May: Mental Health Awareness and Suicide Prevention Month

May is mental health awareness and suicide prevention month; many people start to feel desperate with their depression symptoms around the first couple weeks of spring. Mostly because people think once the “winter blues” are over, and spring has sprung, they will start to feel better miraculously. When that doesn’t happen, the true feelings of depression can sink in: helplessness and thoughts of harming themselves (i.e. suicide) can become overwhelming. It can be hard to see the signs in people who are really close to you, but it is important to know the signs and see them in others, as over 1 million people attempt suicide annually.

depressionWhat are some signs of Depression/Suicide?

-Clinical Depression is usually emphasized by a loss of interest in life, sadness, disinterest in previously enjoyed hobbies, difficulty concentrating, trouble with eating and sleeping.

-Thinking about death a lot (verbalizing, drawing, or referring to death a lot)

-Feelings of hopelessness or worthlessness

-Making changes to wills, plans, or making statements about not being around much longer

-A sudden switch from someone being really deeply depressed and sad to very happy

-Calling people to say goodbye

-Previous suicide attempts (50% of those with prior attempts will try again and be successful)

Risk Factors:

-Previous suicide attempts

-Family violence

-Physical or sexual abuse history

-Firearms in the home

-Chronic illness or pain

-Mental illness history

-Substance abuse problem

What do you do if you think someone is at risk?

-Listen to them, and reassure them that you care about them, you are listening, and you care. If they say that they want to kill themselves, it is an emergency, call 911 (or emergency services where you live), do not leave them alone, and remove any firearms, knives, other weapons, or drugs and alcohol.

-If they are not actively threatening but you feel they are at risk, have them call a Suicide Hotline 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255). And, assist them with finding a mental health professional and you can always start with your Healthcare Practitioner (HCP) to help with a referral.

Many times we missed the subtle signs and symptoms, especially when we are close to the victim. It has happened to me in my very own family, and right after it happened all you think about is “how did I miss the signs?? I spent so much time with them?” It’s important to remember that we all have comfort levels with people, and sometimes you are too close, it almost takes an outsider to see the situation for what it is; you are so used to the persons behaviors or traits, that it is not abnormal to you. And you might just think they are finally out of their funk when they become happy again; but really they have made a plan. It is important to not blame yourself, if someone you love takes his or her own life. It is not your fault, and the symptoms are very hard to see. What’s important is learning and seeing the symptoms in others and helping them.

Knowing when you see the symptoms, and what to do is important. So pay attention to the signs, and how you can help.

Yours in Good Health


Post Traumatic Stress Disorder: Diagnosis & Current treatments

In light of the Marathon Monday bombings, fires in Texas, the Sandy Hook School shooting, the devastation of hurricane Sandy, along with other horrific and traumatic events have occurred recently, there have been many people experiencing Post Traumatic Stress Disorder symptoms, including me, the first few days after the bombing. Post Traumatic Stress Disorder (PTSD) is frequently associated with combat veterans coming back from war, but it is also associated with other traumatic events, and is commonly misunderstood.  There are many side effects, some subtle and some not so, but the average person tends not to really understand this disorder, what sufferers go through, and the current available treatment options.

What is PTSD?

PTSD is the bodies stress response after some sort of traumatic event, usually where people feel their lives (or others around them) are in danger.  Some events that can result in PTSD are: exposure to live combat (i.e. war veterans), serious accidents (car accidents, plane crashes), physical and/or sexual abuse (especially during childhood), large-scale or national disasters (terrorist attacks, school shootings), after a loved one’s suicide or traumatic loss of life, and natural disasters (tornadoes, forest fires, hurricanes).  Basically any major traumatic event will lead to some form of PTSD, which can be transient, in that the symptoms come and go, or are experiences for a short period of time then go away and never come back, while some people experience the symptoms for the rest of their lives.

one of the many reasons for PTSD

one of the many reasons for PTSD

Who will get PTSD?

It is truly unknown why some people experience symptoms and others don’t.  You can put two people in the exact same situation and they will respond differently, and it is very difficult to predict who will have more severe symptoms.  Usually the experience itself determines if people have symptoms and the length of time. Some other factors that may lead to a more intense PTSD reaction:

-If the event was fatal (people died)

– How close the survivor was to the event (i.e. someone who actually had a gun aimed at them during en event and were not shot would have more risk of long-term symptoms vs. their significant other would be effected by the event but have a lesser risk for long-term symptoms)

– If a person was injured during and event or lost someone close to them

– The control you felt during the event(s) or lack thereof

– If treatment, therapy, assistance was sought out after the event

What are the symptoms of PTSD?

