Different people define emotions in different ways. Some make a distinction between emotions and feelings saying that a feeling is the response part of the emotion and that an emotion includes the situation or experience, the interpretation, the perception, and the response or feeling related to the experience of a particular situation. For the purposes of this article, I use the terms interchangeably.

John D. (Jack) Mayer says, “Emotions operate on many levels. They have a physical aspect as well as a psychological aspect. Emotions bridge thought, feeling, and action – they operate in every part of a person, they affect many aspects of a person, and the person affects many aspects of the emotions.”

Dr. Maurice Elias says, “Emotions are human beings’ warning systems as to what is really going on around them. Emotions are our most reliable indicators of how things are going on in our lives. Emotions help keep us on the right track by making sure that we are led by more than the mental/ intellectual faculties of thought, perception, reason, memory.”

· Why Bother With Emotions:

Emotions control your thinking, behavior and actions. Emotions affect your physical bodies as much as your body affects your feelings and thinking. People who ignore, dismiss, repress or just ventilate their emotions, are setting themselves up for physical illness. Emotions that are not felt and released but buried within the body or in the aura can cause serious illness, including cancer, arthritis, and many types of chronic illnesses. Negative emotions such as fear, anxiety, negativity, frustration and depression cause chemical reactions in your body that are very different from the chemicals released when you feel positive emotions such as happy, content, loved, accepted.

· Belief Systems

Underlying much of our behavior is what is called a belief system. This system within us filters what we see and hear, affecting how we behave in our daily lives. There are many other elements that affect our lives, including past lives and the core issues we come into this life for resolution, but our belief systems in this life have a major effect on what we think and do.

Your belief system affects your perceptions or how you interpret what you see, hear and feel. For example, a person raised by an angry man or woman will view people in the future with beliefs that anger is bad or that it is something to fear. Another example would be someone who is quite intelligent but who has never been encouraged or honored for their intelligence, this person might believe they are stupid. Men raised in conservative societies might have the belief that women who work outside of the home are not as good as those who do not work outside of the home.

It takes a lot of work to look at yourself and identify the beliefs that are affecting your life in a negative manner. However, knowing your beliefs will give you a sound basis for emotional freedom. I do believe that it’s wise to deal with the belief systems before dealing with the identification and release of emotions. First things first!

· Other People, Places, and Things Cannot Change How You Feel

The only person who can change what you feel is you. A new relationship, a new house, a new car, a new job, these things can momentarily distract you from your feelings, but no other person, no material possession, no activity can remove, release, or change how you feel.

How often do you hear people say things like “when I have enough money, I won’t be afraid anymore”, only to find there never seems to be enough money to stop being afraid. Or “when I’m in a secure relationship I won’t feel lonely any more”, and finding they are still lonely regardless of their relationship. We need to understand that we take our feelings with us wherever we go. A new dress, a new house, a new job, none of these things change how we feel. Our feelings remain within us until we release them.

· Emotions Are Not the Only Cause of Illness

Emotions are not the only cause of illness. Little babies and young children get ill, and not always because of their emotional issues. There are many causes of illness including emotions, but they are not the sole cause of illness.

The causes of illness today are quite different from the issues causing illness 20 or 30 years ago. We are living in a world filled with chemical, metal, and atomic poisons, radiation, pollution, and pesticides in our food. We are bombarded with all types of electricity. These energies affect the physical, mental/ intellectual, energetic and emotional health of people.

As we travel more, moving with ease from country to country, different types of infection causing elements are spreading around the world more easily. Infections of parasites, worms, viruses, and different types of infectious bacteria are many times greater than 20 years ago. Our water supplies are filled with chemicals and metals. The benefits of antibiotics have also brought with them the difficulty of the candida fungus overgrowth and other physical and emotional difficulties. The causes of illness today are different.

· Two Basic Emotions In Life – Love and Fear

There are only two basic emotions that we all experience, love and fear. All other emotions are variations of these two emotions. Thoughts and behavior come from either a place of love, or a place of fear. Anxiety, anger, control, sadness, depression, inadequacy, confusion, hurt, lonely, guilt, shame, these are all fear-based emotions. Emotions such as joy, happiness, caring, trust, compassion, truth, contentment, satisfaction, these are love-based emotions.

There are varying degrees of intensity of both types of emotions, some being mild, others moderate, and others strong in intensity. For example, anger in a mild form can be felt as disgust or dismay, at a moderate level can be felt as offended or exasperated, and at an intense level can be felt as rage or hate. And the emotion that always underpins anger is fear.

· Physical Effects of Emotions

Emotions have a direct effect on how our bodies work. Fear-based emotions stimulate the release of one set of chemicals while love-based emotions release a different set of chemicals. If the fear-based emotions are long-term or chronic they damage the chemical systems, the immune system, the endocrine system and every other system in your body. Our immune systems weaken and many serious illnesses set in. This relationship between emotions, thinking, and the body is being called Mind/Body Medicine today.

· You Cannot Control Your Emotions

You cannot change or control your emotions. You can learn how to be with them, living peacefully with them, transmuting them (which means releasing them), and you can manage them, but you cannot control them.

Think of the people who go along day after day seeming to function normally, and all of a sudden they will explode in anger at something that seems relatively trivial and harmless. That is one sign of someone who is trying to control or repress their emotions but their repressed emotions are leaking out.

The more anyone tries to control their emotions the more they resist control, and the more frightened people eventually become at what is seen to be a “loss of emotional control”. It is a vicious circle.

It’s important today to be politically correct. And that means not challenging or disagreeing with what the average person believes. It means not expressing negative emotions in public. Showing emotion in public in North American and European societies represents being “out of control” a great sign of weakness. People feel uncomfortable with those who express strong emotions. We are a society that is taught to hide our emotions, to be ashamed of them or to be afraid of them. Regardless, we are born with them and must live with them. This means learning how to know them, be with them, and release them.

· The Difference Between Core Issues and Emotions

We each come into this lifetime with at least one core issue to resolve. Different situations will continue to present themselves in different but repeat patterns until you have dealt with the core issues in your life.

A few examples of core issue are abandonment / victimization, demanding justice in all matters, living spiritually rather than materially. These are overarching issues that affect emotions completely. Many people find out about their core issues by learning to deal with their emotions. It is a gentle pathway that leads you into a deeper knowing of your core issues.

· Emotions and Emotional Abuse

Emotional abuse is a form of violence in relationships. Emotional abuse is just as violent and serious as physical abuse but is often ignored or minimized because physical violence is absent. Emotional Abuse can include any or all of the following elements. It can include rejection of the person or their value or worth. Degrading an individual in any way is emotionally abusive, involving ridiculing, humiliating and insulting behavior. Terrorizing or isolating a person is deeply abusive and happens to children, adults, and often the elderly. Exploiting someone is abusive. Denying emotional responses to another is deeply abusive. The “silent treatment” is a cruel way of controlling people and situations. Where there is control there is no love, only fear.

If you are living in a situation that is emotionally abusive please seek help from either a professional or one of the many helpful organizations present in most communities, to help you sort out your issues. Emotions stemming from emotional abuse are deep and complex, requiring ongoing help from those trained to deal with emotional abuse.

· “Go South” – Feeling Your Feelings

People spend much time talking about how they feel. They attend workshops, they visit therapists, and they tell others who did what to them and describe how they feel about it. They talk and talk about their feelings but they don’t feel their feelings. They intellectualize and analyze their feelings without feeling them.

People are afraid to really feel their feelings, afraid of losing control, afraid of the pain involved in feeling their emotions, of feeling the sense of loss or failure or whatever the emotion brings with it. People are afraid to cry. So much of life is about what you feel rather than what you think. Being strongly connected to your emotional life is essential to living a life with high energy and a sense of fulfillment and satisfaction.

I was privileged to work with a professional many years ago when I was learning about my emotional self. I remember the day Fred told me that he knew what I thought about the situation, and then asked me “How did it feel?” I was smiling as long as I was providing a description of the situation. As soon as I looked for the feelings inside of me I began to cry. It did not feel very good. I was hurting. Fred used a term “Go South” to help me go to my feelings rather than an intellectual approach. He used to tell me to “Go South”. Many of our feelings reside in our midriff and navel area. Today I will often tell myself to “Go South” Mary, meaning, “How does it really feel Mary”?

· How We Repress Emotions

When we have an experience that we find painful or difficult, and are either unable to cope with the pain, or just afraid of it, we often dismiss this emotion and either get busy, exercise more, drink or eat a bit more, or just pretend it has not happened. When we do this we do not feel the emotion and this results in what is called repressed, suppressed or buried emotions. These feelings stay in our muscles, ligaments, stomach, midriff, auras. These emotions remain buried within us until we bring that emotion up and feel the emotion, thus releasing it. Emotions that are buried on the long-term are the emotions that normally cause physical illness.

The following are a few examples of the methods people use to avoid feeling their emotions.

Ignoring your feelings
Pretending something hasn’t happened
Overeating
Eating foods loaded with sugar and fat
Excessive drinking of alcohol
Excessive use of recreational drugs
Using prescription drugs such as tranquilizers or Prozac
Exercising compulsively
Any type of compulsive behavior
Excessive sex with or without a partner
Always keeping busy so you can’t feel
Constant intellectualizing and analyzing
Excessive reading or TV
Working Excessively
Keeping conversations superficial
Burying angry emotions under the mask of peace and love

· Symptoms of Repressed Emotions

It takes a lot of energy to keep emotions repressed and buried. If you keep emotions buried for a long period of time, you lower your overall vibrations, and lower vibrations lead to illness and an accelerated ageing process. Buried emotions create fatigue and depression. The following are some major symptoms of buried and repressed emotions.

Fatigue
Depression without an apparent cause

Speaking of issues/interests rather than personal matters and feelings
Pretending something doesn’t matter when inside it does matter
Rarely talking about your feelings
Blowing up over minor incidents
Walking around with a knot in your stomach or tightness in your throat
Feeling your anger not at the time something happens but a few days later
In relationships, focusing discussions on children/ money rather than talking about yourselves
Difficulty talking about yourself
Troubled personal relationships with family, friends, acquaintances
A lack of ambition or motivation
Lethargic – who cares - attitude
Difficulty accepting yourself and others
Laughing on the outside while crying on the inside

· Effects of Repressed or Buried Emotions

Repressed or buried emotions can cause major difficulties in the physical body and energetic systems. They affect all your relationships, and they especially affect your ability to grow spiritually and shift your level of consciousness.

Emotions repressed for the long-term can cause serious illness including cancer, arthritis, chronic fatigue, and many other major health problems. Since repressed emotions can rest either in your body or auras, they can cause holes in your auras, through which your energy leaks out creating fatigue, a sense of vulnerability, and low self-confidence.

When you have repressed emotions, your behavior and reactions to events in the present moment are really reactions to past events as well as the present. This has a negative effect on all relationships in your life. You cannot be fully present with those you love in today until you have released your emotions from the past. You buried emotions because they were too painful and difficult to deal with when they occurred and your reactions to today’s events are affected by this pain and hurt that remains buried in your body.

It takes a lot of energy to bury emotions and to keep them buried. There isn’t much energy left over for other activities when your energy is being used to keep stuffing these emotions back down. By nature, buried emotions want to come up so you can become aware of them, feel them and release them. You work very hard to keep them stuffed down.

Our real purpose in being on Mother Earth is to keep increasing our level of consciousness and living a more spiritual or love-based life. The higher the consciousness someone has, the higher degree of spirituality in his or her life. The higher the spirituality the closer we are to being what we are meant to be, a fully integrated and loving human being. You cannot shift to higher levels of consciousness as long as you have major negative emotions buried within you.

Committing To Emotional Health

People who make a deep commitment to themselves to become emotionally healthy are willing to go to great lengths to learn about their emotional selves and to do what is required to release buried emotions. This is often an uncomfortable and difficult journey when you begin, but I promise you great joy once you’ve gotten over the first few hurdles. Once you make this commitment your journey to identify your issues and release buried emotions will become much easier.

· Methods To Identify Your Emotions

Emotions are reliable indicators of what is really going on inside of us. There are many ways to identify emotions and you will have to choose the manner that is most suitable to your personality. Some people need to do this in solitude whereas others need to do this with others. Some will want to write while others will use a much more casual approach. Sometimes it’s best to combine a number of approaches for a deeper identification of emotions.

The following are a few methods you can use to identify what you are really feeling about a person, place, situation or thing. Identifying your emotions is the first step to a rich and healthy emotional life. Use a number or all of these methods. Find the ones that suit you and use them to help you in your journey towards emotional health.

Awareness is the first step of change!

Use Choming Essences To Dig Out Buried and Repressed Emotions: I have worked with many people who have told me they did not have buried emotions, even when a Vibrational Assessment showed them they had many such emotions. I have seen these same men and women tell me after using Choming Essences for a few months that they began to remember old angers, resentments, feel sadness, regret, and other emotions. They thought these feelings and memories had long gone from them and were quite surprised to see they were still present. Using Choming Essences is a very powerful help in bringing your emotions to the surface!

Choming Essences will dig out buried emotions and memories and bring them to the surface so you can remember them, feel them and release them. The Choming Essences that are especially powerful for this are as follows: Chiastolite Gem Essence; Love Lies Bleeding Flower Essence; Pearl Gem Essence; Spirea Bush Flower Essence; the Sunflower Essence; and the White Olive Tree Essence. Many other Choming Essences will also help to bring emotions to the surface so you can feel them.

To learn more about healing with vibration and Choming Essences, please visit my website at www.mkprojects.com.

Listen To Your Thoughts and Daydreams – We become so accustomed to thinking in certain patterns that we are no longer aware or conscious about our thoughts and daydreams. Catch those daydreams, hold the thoughts, bring them up into your conscious mind. This will tell you a great deal about yourself, what you love and hate, and about your relationships. If you possibly can, keep a written diary of these for a month or two. Writing down your thoughts and daydreams will help you to organize, experience, and understand your thought patterns and bring them into a higher level of awareness within you. If you keep a written record for a period of time you will begin to see important patterns in your feeling and thinking.

Identify Your “Little and Unimportant Hurts” – More people walk around saying it’s not important or it doesn’t matter when it is very important and a big piece of hurting emotion is buried within them. They will describe this hurt and being small and unimportant. Men tend to do this rather frequently. Write down a detailed description of all the “little and unimportant hurts” that somehow don’t go away. Every little hurt that you keep remembering, that won’t go away, regardless of when it happened, must go on this list. Many people have many of these little hurts from childhood. These emotions are buried within creating difficulties with their health. Identifying these hurts will tell you a great deal about your buried and unexpressed emotions.

Record What Makes You Feel Strongly For Two Months: Keep an ongoing record of strong emotions for 8 weeks. Regardless of the cause, if it’s the weather, the traffic, your husband, wife, children, politicians, the stock market, your fellow church members, whatever and whoever, add it to your list. Try to identify what really made you angry. Sadness is a mask for anger, and anger is a mask for fear. If you can identify you real fears, what you are afraid of losing or not having, you are well on your way to emotional health. Again, writing this down will help you see things much more clearly, increase your awareness, and help you to know your emotional self at a much deeper level.

Memories That Won’t Go Away: If you keep remembering situations, hurts that happened some time ago, you are guaranteed to have repressed emotions around this person or situation. You will need to pull this situation out and re-feel the hurt around it. Try to document these carefully since these are more than likely causing you much physical distress. Forgiveness is something that occurs as a result of owning and releasing your emotions. We often reach for forgiveness without doing the work required to release emotions of hurt and anger. Forgiveness is a result of an emotional process. There are no short cuts.

Keep a Journal of the Emotions in Your Dreams: Many people who begin to take Choming Essences find that they begin to remember their dreams, dreams full of emotions, stories and colors. Keep paper and pencil by your bedside and jot down your dreams as soon as you begin to waken. Write down the emotions you are experiencing in your dreams. The activity in a dream can be secondary, the emotions being experienced there are essential. The emotions in your dreams are the very emotions that you are repressing and burying within. Dreams can give you a deep insight into your emotional self.

Be Specific About The Emotions You Are Experiencing: Confusion occurs when people are trying to get to know their emotions because they speak in general terms rather than specific emotions. A good example of this is depression. You may be experiencing loneliness for people, loneliness for God (spiritual loneliness), boredom, and a lack of creativity in your life. You may be feeling abandoned because of a death or divorce. If you just say you are depressed you will have great difficulty releasing the emotion or finding a solution to the situation causing the emotion.

A good example of this is the difference between jealousy and envy. Jealousy relates to being resentful of a person’s advantages be they in social standing, education, profession, or it can relate to resentment of a rival in love or affection. Envy is a discontentment or resentment aroused by another’s good fortune or success.

Are You Using Sex To Release Your Emotions? Sex is a normal and healthy part of life. Many people engage in sexual acts, with others, alone, or using pornography on the Internet, to release emotions buried within them that they have been unable to feel and release. These individuals tend to have a very high sex drive since this is their primary way of releasing emotions that are pent up within. These are people who enjoy sex more than once a day. They tend to be very cerebral or intellectual, highly emotional, but very much out of touch with their emotions. If you identify with this description, keep a record of the thoughts/ experiences/ fears that you are having prior to engaging in this type of sex. Sex can be used to stuff down feelings so you won’t feel them and identifying these feelings and releasing them will help you move into a much healthier and enjoyable sexual life.

Eating, Drinking, Exercising, or Any Type of Compulsive or Excessive Behavior: We often go for weeks, even years acting in a manner that is normal for us – and what is normal for you may not be normal for another person. Then we will find ourselves overeating, working excessively, drinking daily, engaging in compulsive sex, working long hours, and many other types of compulsive behavior. We stuff down our feelings through excessive behavior, ensuring we do not feel them at that moment. We do this because the feelings are too painful or we are just too afraid of these feelings and where they might lead us in our thinking and actions.

Try to identify the times when your excessive behavior was triggered and, as soon as you can, identify the emotion that is causing this behavior. It can be stress or fear related to a new job, the death of a friend or partner, difficulties with lovers or children. Document these emotions as best as you can. We never do anything without getting something from it. There is a reason why you are engaged in excessive or compulsive behavior.

