zoloft side effects women

Zoloft Side Effects in Women: What You Need to Know

By Dr. Alex Dimitriu

Sertraline, also called Zoloft, is a drug known mainly as a treatment for depression. First approved in the U.S. in 1991, recently it has been prescribed nearly 40 million times per year.

Although Zoloft can cause side effects in anyone, it can affect women in specific ways. Knowing about the possible side effects of Zoloft in women can help patients know what to expect and play a more informed role in their mental health care.

Understanding Zoloft and Its Uses

Zoloft is the brand name of the drug sertraline. It is a type of selective serotonin reuptake inhibitor (SSRI). These drugs work by increasing the activity of a chemical in the brain called serotonin, which helps regulate your mental state and emotions. Selective serotonin reuptake inhibitors are a common antidepressant medication.

In addition to depression, Zoloft is FDA-approved as a treatment for post-traumatic stress disorder (PTSD), social anxiety disorder, panic attacks, obsessive-compulsive disorder (OCD), and the symptoms of premenstrual dysphoric disorder. In addition to these formally recognized uses, doctors may give Zoloft as an off-label prescription for conditions like generalized anxiety disorder, bulimia, and binge-eating disorder.

Zoloft is taken by mouth as a tablet, capsule, or liquid concentrate solution. It can be prescribed for children, adolescents, and adults.

Common Side Effects of Zoloft in Women

Both men and women can experience side effects from Zoloft. However, certain side effects only affect women or have different risks in women. These include sexual dysfunction, weight changes, menstrual changes, nipple discharge, and bone loss.

In my clinical experience, it is worth noting that depression and anxiety carry significant health risks as well, and these should be weighed against the side effects of medication like SSRIs. Additionally, side effects are often dose dependent, which is why we always aim to “test” the lowest dose that is effective for our patients.

Sexual Dysfunction

It is common for both males and females taking Zoloft to encounter difficulties in their sex life. In females, this sexual dysfunction may affect sex drive and libido, or the desire for sex. In addition, Zoloft can affect a woman’s ability to have an orgasm. In my practice, I often remind patients that untreated depression and anxiety can also negatively impact sex drive.

Studies suggest that 50% or more of patients who take SSRIs like Zoloft experience sexual problems. Sometimes these side effects continue even after someone stops taking these medicines.

Experts aren’t entirely sure why this happens, and in some cases, sexual dysfunction may be linked to the underlying mental health condition that Zoloft is intended to treat.

Weight Changes

Zoloft can induce changes in body weight, and some research has found that women express more concern than men about weight and body image.

Among all people taking Zoloft, the average weight gain is around 1% to 1.5% of their original body weight. This may relate to an increase in appetite and cravings for carb-rich foods. These dietary changes may be linked to improvements in mental health from Zoloft.

Weight gain may also have a genetic component or be a consequence of modified serotonin levels. Although not common, weight gain from long-term Zoloft use may contribute to a person’s risk of diabetes.

At the same time, some people experience weight loss when taking Zoloft. A small percentage of patients report a decrease in appetite. Weight loss could relate to gastrointestinal side effects like nausea, stomach pain, and indigestion.

Menstrual Changes

Zoloft can affect hormones in the body, which may alter the menstrual cycle. When taking Zoloft, a woman’s menstrual periods may stop or become irregular.

These issues are believed to relate to an increase in the production of a hormone called prolactin, which is mostly involved in lactation but affects other bodily processes. Serotonin levels are one of many factors involved in the production of prolactin. Excess prolactin in the body can disrupt the menstrual cycle, interfere with sexual health, and contribute to other side effects of Zoloft in women.

Nipple Discharge

Zoloft can cause the discharge of breast milk in women who are not lactating, a condition known as galactorrhea. This reaction to Zoloft is driven by prolactin levels that are too high.

Bone Loss

Some data indicates that there is an elevated risk of bone loss in people over the age of 50 when taking Zoloft. A lack of bone strength can result in osteoporosis, a condition that makes fractures more likely. Osteoporosis is more common in women than in men.

Doctors cannot fully explain the findings of bone loss in people taking Zoloft. It may be related to elevated prolactin levels or disruptions in the metabolism of cells in the bones. More research is needed to document, confirm, and understand the impact of Zoloft on bone health.

“In my clinical experience, it is worth noting that depression and anxiety carry significant health risks as well, and these should be weighed against the side effects.”

Two pharmacists, one male one female, discussing drug interactions and side effects of Zoloft.

General Zoloft Side Effects

Side effects of Zoloft occur in both males and females. While every patient can have a different reaction to the drug, researchers have identified the most common side effects.

The most frequent side effects, which tend to affect between 10% and 25% of people, include:

  • Gastrointestinal problems like nausea, vomiting, stomach discomfort, diarrhea, and constipation
  • Headaches
  • Dry mouth
  • Feelings of fatigue or physical weakness
  • Dizziness
  • Insomnia or an inability to sleep normally
  • Drowsiness or tiredness

Other side effects that have been found to impact up to 10% of people taking Zoloft include:

  • Excess sweating
  • Mood changes like restlessness, agitation, nervousness, or irritability
  • Tremors
  • Visual problems like blurred vision
  • Fast heart rate

It is important to recognize that not everyone will experience significant side effects. The incidence of these adverse reactions is relatively low, and any given person may have a distinct combination of effects or very few effects at all. In general, Zoloft is well tolerated, and most people find that it provides more benefit than harm.

In addition, initial side effects are not always lasting. Some effects may start to improve after the first weeks of taking Zoloft.

Managing and Minimizing Zoloft Side Effects in Women

The first step in addressing any side effects of Zoloft is to talk with your doctor or psychiatrist. They can recommend an adjustment to your dosage, a change in medication, or other specific actions and tips that are most appropriate in your situation.

“In my practice, I often remind patients that untreated depression and anxiety can also negatively impact sex drive.”

Other things that may help manage or minimize the side effects of Zoloft in women can vary based on the nature of those effects.

  • Sexual Dysfunction: If Zoloft is providing benefits in treating depression but also causing sexual problems, doctors may prescribe additional medications, which studies have shown may help with a low libido or difficulty having orgasms. Consulting with a sex therapist for advice may be effective for some individuals.
  • Weight Changes: For weight gain, a number of steps may help, including making adjustments to your diet and exercise habits.
  • Menstrual changes: When menstrual changes occur, your doctor may check for other potential causes and consider changing your medication or daily doses. If high prolactin levels are detected, you may be prescribed additional medication or hormone therapy.
  • Nipple discharge: If this symptom is significant and affecting your daily life and activities, medication may be suggested to address elevated prolactin levels.
  • Bone loss: Some steps to minimize bone loss can include taking supplements of vitamin D and calcium and avoiding cigarette smoking. If you have other risk factors for osteoporosis, your doctor may order a bone mineral density test. To prevent fractures, you can decrease the risk of falls by improving your balance and eliminating tripping hazards in your home.

