Posts by Planet Therapy

Antidepressant Medications

Posted by on Apr 25, 2012 in Depression | 0 comments

“Antidepressant drugs are not habit-forming, however, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given.”

“Engage the depressed person in conversation and listen carefully and do not disparage feelings expressed, but point out realities and offer hope, and lastly do not ignore remarks about suicide, Report them to the depressed person’s therapist.”

Antidepressant Medications

“It is important to keep taking medication until it has a chance to work, though side effects (see section on Side Effects, pages 19 20) may appear before antidepressant activity does.”

There are several types of antidepressant medications used to treat depressive disorders. These include newer medications chiefly the selective serotonin reuptake inhibitors (SSRIs) the tricyclics, and the monoamine oxidase inhibitors (MAOIs). The SSRIs and other newer medications that affect neurotransmitters such as dopamine or norepinephrine generally have fewer side effects than tricyclics. Sometimes the doctor will try a variety of antidepressants before finding the most effective medication or combination of medications. Sometimes the dosage must be increased to be effective. Although some improvements may be seen in the first few weeks, antidepressant medications must be taken regularly for 3 to 4 weeks (in some cases, as many as 8 weeks) before the full therapeutic effect occurs.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn’t helping at all. It is important to keep taking medication until it has a chance to work, though side effects may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for at least 4 to 9 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust. Never stop taking an antidepressant without consulting the doctor for instructions on how to safely discontinue the medication. For individuals with bipolar disorder or chronic major depression, medication may have to be maintained indefinitely.

Antidepressant drugs are not habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness regularly.

For the small number of people for whom MAO inhibitors are the best treatment, it is necessary to avoid certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles, as well as medications such as decongestants. The interaction of tyramine with MAOIs can bring on a hypertensive crisis, a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the patient should carry at all times. Other forms of antidepressants require no food restrictions.

Medications of any kind prescribed, over-the counter, or borrowed should never be mixed without consulting the doctor. Other health professionals who may prescribe a drug such as a dentist or other medical specialist should be told of the medications the patient is taking. Some drugs, although safe when taken alone can, if taken with others, cause severe and dangerous side effects. Some drugs, like alcohol or street drugs, may reduce the effectiveness of antidepressants and should be avoided. This includes wine, beer, and hard liquor. Some people who have not had a problem with alcohol use may be permitted by their doctor to use a modest amount of alcohol while taking one of the newer antidepressants.

Anti-anxiety drugs or sedatives are not antidepressants. They are sometimes prescribed along with antidepressants; however, they are not effective when taken alone for a depressive disorder. Stimulants, such as amphetamines, are not effective antidepressants, but they are used occasionally under close supervision in medically ill depressed patients.

Questions about any antidepressant prescribed, or problems that may be related to the medication, should be discussed with the doctor.

Lithium has for many years been the treatment of choice for bipolar disorder, as it can be effective in smoothing out the mood swings common to this disorder. Its use must be carefully monitored, as the range between an effective dose and a toxic one is small. If a person has preexisting thyroid, kidney, or heart disorders or epilepsy, lithium may not be recommended. Fortunately, other medications have been found to be of benefit in controlling mood swings. Among these are two mood-stabilizing anticonvulsants, carbamazepine (Tegretol) and valproate (Depakote). Both of these medications have gained wide acceptance in clinical practice, and valproate has been approved by the Food and Drug Administration for first-line treatment of acute mania. Other anticonvulsants that are being used now include lamotrigine (Lamictal) and gabapentin (Neurontin): their role in the treatment hierarchy of bipolar disorder remains under study.

Most people who have bipolar disorder take more than one medication including, along with lithium and/or an anticonvulsant, a medication for accompanying agitation, anxiety, depression, or insomnia. Finding the best possible combination of these medications is of utmost importance to the patient and requires close monitoring by the physician.

If you feel drowsy or sedated you should not drive or operate heavy equipment.

Antidepressant drugs are not habit-forming, however, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given.

Antidepressant Medication Side Effects

“Substantial evidence from neuroscience, genetics, and clinical investigation shows that depressive illnesses are disorders of the brain.”

“Engage the depressed person in conversation and listen carefully and do not disparage feelings expressed, but point out realities and offer hope, and lastly do not ignore remarks about suicide, Report them to the depressed person’s therapist.”

