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Is It Bipolar Disorder or Borderline Personality Disorder?

10/22/19. Dr. Dimitriu was published in Psychology on the topic of bipolar vs borderline personality disorder.

Diagnosing psychiatric illness isn’t easy. There’s usually no lab test, physical indication, or quantitative measurement that can distinguish one illness from another and often no magic bullet that can ensure effective treatment. Clinicians are dependent on a description of symptoms and patterns over time to make a diagnosis and these often appear similar even when the underlying illness is very different.

One example of this difficulty is in the incidence of borderline personality disorder being misdiagnosed as bipolar disorder. Both are characterized by impulsive behavior, mood swings, and suicidal thinking but have different causes and different treatments. Only an experienced medical professional can make the right diagnosis and determine appropriate treatment, but patients and their families can help by paying attention to their own thoughts and feelings and describing them accurately.

Click HERE for the full article

Is “Ego Fatigue” Sabotaging Your Willpower?

9/24/19. Dr. Dimitriu was published in Psychology on the topic of Sleep and Memory: How They Work Together.

For many people, just getting through the day is a monumental struggle. Those suffering from anxiety, depression, and ADHD must fight to control their impulses simply to function and stay on task through a day of work or school when they’d rather be home in bed or playing video games. Having held it together all day, they then find those impulses even harder to control at the end of the day. Twenty years ago, a series of experiments demonstrated that impulse control is a finite resource that can be depleted – that suppressing impulses and feelings for some length of time can eventually make those impulses and feelings harder to resist. This phenomenon, known as “ego fatigue” or “ego depletion,” is recognized as a problem for those struggling with anxiety, depression, and ADHD as well as for people battling substance abuse and binge eating. The effect is similar to the depletion of physical and cognitive energy at the end of a long, busy day when all you want to do is relax and do nothing. Saying “no” to your urges all day makes it harder to control those urges in the evening when your store of control has been used up.

Click HERE for the full article

how much sleep do teens need?

How Much Sleep Do Teens Need?

When you look at your teenager, try to soften the lens and view him/her as an oversized toddler. We say this because the developmental changes taking place in a teen’s brain and body as the result of puberty are equivalent to the changes that take place as infants transition into toddlerhood. With that perspective, it’s easier to understand why teenagers need more sleep than they did just a year or two younger.

So just how much sleep do teens need? On average, teenagers need between nine- and 10-hours of sleep per night (the average is about 9.25 hours), but that varies from kid to kid. Keep in mind that things such as involvement in sports, academic drive, or teens experiencing a higher-level of stress or anxiety may require even more sleep to feel and perform their best.how much sleep do teens need?

Photo by Giftpundits.com from Pexels

Help Your Teenager Establish Healthy Sleep Patterns

One of the best ways you can support your teenager is to help him/her establish healthy sleep patterns. A synchronized circadian rhythm has a myriad of health benefits, including getting better sleep, being more alert and attentive in school, supporting healthy metabolism, and minimizing depression, moodiness, or irritability.

Here are some of the things you can do:

Understand their internal sleep rhythm

If you have a teen who is early-to-bed and early-to-rise by nature, lucky you! Most teens experience a shift in their circadian rhythm when they hit puberty, and won’t be sleepy until about two hours later than their previously scheduled bedtime. This is good to note if you have younger children because syncing their sleep times to 7:30 or 8:30pm means they’ll be ready for bed by 9:30 or 10:30 pm when they enter their teens.

Since most junior high and high schools start between 7:30 and 8:30 in the morning, this natural shifting of a teen’s circadian rhythm leaves most teens sleep deprived – they simply aren’t able to get the adequate amount of sleep they need each night.

This explains why so many teens can sleep for up to 12 hours or more on the weekends; they’re not lazy – they’re simply making up for all that lost sleep during the week.

Create a teen-relevant “bedtime routine”

The bedtime routine you created to help your baby, then toddler, then child calm down, relax, and fall asleep probably faded or ceased entirely when your son or daughter hit about 9-, 10- or 11-years old.

Now, it’s time to re-establish some sort of routine to help him/her get into bed early enough to get at least 8 hours – optimally 9 hours – of sleep each night.

Examples include:

  • Ceasing all screen activity at least 30-minutes before lights out (more on this below)
  • Creating a more relaxed and sleep-friendly atmosphere in the home for the 30-minutes or so before bedtime
  • Drinking herbal tea or warm milk or some other non-caffeinated, soothing beverage that signals “wind downtime”
  • Installing dimmer switches in main living areas and bedrooms so lights can be dimmed before bed
  • Taking a shower or bath
  • Playing relaxing music (if they’re up for it – some teens balk at his one)
  • Giving them a foot, back, or shoulder rub on the couch

The first week or two is the most important because once the routine is established, it creates an automatic response in the body; the brain and body establish that Steps 1, 2, 3…etc., mean it’s time to go to sleep, making it easier for your child to relax and drift easier into sleep.