When What You Say and Do Is Not In Sync With What You Feel: Men and women go through many situations telling themselves that “it doesn’t really matter” or “it’s not important enough to argue about”, basically buying peace by agreeing to something that deep down they do not agree with. They find themselves feeling unhappy, disgruntled, and angry with the individual involved. This type of situation creates tensions and unhappiness in relationships. Buying peace at any price creates negative feelings within you.

Identify those situations where you have created depressing feelings within yourself by agreeing to something that makes you don’t really agree with. Write them down. This will be difficult for people who have difficulty saying no, or who are too anxious to please others. But the feelings generated by these situations are very important when dealing with your emotional life. Many times we need to excuse things and just overlook them. That’s normal in life. But we apply this to situations that affect us deeply. It’s these situations we need to identify.

Positive Emotions: It is crucial that you identify your positive emotions during these exercises. You are probably very loving, caring, compassionate, trusting, forgiving, generous, many times in each day. Be certain to include the wonderful and good things about yourself as you identify your emotional self. This provides a realistic picture. If you record only negative emotions, your picture of yourself will be quite distorted and lacking in reality. Each one of us is born with all emotions and each emotion needs to be seen in its full and loving energy.

The Gentle Whispers of Your Soul: Find a quiet place and time and listen to that inner voice of intuition within you. Each person has it. And listen with your heart rather than your head. Your heart will hear different things from your head.

There is a very special time just as you are waking up in the morning but before you are fully awake. This is the time zone when you can often hear your sub-conscious speaking to you. Listen to your thoughts at this time carefully and you will pick up important messages, messages that can help you to identify your emotions, even your core issues.

Using Your Guides/ Angels/ The Divine Universal Energy: Ask your guides, angels, or whoever you call on from the Divine Universal Energy, to help you to see not just your emotions, but to see the core issues that you have come to deal with in this lifetime. Our Guides and Angels need to be asked, they are so respectful. They do not intervene unless asked. You will be amazed to see the Divine assistance come into your healing journey once you seek their assistance. Pray, meditate, ask them to help you see, understand and release your buried emotions. Believe in their help, it’s guaranteed to come.

· Crying About Your Experience: Crying is a normal releasing function for each human being. We are born with this ability because through crying we release pain, hurt, and associated stress. Please begin to cry about whatever hurts you.

Crying or writing and crying about what has happened to you can help you sort out your experience and understand it. And understanding is crucial for many people. If you have had a very painful experience, write one sentence and sit with this sentence and cry. Then write another sentence and sit and cry. In time this process will relieve some of the sensitive pain around your experience and eventually make it endurable. With time, the pain around the situation will lesson, as long as you allow yourself to feel it.

Writing About Your Emotions: We can play all sorts of games with our minds, denying reality is something we all do. However, it’s much harder to do that when we write things down. You don’t have to show your list to anyone, but for complete emotional health you have to fully accept your emotions. This acceptance will be accelerated if you write your list and share this list of emotions with one other human being. But be very careful and choose someone who will guarantee you confidentiality. I highly recommend a counselor, minister, priest, psychiatrist or someone trained in this type of work and who guarantees confidentiality. A professional can often help you put a healthy perspective on these emotions. Writing this list is important.

Friends/ Counselor/ Minister/ Therapist: You might want to consider seeking the assistance of a counselor, therapist, or minister. They can help you to see things in a more balanced fashion, and help you understand more fully what you are observing in yourself. It can be difficult at times to be objective about yourself.

We need friends who love us and care about us, especially when we are hurting. And usually this is not the time when you could say we are at our best. Tell your friends about what hurts you. Feel their comfort and love. Make sure they understand you may not want advice on how to resolve your issues. What we all need is a loving ear to listen to us with their heart. We need loving friends in our lives. Many people pay for a therapist to listen to them because they cannot tell their friends about their experiences. Take the risk and share these happenings and your feelings with close friends whom you can trust.

· How To Release Emotions

Don’t be afraid of your emotions. Don’t fight them, run away from them, blocking them out. Welcome them, be with them, regardless of what they are. We were born with all emotions. They are neither good or bad, they just are. Emotions dissipate and slowly disappear if you feel them, and are present with them. Just close your eyes and feel them as deeply as you can.

Use Choming Essences (Vibrational Healing) To Help Release Emotions: Once emotions have come to the surface, been identified, and you are feeling them, effort needs to be made to own them and release them. Choming Essences are made from flowers, trees, gems, crystals, grasses, bulrushes, and many different elements of nature. They are very powerful and made by using the healing power of the Universe to help in your healing journey. They help to transmute many emotions, helping them to release more easily from your physical and energetic bodies. The Choming Essences very powerful for releasing emotions are as follows: Amethyst Gem Essence; Chiastolite Gem Essence; the Sumac Tree Flower Essence; the Stinging Nettle Plant Essence; The Tamarack Tree Essence; and the Weeping Willow Tree Essence.

I have repeatedly found when working with clients that their repressed emotions began to surface once they had eliminated their parasites, candida, toxins, metal and chemical poisons, and all things not natural to the physical and energetic body. A Detoxification Program with Choming Essences can eliminate all “invaders”. It seems that once these “invaders” are eliminated and the body is deeply cleansed of toxins and poisons, emotions rise to the surface much more easily. These “invaders” can be part of repressing emotions. To learn more about vibrational healing with Choming Essences, please visit my website at www.mkprojects.com.

Deciding How To Respond To Your Emotions: Once you have identified a certain emotion you will at times need to decide how to proceed in dealing with it. There are many options that need to be considered carefully. Certain approaches can have very serious effects. You could lose your job, or you could lose your marriage. It’s very important to consider your options carefully before saying or doing something that cannot be taken back.

The following are a few questions you can ask yourself when deciding what response would suit a particular situation best – and each emotion, each situation is different. *Am I reacting to this situation or is this reaction partially a reaction to a past situation as well? *Am I able to discuss the issues with the person without venting anger? *Will I be able to talk about how I feel to the person? *Is a direct approach the best way to proceed? *What are the consequences of dealing directly with the person/ situation? *What do I expect from this discussion? *Are my expectations realistic? *Should I discuss this with someone before doing anything?
By asking these questions you will be deciding whether a direct approach is the best approach, and if so if you are ready do this at the present time. If your anger is at a “rage” stage, you need to release some of this anger before proceeding to discuss this with anyone.

The Physical Part of Releasing Your Emotions: There are a number of ways you can begin to release your emotions, especially those relating to anger and hurt.

1) Go into an empty room, or go for a drive alone, and scream, scream as loudly as you can. Scream the words “I hate” or whatever it is you are feeling. So many people have never screamed out their hurt, their rage. Continue to do this as long as it feels right inside. Cry, allow yourself to cry your feeling.

2) If you cannot scream aloud, imagine you are screaming your rage, hurt, and pain. Imagine it and imagine it. See it, and hear it, and especially, feel it as deeply as you can.

3) If you are a physical person, take a pillow and keep hitting a chair, your bed, something, feeling your hurt every time you hit that object with the pillow. Every time you hit that pillow say the words “I hate” or “I am frustrated” or whatever it is that you are feeling.

4) Get yourself a punching bag and hang it in your basement. Then take time to keep hitting that punching bag, releasing your rage.

5) Take your fists and keep pounding a table saying, “I hate” and just keep doing it.

6) If you like to write, write about your anger; write about your hate; write about how hurt you are; write about how afraid you really are. Journal about what happened and how it is affecting you today. Write about what you have lost, or what you have never had that has hurt you so deeply. Feel the feeling! Don’t be afraid of it!

Under all the anger, rage, hate, and hurt is one emotion – FEAR!

It’s essential to whatever method you choose to realize that you are hating, that you are full of rage and anger, and that this is a safe way to begin to accept your anger, your hate, and to own your anger and hate as your own. So often we are too afraid to lose control or just afraid of the intensity of our rage, that we run away from it and ignore it. The more you ignore it, the bigger it gets.
One of the most important things about releasing an emotion is to concentrate on the emotion rather than what caused the emotion. Forget who did what that caused the emotion, forget about the person who did something to you, concentrate on the “I hate” or “I am angry” or “I am so hurt”. It’s the emotion you need to release. Don’t be afraid to feel your feelings. Feeling them means owning them.

Speaking Your Truth – To release emotions you need to tell one human being one time only about the situation that caused the feeling buried within you. You need to explain in detail what happened, your feelings around this experience, and how this experience is affecting your life today. So often we hide situations and life’s happenings because we are ashamed and somehow feel things happen to us because we are “bad people”. It’s important to tell your complete story in detail to one person. This will help you to gain a healthier perspective on the situation. However, if you keep repeating the story to different people, talking about it repeatedly, thinking about it over and over again, this becomes a resentment (a recurring negative thought). The resentment then becomes another problem rather than part of the solution.

Secrets are shame-based and incidents kept secret or feelings hidden from others will make these feelings deeper and longer lasting. Emotional secrets lead to emotional and mental illness.

Transmuting Emotions: Sit in a comfortable chair, close your eyes, put your head back, and relax as best you can. Do the following exercise for 10 deep breaths. Concentrating on your breathing, inhale on the count of six, hold this breath to the count of six, exhale to the count of six, and rest to the count of six, then begin again. If the count of six is too difficult try the count of four or five. Concentrate fully on your process of breathing only. Keep doing this exercise until you feel more relaxed and your head noises have gone away.

Then slowly look for the emotion, find where it is buried in your body. All repressed emotions rest in your body and at times in the aura as well. Anger rests around your belly button area but it can also be seen as a black thread-like substance all through the body. Sadness sits in the midriff area. Emotions can rest anywhere in your body including the muscles, ligaments, in bone joints. Take your time, find your emotion.

Then take time to really see what this emotion looks like. I had a huge amount of sadness and when I finally found it I saw that it was the shape of a large mass of clouds, clouds so dense and thick that you couldn’t begin to even dent them. These clouds were a very dark gray color.

Once you have found your emotion, and described it to yourself, stay with it, hold it, be with it. Do not try to do anything to it – VERY IMPORTANT - just be with it. By being with it you begin to integrate this emotion into your very consciousness and this is the next step in releasing your emotion. As you go back to visit your buried emotion week after week you will find the shape getting smaller and smaller, until eventually it just disappears. It takes many months to transmute an emotion in this way, but it is a powerful manner to release emotions. This is what is meant by “transmuting emotions”.

Releasing Resentments: A resentment is a recurring anger where, on a recurring basis, we keep thinking about something someone has done to us, reliving all the particulars around this situation, with ongoing anger, hate, hurt, or whatever the emotion might be.

Pray for the person you are resenting. Wish for this person every wonderful thing you would want to have in your most perfect life. Wish them blessing and good fortune in all things. In time, this type of a prayer will release you from your resentment. This is difficult.

You can also write about this person. Write all the negative qualities you see in this person. Then write about all the positive qualities you see in this person. Eventually, by writing about the different qualities, a shift will occur within you, bringing you peace of mind.

You can write about the situation, what the person did to you and how it affected you, how it made you feel. Write about how you reacted to this situation, what you said and what you did. When we accept responsibility for our own behavior, the resentment often disappears.

The Power of Prayer: Certain emotions just hang on, regardless what you do. When human effort fails to produce the desired change, then it’s time to hand this over to the God of your understanding or the Divine Spirit of the Universe. Ask in prayer, that the emotion be lifted from you. My own personal experience has proved to me that this works, when all human effort has failed.

There is one thing that I have included in my prayers for many years, asking for a grateful heart. In my late 20s, I was in deep emotional pain and did not believe life was worth living. I was taught to look for things in my life that I could be grateful for, regardless of the difficulty. It was hard to do this when I was in such emotional pain, but it was essential to my healing. This prayer for a grateful heart has stayed with me for the past 30 years. And today I do have a grateful heart. Being very human, it disappears at times, but it returns when my energy goes there.

A Meditation With the Heart of the Universe: Close your eyes, sitting in a relaxed and comfortable position with both feet on the ground, your hands sitting gently on your thighs. Begin to breathe deeply, inhaling and exhaling slowly and gently, concentrating on your breathing. Do this deep breathing at least 10 – 15 times, concentrating on only your breathing. This will help you relax at all levels and clear the noises from you mind. You will have to practice this relaxation a number of times before proceeding with the full meditation.

Once you have relaxed, feel your heart, be with your heart. Then go out into the Universe, and visit the stars and the spaces between the stars, until you find that sacred place, the Heart of the Universe. Approach it slowly, respectfully and with humility. Then ask that the love of the Universal Heart be more deeply connected with your heart, and that your heart be filled with the love of the Universe. Stay with this for as long as you can. Feel the love of this Universal Heart. Once you feel your heart has received the love it needs at this time, thank the Universal Heart for sharing its love with you and slowly open your eyes and come back into the present moment.

We need to ask!

Over time, this meditation will expand your ability to love more deeply, shifting out the negative emotions. It’s a powerful meditation.

Shifting Your Perspective: Life brings injustice, abuse, bad luck, and emotions of hurt, anger, self-pity, and depression. It’s quite easy to look at what others have done that you consider to be wrong, and these wrongs are very real. It’s not as easy to look at your response to the real wrong or injustice done to you. Someone might have demeaned you and degraded you. Did you punish them in some manner for their behavior? Was your response to the situation a healthy and loving response? Emotions around injustice of any kind are complex. Once we accept personal responsibility for our responses, the emotions around a given situation tend to lose their hold over us. It’s important to honor that an injustice has occurred. But it’s equally important to be ready to release that from your life, which involves looking at your own behavior, and accepting responsibility for your own actions.

· Detach Yourself: When your emotions are running high and you are having difficult reducing the intensity, try to detach yourself from the situation and the emotion. Try to imagine the same situation happening to someone else. Try to see if the behavior would be the same if someone else were in your situation. If the answer is yes then you can begin to see that the experience is not necessarily being focused at you. The other person is probably acting unconsciously, and you just happen to be the individual “in their way”. Detaching yourself in this manner can help you move through very difficult situations without taking the abuse personally. You might need to terminate the situation causing the emotions, but your detachment allows you to look at things more rationally and quietly.

Knowing Your Fears: What are the fears underlying your emotions? You will need to know and understand your fears. To do this you will have to swallow some pride and admit and accept that you have many fears that are affecting what you do each day. These fears are often not at the conscious level. Are you afraid of being alone; abandonment; the unknown; adventure; losing face; ridicule; not having enough money; loneliness; death; suffering; losing prestige; not being honored for your work and effort; losing your wife or husband – the list is endless?

Fears are tricky things. There are some that you need to ignore and just act as if you were not afraid. For example, if you’re afraid to say no, your fear will leave as you begin to say no when you need to say no. At times it’s like exercising a muscle. The more you use it the easier it gets. Other fears are a healthy warning that something is very wrong. For example, a person might be afraid of another person. This fear might be the signal to avoid that person, to leave the relationship.

As you become aware of your fears and own them to be truly yours, a day will come when you will notice that one of them has somehow disappeared. That’s the way it is with fear. As you live a life in tune with your emotions, a life focused on coming from that place of love, you will find that many of your fears will just disappear.

· Accepting Responsibility For Your Emotions: Taking care of ourselves is the greatest way we can love ourselves in a wholesome and healthy manner. And this means accepting responsibility for our emotions. Remember, emotions are not good or bad. They just are. But be careful and don’t punish yourself or be too hard on yourself. Balance is the key work. Each human being is very human, and that means each one of us is born with a full range of emotions.

· Conclusion

· Living In Peace: Once you have completed the looking, the understanding, the releasing of your buried emotions, you may find you have become accustomed to being in a more intense emotional state. The exercises above will heighten your overall emotionality. If you are relatively certain you have done what can be done, make a decision to live in peace, at peace with yourself, and at peace with others. You can decide this. Avoid those situations that you know will create conflict and upsets. You cannot change others, you can only change yourself. There are times where it’s important to stand and fight. It takes a lot of wisdom to “accept the things you cannot change, and change the things you can”. Wisdom to know the difference brings peace of mind.

Contact Information: Mary Kurus is a Canadian Vibrational Consultant who conducts detailed Vibrational Assessments that identify the physical, energetic and emotional areas that are affecting your health today. Mary also makes vibrational medicines called Choming Vibrational Essences and Choming Herbal Tinctures that can change your energy so that you feel vital and healthy again. Mary has written many articles about vibrational healing which can be found on her Website atwww.mkprojects.com . You can contact Mary for a Vibrational Assessment at (613) 733-2856 or e-mail her at mary@mkprojects.com.

by Cosmo | Saturday 29 July 2007 0:05 | Recovery
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Gene variant increases risk for alcoholism following childhood abuse

Girls who suffered childhood sexual abuse are more likely to develop alcoholism later in life if they possess a particular variant of a gene involved in the body’s response to stress, according to a new study led by researchers at the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH). The new finding could help explain why some individuals are more resilient to profound childhood trauma than others.

“With this study we see yet again that nature and nurture often work together, not independently, to influence our overall health and well-being,” says NIH Director Elias A. Zerhouni, M.D.

“This finding underscores the central role that gene-environment interactions play in the pathogenesis of complex diseases such as alcoholism,” adds NIAAA Director Ting-Kai Li, M.D. A report of the study appears in the June 26, 2007 advance online publication of Molecular Psychiatry.

Previous studies have shown that childhood sexual abuse increases the risk for numerous mental health problems in adulthood. However not all abused children develop such problems, a likely indication that genetic factors also play a role. Recent studies have linked the monoamine oxidase A (MAOA) gene with adverse behavioral outcomes stemming from childhood mistreatment.

“MAOA is an enzyme that metabolizes various neurotransmitters that regulate the body’s response to stress,” explains first author Francesca Ducci, M.D., a visiting fellow in NIAAA’s Laboratory of Neurogenetics in Bethesda, Maryland. DNA variations occur within a regulatory area – the MAOA-linked polymorphic region (MAOA-LPR) -- of the MAOA gene. Two such MAOA-LPR variants occur most frequently and result in high or low MAOA enzyme activity. In a recent study, researchers found that maltreated boys who possessed the low activity MAOA-LPR variant were more likely to develop behavior problems than boys with the high activity variant.

