Autism is the general term for a spectrum of developmental disorders that begin in early childhood. People with this disorder may have difficulty socializing, understanding emotional cues, or functioning in daily life. People with autism are not, as was once thought, intellectually impaired. In fact, many children and adults with autistic disorder show remarkably high intelligence in a variety of areas. Despite years of research, scientists are still not able to explain what causes autism, much less develop preventative measures or cures. The best approaches we have for helping those with autism are therapy and behavioral counseling. The goal of such therapy is to keep behavioral symptoms under control and improve the overall quality of life.

Children with autism show different signs and symptoms. Some are completely withdrawn, seemingly trapped in their own consciousness. Others are very outgoing but oblivious to the social or emotional needs of those around them. Among all behavioral symptoms, aggression towards oneself and others is the most troubling. In two controlled trials, the antipsychotic medication Abilify (aripiprazole) was shown to significantly reduce aggressive outbursts and mood variability in children aged 6 to 17 years.

In most instances, Abilify represents a good choice for modifying aggressive behavior. Adverse side effects reported from the trials included sedation, fatigue, and vomiting. These side effects typically occurred in the first week or two of taking the medication and faded with time. About 10% of patients in the trials discontinued Abilify because of adverse effects, compared with 7% for placebo. In the long term, the most commonly observed side effect was weight gain, which also plateaued after several weeks. Physical activity and a well-managed diet may offset some of this weight gain. In a 52-week trial, the effectiveness of Abilify at reducing irritability appeared unchanged. This finding is encouraging, as the benefits of some psychotropic drugs have been shown to diminish after prolonged use.

Stabilizing the emotional states of children with autism is an important goal for therapists and parents. When the child is calm and responsive, talk therapy and other interactive activities can be more meaningful and effective. Aggressive outbursts and irritability lead to a poor quality of life for the child with autism. Although a cure may still be a long way off, Abilify has proven that it can help improve quality of life for autistic children who exhibit anger and aggression toward themselves and others.

References
Curran, M. P. (2011). Aripiprazole in the treatment of irritability associated with autistic disorder in pediatric patients. Pediatric Drugs, 13 (3), 197-204.

Amphetamine abuse and addiction is a serious and growing public health issue throughout the United States. Addiction inevitably leads to rising health costs, lost productivity, broken families, and progressively declining quality of life for drug users. Medical science has yet to formulate a satisfactory answer to this problem. Rehabilitating users is clearly one of the primary objectives, but there are numerous stumbling blocks along the way. Typical users deny the seriousness of their addiction unless and until dire consequences arise. Withdrawal effects from amphetamine are profound, and recovering addicts experience relapse at alarmingly high rates. The current best practices for addiction treatment include supportive individual therapy, group therapy, and profound lifestyle changes. In severe cases of withdrawal, anti-anxiety medications are often prescribed to ease feelings of fear and discomfort.

Ironically, amphetamines serve a therapeutic purpose in the treatment of both attention deficit hyperactivity disorder (ADHD) and narcolepsy. Dexedrine (dextroamphetamine), Adderall (dextroamphetamine and amphetamine), and Ritalin (methylphenidate) are the three primary stimulant drugs prescribed for these purposes. Recently, a nonstimulant medication, Strattera (atomoxetine) has received attention both as an alternative treatment for ADHD and as a possible therapy for recovering amphetamine addicts. Researchers in Connecticut discovered that Strattera, when taken over the course of several days, actually suppresses the effects of Dexedrine. Participants in a study group pretreated with Strattera reported fewer positive drug feelings when given a single dose of Dexedrine. Similarly, blood plasma levels showed fewer chemical markers of the heightened mood state typically associated with Dexedrine and other amphetamines.

The mechanics of amphetamine addiction are still something of a mystery. Researchers know that several chemicals in the brain are important to building and maintaining a state of dependence. Dopamine is one of these chemicals, and it plays a major role in the so-called “reward system.” Norepinephrine is thought to be responsible for the feelings of energy and euphoria experienced by users. Effective pharmaceutical interventions will need to disrupt some of the patterns that amphetamines establish within the brain. The most recent experiments have shown that norepinephrine is at least as important as dopamine in generating the stimulating physical and psychological effects of amphetamines. By altering the levels of norepinephrine with Strattera, the positive drug feelings of Dexedrine are greatly reduced.

