The Journal of Psychosomatic Medicine Recently completed a follow up study comparing the effective of aerobic exercise to the drug Zoloft (sertraline) for treating depression.  The results?

After 4 months depression was in remission in:

47% of patients treated with Zoloft

45% of patient in a supervised exercise class

Their follow up study looked at these same patients one year later and found that patients in the exercise group had LESS depressive symptoms than those taking medications.

This study should speak volumes and should have been all over the news.     Here are some of the things that this study also did not take into affect.

1. Many patients taking zoloft will experience sexual side effects such as decreased libido, delayed ejaculation and also a general apathetic attitude about sex.

2. People who exercise stimulate growth hormone, sex hormone production, lose weight, look better and will have an enhanced sex life.

So when you really compare the results of this study exercise is SIGNIFICANTLY better.

I tell every single one of my patients with depression about this study.   It is worth trying even before starting marijuana therapy.

So get moving!

Step 1: Determine if you have a qualifying diagnosis
Most patients think medical marijuana can only be recommended for dying patients or those with severe disabilities. In California, that is not the case. The most common reasons patients receive a medical marijuana card are:

a. Chronic Pain: any condition where chronic pain is a component can qualify. For example, back pain, joint pain, post-operative pain etc.

b. Muscle spasms: can be for many reasons but things like Multiple Sclerosis, Restless Legs Syndrome

c. Nausea and Poor Appetite

d. Insomnia and Anxiety

e. Mood disorders such as depression.

f. Inflammatory bowel disease including Irritable Bowel Syndrome: Crohns Disease and Ulcerative Colitis

***There are over 250 indications that we can recommend cannabis for. You can simply call our office and find out if your diagnosis will qualify. 877-721-0047

Step 2: Gather your medical documentation.
When you see a doctor for medical marijuana he will need to review your medical records and verify your diagnosis. You can simply contact your treating doctors office and ask that they release your medical records to you. They simply have you fill out a form.

Step 3: Locate a doctor that is specialized in recommending medical marijuana
Dr. Breen has extensive knowledge about the medicinal benefits of using marijuana and will be able to answer any questions you may have. Visit our website at www.MCSoCal.com and see our office locations in Irvine, CA and Long Beach, CA

Step 4: Simply bring in your documentation.
At your appointment Dr. Breen will review you medical records, go over all the benefits and risk of using medical marijuana, perform a physical exam and then determine if it is an appropriate treatment approach.

Step 5: Purchasing your Medicine at a Medical Marijuana Dispensary
Doctors are not allowed to provide you with the medical marijuana so you have to go to a local medical marijuana dispensary. You will need to bring your written recommendation signed by Dr. Breen They will make a copy of it and verify your eligibility by using our 24 hour online verification system. You can then purchase up to 8 ounces of medical marijuana.

The process is as simple as that. Dr. Breen and the staff of MCSoCal will make sure that all your questions are answered before your leave our office. We realize that for many patients this is a very new experience and can be nerve racking. We want to assure you that your doctors visit will be very professional and compassionate.

Thanks for visiting our site and reading our blog.

MCSoCal Staff

Patients often question if marijuana is addicting, if they can develop a dependence, tolerance and/or experience withdrawal symptoms.    The DSM-IV manual (main psychiatric diagnosis manual) defines cannabis dependence:  It reads as follows:

“The essential feature of Substance Dependence is a cluster of cognitive, behavioral and physiologic symptoms indicating that the individual continues use of the substance despite significant substance-related problems”. Accordingly, a diagnosis of substance dependence is made if three or more of the following criteria occur at any time in the same 12-month period:

• Tolerance, as defined by either or all of the following:
  • A need for markedly increased amounts of the substance to achieve intoxication or the desired effect
  • A markedly diminished effect on the user with continued use of the same amount of the substance
• Withdrawal, as manifested by either of the following:
  • Characteristic withdrawal symptoms from the substance, such as insomnia, restlessness, loss of appetite, depression, irritability, and anger.^[42]
  • The same or closely related substance is taken to relieve or avoid withdrawal symptoms
• The substance is often taken in larger amounts of over a longer period than was intended
• There is a persistent desire to cut back or control substance use, or unsuccessful attempts to do so
• Considerable time is spent obtaining the substance
• Social, occupational or recreational activities are given up or reduced because of use of the substance
• The substance is used despite knowledge of persistent or recurrent physical or psychological problems caused by the substance.

