The Importance of Annual Dermatology Skin Checks

 By: Allison Andrews, N.P.

Why are we recommending “annual” dermatology skin checks? Well, because the most important strategy in combating skin cancer is early detection. By having a proper screening by a licensed dermatologist yearly, you significantly reduce the chance of developing skin cancer. 

Skin cancer is the most common cancer that anyone will face and one of the only cancers that can be seen on the surface of your skin. Yet, one in five Americans will be diagnosed with skin cancer in their lifetime and one person dies from the deadliest form of skin cancer, melanoma every hour. 

The most common cause of skin cancer is sun-damaged skin. It is also important to know, that this means all levels of damage; not just sunburn. No matter the season, any unprotected exposure can cause damage to the skin, because natural skin has no protection from UV rays of the sun. 

Skin cancer can be broken up into two basic categories; melanoma and non-melanoma. Non-melanoma includes basal cell carcinoma and squamous cell carcinoma. When non-melanoma affects the head and neck, this will present as a sore or bump that does not disappear. On other parts of the body, non-melanoma can appear flesh colored or a brown tinted scar that often bleeds or releases a liquid substance. Generally, basal cell is characterized by a smooth, white appearance, while the squamous cell bumps are rough. 

To spot melanoma, dermatologists suggest using the ABCDE rule. Even when doing your self-exams and using the ABCDE rule, remember that not all irregularities are problematic:

                 Asymmetry – does one side have a different shape than the other

                Border- is it irregular, scalloped or poorly defined?

                Color- is the color varied from one area to another?

                Diameter- is it greater than the size of a pencil eraser?

                Evolving- is it changing from what it once looked like?

Always prepare for your annual dermatology skin check by doing a head to toe self-exam and note any concerns to take with you to your visit. You are primarily looking for spots or bumps that are new, that do not go away, and that change in color, size shape, or all three. At the time of your visit, point out any abnormalities to your dermatologist who will closely examine any moles, growths, or lesions you noted and may even take a biopsy if needed. 

Remember, the two best ways to reduce your risk of skin cancer is to protect your skin from the sun and have your annual dermatologic skin checks!

Sexual Dysfunction and Painful Sex

 By: Dr. Dana Shanis

A woman’s sexuality is a complex mix of many physical and psychological responses, which can affect the way a woman thinks and feels about herself and her relationships. More than 40% of women in the United States report some kind of sexual dysfunction, according to a study published in the Journal of the American Medical Association (JAMA). While common, problems with sex often cause personal distress and can interfere in the relationship with a partner. Many women are hesitant to discuss these concerns with their providers and some women have had their concerns dismissed by healthcare providers in the past, left to suffer in silence.

Sexual Dysfunction

Women can experience problems in any of the stages of sexual activity, including desire, arousal, or orgasm. Psychological and intrapersonal issues can have a significant effect on all aspects of sexual function. It can be helpful to discuss your concerns with your partner and many couples benefit from individual or partnered counseling with a therapist trained in sexual dysfunction.

Sexual desire varies greatly from woman to woman, and can fluctuate from one time to another throughout a woman’s life. Lack of sexual desire is a common issue for women, with a national survey showing a third of women reporting this concern in the past year. When this causes personal distress, it is known as Hypoactive Sexual Desire Disorder (HSDD).

During the arousal stage of sexual activity, there is typically increased blood flow to the clitoris and vagina, increased lubrication and relaxation of vaginal muscles. An interruption in this can be caused by many factors, including medical illnesses, such as diabetes or thyroid disease. Medications also can affect the arousal response, and often there are alternative drug options that may have a less significant effect on libido. Along with your symptoms, it is important to inform your provider of any medications you are taking.

The absence or delay in orgasm can result from problems with desire or arousal, or from a variety of medical or physical factors. Issues with orgasm are most common in young women, but can occur at any stage of life.  

Many women experience urinary incontinence (leaking urine) during intercourse, especially common in women after pregnancy and during menopause. For many, this can cause embarrassment and anxiety that prevents enjoyable sexual activity.