Establish set bedtime & wake time

Rule #1 of any “how to get healthy sleep” guidelines is to establish set sleeping and waking times. Again, this is trickier for teens on the weekend. However, if you’ve stuck with it and created a system for weekdays, your teen will more naturally adhere to the same patterns on weekend nights at home.

Turn off screens at least 30 minutes before bedtime

It’s scientifically proven that the blue light emitted from TV, computer, gadget, and phone screens disrupt the brain’s natural melatonin cycles. That makes it notably harder to fall asleep – and stay asleep.

Everyone in the family should turn screens off at least 30 minutes before bedtime, and then dim the lights to mimic the setting of the sun. These two simple steps allow your brain to create the biochemistry required to facilitate sound sleep.

Read this article (as a family!) from Harvard Health about the dark side of blue light.

Don’t allow phones, gadgets, or computers in the bedroom

There are multiple reasons that go far beyond healthy sleep for why phones and other computer-like gadgets have no place in teenagers’ bedrooms – especially during sleep times.

Want some proof? Check out, Teenagers’ Sleep Quality & Mental Health at Risk Over Late-Night Mobile Phone Use.

Good ol’ fashioned alarm clocks (with red light digital displays) work just fine. You can be the best model of this by creating a set “charging station” in a common area where everyone docs their phones/tablets at night. This prevents your teen from countless social media alerts and the temptation of the phone during sleep time.

Do you or someone in your family suffer from insomnia or anxiety? Contact the compassionate team at Menlo Park Psychiatry & Sleep Medicine at 650-326-5888. We’re dedicated to treating any issue as part of a whole, and for finding the most natural and healthy, long-term solution(s).

Sleep and Memory: How They Work Together

Dr. Dimitriu was published in Psychology Today on the topic of Sleep and Memory: How They Work Together.

Medieval philosopher Thomas Aquinas once wrote that “sorrow can be alleviated by good sleep.” Now, scientists are learning he was not far from the truth. 

A study published in July 2019 in the journal Current Biology indicates a poor night’s sleep—specifically, restless rapid-eye-movement (REM) sleep—negatively impacts brain function, including the work of amygdalae. These are almond-sized clusters of nuclei located deep within the brain’s temporal lobes and responsible for the consolidation of memories for long-term learning, as well as the processing and storage of memories associated with events that elicit strong emotions like sorrow, embarrassment, fear, and anxiety.  Upon awakening, study volunteers who experienced disrupted REM sleep remained reactive to emotional events from the previous day while well-rested individuals labeled prior-day events as being of lesser emotional significance than they originally thought, according to the researchers.

Click HERE for the full article.

Night and Day: The Essential Role of Sleep Medicine

Dr. Dimitriu was published in Psychology Today on the topic of The Essential Role of Sleep Medicine.

Sleep is truly the other half of our waking lives, as well as an essential half of modern psychiatry. During sleep, our brains recharge the neurotransmitters that are so important to our mood and thinking—dopamine, norepinephrine, and serotonin, to name a few. Training in both psychiatry and sleep medicine has allowed me a unique perspective on these two highly related fields of medicine, which, unfortunately, tend to be practiced in isolation of each other. Through this unique perspective, I have seen some truly remarkable breakthroughs in difficult, treatment-resistant cases. A careful analysis and understanding of sleep and sleep architecture has made this possible. “If there is no gas in the tank, you can’t push the gas pedal,” is something I often say to my clients, because indeed, if you are not well-rested and recharged, not much will work.

Click HERE for the full article.

 

 

Shocking Sleep Statistics

Sleep is truly the other half of our waking lives as well as an essential half of modern psychiatry.

During sleep, our brains re-charge the neurotransmitters that are so important to our mood and thinking – dopamine, norepinephrine, and serotonin to name a few. “If there is no gas in the tank, you can’t push the gas pedal,” is something I often say to my clients, because indeed, if you are not well-rested, recharged, not much will work.

This article points to the alarming sleep epidemic that we have seen over the past several years, where indeed, most of us, may not be getting enough sleep. The good news is that it is indeed an alarming article. A 2015 study of preindustrial societies, living without light, heat, wifi, and Netflix, show that sleeping 5.7 to 7.1 hours per night may actually be quite “normal,” and natural. The long lines at Starbucks, and marked increase in stimulant prescriptions, do point out, we could all sleep a little more.

