Author: sparklypsychiatrist

Do You Love Your Shampoo?

Good morning! Happy Monday. Generating content the way I’ve wanted to has been difficult being home with a little one, working, or working while being home with a little one. I have chosen to take my own advice and be kind to myself, realizing these are unique times and congratulating myself for small victories.

So why am I asking you about shampoo?

There are four shampoos in my shower.

This morning was a tough Monday after a tough weekend. Feels a little bit groundhog day and the gray weather is definitely affecting my mood. But as I engaged my glutes in some old-school leg lifts while jazzercising on Facebook, I had a moment of clarity. It’s wild how the mind clears with increased blood flow from exercise. I promise I’m getting to the shampoo.

In other areas on the site, you may have read about depression. We work with people with depressive disorders every day and there are some common themes. One of the questions I frequently ask my patients is, “What brings you joy?” Why do I ask this? It can answer many questions. Not least of all, assessing for anhedonia. If nothing brings you joy, you may be experiencing anhedonia and should check out Dr. G’s series on depression.

I’ve been thinking about the things that bring me joy and have come to the conclusion that I am unable to do many of them right now. Among those include spending time with friends and family, enjoying new restaurants, taking live workout classes, and perhaps the most missed activity, traveling. What that means is that I need to fill the joy bank with other things in order to prevent anxiety and depression. Preventive medicine is the best medicine after all.

Finally, the shampoo.

I shampoo my hair probably every other day. That means I’m spending a decent amount of time engaging with my shampoo. Recently, I determined that I don’t really like my shampoo. It was simply shampoo, got the job done, nothing special. Then, one evening at approximately 1AM, I made the bold decision to try to love my shampoo. (Side bar: the mind readers on Facebook advertising may have nudged this decision ever-so-slightly. Thanks omniscient overlords of Facebook.) While it took three tries, and a few dollars from my pocket, I now love my shampoo. I like the smell, how it feels in my hair, and the overall results. Best part? Creating a little bit of joy. A little bit of joy every day as a result of a small change adds up to serious improvements in mood.

Below I will make some suggestions for ways to increase joy in your daily life. Who knows when I will take my next trip to Key West or participate in my next 10k? It is time to create some joy and prevent dips in my mood that might contribute to the development of depression or anxiety.

  1. Food

If you are like me, social distancing might have you realizing how frequently you were eating out. Cooking and eating-in are definitely increased in my household. When we do order out, it requires more thought and intention about how to acquire the food and if it will be worth the effort involved.

Honest moment: I’m still not that into cooking. If you love to cook, yay you! Keep cooking and generate some joy. Just learning? Even better! America’s Test Kitchen is a tried and true resource and they are having some excellent promotions right now.

As for me, the answer is avocados. Prior to life in social distancing, I never purchased avocados. They either taunt me while being completely unripe at the exact moment I crave guacamole or slowly disintegrate into a pile of mush in the corner of my counter. Now, I have the time to commit to avocados. Each week, I splurge on delicious avocados and excitedly anticipate the moment my thumb gently indents the skin of the avocado easily, indicating nature’s mayonnaise is ready for consumption. I’m currently at a pace of half of an avocado per day. Sliced up with salt, pepper, and parsley on top of toast – maybe with some tomatoes? Go wild. Breakfast is elevated and I am happy. Every time I have this breakfast (which is quite frequently now) I am tempted to document my elegant meal.

Are there any foods that bring you joy? (I’m not referring to in-the-moment joy that leaves you feeling tired and unmotivated afterwards – although of course there is a time and place for that.) Just think, if you could be excited by your breakfast, that would add some serious coin to your joy bank.

2. Bathing

Most people I know bathe every day. (This is a judgment free zone, and you may not have left the house in several days, so please continue to do you. Unless the people around you complain. In that case, please take a shower.) For this article, let’s assume you bathe every day for about ten minutes. Why not make those 70 minutes per week joyful? What type of soap do you use? Do you love it? (I love my soap, check out Little Egg Harbor soaps online, loving Citrus Twist right now.) I already addressed the shampoo situation. What about a loofah or new set of plush washcloths? Doesn’t have to be expensive, I am very happy with my set of purple Amazon Basics washcloths. Take the time to assess your shower routine. Are there any ways you can make it better, specifically in a way that increases your happiness?

