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
Saturday, June 20, 2009
Friday, June 19, 2009
Can inositol help reverse depression?
Over the years, alternative health care practitioners have been advocating a variety of herbs and nutrients for the treatment of depression. One of nutrients which is widely consumed by depressed individuals is inositol.
Inositol is a simple molecule and used by the body to make important components of the cell membrane. Products made from inositol are believed to play a vital role in signaling events in the body. Most individuals get adequate levels of inositol from food and no one has ever been identified as having inositol deficiency. Further, there is no relationship between depression and inositol levels in the body.
Inositol is readily available in most health food stores without a prescription and recommended for the treatment of a variety of mental disorder including depression. Because many depressed patients take a number of health supplements and other products, it has been difficult to evaluate the role of inositol. Of course, as with all supplements the vendors of inositol claim it is a miracle product. As far as consumers are concerned, there are a few anecdotal reports of inositol and depression. The majority of depressed individuals claim that the supplement does nothing.
In the past few years, four double blind trials have evaluated 141 depressed individuals who took inositol. Inositol was compared with an anti depressant or a placebo.
The Results?
The results did not show any evidence that inositol had anti depressant activity. Even though most of these studies were of short duration and the sampling population was small, inositol turned out to be just another hyped up supplement. The only good thing to come of the trials was that the supplement was safe and not associated with any side effects.
So where does the individual with depression stand?
Like many nutrients and herbs, inositol has failed to live up to expectations when it is properly evaluated in clinical studies. Nevertheless, the health supplement industry continues to market the product for many illnesses. A month’s supply of inositol is about $30. For those who are depressed and do not have money to spare, forget inositol and spend your money wisely on something that works. For those who are depressed and have money, cherries are in season- go eat some.
Inositol is a simple molecule and used by the body to make important components of the cell membrane. Products made from inositol are believed to play a vital role in signaling events in the body. Most individuals get adequate levels of inositol from food and no one has ever been identified as having inositol deficiency. Further, there is no relationship between depression and inositol levels in the body.
Inositol is readily available in most health food stores without a prescription and recommended for the treatment of a variety of mental disorder including depression. Because many depressed patients take a number of health supplements and other products, it has been difficult to evaluate the role of inositol. Of course, as with all supplements the vendors of inositol claim it is a miracle product. As far as consumers are concerned, there are a few anecdotal reports of inositol and depression. The majority of depressed individuals claim that the supplement does nothing.
In the past few years, four double blind trials have evaluated 141 depressed individuals who took inositol. Inositol was compared with an anti depressant or a placebo.
The Results?
The results did not show any evidence that inositol had anti depressant activity. Even though most of these studies were of short duration and the sampling population was small, inositol turned out to be just another hyped up supplement. The only good thing to come of the trials was that the supplement was safe and not associated with any side effects.
So where does the individual with depression stand?
Like many nutrients and herbs, inositol has failed to live up to expectations when it is properly evaluated in clinical studies. Nevertheless, the health supplement industry continues to market the product for many illnesses. A month’s supply of inositol is about $30. For those who are depressed and do not have money to spare, forget inositol and spend your money wisely on something that works. For those who are depressed and have money, cherries are in season- go eat some.
Monday, June 8, 2009
Shock Therapy for OCD
Obsessive Compulsive Disorder (OCD) is a difficult disorder to treat. The disorder is associated with distressing obtrusive thoughts which so far have only been partially controlled with drug therapy. Well, there is something new now. Shock therapy, similar to one that is used to treat depression is now being used to treat certain patients with OCD. However, there is one major difference between the device that is used to treat depression. The latest devices made by Cyberonics and Medtronic’s are the size of a small pacemaker which is implanted in the body. The pacemaker does not cause seizures but delivers stimulation to certain nerves that relieves the disturbing thoughts. The first Medtronic’s Reclaim Deep Brain Stimulator has just been approved for use on people with chronic OCD.
Even though there are millions of people who suffer from OCD, this device is only available for individuals with severe OCD who have failed drug therapy. At present the Medtronic’s device is set to be inserted in less than 4,000 individuals per year.
But the question is does this device work? Well, from the limited clinical studies the device has relieved obtrusive thoughts in some individuals but patients still need to continue to take their medications.
Reclaim is not a cure for OCD but just another modality of treatment which is more invasive.
