Anxiety’s Alarm Bells: Recognizing Your Triggers

Anxiety, a complex emotional response characterized by feelings of tension, worried thoughts, and physical changes, is more than just a fleeting sensation of uneasiness. The American Psychological Association describes it as an emotion marked by feelings of tension and worried thoughts, as well as physical changes like increased blood pressure. 

Anxiety is not inherently detrimental; it serves as an evolutionary response to danger, preparing individuals for fight-or-flight reactions. However, when anxiety becomes pervasive, it seeps into every crevice of daily life, transforming routine tasks into daunting challenges. It can erode the quality of life, impairing social interactions, work performance, and overall well-being. The persistent dread and anticipation of future threats, often without apparent cause, can lead to avoidance behaviors, further isolating individuals from potential support systems and coping mechanisms.

At the heart of anxiety’s pervasive grip on individuals is the concept of “anxiety triggers” — specific stimuli or conditions that precipitate an anxiety response. These triggers are as varied as the individuals affected by anxiety, ranging from external stimuli like crowded environments to internal stimuli such as thoughts of inadequacy or fear of failure. Understanding these triggers is not just about recognizing the immediate precursors to anxiety episodes; it’s about mapping the landscape of one’s emotional responses and pinpointing the sources of distress.

The thesis that understanding and managing anxiety triggers is pivotal in breaking the cycle of anxiety is grounded in the principle that knowledge is power. By identifying and acknowledging what specifically ignites one’s anxiety, individuals can devise targeted strategies to confront and manage these triggers. This proactive approach empowers individuals, shifting the narrative from one of vulnerability to one of control. 

Managing triggers effectively can dilute their potency, reducing the frequency and intensity of anxiety episodes and paving the way for a restored sense of peace and control. Thus, the journey to mitigate the impact of anxiety and enhance life quality begins with a comprehensive understanding of the triggers that initiate the cycle of anxiety.

Man speaking to an audience

Understanding Anxiety Triggers

Anxiety triggers, fundamentally, are specific stimuli or situations that spark an immediate or heightened state of anxiety in individuals. These triggers act like a switch that, once flipped, can catapult someone into a whirlwind of anxious thoughts and physical responses. 

The intricate aspect of anxiety triggers lies in their vast diversity and deeply personal nature. What might provoke a significant anxiety response in one person could be entirely benign to another, underscoring the subjective fabric of anxiety experiences. This variability necessitates a personalized approach to understanding and managing anxiety.

Common triggers of anxiety can be broadly categorized into several key areas:

  1. Social Interactions: Engaging in or even anticipating social gatherings, public speaking events, or personal encounters can be daunting for many. The fear of judgment, rejection, or failure in social contexts can provoke anxiety.
  2. Stress: Chronic or acute stress, whether stemming from workplace demands, academic pressures, or personal challenges, can significantly contribute to anxiety levels. The body’s response to ongoing stress can exacerbate or trigger anxiety episodes.
  3. Health Concerns: Worrying about health — either one’s own or a loved one’s — especially in the context of illness or medical procedures, can be a potent trigger for anxiety.
  4. Environmental Factors: Certain environmental conditions, such as crowded spaces, loud noises, or even specific weather conditions, can induce feelings of anxiety in some individuals.
  5. Negative Thinking Patterns: Patterns of thought that lean towards pessimism, catastrophizing, or black-and-white thinking can trigger anxiety. These patterns often involve anticipating the worst possible outcomes in any given situation.

The identification of personal anxiety triggers is a crucial step in the journey toward managing anxiety more effectively. This process involves self-reflection and, often, the maintenance of a diary or journal to record instances of anxiety episodes and their potential triggers. Over time, patterns emerge, providing valuable insights into the specific conditions or stimuli that provoke anxiety.

Recognizing one’s triggers is the first step in developing targeted strategies to confront and manage these triggers before they escalate into full-blown anxiety episodes. It allows for the implementation of coping mechanisms, whether through cognitive-behavioral techniques, mindfulness practices, or lifestyle adjustments, tailored to address these specific triggers.

Understanding the unique triggers of one’s anxiety is indispensable for crafting an effective management plan. It empowers individuals to anticipate and mitigate the impact of these triggers, fostering a sense of control and resilience in the face of anxiety.

meditating at the beach

Breaking the Cycle: Strategies for Managing Anxiety Triggers

1. Identify and Understand Your Triggers

Keeping a Journal: Maintaining a daily log of activities, emotions, and anxiety levels can unveil patterns and specific triggers of anxiety. This methodical tracking helps individuals pinpoint the circumstances or thoughts that precede anxiety episodes, making it easier to address them proactively. Fostering this habit can lead to significant insights, as noted in a study by Smyth et al. (1999), which highlights the therapeutic benefits of journaling on emotional well-being.1

Self-Awareness: Developing self-awareness is crucial in recognizing personal triggers. It involves an introspective look into one’s reactions and the situations that exacerbate anxiety. This self-knowledge is the bedrock of effective anxiety management, as it enables tailored coping strategies. Kabat-Zinn (1994) emphasizes the role of mindfulness in cultivating self-awareness, suggesting that mindfulness practices can enhance our ability to detect and understand our emotional states, including anxiety.2

2. Practice Mindfulness and Meditation

Mindfulness Techniques: Mindfulness keeps individuals grounded in the present moment, mitigating the impact of anxiety triggers. By focusing on the here and now, mindfulness practices prevent the mind from dwelling on past concerns or future worries, which are common sources of anxiety. A meta-analysis by Hofmann et al. (2010) supports the effectiveness of mindfulness meditation in reducing anxiety symptoms, demonstrating its value in anxiety management.3

Meditation: Regular meditation practice can significantly lower stress levels, creating a sense of calm that counteracts the hyperarousal state of anxiety. Meditation fosters a tranquil mind, enabling individuals to face triggers with a more balanced perspective. Goyal et al. (2014) provide evidence for the stress-reducing benefits of meditation, highlighting its potential to improve anxiety disorders and overall mental health.4

3. Cognitive-Behavioral Therapy (CBT)

CBT Overview: Cognitive-Behavioral Therapy is a structured, time-limited approach that focuses on identifying, understanding, and changing negative thinking and behavior patterns. CBT is highly effective in treating anxiety by addressing the underlying thought processes that fuel anxiety symptoms. Beck (1976) outlines the cognitive model of emotional disorders, laying the groundwork for CBT’s application in anxiety management.5

Challenging Irrational Fears: CBT involves techniques such as cognitive restructuring, which helps individuals challenge and reframe irrational thoughts or beliefs contributing to anxiety. Through this process, individuals learn to replace fear-driven narratives with more realistic and positive ones. Hofmann et al. (2012) discuss the efficacy of CBT in modifying dysfunctional thought patterns in anxiety disorders.6

4. Lifestyle Changes

Exercise, Diet, and Sleep: Regular physical activity, a nutritious diet, and adequate sleep are foundational elements of a healthy lifestyle that can significantly reduce anxiety levels. Exercise acts as a natural anxiety reliever, diet influences mood, and sleep is essential for emotional regulation. Ströhle (2009) discusses the anxiolytic effects of physical activity7, while Jacka et al. (2010) explore the relationship between diet quality and mental health.8

Minimizing Caffeine and Alcohol: Reducing the intake of caffeine and alcohol can help manage anxiety. Both substances can exacerbate anxiety symptoms and disrupt sleep patterns, contributing to a cycle of anxiety. Smith (2002) highlights the role of caffeine in increasing anxiety levels, advocating for moderation or elimination to reduce anxiety.9

