Antidepressants Blog

How Does Capsaicin Work?AH sensations from the skin are relayed to the brain. One of the chemicals used by nerve cells that carry the sensation of pain is a small protein called substance P.Capsaicin causes these nerve cells to release substance P. This release is what produces the characteristic hot, burning sensation you feel when you eat hot peppers. However, when capsaicin is applied continuously for a while, substance P is depleted, and the nerves can’t pass along pain signals as efficiently as before. (Actually, this is a somewhat simplified version of a more complicated process.) Other sensory nerves are unaffected, so you will not experience numbing of the area to which the capsaicin is applied. What you will experience is some welcome relief.You may be asking yourself how applying capsaicin to the skin will help when the pain is coming from the joints beneath the skin. The answer lies in the fact that these nerve cells are branched, with some of the branches supplying the skin and others supplying the structures beneath the skin. Substance P is apparently depleted from all of the branches at the same time, providing relief from the pain of the arthritic joint.
DosageCapsaicin-containing creams are widely available in pharmacies. The creams used in the scientific literature contained either 0.025% or 0.075% capsaicin. A recent review article suggests using the higher dosage cream.When you start out, use only a little cream, as it will produce a burning sensation. After several applications, the burning will begin to diminish. This means that substance P is starting to be depleted. You can then increase the amount of cream you use. When you no longer feel the burning, you then know that you have reached the right dose. (The same method works with hot sauces. If you build up gradually, you will soon be able to painlessly down enough hot peppers to amaze and thrill your friends!)
Safety IssuesCapsaicin creams appear to be safe. The only reported side effect is the initial uncomfortable burning sensation, which stops after a few moments. In the studies, a few people quit using the medication because of this. However, remember that this effect will subside. Of course, you will want to avoid getting capsaicin into your eyes or onto other sensitive tissues. The pain can be quite excruciating, although no real harm should result. Take care to wash your hands after each application, or wear a glove while applying it. If you should need to apply capsaicin to your hands, one manufacturer’s recommendation is to apply it for 30 minutes, then wash it off after it has had time to have its effect. Otherwise, you may very well end up rubbing it into your eyes.*63/306/5*

The growing interest in alternative medicine—from herbs and homeopathy to meditation and imagery—has been applied with a vengeance to the treatment of colds and flu. Two facts are worth remembering: “natural” does not necessarily mean “safe”—botulinum toxin is 100 percent natural and extremely deadly—and none of the so-called natural remedies have been subject to well-designed clinical studies that could unequivocably establish their effectiveness (or lack of effectiveness). Still, here are some natural remedies that there is good reason to believe may have some usefulness in countering the symptoms of a cold and perhaps speeding recovery. Warning: If you use any herbal remedies, be sure to treat them with the same cautions you would exercise with a “real” drug; overdosing can be just as dangerous since many plants contain potent medicinal substances.

Chicken soup: Popularly known as “Jewish penicillin,” soup made from a fat hen was first prescribed for colds by Moses Maimonides, a rabbi and physician in twelfth-century Egypt. But it doesn’t have to be made by your grandmother to make you feel better. Dr. Marvin Sackner of Mount Sinai Hospital in Miami, Florida, tested soup from a nearby delicatessen and showed that it helped to loosen and clear nasal mucus. See page 57 for my recipe for homemade chicken soup; if my grandmother were still alive, she would insist it is far more therapeutic than anything from a can or store.
Echinacea: This plant, a member of the daisy family, contains substances that are capable of strengthening the immune system and thus may help the body fight off an infection by a cold or flu virus. It should not be used on a regular basis, only when a cold or flu threatens.

Ephedra: This substance, from a broomlike shrub native to China, can be found in some herbal teas, including the American version, Mormon tea. Ephedra is an effective decongestant and it is the prototype for pseudoephedrine, the most popular synthetic decongestant.