References

  1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Atomoxetine. Retrieved April 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000222/
  2. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Dextroamphetamine. Retrieved April 18, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000310/
  3. Sofuoglu, M., Hill, K., Kosten, T., Poling, J. (2009). Atomoxetine attenuates dextroamphetamine effects in humans. American Journal of Drug and Alcohol Abuse, 35(6), 412-416.

Children under severe psychological duress sometimes develop an involuntary reflex that causes them to swallow large volumes of air. Known as pathologic childhood aerophagia (PCA), this condition leads to a variety of stomach and intestinal problems if left untreated. Bowel distention, malabsorption of nutrients, and abdominal cramping are all potential symptoms of long-term PCA. Treatment of PCA usually consists of supportive counseling and reassurance, along with an attempt to identify and manage sources of stress and worry. Attending physicians may also prescribe anti-anxiety drugs on a case-by-case basis when the first line of treatment fails. Researchers in Korea performed a small-scale test to determine whether the anti-anxiety drug Klonopin (clonazepam) might be safe and effective in treating PCA.

Twenty-two children at a Korean clinic were enrolled in the PCA management study. Fifteen received Klonopin, and the other seven received counseling alone. Parents provided informed consent on behalf of their children, and there was no placebo-controlled group for comparison. Video observation of the children’s esophagus confirmed that abdominal symptoms were a result of PCA and not another condition. Throughout the study, regular observation with a videoscopic device helped clinicians determine the state of the child’s PCA. Children and parents also self-reported PCA symptoms and any potential medication side effects throughout the study.

Researchers dispensed Klonopin to the children at doses far below the normally therapeutic amounts. However, even at these low doses, empirical video evidence confirmed that the muscles controlling the involuntary swallowing action relaxed quickly after administration. The effective dosage of Klonopin in the study was low enough that long-term maintenance treatment presented relatively little risk. Children treated with Klonopin experienced remission of their PCA at a rate of 67%, compared with only 15% for children treated only with reassurance. In the absence of follow-up treatment, however, the likelihood of relapse was fairly high. A combination approach that incorporates both pharmaceutical and behavioral treatments offers the most comprehensive solution.

Except in cases of mental retardation, PCA is nearly always a symptom of psychological distress. Although Klonopin and similar psychotropic medications offer relief from the condition, cognitive therapy is important for maintaining remission and enhancing the individual’s self-confidence and coping mechanisms.

References

  1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Clonazepam. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000635/
  2. Hwang, J., Kim, J. S., Ahn, B. H., Jung, C., Lee, Y. H., Kam, S. (2007). Clonazepam treatment of pathologic childhood aerophagia with psychological stresses. Journal of Korean Medical Science, 22, 205-208.

In psychiatric emergency settings, the standard treatment for aggressive or agitated behavior during psychosis is an injection of Haldol (haloperidol). A dosage of 5 to 10 mg is typically effective at putting a restless patient to sleep in a relatively short period. Aggressive patients are worrisome because they can do harm to themselves or others. An agitated person in the middle of a psychotic episode is not going to respond to the ordinary line of treatments. In some emergency settings, attending physicians choose to combine Haldol with a strong antihistamine such as Phenergan (promethazine). This practice is not recommended by international guidelines; however, researchers believed that the practical experience of emergency room doctors might have revealed a better, safer treatment option for agitated patients.

A group of international researchers conducted a study at a Brazilian hospital comparing the effectiveness of certain approaches to managing aggression and restlessness in patients admitted to a psychiatric emergency room. When an admitted patient qualified for participation in the study, they were randomly administered either Haldol alone or Haldol in tandem with Phenergan. A total of 316 people participated before the trial was stopped. One-hundred and sixty received the combination treatment, while the other 156 received only Haldol. Doctors and nurses observed and recorded how much time passed between administration of drugs and sedation, as well as any adverse side effects.

The trial ended early because data monitors quickly saw the results. Haldol by itself is neither as safe nor effective as when used together with an antihistamine like Phenergan. First, full sedation took much longer with Haldol alone. The longer patients remain agitated, the greater the danger they represent. In addition, one of the more troubling side effects of Haldol is dystonia—painful spasms of large muscle groups. Antihistamines seem to counter this effect, although the exact mechanism isn’t well understood. Because of these dangers, the study was halted when only halfway complete.

