Depression Causes and Treatments

Destroy Depression

Destroy Depression is written by James Gordon, a former sufferer of depression from the United Kingdom who was unhappy with the treatment he was being given by medical personnell to fight his illness. Apparently, he stopped All of his medication one day and began to search for answers on how to cure himself of depression in a 100% natural way. He spent every waking hour researching all he could on the subject, making notes and changing things along the way until he had totally cured his depression. Three years later, he put all of his findings into an eBook and the Destroy Depression System was born. The Destroy Depression System is a comprehensive system that will guide you to overcome your depression and to prevent it from injuring you mentally and physically. Read more...

Destroy Depression Summary

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Author: James Gordon
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Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

My opinion on this e-book is, if you do not have this e-book in your collection, your collection is incomplete. I have no regrets for purchasing this.

Antidepressant Medications

Change in body weight is a frequent symptom of major depression, most likely a result of alterations in appetite. Patients typically lose weight (1-3), although some do gain weight during a depressive episode (3-5). As a pharmacologic treatment, the tricyclic antidepressants remain, even after almost 40 years, the first choice of medication for the treatment of severe major depression throughout the world (6). Although very effective agents for restoration of normal mood, there are numerous side effects associated with this drug treatment, particularly unwanted and excessive weight gain. Previously, weight gain during antidepressant treatment had been interpreted as a positive sign of improvement, so prevalent and predictable was the effect. Such weight gain is of concern to both patient and clinician, as this is the reason often cited for medication non-compliance. It is important to point out that over the past 15 years, several newer medications of a different drug class, the...

Do Stressful Events and Depressive Mood Exacerbate IBD

Patients with IBD who had at least one relapse in a 2-year period after entry into the study. A mean of 2.2 exacerbations was seen per subject during the study period. Mood changed concurrently with exacerbations of IBD, but no evidence indicated that stressful life events or depressed mood precipitated exacerbations in this study group 3 . Interestingly, in another investigation carried out on a larger series of 107 IBD patients and 60 controls, patients reported a lower amount of life-event stress than controls but listed more feelings of being under pressure 4 . Greene et al. found that psychosocial stress contributes to the clinical course of IBD 5 and, more recently, Mittermaier et al. reported that psychological factors such as a depressive mood associated with anxiety and impaired quality of life may exert a negative influence on the course of IBD. Therefore, assessment and management of psychological distress should be included in clinical treatment of patients with IBD 6 .

Recurrent depressive disorder

A disorder characterized by repeated episodes of depression as described for depressive episode (F32.-), without any history of independent episodes of mood elevation and increased energy (mania). There may, however, be brief episodes of mild mood elevation and overactivity (hypomania) immediately after a depressive episode, sometimes precipitated by antidepressant treatment. The more severe forms of recurrent depressive disorder (F33.2 and F33.3) have much in common with earlier concepts such as manic-depressive depression, melancholia, vital depression and endogenous depression. The first episode may occur at any age from childhood to old age, the onset may be either acute or insidious, and the duration varies from a few weeks to many months. The risk that a patient with recurrent depressive disorder will have an episode of mania never disappears completely, however many depressive episodes have been experienced. If such an episode does occur, the diagnosis should be changed to...

Tricyclic Antidepressants

Tricyclic antidepressants have multiple mechanisms of action and have been most thoroughly studied in the treatment of neuropathic pain. They function by decreasing depression and, thereby decreasing the amplification of pain. They also decrease the inhibitory neurotrans-mitters norepinephrine and serotonin, thereby amplifying the impact of the body's own mechanisms to inhibit pain transmission.

Miscellaneous Antidepressants

The miscellaneous antidepressant drugs are contraindicated in patients with known hypersensitivity to the drugs. Among the miscellaneous antidepressants, bupropion and maprotiline are Pregnancy Category B drugs. Other miscellaneous antidepressants discussed in this chapter are Pregnancy Category C drugs. Safe use of the antidepressants during pregnancy has not been established. They should be used during pregnancy only when the potential benefits outweigh the potential hazards to the developing fetus. These drugs are used cautiously in patients with liver or kidney impairment and during lactation. The miscellaneous antidepressants are given with caution to patients taking alcohol or other CNS depressants.

Depressive episode

In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by so-called somatic symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before the usual time, depression worst in the morning, marked psychomotor retardation, agitation, loss of appetite, weight loss, and loss of libido. Depending upon the number and severity of the symptoms, a depressive episode may be specified as mild, moderate or severe. recurrent depressive disorder ( F33.- )

Educating the Client on the Use of Herbs and Nutritional Supplements

The use of herbs and nutritional supplements to treat various disorders is common. Herbs are used for various effects, such as to boost the immune system, treat depression, and for relaxation. Individuals are becoming more aware of the benefits of herbal therapies and nutritional supplements. Advertisements, books, magazines, and Internet sites abound concerning these topics. People, eager to cure or control various disorders, take herbs, teas, megadoses of vitamins, and various other natural products. Although much information is available on nutritional supplements and herbal therapy, obtaining the correct information sometimes is difficult. Medicinal herbs and nutritional substances are available at supermarkets, pharmacies, health food stores, specialty herb stores, and through the Internet. The potential for misinformation abounds. Because these substances are natural products, many individuals may incorrectly assume that they are without adverse effects. When any herbal remedy...

Nonnuisance Nonmaleficence

Ing that at the same time there is no debate about the older antidepressants, which have well-known but much higher safety risks. It is difficult to kill oneself with overdoses of SSRIs, but this can easily be done with a tricyclic antidepressant. Obviously these debates on safety also are connected with marketing of the drugs and the stockholder interests involved. One does not have to wholly subscribe to the provocative conspiracy theories of David Healy (2004), expounded in a polemic written by the British psychopharma-cologist, physician and medical historian (Let Them Eat Prozac), to accept that there was a clear publication bias (Whittington et al. 2003) that resulted in prescribers only being aware of the positive studies of efficacy. In the United States, John March is now setting up a nationwide psychopharmacol-ogy pharmacovigilance network, sponsored by the NIMH (March 2005 and March et al. 2004). One can conclude that the SSRI debacle shows that the political rules of the...

F204 Postschizophrenic depression

A depressive episode, which may be prolonged, arising in the aftermath of a schizophrenic illness. Some schizophrenic symptoms, either positive or negative, must still be present but they no longer dominate the clinical picture. These depressive states are associated with an increased risk of suicide. If the patient no longer has any schizophrenic symptoms, a depressive episode should be diagnosed (F32.-). If schizophrenic symptoms are still florid and prominent, the diagnosis should remain that of the appropriate schizophrenic subtype (F20.0-F20.3).

Phobic anxiety disorders

A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous. As a result these situations are characteristically avoided or endured with dread. The patient's concern may be focused on individual symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression often coexist. Whether two diagnoses, phobic anxiety and depressive episode, are needed, or only one, is determined by the time course of the two conditions and by therapeutic considerations at the time of consultation.