As I stated earlier, some of these symptoms are more subtle than others, and most people who survive traumatic events will have some of these symptoms immediately, then they can go away, or continue on. I was in a state of hyper-arousal for a few days following the bombing and definitely having nightmares, but I also felt like I was in a fog and very forgetful, so I appreciated people being understanding with me. Once the symptoms last more than 4 weeks continuously and start to effect your personal life and work life, or cause you great distress consistently, you fit the criteria for PTSD as a diagnosis. The four main symptoms of PTSD are: 1. Reliving the event (having nightmares, constantly thinking about the events during the day causing you to be unable to concentrate). 2. Avoiding similar situations (If you were in a traumatic car or plane accident, no longer riding in cars or planes). 3. Inability to feel (many PTSD victims have a lack of experiencing true feelings after the event, they describe themselves as being “numb”  or having “dulled” feelings). 4. Constant hyper-arousal (always anxious and expecting something bad to happen, constantly looking over their shoulders, worried). These symptoms can lead to behaviors by the victims to try to combat them.  Some people drink or take drugs to slow their minds so they aren’t constantly thinking about the event, while some become severely depressed leading to suicidal thoughts/actions or extreme anger, or acting out and being very promiscuous to try to get their mind off of the event. These are all coping skills that are not healthy and can lead to problems at work, in relationships, suicide, and addiction.  There are ways to help and alleviate the symptoms of PTSD.


What are the Treatments?

Some people are treated with Selective Serotonin Reuptake Inhibtors (SSRIs) to help with depression.  Psychotherapy (counseling) in conjunction with SSRIs can help to alleviate the symptoms of PTSD and help people to get back to their mental state (basically) from before the event.  Cognitive Behavioral Therapy (CBT) is the most effective type of therapy to help victims to work through their feelings about the event and their responses to it; you learn the skills to actively change your thoughts and feelings in response to the traumatic event.  Essentially you work through your feelings and change your response, and no longer keep your feelings bottled up about the event, prior, and after. There is also Prolonged Exposure therapy, where you talk about the event and your feelings so extensively, that it no longer causes you such pain and anxiety, you then expose yourself to   things you have been staying away from to decrease your anxieties.

There are treatments out there, and they are not quick or easy, but they work.  All victims need to know that they should not keep their feelings inside, and they need to talk to a therapist that will help them work through their feelings. I was encouraged to talk about the event with people at the hospital that experienced the same event, and talk to everyone who asked; it was very, very hard, but also made me feel better.  I also used the outlet of writing about the event as a form of therapy, and I felt SO much better having people hear my story. It can be horrible to relive experiences, but it will be worth it to work through the feelings and anxiety, and be able to live your life without the fear or stress of that traumatic experience, and truly begin to live your life again.  If you know anyone with symptoms, or you think you might have symptoms, talk to a family member, your HCP, a therapist, anyone to get help.  If you are in crisis, call 911, go to the nearest emergency room, or call a suicide prevention line (800-273-8255) * if you are a veteran, you can press 1 after dialing the same suicide prevention number and speak with someone trained to specifically work with veterans.

**The FBI set up a victim assistance line specifically for the victims of Monday’s bombing.  Please ask for help, and talk to someone….anyone. It WILL make you feel better.

Take control of your life back.

Yours in Good Health


Are you on Antidepressants? Having Sexual Dysfunction? You are in good company!

I feel like more and more people lately have been pulling me aside to ask me questions about either a low sex drive, no sex drive, or men are having erectile dysfunction (at young ages)…and each time I ask, “Is there any chance you are on an antidepressant or SSRI”? Without a doubt, the answer is always “yes, is this related?” and the lightbulb goes off.  This makes me think that HCPs don’t necessarily do a great job preparing patients for the side effects of these medications that can be used to treat anxiety, depression, post traumatic stress disorder (PTSD), along with other issues.  It is neither abnormal to have these side effects nor be on one of these medications….just to get that out there! And there are certain Selective Serotonin Reuptake Inhibitors (SSRIs)/antidepressants that cause more sexual side effects than others.

What is considered sexual dysfunction?

Well, a lack of interest in sexual intimacy for someone who once had a higher sexual drive is considered sexual dysfunction, along with erectile dysfunction (for men) and vaginal dryness and decreased sensitivity (for women).  Also, for both sexes, antidepressants can lead to a decrease in the ability to achieve orgasm….or make it much more difficult to reach orgasm.  This happens in one form or another to almost everyone at some point in their lives (whether they want to admit it or not) and many antidepressants just increase these issues, but they are so helpful in treating depression and anxiety.

