Antidepressants Blog

If you are courting now, or if you have accepted my invitation to re-court with your spouse by discussing the issues raised in this chapter, I suggest that the following five systems rules replace the hypocritical, distancing rules that you read at the beginning of this chapter.

Never Lie

Right from the beginning, tell the truth, nothing but the truth, so help your present or future marriage. Give the gift of self-represen-tation. Don’t even tell little white lies; lies of any color are still lies. In courtship, in marriage, and in every religious system in the world, integrity is the key. Remember the material in Chapter One on the “protective insult” and how damaging that can be to love. Some lies may maintain some marriages, keep them surviving, but they never make for a super marriage.

My colleagues suggest that it is unwise to disclose extramarital affairs. They say this is only a “guilt dumping” on the partner, a way of clearing one’s own conscience at the emotional expense of that partner. They say that the affair is irrelevant; just go to work on the marriage.

I say that such an approach is totally without support in the literature. It is opinion, and it helps a marriage survive, but not thrive. It will never work for making a super marriage, for super marital sex. It is just another form of the protective insult that can block the “psychasms” I will describe later. The question is how to deal with major problems in marriage, not how to cover them up and go on. Having sex outside of marriage is not irrelevant; it is a major obstacle to super marital sex, and that applies to extramarital sex of both Types I and II.

“There has never been anything like this in our marriage,” reported the husband. “We seem to be more open than ever. The honesty seems to be arousing, sort of a stimulant. I guess truth is an aphrodisiac. I carried that burden for so long and wondered why I felt incomplete in my marriage. Now I know it was because I was not completely in my marriage. It was a risk, but it was worth it, a risk for love. I took a risk for sex, had sex outside my marriage. At least I should be willing to take this risk for love.”

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Nightmares occur during REM sleep and the child or adult wakes and can remember not only at that time but the next day, most of the details of the dream which caused the awakening.

Sleep paralysis, or hallucination to sight and sound may occur in children and adults and it is often most marked when they are just drifting off to sleep.

They are of no significance but may cause anxiety.

Narcolepsy is a specific disorder with episodes of severe lethargy during the day so that the person must sleep.

This sleep can last for minutes or hours and may recur throughout the day.

Probably the worst treatment for insomnia is to get into the habit of taking sleeping tablets.

These are satisfactory for the short term, taken for a few nights or even a week or two, but if their use is prolonged beyond this then dependence and tolerance may develop.

Most people with sleep problems just need simple reassurance and help in modifying their habits so as to gain the benefits of a good night’s sleep.

For others with marked disturbance it may be necessary to refer them to special clinics which are being developed in many major hospitals.

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Injections of a hormone prepared from the urine of pregnant women, chorionic gonadotrophin or HCG, has been popular in some weight reducing clinics. But controlled studies have shown that it is the diet, the daily visits to the clinic and the encouragement the patients receive that causes the weight loss — and not the injection.

Motivation is all-important in losing weight. Overweight people who have had a heart attack usually lose weight rapidly and maintain their ideal weight. The aim should be to provide that motivation before the heart attack.

I think it is important for the person trying to lose weight to have the help and encouragement of someone else. If this is to be the doctor, then he or she needs to see the patient regularly to check weight loss, encourage, praise, cajole or abuse the patient.

Some patients react better to one of these methods than to others. Some need all measures at different times. Group therapy can be useful and this is why self-help organisations such as Weight Watchers have success.

Many people will seek less orthodox means and have acupuncture or hypnosis to help them control their eating. Others have had their jaws wired together so they cannot eat solid food. Some people even resort to surgery to lose weight. There is an operation called an apronectomy where the surgeon can remove the apron of fat from the abdomen. It certainly is a quick, if expensive, way to shed 10 kg.

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Infantile eczema or atopic dermatitis may produce a rash on the limbs, the trunk, the nappy area and even the face.

It may be dry and red or weeping and crusting.

This skin condition is one of the atopic diseases which have a strong family history, and include asthma, hayfever, sometimes migraine and, of course, eczema.

In some families there may be little evidence of the disorder but in others most or all of the members suffer from one or more of these disorders.

The role of allergy in atopic dermatitis in infants is difficult to evaluate. Some may be allergic to cow’s milk, or to other foods, but this is unusual.

What is definite is that breast-feeding tends to delay the development of eczema, and the outbreak is usually not as severe.

