A word of caution: Do these things only if you are sincere and want an emotional and neurochemical attachment to the other person. When people get tightly bonded to others, which likely will happen if you follow the suggestions below, it is very hard for them to separate or break up with their loved one. Relationship breakdowns are horrible when bits of the other person are stored in every fun part of your brain. The grieving process can be very hard on your immune system. People are known to become sick and even die when an intense relationship ends. Giving someone hundreds of cards and then abandoning him or her is cruel and likely to cause a person to feel depressed, obsessed, and perhaps even to set up stalking behavior. If you are going to connect yourself to others, be serious. Otherwise, get a dog, get a hooker, or get a vibrator.

Twelve Ways to Make Your Love Unforgettable 1. Take your partner"s breath away. Do something amazingly thoughtful and out of the ordinary. These events solidify you in the person"s limbic brain. A close friend was dating a new woman. On his birthday, his girlfriend gave him birthday cards signed by all four of his siblings and his ten cousins. He was stunned by the thoughtfulness of the gesture. Not only was it unique, it showed that she thought about him and planned something special weeks ahead of time. Her thoughtfulness was embedded in his memory.

Once I gave a beautiful flower arrangement to my sweetheart. I knew it would be special, because five women who saw the arrangement at the store asked if I would be their boyfriend. Flowers are one of the best brain gifts. The scent helps to soothe and activate the limbic brain. The smells last for days and they have no calories to make someone fat. My sweetheart was grateful for weeks. Along the same lines, once I received a huge flower arrangement from a woman I was dating. It so surprised me that it embedded her kindness in my heart for a long time. Men love getting flowers, too.

The thoughtfulness does not have to be about money. It means the most when it is about the time spent and forethought that goes into making it happen. In a similar vein, writing poetry or making someone a sentimental CD can also be very special.

Taking someone"s breath away involves surprise, in a wonderful way, even if it is a small gesture of love. You can also teach your partner how you want to be surprised. If you like chocolate, tell him to hide some around the house in creative places so that you can find them throughout the day and think of him. If you like flowers, tell him or her to send them on occasion.

I have a friend who surprised her husband by showing up at his office in a trench coat, with nothing on underneath except fishnet stockings and s.e.xy shoes. This was so much fun for both of them. Another wonderful little surprise is to leave notes in pockets so that he or she can find them throughout the day. Another idea is to pick up your partner from work for a surprise gourmet lunch in a beautiful park. Find out what makes your partner tick and then find a way to tie it into your little plot to bring more joy and pleasure into his or her world.

2. Do something special on a regular basis. One of the best ways to make yourself unforgettable is to do things for your partner on a regular basis. Make his or her nervous system expect your call, want to hear your voice, miss your touch or the look into your eyes. Giving someone greeting cards, paper cards, or e-cards on a regular basis is a wonderful way to stay connected. Being your partner"s first call in the morning and last call at night helps to solidify you in his or her neural networks. Many greeting card companies and florists have programs to remind you on a regular basis to send something special. It is the reinforcement of thoughtfulness that makes a difference.

3. Do something special on an intermittent or unpredictable basis. This may even be more powerful than doing something regularly. Sometimes, when we do something on a regular schedule, people come to expect it and it loses its power, sort of like living at the beach and seeing sunsets every night. They tend, for some (not me), to lose their special nature. There is a concept in "learning theory" called intermittent reinforcement. It is one of the most powerful learning tools known. Here, the reinforcers, such as flowers, are not sent on a regular schedule, but rather on an irregular one, such as once or twice a month. The trick is to make it unpredictable and unexpected.

4. Frequent, loving eye contact (some cultures call it eye gazing) is an especially powerful connection tool for bonding. Eye contact enhances intimacy. No eye contact decreases bonding and connectedness. New York psychologist Professor Arthur Arun has been studying the dynamics of what happens when people fall in love. He has shown that the simple act of staring into each other"s eyes has a powerful impact. He asked two strangers to reveal intimate details about their lives to each other. They did this for an hour and a half. The two strangers were then made to stare into each other"s eyes without talking for four minutes. Afterward, many of his couples confessed to feeling deeply attracted to their opposite number, and two of his subjects even married later. When we are aroused and interested in what we are looking at, our pupils dilate. In medieval Italy, women put the chemical belladonna (literally meaning "beautiful lady") into their eyes to make their pupils look bigger. However, this is not recommended, as belladonna can be poisonous and eventually leads to blindness. It is better and safer to stick to eyeliner and mascara.