It has been my experience speaking with patients that when marijuana is used therapeutically to treat a certain conditions (i/e pain, headaches, nausea) there isn’t the amount of dependence that is seen with recreational use.    There has been evidence in the literature of patients requiring more medicine to get the same effect of the drug.    However this usually plateaus at a certain dosage.

I do see a withdrawal syndrom in patients who have used marijuana recreationally for prolonged periods of time (daily for years).  When they stop they experience irritability, insomnia, difficulty focusing and depression.     These effects can be mitigated in the patient who uses medical doses for a specific condition by taking a drug holiday (usually one week every few months).   Scientist are not exactly sure of the mechanism for which dependence develops but feel its most likely due to changes in the CB1 and CB2 receptors.

Studies of long term marijuana users (recreational) have shown over 50% experience dependence issues.    Research points to risk factor for dependence as: regular daily use (or more than 3x/week) and when people start using in their teens.  Adolescents over experience amotivation and fall behind in school and other scholastic achievements.

My primary focus is trying to determine if the benefits of using marijuana outweigh the risks for patients, not recreational users.  The majority of my patients are using medical marijuana as a substitute for another drug.  For example, they use marijuana instead of opiates for pain, benzodiazepines for anxiety and sleep and other drugs with far more potential for dependence, withdrawal and tolerance.     So I guess you have to look at each case individually and make a determination what is best for each patient.

For example today I had a pain patient who has been using a fentanyl patch and also using oxycodone for breakthrough pain.   He has been able to reduce his oxycodone dose from twice daily to maybe one pill a week.  That in my mind is significant and is worth studying.   If you could follow the path of a pain patient on oxycodone and parallel that with someone using medical marijuana I think the results would show significant less morbidity and mortality from using marijuana.   The chronic nausea and constipation alone associated with opiate use is enough justification to use medical marijuana.     This is strictly from thousands of discussions with patients about the overall quality of their life.

In conclusion, I do believe that there are tolerance and dependence issues with marijuana.   However we need to study the right populations to see if this is the case with medical doses vs recreational use.   Secondly, the must also consider the risk/benefit ratio of using medical marijuana in RELATION to the other medications that patients WOULD be using.

More studies need to look at this so that we can give patients more scientific data vs speculation and an educated guess.

Feel free to leave comments about your thoughts on this issue.

Be blessed,

He came to me because for the last 2 months he has been using medical marijuana and says it has helped tremendously.   He feels he is sleeping better and his days are not spent worrying (as much) about his mortality.     READ ON….

What is CLL?  It is simply a cancer that affects the white blood cells in the body.  White blood cells fight infection and regulate the inflammatory response in the body.   Cancer means that cells grow out of control, unchecked.   Normally cells grow, function and then die off.  They do not just keep proliferating.   So in this case we see a rapid growth of white blood cells in the body.  What happens is that these cells grow unchecked in the bone marrow (where blood cells are formed) and take over.    The bone marrow becomes overwhelmed and can not properly produce blood cells.

This patient noticed this when he started feeling fatigued more than usual.  This was most likely because he wasn’t producing enough red blood cells (which carry oxygen to the cells of the body).   He also noticed that he had reoccurring mouth infections (result of abnormal white blood cells).   When his doctor checked his blood counts it was clear something was wrong.

A diagnosis of cancer is a very life altering event.   It instantly changes patients priorities and immediately forces them to consider their mortality.   Fo my patient is threw him into a severe depression with underlying anxiety.  (interestingly the survival rates for CLL are pretty good)   He had a real difficult time knowing his days were numbered… even though every one reading this, including me, is “on the clock.”  The difference is that we don not think about often.  Cancer patients do all the time.

Cannabis (marijuana) can be a great alternative for patients that do not respond to traditional medications or have to stop them due to side effects.   Typically one or two doses of a medical grade strain will suffice.   This will allow patients to still function as far as their day to day responsibilities yet get the benefits of the medicine.

He told me he used many different medications and they all worked to a certain extent.  However the side effects he was experiencing made the risks outweigh the benefits.    It wasn’t until he tried cannabis that he felt some relief without worrying about any side effects.    He simply has been using it in the afternoons and at night to help him sleep.   He uses a vaporizer to avoid having to smoke it and prefers an indica strain because of its sedating affects.

