Dr. Dave's Blog

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Too much baggage?

We all seem to know when we’re carrying too much emotional baggage. And we all seem to know when others are overloaded as well.

OK. So how do we lighten the load, or gently suggest that others might benefit from doing the same?

The secret to letting go is recognizing that hanging on is hard work.
Let Go!

Sun, April 25 2010 » Thoughts from Dr. Dave » 1 Comment

New Book for Couples

Are you married or in a committed relationship?

 

Ta-da! At last I can announce the launch date of my new book.

It’s called COUPLES – How to Create Happiness in Your Marriage or Relationship.

The book consists of six chapters. Each chapter addresses a different topic as it applies to couples, topics that are almost certainly not taught to couples counselors in graduate school.

Each chapter begins with a serious threat to couples, well-supported by scientific evidence and case studies.

The end of each chapter is devoted to easy ways to avoid the perils described at the chapter’s beginning, so you can fully enjoy your marriage or relationship and experience all of its joyful potential with each passing year.

The launch date is December 14th, 2016 on Amazon’s Kindle store.cropped_dransen_cover

Wed, November 9 2016 » Notes from experts, Thoughts from Dr. Dave » Comments Off on New Book for Couples

Think you “are bipolar?” Not so fast, pardner!

At least 70 percent of my clients announce with confidence that they “are bipolar” at the beginning of their first session. I find this interesting, since there exists no test for bipolar disorder. Many mental health experts have expressed their skepticism that this even qualifies as a disorder at all.

A 2015 research study conducted by the British National Health Service found that only 3.9 percent of Americans complaining of mood swings were given a diagnosis of this “disorder.” The percentage of Britons given a diagnosis of bipolar disorder was just 0.8 percent.

 

The following article just published by Princeton University is eye-popping:

http://pjb.mycpanel2.princeton.edu/wp/index.php/2016/01/29/the-ethical-implications-of-formalized-psychiatric-diagnosis/

 

Even more revealing is the recent study funded by the National Institutes of health:

http://www.nimh.nih.gov/news/science-news/2007/rates-of-bipolar-diagnosis-in-youth-rapidly-climbing-treatment-patterns-similar-to-adults.shtml

 

Be skeptical, my friends. Mood swings very commonly result from sleep deprivation, and require no drugs to cure,  just a few easy lifestyle changes to cure.

Thu, March 31 2016 » Notes from experts, Thoughts from Dr. Dave » Comments Off on Think you “are bipolar?” Not so fast, pardner!

AA is Faith-Based, Not Evidence-Based

Alcoholics Anonymous is the most widely used treatment for alcoholism. It is mandated by the courts, accepted by mainstream medicine, and required by insurance companies. AA is generally assumed to be the most effective treatment for alcoholism, or at least “an” effective treatment. That assumption is wrong.

We hear about a few success stories, but not about the many failures. AA’s own statistics show that after 6 months, 93% of new attendees have left the program. The research on AA is handily summarized in a Wikipedia article[2]. A recent Cochrane systematic review [3]found no evidence that AA or other 12 step programs are effective.

In The Skeptic’s Dictionary, Bob Carroll comments[4]:

Neither A.A. nor many other SATs [Substance Abuse Treatments] are based on science, nor do they seem interested in doing any scientific studies which might test whether the treatment they give is effective.

In the current issue of Free Inquiry, Steven Mohr has written a thorough and incisive article “Exposing the Myth of Alcoholics Anonymous.” [5]

Mohr characterizes AA as a religious cult. The founder, Bill Wilson, had a religious experience while under the influence of strong psychotropic drugs.

He had a vision of a bright light and the revelation that he could be saved only by giving his life completely and fully to God – and that an important part of his recovery would be to bring the news of his epiphany and recovery to other suffering alcoholics.

The 12 steps of AA [6]refer repeatedly to God. They require admitting you are powerless, accepting that only a Higher Power can help you, turning your will and your life over to God, taking a moral inventory, admitting your wrongs, being ready to let God remove your shortcomings, making amends to those you have harmed, improving your conscious contact with God through prayer and meditation, and spreading the word (proselytizing).

