Antidepressants Blog

Myalgic encephalomyelitis is rather a mouthful, so it is often abbreviated to ME.

Myalgia means painful muscles, and encephalomyelitis means inflammation of the brain and spinal nerves.

This disease is uncommon and the cause unknown, but it is believed to be either a viral infection or a reaction of the body to recent infection with a virus.

The symptoms vary widely and are often present without specific signs. It is not surprising that many sufferers have been thought to be overreacting to some simple illness or to have emotional rather than physical problems.

Following what appears to be a simple respiratory or bowel infection, the symptoms of ME may come on suddenly or slowly.

There may be headache and muscle pains, but particularly muscle weakness and fatigue.

While there may be sporadic cases, often there is a minor epidemic with a cluster of cases eventually being recognised.

There is no specific treatment. Most sufferers do get better, but relapses are common. In a few, the condition runs a chronic course.

Both sexes and all age groups are susceptible.

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Diabetes predisposes a person to the earlier development of cataract. In most cases, the opacity is present in both eyes although one may be more advanced than the other.

To the sufferer, it seems as if he is looking through glass which is gradually frosting. Even when fully developed, light can always be perceived and shadowy movements may be seen.

The opacity is more marked in the middle of the lens so that vision is often better in dim light when the pupil is dilated and vision is perceived through the edges of the lens.

In bright light, the pupil contracts and light entering the eye must pass through the centre of the lens where the opacity is more marked and so vision is not as clear.

Because the cataract progresses so slowly, treatment may not be necessary for years. Operation is the only effective treatment. Vitamins or drops are of no use. At operation, the lens and sometimes its capsule are removed.

The operation may be done under local or general anaesthetic. After this glasses are necessary to focus the light rays on the retina.

A newer operation is the insertion of an artificial lens following removal of the opaque natural one. This removes the need for thick glasses which may distort vision.

The timing of the operation may depend on how far the vision has deteriorated, the level of vision in the other eye and how important clear vision is to the lifestyle of the person.

The use of contact lenses after the removal of cataracts in association with glasses may avoid the need for very thick glasses and improve vision.

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Don’t feel stupid about asking for information to be explained in a different way and/or repeated as many times as you need. No reasonable person would expect you to understand and remember everything after being told only once.

Many patients hold back from asking questions because they are worried about looking ignorant or stupid. If you don’t understand what your practitioner tells you it is because, whether deliberately or not, he or she hasn’t explained it well enough. Communicating effectively should be an important part of your practitioner’s responsibilities. He or she should be prepared to persevere until you do understand what is being said.

Nothing is so complex that it can’t be made perfectly understandable by someone who is willing to share it with you. It is possible that your practitioner is so familiar with certain words that he or she has forgotten that a non-medical person doesn’t know what they mean. You are not an expert and can’t be expected to understand medical terms so just say if you don’t understand. Sometimes a practitioner uses technical words to cover up his or her own emotions when giving bad news. You might have to help your practitioner by making it very clear that you want straight answers.

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Cancer can be produced by chronic irritation of the skin. In England, in 1775, Dr Percival Pott described cancer of the scrotum in chimneysweeps which was caused by soot. Natives of the northern Himalayas who carry canisters of hot charcoal next to the skin of their abdomens to keep warm, develop cancer in this area. In Australia, sun-exposed areas of skin commonly develop skin cancer.

The word ‘carcinogen’ has become all too familiar in recent years. A carcinogen is something that causes cancer. In our society, sunlight is the most common carcinogen, it being the leading cause of skin cancer which is the most common form of all cancers. (Despite being the most common form of cancer, skin cancer causes only about 2 per cent of all cancer deaths, and such cases could virtually all be prevented.)

Skin cancer is predominantly caused by chronic cell injury induced by prolonged exposure to infra-red and ultraviolet radiation. There is usually, however, quite a long latent period or delay between the exposure to solar radiation and the appearance of skin cancer. The energy from this UVA and UVB radiation is absorbed at various levels of the epidermis, causing cellular damage. Most of the damage occurs in the genetic material known as DNA, which enables cells to duplicate themselves. In most cases a cell manages to repair this damage. Eventually though, it may not be able to do so, in which case the cell may die, contributing to the appearance of premature skin ageing, or may change its character completely. Such changes in cells are called mutations, and some of these mutations may be cancerous.

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‘The psychological problems [of the menopause] tend to be insidious and can impair a woman’s ability to her domestic and work environment . . . They can destroy self-confidence and self-esteem and are an incomprehensible low point in the lives of previously well-adjusted and competent women.’ from The Menopause, J. Studd and M. Whitehead (eds.), 1988.

‘The only word I can use to describe how I felt during this period is wretched. I work in a doctor’s surgery and spend my working day in contact with the patients. I was moody, bad-tempered and thoroughly unpleasant to everyone – yet I couldn’t stop myself being tike that. My feelings about myself reached rock-bottom and my normal self-confidence disappeared completely until I could hardly bring myself to get out of bed in the morning. I think if I’d worked anywhere else I would have lost my job within a few weeks; but luckily the menopause specialist nurse in the practice recognised my changed personality for what it was, suggested I asked my GP about HRT, and I’m now back in the human race again.’