5. Learn what pleases your partner s.e.xually. Their pleasure should be your pleasure, if you want to make your love life unforgettable. Gain skill in the things that make him or her happy, in what turns him or her on, in what brings joy. Making this a priority will give you many, many dividends. Think of it as a cla.s.s (yes, there should be tests) on the ins and outs of your partner. This is one of the best ways to keep the relationship young and happy. As part of the cla.s.s, you need to know all about pleasing your partner. It shouldn"t be a mystery or only talked about when you feel frustrated. It is time for a great collaboration. Here is one exercise I use with couples. Do it on each other. I like to have couples show the other person what they like. Make it a kinesthetic exercise. Show your partner how you like to have your ears kissed, by kissing her ears the way you would like to be kissed. Show your partner how you like your back being rubbed by rubbing his back the way you like.

Many couples are embarra.s.sed to ask for what they want and what they like. Your partner is probably not good at reading your mind. Tell him or her what turns you on. Go into detail. Have your partner practice on you. Try this exercise by filling out the following form and working through each question with your partner.

1. I like it when you___with my hair.

2. I like it when you___with my ears.

3. I like it when you___with my eyes.

4. I like it when you___with my nose.

5. I like it when you___with my neck.

6. I like it when you___with my upper back.

7. I like it when you___with my lower back.

8. I like it when you___with my breast/chest.

9. I like it when you___with my belly.

10. I like it when you___with my genitals.

11. I like it when you___with my b.u.t.t.

13. I like it when you___with my thighs.

14. I like it when you___with my lower legs.

15. I like it when you___with my feet.

6. Teach your partner what you like. Most people get joy by pleasing others. Be an expert communicator by sharing your wants and desires. The brain loves the sounds of excitement. Make sure when your partner is pleasing you that you let him or her know.

When Dr. Irwin Goldstein, an expert in s.e.xual medicine, presented recent research findings to a scientific meeting, he said: "It is rare for me to stand in front of an audience and say, "This is a ma.n.u.script that has changed my life." But this one has done that." The study, published in the Journal of s.e.xual Medicine, seemed obvious. The results showed that females in committed relationships with men who were treated with an impotence drug (Levitra) had better s.e.x. But, the women didn"t just like s.e.x better, they liked it better because their bodies worked better. Lubrication was better. o.r.g.a.s.ms were more intense. They l.u.s.ted more. The women"s bodies reacted as if they were receiving the drug. So a drug they didn"t even take affected their bodies. "Her physiology is linked to him," Goldstein says. "Men share problems with women, and the solutions. ... It totally intrigues me. I can change someone"s physiology without treating them. It"s the wildest thing!" In fact, the better a man"s response to the drug, the better her response to him.

"Entanglement" is a physics concept. Subatomic particles have "partners"-other subatomic particles-with which they can be entangled, sometimes over great distances. If you change one particle, the change affects the other one with which it is entangled. Dr. Goldstein"s study is a strong indicator that humans can be entangled. We change when we fall in love, we become one unit, at least s.e.xually. The two shall become one, as it says in the Bible. "There are no other physiologic abilities of men and women that are shared, and that is what is so fascinating about these data," Goldstein says. He also says there is some evidence that when he successfully treats women who suffer from dyspareunia, or pain with intercourse, their men get better erections and have more s.e.xual satisfaction. And he suspects that male partners of women with low libido have poorer erections and that if those women could be treated, the men would improve, too. Taking care of yourself is taking care of your relationship.

7. s.e.xual novelty can boost lasting love. Some people like routine. It makes them feel safe and comfortable. Others need variation and new challenges. According to Emory University psychiatrist and researcher Gregory Berns, novelty is a central factor in achieving and maintaining satisfaction in life and in intimate relationships. He thinks the basal ganglia, which uses the neurotransmitter dopamine, hold the key. He published his findings in a book t.i.tled Satisfaction: The Science of Finding True Fulfillment. He starts his exploration with a simple question, "What do humans want?" He challenges the belief that we are driven primarily to pursue pleasure and avoid pain. Rather, Berns finds that "satisfaction comes less from the attainment of a goal and more in what you must do to get there." With a series of experiments using cutting-edge functional MRI scanning technology, he sees that the interaction of dopamine, the neurotransmitter secreted in the brain in antic.i.p.ation of pleasure, and cortisol, the chemical released when we are under stress, produces the feelings people a.s.sociate with satisfaction. Berns ventures into the world to demonstrate his ideas, studying the bruised and reddened S&M players, as well as looking at the ultramarathoners who collapse after a hundred-mile run. Berns then brings his journey home, looking at issues in his own marriage and the s.e.xual dissatisfaction that so often plagues long-term relationships. His conclusion is simple and compelling: People are wired for novel experience, and when we seek it out, we are satisfied. Look for ways to bring novelty into your intimate relationships. Do things differently, from the way you kiss your partner, to the way you show love, to the activities you do together.

