic version of a naturally occurring compound known as delta-9-THC.   Honestly, tell your prescriber that you are misusing illegally obtained unknown drugs and if they think it's ok for you to continue on the klonopin.  How about simply asking yourself....Does it seem like the right thing to do...taking your klonopin with unknown illegally obtained substances?  If you didn't need the klonopin for over a week, you probably don't need it at all. Please get some therapy. Your current hobby of experimenting with drugs is high risk and possibly lethal. Time for a new hobby.

Thursday, May 24, 2012

Alpha Mom vs. Buddhist Mom

Question: My 17 year old daughter is rude, she says she is just straight forward, she is not false like me. She is manipulative, demanding. I have been divorced twice from demanding, controlling abusive aggressive men. She is upset that I divorced her father when she was 3 years old. My daughter and I used to do everything together when she was young. I was trying to be the best wife and mother. She is difficult the last 2 years. Its 3 years since I have been divorced from my 2nd husband. She hates him and has also blamed me that I married him in the first place. My 1 collegue, 2 of her father's friends and my 1 friend has told me that she is a very difficult person to live with and that she is rude. She was always my little angel, I was always so proud of her. Now she makes everyone unhappy, my 9 year old son in tears and my lapdogs aggressive. When he is in front of the computer she just demands that he gets up and she takes over the computer. A lot of people say that I am too soft on her. She has told me several times that she does not want me to read nor play games, gardening, playing with the dogs, visiting my friends - things I enjoy doing. She wants me to watch movies with her, she wants to spend time with me and wants us to do things together like going to the lodge bar, playing cards with her and her friends (which is not my place I feel), teaching her to drive. She can drive, but is still battling with the parking. It just seems she is unsatisfied with everything and appreciates nothing. I did not want internet or a laptop, she wanted it, I bought it after several heated arguments and she got it and she still is not happy. She wants me to cook her breakfast, lunch and dinner, I only do dinners. Then she goes and tells everyone that there is no food in the house. There is food, she just does not want to make it – sandwiches, cereals, eggs, meat, etc). I just want peace in my house and to relax weekends. I do not want to have to entertain her or keep her busy! We live in a small town, her father lives in the city. I am always there for my kids for a nice chat, I have even talked to my daughter Saturday until 4 the morning and it was nice. Her father works a lot and is seldom home, when she goes to visit him she demands that I go with. She is in a private boarding school in a town nearby me. She complains she is alone at her father’s house and she also feels lonely during the day at my house when I work. I have asked her to help me with the cooking and house cleaning as I feel this is also spending time together, but she does not want to. Her father has bipolar. I have tested her. She does not have bipolar. She did go see a psychiatrist, but he lives in a city far away. The psychiatrist said she is a very intellegent adult person and its been years that he met someone as interesting as her. He is just very worried about the fact that our mother daughter role seems reversed. She acts like she is my mother. How do I get this right? He lives to far away to go and see. Should I take all her privileges away, should I smack her bottom?

Answer: There is a fork in the road and you must choose a route. Neither route is right or wrong. They are both journeys.

Rick Hanson, in his book Buddha's Brain, said, "If you can be without the pleasant without chasing after it, with the unpleasant without resisting it, and with the neutral without ignoring it- then you have cut the chain of suffering, and that is an incredible blessing!"

The first path is a journey of meditation and mindfulness. Rediscover your virtue by regulating your actions, words, thoughts in order to find your safe place. This path is about finding yourself. Your question reflects all the "wrongs" that you believe others are doing to you. You present yourself as a victim. Is that how you want us to think of you? Perhaps you believe that if you don't control people then things won't turn out right. But...maybe it's not that they won't turn out right; maybe it's that they won't turn out the way you want them to. On this path, you imagine letting people develop responsibility for themselves. You meet mistreatment head on with loving kindness. You accept that you can not and do not control others. Choose this path if you want peace.

The second path is the primitive choice of taking action to become the alpha dog. To be the alpha, you must control the games, control the food, control the sleep, and control the social interactions. You must eat before all others, you must walk through doorways first. If you establish eye contact with another, the other person must avert their gaze first! Only give attention when YOU want to. Choose this path if you desire power.

