Nesrin Abu Ata, MD | Reclaim Joy Medical

Fear Of Being On Medications

by Nesrin Abu Ata, MD | Mar 11, 2022 | Uncategorized

A question from a reader:

Dr. A, I tried non-pharmacological approaches to help with my mood, which included therapy and lifestyle changes without feeling much better. Finally, my therapist suggested that I go on medication for my anxiety and depression. I am really nervous about taking a medication because I feel like something is really “wrong” with me.” By agreeing to take a medication, am I admitting that something is wrong with me? Am I broken and would have to stay on this medicine for the rest of my life?

Great job on being proactive about your mental wellbeing, and making the choice to invest in your mental health with lifestyle changes and seeking therapy! You are not alone in feeling apprehensive about taking a medication. Actually, between 30% to 50% of people do not adhere to prescribed medications. There are many reasons why people do not want to take medications. One of them is pharmacophobia (Yes, everything has a fancy term in medicine!), which refers to fear of medication and less than optimal attitude towards medications.

Why is pharmacophobia (fear of taking pills) a problem?

Untreated mental illness can grow into incapacitating hurdles in a person’s life. The illness usually starts as one small problem, and if not addressed early on or adequately, it transforms into a gigantic issue that affects the person’s quality of life, relationships, work and their sense of who they are.

Let’s Explore Some Potential Root Causes Of Fear of Pills:

Possible Traumatic Experience With Medications:

Explore your experience with medications. Ask yourself if you watched someone in your life have an adverse reaction when they took a medication. What happened to them and how did that affect you? Or, you may have had negative experience from taking medications from when you were a child. Were you feeling sick and not well, and didn’t like swallowing pills? Did you argue with your parents over taking a medication?

A Perceived Lack Of Control:

Not being in control of the mind or body can be a frightening experience and result in someone not feeling safe in their mind or body. Being in control gives us a sense of safety. It is easy to see why someone would develop a fear of medications, due to fear of “becoming addicted”, and feeling like they lose control. Another reason for fear of loss of control is the fear of side effects that can potentially come with medications.

What is the antidot to fear of loss of control? Remind yourself that you are the one in control of how you want your healthcare to be. Taking a medication is a choice that you make, not something that just “happens to you.” By you choosing to direct your own healthcare in a manner consistent with your goals, taking a medication becomes a choice that you make, and that you can always change. Remember to make decisions because of your goals and your sense of worth, and not because of fear.

Social Stigma And Misinformation Can Lead to Shame:

You may also want to reflect if you have had an experience where you felt judged or shamed for taking a medication. What did others say to you, or was it the way they looked at you? How old were you and how did you cope with it? Maybe you heard others talk negatively about someone else being on a medication.

Reframe Your Thoughts About Taking Medications:

If someone has a sinus infection, they take a medication to help them get better and suffer less. Taking a medication for mental health is no different. The goal being to improve someone’s quality of life and optimize relationships. If, after you tried therapy and lifestyle changes and feel like you haven’t made much progress or felt any alleviation of symptoms, evaluate how you are meeting your goal of wellness and is it time to consider being on a medication? What is your intention behind taking a medication?

If feelings of shame come up, can you reframe your thoughts, so that you are not taking a medicine “because something is wrong with you”. Rather you are choosing to take a medication because you matter, and you care about your wellness, and this medicine can potentially help you with that. Can you reframe your thoughts so that you look at taking a medicine as a self-care tool, no different than going to the gym, having yearly dental check up and taking care of your body?

Seek A Reliable Information Source and Avoid Misinformation:

Your mind or other people might tell you “that you will be on these medications forever.” However, this is not true. Seek a reliable and trusted source of information to help guide you make the most informed decisions that are aligned with your goals of wellness and recovery. Making decision based on misinformation or fear may likely cause you harm in the long run.

Build Your Wellness Dream Team and Find a Provider that is Your Ally:

I can’t stress this enough. It is important that you feel heard and supported when it comes to working with your mental health provider. When you meet with your mental health provider, pay attention if they are answering your concerns and not dismissing them. Do they ask you questions and listen to your answers till the end? You may want to create your own checklist of what you are looking for in a mental health provider: Ask yourself if this mental health provider is there to support you and answer your questions as you weigh the risks and benefits of being on medications. Remember that there is no right or wrong answer. The right answer is what meets your needs and goals that you can only decide.

Remember, the ball is in your court of how you want your healthcare to be and fit your goals and needs.