If you tell people they can sleep 7 hours, they tend to sleep 6. So be alarmed.

Sleep Statistics Infographics

When Sleep Won’t Come…Do You Need Help?

By Dr. Alex Dimitriu, July 11, 2019

We all have occasional trouble sleeping. Anxiety, jet lag, something we ate, or any number of other things can have us tossing and turning restlessly now and then. Most of the time, these episodes of sleeplessness are of brief duration and with resolution of the root cause we once again sleep for seven to nine hours a night. But for millions of Americans, a night of restorative sleep is elusive and with prolonged difficulty sleeping they suffer both immediate impairment to daytime functioning and long-term risks to health and cognitive function. Read more

smiling depression

Smiling Depression: Masking the Pain

Smiling depression isn’t an oxymoron. It’s a serious atypical manifestation of depression in which the sufferer masks typical depressive symptoms like sadness and lethargy with the outward appearance of a happy, successful, productive life. While approximately 10 percent of the U.S. population suffers from depression, not all sufferers experience it in the same way. Typically, depression is associated with a deep sense of sadness, despair, and lethargy, a figurative and sometimes literal inability to get out of bed that depletes energy and impacts all aspects of life. In contrast, someone living with smiling depression feels the same sadness inside but is able to function normally and present a facade of contentment and happiness to the outside world. Read more

Overcoming Insomnia Without Drugs

By Dr. Alex Dimitriu, March 12, 2019

Sleep isn’t optional. It is one of our most basic physiological needs, right up there with air, water, food, and shelter. It isn’t heroic to go without sleep and it isn’t true that many people need only four or five hours a night. Most of us need seven to nine hours. Critical functions needed to maintain life and health occur while we sleep and insufficient sleep doesn’t just cause daytime fatigue, irritability, and sleepiness but is associated with a broad range of health risks including heart disease, obesity, diabetes, and a weakened immune system. Sleep is a natural function and critical to our health yet millions of people struggle to get to sleep, stay asleep, and get sufficient restful, restorative sleep. Read more

Sleep Restriction Therapy

Sleep Restriction Therapy for Insomnia: Can Spending Less Time in Bed Help You Sleep More?

By Dr. Alex Dimitriu, March 12, 2019

Insomniacs know all about good sleep hygiene. They’ve lowered the temperature in the bedroom, hung room-darkening shades, eliminated nicotine, caffeine, and liquids before bedtime, taken warm baths, and banished electronic devices from the bedroom. Many have tried prescription sleeping pills but were groggy the next day. Natural relaxation and sleep remedies may have been calming and soothing but otherwise unhelpful as regular nights of restful, restorative sleep have remained elusive. Trouble falling asleep or long periods of wakefulness during the night or too-early awakening or combinations of all three persist for millions of people. These sufferers from chronic insomnia may be candidates for a seemingly contradictory therapy known as “sleep restriction.”  Read more

Natural Sleep Remedies

Natural Sleep Remedies: Do They Work?

By Dr. Alex Dimitriu, February 21, 2019

We all have occasional trouble sleeping. Stress, anxiety, a change in routine, something we ate, …any number of things might be responsible for a night of restless tossing and turning. For most of us, bouts of insomnia are of short duration. But for many millions of people, sleepless nights are a regular occurrence, as are the daytime sleepiness, irritability, impaired job performance, accidents, and health risks that follow. In search of a good night’s sleep, many are tempted by the quick fix of sleeping pills but while they can be effective in the short term, they don’t offer a long-term solution.

Sleeping pills come with troublesome side effects and most people quickly build up a tolerance to them and must take higher and higher doses to achieve the same effect. No wonder many ask if natural, herb-based sleep remedies might be a better choice. They may be but your first order of business should be to develop better sleep habits and make lifestyle changes that are conducive to better sleep. If you still feel you need help, a natural sleep remedy might be useful, particularly in helping you relax at bedtime. Here are some suggestions that will help you achieve restful sleep. Read more

agitated depression

Coping with Agitated Depression and “Rockstar” Histories

Millions of people experience episodes of depression every year, making it one of our most common mental disorders. Although its symptoms may look similar, clinical depression differs in its intensity and duration from the ordinary sadness that we all experience from time to time. Sadness triggered by a loss, disappointment, or a major life change is typically short-lived, fading over time as we adjust to new situations. Clinical depression, also known as major depressive disorder, can be precipitated by a specific event but can also result from a change in brain chemistry that makes it difficult to maintain mood stability. Depression is a long-lasting, serious medical condition that must be diagnosed and treated by a medical professional. Read more

reducing anti-anxiety medications

Reducing Anti-Anxiety Medications : Risks and Rewards

By Alex Dimitriu, MD, January 22, 2019

With anxiety disorders ranking as the most common mental illness in the United States – affecting 18% of the adult population every year – perhaps it’s not surprising that more than 1 in 10 Americans take antidepressants, the class of medications used most often to combat anxiety. Read more

Is There a Place for CBD in Treating Insomnia?