Warnings and Potential Serious Side Effects of Zoloft

Although serious side effects are rare, anyone taking Zoloft should be aware of the potential risks so that they can take precautions and watch for possible warning signs.

  • Worsening of mental health: Some people have a sudden exacerbation of their mental health problems after taking Zoloft. This may result in deep sadness and suicidal thoughts and behaviors. In people with a diagnosis of bipolar disorder, Zoloft may lead to swings between mania and depression. Bipolar disorder is relatively rare, but it is important that a provider screen for the condition to prevent adverse reactions from SSRIs. People with thoughts of suicide should seek help immediately.
  • Low sodium levels: Zoloft can lower the amount of sodium in the blood, a condition known as hyponatremia. Some signs of hyponatremia include memory problems, confusion, headache, and physical weakness. The risk of this side effect is higher in older patients.
  • Bleeding: Taking Zoloft makes people more susceptible to bleeding. This is more likely in people who also take blood thinners like warfarin or other drugs that thin the blood, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
  • Angle-Closure Glaucoma: Glaucoma occurs when fluid can’t drain from the eyes, raising pressure that leads to eye damage. Pain, vision changes, and redness of the eyes are symptoms of glaucoma.
  • Serotonin syndrome: This condition can occur if serotonin levels get too high. It may result in confusion, changes to heart rate or blood pressure, tremor, seizures, and other symptoms. A risk factor is when Zoloft is taken with other substances that can increase serotonin, including amphetamines, other antidepressants like serotonin and norepinephrine reuptake inhibitors (SNRIs), tramadol, tryptophan, and St. John’s wort.
  • Drug interactions: Although major drug interactions are limited, it is best to inform a pharmacist about all prescriptions, supplements, and over-the-counter medicine and ask questions about any potential interactions with Zoloft.
  • Coexisting conditions: People with liver problems or a diagnosis of a seizure disorder may require more caution than others when planning the dosage and administration of Zoloft.
  • Allergic reactions: As with any medication, allergic reactions are uncommon but may occur. Signs of allergies when first taking Zoloft can include hives or skin rash, fever, unexplained swelling, or trouble breathing.
  • Withdrawal: Abruptly stopping the use of Zoloft may cause headache, mood and behavior changes, irritability, seizure, and confusion.

If any indications of severe reactions or complications arise, patients should seek prompt attention from a healthcare professional.

To reduce the risks of adverse effects, Zoloft should always be used according to the package directions. A regular dose should be taken as stipulated by the doctor and pharmacist, and patients should avoid suddenly stopping taking Zoloft.

Zoloft When Pregnant or Breastfeeding

Taking Zoloft and other SSRIs during pregnancy can affect a fetus. The risks of exposure during the first trimester are not clearly established. A baby who was exposed to Zoloft during the third trimester, though, is at risk of certain issues, some of which can be serious.

That said, untreated mental health conditions during pregnancy may also pose health risks for newborns. As a result, many pregnant women continue taking Zoloft with extra care devoted to watching for effects on the fetus. Consulting with a health care team can help women weigh the pros and cons of using Zoloft while pregnant.

In most situations, Zoloft is considered to be safe to use while breastfeeding. Only a small amount of Zoloft passes into breast milk, so it poses very low risk to infants. Zoloft is considered one of the best of the SSRIs for women who are lactating.

FAQs About Zoloft Side Effects

How long does it take for side effects to start?

Some side effects may begin within days of starting to take Zoloft, and others become more likely with long-term use. For example, stomach problems may arise initially. But when issues like weight gain or bone loss occur, it is normally only after many months or years of taking Zoloft.

Do women have more side effects from Zoloft?

Many reactions to Zoloft are similar for both men and women. However, some side effects, such as nipple discharge and menstrual changes, only affect women.

Does Zoloft have more side effects than other SSRIs?

With an extensive history of use, Zoloft has been found to be well tolerated overall. Within the SSRI group of antidepressant medications, most drugs have a similar side effect profile. But there can be some variation in the frequency or severity of certain side effects.

Other types of SSRIs include:

  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluvoxamine (Luvox)

A doctor or psychiatrist can review the comparative benefits and drawbacks of each of these drugs based on your diagnosis, health history, and personal concerns about specific side effects.

A.D.A.M. Medical Encyclopedia. Orgasmic dysfunction in women. MedlinePlus. Retrieved on May 8, 2024, from https://medlineplus.gov/ency/article/001953.htm.

AHFS Patient Medication Information. (2022, January 15). Sertraline. MedlinePlus. Retrieved on May 8, 2024, from https://medlineplus.gov/druginfo/meds/a697048.html.

American Association of Psychiatric Pharmacists (AAPP) and the National Alliance on Mental Illness (NAMI). (2024, January). Sertraline (Zoloft). Retrieved May 8, 2024, from https://www.nami.org/about-mental-illness/treatments/mental-health-medications/types-of-medication/sertraline-zoloft/

American Chemical Society. (2022, June 27). Sertraline. Molecule of the week archive. Retrieved on May 8, 2024, from https://www.acs.org/molecule-of-the-week/archive/s/sertraline.html.

Bibiloni, M. D., Coll, J. L., Pich, J., Pons, A., & Tur, J. A. (2017). Body image satisfaction and weight concerns among a Mediterranean adult population. BMC public health, 17(1), 39. https://doi.org/10.1186/s12889-016-3919-7

Choi, L. (2024, January). Nipple discharge. Merck Manual Professional Version. Retrieved on May 8, 2024, from https://www.merckmanuals.com/professional/gynecology-and-obstetrics/breast-disorders/nipple-discharge.

Hirsch, M. & Birnbaum, R. J. (2023, July 31). Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects. In: P. P. Roy-Byrne (Ed.). UpToDate. Retrieved on May 8, 2024, from https://www.uptodate.com/contents/selective-serotonin-reuptake-inhibitors-pharmacology-administration-and-side-effects.   

Hirsch, M. & Birnbaum, R. J. (2024, May 6). Sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs): Clinical features and management. In: P. P. Roy-Byrne (Ed.). UpToDate. Retrieved on May 8, 2024, from https://www.uptodate.com/contents/sexual-dysfunction-caused-by-selective-serotonin-reuptake-inhibitors-ssris-clinical-features-and-management.

