MNrural Health School

Archive for the ‘Depression’ Category

It’s estimated there are about four million people with Obsessive Compulsive Disorder (OCD) in the US. This is a disorder where people find their lives dominated by repeated behavioral patterns and rituals, and it’s often associated with depression. According to the International OCD Foundation, the disorder mainly affects adults with only about 2% of children and teens at risk. One of the difficulties faced by those who suffer this disorder is the element of social shame. As the condition progresses, the rituals become more dominant and so harder to hide in everyday life. Take insecurity about whether a door is properly closed. Around the home, it might not be immediately obvious that one family member is now opening and closing doors “just to make sure”. But, as the pattern develops, it will slowly reveal itself to the others who share the same space. This is not something that would immediately spread outside the home. We can lives our everyday lives without feeling responsible for checking that all the doors we pass are properly closed. The difficulty is that, once one ritual is established, others can follow. It can therefore become necessary either to explain or suffer the bemusement of people outside the home. Left untreated, this can lead to social anxiety disorder or, in the worst cases, agoraphobia. Individual therapy is considered the best long-term hope for those with OCD. As the disorder is becoming better understood, not the least because of TV programs like Monk, it’s easier to admit the disorder and feel less hostile judgements. There are also an increasing number of support groups being established as more people with the disorder reach out for fellow sufferers and establish a network for self-help. John Hopkins University is now running a study, looking for genetic markers that might identify a cause. With a cause, it’s always possible to look for a cure. The study involves taking blood samples from at least two generations in the hope that shared or non-shared genes may suggest where the problem lies. While we wait for news, the established forms of treatment rely on two elements. The first is medications. There are a range of drugs including Valium (Diazepam) used for this purpose and the current research suggests that, with the medication alone, the obvious rituals decline by about 40%. This is socially useful but the cost, in both physical and financial terms, makes this difficult to justify over the longer term as side effects become as much of a problem as the OCD. Drugs like Valium (Diazepam) are best used in short bursts to break the cycle of behavior. The second form of treatment is psychotherapy. This is more effective because it identifies the situations that trigger the rituals and devises ways of avoiding the trigger. If the individual is still in the family, the rest of the family is involved in the treatment both to learn more patience and to establish new household routines to reduce the number of triggers. Put the two together and Valium (Diazepam) will produce a calm and more receptive state of mind in which to go through the therapy. The combination is the most effective and the most likely to produce long-lasting improvement.

Everyone gets worried every now and again. That’s all part of being human. But when worry and anxiety get out of control, the world gets to be impossible. Any little thing can set you off. Watching television, you see a report about a terrorist bomb and suddenly you’re afraid the terrorists may leave a bomb in the mall the next time you’re shopping. A casual remark at work about the recession immediately turns into fear you’re the next in line for a pink slip. You hear a friend talking about relationship problems and you’re looking anxiously over your shoulder at your partner. When anything can trigger another wave of anxiety, all you want to do is hide yourself away. You know you can’t stop the worry. That means avoiding the world. You stop going out. You won’t answer the phone. Except that just leaves all those thoughts running through your mind, worrying about what people are saying about you now you’re no longer around. Ordinary worry grows into generalized anxiety disorder (GAD) when there’s no real reason for any of your fears. You just can’t stop thinking about all the worst things that could happen to you. This is not to say there won’t be good and bad days. But doctors will diagnose GAD when the bad days seriously outweigh the good over at least three months. There are likely to be a mixture of physical and psychological symptoms from tension in your muscles, insomnia and fatigue, to feeling irritable, finding it impossible to relax, and living with the fear you’re losing control of your life. So what can you do to help yourself feel better? The first step is admitting you have a problem and then confronting your fears. If you can be honest with yourself and see the fears as irrational, you can start to move forward. There’s some uncertainty in everyone’s life. You just have to learn to accept it in yours. Then look at your lifestyle. If you live for the next hit of caffeine, dial it back. Instead, start a gentle exercise program to tire you physically and help you relax. Gather friends and family around you and get their support. If you find these simple steps are not working, go for some counseling. There are some excellent relaxation techniques. Yes, you may be skeptical about meditation and the idea of being able to calm yourself, but many people find they do work. The aim is to switch from a negative to a positive view of the world. Recognize your worst fears are almost never realized. Start to hope for the best instead. Of course, it’s always possible you can’t make self-help work. If that’s the case, a quick course of Xanax may well give you the edge. Sooner or later, you must learn to deal with anxiety head-on. If you fail, GAD can grow into depression or you may find yourself dependent on alcohol or prescription drugs. Xanax can give you a vital breathing space while you get professional help to resolve your problems.

Putting aside all the pointless arguments about whether people should get so anxious, the practical reality is that they do. If this seriously disrupts their ability to lead normal lives, then something should be done. Common humanity requires that society makes reasonable provision for their treatment. The pharmaceutical industry would have us believe drugs are the best answer to all our problems and, when it comes to dealing with anxiety disorders, our doctors have a mass to choose from. We start of with antidepressants. Yes, the name apparently suggests their function is limited to treating depression, but they can be just as useful in treating anxiety disorders. So now your doctor decides which variety to try out on you. There are the SSRIs and the tricyclics, and do not forget the MAOIs. Then we get into the anti-anxiety drugs, most often derived from the benzodiazepines. If those do not take your fancy, there are always the beta-blockers. The cabinet in your bathroom can be filled to overflowing (subject to deciding whether all these options are covered by your health plan). But, for all this choice, there is one inconvenient truth. All the independent research evidence (that’s the research not paid for by the pharmaceutical industry) shows psychotherapy to be more effective than medication.