5. Exposure Therapy

Exposure Therapy Defined: This therapeutic approach involves gradual, controlled exposure to the feared object, situation, or thought, helping individuals build tolerance and reduce anxiety responses over time. It’s particularly effective for specific phobias and social anxiety. Foa & Kozak (1986) describe the process and benefits of exposure therapy in the treatment of anxiety disorders.10

Desensitization Process: Through repeated exposure in a safe environment, individuals learn to desensitize their reactions to triggers, diminishing their power to provoke anxiety. This method encourages a reevaluation of the perceived threat, fostering a more rational response. Wolitzky-Taylor et al. (2008) provide evidence for the effectiveness of exposure therapy in reducing fear and anxiety responses.11

6. Develop a Support Network

Sharing Experiences: Engaging with friends, family, or support groups offers emotional relief and a sense of belonging. Sharing struggles and successes with others who understand can validate feelings and provide new coping strategies. Pfeiffer et al. (2011) emphasize the importance of social support in mental health recovery, highlighting its role in reducing anxiety and stress.12

7. Learn Relaxation Techniques

Relaxation Methods: Techniques such as deep breathing, progressive muscle relaxation, and visualization can alleviate the physiological symptoms of anxiety, promoting a state of calm. These practices help regulate the body’s stress response, offering immediate relief from anxiety symptoms. Manzoni et al. (2008) review the effectiveness of relaxation techniques in reducing anxiety, underscoring their utility in anxiety management.13

8. Seek Professional Help

Professional Consultation: When anxiety significantly disrupts daily functioning, professional help from a mental health practitioner can provide personalized strategies for managing anxiety and its triggers. Accessing professional support can offer a pathway to understanding and overcoming anxiety in a structured, supportive environment. Andrews et al. (2010) advocate for seeking professional help in treating anxiety disorders, highlighting the benefits of tailored therapeutic interventions.14

The Importance of Patience and Persistence

The endeavor to manage anxiety triggers is not a sprint; it’s a marathon. It’s a journey marked not by the swiftness of reaching the destination but by the steadfastness of one’s commitment to the path. Acknowledging the ongoing nature of this process is crucial. Anxiety, with its myriad triggers and complex underpinnings, does not adhere to a one-size-fits-all solution or a predictable timeline for improvement. It requires a tapestry of strategies, a dose of patience, and a reservoir of persistence.
Encountering setbacks is an integral part of this journey. 

Although disheartening, these moments are not indicators of failure but signposts for learning and growth. Celebrating progress, no matter how small it may seem, is vital. Each step forward, each trigger identified and managed, each day that ends with a sense of accomplishment, is a victory in its own right. These moments of triumph build resilience, fostering a sense of self-efficacy and empowerment.

Consistent effort over time is the linchpin in the machinery of managing anxiety. The application of strategies to cope with triggers must be persistent. The fabric of change is woven slowly through daily practices, the accumulation of small victories, and the patient retraining of our responses to the world around us. This persistence is what ultimately leads to meaningful results—a gradual but tangible decrease in the power of anxiety over our lives.

The identification and management of anxiety triggers are paramount in breaking the pervasive cycle of anxiety. Though fraught with challenges, this journey holds the promise of a life where anxiety does not hold the reins. The significance of understanding one’s triggers cannot be overstated; it is the first step towards a semblance of control in a seemingly uncontrollable aspect of our lives.

The path to managing anxiety is undeniably challenging. It tests our patience, demands our persistence, and asks us to embrace vulnerability. Yet, the rewards of this journey—a sense of peace, a reclaiming of freedom, a life not overshadowed by anxiety—are immeasurably valuable. They represent not just the alleviation of symptoms but the reclaiming of the joy and spontaneity that anxiety often eclipses.

As we draw this blog post to a close, let us issue a call to embrace this journey with hope and determination. Each step taken is a step towards reclaiming the peace and freedom that anxiety has obscured. Let us move forward with the understanding that while the road may be long and winding, it leads to a destination where the air is clearer, the burden is lighter, and the heart is unencumbered. This is not just a journey away from anxiety but a journey towards a fuller, richer experience of life itself.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Lady crying with mirror with lines of cocaine and a syringe

What do Cross-Addiction and Cross-Dependence Mean?

Lady crying with mirror with lines of cocaine and a syringe


Cross addiction, or addiction transfer, occurs when a person is addicted to more than one substance or activity. Remember, addictive behaviors don’t only apply to substances. People can become addicted to gambling, sex, food, shopping, video games, work, and cell phones. 

A classic example of cross-addiction is when a person is addicted to alcohol and another substance. Alcohol use disorder and drug addiction are often seen together and can lead to negative consequences such as poor health, decreased productivity, and legal trouble. 

We know that those who abuse alcohol are at higher risk of using other substances, including prescription medications. They may also be at higher risk of becoming addicted to gambling. Alcohol impairs judgment. Why do you think the casinos in Las Vegas give free alcoholic drinks to those who gamble? 

teenagers drinking at a party

It is important to remember that people don’t become addicted to substances by choice. Addiction can occur for a variety of reasons. 

  • It may result due to peer pressure. 
  • Post-op patients may be prescribed a new substance for pain control and may obtain pleasurable feelings while using this substance. They may continue to use it even in the absence of pain. 
  • People with poor coping skills may use addictive substances to numb the pain of a lost job, relationship, or the death of a loved one. 
  • Patients with bipolar disorder and other mental health conditions may develop new habits while trying to self-medicate. 

When patients have a mental illness and abuse substances, we refer to them as dual-diagnosis patients.

multiple drugs of abuse pictured


Cross-dependence has three different meanings.

The first is the ability of one substance to prevent withdrawal symptoms of another substance.

A classic example is using methadone to avoid the withdrawal symptoms from heroin or other opiates.

As healthcare professionals, we use this to help keep opiate addicts from using heroin and other dangerous street drugs.

woman snorting cocaine

Another definition of cross-dependence is when a patient rapidly becomes dependent on a substance related to another drug to which the patient already has a tolerance or dependence. This can happen, for example, with two addictive drugs, both opiates. This can lead to a dangerous balancing act where the patient tries to get the desired effect of the substances without overdosing.

The third definition of cross-dependence is when the person simultaneously depends on more than one substance or activity. This is the concept of cross-addiction. 

The most common cross-addictions are drugs to alcohol and drugs or alcohol to gambling. 

The patient may also substitute one addiction for another. For example, a patient suffering from cocaine addiction may start playing video games to take their mind off their drug of choice. Video games can release dopamine from the brain, which leads to positive reinforcement and an increase in the time spent playing video games. What started as a coping mechanism to try to abstain from cocaine use could result in the development of a video game addiction.

Cross-addiction and cross-dependence are concepts that must be considered when treating patients with substance addiction. 

Many treatment centers are available to help those suffering from drug dependence and other addictions. The first step in recovery is admitting a problem and finding support groups to help or seeking inpatient treatment when necessary. 

Developing healthy coping skills BEFORE you need them is the key to preventing addiction. 

Other aspects include mental health issues, chronic pain, a family history of addiction, and environmental factors that may lead to compulsive behaviors and an increased risk of addiction.

We must all remember that mental health disorders are no different than other medical conditions. 

They involve a different organ. The brain is the most complex organ in our body, and there are many things we still don’t understand. 

