Agoraphobia: "unrealistic fear" Part 1

Agoraphobia is a mental disorder associated with unrealistic fear. The syndrome is intricately linked to anxiety. People who have agoraphobia fear being in certain places and easily develop panic like symptoms.

Agoraphobia tends to make people afraid even in open public places like elevators, bridges, high buildings, sporting events, use of public transportation, shopping malls and air planes. This fear can be so devastating that many people are trapped in their homes- this is the only place where they feel safe and rarely venture outside. Some individuals even fear being left alone at home, feel feeble and become dependent on others.

Agoraphobia is difficult to treat because it means confronting the fears. Other symptoms of agoraphobia include difficulty breathing, dizziness, sweating, fast heart rate, nausea, facial flushing, stomach cramps, chest pain, feeling complete lack of control, difficulty swallowing and a sense of doom.

Should I take Kava extract for my anxiety?

Generalized anxiety is a common medical ailment in North American society. This medical disorder can present with a range of symptoms. In severe cases, anxiety can be disabling and affect one’s life style. For decades, the only treatment available for generalized anxiety has been pharmaceutical drugs. There are many drugs which have been used to treat anxiety, and while effective, drugs also possess adverse side effects. For this reason, many patients have been turning to alternative health care for managing their anxiety.

One of the products frequently consumed by individuals with anxiety is kava. Kava is easily available in most health food stores and estimates indicate that sell of this herbal extract brings in hundred of millions of dollars. The question remains, "is Kava effective for treating anxiety?"

Cochrane reviews recently published the results of twelve trials that looked at kava versus placebo in the management of anxiety. The study looked at the oral preparation of kava extract. Out of the 12 studies, results of 7 studies were compared and assessed using stringent clinical criteria.

Compared with a sugar pill, kava extract was more effective for symptomatic relief of anxiety. Even though the number of patients assessed was small, the results did show a mild to moderate improvement in patients treated with kava. Further, kava was also found to be safe and relatively free of side effects when treatment was conducted anywhere from 1-24 weeks.

So what does mean for the consumer who has anxiety?

For once at least, some herb appears to be effective in treating a medical ailment. Kava has been shown to be safe for short-term usage and it does relieve anxiety. What is not known so far is whether kava works in all people with anxiety. Kava is a lot cheaper than all currently available pharmaceutical medications. For the individual with anxiety, one should perhaps try out kava for at least 4-6 weeks to determine if it works. If kava makes no difference after a 2-month period, it is not going to work at all. Before doubling up on the dose, perhaps one should discuss this situation with a health care professional. In the end when all else fails, one has no choice but to revert back to the pharmaceutical drugs.

http://www.cochrane.org/reviews/en/ab003383.html

Is Valerian effective for anxiety?

Anxiety disorders are quite common in our society. Anxiety can vary in intensity and can severely affect one’s lifestyle. There are many medications available to treat anxiety but none is ideal and all of them have side effects. For this reason, many individuals with anxiety have now been turning to alternative health care for treatment of anxiety. One of the natural substances high highly recommended by the herbalist for anxiety is valerian.

Valerian is a herb sold as a dietary supplement in health food stores. It is a common ingredient in natural products recommended for sleep, tension, and stress relief. As far as clinical evidence about its sedating ability is concerned, most of the data are inconclusive and not supportive. Nevertheless, the herb is found to be safe when ingested for a short time, but there are no long-term data.

As far as anxiety is concerned, the effectiveness of Valerian is a puzzle. To date, all reports about valerian for treatment of anxiety are anecdotal and most are made by the vendors of this product. Individuals who take valerian seem to indicate that it does not work all the time. Other individuals have tried out different brand names of the same herb and found no difference in the anxiety symptoms.

As far as clinical evidence is concerned, there is very little data. However, recently Cochrane reviews looked at one randomized study involving 36 patients with generalized anxiety. This 4-week study compared valerian to diazepam and a placebo. The patient population was homogenous and various scales were used to measure anxiety symptoms. At the end of 4 weeks, valerian was no different from the sugar pill when it came to relief of anxiety symptoms. Diazepam was more effective than valerian when it came to symptom relief for anxiety. The only good news about valerian was that no patients reported side effects.

So what about the consumer with anxiety?

This was only one small study but again, despite all the hype about valerian, it did nothing for relief of symptoms of anxiety. Even though benzodiazepines have side effects and are addictive, these drugs still remain effective for anxiety. The other negative about benzodiazepines is that they are expensive and often interact adversely with other drugs. For the individual with anxiety, the choice of how to treat anxiety is difficult. Should one take a herb which is useless and moderately expensive or take a drug which is very expensive, has side effects but works?