Eucalyptus: The aromatic oil from this giant evergreen can help to relieve mucous congestion. It can be used with steam to relieve coughs and it is a component of some cough drops and cough suppressants. Warning: Eucalyptus should not be used for children.

Garlic: Allicin, the active ingredient in garlic, has antiviral properties and may also relieve aching joints (when applied to the skin). Garlic is said to act as an expectorant when consumed in a tea or used in a gargling solution.

Ginger: Ginger tea (made from the fresh ginger root) is a time-honored favorite for getting rid of the chills, relieving sinus and chest congestion, and countering nausea.

Goldenseal: This plant contains an antibiotic substance, berberine, that, like echinacea, is said to stimulate the immune system, prompting it to engulf and destroy infectious organisms. Like echinacea, it should be used only when fighting an illness like a cold or flu.

Imagery: Put yourself in a relaxed, meditative state and use your imagination to picture your strong and powerful immune system attacking those feeble cold and flu viruses. A study conducted by a Harvard University psychologist among thirty healthy students showed that those who used imagery in this way succeeded in boosting their immune systems, especially those elements that would fight off an invading respiratory virus.

Oscillococcinum: Although this homeopathic medicine is more than half a century old, it has yet to be put to a scientific test. Many swear by its ability to ward off colds and flu if taken at the first hint of an impending infection. However, anecdotal evidence does not establish facts. Homeopathy is based on a principle of dilution that in effect produces remedies with little or no active ingredients. The active ingredient in Oscillococcinum is listed as Anal barbariae hepatis et cordis extractum. It is made from many serial dilutions of an extract prepared from the heart and liver of ducks. In all likelihood, it is the user’s belief in its effectiveness that occasionally results in a positive effect.

Peppermint: The aromatic oil of this mint plant is touted as an all-around cold fighter—a decongestant, expectorant, and cough suppressant rolled into one. A strong infusion of peppermint tea, consumed at the first sign of a cold or flu, may or may not keep it at bay but at least can alleviate the symptoms of viral infection, including cough and fever.

Vitamin C: Though well-designed studies have shown no benefit of even large doses of this vitamin in preventing colds, several studies have indicated that when taken at the first hint of an impending cold, it can reduce cold symptoms and shorten the duration of the infection. The recommended doses needed for an effect, though, are very high—about 500 milligrams to 1 gram every hour for the first day, and about half that amount the second day. This may result in gastric and urinary irritation in some people.

Zinc: Evidence for the value of zinc gluconate lozenges in countering the symptoms of a cold is mixed. Some researchers have found it helpful, while others showed no effect. Supposedly, sucking slowly on the lozenge coats the throat with zinc and stops reproduction of cold viruses. One downside: the lozenges may taste awful. Also, beware of overdosing; too much zinc can cause nausea and raise cholesterol levels.
*25\296\2*

Try not to listen to gossip about other people’s experiences.
Unfortunately it is at times like this that people share all the dramatic experiences of someone else’s cancer.
It is their experience, not yours. Horror stories are your f friend’s way of voicing their fear – they are scared that you are going to die. Treatments are advancing quickly to minimize all the unpleasant side effects, and the survival rate of most cancers is increasing each year. Make a pact to surround yourself, in the first few weeks, only with those people who are sensitive to your needs and act in a supportive way. The gossips can wait until later! Likewise, you will be inundated with stories of how friends and relatives were ‘cured’ of their cancers by all sorts of unusual potions. Talk with your doctor about these. Your doctor will be quite familiar with these suggestions and can give you advice.
Do it in your way that makes you feel best and helps you cope.