HypericumSt Johns Wort

The dried flowering tops of St John's Wort Hypericum perforatum Guttiferae Hypericaceae) have been used as a herbal remedy for many years, an extract in vegetable oil being used for its antiseptic and wound healing properties. St John's Wort is now a major crop marketed as an antidepressant, that is claimed to be as effective in its action as the widely prescribed antidepressants of the selective serotonin re-uptake inhibitor (SSRI) class such as fluoxetine Prozac ), and with fewer side-effects. There is considerable clinical evidence that extracts of St John's Wort are effective in treating mild to moderate depression and improving mood. However, to avoid potentially dangerous side-effects, St John's Wort should not be used at the same time as prescription antidepressants. St John's Wort is a small to medium height herbaceous perennial plant with numerous yellow flowers characteristic of this genus. It is widespread throughout Europe, where it is generally considered a weed, and has...

The Nature Of Depression

In terms of DSM-IV criteria, a diagnosis of Major Depression requires evidence of at least one primary symptom and at least four associated symptoms lasting nearly every day for at least two weeks. Depressed mood and a distinct loss of interest or pleasure in most or all activities (anhedonia) count as primary symptoms. The secondary symptoms are (a) appetite disturbance or weight change (b) sleep disturbance (c) psychomotor agitation or retardation (d) fatigue or loss of energy (e) feelings of worthlessness or guilt (f) diminished concentration or decision-making ability, (g) thoughts of death or suicide. DSM-IV distinguishes between Major Depression and a range of other mood disorders including Dysthymic Disorder and Bipolar I Disorder. This range of classifications attempts to encompass the variety of presentations of significant depressive mood. Current thinking (e.g. Parker, 1996) emphasizes that the notion of depression includes a range of disorders 'As ''depression''...

Gerontologic Alert

On rare occasions, when pain is not relieved by the narcotic analgesics alone, a mixture of an oral narcotic and other drugs may be used to obtain relief. Brompton's mixture is commonly used to identify these solutions. In addition to the narcotics, such as morphine or methadone, other drugs may be used in the solution, including antidepressants, stimulants, aspirin, acetaminophen, and tranquilizers. The pharmacist prepares the solution according to the primary health care provider's instructions.

Severely Depressed Individuals Lack The Capacity To Utilize Hypnosis

Pettinati, Kogan, Evans et al. (1990) compared hypnotizability on two measures, the Hypnotic Induction Profile (HIP) and the Stanford Hypnotic Suggestibility Scale C (SHSS C) for five clinical and one normal college populations. The group with a diagnosis of major depression scored higher on the SHSS C than the normal population and only marginally lower, although higher than the anorexia nervosa and schizophrenia groups, on the HIP.

Utilizing Hypnotic Techniques In A Cognitivebehavioural Management Programme For Depression

2 Hopelessness may need to be addressed before an individual experiencing major depression is able to engage in any other aspect of therapy. An understanding of hopelessness is a significant feature of cognitive-behavioural approaches to depression. The learned helplessness model of depression (Abramson, Seligman & Teasdale, 1978) emphasizes 'depressive' attributional style whilst Beck's (1979) theory of depression included a negative view of the future as one aspect of his depressive triad. Yapko (1992) describes several strategies to address hopelessness. Appendix A contains a description of a possible approach to the modification of hopelessness using a hypnotic process.

Adverse Reactions

Reserpine is used cautiously in patients with a history of depression, in patients with renal impairment or cardiovascular disease, and during pregnancy and lactation. Guanethidine, another peripherally acting antiadrenergic drug, is con-traindicated in patients with pheochromocytoma and congestive heart failure. The drug is used cautiously in patients with bronchial asthma and renal impairment and during pregnancy and lactation. Anorexiants, haloperidol, the monoamine oxidase inhibitors, tricyclic antidepressants, and phenothiazines decrease the hypotensive effects of guanethidine.

Morbidity And Mortality And

In appropriately selected patients, a reasonable morbidity and mortality can be achieved with good long-term outcome and QoL. McQuellon first studied the issue of QoL in this particular population of patients using the Functional Assessment of Cancer Therapy-Colon (FACT-C) scale (58). Initially, the overall QoL decreased significantly from baseline to the postsurgery period, but rebounded to greater than baseline at 3 mo and improved over a year. For patients with ascites, their QoL increased immediately postoperatively and improved continuously at 3 mo and 6 mo. They did report considerable distress in the form of depressive symptoms preoperatively. This decreased over the course of time, reflecting that the patients who were treated successfully gained a new sense of hope and experienced fewer physical symptoms. In a follow-up study on long-term survivors by the same group, good QoL was reported in 17 patients who survived from 3 yr to 8 yr after CRS + HIPEC. The majority of...

Contraindications Precautions And Interactions

As with all antidepressants, the TCAs are used cautiously in patients with hepatic or renal impairment. The tricyclics are used cautiously in patients with heart disease, angina, paroxysmal tachycardia, increased intraocular pressure, prostatic hypertrophy, or a history of seizures.

Ongoing Assessment

The nurse monitors vital signs at least daily as part of the ongoing assessment. In some instances, such as when hypotensive episodes occur, the nurse monitors the vital signs more frequently. The nurse reports any significant change in the vital signs to the primary health care provider. Initially, the patient may need assistance with self-care because patients with depression often do not have the physical or emotional energy to perform self-care activities. Some antidepressants cause excessive drowsiness during the initial stages of treatment, and patients may need assistance with ambulation and self-care activities. These reactions usually subside as the depression lifts and with continued use of the antidepressant. Patients with a high suicide potential require protection from suicidal acts and a well-supervised environment.

Promoting an Optimal Response to Therapy

When caring for hospitalized patients with depression, the nurse must develop a nursing care plan to meet the patient's individual needs. When the antidepressants are given parenterally, the nurse gives these drugs intramuscularly in a large muscle mass, such as the gluteus muscle. The nurse keeps the patient lying down (when possible) for about 30 minutes after the drug is given. MAOIs. The MAOIs are less frequently prescribed than other antidepressants, probably because of the risk of hypertensive crisis when food containing tyramine is ingested during MAOI therapy. Patients receiving MAOIs

General Physical Health

Nevertheless, researchers in San Diego (Jeste et al. 1996 Lacro andJeste 1994) found that middle-aged and older schizophrenic persons had fewer medical illnesses (mean 1.0) than persons with Alzheimer's disease (mean 1.4) and major depression (mean 2.4), with a comparable severity index on the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) compared with an older normal comparison group. Similarly, a study in New York City of 117 schizophrenic persons age 55 and over, with a mean age of 63 years (C.I. Cohen, unpublished data), found that 33 of the schizophrenia sample and 48 of the community sample reported 2 or more physical disorders the mean number of disorders was 1.35 and 1.66 for the schizophrenia and community groups, respectively. In the latter studies, the annual rate of hospitalization was comparable between the groups (21 community group, 22 schizophrenia group), although more than half the hospitalizations among the schizophrenia group had been for psychiatric...