What we do know is the average person can become a drug addict at any time. 

As a society, we are responsible for caring for our population’s poor and vulnerable members. This includes those with mental health issues. 

The only way to be sure not to become addicted to a substance is total abstinence. This is also true of the activities that people may become addicted to. I am not suggesting never to eat or have sex but being aware of your actions and what habits you are forming. 

I hope everyone reading this will develop coping skills to help weather the storms that life creates. 

Remember, if you are addicted to anything and want help, 

call 1-800-662-HELP (4357). 

This is the greatest gift you can give yourself if you are suffering from an addiction.


Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


How to Break the Addiction Cycle

Do you have an addiction that is affecting your life?
Would you like a more healthy lifestyle?
Do you know the different stages of drug addiction?

This post will help you break the cycle of addiction. Reading this blog post starts your first step in getting clean and taking back your life. Addictive behavior should not rob you of your happiness. So read on and break the vicious cycle of addiction for good!

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.


According to the National Center for Drug Abuse Statistics 1

  • 11.7% of Americans age 12 and overuse illegal drugs, and 31.9 million have used them within the last 30 days.
  • 139.8 million Americans 12 and over drink alcoholic beverages, and 14.8 million (10.6%) have an alcohol use disorder (AUD).
  • Less than 8% of those with an AUD receive treatment.
  • There have been 700,000 deaths due to drug overdoses in the United States since 2000.
  • 47% of America’s youth use an illicit drug before high school graduation.

Risk Factors and Protective Factors

Research has shown that drug addiction is multifactorial.

We know that most individuals do not begin using substances to become addicted. We also know that a risk factor for one person may not be a risk factor for another.

The more risk factors one is subjected to in childhood, the greater chance of addiction.

Timing is also essential. Peer pressure during middle and high school is usually more powerful than at other stages of life.

This is also true of protective factors. A robust parent-child bond can have a more significant effect during the Childs early years of life.

Environmental factors such as drug availability and anti-drug use policies are critical. It is impossible to start using drugs or alcohol if they are unavailable.

The table below shows important risk factors and protective factors regarding drug addiction.2

risk factors and protective factors regarding drug addiction

The Seven Stages of Addiction

The infographic below outlines the seven stages of drug addiction.

Unfortunately, it may take several years to progress through all stages. As a result, first-time drug users may not make it to stage 7.

In addition, each stage comes with a higher risk of negative consequences.

Remember, illicit drugs are not the only addictive substances. Prescription drugs can also be abused and are very dangerous if misused.

In 2017, prescription opiates caused 17,029 deaths.3

Ways to Break the Addiction Cycle

respect yourself note on cork board with heart

The Most Important Thing to Remember

If you are reading this post, please realize that you are worthy of happiness.

It doesn’t matter what has happened in your past; you have a gift to give humanity.

I believe the first step in the recovery process is learning how to love yourself. Low self-esteem is an emotional trigger for drug use.

Many of us try to use substances to escape daily life stressors or to numb recurring emotional pain. This might work initially, but it often leads to drug dependence. Remember, the first step is to learn to love yourself.

I am a firm believer in self-love.

Man and woman holding hands looking at ocean during sunset

Engage in Activities that Exclude Intoxicants

One of the easiest ways to break the addictive cycle is to limit activities to those that don’t involve intoxicants. Many forms of entertainment fit this category.

Some ideas are listed below:

  • Engage in a hobby such as scuba diving or photography.
  • Meet a friend and work out at your local gym.
  • Watch a movie.
  • Go on a bike ride.
  • Cook your favorite meal.
  • Go hiking.
  • Take a walk on the beach.
  • Go to church.
  • Attend a support group.
  • Meditate
  • Read a good book.
  • Play a round of golf.
  • Take a road trip.
Man shopping for a guitar

Develop a Reward System for Not Using

I will never forget things from my experience as Director of Pharmacy in a private psychiatric hospital during the late ’90s.

One of the psychiatrists would tell his patients to take half of the money they would spend on drugs and alcohol and buy something they enjoyed. This can be a powerful tool. Using drugs is expensive, and buying things you want with some of the money you would have spent on your habit can be a compelling deterrent.

You can reward yourself with a trip to the beach, the nail salon, or an expensive meal. A piece of artwork or even a new car!

Whatever it is that makes you happy.

Buy Anxiety Formula Here

Traffic sign that reads new skills ahead

Work on Coping Skills


Learning how to deal with stress is crucial if you expect to break the addiction cycle. Pressure can come from relationship problems, job loss, the death of a family member or pet, and even everyday life. Stress often leads to anxiety which can prompt drug or alcohol use. Please read my blog post “9-useful tools for anxiety relief.” for ideas on how to relieve anxiety symptoms. Here are some ideas to help reduce stress. Pick the activities that work best for you.

  • Practice deep breathing techniques.
  • Listen to your favorite music.
  • Try herbal supplements or drink herbal tea.
  • Take a warm bath.
  • Practice yoga.
  • Get a massage.
  • Spend time in your garden.

The good news is many other choices can help reduce stress. Doing what you enjoy and having a good time is what is important.

Stop the Negative Thinking

Thinking errors can lead to relapse. If you plan to break the addiction cycle, you must learn how to minimize these thoughts. Thinking errors come in many forms, but they can all be detrimental to mental health. Please see my blog post for a more detailed discussion on thinking errors.

Cognitive-behavioral therapy (CBT) is the best way to combat thinking errors. This therapy helps to identify unhealthy thoughts and learn to react to them positively. CBT is available as an outpatient or part of a good inpatient substance abuse treatment program.

I highly recommend the book “Feeling Good” by Dr. David D. Burns. This is a must-read for those suffering from substance dependence. I have read this book several times, and it does help with not only thinking errors but anxiety and depression.

Eat Healthily

I cannot overstate the importance of eating healthy

A good diet is not only good for your body, but it also helps your mood. One study showed an unhealthy, high-glycemic diet led to more depression symptoms and an increase in mood disturbances compared to a low-glycemic-load diet.4

A healthy diet can also improve sleep quality.

Be Grateful

Gratitude is an essential aspect of the recovery process.

When a person stops using drugs or alcohol, emotions begin to appear. Addicts often feel guilt, shame, and remorse. It is crucial to balance these negative emotions with positive ones.

We all have many reasons to be grateful. The secret is to focus on the positive aspects of our lives and not dwell on the negative.

For a more in-depth discussion on gratitude, read my blogpost Gratitude Unlocks the Fullness of Life

Bright neurons

Understand the Effects of Dopamine on Your Behavior

Dopamine is a neurotransmitter responsible for feelings of pleasure. The dopamine receptors in our brain bind to the dopamine, which leads to the feeling of pleasure. Many things lead to an increase in dopamine release, including:

  • Drugs
  • Sugar
  • Sex
  • Gambling
  • TV
  • Social Media

When we indulge in these behaviors that increase dopamine release, our brains adjust by decreasing the number of dopamine receptors available. When this happens, we need more dopamine to feel normal. If we stop participating in “dopamine-producing” activities, we begin to experience withdrawal symptoms. These symptoms include:

  • Insomnia
  • Dysphoria (dissatisfaction with life)
  • irritability
  • Anxiety
  • Craving

This often leads to the person engaging in whatever activity produced the dopamine surplus, to begin with. However, we can break this cycle. If we stop flooding our brains with dopamine long enough, we can return to a balanced state.

