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ASK DR. STEVE

Many people ask me questions, some in written form via email or more often in person in the office. Many of the questions repeat, and most are very good. Someone suggested I post the questions and my answers on my website. This is a new page so I don't know how many questions (or how much disinterest) I might get. If there is interest, this might serve as a forum for others and save folks a lot of time. So, if you have a question, send it to me at the below email link. Keep in mind email can be read by anyone capable between your and my computer, thus, email is not confidential. You assume the risk for any breach. So, keep it anonymous, but make it meaningful to you. I'll review each question and post it and my reply below. If I get too many, I'll group them into categories or figure out some way to go to the area you might have interest. I'm interested in meaningful questions, and will answer sincerely, with the best of intentions, drawing upon my experience and any relevant research.


Dr. Griggs*

 

 

 

*Please use this email only for questions, not for other stuff...See my email policy at:

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HEALTHTAP QUESTIONS ANSWERED

     These are some of the questions I've answered on Healthtap, an online Q and A between the general public and providers of all types.  Psychological questions are directed to psychologists and psychiatrists.  If you have a question, besides using the email above, you can also submit it through Healthtap.   (This might also be faster and will share your question with unknown others, which might actually be more helpful.) On Healthtap, you can also schedule a Virtual session with me or other providers.   Here's the link:

 

 

Visit the Virtual Practice of Dr. Steven Griggs on HealthTap
 

 

MEDICATIONS

Q)  A 20 year-old female asked:

I take Vyvanse, and have OCD. Have a serious skin picking problem. Meth can cause that symptom. Can amphetamines cause skin picking too?

A) Yes, and so can Vyvanse, which has a version of amphetamine in it.  OCD doesn't help matters, as this can also manifest in heightened attention to body conditions.  I'd check with your prescribing MD first, possibly to reduce or change your prescriptions. Then see a psychologist and/or a dermatologist. I assume you have ADHD. Are you treating this?

***

Q) I seem to get so hot when others are OK and sweat a lot especially on my back. I feel it running down... I'm 52 and on Sertraline and hate summers but like cold.

A) Do you have a history of hyperhidrosis? Or, is sweating a recent phenomenon after taking Sertraline? Start with a visit to your MD for a physical and then ask questions about side effects of your medications. Do you sweat less in cold climes? Likely, climate is not the culprit.

***

A 20 year-old male asked:

Q) I had been on an SSRI for 3 months but it causees sleepiness, I thought it is going to boost mood. Does that mean I don't have serotonin deficiency but something else?

A) If it boosts your mood stay on it and consider taking it at night, since its causing sleepiness. Consult with your prescribing MD first, but this is the common way of dealing with this pattern of side-effects. If you're not getting a mood lift, then consider changing to another medication by consulting with your MD before making changes. Serotonin deficiency is a little deeper and broader topic...

***

Q) Can I take Seroquel as a prn as I'm feeling a manic psychotic episode coming on. If I can what dosage until I see my psych?

A) You could but only if your prescribing MD said so. Prescribing a dose to take on this forum is not wise, as we don't know what else you take, or anything else about your psychological state. Get in to see your psychiatrist ASAP.

***

Q) I've been having trouble sleeping. Ativan doesn't work. Docs want me to try Valium. I don't really want to do anymore benzos. How's Melatonin for anxiety? Will it effect it, because my anxiety is BAD.

A) Melatonin is usually taken before bed to induce sleep by boosting the natural hormones the brain generates as it gets sleepy (anticipates darknes). Some experience a reduction of anxiety is they take a very small amount of Melatonin as needed during the day. I don't know of any studies that have investigates this, so consider this an "off label" idea. Run this by your MD first, but you also might try Valerian Root, which is an herbal version of Valium and not addictive. Valium and Ativan are both benzo's and are usually not good sleep aids, plus there is dependence potential.

***

 

SUICIDE

 

A 36 year-old female asked:

Q) About 3 years ago my 10 year son's dad committed suicide, on my son's birthday, His dad was very abusive to me and my son saw most of it. My son rarely talks about his dad and when he does it is just memories of the abuse.  I am not sure what to say?