Win Races and Lose Racing The Example of Physical Enhancements

The basic idea behind this worry seems to be that we view and appreciate ourselves and others not just in the light of what we (or they) are factually able to do, but also in the light of what we (they) deserve praise or reproach for. That is, we usually judge a person in terms of what she has achieved or made of herself. Seen in that light, even interventions into the brain that aim only at eliminating real psychic diseases by using purely medical means may sometimes draw some suspicion. To illustrate the point further, serious emotional suffering, say in the course of a major depression (as an example of a genuine disease) seems to be different in important respects from physical pain. It usually has its roots, or at least some of them, in deep structures of the individual psyche which are often the results of particular features of an individual biography. If psychotherapy takes as its normative ground the idea of maintaining or restoring a personal self, it might be committed not...

Box 1 Indications and contraindications to therapy

Inflammation and fibrosis on liver biopsy are obvious candidates for treatment. At the National Institutes of Health (NIH) consensus conference in 2002, however, there was a strong movement toward expanding the number of potential treatment candidates to include people with controlled depressive illness, methadone users, and patients who had stopped using alcohol recently. The other controversial area is whether to treat patients with persistently normal ALT. In the era of interferon (IFN) monotherapy, several case series suggested that patients with normal ALT might experience ALT flares and have a reduced SVR rate if treated with IFN 7,8 . Larger studies with IFN and ribavirin (RBV), however, have shown that ALT flares are not common and that the SVR rate is similar in patients with normal ALT compared with those with elevated ALT 9,10 . The current recommendation is that treatment of patients with normal ALT be considered on an individual basis, and it is believed that these...

Antipsychotic Medications

Weight gain as a side effect of antipsychotic treatment has been well documented for over 40 years (29,30) but its importance in the clinical management of chronic schizophrenia has been downplayed (31). Like antidepressants, it is also a common reason for medication non-compliance (31-33). Although numerous mechanisms have been proposed to explain such medication-induced weight gain, the mechanism(s) involved are even less clear than those for antidepressants some data sup

Summary And Conclusions

Weight gain associated with tricyclic antidepress-ant and certain antipsychotic medications is problematic for many treated patients, and often a reason for non-compliance. Such weight gain is associated, at least in part, with reductions in resting metabolic rate and diet-induced thermogenesis. Changes in food preference towards calorically dense ('fattening') sweet-tasting foods do not appear to affect a majority of patients treated with tricyclic medications, but can occur. When such preference changes do occur, though, they are not associated with the development or maintenance of obesity. Another class of antidepressants, specific serotonin reuptake inhibitors (SSRIs), have been used in the past few years as effective antidepressants, but do not promote weight gain during treatment, although this is occasionally seen. The antipsychotic medications often promote weight gain, particularly the conventional medications, but also some of the novel antipsychotics seem to have weight...

Pharmacokinetic and Pharmacodynamic Factors

Year after age 25 (Chutka et al. 1995). This results in a substantial reduction in first-pass metabolism of a drug in the liver, so more of the active drug remains available. Phase I hepatic metabolism is performed by the microsomal oxidase cytochrome P450 (CYP) system. Initially, these oxi-dative conversions may produce pharmacologically active metabolites, and subsequent oxidations produce progressively more water-soluble compound that can be excreted by the kidneys and gut. Some of the cy-tochrome enzymes are affected by aging, most notably CYP 1A2 and CYP 3A4 ( Jacobson et al. 2002). The latter is one of the most abundant of the CYP enzymes and is important in the metabolism of a wide variety of drugs (e.g., retroviral agents, antibiotics, antifungals, quinidine, calcium channel blockers, statin drugs, various serotonin reuptake inhibitors, and several antipsychotics, including haloperidol, quetiapine, clozapine, and ziprasidone). The CYP 1A2 enzymes are involved in the metabolism...

Mechanisms of Differential Exposure Misclassification

Similarly, undiagnosed chronic disease has the potential to distort certain exposures of interest as potential causes, illustrated in a recent study of depression as a potential influence on the risk of cancer. In a large cohort study in Denmark, Dalton et al. (2002) evaluated the association between depression and other affective disorders in relation to the incidence of cancer. By stratifying their results by years of follow-up (Table 8.8), they were able to consider the time course of depression and cancer incidence to better understand the etiologic significance of the results. Focusing on the results for the total cohort, note that brain cancer risk was substantially elevated for the first year of follow-up only, returning to near baseline thereafter. Although it could be hypothesized that depression is causally related to brain cancer with a short latency, it seems much more likely that undiagnosed brain cancer was a cause of the depressive symptoms given what is known about the...

What Are Ways Of Coping With An Anxious Personality

The type of drug used to treat depression must be selected by a doctor. Some older forms of antidepressant tablets (tricyclic antidepressants), which are now not commonly used, can, in some people with severe heart disease, result in heart rhythm abnormalities. Some treatments make people feel giddy when they stand up because they lower blood pressure. The new forms of antidepressants used are generally very safe, even in people with heart disease.

Adverse Events From Cannabis Administration

Acute cannabis administration can cause a spectrum of adverse psychological effects, ranging from hypervigilance and anxiety, to panic, agitation, paranoid thinking, and psychosis (38,40). These are rare at the doses commonly used in research studies but are more likely to occur in susceptible individuals (46,47). Although controlled studies have not been done, susceptible subjects include those with preexisting psychopathology or a history of a psychiatric illness such as schizophrenia, schizoaffective disorder, major depression, manic depression (bipolar disorder), or anxiety disorder. Screening for these conditions relies largely on subject self-report and so may not always be completely reliable. Thus, it is prudent to conduct cannabis-administration studies in a setting where appropriate psychiatric intervention is promptly available. This should include facilities for safe physical restraint of agitated subjects and administration of parenteral medication. Cannabis-induced...

Is The Pain In The Main Plainly In The Brain

Effectively managing TMD requires a two-pronged approach of physically eliminating the noxious dental stimulus and mentally relaxing the muscles of mastication and muscles of facial expression. The use of medication and massage of sore muscles may expedite the healing process. Treatment of the physical etiology may be as simple as polishing fillings that have expanded with the course of time. Other treatment options may range from wearing a specially designed 'bite guard' appliance during sleep (or when stress is experienced during the day), to comprehensive orthodontic treatment and full mouth reconstruction with dental implants, crowns and bridges. But it may be impossible to determine the proper bite relation as long as the supporting muscles are in the clenched or braced posture. Resolution of the disorder requires a coordinated effort. The patient needs to learn how to relax the muscle of mastication and the dentist needs to adjust the bite for optimal comfort. Learning how to...

Formal Thought Disorder

Formal thought disorder is the clinical term used to describe manifestations of language abnormalities in schizophrenia. Studies using clinical rating scales have found that 50 of patients with schizophrenia manifest some form of communication disorder at a moderate or greater level. The most common abnormalities are in the domains of verbal productivity (e.g., the amount of speech produced) and speech connectedness (e.g., the logic, coherence, and referential nature of speech). Much less common (less than 10 ) are disorders such as neologisms and word approximations (Peralta et al. 1992). These disturbances are not diagnostic rather, they are nonspecific features. However, there is some evidence for communication disorder being useful in distinguishing mood disorders (both bipolar and depressive disorders) from schizophrenia (Andreasen and Grove 1986 Cuesta and Peralta 1993). Poverty of speech is an indicator of risk for poor functional outcome as alogia, it is considered a negative...

