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by Michael Cheikin, MD

Since it's usually transient and does not affect quality of life, there's no diagnosis code for irritability. Most of us can be irritable when sleep deprived or hungry. However, many common conditions that require treatment have an irritability working behind the scenes.

  Irritability can be overlooked or ignored because it can be subtle, and only a subset of its victims seek help. Since 80% of visits to primary care are not for medical disease, it is often present. 

People who complain that they are "stressed" are often describing their irritability. When more time is spent being irritable than not, quality of life is impacted. In most cases there is a gradual recognition that this is a problem that should be addressed. 
Definitions and Basic Science
The definition of irritability means that a system is overly reactive--the response is larger than that required for the situation. Typically, the response looks like a fight-or-flight reaction, with some aggressiveness, raised pulse and blood pressure, sometimes associated with feelings of panic or "impending doom"; but the opposite can also occur--feeling overwhelmed, freezing, fatigued, withdrawal or surrender/giving up.

Based on individual makeup, including genetic and epigenetics, each of our systems will tend to show a specific and predictable pattern when imbalances occur. For one person it might be high blood pressure, for another it might be episodes of colitis and for a third anxiety.

Our systems have evolved over hundreds of millions of years and are finely tuned and integrated, representing a balance of forces, similar to how a car tire is held on by a balance of five bolts. Any one loose bolt will eventually cause a wobble and progressive instability of the whole system. At that point, which bolt doesn't matter.

Evaluation and Treatment
Conventional evaluation of irritability includes looking for thyroid or other hormonal issues (sex and/or blood sugar hormones), and disorders of sleep, mood or certain neurological conditions.  

If the work-up is negative, which is common, then the usual treatment is to address the manifestation of irritability. If it is blood pressure, then blood pressure medication is prescribed. If it is depressive or anxious episodes, then various psychotropic medications are used. Interestingly, anti-seizure medications are used not only for epilepsy, but also for the irritability of mood, pain and other systems.

Since holistic medicine does not look for single causes or cures, helping irritability requires casting a broad net. Finding root causes and missing factors through more extensive history, special diets and non-conventional lab studies can sometimes yield a simple correction to lifestyle. Using other paradigms such as Chinese and Ayurvedic, bio-electric and bio-energetic models can sometimes enable healing without a formal medical diagnosis. For example, sleep hygeine, yoga, acupuncture, biofeedback and gluten elimination can work wonders.

An article on irritability would not be complete without emphasizing the magnificent mineral, Magnesium. Most of us are magnesium deficient, the manifestations of which can look like any of the listed diagnoses. Proper measurement and interpretation of magnesium and other stabilizing nutrients require the help of a practitioner experienced in this field.

In most cases, the situation can be much better and sustain without dependence upon the medications typically used for such complaints (i.e. anti-anxiety, anti-depressant and sleep medications).  Holistic solutions including education and lifestyle change are efficient and cost-effective, and worthy of investment to improve quality of life for self and others. 
1. This educational material may not be used to influence medical care without supervision by a licensed practitioner. 
2. These contents are ©2015 by Michael Cheikin MD and may not be reproduced in any form without express written permission.
3.     Dr. Cheikin's website has related articles such as ‚ÄúStress"  and many others.

Michael Cheikin MD is a holistic physician, Board Certified in Physical Medicine and Rehabilitation ("Physiatry"), Pain Management, Spinal Cord Medicine and Electrodiagnostic Medicine and licensed in Medical Acupuncture. Dr. Cheikin has extensively studied yoga, diet and metabolism, Ayurvedic, Chinese and energy medicine and other alternative modalities for over 30 years. He specializes in obscure, chronic and severe problems that have not responded satisfactorily to other methods of healing.  www.cheikin.com    

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