Despite the fact that the Brazilian study was left unfinished, the results are still significant. The researchers strongly recommend that psychiatric emergency wards institute administration of Haldol plus Phenergan as standard procedure for aggressive patients. This combination helps increase the safety of both patients and those charged with caring for them.

References

  1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Haloperidol. Retrieved February 29, 2012. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000604/
  2. Huf, G., Coutinho, E., Adams, C. (2007). Rapid tranquillisation in psychiatric emergency settings in Brazil: pragmatic randomised controlled trial of intramuscular haloperidol versus intramuscular haloperidol plus promethazine. BMJ. 335(7625):869. Published online 2007 October 22. doi: 10.1136/bmj.39339.448819.AE

 

Teachers and parents of children with ADHD know all too well how easily these special children can get distracted. The majority of research has shown that children with ADHD focus better and stay on task more when they are in an environment free from stimulation. But there is some evidence that specific stimulation can have a positive effect on these children. “Other studies have shown that background music significantly improves performance on cognitive tasks for children with ADHD but does not impact or negatively impact the performance of non-ADHD controls,” said W.E. Pelham, Jr. of the Department of Psychology at the Center for Children and Families at Florida International University, and lead author of a study on distraction among ADHD boys. “Despite these research findings, classroom teachers and the committees that revise the DSM continue to report and conclude that children with ADHD are more easily distracted than children without ADHD, and that distractors have only negative effects.”

Pelham examined how music or videos affected the attention of boys with ADHD who were non-medicated versus boys who were on methylphenidate (MPH) in a classroom environment. In three separate studies, Pelham found that the boys responded well to only musical stimulus. “Video produced significant distraction, particularly for the boys with ADHD, and MPH improved the performance of boys with ADHD across distractor conditions,” said Pelham. “In the presence or absence of music, MPH improved performance relative to placebo.” However, Pelham noted that although the video distracted all of the children, and specifically the children with ADHD, music had a beneficial effect, improving productivity in the boys with ADHD. “Thus, rather than recommending that children with ADHD perform homework in complete silence, our results suggest that listening to music while studying will not hurt most and may help some children with ADHD.” He added, “Rather than isolating a child with ADHD in a stimulus-free environment, these findings suggest that providing the child with headphones on which he or she could listen to music while working may enhance the classroom productivity of some children with ADHD.”

Reference:
Pelham, Jr., William E., Daniel A. Waschbusch, Betsy Hoza, Elizabeth M. Gnagy, Andrew R. Greiner, Susan E. Sams, Gary Vallano, Antara Majumdar, and Randy L. Carter. “Music and Video as Distractors for Boys with ADHD in the Classroom: Comparison with Controls, Individual Differences, and Medication Effects.” Journal of Abnormal Child Psychology 39 (2011): 1085-098. Print.

Depression and anxiety are among the most common mood problems, regardless of age or demographics. Children and adolescents experience anxiety and depression at a significant rate, although treatment for this population brings some complicating factors. The most frequently prescribed antidepressant medications incur a small but real risk of suicide or suicidal thoughts in young people. Known as selective serotonin reuptake inhibitors (SSRIs), this class of antidepressants is otherwise well regarded for both safety and effectiveness. When parents and physicians are cautious and attentive, SSRIs can be prescribed to children with a fair degree of safety. However, other side effects appear in younger patients that do not seem to affect adults. Hyperactivity, for example, is one such side effect of SSRIs that is confined to children and adolescent patients.

A review of previous studies revealed that so-called “activation events” might be extremely common in children taking certain antidepressants. Activation events are defined by abnormal energy, hyperactivity, and disinhibition. None of these effects reaches the level of mania, however, and sometimes it’s difficult to distinguish between “normal” activity levels and hyperactivity in young children. In a clinical trial of Luvox (fluvoxamine) prescribed to children, nearly 50% of participants experienced an activation event. Age appeared to be a significant factor—younger children were more likely to experience these side effects. Blood tests also showed that children who experienced activation events had higher concentrations of Luvox in their blood, despite lowering the dosage to mitigate side effects. This suggests that the medication is metabolized differently depending on the individual.

