Medical Blog

December 16, 2009


Filed under: Anti Depressants-Sleeping Aid — admin @ 12:11 pm

This technique also applies to people who dissociate first and become frightened by the altered state. ‘What’s happening to me. Here it comes again. I’m going insane’. We can stop the escalation into anxiety and panic simply by being aware. ‘I’m dissociating.’ I’ve just gone into a trance state’. When we acknowledge what is happening to us, without letting our thoughts race out of control, we can break the dissociated state very easily, simply by breaking our stare, by blinking our eyes a few times. When our thoughts race away with how terrible the dissociated state is, our fear will not only hold us in the altered state, but will create even more symptoms.

Taking back the power: letting go

The second stage involves letting go of our thoughts. It is not the avoidance of thoughts by trying to distract ourselves in some way, that only creates further anxiety. As in meditation, the secret of the letting-go process is not the avoidance or annihilation of our thoughts. It is the letting go of our thoughts. When we are aware of how our thoughts create our symptoms, we see we have a choice. If we keep on the rollercoaster we know where we are going to end up. Anxiety and panic.

Don’t fight the thoughts. Don’t try to stop the thoughts or try to avoid them. Validate the thoughts by naming them, ‘anxiety’ thought, ‘panic’ thought, ‘depressive’ thought, ‘mental abuse’ thought, ‘negative’ thought, ‘guilt’ thought and then let them go, which means we don’t concentrate on them, we stop them by letting them go. This is the hard part. As soon as we let go of one thought, another is there to take its place. We let go of that and another comes.

This is where we need to have a lot of discipline. Remember, we are learning a new skill and it is going to take time and patience. In essence, what we are doing is learning to gain control over our thoughts and in doing so take back the power from the disorder. With practice, we become caught up in the letting-go process instead of becoming caught up in our thoughts.


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:11 pm

The first step in learning to control our thinking is to be aware of what is actually taking place. To do this we can draw from the meditation technique, although with this exercise we will not be meditating. Part of meditation is becoming aware of when we get caught up in our thoughts. We can extend this by becoming aware of what we are thinking throughout the day and evening.

Part of us needs to stand back and observe the whole process. All we need to do at this stage is to observe our thoughts. Don’t analyse them or interfere with them. Just watch them as they come tumbling in. Then bring the awareness to the body. Watch how our body responds to our thoughts and how in turn our thoughts respond to the symptoms. It isn’t the symptoms which create the fear. The way we think creates the fear, which creates the symptoms, which creates further thoughts, which creates further fear and the cycle continues.

Nor do we need to be thinking about the disorder or symptoms. Whatever we are thinking about is usually negative, the mental abuse, ‘I’m stupid, weak, hopeless’; the negative internal conversations; guilt; what we should have done, or shouldn’t have done. The overall result is the same-anxiety and attacks. When we see this relationship, we begin to see through the fear.

We need to become aware of the whole process of our thinking and our physical reaction to our thinking. We need to see how they build upon each other and create our symptoms.

If I ask people what they were thinking about before their last attack, they usually say that they weren’t thinking of anything. This is not so. They were thinking, they just weren’t aware of their thoughts. Asking the same question of people who feel continually anxious brings the same reply. They also are not aware.

We need to be aware of the relationship between our thoughts and our symptoms. When we see the relationship we will

understand why there is nothing to fear. The anxiety and the panic are a response to our thinking. We are simply frightening ourselves. Nothing more.


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:11 pm

Our lack of understanding about our disorder has, in many cases, meant years of suffering, and to many people it seems that the future will be no different. One of the first things we need to do is to stop drawing on the past and projecting into the future, which incidentally is only a thought away!

It is difficult for many people to believe recovery is possible. After trying many different treatment methods without success, it is difficult to believe anything will succeed. If we think something isn’t going to work, then it won’t. That’s our problem—our thinking.