“Our aim was to test whether this low activity variant influences the impact of childhood sexual abuse on alcoholism and antisocial personality disorder (ASPD) in women,” says Dr. Ducci.

She and her colleagues analyzed DNA samples from a group of American Indian women living in a community in which rates of alcoholism and ASPD are about six times higher than the average rates among all U.S. women. Childhood sexual abuse is also prevalent in this population, reported by about half of the women in the community, compared with a U.S. average of 13 percent.

“The high rates of sexual abuse and alcoholism in this population make it particularly suitable for studying the interaction of genes and stressful environmental exposures,” explains senior author David Goldman, M.D., chief of the NIAAA Laboratory of Neurogenetics.

Analyses of MAOA-LPR genotypes in this study revealed that women who had been sexually abused in childhood were much more likely to develop alcoholism and antisocial behavior if they had the low activity variant whereas the high activity variant was protective. In contrast, there was no relationship between alcoholism, antisocial behavior and MAOA-LPR genotype among non-abused women.

“Our findings show that MAOA seems to moderate the impact of childhood trauma on adult psychopathology in females in the same way as previously shown among males,” says Dr. Ducci. “The MAOA-LPR low activity allele appears to confer increased vulnerability to the adverse psychosocial consequences of childhood sexual abuse.”

Dr. Ducci and her colleagues suggest that the effect of MAOA on the hippocampus, a brain region which is involved in the processing of emotional experience, may underlie the interaction between MAOA and childhood trauma. They note that previous research showed that people with the low activity variant at the MAOA-LPR locus have hyperactivation of the hippocampus when retrieving negative emotional information.

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Other co-authors of the study include Mary-Anne Enoch, M.D., Colin Hodgkinson, Ph.D. and Ke Xu, MD, Ph.D., of the NIAAA Laboratory of Neurogenetics, Mario Catena, MD, of the Department of Psychiatry, University of Pisa, Italy, and Robert W. Robin, Ph.D., of the Center for the Prevention and Resolution of Violence in Tucson, Arizona.

The National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems and disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at www.niaaa.nih.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

by Cosmo | Monday 26 June 2007 8:55 | Addiction
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How AA is changing

My own experience

By an AA member

I first came into contact with Alcoholics Anonymous 20 years ago. I had just been discharged from mental hospital after a suicide attempt and after losing two jobs within a few weeks. AA was the main thing which kept me going over the following months, although I also got help from family, friends, my doctor and my therapist. I have not had an alcoholic drink since my first AA meeting. I have had many problems getting my life together since then, not least with depression.

With the benefit of hindsight depression was probably one of the reasons why I drank, but the drinking was more a cause than an effect of my problems.

I still attend AA meetings regularly. I do not want to drink again and I still value the support I get in maintaining sobriety, among other things by listening to people who have had a harder time than I have, have only just stopped drinking or are still trying to stop. AA is also part of my social life.

Carrying the AA message

The 12th step of the AA programme encourages its members to carry the AA message to other alcoholics. The proposition that helping others helps you to stay sober has support in peer-reviewed scientific literature as well as in the practical experience of AA groups. In London, where I live, current initiatives include AA members speaking to school children about their experiences, giving presentations at magistrates courts, working with the probation service and supporting AA meetings at prisons. A seminar about the work of AA was held at the Houses of Parliament in March 2005 and a repeat of this is due in May 2006.

AA has been particularly successful in working with some leading hospitals which provide treatment for alcohol dependence. AA meetings are held in the hospitals and AA members give separate talks to the patients to help them to think about becoming members too.

In other hospitals AA meetings may be held in the premises without such a close working relationship. There may be a clash of cultures. There are sometimes strong contrasts in general approach and language between AA members and those who work professionally in the field of addiction, although both sides are usually trying to achieve what is essentially the same thing.

Working with AA

A doctor in charge of an alcohol treatment unit once told me that I was the first AA member he had met. Others may strongly encourage their clients to try AA without having any direct contact with the fellowship themselves.

Professionals who want to make optimal use of AA as a resource may sometimes need to make a greater effort to understand its programme, meet with members involved in outreach activities and attend a few “open” meetings (which should usually be done far enough away from where you work to ensure that you do not meet your own clients). This is surely not a disproportionate time commitment. It can enable the professional, for instance, to tell his or her patients or clients at first hand what they should expect. You do not have to become an alcoholic yourself (or apply the ‘Minnesota Model’, which involves integrating the AA programme within treatment) to get to this point.

Why should you make the effort? Partly because there is now a sound body of scientific evidence suggesting that AA does work for a significant number of people with drink problems. It operates at no cost to the taxpayer and is paid for entirely by voluntary contributions from those members who can afford to make them. It is also most active outside normal working hours and thus complements the help that can be provided at a professional level.

The need for AA to adjust

AA members actively involved in its public relations activities may need to make an equivalent effort to understand other people’s points of view and find common ground. Involvement in AA outreach activities helps to achieve this up to a point as does, for instance, reading some scientific literature, contact with professionals, attending conferences focusing on alcohol problems and involvement in working groups at a local level.

One of the co-founders of AA, William Wilson, acknowledged that some AA members ‘decry every attempt at therapy except our own’ but the majority ‘don’t care too much whether new and valuable knowledge issues from a test tube, a psychiatrist’s couch or revealing social studies’.

AA has changed considerably over the 20 years I have been a member. There are, for instance, more people under 30 and more women. There are meetings focused on the needs of young people, women, gays and lesbians and some provision in Central London (although still not nearly enough) for child care. It was rare in the 1980s to see anyone from racial minorities at meetings. Now it is rare not to see them. The fellowship is making every effort to provide help to people whose first language is not English or who may have other communication problems or disabilities.

The Internet and email has also helped to spread the AA message. For instance the basic ‘Alcoholics Anonymous’ textbook is now available online in full text in English, French and Spanish as well as being available in hard copy in many other languages.

The anonymity tradition

There is sometimes a tendency to over-interpret the AA anonymity tradition. It only requires members to maintain anonymity at the level of press, radio, film etc. The second cofounder of AA, Dr Robert Smith, argued that maintaining anonymity at any other level and in particular “being so anonymous you can’t be reached by other drunks” was itself a breach of the anonymity tradition. He also considered that AA members should let themselves be known as such in the community.

This may be feasible in North America, but in Europe it is perhaps more an ideal to be strived for. I am a professional myself, although I do not practise in the field of addictions. I do not tell my colleagues at work (whom I have only known for about 18 months) about my past drinking problems and my membership of AA. When I get to know them better, and if it were to serve a useful purpose, I might perhaps do so.

References

1 www.alcoholicsanonymous.org.uk/geninfo/05steps.shtml 2 See Zemore SE, Kaskutas, LE and Ammon LN (2004) ‘In 12-step groups, helping helps the helper’, Addiction 99, 1015. 3 Seewww.hazelden.org/servlet/hazelden /go/INFO_MNMODEL 4 See, for instance: Vaillant, GE (2003) ‘A 60-year follow-up of alcoholic men’ Addiction, 98, 1043- 1051. Gossop M, Harris, R, Best D, Man L-H et al, ‘Is attendance at Alcoholics Anonymous meetings after inpatient treatment related to improved outcomes? A 6 month follow-up study’ Alcohol and Alcoholism, Vol 38 No 5 421-426. Project MATCH Research Group (1997) ‘Matching alcoholism treatments to client heterogeneity: Project MATCH post treatment outcomes’. Journal of Studies on Alcohol 58, 7-29. 5 ‘Let’s be friendly with our friends’,AA Grapevine March 1958. 6 www.aa.org/bigbookonline/. 7 ‘Doctor Bob and the Good Oldtimers’, page 264, 1980 AA World Services inc

by Cosmo | Tuesday 20 June 2007 3:15 | Recovery
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Sleep problems get in the way of alcoholism recovery

Sleep problems - real and perceived - get in the way of alcoholism recovery

Doctors and patients should discuss and address sleep issues as part of recovery

The first few months of recovery from an alcohol problem are hard enough. But they’re often made worse by serious sleep problems, caused by the loss of alcohol’s sedative effects, and the long-term sleep-disrupting impact that alcohol dependence can have on the brain.

Now, a new study gives further evidence that insomnia and other sleep woes may actually get in the way of recovery from alcohol problems. In fact, a person’s perception of how bad their sleep problems are may be just as important as the actual sleep problems themselves, the study suggests.

The study is published in the journal Alcoholism: Clinical and Experimental Research, by a team from the University of Michigan’s Department of Psychiatry. They report the results of a small but thorough evaluation of sleep, sleep perception and alcohol relapse among 18 men and women with insomnia who were in the early stages of alcohol recovery.

The authors say their results show how important it is for alcohol recovery patients, and those who are helping them through their recovery, to discuss sleep disturbances and seek help. Often, sleep isn’t discussed in alcohol recovery programs - but it should be, they stress.

In fact, members of the U-M team have now launched a new study that aims to help those who have just entered treatment for alcohol problems, and are having trouble sleeping. Instead of using sleep medications, which can carry their own risk of addiction, it’s based on a series of "talk therapy" sessions with a trained sleep therapist who can help patients change behaviors and patterns of thinking that contribute to sleep problems.

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Sleep and Half Brother Death [Drunk] by John William Waterhouse

In the meantime, the newly published results add to the understanding of how alcohol and sleep intertwine.

"What we found is that those patients who had the biggest differences between their perception of how they slept and their actual sleep patterns were most likely to relapse," says lead author Deirdre Conroy, Ph.D., who led the study as a fellow in the U-M Addiction Research Center. "This suggests that long-term drinking causes something to happen in the brain that interferes with both sleep and perception of sleep. If sleep problems aren’t addressed, the risk of relapse may be high."

"We are now interested in what brain mechanisms are involved in the disrupted sleep of alcohol-dependent individuals," says Brower, who has previously led studies illustrating the prevalence of sleep disorders among people with alcohol dependence and abuse issues, and their correlation with relapse back into drinking. He is the executive director of the U-M Addiction Treatment Services, which provides alcohol and drug treatment to hundreds of patients each year.

The new study involved women who had volunteered for a randomized clinical trial of gabapentin, an experimental treatment for alcohol dependence. Each one started the trial when they had been off alcohol for about a week.

The volunteers spent two separate nights in the sleep-monitoring area of the U-M General Clinical Research Center, wearing electrodes on their head and body that measured their brain waves during sleep, as well as their breathing, muscle activity and heart rhythm. The detailed measurements, which together make up a procedure called polysomnography, allowed the researchers to determine when the volunteers were sleeping, when they were awake, and which stage of sleep they were in.

These sleep data were compared with the participants’ answers on morning evaluations of how they slept - including how long they thought it took them to fall asleep, how long they were awake in the night, and other measures. The two nights of sleep monitoring were done several weeks apart. The researchers also asked the participants to report any alcohol they drank during the six weeks following each sleep test.

In all, the patients overestimated how long it took them to fall asleep, but thought they had been awake in the middle of the night for far less time than they actually were. These perceptions about how they slept were actually more accurate in predicting their potential for relapse to alcohol use than were the actual sleep measurements.

"Our study suggests that in early recovery from alcoholism, people perceived that it took them a long time to fall asleep and that they slept through the night," says Conroy. "The reality was that it did not take them as long to fall asleep as they thought it did, and their brain was awake for a large portion of the night. On average, the participants that were less accurate about how they were sleeping were more likely to return to drinking."

Conroy explains that poor sleep quality can lead to mood disturbances. "If recovering alcoholics are irritable because they are not getting quality sleep at night, they might be more vulnerable to return to drinking," she says. "Previous studies show that non-alcoholics with insomnia actually think they are sleeping worse than they are, so they may be more likely to seek appropriate treatment.

Our study shows that an alcoholic in early recovery has a lot of wakefulness in the night but they are not necessarily picking up on this. It is important for the clinician working with the alcohol-dependent patient to have a differential of poor sleep quality in the back of their mind as a potential challenge for the patient throughout alcohol recovery."

by Cosmo | Monday 19 June 2007 14:13 | Recovery
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More women seek treatment for alcoholism

There has been a huge increase in the numbers of wine-drinking, middle aged, professional women seeking treatment for alcohol addiction, the clinical director of the Rutland Clinic has said.

"In my view, drinking alone is a very serious symptom of possible trouble," said Stephen Rowen. ’‘We are getting more and more women in the door who are middle-aged and who have not been heavy drinkers since their teenage years.

"They are not women who have always been wild party girls, rather people who would have had an occasional drink, busy careers and families. Suddenly, they find they have a problem with drink and a lot of the reports show that wine is a major feature of that exacerbation. There is more and more of what I call late-onset alcoholism where, in a very short space of time, drinking has become a problem."

Rowen has warned that tippling alone and downing more than two glasses of wine regularly is a major warning sign for women that they may be slipping into high-risk drinking territory.

Rowen said that the clinic, one of Ireland’s foremost addiction treatment centres, was experiencing a surge in the numbers of women in their late 30s, 40s and early 50s presenting as first-time problem drinkers.

He blames a "drinking wine is harmless’’ attitude for the health time-bomb ticking for a generation of middle-class women who think nothing of sinking a bottle of wine on their own.

"Most of us wouldn’t consider drinking vodka while preparing a meal yet when it comes to wine, it is seen as harmless. There is an attitude that wine is okay and that it is good for us. But it is alcohol, and there is a lot of alcohol in a bottle of wine," he said.

"It used to be the case that, when treating women, vodka was the only drink we would ever hear mentioned, now wine is taking over that accolade."

Rowen believes that the government should follow the example of Britain and target middle aged drinkers in a campaign to highlight the dangers of alcohol. Figures indicate that for 85 per cent of the population alcohol will not cause them serious harm at any point during their lifetime.

But Rowen says that the current acceptance of wine consumption has to be tackled and he has urged the government to look at ways of highlighting the problem.

"I think we should do more," he said. "I don’t think we have a truly well developed addiction research centre in Ireland, and I think that is important. I would also like to see the government taking action and announcing, if that is what is needed, that wine is as addictive as any other type of alcohol.

"They need to educate and inform and remind and encourage the public about wine."

Sunday Business Post

by Cosmo | Saturday 17 June 2007 6:11 | Recovery
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Sex Addiction

The Secret Pain of the Sex Addict
What is the difference between someone who has a lot of sex and a sex addict?
Perhaps the best person to ask is a counsellor who is himself in recovery from sex addiction.

To family members and friends trying to deal with the consequences of a loved one's sexual actions, the question of whether they are someone who has a lot of sex or a sex addict might seem irrelevant. Broken noses, hearts and relationships do not heal any quicker in response.

I have been in recovery from sex addiction for some years now, and work as a counsellor specialising in cases of sexual addiction, compulsion and obsession. I have heard many stories. They are as varied as the people who tell them. But there are broad trends:

Sex is used to escape from reality. Sex is ritualised and 'scripted' rather than being playful and spontaneous, and sex assumes an importance which dominates all other considerations.

Many clients come into recovery from sexual addiction after years of dealing with alcoholism or drug use. "Alcohol was a doddle compared to this," says Simon, a recovering alcoholic, now in recovery from sexual addiction. "The trouble with sex addiction is that you carry your own supply. The bottle is permanently uncorked.

"My sex addiction pre-dates my alcoholism by years. I became an alcoholic as a way of dealing with the shame of my sex addiction."

Alex was forced to recognise that he had a problem after being arrested for trying to proposition a 13-year old boy. He is now 46. Alex's story is neither typical nor atypical. But it does share the common traits listed above.

Alex became a sex addict at the age of four. "Surprised? Once I started to look honestly at my life, I saw that I had been masturbating at least once a day since that age. My addiction did not suddenly materialise with the onset of puberty."

It took 10 years after his arrest for Alex to recognise that the behaviour which had almost landed him in prison was only the tip of the iceberg. "I was more devoted to finding strangers for sex than I was to my friends. I told friends and family that I was happy, and believed it myself. In reality, I was lonely and depressed almost to the point of suicide. My addiction was killing me - but I saw it as the only thing worth living for."

Alex's infancy contains little that is remarkable. There are no horror stories of gross abuse. But a series of relatively minor events had a devastating cumulative effect. First, in common with many babies of his generation, Alex was taken away from his mother immediately after birth. His addiction includes a craving for the all-embracing skin-on-skin touch which he missed in those moments.

And his mother was 42 when he was born. "I was the fourth child. She was exhausted. I was not grossly neglected but I was left alone more than was good for me."

When Alex was four and a half, his mother developed a brain tumour. "My family did not have time for a four-year old. And why complicate matters by trying to comfort me when I did not seem to need comforting? But I was in shock. I felt utterly alone. I was terrified. I did not have the words to say that I knew my mother was dying."

Alex discovered an escape. "If I rubbed my penis, everything felt OK. It was my secret and it kept me safe." Furthermore, the good feelings allowed Alex to escape into a fantasy world where people did what he wanted of them.

But Alex became stuck in fantasy. "I wanted friends but did not know how to befriend people I liked. I was insufferable, and got teased and bullied. I took control by fantasising about having sex with them."

Another addict, Ian, came to need more than his fantasy world. Pornography helped to refuel a waning excitement but sooner or later he would need to have "real" sex. "I grew older but emotionally I remained a child. I don't remember if I experienced sexual abuse as a child. But I was certainly experiencing it now. I was an emotional four-year old having sex with adults."

Alex, too, reinforced his childish fantasies through pornography - which was, of course, written by people as blind as he was. "I looked for sex from people who saw the world in identical terms to my own." In his sexual world, what he did was "normal and acceptable" but at the same time he knew that it was not. "My brother spotted one of my pornographic magazines. The shame was terrible. I acted out even more then. It was the only strategy I knew to numb out the shame."

Alex was 38 - like many addicts - when the tension between his addiction and "real" life reached breaking point. The addiction had covered up an intolerable pain which, at the age of four, would have killed him. He had not stopped hurting.

