Many medication labels feel scary and anxiety-inducing. The package warnings make it seem like you are about to ingest a concoction of lighter fluid, rat poison, and asphalt. It’s easy to get lost in the gauntlet of warnings. Here’s what I suggest doing instead: ask your doctor or pharmacist these four questions (if they haven’t already answered them):

· What are the most common side effects?

· What are the potential serious side effects?

· Are there any effects that should prompt me to seek medical care?

· Are there any alternatives?

For most people, with a doctor’s supervision and when taken as prescribed, ADHD medications are safe. But in most circumstances, if someone has a history of substance use, I don’t recommend stimulant medication because it may be a setup for relapse. For this reason, treating someone with severe ADHD who has been using non-prescription stimulants for years becomes complicated. Someone may feel they cannot function without a stimulant. Sometimes doctors prescribe stimulants in small amounts or ask family members to ration them. Some doctors feel this does more harm than good and decline to prescribe stimulants in certain circumstances. Overuse or inappropriate use poses many risks. Take, for example, insulin. For people with type 1 diabetes, insulin saves lives. For someone who doesn’t have diabetes, it could cause seizures, coma, or even death. The same is true for stimulants. Overuse or misuse can have disastrous consequences.

I understand there is a lot of frustration when a patient requests a stimulant and a doctor declines to prescribe it. It might be useful to know that it is much easier for a doctor to write a prescription, even when they fear it may lead to relapse, than to explain their rationale for declining and face the aftermath of frustration. A doctor’s decision not to prescribe medication usually means they care enough to do what’s best. It’s not about standing up to a patient but instead about standing up for a patient.

As an alternative to stimulant medication, your doctor may prescribe one of the non-stimulant options. Some people prefer these options because they often require less monitoring and have a lower potential to be habit-forming. One of the most commonly prescribed non-stimulant medications for ADHD is Strattera (atomoxetine). Atomoxetine mainly acts on norepinephrine but can also increase dopamine activity in specific brain regions. Atomoxetine reduces ADHD symptoms by 30 to 40 percent, which is less than the 60-70 percentage reduction seen with stimulants.^[1] Some people who have tried stimulants report that the medication is less effective or not effective at all.

Although its effectiveness might be lower, atomoxetine has fewer side effects than stimulants. However, it can cause drowsiness, dry mouth, urinary retention, and constipation. It may also decrease appetite and cause changes in blood pressure, an increased heart rate, and sweating. Atomoxetine can lead to rapid symptom improvement, but symptoms may continue to improve for up to three months. If there is no progress within six weeks, your doctor will likely try another option.

Guanfacine (Intuniv/Tenex) targets a specific type of receptor in the prefrontal cortex, an area of the brain responsible for memory, impulse control, attention, and planning. Another non-stimulant medication, Guanfacine, reduces ADHD symptoms by 30 to 40 percent^[2]. It targets a specific type of receptor in the prefrontal cortex, an area of the brain responsible for memory, impulse control, attention, and planning. Guanfacine is generally considered safe, but may cause sedation, dizziness, dry mouth, constipation, and abdominal pain. There is also a small risk of low blood pressure. Heart rate will be monitored during appointments. Blood pressure may drop as early as thirty minutes after taking the medication. The most noticeable effect occurs between two and four hours. However, it can take a few weeks for ADHD symptoms to improve.

Clonidine (Catapres) is another non-stimulant that is FDA-approved for the treatment of ADHD. Similar to guanfacine, clonidine acts on a specific receptor in the prefrontal cortex, an area of the brain responsible for memory, impulse control, attention, and planning. However, the studies showing response rate to Clonidine are not as clear. Some reports, including those looking at teachers noticing responses, suggest no improvement at all. Clonidine can cause fatigue, dry mouth, headaches, dizziness, and constipation. It is safe when blood pressure is monitored, but it can cause low blood pressure or low heart rate. Blood pressure may decrease as soon as thirty minutes after ingesting the medication. The most significant effect is between two and four hours. Rebound high blood pressure may occur after the medicine clears the system. Doctors will monitor your vital signs at appointments. Although the effects on blood pressure occur quickly, the symptoms of ADHD can take a few weeks to improve.

Wellbutrin (bupropion) works similarly to Strattera by blocking the reuptake of norepinephrine by the cell that released it into the synaptic gap. Wellbutrin also inhibits dopamine reuptake. Although doctors prescribe Wellbutrin in specific cases, such as when a patient cannot tolerate a stimulant, it is not FDA-approved for treating ADHD, and the response rates for ADHD do not significantly differ from placebo.

Coming up…

Part 4: Medication Safety and Important Questions to Ask Your Doctor

^[1]Marcialee Ledbetter, “Atomoxetine: A Novel Treatment for Child and Adult ADHD,” Neuropsychiatric Disease and Treatment 2, no. 4 (2006): 455-66. https://doi.org/10.2147/nedt.2006.2.4.455

^[2]Brandon Strange, “Once-Daily Treatment of ADHD with Guanfacine: Patient Implications,” Neuropsychiatric Disease and Treatment 4, no. 3 (2008): 499. https://doi.org/10.2147/ndt.s1711

The primary treatment for ADHD is a class of medications called stimulants. Prescribers usually begin with one of two drugs: methylphenidate (Ritalin) or amphetamine/dextroamphetamine (Adderall). Both medications work by modulating the chemical signals in the brain’s communication system. These signals are essential for daily functions such as sleeping, learning, moving, and mood regulation. Dopamine, a primary target of many ADHD medications, allows us to experience pleasure, set goals, work toward them, and regulate attention. When stimulant medication enters a brain cell, it triggers the cell to release stores of dopamine (along with other neurotransmitters) into the synapse.