Group counseling session

Get Professional Treatment

It is critical to realize that drug addiction is a chronic disease process. For a treatment program to be successful, it must help the patient:

  • Cease the use of intoxicants.
  • Remain drug-free.
  • Become productive at work and in society.
  • Develop into a positive influence on family and friends.

The best treatment programs combine several treatment approaches to provide individualized healing. Drug treatment must provide for individualization. What works well for one patient may not be effective for another. The figure below outlines the principles of an effective drug treatment program according to the National Institute on Drug Abuse.

There are many outstanding treatment facilities available throughout the United States to choose from. A simple Google search for “drug and alcohol treatment near me” will give you a list of treatment centers in your area.


My Final Thoughts

Drug and alcohol addiction can rob us of happiness and joy. What begins to be an enjoyable activity can turn into a nightmare. Many people have a family history of addiction. If you fall into this category, you owe it to yourself and your family to start a new life.

  • A new life without drugs and alcohol.
  • A new life of happiness.
  • A new life where YOU are in control.


Take a minute to think of your life without intoxicants.


How do you feel?

What will you accomplish?

How will this affect the people around you?

There is no better time to start your recovery than right now! You deserve to be happy! You deserve a better life!

If you have any questions about this post or anything related to health and wellness, feel free to email me at [email protected].

Remember, it is up to you to live a happy, healthy life, and Sunshine Nutraceuticals can help!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Vistaril vs Xanax for anxiety – A Pharmacists perspective

Do you suffer from anxiety?

Have you tried different therapies with no luck?

Do anti-anxiety medications lead to adverse effects?

This post will compare Vistaril vs Xanax for anxiety treatment.

Woman with anxiety


Did you know that anxiety disorders are the most prevalent mental health conditions and cause significant disability? According to the National Comorbidity Survey Replication (NCS-R), the lifetime prevalence of anxiety disorders in the United States is about 32%.


It is not surprising that anxiety disorders can lead to a loss of productivity greater than other mental health disorders. Even though there are many treatments for anxiety symptoms, only 60-85% of patients experience at least a 50% improvement in their symptoms using current medical and psychological treatments.2

Below are some symptoms of general anxiety3

  • Feeling restless, wound-up, or on-edge
  • Being easily fatigued
  • Having difficulty concentrating; mind going blank
  • Being irritable
  • Having muscle tension
  • Difficulty controlling feelings of worry
  • Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

The symptoms of panic disorder are listed below:

  • Heart palpitations, a pounding heartbeat, or an accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath, smothering or choking
  • Feelings of impending doom
  • Feelings of being out of control

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Xanax picture

Alprazolam (XANAX) is a benzodiazepine used for the treatment of general anxiety disorder and panic attacks. In 2013, more than 48 alprazolam prescriptions were dispensed in the United States.4

Although alprazolam is an effective medication for treating anxiety, it does have some serious adverse effects. Some of the more significant unwanted side effects are listed below:

  • confusion
  • Problems speaking
  • poor balance or coordination
  • severe drowsiness
  • seizures
  • shortness of breath (respiratory depression)
  • Yellowing of the skin or eyes (jaundice)
  • severe skin rash

Alprazolam is also a controlled substance which means it has a high potential to be addictive. Therefore, other treatment options are preferred in those patients with a substance use disorder history.

The symptoms of withdrawal from alprazolam are as follows5

  • Sleep disturbances
  • Irritability
  • Increased tension and anxiety
  • panic attacks
  • hand tremor
  • sweating
  • Poor concentration
  • Dry heaves and nausea
  • Weight loss
  • Heart palpitations
  • Headache
  • Muscular Pain and stiffness
  • Seizures
  • Psychosis

Even those using alprazolam as an anxiety treatment may become psychologically and physically addicted. Since this drug decreases abnormal brain excitement and produces a calming effect, it has a high potential for misuse. It also has a swift onset of action and short duration, increasing its abuse potential and severity of withdrawal symptoms. Alprazolam’s severe withdrawal symptoms may be especially dangerous when abrupt discontinuation after long-term use.

As a medical professional, I only recommend alprazolam for the short-term treatment of severe anxiety.

Xanax has a black box warning for:

  • Risks from Concomitant Opioid Use – This combination may lead to profound sedation, difficulty breathing, coma, and even death.
  • Addiction, Abuse, and Misuse.
  • Dependence and withdrawal reactions.

I strongly suggest contacting a healthcare provider if you believe you are addicted to alprazolam or other medication.

One more interesting fact regarding alprazolam. This is one of the few drugs that I have heard patients complaining that the generic form does not work as well as the brand name. This may be an imagined phenomenon, but I have heard it from several patients.

Hydroxyzine pamoate is an antihistamine that non-selectively blocks peripheral and central histamine receptors. This medication can be used for medical conditions other than anxiety such as itching, nausea and vomiting, insomnia, and as a surgical adjunct.

As with any drug, Vistaril has side effects, some of which are listed below.

  • Dry mouth
  • Dizziness
  • Ataxia
  • Weakness
  • Slurred speech
  • Headache
  • Agitation
  • Nausea

More severe side effects of Vistaril include:

  • QT prolongation
  • torsades de pointes
  • Heatstroke
  • Seizures
  • Dyspnea
  • Hypersensitivity reactions

The recommended dose of Vistaril for anxiety in adults is 50-100mg by mouth every six hours as needed. Unlike Xanax, Vistaril is not a controlled substance but is a prescription medication. Hydroxyzine may interact with other anticholinergic agents, CNS depressants, and agents that prolong the QTc interval. Be sure to contact your doctor or pharmacist if you are taking other prescription medications before initiating Vistaril.

So which medication is a better choice for anxiety?

Both Xanax and Vistaril can help relieve the symptoms of anxiety. However, they both cause drowsiness and will interact with other CNS depressants, including ethanol. They are both prescription drugs, but Xanax is a controlled substance, so it is not suitable for those with a history of addictive behavior. In my professional opinion, Xanax is a better option for the short-term relief of severe anxiety and panic attacks. I believe it is more effective than hydroxyzine. Unfortunately, I was only able to find one study comparing the two agents in the setting of pre-anesthesia. This study came to the following conclusion:

“Alprazolam and hydroxyzine are both efficient and safe pre-anesthetic medications. However, a more pronounced, although modest, anxiolytics and the the absence of side effects favors the use of alprazolam over hydroxyzine.”6

Both alprazolam and hydroxyzine should be avoided during pregnancy. Xanax carries a possible risk of teratogenicity and risk of neonatal withdrawal symptoms, and floppy infant syndrome. Xanax is a better choice than hydroxyzine when breastfeeding, according to Epocrates (accessed 11/28/2021). Epocrates states, “May use low doses of alprazolam short-term with breastfeeding, otherwise monitor infant closely. There is a possible risk of CNS depression in the infant when the breastfeeding mother takes alprazolam.

Michael's Professional Opinion

Anxiety can be a debilitating condition and can lead to poor quality of life in some individuals. As with most diseases, there is a broad range of severity in the various anxiety disorders. My concern is that patients will go straight to their provider and end up with a prescription to treat their anxiety when a drug-free alternative may work just fine. In addition, there are non-drug options available for anxiety symptom relief.