The device is about 3 x 3 cm, circular and has four electrodes running out of it. The device is implanted superficially in the chest wall and four electrodes are tunneled underneath the skin and implanted in the brain. The pacemaker is adjusted so that signals are delivered to the brain and block abnormal brain thoughts.
Medtronic’s is currently designing similar devices for use in patients with depression. Similar devices have been used in the treatment of patients with Parkinson’s disease but the results have been mediocre at best.
At present, Medtronic’s says that it will allow the device to be used free on a “humanitarian basis” (a better word is guinea pig). The aim is to get more patients fitted with the device and follow up them before more making the device available to the public at large.
Even though there are millions of people who suffer from OCD, this device is only available for individuals with severe OCD who have failed drug therapy. At present the Medtronic’s device is set to be inserted in less than 4,000 individuals per year.
But the question is does this device work? Well, from the limited clinical studies the device has relieved obtrusive thoughts in some individuals but patients still need to continue to take their medications.
Reclaim is not a cure for OCD but just another modality of treatment which is more invasive.
The device is about 3 x 3 cm, circular and has four electrodes running out of it. The device is implanted superficially in the chest wall and four electrodes are tunneled underneath the skin and implanted in the brain. The pacemaker is adjusted so that signals are delivered to the brain and block abnormal brain thoughts.
Medtronic’s is currently designing similar devices for use in patients with depression. Similar devices have been used in the treatment of patients with Parkinson’s disease but the results have been mediocre at best.
At present, Medtronic’s says that it will allow the device to be used free on a “humanitarian basis” (a better word is guinea pig). The aim is to get more patients fitted with the device and follow up them before more making the device available to the public at large.
Thursday, June 4, 2009
Depression and pregnancy: Part 2
Unlike post partum depression, antenatal depression has not been studied well. There are no studies that have followed these women to determine how long the depression lasts, its severity, and what the relapse rates are. So far, most studies have only identified depressed pregnant women based on their symptoms but the chronology of depression has not been studied well.
The criteria for making a diagnosis of depression in pregnancy are the same as in the non-pregnant state. However, making a diagnosis of depression in pregnancy is somewhat difficult. Many women develop fatigue, sleeping difficulties, change in weight and appetite during a normal pregnancy and these symptoms cannot automatically all be ascribed to depression.
Given this dilemma in making a firm diagnoses, screening tools have been developed to help physicians in indentifying women with clinical depression. The Edinburgh Postnatal Depression Scale has been endorsed for use, screening not only postpartum depression but also depression during pregnancy.
Some of the factors that increase risk of depression during pregnancy include:
- prior history of depression
- prior history of premenstrual dysphoric disorder
- younger age
- limited social support
- living alone
- greater number of children
- marital conflict
- Ambivalence about pregnancy.
A history of depression during the antenatal phase is considered to be the strongest predictor of depression during any following pregnancy and during the early postpartum period.
http://www.medscape.com/viewarticle/584773_4
The criteria for making a diagnosis of depression in pregnancy are the same as in the non-pregnant state. However, making a diagnosis of depression in pregnancy is somewhat difficult. Many women develop fatigue, sleeping difficulties, change in weight and appetite during a normal pregnancy and these symptoms cannot automatically all be ascribed to depression.
Given this dilemma in making a firm diagnoses, screening tools have been developed to help physicians in indentifying women with clinical depression. The Edinburgh Postnatal Depression Scale has been endorsed for use, screening not only postpartum depression but also depression during pregnancy.
Some of the factors that increase risk of depression during pregnancy include:
- prior history of depression
- prior history of premenstrual dysphoric disorder
- younger age
- limited social support
- living alone
- greater number of children
- marital conflict
- Ambivalence about pregnancy.
A history of depression during the antenatal phase is considered to be the strongest predictor of depression during any following pregnancy and during the early postpartum period.
http://www.medscape.com/viewarticle/584773_4
Depression and Pregnancy
The majority of women who do get pregnant are delighted and looking forward to having a baby. It is a time of joy and there is a gradual change in life style. Women who are pregnant often get doted upon and are treated well. Great effort is made in society to protect the physical well being of the pregnant mother. However, it is now recognized that pregnancy is also a time of emotional stress and a fair number of women do develop depression. Even though it is well known that post partum women do develop depression and the blues, it was not appreciated until recently that depression during the pregnancy can also be quite moderate to severe in intensity. Many pregnant women with depression have been overlooked and underdiganosed. Unfortunately, depression during pregnancy has often been disregarded and never adequately treated.
