Important information on switching antidepressant medications. Learn about antidepressant withdrawl.

Gold Standard for Treating Depression (part 9)

Some antidepressants have very serious withdrawal effects if they are stopped too quickly. Tapering off a medication too quickly or suddenly stopping a medication can cause considerable physical problems, worsen depression and even cause suicidal thoughts. Trading off original side-effects for possibly more side-effects due to reducing a dose too quickly is not a good decision. As the Star*D study shows, keeping track of your side-effects and their severity will help you determine if they are lessening or if they are not tolerable. You can then give this concise information to your medications healthcare professional so that you can work together in changing your depression medications.

What is Antidepressant Withdrawal?

Potentially serious consequences can happen if you go off an antidepressant too quickly. You may see an increase in your side effects and your body may go through some very uncomfortable sensations. As the medication lessens in your system, you can experience severe physical pain from stiff muscles to stomach problems as well as an increase in suicidal thoughts. This simply can't be taken lightly. Your doctor will need to help you with a correct dose reduction and even then, you will have to monitor your withdrawal symptoms carefully in case you need to get off the medications much more slowly than you would like. This gradual discontinuation approach almost always works to avoid withdrawal symptoms.

video: Depression Treatment Interviews w/Julie Fast

Self-Therapy For People Who ENJOY Learning About Themselves

FEARFULNESS

The most troubled adults I know are those who were frightened as children by extreme physical abuse or psychological terror. Their parents called it "discipline." The more horrendous the beatings and the more frightening the threats, the longer it takes them as adults to believe that I care, or that anyone does.

Perhaps because they've were frightened so often as children, adults who were treated badly as children often wisely choose safe and kind partners. But they find it hard to trust these partners even after many years of being treated well.

Scared kids become scared adults, always waiting for the next beating or betrayal.

A PARENT'S JOB

It is not a primary duty of parents to CONTROL their children. The primary duty of parents to PROTECT their children.

WHEN IS DISCIPLINE WISE?

Discipline is wise only WHEN IT MAKES SENSE TO THE CHILD. And children can only think SELFISHLY. Therefore, discipline is only WISE  when the child knows that what they did wrong was that they DIDN'T TAKE GOOD CARE OF THEMSELVES!

If you send a child to their room because they haven't learned to look both ways before crossing a street, they won't put up much of a fight. But if you use the same punishment because they've been "impolite," they may fight you all the way.

This is because politeness is not a value a self-centered child can understand, but protecting themselves from being hit by a car definitely is.

You can force "politeness," or any other behavior, simply by hurting or scaring a child. But you can't teach them the VALUE in being polite until they are old enough to understand. Unfortunately, a healthy child only achieves such maturity around puberty. (And the kids who have been frightened and beaten all their lives will be rebelling so strongly at this age that "being polite" will be the least of a parent's worries!)

NATURAL CONSEQUENCES = NATURAL DISCIPLINE

Misbehavior has NATURAL consequences. The best discipline of all is simply to POINT OUT these natural consequences.

Example:

Suppose you see a group of children at a day care center. One child is pushing another child around, acting like a bully. If you don't need to protect the child who is being bullied, just wait a few minutes. Then notice that all of the other children have NATURALLY moved away from the bully. Then simply go up to the bully and point out what is going on. Say something like: "When you act like that the other kids don't like you." This is how you use "natural consequences."

Bad Example:

Many parents would handle this situation quite differently. They would run up to the bully, grab them violently, turn them around, and yell at them about their behavior. They may even hit the child. The parent's yelling and hitting then "changes the subject" in the child's mind. The child no longer thinks about their own bullying behavior, they think instead about their parent's bullying behavior toward them!

The parent's actions were "unnatural" consequences which were ADDED to the situation by the parent. Unnatural consequences don't teach children anything, they only confuse them. Always look for NATURAL CONSEQUENCES when you want to teach your children.

DON'T TEACH FEAR

In recent years many "liberal" parents say that they don't hit their children. But then they usually add with an apparently wise smile: "I just scare 'em!" Thank Go   for small favors.

Scaring kids is by no means better than hitting them. Both of these are unnatural consequences which undermine parental authority, and both are abusive - especially if used to extreme.

BUT WHAT IF THE CHILD DOESN'T LEARN?

Real life is the best teacher of all. So our children WILL learn. But they will learn AT THEIR OWN PACE, and WE PARENTS WILL ALWAYS BE FRUSTRATED by that pace. (If someone told you parenting was easy, they lied.)

next: Mistakes Every Good Parent Makes

teenage sex

What's the big deal? In some cases, it's no big deal. But lots of times, older people go out with much younger ones so they can control the relationship. It makes them feel more powerful.

Older guys, especially, tend to have more experience, more "prestige" and more money. This can give them an unfair advantage over younger, teen girls, who have neither. That might show up as your older boyfriend always deciding where you go and what you do. It can also mean pressuring you to have sex.

Problems also crop up if the older person - who can be male or female - stops you from hanging out with friends your own age. That can get in the way of the normal process of growing from a teen to an adult.

If your relationship is sexual, you need to check the laws about sex with minors in your state. Your boyfriend could be charged with statutory rape. In nearly all states, it is illegal for anyone over 18 - male or female - to have sex with someone under 16. So, he could be sent to jail for it, even if you say you agreed to have sex.

Each relationship is different. Not all different-age relationships are bad. But you're young and you should be careful. If your friends or family are worried about your relationship, you'd be smart to listen.

next: How Can I Tell If My Sexual Activities Are Healthy and Normal?