Focus on the ‘success’ stories of cancer survivors
Ask your doctor to introduce you to someone who has made a successful recovery from your type of cancer. A ‘survivor-mentor’ can be a great support and inspiration during those ‘blue days’. Having someone there who has been down the same road and experienced all the things that you will is the best thing you can do at this stage. Cancer support groups can be a great way of finding like-minded people and support. Many women and their ‘expert’ friends will be tempted at the initial stage of diagnosis to search for as much information on the disease as is readily available. Most of it through the Internet. Ask your doctor to refer you to some credible, well-referenced sites. Many sites do not contain accurate information, and are often a dumping or cleansing ground for all the negativity that some experience. At this stage well-balanced information will help you most. The Cancer Council in your area is a great starting point for good resources. Remember that your doctor will be treating your specific needs and is the best person to discuss your concerns with.
*20/144/5*

What Is the Pain Message in RA?
We’ve stated that pain is a signal or message. What exactly is that message in the case of RA? In RA, inflammation that occurs in the joints can irritate nerve endings in the joint lining (synovium), capsule, and ligaments. This inflammation leads to swelling within the joints which causes these same structures to become stretched. Inflammation causes pain, and that pain is intensified by swelling. Pain from joints that are highly inflamed (warm, swollen, and tender) sends the following messages: (1) Respect your pain. (2) Slow down, you’re overdoing it. (3) Protect and rest your joints until the inflammation subsides.

Decreasing Pain
Just because pain is a valued signal doesn’t mean you have to suffer through it without trying to decrease its intensity. After all, pain is exhausting! The first step in decreasing the intensity of pain is accepting that pain exists in your present life. This doesn’t mean that you should surrender to a painful existence; it simply means that you must accept the fact that your joints are painful today and that you’ll need to direct your energies toward getting through today. If you are filled with regrets about the past and fears of the future, you are unsuccessfully fighting the presence of pain in your life. Regret and fear are wasted emotions that create feelings of guilt, blame, and anxiety, and these cause you further pain today. It is true but ironic that accepting pain is the first step in decreasing it.
Next, recognize pain as being a very personal experience. Understanding that each person has a unique awareness of his or her pain is critical because effective strategies for combating pain will differ for each person. You will need to take responsibility for your experience of pain, from how you perceive it to how you handle it. This does not mean accepting the blame for having RA. Rather, it means not viewing pain as an outside force that is directing you; don’t allow your pain to have that much power! Instead, view pain as a force over which you can exert some control. This will mean assessing the source of your pain, conditions that worsen it, your perception of it, and options that will allow you to direct it.
*41/209/5*

Finally I begin to see some light in the mystery. Sam’s primary process is to be an easy-going, decent fellow who feels a lot and who expresses himself kinesthetically. He claims he wants to talk things out and has trouble doing so. He dresses like a very sociable person.
His secondary process consists of the aggressive, nasty and unmannerly people in the house he is running from. His own aggression is obvious to me; I see his right hand on his hip while he is sitting, like a cowboy’s posture. What exactly is this split off anger about?
Amy:  Why do you live there?
Sam (shaking his head ‘No’): People are there who did nasty things . . . came from other places. . . . [Changing the subject] … at the table I could not take it any more, such disgusting asses at the table. They act and eat terribly, throw stuff on the floor. I left the table several times . . . and I had to leave. Amy:  How do they eat?
Sam:   They throw stuff on the floor, not appetizing. . . you know? Or they throw stuff . . . awful.
Because I could not understand Sam’s story, I did not focus on the content of what he was saying. I did not think of those nasty guys as part of the world he has to learn to get along with or as part of his process, his own aggression and sloppiness.
Amy:  But why are you there?
Sam:    I was told it is the best place for me … ah . . . oh … I was forced to go.
Amy:   But why were you sent there, did you steal? Did you hit someone? I would not live there even if they forced me.
Sam (interrupting me in a moral and indignant tone): Before ‘ I hit, I always talk to people!
*135\227\8*

