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HOW TO DIFFERENTIATE BDD FROM NORMAL APPEARANCE CONCERNS – DISTRESS OR IMPAIRMENT IN FUNCTIONING

admin — Fri, 31 Dec 2010 10:47:27 +0000

To be considered BDD, appearance concerns must also cause clinically significant distress or impairment in functioning. Nearly all people with BDD experience both. One potential drawback of this definition is that “clinically significant” is a somewhat imprecise term that involves informed judgment. The opinion of a mental health professional can be helpful in determining whether appearance concerns are clinically significant. In most cases of BDD, however, the degree of preoccupation, distress, and impairment in functioning is clearly greater than what most people experience. Most people may have BDD-like concerns, but most people don’t have BDD.
It’s interesting to hear what people with BDD say about how their BDD concerns differ from normal appearance concerns. In making this differentiation, they often use preoccupation, distress, and impairment as their benchmarks. Kathleen disliked her “wide” nose, “fat” stomach, and “grotesque” veins on her legs. She considered her nose concerns to constitute BDD, but her stomach and vein concerns to be “normal.” “With my stomach and veins, it’s different,” she explained. “I can accept them and put them into perspective. My nose takes up much more of my time. I think about it a lot, and it’s getting in the way of my life. My stomach and legs bother me, but they don’t cause me such intense anxiety and pain. They don’t keep me from socializing. My nose drives me out of my mind.”
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SLEEP WITHOUT DRUGS: DREAM THEORY

admin — Fri, 08 May 2009 09:28:24 +0000

Another possible explanation of why we need to sleep is perhaps a psychological one. When we are sleeping, we all dream. Dreaming has a restorative function. We act out and experience some of our frustrations and anger during dreams. When we wake up the next morning, we have forgotten our dreams. This forgetting is important, as it allows us to forget our frustration and anger at the same time. Dreams are like a psychological filter, filtering out the worries that accumulate during the day. Sleep laboratories have demonstrated that when we are dreaming all the big muscles of the body are totally relaxed. This may be the only time that the body muscles are ever completely relaxed.

Another recent discovery in dream study is the occurrence of a male erection, which is discussed in chapter 8 on Sex and Dreams. It has been observed that whenever a man dreams his penis is erect, no matter what sort of dream he is having. This dream erection occurs in all age groups and this to be important for the proper development of the penis. Hence, at least for men, dreams are very important.

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COMMON CAUSES OF ANXIETY: FEAR OF PREGNANCY

admin — Wed, 29 Apr 2009 10:18:55 +0000

This is one of the most common causes of anxiety in women of childbearing age. The unmarried woman who has let herself be led into a foolish sexual experience without proper contraceptive precautions inevitably experiences severe tension. Her anxiety is often sufficient to inhibit her next menstrual period. She sees this as proof that her worst fears are confirmed, and desperation and self-loathing may easily drive her into precipitate action.

The married woman who fears pregnancy usually says that she does so because it would be financially embarrassing or would interfere too much with her social life. However, on close questioning it frequently turns out that there is much more to it than this, and that the fear is really based on a deep-seated fear of childbirth which developed when she was a girl as a result of foolish talk on the part of her mother or elder sister. That this fear is in fact neurotic is shown by the fact that these women are in no way reassured by completely adequate contraceptive measures, and their intimate life with their husband leaves them cold and in constant tension.

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CAN ST JOHN’S WORT BE USED IN THE TREATMENT OF BIPOLAR DEPRESSION, ALSO KNOWN AS MANIC DEPRESSION?

admin — Wed, 29 Apr 2009 08:52:11 +0000

People with recurrent depressions can be divided into unipolar and bipolar categories. Those with recurrent unipolar depressions suffer only from periods of low mood, separated from one another by normal periods. In contrast, those with bipolar depression experience periods of exaggerated energy and activation as well as depressions. During their activated periods, known as manic or hypomanic (less than manic) episodes, these individuals need less sleep, think and talk more quickly and are more sped-up than normal. Sometimes they are elated but at other times quite irritable and angry, especially when they feel blocked, frustrated or thwarted by those around them, who appear to them to be moving at a snail’s pace. The question here is whether a bipolar person can safely use St John’s Wort during a period of depression.