Before starting a new medication, ask the doctor to tell you about any side effects you may experience. Antidepressants may cause mild and, usually, temporary side effects (sometimes referred to as adverse effects) in some people. Typically, these are annoying, but not serious. However, any unusual reactions or side effects, or those that interfere with functioning, should be reported to the doctor immediately.

The most common side effects of the newer antidepressants (SSRIs and others) are:

  • Headache will usually go away.
  • Nausea also temporary, but even when it occurs, it is short lived after each dose.
  • Insomnia and nervousness (trouble falling asleep or waking often during the night) may occur during the first few weeks but are usually resolved over time or with a reduction in dosage.
  • Agitation (feeling jittery) notify your doctor if this happens for the first time after the drug is taken and is persistent.
  • Sexual problems consult your doctor if the problem is persistent or worrisome. Although depression itself can lower libido and impair sexual performance, SSRIs and some other antidepressants can provoke sexual dysfunction. These side effects can affect more than half of adults taking SSRIs. In men, common problems include reduced sexual drive, erectile dysfunction, and delayed ejaculation. For some men, dosage reductions or acquired tolerance to the medication reduce sexual dysfunction symptoms. Although changing from one SSRI to another has generally not been shown to be beneficial, one study showed that citalopram (Celexa) did not seem to cause sexual impairment in patients who had experienced such events with another SSRI.

Some clinicians treating men with antidepressant associated sexual dysfunction report improvement with the addition of bupropion (Wellbutrin) or sildenafil (Viagra) to ongoing treatment. Be sure to discuss the various options with your doctor and inquire about other interventions that can help.

Tricyclic antidepressants have different types of side effects:

  • Dry mouth drinking sips of water, chewing sugarless gum, and cleaning teeth daily is helpful.
  • Constipation adding bran cereals, prunes, fruit, and vegetables to your diet should help.
  • Bladder problems emptying the bladder may be troublesome, and the urine stream may not be as strong as usual; notify your doctor if there is marked difficulty or pain. This side effect may be particularly problematic in older men with enlarged prostate conditions.
  • Sexual problems sexual functioning may change; men may experience some loss of interest in sex, difficulty in maintaining an erection or achieving orgasm. If they are worrisome, discuss these side effects youre your doctor.
  • Blurred vision will pass soon and will not usually necessitate a new glasses prescription.
  • Dizziness rising from the bed or chair slowly is helpful.
  • Drowsiness as a daytime problem usually passes soon. If you feel drowsy or sedated you should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.

Therapy can help the child deal with his past in a healthy manner, and to learn ways to cope with the very difficult process of growing up.

A good diagnostic evaluation will include a complete history of symptoms, when they started, how long they have lasted, how severe they are, whether the patient had them before and, if so, whether the symptoms were treated and what treatment was given.

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Integrative Therapy Workshop Bundle

Posted by on Apr 8, 2012 in Professional CE Workshops Bundles | 0 comments

This bundle is comprised of two workshops [5 APA CE credits]

1. Introduction to Psychotherapy Integration

Recent developments in cognitive-behavioral and psychodynamic psychotherapies have seen a convergence of distinct and seemingly antithetical traditions. This allows for the possibility of integration of these two models as well as with humanistic and interpersonal approaches.
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2. A Dialectical Exploration of Psychotherapy Integration

The basic definitions of psychotherapy integration are outlined and developed, providing a background in common factors, assimilative integration, and theoretical integration.
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Taken individually, the combined cost of these workshops is $60, but our our intensive Integrative Therapy Program costs only $45.

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Feminist Therapy Workshop Bundle

Posted by on Apr 8, 2012 in Professional CE Workshops Bundles | 0 comments

This bundle is comprised of three workshops [5 APA CE credits

1. Discourses in the mirrored room: A Postmodern Critique of Therapy

An exquisitely crafted workshop by one of the field’s preeminent postmodern feminist thinkers. The workshop takes you through a closeup view of Rachel Hare-Mustin’s approach to therapy, provides a critique of the dominant trends of psychological practice, addresses gender inequality within the therapy room, and offers insight in ways that we might change our practice.
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2. Integrating Feminist and Narrative ideas in Psychotherapy

Dr. Judith Myers Avis offers a brilliant discussion on the importance of considering gender within the process of therapy. She brings together ideas and practices from feminist and narrative therapy as a platform to discuss diverse issues.
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3. The Therapist and Therapeutic Change: Survivors of abuse and the moral courage needed for therapists to evoke change

Johnella Bird passionately discusses the act of moral courage a therapist must take to be open to and hopeful for when addressing clients who have been abused.
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Taken individually, the combined cost of these workshops is $65.00. Take our intensive Feminist Approaches to Therapy Program and it will cost only $49.