The following example illustrates application of positive reinforcement to a child for managing his medication. When one step is assimilated, move on to the next one until the final goal is achieved.
Step 1: The child is taught to identify the shape, size and colour of the medication he has to take. This can be done by showing the child what different tablets look like — one that is white, another which is circular like a coin and or smaller than any coin. Make him repeat each characteristic and reinforce after each medication is correctly remembered.
Step 2: The child is taught the names of the medicines. Make him repeat the names and reinforce when it is done correctly.
Step 3: The child is taught to recognize and recall the times and situations when medicines have to be taken. For example, evening medicines may have to be taken at 8:00 p.m. which may be the bed time. Make the child keep a daily calendar where he can mark the time when a particular medication is taken. This not only serves as a reinforcer but also keeps a check that the medicines for that particular time have been taken.
Step 4: The child starts taking the medication under close supervision according to a previously prepared routine. For example, the parents can put the morning pills in the middle of the breakfast plate. The medicine must be taken before the plate is filled. The child can be encouraged to say something like ‘Okay mummy, I am taking my medicine now.’
Step 5: The next step is to encourage the child to come and ask for his medicines at the proper time.
Step 6: The child progresses to taking the medicine in the presence of parents.
Step 7: If the child can consistently take medicine without being reminded for about two weeks he may be allowed to manage his own medication. The parents must continue to supervise for the next three times or so. Slowly the supervision can be tapered off.
Step 8: Gradually the child becomes self-sufficient as far as his medicines are concerned.
Step 9: Slowly the child is taught to tackle situations like vacations, changes in school routine and spending the night with a friend. If necessary, the child can be helped to develop a method for remembering to take medication at unusual hours.
*110\260\8*

Q: What about self-help? Aren’t there things I can do for myself now that I know I have ADHD?
A: Yes. First, educate yourself about ADHD by reading books and discussing the disorder with your specialist. The more you understand about how this underlying disorder has affected each area of your life, the better you will be at improving your situation.
Next, educate the significant others in your life. This may include family, friends, and work colleagues. The more they understand about your difficulties, the more they will be able to help you.
Then it is time to structure and organize your life. While an ADHD specialist can be a valuable advisor or coach in this task, there are steps that you can follow on your own.
Define the problem. You should start by defining
your problem areas. Write them down. One at a time,
break each problem down into its components. It may
help to ask yourself just what aspect of the task or
situation makes it difficult for you.
For example, the problem of being perpetually late may have several typical causes. It may be that you don’t plan activities ahead of time and have no real idea how long it takes you to do things. Or the problem may be with your distractibility. While you may plan to do something and have adequate time to get to it and do it, you may be repeatedly distracted from the task.
Brainstorm solutions to each component of your problem. Use paper and pen to write down all solutions and alternative ways of doing things that come to mind.
Mentally test your solutions. Here you begin to use your critical faculty and, in your imagination, go through the solutions and assess the likely outcome.
Critically plan your solution. Here you can discard
the ideas that clearly won’t work and begin to plan
your new strategies for coping with certain situations.
For example, after defining the problem of lateness, you have come up with some solutions: “Run or drive faster. Just get more done in a day! Wear three wristwatches; set three alarms. Begin by estimating the time for each activity you plan to do in a day, write it down, and as you actually do the activity, record the length of time it took. Compare the estimate with the actual time.” Well, you will soon see that some solutions, like the last, are better than others, like the first three. You can discard the ideas that clearly come from your impatience, impulsiveness, and self-punitive feelings, and begin to see that if you allow yourself to tackle problem-solving in this way, you can actually come up with some good solutions.
Add organization and structure to your life. This change could benefit all aspects of your life. You can start with external structure. This may include ordering your possessions; organizing your time with lists and schedules; using filing systems, notebooks, and lists as external memory banks and reminders; and minimizing distractions in your workplace. Such external structure can also help internally: the more information you structure and record externally, the less you have to be trying to remember and deal with in your mind. In other words, you can minimize the clutter and distractions in your mind by making some of your tasks, reminders, and organizing needs external and concrete. Then you can better focus on what is essential.
Define tasks more clearly. This may include breaking down tasks into smaller components, prioritizing them, and taking into account your own attention span and need for variation, breaks, and physical activity. Perhaps you work best in forty-five-minute chunks, or perhaps you work best with a long expanse of uninterrupted time, in order to better focus your attention. Then plan your work accordingly.
Use time-out strategies to deal with intense emotions. If a major part of your difficulty stems from impulsive actions and heated emotional outbursts, then you can begin to train yourself to deliberately take time out when emotionally aroused. This may mean counting to ten, or it may mean actually going somewhere to cool out. During this cool-out period, follow several mental steps: Define the problem. What upset you and why? What is your impulsive solution, and is that really the best way to react? What would be an alternative way of handling the situation? What is the outcome of that reaction or action likely to be? Is there an even better way of handling the situation? This process allows you to delay impulsive action and to practice bringing your inner reflective skills to bear on the situation. This is often very difficult for ADHD sufferers. As I have explained in Chapter 6, psychotherapy is often necessary in order to strengthen these inner reflective skills. However, setting up a disciplined time-out strategy can be an enormous help in gradually making this reflectiveness become more automatic and in making intense emotional states more tolerable.
*135\173\2*

