Antidepressants Blog

We are all basically insecure, and this is the root of much of our anxiety. Our bodies are frail; therefore we can never hope for real material security. At any moment, even in the most protected situations, we may be stricken down with illness or death. Aware of this, man has sought another form of security—security in the sight of God. Such security can transcend the insecurity of life and death. But man has learned to doubt, the security of religious belief has ebbed from him, and as a result his latent anxiety and tension is so much the worse.

Childhood-Insecurity In childhood we are insecure because of our relative weakness compared with those about us. This childhood feeling of insecurity may persist, and form a

pattern of tension and anxious behaviour in adult life. Whether this will happen or not depends very largely on the degree to which the child perceives his early environment as threatening.

An interesting point in this regard is that the child withstands the evil influence of a constantly hostile environment better than he does an inconsistent one, where those around him are changeable, sometimes harsh and sometimes loving. In these circumstances the child does not know what to expect, and as a result lives in a state of chronic anxiety.

At school the child may be subject to influences which further increase his insecurity. These influences may be extremely subtle and may escape the notice of both teachers and parents only to be disclosed years later in psychotherapy.

The native aggressive impulses of children are only just beneath the surface. They are easily turned on some less fortunate member of the group. Minor degrees of bullying may take a form that is scarcely perceptible to adults, but at the same time, may produce chronic tension in the unfortunate victim.

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This question could just as easily be asked in relation to any other anti-depressant. In one form or another, it is one of the more common questions on the mind of anyone who has felt the benefit of an anti-depressant medication. The relief and gratitude experience is counterbalanced in many people by a sense of unease at having to be on a medication for an undefined and possibly indefinite period of time. The honest answer is that we just can’t predict how long someone will need to be on an anti-depressant. If the depression has been a single short-lived episode, it may be possible to stop the anti-depressant after six months of remission without risking relapse. If there is a history of repeated episodes or long-standing depression, however, there is a high likelihood that depression will recur or relapse if the anti-depressant is stopped. In such people it generally makes good sense to stay on an antidepressant indefinitely. Although there have been no long-term studies of St John’s Wort in depression – and I should say that such studies are few and far between for other anti-depressants as well – there is no evidence of any long-term problems in those who have been on St John’s Wort for months or even years.

After several months on treatment, people often experiment and stop their anti-depressants just to make sure that they still really need them. If you do this, be sure to watch out for early signs of relapse and return to the anti-depressant as soon as these appear. It is much easier to reverse the symptoms of depression in their initial stages than after they are fully established again.

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More specific than any of the precipitants so far discussed are the stimuli which result in

so-called reflex epilepsy. Some young people have seizures induced by flashing lights, as in a discotheque, and this can be studied on an EEC In most of us, an obvious wave can be recorded from the back of the head (the occipital region) if a light is flashed in the eyes. With repeated flashes, these waves follow the flash frequency. At a critical frequency in a young person with photosensitive epilepsy, a totally different response of multiple spikes and waves—the photoconvulsive response—occurs, and a seizure may be induced. This of course is a laboratory situation, but seizures may result, in photosensitive children, from flickering light reflected from water, or by the interruption of steady light filtered through trees observed from a moving car.

The most common type of photosensitivity now encountered is television epilepsy. Experiments have shown that it is the normal sweep of the spots that make up the picture from side to side and down the face of the tube that is responsible, and not any malfunction of vertical picture or horizontal line hold. Susceptible children are most at risk when the screen occupies a considerable proportion of the visual field, as will occur if the size of the screen is large, and the child sits close to it, or approaches it to change the programme. The chances of seizures occurring are lessened by sitting far away from the screen. It may also help to reduce contrast between the screen and surroundings by placing the set near a lamp.

It has also been shown that the photoconvulsive response cannot be elicited if only one eye is exposed to the flashing light. It makes sense, therefore, for susceptible children to cover one eye if they approach the set. Remote programme selection by infra-red control is useful for such children. Both colour and monochrome television sets induce seizures, which are invariably generalized, though they may sometimes be of very short duration—just a few myoclonic jerks of arms and trunk muscles. Video games may also precipitate seizures. However, althought text on computer screens is occasionally associated with seizures, the problem is far less, and only occasional seizures have been reported.

Another type of visual reflex epilepsy occurs on looking at patterns such as squares of linoleum tiling. This may be regarded as typical of the highly specific reflex epilepsies occurring in a very few patients in which seizures may be induced by, for example, reading, hearing music (sometimes by only one particular phrase), or by performing mental arithmetic. The perception of such external stimuli must result in a particular pattern of nerve cell activity—this is presumably in part how we recognize tunes and words. One can only imagine that this particular set of activity in susceptible people acts as a specific template which, like a key in a lock, unlooses a seizure.