As a result of stimulants, many people experience an improved mood, increased productive behavior, and increased attention. You can see how this helps an ADHD brain function more efficiently. Approximately 60 to 70 percent of people with ADHD respond positively to stimulants.^[1]

There are many formulations of stimulants on the market. Both Adderall and methylphenidate come in long-acting preparations which are designed to provide a consistent level of medication in the bloodstream. These formulations usually cause fewer highs and lows, which helps reduce their addictive potential. Despite the manufacturer’s efforts, some people still misuse the medication.

Many people ask me if it’s ok to take a generic formulation of the medication. It is unlikely that you will get better results with a brand name over a generic. Sometimes, manufacturers add dyes or preservatives that might cause an allergic reaction or disagree with you. For example, I can’t take any medication with red food dye because I’m allergic to it. Overall, I prefer generic medicines because they contain the same active ingredient at a lower cost.

While many people respond positively to stimulants, they also cause side effects. Stimulants cause insomnia if they are taken late in the day. They may also affect the digestive system, resulting in abdominal pain, nausea, and a suppressed appetite. Long-term use of stimulants can slow growth. Research shows that children achieve the same adult height they would without medication, but more gradually.^[2] Other common side effects include feeling jittery, nervous, or irritable. Stimulants may also worsen tics and cause headaches. Doctors monitor height, weight, blood pressure, and heart rate to prevent rare but serious effects such as rapid heartbeat, high blood pressure, and seizures. They might also check blood work, including a CBC and platelet count.

Coming up…

Part 3: Medication options for ADHD: Non-stimulants

Part 4: Medication Safety and When to Avoid Medications and Important Questions to Ask Your Doctor

^[1]Shaheen E. Lakhan and Annette Kirchgessner, “Prescription Stimulants in Individuals with and Without Attention Deficit Hyperactivity Disorder: Misuse, Cognitive Impact, and Adverse Effects,” Brain and Behavior 2, no. 5 (2012): 661-77. https://doi.org/10.1002/brb3.78

^[2]J. Biederman et al., 2010. “A Naturalistic 10-Year Prospective Study of Height and Weight in Children with Attention-Deficit Hyperactivity Disorder Grown Up: Sex and Treatment Effects,” Journal of Pediatrics 157, no. 4 (2010): 635-40, 640.e1. https://doi.org/10.1016/j.jpeds.2010.04.025

ADHD can impact identity from a very early age. Think of the stories your children told you about the other kids in their classes or maybe the stories you were told about your own kid. Alex hit me. Alex is so annoying. Alex threw a paper airplane across the room. Alex is always in trouble. Alex is so mean. Of course, these reports can be one-time incidents of mischief, but sometimes they are not. When a child shows a pattern of impulsive and disruptive behavior, the other children may start to avoid them.

Alex may start to dislike school. He might see himself as a dumb kid, or worse, a bad kid. Subconsciously, Alex could feel unworthy of friendships and begin bullying others. Over time, they might earn the label of “bad kid” and reinforce both others’ and their own negative perceptions of themselves. ADHD had the potential to change Alex’s path and character. In this case, I, would strongly consider medication.

ADHD impacts key aspects of human identity in relationships and school or work. When someone cannot keep up with relationships or jobs, their quality of life declines. In Sweden, researchers studied patterns among individuals with ADHD from 2006 to 2020. During this time, there was a notable increase in prescriptions for ADHD medication—nearly five times higher in children and ten times higher in adults. Researchers had an opportunity to determine if the medication influenced real-world results. They monitored rates of crime, traffic accidents, self-harm, and unintentional injuries among patients with ADHD before and after the sharp rise in medication use. They asked: Does medication truly help people over the long term? Across all ages and genders, higher medication use was linked to reductions in every negative area studied. People with ADHD were much less likely to commit crimes, be involved in traffic accidents, harm themselves, or suffer unintentional injuries if they took medication.^[1] As with most studies, there could have been confounding factors, but the results strongly suggested that medication has a positive impact.

Coming up…

Part 2: Next week: Medication options for ADHD: Stimulants

Part 3: Medication options for ADHD: Non-stimulants

Part 4: Medication Safety and When to Avoid Medications and Important Questions to Ask Your Doctor

^[1]Lin Li et al., “Increased Prescribing of Attention-Deficit/Hyperactivity Disorder Medication and Real-World Outcomes Over Time,” JAMA Psychiatry 82, no. 8 (2025): 830. https://doi.org/10.1001/jamapsychiatry.2025.1281

Over the past five years, the questions about neurodivergence have exploded in quantity and intensity. What exactly is neurodivergence? Judy Singer, an Australian sociologist, coined the term in the late 1990s to describe the individuality of brain development.^[1] Simply put, neurodivergence describes the range of differences in how people interpret the world and express themselves. Neurodivergence includes learning disabilities, medical conditions, and a wide range of phenomena society has traditionally labeled as strange. When doctors use the term, they most often refer to one of two diagnoses: Autism or ADHD.

But much of the information on neurodivergence available can be confusing and misleading. ADHD and autism are both over- and underdiagnosed. Many people feel unheard and invalidated simply searching for answers to explain who they are and why they feel the way they do.