Criticism of the religious orientation led AA to switch emphasis from “God” to any “higher power.” One member allegedly designated a doorknob as his higher power and believed that praying to the doorknob helped him maintain sobriety.

There are other options for treatment. Inpatient programs, various medications, Secular Organizations for Sobriety[7].

Curiously, the best treatment may be no treatment at all.

The 1992, the National Institute on Alcohol Abuse and Alcoholism’s National Longitudinal Alcohol Epidemiologic Survey studied 42,000 Americans. 4500 had been dependent on alcohol at some time in their lives. Of these, only 27% had had treatment of any kind, and one-third of those who had been treated were still abusing alcohol. Of those who had never had any treatment, only one-quarter were still abusing alcohol. George Bush is a well-known example of someone who stopped drinking on his own without attending AA and without admitting that he was an alcoholic.

According to Stanton Peele in Psychology Today[8], the most successful treatments are nonconfrontational approaches that allow self-propelled change. Psychologists at the University of New Mexico led by William Miller tabulated every controlled study of alcoholism treatment they couldfind. They concluded that the leading therapy was barely a therapy at all but a quick encounter between patient and health-care worker in an ordinary medical setting. The intervention is sometimes as brief as a doctor looking at the results of liver-function tests and telling a patient to cut down on his drinking. Many patients then decide to cut back—and do!

A Cochrane systematic review [9]confirmed the effectiveness of brief interventions.

Instead of telling people they are powerless, wouldn’t it make more sense to empower them and build on their strengths? Why not tell them they are stronger than alcohol and they can choose not to let it control them? Even if you prefer a religious approach, you could pray for God to support your strength to change your own life, taking full personal responsibility rather than passively turning over the responsibility to a higher power. The old adage “God helps those who help themselves” applies.

Instead of the religious model of sin, confession and absolution, what if we avoided harping on the past and started fresh, concentrating on the patient’s behavior today and in the future? Sure, make amends to those you have harmed for the bad things you have done, but why not put the emphasis on doing good things for other people today and tomorrow?

Instead of being “ready to let God remove your shortcomings,” how about taking active steps to improve your own behavior? Why not build self-esteem instead of re-visiting past experiences that damaged self-esteem?

There have as yet been no scientific studies of Secular Organizations for Sobriety, but their approach seems more promising than AA’s. More and more physicians are routinely screening all patients for alcohol abuse: every time I go to a doctor’s office I am asked “Do you drink” and “How much?” By asking everyone these questions we may help prevent some cases of full-blown alcoholism by catching problem drinking early. More and more doctors are offering the brief interventions that science has shown to be effective.

Surely we can do better than AA. If three-quarters of alcoholics can stop drinking on their own with no treatment, we should be looking for ways to help them succeed rather than imposing a treatment that has not been proven effective and that may actually make things worse.

Links

1. https://www.sciencebasedmedicine.org/author/harriet-hall/

2. http://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_Anonymous

3. http://www.ncbi.nlm.nih.gov/pubmed/16856072?

4. http://www.skepdic.com/sat.html

5. http://www.secularhumanism.org/index.php?section=fi&page=index

6. http://www.serenityfound.org/steps.html

7. http://www.cfiwest.org/sos/index.htm

8. http://www.psychologytoday.com/articles/index.php?term=pto-20040712-000003.xml&page=2

9. http://www.cochrane.org/reviews/en/ab004148.html

-Harriet Hall, Psychology Today

Sat, December 5 2015 » Notes from experts » Comments Off on AA is Faith-Based, Not Evidence-Based

How & Why to Pay Off Your Sleep Debt

Why?

Eating well and getting exercise are critical, of course – but so, too, is getting enough sleep to replenish and restore our bodies. It’s why we need to change our perceptions about shuteye.