As if consumers weren’t already confused enough by the hundreds of cold/flu remedies, every year several dozen new products are introduced in hopes that they will capture a significant portion of the more than $1.4 billion over-the-counter market. Most are slightly altered versions of already existing products. Many contain a mix of ingredients, only some of which may be useful while others may be counterproductive.
If any medications are taken at all, experts advise that single-ingredient products be used, chosen to counter the most bothersome of your symptoms. When treating a cold, less is best. The more ingredients you take, the more likely you will experience adverse side effects that may actually make you feel worse. Keep in mind, too, that as a cold progresses, the symptoms change, and so should the treatment.
Pregnant women should not take any medication without checking first with their physicians. The elderly, too, should exercise caution, since they are more likely to experience toxic side effects from both over-the-counter and prescribed drugs. Also, anyone with a chronic health problem, from heart disease to glaucoma, and anyone taking prescribed medication, including psychotherapeutic drugs, should check with a physician before taking any over-the-counter cold/flu product.
Whatever drug you choose, there is no inherent advantage in paying more for heavily advertised “name” brands; generic or storebrand versions will work just as well (or as poorly). Here is what you might find in a cold/flu medicine.
Active ingredients: These are the substances that are supposed to have a direct effect on symptoms. They include analgesics (painkillers) and antipyretics (fever reducers), decongestants, cough suppressants, expectorants, and antihistamines.
Inactive ingredients: These include substances like alcohol that give the medicine form and texture, flavoring and coloring agents, stabilizers, sugar, and caffeine (often added to counter the drowsiness induced by antihistamines, but not too helpful if what you need most is sleep).
Analgesics and antipyretics: The common painkillers—aspirin, acetaminophen, and ibuprofen—play two roles. They relieve headaches and muscle aches and they reduce fever. If a product containing any of these is used, additional pain or fever medication should not be taken. Of the three, acetaminophen is least likely to cause stomach upset. Before taking aspirin or ibuprofen, it is wise to eat something. Aspirin has been shown to increase viral shedding (and thus may help to spread the cold to others) and it may also prolong the infection. Remember, too, that fever is one of the body’s main weapons against infectious organisms, so unless it is very high (say, above 102°F in an adult), you may want to let it run its course.
Decongestants: These help to relieve upper respiratory congestion (stuffy nose and sinuses) by shrinking blood vessels and reducing swelling in the nasal passages. But relief comes at a price. Oral decongestants can cause dry mouth, agitation, insomnia, increased heart rate, and raised blood pressure. Pseudoephedrine is the most popular decongestant used in oral medications. Phenylpropanolamine (PPA), the most common ingredient in diet drugs, is also often used as an oral decongestant, but it is more likely than pseudoephedrine to cause a steep rise in blood pressure. Oral decongestants may interfere with restful sleep and result in daytime fatigue. Limit their use to one week to avoid a rebound reaction— an increase in congestion and dependency on the product. Fewer side effects are associated with topical decongestants in nose drops and nasal sprays. Effective ingredients include xylometazoline, oxymetazoline, ephredrine, and phenylephrine. However, nose drops and sprays should not be used longer than three days; longer use can cause a rebound reaction.
Cough suppressants: These products, also known as antitussives, are used to suppress an irritative, dry cough. Experts recommend that they be reserved for coughs that disrupt sleep. Lingering coughs that interfere with a person’s waking life are best treated with home remedies like ample fluids, cough drops, and lozenges. The most popular cough-suppressant product is dextromethorphan. Others deemed effective are chlophendianol and codeine (a prescription drug that is sleep-inducing and can be habit-forming).
Expectorants: When a cough is “productive”—sputum-producing—it is consider a “good” cough that is cleansing the breathing tubes of excess mucus and potentially infectious microorganisms. The goal is not to suppress such a cough but rather to liquefy and loosen the phlegm so that it is more easily coughed up. This is the role of expectorants. Expectorants may also help to loosen up a “tight-chested” nonproductive cough that results from an accumulation of secretions so thick they cannot be coughed up. The only expectorant approved as safe and effective for over-the-counter use is guaifenesin. Though it may seem counterproductive to take a product that contains both an expectorant and a cough suppressant, the combination may be helpful when taken before bedtime if a productive cough frequently interrupts sleep.