Stephen Gaskin(2005): "Described karma as hitting golf balls in a shower. Often our attempts at payback just get in the way of balls already ricocheting back toward the person who sent them flying in the first place. "

Submitted @ http://www.eleventhhourllc.com/online-advice/submit-a-question.aspx
Timestamp: Tuesday, May 22, 2012

Wednesday, May 16, 2012

Get Over Test Anxiety

Question: Hello, I have test anxiety really bad and these Science MCA's are approaching very soon. These are very important tests to me and I can't handle myself. I have asked if I could take the test in a room without other students. She said I could if I talked to a doctor about this. So, here I am; can anyone help me please?

Answer: You certainly can go see a psychiatric clinician to explain how you need a note to have special accommodations for the exams.  Or, you can march yourself right in front of a mirror and look yourself straight in the eye and tell yourself, "I know the material on this test, I am prepared and calm. I am successful."  Stop the negative thoughts. Your negative thoughts and worry are causing the physical anxiety you are feeling. And...your positive thoughts will cause the calm and success you crave right now. The power and the peace are within you.

Wednesday, May 9, 2012

Life Of Julia! ...Now At A Theater Near You

Have you read the reviews? The sci-fi summer blockbuster hit Life of Julia has just been released by the acclaimed director Barack Obama!

The heroine, Julia, is a cartoon girl whose life we follow through a maze of government programs that she simply can't live without!  It's setting is the beautiful shorelines of Greece and it takes a little suspension of disbelief to remember that its an American story.  But hey, that's why we love sci-fi movies!

The movie starts off with an urgency as the heroine suddenly needs the Head Start Program to help her blossom in elementary school. But within minutes, the villains swoop in and spew statistic after statistic that proves the program is useless.  Spoiler alert!!   ...Julia slays the villains with her cross and bow and moves on through school to eventually get into college. Wow! It's a thriller too!

In college, our heroine easily glides through life without worries because her parents are paying her health insurance until she is 27! She can drink and smoke and use birth control all without worrying about the health consequences because she is covered!

The movie starts dragging a bit in the middle as Julia has a baby out of wedlock.  She refuses to divulge the baby daddy and the theme of men getting away without having to be accountable causes the patriarchal government to rescue our poor Julia and give her food stamps and baby formula so she stays quiet and oppressed. Our Julia becomes content and doesn't join the women's movement. She eventually files for bankruptcy because her student loans doubled their interest rate in a sudden plot twist!

She tries to start her own web business but becomes so bogged down in government regulations and taxes that even her trusted bow and arrow fail to cut through the red tape.  A sad ending ...but a sequel is already in the air as her son heads off to elementary school and the infamous head start program.

Well the reviews are all in:

"This is a naive director with so little insight you wonder what comic books he's been reading." - New York Observer          Oops!...this review was about the movie Bullhead, but it works for this movie too!

"A perfectly enjoyable film, as long as you let go of a few glaringly obvious contradictions." -John Anderson, News Day    Oops!...this review was about the movie Legally Blonde, but it works for this movie too!

"This film can't figure out where to go with its concept and increasingly unravels as it marches along." -Kenneth Turan, LA Times   Oops!...this review was about the movie Legally Blonde, but it works for this movie too! 

Government "help" to business is just as disastrous as government persecution... the only way a government can be of service to national prosperity is by keeping its hands off. Oops! ...this is a quote from Ayn Rand, but it works for this movie too!

Wednesday, May 2, 2012

My Husband And His Female Coworker

Question: My husband is a truckdriver. He has just decided to become a team driver with a straight woman and he did not tell me until after the fact. He swears it's for the money and he's not attracted to her but to me this is a deal breaker. Should  a decision such as this not be discussed with your wife? I am ready to divorce him.

Answer: I definitely don't think it's a deal breaker. I'm not sure why your reaction is so severe. Are you worried about your husband cheating on you? Do you trust him? Perhaps he has done things in the past that have caused you to react so negatively. He is making a career choice, not a relationship choice. Be supportive. Don't fret about something that is nothing. It is not ok to accuse him of something you think may happen in the future. It is great he has a job he likes and is able to advance into a position to make more money for your family.