Rubbing and scratching may break the skin and lead to secondary infection. Repeated scratching in children and also in adults may lead the skin to become thick and dry and this increases the itch, so a vicious cycle becomes established.

Due to a disturbance in the immune system of the body associated with this disorder, general infection and infection of the skin is common.

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So, for example, what do we see on a chest X-ray? The air in i he lungs and around the body looks black, because all the X-rays get through the air. The heart and big blood vessels look greyish-white (a few X-rays get through). The bones of the ribs and spine look very white (hardly any of the X-rays get through). A solid irea in the lung is easy to see. It looks white against the black of the air in the normal lung around it. Weaknesses in bones are also fairly easy to see— more X-rays get through the softer bone. The weakened part shows as a grey area in the normal white bone. Because very few X-rays get through bones and some of the lurger organs, it is often necessary to take X-rays from more than one angle to get a complete picture. For example, if we want to Bee’ the part of the lungs that lies behind the heart we need to lake an extra X-ray from the side of the body as well as the front-to-back one.

Unfortunately, in many parts of the body it is very hard to see an abnormality on a simple X-ray. This is the case when the abnormality lets through as many X-rays as the normal part, because it is the same density. For example, cancer spots in the I idney are not much harder or softer than the normal kidney. On in X-ray they come out white and so does the normal kidney.

This means you can’t see them. The same applies to the brain, liver, stomach, bowel, pancreas and many other organs. What can we do to overcome this problem?

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Pregnancy. Pregnancy and body weight increases are intertwined in a complicated pattern. Female fat stores have a primary function to provide energy for pregnancy and lactation. A pregnant woman requires approximately 130 000 kcal extra as the metabolic cost of pregnancy. Women who tend to put on too much fat in the early stages of pregnancy have been shown to keep this longer than those who do not put on excessive fat, or put on most fat later in the pregnancy. The recommended weight gain during pregnancy by the US medical specialists has risen from 7-Skg in the 1920s to 10-12kg in the 1970s. In 1989, the National Task Force on Prevention and Treatment of Obesity raised the recommendations to 14-16kg in 1995. However, there are now suggestions by some experts that this is too much and that the most recent recommendations are based simply on the modern average weight gain of pregnant women in the US. The previously recommended gain of 10-12kg has been suggested as a more appropriate health ideal for which to aim.

Breast-feeding is also known to be an effective form of fat burning, using up to 400kcal of energy per day. In one study carried out in the US, women who breast-fed for at least six months stayed leaner for up to two years than women who did not breast-feed at all or did so for less than six months. It has also been claimed that the risk of obesity increases with parity or the number of childbirths. This may be due to the repetitive exposure to the fat storing hormones of pregnancy, restrictions on physical activity or increased opportunity to eat more. In any case, for some women, pregnancy does appear to be a particularly high risk period for increases in obesity.

Research from the Stockholm Pregnancy and Weight Development Study in Sweden suggests that the greater the weight gain during pregnancy, the more likely the increase in post-partum body fat levels. Cessation of smoking with the onset of pregnancy may increase weight gain in the mother (although it certainly reduces the risk of birth complications in the baby). Those women who gained most weight during and after pregnancy were found to be those who had significantly changed their lifestyle from prepregnancy levels such as increased eating/snack eating and decreased levels of physical activity. Maintenance of physical activity through pregnancy and attention to nutrition, therefore, are most important to ensure a return to normal fat levels, but there are also special considerations for exercise which need to be considered. These are now available from most Health Departments.

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What happens to the space occupied by my uterus?

Women often wonder if an empty space remains after a hysterectomy, but you can be sure this does not occur. Organs such as the bladder, bowel and intestine reposition themselves and take up the space.

I have heard that some women get depressed after a hysterectomy. How likely is this to happen?

Recent studies suggest that, overall, rates of depression in women who have a hysterectomy are less than they were in the same women before they had the operation. In individual cases, however, depression may be increased due to complications of the operation or regrets about having it. Hysterectomy can actually reduce levels of depression in women for whom the operation relieves painful and heavy periods.

How can I improve my health before having a hysterectomy?

Avoid smoking, have regular physical activity, and keep your weight under control. Doing these things reduces the risks associated with surgery and post-operative complications. If you are having heavy bleeds, you should take iron supplements to increase your haemoglobin level.

Will I have an early menopause if I have a hysterectomy hut keep my ovaries?