Kimmel, M.C. & Meltzer-Brody, S. (2022, September 21). Safety of infant exposure to antidepressants and benzodiazepines through breastfeeding. In P.P. Roy-Byrne and C.J. Lockwood (Eds). UpToDate. Retrieved May 8, 2024, from https://www.uptodate.com/contents/safety-of-infant-exposure-to-antidepressants-and-benzodiazepines-through-breastfeeding.

Kornstein, S. G., Schatzberg, A. F., Thase, M. E., Yonkers, K. A., McCullough, J. P., Keitner, G. I., Gelenberg, A. J., Davis, S. M., Harrison, W. M., & Keller, M. B. (2000). Gender differences in treatment response to sertraline versus imipramine in chronic depression. The American journal of psychiatry, 157(9), 1445–1452. https://doi.org/10.1176/appi.ajp.157.9.1445

Majumdar, A., & Mangal, N. S. (2013). Hyperprolactinemia. Journal of human reproductive sciences, 6(3), 168–175. https://doi.org/10.4103/0974-1208.121400

Medscape. (n.d.). Sertraline (Rx): Adverse effects. Retrieved on May 8, 2024, from https://reference.medscape.com/drug/zoloft-sertraline-342962#4.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2022, December). Osteoporosis. Retrieved on May 8, 2024, from https://www.niams.nih.gov/health-topics/osteoporosis.

Rosen, H. N. (2024, April 6). Drugs that affect bone metabolism. In: D. E. Sellmeyer (Ed.). UpToDate. Retrieved on May 8, 2024, from https://www.uptodate.com/contents/drugs-that-affect-bone-metabolism.

Snyder, P. J. (2022, July 26). Management of hyperprolactinemia. In: D. S. Cooper (Ed.). UpToDate. Retrieved May 8, 2024, from https://www.uptodate.com/contents/management-of-hyperprolactinemia.

UpToDate Lexidrug. (2024). Sertraline: Drug information. Retrieved May 8, 2024, from https://www.uptodate.com/contents/sertraline-drug-information.

United States Food and Drug Administration. (2016, December). Zoloft prescribing information. Retrieved May 8, 2024, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839s74s86s87_20990s35s44s45lbl.pdf.

Chess is best played calm

“Chess Is Best Played Calm.” Relaxing Stress and Anxiety to Win

By Dr. Alex Dimitriu

“We suffer more in imagination than in reality.”

These were the words of an ancient Roman stoic philosopher, Seneca. While he died in 65 AD, his words could not be more true now, two thousand years later.

Am I Stressed or Anxious?

Knowing the difference between stress and anxiety can help you better understand yourself, as well as to help you find ways to improve your life.

Everyone has experienced stress. Being rushed is stressful. Having a lot of work to do is stressful. Being asked to do multiple things at once is stressful. An easy way to conceptualize stress is any time there is a mismatch between your ability and the demands in front of you. Being told you will have to run a marathon tomorrow morning, could be stressful for most. Stress happens in real-time, now.

Anxiety can be based on real stressors, but it lives more in your head and not in the present moment. A key differentiating factor is the amount of departure from reality, into imagination. You see, stress is real, tangible, and here and now. Anxiety is a bit more of a story. It’s imagination. It can be exaggerated, obsessive, catastrophic, or even paranoid at times. Anxiety is able to induce worry and feelings of adrenaline, even when there is no real stressor happening in the moment. Read more

Daymares – How to Stop Negative Thoughts (and what to do if you can’t)

By Dr. Alex Dimitriu

You get an email from your boss asking you to meet later that day, and you immediately think you’ve done something wrong, and might get fired, then lose your home, then your marriage.

A lab result comes back slightly off, and you immediately think you might have some serious life-threatening malady, “what could this mean??” as you envision your funeral.

You believe in superstition or following certain rituals to make sure you either do well on a date, job interview, or upcoming exam. Not having your lucky pen or favorite shirt might spell failure.

When Daydreams Turn into Daymares

People daydream all the time, but certain people go down negative wormholes that can feel shockingly real. These fantasies can occur several times per day, leaving you feeling anxious or sick or tired or paralyzed in fear of some pending doom. In more intense experiences, out of desperation, people get compelled to action. They’ll call their doctor or boss for reassurance or lash out at someone close to them in an effort to unload a heavy burden of anxiety (which also makes people quite irritable, short tempered, and unemphatic, btw).

As a psychiatrist, I am privileged to hear about people’s inner dialogue all the time. I get a window into their thinking, and after seeing hundreds of patients, patterns become apparent, and certain solutions emerge as being highly effective. One pattern I see often in people who are either anxious, depressed, or have ADHD is the tendency to go down negative thought spirals. I have often called these “daymares,” as the daytime / daydream version of a nightmare. These can be rooted in reality, quite real, and quite scary.

Interestingly, anxious thoughts really come in 2 varieties – ones that are useful, and ones that are not. The immediate solution that has helped so many of my patients is asking one fundamental question:

Ask yourself: “What is the utility of this thought?”  2 possible outcomes emerge.

1 – Certain thoughts are useful. Like the thought that you might fail the upcoming exam or not meet the deadline for a work project if you don’t get working on it. Indeed. In those cases, you might listen to the anxious thought, and consider doing something about it. Some anxious thoughts have utility, they serve as healthy reminders to prepare or start getting something done. These thoughts are easier to work with because they are rooted in reality and have actionable steps that you have control to take. Important to emphasize here that these are real issues for which you are in a position to take useful action. This will differ greatly from the next type of thought.

2- Stabbing thoughts, or as previously described by Daniel Amen, “ANTS,” or automatic negative thoughts. I call these stabbing thoughts because it really is no different than stabbing yourself repeatedly with a fork. When faced with the question of “What is the utility of this thought,” these types of thoughts start to fail the test. There is often a greatly exaggerated outcome, and nothing you can do about it. If you can catch them, and label them for what they are, you might start to realize there is some tendency to poke yourself with a fork when there is nothing you can do about it. For some people, living in a state of stress or self-oppression becomes a default state. Patients of mine will sometimes wake in the morning and scan the news to find something to worry about. It is like stabbing yourself with a fork. Catch it and stop it. There is no utility to those thoughts, it’s your head messing with you.

“What if I drove off the cliff??” Lessons From OCD’s Intrusive Thoughts

We can learn a lot from people with high anxiety or OCD – because they often experience “intrusive negative thoughts,” which are more dramatic and easier to recognize. Let me give you some examples.

I’ve met a woman who while cutting fruit on a cutting board would have a sudden flash of cutting her husband’s throat with the knife. A nursing mother who would have a flash thought of throwing her infant at a wall when it was crying. A man who would often wonder what would happen if he jerked the steering wheel and drove the car off a cliffside road.