My upcoming book serves as a guide for family members and loved ones of those struggling with ADHD or autism, and it provides resources for navigating the diagnosis. It speaks to the dynamics of today’s society that produce a crisis of identity and to how to establish an identity that embraces the strange and the wonderful. Neurodiversity can be an incredible gift… and can also create enormous pain. My heart is to create a space that recognizes both the struggle and the pain and offers new hope for the gift that accompanies neurodivergence.

The preorder button for my new book, Neurodivergence: A Guide to Understanding and Supporting Loved Ones with ADHD and Autism, is now available on Amazon.

https://www.amazon.com/dp/1514017466?lv=shuf&tag=ivp02-20&channelId=1&ref_=nosim&plpRedirect=mhFallback

^[1]Amy S. F. Lutz, “A New Framework to Promote Honest Discussion About Impairment.,” Psychology Today, June 26, 2023, www.psychologytoday.com/us/blog/inspectrum/202306/an-interview-with-neurodiversity-originator-judy-singer. Accessed November 24, 2025.

Imagine a string on a table arranged in a random pattern of peaks and valleys. The string represents your mood. Now, take both ends of the string and pull them tight into a straight line. Your fingers act as the mood stabilizer. Mood stabilizers are generally used for bipolar disorder, but they can help smooth out the highs and lows in mood, regardless of the diagnosis or cause.

Mood stabilizers are most often used to treat Bipolar Disorder but can also help with symptoms of mood instability related to other conditions. One of the most commonly prescribed mood stabilizers is Lithium. Just hearing about it can freak out many people, and I understand why. Years ago, food manufacturers used Lithium to imitate table salt. If you remember from high school chemistry, Lithium is in the salt group of the periodic table. The problem arose when people ate too much Lithium in their potato chips; they started to get really sick—nausea, vomiting, diarrhea, shaking, confusion, and if not treated, even death from kidney failure.

For this reason, when most people hear the word Lithium, their minds immediately think of poison. At high doses, Lithium is toxic, but at proper doses, it saves many lives. Doctors also have robust evidence that Lithium can prevent both death by suicide and suicide attempts. Lithium remains one of our toolbox’s fastest-working and most effective medicines. It is also one of the least expensive medications available.

Lithium is one medication that can be fine-tuned by adjusting blood levels. For this reason, doctors regularly monitor Lithium levels to ensure they stay within the optimal range—high enough to be effective and low enough to be safe. On most scales, this range is from 0.5 to 1.2.

Lithium, like all medications, carries a risk of side effects, including stomach upset, tremors, and acne. It can also impact the kidneys and thyroid. Lithium is not for the faint of heart, but I thank God for its discovery, as I have seen it help many patients.

Another commonly used mood stabilizer is Valproic Acid (Depakote), originally developed as an antiseizure medication. Valproic Acid (Depakote) can lower the risk of seizures and improve mood stability. Valproic acid also acts quickly and requires regular blood monitoring. Ideal levels usually range between 75 and 120. Like Lithium, Valproic Acid (Depakote) has a significant list of potential side effects. Hair loss, tremors, liver issues, weight gain, and fatigue are among the most common. However, for rapid mood cycling and disruptive behaviors, Valproic Acid (Depakote) is also a game changer.

Some considerations regarding the combination of Lithium and Valproic Acid (Depakote). If there’s any possibility that someone might be pregnant, we do not recommend these two medications. During the first trimester, Lithium and Valproic Acid (Depakote) can disrupt the development of the baby’s essential organs. In rare, life-threatening situations, mood stabilizers have been used later in pregnancy with careful monitoring.

If an individual takes this medication, their doctor will order a blood test. If they do not follow instructions carefully, the lab might return a blood level that does not provide an accurate picture. These medications can also interact with other drugs, sometimes raising or lowering the levels of Lithium or Depakote out of the ideal range. Conversely, Lithium or Depakote can affect the levels of other medications. For example, taking ibuprofen for an injury or headache while on Lithium may cause the level to become toxic quickly.

Other anti-seizure medications can also help stabilize mood. Mood stabilizers often overlap with drugs used to prevent seizures for a good reason. Both function to calm brain hyperactivity and reduce neuronal excitability. The common goal for both behavioral issues and seizures is to stabilize brain cells. Other, alternative drugs work more slowly than the first-line agents mentioned earlier and have less extensive data supporting their effectiveness; however, they also tend to cause fewer side effects and need less monitoring. Many patients choose these medications for maintenance treatment because of their better side effect profiles.

Lamotrigine (Lamictal) is an example of a medication that treats both seizures and bipolar disorder, and it can also help with depression symptoms. I usually use Lamotrigine (Lamictal) when there is mild to moderate mood instability, but the patient is not in an acute mania episode. Patients generally experience few side effects with Lamotrigine (Lamictal), although there is a very rare risk of a severe rash. In short, Lamotrigine (Lamictal) works slowly, taking a long time to have an effect, but it often does so without causing a fuss.

Some other medications that doctors may prescribe to stabilize mood include carbamazepine (Tegretol) and off-label drugs not approved by the FDA for bipolar disorder, such as oxcarbazepine (Trileptal), levetiracetam (Keppra), and topiramate (Topamax). While these have slightly different side effect profiles, they generally work to stabilize brain activity.