What Antidepressants have a lower risk of sexual side effects?

-Buproprion (Wellbutrin- in all forms including XL and SR)

-Mirtazapine (Remeron and Remeron SolTab)*

*One study showed a very high rate of sexual dysfunction, while a couple of other studies showed much lower rates. Due to that, I am suggesting it as a lower rate drug, but you should talk it out with your HCP.

Which ones have higher rates of sexual dysfunction?



-Paxil (almost half of all users experience sexual dysfunction)





Is there anything I can do to combat the sexual side effects?

YES!  If your antidepressant is working well and you feel good on it, there is no need to change medications (it is an option if you are just starting a medication or are switching meds, you can ask your HCP for one that may have lower sexual side effects), but there are also other options to help and improve your sexual desire while improving your mental state, because a huge component of the sexual dysfunction is mind over matter.  Really. People stress themselves out because they do not have a strong sexual desire, so they anxious about performing, etc. and then they have difficulty performing.  Some tips to try to work through it:

-Talk to your partner about your concerns…sometimes talking about it alleviates some of the fears related to sexual performance.

-If you take your antidepressants at night, schedule to take it a little later that night if you plan on having a special night with your significant other.

-Talk to your HCP about lowering your dose, do you ned to be on the dose you are?  Also, there are studies that show some people do very well on drug “holidays”; maybe taking their antidepressants Sunday through Thursday so they have a good level of the drug in their system but they can have more of a sexual desire on weekends.

-Add another medication: 50-100mg of Viagra or 5-20mg of Cialis taken before sexual activity has been shown in studies to improve arousal, erectile function, and lead to meaningful orgasm (men).  Low doses of Viagra have also been found to help women with their sexual arousal and ability to reach orgasm.

I am not advising to stop medications or decrease doses without talking to your HCP, they know you and your needs better than I do, but it is important to talk about these things with them.  Really, they should be asking you how your sex life is after you start these medications…but if they don’t screen you, tell them! We are so used to getting questions like this, it is great to have it out in the open, so please do not suffer in silence, your HCP will work with you no matter what route you want to take in treating your side effects from your antidepressants.

So get chatting with your HCP and get humping with your partner (safely)  😉

Yours in Good Health




In honor of mental health week, I thought that I would talk a little bit about anxiety: something that affects us all, in different ways, and totally different levels.  We all face stress, and we all get some form of anxiety, and every single person has a different way of dealing with it…some healthy, and some not so healthy.  I want people to know the difference between “normal” anxiety and “I really need some help” anxiety, and how we can treat it.  Anxiety disorders can start as a child and be a lifetime battle, or it can crop up at any point in your life.

What are some symptoms of anxiety?
Restlessness, feeling “on edge”
Constant worry about issues (small or large)
Difficulty concentrating
Poor sleeping (unable to get to sleep OR waking up in the middle of the night and unable to get back to sleep- constant exhaustion)
Constant muscle pains/strains (i.e. that tension that might occur in your back, shoulders, etc)
Rapid heartbeat
Shortness of breath

What can put you at a higher risk for anxiety disorders?
-Simply being a woman (gross!): women have a 2 times higher rate of anxiety than men
-Personality: Some personality types are more prone to be anxious (hello Type A! I’m not judging, I am a Typer A’er!)
-Genetics: If you come from a family of worriers and stressed out people, you are much more likely to sweat the small stuff.
-Trauma: Anyone who has survived a trauma (childhood, adult) as either a bystander OR someone directly involved in the event, you are much more likely to develop an anxiety disorder if you don’t get help to cope with the situation.
-Chronic Illness: If you have a chronic medical problem which can have flare-ups or cause you to require medical treatment on and off, it can be a constant stressor.
-Substance Abuse: The use of drugs and alcohol can make general anxiety disorders worse, but people try to use the drugs and alcohol to treat the anxiety,and it leads to a very unhealthy cycle of “self treatment”.

