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

Segmented Sleep May Boost Productivity, but Is It Healthy?

February 14, 2022 Dr. Dimitriu was published in Psychology Today in an article titled:

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

Can knowledge of how our ancestors slept truly lead us to a life of more natural—and healthy —sleeping patterns?

Authors on the Internet have been exploring that possibility, writing a spate of recent articles indicating how the ancients, as far back as early Greece, slept in segmented or “divided” phases, which were seemingly in line with human circadian rhythm. Indeed, one online article references the Odyssey, written in the 8th or 7th century BC, in which Homer reportedly mentions the “first sleep.”

Click HERE for the full article.

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.

Exercise, Good Food, Meditation: Alternatives to ADHD Meds

December 14, 2021 Dr. Dimitriu was published in Psychology Today in an article titled:

Exercise, Good Food, Meditation: Alternatives to ADHD Meds

Struggling with symptoms of attention deficit hyperactivity disorder (ADHD)? Call the doctor; get more meds. Right? Not necessarily. In fact, recent research results are expanding the arsenal of behavior and lifestyle strategies that patients can use to manage this chronic and pervasive disorder without upping their supply of pills.

Click HERE for the full article.

 

ADHD Is Not Just for Kids

November 22, 2021 Dr. Dimitriu was published in Psychology Today in an article titled:

ADHD Is Not Just for Kids

A 2017 online article from CHADD, Children and Adults with Attention Deficit Hyperactivity Disorder, agrees. Coping mechanisms, often coupled with treatment plans, help mitigate ADHD symptoms in adults. However, CHADD experts go a step further, suggesting that the estimated 20 percent of children who seemingly outgrow ADHD when they become adults likely include those who never had the problem in the first place. They were just misdiagnosed.  ADHD is the result of a malfunction in the brain’s ability to process information due to genetics, head injury, exposure to environmental toxins, or other potential causative agents. Key characteristics of the disorder are inattentiveness and lack of concentration, hyperactivity, impulsiveness, or a combination of all these.

Click HERE for the full article.

ADHD Not Simply Lack of Focus; It’s Downright Dangerous

October 21, 2021 Dr. Dimitriu was published in Psychology Today in an article titled:

ADHD Not Simply Lack of Focus; It’s Downright Dangerous

Many fail to understand that ADHD is far more than a benign condition simply challenging one’s learning and organizational skills and ability to focus and concentrate on daily routines and tasks. It is not merely a caricature of the joking remark, “You must be a little ADHD,” directed at someone acting a bit distractedly. Indeed, unchecked, the condition can prove literally dangerous, its victims pursued by their propensity for life-altering addictions, risky behaviors, and even suicide.

Click HERE for the full article.

High-Functioning ADHD: Often Subtle, But Still a ‘Mountain’

October 1, 2021 Dr. Dimitriu was published in Psychology Today in an article titled:

High-Functioning ADHD: Often Subtle, But Still a ‘Mountain’

“Eden,” Cyrus snapped…”I have a sword pointed at you. Will you please focus.” That online passage from author Samantha Young’s book Blood Past offers a somewhat humorous depiction of what the American Psychological Association defines as a “behavioral condition that makes focusing on everyday requests and routines challenging,” namely attention-deficit hyperactivity disorder or ADHD. This disturbance — a syndrome involving dysregulation of certain neurological functions and related behaviors — is among the most common psychiatric problems and is associated with inattention, poor concentration, distractedness, memory problems, lack of organizational and social skills, impulsive behavior, hyperactivity (high energy?), and intense emotions. 

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.

Can’t Remember What You Discussed in Therapy?

July 26, 2021. Dr. Dimitriu was published in Psychology Today in an article titled:

Can’t Remember What You Discussed in Therapy?

Have you had the experience where you can’t remember what you discussed in your recent therapy session? Blame it on sleep deprivation, increasing cases of depression and anxiety disorders, or the past social isolation forced on us by the COVID-19 pandemic. Blame it on attention deficit hyperactivity disorder (ADHD) or the general sameness of our lives and on what psychologists refer to as “Groundhog Day” syndrome. Something seems to be affecting our memories—individually and collectively. We are a people increasingly struggling with problems of concentration, inattention, lack of focus, forgetfulness.