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Brief Therapy Workshop Bundle

Posted by on Apr 8, 2012 in Professional CE Workshops Bundles | 0 comments

This bundle is comprised of three workshops [9 APA CE credits

1. The Heroic Client—Principles in Solution Focused Therapy

The workshop takes a thorough and close up look at the research and outcome studies analysing the use of medication and the utility of DSM diagnosis within the context of therapy and client change.
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2. Narrative Therapy

Stephen Madigan presents a variety of Narrative practices, including externalizing, deconstructing, and re-authoring. Applications to problems of depression and anxiety.
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3. A Self-Relations Approach

Steve Gilligan describes methods and techniques for transforming a problem complaint into a solution outcome, in ways that clients learn to recognize the “non-rational” and unexpected events in their lives as gifts to be opened and enjoyed.
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Taken individually, the combined cost of these workshops is $100 US, but our our intensive Brief Therapy Program costs only $69 US.

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Revitalizing Your Relationship

Posted by on Apr 7, 2012 in Features | 0 comments

by Michele Weiner-Davis, Ph.D.

Michele Weiner-Davis has written numerous books that have been helpful to both therapists and consumers of therapy. As the author of “Divorce Busting”: A Step-by-Step Approach to Making Your Marriage Loving Again, she has the following advice to offer couples.

Time Together

Couples need to make their relationships a priority. I believe the single biggest contributing factor to a breakdown in relationships today is the fact that couples aren’t spending enough time together. The relationship gets put on the back burner. Everything else seems more important: careers, children, hobbies, community involvement, and personal pursuits. When relationships aren’t attended to, trouble sets in.

People who don’t prioritize their relationships tell me that they often end up fighting during the little time they do have together. They argue about day-to-day issues: unpaid bills, uncleaned houses, unruly children.

But the truth is, arguing about “who’s doing what around the house,” may be connected to a variety of other problems. Some of these may be related to the relationship itself, such as problems of isolation, loneliness, and resentment. At other times the problems may be more socially and culturally related: gender inequities, economic issues, or problems of depression (see information for couple on Depression in the Circle of Life) and anxiety. Most of the time people argue about the mundane issues when their emotional needs aren’t being met. The soda can left in the living room becomes a symbol of a lack of care for the partner. Does this sound familiar?

And here’s the Catch-22: if you and your partner are arguing a lot, you don’t feel like spending time together. In fact, you want to spend as little time as possible with him or her. Unfortunately, avoidance only makes matters worse: more distance, more tension, less cooperation, more conflict, and so on.

However, time together can be the great healer. Even if it’s awkward at first, when two people commit to investing energy and time to their love life, good things can come from it. When people put their relationships first, they start to feel appreciated and important. They feel loved. Spending time with your partner tells him or her in no uncertain terms, “You matter to me.” Time together gives people opportunities to collect new memories, remember old ones, do activities they enjoy, laugh at each other’s jokes, and renew their love.

Some do’s and don’ts:

  • Do plan and schedule dates together. Write these dates on your calendar or appointment book, the same way you would a business appointment.
  • Do spend some time together without your kids. The best thing you can do for your kids is to make your marriage work. (see advice for Couples from the Curse of Perfect Parenting section)
  • Do something enjoyable together; it will make you and your partner feel more loving. As a result, you may even be able to resolve heated topics more easily in the future.
  • Do go for a walk around the block. Read a novel together. Set aside ten minutes each day to talk. Ride a bike. Be creative.
  • Don’t think you have to spend enormous amounts of time together to create closeness and connection. Regular, brief get-togethers work too. Small changes in your schedule can make a huge difference.
  • Don’t think you have to go to a tropical island to make time together meaningful. You don’t have to spend a lot of money to show your love for your partner.

Remember, having fun together is a way of acknowledging that relationships are a serious business.

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