Cognitive Behavioral Therapy (CBT)

One of the best treatments for anxiety is CBT. Cognitive Behavioral Therapy is the most researched form of psychotherapy in history. CBT is a psychological treatment that helps patients recognize thought patterns that are contributing to their anxiety. I believe we are all prone to thinking errors. Suppose we can learn to recognize these and train our minds to think differently. In that case, we can decrease our anxiety and depression symptoms without introducing chemicals into our bodies. The other problem is that when we become anxious, these thinking errors become distorted and amplified, leading to more anxiety.

I strongly suggest giving CBT a try before starting any anti-anxiety or antidepressant medication. The results will likely surprise you. If you don’t have the time to spend in therapy sessions, there is a book I recommend reading. I have included a link to this book below. I have read this book several times, and it has helped me deal with my thinking errors and helped many others do the same.

Lifestyle Changes

Smoking, drinking too much alcohol, eating the wrong types of foods, and not getting the proper amount of sleep can all make anxiety symptoms worse. Exercise can significantly help. Read my recent blog post on anxiety for more information on lifestyle changes.

Nutritional Supplements

As many of you know, I am the owner of Sunshine Nutraceuticals. I believe that natural supplements are a vital piece of the health and wellness puzzle. I also think that one of the possible uses of these supplements is to treat anxiety symptoms.

Prescription Drugs

If you are having a hard time coping with daily living or are considering hurting yourself, please call 911 and get help NOW. Regardless of how bad things seem, you can be helped. A person with a mental health disorder is no different than someone with heart disease, diabetes, or asthma; they just have a different organ of their body affected.

Back to our two drugs. Alprazolam should not be used for the long-term relief of anxiety. As mentioned earlier, it can be addictive and has a short duration of action. We often use a benzodiazepine such as alprazolam while waiting for the long-term anxiety medication to work. To treat anxiety, the drugs we start with are antidepressants, specifically selective serotonin reuptake inhibitors (SSRI’s). These medications often take several weeks to show maximum benefit, so it is critical to have a backup.

If you have any questions regarding this topic or any other subject, don’t hesitate to contact me by clicking the link in the author box below. Remember to take care of your mind and body always!  

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Compulsive vs Impulsive Behavior, Are They the Same?

What is the main difference between compulsive behavior and impulsivity? I tell my students that compulsive behavior is repeated by the person even though that person is aware that this behavior will not result in the desired goal.

9 Useful Tools For Anxiety Relief

We have all experienced anxiety during our lives.  Most of us are able to cope with stress and anxiety but it can become problematic and may even cause other more serious medical issues.  In this post, I am going to give you 9 ways to obtain anxiety relief without drugs.  Most of these techniques can be learned quickly and some you may already know.

1. Take A Walk

One of the quickest and easiest ways to reduce stress and anxiety is to remove yourself from the current situation.  I like to take a quick walk outside when possible.  Just breathing fresh air can really help.  Take some time to appreciate nature.  Pick up a leaf and notice how remarkable nature can be.  Walk to a river or stream and just watch and listen to the running water.  Taking a walk not only helps with anxiety but can also improve blood flow to your brain and help you think more clearly.

2. Exercise

Exercise is one of the best weapons against stress and anxiety.  It is so important that it is one of my five pillars of health.  We all know the many benefits of exercise.  If you find yourself experiencing stress and anxiety, make time for physical activity.  It is important that you pick a form of exercise you enjoy.  If you don’t like the activity, you probably won’t stick to it.  I recommend setting aside at least 30 minutes a day, five days a week for exercise.

3. Be Sure to Get Plenty of Sleep

Sleep is also one of my five pillars of health.  I have found that if I don’t get enough sleep, I become more easily stressed and my anxiety level increases.  Most of us need at least seven to eight hours of sleep per night.  This will vary depending on the individual.  When we are under stress, our bodies need more sleep.  Be sure to practice good sleep hygiene as well.

4. Watch What You Eat

5. Avoid or Limit Alcohol

Drinking  alcohol can make anxiety and stress much worse.  It can decrease sleep quality and using it to relax can backfire.  Click here for a more in depth discussion on why you should avoid drinking alcohol.

6. Just Breathe

The quickest and easiest way to reduce anxiety is to concentrate on your breathing.  I like to use square breathing.  Breathe in for 3 seconds, hold your breath for 3 seconds, breath out for 3 seconds, hold your breath for 3 seconds, and repeat as many times as necessary.  This takes your mind away from whatever it is that is causing the stress. 

7. Stay Positive

I believe positivity can improve almost anything.  Always remember that things can always be worse.  Think of what you are grateful for and consider keeping a gratitude journal.  Writing these things down can improve happiness and reduce anxiety. 

8. Be Careful With Caffeine

Coffee and caffeinated beverages can keep you alert, but too much caffeine may make stress and anxiety worse.  Know your limits.  Be sure to stop drinking caffeine several hours before going to sleep.  

9. Consider Natural Supplements

Our Anxiety Formula is specifically designed to help reduce the symptoms caused by stress and anxiety.  Order yours today by clicking on this link.

Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.


Psilocybin for Depression and Anxiety

Can the psychoactive substance found in “magic mushrooms” be used to treat depression?

Psilocybin is a hallucinogenic drug present in some species of mushrooms. This compound was utilized in the 1960’s for various psychiatric conditions before being classified as a schedule I substance by the FDA in 1970. 

Schedule I substances have no current acceptable medical use and have a high potential for abuse. 

Some examples of Schedule I substances are heroin, LSD, and PCP.

Recently, some cities have decriminalized psilocybin. The first to do so was Denver, Colorado, in May of 2019.  

The first state to legalize psilocybin is Oregon, where I live. Measure 109 passed in November of 2020. This measure allows the Oregon Health Authority (OHA) to develop a program to enable licensed providers to administer mushrooms and fungi containing psilocybin to individuals over 21.

This measure opens the door for psilocybin to be used for psychiatric conditions where traditional treatment has failed.

What is Psilocybin?

Psilocybin is a psychedelic substance that alters consciousness through interaction with serotonin (5HT2A) receptors.

The question is whether this substance has any benefit for these conditions. To answer this question, I looked at the available studies.


Psilocybin Treatment for Anxiety and Depression in Cancer Patients

Cancer patients commonly suffer from significant anxiety and depression. It is estimated that 30-40% of these patients are affected by these disorders when hospitalized.

Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies.1

Anxiety and depression are associated with a variety of symptoms that lead to poor outcomes.  Some of these include:





  • Increased suicide rates.
  • Increased disability
  • Poor medication compliance.
  • Increased health care utilization.
  • Decreased quality of life.
  • Increased pain.
  • Decreased social functioning.
  • Decreased survival rates.

Although this is a significant problem, no FDA-approved pharmacotherapies are approved for psychological distress related to cancer. Antidepressant agents take time to take effect, side effects compromise treatment adherence, many treatments are ineffective, and relapse rates are significant.5



A double-blind, placebo-controlled, crossover trial involving 29 patients with cancer-related anxiety and depression was published in the Journal of Psychopharmacology in December of 2016.7

This study was designed to determine the efficacy of a single psilocybin dosing session compared to an active control (niacin 250mg) in treating cancer patients with anxiety and depression.  

The investigators concluded that moderate-dose psilocybin (along with psychotherapy) produced rapid and sustained anxiolytic and anti-depressant effects.  These effects lasted anywhere from 7 weeks to 8 months. These patients exhibited decreased cancer-related existential distress, increased spiritual well-being, quality of life, and improved attitudes towards death.

There were no serious adverse effects reported during this study in either group.

