Archive for 'Anti Depressants-Sleeping Aid'

CAN ST JOHN’S WORT WORK AT FIRST AND THEN STOP WORKING? WHAT SHOULD I DO IF THAT HAPPENS?

It is not uncommon for an anti-depressant that works initially to stop working after a period, which may range from weeks to years. St John’s Wort is no exception in this regard and depressive symptoms may recur after an initial response. A relapse of this kind may be due to a worsening of the depression, which is sometimes the result of a definable cause such as a personal loss, a new stress or the onset of winter. Wherever possible, the first-line response to such a setback is to deal with the underlying cause, for example to obtain extra support from friends and family, adopt strategies to help deal with the stress or increase the amount of environmental light.

If the trigger for relapse cannot be identified or if the steps to correct it by making environmental changes are unsuccessful, medication adjustments can be made, including increasing the dosage of St John’s Wort or adding another anti-depressant. Sometimes a person develops what is known as tolerance to an antidepressant, which means that certain chemical changes in the brain override the beneficial effects of the medication. In this case it can pay to switch to another medication or to add a medication specifically designed to potentiate the effects of the anti-depressant. Drugs such as lithium carbonate and synthetic thyroid hormone have been reported to be effective potentiators of conventional anti-depressants and may be of value when added to St John’s Wort as well. If the medication situation is complicated enough to warrant potentiation of an anti-depressant, it is certainly necessary for a highly skilled doctor to be involved in treatment decisions. The purpose of providing you with this information is so that you can understand some of the steps your doctor is likely to consider in dealing with the delayed development of unresponsiveness to an anti-depressant.

One possible reason why St John’s Wort may stop working is that the composition of active ingredients may vary from one batch of St John’s Wort to another. You might suspect this to be the case if you purchased a new batch of St John’s Wort just before noticing the change in anti-depressant effect. Reliability of quality control is one reason why I recommend the brand of St John’s Wort with the best documented and most reliable track record, namely Kira™, so as to minimize the likelihood of relapses due to inconsistencies between batches.

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ANXIETY DISORDERS/WORKING THROUGH THE RECOVERY: OUR THRESHOLD TO STRESS

The working-through process may at first seem difficult and confusing, but it isn’t. Some people can feel daunted and overwhelmed by the amount of effort needed. It is worth it. Everything which is required from us during the working-through process will be given back to us in the sheer joy and total freedom of recovery.

The working-through process is the same for everyone. The only difference is our personal threshold to stress. Some people may have reached the point where they cannot tolerate even the smallest stress. Other people may have a higher threshold to stress, but it is still low enough to trigger fearful thoughts.

The time it takes people to recover will vary. The individual threshold to stress comes into account, but the amount of effort and discipline we put into our recovery is most important.

The first attack was the result of either a build-up of stress or a major life stress. In other words, the anxiety and/or attack happened when we reached the limit of our individual threshold to stress. This doesn’t mean we are weak. It simply means we have reached our limit to stress, just as most people will reach their limit to stress at one point or other in their life. Continual worry about the symptoms of anxiety and attacks only increases our stress and lowers our threshold to it.

As we begin the working-through process it is helpful if we have an understanding of how low our threshold to stress is and how high our anxiety is.

If our threshold to stress is now extremely low we may not be able to tolerate even the smallest daily stress. Our threshold to stress would be zero, while our anxiety level would be ten. At level five we would be able to tolerate the daily stress/es, but would find our anxiety level rising if there is a break in our normal daily routine. At level ten we would be able to deal with almost any stress without becoming anxious.

The working-through process means working to increase our threshold to stress back to normal levels, while decreasing our anxiety level.

It’s no use just hearing or reading about panic anxiety management skills. We have to practise them. There have been occasions when we say we’re not getting any better, and nothing has changed. If we are not getting results it usually means we are not practising enough, or even not practising at all!

