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Archive for 'Anti Depressants-Sleeping Aid'

ALCOHOLICS ANONYMOUS

Posted on May 17, 2011, under Anti Depressants-Sleeping Aid.

Volumes have been written about the phenomenon of AA. It has been investigated, explained, challenged, and defended by laypeople, newspapers, writers, magazines, psychologists, psychiatrists, physicians, sociologists, anthropologists, and clergy. Each has brought a set of underlying assumptions and a particular vocabulary and professional or lay framework to the task. The variety of material on the subject reminds one of trying to force mercury into a certain-sized, perfectly round ball.
In this brief discussion, we certainly have a few underlying assumptions. One is that “experience is the best teacher.” This text will be relatively unhelpful compared to attending AA meetings over a period of time, watching and talking with people in the process of recovery actively using the program of AA. Another assumption is that AA works for a wide variety of people caught up in the disease and for this reason deserves a counselor’s attention. Alcoholics Anonymous has been described as “the single most effective treatment for alcoholism.” The exact whys and hows of its workings are not of paramount importance, but some understanding of it is necessary to genuinely recommend it. Presenting AA with such statements as “AA worked for me; it’s the only way,” or, conversely, “I’ve done all I can for you, you might as well try AA,” might not be the most helpful approach.
History
Alcoholics Anonymous had its beginnings in 1935 in Akron, Ohio, with the meeting of two alcoholics. One, Bill W, had had a spiritual experience that had been the major precipitating event in beginning his abstinence. On a trip to Akron after about a year of sobriety, he was overtaken by a strong desire to drink. He hit upon the idea of seeking out another suffering alcoholic as an alternative. He made contact with some people who led him to Dr. Bob, and the whole thing began with their first meeting. The fascinating story of this history is told in AA Comes of Age. The idea of alcoholics helping each other spread slowly in geometric fashion until 1939. At that point, a group of about a hundred sober members realized they had something to offer the thus far “hopeless alcoholics.” They wrote and published the book Alcoholics Anonymous, generally known as the Big Book. It was based on a retrospective view of what they had done that had kept them sober. The past tense is used almost entirely in the Big Book. It was compiled by a group of people who over time, working together, had found something that worked. Their task was to present this in a useful framework to others who might try it for themselves. This story is also covered in AA Comes of Age. In1941, AA became widely known after publication of an article in a national magazine. The geometric growth rapidly advanced, and in 1983 there were an estimated 1 million active members world wide.
Goals
Alcoholics Anonymous stresses abstinence and contends that nothing can really happen for a drinker until “the cork is in the bottle.” Many other helping professionals tend to agree. A drugged person-—and an alcoholic is drugged—simply cannot comprehend, or use successfully, many other forms of treatment. First, the drug has to go.
The goals of each individual within AA vary widely; simple abstinence to a whole new way of life are the ends of the continuum. Individuals’ personal goals may also change over time. That any one organization can accommodate such diversity is in itself something of a miracle.
In AA, the words sober and dry denote quite different states. A dry person is simply not drinking at the moment. Sobriety means a more basic, all-pervasive change in the person. Sobriety does not come as quickly as dryness and requires a desire for, and work toward, a contented, productive life without reliance on mood-altering drugs. The Twelve Steps provide a framework for achieving this latter state.
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OVERCOMING BARRIERS TO BDD TREATMENT: OVERCOMING RELUCTANCE TO TRY PSYCHIATRIC TREATMENT

Posted on March 19, 2011, under Anti Depressants-Sleeping Aid.