However, because my routine has been thrown off by dining out, long drives and late nights I stopped exercising this week, have drank more coffee than I normally do (3 cups per day vs 1-2 per week) and have been eating donuts and banana bread from starbucks without any care in the world.

Typically I take very good care of my health.  I exercise hard at crossfit714 (www.crossfit714), eat healthy 6 days per week, drink very little coffee and get a solid 7-8 hours per sleep each night.

When I speak with patients about their diet and lifestyle, most live the way I have been living this past week.  Very little exercise, a lot of coffee, lack of sleep and diet high in refined sugars and carbohydrates.

I AM HERE TO TELL YOU THAT THE WAY I HAVE BEEN LIVING IN JUST ONE WEEK CAUSED DEPRESSION.  And here is why:

Serotonin is a neurotransmitter in the brain (one of many) that primarily affects mood.    Normal levels of serotonin in general lead to good energy levels, happy, rested and mentally sharp people.    Swings in serotonin from high-low or low-high can cause anxiety, insomnia, anger, irritability, depression etc.    Chronic depletion in serotonin can lead to chronic depression and mood disorders.   THIS IS FACT.

Now how does what you eat affect serotonin?   Serotonin is synthesized in the body from an amino acid called tryptophan.   Amino acids (including tryptophan) are digested and absorbed in the body from eating protein (eggs, meat, fish, almonds etc).   People who do not eat enough protein daily will have lower levels of all neurotransmitters including serotonin.

Secondly, when we eat foods high in sugar or refined carbohydrates (breads, pasta, cereals, donuts, muffins) it causes our body to over-secrete a hormone called insulin by the pancreas.  Insulin senses how much sugar we have in the blood and tells the cells to use that insulin for energy (very elementary explanation).     High levels os insulin also cause a SURGE in serotonin levels in the brain.   This makes you feel GREAT!!!  But ONLY temporarily.   After a period of time you start to feel lethargic, your energy levels go down, you get cranky, irritable and just want to sleep OR——-> eat more sugar to get that rush again.   It is a chemical reaction in the body that causes this vicious cycle of eating sugar—-> feel great—-> feel terrible—–>eat more sugar.   THAT IS ALSO FACT.

There are many other things that we put in our body that have the same affect on serotonin levels.  I will list the most common here:  1. Caffeine (terrible for you for this reason) 2. Alcohol 3. Tobacco 4. Over the counter stimulants 5.Chocolate 6. Cocaine

So how am I going to bounce back from my temporary depression?  This is how.

Last night I slept 7 hours.

This morning I did a great workout at 8am.

At 9:30 I ate some organic chicken salad and an apple.

In about 30 minutes  (noon) my wife, 10 week old son and I are going to have a nice healthy lunch.

By 3pm I will be ready to eat some almonds as a snack.

At 6 pm I will have fish for dinner with some vegetables.

At 9m I am going to eat 3 beef sticks with an orange.

Before I go to bed I will pray and thank God for everything that is great in my life.

I will be back to drinking only water.

By tomorrow I should start feeling better again.

BEFORE YOU START TAKING AN ANTI-DEPRESSANT OR ANTI-ANXITY MEDICATION…. LOOK AT YOUR DIET, SLEEP AND EXERCISE HABITS.  MAX THEM OUT FIRST AND SEE HOW YOU FEEL AFTER A FEW MONTHS.

I GUARANTEE YOU WILL FEEL MUCH BETTER.

Dr. Breen

Today in Irvine I took care of an 87 year old man named Sol who suffered from chronic pain after having his left hip replaced.  He has been taking vicodin to help with the pain but the problem is that it constipates him and doesn’t relieve the pain to where he can fall asleep.  ”I just want to get a good night’s sleep.  If I can do that this will be a blessing.”

This is a very common concern for my elderly patients.   Poly-pharmacy  causes numerous side effects… and many just want to try a more natural alternative.   The good news is that cannabis has anti-inflammatory properties, analgesic properties and can also be very sedating.  So it is the perfect medication for patients like Sol.