*85/94/8*

MEDITATION FOR ANXIETY DISORDERS: STAGES OF MEDITATION

There are various phases of the meditative process. Most people experience them in varying degrees. Some people become very worried about these experiences. Therefore it is important to discuss them.

The one experience people worry about is the sensation of their body relaxing. Sometimes people have been so tense for so many years they have forgotten what it is like to feel even slightly relaxed. As their bodies begin to let go of the tension, people become anxious and interpret the sensations as a sign that their worst fears are about to come true. They don’t.

The first stage of meditation can be difficult for beginners. Our thoughts are not used to being ignored and they continually break through and demand attention. As long as we can accept this as normal and let go of them without becoming frustrated, we can move into the second stage of meditation.

As we enter the second stage of meditation we feel the quiet settle over us. Our breathing begins to slow down. Our thoughts are still rising and falling, but our attention is now much more focused on our technique. Everything moves into the background as our quietness grows.

We enter the third stage. Our breathing slows down even further and our body becomes deeply relaxed. We may feel as if we are as light as a feather, or we may feel a comfortable heaviness. We become aware that the continuous stream of thoughts has broken. They now rise slowly and separate from each other. Individually, they quietly rise and fall without us becoming distracted by them. We find our word or mantra becomes distorted. This is what is supposed to happen. Some of us may see brilliant white, black or other swirls of colour. We can use them to take ourselves deeper. Our thoughts drift in and out, slowly and quietly.

We then enter the full meditative state in which there is perfect quietness, an absence of thought, feeling or emotions. Unlike the stages of deep sleep, this state of consciousness is very dynamic. There is full awareness of ‘nothing’, but in that ‘nothing’ is an awareness of ‘every-thing’. In this state there is no technique and no thoughts or feelings-just an all-pervasive quiet. Yet we are aware of everything and in full control. When we think ‘this is wonderful’ the quiet is broken by that thought, but we can return to the quiet simply by returning to our technique.

This is meditation.

*74/94/8*

TREATMENT OF YOUR DEPRESSION: A DOCTOR AS A COMPANION

In a recent article, the eminent doctor and author Sherwin Nuland writes about the deficiencies of modern medicine in which the doctor treats the disease but not the patient who is suffering from the illness. Being ill is a lonely and scary condition and, of all illnesses, depression must surely be one of the loneliest and scariest. A good doctor should be a source of comfort to you in your illness and in the recovery process. You would do well to invest the time and energy in finding a doctor who is not only technically competent but is also able to play this critical role.

Choosing a Doctor

I can’t emphasize enough how important is the choice of a doctor. I am often astonished by how some highly discriminating people, who are careful in the selection of their barber or hairdresser and will go to great lengths to buy the right car at the right price, will take pot luck with whatever doctor is in their neighbourhood. I always like to go to doctors recommended to me by other doctors, figuring that if you’re in the trade yourself, you know the wheat from the chaff.

Credentials are of some value in choosing a good doctor, but sometimes doctors trained at the best places can also be conceited and closed to new ideas. In seeking a doctor, find someone who is clever, up-to-date, sympathetic, open-minded and not too impressed with his or her own opinions. Find someone who will take the time to listen to you and really hear what you are saying. Finally, keep an eye on your doctor. Even the best doctors are only human, can make mistakes and don’t always think of all the possibilities. Even if you are in treatment with a good doctor, you still have some responsibility to use your wits to be sure that you get the best possible care.

Extricating Yourself from an Unsuitable Doctor

A good doctor should not only keep up with the literature but also be open to learning new things. Ignorance is human and often forgivable; it is, after all, a treatable condition. Closed-mindedness, however, is hard to treat and if your doctor is not open to new information, that is a real problem since medicine is constantly changing and new diagnostic and treatment approaches are regularly being developed. It can also be very distressing to end up with a doctor who, rightly or wrongly, reflexively dismisses your point of view, as illustrated by the following cautionary tale.