What can happen to me when I have an anxiety disorder?
-Chronic headaches
-Substance abuse
-Digestive difficulty
-Teeth grinding (TMJ)

What will my HCP be looking for?
Just like a medical diagnosis, with anxiety disorders there are some criteria that HCP’s are looking for to “diagnose” you with a general anxiety disorder:
-Excessive worry or anxiety about numerous events several days out of the week
-Difficulty controlling your feelings of worry
-Anxiety or worry that interferes with your activities of daily living
-Anxiety that isn’t related to another mental health condition (like Post Traumatic Stress Disorder, Depression, etc)
-And at least three of the following symptoms: insomnia, restlessness, fatigue, difficulty concentrating, irritability, muscle tension.

OK. SO what do we do?  How do we treat this?
Alternative therapies:
-Exercise: Many studies have shown that daily exercise of 30 minutes (at least) can help reduce symptoms of anxiety and depression.
-Eat Healthy: cut out processed foods, fatty, and high sugar foods and add things that are high in Omega-3 fatty acids and Vitamin B
-Avoid Alcohol and other drugs: as I said before, they can make things worse!
-Use relaxation techniques: yoga, mediation, and take time for yourself to shut off your phone, TV, and all other stimulation if only for 20 minutes a day, or when anxiety is at it’s worst.
-Sleep: shut off your TV, set a bedtime, get into a routine to help your mind turn off.
-Kava*: can help to promote relaxation, but be careful if you have any liver disorders.
-Valerian*: It can help promote sleep and help with relaxation
*talk to your HCP before starting any new supplements!
-Antidepressants: can help reduce anxiety and fight off the depressant hat can come with anxiety (i.e.Paxil, Zoloft, Effexor).
-Benzodiazepines: sedatives for SHORT-term relief of anxiety, they should only be used for anxiety attacks and for other sporadic treatment of anxiety, not every day and NOT for long-term use- they can make anxiety worse if taken long-term.
-Buspirone: Can take weeks to get full effect, but can be used for longterm or ongoing treatment of general anxiety disorders.
-Psychotherapy: AKA Talk therapy. For some people scheduling an hour a week of talking to someone who won;t judge you and can help to shape your behavior really works, and I suggest that anyone taking medication is also getting psychotherapy, they really enhance one another!

So many people have anxiety, we live in a high stress world, and I see people all the time that try to combat their stress with drugs and alcohol, because they don’t understand that what they are doing is self-“treating” their anxiety. And I see other people that end up completely breaking down from stress and unable to live their lives. In times of high stress, like a family member is sick, or you are tight for money, etc these things might happen for a few days/weeks.  BUT is this your life?  Am I describing things that you feel every single day?  If so, you need to talk to your HCP to get help and it is not a sign of weakness, it is not something to be embarrassed about- EVERYONE needs a helping hand sometimes!If you have any of these symptoms, PLEASE GET HELP!  If you know someone who needs help, urge them to go to their HCP, bring them to the Emergency Room if it is life threatening; just make sure that your love ones get treated and ask for help- there are tons of people out there to help and support you.  You aren’t dealing with stress and anxiety alone, I promise, and it is nothing to be embarrassed about.  Please talk to someone, and your HCP, and just tell them what you are going through, we can help you!

Yours in Good Health

This is a little hard to talk about: Erectile Dysfunction

Many people are unclear as to what Erectile Dysfunction (ED) actually is, despite those really ridiculous Cialis and Viagra commercials on TV (which can be horribly awkward to watch in mixed company at times!!) ED affects between 15 and 30 million men in the US and approximately 22.3% of all office visits to HCP’s are for ED.  It is something that many men are embarrassed about and feel unable to speak to their partner about, and it can cause huge rifts in relationships. It is important to know that signs and talk to your partner about it, it is a physical issue that is normal, and totally fixable, so go to the doctor together and make it a couple problem, and don’t let your partner suffer and feel badly alone!

What exactly is the definition of ED?

It’s the inability to maintain an erection that is firm enough to have sex, on an ongoing basis, along with trouble getting an erection, difficulty maintaining an erection, and/or a reduced sexual desire.  If you have any of these symptoms, especially if you have diabetes or heart disease, you should go see your HCP and talk to them about it, your options, and to find out what might be going on with your body. Don’t let it get too far that your partner might get upset or think that they are the one causing the problem…be open about it and go to see your HCP.

erectile-dysfunctionWhat are the causes?