In the case of Luvox, hyperactivity as a side effect is not typically serious enough to require a change of medication. If the side effect is accompanied by self-injurious behavior, however, then a medication change is likely the best solution. Insomnia and aggressiveness are also signs of mania beyond simple hyperactivity. In a review of published work, researchers determined that demographic or family characteristics were not predictive of activation side effects. In addition, these side effects typically diminished and did not recur once the dosage was lowered.

In summary, because of differences in metabolism and physiology, children and adolescents react differently to medications. With Luvox and other antidepressants, there is a strong possibility of hyperactive or disinhibited behavior but not to the point of mania. Physicians and parents should always monitor children taking antidepressants for signs of worsening symptoms or suicidal tendencies. The side effect of hyperactivity by itself is generally not considered to be a cause for concern.

References

  1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluvoxamine. National Center for Biotechnology Information. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
  2. Reinblatt, S.P., dos Reis, S., Walkup, J.T., Riddle, M.A. (2009). Activation adverse events induced by the selective serotonin reuptake inhibitor fluvoxamine in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 19(2), 119-126.

Depression among older adults is an often-overlooked health crisis. Studies show that more than half of all people older than 60 diagnosed with depression fail to respond to initial treatment programs. In general, a psychotropic medication such as Lexapro (escitalopram) is one option of many as a first treatment. A variety of factors, however, complicate the successful treatment of elderly depression. Comorbid conditions, such as anxiety or poor physical health, may exacerbate the symptoms of depression. For reasons not fully understood, elderly patients respond more slowly to psychotropic medications in general. The patient’s level of independence likewise contributes to the success or failure of standard treatments. Despite the well-documented difficulty of treating depression in the elderly, relatively little work has been done to find more age-appropriate solutions to the problem.

In the case of elderly adults with depression, behavioral therapy may be at least as important as medication. One form of therapy known as depression care management (DCM) focuses on educating the patient about depression, their treatment, and practical measures for improving mood and daily functioning. Another therapy, known as interpersonal psychotherapy (IPT), is more intense and individually targeted. IPT resembles traditional cognitive-behavioral therapy, whereas DCM is more akin to routine counseling.

In a study of elderly adults, researchers tested whether DCM alone or coupled with IPT is more beneficial for those with a history of poor response to antidepressant medication. Study participants were administered standard prescriptions for Lexapro, which was increased as needed after an initial 6 weeks. People who experienced remission with medication alone were dropped from the study. Poor responders were divided into a DCM group and a DCM plus IPT group. Eighty percent of these individuals saw some improvement, while half experienced full remission of symptoms. Interestingly, there were no significant differences between the groups. Researchers theorized that “quantity” of therapeutic attention was less important than the existence of the attention at all. Therefore, the addition of DCM alone produced benefits; adding IPT did not produce more benefits.

The study was somewhat limited because researchers did not control for external variables, other than medical conditions that might argue against the use of Lexapro. In addition, some patients might have improved simply because of increased dosages and not behavioral interventions. More investigation is necessary to answer such questions.

References
Reynolds III, C. F., Dew, M. A., Martire, L. M., Miller, M. D., Cyranowski, J. M., Lenze, E., et al. (2010). Treating depression to remission in older adults: a controlled evaluation of combined escitalopram with interpersonal psychotherapy versus escitalopram with depression care management. International Journal of Geriatric Psychiatry, 25(11), 1134-1141.

Woman holding newbornMandy nuzzled her 3 month old baby happily as she warmed his bottle. It felt so good to breathe in his sweet baby smell and touch his soft delicate skin, his little body curled in a warm embrace into the curve of her neck. Mandy was starting to feel like she had her “sea-legs’ as a new mom and was particularly enamored of the fact that her new baby was sleeping through the night. The rough night-time awakenings were beginning to subside as baby Noah matured and slept for longer periods. She was looking forward to meeting a new mom friend in the park with their babies after she gave Noah a bottle.

Suddenly, in the wink of an eye, the tender moment vanished. Mandy watched the water warm Noah’s bottle on the stove. She  was blind-sided by a  horrific thought, flashing through her mind of the  water morphing into hot lava and scalding her baby boy. Mandy flinched, gasping and clenching tightly onto Noah, quickly backing away from the oven. The thought terrified her, and she could not believe such an image threatened to envelop her mind. Mandy’s entire body tensed as she began to pant, shallow breaths. She didn’t know it at the time, but, she was well on her way to her first panic attack after experiencing an intrusive thought…a hallmark symptom of perinatal depression and/or perinatal OCD.