Now the addiction was compounding that pain. His periods of acting out became more desperate. He was also more frightened at his own lack of control. It is the paradox of Alex's addiction that every time he acted out sexually, he reproduced his original loneliness and terror. He was locked in a cycle of self-abuse and had reached the point where he could no longer deny the pain.

Alex went to his first Sex Addicts Anonymous meeting in 1991. "It saved my life. The meetings are often infuriating, disorganised and ramshackle, full of confused people with confused ideas, fears and prejudices - but for me they worked, and they continue to work.

"They do not provide the whole answer. I have been in treatment and I go to regular counselling. But meetings are the bread and butter of my recovery. They are a place where I feel supported, without being either shamed or condoned. And I could start being honest."

But some months ago, Alex had a relapse on Internet pornography. "I am now in a committed relationship with a partner whom I love and who loves me. I found myself lying to him and could see no way of being truthful. If I told him what I was doing, I would hurt him. If I did not, then I was just as hurtful... I was damned if I did and damned if I didn't. "But I could talk with my therapist and SAA members. I rang them every day, just telling them what I was doing and feeling. After two months, I came out of relapse and back into recovery."

What is a sex addict? I have heard dozens of stories. The range of addictive focus is almost as varied as the numbers of people experiencing them: children, older men or women, domination, sex in parks, sex for money, telephone sex, hardcore pornography, top-shelf magazines, self-exposure, voyeurism, fantasy. Some behaviours are illegal, most are not. Some are clearly abusive, many seem normal and respectable. Then there are people who have a lot of sex but are not necessarily sex addicts. They simply and genuinely enjoy it.

How can we help the sex addict?
And how can the sex addict help him/herself?

Intervention. Sex addiction is based on shame. The shame of childhood abuse is compounded by social judgments which go with sexual acting out. It is vital that anyone contemplating intervention should have great understanding, preferably from the inside, of the addict's motives and his/her styles of manipulation.

Suspend moral judgment. One of the keys to recovery is to bring the addict's sexual history out of fantasy and into reality. This includes confronting the consequences of the addiction, both moral and practical. But the addict must be able to talk about his/her sexual behaviours and feelings without feat of being shamed or, indeed, condoned.

Support groups. The recovering addict needs everyday support where s/he can talk about sex in ways which are straightforward and honest, rather than secretive or titillating. Brief details of the 'S' fellowships are given below.

Abstinence, if it is going to work, must be seen as a means not an end. Remaining abstinent for a day or a week as a means to understanding is different from the "never ever" promises of the active addict. The timescale must be manageable. It might also mean making a decision to abstain from some behaviours, while encouraging others. Every case is different.

Above all, if the addict cannot maintain abstinence, there must be no sense of failure. Every slip is a chance to gain information and understanding.

Further reading includes Don't Call It Love by Patrick Carnes, Women, Sex and Addiction by Charlotte Davis Kasl and Hope and Recovery, the "big book" of Sex Addicts Anonymous and Sexual Compulsives Anonymous. A good supplier is Living Solutions on 00353-21-314318.

by Cosmo | Thursday 8 June 2007 0:41 | Addiction
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Eating Disorders

Eating Disorders: Facts About Eating Disorders and the Search for Solutions

Eating is controlled by many factors, including appetite, food availability, family, peer, and cultural practices, and attempts at voluntary control. Dieting to a body weight leaner than needed for health is highly promoted by current fashion trends, sales campaigns for special foods, and in some activities and professions. Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight. Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, at some point move beyond control in some people and develop into an eating disorder. Studies on the basic biology of appetite control and its alteration by prolonged overeating or starvation have uncovered enormous complexity, but in the long run have the potential to lead to new pharmacologic treatments for eating disorders.

Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa.1 A third type, binge-eating disorder, has been suggested but has not yet been approved as a formal psychiatric diagnosis.2 Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood.3

Eating disorders frequently co-occur with other psychiatric disorders such asdepression, substance abuse, and anxiety disorders.1 In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure which may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.

Females are much more likely than males to develop an eating disorder. Only an estimated 5 to 15 percent of people with anorexia or bulimia4 and an estimated 35 percent of those with binge-eating disorder5 are male.

Anorexia Nervosa

An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime.1 Symptoms of anorexia nervosa include:

Resistance to maintaining body weight at or above a minimally normal weight for age and height
Intense fear of gaining weight or becoming fat, even though underweight
Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
Infrequent or absent menstrual periods (in females who have reached puberty)

People with this disorder see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession. Unusual eating habits develop, such as avoiding food and meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, or purging by means of vomiting and abuse of laxatives, enemas, and diuretics. Girls with anorexia often experience a delayed onset of their first menstrual period.

The course and outcome of anorexia nervosa vary across individuals: some fully recover after a single episode; some have a fluctuating pattern of weight gain and relapse; and others experience a chronically deteriorating course of illness over many years. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, or approximately 5.6 percent per decade, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population.6 The most common causes of death are complications of the disorder, such as cardiac arrest or electrolyte imbalance, and suicide.

Bulimia Nervosa

An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime.1 Symptoms of bulimia nervosa include:

Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging); fasting; or excessive exercise
The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months
Self-evaluation is unduly influenced by body shape and weight

Because purging or other compensatory behavior follows the binge-eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.

Binge-Eating Disorder

Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge-eating disorder in a 6-month period.5,7 Symptoms of binge-eating disorder include:

Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode
The binge-eating episodes are associated with at least 3 of the following: eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; feeling disgusted with oneself, depressed, or very guilty after overeating
Marked distress about the binge-eating behavior
The binge eating occurs, on average, at least 2 days a week for 6 months
The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e.g., purging, fasting, excessive exercise)

People with binge-eating disorder experience frequent episodes of out-of-control eating, with the same binge-eating symptoms as those with bulimia. The main difference is that individuals with binge-eating disorder do not purge their bodies of excess calories. Therefore, many with the disorder are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.

Treatment Strategies1

Eating disorders can be treated and a healthy weight restored. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling and, when appropriate, medication management. At the time of diagnosis, the clinician must determine whether the person is in immediate danger and requires hospitalization.

Treatment of anorexia calls for a specific program that involves three main phases: (1) restoring weight lost to severe dieting and purging; (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts; and (3) achieving long-term remission and rehabilitation, or full recovery. Early diagnosis and treatment increases the treatment success rate. Use of psychotropic medication in people with anorexia should be considered only after weight gain has been established. Certain selective serotonin reuptake inhibitors (SSRIs) have been shown to be helpful for weight maintenance and for resolving mood and anxiety symptoms associated with anorexia.

The acute management of severe weight loss is usually provided in an inpatient hospital setting, where feeding plans address the person's medical and nutritional needs. In some cases, intravenous feeding is recommended. Once malnutrition has been corrected and weight gain has begun, psychotherapy (often cognitive-behavioral or interpersonal psychotherapy) can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns. Families are sometimes included in the therapeutic process.

The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention, and medication management strategies are often employed. Establishment of a pattern of regular, non-binge meals, improvement of attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of co-occurring conditions such as mood or anxiety disorders are among the specific aims of these strategies. Individual psychotherapy (especially cognitive-behavioral or interpersonal psychotherapy), group psychotherapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective. Psychotropic medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety, or those who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse. The treatment goals and strategies for binge-eating disorder are similar to those for bulimia, and studies are currently evaluating the effectiveness of various interventions.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long term.

Research Findings and Directions

Research is contributing to advances in the understanding and treatment of eating disorders.

NIMH-funded scientists and others continue to investigate the effectiveness of psychosocial interventions, medications, and the combination of these treatments with the goal of improving outcomes for people with eating disorders.8,9
Research on interrupting the binge-eating cycle has shown that once a structured pattern of eating is established, the person experiences less hunger, less deprivation, and a reduction in negative feelings about food and eating. The two factors that increase the likelihood of bingeing—hunger and negative feelings—are reduced, which decreases the frequency of binges.10
Several family and twin studies are suggestive of a high heritability of anorexia and bulimia,11,12 and researchers are searching for genes that confer susceptibility to these disorders.13 Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses. Identification of susceptibility genes will permit the development of improved treatments for eating disorders.
Other studies are investigating the neurobiology of emotional and social behavior relevant to eating disorders and the neuroscience of feeding behavior.
Scientists have learned that both appetite and energy expenditure are regulated by a highly complex network of nerve cells and molecular messengers called neuropeptides.14,15 These and future discoveries will provide potential targets for the development of new pharmacologic treatments for eating disorders.
Further insight is likely to come from studying the role of gonadal steroids.16,17 Their relevance to eating disorders is suggested by the clear gender effect in the risk for these disorders, their emergence at puberty or soon after, and the increased risk for eating disorders among girls with early onset of menstruation.

For More Information

Eating Disorders Information and Organizations from NLM's MedlinePlus (en Español)

References

1American Psychiatric Association Work Group on Eating Disorders. Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 2000; 157(1 Suppl): 1-39.

2American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.

3Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. New England Journal of Medicine, 1999; 340(14): 1092-8.

4Andersen AE. Eating disorders in males. In: Brownell KD, Fairburn CG, eds.Eating disorders and obesity: a comprehensive handbook. New York: Guilford Press, 1995; 177-87.

5Spitzer RL, Yanovski S, Wadden T, Wing R, Marcus MD, Stunkard A, Devlin M, Mitchell J, Hasin D, Horne RL. Binge eating disorder: its further validation in a multisite study. International Journal of Eating Disorders, 1993; 13(2): 137-53.

6Sullivan PF. Mortality in anorexia nervosa. American Journal of Psychiatry, 1995; 152(7): 1073-4.

7Bruce B, Agras WS. Binge eating in females: a population-based investigation.International Journal of Eating Disorders, 1992; 12: 365-73.

8Agras WS. Pharmacotherapy of bulimia nervosa and binge eating disorder: longer-term outcomes. Psychopharmacology Bulletin, 1997; 33(3): 433-6.

9Wilfley DE, Cohen LR. Psychological treatment of bulimia nervosa and binge eating disorder. Psychopharmacology Bulletin, 1997; 33(3): 437-54.

10Apple RF, Agras WS. Overcoming eating disorders. A cognitive-behavioral treatment for bulimia and binge-eating disorder. San Antonio: Harcourt Brace & Company, 1997.

11Strober M, Freeman R, Lampert C, Diamond J, Kaye W. Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes. American Journal of Psychiatry, 2000; 157(3): 393-401.

12Walters EE, Kendler KS. Anorexia nervosa and anorexic-like syndromes in a population-based female twin sample. American Journal of Psychiatry, 1995; 152(1): 64-71.

13Kaye WH, Lilenfeld LR, Berrettini WH, Strober M, Devlin B, Klump KL, Goldman D, Bulik CM, Halmi KA, Fichter MM, Kaplan A, Woodside DB, Treasure J, Plotnicov KH, Pollice C, Rao R, McConaha CW. A search for susceptibility loci for anorexia nervosa: methods and sample description. Biological Psychiatry, 2000; 47(9): 794-803.

14Frank GK, Kaye WH, Altemus M, Greeno CG. CSF oxytocin and vasopressin levels after recovery from bulimia nervosa and anorexia nervosa, bulimic subtype. Biological Psychiatry, 2000; 48(4): 315-8.

15Elias CF, Kelly JF, Lee CE, Ahima RS, Drucker DJ, Saper CB, Elmquist JK. Chemical characterization of leptin-activated neurons in the rat brain. Journal of Comparative Neurology, 2000; 423(2): 261-81.

16Devlin MJ, Walsh BT, Katz JL, Roose SP, Linkei DM, Wright L, Vande Wiele R, Glassman AH. Hypothalamic-pituitary-gonadal function in anorexia nervosa and bulimia. Psychiatry Research, 1989; 28(1): 11-24.

17Flanagan-Cato LM, King JF, Blechman JG, O'Brien MP. Estrogen reduces cholecystokinin-induced c-Fos expression in the rat brain. Neuroendocrinology, 1998; 67(6): 384-91.

by Cosmo | Thursday 8 June 2007 0:37 | General Blogging
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Bipolar Disorder

Introduction

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year,1 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

"Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide."
"I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do."
Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6.
(Reprinted with permission from Alfred A. Knopf, a division of Random House, Inc.)

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

Increased energy, activity, and restlessness
Excessively "high," overly good, euphoric mood
Extreme irritability
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can't concentrate well
Little sleep needed
Unrealistic beliefs in one's abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

Lasting sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in activities once enjoyed, including sex
Decreased energy, a feeling of fatigue or of being "slowed down"
Difficulty concentrating, remembering, making decisions
Restlessness or irritability
Sleeping too much, or can't sleep
Change in appetite and/or unintended weight loss or gain
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms ofpsychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

double-sided arrow listing range of moods, from severe mania to severe depression

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Diagnosis of Bipolar Disorder

Like other mental illnesses, bipolar disorder cannot yet be identified physiologically—for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).2

Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:: Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total, the desperate hopelessness of it all…. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?; Hypomania: At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.; Mania: The fast ideas become too fast and there are far too many… overwhelming confusion replaces clarity… you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped.

Suicide

Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

talking about feeling suicidal or wanting to die
feeling hopeless, that nothing will ever change or get better
feeling helpless, that nothing one does makes any difference
feeling like a burden to family and friends
abusing alcohol or drugs
putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one's death)
writing a suicide note
putting oneself in harm's way, or in situations where there is a danger of being killed

If you are feeling suicidal or know someone who is:

call a doctor, emergency room, or 911 right away to get immediate help
make sure you, or the suicidal person, are not left alone
make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

What Is the Course of Bipolar Disorder?

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.3

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see below—"How Is Bipolar Disorder Treated?"). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.4 But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

Can Children and Adolescents Have Bipolar Disorder?

Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.5Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms.

For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

What Causes Bipolar Disorder?

Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes—the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow—passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.6

In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene.7 It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses.8,9 New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

How Is Bipolar Disorder Treated?

Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.10,11,12 Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications

Medications for bipolar disorder are prescribed by psychiatrists—medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder.10 Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.

Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.
Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.
Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20.13 Therefore, young female patients taking valproate should be monitored carefully by a physician.
Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant.14Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.

Treatment of Bipolar Depression

Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.

Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16 Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.17 Olanzapine may also help relieve psychotic depression.18
If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead.
Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication.
Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions.
To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.

Thyroid Function

People with bipolar disorder often have abnormal thyroid gland function.4Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.

Medication Side Effects

Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist's guidance.

Psychosocial Treatments

As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or "talk" therapy)—are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.12 A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.
Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms.
Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments

In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.19
Herbal or natural supplements, such as St. John's wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John's wort can reduce the effectiveness of certain medications.20 In addition, like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.21
Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.22

A Long-Term Illness That Can Be Effectively Treated

Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes.

Do Other Illnesses Co-occur with Bipolar Disorder?

Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders.23Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder.24,25Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment. For more information on anxiety disorders, contact NIMH (see below).

How Can Individuals and Families Get Help for Bipolar Disorder?

Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at:

University—or medical school—affiliated programs
Hospital departments of psychiatry
Private psychiatric offices and clinics
Health maintenance organizations (HMOs)
Offices of family physicians, internists, and pediatricians
Public community mental health centers

People with bipolar disorder may need help to get help.

Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness.
A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referral to a mental health professional.
Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment.
A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes.
Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.
In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.
Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers.
Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors.
Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations. For contact information, see the "For More Information" section at the back of this booklet.

What About Clinical Studies for Bipolar Disorder?

Some people with bipolar disorder receive medication and/or psychosocial therapy by volunteering to participate in clinical studies (clinical trials). Clinical studies involve the scientific investigation of illness and treatment of illness in humans. Clinical studies in mental health can yield information about the efficacy of a medication or a combination of treatments, the usefulness of a behavioral intervention or type of psychotherapy, the reliability of a diagnostic procedure, or the success of a prevention method. Clinical studies also guide scientists in learning how illness develops, progresses, lessens, and affects both mind and body. Millions of Americans diagnosed with mental illness lead healthy, productive lives because of information discovered through clinical studies. These studies are not always right for everyone, however. It is important for each individual to consider carefully the possible risks and benefits of a clinical study before making a decision to participate.

In recent years, NIMH has introduced a new generation of "real-world" clinical studies. They are called "real-world" studies for several reasons. Unlike traditional clinical trials, they offer multiple different treatments and treatment combinations. In addition, they aim to include large numbers of people with mental disorders living in communities throughout the U.S. and receiving treatment across a wide variety of settings. Individuals with more than one mental disorder, as well as those with co-occurring physical illnesses, are encouraged to consider participating in these new studies. The main goal of the real-world studies is to improve treatment strategies and outcomes for all people with these disorders. In addition to measuring improvement in illness symptoms, the studies will evaluate how treatments influence other important, real-world issues such as quality of life, ability to work, and social functioning. They also will assess the cost-effectiveness of different treatments and factors that affect how well people stay on their treatment plans.

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is seeking participants for the largest-ever, "real-world" study of treatments for bipolar disorder. To learn more about STEP-BD or other clinical studies, see the Clinical Trials page on the NIMH Web site http://www.nimh.nih.gov, visit the National Library of Medicine's clinical trials database http://www.clinicaltrials.gov, or contact NIMH.

For More Information

Bipolar Disorder Information and Organizations from NLM's MedlinePlus (en Español)

Addendum to Bipolar January 2007

Aripiprazole (Abilify) is another atypical antipsychotic medication used to treat the symptoms of schizophrenia and manic or mixed (manic and depressive) episodes of bipolar I disorder. Aripiprazole is in tablet and liquid form. An injectable form is used in the treatment of symptoms of agitation in schizophrenia and manic or mixed episodes of bipolar I disorder.

References

1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

2American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.

3Hyman SE, Rudorfer MV. Depressive and bipolar mood disorders. In: Dale DC, Federman DD, eds. Scientific American®; Medicine. Vol. 3. New York: Healtheon/WebMD Corp., 2000; Sect. 13, Subsect. II, p. 1.