“Too many people say, ‘I have a big presentation at work’ or ‘I have to get this project done for my client’ – then pull all-nighters or sleep just a few hours, thinking that’s okay. They just drink coffee and say, ‘I’ll be fine.’”

Try that once or twice and you’ll get by – but forget about it long term.

Our bodies and brains aren’t built for that behavior. “If you consistently get six hours or less of sleep a night, studies show you’re basically functioning at the same level as someone who’s legally drunk.”

Consider that roughly 20 percent of car accidents are caused by drowsy driving, according to the Centers for Disease Control and Prevention. Sleep-deprived pilots have been involved in several near misses in the sky in recent years. And the dangers of nodding off on the job – or going into a “hypnotic haze” – are all too real after the recent Metro North train derailment in the Bronx, N.Y., which killed four people and injured 70. The engineer, who was driving the train at 82 miles an hour on a curved section of rail in which the speed limit was 30 miles an hour, told authorities later that he became “dazed” just before the crash occurred.

Experts say it’s time we realize that getting a decent night’s sleep is critical not just for good health but for maintaining our mental abilities. Here are six ways to help ensure we give sleep the priority it deserves:

Cut the light at night. It’s critical to reduce our exposure to light at night, especially bluish-white light. “Our brains are essentially built for a world in which the sun is the only bright light, and the sky is a deep blue. When the brain perceives bright light at night — especially bluish light like emitted from TVs, computers, and smartphones — it tricks our brains into behaving as if it’s daytime; it signals us to stay awake longer – making it harder for us to fall asleep.”

One of the worst things we can do before bedtime is watch TV, use our iPads, or check emails on our laptops or smartphones – exactly what so many of us do regularly. “The bluish-white light of the screen is mimicking sunlight and telling our brains, ‘It’s not time to sleep yet.’” No wonder so many of us toss and turn for an hour or more before finally drifting off.

At the center of our brains lies the pineal gland. It’s only job is to secrete a hormone called melatonin, which allows us to enjoy a restful sleep with plenty of dream time.

Speaking of tossing and turning, this is the worst thing we can do if we awake at night and have difficulty falling asleep again. It is essential to train our minds to associate the bed with sleep and sex; if we’re doing neither, it is critical to get out of bed and the bedroom. Instead, go to another comfortable room and read or listen to soft music until you yawn. That is your body’s way of telling you to go back to bed.

Know the links to what we drink. As much as we love coffee or tea at night, it’s far better to cut off the caffeine well before evening. Even caffeine ingested six hours before bedtime has notable disruptive effects on sleep, according to a recent study reported in The Journal of Clinical Sleep Medicine.

Heavy, spicy foods at night will also interfere with sleep – as will alcohol. “Alcoholic drinks might help us fall asleep faster, but as our bodies metabolize the sugar in those drinks, we’ll wake up more during the night than we would otherwise,” says Randall. That’s why you can feel groggy the morning after even if you’re not hung over.

Be wise about exercise. It’s not just the amount of physical exercise we get in a given day that’s important – “it’s how hard we think that exercise was. Our brains share the message, ‘I worked hard. I deserve to sleep,’” says Randall. It’s also never smart to exercise vigorously right before bedtime.

Remember regular bedtimes (and wake times) aren’t just for kids. A regular sleep schedule trains our bodies to fall asleep at generally the same time every night – and wake up at the same time the next morning. Yes, this applies to weekends as well. And if we’re in sleep debt, short naps during the day can help.

Understand that pills won’t fix all ills. A recent National Institutes of Health study determined that sleeping pills make most people fall asleep only about 20 minutes sooner than placebos do. Popular products such as Ambien and Lunesta “don’t always work as effectively as people seem to give them credit for,” says Randall. While some people swear by the medication, it’s wise to consider the pros and cons of prescription sleep meds before getting into the habit.

