Antidepressants Blog

Most of these reactions are due to sympathetic stimulation. Some, such as the desire to use the bladder or bowels and the sweating are due to parasympathetic overstimulation.

All are normal reactions to real or implied danger. If we could not respond quickly, almost without thinking, we would not survive.

But this normal response to stress can become abnormal.

If we are tense and anxious, the autonomic nervous system may be overstimulated and produce many or all the symptoms associated with the normal response to a fright.

We can develop nervous palpitations or diarrhoea. We can even pour out so much acid from our stomachs, that it eats a hole into the wall of the stomach or duodenum and forms an ulcer.

Most people believe that “nerves” mean imagination, yet they know their symptoms are real. So they believe they have a real organic illness, such as heart disease or cancer.

This causes further worry and anxiety. This secondary anxiety further stimulates the autonomic nervous system and, in turn, results in more symptoms and so we have established a vicious circle.

This malfunction in the autonomic nervous system is called autonomic dyspraxia or dystonia.

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Depression is one of the most common disorders of modern life and is believed to be increasing.

In the past, depression was classified into two groups: endogenous, or coming from within, and exogenous, or coming from without. This latter form was also called reactive depression and was usually associated with loss.

Most doctors now think of depression as one illness.

The classification of psychiatric illnesses is always difficult. We are all individuals with our own unique personality, habits and attitudes, so when we suffer emotional disorders they are likely to be as individual as the people who suffer them. Depression is not merely a lowering of mood.

Many refuse to accept they are depressed because they do not feel sad. Sadness, unhappiness and a feeling of depression are normal emotions. Like anxiety they may affect us all at different times.

They become abnormal only when they are inappropriate to the precipitating factors or if they become so severe as to interfere with our normal life.

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The cause of the sudden infant death syndrome is not known. Well over 100 theories have been suggested and despite considerable research there is no proven one cause. It may well be that there are several factors which can lead to cot death. It is common in all races and cultures and in all socio-economic classes. It affects infants who are breast fed as well as those on the bottle. It is not due to suffocation by a pillow, blankets or sheepskin rugs. It is not due to any vitamin or mineral deficiency nor to any other nutritional factor. It is not due to allergy to the house dust mite or to cow’s milk and it is not due to a reaction to a recent immunisation to triple antigen or other vaccine.

And it is definitely not due to neglect by the parents.

If a cause for the child’s death can be found, then it is not classified as SIDS. The death is totally unexpected. The child may even have been checked as recently as that day by a doctor and found to be in good heath.

It is not easy for the parents, other children, grandparents, other relatives and friends to accept the death. The parents have to cope with both grief and guilt.

Guilt is a normal feeling at this time, but is unfounded. The cause is not something the parents did or did not do.

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Of course, this is not to say that we can’t identify some of these factors. The immune system can be weakened by other illnesses, poor nutrition, some drugs, some infections, stress, old age, cancer itself and some rare inherited disorders. Very active cancer cells can just develop by chance, but the more mutations that are occurring, the greater chance that one will lead to a cancer. The number of mutations is increased by exposure to radiation, some drugs, sunlight (skin cells only), many chemicals, and some types of infection. Exposure to any one of these factors does not necessarily lead to cancer. Thus, although we know that there are cancer-producing chemicals in cigarette smoke, not everyone who smokes gets cancer. Some smokers are lucky enough either to miss out on any mutations which lead to cancer or to have an effective immune system which prevents any cancers from developing. It usually takes more than one factor to produce cancer—unfortunately we have by no means identified them all yet.

Let me reassure you on two particular factors which worry many people with cancer.

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‘Few therapies in the medical field have generated such controversy as that of hormone replacement.’ from Medical Clinics of North America, 1987.

One day, possibly, medicine will come up with a treatment that is 100 per cent effective, 100 per cent safe, and totally without side-effects in anybody. But don’t hold your breath!

Hormone replacement has many advantages, particularly in improving the quality of life for women at, or beyond, the menopause. With the exception of heart attack or stroke, the symptoms of low oestrogen are not life-threatening; women are not going to die from hot flushes, tiredness, loss of continence, or even directly from osteoporosis. But all these things greatly reduce their self-image, self-esteem and general enjoyment of life. So any treatment that can improve these conditions would seem to be well worth considering.

HRT, like every treatment for every condition currently available on the traditional medical market, has its drawbacks. But it’s the best we’ve got at the moment, and millions of women derive great benefit from it: their hot flushes disappear, sex becomes enjoyable again, and their chance of getting osteoporosis or heart disease is greatly reduced. Many also notice an improvement in the quality of their skin and hair, in reduced muscle and joint pains, in increased energy and vitality and in their sense of well-being.