Atypical antipsychotics are also used to treat mood swings associated with bipolar disorder. Some examples include Risperidone (Risperdal) and aripiprazole (Abilify), Olanzapine (Zyprexa), Quetiapine (Seroquel), Lurasidone (Latuda), and Paliperidone (Invega). Atypical antipsychotics carry the risk of metabolic effects, including weight gain, high blood pressure, lipid and glucose abnormalities, and obesity. The risk levels among agents in this class vary. Abilify and Geodon have a lower risk compared to Risperdal, Seroquel, and Zyprexa; however, some data suggest that the latter drugs, especially Zyprexa, may be more effective in relieving symptoms.

The group of medications often called mood stabilizers has its share of side effects. But if you have bipolar disorder or know someone who does, you understand how devastating mood swings can be. These medications enhance quality of life through various mechanisms but share a common goal: preventing the extreme highs and lows that can cause chaos in many lives.

Mood stabilizers are most often used to treat Bipolar Disorder but can also help with symptoms of mood instability related to other conditions. One of the most commonly prescribed mood stabilizers is Lithium. Just hearing about it can freak out many people, and I understand why. Years ago, food manufacturers used Lithium to imitate table salt. If you remember from high school chemistry, Lithium is in the salt group of the periodic table. The problem arose when people ate too much Lithium in their potato chips; they started to get really sick—nausea, vomiting, diarrhea, shaking, confusion, and if not treated, even death from kidney failure.

For this reason, when most people hear the word Lithium, their minds immediately think of poison. At high doses, Lithium is toxic, but at proper doses, it saves many lives. Doctors also have robust evidence that Lithium can prevent both death by suicide and suicide attempts. Lithium remains one of our toolbox’s fastest-working and most effective medicines. It is also one of the least expensive medications available.

Lithium is one medication that can be fine-tuned by adjusting blood levels. For this reason, doctors regularly monitor Lithium levels to ensure they stay within the optimal range—high enough to be effective and low enough to be safe. On most scales, this range is from 0.5 to 1.2.

Lithium, like all medications, carries a risk of side effects, including stomach upset, tremors, and acne. It can also impact the kidneys and thyroid. Lithium is not for the faint of heart, but I thank God for its discovery, as I have seen it help many patients.

Another commonly used mood stabilizer is Valproic Acid (Depakote), originally developed as an antiseizure medication. Valproic Acid (Depakote) can lower the risk of seizures and improve mood stability. Valproic acid also acts quickly and requires regular blood monitoring. Ideal levels usually range between 75 and 120. Like Lithium, Valproic Acid (Depakote) has a significant list of potential side effects. Hair loss, tremors, liver issues, weight gain, and fatigue are among the most common. However, for rapid mood cycling and disruptive behaviors, Valproic Acid (Depakote) is also a game changer.

Some considerations regarding the combination of Lithium and Valproic Acid (Depakote). If there’s any possibility that someone might be pregnant, we do not recommend these two medications. During the first trimester, Lithium and Valproic Acid (Depakote) can disrupt the development of the baby’s essential organs. In rare, life-threatening situations, mood stabilizers have been used later in pregnancy with careful monitoring.

If an individual takes this medication, their doctor will order a blood test. If they do not follow instructions carefully, the lab might return a blood level that does not provide an accurate picture. These medications can also interact with other drugs, sometimes raising or lowering the levels of Lithium or Depakote out of the ideal range. Conversely, Lithium or Depakote can affect the levels of other medications. For example, taking ibuprofen for an injury or headache while on Lithium may cause the level to become toxic quickly.

Other anti-seizure medications can also help stabilize mood. Mood stabilizers often overlap with drugs used to prevent seizures for a good reason. Both function to calm brain hyperactivity and reduce neuronal excitability. The common goal for both behavioral issues and seizures is to stabilize brain cells. Other, alternative drugs work more slowly than the first-line agents mentioned earlier and have less extensive data supporting their effectiveness; however, they also tend to cause fewer side effects and need less monitoring. Many patients choose these medications for maintenance treatment because of their better side effect profiles.

Lamotrigine (Lamictal) is an example of a medication that treats both seizures and bipolar disorder, and it can also help with depression symptoms. I usually use Lamotrigine (Lamictal) when there is mild to moderate mood instability, but the patient is not in an acute mania episode. Patients generally experience few side effects with Lamotrigine (Lamictal), although there is a very rare risk of a severe rash. In short, Lamotrigine (Lamictal) works slowly, taking a long time to have an effect, but it often does so without causing a fuss.

Some other medications that doctors may prescribe to stabilize mood include carbamazepine (Tegretol) and off-label drugs not approved by the FDA for bipolar disorder, such as oxcarbazepine (Trileptal), levetiracetam (Keppra), and topiramate (Topamax). While these have slightly different side effect profiles, they generally work to stabilize brain activity.

Atypical antipsychotics are also used to treat mood swings associated with bipolar disorder. Some examples include Risperidone (Risperdal) and aripiprazole (Abilify), Olanzapine (Zyprexa), Quetiapine (Seroquel), Lurasidone (Latuda), and Paliperidone (Invega). Atypical antipsychotics carry the risk of metabolic effects, including weight gain, high blood pressure, lipid and glucose abnormalities, and obesity. The risk levels among agents in this class vary. Abilify and Geodon have a lower risk compared to Risperdal, Seroquel, and Zyprexa; however, some data suggest that the latter drugs, especially Zyprexa, may be more effective in relieving symptoms.