4Goodwin FK, Jamison KR. Manic-depressive illness. New York: Oxford University Press, 1990.

5Geller B, Luby J. Child and adolescent bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 1997; 36(9): 1168-76.

6NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998.

7Hyman SE. Introduction to the complex genetics of mental disorders. Biological Psychiatry, 1999; 45(5): 518-21.

8Soares JC, Mann JJ. The anatomy of mood disorders—review of structural neuroimaging studies. Biological Psychiatry, 1997; 41(1): 86-106.

9Soares JC, Mann JJ. The functional neuroanatomy of mood disorders. Journal of Psychiatric Research, 1997; 31(4): 393-432.

10Sachs GS, Printz DJ, Kahn DA, Carpenter D, Docherty JP. The expert consensus guideline series: medication treatment of bipolar disorder 2000. Postgraduate Medicine, 2000; Spec No:1-104.

11Sachs GS, Thase ME. Bipolar disorder therapeutics: maintenance treatment.Biological Psychiatry, 2000; 48(6): 573-81.

12Huxley NA, Parikh SV, Baldessarini RJ. Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harvard Review of Psychiatry, 2000; 8(3): 126-40.

13Vainionpaa LK, Rattya J, Knip M, Tapanainen JS, Pakarinen AJ, Lanning P, Tekay A, Myllyla VV, Isojarvi JI. Valproate-induced hyperandrogenism during pubertal maturation in girls with epilepsy. Annals of Neurology, 1999; 45(4): 444-50.

14Llewellyn A, Stowe ZN, Strader JR Jr. The use of lithium and management of women with bipolar disorder during pregnancy and lactation. Journal of Clinical Psychiatry, 1998; 59(Suppl 6): 57-64; discussion 65.

15Thase ME, Sachs GS. Bipolar depression: pharmacotherapy and related therapeutic strategies. Biological Psychiatry, 2000; 48(6): 558-72.

16Suppes T, Webb A, Paul B, Carmody T, Kraemer H, Rush AJ. Clinical outcome in a randomized 1-year trial of clozapine versus treatment as usual for patients with treatment-resistant illness and a history of mania. American Journal of Psychiatry,1999; 156(8): 1164-9.

17Tohen M, Sanger TM, McElroy SL, Tollefson GD, Chengappa KN, Daniel DG, Petty F, Centorrino F, Wang R, Grundy SL, Greaney MG, Jacobs TG, David SR, Toma V. Olanzapine versus placebo in the treatment of acute mania. Olanzapine HGEH Study Group. American Journal of Psychiatry, 1999; 156(5): 702-9.

18Rothschild AJ, Bates KS, Boehringer KL, Syed A. Olanzapine response in psychotic depression. Journal of Clinical Psychiatry, 1999; 60(2): 116-8.

19U.S. Department of Health and Human Services. Mental health: a report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.

20Henney JE. Risk of drug interactions with St. John's wort. From the Food and Drug Administration. Journal of the American Medical Association, 2000; 283(13): 1679.

21Nierenberg AA, Burt T, Matthews J, Weiss AP. Mania associated with St. John's wort. Biological Psychiatry, 1999; 46(12): 1707-8.

22Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LB. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry, 1999; 56(5): 407-12.

23Strakowski SM, DelBello MP. The co-occurrence of bipolar and substance use disorders. Clinical Psychology Review, 2000; 20(2): 191-206.

24Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher FC, Vidaver R, Auciello P, Foy DW. Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 1998; 66(3): 493-9.

25Strakowski SM, Sax KW, McElroy SL, Keck PE Jr, Hawkins JM, West SA. Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization. Journal of Clinical Psychiatry, 1998; 59(9): 465-71.

by Cosmo | Thursday 8 June 2007 0:36 | General Blogging
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Anxiety Disorders

Introduction

Anxiety Disorders affect about 40 million American adults age 18 years and older (about 18%) in a given year,1causing them to be filled with fearfulness and uncertainty. Unlike the relatively mild, brief anxiety caused by a stressful event (such as speaking in public or a first date), anxiety disorders last at least 6 months and can get worse if they are not treated. Anxiety disorders commonly occur along with other mental or physical illnesses, including alcohol or substance abuse, which may mask anxiety symptoms or make them worse. In some cases, these other illnesses need to be treated before a person will respond to treatment for the anxiety disorder.

Effective therapies for anxiety disorders are available, and research is uncovering new treatments that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment right away.

This booklet will

describe the symptoms of anxiety disorders,
explain the role of research in understanding the causes of these conditions,
describe effective treatments,
help you learn how to obtain treatment and work with a doctor or therapist, and
suggest ways to make treatment more effective.

The following anxiety disorders are discussed in this brochure:

panic disorder,
obsessive-compulsive disorder (OCD),
post-traumatic stress disorder (PTSD),
social phobia (or social anxiety disorder),
specific phobias, and
generalized anxiety disorder (GAD).

Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread.

Panic Disorder

"For me, a panic attack is almost a violent experience. I feel disconnected from reality. I feel like I'm losing control in a very extreme way. My heart pounds really hard, I feel like I can't get my breath, and there's an overwhelming feeling that things are crashing in on me."
"It started 10 years ago, when I had just graduated from college and started a new job. I was sitting in a business seminar in a hotel and this thing came out of the blue. I felt like I was dying."
"In between attacks there is this dread and anxiety that it's going to happen again. I'm afraid to go back to places where I've had an attack. Unless I get help, there soon won't be anyplace where I can go and feel safe from panic."

Panic disorder is a real illness that can be successfully treated. It is characterized by sudden attacks of terror, usually accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. During these attacks, people with panic disorder may flush or feel chilled; their hands may tingle or feel numb; and they may experience nausea, chest pain, or smothering sensations. Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.

A fear of one's own unexplained physical symptoms is also a symptom of panic disorder. People having panic attacks sometimes believe they are having heart attacks, losing their minds, or on the verge of death. They can't predict when or where an attack will occur, and between episodes many worry intensely and dread the next attack.

Panic attacks can occur at any time, even during sleep. An attack usually peaks within 10 minutes, but some symptoms may last much longer. Panic disorder affects about 6 million American adults1 and is twice as common in women as men.2 Panic attacks often begin in late adolescence or early adulthood,2 but not everyone who experiences panic attacks will develop panic disorder. Many people have just one attack and never have another. The tendency to develop panic attacks appears to be inherited.3

People who have full-blown, repeated panic attacks can become very disabled by their condition and should seek treatment before they start to avoid places or situations where panic attacks have occurred. For example, if a panic attack happened in an elevator, someone with panic disorder may develop a fear of elevators that could affect the choice of a job or an apartment, and restrict where that person can seek medical attention or enjoy entertainment.

Some people's lives become so restricted that they avoid normal activities, such as grocery shopping or driving. About one-third become housebound or are able to confront a feared situation only when accompanied by a spouse or other trusted person. 2 When the condition progresses this far, it is called agoraphobia, or fear of open spaces.

Early treatment can often prevent agoraphobia, but people with panic disorder may sometimes go from doctor to doctor for years and visit the emergency room repeatedly before someone correctly diagnoses their condition. This is unfortunate, because panic disorder is one of the most treatable of all the anxiety disorders, responding in most cases to certain kinds of medication or certain kinds of cognitive psychotherapy, which help change thinking patterns that lead to fear and anxiety.

Panic disorder is often accompanied by other serious problems, such as depression, drug abuse, or alcoholism.4,5 These conditions need to be treated separately. Symptoms of depression include feelings of sadness or hopelessness, changes in appetite or sleep patterns, low energy, and difficulty concentrating. Most people with depression can be effectively treated with antidepressant medications, certain types of psychotherapy, or a combination of the two.

Obsessive-Compulsive Disorder

"I couldn't do anything without rituals. They invaded every aspect of my life. Counting really bogged me down. I would wash my hair three times as opposed to once because three was a good luck number and one wasn't. It took me longer to read because I'd count the lines in a paragraph. When I set my alarm at night, I had to set it to a number that wouldn't add up to a 'bad' number."
"I knew the rituals didn't make sense, and I was deeply ashamed of them, but I couldn't seem to overcome them until I had therapy."
"Getting dressed in the morning was tough, because I had a routine, and if I didn't follow the routine, I'd get anxious and would have to get dressed again. I always worried that if I didn't do something, my parents were going to die. I'd have these terrible thoughts of harming my parents. That was completely irrational, but the thoughts triggered more anxiety and more senseless behavior. Because of the time I spent on rituals, I was unable to do a lot of things that were important to me."

People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.

For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get "caught" in the mirror and can't move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.

Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.

Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.

OCD affects about 2.2 million American adults,1 and the problem can be accompanied by eating disorders,6 other anxiety disorders, or depression.2,4 It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood.2 One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.3

The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.4,5

OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them. NIMH is supporting research into new treatment approaches for people whose OCD does not respond well to the usual therapies. These approaches include combination and augmentation (add-on) treatments, as well as modern techniques such as deep brain stimulation.

Post-Traumatic Stress Disorder (PTSD)

"I was raped when I was 25 years old. For a long time, I spoke about the rape as though it was something that happened to someone else. I was very aware that it had happened to me, but there was just no feeling."
"Then I started having flashbacks. They kind of came over me like a splash of water. I would be terrified. Suddenly I was reliving the rape. Every instant was startling. I wasn't aware of anything around me, I was in a bubble, just kind of floating. And it was scary. Having a flashback can wring you out."
"The rape happened the week before Thanksgiving, and I can't believe the anxiety and fear I feel every year around the anniversary date. It's as though I've seen a werewolf. I can't relax, can't sleep, don't want to be with anyone. I wonder whether I'll ever be free of this terrible problem."

Post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic incidents, such as mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.

People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent. They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult. PTSD symptoms seem to be worse if the event that triggered them was deliberately initiated by another person, as in a mugging or a kidnapping. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again.

Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

PTSD affects about 7.7 million American adults,1but it can occur at any age, including childhood.7 Women are more likely to develop PTSD than men,8 and there is some evidence that susceptibility to the disorder may run in families.9PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.4

Certain kinds of medication and certain kinds of psychotherapy usually treat the symptoms of PTSD very effectively.

Social Phobia (Social Anxiety Disorder)

"In any social situation, I felt fear. I would be anxious before I even left the house, and it would escalate as I got closer to a college class, a party, or whatever. I would feel sick in my stomach-it almost felt like I had the flu. My heart would pound, my palms would get sweaty, and I would get this feeling of being removed from myself and from everybody else."
"When I would walk into a room full of people, I'd turn red and it would feel like everybody's eyes were on me. I was embarrassed to stand off in a corner by myself, but I couldn't think of anything to say to anybody. It was humiliating. I felt so clumsy, I couldn't wait to get out."

Social phobia, also called social anxiety disorder, is diagnosed when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. People with social phobia have an intense, persistent, and chronic fear of being watched and judged by others and of doing things that will embarrass them. They can worry for days or weeks before a dreaded situation. This fear may become so severe that it interferes with work, school, and other ordinary activities, and can make it hard to make and keep friends.

While many people with social phobia realize that their fears about being with people are excessive or unreasonable, they are unable to overcome them. Even if they manage to confront their fears and be around others, they are usually very anxious beforehand, are intensely uncomfortable throughout the encounter, and worry about how they were judged for hours afterward.

Social phobia can be limited to one situation (such as talking to people, eating or drinking, or writing on a blackboard in front of others) or may be so broad (such as in generalized social phobia) that the person experiences anxiety around almost anyone other than the family.

Physical symptoms that often accompany social phobia include blushing, profuse sweating, trembling, nausea, and difficulty talking. When these symptoms occur, people with social phobia feel as though all eyes are focused on them.

Social phobia affects about 15 million American adults.1 Women and men are equally likely to develop the disorder,10 which usually begins in childhood or early adolescence.2 There is some evidence that genetic factors are involved.11 Social phobia is often accompanied by other anxiety disorders or depression,2,4and substance abuse may develop if people try to self-medicate their anxiety.4,5

Social phobia can be successfully treated with certain kinds of psychotherapy or medications.

Specific Phobias

"I'm scared to death of flying, and I never do it anymore. I used to start dreading a plane trip a month before I was due to leave. It was an awful feeling when that airplane door closed and I felt trapped. My heart would pound, and I would sweat bullets. When the airplane would start to ascend, it just reinforced the feeling that I couldn't get out. When I think about flying, I picture myself losing control, freaking out, and climbing the walls, but of course I never did that. I'm not afraid of crashing or hitting turbulence. It's just that feeling of being trapped. Whenever I've thought about changing jobs, I've had to think, "Would I be under pressure to fly?" These days I only go places where I can drive or take a train. My friends always point out that I couldn't get off a train traveling at high speeds either, so why don't trains bother me? I just tell them it isn't a rational fear."

A specific phobia is an intense fear of something that poses little or no actual danger. Some of the more common specific phobias are centered around closed-in places, heights, escalators, tunnels, highway driving, water, flying, dogs, and injuries involving blood. Such phobias aren't just extreme fear; they are irrational fear of a particular thing. You may be able to ski the world's tallest mountains with ease but be unable to go above the 5th floor of an office building. While adults with phobias realize that these fears are irrational, they often find that facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.

Specific phobias affect an estimated 19.2 million adult Americans1 and are twice as common in women as men.10 They usually appear in childhood or adolescence and tend to persist into adulthood.1 2 The causes of specific phobias are not well understood, but there is some evidence that the tendency to develop them may run in families.11

If the feared situation or feared object is easy to avoid, people with specific phobias may not seek help; but if avoidance interferes with their careers or their personal lives, it can become disabling and treatment is usually pursued.

Specific phobias respond very well to carefully targeted psychotherapy.

Generalized Anxiety Disorder (GAD)

"I always thought I was just a worrier. I'd feel keyed up and unable to relax. At times it would come and go, and at times it would be constant. It could go on for days. I'd worry about what I was going to fix for a dinner party, or what would be a great present for somebody. I just couldn't let something go."
"I'd have terrible sleeping problems. There were times I'd wake up wired in the middle of the night. I had trouble concentrating, even reading the newspaper or a novel. Sometimes I'd feel a little lightheaded. My heart would race or pound. And that would make me worry more. I was always imagining things were worse than they really were: when I got a stomachache, I'd think it was an ulcer."

People with generalized anxiety disorder (GAD) go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety.

GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months.13 People with GAD can't seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can't relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.

When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don't avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.

GAD affects about 6.8 million adult Americans1 and about twice as many women as men.2 The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age.2 It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. There is evidence that genes play a modest role in GAD.13

Other anxiety disorders, depression, or substance abuse2,4 often accompany GAD, which rarely occurs alone. GAD is commonly treated with medication or cognitive-behavioral therapy, but co-occurring conditions must also be treated using the appropriate therapies.

Treatment of Anxiety Disorders

In general, anxiety disorders are treated with medication, specific types of psychotherapy, or both.14 Treatment choices depend on the problem and the person's preference. Before treatment begins, a doctor must conduct a careful diagnostic evaluation to determine whether a person's symptoms are caused by an anxiety disorder or a physical problem. If an anxiety disorder is diagnosed, the type of disorder or the combination of disorders that are present must be identified, as well as any coexisting conditions, such as depression or substance abuse. Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.

People with anxiety disorders who have already received treatment should tell their current doctor about that treatment in detail. If they received medication, they should tell their doctor what medication was used, what the dosage was at the beginning of treatment, whether the dosage was increased or decreased while they were under treatment, what side effects occurred, and whether the treatment helped them become less anxious. If they received psychotherapy, they should describe the type of therapy, how often they attended sessions, and whether the therapy was useful.

Often people believe that they have "failed" at treatment or that the treatment didn't work for them when, in fact, it was not given for an adequate length of time or was administered incorrectly. Sometimes people must try several different treatments or combinations of treatment before they find the one that works for them.

Medications

Medication will not cure anxiety disorders, but it can keep them under control while the person receives psychotherapy. Medication must be prescribed by physicians, usually psychiatrists, who can either offer psychotherapy themselves or work as a team with psychologists, social workers, or counselors who provide psychotherapy. The principal medications used for anxiety disorders are antidepressants, anti-anxiety drugs, and beta-blockers to control some of the physical symptoms. With proper treatment, many people with anxiety disorders can lead normal, fulfilling lives.

Antidepressants

Antidepressants were developed to treat depression but are also effective for anxiety disorders. Although these medications begin to alter brain chemistry after the very first dose, their full effect requires a series of changes to occur; it is usually about 4 to 6 weeks before symptoms start to fade. It is important to continue taking these medications long enough to let them work.

SSRIs

Some of the newest antidepressants are called selective serotonin reuptake inhibitors, or SSRIs. SSRIs alter the levels of the neurotransmitter serotonin in the brain, which, like other neurotransmitters, helps brain cells communicate with one another.

Fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), and citalopram (Celexa®) are some of the SSRIs commonly prescribed for panic disorder, OCD, PTSD, and social phobia. SSRIs are also used to treat panic disorder when it occurs in combination with OCD, social phobia, or depression. Venlafaxine (Effexor®), a drug closely related to the SSRIs, is used to treat GAD. These medications are started at low doses and gradually increased until they have a beneficial effect.

SSRIs have fewer side effects than older antidepressants, but they sometimes produce slight nausea or jitters when people first start to take them. These symptoms fade with time. Some people also experience sexual dysfunction with SSRIs, which may be helped by adjusting the dosage or switching to another SSRI.

Tricyclics

Tricyclics are older than SSRIs and work as well as SSRIs for anxiety disorders other than OCD. They are also started at low doses that are gradually increased. They sometimes cause dizziness, drowsiness, dry mouth, and weight gain, which can usually be corrected by changing the dosage or switching to another tricyclic medication.

Tricyclics include imipramine (Tofranil®), which is prescribed for panic disorder and GAD, and clomipramine (Anafranil®), which is the only tricyclic antidepressant useful for treating OCD.