Painful Sex

Painful sex affects 2 out of 3 women at some time in their lives, according to the American College of Obstetricians and Gynecologists (ACOG). There are some causes that are temporary, such as a vaginal infection or changes in hormones or medications. But others causes can remain until addressed. Occasionally, pain with sex can be a sign of a more significant illness, infection, or tumor, a reason discussing your symptoms with a provider is important.

Vaginal dryness is a common cause of pain, which can result from taking birth control pills or other medications, or following cancer treatments or menopause. Pelvic floor spasms are also commonly found in women who experience painful sex. These spasms can result from previous painful experiences, such as a pelvic infection or sexual assault, or in some cases occur spontaneously. Once a woman experiences pain during sex, anxiety can arise with future activity that can interfere with other aspects of sexual function, creating a negative feedback cycle.

Research in sexual health has become more commonplace in modern medicine and new diagnoses and treatments are being discovered every year. The GYN providers at Rittenhouse Women’s are trained in assessing and treating many causes of sexual dysfunction. We offer several treatment options, procedures, and new technology to address painful sex and related issues in the office, including:

  • Behavioral and medical treatments for decreased desire, dryness, and pain
  • Pelvic floor injections for muscle spasms leading to painful sex or pelvic pain
  • ThermiVa® for dryness, vaginal laxity, pain, incontinence, and decreased sexual function
  • O-shot® (Plasma-rich protein injection) for decreased arousal, unsatisfactory orgasm frequency/intensity, and urinary incontinence



It is important to discuss symptoms with your provider, as sometimes they can be a sign of a more significant problem. Do not suffer in silence.

Endometrial Ablation for Heavy Periods

By: Dana Shanis, M.D.

Many women across the US suffer from heavy periods.  For some it is only an inconvenience, but for other women it can interfere with their daily activities or lead to health issues like anemia. Heavy bleeding can be a sign of a benign growth in the uterus, such as a polyp or fibroid.  While some women experience a normal increase in menstrual bleeding as they get older, heavy or increasing bleeding should be evaluated to rule out abnormal growth in the uterus that could lead to cancer over time.

There are several medical treatments that can help with heavy bleeding, but typically this response is temporary.  Many women are looking for more definitive treatment to help control their cycles. In the past, women with heavy periods that have completed childbearing were often treated by a hysterectomy (surgical removal of the uterus), which has significant risk of complication and often requires a hospital stay.  As a result, lower risk procedures have been created for women who wish to keep their uterus, avoid major surgery or who are not good surgical candidates.

The most effective of these procedures is called endometrial ablation, which is the destruction of the lining of the uterus.  This procedure is minimally invasive and does not require an incision.  Previous techniques involved using electric current with a rollerball or circulating hot water in a balloon to destroy the lining.  These procedures were technically difficult to perform and limited in their success.

Current technology uses plasma or radiofrequency energy to more effectively target the uterine lining, increasing success rates and decreasing risk of complications.  These procedures are performed without a hospital stay and can even be done in the office, avoiding the risk of intravenous anesthesia.   

The Minerva device, the newest of the endometrial ablation technologies, has a soft conforming balloon, which increases comfort during the procedure. It also takes only 120 seconds to run, making it an ideal procedure to be performed in the office.  Due to its design and energy source, it is the most effective of current ablation options, with 66% of women having no more periods after the procedure and a 98% satisfaction rate. 

While endometrial ablation is not a form of contraception, it is not recommended that women get pregnant after it is performed, as there is an increased risk of serious complications. If desired, an additional procedure for sterilization can be performed at the time to address this concern.

Prior to endometrial ablation, evaluation of the uterine cavity and sampling of the uterine lining is performed to assess for abnormalities.  This is done by hysteroscopy (camera in the uterus) with endometrial biopsy, which can also be performed in the office with minimal discomfort.