Why, then, are only 9 per cent of menopausal and postmenopausal women in the UK taking HRT at any one time, and why do most give up after just a few months?

‘I felt quite bloated, and had headaches and breast tenderness.’

‘After three months I just couldn’t cope with having periods again.’

‘HRT certainly helped my hot flushes, but I gave up after putting on weight.’

‘It made me feel irritable and depressed.’

‘I am afraid of breast cancer.’

‘The patch made my skin red and itchy, so I changed to tablets, but they caused heart palpitations.’

‘Fluid retention and leg cramps made me feel really uncomfortable.’

‘My doctor doesn’t believe in it. 9 CI just don’t think it’s natural.’

The main reasons why women don’t even start taking HRT are the feeling that it is ‘going against nature’, together with a lack of knowledge of how it works and why replacing oestrogen after the menopause can be such a good thing.

‘I think HRT is interfering with nature, and I can’t imagine that I would ever want to use it. It seems all wrong to me.’

The two commonest reasons why women who are already on HRT give it up are a dislike of monthly bleeds, especially among those well past the menopause, and the fear of breast cancer, which is shared by doctors and patients alike. Other real turn-offs are the need to take a pill every day (or change a patch every few days), the cost of prescriptions for the under-sixties, a slight weight gain and nausea, a return to pre-menstrual tension (if you take progestogen), and the need for regular gynaecological checkups. This chapter looks at these, and also at who may be advised not to take it at all for medical reasons.

In addition to those who give up HRT for all the above reasons, there are those who do so because it doesn’t relieve their symptoms. Unfortunately, most women who give up because of side-effects have only ever tried one form of HRT. But as you will realise by now, if you get either no relief, or undesirable side-effects, the many combinations of oestrogen and progestogen on the market should mean that you can eventually find one that is right for you. If you are to find the right one, you may have to persevere for several months, trying out different preparations, and this will obviously mean several return visits to the doctor. A survey of women conducted in 1992 by The Amarant Trust found that women who had received only brief and inadequate information on HRT when they were first prescribed it, were very much more likely to give up after only a few months than women whose doctors had taken the time and trouble to explain about the menopause, about how HRT works, and to give them a realistic idea of possible side-effects. Don’t be afraid of being thought a member of The Awkward Squad: it’s your body, and oestrogen replacement could make all the difference to your present well-being and future health.

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If you are uncertain about whether to have a particular treatment, you should take the time to discuss the issues with your general practitioner and perhaps a second specialist. Either your general practitioner or the first specialist may refer you to a second specialist. If the first specialist refers you to another specialist for a second opinion, it is a good idea to ask the referring specialist if he or she still wishes to perform a procedure recommended by the second specialist.

A second opinion is worthwhile because doctors often disagree on the appropriateness of major surgery like hysterectomy in a given situation. You may find after consulting the second doctor that you have two completely different views about the course of action you should follow. In this case, you may find your general practitioner can help you decide between the two opinions by encouraging you to examine carefully your own needs and situation. If you decide to accept a treatment approach suggested by a second specialist, you can choose treatment from the specialist you prefer. The second specialist should notify both your general practitioner and the first specialist of his or her findings and recommendations.

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External disturbances. A comfortable room and surroundings are beneficial to a good night’s sleep. Noise from the street, or noise from your snoring partner, may be disturbing. Bright light or an uncomfortable bed may distract you from concentrating on falling asleep. A bedroom that is too warm or too cold is not suitable.

The bed. Some beds nowadays are not specifically designed for the purpose of sleep. Someone has told me that he gets seasick when he sleeps in a water bed. On the other hand, some people are so used to water beds that they can no longer sleep in an ordinary bed when they take a holiday.

Bed manufacturing is a huge industry, as everyone needs a bed. Ideally, beds are designed to give good support to the spine and the body during sleep. A firm bed is essential. As discussed earlier, when the sleeper enters REM sleep, the whole body is paralyzed. If the bed is very soft and sagging in the middle, during REM sleep the spine will conform to the curve of the sagging bed. In the morning there will be muscle pain because the muscles have been stretched in an abnormal posture for about 25 per cent of the time spent in sleep. For people who have back problems, a soft comfortable bed is not ideal.