Holistic Ways to Manage Anxiety

by Nesrin Abu Ata, MD | Feb 16, 2022 | Mental Health Conditions

Question: I am diagnosed with an anxiety disorder and I am interested in holistic tools and more natural medicines to manage my anxiety, what treatment options should I bring up with my mental health provider for my treatment for my anxiety?

I am glad that you are being proactive about your mental health and looking at increasing the tools in your toolbox to manage anxiety and your overall mental health. With the pandemic, people have been experiencing more anxiety. Anxiety affects 40 million adults in the US every year, making it one of the most common mental health conditions. Untreated anxiety can make it difficult to work, relax, get good sleep, and spend time with loved ones. Please bear in mind that the response below is for educational purposes and is not providing medical advice. The information below does not replace getting medical care. Please remember to always consult with your mental health provider for your individual treatment for your mental health.

There are many different ways to manage the symptoms of anxiety. And it is important to consider combining different healing modalities, which is very unique to every individual.

1. Managing life stressors and practicing self-care

When someone feels anxious, the sympathetic system goes into over drive. That means that instead of slowing down, and cutting back on to do lists, the nervous system drives the person to want to add more to the to do list, especially around the holidays. Practice setting boundaries, saying no and taking some time to rest. Practice good social media hygiene, which means limiting how much time you spend on social media.

2. Limiting caffeine intake

While caffeine does not cause anxiety, it can worsen anxiety in someone who is prone to anxiety. Caffeine is considered a psychostimulant drug that affects the nervous system. It blocks a molecule called adenosine, causing the alertness associated with caffeine. Some side effects as a result of blocking the adenosine are nervousness, restlessness, fast heart rate, irritability, shakiness and excitement. These side effects can start as soon as 45-60 minutes and last as long as 4-6 hours, or even longer depending on your metabolism rate.

3. Mind-body practices

This includes practices like yoga, qi-gong, Tai Chi and meditation. These practices also include different forms of breathing that can activate the parasympathetic nervous system. Activating the parasympathetic system helps bring a sense of calm and feeling present, grounded and connected. Some of the breathing techniques include unilateral and alternate nostril breathing, 4-4-6-2 breath, coherent breath/resonant breath, breath moving, resistance breathing and high frequency breathing (such as bhastrika breath and Kapalabjati breaths in yoga).

4. Herbs

Do not take any herbs without consulting with your medical provider as they can potentially interact with other medications you are on and can affect certain body organ such as the liver. Herbs can be taken as tinctures, teas or supplements.

This includes herbs that are known as adaptogens. Botanical adaptogens are plant extracts and constituents that increase the ability of an organism to tolerate, adapt, survive and perform under a wide range of stressors. The term adaptogen was introduced In 1959 to describe substances that increase the ability of an organism to resist stress and mitigate the effects of environmental and emotional stress. Some examples include Rhodiola rosea, Schisandra chinesis, Eltherococcus senticosus (Siberian Ginseng) and Withania somnifera (Ashwagandha).

Other forms of herbs include Valerian root, lemon balm, passion flower, kava, ginkgo, and chamomile. It is important to let you your mental health provider know if you are taking any of these herbs, as they have the potential to affect the liver, interact with the metabolism of other medications. Because these herbs help with anxiety, they can also cause sedation or sluggishness.

Lavandula angurtifolia (English Elavendar) is recommended to be used in the form of aromatherapy, and not to be ingested. It is also not recommended to use in children or adolescent as it is considered a hormone disrupter and can affect children’s hormonal development.

5. Nutrients

This includes GABA, L-theanine, Omega three, L-lysine, L-arginine, Inotisol, Magnesium and Hydroxytryptophan (5-Htp).

Gamma amindobutyric acide (GABA) is a naturally occurring amino acid that works as a neurotransmitter in your brain. Neurotransmitters function as a chemical messenger in the brain. When GABA attaches to a protein in your brain known as a GABA receptor, it produces a calming effect. GABA is available in foods like kimchi, miso and tempeh.

L-theanine is a nonessential amino acid found almost exclusively in the tea plant Camellia Sinesis, also known as green tea. It is non sedating. It can be consumed as capsules or as green tea.

Omega 3 fatty acid is considered to be anti-inflammatory. The brain is sensitive to general inflammation which can result in anxiety. When there is general inflammation in the body, the omega 3 levels can be low. Omega 3 fatty acid can be found in fish or taken in supplements.

L-lysine and L-arginine are a essential amino acids that block receptors involved in the stress response. L-arginine is found in red meat, poultry, fish, dairy products, nuts, sees, legumes and seaweed. L-lysine is found in avocado, beets, leeks, tomatoes, pears, green and red peppers, pumpkin seeds and quinoa.