The past belongs to the past-except for one major point. Despite the enormous difficulties we have encountered through the disorder, nothing physically has happened to us. None of our major fears have been realised, and they aren’t going to be in the future. The next attack is not going to be the ‘one’ in which our fears come true. If anything were going to happen to us it would have happened in the first attack. We are continually drawing on our past experiences of the anxiety and attacks and projecting them into the future. We don’t concentrate on what is happening now.

If we always have an attack at 7.00 a.m. we expect to have one every morning. When we have an attack we think ‘I knew it would happen’. We expect to have one the following morning, and we do. We don’t see what is happening now because we are too busy anticipating the next attack.

As an example, we need to be aware of our first thoughts when we wake. The first thought is usually ‘where is it’, and we usually feel frightened because we know ‘it’ is going to be there. We turn on our internal radar and check to see wbat is happening. We move down our body. ‘I’m going to have a headache, my throat is tight, my heart is racing, I am having trouble breathing, I feel sick, I’m shaking.’ And a full scale attack may develop. After it subsides we worry about the next one. As we go to sleep at night we think to ourselves, ‘What if I have an attack in the morning?’


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:09 pm

If your depression is severe, I recommend that you start treatment with a conventional anti-depressant as opposed to St John’s Wort.

I would regard depression as being severe if it disrupts important functions, such as personal relationships or work to a major degree, if it is seriously interfering with physical functions such as sleeping or eating, or if it is accompanied by a sense of hopelessness or suicidal ideas or plans. To date, there has been only one study with St John’s Wort for relatively severe depression.

Although the results of that study revealed a beneficial effect of St John’s Wort equivalent to a modest dose of a conventional antidepressant, there are numerous studies indicating the value of more conventional anti-depressants in severe depression. At this point the benefits of St John’s Wort for severe depression must be considered somewhat experimental, and a more proven first-line approach makes more sense, given how much is at stake when depressive symptoms are severe. Severe depression can jeopardize a person’s job, relationship or the successful outcome of a project. Of even greater concern is the danger of suicide, which is a major risk of severe depression. A delay resulting from starting with a less well-established approach is therefore too risky. A doctor should be consulted and a trial of a conventional anti-depressant should be initiated without delay.

If you are currently being treated with one or more antidepressants and are considering using St John’s Wort, you need to ask how to proceed if:

You are doing well, your depressive symptoms are under good control and side-effects are at an acceptably low level.

You are already being treated for depression but are not doing as well as you would like either because your depressive symptoms are not under control or because side-effects are unacceptable or undesirable.


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:09 pm

A recent study reported the annual cost of depression in the US to be approximately $43 billion a year. This amount includes the cost of treating the condition and the loss of productivity and positive contribution to the economy resulting from the illness. Even without taking into account the human suffering involved in the condition, depression is considered to be one of the ten costliest conditions to any nation’s economy.

While depression is costly, its treatment is lucrative. Thus, the anti-depressants such as Prozac and Lustral are among the best-selling medications, representing billions in revenue for their manufacturers. While these medications can literally be life-savers, those who offer these commodities have a marked vested interest in maintaining their share of the market. They might be understandably concerned by the advent of an effective, off-prescription alternative treatment for depression. While some concerns about this new way of treating depression are warranted, others may be suspect, motivated by an attempt to protect economic turf.

In all cases, arguments against the self-administration of St John’s Wort need to be considered on their merits. For example, a leading psychiatrist was quoted in a recent article in the Washington Post on St John’s Wort as saying, ‘If a drug has enough activity to actually treat something that is real and substantial, then it ought to be administered under somebody’s supervision.’ If you consider the many active drugs available without prescription, which are routinely self-administered to treat real and substantial problems, such as aspirin for arthritis or antihistamines for allergies, it is clear that this argument is not universally applied in other areas of medicine. Nor, in my opinion, does it necessarily apply in psychiatry either. Perhaps the psychiatric establishment has yet to get used to the novelty of an over-the-counter treatment for depression.