Non-specific stimuli—such as a loud noise, or a startle, however caused, may induce myoclonic jerks, and occasionally a generalized tonic-clonic seizure. This type of epilepsy is seen as an inherited feature in some strains of mice, and provides a model for the investigation of the physiology of such seizures, and a model for trying out the potential effectiveness of new anti-epileptic drugs.

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Mrs LF, of Kent, England Age 35 years. “I would like to thank you for your help and support while I was taking CMO.”

“After suffering with chronic fatigue syndrome for about thirteen years I spent most of my time resting as I was too tired to manage the most simple tasks, it was like a living death as I have previously been very active. After taking CMO I had a very bad headache and nausea for the first few days but after that I felt much better. I felt relaxed and slept very well I carried on taking the CMO and noticed after doing things around the house I wasn’t feeling so tired and this continued. I tested myself by doing a bit more, I even ran across a field which was out of the question before.”

“I feel thanks to CMO I have got my life back. I feel young again and things I thought I would never be able to do I’m starting to rediscover, as you know I am planning to marry and thanks to CMO I can look forward to my future. Thanks again.”

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Signs and symptoms

The condition is recognized by a yellow tinge to the skin and the whites of the eyes. To judge the yellowness of the skin and eyes accurately, observe the baby in natural light. (Artificial light obscures the true color.) If you suspect jaundice, inform the doctor at once.

Home care

The parents of a newborn should watch carefully for the development of jaundice in the first week of the child’s life at home. If jaundice develops, a doctor should see the child promptly.

Precautions

•     Jaundice in the first 24 hours of life is abnormal. Because a newborn infant’s nervous system is especially susceptible to permanent damage, jaundice during the first days of life has special significance.

•     Jaundice that develops or worsens after a baby leaves the hospital should be reported to your doctor.

•     Poor nursing, excessive drowsiness, irritability, and fever in a jaundiced baby should be reported to the doctor immediately.

•     If your infant develops jaundice, follow your physician’s directions exactly.

Medical treatment

Blood tests and cultures are used to identify the cause of the jaundice and to chart the progress of the condition. To lower the bilirubin level, your doctor may expose the baby to ultraviolet light or replace the infant’s blood with that of a donor.

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What is it?

A condition of the gums that causes them to become inflamed, resulting in the loosening and eventual loss of teeth.

Three-quarters of those over the age of 35 have gum disease, at least to some degree, and nearly half of all 60-year-olds have lost teeth as a result of it. Tooth decay is what wrecks children’s teeth but in adults gum disease is to blame.

What causes it?

Gum disease, like dental caries, is caused by a bacterial coating of plaque. This collects all the time along the gum line and, if it is not removed once a day, builds up to produce inflammation of the gums. Gums that are affected in this way bleed on brushing (healthy gums never bleed) and start to recede, making the teeth look longer. The fibres that tether the teeth into the jawbone weaken and eventually the affected tooth falls out.

The problem with gum disease is that you often do not even realize you have it until you start to notice bad breath, bleeding gums or loose teeth. Treatment is uncomfortable and time-consuming.

There is one specific cause of gum disease:

• Poor, or insufficient, cleaning of the teeth. Plaque has to be removed at least once a day if it is not to build up and cause gum disease.

Other contributory causes are:

• A lack of vitamin C. There is evidence that this vitamin protects against gum infections but no one knows why. Certainly vitamin Ñ is known to play a vital role in combating infection generally but it seems to be exceptionally valuable in gum disease.

• Certain foods produce a transitory inflammation of the gums which can be very painful indeed. These are usually nitrate-containing foods (preserved meats and other meats that have large amounts of preservative in them). The condition is self-limiting when you stop eating the foods.

• Stress. Some people have serious gum inflammation at a time of high stress in their lives. Drugs and oral surgery can cure the condition but obviously prevention is better.

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Pat is 65 and has three children.

She noticed one day that one of her breasts seemed to have become smaller. She had had a mammogram the previous year, and was not unduly concerned, deciding to show the breast to a doctor at her annual clinic check-up, 6 months later. However, shortly afterwards, she visited her GP with an unrelated problem and the GP noticed some puckering of the skin around Pat’s nipple, and decided to send her to a breast specialist.

Some 13 years previously Pat had had surgery for cancer of the pancreas, and so felt she did not want to worry her family unnecessarily. She therefore kept her concerns to herself, and found the month she had to wait before seeing the specialist very stressful.