The problem with trying to treat an emotional problem with a pill is there cannot be a conversation about why you are feeling the emotion and how you are going to deal with its consequences. Talking through the problems with a mental health specialist has the best success record in restoring quality of life and avoiding a relapse into an anxiety state. For a start, it treats you as a human being. You become the focus of attention. People listen to you and advise you on how to improve the quality of your life. In the current healthcare market, you see your doctor for a few minutes, collect a prescription and pick up the bill on the way out. People respond well when they believe their interests are being taken seriously. Their treatment is progressed rapidly if the advice they receive is seen to be useful. There is no point in advising people out of books.  Read more...

Well, it’s that time of the decade again and the American Psychiatric Association (APA) is going through it ritual of revising the Diagnostic and Statistical Manual (DSM). Let’s be clear why this is important. For better of worse, the DSM is like a bible, containing words of wisdom on which clusters of symptoms represent which disorders. The idea is to do away with the zip code lottery of diagnosis. In one US state you might be diagnosed as a bit eccentric. With the same behavior in a different state, you might be considered a danger to the community and committed to care. With the DSM as a guide, you hope to get the same diagnosis no matter who the patient is, where he or she may be found and who the doctor is. Unfortunately, the APA is caught in a terrible conflict of interest. The majority of its members regularly receive gifts and incentives from the drug manufacturers. This benevolence is designed to encourage the use of the relevant drugs. When these same doctors sit down to discuss diagnoses and which drugs to recommend, they cannot forget all the past generosity. It inevitably influences their decisions.

More importantly, if particular drugs receive approval in the DSM, this represents several billion dollars in revenue. The manufacturers therefore spend heavily in trying to ensure their drugs continue to be linked to the relevant disorders. The result is the DSM is full of disorders that are only poorly defined and linked to drugs often little more effective than placebos. If we go back sixty years, psychiatry in the US was still running in parallel with the European tradition of scientific method. This produced carefully defined diagnoses for general conditions, leaving practitioners with some flexibility to take a common sense view of the individual patient. Hence, the technical term might be a “nervous breakdown” which is a catch-all definition for anyone who has a few problems. But as the pharmaceutical industry used its economic power, these broad definitions were increasingly broken down into separate classes of disorder.  Read more...

There is a wide selection of anti-anxiety medications that are prescribed to patients with different anxiety disorders and clinical depression. Most people experience anxiety on a regular basis and it’s hard to find a person who hasn’t. The feeling of stress, worry and fear before an important event or in a situation of uncertainty – anxiety is an evolutionary mechanism that helps us respond to uncertainty and potential danger to our being. But anxiety is of course not of the pleasant experiences, as it can strongly interfere with our daily activities and affect the results of any undertaking. When you’re anxious it’s quite hard to concentrate on a particular activity and that can have quite unpleasant consequences in the end. Of course, there is a positive side to anxiety as well. It mobilizes our internal resources and abilities, making us perform at the top of our potential. Like when you fear failing an exam and get a great mark in the end. However, not always anxiety can have a positive consequence about it. Especially if we are speaking about anxiety attacks and anxiety disorders. In such circumstances the intensity of anxiety is beyond one’s control and even a simple thought can provoke panic and illogic fear. People who have had panic attacks know how it is hard to live with such thing. Anxiety disorders will affect most aspects of your life and make it hard to socialize and communicate with other people easily. The good news is that anxiety is treatable and there’s a wide range of medications and psychotherapy methods to control and eliminate most types of anxiety disorders. Still, in order for the therapy or drug to work properly one should use them under a doctor’s strict supervision. Otherwise, there may be more harm than use from these methods. There are several types of anti-anxiety medications on the market these days. One of the most popular options are benzodiazepines including such drugs as Valium, Xanax and Ativan. Aside from Xanax and its peers, there are drugs like beta-blockers, Buspirone and Gabapentin that are also used in certain types of anxiety. Sometimes a doctor will also choose to prescribe a patient with an antidepressant medication depending on the actual situation and type of anxiety disorder present. Medications such as antidepressants or SSRIs are likely to be prescribed to people with certain types of anxiety and a history of substance abuse. Doctors rarely prescribe Xanax or any other benzodiazepines to those who are known to have had an alcoholic or drug dependency, as these medications can interfere with the normal metabolism and cause a new wave of dependency problems. When dealing with anti-anxiety medications it is very important to inform your doctor about any medical conditions you have and any drugs (prescription, over-the-counter and even recreational) that you are currently taking. Anti-anxiety drugs affect the chemical balance of substances in your brain and any undesired drug interaction can cause serious consequences for your emotional and mental states. So there should be no secrets between your and your doctor, and do not even think buying these drugs and using them on your own without the doctor’s consent.