8. Do something a little edgy. Along the same lines as novelty, getting your partners heart rate up may make her more interested in you. She might interpret the rush as a feeling of excitement for you. One experiment showed that if people experience fear on a date, they often misinterpret that feeling as love. So dates at a theme park may be more successful than a science lecture (unless it is on the neuroscience of s.e.x). A bungee jump might even seal your relationship for life. If you do this with an anxious partner, however, he or she may leave you behind forever to avoid the fear. It is important to individualize these suggestions to your partner. For example, being a pa.s.senger with someone who drives fast may be exciting for partners who need excitement and speed, but it may be a disaster for someone who is naturally more cautious.

9. Use every sense. Utilize all of your partner"s senses to make yourself unforgettable. Our five senses are the vehicles that bring the outside world in. They are what sees, hears, tastes, smells, and feels so that we can know another person. A large portion of the brain is dedicated to your senses. It has been estimated, for example, that 50 percent of the brain is dedicated to vision. Use these senses to embed yourself deeply into the sensory circuits of your partner"s brain. Embedding works best if you are helping to encode good memories or feelings, rather than annoying ones. Begin by taking a look at how you emit each sense and see if there is a way to smooth out any rough edges to make yourself more desirable, more enticing. For instance, it often amazes me when I hear couples talking to each other. So often the words and voice tone are so grating that I am sure they are embedding anger and irritation day in and day out.

One way to a.s.sess your own voice is to listen to it on a tape recorder. The sound of your voice can be a powerful elixir of pa.s.sion or an irritant to those around you. I used to be surprised when I heard my recorded voice. It sounded different being played back to me than it did when I heard it while I was talking. Record your voice and listen to the quality of it. Then, focus on adding a bit of richness or lower tonal quality to your voice and record it again. When you play it back, hear if your voice sounds more pleasing to you. If it does, keep working on it. Initially, it takes practice to be conscious of such aspects of your self, such as the voice, but with time it gets easier. Some people benefit from a voice coach to help smooth it out. When I started to do radio and television interviews, I used a wonderful voice coach who was ever so helpful. When a friend from Buffalo decided to lose some of her accent to do more voiceover work, it took her almost a year of conscious speaking before it became her natural sweet voice. I"m not suggesting that anyone change who he is to be more appealing, rather than to augment the natural beauty that already exists within. Just because we develop a habit or certain way of doing something doesn"t mean that it"s the best way to do it. So, be open to using the natural talents that exist within you to be more of who you truly are in the world around you.

Once you have found a nice tonal quality and voice level and speed, leave a sultry message for your mate on voice mail. By leaving a recorded message that is fun and appealing, your mate can play it back, over and over, whenever he or she needs a lift or a smile. This is a wonderful way of embedding yourself in your partner"s day-to-day life.

Next, look at the other aspects of your senses to see if they can be refined for the purpose of embedding yourself in your partner"s consciousness. For instance, it"s nice to take some time to get a manicure and pedicure, shave and groom a few extra moments, check your breath, keep your lips soft and supple for more sensual kisses, find a scent that your partner likes and wear it to embed your odor on clothing that he or she will smell throughout the day. If you like to cook or draw, make something special and send it along on his or her journey for the day. Take pictures of yourself, as well as yourself and your partner, in clothing or environments that would inspire your mate while looking at it. Frame that picture and give it as a gift or place it somewhere where it will be seen often. In feng shui, it is believed that a loved one"s picture placed in view of the bed is good for that relationship. Flowers or little knickknacks that your mate would like as gifts are nice reminders that you are near, as these items can be placed within immediate sight. Use every sense available, be it smell, sight, sound, taste or touch.

Here are more sensory specific ideas: Vision. Give pictures of yourself and your loved one embracing. Wear s.e.xy clothes. Go shopping with your partner and let him or her help you pick out part of your wardrobe. Wear clothes that he or she likes on you. Take care of your appearance. Find out if there are any visual cues that upset your partner and take care of them if possible. Add candles or a fire to the environment. The light from gentle flames often enhances sensuality.

Sound. Watch the sound and tone of your voice. Decrease distractions when you are together. Music is a wonderful way to connect with your partner. By introducing your mate to new sounds and choosing "your song" together, a switch will be flipped to remind her of you whenever she hears it. This can be a double-edged sword if you break up. One woman I dated once made me a fabulous mix CD of my favorite songs and a few of hers. I was so touched by this gesture that every time I played the CD I had kind thoughts of her. Be conscious of your partner"s taste in music and when a new alb.u.m comes out or that band comes to town that he really likes, buy tickets and experience his favorite sounds together. Learn to dance together to this music. Perhaps, even create exotic dances that you can do for your partner to melodies that are really impa.s.sioning to them. The subconscious power of music is one of the most powerful elixirs of pa.s.sion that can be utilized to strengthen a long-term partnership.