Sat, December 5 2015 » Thoughts from Dr. Dave » Comments Off on How & Why to Pay Off Your Sleep Debt

Five Reasons Not to Take SSRIs

For the past five years, and in my recent book Obession: A History, I have been questioning the effectiveness of Prozac-like drugs[1] known as SSRIs[2]. I’ve pointed out that when the drugs first came out in the early 1990’s there was a wildly enthusiastic uptake in the prescribing of such drugs. Doctors were jubilantly claiming that the drugs were 80-90 per cent effective in treating depression [3]and related conditions like OCD[4].

In the last few years those success rates have been going down, with the NY Times pointing out that the initial numbers had been inflated by drug companies supressing the studies that were less encouraging. But few if any doctors or patients were willing to hear anything disparaging said about these “wonder” drugs.

Now the tune has changed.

Reason One: A study in the Journal of the American Medical Association (link is external)[5]says that SSRI’s like Paxil and Prozac are no more effective in treating depression[6] than a placebo pill. That means they are 33 per cent effective, which is the percent of patients who will respond well to a sugar pill[7]. The article goes on to say that although SSRI’s are effective to some degree in treating severe depression they don’t have any effect on the routine type of depressions they are most often used to treat. The takehome message is—don’t take SSRI’s if you have normal, mild, or routine depression. It’s a waste of money, and the drugs have serious side-effects including loss of sexual drive.

Reason Two: A January 4 article in MedPage Today (link is external)[8] cites a study done at Columbia University and Johns Hopkins. The study says that doctors routinely prescribe not one but two or three SSRI’s and other psychopharmicological drugs in combination with few if any serious studies to back up the multiple usage. It’s pretty obvious that the reason for these multiple prescriptions is that if one drug doesn’t work, then perhaps two or three will. Doctors are in essence performing uncontrolled experiments on their patients, hoping that in some scattershot way they might hit on a solution. But of course drugs have dangerous interactions and most physicians are shooting in the dark with all the dangers that attend such bad marksmanship.

Reason Three: More and more psychiatric[9] disorders are appearing that might be called “lifestyle” diseases. What was called shyness[10], sadness, restlessness, shopping too much, high sex[11] drive, low sex drive, and so on have increasingly been seen as diseases and many more will appear in the new DSM, the diagnostic manual of psychological and psychiatric disorders. Increasingly the criteria for inclusion in the DSM involves whether the disorder responds to a category of drugs. If, as we’ve just seen, one of the key class of drugs that for 20 years has been considered effective now fails, what does that say for this idea that if a disease responds to a particular drug, then it is a particular disease? We have to rethink the whole biological basis for lifestyle disorders.

Reason Four: We’re an over-medicated society, and the goal of drug companies and a compliant and harried medical establishment is ultimately to have some drug coursing through every individuals’s bloodstream. It’s a lot easier to quickly pop a pill or prescribe than it is to explore the reasons for a person’s distress. Many of us remember the scenario in 1960’s science fiction movies of a dystopic future or Soviet-style world with drugs used to control minds. Well, that future is here and the social control we dreaded is now accepted in the form of a pill.

Reason Five: The whole serotonin hypothesis is challenged by these findings. What this new information shows is that there may be some help using SSRIs if there is a severe shortage of serotonin, but the average person’s depression cannot simply be related to a “chemical imbalance.” The human brain[12] is too complicated and so are we to have a simple, quick explanation related to serotonin alone. We have no way of measuring serotonin the brain of a living person, short of cutting open the skull. We have not come up with what a normal level of serotonin should be and below which we can say that you would be depressed and above which we can say you will be happy. People with high serotonin levels can be depressed and those with low levels can be happy. Serotonin inducing drugs like ecstasy can make you feel very happy, but so can alcohol [13] and heroin. We have to go back to the drawing boards on this one, so don’t ever let anyone say “I’ve got a chemical imbalance” without asking them what they actually mean and where is the science to prove that statement.

What Should You Do?

Think twice, be skeptical, and question a simplistic diagnosis you might receive after discussing your condition for a short time with a rushed practitioner. If each person takes a stand, is willing to engage in therapies beyond drug-taking, we might actually have a responsible and informed public confronting an increasingly powerful medical-pharmacological establishment. Drugs may not be the answer for you, and now it turns out that some drugs may not be the answer for almost anyone.