MAOIs

Monoamine oxidase inhibitors (MAOIs) are the oldest class of antidepressant medications. The MAOIs most commonly prescribed for anxiety disorders are phenelzine (Nardil®), followed by tranylcypromine (Parnate®), and isocarboxazid (Marplan®), which are useful in treating panic disorder and social phobia. People who take MAOIs cannot eat a variety of foods and beverages (including cheese and red wine) that contain tyramine or take certain medications, including some types of birth control pills, pain relievers (such as Advil®, Motrin®, or Tylenol®), cold and allergy medications, and herbal supplements; these substances can interact with MAOIs to cause dangerous increases in blood pressure. The development of a new MAOI skin patch may help lessen these risks. MAOIs can also react with SSRIs to produce a serious condition called "serotonin syndrome," which can cause confusion, hallucinations, increased sweating, muscle stiffness, seizures, changes in blood pressure or heart rhythm, and other potentially life-threatening conditions.

Anti-Anxiety Drugs

High-potency benzodiazepines combat anxiety and have few side effects other than drowsiness. Because people can get used to them and may need higher and higher doses to get the same effect, benzodiazepines are generally prescribed for short periods of time, especially for people who have abused drugs or alcohol and who become dependent on medication easily. One exception to this rule is people with panic disorder, who can take benzodiazepines for up to a year without harm.

Clonazepam (Klonopin®) is used for social phobia and GAD, lorazepam (Ativan®) is helpful for panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD.

Some people experience withdrawal symptoms if they stop taking benzodiazepines abruptly instead of tapering off, and anxiety can return once the medication is stopped. These potential problems have led some physicians to shy away from using these drugs or to use them in inadequate doses.

Buspirone (Buspar®), an azapirone, is a newer anti-anxiety medication used to treat GAD. Possible side effects include dizziness, headaches, and nausea. Unlike benzodiazepines, buspirone must be taken consistently for at least 2 weeks to achieve an anti-anxiety effect.

Beta-Blockers

Beta-blockers, such as propranolol (Inderal®), which is used to treat heart conditions, can prevent the physical symptoms that accompany certain anxiety disorders, particularly social phobia. When a feared situation can be predicted (such as giving a speech), a doctor may prescribe a beta-blocker to keep physical symptoms of anxiety under control.

Psychotherapy

Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what caused an anxiety disorder and how to deal with its symptoms.

Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy Cognitive-behavioral therapy (CBT) is very useful in treating anxiety disorders. The cognitive part helps people change the thinking patterns that support their fears, and the behavioral part helps people change the way they react to anxiety-provoking situations.

For example, CBT can help people with panic disorder learn that their panic attacks are not really heart attacks and help people with social phobia learn how to overcome the belief that others are always watching and judging them. When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.

People with OCD who fear dirt and germs are encouraged to get their hands dirty and wait increasing amounts of time before washing them. The therapist helps the person cope with the anxiety that waiting produces; after the exercise has been repeated a number of times, the anxiety diminishes. People with social phobia may be encouraged to spend time in feared social situations without giving in to the temptation to flee and to make small social blunders and observe how people respond to them. Since the response is usually far less harsh than the person fears, these anxieties are lessened. People with PTSD may be supported through recalling their traumatic event in a safe situation, which helps reduce the fear it produces. CBT therapists also teach deep breathing and other types of exercises to relieve anxiety and encourage relaxation.

Exposure-based behavioral therapy has been used for many years to treat specific phobias. The person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Often the therapist will accompany the person to a feared situation to provide support and guidance.

CBT is undertaken when people decide they are ready for it and with their permission and cooperation. To be effective, the therapy must be directed at the person's specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety.

CBT or behavioral therapy often lasts about 12 weeks. It may be conducted individually or with a group of people who have similar problems. Group therapy is particularly effective for social phobia. Often "homework" is assigned for participants to complete between sessions. There is some evidence that the benefits of CBT last longer than those of medication for people with panic disorder, and the same may be true for OCD, PTSD, and social phobia. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.

Medication can be combined with psychotherapy for specific anxiety disorders, and this is the best treatment approach for many people.

TAKING MEDICATIONS

Before taking medication for an anxiety disorder:

Ask your doctor to tell you about the effects and side effects of the drug.
Tell your doctor about any alternative therapies or over-the-counter medications you are using.
Ask your doctor when and how the medication should be stopped. Some drugs can't be stopped abruptly but must be tapered off slowly under a doctor's supervision.
Work with your doctor to determine which medication is right for you and what dosage is best.
Be aware that some medications are effective only if they are taken regularly and that symptoms may recur if the medication is stopped.

How to Get Help for Anxiety Disorders

If you think you have an anxiety disorder, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.

If an anxiety disorder is diagnosed, the next step is usually seeing a mental health professional. The practitioners who are most helpful with anxiety disorders are those who have training in cognitive-behavioral therapy and/or behavioral therapy, and who are open to using medication if it is needed.

You should feel comfortable talking with the mental health professional you choose. If you do not, you should seek help elsewhere. Once you find a mental health professional with whom you are comfortable, the two of you should work as a team and make a plan to treat your anxiety disorder together.

Remember that once you start on medication, it is important not to stop taking it abruptly. Certain drugs must be tapered off under the supervision of a doctor or bad reactions can occur. Make sure you talk to the doctor who prescribed your medication before you stop taking it. If you are having trouble with side effects, it's possible that they can be eliminated by adjusting how much medication you take and when you take it.

Most insurance plans, including health maintenance organizations (HMOs), will cover treatment for anxiety disorders. Check with your insurance company and find out. If you don't have insurance, the Health and Human Services division of your county government may offer mental health care at a public mental health center that charges people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan.

Ways to Make Treatment More Effective

Many people with anxiety disorders benefit from joining a self-help or support group and sharing their problems and achievements with others. Internet chat rooms can also be useful in this regard, but any advice received over the Internet should be used with caution, as Internet acquaintances have usually never seen each other and false identities are common. Talking with a trusted friend or member of the clergy can also provide support, but it is not a substitute for care from a mental health professional.

Stress management techniques and meditation can help people with anxiety disorders calm themselves and may enhance the effects of therapy. There is preliminary evidence that aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of anxiety disorders, they should be avoided. Check with your physician or pharmacist before taking any additional medications.

The family is very important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one's symptoms. Family members should not trivialize the disorder or demand improvement without treatment. If your family is doing either of these things, you may want to show them this booklet so they can become educated allies and help you succeed in therapy.

Role of Research in Improving the Understanding and Treatment of Anxiety Disorders

NIMH supports research into the causes, diagnosis, prevention, and treatment of anxiety disorders and other mental illnesses. Scientists are looking at what role genes play in the development of these disorders and are also investigating the effects of environmental factors such as pollution, physical and psychological stress, and diet. In addition, studies are being conducted on the "natural history" (what course the illness takes without treatment) of a variety of individual anxiety disorders, combinations of anxiety disorders, and anxiety disorders that are accompanied by other mental illnesses such as depression.

Scientists currently think that, like heart disease and type 1 diabetes, mental illnesses are complex and probably result from a combination of genetic, environmental, psychological, and developmental factors. For instance, although NIMH-sponsored studies of twins and families suggest that genetics play a role in the development of some anxiety disorders, problems such as PTSD are triggered by trauma. Genetic studies may help explain why some people exposed to trauma develop PTSD and others do not.

Several parts of the brain are key actors in the production of fear and anxiety. 15Using brain imaging technology and neurochemical techniques, scientists have discovered that the amygdala and the hippocampus play significant roles in most anxiety disorders.

The amygdala is an almond-shaped structure deep in the brain that is believed to be a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret these signals. It can alert the rest of the brain that a threat is present and trigger a fear or anxiety response. It appears that emotional memories are stored in the central part of the amygdala and may play a role in anxiety disorders involving very distinct fears, such as fears of dogs, spiders, or flying.

The hippocampus is the part of the brain that encodes threatening events into memories. Studies have shown that the hippocampus appears to be smaller in some people who were victims of child abuse or who served in military combat.17, 18 Research will determine what causes this reduction in size and what role it plays in the flashbacks, deficits in explicit memory, and fragmented memories of the traumatic event that are common in PTSD.

By learning more about how the brain creates fear and anxiety, scientists may be able to devise better treatments for anxiety disorders. For example, if specific neurotransmitters are found to play an important role in fear, drugs may be developed that will block them and decrease fear responses; if enough is learned about how the brain generates new cells throughout the lifecycle, it may be possible to stimulate the growth of new neurons in the hippocampus in people with PTSD.23

Current research at NIMH on anxiety disorders includes studies that address how well medication and behavioral therapies work in the treatment of OCD, and the safety and effectiveness of medications for children and adolescents who have a combination of anxiety disorders and attention deficit hyperactivity disorder.

References

2Robins LN, Regier DA, eds. Psychiatric disorders in America: the Epidemiologic Catchment Area Study. New York: The Free Press, 1991.

3The NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998.

4Regier DA, Rae DS, Narrow WE, et al. Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. British Journal of Psychiatry Supplement, 1998; (34): 24-8.

5Kushner MG, Sher KJ, Beitman BD. The relation between alcohol problems and the anxiety disorders. American Journal of Psychiatry, 1990; 147(6): 685-95.

6Wonderlich SA, Mitchell JE. Eating disorders and comorbidity: empirical, conceptual, and clinical implications. Psychopharmacology Bulletin, 1997; 33(3): 381-90.

7Davidson JR. Trauma: the impact of post-traumatic stress disorder. Journal of Psychopharmacology, 2000; 14(2 Suppl 1): S5-S12.

8Margolin G, Gordis EB. The effects of family and community violence on children.Annual Review of Psychology, 2000; 51: 445-79.

9Yehuda R. Biological factors associated with susceptibility to posttraumatic stress disorder. Canadian Journal of Psychiatry, 1999; 44(1): 34-9.

10Bourdon KH, Boyd JH, Rae DS, et al. Gender differences in phobias: results of the ECA community survey. Journal of Anxiety Disorders, 1988; 2: 227-41.

11Kendler KS, Walters EE, Truett KR, et al. A twin-family study of self-report symptoms of panic-phobia and somatization. Behavior Genetics, 1995; 25(6): 499-515.

12Boyd JH, Rae DS, Thompson JW, et al. Phobia: prevalence and risk factors.Social Psychiatry and Psychiatric Epidemiology, 1990; 25(6): 314-23.

13Kendler KS, Neale MC, Kessler RC, et al. Generalized anxiety disorder in women. A population-based twin study. Archives of General Psychiatry, 1992; 49(4): 267-72.

14Hyman SE, Rudorfer MV. Anxiety disorders. In: Dale DC, Federman DD, eds.Scientific American>® Medicine. Volume 3. New York: Healtheon/WebMD Corp., 2000, Sect. 13, Subsect. VIII.

15LeDoux J. Fear and the brain: where have we been, and where are we going?Biological Psychiatry, 1998; 44(12): 1229-38.

16Rauch SL, Savage CR. Neuroimaging and neuropsychology of the striatum. Bridging basic science and clinical practice. Psychiatric Clinics of North America, 1997; 20(4): 741-68.

17Bremner JD, Randall P, Scott TM, et al. MRI-based measurement of hippocampal volume in combat-related posttraumatic stress disorder. American Journal of Psychiatry, 1995; 152: 973-81.

18Stein MB, Hanna C, Koverola C, et al. Structural brain changes in PTSD: does trauma alter neuroanatomy? In: Yehuda R, McFarlane AC, eds. Psychobiology of posttraumatic stress disorder. Annals of the New York Academy of Sciences, 821. New York: The New York Academy of Sciences, 1997.

19Molavi DW. The Washington University School of Medicine Neuroscience Tutorial for First-Year Medical Students. (1997) Washington University Program in Neuroscience. Retrieved November 16, 2005, from http://thalamus.wustl.edu/course.

20Understanding Obsessive-Compulsive and Related Disorders. Stanford University School of Medicine. Retrieved November 16, 2005, from http://ocd.stanford.edu/about/understanding.html.

21Rolls ET. The functions of the orbitofrontal cortex. Neurocase. 1999;5:301-312.

22Saxena S, Brody AL, Schwartz JM, et al. Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. British Journal of Psychiatry Supplement. 1998;35:26-37.

23Gould E, Reeves AJ, Fallah M, et al. Hippocampal neurogenesis in adult Old World primates. Proceedings of the National Academy of Sciences USA, 1999, 96(9): 5263-7.

by Cosmo | Thursday 8 June 2007 0:35 | General Blogging
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Depression

In any given 1-year period, 9.5 percent of the population, or about 20.9 million American adults, suffer from a depressive illness5 The economic cost for this disorder is high, but the cost in human suffering cannot be estimated. Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them. Serious depression can destroy family life as well as the life of the ill person. But much of this suffering is unnecessary.

Most people with a depressive illness do not seek treatment, although the great majority even those whose depression is extremely severe can be helped. Thanks to years of fruitful research, there are now medications and psychosocial therapies such as cognitive/behavioral, "talk" or interpersonal that ease the pain of depression.

Unfortunately, many people do not recognize that depression is a treatable illness. If you feel that you or someone you care about is one of the many undiagnosed depressed people in this country, the information presented here may help you take the steps that may save your own or someone else's life.

WHAT IS A DEPRESSIVE DISORDER?

A depressive disorder is an illness that involves the body, mood, and thoughts. It affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

TYPES OF DEPRESSION

Depressive disorders come in different forms, just as is the case with other illnesses such as heart disease. This pamphlet briefly describes three of the most common types of depressive disorders. However, within these types there are variations in the number of symptoms, their severity, and persistence.

Major depression is manifested by a combination of symptoms (see symptom list) that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

A less severe type of depression, dysthymia, involves long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.

Another type of depression is bipolar disorder, also called manic-depressive illness. Not nearly as prevalent as other forms of depressive disorders, bipolar disorder is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, an individual can have any or all of the symptoms of a depressive disorder. When in the manic cycle, the individual may be overactive, overtalkative, and have a great deal of energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state.

SYMPTOMS OF DEPRESSION AND MANIA

Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Severity of symptoms varies with individuals and also varies over time.

Depression

Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania

Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior

CAUSES OF DEPRESSION

Some types of depression run in families, suggesting that a biological vulnerability can be inherited. This seems to be the case with bipolar disorder. Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic makeup that causes vulnerability to bipolar disorder will have the illness. Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

In some families, major depression also seems to occur generation after generation. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with changes in brain structures or brain function.

People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

In recent years, researchers have shown that physical changes in the body can be accompanied by mental changes as well. Medical illnesses such as stroke, a heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness, making the sick person apathetic and unwilling to care for his or her physical needs, thus prolonging the recovery period. Also, a serious loss, difficult relationship, financial problem, or any stressful (unwelcome or even desired) change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder. Later episodes of illness typically are precipitated by only mild stresses, or none at all.

Depression in Women

Women experience depression about twice as often as men.1 Many hormonal factors may contribute to the increased rate of depression in women particularly such factors as menstrual cycle changes, pregnancy, miscarriage, postpartum period, pre-menopause, and menopause. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and for aging parents.

A recent NIMH study showed that in the case of severe premenstrual syndrome (PMS), women with a preexisting vulnerability to PMS experienced relief from mood and physical symptoms when their sex hormones were suppressed. Shortly after the hormones were re-introduced, they again developed symptoms of PMS. Women without a history of PMS reported no effects of the hormonal manipulation.6,7

Many women are also particularly vulnerable after the birth of a baby. The hormonal and physical changes, as well as the added responsibility of a new life, can be factors that lead to postpartum depression in some women. While transient "blues" are common in new mothers, a full-blown depressive episode is not a normal occurrence and requires active intervention. Treatment by a sympathetic physician and the family's emotional support for the new mother are prime considerations in aiding her to recover her physical and mental well-being and her ability to care for and enjoy the infant.

Depression in Men

Although men are less likely to suffer from depression than women, 6 million men in the United States are affected by the illness. Men are less likely to admit to depression, and doctors are less likely to suspect it. The rate of suicide in men is four times that of women, though more women attempt it. In fact, after age 70, the rate of men's suicide rises, reaching a peak after age 85.

Depression can also affect the physical health in men differently from women. A new study shows that, although depression is associated with an increased risk of coronary heart disease in both men and women, only men suffer a high death rate.2

Men's depression is often masked by alcohol or drugs, or by the socially acceptable habit of working excessively long hours. Depression typically shows up in men not as feeling hopeless and helpless, but as being irritable, angry, and discouraged; hence, depression may be difficult to recognize as such in men. Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or worksite mental health programs can be of assistance in helping men understand and accept depression as a real illness that needs treatment.

Depression in the Elderly

Some people have the mistaken idea that it is normal for the elderly to feel depressed. On the contrary, most older people feel satisfied with their lives. Sometimes, though, when depression develops, it may be dismissed as a normal part of aging. Depression in the elderly, undiagnosed and untreated, causes needless suffering for the family and for the individual who could otherwise live a fruitful life. When he or she does go to the doctor, the symptoms described are usually physical, for the older person is often reluctant to discuss feelings of hopelessness, sadness, loss of interest in normally pleasurable activities, or extremely prolonged grief after a loss.

Recognizing how depressive symptoms in older people are often missed, many health care professionals are learning to identify and treat the underlying depression. They recognize that some symptoms may be side effects of medication the older person is taking for a physical problem, or they may be caused by a co-occurring illness. If a diagnosis of depression is made, treatment with medication and/or psychotherapy will help the depressed person return to a happier, more fulfilling life. Recent research suggests that brief psychotherapy (talk therapies that help a person in day-to-day relationships or in learning to counter the distorted negative thinking that commonly accompanies depression) is effective in reducing symptoms in short-term depression in older persons who are medically ill. Psychotherapy is also useful in older patients who cannot or will not take medication. Efficacy studies show that late-life depression can be treated with psychotherapy.4

Improved recognition and treatment of depression in late life will make those years more enjoyable and fulfilling for the depressed elderly person, the family, and caretakers.