Sleep and sex. The bed should be restricted to two basic forms of activity. Sleep, and the familiar reproductive activity starting also with the letter ‘s’. However, some people use the bed for other activities, such as reading, watching television, drinking, thinking, and planning. All these activities have the tendency to distract you from sleep, and may let you form a habit of thinking about your past and planning your future in bed. This generates unnecessary tension and anxiety, which obviously leads to insomnia. From now on, remember, the bed is reserved purely for the enjoyment of the two activities starting with V: sleep and sex, or sex and sleep, and nothing else. A bedside TV set or a reading lamp are not recommended in the bedroom of the problem sleeper.

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A doctor came to me asking if I could help him stop smoking. I had steadfastly refused to become concerned with people’s smoking habits. As a psychiatrist I wish to spend my time with those in more urgent need of help.

However, he seemed sincere about it, so I agreed. I spent some time showing him how to relax. He was to come back again that afternoon without having smoked at all. He did this, and I was able to show him further relaxation. He was then to practise this at home in the evening and see me the following morning. Again he complied. He saw me the following day, and has not smoked since. This was four or five years ago.

Of course there is nothing very remarkable about this. But if you yourself wish to stop smoking, I would advise you to go about it this way. Set yourself a deadline, some day about two weeks hence, which is to be the day on which you will stop smoking. It is good to make it in the weekend or some day when you will have reasonable leisure. If you want to stop smoking, do it now. Now. Pause for a minute and fix the day. And in these two weeks learn to do the exercises properly—very completely. When you have mastered the physical and mental relaxation, and can let yourself regress a little, you can present ideas to your mind: smoking – silly habit – dirty habit – all that stuff in your lungs – unnatural – nasty – tastes nasty – smells nasty. Then on the morning of the allotted day throw away your cigarettes. And that is the end of it. There is no thought of giving in—no possibility of giving in. That first day you do the exercises quite a bit. You do them just to make yourself more comfortable, not because there is any doubt about the outcome.

Let us be quite clear about this. The basic difficulty in giving up smoking is that we feel we want a cigarette, and if we do not have one, we become tense. When we have mastered the exercises, we can control our tension, and it becomes relatively easy just not to have another cigarette.

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The chemical composition of proteins is well known but their biological properties and their full role in the metabolic processes is not too well understood, and perhaps never will be. We know that proteins in the body are in the so-called dynamic state. This means they are constantly being changed from one state to another, being decomposed and resynthesized from the blood plasma amino acids. This phenomenon, perhaps, may help to solve the protein cult mystery. It is claimed that we need a new protein supply, “lots of it,” every day. The fact is,

however, that our body can exist without any food, and consequently without any proteins, for weeks and months, as for instance in the case of complete therapeutic fasting. And not only without harm but with evident health benefits! The reason for this is that our body has a way of decomposing and re-synthesizing proteins and reusing them again where they are needed. Protein stored in the liver is converted to plasma proteins, which then supply the cells with needed amino acids.

The greatest fault of the high-protein diet is that all protein in excess of the actual need is burned up as energy or stored in the body as fat. Also, the digestion of animal protein causes building of certain toxins. Nitrogen is transformed to uric acid which exerts an added stress on kidneys and the liver.8 It also causes intestinal poisoning through putrefaction. In the case of weakened kidneys and impairment in the functioning of other eliminative organs, toxic wastes are deposited in the tissues and may cause autointoxication and sluggishness—the factors usually associated with development of arthritis. Particularly for arthritis sufferers it is important to adopt a low animal protein diet. Dr. D. C. Jarvis, M.D., in his book on arthritis stresses this point and advocates a diet high in natural carbohydrates and low in animal proteins, especially meat.4

Although the majority of medical physicians, encouraged by the official support of AMA and the National Arthritis Foundation, stubbornly persist in their belief that nutrition has nothing to do with the cause or cure of arthritis, there is an encouragingly growing number of more progressive physicians who are beginning to realize the vital role nutrition plays in the development and management of this crippling disease. Particularly, the currently fashionable high-protein cult is under suspicion as a possible culprit in many diseases, including arthritis. At the annual meeting of the New York Rheumatism

Foundation, Dr. Donald A. Gerber, assistant professor of medicine at New York University, stated that development of rheumatoid arthritis could be caused by a defect in body chemistry which interferes with the metabolism of protein. He then suggested that a low-protein diet may provide the answer to sufferers of this painful affliction.5

In the biological program of treatments for arthritis, meat and fish are always excluded completely. The only animal proteins used are milk and cheese. The importance of the vegetable protein foods, such as beans, nuts, grains, and especially soybeans, is emphasized.