If you have had a similar experience, you are not alone. A great many women between the ages of 40 and 60 find they become moody, unable to concentrate, and very tired. Many of the psychological problems of the menopause are due to night sweats causing disturbed sleep, and will resolve themselves once broken nights come to an end. Others are due more directly to the loss of oestrogen. Part of the brain contains many oestrogen receptors, and if oestrogen levels fall, mood changes may occur; once the oestrogen is replaced by HRT, most women find their confidence and self-esteem restored and their problems with mood swings, forgetfulness and anxiety considerably alleviated. HRT is not as reliable in improving these complaints as it is for flushes and sweats, but if your general wellbeing and feelings about yourself have taken a plunge, then it’s worth asking about HRT. It won’t, however, do anything to alleviate depression, anxiety or unhappiness that existed before the menopause, and which is not due to lowered levels of oestrogen.

Oestrogen seems to have a ‘mental tonic5 effect, and lowered levels of the hormone during and after the menopause can lead to a whole range of psychological problems, such as:

• less energy and drive

• irritability

• mood changes

• headaches

• feelings of unworthiness

• loss of self-esteem

• loss of self-confidence

• feeling unable to cope

• difficulty in concentrating

• feelings of aggressiveness

• depression

• anxiety

• forgetfulness

• fear of loneliness

• unusually prone to tears

• loss of libido (sex drive)

There are still too many doctors who, faced in the surgery with a woman aged between 40 and 60 complaining about any of these problems, will say, ‘I’m afraid it’s just your age, my dear,’ or ‘You’ll just have to live with it -there’s nothing I can give you that a good night’s sleep/doing some voluntary work/joining an evening class won’t cure.”‘ And he writes out a prescription for some antidepressants and hopes she won’t bother him again. (In this book, the doctor is depicted as male, simply to avoid confusion with the patient who, in matters concerning the menopause, is inevitably female.)

Prescribing tranquillisers and anti-depressants for problems in the mind that are caused by a fall in oestrogen is difficult to justify. Yet for many women, even nowadays, that is all they get, and then everyone is surprised that it seldom has the desired effect. It is hardly believable that 30-40 per cent of women aged 45-55 with menopausal depression are still prescribed tranquillisers and anti-depressants despite the fact that replacing their oestrogen will usually reduce these symptoms and thereby, in the majority of cases, lift the depression.

The majority of psychiatrists still believe that anti-depressants, tranquillisers or psychotherapy are the best forms of treatment for women at these three critical times of depression, yet they appear to have a low success rate. By contrast, replacing the oestrogen that is probably causing the depression appears to be very effective in many women. If the psychological symptoms are due to a lack of oestrogen, they will respond to a course of HRT; if they are due to some other cause, then HRT will not bring any real benefit. As HRT is a much cheaper form of treatment than psychotherapy or in-patient psychiatric care, it is surely worth considering as a first-line form of treatment for depression that occurs around the time of the menopause.

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Several nonsteroidal anti-inflammatory drugs (often shortened to NSAIDs) have been used successfully to reduce excessive menstrual bleeding. The NSAIDs concerned include ibuprofen, mefenamic acid, naproxen and flurbiprofen. (Some of these substances, for example mefenamic acid, are also anti-prostaglandin drugs or prostaglandin inhibitors.) While helpful, NSAIDs are not drugs to be taken lightly. The lowest possible dose of the least toxic NSAID should be used initially as this group of drugs produces side-effects in about a third of women, resulting in nausea, vomiting, diarrhoea, headache, dizziness and rashes.

Blood clotting mechanisms. Success in halving blood loss has been reported with several drugs that act on the body’s blood clotting mechanisms. They are of particular value to women with blood clotting defects. The drugs include tranexamic acid and ethamsylate. Once again, however, about a third of women on them experience side-effects of nausea, headache, dizziness, vomiting and rashes. Research studies have also raised the concern that these drugs may precipitate strokes in some women.

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Dreaming is the most fascinating part of our sleep. This is a universal experience; we all dream. Those who say they never dream probably forget their dreams, for we all dream during REM sleep. This has been studied both biologically and psychologically.

There is no reason to believe that the basic structure of the dreams of primitive man was very much different from that of modern man’s dreams. Of course the contents of the dreams would change with the passage of time—buildings, modes of transportation, food, clothing, customs, etc. kept on changing and will continue to change in the future. Naturally, the contents of dreams will be very much different a thousand years from now.