They were all ashamed and terrified of these thoughts and would never in their life act on them. But the more the thoughts scared them, the more they came back. Many of these patients were much improved just by talking to someone about it. By understanding that sometimes people get crazy thoughts, and the scarier they are, and the more you keep them secret, the more they come back to haunt you. You’d be amazed at how many people experience wild crazy fantasies or daymares like this if you ask. 99% know they would never act on it, but even a slight doubt can turn big and scary, “but what if…” The more the thoughts bite, the more they come back. Until you realize that the only thing you have to fear is fear itself. The thought is a fantasy that recurs because it gets your attention. Talk to your fears. Running never works.

Lastly, I want to point out a fascinating study which may also reveal the basis of some stabbing thoughts. The experiment looked at how people deal with boredom and found that “67% of men and 25% of women chose to inflict it on themselves rather than just sit there quietly and think.” Yes, people would rather painfully zap themselves with electricity than just sit there and think. Ref https://www.science.org/doi/10.1126/science.1250830.

Don’t Zap Yourself Repeatedly

Filter the thoughts, by asking about “what is the utility?” talk about them and identify and stop the useless ones in their tracks. Say to yourself, “I don’t entertain that type of thinking.” Mindfulness meditation, exercise, and journaling help. The RAIN method for dealing with these thoughts helps too. It stands for R- recognize the thought, A-accept the thought, I-investigate the thought, N- non-identification. Read more about RAIN here.

For more information, be sure to check out my post on “Bingeing on Negativity.”and also “Unwinding Anxiety,” by Judson Brewer is a great read on this topic.

If the negative thoughts are too much to handle (as is the case for depressed or significantly anxious people), or happen too often, speak to a professional soon.

5 Essential Steps Towards Joy in the New Year

By Dr. Alex Dimitriu

The power of positivity is a skill to be developed. Certain simple behaviors and mindsets have the power to improve your mood almost immediately. I know change takes time, and no one expects you to change completely overnight. However, as I tell my patients, it’s good to have some direction and a goal, and any progress is good. So let’s get started:

Smile More – Fake Smiles Turn Real

In one study, they had people fill out happiness questionnaires. One group did the questionnaire while holding a pencil in their teeth. You know what holding a pencil in your teeth does? It makes you smile. Smiling people were happier on their questionnaires. Smile more. At yourself, at the person you just passed in the street, and as you enter the next space, be it a meeting or family dinner. (Ref https://pubmed.ncbi.nlm.nih.gov/3379579/) Read more

Finally… A Sleep Apnea Pill

By Alex Dimitriu MD

Finding an effective pharmacologic approach to alleviating obstructive sleep apnea (OSA) could revolutionize treatment of this complex, underdiagnosed, and life-threatening sleep disorder. Results of a study – the MARIPOSA trial — published in the October 2023 issue of the American Journal of Respiratory and Critical Care Medicine indicate a combination of two medications, oxybutynin, and atomoxetine, has been shown “clinically meaningful” in improving OSA.

The double-blind investigation involved more than 200 patients, including 176 who actually completed the four-week protocol. The drugs reportedly act together to increase what one physician describes as “the activity of the dilator muscles in the upper airways.” They do so by “activating the genioglossus muscle [a muscle of the tongue] with a synergic effect on the upper respiratory tract during sleep.”

Study authors report patients receiving the drug combination experienced significantly less sleep disturbance due to disruptions in their breathing and a higher quality of sleep. But neither medication taken alone proved effective and, in some cases, slightly worsened a person’s sleep disturbance score or lowered sleep quality, the scientists state. With CPAP compliance rates at about 50%, any alternative to improving airflow during sleep is a welcome addition to the field.

But No Pill Yet for the Problem

No FDA-approved pharmaceutical treatment option currently exists for treatment of OSA, an issue that continues to spur ongoing drug investigations. The MARIPOSA trial is only the latest of a series of OSA-related pharmacologic studies published during the past several years. Some scientists have likened the hunt for an effective OSA drug to a “search for the Holy Grail.”

One report — in a 2022 issue of the Journal of Clinical Sleep Medicine — suggests reboxetine, a drug formerly used to treat depression, shows positive action in reducing the severity of OSA. The National Sleep Foundation indicates that, in July 2023, the FDA approved further testing of an investigational sleep apnea drug, IHL-42X, in phase II and phase III patient trials. Advanced by Icannex Healthcare, IHL-42X contains dronabinol and acetazolamide. Dronabinol is a synthetic cannabinoid with effects similar to compounds in the marijuana plant. Preliminary research shows IHL-42X can cut sleep apnea patients’ episodes of disruptive breathing by more than half, according to the Sleep Foundation.

Also being tested for potential efficacy in decreasing the severity of OSA is a combination of AD109 and AD504, under development by the pharmaceutical firm Apnimed.

All About Obstructive Sleep Apnea

OSA is characterized by the narrowing and obstruction of the upper airway during sleep, causing a person to stop breathing repeatedly. The term “apnea” or “apnoea” applies to the cessation of breathing for 10 seconds or longer. Symptoms include excessive snoring, awakening from sleep gasping, daytime sleepiness and fatigue, morning headaches and sore throat, and problems focusing. If untreated, the disorder increases a person’s risk for stroke, cardiovascular disease, heart failure, pulmonary arterial hypertension, and development of neurobehavioral issues like mood changes and depression. The disease also may eventually lead to poor dietary habits, lack of exercise, altered insulin resistance, and systemic inflammation.

Obesity, older age, genes, alcohol use, smoking, and anatomical issues like a deviated septum, mandibular hypoplasia, or enlarged tongue or tonsils are all factors that can promote occurrence of OSA. The disease tends to be more prevalent in men, and, according to health professionals, affects between 9 percent and 38 percent of adults in the United States and nearly a billion people worldwide.

Less Sleep Quality Most Concerning

Perhaps, one of the most disconcerting aspects of the disorder is its association with a decline in sleep duration, sleep hygiene, and overall quality.

A study just published in December 2023 by JAMA Network Open indicates OSA patients with “shorter objective sleep duration had higher risk for all-cause mortality independent of AHI [apnea-hypopnea index] compared with those sleeping at least seven hours.” The research involved 2,574 OSA patients, representing men and women from a variety of races. AHI measures the average number of apnea (breathing stops) or hypopneas (incidents of abnormally shallow breathing) a person experiences in an hour. In other words, according to the researchers, lack of sufficient sleep plays a much greater role in an OSA patient’s morbidity and mortality than simply the number of times the person experiences a breathing episode during sleep.