Psilocybin in Unipolar Depression

An open-label study of 12 patients with moderate-to-severe, unipolar depression was published in Lancer Psychiatry in July of 2016. This was a feasibility trial involving six men and six women.8

These patients received two oral doses of psilocybin (10mg and 25mg) seven days apart. The figure below represents the Schedule of study interventions for this trial.

This study’s main objective was to create an optimized protocol for psilocybin administration and gain information about its efficacy in treating unipolar depression.

No severe adverse effects occurred during this study, and the psilocybin was well-tolerated. The side effects that did appear were:

  • Anxiety (mostly mild)
  • Confusion or thought disorder
  • Nausea
  • Headache

No prolonged psychosis was observed in any of the subjects.

Depression severity was measured using the Quick Inventory of Depressive Symptomatology (QIDS) score. Scoring is as follows:

>21 – Very severe depression

16-20 – Severe depression

11-15 – Moderate depression

6-10 – mild depression

5 or below – No depression

<=9 – Indicates remission of depression


All scoring was completed at the intervals shown on the graph below. The time period reflects time passed after the high-dose session. The figure below shows the results over time. These results were also confirmed using the Beck’s Depression Inventory Scale.

Every patient had a reduction in depression severity one week after the high-dose session. Week 2 showed the most significant results. Eight of the twelve patients (67%) achieved complete remission at week one, and five of these (42%) were still in remission at three months.

Although this was a study with a small sample size and no control group, it is promising that many of these treatment-resistant patients achieved remission of their depression. More studies are needed to confirm what was gleaned from this study, but it appears that psilocybin can be safely administered to patients who are appropriately screened and receive adequate support.

Anxiety and depression are prevalent in today’s society. Many of our traditional antidepressant medications take weeks to work and are often ineffective. Psilocybin shows promise in the management of those with treatment-resistant anxiety and depression.

Psilocybin is also associated with only minor side effects. It does not typically cause compulsive drug-seeking behaviors and is relatively non-toxic.  

In addition to the studies mentioned above, psilocybin has also had positive effects on smoking cessation.9

It has also been shown to significantly decrease alcohol consumption in alcoholic patients.10

More studies need to be conducted to determine the optimal dose and frequency of psilocybin administration in treating psychiatric disorders. One thing is certain; we desperately need more treatments for anxiety and depression.  

If you have any comments regarding this post or any other, please feel free to contact me through the link in the author box below.

As always, have a happy week and stay safe!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.



Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Gaslighting in Relationships, Is it Happening to you?

Are you being gaslighted in your relationship?
What is gaslighting?
How do you stop it?

Gaslighting describes a form of manipulation. In gaslighting, the manipulator convinces their victim that the victim’s thinking or thoughts are distorted. They proceed by convincing the victim that their (the manipulators) views are correct. This may lead to the victim questioning their sanity. The victim may start to question their thoughts, memories and experiences.

This term was born as a result of Patrick Hamilton’s stage play Gas Light in 1938. This play became a movie starring Ingrid Bergman and Joseph Cotton in 1944. In Gas Light, the husband slowly dims the lights in their home, powered by gas. When his wife asks about the dim lights, the husband insists that the lights haven’t changed, and she is making a mistake in believing so.

Is this a big deal?

Why worry about such a trivial thing?

The truth is gaslighting can have an impact on our emotional, psychological, and even physical health. How can we detect gaslighting and stop it from affecting us in a negative way?

The Signs of Gaslighting

The following are signs that may suggest that you are the victim of gaslighting.  

  • You often wonder if you are too sensitive.
  • You find yourself apologizing often.
  • You feel like something is wrong but can’t identify it.
  • You feel isolated from your friends and family.
  • You have a hard time making your own decisions.
  • You feel hopeless.
  • You are unable to experience pleasure from activities you enjoyed in the past.
  • You make excuses for your partner’s behavior.
  • You always think it is your fault when things go wrong.
  • You are becoming increasingly anxious.
  • You don’t feel like yourself anymore.
  • Your confidence has diminished.
  • You question the responses you give to your partner.

Although many of these signs are also present in depressive and anxiety disorders, the difference is that gaslighting involves another person. If you experience these symptoms with a specific individual, you may be the victim of gaslighting.

How to Fight Gaslighting

The first step to fighting gaslighting is recognizing that it is occurring. If you have any of the symptoms listed above ask yourself if they happen around everyone or just a particular person. As I have pointed out in previous posts, if you believe you are suffering from anxiety or depression and you feel like it is affecting your ability to live a meaningful, happy life, you should seek professional help.

Remember, mental disorders are no different than any other medical issue, they just affect a different organ. Never feel distressed about seeking medical attention for any reason. You deserve to be happy!

It may also be important to seek professional help if you are being gaslighted, especially if it involves someone who is hard to escape from such as a live-in partner. Many times, getting the advice of a third-party who can see the situation objectively is critical.

I also want to point out that many individuals with narcissistic personality disorder use gaslighting to manipulate their victims. You can read my blog post on narcissism by clicking here.

Gaslighting can lead to emotional, psychological, and physical unrest. It may also be one sign of an abusive relationship. Always remember that toxic people should be avoided at all costs.   

This post is meant to be a brief description of gaslighting.  There is much more to learn about this tactic.  If you want a more in-depth view, I suggest reading “The Gaslight Effect:  How to Spot and Survive the Hidden Manipulation Others Use to Control Your Life.” by Dr. Robin Stern. 

My suggestion is to work on your personal development daily. Here are some ideas:

  • Remind yourself that you deserve to be happy.
  • Read at least a few pages in a positive motivational book daily.
  • Start and end your day by being thankful for what you have.
  • Consider starting a gratification journal.
  • Exercise and eat healthy, whole foods.
  • Spend as much time as possible with your happiness elements.

If you make a commitment to spend some time on yourself each day, it will pay off.

If you have any questions, feel free to contact me.  

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.



Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Three Specific Types of Eating Disorders, Signs, Symptoms, Risk Factors, and Treatment

Do you or someone you know have an eating disorder?

What are the most common types of eating disorders?

What are the treatments available for eating disorders?


This post will concentrate on the three most prominent eating disorders.  These include

  • Anorexia nervosa (AN)
  • Bulimia nervosa (BN)
  • Binge eating disorder (BED


We will explore these disorders one at a time.  The most important thing to remember is that getting professional help is crucial if you suffer from any of these conditions.  All of these disorders can progress to death if not treated.

Anorexia Nervosa (AN)

Anorexia is probably the most well-known eating disorder.  Although estimates vary based on the study, it is estimated that the lifetime prevalence rate of AN is 0.8%.1



It is important to note that eating disorders are often underreported in the literature because many with these conditions do not seek treatment.

Patients with anorexia have significantly low body weight in relation to age, sex, and physical health.  These individuals have an intense fear of gaining weight and becoming fat.  They also underestimate the seriousness of their low body weight and have a distorted view of their body shape.  There are two types of anorexia.

  • Restricting type – The patient has not regularly engaged in binge eating or purging in the last three months.
  • Binge eating/purging type – The patient has regularly engaged in binge eating or purging in the last three months.

Signs and Symptoms of Anorexia

The signs and symptoms of anorexia can be split into three specific categories, as follows:3

Psychiatric symptoms:

  • Preoccupation with food, cooking, and nutrition
  • Fear of weight gain
  • Restlessness
  • Social isolation and withdrawal
  • Ritualistic behaviors
  • Irritability

Many of these patients also suffer from other psychiatric disorders such as depression, anxiety, or obsessive-compulsive disorder.