Most insurance companies currently cover hysteroscopy and endometrial ablation, making it an affordable and effective option for diagnosing and treating heavy periods.
If you are experiencing increased or heavy bleeding, you should see your provider for evaluation and to discuss which treatment options are right for you. 

The Medical Treatment of Acne

By: Lauren O'Brien, M.D.

Everyday I have patients ask me, “Why am I still breaking out? I thought acne was just for teenagers!”. Unfortunately, this is a myth and more and more women are dealing with acne into the 20s, 30s, and 40s. Skin specialists are not sure what is causing this increase in acne, but it is our new reality.

Why do we treat acne?

Acne can have a huge impact on a woman’s self esteem so early treatment is paramount. These days, almost all cases of acne can be treated successfully. The best results occur when treated early. If left untreated, scarring and hyperpigmentation can occur which can be permanent.

What treatments and solutions do we have for you?

Our DermaCenter medical spa can treat acne with chemical peels such as Environ's Tca peel, which can combat acne by killing bacteria in the skin, controlling oil production and removing dead skin cells from the surface which will break up congestion allowing the skin to breath and products to penetrate more effectively. For best results Environ's TCA peels should be done 3-4 weeks apart. We also have Environ's Sebu line which includes various products specifically designed to treat acneic skin.

What can I do at home?

There are many over the counter products geared at treating acne. If you have mild-moderate acne, these over the counter regimens can be very helpful. Ingredients to look for include:

  1. Benzoyl peroxide- kills the bacteria responsible for acne
  2. Salicylic acid- helps breakdown blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicle
  3. Sulfur- helps breakdown blackheads and whiteheads
  4. Adapalene- new to the over the counter market, this is a vitamin A derivative (in the same class as Retin A). This medication regulates skin cell turnover to keep pores from clogging as well as reducing redness and inflammation.

Just because these medications are over the counter does not mean they are free of side effects. Burning, dryness, and redness are common and will often go away with time. If you experience severe or prolonged side effects, stop the medication and come in to see us.

It is important to realize that any treatment regimen for acne takes time. The life cycle of a pimple can be up to 8 weeks, so patience is key. Before stopping any medication for lack of benefit, give it 8 weeks for the best chance of success.

OTC products didn’t work, now what?

If the over the counter products were not successful, it’s time to head into the office for more advanced treatments. There are many prescription options for treating acne these days. Depending on the history and severity of your acne, your provider may start with a topical medication. These include: antibiotics and vitamin A derivatives either alone or in combo with other medications.

Oral medications treat acne in a more systemic way. For individuals with moderate to severe acne on the chest, back and face, a course of oral antibiotics may be warranted to control acne. Some women may have hormonally influenced acne. Clues that this may be the case include: excessive hair growth, acne only on the jaw/lower face, premenstrual acne flares, or irregular menstrual cycles. In these cases different medications such as birth control pills or anti-androgen drugs (spironolactone) can be utilized.

For individuals with severe nodular or cystic acne, oral isotretinoin (Accutane) can be very effective. This is a Vitamin A derivative taken once or twice a day for 15-20 weeks. If reduces the size of oil glands leading to a reduction in oil production and decreased growth of bacteria. Though very effective, this medication certainly has its downside. Isotretinoin is known to cause birth defects, so it is imperative that women are not pregnant and do not get pregnant while taking this medication. Two forms of birth control are required when taking this drug and blood tests are often followed to monitor for any organ damage. Given the extensive monitoring required, this medication is generally only prescribed by dermatologists.

Is there anything else I can do?