Smell. Put sweet fragrances in the environment, such as flowers or potpourri. Cook his or her favorite foods. Use some of the aphrodisiac foods and scents from Lesson Nine. Take a shower, or not, before you make love. Check with your partner to see what he or she likes best. Napoleon specifically asked Josephine not to take baths for two weeks before he came home from battle; he loved her natural scent.

Touch. Touch is very important in the embedding process. Learn to touch your partner in subtle, pleasing ways, be it ma.s.saging while she is driving or working at the computer, placing your hand on her while you are talking, brushing your head against his body as you walk by, kissing her in places that are pleasing to her throughout the day, learning to ma.s.sage him in ways that create ecstasy, and learning to sleep so that some part of you and your partner is in contact. Every sense is an entry point to embed yourself in your partner"s mind. If you take the time to do this practice, it will make all the difference in the world in your intimate encounters and longevity of your relationship.

Kisses belong under touch and taste. Remember the very strange-looking little man, the homunculus, that represented the sensory strip in the brain that processes touch? He has very large lips, because there are millions of nerve endings in the brain dedicated to lips. Kisses are critical to bonding. Do you have lips that fit your partner"s? Learn to use your lips in ways that please him or her. Pay attention (use your prefrontal cortex) when kissing. What stimulates him or her? What causes her to moan and come back for more? Linger when you kiss. I once read a book by Ellen Kreidman called The 10 Second Kiss. I thought it was a brilliant embedding technique. Her premise was that rather than giving a quick peck to your partner to say h.e.l.lo or good-bye, spend ten seconds and make the moment last. She says that a "10-second kiss" can transform a simple act into a clear message of "I love you" each and every day. The technique takes communication to a level so deep, it"s magical. Eliminate pecks; we are not chickens.

Taste. Avoid bad tastes and enhance great ones. Kissing someone with the taste of candy or cinnamon on their lips can be very s.e.xy. Take care of bad breath, but see what tastes your partner loves. Someone may really think Listerine mouthwash is the sweet elixir of pa.s.sion, while others might feel it reminds them of going into surgery. Check out what your partner likes. Also, keep the genital area as tasty as possible. Some people love performing oral s.e.x on their partner after they have bathed, others prefer a more natural state. Ask. Feeding each other during meals can also be very exciting. When you taste something you love, feeding it to your partner with words like, "This is great, try it," shows her that her pleasure is on your mind.

10. Do something great for someone your partner loves. When we take care of important people in our partner"s life, we take care of him or her. This is one of the most powerful bonding techniques I know. When you care for your partner"s children, parents, friends, employees, or even pets, the partner"s limbic brain is grateful and you become more deeply embedded in his or her consciousness. I am often amazed at how many people do not understand this technique. Given that there are many second and third marriages in our society, dealing with a partner"s children is often an important issue. Setting up compet.i.tion or conflict between a new love and his or her children almost always leads to disaster. In bonding to someone, spend time with his or her children, or help her parents and you will be much more likely to be solidified in her head.

11. Summarize and immortalize loving moments. When you have great moments with your lover, write them down and send your missive to him or her. When you experience a great moment, that by itself helps to embed it into memory; when you then take the time to write it down, it helps to further engrain it into the memory tracks of the emotional brain.

Writing loving thoughts have occurred from the beginning of recorded history.

Bridegroom, dear to my heart, Goodly is your beauty, honeysweet. ...

Bridegroom, I would be taken by you to the bedchamber.

You have captivated me, Let me stand tremblingly before you.

That"s the enticing start to the oldest love known poem in the world. Scholars discovered the poem over a hundred years ago buried in the ancient sands of Iraq. The poem was written around 2030 BC by a Sumerian scribe from the city of Ur using a reed stylus on wet clay, which was then baked, preserving the tablet of pa.s.sion for forty centuries. The pa.s.sion, scholars say, was part of a Mesopotamian festival ritual of fertility and power called Sacred Marriage.

12. Learn from parrots. Neurologist Barbara Wilson has trained and kept parrots for years. She says that they have taught her a lot about relationships (no kidding): Share your food with the one that you love, groom each other, sing constantly, build nests together, and repeat each other"s words and actions! If people would think like parrots, all babies would be planned. Parrots don"t just randomly mate. First, they have to genuinely like the other bird. Then there has to be a constant reliable source of food, light, and stability. Then there has to be a nest box. The male inspects it first, then the female. The female waits until the male feeds her. Only then do they get frisky. If one dies, the other one in the mated pair grieves and mourns and has been known to just up and die, too.

