Panic disorder treatment in Phoenix: A personalized and comprehesive approch to care

Panic disorder treatment in Phoenix: A personalized and comprehensive approach to care Panic disorder is one of the most debilitating psychiatric illnesses and it is also one of the most incorrectly treated. I specialize in Panic disorder treatment and I combine multiple treatment modalities in order to target the underlying problem. This integrative approach combines several things including: 1. Cognitive behavioral therapy-This specific type of therapy is focused on reversing the core behaviors and maladaptive negative thoughts associated with panic disorder and panic attacks. I teach my patients how to identify rational vs. irrational thoughts and they learn how to stop acting on different negative thought patterns. 2. Exposure therapy-This very specialized type of therapy exposes patient’s to their fears and it is a cornerstone of treatment when it comes to Panic disorders and panic attacks. A process called desensitization occurs throughout the exposure therapy process. Unfortunately unless a therapist is very experienced in the treatment of Panic disorders, this is...
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St. John’s Wort vs SSRI’s for depression

St. John's Worts vs. SSRI for depression St. John’s Wort or SSRI’s for depression? This is a common question posed by patient’s but there is often misunderstanding behind these natural supplements. Some people are more willing to trying “natural” products such as supplements and are not willing to take pharmaceutical products which on the surface is understandable. I learned however over time that the supplement market is so poorly regulated that there is often problems with the more natural products. Putting the regulation aside and assuming one gets a high quality form of St. John’s wort, which one is better? The bottom line is there is very little difference if the potency of each is taken into account. The fact is St. John’s Wort effects the neuronal circuits in very similar ways to an SSRI and whether it is natural or not makes no difference to your body. St. John’s Wort is a potent serotonin re-uptake inhibitor that also effects many other...
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Ssri’s for depression

Ssri's for depression SSRI medication is the most commonly prescribed psychotropic medication utilized today. A frequent question is whether there is a difference between the SSRI’s such as Zoloft, Prozac, Paxil, Lexapro, Celexa and Luvox. They all share the common mechanism of being a serotonin reuptake inhibitor which means they block the proteins responsible for the reuptake of serotonin in the neuronal circuits which leads to increased levels of serotonin in the synaptic clefts. This is simplistic however and unrelated to how the medications actually help alleviate depression. While several mechanisms of action are known for SSRI’s, the truth is none of them decisively explain why they help with depression. They all work to effect dozens neuronal networks and signaling pathways that are far more complex than their name suggests. One such pathways is Brain Derived Neuro-trophic factor (BDNF) which is a critical neuronal protein responsible for organization of neuronal pathways and is responsible for synaptic plasticity. This is an example...
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Elephant mom parenting-Gateway to enabling?

Elephant parenting-Nurturing or enabling? Elephant parenting has hit the news recently has the latest addition to animal descriptions of parenting styles. This to follow “Tiger parenting” back in 2011 when a an article hit the Wall Street Journal discussing the overly aggressive Asian style of parenting founded on discipline, strict rules and rigid structure. Elephant parenting is being dubbed as the nurturing, caring more passive parenting where parents do more for their kids in the name of “nurturing.” Interestingly however what follows in the description of nurturing in the recent articles are examples of parents doing things for their kids. Is doing things for our kids such as tying their kids, sheltering them from emotional strife and protecting our kids from having to fall-and learn to stand up again, really nurturing? As a psychiatrist I can assure you I have seen elephant parenting but I have known it as enabling, often coupled with emotional distance or inability to connect in a...
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Exposure therapy for severe anxiety in Scottsdale

Exposure therapy for severe anxiety and panic disorder in Scottsdale- Severe anxiety and panic disorder treatment is hard to come by when dealing with extremely difficult cases. As a psychiatrist in Scottsdale who focuses on severe cases of anxiety and panic disorder, I utilize a behavioral approach to treatment called exposure therapy. Often times medications are utilized as a tool to enable my patient to participate fully in the exposure therapy because in severe cases, patients often cannot even participate in the exposure’s without some relief of symptoms. I specialize in treatment of these cases in Scottsdale. Steps below outline the approach to exposure therapy which unfortunately unless followed very specifically leads to poor results and an actual worsening of symptoms. Exposure therapy is a behavioral therapy that relies on the process of conditioning and counter-conditioning. The specific process to counter-condition a feared response, such as leaving the house or experiencing anxiety in general, is called desensitization. Essentially we induce very small levels...
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Scottsdale addiction treatment-Sinclair method for alcohol addiction