Here are some basic tips from the American Academy of Dermatology to help you get the most out of your acne treatments:

  1. Wash twice a day and after sweating
  2. Use fingertips to apply a gentle, non-abrasive cleanser- washcloths/mesh sponges can irritate skin
  3. Be gentle with your skin- use alcohol-free products and avoid astringents/toners and exfoliants if they irritate your skin.
  4. Rinse with lukewarm water
  5. Shampoo regularly- especially if you have oily hair
  6. Let your skin heal naturally- no picking!
  7. Keep your hands off your face throughout the day
  8. Stay out of the sun and tanning beds

Food and Your Skin

By: Angela Luciani, Registered Dietitian

The skin is the largest organ in the human body and its main function is to act as protection for internal organs from external factors such as pollution, toxins, and the environment. Diet is an important factor in the health and overall appearance of your skin - while some foods may be beneficial for your skin, paying attention to how your skin reacts to certain foods is your body’s way of alerting you that you may be allergic or intolerant. Believe it or not, there is a difference. A food intolerance is often mislabeled as a food allergy; however, the reaction does not involve the immune system and is often delayed in response.

A food allergy occurs when your immune system overreacts to a food or substance in a food, identifying it as a danger and triggering a protective, usually immediate, response. Symptoms of a food allergy may include but is not limited to tingling sensation of the mouth, swelling of the tongue and/or throat, hives, skin rashes, abdominal cramps, diarrhea and more. Severe reactions known as anaphylaxis can result in death. Common food allergies in children include milk, eggs, peanuts, tree nuts and soy while food allergies in adults are caused by fish, shellfish, peanuts and tree nuts.

Other skin problems including psoriasis, eczema, rosacea and acne are inflammatory responses and may be a heightened by the foods that you eat. It is demanding to define which foods may be exacerbating symptoms. Determining food allergies and intolerances poses a challenge and diagnostic tests can be expensive and unreliable.  It may be effective to remove suspected foods from your diet and observe changes.  Completing an elimination diet can help evaluate which foods you should avoid; however, it can also be difficult. A dietitian can help in assessing and re-assessing your food logs, eliminated foods and supplements to ensure you are maintaining a healthy diet and avoiding deficiencies. 

May: National Osteoporosis Month

By: Catherine McGinty, MSN, FNP-BC

May is National Osteoporosis Month and we wanted to take the opportunity to share information on this condition which affects many women.

Osteoporosis is defined as a progressive loss in bone mass and density which can cause the bones to become thin and weak. When bones weaken, they can easily fracture, especially on the spine, hips, and forearms. Fractures caused by osteoporosis can lead to significant decrease in quality of life and increased risk of mortality.  

Of the 10 million estimated Americans who have osteoporosis, about 80% of them are women.  Women naturally have smaller and thinner bones than men, but are also at greater risk of bone loss after menopause due to lower levels of estrogen. This is because estrogen helps to protect and maintain bone density, so the decreasing levels of estrogen that occur in menopause lead to increased risk of osteoporosis.  

Fortunately, there are plenty of preventative, diagnostic and treatment measures to help maintain, detect, and/or increase bone density. We will primarily discuss the preventative measures available to help maintain or increase your bone density.  

The optimal diet for preventing and treating osteoporosis requires consuming adequate calories, as well as, appropriate amounts of Calcium and Vitamin D.  The current nutritional recommendations for Calcium and Vitamin D are:


·        Pre-menopausal women should consume at least 1,000 mg of Calcium per day, which includes foods, beverages, and supplements

·        Post-menopausal women should consume 1,200 mg per day

·        It is not recommended to take over 2,000 mg of Calcium per day due to risk of side effects

·        The best sources of Calcium in our diet are: milk, yogurt, cottage cheese, hard cheeses, and green vegetables, like kale and broccoli

Vitamin D:  

  • Pre-menopausal women should consume about 600 International Units (IU) of Vitamin D each day
  • Post-menopausal women should consume 800 IUs per day
  • Milk supplemented with Vitamin D is one of the largest sources of dietary Vitamin D.  Other good sources are salmon, cod liver oil, mackerel, and tuna fish              
Another important preventative measure for bone health is exercise. Physical activity helps to increase bone mass, as well as increase muscle strength which reduces the chances of falling due to weakness. Most experts recommend exercising for at least 30 minutes three times per week for bone health.