A) Bad memories Perhaps your son and you could benefit from professional psychotherapy. In the meantime acknowledge his memories and listen. Then make sure he knows, and sees, that you are taking good care of yourself  and him, and that he had no part in his father's behavior.

 

ANXIETY

A 23 year-old female asked:

Q) I get hot/cold off & on lately. (Have anxiety) I grind my teeth often.. Still have dull ache above brow. My energy is up & down too. What's going on?

A) This is a case for visiting your MD, especially for the symptoms of being hot and cold. That could be caused by LOTS of conditions, some medical. Teeth grinding (Bruxism) usually signals too much tension/stress. The dull ache could come from that or sinus conditions--again see your MD or dentist for these. Stress? Consult a psychologist to see what drives your anxiety.

***

Q) I have anxiety would this cause adrenaline rush in throat and skipped heartbeat at the same time?
 
A) Yes. There are 33 symptoms of functional (psychological) anxiety, and these two are among them. It's important to understand the dynamics of anxiety and its many manifestations. Here's a place to start: http://www.psychologyproductsandservices.com/page2.html

***

Q) Waiting to hear back from doc about meds but can depersonalization, anger, and lack of memory/confusion stem from anxiety? I got mad and depersonalized now I have frequent urination?

A) You do seem to have many of the symptoms of anxiety, although depersonalization suggests a more severe psychological reaction to stress, including anxiety. Frequent urination, believe it or not, IS one of the symptoms of strong anxiety, although it is not one of the most common. Your other sx's fall in line, too. Here's a reference: http://www.psychologyproductsandservices.com/page2.html

***

Q) Severe anxiety, heart racing, breathless, chest pain, constant hospital trips.  Don't believe I'm ok. In this state all time.   gf won't help.  Unspecified t wave abnormality on ECG.  Plz help?

A) There are 33 symptoms of anxiety and you seem to have the most common and biggest ones. Do you have a psychiatrist? They do better with these Sx's than GP's. A cardiologist is indicated for EKG abnormalities. If anxiety alone is responsible for all this, then you need a psychologist. Here's a start: http://www.psychologyproductsandservices.com/page2.html

***

Q) I went to ER 2 times allready from chest pain but passd all my heart check ups. and doc says it could b from anxiety or muscle. by lower pec wat is it?

A) First eliminate muscle trauma. Then look at the possibility of panic attacks. This symptom is one of 33 and can be reduced or eliminated by psychotherapy, medication, yoga, or other techniques. Start by looking at your background. Here's a beginning reference on anxiety: http://www.psychologyproductsandservices.com/page2.html

***

A 31 year-old female asked:

Q) Extreme sensitivity to fluorescent light. Cause fuzzy feeling in head. High anxiety.  Occasional wave sensation in head. Help!!

A) This could be sub-migraine headaches, so start with a general physical and ask for a referral, if needed, to a neurologist. This could also be atypical light sensitivity of just the eyes and/or eye/brain interactions. For this, see an ophthalmologist. This should lower your anxiety, but if not, the anxiety could also cause hypersensitivity to external stimuli. Now, we have a different problem...anxiety.

***

Regarding a 17 year-old female:

Q) A "weird" feeling in my left arm, breast, shoulder and chest.  It's not exactly sore, but it feels really tense. Is this due to my recent panic attacks?

A) Could be.  Panic attacks present with about 33 symptoms, and lots of after-effects. Here's a link to begin to figure this out, although a visit to a MD is in order to rule out physical problems.

***

Q) My doctor suspects chronic hyperventilation due to my anxiety history and my symptoms. How can this be cured? It's making me feel off all the time.

A) If this is anxiety,find a mental health provider and treat it. Hyperventilation is one of 33 possible symptoms of anxiety, of which there are about seven categories...Here's a beginning reference: http://www.psychologyproductsandservices.com/page2.html

***

Q) .How long can anxiety symptoms last? I've been have symptoms of a panic attack for like 3 hours but haven't had an actual panic attack. Is that normal?