Breast implants and suicide

Surprising results from a study on mortality among augmentation mammoplasty patients indicated that while overall mortality was slightly lower than the general population, the standardized mortality ratio for suicide was 4.24 (95 CI 0.9-19.2) for this group compared to similar patients undergoing other plastic surgery procedures 67 . Subsequent studies have been consistent with increased suicide risk among Finnish 68 , Swedish 69 , and Danish 70 women with breast augmentation. Whether women who are likely to desire and get cosmetic augmentation are in a high-risk group for suicide to begin with is the subject of debate, with some arguing that they may be and others arguing that the increase in suicide is due to depression over serious adverse events associated with breast implants 71-73 . One study suggests that psychotropic drug use, including antidepressants, may be more likely in women with breast implants compared to population controls or women who have had breast reduction...

Mood affective disorders

This category of ICD-10 (F3x) comprises manic episodes, hypomania (elated and irritable mood below the threshold to mania), bipolar disorder, depressive disorders, cyclothymia (continued mood fluctuations) and dysthymia. The core symptoms are changes of mood and affect to either a depressed form or - on the other side of the scale - a lifted, even manic state of mind. Disorders are classified according to their severity and the presence or absence of psychotic symptoms. Symptoms typical for a depressed state of mind are e.g. loss of interest, decreased mood, sleep irregularities, fatigue or feelings of diminished energy, whereas concomitant symptoms of a manic state include increased talkativeness, delusional thinking, flight of ideas, increased activity, restlessness, decreased need to sleep, reckless behaviour or unnecessary expenses.

Hypocretin Replacement Therapy

Hypocretin

Monoaminergic and cholinergic control of sleepiness and cataplexy in relation to hypocretin input a schematic perspective. The stimulation of adrenergic transmission by adrenergic uptake inhibitors potently reduces cataplexy this pharmacological property is likely involved in the mode of action of currently used anticataplectic agents (e.g., tricyclic antidepressants). The fact that both presynaptic alpha-2 autoreceptor stimulation and postsynaptic alpha-1 blockade aggravate cataplexy is consistent with an inhibitory role of adrenergic transmission in the control of REM sleep atonia. Dopaminergic uptake inhibitors have no effect on cataplexy, although these compounds strongly induce EEG arousal. In contrast, D2 3 autoreceptor stimulation worsens both cataplexy and sleepiness. Since DA uptake inhibitors are reported to be mostly active at the level of mesocortical and mesolimbic DA terminals, DA projections to these regions may be more involved in mediating EEG arousal....

Is Lazer Treatment For Crps Type 1 Dangerous

Bier Block Technique

Tricyclic antidepressants (TCAs) have been well studied in neuropathic pain. TCAs (amitriptyline, nortriptyline, desipramine) inhibit monoaminergic transmitters by blocking reuptake of serotonin and norepinephrine. The dose used for treatment of neuropathic pain is typically much less than antidepressant doses. The selective serotonin reuptake inhibitors (paroxetine, sertraline), although used anec-dotally in chronic CRPS, have not been formally studied for this purpose.

Monoamines as Neurotransmitters

Monoamine oxidase (MAO) inhibitors are drugs that block monoamine oxidase, the enzyme in presyn-aptic endings that breaks down catecholamines and serotonin after they have been taken up from the synaptic cleft. These drugs thus promote transmission at synapses that use monoamines as neurotransmitters. Such drugs have proven useful in the treatment of clinical depression, suggesting that a deficiency in monoamine transmission contributes to that disorder. An MAO inhibitor is also used to treat Parkinson's disease, because it increases the ability of dopamine to function as a neurotransmitter.

Excludes obsessivecompulsive personality disorder F605 F420 Predominantly obsessional thoughts or ruminations

These may take the form of ideas, mental images, or impulses to act, which are nearly always distressing to the subject. Sometimes the ideas are an indecisive, endless consideration of alternatives, associated with an inability to make trivial but necessary decisions in day-to-day living. The relationship between obsessional ruminations and depression is particularly close and a diagnosis of obsessive-compulsive disorder should be preferred only if ruminations arise or persist in the absence of a depressive episode.

Transcutaneous electrical nerve stimulator TENS therapy is helpful in some cases

Chronic pain arises from a failure of standard therapy, and patients with this problem are a very difficult group to treat. A subset of this group has fibromyalgia, and these patients are identified by poor sleep, fatigue, and widespread pain and tender points. They may respond well to low doses of tricyclic antidepressants at bedtime (e.g., begin 10 mg of amitriptyline nightly, and escalate the dose by 10 mg once weekly to 50 to 70 mg nightly). In general, however, these patients are best managed by a multidisciplinary approach that combines psychosocial evaluation with one or more of the modalities discussed above.

Hypocretin Deficiency And Pharmacologic Correlates

Anecdotal information is available on the treatment of hypnagogic hallucinations, sleep paralysis, and disturbed nocturnal sleep. The first two symptoms partially respond to antidepressants, while disturbed nocturnal sleep can be treated using GHB or benzodiazepine hypnotics but the latter of these does not improve daytime sleepiness.

Monoaminergic and Cholinergic Interactions and Cataplexy

Monoaminergic transmission is also critical for the control of cataplexy. All therapeutic agents currently used to treat cataplexy (i.e., antidepressants or monoamine oxidase inhibitors MAOIs ), are known to act on these systems. Furthermore, whereas a subset of cholinergic neurons are activated during REM sleep, the firing rate of monoaminergic neurons in the brainstem (such as in the locus coeruleus (LC) and the raphe magnus) are well known to be dramatically depressed during this sleep stage.34,35 Using canine narcolepsy, it was recently demonstrated that adrenergic LC activity is also reduced during cataplexy.36 In contrast, dopaminergic neurons in the ventral tegmental area (VTA) and substantia nigra (SN) do not significantly change their activity during natural sleep cycles.37,38 Since cataplexy in dogs can be easily elicited and quantified, the canine narcolepsy model has been intensively used to dissect the mode of action of currently used anticataplectic medications. The most...

Psychiatric Disorders

Sleep disturbances are common and early symptoms in depression. The relationship between depression, sleep and circadian rhythms has been strongly documented. In some cases insomnia, stress and depression are even seen as continuum and a significant number of narcoleptic patients suffer from depression. Depression is associated with short REM sleep latencies in many cases. REM sleep is suppressed by almost all antidepressant medications and sleep deprivation. REM sleep deprivation has antidepressant effect. The neurochemistry of depression has focused on monoaminergic dysfunction, especially noradrenergic and serotoninergic pathways. The hypocretins, two neuropeptides that promote wakefulness and inhibit REM sleep are upregulated under REM sleep deprivation45 and might be involved in his antidepressant effect. In addition, the projections distribution of the hypocretins is coherent with a direct involvement in depression since these projections are noted in aminergic cell groups i.e....