Saturday, February 25, 2012

Santorum vs. Romney - The Hair Wars!

When it gets to the point when all you here is "blah blah blah" when you turn on the Republican debates, it's time to focus on other issues that seem more important than "blah!"  I took a look at Romney's and Santorum's websites. Romney has a little grey on the sides and it looks like he uses some gel to slick it all back. He looks kind of tan too. Santorum doesn't have any grey and it's a bit puffy on top. It seems "touchable"...like your fingers wouldn't get stuck if you ever got a chance to sweep your hand across his head.  Santorum doesn't look tan...probably because he doesn't get as many donations as Romney.

Romney has 1.4 million "likes" on his website! Santorum only has 154,393 "likes."  Romney has 7 topics with cute clip art that you can click on to learn about his platform. Santorum has a simple list of 32 points in his platform.

Santorum has a cute little picture of him with his family and a BIG RED DONATE button on the top right of the page.  Romney has a huge picture of himself at a microphone with the crowd in the background appearing like teeny tiny followers. The angle of the camera makes Romney look like a big-pompous-power-hungry-dictator-type. Oh...Romney has a BIG RED DONATE button too.  

Well I hope this information helps you to pick the right candidate! 

Thursday, February 23, 2012

Talking About Suicidal Thoughts

Question: When talking to a psychiatrist about suicidal thoughts under what conditions will they send you to treatment?

Answer:  This involves a very systematic process of evaluating your risk factors and your protective factors. It involves your history of self-harm, your history of thought processes, and your history of suicidal thoughts. It also involves talking with the people in your life and how they view your safety in the community.  It takes a skilled clinician to get you the right help. And, sometimes, this involves hospitalizing a person against their will. The relationship you have with your clinician is also a factor. Your clinician is there to help you. Being honest about your thoughts and plans is vital. If you are having thoughts of hurting yourself, please call 911 and tell someone right away so that you can get the appropriate help.

Sunday, February 12, 2012

Too Much Adderall?

Question: What would the maximum dose for Adderall Extended Release be for an adult male? I am very concerned that my brother in law was given a RX for far more than he needed.

Answer:   Well, many prescriber's go above the FDA recommended dose of Adderall XR 20mg daily. The XR should only be taken once a day.  This is not a medication that adults should take long-term. In my practice, I avoid prescribing this medication. I just have not seen long-term success with it and too many people abuse the medication. I know this sounds quite negative, but it's my opinion, it's a dangerous medication if not prescribed and taken appropriately. Your brother-in-law should get a second opinion.

Wednesday, January 11, 2012

Plan B - Burger or Birth Control?

Why oh why is there a burger joint named plan B? I found out about Plan B Burgers when my 17 year old daughter said,  "I'm going out for Plan B."  I almost had a heart attack! Then she explained it was a yummy burger place.

So just to clarify...

Plan B is a pill intended to prevent pregnancy after known or suspected contraceptive failure or unprotected intercourse.


Plan B is a burger bar that sells 100% certified natural beef,as opposed to unnatural beef...which is....maybe... a gay cow if you're republican or a gas-guzzling SUV driving cow if you're a democrat.

The real definition of plan B is "a secondary plan of action in the event that changes would make the primary plan unsuccessful."

Wait I'm getting confused... plan A is "the primary plan of action." So is plan A the intercourse moment and a McDonald's quarter pounder? Because then plan B would be the morning after pill and the organic burger?? Because there has to be a plan A .... or there would be no need for a plan B. Right???

I thought plan A was the best plan and plan B was a just-in-case thing.  Like when you go to the movies, plan A is two tickets for Mission Impossible IMAX and plan B is two tickets for Alvin and the Chipmunks Chipwrecked.

But I guess plan B could be the better plan...like for Brad Pitt...Jennifer Aniston was plan A and Angelina Jolie was plan B. So I see how this can work either way!

So whatever your plan A may be, practice safe sex and become a vegetarian...because then you will never need plan B.