The consultant who examined her was 80 per cent certain that her condition was malignant, and did a fine needle aspiration biopsy. There was no discussion at this appointment about what Pat’s options would be in the event of the consultant being proved right. She was sent for a mammogram and an ultrasound test.

About 10 days later, Pat went with her daughter to receive the results of the tests. To their delight, the consultant told them that the lump was almost certainly benign and was a fat necrosis, formed of dead cells. However, he did a further fine needle biopsy as well as a Tru-Cut biopsy, and said he did feel that the lump should be removed. Pat’s daughter took down all that was said at this appointment in shorthand so that she and her mother could go through it together when they felt calmer.

A couple of days later, Pat received a letter asking her to go in to hospital the following day for a lumpectomy. Feeling much more cheerful, she had her operation, and left hospital within 3 days.

Pat returned alone for a follow-up visit to the consultant a week later, and her dressing was changed by a nurse. The consultant told her that his first diagnosis had been correct, and the lump had been cancer – a ductal adenocarcinoma which was encased in dead cells within the fat necrosis. He also told her that she would need to have a course of radiotherapy. Pat was very frightened, and went home to ring BACUP, who sent her leaflets and were very supportive.

She has had a meeting with the oncologist to discuss her proposed treatment, and is waiting to start her radiotherapy. The oncologist has warned her that, as the cancer was deep rooted, the radiation treatment may leave scar tissue on her lung, and she should ask her GP for some antibiotics if she has any subsequent sign of chest infection.

Once the radiotherapy course is finished, Pat will have a partial prosthesis as her breast will have shrunk slightly.

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Effectiveness of a conservative laparotomy

It is difficult to give an indication of the success rates of a conservative laparotomy due to the lack of large-scale studies carried out to evaluate its effectiveness. There are few statistics on the success of surgery in terms of relieving the symptoms or on the proportion of women who experience a recurrence of their symptoms following surgery. Almost all of the available statistics are concerned with the proportion of women desiring pregnancy who conceived following surgery. Although the reported figures vary widely those statistics indicate that on average approximately 60% of women with mild disease, 50% of women with moderate disease and 40% of women with severe disease, can expect to conceive following a conservative laparotomy.

Risks and complications of a conservative laparotomy

The risks and complications of a conservative laparotomy are the same as for a laparotomy.

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The essence of cognitive therapy is to change these unhealthy beliefs into more flexible and realistic attitudes. Of course, patients may resist changing, since doing so may challenge the basic structure of their lives. One cause of resistance is known as symptomatic self-reinforcement.” In other words, if starving yourself makes you feel good about yourself, then that behavior may be hard to give up. Or the patient may resist because she doesn’t want to surrender the “guidelines for living” that she has established for herself. She must confront an onslaught of new feelings and experiences, but she lacks the “rulebook” that in the past told her how to respond.

Naturally, during this time the patient feels confused, frustrated, and frightened. Or she may shut down emotionally. Many patients who reach this phase of therapy tell me, “I just feel empty,” or, “I feel nothing at all.” Sometimes, as treatment takes effect, she encounters emotions she hasn’t felt in ages. She may want to interpret her sadness, anger, or depression as evidence that she is weak. In the past, she knew that such weakness would lead to a dietary catastrophe. In therapy, she learns that such emotions are part of daily life, and that she can learn how to handle them without falling back on her symptoms.

One way to change distorted thinking is through de-centering. In this strategy, I encourage the patient to think about the problem from another perspective, to remove herself from the center of the issue and try to evaluate things more objectively.

Here’s an example. A patient named Liz told me, “Everyone always watches me when I eat.” I asked her, “Do you always notice what other people eat?” “Of course not,” Liz answered, “Why should I?” By exploring this topic further, the patient eventually realized that, just like herself, other people are probably too wrapped up in their own concerns to spend much time noticing her. Liz learned that she was not the center of someone else’s universe-and found she was much happier with that thought.

Another way to counteract distorted thinking is through decatastrophizing. Let me explain. A patient might say, “If I don’t get that promotion at work, then my life won’t be worth living.” I might challenge this by exploring it further, saying, “What’s the worst that can happen?” or, “What can you do to make this situation better?” My goal is to help the patient take a more realistic view of the event, and to help her discover some of the alternatives open to her. When you are feeling depressed, it generally helps to be active rather than to sit passively and helplessly.

A similar approach works to counteract the “tyranny of the ‘Shoulds.’ “If the patient says she “should” do something-study harder, eat less-I will urge her to explore what would happen if she didn’t. Often, she begins to see that the dire consequences she had predicted would actually fail to materialize.