Typically a patient will only need one or two doses 30 minutes prior to going to sleep to see good results.  In some cases patients will require more doses but the reality is that they can use as much as they need.  It does not cause respiratory depression and is not toxic to any of the major organ systems.   AND the beautiful thing about this treatment approach is that if it doesn’t work… they don’t have to use it.  No harm no foul.   Why NOT give it a try?

The biggest concern in elderly patients using medical marijuana is whether or not it will affect their ability to perform activities of daily living.   Because it is psychoactive and affects balance, coordination and perception they have to be very careful about falling and breaking a bone.   For this I suggest that the first few times they medicate that they make sure someone is in the house with them.

So what are the benefits that the elderly patients receive from using cannabis?

1. Decreased pain

2. Increased appetite.

3. Improved sleep.

4. Improved mood.  New out look on life.

5. Reduced dependance on medications.

6.  Gain the feeling of taking control over their health.

7. Increase in activity level.   More golf, tennis, recreational activities

There are many more benefits but these are the ones that patients tell me most frequently.

If you are a wondering if cannabis can improve the quality of your life feel free to come in and see a MCSoCal physician.  We will make sure you make a well informed decision about using medical marijuana.

Be blessed,

Dr. Breen

Today I treated a 43 year old women who came to me to try medical marijuana as an alternative to Wellbutrin, Xanax and Ambien for her insomnia, anxiety and depression.  She states that this has gone on for about 15 years.     She was tired of how those medications made her feel.  ”Like a zombie” she said.      Then she asked me “do you think this will help.”

My first response to her was: “Let me ask you this question.  What do you typically eat throughout the day and how often do you eat?”

That is when her husband started shaking his head and she became reluctant to discuss her diet with me.   To put it mildly; she ate like shit.     Skips breakfast, drinks soda and coffee, eats a ton of candy and ice cream prior to going to bed.   She ate very few protein foods and no healthy fats.  The carbohydrates she at were all high glycemic (raised her blood sugar very high very quickly) foods.

This patient is depressed and has anxiety because (most likely) her serotonin levels are all over the place.   Serotonin is the main neurotransmitter in the brain that controls mood.   It requires adequate protein and fat in the diet in order to manufacture.   Specifically you have to eat an essential amino acid (must eat, can not make) called tryptophan in order to make it.   Diets high in carbohydrates and sugar and low in protein are going to deplete stores of serotonin.

Now consider this.  Her doctor put her on a Selective Serotonin Reuptake Inhibitor to improve her mood.   But the problem is that there is most likely not enough serotonin in the first place.   What this patient needs first is to fix her nutrition.   Once she does that her mood HAS to improve.

There depressive and anxious states are the result of poor nutrition compounded by life stresses that patients do not have the ability to deal with (mostly because of poor nutrition and lifestyle habits)

My recommendation: fix your nutrition first.  Give your body everything it needs and stop giving it toxins and THEN see what happens.   If you are still symptomatic then and only then should you consider medications.

Be blessed,

It is fairly common for patients to come into my office taking 5 or more medications every day.  They start with one or two… develop side effects and then are prescribed a few more to deal with those side effects.   It starts to snowball and before you know it they are taking pills all day.   PATIENTS HATE THIS! I have found compliance with medication to be very low with patients who take multiple medications.

This patients medication regimen is as follows:

1. Wellbutrin 150mg 2x/day : this is used to treat her depression and improve her mood.  It’s not known exactly how it works but it increased dopamine and norepinephrine levels in the brain.   THERE ARE 25 LISTED COMMON SIDE EFFECTS!

2. Lamotrigine (lamictal) 300mg per day:  this is used as a mood stabilizer for her Bipolar.It is not known how this medication works.  It is also used to treat seizures.   IT HAS 32 COMMON SIDE EFFECTS!

3. Risperidone (Risperdal) 1.5md per day: this drug is to treat the manic symptoms associated with bipolar and also schizophrenia.   THis works by changing serotonin and dopamine levels in the brain…. but the exact mechanism of action is unknown. IT HAS 28 COMMON SIDE EFFECTS!

4. Clonazepam (Klonopin) 3 mg/day: this is used to treat anxiety.  Is a benzodiazepine and works by influencing a neurotransmitter called GABA.   IT HAS 22 COMMON SIDE EFFECTS!