Barbara once had a mealy Amazon parrot that she rescued from a too small cage at a breeder"s farm. Having been stolen from the wild (you can trace their import origin from the type and numbering on the band on their leg), the female bird had not seen another mealy (specific subspecies of parrot with its own squawking language) since its infancy. She was depressed and overweight from being in the confining cage. Barbara put the bird in a large cage, where the parrot got significantly better, but still she was lonely. Barbara never heard a peep out of the bird, even when she once cut her toenail too short. Barbara did some Internet parrot dating for the bird and found a single male of her subspecies in south Texas. After several e-mails, phone calls, and high-level bird trading, Barbara drove sixteen hours round-trip to get her parrot a "man." When she brought the male back, both birds were ecstatic. They squawked for hours at loud volume. The two birds dated for three weeks. They would not share a cage. Barbara opened the two cages, they would meet on top, and squawk for hours. Eventually they groomed each other, then each night they would go back to their own cage. Finally, Barbara says she had a talk with them on the human facts of life: She only had room for one big cage and was tired of cleaning two cages, so like it or not, they were going to have to live together. They slept on separate perches for three more months despite genuinely loving each other. The female lost weight and looked years younger due to the affection. Then they slept together, ate together, and made a life that worked.

When you ask her about parrot behavior, she says, "It"s just your own behavior and words repeated back to you. And if you ignore them they start to bite and pick their feathers, and you wonder why you have a mean and ugly bird." After she achieved success with parrots (she had a flock of twelve at one time), she decided it was time to find a husband. Really cool fact, she tells me, men catch on quicker than birds.

Lesson #10: Make it last by leaving enduring impressions on your partner"s brain.

FIX THE BRAIN ISSUES.

THAT GET IN THE WAY OF s.e.x.

PMS, Depression, ADD, Substance Abuse,

Denial, and Being a Jerk

Get away, get away, get away, get away

Get away cause I"m pms-ing

-"PMS," MARY J. BLIGE Celia and Greg fell madly in love for five weeks. They met on Match.com shortly after Labor Day. On the surface they seemed like a perfect couple. They were both well educated, caring, hardworking, and had similar lifestyle habits. The attraction was amazing, even between their families. Greg loved Celia"s little girl, and Greg"s teenage girls got along very well with Celia. With new love comes hope. They were together most days and on the phone for several hours a day when they were apart. Five weeks into the pa.s.sionate relationship things started to abruptly change. Celia started to back up. She became distant, irritable, and short tempered. Nothing Greg did seemed right. Even though she was fully involved with moving the relationship forward, she felt the need to backtrack. Greg felt disoriented. What happened?, he wondered. Initially, he felt anxious at the change. He had met few women as wonderful as Celia, few women that took his breath away. But he did as Celia wanted. That still didn"t seem good enough and Celia broke off the relationship. Greg felt very sad. Then Celia started her menstrual period. She was horrified by her behavior and for losing Greg. When she called him, he was happy to hear from her, but hurting from what happened. He was gun shy. Premenstrual tension syndrome (PMS) is real and causes real problems in the brain and in relationships.

It is not just PMS that can ruin relationships. Other brain problems, such as depression, ADD, substance abuse, anxiety disorders, obsessive-compulsive disorder, and personality disorders also interfere with love. Understanding and treating these problems is critical to healthy relationships and healthy s.e.x. In this chapter, I will explore the most common brain ailments interfering with love and s.e.x that we see in our clinics and give you a way to think about how to get the best help for them. Some people will need psychotherapy; some will need medication; others will need more directed guidance with supplements or other alternative treatments. I will also help you decide if and when you need to seek professional help. In lecturing around the world, I am frequently asked the following questions: When is it time to see a professional about my brain? What should I do when a loved one is in denial about needing help? How do I go about finding a competent professional?

A Quick View of Common Brain Problems Affecting Love and s.e.x PMS.

When I saw patients with PMS after I started my brain-imaging work in 1991, I just had to look. Now I know more about PMS than I want to. I have five sisters and two daughters. Plus, I have an ex-lover (I"ll call her Laura) who suffered from severe PMS. She loved me pa.s.sionately for the first seven days of her menstrual cycle, was very neutral on me for the next fourteen days, and just seemed to hate me for the last seven days or so of her cycle. Laura"s behavior the first seven days of her cycle kept me hooked into the relationship. Our relationship was being intermittently reinforced, a psychological term about learning behavior; when someone is reinforced occasionally or intermittently, it causes them to want to stay in a relationship, hoping for more.

Over the past years we have scanned many women with PMS just before the onset of their period, during the worst time of their cycle, and then again a week after the onset of their period, during the best time. Even though brain-SPECT scans are very consistent from day to day in most people, they can radically change in women with PMS. I knew from my own experience with Laura that likely the PMS brain changed over the month. When PMS is present, we see dramatic differences between the scans. When a woman feels good, her deep limbic system (emotional brain) is calm and cool and she has good activity in her temporal lobes (mood stability and memory) and prefrontal cortex (judgment). Right before her period, when she feels the worst, her deep limbic system and anterior cingulate gyrus (worry center) is often overactive and she has poor activity in her temporal lobes and prefrontal cortex!