Experiences like Mandy’s are common in some 20% of all child-bearing women who develop perinatal mood/anxiety disorders (the clinical term for depression/anxiety during pregnancy and up through the first year after having a baby). Some women develop symptoms of anxiety with intrusive thoughts while others may not experience these often debilitating and traumatic images. Others may have more depression symptoms with a smattering of anxiety, panic attacks, and sometimes intrusive thoughts.

PMADs (perinatal mood/anxiety disorders) are the clinical term for a myriad of symptoms under the umbrella of depression and anxiety from conception through the first year following childbirth.  In layman’s terms, perinatal challenges/neurobiochemical imbalances while pregnant and after having a baby often leave women completely stunned, horrified, and traumatized…because  women don’t know what hit them. And no one talks about it.

The reality is that PMADs are very common, and most likely under-reported due to the stigma connected to them. Mothers can be wracked with so much guilt about any of the symptoms, particularly if she has intrusive thoughts, that they are loathe to talk to a specialist to get help or to a family member. Many women report they feel like they are “going crazy” or afraid to be “like that woman on TV who killed her kids.”

I want to underscore the importance of supporting a woman who is experiencing intrusive thoughts to not delay in seeking help, to get help immediately with a trained specialist in perinatal challenges. The differential amongst these particular perinatal struggles is quite delicate. Furthermore, to receive the best care, she must have help from a skilled perinatal psychotherapist who can provide a comprehensive bio-psycho-social assessment and steer her in the appropriate direction for what is ideally a multidisciplinary approach to treatment.

This article is not intended to be a primer on the difference between perinatal intrusive thoughts and hallucinations since such is the subject of a workshop or conference. And, each set of circumstances requires a different course of treatment (both medically and in psychotherapy). Generally speaking, however, when a woman experiences intrusive thoughts, she is grounded in reality and horrified of the images that are occurring, feeling that her body is betraying her. She will often respond with disgust at the images and in turn demonstrate behaviors that lessen her anxiety and protect her baby (for example, Mandy avoided ovens for a time because such objects were a trigger for her). Intrusive thoughts can be part of perinatal depression and will remit with psychotherapy and in many cases, medication management (typically an SSRI), along with a good self-care plan and social supports in place.  Hallucinations, on the other hand, are considered a medical emergency and potentially part of a more rare PMAD, perinatal bipolar disorder or psychosis. In such a case, the woman is not grounded in reality, and hallucinations can cause her to do or say things that she would not normally do and have the potential to be life-threatening to her or the baby. If you suspect that you or a loved one are experiencing hallucinations, call 911 or go to your nearest emergency room immediately. Do not attempt to diagnose.

Fortunately for Mandy, she realized something was amiss in her brain biochemistry and immediately sought help with a trained perinatal psychotherapist. Upon consulting with a psychiatrist specializing in reproductive mental health, she agreed to try an antidepressant (Zoloft) to help her biochemistry restore itself. Mandy’s recovery was swift because she sought help immediately, she received support, non-judgment, validation, psycho-education, as well as cognitive behavioral strategies in psychotherapy to help her diminish the anxiety and intrusive thoughts. She worked with her therapist on a solid self-care plan and put in place the help of a doula (hired caregiver specifically for new parents). Mandy feels empowered now as a new mom, free of intrusive thoughts and filled with pride at the arrival of Noah in her life. She is now on to a full recovery, enjoying her 7 month old son. (Please note: swiftness of recovery times vary with each individual’s unique circumstances).

If you or someone you love appears to have intrusive thoughts after having a baby (or even while pregnant), do not attempt to diagnose her. Do find a trained perinatal specialist to help the woman you care about to get treatment. The good news is that PMADs are treatable and temporary, and with help, women recover fully.

Other useful resources:

Great book on intrusive thoughts:
Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood by Karen Kleiman and Amy Wenzel (2010). –excellent book for new moms dealing with PMADs, also for perinatal professionals

The bottom end of a bed is shown with clothes laying on it.Since my last blog, Depression Medications: How Can You Get Your Libido Back? a number of you have asked for more information about possible sexual side effects caused by antidepressants. Before I say more—a cautionary word—I’m a psychotherapist/counselor, not a medical doctor/psychiatrist. So what I write in this blog is drawn from my (extensive) experience working with people who have challenges and/or difficulties with sex—I’m a sexologist, not a psychopharmacologist!