5. Clomipramine (Anafranil) 75mg/day: This is used to treat her OCD symptoms.  It works by increasing norepinephrine and serotonin levels in the brain.   IT HAS 31 COMMON SIDE EFFECTS!

These 5 medications to treat her mood disorders have over 158… that is correct… 158 common side effects.   Pretty much includes every possible symptom you could imagine.

On top of that they have a combined almost 100 additional “serious side effects” between them.

Is there any wonder that this patient feels like a zombie??

The goal with this patient is to treat as many symptoms as possible with medical cannabis to see if she can reduce the dose or stop some of her other medications that are NOT improving the quality of her life.

In the past she was able to eliminate all but ONE medication and felt great.   Here goal is to do the same.

She is highly functional despite her many medications she takes.  She works full time and also has a family.   She seems to be determined to get better which is the first and most important step for many patients.

We REALLY need to educate ourselves as physicians as to the alternatives to handing out medications.  There are herbs, supplements, foods and other natural remedies that can do everything some of these meds are without all the side effects.

If you want more information on medical marijuana feel free to come in for an appointment or visit our website.  877-721-0047

Be blessed,

Dr. Breen

61 year old white female who using cannabis for her restless legs syndrome.

34 year old white male who has a diagnosis of anxiety and depression.

61 year old white female who suffers from arthritis

55 year old white male who had surgery to repair C5-6-7 herniated discs following a motor vehicle accident

51 year old white female who is going through menopause.  She has symptoms of anxiety, hot flashes, insomnia and is easily irritated.

41 year old white make who had reconstructive surgery on his right ankle and suffers from arthritis.

27 year old white female who suffers from anxiety since the age of 17.  She uses cannabis instead of xanax.

25 year old white make who injured his C6-7 vertebra surfing.   He uses cannabis for pain management.

59 year old white female who has sciatica and chronic lower back pain.  She uses cannabis instead of oxycontin.

You would be very surprised by the typical patients that I see using cannabis for their symptoms.   I think the majority of people when they think of medical marijuana envision “teenagers getting stoned.”  That is not the case and quite the opposite.

If you are suffering and would like more information on whether or not cannabis can help you improve the quality of your life feel free to call our office at 877-721-0047 or contact us online at www.mcsocal.com

Be blessed,

Dr. Breen

Selective Serotonin Reuptake Inhibitors (SSRI’s- i.e Prozac, Paxil, Zoloft, Lexapro etc) are drugs commonly used to treat depression and anxiety.  They work by increasing the amounts of serotonin that build up and concentrate around nerve cells in the brain which in turn elevates patients moods.   They are THE most common drug to treat depression and anxiety.

One of the downsides to using these medications is that they can reduce a patients libido and also make orgasm very difficult.

My first patient was a 27 year old women who had been taking Lexapro for the past 12 months for her Social Anxiety.    She went on to tell me that she is engaged to her boyfriend of 7 years.  Over the past year her sex drive has been “non-existent” which has made her relationship very challenging.   Even though her fiance has been extremely supportive she told me she feels “inadequate”  because of this.   Her boyfriend decided to search out alternative therapies when he came upon my website and read about previous patients in similar situations.

SHE TOLD ME THAT FOR THE PAST MONTH SHE HAS BEEN MEDICATING WITH CANNABIS AND HER SEX LIFE HAS BEEN GREAT. In addition to having sex more she stated that she was less inhibited which even enhanced her sexual experience with her fiance.   Her plan is to continue to use the Lexapro and use cannabis to stimulate her sex life.

My second patient was a 44 year old women who came in with her husband of 13 years.  She had a very similar story although she had been taking lexapro for depression which she had “as long as I can remember.”   They also had two autistic sons ages 10 and 8 which made time for romance very difficult.    Although she initially felt apprehensive about using marijuana as a medicine those feeling quickly subsided as her sex life started to improve.   Her husband was definitely supportive as he said there marriage is “in a place that it hasn’t been in… in a long time.”

I tell every patient that comes into my office that there are benefits and risks to using every medication.  Cannabis is no different.   In these two examples both women had to weigh the benefits they were receiving from using Lexapro from the risks… which in this case were a decline in their sex life—-> leading to stress in their relationships.

The plan was simple.  If cannabis improved the quality of their lives and relationships then they would use it… if not no harm done.  Cannabis is relatively benign if used responsibly.