3. Clothes

This category will be different for everyone depending on how you are most comfortable. Are you someone who loves getting dressed up for work every day and now you never change out of sweatpants? That probably isn’t going to add any joy to your life. I’ve spoken to some friends who feel much happier putting on jeans and a cute top, and this simple action of putting on clothes that make you feel good can improve your self esteem and help prevent problems with your mental health.

As for me… if one more person on social media suggests putting on pants with buttons to keep myself in check, I might yell at the computer. Why on earth would I put on pants with a button if that is unnecessary at this time? What an absurd notion. So how has clothing brought me joy? Glorious sweatpants and leggings. Soft flowy tops. Buttery wire-free sports bras.

I have two pairs of sweatpants that I love. One pair has dinosaurs on them and the other I purchased at a brewery a few months back. I also treated myself to a pair of overpriced camo print leggings. Every time I slide them on, I take a moment to deep squat and stretch it all out and bask in the sensation of unrestricted leg movement.

4. Sleep

Good sleep is integral to your mental health and I would like to devote a post in the future exclusively to sleep. For the purpose of this post, I’m suggesting improvements to your sleep routine that might make you smile. Do you sleep with an eye mask? These can be wonderful, especially for city living. What about aromatherapy? A touch of lavender on your pillow prior to bed time might trick your senses into thinking you are at an upscale spa hotel. Some other suggestions: update your pajamas, sheets, or pillows.

5. Self Care

Self care means different things to different people. For me, one of the things I think of is makeup. I love makeup, but my relationship with makeup has evolved over the years. In the past, I loved a full face. Bring on the bronzer! When I started my residency training, I wore full makeup (and heels… what was I thinking?) every day. I think it was almost like wearing armor. As I’ve grown more comfortable over the past few years in my role as a resident physician, I feel perfectly comfortable going to work with no makeup.

    For me, playing with a new eye palette in preparation for an upcoming wedding or watching a YouTube tutorial on liquid eyeliner or DIY lashes is fun and makes me happy while applying makeup daily does not. I treasure the extra fifteen minutes in the morning to eat my fancy avocado toast with my family (see above.)

    I also no longer feel like I need makeup to be attractive. I have my daughter to thank for that… I see her tiny face sprinkled with my features and I never want her to feel anything less than beautiful. If I think I need makeup and her face looks like mine, that would suggest her perfect face needs makeup too – which it most certainly does not.

    I’ve also become comfortable with the mascara and lip only makeup which takes exactly one minute. You’ll find me wearing that makeup look in the photo above posing with shampoo. This applies to hair, waxing, nails, and skin care. As much or as little as makes you happy. Does being home and not needing to do your hair feel amazing? Time to harness that and include it as added happiness to your day. Have you perfected the at-home gel manicure? Color me impressed by both your artistic ability and commitment to nail care. It might even save you money in the future.

    6. Sexual health

    Sexual health is part of your health. This might mean a celibate hiatus due to a lack of interest at this time. Prefer the Netflix portion of Netflix and chill? That’s just fine. Despite what the internet might have you believe, global pandemics and social distancing aren’t an absolute aphrodisiac for most people.

    If the mood does strike you, this might present an opportunity to get to know your needs more, with or without assistance from a device or adult entertainment. Or maybe now is the time to revisit your sexual health needs with your partner.

    Pro-tip: Continue to use contraception while engaging in partnered sexual activity if you do not wish to grow your family.

    I’m sure there are other ways to add joy into your day. We would love to hear suggestions in the comments! Whatever you choose, take time to assess your piggy bank of joy. Don’t let the balance get too low or you may risk experiencing depressed moods or feelings of anxiety.

    One further comment on this subject, and I alluded to it above: you don’t actually NEED to do anything. We are in an uncharted time of global pandemic. If you are alive and keeping any persons that depend on you alive, you are doing a fabulous job! This post seeks to protect the integrity of your mental health by way of experiencing happiness in your daily life.

    Sincerely,

    Kris @shrinksinsneakers

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    Addiction 101: Making the Diagnosis

    Chances are high that you know someone with an addictive disorder. This article provides information on how we diagnose addictive disorders and the symptoms included in substance use disorder diagnoses.