The exact number of females who develop depression during pregnancy is not known but is believed to be quite common. One large study indicates that anywhere from 7-12 percent of pregnant women may develop depression. Further, women who already have been diagnosed with major depression are at a high risk for relapse during pregnancy. One has to remember that many women stop their anti depressants during pregnancy to avoid damage to the fetus, thus making them even more vulnerable to relapse.
The question being asked to day is if there is a link between perinatal depression and adverse neonatal outcomes. Even though the topic is controversial, one review did conclude that presence of depression during pregnancy might be an independent risk factor for later adverse effects on both the mother and the fetus.
There is now ample evidence that when depression is untreated during pregnancy, it may lead to poor prenatal care. Medical and obstetrical difficulties, self-medication, illicit substance abuse, weaken bonding, suicide, and a higher risk of relapse of depression in the postpartum period.
What is of concern today is that despite the high number of females who develop depression during pregnancy, very few actually are diagnosed and adequately treated
The exact number of females who develop depression during pregnancy is not known but is believed to be quite common. One large study indicates that anywhere from 7-12 percent of pregnant women may develop depression. Further, women who already have been diagnosed with major depression are at a high risk for relapse during pregnancy. One has to remember that many women stop their anti depressants during pregnancy to avoid damage to the fetus, thus making them even more vulnerable to relapse.
The question being asked to day is if there is a link between perinatal depression and adverse neonatal outcomes. Even though the topic is controversial, one review did conclude that presence of depression during pregnancy might be an independent risk factor for later adverse effects on both the mother and the fetus.
There is now ample evidence that when depression is untreated during pregnancy, it may lead to poor prenatal care. Medical and obstetrical difficulties, self-medication, illicit substance abuse, weaken bonding, suicide, and a higher risk of relapse of depression in the postpartum period.
What is of concern today is that despite the high number of females who develop depression during pregnancy, very few actually are diagnosed and adequately treated
Wednesday, June 3, 2009
Borderline Personality: Part 3
SYMPTOMS
Individuals with borderline personality often develop symptoms from acute events like loss of a job, failure at work, breakup of friendship, lack of career goals and most of all, a sense of having no identity
Many of these individuals view themselves as worthless or bad. Often they feel as they have been mistreated or deceived. They often complain of feeling bored, empty and lack of self recognition is quite common.
The symptoms of BPD generally are more severe when the individuals have little family support and no friends. The individual in turn makes desperate attempts to socialize.
Because of the persistent negative feelings or emotional traits, BPD individuals have few friends. While they do develop intense attachments, these are often stormy. These individuals are very labile in their feelings with emotions switching from love to hate in a matter of minutes. Loyalty to a friendship is rare because they constantly switch their feelings at the slightest hint of feeling poorly treated. Being highly sensitive to rejection, they often react with anger, self injury and spontaneous unrealistic decisions. In the middle of a vacation, they many cancel the trip and return back home. Sudden changes in plans are not common with these individuals.
Like manics, BPD individuals also act with impulsivity and may go on a spending spree, practice risky behaviors like sex with strangers, binge eating and drinking. In most cases BPD occurs as an isolated disorder but can occur in association with other mental health disorder like depression, substance abuse, mania and anxiety.
Individuals with borderline personality often develop symptoms from acute events like loss of a job, failure at work, breakup of friendship, lack of career goals and most of all, a sense of having no identity
Many of these individuals view themselves as worthless or bad. Often they feel as they have been mistreated or deceived. They often complain of feeling bored, empty and lack of self recognition is quite common.
The symptoms of BPD generally are more severe when the individuals have little family support and no friends. The individual in turn makes desperate attempts to socialize.
Because of the persistent negative feelings or emotional traits, BPD individuals have few friends. While they do develop intense attachments, these are often stormy. These individuals are very labile in their feelings with emotions switching from love to hate in a matter of minutes. Loyalty to a friendship is rare because they constantly switch their feelings at the slightest hint of feeling poorly treated. Being highly sensitive to rejection, they often react with anger, self injury and spontaneous unrealistic decisions. In the middle of a vacation, they many cancel the trip and return back home. Sudden changes in plans are not common with these individuals.
Like manics, BPD individuals also act with impulsivity and may go on a spending spree, practice risky behaviors like sex with strangers, binge eating and drinking. In most cases BPD occurs as an isolated disorder but can occur in association with other mental health disorder like depression, substance abuse, mania and anxiety.
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.
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.
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