Click HERE for the full article.

Does Nature or Nurture Determine Your Personality?

June 10, 2021. Dr. Dimitriu was published in Psychology Today in an article titled:

Does Nature or Nurture Determine Your Personality?

Blame it on your parents (nature). Blame it on your friends (nurture). But, in truth, you can probably blame your personality on both. Is the development of human personalities the result of inherited genetic traits from parents or the layering of years of experiences through interaction with the surrounding environment (including friends) — nature versus nurture? Scientists have been arguing about this question for centuries. In fact, as far back as 400 BC, Hippocrates emphasized the commanding role of nature, when he identified four biological fluids – yellow bile, black bile, phlegm, and blood – as underlying the various classifications of all human behavior. That aside, thanks to 21st-century science and technology, the truer answer to personality may well be found in a seminal study published December 2017 in Nature Neuroscience.

Click HERE for the full article.

How Sleep Deprivation Impairs your Mind, Moods & Memory

May 11, 2021. Dr. Dimitriu was published in Psychology Today in an article titled: “How Sleep Deprivation Impairs your Mind, Moods & Memory

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.

Click HERE for the full article.

The SSRI Experience: Part 1 of 30 days on psychiatric medications

April 5, 2021. Dr. Dimitriu was published in Psychology Today in an article titled: “The SSRI Experience: Part 1 of 30 days on psychiatric medications”

Depression will affect up to 20% of people at some point in their lives. That number is tremendous! So few people seek help, and so many more suffer quietly, either not recognizing something is wrong, or not doing anything about it. The brain is a far more complex organ than the eye, and even the eye needs help. Seventy-five percent of adults use some sort of vision correction. According to a World Health Organization study, one-half of anxiety disorders are actually recognized, and then, only one-third of the people are offered treatment. That’s 1 in 6 people with anxiety who are actually treated. Taking psych meds can unfortunately still carry unnecessary stigma these days, and some doubt whether they work altogether.

Click HERE for the full article.

 

 

A Little Bit of Anxiety Can Do a Whole Lot of Good

March 17, 2021. Dr. Dimitriu was published in Psychology Today in an article titled: “A Little Bit of Anxiety Can Do a Whole Lot of Good”

Anxious?  Well, that may be a good thing – in moderation.

Experts say anxiety increases a person’s arousal to the point where motivation, performance, and the ability to complete difficult tasks or activities are significantly enhanced. Too much of it, though, leads to neurological, psychological, and even physical disorders; too little of it might encourage an “It-don’t-matter-that-much” attitude, causing distractedness, disorganization underachievement, and lack of ardor to do a job well.

Click HERE for the full article.

The Essential Role of Sleep in Immunity

February 18, 2021. Dr. Dimitriu was published in Psychology Today in an article titled: “The Essential Role of Sleep in Immunity”.

Want to ensure your vaccination offers the greatest protection against COVID-19? Sleep—and sleep well—before and after your vaccine appointment, because natural sleep boosts the immune system significantly.

Click HERE for the full article.

Is It Just the COVID-19 Blues or Is It Depression?

January 27, 2021. Dr. Dimitriu was published in Psychology Today in an article titled: “Is It Just the COVID-19 Blues or Is It Depression?”

“Don’t wish it away. Don’t look at it like it’s forever. Between you and me, I could honestly say that things can only get better.”

These words from Elton John’s song “I Guess That’s Why They Call It the Blues” may be good advice for many of us who have become a bit stir crazy after being cooped up at home for months, compliments of the unrelenting COVID-19 viral pandemic. But what exactly are “the blues?” Do they constitute a mental health disease – like anxiety disorder or clinical depression — requiring professional therapy? Or do those feelings of sadness, loneliness, anxiousness, pessimism, and melancholy ascribed to “the blues” represent simply a transitory “psychological state of mind,” in this case, one effected by the confinement, social isolation, and repetitive daily sameness wrought by the virus?

Click HERE for the full article.

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