    Diagnosing addictive disorders is based on the Diagnostic and Statistical Manual of Mental Disorders aka DSM, which is currently on version 5. The DSM is considered the Bible of psychiatry (be on the look-out for a forthcoming article on the storied history of the DSM, it’s more dramatic than you might think). First, let’s address which substance use disorders are currently included in the DSM.

    1. Alcohol

    Self-explanatory. Beer, wine, liquor, hand sanitizer (yup, I’ve seen it).

    2. Caffeine

    That’s right, caffeine use disorder is a psychiatric diagnosis. It’s a substance that produces psychological and physiological effects in the body and is frequently overlooked. This includes coffee, tea, diet coke, monster energy drinks, and the list continues. Some over the counter supplements contain caffeine such as popular pre-workout drinks. It’s a sneaky chemical and found in many foods and beverages.

    3. Cannabis aka marijuana

    Consumed in various ways. Comes from the various parts of the cannabis sativa or cannabis Indica plant. There is a frequent misconception that “marijuana isn’t addictive.” While marijuana doesn’t typically have a withdrawal syndrome, it most certainly is included in the list of substances that may result in substance use disorders.

     4. Hallucinogens

    Hallucinogens are divided into classic and dissociative hallucinogens. The classic category includes drugs like LSD, psilocybin (magic mushrooms), peyote, and DMT (ayahuasca.) Examples of dissociative hallucinogens include PCP, ketamine, dextromethorphan (found in cough syrup), and salvia. They can be used in a variety of ways and generally alter awareness and perception.

    5. Inhalants

    Okay so this is a really random category because it may include so many things. Basically, anything that can be inhaled and shouldn’t be. Spray paint, gasoline, whipped cream bottles, cleaning spray, lighters. If it is a substance that gets inhaled, it falls in this category.

    6. Opioids

    Makes the news all the time due to the high risk of overdose death. Includes drugs like Percocet, OxyContin, heroin, and fentanyl. May be taken by mouth, snorted, or injected. The respiratory arrest caused by these drugs is reversed by a drug called Narcan or naloxone, which is administered via injection or nasal spray.  

    7. Sedatives/Hypnotics/Anxiolytics

    This category encompasses CNS depressants including the ever-popular benzodiazepines (such as Xanax and Valium). Also includes sleeping medications such as Ambien as well as some old school medications like phenobarbital. (Fun fact: butalbital, a barbiturate related to phenobarbital, is one of the ingredients in a prescription headache medicine Fioricet, in combination with Tylenol and our friend caffeine.)

    8. Stimulants

    Most famous drug of abuse stimulant first: cocaine. My favorite song about cocaine is White Lines by Grandmaster Flash and the Furious Five. Give it a listen. White Lines on YouTube. Methamphetamine (crystal meth) is probably the second most well-known stimulant, sensationalized by the popular show Breaking Bad. Other drugs of abuse in this category include medications for ADHD such as Adderall.

    9. Tobacco

    Cigarettes, dip, vaping. Perhaps the deadliest of the drugs of abuse. According to the American Academy of Addiction Psychiatry, tobacco use disorder is the most common substance use disorder and affects 60-80% of smokers. (Reference) This drug has been directly linked to a number of cancers, stroke, blood clots, heart disease, and lung disease and causes a tremendous burden to public health.

    10. Other

    Catch-all for any other drugs that meet criteria for a substance use disorder. Continually evolving.

    Bonus: Gambling

    Gambling is the only behavioral addiction currently included in the DSM although internet gaming and hypersexual disorders are under investigation. 

    Diagnosing

    Next – how are these disorders diagnosed? Contrary to what you may think, quantity of drug consumed and frequency of use aren’t included in the diagnostic criteria. The mandatory component to diagnosing a substance use disorder is that the drug use leads to significant impairment or distress. If there is no impairment in life functioning or distress, there is no substance use disorder, regardless of whether the behavior upsets others.