OSA’s negative impact on sleep architecture and hygiene is a prime impetus for doctors’ efforts to find effective medications.

Current OSA Treatment Options

Until now, treatment for OSA has been limited to use of electrical devices that exert continuous positive airway pressure (CPAP machines), which an estimated half of OSA patients have difficulty tolerating; custom-fitted oral appliances to push the jaw forward and alleviate airway obstruction; lifestyle changes and correction of underlying medical conditions like obesity and atrial fibrillation; positional therapy for keeping patients sleeping in their side; and surgical procedures to eliminate anatomical defects like enlarged tonsils and create more breathing space in the oropharynx. The oropharynx is that part of the throat connecting the mouth and the upper portion of the airway.

Experts warn of the long-term consequences of uncontrolled OSA. In fact, some speculate that sleep apnea may have been the ultimate cause of the 2016 death of Supreme Court Justice Antonin Scalia. But who should be screened for the disorder? Many OSA patients are either asymptomatic or report only vague symptoms like daytime fatigue that is unaccompanied by any other obvious signs.

Authors of a 2022 article on the website of the National Center for Biotechnology Information indicate universal OSA screening for asymptomatic individuals is not recommended. However, they advise people who experience excessive daytime sleepiness or are told by a bed partner that they snore loudly, choke or gasp during sleep, or seem to stop breathing multiple times should contact a physician.

A Few Tips

Although not all factors that increase the potential for developing OSA can be eliminated or controlled, people may reduce their risks. Among important steps to take:

  • Get enough sleep – sleep apnea is worse when you are sleep deprived or exhausted. Stick to regular timing, and a cool, dark and quiet bedroom.
  • Increase physical activity, especially if much of the time is spent sitting in an office or at home in front of a computer.
  • Undergo treatment for hypertension, chronic nasal congestion and upper respiratory infections, and other conditions that contribute to OSA.
  • Achieve a weight and body mass index appropriate to age and height.
  • Reduce consumption of alcohol, particularly just before bedtime, and
  • Eliminate smoking as part of an overall healthy lifestyle.
  • Be careful driving and avoid doing so if you have any tendency to doze off. Speak with your doctor immediately if you have trouble staying awake during the day.

When it comes to our health, American philosopher and historian Will Durant, perhaps, said it best: We are what we repeatedly do. Excellence [good health] then, is not an act, but a habit.”

Bingeing on Negative Emotions – How ADHD and Anxiety Impulsively Feed on Drama

By Dr. Alex Dimitriu

Checking your phone for the 10th time this hour? You can learn a lot about yourself through observing this simple habit. People with ADHD and anxiety share the common element of impulse control. They can both be “bingey,” – and check their phones or do other things repeatedly.

Shiny! Understanding the ADHD brain

The ADHD or “dopamine brain,” loves novelty and stimulation in general. It does much better when there’s some chaos rather than some silence. I use the term “dopamine brain” because ADHD is a medical diagnosis, and in reality, everyone is on the spectrum between having too little or too much dopamine sensitivity and dopamine desire. Evolution kept the more dopamine-hungry brains around for their creativity, potential for positive intensity, as well as how well they perform when everyone else is overwhelmed, or the deadline is tomorrow. People with ADHD literally perform better on cognitive tests with white noise playing in the background than with silence.

However, when there is peace and quiet, the dopamine brain is actually hungry, and “food,” or stimulation can come from positive as well as negative sources. Read more

Aromatherapy May Lead to a 226% Boost in Cognition

Aug 22, 2023 Dr. Dimitriu was published in Psychology Today in an article titled:

Aromatherapy May Lead to a 226% Boost in Cognition

You know those small vials of fragrant oils sometimes placed on a hotel pillow to calm a guest and improve sleep? Well, science says they work, even suggesting certain aromas can help build better brains—and memories—during sleep. Researchers writing in a July 2023 issue of Frontiers in Neuroscience contend “olfactory enrichment”—inhaling pleasant fragrances during sleep—influences brain function in ways that significantly improve cognition and boost memory.

Click HERE for the full article.

Better Deep Sleep May Delay or Prevent Alzheimer’s Disease

June 22, 2023 Dr. Dimitriu was published in Psychology Today in an article titled:

Better Deep Sleep May Delay or Prevent Alzheimer’s Disease

Quality deep sleep may compensate for the cognitive dysfunction and memory impairment of Alzheimer’s disease and could become the target of future therapies, especially in early and mild cases of the disorder. That is the conclusion of a recent study investigating the relationship between sleep and Alzheimer’s. The finding offers a potential new weapon — a good night’s sleep — in the battle against what has become the sixth-leading cause of death in the United States, more lethal than prostate and breast cancers combined.

Click HERE for the full article.

Winning The “Prior Authorization” Medication Game

By Dr. Alex Dimitriu, Mar 17, 2022

Top tips for consumers about managing medication costs

  • Consider generic medication if possible to lower costs
  • Check on GoodRx.com to find the best prices and pharmacies for meds
  • When a generic request is denied due to prior authorization, ask about the cash price
  • Pay cash over using insurance when the cost of the medicine is low to speed things up

I work as a physician. When I put my patient on a new medication which they need to start, the sooner the better. I also have existing patients who need refills of medications they are on, which are generic, and I try to order a refill. Often, the pharmacy tells my patient they cannot have their medicine, because “your doctor needs to speak with your insurance company.” The patient is sent away and left in a land of limbo, sometimes in urgent need of a refill which now has been denied. Read more

ADHD: All About Power, Paradox, and Yes Pain, Too

January 13, 2022 Dr. Dimitriu was published in Psychology Today in an article titled:

ADHD: All About Power, Paradox, and Yes Pain, Too

Despite all its complexities, attention deficit hyperactivity disorder (ADHD), a neuropsychological condition characterized by disorganization, procrastination, time impairment, impulsive decision-making, “wandering attention,” and problems with self-management, might be best described in three words: pain, power, and paradoxes.

Click HERE for the full article.

How Sleep Deprivation Impairs your Mind, Moods, Memory and Impulses

by Dr. Alex Dimitriu

Pioneering sleep scientist William Dement once called sleep deprivation “the most common brain impairment.” The research is proving him right.

Authors of the latest sleep study, just published (April 2021) in the journal Nature Communications, find that “persistent” sleep deprivation during the midlife years – 50s, 60s, up to age 70 – is associated with a 30 percent greater chance for developing dementia.  And this increase is independent of other sociodemographic, physical, behavioral, and mental health variables, according to the researchers.