Scottsdale addiction treatment with the Sinclair method- Scottsdale addiction care and addiction treatment in general is quite narrow minded when considering there are many people who desire to curb problematic drinking but do not desire to stop drinking completely. There is also a narrow definition of an addict or alcoholic that has been perpetuated by media lack of general understanding. Unfortunately this leads to many people not realizing they may have problems with drinking because they are not getting in legal trouble, have never lost a job and do not drink during the day. The truth is that utilizing a much more flexible and personalized definition of addiction can identify problematic patterns of behavior that often do include using alcohol or drugs as a coping mechanism. As a Scottsdale psychiatrist who treats addiction, I always offer people help no matter which step in recognizing their problem they are at. I have developed skills in providing home detox for those wishing to completely...
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An Alternative to abstinence for alcohol Addiction

Abstinence alternatives for the heavy drinker- Abstinence is the crux of the vast majority of alcohol addiction treatment programs in the U.S. However abstinence is often impossible to achieve or frankly not desired by drinkers even thought they realize their drinking has become problematic. As a psychiatrist who treats alcohol addiction frequently, I know many people are extremely intimidated by the concept of complete abstinence and even if ultimately that is the goal of treatment, starting with complete abstinence can be counter-productive to one taking steps to get help. Ideally when one is faced with problematic drinking, which can range from legal issues to problems in their relationship, they would give up alcohol and never drink again. However despite recognizing their drinking may be excessive or problematic, many people do not have the desire to stop all together and thus do not bother to get treatment at all. Unfortunately many physicians and addiction counselors are unaware of alternatives to complete abstinence and...
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Antidepressants for menopausal hot flashes

Antidepressants to treat menopausal hot flashes One of the most debilitating aspects of menopause for women is severe hot flashes which often cause high levels of insomnia, discomfort and contribute to depression overall.  The mainstay of treatment has always been hormone replacement in the form of estrogen.  However estrogen can increase some types of cancers  so many women and doctors alike are reluctant to use them.  Using antidepressants to treat hot flashes has been looked into off and on over the years in a variety of smaller studies but no clear guidelines have emerged that are based on Grade 1 level evidence. Although still unclear how antidepressants work in general, including for depression, it may be even more a mystery why they work in menopausal hot-flashes.  While the mechanism is not clear, only the serotonergic antidepressants appear to have efficacy compared to medications like Wellbutrin which have a unique mechanism that does not utilize serotonergic pathways. Another finding without a clear reason, is...
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Key to successful relationships: Hit the gym together!

How to sustain a healthy, happy, lasting marriage Wedding bells sound as newlyweds imagine the high they feel is ever lasting. Reality sets in however, and a successful relationship involves work!  Working out together may actually be the key to a lasting marriage as it incorporates strengthening of the most key elements needed for success. How to obtain a happy marriage becomes obvious as you understand this phenomenon. Going to work-out with your partner can help motivate you to make it to the gym, can help you burn more calories,  push you to work harder, and ultimately results in more consistent, intense exercise regimens. An intense shared experience sets the stage for the physical and emotional benefits that follow. When a couple works out together, the exercise itself can physically and emotionally have a positive impact.  Both partners come away with feelings of synchronicity, cooperative spirit and shared passion.  Throw in a blast of endorphins (natural opioid high) and it can be a real...
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Alcohol addiction and numbing your emotions

Alcohol addiction causes a complete numbing of emotions Alcohol addiction causes one to detach and numb their emotions which is more often than not the reason people turn to alcohol addiction in the first place. While other drugs can do similar things, alcohol addiction specifically eliminates the majority of emotional feeling and comprehension which can be the largest challenge alcoholics face when getting sober. I treat many severe alcohol addiction patients and the most consistent reason for relapse is the inability to deal with the potent emotions that they experience without the numbing effect of alcohol. They have to re-learn how to understand, feel, convey and cope with emotions, sometimes after decades of being completely out of touch. To give an example of how an alcohol addiction patient may feel when getting sober is equivalent to taking the worst emotional experience you have ever had and understand that is the level of distress they feel over much smaller challenges or difficulties in...
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