Health Issues is a general health based blog concentrating on multiple health topics.

TREATMENT OF STRESS BREAKDOWN: STRESS WE CANNOT AVOID

Friday, April 15th, 2011

We come now to the people who are suffering from stage one stress breakdown symptoms as a result of stress that they cannot possibly avoid. In this category I place the people whose occupations require them to accept long periods of stress when they may also be short of sleep and malnourished. Soldiers come into this category; so do the families caring for severely handicapped relatives and some mothers of newborn babies, if they are denied help from others. My advice to people suffering from stress-breakdown symptoms from unavoidable stress is:
• Are you really sure you can’t get any help at all? Are you really a coper who thinks it is a sign of weakness to ask for help?
• If you cannot avoid stress symptoms, at least don’t mistake them for symptoms of illness, and don’t make any wrong assumptions about the origins of your symptoms. For example, if you are bursting into tears at the thought of having to psych yourself up to do the shopping on your own, don’t load yourself up with guilt for being lazy.
• If you can’t avoid the big problems, at least get rid of as many of your other little problems as you can. It’s like jettisoning extra baggage to lighten the load if the ship is in danger of sinking. So if you can’t look after your sick baby and the other children as well, and keep the house clean, let as many non-essentials go as you can.
• Get as much sleep as possible, even if it’s just ‘forty winks’ now and then during the day. Don’t skip meals, and don’t do anything like deciding now is the time to go on a crash diet to lose weight. Don’t drink alcohol or ask the doctor for sedative drugs. Cut down on your tea and coffee intake.
• Decide to take a holiday when the stress is over, and do it. The holiday might be going to bed for a few days, or going away to recuperate and be pampered.

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ANTI-DEPRESSANT LIFESTYLE: WATCHING YOUR ALCOHOL INTAKE

Wednesday, April 29th, 2009

Even if you don’t have a defined problem with alcohol, it is very important for a person who suffers from depression to pay careful attention to his or her alcohol intake. First of all, alcohol is capable of interacting negatively with any drug that affects brain functioning. Even though one study of individuals taking St John’s Wort suggested that the effects of alcohol on their co-ordination and ability to concentrate was no different from that seen in people on placebo, I would recommend moderation in alcohol consumption to someone on St John’s Wort as I would to a person on any other type of anti-depressant. In practical terms, this generally means no more than one (or at the most two) glasses of wine or single shots of alcohol per day, depending on an individual’s tolerance. As always, it is important to exercise judgement when driving or operating machinery under such combined drug influences.

Even in those who appear to handle their alcohol very well in the hours after drinking it, I have often noticed a ripple effect on mood in the days that follow. This sometimes occurs after a very small amount of alcohol (even a single glass of wine) and takes the patient quite by surprise when the association is finally recognized. As I mentioned, sometimes it is only by logging one’s mood on a daily basis that a person will come to appreciate that there is indeed a cause-and-effect relationship between drinking alcohol and becoming depressed.

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Tags: Anti Depressants
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IS PROZAC AN EFFECTIVE TREATMENT FOR ANXIETY, PTSD AND OTHER DISORDERS?

Monday, March 23rd, 2009

Yes—if the anxiety is secondary to depression, as it often is. Evidence clearly suggests that Prozac and the other SSRIs are as effective as tricyclic antidepressants in decreasing the anxiety felt by depressed patients. It is not approved for primary anxiety disorders, which are best treated with a combination of tranquilizers and psychotherapy.

For a small percentage of patients, Prozac can increase anxiety. In clinical tests, 9.4% of the patients reported feeling anxiety as a side effect, and 14.9% complained of nervousness.

Once known as shell shock, post-traumatic stress disorder afflicts the survivors of dire catastrophes such as childhood abuse wartime battles, confinement in concentration camps, assault, rape, being in a fire, or seeing another person killed. People suffering from this syndrome feel numbed, irritable, anxious, and depressed, in part because the memory of the trauma plays over and over in their mind and is often so vivid that it may feel real for years after the event. Several reports have indicated that patients treated with Prozac show a lessening of PTSD symptoms.

In patients with PTSD, I consider psychotherapy the major treatment modality. Medications, while helpful, are secondary.

Does Prozac effectively treat disorders other than depression? In July 1993, the FDA approved Prozac for obsessive-compulsive disorder. OCD causes people to become obsessed with certain thoughts and indulge in time-consuming behaviors such as repeated hand-washing, checking and rechecking that the doors and windows are locked, counting or touching compulsively, being inordinately concerned with arranging objects in specific, often symmetrical ways, and many other irrational actions. The best treatment is behavioral therapy combined with one of die three most effective medications: Anafranil, Prozac, and Luvox.

In April 1994, the FDA also approved Prozac’s use for bulimia, a psychiatric disorder characterized by vomiting and binge eating.

How effective Is Prozac in long-term prevention of depression and other diagnostic entities?

Although a sufficient number of carefully controlled long-term scientific studies of Prozac in recurrent depression have not been completed, early scientific reports, observations, and case histories from individual psychiatrists including myself have suggested that Prozac is as effective as earlier antidepressants in preventing the reappearance of depression, which usually returns in cycles. To keep this from happening, Prozac, like the other antidepressants, must be given on a long-term basis;

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Tags: Anti Depressants
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HOW DOES PROZAC AFFECT SUBCLINICAL DEPRESSION?