*64/75/2*

SIGNS OF DEPRESSION: LIFE SEEMS NOT WORTH LIVING

As you can imagine, with all the symptoms I have just listed, including a grim and bleak view of your present situation and future prospects, a depressed person may easily reach the conclusion – or entertain the possibility – that life is not worth living. This symptom of depression, known to the clinician as suicidal ideation, is a very troublesome one. If you are experiencing any such ideas, please do yourself and everyone who cares about you a great favour and consult a doctor without delay. Depression is a condition where hope is in short supply and one way to get an infusion of hope is to reach out to those who may be able to guide you out of the dark place. Your GP is a logical first port of call in such an attempt to reach out. But if, for any reason, it is difficult for you to talk to your doctor about the problem, tell someone – a family member, friend, or even someone on a crisis hot line. Suicidal ideation is not a symptom that anyone ought to have to suffer alone.

As depression deepens, suicidal ideation may progress to passive suicidal longings, which may be accompanied by lack of self-care or carelessness. A depressed woman may feel a lump in her breast while taking a shower and may say to herself, ‘So what if it’s cancer? It would probably be all for the best anyway’ Another depressed person might cross the road carelessly and, in the back of his mind, be thinking, ‘Well, if I get run over, what loss will that be to anyone?’

Matters become even more serious when suicidal ideas begin to gel into actual plans, and even more so when actions are taken to put these plans into effect. It might seem unnecessary to say that if someone you know or love should mention suicidal ideas or plans to you, these should always be taken seriously. Unfortunately it is still all too common for people to minimize the seriousness of such communications. The idea that if someone tells you he is considering suicide, he is unlikely to act on it, is a very dangerous myth. Such divulgences should always be heard as a communication of despair, which may or may not involve immediate danger but which always warrants serious attention. At the very least it is an expression of severe mental anguish.

If you think that life is not worth living or have any thoughts or plans to end your life, you are very, very likely to be depressed. Please don’t delay in getting professional help for this problem.

*58/75/2*

A PRACTICAL GUIDE TO USING ST JOHN’S WORT: GETTING THE DOSE RIGHT

Since the target dosage in most of the anti-depressant studies of mild-to-moderate depression has been 900 mg of Hypericum per day, this is a reasonable dose to aim for. The Kira brand of St John’s Wort which, for reasons that I discuss later, is the one I recommend most highly, comes in only 135-mg dosage, at least in the UK, which would mean taking about six 135-mg pills every day. Whenever I start an anti-depressant, I always begin with a low dose and increase the dosage somewhat gradually until the final or target dose is reached. The reason for this is that some people are very sensitive to medications and it is often not possible to predict who will be very sensitive and who will not. An average dose of an anti-depressant may be far too much for such a person to tolerate, especially when just beginning the medication. If a highly sensitive person starts right out with an ‘average’ dose of an anti-depressant without building up to the final target dosage, unpleasant side-effects may result and the person may be disinclined ever to try the medication again. So I would rather err on the side of moving a little too slowly. In practice, this means that I start a person on 300 mg (approximately two 135-mg pills) of Hypericum once a day for two or three days, then twice a day for two or three days, then three times a day. In older people, say over 60,1 would proceed even more gradually.

If unpleasant side-effects should develop, I slow down this progression, always working within the patient’s comfort zone. In other words, if you are uncomfortable with two 135-mg tablets of

Hypericum per day, don’t move up on the dosage until the side-effects dissipate, as they generally will. Be sure to listen to what your body is telling you. Discomfort of any sort is a signal for you to slow down. In some sensitive people, including the elderly, a final dose of less than 900 mg, such as 600 mg (4 x 135 mg), may work best.

I should note that my practice of starting slowly differs from the widespread practice in Germany of starting with 900 mg per day – approximately two Kira tablets three times a day. According to my German colleagues, they do not experience problems with this approach.

Be sure to take the Hypericum with meals, as this minimizes the chances of developing indigestion or abdominal discomfort which may occur in certain people on the herbal remedy.