Through reattribution, the patient learns to interpret her experience more accurately. For example, an anorexic might feel that her excess energy is a sign of vitality and health, a vindication of her decision to starve herself. I will work to show her that extreme anxiety may result when the body is threatened with emaciation and that this can result in the need to be constantly active.

Another technique, developed by Christopher Fairburn, focuses on problem solving. In this strategy, the patient learns how to tackle problems in new and creative ways without resorting to bingeing.

First she must identify the problem precisely and come up with as many alternative solutions as possible. Say, for example, that her boyfriend breaks their date for Saturday night. Normally such a catastrophe would prompt her to binge. In therapy, though, we look at the other actions she might take: calling another friend, running errands she has been putting off, finishing a project, and so on. She then looks at each of these alternatives and decides which is the most practical and effective. After rehearsing the solution in her head, she carries it out. Later that day or the next, she reviews her decision and decides how well it worked, perhaps giving herself a grade on a scale of one to ten.

I ask patients to use their food-monitoring sheets to note these problems and how they came up with their solution. We can then review the process in therapy sessions. Doing so lessens the impact of problems. What’s more, it reduces the frequency with which problems occur.

I’ve mentioned just a few of the strategies of cognitive therapy. Regardless of the approach, the goal is to help the patient express her thoughts and to examine those thoughts from many different angles. We challenge her overly constricted ways of thinking and feeling. In the process, we help bring about a fundamental change in the way she perceives and interprets the world.

When we reach that goal, the patient finds herself equipped with a magnificent tool for fixing disordered eating: her mind.

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As a personal trainer and motivational speaker, Barbara Press is devoting her life to helping others meet their health-and-fitness goals. To look at this dynamic young woman now, you’d never guess that she once weighed 250 pounds.

“I turned my life around, and I tell everyone who asks me that they can, too,” says the Oxnard, California, resident. “But I also tell them that if they’re not willing to give 100 percent, they shouldn’t even bother getting started.”

It was her own willingness to give 100 percent that transformed Barbara from an overweight, out-of-shape 20-year-old into the fit and trim 33-year-old that she is today. Her 115-pound weight loss was spurred by a man whom she barely knew.

“We were on our first—and last—date when, for reasons that I still can’t explain, he started telling me that I was too fat,” she recalls. “At the time, I was hurt and angry. But his insults persuaded me to turn my life around. If I were to run into that guy today, I’d thank him from the bottom of my heart.”

Once Barbara made up her mind to slim down, she went at it with gusto. “I worked harder at that than at anything that I ever had before,” she says.

She read as much as she could on all aspects of weight loss, then began making changes in her diet. She concentrated on controlling her portion sizes and making healthy food choices. Within 1 year, she lost 60 pounds.

Inspired by her progress, Barbara added exercise to her weight-loss program. She walked regularly, working her way up to 5 miles every day. “I got addicted to it,” she says. “My day just wasn’t complete without a good workout.”

After taking off those first 60 pounds, Barbara set a more modest goal: to lose just 10 pounds a year. She consistently surpassed that goal, and by age 26, she had dropped to 135 pounds.

One year later, after losing her job in the insurance industry, Barbara enlisted in the navy at her brother’s urging. She served as a physical fitness coordinator for 6 years. “If I hadn’t lost all of that weight, I never would have been gotten into the military,” she says. “Slimming down definitely changed my life.”

During her stint in the navy, Barbara allowed her weight to bounce back to a more comfortable 155 pounds, where she is still holding steady. These days, she’s a full-time student, pursuing a bachelor’s degree in health education. She works as a personal trainer at a local gym and has her own health-and-fitness business on the side. And she’s often invited to speak about weight loss and health to various groups in her community.

When new clients visit Barbara for the first time, she asks them to spend a day or two thinking about whether they’re ready to commit 100 percent to a fitness program. “I want them to understand that getting healthy isn’t something that they can work at for a couple of days and then forget about for a while,” she says. “Anybody can do a fitness program and feel great. But you have to be ready to give what it takes.”

WINNING ACTION

Contemplate your ability to commit. Take Barbara’s advice: Spend a day or two carefully considering whether you’re really ready to commit to eating better and exercising more. You may realize that now is not the time or that slimming down isn’t a high priority for you or that you’re doing it for the wrong reasons. As the first of the

Ten Commandments of Weight Loss says, you have to believe in yourself and make yourself a top priority in order for weight loss to happen. When you’re really ready, that’s the time to get started. Then nothing will stop you.

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