Depression in Children

Only in the past two decades has depression in children been taken very seriously. The depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel misunderstood. Because normal behaviors vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary "phase" or is suffering from depression. Sometimes the parents become worried about how the child's behavior has changed, or a teacher mentions that "your child doesn't seem to be himself." In such a case, if a visit to the child's pediatrician rules out physical symptoms, the doctor will probably suggest that the child be evaluated, preferably by a psychiatrist who specializes in the treatment of children. If treatment is needed, the doctor may suggest that another therapist, usually a social worker or a psychologist, provide therapy while the psychiatrist will oversee medication if it is needed. Parents should not be afraid to ask questions: What are the therapist's qualifications? What kind of therapy will the child have? Will the family as a whole participate in therapy? Will my child's therapy include an antidepressant? If so, what might the side effects be?

The National Institute of Mental Health (NIMH) has identified the use of medications for depression in children as an important area for research. The NIMH-supported Research Units on Pediatric Psychopharmacology (RUPPs) form a network of seven research sites where clinical studies on the effects of medications for mental disorders can be conducted in children and adolescents. Among the medications being studied are antidepressants, some of which have been found to be effective in treating children with depression, if properly monitored by the child's physician.8

DIAGNOSTIC EVALUATION AND TREATMENT

The first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview, and lab tests. If a physical cause for the depression is ruled out, a psychological evaluation should be done, by the physician or by referral to a psychiatrist or psychologist.

A good diagnostic evaluation will include a complete history of symptoms, i.e., 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. The doctor should ask about alcohol and drug use, and if the patient has thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and which were effective.

Last, a diagnostic evaluation should include a mental status examination to determine if speech or thought patterns or memory have been affected, as sometimes happens in the case of a depressive or manic-depressive illness.

Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression most often benefit from antidepressants. Most do best with combined treatment: medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems, including depression. Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe medication and/or one of the several forms of psychotherapy that have proven effective for depression.

Electroconvulsive therapy (ECT) is useful, particularly for individuals whose depression is severe or life threatening or who cannot take antidepressant medication.3 ECT often is effective in cases where antidepressant medications do not provide sufficient relief of symptoms. In recent years, ECT has been much improved. A muscle relaxant is given before treatment, which is done under brief anesthesia. Electrodes are placed at precise locations on the head to deliver electrical impulses. The stimulation causes a brief (about 30 seconds) seizure within the brain. The person receiving ECT does not consciously experience the electrical stimulus. For full therapeutic benefit, at least several sessions of ECT, typically given at the rate of three per week, are required.

Medications

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 (see section on Side Effects on page 13) 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.

Antianxiety 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.

Side Effects

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 tricyclic antidepressants, and ways to deal with them, are:

Dry mouthit is helpful to drink sips of water; chew sugarless gum; clean teeth daily.
Constipation bran cereals, prunes, fruit, and vegetables should be in the diet.
Bladder problems emptying the bladder may be troublesome, and the urine stream may not be as strong as usual; the doctor should be notified if there is marked difficulty or pain.
Sexual problems sexual functioning may change; if worrisome, it should be discussed with the doctor.
Blurred vision this will pass soon and will not usually necessitate new glasses.
Dizziness rising from the bed or chair slowly is helpful.
Drowsiness as a daytime problem this usually passes soon. A person feeling drowsy or sedated should not drive or operate heavy equipment. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.

The newer antidepressants have different types of side effects:

Headache this will usually go away.
Nausea this is also temporary, but even when it occurs, it is transient after each dose.
Nervousness and insomnia (trouble falling asleep or waking often during the night) these may occur during the first few weeks; dosage reductions or time will usually resolve them.
Agitation (feeling jittery) if this happens for the first time after the drug is taken and is more than transient, the doctor should be notified.
Sexual problems the doctor should be consulted if the problem is persistent or worrisome.

Herbal Therapy

In the past few years, much interest has risen in the use of herbs in the treatment of both depression and anxiety. St. John's wort (Hypericum perforatum), an herb used extensively in the treatment of mild to moderate depression in Europe, has recently aroused interest in the United States. St. John's wort, an attractive bushy, low-growing plant covered with yellow flowers in summer, has been used for centuries in many folk and herbal remedies. Today in Germany, Hypericum is used in the treatment of depression more than any other antidepressant. However, the scientific studies that have been conducted on its use have been short-term and have used several different doses.

Because of the widespread interest in St. John's wort, the National Institutes of Health (NIH) conducted a 3-year study, sponsored by three NIH components the National Institute of Mental Health, the National Center for Complementary and Alternative Medicine, and the Office of Dietary Supplements. The study was designed to include 336 patients with major depression of moderate severity, randomly assigned to an 8-week trial with one-third of patients receiving a uniform dose of St. John's wort, another third sertraline, a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, and the final third a placebo (a pill that looks exactly like the SSRI and the St. John's wort, but has no active ingredients). The study participants who responded positively were followed for an additional 18 weeks. At the end of the first phase of the study, participants were measured on two scales, one for depression and one for overall functioning. There was no significant difference in rate of response for depression, but the scale for overall functioning was better for the antidepressant than for either St. John's wort or placebo. While this study did not support the use of St. John's wort in the treatment of major depression, ongoing NIH-supported research is examining a possible role for St. John's wort in the treatment of milder forms of depression.

The Food and Drug Administration issued a Public Health Advisory on February 10, 2000. It stated that St. John's wort appears to affect an important metabolic pathway that is used by many drugs prescribed to treat conditions such as AIDS, heart disease, depression, seizures, certain cancers, and rejection of transplants. Therefore, health care providers should alert their patients about these potential drug interactions.

Some other herbal supplements frequently used that have not been evaluated in large-scale clinical trials are ephedra, gingko biloba, echinacea, and ginseng. Any herbal supplement should be taken only after consultation with the doctor or other health care provider.

PSYCHOTHERAPIES

Many forms of psychotherapy, including some short-term (10-20 week) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal exchange with the therapist, sometimes combined with "homework" assignments between sessions. "Behavioral" therapists help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's conflicted feelings. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.

HOW TO HELP YOURSELF IF YOU ARE DEPRESSED

Depressive disorders make one feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
Break large tasks into small ones, set some priorities, and do what you can as you can.
Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
Participate in activities that may make you feel better.
Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
Expect your mood to improve gradually, not immediately. Feeling better takes time.
It is advisable to postpone important decisions until the depression has lifted. Before deciding to make a significant transition change jobs, get married or divorced discuss it with others who know you well and have a more objective view of your situation.
People rarely "snap out of" a depression. But they can feel a little better day-by-day.
Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
Let your family and friends help you.

How Family and Friends Can Help the Depressed Person

The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication. The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

WHERE TO GET HELP

If unsure where to go for help, check the Yellow Pages under "mental health," "health," "social services," "suicide prevention," "crisis intervention services," "hotlines," "hospitals," or "physicians" for phone numbers and addresses. In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for an emotional problem, and will be able to tell you where and how to get further help.

Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.

Family doctors
Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
Health maintenance organizations
Community mental health centers
Hospital psychiatry departments and outpatient clinics
University- or medical school-affiliated programs
State hospital outpatient clinics
Family service, social agencies, or clergy
Private clinics and facilities
Employee assistance programs
Local medical and/or psychiatric societies

For More Information

Depression Information and Organizations from NLM's MedlinePlus (en Español)

REFERENCES

1 Blehar MD, Oren DA. Gender differences in depression. Medscape Women's Health, 1997;2:3. Revised from: Women's increased vulnerability to mood disorders: Integrating psychobiology and epidemiology. Depression, 1995;3:3-12.

2 Ferketick AK, Schwartzbaum JA, Frid DJ, Moeschberger ML. Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey. Archives of Internal Medicine, 2000; 160(9): 1261-8.

3 Frank E, Karp JF, Rush AJ (1993). Efficacy of treatments for major depression.Psychopharmacology Bulletin, 1993; 29:457-75.

4 Lebowitz BD, Pearson JL, Schneider LS, Reynolds CF, Alexopoulos GS, Bruce MI, Conwell Y, Katz IR, Meyers BS, Morrison MF, Mossey J, Niederehe G, Parmelee P. Diagnosis and treatment of depression in late life: consensus statement update.Journal of the American Medical Association, 1997; 278:1186-90.

5 Robins LN, Regier DA (Eds). Psychiatric Disorders in America, The Epidemiologic Catchment Area Study, 1990; New York: The Free Press.

6 Rubinow DR, Schmidt PJ, Roca CA. Estrogen-serotonin interactions: Implications for affective regulation. Biological Psychiatry, 1998; 44(9):839-50.

7 Schmidt PJ, Neiman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. Journal of the American Medical Association, 1998; 338:209-16.

8 Vitiello B, Jensen P. Medication development and testing in children and adolescents. Archives of General Psychiatry, 1997; 54:871-6.

by Cosmo | Thursday 8 June 2007 0:31 | General Blogging
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Alcoholics cannot learn to be 'social' drinkers

by James E. Royce

Can alcoholics be conditioned to drink socially? Under such titles as "harm reduction" and "moderation management" that old question has been resurrected. Moderate drinking is certainly a more appealing goal to many problem drinkers than total abstinence. But medical professionals and additions counselors are unanimous in their opposition. Are they just rigid prohibitionists?

As a lifetime member of the board of directors of the National Coucil on Alcoholism and Drug Dependence, I must point out that the big problem is that alcoholism is a progressive disease, often labeled as "problem drinking" in its early stages. Monday's cold is the flu on Wednesday and pneumonia on Friday. Most alcoholics are sure they can control their drinking on the next occasion. The result is killing alcoholics, who can expect a normal lifespan if they remain abstinent. For decades I have defined an alcoholics as one who says, "I can quit any time I want to." Self-deception is so typical of alcoholics that the American Society of Addiction Medicine included the term "denial" in its latest definition. Talk of harm reduction just feeds that denial.

Most research fails to adequately separate true alcoholics from alcohol abusers or problem drinkers, which makes reports of success misleading. We can't know how many of the latter may progress into true alcoholism. The most thorough research (Helzer and Associates, 1985) studied five- and seven-year outcomes on 1,289 diagnosed and treated alcoholics, and found only 1.6 percent were successful moderate drinkers. Of that fraction, most were female and none showed clear symptoms of true alcoholism. In any case, it would be unethical to suggest to any patient a goal with a failure rate of 98.4 percent.

We psychologists know that conditioning is limited in its ability to produce behavioral changes. To attempt to condition alcoholics to drink socially is asking of behavior modification more than it can do. Some have thought one value of controlled-drinking experiments could be that the patients learns for himself what he has not been able to accept from others, that he cannot drink in moderation — giving all that extra scientific help might destroy the rationalizations of the alcoholic who still thinks he can drink socially "if I really tried." Actually, most uses of conditioning in the field have been to create an aversion against drinking, to condition alcoholics to live comfortably in a drinking society and to learn how to resist pressure to drink. In that we have been reasonably successful, since this is in accord with the physiology and psychology of addiction.

The discussion about turning recovered alcoholics into social drinkers started in 1962, but no scientific research had been attempted until 1970, when Mark and Linda Sobell, two psychologist at Patton State Hospital in California with no clinical; experience in treating alcoholics, attempted to modify the drinking of chronic alcoholics, not as a treatment goal but just to see whether it could be done. The research literature is largely a record of failure, indicating that the only realistic goal in treatment is total abstinence.

The prestigious British alcoholism authority Griffith Edwards (1994) concluded that research disproved rather than confirmed the Sobell position. Drs. Ruth fox, Harry Tiebout, Marvin Block and M.M. Glatt were among the authorities who responded in a special reprint from the 1963 Quarterly Journal of Studies on Alcohol to the effect that never in the thousands of cases they had treated was there ever a clear instance of a true alcoholic who returned to drinking in moderation. Ewing (1975) was determined to prove it could be done by using every technique known to behavior modification, but he also did careful and lengthy followup — and at the end of four years every one of Ewing's subjects had gotten drunk and he called off the experiment. Finally, Pendery and Maltzman (AAAS Science, July 9, 1982) exposed the failure of the Sobell work, using hospital and police records and direct contact to show that 19 of the 20 subjects did not maintain sobriety in social drinking, and the other probably was not a true alcoholics to begin with.

THE RESEARCH of Peter Nathan indicates that whereas others may be able to use internal cues (subjective feelings of intoxication) to estimate blood-alcohol level while drinking, alcoholics cannot; so that method of control is not available to them. To ask a recovered addict to engage in "responsible heroin shooting" or a compulsive gambler to play just for small amounts is to ignore the whole psychology and physiology of addiction. Alcoholism is not a simple learned behavior that can be unlearned, but a habitual disposition that has profoundly modified the whole person, mind and body. That explains the admitted failure of psychoanalysis to achieve any notable success in treating alcoholics, and renders vapid the notion of Claude Steiner in "Games Alcoholics Play" that the alcoholic is a naughty child rather than a sick adult. Even the Sobells' claimed successful cases are now reported to have given up controlled drinking. For them abstinence is easier — for them trying to take one drink and stop is sheer misery. The reason is that one cannot "unlearn" the instant euphoric reinforcement that alcohol gives.

by Cosmo | Thursday 8 June 2007 0:25 | Addiction
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The 12th Step

THIS COVERS THE TWELFTH STEP

"Having had a spiritual experience as the result of these steps, we tried to carry this message to other alcoholics, and to practice these principles in all our affairs."

This STEP logically separates into 3 parts.

1. The SPIRITUAL EXPERIENCE.
The terms "spiritual experience" and "spiritual awakening" used here and in the book ALCOHOLICS ANONYMOUS, mean, upon careful reading, that the personality change sufficient to bring about recovery from alcoholism has manifested itself among us in many forms.
Do NOT get the impression that these personality changes, or spiritual experiences, must be in the nature of sudden and spectacular upheavals. Happily for everyone, this conclusion is erroneous.
Among our rapidly membership of thousands of alcoholics such transformations, though frequent, are by no means the rule. Most of our experiences are what the psychologist William James calls the "educational variety" because they develop slowly over a period of time. Quite often friends of the newcomer are aware of the difference long before he is himself.
The new man gradually realizes that he has undergone a profound alteration in his reaction to life; that such a change could hardly have been brought about by himself alone. What often takes place in a few months could seldom have been accomplished by years of self-discipline. With few exceptions our members find that they have tapped an unsuspected inner resource which they presently identify with their own conception of a Power greater than themselves.
Most emphatically we wish to say that any alcoholic capable of honestly facing his problem in the light of our experience can recover provided he does no close his mind to all spiritual concepts. He can only be defeated by an attitude of intolerance or belligerent denial.
We find that no one need have difficulty with the spiritual side of the program. Willingness, Honesty and Open Mindedness are the Essentials of Recovery. But these are indispensable.
2. CARRY THE MESSAGE TO OTHERS.
This means exactly what it says. Carry the message actively. Bring it to the man who needs it. We do it in many ways.
a. By attending EVERY meeting of our own group
b. By making calls when asked.
c. By speaking at Group Meetings when asked.
d. By supporting our Group financially to make group meetings possible.
e. By assisting at Meetings when asked.
f. By setting a good example of complete sobriety.
g. By owning, and loaning to new men, our own copy of the big A.A. Book.
h. By encouraging those who find the way difficult.
i. By serving as an officer or on group committees or special assignment when asked.
j. By doing all of the foregoing cheerfully and willingly.
k. We do any or all of the foregoing at some sacrifice to OURSELVES WITH DEFINITE THOUGHT OF DEVELOPING unselfishness in our own character.
3. WE PRACTICE THESE PRINCIPLES IN ALL OUR AFFAIRS.
This last part of the TWELFTH STEP is the real purpose that all of the twelve steps lead to-a new "way of life"; a "design for living." It shows how to live rightly, think rightly and to achieve happiness.
HOW DO WE GO ABOUT IT?
a. We resolve to live our life, one day at a time-just 24 hours.
b. We pray each day for guidance that day.
c. We pray each night-thanks for that day.
d. We resolve to keep our heads and to forego any anger, no matter what situation arises.
e. We are patient.
f. We keep calm-relaxed.
g. Now, and most important, whatever LITTLE ordinary situation as well as BIG situations arise, we look at it calmly and fairly, with an open mind. Then act on it in exact accordance with the simple true principles that A.A. has taught and will teach us.

In other words, our SOBRIETY is only a correction of our worst and most evident faults. Our living each day according to the principles of A.A. will also correct all of our other lesser faults and will gradually eliminate, one by one, all of the defects in our character that cause frictions, discontent, and unhappy rebellious moods that lead right back to our very chief fault of drinking.

by Cosmo | Thursday 8 June 2007 0:14 | Recovery
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Inventory and restitution - recovery continues.

INVENTORY AND RESTITUTION

STEP 4-"Make a searching and fearless moral inventory of ourselves." The intent and purpose of this step is plain. All alcoholics have a definite need for a good self-analysis-a sort of self-appraisal. Other people have certainly analyzed us, appraised us, criticized us and even judged us. It might be a good idea to judge ourselves, calmly and honestly. We need inventory because-

1. Either our faults, weaknesses, defects of character-are the cause of our drinking OR
2. Our drinking has weakened our character and let us drift into all kinds of wrong action, wrong attitudes, wrong viewpoints. In either event we obviously need an inventory and the only kink of inventory to make is a GOOD one.

Moreover, the job is up to US. WE created or WE let develop all the anti-social actions that got US in wrong. So WE have got to work it out. WE must make out a list of our faults and then We must do something about it.

The inventory must be four things-

1. It must be HONEST. Why waste time fooling ourselves with a phoney list. We have fooled ourselves for years. We tried to fool others and now is a good time to look ourselves squarely in the eye.
2. It must be SEARCHING. Why skip over a vital matter lightly and quickly. Our trouble is a grave mental disease, confused by screwy thinking. Therefore, we must SEARCH diligently and fearlessly to get at the TRUTH of what is wrong with us-just dig in and SEARCH.
3. It must be FEARLESS. We must not be afraid we might find things in our heart, mind and soul that we will hate to discover. If we do find such things they may be the ROOT of our trouble.
4. It must be a MORAL inventory. Some, in error, think the inventory is a lot of unpaid debts, plus a list of unmade apologies. Our trouble goes much deeper. We will find the root of our trouble lies in- resentments-False Pride-Envy-Jealousy-Selfishness and many other things. Laziness is an important one. In other words we are making an inventory of our character-our attitude toward others-our very way of living. We are not preparing a financial statement. We will pay our bills all right, because we cannot even begin to practice A.A. without HONESTY.