Monday, March 23rd, 2009

With the help of Prozac or other antidepressants, people can come out of the subclinical depressions hidden within personality disorders and feel better than they’ve ever felt before. This is particularly possible for patients who are given Prozac or other SSRIs, since the side effects are much milder than those associated with the traditional tricyclics and MAOIs. Like Prozac and the other SSRIs, the TCAs and MAOIs may also quickly eliminate the symptoms of depression. But the typical side effects of dry mouth, constipation, blurred vision, and weight gain are troublesome. With Prozac, the worst side effects—temporary nausea, insomnia for two to three days, or a jittery reeling—are temporary, and most patients find that their painful symptoms disappear in one to two weeks. When that happens, the distinctions between before and after become so crystal clear that these people may claim to feel better than they’ve ever felt in their lives-”better than normal,” thanks to the antidepressant’s effects on the hidden depressive symptoms. The therapist may call this a complex personality transformation. It has nothing to do with defense mechanisms, transference, or interpretation of dreams; it’s the antidepressant working effectively and biochemically on the serotonergic system at the synapses of the brain, a process which can alter symptoms of the unrecognized subclinical depression.

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Tags: Anti Depressants
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WHAT ARE THE MAJOR SCIENTIFIC FINDINGS REGARDING ANY POSSIBLE CONNECTION BETWEEN PROZAC AND SUICIDE?

Monday, March 23rd, 2009

An important study undertaken in 1991 by two Harvard psychiatrists analyzed the data of twenty-seven psychiatrists who had treated a total of 1017 depressed patients with various antidepressants. They recorded how many patients were given each kind of antidepressant; how many patients in each group were suicidal before beginning therapy (the total for the entire population was about 17%); how many in each group were not suicidal; and how many in each group were not suicidal before therapy but became so afterwards. This latter finding was the real purpose of this survey. The survey reported that:

* of the 231 non-suicidal patients who took Prozac, 3.5% became suicidal after initiating therapy;

* of the 62 non-suicidal patients who took Prozac in combination with a tricyclic antidepressant (TCA), 6.5% became suicidal;

* of the 385 non-suicidal patients who took a TCA alone or in combination with lithium, 1.3% became suicidal;

* of the 63 non-suicidal patients who took a Monoamine Oxidase Inhibitor (MAOI) antidepressant, not one became suicidal;

* of the 101 non-suicidal patients who took other antidepressants, 3% became suicidal.

The differences between these groups were not statistically significant except for the group given a combination of Prozac and a TCA.

An even more extensive study investigating the possible association between Prozac and suicidal acts and thoughts was published in the British Medical Journal. This report presented a retrospective analysts of data from seventeen double-blind trials involving 3065 patients with major depressive disorder. (This included data from my original research study on 120 depressed patients.) For five or six weeks, 1765 patients were put on Prozac, 731 received a tricyclic antidepressant, and 569 were given a placebo. These trials clearly showed that Prozac

was not associated with an increased risk of suicide or suicidal thoughts. The findings include the following:

• substantial suicidal thinking emerged in 1.2% of the patients taking Prozac, 3.6% of those on a TCA, and 2.6% of those taking a placebo;

• suicidal thinking became worse with 153% of those on Prozac, 16.3% of those on a TCA, and 17.9% of those who were given a placebo;

• in most patients, suicidal thinking lessened considerably with both antidepressants. 72.0% improved on Prozac compared to 54.8% on the placebo, and 72.5% improved on the TCA vs. 69.8% on the placebo;

• the pooled incidence of suicidal acts was 03% for Prozac, 0.4% for the TCAs, and 0.2% for the placebo;

• none of these differences were considered statistically significant.

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Tags: Anti Depressants
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CAN PROZAC BE SAFELY TAKEN DURING PREGNANCY? WILL IT HARM UNBORN CHILD?

Monday, March 23rd, 2009

A patient on Prozac who is pregnant or intends to become pregnant should notify her physician immediately. While studies in animals show that even with a dose of Prozac ten times larger than what is normally considered the maximum there is no evidence of harm to the fetus, adequate well-controlled studies have not yet been done with pregnant women. Since animal studies are not always predictive of what occurs in humans, it is a safer policy to avoid Prozac (and other antidepressants) while trying to conceive, or to withdraw from it if already pregnant. Only if a severe depressive relapse occurs should Prozac or other antidepressants be considered during pregnancy.

However, one substance requires a specific warning: lithium. Most studies, except one recent publication, have shown that lithium therapy throughout the first trimester of pregnancy and beyond may be associated with birth defects, especially in the cardiovascular system. Consequently, women who are taking lithium are advised to discontinue immediately if they are actively trying to become pregnant or have just conceived.

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Tags: Anti Depressants
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HOW LONG DOES PROZAC LAST IN THE BODY?

Monday, March 23rd, 2009

One way of answering this question is to look at the half-life. The pharmacologic term “half-life” is used to describe the time it takes for the drug in the blood to decrease by half of its original administered amount The half-life of Prozac is approximately one to three days, while the half-life of its breakdown metabolic product (metabolite), norfluoxetine, ranges from seven to fifteen days, meaning that Prozac and its metabolite leave the system gradually. In comparison with other antidepressants, including the SSRIs Paxil and Zoloft, the half-life of Prozac is extended. The half-life of Zoloft is about twenty-six hours and mat of Paxil about twenty-one hours.

The extended half-life of Prozac may have several advantages. First of all, upon discontinuation it is less likely to precipitate withdrawal symptoms man an antidepressant with a short half-life. Within only twelve hours after suddenly discontinuing a large dose of a tricyclic antidepressant or an MAOI medication, a patient may experience nausea, dizziness, vomiting, sleep disturbance, symptoms of rapid withdrawal, and even rebound hypomania or mania in bipolar depressions not simultaneously treated with lithium. Prozac’s extended half-life prevents these acute withdrawal symptoms.

The stable blood levels associated with an extended half-life may help prevent relapse when the dose is lowered or when the patient simply forgets to take the medication for a day or two.

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Tags: Anti Depressants
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