Some of the worst culprits, or libido smashers, are the selective serotonin reuptake inhibitors (SSRIs) such as Effexor, Paxil, Prozac, and Zoloft. Unfortunately, these are all heavily prescribed. I mentioned last month that many folks can benefit from a so-called “drug holiday,” when they forgo their medication for a few days. Be aware that this intervention does not work for Prozac. This is due to the much longer period of time that Prozac remains in the bloodstream, compared to the other shorter-acting SSRIs, like Zoloft.

Several types of antidepressants have virtually no side effects. The most common ones that I hear about are Wellbutrin, Xanax, and Klonopin. I’ll often suggest, to the new people I see, substituting (with the agreement of their medical doctor, of course) Xanax or Klonopin for Wellbutrin because the latter can exacerbate anxiety or “agitated depression,” as it’s called by psychiatrists.

Wellbutrin is also infamous for causing insomnia and headaches, which tend to make most of us anxious, and it certainly doesn’t contribute to an enjoyable sexual connection! Wellbutrin is pharmacologically distinct from the SSRIs, as it enhances the neurotransmitter dopamine, which has the opposite effect on libido and orgasm of serotonin. Xanax and Klonopin are usually prescribed to combat anxiety, not serotonin, so they tend to have very few sexual side effects.

I will often recommend that people who are leery about psychotropics try St. John’s Wort, which is most effective, I’ve found, for Type A blood types (remember, I’m not prescribing, just using anecdotal experience to make these suggestions!). Because it’s not regulated as a pharmaceutical substance, I’m told that efficacy can vary widely.

[fat_widget_left] The individuals I see in my office have reported that Viagra is effective for SSRI-induced absence of orgasm, and I’ve known people of both genders who swear by the botanical preparation ginkgo biloba to reverse libido, arousal, and/or orgasm problems. One sex therapist colleague tells me that Viagra can be helpful for women as well, but no one I work with has directly reported this to me.

If switching to an alternative psychotropic is not clinically appropriate or effective, some doctors might recommend adding another medication on a daily or as-needed basis. Many people are hesitant about taking one drug, let alone two! But for those who are comfortable with it, a second medication can often offer an antidote to the side effects of an otherwise helpful medication.

Most commonly, a sexual-savvy psychiatrist will prescribe a single low dose of Wellbutrin for people complaining of sexual side effects from other antidepressants—employing lower does of Wellbutrin than would be necessary to treat depression alone. These small doses can restore the serotonin-dopamine balance that I mentioned earlier, alleviating sexual side effects.

People starting out with me often ask if I suspect that their sexual problems are relationship issues or caused by medication. I always ask them how long the sexual challenges have been occurring. SSRI-induced sexual dysfunction follows a fairly typical pattern: it begins within days or weeks of starting the new psychotropic medication. For example, a woman may report that she can no longer reach orgasm with her husband within weeks of beginning Prozac for obsessive compulsive disorder.

Women rarely volunteer this immediately, but I ask LOTS of questions, which makes it easier to discuss sexual concerns. Men usually have less hesitation talking about such problems, and as one man said to me recently, “that’s why we came to a sex therapist and not the marriage therapist down the street!” The fact that I coach by phone also seems to help, especially for men, who might have difficulty opening up “when the plumbing doesn’t work!”

Don’t forget—if you have questions about your medications, make sure to discuss them with your medical doctor or psychiatrist.

For those who feel cognitively sluggish or emotionally lethargic, it’s certainly admirable to turn to natural remedies before prescription drugs. But many of the foods and dietary supplements presented as “brain boosting” haven’t been thoroughly studied. New research on diet’s impact on mental energy finds that there is some truth to some of the hype: “The strongest evidence suggests” that omega-3 fatty acids may truly reduce the risk of cognitive decline, and that Gingko biloba does positively impact mood and attention. This research also highlights the need for further researchers before stronger claims are made. If your mood is low and you’re having problems focusing, it doesn’t hurt to incorporate a variety of vitamins and nutrients. If exercise, adequate sleep, and a varied, balanced diet still leave you feeling off, there might be something else going on: talk to your doctor or therapist. But if you’re pinning all of your hope on a single supplement, you may want to reassess.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.