It is also important to note things to avoid if you are at risk for Osteoporosis:

  • Alcohol: Drinking alcohol excessively (average of more than 2 drinks per day) can increase the risk of fracture due to increased risk of falling and poor nutrition
  • Smoking: Smoking cigarettes is known to speed bone loss. One study suggested that women who smoke one pack per day throughout adulthood have a 5 to 10 percent reduction in bone density by menopause, resulting in an increased risk of fracture
The risk of Osteoporosis is evident in women, especially in post-menopausal years.  To further discuss prevention, detection, and treatment of this condition, please schedule an appointment with one of our medical providers today.  

Produce: Fresh, Frozen or Canned?

By: Marissa Martino, Registered Dietitian

Having access to the millions of food choices every day is a privilege that not everyone can say they have. While it’s a great benefit to be able to choose healthy foods for ourselves and our families, sometimes the amount of options can be overwhelming, especially while trying to stay on a budget. In terms of produce, how do we know to choose between fresh, frozen or canned?

The first choice should always be fresh, local produce- if available. If your town has local farmers, or a farmer’s market, take advantage! Local produce is ideal since the time between harvest and your purchase is very short-lived. The nutrients and enzymes are still alive and potent. Not many people have handled the produce, and there isn’t a lot of travel time from where the produce was grown and picked, to where it is being sold and purchased.

                Since not all of us are lucky enough to have local farmer’s markets, there are some secrets to choosing the best option at the grocery store; which include fresh, frozen or canned fruits and veggies. Many people would argue that fresh produce is the best. However, several studies show that fresh veggies lose about half of their nutrient content in less than a week. This is because vitamins and minerals can be easily destroyed by light, air, and handling. Consider how much time passes from when and where produce is picked, to the travel time to the store and then the actual display where they may sit for a few days as several shoppers handle them, squeeze and sniff them, only to put them back. Produce then continues to lose its  nutritional value. So unless you are buying and eating your produce daily, fresh is not always the way to go.

Make your way to the frozen aisles. Normally, we associate frozen foods with processed, high sodium junk foods. But, the frozen veggie and fruit sections are key! Not only is frozen produce cheaper, but the nutrient content is much higher than that of fresh. This is because the process of freezing veggies starts with harvesting them at their peak nutritional state. Then, they are blanched to kill off any bacteria. Lastly, they are flash frozen, which essentially locks in the nutrition of the veggies.  If you choose the “steamfresh” bags, then even the preparation of your veggies will retain most of its nutrients, since steaming is the best way to do this.

Finally, we have the option of canned fruits and veggies. Let’s put aside the not-so-appetizing color and texture of canned string beans, and take a look at the facts. During the canning process, they lose up to half of their vitamin content, which continues to decrease another 20% each year that they are sitting on your shelf.

In conclusion, unless you are either growing your own produce, or have a local farmer’s market, or stop at the grocery store daily for your produce, stick with the frozen options for your health and your wallet!

Separating the Wheat from the Chaff: Celiac Disease and Non-Celiac Gluten Sensitivity

By: Elizabeth Galbrecht, MSN, AGNP-C, WHNP-BC

There's no denying that gluten, a protein found in wheat and other related grains such as rye and barley, has gained a bad reputation in recent years. So much, it seems, that gluten-free food products are a fixture on many restaurant menus and grocery store shelves, and gluten-free diets and cleanses are now ingrained in popular culture. Despite its ubiquity, however, a gluten-free lifestyle is not necessarily warranted and may even be harmful for those without a known predisposition to gluten sensitivity, such as Celiac Disease. May is Celiac Disease Awareness Month, and now is a better time than ever to bring our attention to gluten and understand its activity in the digestive tract.