Unfortunately there are as yet no published studies on the use of St John’s Wort in the treatment of bipolar depressions. We do, however, know two important facts about the treatment of bipolar depression with other anti-depressants: (1) All anti-depressants that work in the treatment of unipolar depression also work for bipolar depression; and (2) All anti-depressants are capable of inducing hypomanic or manic episodes in patients with bipolar depression. Based on these observations, I would expect St John’s Wort to be an effective anti-depressant in bipolar depressions. I would also caution anyone with a tendency to develop hypomanic or manic symptoms to be sure to use the herbal antidepressant only under the close supervision of a doctor, and on no account to experiment with its use on your own. In addition, in most bipolar patients it is customary to use a mood stabilizer such as lithium carbonate or valproic acid before adding an antidepressant, to guard against the development of a hypomanic or manic episode. For those of you who are wondering why one should be so careful to prevent the development of a hypomanic or manic episode, I should mention that they can be extremely disruptive and destructive to a person’s life. Even though a mild hypomanic episode may not be harmful, when the process reaches its extremes it can cause the breakup of a marriage, the loss of a job, serious financial reversals and physical injury to the affected person.

I should emphasize that, to my knowledge, there has not been a single report to date of a manic episode induced by St John’s Wort and that there is no greater reason to be concerned about the herbal remedy in this regard than about any other effective anti-depressant. Even so, it is good to be aware of the potential risk, especially if you have a history of hypomania or mania. One of my patients who has experienced recurrent depressions and mild hypomanias in the past is on a maintenance dose of lithium carbonate to stabilize his moods. When he developed a mild depression I started him on 600 mg of St John’s Wort per day. A week later he rang me to say that he was feeling ‘too good’ and waking up in the early hours of the morning. I interpreted this as possible evidence of hypomania and suggested that he cut back to 300 mg a day, which turned out to be just the right amount for him. Once you are aware of the possibility that hypomania can develop with the use of any anti-depressant, you are forewarned

and better able to deal with the symptoms should they arise.

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WHEN SHOULD A PATIENT TAKE PROZAC AS OPPOSED TO ANOTHER ANTIDEPRESSANT?

admin — Mon, 23 Mar 2009 07:03:25 +0000

Prozac is a particularly beneficial treatment for:

• patients who are sensitive to side effects of medications in general, and especially the side effects of tricyclic antidepressants and MAOIs

• patients who dislike taking pills, since Prozac can be taken as one pill a day or in liquid form rather man the three to six capsules a day often needed with the tricyclics and MAOIs

• patients who have tried to overdose on other antidepressant drugs

• patients with cardiovascular disease, since Prozac’s effects on blood pressure and the electrocardiogram appear to be minimal (however, patients with unstable heart disease and recent myocardial infarction were not included in early studies).

What has been the major impact of Prozac on the treatment of depression, manic depression, dysthymic and personality disorders? Because the clinical efficacy of Prozac in depression is at least equal to the standard antidepressants, and because the side effects of Prozac are so much milder, the major impact of Prozac has been that patients, families, and physicians have preferred it and the newer drugs to most of the previously used drugs. Its safety and efficacy, in combination with the flood of publicity, both good and bad, it has received since it was first introduced to the American market in 1987, have made Prozac the number one best-selling antidepressant in the United States. In 1993, its sales reached $1.2 billion, exceeding the sales of all previously used antidepressant drugs both nationally and internationally.

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DO YOUNG PEOPLE SUFFER FROM THE SAME SIDE EFFECTS OF PROZAC AS ADULTS?

admin — Mon, 23 Mar 2009 06:59:26 +0000

Not entirely. In large clinical trials of Prozac, the most commonly felt side effects in adults were nausea (21.2%) and headache (20.3%), while in an open study of a small group of young people; the most frequent side effects were restlessness (27%) and sweating (20%). Drowsiness, dry mouth, tremor, and thinning hair also showed up more frequently in the young people than in adults. Compared to other antidepressants, these side effects were minimal both in young people and in adults.

