Problems

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.

Read More

Advice for living with ADHD

Posted by on Mar 27, 2012 in Attention Deficit Disorder / Attention Deficit Hyperactive Disorder [ADD / ADHD] | 0 comments

Advice to Families

Some of the issues relevant to dealing with this problem can include:

Responsibility

All of us need to feel competent, able to take on life’s many responsibilities. Therefore, it is risky to view your child as hopelessly irresponsible because of his/her disability. it renders both you and your child powerless. On the contrary, parents need to encourage their children to accept responsibility for themselves. In turn, children who are respected by adults are more likely to feel self-confident and competent.

Competency

Family members of children diagnosed with ADD or ADHD often report experiencing a loss of their own coping and competency skills. Family members need to seek ways to rebuild their own confidence, competency and self-worth. These ways may include conversations with extended family, friends, and/or professionals, all of whom can help family members reconnect with their own talents and skills. One of the major effects of ADD or ADHD is the undermining of self-confidence and the competency of family members. In order to succeed there must be a rebuilding of confidence, competency, and self-worth for all family members.

Support

Most of us need the support of our family and friends. This is especially true with difficult situations. Our children cannot solve all their problems on their own. They need to know they havea support from competent, caring people (family, friends, teachers) who can help them deal with the problem–and not see them as the problem.

Parenting issues

When difficulties arise with our children, we inevitably judge ourselves as caregivers and parents. We may wonder: have we done the right thing?. Did we do enough? Too much?, Did our partners do the right/ wrong thing? What more could we have done?
But perhaps it is equally beneficial to ask ourselves the following questions:

  • What effect has my child’s problem had on how I feel about myself?
  • How has it affected how I feel about my child? My partner?
  • How distressed am I?
  • Am I finding ways to avoid my feelings of anger, bitterness, disappointment, resentment and/or fear?
  • Should my reactions be address in their own right?
Read More

Solutions – do’s and don’t’s

Posted by on Mar 27, 2012 in Attention Deficit Disorder / Attention Deficit Hyperactive Disorder [ADD / ADHD] | 0 comments

Do’s

  • Be clear about what exactly the problem is rather than looking at diagnoses.
  • Address these problems directly.
  • See the problem as something that has characteristics and a life of its own.
  • Notice how this problem has different effects on the lives of everyone it touches.
  • Be on the lookout for how you can join with others, particularly the child, to undermine the strength of the problem.
  • Try to do this without excluding or isolating anyone.
  • Look for evidence of the child’s success over the problem.
  • Make the most of the child’sis success.
  • Create a context for the recognition and encouragement of success.
  • If the child takes medication, give him/her/them credit for theirtheir contribution to any success.
  • When the child has outgrown the diagnosis of ADD or ADHD, celebrate their graduation.

Don’ts

  • Don’t give in to the pressure to label or diagnose.
  • Don’t notice only the problematic behaviors.
  • Don’t think of medication as the “solution.”
  • Don’t blame yourself for your child’s difficulties.
  • Don’t let the experience of this problem isolate you from others who might provide support.
Read More

Questions about ADHD

Posted by on Mar 27, 2012 in Attention Deficit Disorder / Attention Deficit Hyperactive Disorder [ADD / ADHD] | 0 comments

Questions for Parents and Caregivers

Some questions parents and caregivers can ask themselves include:

  • What problems lead you to suspect your child has ADD or ADHD?
  • Do you feel like you are in a power struggle with your child?
  • Is there any way you can undermine this power struggle?
  • Are there times when your child has exerted some control over these problems?
  • Are there times when your child has not allowed the problem to happen or been able to eliminate it sooner than usual?
  • Can you begin to look for instances when your child is exerting some influence over these problems?
  • How can you talk with your child to help them see and experience these instances of influence over the problem?
  • How can you help them notice success (however small) instead of failure (however great) in dealing with the problem?
  • What effect have these problems had on you, your sense of yourself, as a parent and as a person?
  • Should these effects be addressed in their own right?

Questions for Young People

A child or young person faced with such difficulties can find it helpful to respond to the following:

  • If you were to speak for yourself, what would you say is a problem in your life?
  • How have others described your difficulties?
  • Do you agree with them? What do you agree with? What do you disagree with?
  • Would you like these problems to stop or go away?
  • Have there been any times when you were able to stop these problems from happening or make them go away more quickly than usual?
  • Have there been times when you were able to recover from them more quickly than usual?
  • Would you be able to experiment for a short time with trying to stop the problems from happening, making them go away more quickly than usual, or recovering from them more quickly than usual?
  • Who would you like to help you in this experiment?
  • How can others be of help to you in this experiment?
  • Who would you like to notice you being successful in this experiment?
  • When the experiment is over, would you like others to look for evidence of failure or evidence of success?
  • What would it be like for you if others found evidence of success?
  • Would feeling successful at being able to influence these problems make it easier or harder to put effort into being more successful?