Some people are reluctant to try psychiatric treatment. The reasons vary. Sometimes, it’s a concern about stigma. For others, it’s fear of the treatments themselves, which is often based on a misunderstanding of them and possible side effects. Others insist that surgery is the solution. Sometimes this reluctance stems from a desire to “do it on my own,” and the person feels like a failure if they accept psychiatric care. While reluctance may be understandable, it shouldn’t keep you from getting treatment and getting better. Although SRIs can have side effects and CBT can be challenging, most people fare well with these treatments and easily tolerate them. You shouldn’t feel or look “drugged” while taking an SRI, and these medications aren’t addictive. If medication sjde effects occur, or CBT is too difficult, a good doctor or therapist will work with you and probably succeed in making them tolerable. I’ll say more about surgery in chapter 15, but as best we know it usually doesn’t work for BDD and may even make you worse. It isn’t a good substitute for psychiatric treatment. And trying to get better on your own is unlikely to work. Perhaps, if your BDD is mild, you may benefit from trying accepted CBT techniques on your own. But most people—and certainly those with moderate or severe BDD—will need professional help. As best we know, herbs, diet, “natural” remedies, and other strategies (other than SRIs or CBT) are unlikely to work.
When you overcome these barriers, the stage is set for a successful—in some cases a lifesaving—outcome. Anne, who had an excellent response to Celexa (citalopram) told me, “I’m feeling terrific, for the first time in 30 years.” Like some people I’ve treated who responded to medication, Ann “tested” the medication by trying to bring her obsession back. But she couldn’t. Sandy told me something similar: “The medication definitely curbs the obsession. It released a logjam. My life felt like a stream that had thousands of huge boulders and logs in it—the water couldn’t flow through smoothly. Now it flows with ease. I feel full of energy and creativity.” And after CBT, Jason felt that he—not the BDD— was in change of his life.
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OVERCOMING BARRIERS TO BDD TREATMENT: OVERCOMING RELUCTANCE TO TRY PSYCHIATRIC TREATMENT  Some people are reluctant to try psychiatric treatment. The reasons vary. Sometimes, it’s a concern about stigma. For others, it’s fear of the treatments themselves, which is often based on a misunderstanding of them and possible side effects. Others insist that surgery is the solution. Sometimes this reluctance stems from a desire to “do it on my own,” and the person feels like a failure if they accept psychiatric care. While reluctance may be understandable, it shouldn’t keep you from getting treatment and getting better. Although SRIs can have side effects and CBT can be challenging, most people fare well with these treatments and easily tolerate them. You shouldn’t feel or look “drugged” while taking an SRI, and these medications aren’t addictive. If medication sjde effects occur, or CBT is too difficult, a good doctor or therapist will work with you and probably succeed in making them tolerable. I’ll say more about surgery in chapter 15, but as best we know it usually doesn’t work for BDD and may even make you worse. It isn’t a good substitute for psychiatric treatment. And trying to get better on your own is unlikely to work. Perhaps, if your BDD is mild, you may benefit from trying accepted CBT techniques on your own. But most people—and certainly those with moderate or severe BDD—will need professional help. As best we know, herbs, diet, “natural” remedies, and other strategies (other than SRIs or CBT) are unlikely to work.When you overcome these barriers, the stage is set for a successful—in some cases a lifesaving—outcome. Anne, who had an excellent response to Celexa (citalopram) told me, “I’m feeling terrific, for the first time in 30 years.” Like some people I’ve treated who responded to medication, Ann “tested” the medication by trying to bring her obsession back. But she couldn’t. Sandy told me something similar: “The medication definitely curbs the obsession. It released a logjam. My life felt like a stream that had thousands of huge boulders and logs in it—the water couldn’t flow through smoothly. Now it flows with ease. I feel full of energy and creativity.” And after CBT, Jason felt that he—not the BDD— was in change of his life.*239\204\8*

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ALCOHOL COUNSELING: COUNSELORS WITH TWO HATS

Posted on December 15, 2010, under Anti Depressants-Sleeping Aid.