I have seen two PMS patterns, clinically, and on SPECT, that respond to different treatments. One pattern is increased deep limbic activity often accompanied by poor activity in the temporal lobes, which correlates with cyclic mood changes and anger. This finding often responds best to anticonvulsant medications, such as Depakote, Neurontin, Lamictal, or Tegretol. These medications tend to even out moods, calm inner tension, decrease irritability, and help people feel more comfortable in their own skin.

The second PMS pattern that I have noted is increased deep limbic activity in conjunction with increased anterior cingulate gyrus activity. The anterior cingulate, as we have seen, is the part of the brain a.s.sociated with shifting attention. Women with this pattern often complain of increased sadness, worrying, repet.i.tive negative thoughts and verbalizations (nagging), and cognitive inflexibility. This pattern usually responds much better to medications that enhance serotonin availability in the brain, such as Lexapro, Zoloft, and Prozac. Here are two examples.

Brittany. Brittany was a thirty-eight-year-old married female referred for evaluation of suicidal thoughts, depression, and temper flares. She also experienced problems with anxiety, excessive tension, and overeating. These problems occurred primarily during the last ten days of her menstrual cycle and abated two to three days after the onset of menses. On several occasions she separated from her husband within the seven days prior to the onset of her period; on one occasion, she lashed out at him physically. The patient and her husband confirmed the cyclic changes to her symptoms. Both Brittany and her husband kept a symptom log over the next month. On Day 27 (of a twenty-nine-day cycle) Brittany called the clinic saying that she was having problems with suicidal thoughts and depression. She was scanned the same day. Her SPECT study revealed significant increased activity in the anterior cingulate gyrus and marked decreased activity in the left temporal lobe and prefrontal cortex bilaterally. She was then scanned on Day 8 of the next menstrual cycle when she was symptom free. Her follow-up scan revealed improved temporal lobe and prefrontal cortex function but persistent cingulate hyperactivity. Due to the clear temporal lobe problems, Brittany was placed on the anticonvulsant Depakote, which stabilized her temper outbursts and suicidal thoughts. The serotonergic antidepressant Zoloft was then added a month later due to persistent premenstrual sadness. Three years later she remains symptom free.

Anne. Anne was a thirty-three-year-old married female referred for evaluation of suicidal thoughts, depression, anxiety, and irritability. These problems occurred predominantly during the last week of her menstrual cycle and significantly let up several days after the onset of menses. She had experienced a postpartum depression after the birth of one child but not after the birth of her other two children. Anne and her husband confirmed the cyclic changes to her symptoms. Both she and her husband kept a symptom log over the next month. On Day 25 (of a twenty-eight-day cycle) Anne called the clinic complaining of severe agitation and moodiness. She was scanned the same day. Her SPECT study revealed significant increased activity in the anterior cingulate gyrus and deep limbic regions. She was then scanned on Day 10 of the next menstrual cycle when she was symptom free. Her follow-up scan revealed excess activity in the anterior cingulate gyrus and deep limbic system. Lexapro was very effective in calming her symptoms. Two years later she remains symptom free during the premenstrual period.

Mood Disorders Mood disorders severely affect libido and relationships. Depression is often a.s.sociated with low libido, negativity, and a higher divorce rate. The "up" or manic phase of bipolar disorder can be a.s.sociated with impulsivity, hypers.e.xuality, and hyperreligiosity.

Depression Burl, a fifty-two-year-old contractor, husband and father of two boys, was referred to me because he was tired all the time. His family physician ruled out the physical causes of fatigue and thought he was stressed. Additionally, he had trouble focusing at work and had trouble sleeping. His caffeine use went way up, but it didn"t help his energy, just made him edgy. His s.e.x drive was gone, his appet.i.te was poor, and he had no interest in doing things with his family. Burl would cry for no apparent reason and he even began to entertain suicidal thoughts. Burl had a serious depressive illness.

Depression is a very common brain illness. Studies reveal that at any point in time, 3 to 6 percent of the population have a significant depression. Only 20 to 25 percent of these people ever seek help. This is unfortunate because depression is a very treatable problem.

The following is a list of symptoms commonly a.s.sociated with depression: sad, blue, or gloomy mood low energy, frequent fatigue lack of ability to feel pleasure in usually pleasurable activities irritability poor concentration, distractibility, poor memory suicidal thoughts, feelings of meaninglessness feelings of hopelessness, helplessness, guilt, and worthlessness changes in sleep, either poor sleep with frequent awakenings or increased sleep changes in appet.i.te, either markedly decreased or increased social withdrawal low self-esteem.