F454 Persistent somatoform pain disorder

The predominant complaint is of persistent, severe, and distressing pain, which cannot be explained fully by a physiological process or a physical disorder, and which occurs in association with emotional conflict or psychosocial problems that are sufficient to allow the conclusion that they are the main causative influences. The result is usually a marked increase in support and attention, either personal or medical. Pain presumed to be of psychogenic origin occurring during the course of depressive disorders or schizophrenia should not be included here.

Abdominal distension bloating

Taking drugs with anticholinergic effects, such as tricyclic antidepressants. Painless abdominal distension and constipation from early childhood in the absence of faecal soiling suggests the possibility of Hirschsprung's disease. Fluctuating abdominal swelling which develops during the day hut resolves overnight is particularly common in women and is rarely if ever due to organic disease. It usually occurs with other symptoms of the irritable bowel syndrome, namely abdominal pain relieved by defecation and altered bowel habit. Painful abdominal distension suggests intestinal obstruction associated with intestinal colic. Chronic simple constipation rarely produces painful distension unless associated with the irritable bowel syndrome.

Fibromyalgia Syndrome

Fibromyalgia syndrome (FMS) is a difficult-to-diagnose condition involving the muscles. It is associated with widespread muscle aches, tenderness, and stiffness along with fatigue and sleep disorders in the absence of neurologic abnormalities or any other known cause. The disorder may coexist with other chronic diseases, may follow a viral infection, and may involve immune system dysfunction. Treatments for FMS may include a carefully planned exercise program and medication with pain relievers, muscle relaxants, or antidepressants.

Transcranial Magnetic Stimulation

From the stimulation of facial and scalp nerves. Between 5 and 20 of patients experience headaches after rTMS sessions. Some transient cognitive changes have been observed. However, there is no indication that TMS causes brain damage. rTMS on the dorsolateral prefrontal cortex has been used in healthy subjects to elucidate the basic neurophysiology of mood modulation. In depressed patients, antidepressant effects of rTMS are transitory and, therefore, a maintenance strategy needs to be developed in order to make rTMS useful in a clinical setting. As a research tool, though, rTMS definitely seems to be a promising technique.

Graham D Burrows and Sandra G Boughton

Depression is a frequently occurring disorder with estimates of the lifetime risk for Major Depressive Disorder varying from 10 to 25 for women and from 5 to 12 for men. Significant levels of depression are also associated with many other major disorders, such as chronic pain. There appears to be a widespread assumption that hypnosis has no role, indeed is inappropriate, in the management of depression. In Australia, over the past 10 years, material presented for examination by the Australian Hypnosis Society or for publication in the Australian and New Zealand Journal of Hypnosis has not included any detailed description of clinical or experimental work on the use of hypnosis in the treatment of depression. The understanding has been that expert opinion regards hypnosis as contraindicated for the management of individuals presenting with depression. It would seem that the situation has not significantly changed since Burrows (1980) concluded that It would seem nevertheless that most...

Irritable Pouch Syndrome IPS

IPS is a functional disorder diagnosed in symptomatic patients who suffer mainly from increased bowel frequency, urgency and abdominal pain without endoscopic or histologic evidence of rectal cuff or pouch inflammation 75 . Clinical features overlap with those of pouchitis and resemble those of irritable bowel syndrome. The aetiology is unclear, and is probably multifactorial in nature. Brain-gut factors may play a role in the pathophysiology of IPS. It is currently a diagnosis of exclusion. A recent study by Shen et al. 76 reported that patients with IPS have significantly poorer quality-of-life scores than patients with normal pouches. Treatment is empiric and symptom oriented. Some authors had reported that dietary modifications, antidiarrhoeal medications (e.g. loperamide) or tricyclic antidepressants might be effective in treating these patients 75 . In our series, the incidence of IPS where patients had symptoms but pouch endoscopy and biopsies did not demonstrate a significant...

Psychiatric Disorders Involve the Limbic System

The affective disorders include major depression, which can be so profound as to provoke suicide, and bipolar disorder (or manic-depressive disorder), in which periods of profound depression are followed by periods of mania, in a cyclic pattern. Biochemical studies indicate that depressed patients show decreased use of brain NE. In manic periods, NE transmission increases. Whether in depression or in mania, all patients seem to have decreased brain serotonergic transmission, suggesting that serotonin may exert an underlying permissive role in abnormal mood swings, in contrast with norepinephrine, whose transmission, in a sense, titrates the mood from highest to lowest extremes.

Miscellaneous Anticonvulsants

The miscellaneous anticonvulsants are used cautiously in patients with glaucoma or increased intraocular pressure a history of cardiac, renal or liver dysfunction and psychiatric disorders. When the miscellaneous anticonvulsants are used with other CNS depressants (eg, alcohol, narcotic analgesics, and antidepressants), an additive CNS depressant effect may occur.

To turn off responses synapses must be cleared of neurotransmitter

Second, neurotransmitter may simply diffuse away from the cleft. Third, neurotransmitter may be taken up via active transport by nearby cell membranes. Prozac, a drug commonly prescribed to treat depression, slows the reuptake of the neurotransmitter serotonin, thus enhancing its activity at the synapse.

Comments on the Published Guidelines on Electrical Brain Stimulation for Psychiatric Disorders

For OCD was the existence of very seriously ill OCD patients that need treatment. The main difference with the lesions being produced in this case is the reversibility and adaptability of the treatment. However, doctors still influence patients' behaviour and this could be conceived of as brain manipulation. This thought alone may lead the public to demand an end to the implantation of electrodes in the brain to treat psychiatric disorders. However, doctors also influence the patients' behaviour when performing much more mundane tasks such as prescribing antidepressants to those suffering from depression. Similarly, doctors may also alter the behaviour of patients simply by telling them to make lifestyle changes such as giving up smoking. Therefore, it is not necessarily bad to change the behaviour of a patient. In the case of refractory obsessive compulsive disorder, the patient suffers so much that in many cases suicide is the only alternative. If death is the outcome of the...

Hypnosis And Chronic Pain Management Useful Clinical Strategies

Many good examples of hypnotic pain reduction suggestions have been outlined by Hammond (1990, pp. 45-49) and Evans (2001). The emphasis of these hypnotic interventions is on the learning of mastery experiences and self-control. However, it is especially important that the patient has permission not to use these mastery techniques in all situations. For example, in a litigation case a contract can be established (usually while under hypnosis) that the pain can be controlled using hypnosis, but the patient should feel comfortable about deciding when to use these mastery techniques. The tactic of allowing the patient complete choice as to when to control pain is an important way to handle the problems associated with the exposure to psychological threat, and the removal of the pain as a defensive reaction. The thrust of the hypnotic intervention is simply to teach the patient that he she is capable of controlling pain and the related psychological issues, but...