    In addition to functional impairment, there are eleven criteria that comprise the diasnosis of substance use disorder. Two are needed to make a diagnosis. The criteria are divided into four categories: (i) impaired control, (ii) social impairment, (iii) risky use, and (iv) pharmacological criteria. The diagnoses are further classified into mild (2-3 symptoms), moderate (4-5 symptoms), or severe (6-11 symptoms). The symptoms must have occurred during a twelve month period. Below you’ll find examples of each criteria for alcohol use disorder.

    1. Using more substance than intended or using over a longer period of time than intended.

    Example: Planning to have a glass of wine and then drinking the whole bottle.

    2. Using substances in hazardous situations.

    Example: drunk driving

    3. Continued use despite interpersonal problems.

    Example: arguing with spouse while drunk, arguing about drinking too much

    4. Tolerance

    Example: Needing six drinks to feel buzzed when it used to take three.

    5. Withdrawal

    Example: Getting tremors, or “the shakes” when abstaining from alcohol.

    6. Continued use despite problems at work, school, or home.

    Example: getting suspended from school for showing up drunk

    7. Unsuccessful efforts to cut down on substance use 

    Example: Decided not to drink this weekend, but by Friday night, purchased a case of beer

    8. Lots of time spent obtaining, using, or recovering from the substance.

    Example: Teenager spends the entire day on a Friday finding someone to buy alcohol for the weekend and then all day Monday in bed with a hangover.

    9. Important activities given up due to substance use.

    Example: Stopped going to the gym because of either being drunk or hungover most of the time.

    10. Continued use despite physiological or psychological problems caused or worsened by the substance.

    Example: Drinking despite having elevated liver function tests indicating liver damage.

    11. Craving.

    Example: The strong desire for a drink. If you haven’t had a craving before, it’s difficult to explain. It can occupy your entire brain and thoughts.

    This has been a fairly dense post, but hopefully it clarifies how substance use disorders are diagnosed. In the future, this foundational knowledge will provide a framework for current event topics related to addictive disorders.

    Addictive disorders are of particular interest to Shrinks in Sneakers! If there are any specific topics you would like to hear about, please reach out and we will work on something.

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    Addressing Anxiety During Social Distancing

    As we navigate through uncharted territory related to COVID-19, it seems like people finally understand the need for social distancing. (If this concept still needs clarification, please check out https://www.cdc.gov/coronavirus/2019-ncov/index.html for clear guidelines and current recommendations.) Responsible humans are engaging in social distancing when possible and hand hygiene is totally in right now. If you are feeling calm and well adjusted during this fretful time in world history, congratulations, you may stop reading now. If you wake up and feel like you might throw up or can’t shut your mind down or if your head hurts every time you think about your sister’s wedding in June or your children’s education, read on. 

    You are not alone. (Even if you are physically alone. Sitting on your couch in joggers. We see you.) 

    During conversations with friends and family, I heard some common physical complaints arise after people began to be affected by COVID-19. These include stomachaches, headaches, back pain, neck pain, and racing heart beat among a number of other possible symptoms. While you should discuss any new or concerning medical symptoms with your doctor, these symptoms may be related to anxiety. In psychiatry, we call problems that arise in your body as a result of problems in your mind “somatic symptoms.” They are extremely common in a variety of mental health disorders. Colloquially someone may say “I hold my stress in my neck” which is an example of an anxiety related somatic symptom. If somatic symptoms are plaguing you during this time of COVID-19, see below for some suggestions. All are available in the comfort of your home. 

    You know, because you should be in your home. Once again, if it wasn’t apparent, please stay home.  

    Everything on this list has been personally vetted by me, an extremely extroverted resident physician psychiatrist, struggling to socially distance and loaded with somatic complaints. 

    1. Breathe. 

    I know, you’ve heard it before, deep breathing is frequently met with eye rolls in my practice. I’m serious though – I promise you can do a better job breathing. It is the only vital sign you can control (that is serious power.) There are so many methods that you can use and you can use them any time of day, in any location. 

    Try this: lay on your back on a comfortable flat surface. Put your hand on your belly and make your hand go up and down with each breath. Make your breaths long and slow. Count to 60 breaths; you will probably lose track while you count and your mind may wander. Bring it back to the last number you remember. This always helps.