Another unwanted, sometimes severe, reaction that appears more frequently among young people is mania. A published study described five adolescent girls, all with family histories riddled with major depression and suicide, who developed mania while taking Prozac. Considering the surprising fact that young people who experience serious major depression before the age of 18 almost invariably become bipolar, it is imperative to witch carefully for the development of these symptoms.

The need still exists for carefully controlled clinical studies comparing the responses of children and adolescents to Prozac and other standard drugs. In the meantime, youngsters taking Prozac should be observed closely and frequently by their families, and any side effects should be immediately reported to the psychiatrist.

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HOW DOES PROZAC COMPARE WITH ANAFRANIL (CLOMIPRAMINE) IN TREATING OBSESSIVE-COMPULSIVE DISORDER (OCD)?

admin — Mon, 23 Mar 2009 06:55:09 +0000

An estimated 5 million Americans are afflicted with obsessive-compulsive disorder, a biologically based syndrome whose symptoms are recurrent and intrusive obsessive thoughts and compulsive, time-consuming behaviors that shape and even dominate, the person’s life—even though the patient knows these thoughts and behaviors are irrational. The standard drug for treatment of OCD has long been the tricyclic antidepressant Anafranil (clomipramine), but in July 1993, the Food and Drug Administration unanimously approved Prozac as a treatment for OCD.

Once more, Prozac’s superiority as a treatment for some patients has much to do with its minor side effects. Anafranil, when taken in the high doses required for OCD (200 to 300 mg a day), often produces severe constipation, dry mouth, thirst, urinary problems, and gastrointestinal complaints. These symptoms do not occur with Prozac except an extremely mild form on occasion.

Luvox (fluvoxamine), a recently released SSRI approved for treatment of OCD, appears to be as efffective as Prozac or Anafranil for this condition. Although not FDA approved for depression in the United States, Luvox has been used for depression in Canada and Europe for several years.

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CAN PROZAC BE USED FOR CHRONIC FATIGUE AND PREMENSTRUAL SYNDROMES?

admin — Mon, 23 Mar 2009 06:51:02 +0000

Chronic fatigue syndrome is an elusive disease, difficult to diagnose (in part because some doctors don’t believe it exists) and difficult to treat or certainly to cure. Its primary symptom, overwhelming tiredness, often accompanied by disturbed sleep, can also be an indication of depression. Antidepressants, which boost energy, counteract depression, and may help to straighten out the sleep cycle, are frequently useful, and several studies have found Prozac to be successful in treating CFS.

Reports indicate that Prozac has dramatically alleviated some premenstrual symptoms in a small group of patients. Some of the symptoms of PMS include irritability, weeping, a depressed or changeable mood swinging from high to low within hours or days, and the feeling of wanting to isolate oneself from others and not participate in outside activities. Given Prozac’s highly successful results with dysthymia and depression, it does not seem surprising that premenstrual depression has been reported to be helped considerably by Prozac. However, further studies are needed.

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CAN PROZAC MAKE ME IRRITABLE OR ANGRY?

admin — Mon, 23 Mar 2009 06:46:38 +0000

It depends on your basic temperament and chemistry. Patients who begin taking Prozac when they are both deeply depressed and highly irritable usually find that irritability diminishes or disappears along with the depression. This has the effect of improving their relationships with their spouses, peers, colleagues, and children. Spouses and grown children sitting in my office with their formerly depressed loved ones have often told me how much easier it is to get along now that the crankiness or anger outbursts have faded along with the depression. Of course, many depressed patients are withdrawn rather than angry.

It is another story with patients who have a tendency toward bipolar mood swings with manic highs characterized by irritability, anger, and paranoid delusions rather than by euphoria and grandiosity. If they take Prozac during a depressed phase and have not been previously stabilized on lithium, the hypomanic or manic side of the mood may emerge in the form of these symptoms.

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