STEP 8-"Made a list of all persons we had harmed, and became willing to make amends to them all." Under this step we will make a list (mental or written) of those we have harmed.

We ask GOD to let His Will be done, not OUR will, and ask for the strength and courage to become willing to forget resentments and false pride and make amends to those we have harmed. We must not do this step grudgingly, or as an unpleasant task to be rid of quickly. We must do it WILLINGLY, fairly and humbly-without condescension.

STEP 9-"Made direct amends to such people wherever possible, except when to do so would injure them or others."

Here is where we make peace with ourselves by making peace with those we have hurt.

The amends we make must be direct. We must pay in kind for the hurt we have done them.

If we have cheated them we must make restitution.

If we have hurt their feelings we must ask forgiveness from them.

The list of harms done may be long but the list of amends is equally long.

For every "wrong" we have done, there is a "right" we may do to compensate.

There is only one exception. we must develop a sense of justice, a spirit of fairness, an attitude of common sense. If our effort to make amends would create further harm or cause a scandal we will have to skip the "direct amends" and clean the matter up under STEP 5.

HUMILITY

A state of complete humility is very difficult to attain, but the goal is well worth the effort, considering the serenity that is achieved.

by Cosmo | Thursday 8 June 2007 0:07 | Recovery
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Spirituality - the next steps after admitting to our problem

THE SPIRITUAL PHASE

STEP NO. 2-"Came to believe that a Power greater than ourselves could restore us to sanity."

Our drinking experience has shown-

1. That as we strayed away from the normal SOCIAL side of life, our minds became confused and we strayed away from the normal MENTAL side of life.
2. An abnormal MENTAL condition is certainly not SANITY in the accepted sense of the word. We have acquired or developed a MENTAL DISEASE. Our study of A.A. shows that-
a. In the MENTAL or tangible side of life we have lost touch with, or ignored, or have forgotten the SPIRITUAL values that give us the dignity of MAN as differentiated from the ANIMAL. We have fallen back upon the MATERIAL things of life and these have failed us. We have been groping in the dark.
b. No HUMAN agency, no SCIENCE or ART has been able to solve the alcoholic problem, so we turn to the SPIRITUAL for quidance.

Therefore, we "Came to believe that a Power greater than ourselves could restore us to sanity."

1. We must believe with a great FAITH.

STEP NO. 3-"Made a decision to turn our will and our lives over to the care of GOD as we understand Him." In the first step we learned that we had lost the power of CHOICE and had to make a DECISION.

1. What DECISION could we make better than to
a. Turn our very WILL over to GOD, realizing that our own use of our own will had resulted in trouble.
b. As in the Lord's Prayer you must believe and practice THY WILL BE DONE.
2. GOD as we understand Him.
3. RELIGION is a word we do not use in A.A. We refer to a member's relation to GOD as the SPIRITUAL. A religion is a FORM of worship-not the worship itself.
4. If a man cannot believe in GOD he can certainly believe in SOMETHING greater than himself. If he cannot believe in a POWER greater than himself he is a rather hopeless egoist.

STEP NO. 5-"Admitted to GOD, to ourselves, and to another human being the exact nature of our wrongs."

1. There is nothing new in this step. There are many sound reasons for "talking over our troubles out loud with others."
2. The Catholic already has this medium readily available to him in the Confessional.
But-the Catholic is at a disadvantage if he thinks his familiarity with confession permits him to think his part of A.A. is thereby automatically taken care of. He must, in confession, seriously consider his problems in relation to his alcoholic thinking.
3. The non-Catholic has the way open to work this step by going to his minister, his doctor, or his friend.
4. Under this step it is not even necessary to go to a priest or minister. Any understanding human being, friend or stranger will serve the purpose.
5. The purpose and intent of this step is so plain and definite that it needs little explanation. The point is that we MUST do EXACTLY what the Fifth Step says, sooner or later.
We must not be in a rush to get this step off our chest. Consider it carefully and calmly. Then get about it and do it.
6. "Wrongs" do not necessarily mean "crime. It can well be wrong thinking-selfishness-false pride-egotism-or any one of a hundred such negative faults.

STEP NO. 6-"We are entirely ready to have God remove all these defects of character."

1. After admitting our wrong thinking and wrong actions in Step 5 we now do something more than "admit" or "confess."
2. We now become READY and WILLING to have God remove the defects in our CHARACTER.
3. Remember it is OUR character we are working on. Not the other fellow's. Here is a good place to drop the CRITICAL attitude toward others-the SUPERIOR attitude toward others.
4. We must clean our mind of wrong thinking-petty jealousy-envy-self pity-remorse, etc.
5. Here is the place to drop RESENTMENTS, one of the biggest hurdles the alcoholic has to get over.
6. What concerns us here is that we drop all thoughts of resentment-anger-hatred-revenge.
7. We turn our WILL over to God and let HIS WILL direct us how to patiently remove, one by one, all defects in our character.

STEP NO. 7-"Humbly asked Him to remove our shortcomings." The meaning of this step is clear. Prayer-Humility.

1. Prayer. No man can tell another HOW to pray. Each one has, or works out for himself, his own method.
If we cannot pray, we just talk to God and tell Him our troubles.
Meditate-think clearly and cleanly-and ask God to direct our thoughts. Christ said "ask and ye shall receive." What method is simpler-merely "ask."
If you cannot pray ask God to teach you to pray.
2. Humility. This, simply, is the virtue of being ourselves and realizing how small we are in a big world full of its own trouble.
Drop all pretense. We must not be Mr. Big Shot-bragging, boasting. Shed false pride. Tell the simple, plain, unvarnished truth. Act, walk and talk simply. See the little bit of good that exists in an evil man. Forget the little bit of evil that exists in the good man. We must not look down on the very lowest of GOD'S creatures or man's mistakes. Think clearly, honestly, fairly, generously.
3. The shortcomings we ask GOD to remove are the very defects in character that make us drink. The same defects we drink to hide or to get away from.

STEP NO. 11-"Sought through prayer and meditation to improve our conscious contact with GOD as we understood HIM praying only for knowledge of His will for us and the power to carry that out."

1. We pray each night-every night-a prayer of thanks.
2. We pray each morning-every morning-for help and guidance.
3. When we are lonely-confused-uncertain-we pray.

Most of us find it well to:

1. Choose, for each day, a "quite time" to meditate on the program, on your progress in it.
2. Keep conscious contact with GOD and pray to make that contact closer.
3. Pray that our will be laid aside and that God's will direct us.
4. Pray for calmness-quiet-relaxation-rest.
5. Pray for strength and courage to enable us to do today's work today.
6. Pray for forgiveness for yesterday's errors.
7. Ask for HOPE for better things tomorrow.
8. Pray for what we feel we need. We will not get what we "want." We will get what we "need"-what is good for us.

CONCLUSION

We find that no one need have difficulty with the spiritual side of the program. WILLINGNESS-HONESTY and OPEN MINDEDNESS are the ESSENTIALS OF RECOVERY. BUT THESE ARE INDISPENSABLE.

by Cosmo | Thursday 8 June 2007 0:04 | Recovery
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Admitting to our problem - the first step

WE ADMIT

If, after carefully considering the foregoing, we ADMIT we are an alcoholic (addicted to drugs, gambling, sex etc) we must realize that-

Once a person becomes a pathological drinker, he can never again become a controlled drinker; and-from that point on, is limited to just two alternatives:

1. Total permanent abstinence.
2. Chronic alcoholism with all of the handicaps and penalties it implies. In other words-we have gone past the point where we HAD A CHOICE.

All we have left is a DECISION to make.

WE RESOLVE TO DO SOMETHING ABOUT IT

1. WE MUST CHANGE OUR WAY OF THINKING. (This is such an important matter that it will have to be discussed more fully in a later discussion.)
2. We must realize that each morning, when you wake, you are a potential drunkard for that day.
3. We resolve that we will practice A.A. for the 24 hours of that day.
4. We must study the other eleven Steps of the Program and practice each and every one.
5. Attend the regular Group Meeting each week without fail.
6. Firmly believe that by practicing A.A. faithfully each day, we will achieve sobriety.
7. Believe that we can be free from alcohol as a problem.
8. contact another member BEFORE taking a drink-not AFTER. Tell him what bothers you-talk it over with him freely.
9. Work the Program for ourselves alone-NOT for our wife, children, friends or for our job.
10. Be absolutely honest and sincere.
11. Be fully open minded-no mental reservations.
12. Be fully willing to work the Program. Nothing good in life comes without work.

CONCLUSION

1. Alcoholics are suffering from a MENTAL DISEASE-not a physical illness. Fortunately we in A.A. have learned how it may be controlled (this will be shown in the next eleven Steps of the Program.)
2. We can also learn to be FREE from alcohol as a problem.
3. We can achieve a full and happy life without recourse to alcohol.

by Cosmo | Thursday 8 June 2007 0:02 | Recovery
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Why does an alcoholic drink ?

WHY DOES AN ALCOHOLIC DRINK?

Having decided that we are alcoholics, it is well to consider what competent mental doctors consider as the REASONS why an Alcoholic drinks.

1. As an escape from situations of life which he cannot face.
2. As evidence of a maladjusted personality (including sexual maladjustments)
3. As a development from social drinking to pathological drinking.
4. As a symptom of a major abnormal mental state.
5. As an escape from incurable physical pain.
6. As a symptom of constitutional inferiority-a psychopathic personality. For example, an individual who drinks because he likes alcohol, knows he cannot handle it, but does not care.
7. Many times one cannot determine any great and glaring mechanism as the basis of why the drinker drinks; but the revealing fact may be elicited that alcohol is taken to relieve a certain vague restlessness in the individual incident to friction between his biological and emotional make-up and the ordinary strains of life.

The above reasons are general reasons. Where the individuality or personality of the alcoholic is concerned these reasons may be divided as follows-

1. A self-pampering tendency which manifests itself in refusal to tolerate, even temporarily, unpleasant states of mind such as boredom, sorrow, anger, disappointment, worry, depression, dissatisfaction, and feelings of inferiority and inadequacy. "I want what I want when I want it" seems to express the attitude of many alcoholics toward life.
2. An instinctive urge for self-expression, unaccompanied by determination to translate the urge into creative action.
3. An abnormal craving for emotional experiences which calls for removal of intellectual restraint.
4. Powerful hidden ambitions, without the necessary resolve to take practical steps to attain them and with resultant discontent, irritability, depression, disgruntledness and general restlessness.
5. A tendency to flinch from the worries of life and to seek escape from reality by the easiest means available.
6. An unreasonable demand for continuous happiness or excitement.
7. An insistent craving for the feeling of self-confidence, calm and poise that some obtain temporarily from alcohol.

by Cosmo | Thursday 8 June 2007 0:01 | Addiction
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Addiction Questionaire

Use these questions as a guide for yourself. For those that do not suffer from drinking alcohol - Substitude 'drugs' or 'gambling' or sex' or whatever your affliction may be.

1. Do you require a drink the next morning?
2. Do you prefer to drink alone?
3. Do you lose time from work due to drinking?
4. Is your drinking harming your family in any way?
5. Do you crave a drink at a definite time daily?
6. Do you get the inner shakes unless you continue drinking?
7. Has drinking made you irritable?
8. Does drinking make you careless of your family's welfare?
9. Have you harmed your husband or wife since drinking?
10. Has drinking changed your personality?
11. Does drinking cause you bodily complaints?
12. Does drinking make you restless?
13. Does drinking cause you to have difficulty in sleeping?
14. Has drinking made you more impulsive?
15. Have you less self-control since drinking?
16. Has your initiative decreased since drinking?
17. Has your ambition decreased since drinking?
18. Do you lack perseverance in pursuing a goal since drinking?
19. Do you drink to obtain social ease? (In shy, timid, self-conscious individuals.)
20. Do you drink for self-encouragement? (In persons with feelings of inferiority.)
21. Do you drink to relieve marked feeling of inadequacy?
22. Has your sexual potency suffered since drinking?
23. Do you show marked dislikes and hatreds since drinking?
24. Has your jealousy, in general, increased since drinking?
25. Do you show marked moodiness as a result of drinking?
26. Has your efficiency decreased since drinking?
27. Has your drinking made you more sensitive?
28. Are you harder to get along with since drinking?
29. Do you turn to an inferior environment since drinking?
30. Is drinking endangering your health?
31. Is drinking affecting your peace of mind?
32. Is drinking making your home life unhappy?
33. Is drinking jeopardizing your business?
34. Is drinking clouding your reputation?
35. Is drinking disturbing the harmony of your life?

If you have answered YES to any one of the Test Questions, there is a definite warning that you may be alcoholic. If you have answered YES to any two of the Test Questions the chances are that you are an alcoholic.

If you answered YES to three or more of the Test Questions you are most likely are AN ALCOHOLIC.

NOTE: The Test Questions are not A.A. Questions but are the guide used by Johns Hopkins University Hospital in deciding whether a patient is alcoholic or not.

In addition to the Test Questions we in A.A. would ask even more questions. Here are a few-

36. Have you ever had a complete loss of memory while, or after drinking?
37. Have you ever felt, when or after drinking, an inability to concentrate?
38. Have your ever felt "remorse" after drinking?
39. Has a physician ever treated you for drinking?
40. Have you ever been hospitalized for drinking?

Many other questions could be asked but the foregoing are sufficient for the purpose of this instruction.

by Cosmo | Wednesday 7 June 2007 23:59 | Addiction
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SoberDownUnder Blogging

- OK -

Blogging is now up and running on SoberDownUnder.com !

Use the Blog Admin link in the navigation panel to add blog entries.

Have Fun !

Cosmo

by Cosmo | Tuesday 6 June 2007 8:49 | General Blogging
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Welcome to SoberDownUnder Blogging

This is the first Blog entry !

Hello everyone !

by sdu_admin | Saturday 3 June 2007 14:00 | General Blogging
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Annie
16. December 2009
Hi! my name is Annie and I need some help and guidance to give up alcohol. I am a binge drinker and would like to know how to get off the stuff for good. I have a partner who will help me but where

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Hi Im edmond and here is my musical gift of friendship to all. http://reverbnation.com/t
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Fiona J T
15. September 2009
Hello - my name is Fiona and I am due to start a job in the Northern Territories next week coming from the UK. I am keen to ensure I build myself a strong network of recovering alcoholics to share my

jonnybelfast
01. September 2009
Hey Lolly, Welcome. Tell us a bit about yourself. Jonny

Candy
16. August 2009
If at first you don't succeed...try try again

jonnybelfast
21. July 2009
Hey Candy,Sorry to hear you wrote in vain. I've now emptied the trash, try going to your outbox and re sending hope you are going well. Jonny

jonnybelfast
13. July 2009
All intelligent thoughts have already been thought; what is necessary is only to try to think them again. Goethe

Candy
13. July 2009
Thank God for that. I wrote an essay in vain to both jonnybelfast and cosmo. Hey Johnny SP! Wazzup!

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Consider it done.I look forward to hearing from you Johnny SP!!

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johnny belfast clear out your inbox it wouldnt let me send a msg said you were all full up

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Emotions - How To Understand, Identify Release Your Emotions.

· What Are Emotions – Feelings?

· Why Bother With Emotions:

· Belief Systems

· Other People, Places, and Things Cannot Change How You Feel

· Emotions Are Not the Only Cause of Illness

· Two Basic Emotions In Life – Love and Fear

· Physical Effects of Emotions

· You Cannot Control Your Emotions

· The Difference Between Core Issues and Emotions

· Emotions and Emotional Abuse

· “Go South” – Feeling Your Feelings

· How We Repress Emotions

· Symptoms of Repressed Emotions

· Effects of Repressed or Buried Emotions

Committing To Emotional Health

· Methods To Identify Your Emotions

· How To Release Emotions

· Conclusion

Gene variant increases risk for alcoholism following childhood abuse

More women seek treatment for alcoholism

Eating Disorders: Facts About Eating Disorders and the Search for Solutions

Anorexia Nervosa

Bulimia Nervosa

Binge-Eating Disorder

Treatment Strategies1

Research Findings and Directions

For More Information

References

Bipolar Disorder

Introduction

What Are the Symptoms of Bipolar Disorder?

Signs and symptoms of mania (or a manic episode) include:

Signs and symptoms of depression (or a depressive episode) include:

Diagnosis of Bipolar Disorder

Suicide

If you are feeling suicidal or know someone who is:

What Is the Course of Bipolar Disorder?

Can Children and Adolescents Have Bipolar Disorder?

What Causes Bipolar Disorder?

How Is Bipolar Disorder Treated?

Medications

Treatment of Bipolar Depression

Thyroid Function

Medication Side Effects

Psychosocial Treatments

Other Treatments

A Long-Term Illness That Can Be Effectively Treated

Do Other Illnesses Co-occur with Bipolar Disorder?

How Can Individuals and Families Get Help for Bipolar Disorder?

What About Clinical Studies for Bipolar Disorder?

For More Information

Addendum to Bipolar January 2007

References

Anxiety Disorders

Introduction

Panic Disorder

Obsessive-Compulsive Disorder

Post-Traumatic Stress Disorder (PTSD)

Social Phobia (Social Anxiety Disorder)

Specific Phobias

Generalized Anxiety Disorder (GAD)

Treatment of Anxiety Disorders

Medications

Antidepressants

SSRIs

Tricyclics

MAOIs

Anti-Anxiety Drugs

Beta-Blockers

Psychotherapy

Cognitive-Behavioral Therapy

TAKING MEDICATIONS

How to Get Help for Anxiety Disorders

Ways to Make Treatment More Effective

Role of Research in Improving the Understanding and Treatment of Anxiety Disorders

References

Depression

WHAT IS A DEPRESSIVE DISORDER?

TYPES OF DEPRESSION