A) Panic attacks come in many flavors. Some last seconds, some days. Some are intense, other more mild. Some threaten to emerge into full blown attacks, others threaten then subside. The triggering and your history and pattern of reactions all set this up and require an in-depth understanding. Go to a psychologist. Here's a reference: http://www.psychologyproductsandservices.com/page2.html

***

 

PERSONALITY


Q) What can cause antisocial personality disorder?

A) Big question and not enough room to give a thoughtful reply. Here's a reference from someone who has a lot of thoughtful ideas: The Sociopath Next Door by Martha Stout, Ph.D. Shop around for the cheapest prices... This can be linked to through this website at: http://www.psychologyproductsandservices.com/usefullinks.html

***

Q) What are the different types of personality disorders?

A) The current DSM V lists ten, plus some catch-all categories that are not very specific. The ten are: Paranoid, Schizoid, Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent and Obsessive-Compulsive.

 

DRUGS


A 44 year-old asked:

Q) Is it safe to stay on nicotine patches indefinitely?

A) No. Nicotine patches are designed to quit smoking, which is a short-term project, at least the physical part of the problem. Nicotine is a stimulant and an addictive one at that. Don't stay on nicotine in any form longer than necessary, in this case to drop taking in nicotine in some other way (cigarettes, dipping, etc.). Continuously driving your body with a stimulant is bad medicine.

***

A 28 year-old male asked:

Q) I smoke too much, how can prevent my self from smoking?

A) Quitting smoking is tough, really tough.  It involves not just pulling off nicotine dependence, but, and this is the really difficult part, re-associating behaviors (lots of them) to things other than cigarettes. You'll probably need a comprehensive program of behavior and medical mgt., unless you are one of the fortunate few who can just quit cold turkey (not recommended) or get results from quick techniques.

***

A 21 year-old female asked:

Q) I take a good amount of Adderall and other prescription amphetamines. And smoke marijuana but have 2 jobs just no girlfriend. What do I do?

A) Are the amphetamines all prescribed? Seems odd to have both Adderall (which has two amphetamines) and "other prescription amphetamines" on board at the same time. Check with your MD and be careful not to overdose. You need this many stimulants to manage two jobs? Do you use pot to come back down? To sleep? Seems like the girlfriend is the least of your concerns.

***

Q) I've been smoking Meth for the past 4 days sleeping every night for at least 6 hours a night yesterday I started to gain a thick clear phelm in my mouth and throat no matter how much I cough it up its ...

A) The obvious answer is still the best one--quit smoking Meth. It's terrible for you in more ways than I can list in this space. I'm surprised that you can sleep 6 hours/night, and also surprised about the phlegm, which suggests you might have a sinus problem. (Have you snorted Meth, too?) You could go to an MD but you know what the obvious answer will also be...

***

 

ABUSE

 

Regarding a 17 year-old female:

Q) What is the difference between emotional and psychological abuse or neglect... from a professional standpoint?

A) Not much.  Abuse that causes hurtful emotional reactions can be caused by harshly acted out feelings or thoughts expressed in ways designed to also hurt. If you suspect abuse, seek help from a therapist, teacher or from someone in authority who is safe.

***

 

MOODS

A 19 year-old female asked:

Q) If your parents have fought with each other all your life, what are the chances of having depression?

A) There are correlations between dysfunctional family-of-origin dynamics and later psychiatric/psychological disorders--depression and anxiety being the top two, in frequency.  It's hard to quantify this because there are many reasons parents fight, even some good ones. See a psychologist for a deeper look-see.

***

Q) What differentiates manic depresison from the "regular" kind?

A) Manic Depression is the newer term for Bi-Polar Disorder, which involves both a low (depression) and a high (mania). The "regular" kind of depression has only the low. "Bi" means "two" and polar refers to the direction of the mood--up or down. Accordingly, having only depression without the mania is sometimes referred to as "uni" polar (one direction) depression.