Hydroxytryptopan (5-Htp) is an amino acid that is essential for manufacturing of serotonin in the brain. Serotonin is a neurotransmitter that plays a central told in regulation of mood and anxiety. It can be taken at bed time as it also improved sleep in addition to reducing anxiety.

Inositol is a form of glucose that is present in the diet. Its involved in facilitating communication between brain cells. It can consumed as a supplement and is usually in a powder form

Magnesium is an essential mineral utilized in the body to facilitate many biochemical reactions. There are different supplements forms, and each one has a potential side effect profile. It is important to consult with your mental health provider prior to taking this as a supplement to decide on the appropriate supplement.

Reference: Complementary and Integrative Treatments in Psychiatric Practice.

Holistic Ways to Treat Insomnia: Part 1

by Nesrin Abu Ata, MD | Feb 16, 2022 | Uncategorized

Question from a reader: I have been struggling with my sleep lately and wondering about natural ways to help me with my sleep. Because I haven’t been sleeping well, I am tired during the day. I have tried over the counter medications, but I have woken up with a hang over feeling the next morning.

Dear Reader, you are not alone in your struggle with insomnia. In fact, one third of the population experiences insomnia symptoms and 10%-15% meet criteria for insomnia disorder. Insomnia is characterized by difficulty initiating and/or maintaining sleep or early morning awakening. Insomnia disorder presents with chronic sleep disturbance that impairs daytime function, which you are describing. Chronic sleep dysfunction is associated with poor health outcomes, such as cardiovascular disease, diabetes, obesity, impaired mood and cognitive function. All the more reason to get your sleep taken care of and bring up your concerns about your sleep with your primary care provider. I will share with you some general information about insomnia and things that you can be aware of and consider trying. However, the information below is strictly educational, and it is not medical advice and does not replace you seeing a primary care provider to address your sleep concerns.

Understand Your Sleep Habits

It is important to keep a sleep diary where you note the timing of your sleep habits. So for example, when do you go to sleep? How long does it take you to fall asleep? How often do you wake up at night? How long does it take you before you fall back to sleep again? What time do you wake up in the morning? Do you take naps during the day time? What is the quality of your sleep? How variable is your sleep from one night to the other?

Understand Your Behaviors Around Sleep

Do you use electronic devices in bed? Do you stay in bed when you are not sleeping? Do you use your bed for anything else but sleep?

Be Aware of Prescription and Non prescription medications and “Drugs of habit”

Review the prescription and non prescription medications that you take with your provider. Some medications can be “activating”, which means they make you feel more awake, which would affect your ability to sleep. Some medications are called diuretics, which cause you to use the bathroom, and as a result you would wake up at night to use the bathroom.

Drugs of habit, such as caffeine and alcohol can affect your sleep. Some people are slow metabolizers, which means that it takes them time to break down the caffeine molecule. And so, when its time for bed, their body is still feeling completely awake with the caffeine molecule not being broken down.

While alcohol may be initially sedating and helping with sleep onset, alcohol disrupts sleep later in the sleep cycle, as the liver enzymes metabolize alcohol. This can lead to excessive daytime sleepiness and other issues the following day. Drinking alcohol to fall asleep can also result in building tolerance (which means you are no longer sensitive to the previous amount of alcohol, and need to drink more alcohol to get the same effects you previously got from a lower amount of alcohol). As a result, you will drink more alcohol each night in order to experience some sedative effects.

Take Stock of your General Physical Health

Do you exercise? Exercise helps tire the body out by the end of bedtime for sleep.

Do you feel like you have to keep moving or shaking your legs at bed time, and that in turn is impairing your sleep. That may be a sign of having restless led syndrome. There may be a need to have your iron level checked if there is suspicion for restless leg syndrome.

Do you deal with chronic pain that wakes you up at night?

Do your family members say that you snore at bed time? If that is the case, you may have a condition called sleep apnea, which if untreated can affect your heart.

Take Stock of your Mental Health

Many patients that deal with anxiety, depression, post traumatic stress disorder also struggle with insomnia. How well treated if your mental health? Make sure that you are seeing a mental health provider and a therapist to address your mental health. What is your stress level and how are you managing your stress level?

Take Stock of Your Sleep and Wake Routine

Are you someone who works night shifts? When you do you night shifts, there is a misalignment between your body and the circadian rhythm that regulates the sleep wake cycle. Circadian rhythms are guided by the natural light and darkness. During the day, the retina in your eyes perceives sunlight and signals your brain to release hormones (like cortisol) that keep you feeling alert and energized. As the sun sets and light fades, you brain makes another hormone (melatonin) that causes you to feel sleepy and relaxed.