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:08 pm

A 50-year-old American woman writes to me as follows:

I first heard about St John’s Wort as a treatment for depression when I was reading about natural remedies for menopausal symptoms. I began taking 300 mg but did not find it all that helpful. This past summer my husband suggested I up the dosage to 600 mg and that was the magic amount for the summer Now that we have turned the clocks back again [at the onset of autumn] I am taking an additional 300 mg in the afternoon, which helps.

I have been in and out of therapy since I was 25. Therapy with the right therapist(s) is helpful, but it is also expensive and time-consuming. My employer has a cap on the number of hours of therapy a person can undergo, and I am getting closer to that cap every week. I am hoping that this next calendar year is my last year of needing therapy. I was not in therapy for several long periods of my life. Often, a tragedy such as a death in the family or major surgery would send me back in.

I prefer natural herbs to drugs wherever I can. I have refused to take Prozac or Lustral. I really don’t want to rely on a drug to control my mood.

Whether or not one agrees with Shirley’s opinions about psychotherapy, herbal remedies or anti-depressant medications, she does seem to embody the trend that Naisbitt mentions in his book. I do believe that she speaks for a very large number of people who are concerned about the cost of mental health care, interested in natural remedies and eager to take their lives into their own hands as much as possible. St John’s Wort provides a solution to all of these concerns. Relatively inexpensive, highly effective, safe and mild in terms of side-effects, it offers millions of people the opportunity to help themselves.

It is, of course, critical to know when self-care has reached its limit and when to seek the help of an expert. Shirley appears to be able to make this distinction. It is an important caveat for others to bear in mind as well.


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:07 pm

Is there a time of day or night that you dread? Maybe it’s the fight at naptime, or that first early morning call, or the inevitable middle-of-the-night visit.

Take a minute to look at your trouble spots. Certainly a child can show more than one problem at more than one time of day, but the first step is to figure out “what is happening when?” In this chapter we will break down the day into segments where sleep is likely to become an issue. There are new ways to think about things and some tips to try. Some ideas apply primarily to infants, others are more applicable to older children. Feel free to focus on what fits your child and family the most.

To fall asleep means to be separated from those you love and trust. It is no easy task and is especially hard during times of developmental upheaval. Sleep problems often show themselves when separation anxieties are an expected part of development. A child might think the following:

When I close my eyes, it’s dark—everything is gone. I wonder where I am going…and I wonder where you are.

A parent’s job is to find the balance between being supportive and being firm, to be sure in her own heart that nothing bad will happen to the child while he sleeps—then to communicate that in a cheerful, confident manner.

Let him borrow some of your confidence until he develops his own. Reassure him you are nearby. Call to him or visit occasionally if that helps. Tell him what you do while he sleeps (something boring). After rest time, point out that he woke safely and you were there.

Dr. Spock recommends that parents of children who are experiencing peak separation issues sit in a chair next to their beds until they fall asleep. Don’t over-coddle, but don’t abandon him to tough it out on his own. Because he really needs to see you, letting him cry-it-out at peak separation times will only escalate the fear and crying.


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:06 pm

Sleep disturbances are common with babies. They are so common that ma parents are reluctant to define their situation as a “problem.”

A baby seems to change every day; as she grows and learns, parents expect that she will learn to sleep when she is able. Some babies learn on their own. Some do not. The advantage of working on sleep problems with infants is that their habits are not as ingrained. Sometimes by making a small change a parent can bring about a real improvement. Things may improve on their own if you wait long enough, but you may not be able to wait. Or things could get worse and harder to change. If your infant is six months or older, now is a good time to begin.

Will feeding solid food early help my child sleep better? Research does not support this idea. Sleeping a long stretch at night has more to do w neurological than with digestive functioning. The current medical recommendation is to start solid food at four to six months of age. Your child’s doctor can help you determine the best time for your child according to his si birth weight, and health.

It probably will not hurt to try offering solids, but do not hope for instant success. Also, remember that over-feeding at bedtime will only lead to disrupted sleep. Try to avoid “stuffing” him right before bed.