The group of medications often called mood stabilizers has its share of side effects. But if you have bipolar disorder or know someone who does, you understand how devastating mood swings can be. These medications enhance quality of life through various mechanisms but share a common goal: preventing the extreme highs and lows that can cause chaos in many lives.

Disclaimer: The below blog does not establish a doctor-patient relationship or evaluate any individual’s risk factors or benefits. Instead, the blog offers helpful guidelines from a psychiatrist’s perspective. It does not substitute for advice from your doctor.

What’s so bad about benzodiazepines?

“So, what do you do for a living?” Fran (name changed to protect identity), a woman I met at church, asked me as we chatted at the coffee table.

“I am a psychiatrist.”

Fran stared at me, her eyes widening with surprise, then narrowing into an unmistakable glare.

“You had a bad experience,” I guessed aloud.

“I hate psychiatrists. They have way too much power.”

My mind combed through the possibilities of the negative experiences that may have occurred with Fran and a psychiatrist or therapists. A curt or callous response? A blunt confrontation? The most likely reason I’ve observed for patients to be angry at their psychiatrists: declining to give a diagnosis or medication?

“I’m sorry you had a bad experience. I know it can feel powerless to be a patient. Can I get you some honey or milk for your tea?”

She shook her head no and continued, “Why are they so mean when it comes to prescribing medication?”

“I don’t know your specific situation, but we all have our moments, even when we really try hard and care about our patients. On a hopeful note, I have some close friends who are psychiatrists who are among the kindest people I know.”

“I don’t know if you’d think that if you were one of their patients. If your goals don’t match their goals, forget it.” Fran first struggled to put the plastic lid on her tea, then slammed it down with a fist, spilling some of the tea onto the table.

I wiped it up without commenting and asked myself. How can I show Fran that, beneath the title, I am just an ordinary person who cares about her?

She looked at me, then at her tea. “You might as well know. My doctor refused to give me Klonopin, and I really needed it. She just sent me away to suffer. What’s so bad about Klonopin?”

It’s a good question. When you ask for a Klonopin or something like it, especially by name, you may observe an audible sigh and noticeable tension in your doctor. Ironically, requesting anxiety medications can make your doctor feel anxious. This reaction is unconscious and probably unrelated to you. Most of the harshest insults I have received during my career came from patients seeking these medications.

The class of medicine I’m referring to is called benzodiazepines. It includes Alprazolam (Xanax), Diazepam (Valium), Clonazepam (Klonopin), Chlordiazepoxide (Librium), Lorazepam (Ativan), and others. Why all the attention on these medications? For most people, the medications work very well. When you feel anxiety, you take a pill, and in a matter of minutes, the fear dissipates.

If they work so well, why aren’t they prescribed all the time? There are some drawbacks. As you might have guessed, these medications can be addictive if not used carefully. Some pose a higher risk of addiction than others. Just as quickly as anxiety vanishes, it can return even stronger in a rebound effect.

Some benzos closely resemble street drugs and can be used and sold similarly. Like many illegal drugs, benzodiazepines cause the body to build a tolerance, so you need more of the medication each time to achieve the same effect. Stopping benzodiazepines suddenly can also lead to life-threatening withdrawal symptoms. They can be dangerous when driving and will appear on a toxicology screen. If someone is caught driving with these medications in their system, law enforcement may charge them just as they would if they were intoxicated with alcohol.

Why do we prescribe these medications at all? First, they can prevent seizures related to alcohol withdrawal. I most often prescribe these medications in a hospital setting for someone undergoing detoxification. In this context, they can be lifesaving. Benzodiazepines also help stop seizures in emergency situations.

At times, I prescribe benzodiazepines to treat short-term, intense episodes of anxiety. The longer-term solution, a group of medications called SSRIs, can help prevent anxiety, but they take four to six weeks to take effect. Often, patients need relief faster than a SSRI might provide. Anxiety related to specific situations also responds well to benzodiazepines. For example, if someone fears flying, they can take a benzo before a flight. One pill might enable someone to see the world and visit loved ones. During severe stress, I also prescribe small doses of benzodiazepines. These medications can promote relaxation and sleep, which are essential for healing.

In short, the benzo class of medicine, like all medicine, is neither good nor bad. For each individual, the risk-benefit ratio is unique and can change with circumstances. Ideally, doctors evaluate this ratio and make a prescribing decision appropriate for you. Sometimes this process happens so quickly that it feels arbitrary or cruel. I’m the first to admit that doctors can be rude and arrogant. If your doctor’s decision doesn’t make sense to you, try asking them to share their thought process. “I’d like to understand your thoughts on this…” Even if you still disagree with their opinion, knowing that they heard you and weighed the options can help.

Still, if you want to glare at me over the coffee station at church, I’ll understand.

Yesterday, after the chaos of Christmas had ended and our family members had left for home, I sat down for a moment and returned to writing. I allowed myself the gift of writing whatever I wanted: unfiltered, no editing allowed. In these moments, when I write for the pure joy of it, what emerges so often is a children’s story.

My family gave me the gift of children’s literature and wrapped it in bows and bright paper, the kind covered with small forest critters. Time and time again, I snuggled in next to my mom or my grandma to listen to stories of imaginary worlds where teddy bears searched for homes, and fierce monsters cried. And although both women have long since passed, I can still hear the echo of their voices as they read.