Eating Behaviors:

  • Water loading.
  • Vegan and vegetarian diet.
  • Skipping meals.
  • Calorie restriction.
  • Cutting food into small pieces.

Physical Signs:

  • Underweight, emaciated
  • Constipation, abdominal pain
  • Lethargy
  • Dry skin, brittle nails
  • Yellowish skin
  • Electrolyte imbalances
  • Hypoglycemia
  • Infertility, premature births
  • Bradycardia, hypotension, cardiac arrhythmias
  • Osteoporosis

Risk Factors for Developing Anorexia

Genetic factors – Some studies suggest genetics may be a factor in the development of anorexia.

  • Diabetes
  • Emotional Stress – There is a link between emotional stressors such as the death of a loved one or divorce of parents and the development of AN.
  • Parental pressure regarding achievement and appearance.
  • Participation in sports that are associated with thinness, such as ballet, wrestling, or running.
  • Peer pressure and social media – Young teens are often bombarded with perceived success based on unrealistic body images.
  • Age – Peak onset is early to mid-adolescence.
  • Gender – Lifetime prevalence in females is 0.9% and only 0.3% in females.4

Treatment of Anorexia Nervosa

Treating anorexia should be accomplished using a team approach.  Physicians, nurses, dietitians, therapists, and other health professionals with experience treating eating disorders should be employed. 

A dietician should provide nutritional rehabilitation to avoid refeeding syndrome.  This is done by slowly increasing the patient’s weight. 

The most effective treatment for anorexia in adolescents and young adults is family-based psychotherapy. 

The use of medications in the treatment of AN is controversial and should not be started until the patient has gained sufficient weight in most cases.   These may include:

  • Multivitamins
  • Agents for constipation, abdominal pain and bloating.
  • Calcium supplements for osteopenia.

Medications used to treat co-existing conditions such as depression, OCD, and anxiety may also be initiated when it is safe to do so. 

In severe cases, hospitalization may be necessary to correct dehydration, electrolyte imbalances, cardiac arrhythmias,  or severe malnutrition.

One final comment about AN.  Many people are unaware that this disorder has a high mortality rate.  In fact, a meta-review of all-cause and suicide mortality in mental disorders came to the following conclusion:

 Those with the highest all-cause mortality ratios were substance use disorders and anorexia nervosa.5

Bulimia Nervosa (BN)

Bulemia Nervosa (BN) is an emotional disorder that involves an obsessive desire to lose weight.  BN is characterized by extreme overeating followed by depression and inappropriate compensatory behaviors to prevent weight gain, such as:

  • Excessive exercise.
  • Misuse of laxatives, diuretics, or enemas.
  • Self-induced vomiting or purging.

The severity of BN can be categorized according to the frequency of these inappropriate behaviors:

  • Mild – Average of 1-3 episodes weekly.
  • Moderate – Average of 4-7 episodes weekly.
  • Severe – Average of 8-13 episodes weekly.
  • Extreme – Average of more than 13 episodes weekly.

Signs and Symptoms of Bulimia

As with anorexia, the signs and symptoms of BN can be split into categories.

Psychiatric Symptoms:

  • Substance use disorders
  • Anxiety disorders
  • Impulsivity
  • Depression
  • Mood fluctuations


  • Preoccupation with food and eating
  • Laxative or diuretic abuse
  • Compulsive exercise
  • Poor self-image
  • Self-induced vomiting or purging

These patients often lose control over food intake.  They eat large quantities of high-calorie foods such as cake and ice cream, often attempting to combat dysphoric mood states.  Binging helps with anxiety and dysphoria in the short term but makes them feel guilty.  Patients with BN often conceal their binging, plan it, and eat until they are uncomfortable.

Physical Signs:

  • Normal to slightly overweight
  • Loss of tooth enamel from purging
  • Increase in dental cavities
  • Lethargy
  • Electrolyte imbalances
  • Amenorrhea
  • Hypotension, bradycardia, prolonged QTc interval
  • Osteopenia, osteoporosis

Risk Factors for Developing Bulimia

  • There is a strong genetic predisposition, according to studies.
  • Physical and sexual abuse victims are more prone to BN.
  • Emotional stress.
  • Participation in sports that are associated with thinness, such as ballet, wrestling, or running.
  • Peer pressure and social media – Young teens are often bombarded with perceived success based on unrealistic body images.
  • Those who are impulsive.
  • Those who have inadequate stress coping skills.
  • Gender: Incidence is reported to be 2.6% in females and 0.5% in males.

The peak age of onset for bulimia is 16-20 years. 

The mortality rate is about 1%. 

Early detection is a critical factor in recovery. 

Treatment of Bulimia Nervosa

As with anorexia, the treatment of bulimia should involve a multidisciplinary team of professionals. 

Psychotherapy has the best efficacy for this disorder.  This process can take 4 to 5 months to complete.

SSRI’s such as fluoxetine are also used to reduce binge-purge episodes. 

Dietitians can be instrumental in creating nutritional plans for these patients as adequate meals can decrease food craving.

Some organizations can help get bulimia patients the help they need.  Two great options are:


Overeaters Anonymous: to help locate support groups:

Binge Eating Disorder (BED)

Binge eating disorder (BED) is a condition in which the patient eats a more considerable amount of food than most people would in a similar time period.  Unlike bulimia, these individuals do not regularly employ compensatory measures such as purging to counter the binge eating.  They often eat rapidly until they are uncomfortable.  Binge eaters often eat even when they are not hungry and eat alone due to embarrassment.  They often feel depressed or guilty after eating.

To be diagnosed with BED, binge eating must occur at least once per week for at least three months. 


The severity of BED can be classified as follows:

Mild – Average of 1-3 episodes weekly.

Moderate – Average of 4-7 episodes weekly.

Severe – Average of 8-13 episodes weekly.

Extreme – 14 or more episodes per week.

Signs and Symptoms of Binge Eating Disorder

The signs and symptoms of BED are as follows:

  • Slightly overweight to obese.
  • High level of emotional stress.
  • High incidence of GERD.
  • Presence of stretch marks due to weight changes.
  • Gallbladder disease.
  • Poor impulse control.
  • Feelings of guilt.
  • Comorbid anxiety or depressive disorders.
  • Cardiovascular disease.
  • Hyperlipidemia
  • Hyperglycemia – prone to diabetes.

Risk Factors for Developing Binge Eating Disorder

There seems to be a genetic component with BED.  Family and twin studies have shown a 57% heritability. 

Females have a higher incidence (3%) than males (2%). 

The age of onset peaks at 18-20 years of age, but this disorder may occur later in life. 

Many of these patients have a history of “yo-yo” dieting.  They have large fluctuations in body weight over time. 

There is a strong correlation between binge eating and obesity.  About 50% of obese individuals report binge eating as one of their problems.

Treatment of Binge Eating Disorder

As with the above eating disorders, a multidisciplinary team of professionals should be employed in the treatment of BED.  Psychotherapy has the most significant effect on BED, but drugs may be added.  Some examples of adjunctive medications include:

  • Lisdexamphetamine is the only medication FDA approved for BED. It has been shown to decrease binge eating days, binge eating cessation, and global improvement compared to placebo.6
  • Topiramte
  • Zonisamide
  • SSRI’s (fluoxetine, sertraline, citalopram, fluvoxamine, escitalopram)
  • Orlistat
  • Bupropion/naltrexone

Eating disorders can cause endless problems for patients who suffer from them and the families involved.  Our society has caused our young citizens to believe that they need to look a certain way to be popular or successful. Social media has amplified this lie!  The truth is, we all have a special gift to give, and it has very little to do with our weight or body shape.   