The findings add supporting evidence to results of a 2018 study led by National Institutes of Health investigators who found that impaired sleep led to a build-up of metabolic waste in the brain, namely an increase in the protein beta-amyloid, which plays a role in Alzheimer’s disease.

Even more disconcerting is that these reports are only the latest in a series of studies, conducted during the past 15 years, linking chronic sleep deprivation with a variety of physical, mental, and psychological symptoms.

These include mood shifts and increased irritability; concentration and attention problems; failures in judgment and executive decision-making; physiological changes, such as impairments in brain function and hormone production, reduced immunity protection from disease, overstimulated appetite and weight gain, higher risk for diabetes, an overactive nervous system, chronic fatigue – even earlier death; and a range of psychiatric disorders, including elevated anxiety, depression, and obsessive-compulsiveness.

In fact, research appearing in a 2020 edition of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging suggests loss of just a half night of shut-eye decreases rapid eye movement (REM) sleep, which is important to memory consolidation, and is linked to reduced activity in a portion of the brain related to emotion control.

Those findings are in line with a 2016 eLife study indicating that repeated sleep deprivation interferes with the connectivity of brain neurons involved in memory and learning.  An earlier study by the American Academy of Sleep Medicine determined that chronic lack of sleep disrupts or slows a person’s ability to resolve moral dilemmas or make moral judgments.


Sleep Not an Extravagance, But a Necessity

Our high-tech, fast-paced, achievement-demanding society has come to view sleep as an extravagance, an impingement on our time and our lifestyle.  It is anything but.  Sufficient amounts of sleep – defined as seven hours to eight hours for the average adult and about nine hours for high-schoolers and college-age students – are critical to overall good health and proper brain function.

In the book Sleep for Success, three Cornell University researchers define sleep deprivation as a failure to “meet [one’s] personal need for sleep,” and include among the rank-and-file of the sleep-deprived those who have “difficulty falling asleep or staying asleep, waking too early, or having poor sleep quality.”

Indeed, we are a sleep-deprived nation.

Impaired sleep is reaching epidemic proportions; statistics bear this out.  The national Sleep Foundation estimates about a third of adults in the United States fail to sleep the required number of hours. The Centers for Disease Control and Prevention says the number is closer to 35 percent.  According to the online SleepAdvisor,

Americans in the early 1940s were averaging 7.9 hours of sleep per night; this dropped to 6.8 hours in 2013 – a decrease of 13 percent.  Meanwhile, experts equate lack of sleep to alcohol intoxication, saying sleep deprivation is a major cause of car crashes.  And, as reported by Fortune Magazine, a 2016 study by RAND Europe found that sleep insufficiency among U.S. workers costs the economy in excess of $411 billion annually.


So, Why Are We Not Sleeping?

The causes of impaired sleep are multiple, ranging from musculoskeletal pain and obstructive sleep apnea, which is a breathing disorder, to insomnia.  Insomnia is linked to a variety of cognitive and psychiatric issues, including depression as well as anxiety, bipolar, and attention deficit hyperactivity disorders.

In many instances, the issue is not medically related at all, but simply a failure to consider sleep all that important and to budget enough time for it because of workload or lifestyle.

Some teens and adults may even view “lying in bed too much” as a source of weight gain.

Yet the opposite is true.  Scientists have determined that sleep deprivation disrupts the production of hormones regulating appetite, causing a person to overeat and indulge in “junk” foods high in carbohydrates.  They report a 50 percent increase in the risk of becoming obese among those who sleep five or fewer hours per night.

Sleep deprivation even feeds into the current diabetes epidemic in this country.  After one week of deprived sleep, otherwise healthy young men showed evidence of being in a pre-diabetic state, according to a University of Chicago study.


What’s the Answer?

The solution to sleep deprivation may be as easy as working sleep time into that busy daily schedule.  Believing weekends provide the opportunity to “catch up” on sleep lost during the week is wrong thinking.

A 2019 study in Current Biology indicates that efforts at “recovery” sleep on Saturdays and Sundays not only fails to reverse some of the negative metabolic changes occurring during sleep-deprived weekdays but interferes with – and resets — the body’s circadian clock when a person returns to his or her lack-of-sleep ways during the week.

For those who have trouble falling asleep, staying asleep or waking too frequently and too early, here are some tips:

  • Stick to a regular sleep schedule. Go to bed and get up at the same time every day.
  • Stop constantly checking the time when you are in bed and worrying about falling sleep. The anxiety only increases your difficulties. Put a cloth over the clock on your nightstand, close your eyes, turn off your mind. Your sleepy brain will take it from there.
  • Improve your sleep hygiene. You know the drill: darken the room, lower the temperature, move the television out of the bedroom, put the mobile phone where you cannot see it, and, yes, if necessary, buy a new mattress.
  • Avoid alcohol consumption and caffeinated drinks several hours before bedtime.
  • Depend on natural rather than medicated sleep. Some experts contend that use of sleeping pills is associated with higher risks for mortality and cancer.
  • Finally, if you suspect depression, abnormal anxiety, or other mental issue to be the culprit for lack of sleep, contact a psychiatrist or sleep medicine specialist.

Remember: sleep is essential.  Your health – and your brain — depend on it.

New Research Shows How Sleep Clears Toxins from the Brain

January 14, 2020. Dr. Dimitriu was published in Psychology Today about how sleep clears toxins from the brain.

We’ve long known that sleep is as important to our health as good nutrition and regular exercise. Not getting enough sleep is detrimental to daytime functioning – to our mood, energy, concentration and reaction time and over the long term, it contributes to obesity and the risk of serious illness. But research has found that sleepless nights have implications well beyond making us sleepy the next day. When we go to sleep, our brains go to work, performing critical functions that affect cognition and memory.

Click HERE for the full article.

Agitated Depression and the High Functioning Bipolar Rockstar (of Silicon Valley)

Everyone reads the words “bipolar disorder,” and immediately thinks this cannot possibly be a “disorder” that they have. And indeed, this terminology is a bit clinical for most high functioning people who let nothing slow them down and have moved mountains to get to where they are today. Think of bipolar disorder, and one immediately thinks of mania – shopping sprees, flights to Vegas, talking fast, euphoria, grandiosity, and launching the next big “unicorn startup,” of Silicon Valley.

high-functioning bipolar

Because of this classic view of mania, and its requirement for the diagnosis of bipolar disorder (per the DSM, “handbook,” of psychiatry), many people simply write this off as impossible. And most of the time they are right. Bipolar disorder is rare, affecting about 1 to maybe, 2.4% of the population. The challenge comes for people that do not clearly fit the bill for having had a manic or hypomanic (less than manic) episode. These people are left with a wide array of symptoms that no one diagnosis can explain and no standard treatment or therapy can “fix.” They are left thinking it’s their personality, their childhood, trauma, a medical condition, or even a “spiritual crisis” that just cannot be shaken off.