I passed on their gift and read to my own children for hours as they grew up (even when they were in utero). We read the old classics and the new destined-to-be-classics where pigs are precocious, and pigeons hate going to bed. The night before my son left for college, we read a pile of his old favorites.

Maybe I love children’s books because they recreate childhood moments when I felt safe and loved. Perhaps I love them because they contain simple life truths told without pretense. Maybe I sense the rush of pure joy that their authors, too, felt as they wrote them.

Whatever the reason, my mini writing holiday has ended, and a quirky hedgehog, brought to life by a beloved family friend, has woken from hibernation and begun another adventure.

One of the most common explanations I hear for someone’s anger is the perception of injustice. When we perceive something or someone as unfair, we rush out like knights with our swords drawn, ready to fight. Maybe we are defending a noble cause. Maybe not. Most often, we have made ourselves queens and kings in life and are protecting our own rights.

If you have spent any length of time around children, you have heard the statement ‘It’s not fair’ to the point of exhaustion. Somebody else was chosen captain of the team. It’s not fair. Somebody else got a new car. It’s not fair. Someone did not get punished. It’s not fair.

Notice two things about these statements:

• Justice is relative.

• These statements are not a defense of a cause; they represent a claim of entitlement.

We are called as Christians to fight injustice in defense of others. We are not called into entitlement—quite the opposite. Christ was born in a stable to a poor family. The only crown he wore on earth was made of thorns. He was perfect, yet allowed himself to be killed so that we wouldn’t face justice.

Next time you feel your anger boiling over from being treated unfairly, ask yourself, ‘Am I fighting for justice or my own entitlement?’

Your anger hurts you just as much or more than it hurts anyone else.

Remember back to the last time you felt angry. Likely, you felt a pit in your stomach, a quickening of your heartbeat, or tension in your muscles. Perhaps you couldn’t fall asleep right away. Regardless of what you were angry about, the physical response itself felt lousy.

Even more painful is the action you may have taken. Maybe you yelled at your kids or your dog. Perhaps you said something to your spouse that you regret. Maybe you pounded a fist, destroyed an object, lost a job, or alienated a friend. The list goes on and on.

Now, in addition to the anger, you feel a sense of shame. You could feel anxious, overwhelmed, or depressed.

Are there rare cases where the physical response of anger serves you? Yes. In a situation of danger, going into a fight-or-flight response enables you to respond physically. However, chances are that the situation you are in is not life-threatening. It’s threatening your pride.

Anger involves unrealistic expectations.

One source of anger that may be less obvious is the result of having unrealistic expectations; when those expectations are not met, anger often follows.

Here are some examples:

Anna, a new bride, thinks she is angry with her bridesmaids for not being more involved in her wedding planning. Her real anger comes from her disappointed expectation of having the perfect wedding.

Randa is angry at her parents for not taking her on vacation. Her anger stems from an unrealistic expectation of frequent travel.

As a society in this country, we expect a lot. Take an ordinary starter house in the Midwest. To most of the world, that house is an unachievable paradise. But we want the spare bedroom, the bigger yard, the remodeled kitchen, and sometimes, when we don’t get it, we get angry. This isn’t about us not having enough. Most of us have material goods that many people could only dream about. Our anger is about our unrealistic expectations of what we should have.

1. External things do not create your anger. Your thoughts do.

Imagine your roommate leaves her dirty dishes on the counter for the umpteenth time, even though you have asked her not to. You feel angry and go into your room, shutting the door. Your roommate is not responsible for your anger. Your thoughts are. You may be protesting right now. Yes, your roommates’ action or inaction precipitated a reaction, but that reaction was entirely under the control of your thoughts.

Your automatic thoughts may have gone something like this:

My roommate doesn’t respect me. What does this thought lead you to feel?

What if your thought was instead:

My roommate left the dishes out because she rushed to pick me up from work after my car wouldn’t start. What does this thought lead you to feel?

The action of your roommate remains the same. Your thoughts toward her inaction change, and with the thoughts, the emotion also changes. Your roommate didn’t make you angry; you did.

2. You are not angry at what you think.

Really. Strong emotions divert blood away from the rational centers of the brain, making us less rational.

Let’s say you get fired at work for spotty attendance and tardiness. On the way home, someone cuts you off.

Your automatic thoughts:

The drivers here stink.

Can’t you learn to drive?

Why are people so selfish?

At the moment, you think you are angry at the person who cut you off. It is annoying to be cut off, after all. You realize you feel angry and believe it is about the driver who cut you off. Deep down, you are furious at your boss, and you project your anger onto the other driver.

Later, you realize you feel angry and believe it is about your boss. But deep down, you know your boss must fire people with poor attendance to keep the company running and efficient. All drivers, including you, make careless mistakes. Your anger is about you.

3. Anger is an act of self-defense.

Your body is wired to act in self-protection. If someone throws a rock at you, it is nearly impossible for you not to move. You may duck, dodge the rock, catch it, cover your head, or scream, but you will do something in your defense. Similarly, you respond in anger when someone threatens your sense of inner security.

The next time you feel anger, ask yourself, “Who am I defending?”

The overwhelming majority of the time, the answer will be one word: me.

Why am I angry that my colleague insulted me?

It hurt my sense of who I am. Me.

Why am I angry that my kids leave their messes everywhere?

I feel my time is too valuable to pick up after kids all day. Me.

Why am I angry that the traffic is bad?

Because I did not give myself enough time to get to work, I’ll look bad. Me.

Why am I angry that my dog urinated on the carpet?