*46/75/2*

SUGGESTIONS FOR THOSE WHO ARE STRESSED OR FEELING MILDLY BLUE, DOWN IN THE DUMPS OR UNDER THE WEATHER

An old advertisement for an over-the-counter cold medication observed that you can’t take every cold to a doctor, and proceeded to plug the medicine in question. The advert was right. It is not sensible to go to the doctor with every cold – or, for that matter, whenever you feel blue, down in the dumps or lacking in energy and pep. On the other hand, a case of pneumonia should always be taken to a doctor – and promptly – and that applies to serious depression as well. And just as we have guidelines to help us distinguish between a cold and pneumonia, so we can distinguish between serious depression and feeling mildly out of sorts. In the mildly blue, stressed-out, under-the-weather category, I would put those whose symptoms are not seriously interfering with their work, personal relationships or other aspects of their functioning. Also, the problem should not have been going on for too long, not more, say, than for a couple of months.

If you think you qualify for this very mild category, I suggest that you read about the symptoms of depression anyway because depressed people are often not very good at recognizing how depressed they are – and they are not alone in this regard. Statistics indicate that even doctors fail to recognize and treat depression properly in a very high proportion of cases. If professionals underestimate depression to this extent, lay people can surely be forgiven for doing the same. Because many of the symptoms of depression do not actually involve sadness or depressed mood, but rather physical symptoms, they are easily attributed to other conditions. In addition, depressed people often believe that their problems are due exclusively to influences from the outside world rather than some internal problem. This set of beliefs may be associated with a fear of acknowledging that ‘there may be something wrong with me’ and a pessimism about being able to correct the problem. In fact, the opposite is often true as it may be easier to correct problems that stem from within yourself than those that arise in the outside world, over which you may have very little control.

If, after reflection, you still feel that you are not clinically depressed, but simply overstressed or mildly down in the dumps, you may well benefit from a trial of St John’s Wort as described below. It is always important, of course, to address any underlying causes of your unhappiness in addition to taking the herbal remedy.

*45/75/2*

ANXIETY IN THE BODY: NERVOUS HEADACHES AND MIGRAINE AND PAINFUL MONTHLY PERIODS

These two different conditions are both associated with anxiety—nervous headache directly so, and migraine less directly.

The pain of nervous headache is felt on both sides of the head, and mainly in the front part of the head and behind the eyes or at the back of the head. There is often an accompanying feeling of something pressing on top of the head or of a tight band around the head. Nervous headache is the direct result of nervous tension, and if the tension is relieved by appropriate measures the tendency to headache soon vanishes.

Migraine is a different kind of headache. It is usually preceded by some strange feeling which acts as a warning that an attack of migraine is about to develop. There are often disturbances of vision, so that sight is impaired and further disturbed by flashes of light or bright wavy lines. Then the headache itself comes on. Unlike nervous headache, migraine is usually felt only on one side of the head, quite often behind the eye. As the headache develops there is a feeling of nausea and frequently actual vomiting. The attack may last for some hours or even days before passing off.

The migraine attack is due to a temporary constriction of some of the arteries of the brain which is soon followed by a dilatation of the same vessels. It seems that a number of factors combine to produce this effect, and that emotional stress is one of the most important of these factors. Of the patients with migraine treated by myself with relaxing methods to relieve tension approximately one third have practically ceased to have any attacks at all, one third have been markedly helped but still have some attacks, and one third were not helped at all. So it would seem well worthwhile for anyone who suffers with migraine to give the relaxing mental exercises a fair trial in order to reduce nervous tension as a means of relieving the attacks.

Painful Monthly Periods-A great number of women and girls suffer from this distressing condition, which is technically known as dysmenorrhoea. There are different physical conditions which predispose toward this complaint, but in almost all cases there is an important emotional factor. If this can be remedied by reducing the patient’s general level of anxiety so that she ceases to overreact to stress, the condition is usually cured or at least greatly relieved.