    2. Heart bench. 

    I advocate for yoga whenever possible, but if you only have time for one move during the day to address anxiety, heart bench is the one for you. Frequently included in yin practices, heart bench is designed to open the chest in a gentle way. The heart and lungs are both located in the chest and we spend most of our time hunched over or curled up, our body’s natural response to stress. Unless you have backbends in your yoga practice, this move will counterbalance poor posture and anxiety related symptoms you may feel in your chest. 

    Try this: If you have yoga blocks, set one on its tallest height and one below it on the second highest height in a T shape. To make this pose even more gentle, place a blanket or pillow over the blocks, taking care not to knock them over. Lay back gently, resting the base of your neck on the tallest block and relaxing your spine over the other yoga block. No blocks? No problem. Roll up a towel, yoga mat, or blanket and place a pillow at the top of the roll perpendicularly. Rest gently back on the towel. Keep your feet straight or cross your legs, whichever is more comfortable. If I didn’t mention it before, these techniques are good for your cooped-up children too! 

    3. Move your body – Beginner’s Edition. 

    If you have a fancy watch, follow the clear prompts to get up and move. No fancy watch? 

    Try this: Look at the clock. If the first number is different than the last time you looked at the clock, get up and do something. 

    4. Move your body – Advanced Edition

    Speaking of moving, perhaps now is the time to begin that new workout plan you have been meaning to try.  If you are in a safe area where social distancing outside is possible, take walks. Or maybe this is the time to start a couch to 5k plan or to start training for that longer event. Can’t run or walk outside due to crowds? No worries, the online options are endless. The best workout routine is the one that you will actually do. Be honest with yourself.

    Try this: Love to dance? Feel like a music video star and sweat your butt off with the Fitness Marshall https://www.youtube.com/user/TheFitnessMarshall. Interested in building muscle with no equipment and have $50 to spend? Try this dummy-proof six week workout regimen https://www.onnit.com/six-bodyweight/. They have some free videos on the website too with good step by step instructions for some of the bodyweight moves if you prefer a free resource. 

    5. Practice Moderation

    Use caution with alcohol and snacks. If you are someone who eats junk or boozes during periods of stress (or boredom!) you may be ramping up your intake without realizing it. I am not telling you to completely skip the IPA or Ben and Jerry’s, but self-awareness is key. Feel like the beer you bought last week went more quickly than usual? There is probably not a sneaky beer elf stealing your goods. 

    Try this: Write down the alcohol you consume. This will keep you honest. If you aren’t happy with how things are adding up, you can create a plan to make better choices. 

    6. Monitor Caffeine Intake

    While I already suggested practicing moderation, many of us fail to practice moderation with caffeine unless particularly prompted; however, given its importance, caffeine warrants its own discussion. Caffeine contributes to anxiety, can raise your heart rate, and make you feel like you are vibrating. It may be tempting to drink cup after cup of delicious Columbian roast, but caffeine is one of the first things I address when patients bring up symptoms of anxiety. 

    Try this: There is something seriously soothing about a hot beverage. When it can double as an herbal tea with calming properties, even better. Try sipping on some chamomile or tulsi tea (aka holy basil.) I like Organic India Tulsi Original and Traditional Medicinals Organic Chamomile. Throw in some local honey or agave syrup for a little sweetness.  

    7. Connect with Friends and Family

    Social distancing does not equal social isolation. In the past few days, I’ve spent quality internet and phone time with friends. We’ve had an opportunity to catch up due to this period of slowing down. COVID-19 has taught us to be creative and tech savvy regarding engaging with our friends and family. 

    Try this: Houseparty, Hangouts, WhatsApp and good old FaceTime. Give them a try, might be more fun than you think. 

    8. Limit Your Consumption of COVID-19 Media

    Finally, limit your time reading about coronavirus. Knowledge is power – unless it isn’t. Stick to evidence based sites and avoid Brad from high school spewing conspiracy theories on Facebook. 

    Try this: Set a timer on your phone for what you feel is a reasonable amount of time to educate yourself (I suggest 15 minutes). When the timer goes off, put the phone down and go back to step 1!  

    Hope you found these suggestions helpful. Stay home, have fun, be calm. And keep checking out Shrinks in Sneakers! 

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