In theory, removal of the uterus and cervix, but not the ovaries, should not produce menopause. The only change should be an end to your periods and removal of the problems that made the surgery necessary.

In practice, however, a significant number of women whose ovaries remain after this sort of hysterectomy do experience symptoms of menopause up to four years earlier than might be expected. Possible explanations are that the surgery inadvertently altered the blood supply to your ovaries, or the condition that caused you to have a hysterectomy in the first place, such as endometriosis or cysts, had already reduced the natural life of your ovaries.

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It is interesting to observe that some people fall asleep very easily, but some find it very difficult and need sleeping pills. Even the same person may fall asleep very easily at some times in his life but find it very difficult at other times. Why is this?

There are two sets of forces acting against each other which affect sleep onset One group of forces includes good sleep hygiene, falling asleep at the right time of the biological clock, and, of course, being sleepy. The other group of forces includes poor sleep hygiene, trying to fall asleep at the wrong time of the biological clock, being unable to handle stress effectively, and, of course, having a genetic makeup that is of poor quality for sleeping. It is important to increase those forces that facilitate sleep onset and to decrease those that oppose it.

Genetic make-up. Studies of identical twins show that much of our ability to sleep is coded in our genes. Identical twins, who have the same genes, have similar sleep patterns even if they live apart in different environments for years. Some people are born good sleepers and they can sleep at any time of the day and, in fact, anywhere. My wife is a good sleeper, and she could sleep easily at any time no matter what shift duty she was on when she was working as a nurse in the general hospital. My two daughters have different abilities to fall asleep. Melissa is more like me, whereas Melinda sleeps easily, very much like her mother. But for those of us who are not so lucky and have poor quality genes for sleep, we have to improve those factors that facilitate sleep onset so as to tip the balance in favour of the forces that bring about sleep.

Sleep hygiene. This is the most important force in facilitating sleep onset As discussed in chapter 15, Sleep Hygiene, caffeine is the number one enemy; absolutely no coffee or tea. The bedroom is reserved for sleep and sex and no other activities. Leave the clock under the bed, but set the alarm to the same time every morning, even on Sundays and public holidays. A regular waking up time in the morning is an important Zeitgeber for entraining our circadian rhythm to the 24 hour clock. Daytime exercises are good, as they increase the amounts of NREM sleep.

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When there is no clear cause for the condition, patients suffering from chronic pain are sometimes referred to a psychiatrist for his opinion. When these patients really unburden themselves they often disclose that they are preoccupied in thinking about some wrong they have done in the past. Over the years they have thought about it a great deal, and in thinking about it in this way, the wrong becomes greatly magnified. They have never told anyone about it. “This is something that I always thought I would bring with me to the grave.” And all the time there has been the thought, “Of course I shall be punished for it.” In the first place the pain may have arisen from some quite trivial cause; but once the pain is there, it soon becomes fixed. Only

half-consciously he thinks, “This is what I have been expecting; I knew it had to come; I am glad it has come at last and I shall get it over.” In a sense he is glad of the pain. By suffering the pain he will ease his conscience of the thing that he has done, and his mind will be at rest again.

On the one hand a patient in this situation wants to get rid of the pain because it hurts him, but on the other hand he wants to keep it, as it expiates his feeling of guilt. The pain lingers on, unrelieved by the various medicines he is given. Expiation never seems complete, so it continues until brought to light and worked through in psychotherapy.

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Q. What other forms of medication are used?

A. The Histamine ft-receptor antagonists are currently the most widely used drugs for peptic ulcers. Nevertheless, a form of medication called tri-potassium di-citrato bismuthate (colloidal bismuth) is also claimed to produce very good results. It is said to be about as effective as cimetidine, but until recently the only form available was an unpleasant tasting liquid which had a strong ammoniacal odour. It is now available as a chewable tablet and this has improved patient compliance. There is little doubt that if a person does not like his medication, , he often will not take it. He will invariably lie to the doctor and say he is taking the prescribed medication!

Q. Does it have adverse side effects?

A. Every medication has some side effects in someone as we have already pointed out. However, like cimetidine, these are small and fairly unimportant, at least in the known short term. It may stain porcelain teeth fillings, colour the tongue and cause the stools to turn a strange dark grey. It is taken well before meals. Its effect is negated by the presence in the stomach of food, milk or antacids, so it is essential these are not taken at the same time, or indeed probably within an hour or two either way.

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