Drugs acting on the central nervous system CNS

A special turbulent-flow liquid chromatographic (TFC) technology, coupled with MS-MS to monitor 13 antidepressants and some of their active metabolites in human serum. Such tests are necessary if the drug either is toxic in high concentration or appears ineffective in therapy. Owing to their different chromatographic behavior, the antidepressants are divided into two separate groups (two parallels should be injected to cover the whole range of compounds). Calibration curves have been established for the concentration range of 10-500 ng ml. No memory effect was observed even after the highest concentration samples. Intraassay and interassay precisions 0.4-12 and 1-16 , respectively.

Drugs Used in Treatment

Activating Ssri

A psychotropic drug is one that acts on the mental state. This category of drugs includes antianxiety drugs or anxiolytics, mood stabilizers, antidepressants, and antipsychotics, also called neuroleptics. A form of depression with episodes of mania (a state of elation) manic depressive illness

Many Factors Affect Thermoregulatory Responses and Tolerance to Heat and Cold

Many drugs inhibit sweating, most obviously those used for their anticholinergic effects, such as atropine and scopolamine. In addition, some drugs used for other purposes, such as glutethimide (a sleep-inducing drug), tricyclic antidepressants, phenothiazines (tranquilizers and antipsychotic drugs), and antihistamines, also have some anticholinergic action. All of these and several others have been associated with heatstroke. Congestive heart failure and certain skin diseases (e.g., ichthyosis and anhidrotic ectodermal dysplasia) impair sweating, and in patients with these diseases, heat exposure and especially exercise in the heat may raise body temperature to dangerous levels. Lesions that affect the thermoregulatory structures in the brainstem can also alter thermoregulation. Such lesions can produce hypothermia (abnormally low core temperature) if they impair heat-conserving responses. However, hyperthermia (abnormally high core temperature) is a more usual result...

Miscellaneous Forms of Therapy

Patients with severe COPD frequently have psychosocial and emotional problems related to their disease. They frequently suffer from anxiety and depression, as well as other manifestations of psychiatric dysfunction. In addition to psychosocial support, careful use of psychoactive medications, such as anxiolytics and antidepressants, may be helpful in the overall care of these patients. Drug treatment for dyspnea

The Mood Disorders Depressions and Bipolar Disorders

The term mood refers to a pervasive and sustained inner emotion that affects the person's perception of the world. In addition to being part of the conscious experience of the person, it can be observed by others. In healthy people, moods can be normal, elated, or depressed, and people generally feel that they have some degree of control of their moods. That sense of control is lost, however, in the mood disorders, which include depressive disorders and bipolar disorders. Along with schizophrenia, the mood disorders form the major psychiatric illnesses today. In the depressive disorders (depression), the prominent features are a pervasive sadness a loss of energy, interest, or pleasure anxiety irritability disturbed sleep and thoughts of death or suicide. Depression can occur on its own, independent of any other illness, or it can arise secondary to other medical disorders. It is associated with decreased neuronal activity and metabolism in the anterior part of the limbic system and...

Effects of Nicotine and Smoking on Clinical and Cognitive Deficits Associated With Schizophrenia

A recent study by our group found that schizophrenic former smokers had more negative symptoms than current smokers after adjustment for differences in age, depressive symptoms, and education (George et al. 2002a). Interestingly, one report suggested that smoking was reduced in schizophrenic patients reporting an exacerbation of psychotic symptoms (Ham-era et al. 1995), whereas Dalack and colleagues (Dalack and Meador-Woodruff 1996) observed exacerbation of positive symptoms during smoking cessation or reduction. The Yale Program for Research in Smokers with Mental Illness has studied cognitive function in schizophrenic and nonpsychiatric control subjects as a function of smoking status (George et al. 2002a). Although schizophrenic subjects compared with control subjects had deficits in visuo-spatial working memory (VSWM) function, a task dependent in part on prefrontal cortical dopamine function (Williams and Goldman-Rakic 1995), smoking appeared to improve these deficits in...

Clinical Aspects Of Narcolepsy

Until recently, the diagnosis of narcolepsy has been primarily based on clinical symptomatology, with cataplexy being the most specific symptom and diagnostic predictor for the disorder.27 Cataplexy is, however, sometimes difficult to distinguish clinically from normal experiences these may include feelings of weakness when laughing hysterically, in the context of exciting athletic activities, during sex or when extremely angry. Atonic seizures or other forms of hypotonia may also be difficult to differentiate from cataplexy.26 The MSLT is therefore commonly used to objectively quantify sleepiness and the occurrence of soREMPs, which are both consistent with the diagnosis of narcolepsy. In the MSLT, narcoleptics typically exhibit a short mean sleep latency (< 8 minutes) and more than two transitions into REM sleep (or soREMPs). The MSLT is typically performed after a night in the sleep laboratory, where nocturnal sleep is studied to exclude other causes of EDS or nocturnal sleep...

Uses Of Correlation And Regression

Many biomedical examples call for the use of correlation coefficients A physician might want to know whether there is an association between total serum cholesterol values and triglycerides. A medical school admission committee might want to study whether there is a correlation between grade point averages of graduates and MCAT scores at admission. In psychiatry, interval scales are used to measure stress and personality characteristics such as affective states. For example, researchers have studied the correlation between Center for Epidemiologic Studies Depression (CESD) scores (a measure of depressive symptoms) and stressful life events measures.

Hypoxiainduced Serotonin Transporter

5-HTT can be competitively inhibited by the antidepressants fluoxetine, paroxetine, and citalopram. Consequently, these drugs inhibit the in vitro SMC proliferative response to 5-HT and, to a lesser extent, the growth response to serum. In vivo, we also recently observed that these drugs impaired hypoxia-induced pulmonary vascular remodeling, despite their potentiating effect on acute hypoxic pulmonary vasoconstriction.

The Management Of Chronic Stress

The same applies to depression or anxiety disorders. With the diagnosis of a psychiatric or psychological disorder the treatment of choice may be either pharmacological or psychological or both. The nature and severity of the presenting condition will be considered in making this decision. Effective antidepressant medication or the judicious use of benzodiazepines may have a part to play in treating the outcome of the stress.

General Introduction

The term neural prosthetics may generally also be applied to forms of electrical brain stimulation which are the subject of Chapter 4. This chapter focuses principally on deep brain stimulation (DBS) in which an electrical current is administered through electrodes implanted in the brain. This technique of directly interfering with endogenous neural activity can be described as neuromodulation. It is currently used mainly on patients with otherwise untreatable central motor disturbances (e.g. pharmacologically refractory Parkinson's disease), but is also increasingly being applied to patients with mental or psychiatric disorders such as obsessive compulsive disorder or major depression. In addition to DBS, transcranial magnetic stimulation (TMS) and vagal nerve stimulation (VNS) also seem to hold new promise for the treatment of such psychiatric disorders. The potential ramifications of DBS will be discussed in Chapter 4, whilst VNS will be dealt with in Chapter 3. One particular...