Early detection and treatment is important to a full and complete recovery. My imaging work has revealed that there are multiple types of depression and treatment needs to be specifically tailored to the type. See my book Healing Anxiety and Depression (written with Lisa Routh).

Bipolar Disorder Patricia is a twenty-eight-year-old married mother of two children. She had a period of depression six months earlier and had been prescribed an antidepressant by her OB/GYN. Initially she felt much better. Then she started slowly having trouble sleeping. Her thoughts raced, she became more irritable and much more s.e.xual. She was used to having s.e.x several times a week with her husband, but now wanted it every day. She propositioned three of her male coworkers, which was out of character. Two of her coworkers took her up on her offer and she ended up contracting herpes, which she gave to her husband. On the verge of divorce, they came to see me. Patricia had bipolar disorder triggered by the antidepressant, which is not an uncommon scenario. It is sad to think that an improperly treated psychiatric illness can tear apart families. With the right treatment, which included a mood stabilizer and fish oil, Patricia and her husband did much better.

Bipolar disorder is a mood illness where people cycle between two poles of emotion. There may be periods of depression that alternate with periods of high, manic, irritable, or elated moods. Mania is categorized as a state distinct from one"s normal self, where there is greater energy, racing thoughts, impulsivity, a decreased need for sleep, and a sense of grandiosity. It is often a.s.sociated with periods of hypers.e.xuality, hyperreligiosity, or spending sprees. Sometimes it is also a.s.sociated with hallucinations or delusions. In treating the depressive part of the cycle, both pharmaceutical and supplemental antidepressants have been known to stimulate manic episodes. It is important to vigorously treat this disorder, as it has been a.s.sociated with marital problems, substance abuse, and suicide.

Here is a list of symptoms often a.s.sociated with bipolar disorder: Periods of abnormally elevated, depressed, or anxious mood Periods of decreased need for sleep, feeling energetic on dramatically less sleep than usual Periods of grandiose notions, ideas, or plans Periods of increased talking or pressured speech Periods of too many thoughts racing through the mind Periods of markedly increased energy Periods of poor judgment leading to risk-taking behavior (separate from usual behavior) Periods of inappropriate social behavior Periods of irritability or aggression Periods of delusional or psychotic thinking.

Bipolar I, which used to be called manic depressive illness, is thought to be the more cla.s.sic form of this disorder. In recent years, a milder form of the disorder, called Bipolar II, has been described; it is a.s.sociated with depressive episodes and milder "hypomanic" issues.

The treatment for bipolar disorder, both I and II, is usually medication, such as lithium or anticonvulsants such as Depakote. Recent literature suggests that high doses of omega-3 fatty acids, found in fish or flaxseed oil, can also be helpful.

Antidepressants and Romantic Love Depression inhibits romantic love. People who are depressed tend to be negative, socially isolated, and often have little interest in s.e.x. They might also have suicidal feelings, which are usually a turnoff to potential partners. Treating depression is essential for people to have healthy relationships. Yet, the specific type of treatment can either enhance or hurt attraction in romantic love. In my imaging work I have discovered that depression is not one illness and that the treatment needs to be tailored individually. In general, however, bupropion (Wellbutrin) is pros.e.xual and enhances s.e.xual feelings and function. It enhances dopamine availability in the brain and increases attention and focus. It is useful to treat depressions a.s.sociated with low energy. SSRIs, useful in treating depression a.s.sociated with obsessive thinking, can jeopardize romantic love. Low serotonin levels help explain the obsessive thinking common in early romantic love. In a study by Helen Fisher, subjects reported that they thought about their loved one 95 percent of the day and couldn"t stop thinking about them. This kind of obsessive thinking is comparable to obsessive-compulsive disorder, also characterized by low serotonin levels. Serotonin-enhancing antidepressants blunt the emotions, including the elation of romance, and suppress obsessive thinking, a critical component of romance. "When you inhibit this brain system," Dr. Fisher warns, "you can inhibit your patient"s well-being and possibly their genetic future." These antidepressants also inhibit o.r.g.a.s.m, c.l.i.toral stimulation, penile erection, and seminal fluid. From an anthropological perspective, Dr. Fisher concludes, "a woman who can"t get an o.r.g.a.s.m may fail to distinguish Mr. Right from Mr. Wrong." As one woman on an SSRI told me, "I thought I no longer was attracted to my husband." In a study, women on SSRIs rated male faces as more unattractive, a process called courtship blunting. Seminal fluid contains dopamine and norepinephrine, oxytocin and vasopressin, testosterone and estrogen. Without an o.r.g.a.s.m, men may lose the ability to send courtship signals. These warnings should encourage us to look for alternative treatments in depression.