I have worked with several patients who had gone to the end of the earth seeking a solution. Besides countless therapists and psychiatric interventions, people have sought out ketamine therapy, LSD micro-dosing, Wym Hof breathing, ice-cold showers, ketogenic diets, silent retreats, and float tanks, to find peace. Often, to no avail.

But what exactly is the problem to begin with?

In most cases, the classic triad of symptoms I have seen is a combination of what looks like ADHD, insomnia, and severe anxiety. I call this the “bipolar trifecta” of symptoms, that when seen together, raise the possibility of more than just classic “depression and anxiety.” This is important because the treatment and understanding of one’s life is very different through a bipolar versus a depression/anxiety lens. Many subtle, unrelated things start to make sense.  When it all comes together, it can be meaningful, life-changing, and offer a tremendous amount of hope, through enhanced self-awareness.

“But I’ve never been manic.”

Indeed, this is when the diagnosis is often complicated. When mania is obvious, the diagnosis is easy. Classic mania will present most fundamentally with decreased sleep and increased energy. Additional symptoms may include elevated mood, productivity, speed of movement and thinking, as well as grandiosity. An easy way to conceptualize bipolar disorder is essentially as an energy problem – too little, then too much, for longer than just a day (technically at least 4 days in a row for hypomania). It is important to realize, that not all energy, on the upside, is good. Excess energy can look like ADHD, scattered thoughts, intense moods, a feeling of adrenaline, and the irritability that happens when one is driving 100 miles per hour on a highway where everyone else is driving 55.

Agitated depression, like it sounds, can often look like a combination of really intense anxiety, low mood, along with insomnia. In most cases, where the diagnosis between anxiety and bipolar disorder is unclear, it helps to look for such episodes, along with other soft signs:


Scary symptoms aside, it’s important to recognize just how amazing people with this condition can be. Bipolar disorder is truly a blessing and a curse, and some of the most brilliant and accomplished people in history are suspected to have bipolar. From Beethoven to Robin Williams, the passion, intensity, and brilliance of bipolar disorder cannot be overstated. Their intensity allows them to be visionary, passionate, persuasive, and effective. People with bipolar disorder are like lasers. Unfocused, they will burn themselves and everyone around them. When focused correctly, they can accomplish anything and are a gift to the world.


childhoodBipolar (ish) people tend to have quirky childhoods and come from quirky parents. A family history of anything severe (i.e., suicide, hospitalizations, ECT, legal problems, domestic violence, drug, and alcohol dependence) always raises flags. Note that for most of history, psychiatric conditions were never diagnosed, so I always ask if someone in the family has been “intensely eccentric.” Children may have periods of obsessive behavior, intense interests, and equally intense moods. Early hyper-sexuality, substance use, and inconsistent ADHD are sometimes seen, often with strong academics. A history of significant mood symptoms as a teenager (after puberty) is often also a meaningful flag of bipolarity.


I often use the analogy that stressors in life are like speed bumps on a road. “Normal” people will go over a bump, get knocked around a bit, and get back to driving on the same road within a few days or weeks, depending on what happened. The driver with bipolar disorder hits the bump, and takes off, airborne. Intensity. People with bipolar disorder do not get upset, they get depressed. They do not get angry, they feel blood-boiling rage. They do not get anxious, they feel panic. They are not suspicious, they are paranoid. They do not think of a good idea, they think of the best idea, and want to share it with the world.

The moment can feel critical and they cannot wait. They do not feel happy, they feel excited, euphoric bliss, and sometimes even cosmic nirvana. Intense, rapidly shifting moods can occur. But the key point here is the intensity. In any direction, good or bad, this intensity is often a lot more than average. Unfortunately, most people don’t know what “average” is.

Family, relationships, and feelings

When you feel a lot, the people close to you may hurt your feelings. Why? Because they matter, and they know which buttons to push. In these cases, the buttons are both sensitive, and the people, reactive. I will often tell my patients that their ears are too big – that they feel and sense a lot more than is usual, and it can be truly challenging to manage such intense inputs. Many people I have worked with report distant and damaged relationships, estrangement from parents and siblings, or being embroiled in intense years-long family disputes without any contact.

“Microtrauma” can also occur, though in fairness, this may be seen in non-bipolar spectrum patients as well. This is often the result of someone with very sensitive feelings dealing with a challenging situation for an extended period of time. While there is no clear “traumatic event,” the combination of exquisite sensitivity and prolonged duress can be unforgettable for years. A difficult high school experience for one person can sometimes be a cause of PTSD for another. Depending on the sensitivity and reactivity of an individual, their intensity can amplify relatively “common,” stressors into the stratosphere.


Don Quixote

A lot of people I have worked with through the years go on “crusades.” They get an idea in their head and just cannot let it go. They lose sleep, fixate, obsess, problem-solve, and ruminate. They take action, which can often be highly effective, and yet seemingly excessive to many people around them. It’s basically intensity, or excess energy applied to a target for weeks at a time. This is how symphonies get written and startups get launched. But it’s also a source of relationship, professional, and legal problems. This happens when you just can’t stop or let something go. Don Quixote comes up, with the image of a man on a horse, attacking windmills, which he perceives to be ferocious enemies. Overly determined, sometimes rooted in reality, but clearly gone too far. Friends may have commented, “you’re just too much sometimes.”

Paradoxical Anxiety

Paradoxical Anxiety

People with bipolar disorder are paradoxes, partly because of intensity applied in so many directions, they may *sometimes look like they have every possible psychiatric diagnosis. Most significant is the paradox of anxiety and risk-taking. “Normal” anxious people tend to be risk-averse, calculated, and even overly thoughtful. Bipolar(ish) people have what looks like a weird combination of anxiety along with impulsive, risky, or adrenaline-seeking behavior. They are nervous, yet they speed. They are careful, yet they might go sky diving. They are hyper-calculated and yet they are novelty-seeking. This ultimate paradox, of thoughtfulness along with maverick behavior, allows them to have brilliant and novel insights, along with the obsessiveness to execute and deliver.

Out of character behavior is often a hallmark. It’s the feeling of surprise when you learn that conservative “Tim, from accounting,” has been sleeping with escorts in his time off. Or when the most cautious, calculated CEO is found stealing money from the company. Certainly, these behaviors can be sociopathy or criminal to varying degrees, but in the context of all of the above (and below), it might be something else more biological.