I urge every person reading this to begin to love yourself as you are.  Determine your “gift” and take steps to develop it to share this gift with those who will benefit.

Our body shape is something that we are born with.  We can’t all have the body type of the stars.  The best thing you can do for yourself is:

  • Eat whole, healthy foods.
  • Drink plenty of water.
  • Exercise 5 days per week for at least 30 minutes.
  • Get enough sleep.

If you think you may have an eating disorder, GET HELP!

There are many sources of help available.  Here is one example:

I hope you have learned something from this post.  Remember, eating disorders are serious and can be deadly if not treated.

Have a great week, and stay safe out there.

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.



Disclosure:  This post may contain affiliate links, meaning, at no additional cost to you, I may earn a commission if you click on, or make a purchase through a third-party link.

Ketamine Infusion Therapy for Depression and Suicidal Ideation

Can ketamine infusion therapy work for depression?


What are the advantages?

Ketamine is a medication that has been traditionally used to induce and maintain anesthesia. This drug is often used off-label for conditions such as pain relief, conscious sedation, and depression.

Ketamine has addictive properties and is a popular drug of abuse. The drug is available as white powder, liquid, and tablets and is known as “K”, “Vitamin K”, and “Special K” on the street. Ketamine can cause hallucinations, out-of-body experiences and temporary paralysis. The user may be awake but unable to move or even talk. These effects have led to ketamine being referred to as a “date rape drug.”

In March 2020, SpavatoTM (Esketamine) nasal spray was approved for adults with treatment-resistant depression. This is an important milestone in paving the way for this drug to be used more commonly in depressed and suicidal patients who have tried other treatments without benefit.

Ketamine is not just another antidepressant. It begins to work right away. Other treatments for depression take weeks to work. 

The popular selective serotonin reuptake inhibitors (SSRI’s) must be slowly titrated to the effective dose due to side effects. We must be sure the patient can tolerate the drug and wait weeks to determine effectiveness. 

The same is true for other antidepressants currently available.

This post will describe the use of ketamine infusion therapy for the treatment of depression.  


Suicide rates have increased over the past two decades and are one of the top three causes of mortality worldwide for those between the ages of 15-44.1 

This has occurred despite efforts to reduce suicide.2

We know that approximately 90% of those who commit suicide suffer from a treatable mood disorder.3

Our current treatment options for those with suicidal ideation consist mostly of hospitalization, psychotherapy, and pharmacotherapy.  

Although dialectical behavioral therapy (DBT), cognitive-behavioral therapy (CBT), and treatment with clozapine and lithium have been shown to decrease suicide deaths,4




as well as attempts,7


They take time to work and have not shown effectiveness acutely. This leads us to a search for an antidepressant that can take effect quickly. 


Is ketamine a solution? 

Ketamine for Suicidal Ideation and Mood Disorders

There have been studies showing that ketamine infusions are effective in treating suicidal ideation and depression in the acute setting. A meta-analysis published in the American Journal of Psychiatry in February 2018 came to the following conclusions:9

  • Ketamine significantly reduced suicidal ideation. This occurred within one day and continued for one week after the treatment.
  • The change in the severity of depressive symptoms was strongly correlated with the decrease in suicidal ideation.
  • Ketamine’s effect on suicidality is only partially due to its antidepressant effects.
  • 54.9% of patients had no suicidal ideation 24 hours after a single ketamine infusion, and 60% remained free of suicidal thoughts one week after the infusion.

Are you thinking of Getting a Ketamine Infusion?

If you are considering utilizing ketamine infusions to treat depression or suicidal thoughts, here is what to expect:

  1. You may receive the infusions as an outpatient or inpatient. Several facilities offer ketamine infusions as an outpatient procedure.
  2. You may be asked to fill out a questionnaire to determine your depression level before the procedure.
  3. You will need to arrange for transportation as you will be unable to drive after the infusion.
  4. The following conditions may exclude you from receiving the ketamine infusion:
    • History of schizophrenia, bipolar disorder, or schizoaffective disorder.
    • Dementia.
    • Delirium within the last seven days.
    • Uncontrolled hypertension.
    • Pregnancy.
    • Certain heart conditions.
    • Positive urine drug screen showing substances of abuse or a previous history of substance abuse.
    • An allergy or previous adverse reaction to ketamine.

It is important to note that various facilities will have different protocols. Check with your facility of choice to get their specific guidelines. Here is a few typical guidelines used:

  1. The ketamine infusion will likely last about 40 minutes.  
  2. Vital signs (heart rate, blood pressure, oxygen blood levels, etc) will be monitored during the infusion.
  3. As with any medication, you may experience side effects. Some of these include:
    • Confusion
    • Delirium
    • Dream-like state
    • Excitement
    • Hallucinations
    • Irrational behavior
    • Vivid Imagery
    • Change in heart rate
    • Change in blood pressure
    • Seizure-like movements
    • Rash
    • Nausea and vomiting
    • Double vision
    • Others

Ketamine infusions will normally be given on a pre-determined schedule. A typical schedule may be:

  1. Twice a week for 2-3 weeks (not less than three days apart)
  2. After 2-3 weeks, the infusions should be weekly to every three weeks with a goal to extend the infusions to an interval if possible. This will vary based on patient response.
  3. Ketamine infusions should be tapered when discontinued.
  4. Ketamine infusions range from $400-$800 per infusion, and there may also be an initial consultation fee. These prices are for outpatient procedures. It is important to note that most health insurance plans do not cover these infusions. Inpatient treatment can cost substantially more.

I am a huge proponent of using ketamine infusions for treatment-resistant depression. I have spent many years caring for psychiatric patients, and some do not respond to conventional therapies.  


Depression is a devastating mood disorder that can rob an individual of a fulfilling life. It can ruin careers, relationships, and even result in death.


If you have any thoughts of ending your life or are depressed, GET HELP. Call someone! There are many resources available to help you. You can get better. We can help! 


The Suicide Hotline can be reached at:




With the recent approval of SpavatoTM, my hope is that some of the stigma associated with ketamine will dissipate. Many drugs we use every day have the potential of being abused. The fact is ketamine can help some of our most vulnerable people.


As a society, we have the responsibility to care for our sick individuals. This includes those with mental disorders. Anyone can become depressed!  I pray that we will embrace the potential of ketamine infusions. After other treatments have failed, those who need ketamine should have access to it. 

Insurance companies should pay for it!


It is more costly to hospitalize someone for weeks while our traditional treatments take effect. One of ketamine’s most important benefits is that it begins to work right away. This can be the difference between life and death!

Ketamine is a subject I have wanted to write about for some time. We are unable to use ketamine infusions in our facility due to a perceived danger.  It is possible to refer those patients who might benefit from ketamine to an alternative facility. I plan to continue to lobby for its use within our facility. I believe we owe it to our patients.

If you have any questions about ketamine or any other medication, health issue, or nutraceutical, please contact me.

I am happy to help whenever I can.  That is why I started Sunshine Nutraceuticals in the first place.

Have a great week, everyone, and stay safe!!

Michael Brown in Lab Coat with arms crossed

Michael J. Brown, RPh, BCPS, BCPP

Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.

Read Michael’s story here.

Feel free to send Michael a message using this link.



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