By: Alex Dimitriu, MD, January 6, 2019

With the rise in states legalizing the use of both medicinal and recreational marijuana, more attention is now being given to a component of the cannabis plant that’s been scrutinized for decades – CBD, or cannabidiol. But far from seeking a “high,” many of those giving fresh consideration to using CBD – available in supplement form and legal in all 50 states – are pursuing another elusive benefit: a good night’s sleep. Read more

Overcoming the Stigma of Psychiatric Medication

By Dr. Alex Dimitriu, 12/20/18

Even as the stigma associated with mental illness has – thankfully – dissipated over the last decade, millions of people still fail to get the help they need because the stigma around the medication that can alleviate their suffering endures. Fueled in part by celebrities talking about their struggles with depression, anxiety, and other conditions, openness about mental illness has become more acceptable. But even as people find understanding and support for their illness, they are also subject to a host of unhelpful and stigmatizing attitudes about medication, ranging from the implication that they’re just not trying hard enough to overcome their condition, to the recommendation that all they need is a certain diet, or exercise, or meditation, to the assumption that the cure for what ails them is as simple as taking a pill. Unfortunately, these attitudes are often internalized by the very people who could benefit from psychiatric medication and prevent them from seeking treatment.

The use of psychiatric medications, also known as psychotropics, has grown significantly in recent years. Various studies have estimated that 10% of American adults had taken an anti-depressant, anti-anxiety, or anti-psychotic drug in the previous thirty days and that as many as 17% filled a prescription for a psychiatric medication in the previous year. The growing usage of these drugs has led to widely shared and incorrect attitudes. At the same time, that many people see the use of psychiatric medication as a weakness or a failing on the part of the patient, others downplay the struggle of overcoming mental illness because ‘there’s a pill for that. It’s important to dispel misconceptions about mental illness and the best way to treat it.

Many years of research and clinical experience have proven that the best outcomes for those suffering from mental illness result from a comprehensive approach that combines a medically crafted and supervised regimen of psychiatric medication with psychotherapy. Medication and psychotherapy work together. By relieving severe symptoms, medication gives patients the clarity and stability that enable them to benefit from psychotherapy that can address emotional and behavioral issues and bring about the changes needed. Medication treats the physical aspects of mental illness, managing the levels of certain chemicals in the brain just as a statin manages levels of cholesterol in the blood. Taking medication for mental health is no different than taking it for physical health. With chemical imbalances in the brain under control, the patient is free to work on improving behavioral and emotional imbalances.

Common misconceptions that stigmatize psychiatric medication:

“Isn’t medication a crutch for people who are too weak to manage their problems?” A psychotropic medication relieves the symptoms of a medical disorder. It is no more an indication of weakness than taking medication for high blood pressure. Stigmatizing the taking of medication as a weakness implies that if the patient would just get it together and work harder, medication wouldn’t be necessary. This is akin to advising someone with high blood pressure to just relax. In fact, it takes strength to recognize that you have an illness that can be helped with medication and that you need to use every tool available to take care of yourself.

“Won’t a psychiatric medication change my personality, dull my senses, turn me into a zombie?” There is nothing more destructive to a person’s sense of self, to the unique characteristics that define a personality than a mental illness. Motivation, concentration, even the ability to get out of bed, are often gone. Medication can alleviate the symptoms of illness that sap energy and impair functioning and restore a sense of self. That said, some medications do have troublesome side effects, and the same drug can affect people differently. The medication that works for one person might not be tolerated well by another. That’s why we sometimes have to try several medications until we find the one that works.

“Is medication masking my problem rather than fixing it? Is it just a temporary solution, a quick fix?” Psychiatric medication is not a miracle cure. It doesn’t produce an instant change in mood. It takes a while for the drugs to build up in the system and causes a gradual change that alleviates symptoms enough to improve functioning and enable getting the therapy that will help over the longer term.

Psychiatric medication has helped countless people reclaim their lives. It is an important support for the journey to well-being, not an easy way out. And taking every step necessary to get well is nothing to be ashamed of. Bringing medication out of the shadows will overcome the stigma associated with it and encourage millions of people to get the help they need.

Alex Dimitriu, MD, is founder of Menlo Park Psychiatry & Sleep Medicine in Menlo Park, CA. He is dual board-certified in psychiatry and sleep medicine.