Compliance

Prescribing dings is one matter, taking them is another. About 50 of patients are non-compliant. However, many doctors assume compliance unless the contrary is obvious. Sometimes non-compliance can be established by absent plasma concentrations of drugs or suspected by the lack of common adverse effects such as a dry mouth with tricyclic antidepressants. Inquiring about compliance requires tact

Family history FH

Non-smoking woman with a bronchogenic carcinoma may have had a husband who smoked heavily before he died of a smokmg-related illness. It is necessary also to consider the implications of diseases for instance a patient presenting wilh a depressive illness may (truthfully) say that no member of the family has had a similar illness yet further inquiry may reveal that several relatives committed suicide.

Justice

The three examples from the field of child psychopharmacotherapy have shown that, in general, the treatment of children today cannot be based on the same level of safety data as the treatment of adults. Consequently, a highly vulnerable subgroup of our population that should be particularly well protected ironically suffers from an unacceptable lack of data concerning age specific dosages and effects as well as side effects, even for the most commonly used drugs in child and adolescent psychopharmacotherapy. Children can therefore be described as therapeutic orphans. The health and economy discussion about justice of distribution of healthcare interventions is increasingly dominated by allocation issues. Will it be possible for everybody in a given society to be granted the same access to new intervention techniques Even now there are dramatic differences with respect to the use of new pharmacological agents between the United States, some countries of Europe and, especially,...

Sex Discrimination

Sexism can act as an environmental stressor that can also play a role in a woman's physical and or psychological well-being. Gender-specific stressors can contribute to depressive and anxiety symptoms in women, and Landrine, Klonoff, Gibbs, Manning, and Lund (1995) found that sex discrimination correlates with premenstrual symptoms, obsessive-compulsive symptoms, and depressive symptoms more than other life stressors do.

Benzodiazepines

The benzodiazepines are contraindicated in patients with known hypersensitivity to the drugs. The benzo-diazepines are used cautiously during pregnancy (Category D) and in patients with psychoses, acute narrow angle glaucoma, liver or kidney disease, and neurologic disorders. The benzodiazepines are used cautiously in elderly or debilitated patients. When the benzodiazepines are used with other CNS depressants (eg, alcohol, narcotic analgesics, and antidepressants),

The Role of Emotions

Memories is in a study of older adults who suffered their first major depression. These patients provided brief life narratives, both during the period of their depression and six months later (Fromholt et al., 1995). Alzheimer's patients from an earlier study (Fromholt et al., 1991) were included in addition to healthy controls in an attempt to provide data that could aid in the differential diagnosis between dementia and depression in older adults. All three groups of participants showed a clear bump, but the depressed patients had more recent memories than the other two groups. Depressed patients also had less temporal coherence in their life narratives than the other two groups. As might be expected, depressed patients had more emotionally negative memories, though the increase in negative memories came only from the most recent five years. Depressed patients reported memories similar in emotional tone to the other two groups for memories older than five years, which was well...

Magnets

Another example of a condition with claims of treatment by magnets is diabetic neuropathy, a painful and disabling complication of high blood glucose, which is treated with drugs, including antidepressants, anticonvulsants, and analgesics, with mixed results. A small single-site pilot study of the effectiveness of magnetic foot insoles for the treatment of pain due to diabetic neuropathy reportedly showed a reduction in symptoms of burning and numbness and tingling 30 . Consecutive patients (14) with diagnosed advanced chronic peripheral neuropathic pain secondary to diabetes, who had failed conventional pharmacologic treatments, and 10 patients with peripheral neuropathies not related to diabetes, were recruited for this study. These patients wore active (475 Gauss) or sham magnetic insoles on opposing feet (in shoes). They rated the level of pain on a continuous five-point visual analog scale twice daily for each foot. After 30 days, the active and sham insoles were switched and...

Symptomatic Therapy

A variety of medical therapies are utilized in the care of patients with leptomeningeal metastasis irrespective of whether the patient is offered aggressive neoplastic meningitis-directed therapy. A minority of patients will manifest seizures as a consequence of neoplastic meningitis and the use of non-sedating anticonvulsant drugs is appropriate for this group of patients. Patients with difficult to control pain may be managed with narcotics or, in the instance of neuropathic pain, either anticonvulsant drug or tricyclic antidepressant drug therapy. Depression is a very common symptom in patients with cancer and is often neglected or not recognized. Early recognition and initiation of antidepressants in symptomatic patients is recognized to improve quality of life and benefit both patients and families. In addition, antidepressants, especially tricyclic agents, are also useful for chronic insomnia. Corticosteroids are most useful to control vasogenic edema secondary to parenchymal...

Thermal modalities

Concerns about an associated depression or other psychiatric disorder that perhaps requires treatment with psychotropic agents, behavioral problems that severely compromise the treatment, or medical issues that complicate the use of an antidepressant may indicate the need for a more formal psychiatric consultation. This must be accomplished tactfully and after good rapport has been established (to the extent that this is not prevented by the psychological problems). Both patient and family may resist the suggestion of a psychiatric consult because, in addition to the usual stigma associated with such a consult, they may feel that this is another example of the dismissal of symptoms as being all in the head. Indeed, this might be a good starting place for psychological education to begin Yes, pain is in your head, all of our feelings are in our head. Pain affects mood and mood affects pain. We all have heard stories of soldiers wounded in battle who do not feel the wound until the...

Future Directions

The plus-maze test was developed in 1984 (50) as a behavioral assay for testing antianxiety effects in benzodiazepine drugs. Indeed, this test has been associated most specifically with this class of drugs. However, it can also be used to assess the level of anxiety influenced by other agents such as antidepressants (3) or to assess levels of anxiety as affected by prenatal stress, (51), isolation rearing (93), or to determine differences in basal levels of anxiety in rat strains (94). A9-THC (52), HU210 (53), and anandamide (54) all have been shown to cause anxiety-like behavior in the plus-maze, depending on the dose administered. The involvement of the EPCS in anxiety and the response to stress has been documented thoroughly. For example, intracerebroventricular injections of anandamide or A9-THC activated the hypothalamic-pituitary-adrenal stress axis in rats (55), while the potent cannabinoid receptor agonist HU210 produced a stress-like behavioral response in the defensive...

Clinical Accounts

Concerns about the potential for the use of hypnosis to encourage the acting out of suicidal ideas in the depressed patient have been expressed by many clinicians and researchers. Cheek and Le Cron (1968) warned against the use of hypnosis with depressed patients. Similarly, Spiegel and Spiegel (1978), Miller (1979), Burrows (1980), Crasilneck and Hall (1985) and Watkins (1987) expressed the same concerns about the potential for hypnotically based treatments encouraging

Antiepileptic Drugs

As with valproate, the mechanisms contributing to the weight gain are unknown, but since car-bamazepine shares some chemical properties with tricyclic antidepressants it might affect body weight regulation through the same serotoninergic and noradrenergic pathways increasing the appetite, as suggested in some cases (60).

F340 Cyclothymia

A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder (F31.-) or recurrent depressive disorder (F33.-). This disorder is frequently found in the relatives of patients with bipolar affective disorder. Some patients with cyclothymia eventually develop bipolar affective disorder.