One fact overlooked by proponents of the high animal protein diet is that, according to experiments by many prominent scientists (Schweigart, Rose, and others), some vegetable proteins are of as good or better biological value than animal proteins. The Journal of the American Medical Association reported that protein derived in a proportion of up to two thirds from plant origin is entirely adequate in quality to meet all protein needs required for normal growth and sustenance of health.* Vegetable proteins—grains, beans, seeds, nuts, green plants, potatoes, etc.—consumed in variety and fortified with milk and cheese, will supply you with all the essential amino acids, or complete proteins, needed for perfect health.

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One of the few ways that an average person has of building Capital throughout his lifetime is by house purchase, by payments into regular saving schemes such as with profits insurance policies and personal equity plans (PEPs) and often by a combination of all these. Couples will also usually wish to provide some sort of monetary support to their surviving partner or children in the event of unexpected early death. In short, life insurance is now regarded as part of nearly everyone’s every-day financial arrangements.

Life insurance companies are in business, in the final analysis, to provide a financial return for their shareholders, or, in the case of a Mutual Office, to provide a fair deal for all

policy-holders. It has to be admitted that the mortality of all those with seizures from all causes is higher than the general population. It is therefore not surprising that the Life Offices, if they accept the risk of underwriting the lives of those with epilepsy, require an excess premium to compensate them for the excess risk.

How is this excess premium calculated? The insurance industry uses statistics based on their past experience. As in employment, it is probable that those with a few seizures calculate the risk of ‘getting away with’ concealment. In a financial transaction such as insurance, concealment of epilepsy is clearly fraudulent, and any policy arranged in this way is void. Insofar as the statistical data of the Life Offices cannot reflect those with a few seizures who have concealed their epilepsy, it is probable that their experience of the mortality of those with declared epilepsy is worse than the true mortality. This experience tends to inflate the excess premium, but we believe that there are other factors. The Offices may be corporately possessed of some of the misconceptions about epilepsy that this book is trying to dispel. Although they employ a medical officer, few if any of these advisers are neurologists, and a single physician can hardly be expected to provide informed and modern statistics about the disease suffered by each and every proposer. Furthermore, the industry as a whole does not distinguish between different types of seizure occurring with different frequencies and due to different causes. In these circumstances the Offices adopt an attitude of ‘better be safe than sorry’ and charge a premium that is in excess of standard rates.

There is often a considerable difference between the excess rates quoted by various Offices, so it is well worth while seeking professional advice from an insurance broker. For people in the UK, the firm of Tyser and Company, 12 Camomile Street, London EC3A 7PT have built up a considerable experience of arranging life insurance for those with epilepsy. In general, they expect that any proposer with epilepsy should have been adequately investigated to exclude a progressive organic cause, and that the proposer should be reliable at taking his prescribed medication and in following medical advice. It is very much easier to arrange insurance for those capable of employment and without intellectual impairment, although in other cases a quotation can usually be obtained.

We asked Tyser and Company for their views about three specific examples. Although useful as a general guide, readers must understand that rates will vary as each person with epilepsy is different both in his problems and in his or her requirements for insurance.

Proposal 1 A man aged 27 next birthday who had frequent seizures in childhood, several

seizures in adolescence, and none over the last eight years.

Ordinary rates of premium would be allowed for this case, for any class of

Assurance.

Proposal 2 A man aged 33 next birthday who had a single seizure one year ago. No evidence of

any progressive organic disease. For Term Assurance, where the ordinary rate of

premium is very low, a loading of 50 per cent would be considered by some Offices.

For other types of insurance the market would consider that a small loading for a

short period of one or two years was justifiable. It might be possible to gain

acceptance at normal rates, and this would be easier if the interval between the

seizures and the proposal were longer.

Proposal 3 A man aged 25 next birthday who has had frequent grand mal fits since the age of

16, with four fits in the last year. Assurable, but subject to an extra premium. The

actual amount would probably vary among those Life Offices which are prepared to

accept proposals from those with epilepsy, but in terms of additional mortality, one

underwriter considers that plus 100 per cent would be a reasonable loading. At first

sight this appears high, but regard should be given to the very low mortality rate of

assured lives at this young age. In monetary terms the additional premium for Whole

of Life Assurance would be £2.50 per annum for each £1000 of sum assured. One

underwriter’s practice would be to limit the term of payment of this extra premium to

a period of ten years, but this is by no means general within the industry.

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