I want and should have a clean, nicely scented carpet.

It all boils down to me.

Of course, the real world is infinitely more complex. We are designed with billions of intricacies and personality features. But the concept of the little trains still applies. Thomas is not supposed to be like Gordon. Percy is not supposed to be like Edward. Bruno communicates differently, and that’s OK; the other engines try their best to understand him. The reason we love these engines is that they make a slight echo of the real world with one simple truth. You’re supposed to be different. You’re blessed to be unique. Go ahead and embrace your neurodiverse self.

So many times, as a practicing psychiatrist, I encounter people who struggle with depression centered around unrealized hopes and dreams. They feel that they have promised themselves something or that God has promised them something, but that promise remains unfulfilled. I can relate. The entire time I was in medical school and residency, I kept telling myself, “Once you’re a doctor, you will have realized your dream, and you will be satisfied.” Not surprisingly, being ‘hooded’ as an MD did not come with a lightning bolt of fulfillment. I love being a doctor and feel a tremendous amount of satisfaction and enjoyment in my career, but doctoring in no way could fill the God-shaped hole within me. My contentment came at the moment I realized I had God, and that was truly all I needed. That contentment doesn’t deter me from dreaming or pursuing a goal, but it fills me as I work toward whatever God has laid on my heart. And when I fall short of a goal or completely fail, I can rest with the confidence that my identity is unscathed.

Friend, I don’t know what pain you may be experiencing from an unfulfilled dream, but I do know that whenever a roadblock has occurred in my life, no matter how painful, God has led me down another road, a better road I couldn’t previously conceive. Your road is still ahead.

Our family loves college football. We all have our teams to which we pledge fierce loyalty. When our oldest was studying at UCLA, we raised a flag featuring the UCLA Bruin logo on one side and the USC Trojan logo (my husband’s lifelong team) on the other, with the caption “A House Divided.” Football is one of the reasons my son chose Baylor: it values the college football experience. Freshmen order jerseys with their names and graduation year on the back and dash across the field in a swarm of yellow—the Baylor Line. Baylor alumni fly planes overhead, fireworks explode at every Baylor touchdown, and marching bands perform while creating shapes (notably the state of Texas) and letters.

As our bonus son experienced this spectacle for the first time, dutifully donning a Baylor T-shirt and hat, I reflected on the experience. Why do we revere college football? Of course, there are the usual explanations: economics, escapism, and the community of a shared team and mission, but there’s something more profound. Maybe it’s a celebration of our college years, a time when our dreams were bigger than our responsibilities. Perhaps it’s a way of passing down our most nostalgic traditions to our children. I believe college football also represents everything Americans cherish: supporting the underdog, breaking barriers through hard work, and respecting diversity. College football is about grit, persistence, and family. So, on Saturdays in the fall, we will continue to put on our gear, gather together, and cheer for our teams. What’s not to celebrate?

But then out of nowhere, I am startled by a ruckus of dogs barking and my son yelling, "Mom, the dog is bleeding.” Our twelve-pound poodle mix, Gus, who looks like a teddy bear, had stuck his nose into a bush to investigate a noise and encountered the fangs of a very large rattlesnake.

As blood poured from his wounds, I grabbed him and hurried him to the local vet, who kindly came in after hours to start administering anti-venom. After 24 hours and three rounds of antivenom, the vet allowed me to see my little Gus. He was hooked up to an IV, both eyes swollen shut, and his face black and blue, bruised with large patches of necrosis around the fang entry points. Gus and I cried together. He cried out for relief, and I cried out, wishing I could take his pain away.

“Please keep fighting,” I begged him, feeling selfish for asking him to endure his suffering, but knowing if he survived, he had many years ahead. I thought of my kids at home praying for him. I thought of all the mornings Gus would prance around with the joy of life and wake me with kisses.

I held back my urge to vomit on the way home and fell into the sofa when I arrived.

Twenty-four hours later, Gus arrived home, swollen and bruised with patches of black tissue, but still alive. We took turns holding him, and he told us his story in forlorn whines.

A week later, he is snuggled up next to me as I write. Gus looks nothing like a teddy bear with his shaved head and patches of sloughing skin, but he spent the morning prancing and giving kisses.

I've found myself more than once like Gus, bitten by a venomous force I didn’t see coming. I cried out to God for relief, unaware that He had me connected to the antivenom I so desperately needed. I imagined God’s arms around me in those moments, just as my arms wrapped around Gus. He mourned with me but allowed me to endure the pain, knowing the years of purpose that lie ahead. He knows I'll eventually be home, snuggled up next to him.

Maybe you are currently walking through a season of pain. Friend, I don’t know the wounds you have or the reason for your suffering, and I don’t know the outcome of your injuries, but I do know the comfort of the One who carries you. Hold on. There is hope and purpose ahead.

Our twelve-year-old goldendoodle Bentley tends to get grumpy. She’s a large dog (about the same mass as our other four dogs combined) and has gradually grown blind and arthritic. Overall, she appears content and manages well, navigating around the walls and furniture in our house. But when the grumpiness sets in, she will snarl and show her teeth as a warning to her pack mates to stay clear.

Despite her grumpiness, our family overwhelmingly reports that she is their favorite dog. Why? Because she’s Bentley. For the past twelve years, she has been a pillar of our family, snuggling us into comfort and kissing us into laughter. She’s been there by our sides through moves and transitions, sickness, loss, and joy. She’s just been present.