There are ways that feeding can be used to affect sleep. Mealtime is one of the factors that helps to re-set the internal time clock. Making meals regular as possible during the day helps give rhythm to a child’s day and night. When working to change a skewed schedule, moving the mealtime helps establish a new beginning or ending to the day. Solid food at predictable, longer intervals during the day can help lengthen time between meals at day and night. Offering a solid food snack after the last nursing can help prevent falling asleep at the bottle or breast.

In summary, food will not necessarily “keep him full” through the night, it can be used to cue him for sleep.


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:04 pm

All people have biological cycles that govern their days and nights. Called “Circadian Rhythms,” these rhythms include sleeping, waking, hunger and changes in body temperature and hormones throughout the 24 hour day. The timing of these cycles is linked to the ability to fall and stay asleep instance, as we fall asleep there is a drop in our body temperature. We wake up as it starts to rise again.

Research shows that there is a natural tendency to stretch tow twenty-five hour cycle. Events in our daytime schedules—mealtime, bedtime and time of rising—serve the purpose of re-setting the cycle to fit the 24-hour day. You can probably see this happening, to a small degree, on M morning after you allowed yourself to go off your usual schedule during the weekend. This is also the experience of “jet lag”—when the event experience don’t fit with your biological clock.

Most people don’t have trouble maintaining a twenty-four hour cycle. But for children whose sleep cycles have strayed, this is asking

Sometimes we ask children to go to sleep when their bodies are not ready the sleep cycle. A child would understandably be grumpy and hard to live if his rhythms were not in sync with the clock of his world.

John just can’t seem to get to bed at a decent hour—we always battle bedtime. When he was eleven months old he wasn’t ready to go to bet 11:00 pm. We gradually got it down to 9:00 pm. Then at a year and ? we noticed it had crept back up to 10:00 pm.

Biological rhythms influence sleep in several ways.

It may be necessary to purposefully take control of your child’s sleep if they have gotten off kilter.

Daytime routines are important to maintain biological rhythms an resulting sense of well-being.

If you implicate biological rhythms as a part of your child’s sleep pro changes need to be made in gradual increments so that a shift of cycles can occur smoothly.

When your child is sleeping better and more regularly, you can expect a happier child.


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Filed under: Anti Depressants-Sleeping Aid — admin @ 12:04 pm

If you are wondering if your child’s sleep habits qualify as a “problem,” you might want to consider the following issues. Mark each statement A (agree) or D (disagree). If yours is a two-partner family, it is helpful if both partners mark the statements separately to see how each of you feels about the situation.

     1.1 feel my child is not getting enough sleep. He is irritable during the day and shows subtle

signs of lack of sleep.

     2. My child wakes too early or goes to sleep too late.

     3. Sleep seems frightening to my child.

     4. My child wakes during the middle of the night.

     5. I wonder if my child is eating too much or too frequently.

     6. Bedtime is unpleasant for my child. She goes to bed angry, sad, over-stimulated, or


     7. I believe an undesirable pattern may be developing.

     8. My child needs me at times that seem unreasonable to me. I fear he may be overly

dependent on me.

     9. Bedtime is unpleasant. I dread it.

    10. I usually feel deprived of sleep. I crave a night of undisturbed sleep.

    11. I need to go to bed sooner than I would like in order to accommodate an early riser or a non-sleeper.    

    12. My fatigue or anger is affecting my relationship with my child, his siblings, or my partner.

    13. The current situation feels out of control.

    14. I find myself asking, “Is my child the only one acting like this?”

    15. My child continually disturbs the rest of the family.


Some of these statements reflect the child’s behavior. Others reflect the family’s response. If you agreed with three or more, there is definitely a problem within the family system. This checklist is only a guideline. A child may show only one area of difficulty that turns the family upside down. Go back to the definition of a sleep problem. If you experience it as a problem, then it is a problem worth working on.


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