***

Q) What is the difference between bipolar 1 and 2?

A) BP I symptoms are having really high manic alternating with really low depressive episodes. You have to have both and the mania has to be very high and the depression has to be very low. The length of the cycle is less important. BP II is the same, only the manic phase is not as high. BP NOS (Not Otherwise Specified) is any other pattern with at least a very significant peak in one direction or another. Also see Cyclothymia.

 

PTSD

 

Q) Please share a tip on living with PTSD.

A) Neuron re-set.   PTSD is a condition of neurological hypervigilance. Your brain is always in alert mode. Your psychology follows suit. You'll be jumpy, over-reactive, anxious, too sensitive, experience nightmares,  alternating with periods of depression or general exhaustion. The treatment is to teach your nervous system to go back to mark headings--quieter, slower, calmer. Think meditation, self-hypnosis, etc., for starters.

***

 

THERAPY

 

Q) Ever want to NOT work with clients?

A) Rarely. There are exceptions, like when a client has a personality disorder and/or acts out of entitlement, impulsivity or disregard for others. Such behaviors deprive other clients and make being a therapist difficult. But, we have to act professionally and offer at least three referrals before they are escorted to the door.

***

Q) What are the most common conditions seen by a psychologist.

A) Depression (or mood disorders in general) and anxiety. 25% of people also bring in some form of addiction, alcohol being the most common. Addiction to marijuana and the internet (Facebook, sex, gaming) are the second and third most common these days.

***

Q) Can depersonalization cause anger and last all day? I've had it most of the day since physical therapy for compensation of labyrinthitis. Is this really anxiety? I feel like I'm going nuts.

A) Depersonalization is the result of severe psychological decompensation, usually because of high repression of stressors. It causes the world to look robot-like, or estranged--not personal. You may feel like a robot yourself, which can't be helped by labyrinthitis, which is a vestibular condition (probably physical). After the physical symptoms subside, seek out a therapist who can help you re-integrate feelings.

***

 

WEIGHT LOSS


Q) I heard spicy foods can help you lose weight? Is that true, and if so does my chipotle addiction have health benefits?

A) Spicy foods do more for your mood, as the "hot" in the food triggers endorphins, which lower anxiety and tend to promote a feeling of general well-being. The biggest exercise to lose weight is to push yourself away from the dinner table, no matter what's on it. Here's a starting point: http://www.psychologyproductsandservices.com/page21.html

***

Q) I have gained about ten pounds since I have been on Cymbalta since 2005. Is this common the longer that you stay on an SSRI?

A) Yes. The first SSRI, Prozac, came out around 1986 and was thought to be a good alternative to the older antidepressants (Tricyclics), which had terrible reputations about adding extra pounds. However, lots of people on Prozac gained weight, too, prompting the development of other SSRI's (next came Zoloft, and so on). Unfortunately, there is no SSRI that will absolutely not put weight on you. You have to experiment. Ask your MD...

***

SLEEP

 

Q) Sometimes I dream when I am sleeping, but I am awake, and know I am, but dreaming, too. Kinda like hallucinating. What causes this? How can I stop it?

A) Lucid dreams are special dreams in which the dreamer is aware of dreaming, even though physiologically is in the dreaming state. In such a state, the dreamer can take charge of the dream and make it "do" anything. Many altered states start from this experience. It need not be feared because after all, you are dreaming and in your head just like normal in every other way.

***

 

MEDICAL


Q) Had a baby in Dec 2012, ever since I have been very tired and having trouble getting up in the morning, and I feel sluggish all day. Developed bad memory, brain fog. Thyroid fine. Drs aren't alarmed.

A) This could very well be related to having a baby, as in a longer version of post-partum phenomena. You said your thyroid is OK. Have you been to either an OB-GYN or Internal Medicine doc to check the other hormones? There are many to examine in these cases. Don't forget to follow up with a psychiatrist if recommended, as depression might be lurking.

***