Celiac Disease is a chronic autoimmune medical condition that is triggered by the ingestion of gluten in those who are genetically predisposed. The presence of gluten in the small intestines of people with Celiac Disease induces an inflammatory response, which, over time can cause structural changes in the intestinal wall and lead to malabsorption of important dietary vitamins and minerals. Other possible manifestations of Celiac Disease are numerous and include gastrointestinal symptoms such as abdominal bloating and pain, chronic diarrhea, foul-smelling stool, and myriad possible extraintestinal symptoms such as chronic migraine, peripheral neuropathy, fatigue, mood changes, and rash. Celiac Disease can also be asymptomatic. In such cases, a diagnosis is made after patients who are at-risk are screened. Risk factors include having a first-degree relative with Celiac Disease or a personal history of other autoimmune disease such as Type 1 Diabetes or a thyroid disorder. Diagnostic testing consists of serum antibody measurement and/or genetic testing in addition to biopsy of the small intestine. Celiac Disease is somewhat rare in the general population, affecting approximately 1 in 100 people, and there are currently no recommendations that support universal screening for this disorder. The only treatment for Celiac Disease is strict adherence to a gluten-free diet.

A related condition that is still poorly understood, yet thought to be caused by an immune response to gluten is called Non-Celiac Gluten Sensitivity. People with Non-Celiac Gluten Sensitivity will exhibit similar symptoms as those with Celiac Disease, but will test negative for Celiac Disease on blood testing and biopsy. Furthermore, their symptoms will resolve after excluding gluten from their diet. The prevalence of Non-Celiac Gluten Sensitivity and the demographic characteristics of affected patients are currently unknown, but further investigations are underway to help better understand this clinical entity.

Despite the hype, gluten is innately harmless for those without a known history of Celiac Disease and those who do not have gastrointestinal or extraintestinal symptoms that resolve on a gluten-free diet. Further, gluten-free versions of common foods such as bread and other baked goods may actually be less nutritious than the original. Gluten-free foods often contain higher amounts of calories and might lack fortification with important micronutrients like folate, thiamine, and riboflavin when compared to their gluten-containing counterparts.

If you are concerned about the possibility of Celiac Disease or Non-Celiac Gluten Sensitivity, please talk to your healthcare provider about ways to diagnose and manage these conditions. If you are already adhering to a gluten-free diet for any reason, a Registered Dietician may help guide you towards full and well-balanced nutrition and a healthy life.

Earth Day Tips for Eating Clean While Going GREEN!

By: Angela Luciani, Registered Dietitian

Earth day is celebrated on Saturday, April 22nd. You can help celebrate by incorporating some sustainable practices through your eating habits and daily routine that can protect the environment!

1)      Choose fresh and local - Fresh and local is a great way to help out the environment by reducing fuel for transportation! There are lots of opportunities to ‘eat local’ in Philadelphia through restaurants, food co-ops, community supported agriculture, and farmers markets. Keep in mind the seasonality of the produce. You can find out what is in season by checking out the link here for a list:

2)     Grow your own - If you have the space: start with easy to grow vegetables such as cucumbers, tomatoes, or peppers. If you are living in an apartment or don’t have an outdoor area, you can still grow herbs in a small pot on your windowsill or consider joining a community garden!

3)     Eat clean -  Aim to consume more plant-based, minimally processed foods to cut back on packaging and pollution from transportation and manufacturing. Choose organic, when possible, to reduce pollution in the air and soil, and waste by helping reduce the use of pesticides. Check out the dirty dozen list here for foods that you should aim to purchase organic.

4)     Reduce waste - Food waste has a negative impact on the environment – try getting creative with how to use your leftovers such as taking vegetable leftovers for a morning omelet or using the unwanted ingredients such as the skins/stems for making a delicious broth. When grocery shopping: cut back on food packaging and paper goods by purchasing in bulk for cooking and freeze the rest for another meal and using your own reusable grocery bags!  

When we reduce, reuse and recycle by choosing fresh and eating clean, we can minimize our carbon footprint while simultaneously benefiting our health! If you would like more information on healthy eating, don’t hesitate to schedule an appointment with one of our dietitians today!

Mental Health and Alcohol Abuse

By: Courtney Liggera, Psy.D.