Many of the workers in the alcohol field are themselves recovering alcoholics. Long before national attention was focused on alcoholism, private rehabilitation centers were operated, often staffed by sober alcoholics. In the evolutionary process of recovery, many alcoholics find themselves working in many capacities, in many different types of facilities. We must say here that we do not believe that simply being a recovering alcoholic qualifies one to be a counselor. There is more to it than that. That view ignores the skill and special knowledge that many alcoholics working in the field have gained, on the job, and often without benefit of any formal training. They have had a harder row to hoe and deserve a lot of respect for sticking to it.
Being a recovering alcoholic has some advantages for a counselor but also some clear disadvantages. Being a counselor may at times be the most confusing for the recovering alcoholic who is also in AA. Doing AA Twelfth Step work and calling it counseling won’t do, from the profession’s or AA’s point of view. Twelfth Step work is voluntary and has no business being used for bread earning. AA’s traditions are clearly against this. AA is not opposed to its members working in the field of alcoholism, if they are qualified to do so. If you are an AA member and also an alcohol counselor, it is important to keep the dividing line in plain sight. The trade calls it “wearing two hats.” There are some good AA pamphlets on the subject, and the AA monthly magazine, The Grapevine, publishes articles for two-hatters from time to time. A book, The Para-Professional in the Treatment of Alcoholism, by Staub and Kent, covers a lot of territory on two-hatting very well.
A particular bind for two-hat counselors comes if attending AA becomes tied to their jobs more than their own sobriety. They might easily find themselves sustaining clients at meetings and not being there for themselves. A way to avoid this is to find a meeting you can attend where you are less likely to see clients. It is easy for both you and the clients to confuse AA with the other therapy. The client benefits from a clear distinction as much, if not more, than you. There is always the difficulty of keeping your priorities in order. You cannot counsel if you are drinking yourself. So, whatever you do to keep sober, whether it includes AA or not, keep doing it. Again, when so many people out there seem to need you, it is very difficult to keep from overextending. A recovering alcoholic simply cannot afford this. (If this description fits you, stop reading right now. Choose one thing to scratch off your schedule.) It is always easy to justify skimping on your own sober regimen because “I’m working with alcoholics all the time.” Retire that excuse. Experience has shown it to be a counselor killer.
Another real problem is the temptation to discuss your job at AA meetings or discuss clients with other members. The AAs don’t need to be bored by you any more than by a doctor member describing the surgical removal of a gallbladder. Discussing your clients, even with another AA member, is a serious breach of confidentiality. This will be particularly hard, especially when a really concerned AA member asks you point-blank about someone. The other side of the coin is keeping the confidences gained at AA and not reporting to coworkers about what transpired with clients at an AA meeting. Hopefully, your nonalcoholic coworkers will not slip up and put you in a bind by asking. It is probably okay to talk with your AA sponsor about your job if it is giving you fits. However, it is important to stick with you, and leave out work details and/or details about clients.
Watch out if feelings of superiority creep in toward other “plain” AA members or nonalcoholic colleagues.-Recovery from alcoholism does not accord you magical insights. On the other hand, being a nonalcoholic is not a guaranteed route to knowing what is going on, either. Keep your perspective as much as you’re able. After all, you are all in the same boat, with different oars. To quote an unknown source: “It’s amazing how much can be accomplished if no one cares who gets the credit.”
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ALCOHOL COUNSELING: COUNSELORS WITH TWO HATSMany of the workers in the alcohol field are themselves recovering alcoholics. Long before national attention was focused on alcoholism, private rehabilitation centers were operated, often staffed by sober alcoholics. In the evolutionary process of recovery, many alcoholics find themselves working in many capacities, in many different types of facilities. We must say here that we do not believe that simply being a recovering alcoholic qualifies one to be a counselor. There is more to it than that. That view ignores the skill and special knowledge that many alcoholics working in the field have gained, on the job, and often without benefit of any formal training. They have had a harder row to hoe and deserve a lot of respect for sticking to it.Being a recovering alcoholic has some advantages for a counselor but also some clear disadvantages. Being a counselor may at times be the most confusing for the recovering alcoholic who is also in AA. Doing AA Twelfth Step work and calling it counseling won’t do, from the profession’s or AA’s point of view. Twelfth Step work is voluntary and has no business being used for bread earning. AA’s traditions are clearly against this. AA is not opposed to its members working in the field of alcoholism, if they are qualified to do so. If you are an AA member and also an alcohol counselor, it is important to keep the dividing line in plain sight. The trade calls it “wearing two hats.” There are some good AA pamphlets on the subject, and the AA monthly magazine, The Grapevine, publishes articles for two-hatters from time to time. A book, The Para-Professional in the Treatment of Alcoholism, by Staub and Kent, covers a lot of territory on two-hatting very well.A particular bind for two-hat counselors comes if attending AA becomes tied to their jobs more than their own sobriety. They might easily find themselves sustaining clients at meetings and not being there for themselves. A way to avoid this is to find a meeting you can attend where you are less likely to see clients. It is easy for both you and the clients to confuse AA with the other therapy. The client benefits from a clear distinction as much, if not more, than you. There is always the difficulty of keeping your priorities in order. You cannot counsel if you are drinking yourself. So, whatever you do to keep sober, whether it includes AA or not, keep doing it. Again, when so many people out there seem to need you, it is very difficult to keep from overextending. A recovering alcoholic simply cannot afford this. (If this description fits you, stop reading right now. Choose one thing to scratch off your schedule.) It is always easy to justify skimping on your own sober regimen because “I’m working with alcoholics all the time.” Retire that excuse. Experience has shown it to be a counselor killer.Another real problem is the temptation to discuss your job at AA meetings or discuss clients with other members. The AAs don’t need to be bored by you any more than by a doctor member describing the surgical removal of a gallbladder. Discussing your clients, even with another AA member, is a serious breach of confidentiality. This will be particularly hard, especially when a really concerned AA member asks you point-blank about someone. The other side of the coin is keeping the confidences gained at AA and not reporting to coworkers about what transpired with clients at an AA meeting. Hopefully, your nonalcoholic coworkers will not slip up and put you in a bind by asking. It is probably okay to talk with your AA sponsor about your job if it is giving you fits. However, it is important to stick with you, and leave out work details and/or details about clients.Watch out if feelings of superiority creep in toward other “plain” AA members or nonalcoholic colleagues.-Recovery from alcoholism does not accord you magical insights. On the other hand, being a nonalcoholic is not a guaranteed route to knowing what is going on, either. Keep your perspective as much as you’re able. After all, you are all in the same boat, with different oars. To quote an unknown source: “It’s amazing how much can be accomplished if no one cares who gets the credit.”*187\331\2*

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

Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.

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

Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.

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!

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MEDITATION FOR ANXIETY DISORDERS: STAGES OF MEDITATION

Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.

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.

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TREATMENT OF YOUR DEPRESSION: A DOCTOR AS A COMPANION

Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.

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.

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SIGNS OF DEPRESSION: LIFE SEEMS NOT WORTH LIVING

Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.

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.

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

Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.

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.

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

Posted on December 9, 2009, under Anti Depressants-Sleeping Aid.

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.

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