Anxiety Disorders There are five common types of anxiety disorders that can affect people"s relationships, moods, and s.e.xuality in a negative way: panic disorders, agoraphobia, obsessive-compulsive disorder, post-traumatic stress disorder, and performance anxiety. I"ll briefly discuss each of these and their treatments.

Panic Disorder Healthy s.e.xuality is usually enhanced by a sense of safety and peacefulness. But what if all of a sudden your heart starts to pound. You get this feeling of incredible dread. Your breathing rate goes faster. You start to sweat. Your muscles get tight, and your hands feel like ice. Your mind starts to race about every terrible thing that could possibly happen and you feel as though you"re going to lose your mind if you don"t get out of the current situation. You"ve just had a panic attack. Panic attacks are one of the most common brain disorders. It is estimated that 6 to 7 percent of adults will at some point in their lives suffer from recurrent panic attacks. They often begin in late adolescence or early adulthood but may spontaneously occur later in life. If a person has three attacks within a three-week period, doctors make a diagnosis of a panic disorder.

In a typical panic attack, a person has at least four of the following twelve symptoms: shortness of breath, heart pounding, chest pain, choking or smothering feelings, dizziness, tingling of hands or feet, feeling unreal, hot or cold flashes, sweating, faintness, trembling or shaking, and a fear of dying or going crazy. When the panic attacks first start, many people end up in the emergency room because they think they"re having a heart attack. Some people even end up being admitted to the hospital.

Antic.i.p.ation anxiety is one of the most difficult symptoms for a person who has a panic disorder. These people are often extremely skilled at predicting the worst in situations. In fact, it is often the antic.i.p.ation of a bad event that brings on a panic attack. For example, you are in the grocery store and worry that you"re going to have an anxiety attack and pa.s.s out on the floor. Then, you predict, everyone in the store will look at you and laugh. Pretty quickly the symptoms begin. Sometimes a panic disorder can become so severe that a person begins to avoid almost any situation outside of home-a condition called agoraphobia.

Panic attacks can occur for a variety of different reasons. Sometimes they are caused by medical illnesses, such as hyperthyroidism, which is why it"s always important to have a physical examination and screening blood work. Sometimes panic attacks can be brought on by excessive caffeine intake or alcohol withdrawal. Hormonal changes also seem to play a role. Panic attacks in women are seen more frequently at the end of their menstrual cycle, after having a baby, or during menopause. Traumatic events from the past that somehow get unconsciously triggered can also precipitate a series of attacks. Commonly, there is a family history of panic attacks, alcohol abuse, or other mental illnesses.

On SPECT scans we often see hyperactivity in the basal ganglia, or sometimes temporal lobe problems. Psychotherapy is my preferred treatment for this disorder and in some studies has been shown to calm basal ganglia activity. Sometimes supplements or medications can also be helpful. Unfortunately the most helpful medications are also addictive, so care is needed.

Agoraphobia The name agoraphobia comes from a Greek word that means "fear of the marketplace." In behavioral terms it means the fear of being alone in public places. The underlying worry is that the person will lose control or become incapacitated and no one will be there to help. People afflicted with this phobia begin to avoid being in crowds, in stores, or on busy streets. They"re often afraid of being in tunnels, on bridges, in elevators, or on public transportation. They usually insist that a family member or a friend accompany them when they leave home. If the fear establishes a foothold in the person, it may affect his or her whole life. Normal activities become increasingly restricted as the fears or avoidance behaviors dominate their life.

Agoraphobic symptoms often begin in the late teen years or early twenties, but I"ve seen them start when a person is in their fifties or sixties. Often, without knowing what is wrong, people will try to medicate themselves with excessive amounts of alcohol or drugs. This illness occurs more frequently in women and many who have it experienced significant separation anxiety as children. Additionally, there may be a history of excessive anxiety, panic attacks, depression, or alcohol abuse in relatives.

Agoraphobia often evolves out of panic attacks that seem to occur "out of the blue," for no apparent reason. These attacks are so frightening that the person begins to avoid any situation that may be in any way a.s.sociated with the fear. I think these initial panic attacks are often triggered by unconscious events or anxieties from the past. For example, I once treated a patient who had been raped as a teenager in a park late at night. When she was twenty-eight, she had her first panic attack while walking late at night in a park with her husband. It was the park setting late at night that she a.s.sociated with the fear of being raped and which triggered the panic attack. Agoraphobia is a very frightening illness to the patient and his or her family. With effective, early intervention, however, there is significant hope for recovery. The scan findings and treatment are similar to those for people with panic disorder. The one difference is that people with agoraphobia often have increased anterior cingulate gyrus activity and get stuck in their fear of having more panic attacks. Getting stuck in the fear often prevents them from leaving home. Using medications, such as Prozac and Lexapro, or supplements, such as 5-HTP and St. John"s wort, to increase serotonin and calm this part of the brain is often helpful.