In spite of the changing contents, the basic format of dreams remains the same throughout the ages. The experience of dreams is universal. Whilst we are dreaming, we can experience things considered as supernatural in our real lives. For instance, we can, in a very short space of time, travel thousands of miles away and visit places sometimes totally strange to us. We may even be able to talk to relatives that are no longer with us. It is as if, during dreams, part of us can leave our bodies to experience all these unusual events and rejoin our bodies the moment we wake up. For most of us this is the only time in our lives that we can have these supernatural experiences.

Subconsciously these dream experiences give us some insight into the mystery of the spiritual world. All religions, despite different cultures and different social backgrounds, believe that some separable part of the human being is immortal. When the body dies, this immortal part may leave the body and live on. In Western society, this is known as die soul. Is the understanding of the soul made much easier as a result of the supernatural experience of our dreams night after night?

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There are a number of practical points which I always explain very carefully to patients. In addition, to be quite sure that I get these ideas across, I repeat them in different words each time I see the patient. The reason is that these practical considerations are so simple that the patient is likely to think, “Oh yes,” and ignore the matter as too obvious to be thought about seriously.

I have another way of impressing these very simple ideas on the patient. I like to see the patient together with the person who is closest to him. If the patient is a man, I see him and his wife together; if it is the wife, I see her with her husband; young people I see with their parents; and the elderly with one of their children. I then explain these very simple things to them together. Then when the patient experiences temporary difficulty, or discouragement, he will naturally talk about it to the other person, who in turn will remind him that this is just what I warned him to expect. In order to apply this principle to your own case, I would suggest that you show this book to your wife or husband, and explain what you are doing.

With the patients whom I see in my consulting rooms I carry this principle even further. The patient and the person with him are sitting down talking with me while I explain things to them. When they are both fully at ease, I ask the patient just to show me for a moment how he can relax. He does this quite readily, as it fits into the context of our conversation. So it comes about that I give him his first lesson in his relaxing exercises in the presence of the other person. This helps to overcome a difficulty that many people experience. They tend to be rather

self-conscious about doing their exercises. They seem to want to creep away and do them without anyone else knowing what is going on. It becomes a secret! and what is worse, it can become a kind of guilty secret.

One woman told me that she could do the exercises very well, but it was difficult to find the time, as naturally she could only do them when there was no one else in the house! This, of course, is a completely wrong approach; and I have discouraged it by having the patient do the exercises with the wife or husband sitting naturally in the room with me.

If you are a quick reader, now is the time to slow down a little, and let these simple ideas really sink into your mind. It would be foolish to miss the chance of real help by being too quick. Skimming through this is not enough. It requires more than that. The ideas must be absorbed. When I have the patient with me I see to this by repeating the ideas in different words and on different occasions. In your case, read it, go with it, let it seep into you, and reread it again. Then you will see it work.

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Since the average practitioner of orthodox medicine does not have a clear understanding of the basic causative principles involved in arthritis, his treatments and remedies are understandably symptomatic—that is, he is not treating the disease but the isolated symptoms of the disease. He treats an affected joint with injections, x-rays, and drugs as if it was a question of an isolated disease of the joint. He administers pain-killing drugs which will relieve pain temporarily. But, in the long run, due to their many undesirable side effects, these drugs only cause more damage and ultimately aggravate the condition instead of improving it.

As was evident from the previous chapter, arthritis is a systemic disease which affects the whole body. Therefore, the only measures that can be successful in correcting the disease, bringing it under control, and accomplishing a lasting cure, must be ones directed at correcting its underlying causes. This can only be accomplished by treatments which help to overcome the systemic disturbances, normalize the metabolic processes, and help restore all normal functions of the vital organs and glands. That the conventional remedies fail to accomplish this is evident

While drugs and injections may relieve pain and modify symptoms, they do not go to the bottom of the problem, they do not eliminate the underlying causes, nor do they correct the systemic disturbances. What is even worse, these conventional remedies, being suppressive in nature and having undesirable toxic side effects, interfere with the normal bodily processes and actually inhibit restorative and healing efforts of the body. Eventually they cause more damage than good and lead to a complete invalidism.

It must be emphatically stated that drugs do not possess curative powers. The cure is always brought about by the body itself, and the most that a wise doctor can ever do is assist the body’s own healing forces. The drugs used in conventional treatment of arthritis—aspirin, cortisone, gold injections, etc.— only suppress and mask the symptoms of the disease. They do not promote the healing processes, nor do they provide any lasting benefits.

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Tics in children usually involve the upper part of the face—screwing up the eyes, or rapid blinking. More complex habits such as grunting, and brushing the hair away from the eyes are common in children, and seldom confused with seizures. Sometimes, however, children indulge in strange patterns of movement which they apparently find pleasurable, and which they stop immediately on reprimand. Sometimes infants and toddlers will rock backwards and forwards squeezing their thighs together in a manner which seems to be masturbatory.

Colic-Colic or ‘wind’ is a common symptom in babies and young infants, and is usually easily recognized and diagnosed. However, occasionally infantile spasms (West’s syndrome), may be mistaken for colic or some other type of pain, which can lead to a delay in the diagnosis of this type of epilepsy.

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