Maybe that’s enough. Just being present. When we show up for the people in our lives, we communicate something compelling. I remember distinctly my grandmother getting on her very first plane to see me graduate from Cornell. I can visualize the people who showed up at my mom’s memorial. I remember the people who came to help me move when I was on the verge of collapse. I remember the people who offered to shelter my family when fires raged nearby. And I remember the people who signed up for my blog with no intent other than to support me.

It doesn’t matter if you are grumpy (although please try not to show your teeth), arthritic, or bumping into life’s furniture. Just show up. People will remember.

Thank you, friends, for showing up.

I immediately objected, “No one in our house is average.”

But then I thought about it. I adore Gus and all my other dogs and kids, so of course, they’re not average to me. They are treasured. But statistically, half of us in any given study are average or below average. I am undeniably a below-average singer, typist, and …. (fill in one of so many other areas).

But statistics aside, I protest that any of us is average. I am certain no baby is average. I had the privilege of ‘catching’ many newborns during my obstetrics rotation in medical school. Every single time, it astounded me. A billion microprocesses had to occur in perfect coordination to produce a tiny miracle of a human. How could that possibly be average?

I believe we are all uniquely created, designed with a purpose and intention. None of our fingerprints is the same, and none of our life purposes is identical either. So why do we keep comparing ourselves to others? People compare everything: their wealth, success, work, mission, athleticism, speed, weight… it’s an endless cycle. A trap. It all becomes a setup for disappointment or, worse, jealousy and even hate. There will always be someone more intelligent, kinder, or more beautiful. Even if you are the greatest of all time today, someone will likely surpass you in the future. But this fact doesn’t have to be depressing.

What if instead we found joy in celebrating the beauty of others? We can share in the happiness of our friends and family's successes, as well as those of the person who beat us out for a job or outran us in a race. We could find contentment in knowing that we are uniquely gifted and talented, fulfilling our distinct roles.

You are not average, and you never will be. Stop comparing yourself to the person next to you. You're a lousy version of them. But you are an amazing you, full of purpose and hope. Imagine yourself as a newborn baby with a medical student smiling over you, your sparkle reflected in their tears. Go celebrate and be the miracle you are meant to be.

You can step off the self-esteem ride by defining yourself according to a new standard—one that isn’t set by others or even by yourself. You can find true confidence by understanding that your identity isn't based on your flawed self, but on an infallible, unshakeable, and constant God. Your confidence doesn't come from your abilities; it comes from knowing God's strength and trusting that He is doing good work in you. I can’t do anything good enough to earn my status as a child of God, but I can’t do anything horrible enough to lose it either.

With this identity, I can forgive myself when I make mistakes, and I can accept my successes in stride, knowing that they are not mine alone. I find this liberating. I only have one audience to please and only one objective. “Doesn’t this lead to stagnation?” people ask me, “How can you reach new heights without a drive for success?” My drive comes from being in love with God. I work hard and persist out of love, not a desire to be recognized.

It's all too easy to get back on the ride. The lies start to creep in: You are equal to what you accomplish. You must earn your worth. When I get sucked back on the ride, I know I must spend more time in my quiet place, seeking the presence of God. The more times I exit the ride and the longer I avoid getting back on, the easier it becomes to remain on solid ground.

Instead of spending time trying to build self-esteem, invest your time with God, who will affirm your new identity: one that will never cycle.

Then I began musing about the processes within me that I control: my thoughts, my writing, my parenting, and my interactions with friends and family. I live a relatively regulated life, yet in comparison to my autonomic processes, I am all over the place. I have lapses in consistency, do things that I regret, and get tired in the process.

It struck me that the most brilliant parts of me are the ones I have ceded control over. What if that was also true about our spiritual lives? God has a plan. He has consistently shown me that His plans are better than mine. Yet somehow, I stumble around trying to figure out His will, wrestle for control, and fear there is some task I might do wrong that will keep me from His perfect will. What a load of nonsense. What I really need to do is surrender and let God weave something magnificent that I could never imagine. That doesn’t mean I should stop trying to walk in obedience, and it doesn’t mean I should be lazy. But ultimately, the outcome is not mine to determine. I may never think as radiantly as my body performs, but the more I surrender, the more my life becomes consistent and coordinated, and the less exhausted I become in the process.

Deep down, there’s one person I desperately want to avoid. She wears her frizzy hair pulled back from her face, no makeup, jeans, and forest green Birkenstocks. She woke up every day at 4 AM and ran five miles. She hated shopping, disliked chocolate, and carried a smug mix of dreams, grit, and ambition. To make matters worse, she believed she played some role in her success, thinking she earned her achievements through hard work. What a fool. I hope that girl is long gone.

But there’s a part of her that’s still here. She still wears very little makeup and forest green Birkenstocks (thankfully, they've come back into style). She now gets up at a much more reasonable 5:30 AM to exercise. She likes shopping (if it is efficient and doesn’t involve trying anything on) and enjoys fine chocolate. But that’s where the high school me ends.

Now there’s a woman who is still full of flaws, but who wakes up every day and realizes that everything she has and everything she’s done has been because of God’s grace.

I pray that in ten years, I’ll attend my next reunion and feel grateful I don’t have to meet the person I am today. I hope that person will be gone, replaced with someone more surrendered, more graceful, and more patient: someone who, after spending a decade longer in God’s presence, can look back at the current me and say, “What a fool.”