There are SO MANY possible causes of ED, in which some are physical, mental, and a combination of the two.  Some physical causes are: heart disease, atherosclerosis, high blood pressure, diabetes, obesity, metabolic syndrome, Parkinson’s disease, Multiple sclerosis, low testosterone, Peyronies disease (a build up of scar tissue in the penis), tobacco use, alcohol (alcoholism), substance abuse, pelvic/spinal cord surgery, enlarged prostate, and prostate cancer.  So, obviously it goes from being something that is easily fixed, to things that are more serious. As far as psychological issues: stress, depression, anxiety, fatigue, and relationship issues can all cause ED. Another psychological reason that many men have a form of ED, in this current society, is due to the inability to get their partner pregnant; we have a society wrought with infertility and it can case serious relationship problems on many levels. As well, many medications that your HCP might put you on for various health issues, can also cause ED.

Before you go to your HCP appt:

Write down symptoms that you have had even including things that you might think unrelated to ED.  Also, write down any life changes going on, including anything that might be causing relationship stress.  An update list of current prescribed and over the counter medications are always important to bring to every appointment, but especially to an appointment regarding ED.  Try to bring your partner to your appt and both of you talk before you go and both write down list of questions both separately and together.

What might happen at/after your appt?

A physical exam, which is standard at all appointments, but your HCP will inspect your penis, testicles, and check for nerve feelings.  Most likely you will have blood drawn to assess your risk of heart disease, diabetes, cholesterol, and testosterone levels.  A urinalysis may be performed to also look at your risk of diabetes, etc.  An ultrasound may be done to look at blood flow to your penis, it uses a plastic probe on the outside of your penis to project a video of the current blood flow (a non invasive exam). They also might have you go home and perform an overnight erection tests; many men have erections at night during sleep, and have no idea that they had an erection, if the test is positive, then the reason you have ED is psychological.  What they will ask you to do is to put a piece of tape that they will give you (it is easily split) around your penis, and if you wake up in the morning and the tape it split open, you’ve had an erection.

How do we treat it?

You can take oral pills like Viagra, Cialis, and levitra which are medications that enhance your bodies natural nitric oxide levels which helps muscles relax and allows more blood flow to your penis, allowing for a stronger erection.  You may need to change doses and change times that you take before getting an erection.   You need to talk to your HCP to take these drugs if you also take any nitrate drugs like nitroglycerin, Imdur, or Isosorbide because you can have too much of a build up of nitrates in your blood.  Also be careful with blood thinners and alpha blockers (for enlarged prostate).  Your HCP will have to discuss using medications if you have had a stroke, have either low blood pressure or uncontrolled high blood pressure, heart disease or heart failure, and/or uncontrolled diabetes.
Other medication options:
Alprostadil injections: a small needle is inserted in the base or side of the penis and you inject the medication, due to the small size of the needle there is usually little to no pain, and you can get an erection within 5-20 minutes and the erection usually lasts around an hour.
Alprostadil penis suppository: Using a special applicator, you insert a small suppository 2 inches up the inside of the urethra. The side effects can be pain, bleeding from the urethra, dizziness, and can cause a fibrous build up inside your penis.
Testosterone replacement: if you have low testosterone levels, oral supplements can help to increase your levels and ability to maintain/obtain an erection.
Other options:
Penis pumps: a hallow tube with a hand or battery-powered pump, you put your penis inside, pump out the extra air, which causes blood to flow to the penis and cause an erection, you need to put a tension ring on the base of your penis, then remove the pump.  The erection usually lasts long enough to have sex, then remove the tension ring.
Penile implants: implants are surgically places on both sides of the penis, either inflatable or semi rigid rods.  The inflatable implants, are inflated before sexual intercourse to help obtain an erection and the semi rigid rods allow for a firm but flexible penis at all times. Due to it being surgical in nature, there is a risk of infection, and usually a later option for ED.
Blood vessel surgery: at times a leaking vessel can cause a decrease in blood flow to the penis, a simple surgical procedure may be able to fix that problem.
Psychological counseling: if the problems are psychological in nature, counseling can help to talk about the problems and may help to decrease ED issues.

How can you fix it with lifestyle changes?

If you use tobacco, quit. Lose weight to get to a healthy level, exercise regularly, get treatment for alcohol and drug abuse, and work through relationship issues with your partner and with the help of a professional.

Alternative medicine:
Acupuncture is said to help with ED and relieve stress and anxiety, so it can help with some psychological problems.

Due to all of the possible causes, it is not only the first sign that something serious might be going on, but it also is something that might be fixed simply and easily, so I really encourage seeing an HCP early to talk about it.  Be open and honest with yourself, your partner, and your HCP.  ED is not something to be embarrassed about or something that you should allow to ruin a relationship.  If you notice any of these problems with yourself or your partner, please talk about it and go see you HCP ASAP!!

Yours in Good Health