The answer- neither. Try Buspirone. This non-addictive drug does not impair mechanical performance such as driving. Response to Buspirone occurs approximately in two weeks, as compared to the more rapid onset associated with benzodiazepines. The only negative- individuals who have previously taken benzodiazepines for the treatment of anxiety generally do not respond well to Buspirone.


http://www.cochrane.org/reviews/en/ab004515.html

Borderline personality: part 2

At any one point in time, at least 1/5 individuals afflicted with BPD need long term mental health services and/or repeated admissions to psychiatric facilities. If help is sought out early, many individuals can improve with time, and lead fairly normal and productive lives.

Unlike individuals who have depression or manic disorder, BPD individuals develop similar but more intense feelings of anger, depression, anxiety and sadness –but the feelings only last a few hours. Associated with these symptoms are spontaneous acts of impulsive behaviors such as anger, self injury, drug or alcohol abuse.

Pristiq- a newer antidepressant

Recently the FDA approved a new anti depressant called Pristiq. Known as desvenlafaxine, it has been in use for about 10 months. It works like the other anti depressant medications and brings back the balance of certain neurotransmitters in the brain. Pristiq is quite long acting and is taken once a day. Just like the earlier generation of anti depressants, it also has a few side effects that include:

Nausea
Lightheaded
Excess sweating
Constipation
Generalized tiredness
Diminished appetite
Anxiety, apprehension
Decrease libido in men

While Pristiq does not cure depression, it remains an option for individuals who do not respond to the older anti depressants. The other advantage of Pristiq is that it has been shown to be an excellent drug for treatment of melancholia that occurs during menopause.

From recent clinical trials, it has been shown that about 70% of individual with major depression do respond to Pristiq. Further, the trials also showed that remission rates for Pristiq were much lower than the older anti depressants. Whether the drug works for chronic depression has not been fully evaluated.

Herbs and Anxiety

Anxiety can be a troublesome disorder often associated with both physiological and psychological changes in the body. The emotional and behavioural symptoms can be very unpleasant and typically include apprehension, excessive worry or a feeling of impending doom. In most people, anxiety is a typical response to stress and helps one cope with a difficult situation. However, in some individuals the symptoms do become excessive and start to dictate behavior.

The majority of individuals who have chronic anxiety are referred to a psychiatrist or a psychologist. The treatment of anxiety is often a combination of drug therapy and cognitive behavior counseling. However, a number of individuals do poor with conventional medical therapies and have started to seek out alternative health care remedies. One of these therapies is the use of herbs.

There have been a number of herbs which have been evaluated for their role in treating anxiety. The most common herbs used to treat anxiety are kava, passion flower, valerian and theanine.

Kava has been the most studied and is probably the one which is the most sold in health food stores. Several short term studies have shown that it can reduce anxiety in within a few days after starting the herb. The majority of individuals who have taken kava are now unwilling to take any conventional medications.

However, recently there have been reports of Kava and liver damage. There are reports in the literature that after short term use Kava can induce a form of hepatitis and liver failure. In Europe, Kava has been banned from health food stores. In the USA, the FDA has issued warnings to health stores about this herb. Kava is currently widely available in the USA and the FDA is still deciding on its future.
Passion flower, valerian and theanine have also been shown to reduce anxiety and are considered safe. So far the side effects reported have been mild and of a short duration.

One of the major problem with herbs is that the quality and quantity is variable in each formulation. Herbs are sold as dietary supplements and thus often do not undergo the strict quality control required of a drug. Recent reports also indicate that many herbal products from the orient have contaminants; and fake products are not unheard of.

So if you are considering taking a herbal supplement for your anxiety, discuss this with your health care provider. Even though herbs are cheaper than pharmaceutical medications, you do not want to end up paying more to treat complications of these natural remedies.

What is status of Electroconvulsive therapy today? Part 1

After nearly 30 years of extensive use, there is no doubt that electroconvulsive therapy (ECT) is beneficial in the treatment of some patients with depression. However, the use of ECT in schizophrenia, mania or other mental health disorders is in limbo.

The majority of studies of ECT on mania and schizophrenia are difficult to interpret and the results remain inconclusive. Today, ECT is not a part of the therapeutic regimen of these disorders, except for a few isolated cases.

A lot of evidence exists which shows that ECT is a good form of therapy for individuals with depression. In many instances it has even been shown to be more effective than the conventional drug therapy using anti depressants. Over the years, psychiatrists have learnt that entire brain stimulation produces significantly much better results than stimulating only one half of the brain. Further, like all things American, more is better- meaning that a higher current produces better and long lasting results than use of low current.

In the past, individuals who received ECT were never thoroughly investigated or followed up. Misconceptions of the treatment arose because of anecdotal reports by patients and non health care professionals. The background of the patient, his/her co morbidity, personality, use of medications and other medical problems were never taken into account and everything negative was blamed on ECT.

Further during the evolution of the treatment many of the psychiatrists also failed to maintain safeguards to protect the patient. Infact for the major part of the history of ECT it was felt that the treatment created monsters. Today a lot has changed.