*26/57/2*

ST JOHN’S WORT IN EVERYDAY LIFE: ST JOHN’S WORT AND SOCIAL PHOBIA

Social phobia, one of the most common hidden causes of distress and anxiety in everyday life, is estimated to affect approximately one in eight adults. People with this problem have a persistent and powerful fear of being scrutinized, evaluated or being judged by others. As you can imagine, this condition results in considerable impairment of functioning as it prevents people from asserting themselves in work or social situations. Although people with this difficulty may simply appear shy to outsiders, actually they spend a great deal of time worrying about being embarrassed, and engaging in painful fantasies of being ridiculed or humiliated.

According to Dr Michael Liebowitz of Columbia University in New York, a pioneering researcher in the field of social phobia, there are several lines of evidence suggesting that brain pathways involving the neurotransmitter dopamine are disturbed in social phobia. To a somewhat lesser extent, pathways involving serotonin also seem to be involved in this condition. Studies indicate that anti-depressants may be of some value in the treatment of social phobia. As St John’s Wort has been shown to influence both dopamine and serotonin pathways, there is reason to consider that the herbal remedy might be of some benefit in social phobia. As several of the stories in this book have indicated, after starting the herbal remedy a number of people report becoming more outgoing and less shy, and more willing to take the initiative in a social or work situation.

Currently social phobia is a greatly undertreated problem, in part because it is not recognized by clinicians but perhaps also because the very symptoms of the condition – fear of being judged and humiliated – may prevent people from bringing their problem to the attention of a professional. For these people, an herbal remedy that can be purchased over the counter may be enormously appealing. Although formal studies of this use of the herb are needed, early evidence suggests that if you are painfully shy or afraid of making a social overture or asserting yourself, St John’s Wort may really be worth a try.

As we can see, there are many possible roles for St John’s Wort in everyday life – for stress, low energy, down feelings, insomnia, premenstrual symptoms and painful shyness. Small wonder that the ancients thought this herb capable of miracles, and attributed magical powers to it.

*24/75/2*

ÑHILDREN’S SLEEP PROBLEMS: MOVING THROUGH DISTINCTLY DIFFERENT SLEEP STATES

All people—children and adults—move through distinctly different sleep states which progress from drowsiness to very deep sleep. In the waking state we are rational and functional. In non-REM sleep the body rests and restores itself. In REM sleep the mind is active again and dreaming occurs (REM stands for “rapid eye movement”—a stage of sleep that is characterized by such eye movement.)

The night begins as the child moves quickly through drowsiness and into deep sleep within ten minutes. Waking a child in deep sleep might be almost impossible—this is the time your child can be moved from the car or your arms into bed without waking.

Deep sleep makes up the next two or so hours of sleep. After about an hour (and again after the next hour), it is interrupted by a brief arousal when the child seems to be sleeping and waking at the same time. Behaviors range from crying out or opening eyes to the more extreme thrashing about. It is during this arousal that confused thrashing, sleep terrors, sleep walking, or bedwetting might occur. Although we tend to think that these behaviors are a result î dreaming, that is not the case since dreaming does not occur until REM sleep

The bulk of the remaining night is spent moving between light sleep and the REM episodes in which dreaming occurs. There is a tendency to wake briefly while changing states—the child checks to be sure all is well, goes back to sleep, and generally doesn’t remember this waking in the morning. Sometime when he wakes during these “arousals” he has difficulty returning to sleep. This is a common cause of frequent waking. If he needs your help to get back u sleep, he will wake you.

It is during this block of time (in the REM episodes) that nightmares occur. If he comes to a full waking while moving in and out of the dreaming states, he might be afraid to fall asleep again.

Near morning he returns to another period of deep, non-REM sleep. Following another arousal comes another, more intense, REM dream episode. After more light sleep and dreaming transitions, he wakes for the day. If the child wakes fully during any of these transitions, he might decide that night is over; he then becomes an early waker. If you decide to wake him (to fit your schedule or in an attempt to alter his) during his period of deep sleep, you will both be left out of sorts.

*12/67/8*

 

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