Links

1. https://www.psychologytoday.com/basics/psychopharmacology

2. https://www.psychologytoday.com/basics/ssris

3. https://www.psychologytoday.com/conditions/depressive-disorders

4. https://www.psychologytoday.com/basics/ocd

5. http://www.nytimes.com/2010/01/12/health/12ment.html?ref=health

6. https://www.psychologytoday.com/basics/depression/depression-and-society

7. https://www.psychologytoday.com/basics/placebo

8. http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/17785

9. https://www.psychologytoday.com/basics/psychiatry

10. https://www.psychologytoday.com/basics/shyness

 11. https://www.psychologytoday.com/basics/sex

12. https://www.psychologytoday.com/basics/neuroscience

13. https://www.psychologytoday.com/basics/alcohol

Sat, December 5 2015 » Thoughts from Dr. Dave » Comments Off on Five Reasons Not to Take SSRIs

You Should Know How Drugs Can Fool You

New York Times – February 3, 2015

Expensive drugs work better than cheap ones — or at least some people firmly believe they do.

Researchers told 12 patients with Parkinson’s disease that they were testing two drugs, one costing $100 and one costing $1,500 a dose. The drugs contained the same dose of the same medicine, they said, but the manufacturing process was different, and they wanted to see if they worked equally well. The study appears in the February 24 issue of Neurology.

What the subjects did not know is that they all received an identical injection of plain saline solution.

The “expensive” placebo worked significantly better, producing a twofold improvement compared with the “cheap” one.

The effect was apparent not only in tests of physical activity, but also as measured by brain imaging. In fact, the effect of the expensive placebo was not significantly from that of Levodopa, the most effective medication for Parkinson’s disease. Levodopa acts by raising levels of the neurotransmitter dopamine in the brain.

“One of the reasons why the effect is so large is that it’s mediated by dopamine,” said the lead author, Dr. Alberto J. Espay, an associate professor of neurology at the University of Cincinnati. “We make more dopamine when we have heightened expectations of efficacy.”

When subjects were told the true nature of the study, the researchers write, the reactions ranged from incredulity to astonishment.

Tue, February 3 2015 » Thoughts from Dr. Dave » Comments Off on You Should Know How Drugs Can Fool You

Latest warnings about Ambien.

Hey, you know how scary Ambien is to me, and you know that I always warn people who rely on it for insomnia.

 

Here’s some hard science as published in the New York Times on August 14, 2013.

http://www.nytimes.com/2013/08/14/business/to-judge-sleep-aids-us-looks-at-drowsy-driving-in-the-morning.html?ref=todayspaper

 

Be careful out there!

Wed, August 14 2013 » Thoughts from Dr. Dave, Uncategorized » Comments Off on Latest warnings about Ambien.

At Last: We Now Accept Credit Cards!

OK, it took us a while to pick another credit card processor. As you may know, the entire credit card industry has recently been shaken by a few innovative startup companies who offer greater simplicity and lower fees than the giant companies that owned the market for decades.

Sure, we got plenty of offers from the startups, and they were all tempting. But the last thing we wanted was to depend on a new company that may not still be around a year from now. If you remember what happened to people who bought Sony Betamax VCR’s, then you’ll understand why we didn’t make a quick decision.

So we waited for a few months, in order to see which companies would thrive and which would disappear.

We apologize for the inconvenience until now. The good news is that we have found a winner in the credit card processing business, and we’re now able to accept major credit cards again, with extra features and security for you that you have never gotten from the old giant companies.

Tired of trips to the ATM for cash or for digging up old-fashioned checks that few people use anymore? Problem solved. Visa, MasterCard, AMEX and Discover are now welcome at Delray Holistic Therapy. We hope you are as pleased as we are.

Mon, August 12 2013 » Thoughts from Dr. Dave » Comments Off on At Last: We Now Accept Credit Cards!