Antihistamines: These products are designed to counter the symptoms of allergies by blocking the effects of histamine. Histamines play almost no role in colds and flu, but antihistamines have a potent drying effect, which has prompted their widespread use in products designed to stop the runny nose that is the hallmark of the early stages of a cold. However, this is one ingredient experts say should be avoided by cold and flu sufferers because it can thicken secretions in the chest and sinuses, making them harder to expel and setting the stage for a secondary infection. The antihistamines approved for over-the-counter use also cause drowsiness, adding to the fatigue induced by a cold and making driving or operating machinery very hazardous. Other side effects may include blurred vision, dry mouth, constipation, and urine retention. The most commonly used antihistamines in over-the-counter products are chlorpheniramine, triprolidine, brompheniramine, and doxylamine.
*24\296\2*

Positive reinforcement in daily life are smiles, a pat on the back, attention, an encouraging word or look and praise. All of us thrive on positive reinforcement. So, if something makes the child feel genuinely good about himself then it is a reinforcer. Positive reinforcement is the backbone of the Social Learning Theory.
Positive reinforcement is most effective when given immediately after the desired behaviour has occurred. A connection between the behaviour and the reinforcement is then more easily made. A delayed reinforcement loses some of its value.
It is also important to make the child realise why he is being reinforced, i.e., being praised or encouraged. Even small steps like remembering to take the early morning medication should be positively commented upon and lauded.
A child trying to learn a new behaviour or skill, needs constant encouragement and support especially in the beginning to build his confidence and pride. As the new skill or behaviour slowly becomes a habit, the amount of positive reinforcement can be reduced. Helping a child become self-sufficient requires consistent and diligent effort but the pay off is a happier, more independent child.
*109\260\8*

The following remedies are intended for short-term use only. It is generally not helpful to exchange regular doses of laxatives for regular doses of the appropriate homoeopathic remedy, since underlying causes must be dealt with, rather than being dependent on medication for the regulation of symptoms.
Nux Vomica
Often indicated for people who have become dependent on regular doses of laxatives connected to a busy sedentary lifestyle. The stool may be described as ‘bashful’ because of its tendency to incomplete evacuation. Those needing Nux Vomica are likely to experience a sensation of never quite having completed a bowel motion – it often feels as though something has been left behind. There may be a strong urge for a bowel movement, but however much straining is done, nothing seems to happen. There may also be a residual burning sensation in the rectum once the bowels have acted. Irritability and physical and mental oversensitivity are likely to accompany the problem.
*159\326\8*