“Beer is proof that God loves us and wants us to be happy.” - Benjamin Franklin

It’s easy to be glib about drinking. It is, after all, a significant element of most social activity.  Drinking alcohol helps us let loose, shake off the strains of a hard day, and connect with good friends. It provides a temporary positive impact on one’s mood. It does all of the above… when enjoyed in moderation.

But alcohol abuse, particularly long-term alcohol abuse, can have devastating effects on your mental health, not to mention your physical health. (Apologies for not being glib about that.)

Alcohol abuse tends to increase mental disorders. Specifically, the odds of developing a mood disorder are 3.6x greater for someone abusing alcohol compared to one who does not.  The odds for developing an anxiety disorder are 2.6x greater (Balhara 2015).

The co-occurrence of alcohol abuse and mental illness is associated with:

●     Greater risk of various psychological, interpersonal, and social problems

●     Impaired decision making

●     Poor therapeutic adherence (not sticking with therapy)

●     Increased risk of relapse

●     Increased risk of self-harm (including the risk of suicide)

The brain depends on a balance of chemicals and processes. Alcohol is a depressant, which means it can disrupt that balance, affecting thoughts, feelings and actions – and, at times, our long-term mental health.

The calm feeling one can get after a first drink is due to the chemical changes alcohol causes in the brain. For many people, having one drink can make them feel more confident and less anxious. That’s because the alcohol is starting to depress the part of the brain that is associated with inhibition.

However, the more a person drinks, the more the brain starts to be affected. Regardless of the mood you’re in to begin with, when high levels of alcohol are involved, instead of that calm and relaxing feeling increasing, it’s more likely that a negative emotional response will take over.

In other words, reaching for a drink won’t always have the effect you’re seeking. While having a glass of wine or a beer after a hard day might help someone relax initially, in the long run it can contribute to feelings of depression and anxiety and make stress harder to cope with. This is because drinking a lot on a regular basis can interfere with neurotransmitters in our brains that are essential for positive mental health.

Drinking tends to alter one’s perception of a situation and impacts one’s ability to respond appropriately and accurately to all the cues around us. For example, if someone is prone to anxiety and notices something that could be interpreted as threatening in the environment, it's likely one will focus in on that and disregard other less threatening/neutral information. Or, someone might narrow in on a partner talking to someone they are jealous of, rather than noticing all the other people they’ve been chatting with before that.

If one drinks heavily and regularly, they are more likely to develop some symptoms of depression. That is largely  due to the fact that regular drinking lowers the levels of serotonin in the brain – a chemical that helps to regulate mood.

Someone who already experiences anxiety or depression is more likely to develop drinking problems. For some people, the anxiety or depression came first and they’ve reached for alcohol to try to relieve it. For others- drinking came first, so it may be a root cause of their anxieties.

If you tend to drink to improve your mood or mask your depression, you may be starting a vicious cycle. Here are some warning signs that your drinking is affecting is your mood:

●     Poor sleep after drinking

●     Feeling tired because of a hangover

●     Low mood (depression)

●     Experiencing anxiety in situations where you would normally feel comfortable

Here are some ways to prevent alcohol from affecting your mood and from increasing your dependency on alcohol:

●     Use exercise and relaxation to tackle stress instead of alcohol

●     Learn breathing techniques to try when you feel anxious

●     Talk to someone about your worries. Don’t try and mask them with alcohol

●     Always be aware of why you’re drinking

●     Don’t assume drinking will make a bad feeling go away, it’s more likely to exaggerate it

If you think you have a problem with alcohol or just want to talk with someone about how you are feeling, then the next step is to reach out to someone you trust or to go directly to a mental health professional who can ensure that you get the help and support you need. Getting help for alcohol abuse and mental health issues is much easier when you have people you can lean on for encouragement, comfort, and guidance. Without support, it’s easy to fall back into old patterns when things get tough.

For some individuals, abstinence from alcohol is the only workable solution. For others, drinking in moderation works. However, alcohol abuse works for no one.

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