Depression

Dysthymia is a mild form of depression that is triggered by a serious event and lasts for several months to years. Bipolar disorder (formerly called manic depressive illness) is characterized by depression with episodes of mania, a state of elation, which may include agitation, hyperexcitability, or hyperactivity. Most of the drugs used to treat depression affect the level of neurotransmitters in the brain. The newest of these are the selective serotonin reuptake inhibitors (SSRIs), which prolong the action of serotonin in the brain.

Suicide Risk

It has been argued that the risk of suicide makes the use of hypnosis dangerous in the management of depression. Crasilneck & Hall (1985) argue that hypnosis is inappropriately used in an outpatient setting for this reason. The potential for increased suicide risk has been explained in a number of ways. Burrows (1980) argues that hypnosis may inappropriately relieve anxiety before depressive affect has significantly lifted, allowing the depressed individual sufficient energy and anxiety reduction to act on suicidal impulses. Crasilneck & Hall (1985) observe that this phenomenon is not confined to hypnosis but has also been described for the range of treatment methods including psychotherapy, antidepressant medication and electroconvulsive therapy (p. 323). The evidence to support this proposal is primarily in the form of clinical case material, making it difficult to counter the criticism that, given the significant rate of suicide in patients with major depression, such case...

Altered bowel habit

The nature of any medication, prescribed or self-administered, should be established. Patients may be unaware of the laxative effects of some agents, e.g. magnesium-containing antacids, mefenamic acid or the constipating effects of others, e.g. aluminium-containing antacids, codeine phosphate or iricyclic antidepressants.

John M Mathis

Neuropathy Clinic Arm Unit

Pain resulting from classic nociceptor response to intense, potentially tissue-damaging stimuli. However, neuropathic pain results from spontaneous discharge of injured nerves. It may be enhanced by sympathetic afferent activity as well. This type of pain is not as easy to control with standard analgesics successful treatment has been achieved by means of adjuvant drugs such as antidepressants and an-ticonvulsants. When neuropathic pain is described as burning and constant, the tri-cyclic antidepressants become the first line of therapy. Syndromes such as postherpetic neuralgia and phantom limb pain are examples. Amitriptilyne (Elavil) is the most widely studied drug used for this type of dyesthetic pain. The operative mechanism for antidepressant-mediated analgesia is believed to be the increase in circulating pools of norepinephrine and serotonin created by reductions in the postsyn-aptic uptake of these neurotransmitters. The quantities of drug administered are well below what is...

Sexual Dysfunction

Not consistently improved with androgen therapy (200-400 mg testosterone enanthate weekly) (56-58). Other proposed treatments, such as zinc supplementation (59), pro-lactin-lowering with bromocryptine (60), and tricyclic antidepressants (61), are equally inconsistent. Oral vitamin E supplementation (300 mg d for 8 wk) improved self-reported sexual function (libido, erectile activity, and coitus) in a balanced randomized, double-blind, placebo-controlled study of 24 men with uremia (62). The modest improvement was not associated with significant changes in reproductive hormones and, if reproducible, further studies, including dose optimization, may be worthwhile.

Current Issues

Depression, it is necessary to look more broadly at the wider research on depression and consider the ways in which hypnotic techniques may augment clinical approaches to the management of depression. The National Institute of Mental Health Treatment of Depression Collaborative Research Programme (TDCRP Elkin, Parloff, Hadley & Autry, 1985) with its analysis and follow-up of 250 unipolar depressed outpatients at three different sites, randomly assigned to one of four treatment conditions (cognitive-behaviour therapy, imipramine plus clinical management, interpersonal psychotherapy and a pill-placebo control), contributes significantly to the current body of knowledge. The findings of this research and the ongoing debate (see, for example, Jacobson & Hollon, 1996) raise numerous significant issues for the area. As Shea, Elkin, Imber et al. (1992) point out, none of the treatments perform well in their capacity to promote lasting recovery. Major depression remains a challenge for...

Issues

ICE environments have a significant influence on behavioral functioning. The alterations in light-dark periodicity in polar regions disrupt the circadian sleep cycle, resulting in considerable sleep disturbances during the darkness period, and an associated decline in subjective feelings of well-being and alertness in polar areas (Bhargava et al. 2000 Natani et al. 1970 Palinkas et al. 1995a Palinkas et al. 1996). Also in space, the loss of the 24-h light dark cycle, circadian disruption, microgravity, and workload demands may result in performance decrements, decreased alertness and sleep disruptions (Mallis and Der-oshia 2005). Subjective reports from astronauts (Santy et al. 1988), as well as results from sleep monitoring studies (Gundel et al. 2001), show that sleep in space is shorter, more disturbed, and often shallower than on Earth, though with a considerable degree of inter-individual variation. Other psychological stress reactions have also been reported. During the long...

Menstrual Disorders

Premenstrual syndrome (PMS) describes symptoms that appear during the second half of the menstrual cycle and includes emotional changes, fatigue, bloating, headaches, and appetite changes. Possible causes of PMS are under study. Symptoms may be relieved by hormone therapy, antidepressants, or antianxiety medications. Exercise, dietary control, rest, and relaxation strategies may also be helpful.

Sicca syndrome

Avoidance of medications that exacerbate xerostomia and xerophthalmia is important. In particular, the physician should find substitutes for, or eliminate, antihistamines, decongestants, NSAIDs, antihypertensives, tricyclic antidepressants, and other anticholinergic agents. Aggressive treatment of candidiasis is important. Instructing the patient to use dietetic gelatin lozenges and increase fluid intake with meals may help. Use of topical methylcellulose lacrimal substitutes will often prevent corneal abrasion.

Sulfonylureas

Many drugs may affect the action of the sulfonyl-ureas the nurse must monitor blood glucose carefully when beginning therapy, discontinuing therapy, and any time any change is made in the drug regimen with these drugs. The sulfonylureas may have an increased hypoglycemic effect when administered with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine H2 antagonists, methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfon-amides, and tricyclic antidepressants. The hypo-glycemic effect of the sulfonylureas may be decreased when the agents are administered with beta blockers, calcium channel blockers, cholestyramine, corticos-teroids, estrogens, hydantoins, isoniazid, oral contraceptives, phenothiazines, thiazide diuretics, and thyroid agents.

Case History

A middle-aged man presented to the pain clinic with a 10-year history of intractable burning and itching pain affecting the area of the face supplied by the infra-orbital nerve, following an episode of Herpes Zoster some 10 years previously. His pain was of such severity he was passively suicidal and he had been unable to touch his left cheek for many years. After he was placed on antidepressants his distress was reduced and three sessions of hypnosis using glove anaesthesia enabled him for the first time to control his pain. The imagery technique involved taking him back to his European childhood and asking him to imagine that he was holding a snowball against the affected area of his face.

Training In Hypnosis

Major depression remains a challenge to all treatment modalities, including pharmacotherapy, cognitive-behaviour therapy, and psychotherapy. The traditional prejudice against its use in depression has prevented a serious assessment of whether hypnosis has anything significant to contribute to this widespread disabling

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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