Questions for Professionals

You may be involved with children and families in a professional capacity. Before making interpretations or coming up with diagnostic labels, you may want to identify the exact problem. Some suggested questions are:

  • What behaviors are problematic?
  • How can you and others name and address each of these behaviors without a label being applied?
  • Is there any evidence the child has been able, even in a small way, to take responsibility for the problem behavior?
  • Is there any evidence the child has been able, even in a small way, to stop, reduce, or not engage in the problem behavior?
  • If so, how can others help the child in increasing this ability?
  • How can others help the child take more responsibility for doing this?
  • What can you do to help others encourage the child to further demonstrate this ability and responsibility?
  • How can you create a wider audience of teachers, peers, family and others for the child’s success?
Read More

Case Study: Daniel Age 14

Posted by on Mar 27, 2012 in Attention Deficit Disorder / Attention Deficit Hyperactive Disorder [ADD / ADHD] | 0 comments

Daniel has been in foster care for most of his life. He is now fourteen and has been with the same foster family for the last six years. His foster parents, Jean and Bill, find him extremely demanding and difficult to handle. They believe Daniel has a psychiatric or neurological disorder and want to find the correct diagnosis. However, they feel let down by Social Services, who do not support them in this quest. Jean and Bill have seen a number of programs on TV about Ausberger’s syndrome, autism, Tourette’s syndrome, Oppositional Defiance Disorder, Conduct Disorder, Attention Deficit Disorder, and Attention Deficit Hyperactivity Disorder. However, no medical practitioner with whom they consulted believed Daniel had any of these diagnostic categories. Eventually, they found a pediatrician who was willing to diagnose Daniel with ADHD and prescribe Ritalin. When the Ritalin did not make any difference, they became angry with the medical profession for not being able to recognize Daniel’s pathology.

Eventually, although reluctantly, they succumbed to pressure from Social Services to go to counseling. Jean said that she was not going to stay; she only came to be certain the therapist understood the truth of the situation. She spoke of their conviction of Daniel’s pathology, their anger at Social Services’ lack of support, and the medical profession’s reluctance to agree with them. Daniel, in this situation, was shy and withdrawn.

The therapist asked Daniel if he would be willing to talk on the phone the next time he had a bout of anger. He agreed. Later that day Bill called. Daniel had not been allowed to watch his favorite TV program before finishing his homework. He got angry and abusive, threw around some ornaments, and then went outside and began hacking down the garden with a big stick. To everyone’s surprise, when Bill asked Daniel, he came to the phone. At first he was just huffing and puffing. The therapist talked to Daniel quietly, gently asking him questions. Eventually, Daniel began giving “yes” or “no” answers and indicated that talking on the phone was helping him to calm down. He also said this was what he wanted to do. Over the space of an hour he was able to gain self control and begin an attempt to make amends for his destruction and abusiveness. As a result of this call and with Bill’s support, Daniel began to develop a list of people he knew. He wrote a letter inviting some of them to be part of a telephone support group that he could call on when he was afraid an outburst was threatening. In this way Daniel gradually began to experience support in regaining control over these outbursts.

Read More

Possibilities for Change

Posted by on Mar 27, 2012 in Attention Deficit Disorder / Attention Deficit Hyperactive Disorder [ADD / ADHD] | 0 comments

We might ask others and ourselves what would we do if there had been no invention of ADD/ADHD? Pperhaps we would remember the skills, abilities and resources we could draw upon.

These might include the following:

  • Put the problem into a context. What has happened in the past and what is happening in the present in the young person’s life and relationships?
  • Be aware that some children, especially boys, are vulnerable to reproducing male violence and aggression, especially if they were victims in their lives of abuse and violence perpetrated by men.
  • Realize this problem may be a reproduction of some of men’s ways of being, rather thant a genetic inheritance.
  • Be aware of the ways in which children express emotional distress (often but not always as a result of abuse), and how parents and professionals describe these expressions as “behavioral problems.”

There might be ways of assessing and naming learning difficulties without needing to come up with new labels and categories. There might be ways of providing extra learning supports that do not pathologize children, but rather are helpful to them.

Thinking about the problem in new ways allows us to assist our children toin growing up into theira lives.fe They are given an opportunity to take control back from diagnosis and take responsibility for success back from medication. Believing we need special treatment and interventions for ADD/ADHD blinds us to our long cultural history of expertise:, skills and success in parenting, teaching, social work, and counseling children and families that have such problems.

Read More