Whether prescribed or recreational, most people with bipolar disorder tend to learn over time, “one pill makes you larger, and one pill makes you small.” Varying episodes of drug use, with “uppers” as well as “downers,” at times can make people look like they have been abusing just about everything. Alcohol is just too readily available and many patients use alcohol to slow down and get some sleep when they are going too fast. Cannabis use is seen extensively, with patients smoking several times per hour, to slow down the thoughts and reduce the irritability, so they can interface with the rest of the world. Unfortunately, most forms of self-medication are just too short-lived to be effective. Opiates and pain medications are abused as well to “slow down.” Sleeping pills help with sleep. Stimulants help with getting out of bed during a state of depression and are also used to focus the scattered thoughts during a manic period. I’m always watchful of someone who looks “okay,” but needs a bunch of caffeine to get through the day and a handful of sleeping pills to sleep. These things help, but all too briefly.

They offer quick fixes that last an hour, or at best a night, but do nothing to fix the underlying problem. It’s like putting a Band-Aid on a broken leg or makeup on a bruise. Things might look cosmetically better, but the underlying issue persists. It’s also a terrible idea to self-medicate without external supervision and guidance. Just as dangerous as a surgeon operating on his or herself.


Sleep is never right in someone with bipolar disorder. Part of the bipolar trifecta is sleep and insomnia. Sleep is a vital sign in my work as both a psychiatrist and a sleep doctor. Most of medicine has things that they can check and measure – ECGs, cholesterol, blood pressure. In psychiatry, it’s all self-report, and there’s a lot of recency bias. Yes, the way you felt this past week or even today may convince you that this is how the past month has been. Sleep is perhaps the only objective metric in psychiatry and the most essential restorative tool for the brain, affecting everything from mood to memory. If in doubt, look at sleep.

You might wonder if you’ve been more snappy or irritable than usual and not trust the opinions of those around you. How much sleep you are getting is not a matter of opinion. It’s a data point you can watch closely on your own these days, with whichever gadget you chose. Any period of decreased sleep and increased energy or productivity, or inability to sleep when given the chance to, is concerning. More so when it goes on for four days or more.

Patients with bipolar disorder will often report a chronic history of light, thin, or easily disturbed sleep. Trouble falling or staying asleep, waking before the alarm, being easily awoken, and generally being unable to nap when given a chance to. There is also evidence that between mood episodes, or during low moods, they can experience hypersomnia, which is being really sleepy or needing to sleep more than usual. If you remember anything from this article, remember to look at sleep.


Perhaps why people with bipolar disorder can be so accomplished is because they are never quite happy. The enemy of good is better. Even in between mood states, intensity persists on some level. Patients will report vacillating between over-excitement and boredom, with the accompanying meaninglessness. As the human mind is a meaning-making machine, we will often try to find outside reasons to explain this inner unrest. A consequence of this is having a non-linear life path. Numerous changes in life, career, relationships, and even personal style and preference. Sometimes it feels as if patients have lived three separate lives by the time they are 40.  A drummer in one, a flight instructor in another, and now working as a real estate investor. Successful and “crushing it,” in each role, but quite a surprising assortment of talents.



Hope begins with understanding and awareness. At a minimum, the awareness of one’s own intensity and how it compares to that of others. Also an awareness of the numerous disguises that intensity can wear, from rage to obsession, to brilliance. I will often advise my patients to “check their own temperature” at any given time, to know how much, how long, and why the adrenaline has been surging through their body. Tracking moods can be useful, but confusing when moods shift rapidly in a day – sometimes these intra-day shifts, or “shiftability,” are worth tracking.

Sleep. Again, as an essential vital sign of mental well-being, any ongoing insomnia or period of insufficient sleep (despite having the opportunity to do so) is important and should not be written off as “normal” or buried with sleeping pills. Exercise, the intense kind, helps too. Thirty to forty minutes, three to five times per week, can help brain health, and improve sleep and mood, by “blowing off steam.” And lastly rhythmicity, in all aspects of life, cannot be understated. Regular bed and wake times, work schedules, medication schedules, and exercise schedules, all help create a stabilizing rhythm which can counteract the underlying waves.

Getting Treatment

If the symptoms are enough to cause difficulty in any aspect of life – personal, professional, legal, etc., do consider seeking help. In this regard, suspecting the diagnosis is more than just anxiety or depression is of paramount importance. Why? Because most medications that are used for depression and anxiety (the SSRI’s, selective serotonin reuptake inhibitors), can actually worsen agitation in bipolar disorder. It’s like pouring gasoline on a fire. But this too should be taken with a grain of salt, as indeed some cases of soft bipolar are indeed anxiety and depression, which will improve on an antidepressant, like an SSRI. If in doubt, it helps to remain vigilant, and make sure sleep and anxiety get better, not worse with antidepressant treatment.

Therapy can also be beneficial in managing mood swings and protecting and maintaining relationships at work and at home. Like medication, however, therapy too is more useful when there is an accurate diagnosis, which captures the myriad of diverse symptoms bipolar can present with. Past trauma, losses, and current life stressors can all become significantly amplified during periods of agitation, which would otherwise be at bay. It helps to know when symptoms are biological, or psychological, for ideal therapy work.

The Question of Intensity for People with Bipolar Spectrum Disorder

The aim of this article is not to suggest that everyone has bipolar disorder. But like most things in nature, this may exist on a spectrum, and present to varying degrees in various people. Appropriately, most things in psychiatry are not considered to be a “problem,” until they impact our daily lives and ability to function. This is worth bearing in mind as we test when something is beyond normal and problematic.

Road rage once a year is less concerning than when it happens with every drive to work. It is also worth noting that the above findings are observational, based on patterns of patient experience, and not yet backed by research. There are existing, validated scales that can be used to screen for bipolar disorder.

The Bipolar Spectrum Diagnostic Scale (BSDS) developed by Dr. Nassir Ghaemi and the Mood Disorder Questionnaire are two excellent resources to start putting the symptoms of bipolar together.

One issue with both of these questionnaires is that, while they cover essential symptoms for the diagnosis of bipolar, they may miss the finer symptoms that are far less pathological, but very common and often missed or never connected as a whole. To this end, we are developing a “Rockstar Bipolar Questionnaire,” to shed light on the softer nuances of this condition (reviewed above). We plan to validate the Rockstar questionnaire in our practice and hope to share the questionnaire and outcomes soon.

In looking at the softer signs of bipolar disorder, we can learn a lot about various other psychiatric conditions, and also increase awareness of what is normal, what is “too much,” and what makes some people brilliant Rockstars.


Recommended Reading

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).

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.



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