"Codependence is an emotional and behavioral defense system which was adopted by our egos in order to meet our need to survive as a child. Because we had no tools for reprogramming our egos and healing our emotional wounds (culturally approved grieving, training and initiation rites, healthy role models, etc.), the effect is that as an adult we keep reacting to the programming of our childhood and do not get our needs met - our emotional, mental, Spiritual, or physical needs. Codependence allows us to survive physically but causes us to feel empty and dead inside. Codependence is a defense system that causes us to wound ourselves." * "We need to take the shame and judgment out of the process on a personal level. It is vitally important to stop listening and giving power to that critical place within us that tells us that we are bad and wrong and shameful.

That critical parent voice in our head is the disease lying to us. . . . This healing is a long gradual process - the goal is progress, not perfection. What we are learning about is unconditional Love. Unconditional Love means no judgment, no shame."

* "We need to start observing ourselves and stop judging ourselves. Any time we judge and shame ourselves, we are feeding back into the disease, we are jumping back into the squirrel cage."

Codependence is a dysfunctional defense system that was built in reaction to feeling unlovable and unworthy - because our parents were wounded codependents who didn't know how to love themselves. We grew up in environments that were emotionally dishonest, Spiritually hostile, and shame based. Our relationship with ourselves (and all the different parts of our self: emotions, gender, spirit, etc.) got twisted and distorted in order to survive in our particular dysfunctional environment.

We got to an age where we were supposed to be an adult and we started acting like we knew what we were doing. We went around pretending to be adult at the same time we were reacting to the programming that we got growing up. We tried to do everything right or rebelled and went against what we had been taught was right." Either way we weren't living our life through choice, we were living it in reaction.

In order to start being loving to ourselves we need to change our relationship with our self - and with all the wounded parts of our self. The way which I have found works the best in starting to love ourselves is through having internal boundaries.

Learning to have internal boundaries is a dynamic process that involves three distinctly different, but intimately interconnected, spheres of work. The purpose of the work is to change our ego-programming - to change our relationship with ourselves by changing our emotional/behavioral defense system into something that works to open us up to receive love, instead of sabotaging ourselves because of our deep belief that we don't deserve love.

(I need to make the point here that Codependence and recovery are both multi-leveled, multi-dimensional phenomena. What we are trying to achieve is integration and balance on different levels. In regard to our relationship with ourselves this involves two major dimensions: the horizontal and the vertical. In this context the horizontal is about being human and relating to other humans and our environment. The vertical is Spiritual, about our relationship to a Higher Power, to the Universal Source. If we cannot conceive of a God/Goddess Force that loves us then it makes it virtually impossible to be loving to ourselves. So a Spiritual Awakening is absolutely vital to the process in my opinion. Changing our relationship with ourselves on the horizontal level is both a necessary element in, and possible because we are working on, integrating Spiritual Truth into our inner process.)

These three spheres are:

1. Detachment
2. Inner Child Healing
3. Grieving

Because Codependence is a reactive phenomena it is vital to start being able to detach from our own process in order to have some choice in changing our reactions. We need to start observing our selves from the witness perspective instead of from the perspective of the judge.

We all observe ourselves - have a place of watching ourselves as if from outside, or perched somewhere inside, observing our own behavior. Because of our childhoods we learned to judge ourselves from that witness perspective, the critical parent voice.

The emotionally dishonest environments we were raised in taught us that it was not ok to feel our emotions, or that only certain emotions were ok. So we had to learn ways to control our emotions in order to survive. We adapted the same tools that were used on us - guilt, shame, and fear (and saw in the role modeling of our parents how they reacted to life from shame and fear.) This is where the critical parent gets born. It's purpose is to try to keep our emotions and behavior under some sort of control so that we can get our survival needs met.

So the first boundary that we need to start setting internally is with the wounded/dysfunctionally programmed part of our own mind. We need to start saying no to the inner voices that are shaming and judgmental. The disease comes from a black and white, right and wrong, perspective. It speaks in absolutes: "You always screw up!" "You will never be a success!" - these are lies. We don't always screw up. We may never be a success according to our parents or societies dysfunctional definition of success - but that is because our heart and soul do not resonate with those definitions, so that kind of success would be a betrayal of ourselves. We need to consciously change our definitions so that we can stop judging ourselves against someone else's screwed up value system.

We learned to relate to ourselves (and all the parts of our self emotions, sexuality, etc.) and life from a critical place of believing that something was wrong with us - and in fear that we would be punished if we didn't do life right. Whatever we are doing or not doing the disease can always find something to beat us up with. I have 10 things on my "to do list" today, I get 9 of them done, the disease does not want me to give myself credit for what I have done but instead beats me up for the one I didn't get done. Whenever life gets too good we get uncomfortable and the disease jumps right in with fear and shame messages. The critical parent voice keeps us from relaxing and enjoying life, and from loving our self.

We need to own that we have the power to choose where to focus our mind. We can consciously start viewing ourselves from the witness perspective. It is time to fire the judge - our critical parent and choose to replace that judge with our Higher Self - who is a loving parent. We can then intervene in our own process to protect ourselves from the perpetrator within - the critical parent/disease voice.

(It is almost impossible to go from critical parent to compassionate loving parent in one step - so the first step often is to try to observe ourselves from a neutral position or a scientific observer perspective.)

This is what enlightenment and consciousness raising are all about. Owning our power to be a co-creator of our lives by changing our relationship with ourselves. We can change the way we think. We can change the way we respond to our own emotions. We need to detach from our wounded self in order to allow our Spiritual Self to guide us. We are Unconditionally Loved. The Spirit does not speak to us from judgment and shame.

One of the visualizations that has helped me over the years is an image of a small control room in my brain. This control room is full of dials and gauges and lights and sirens. In this control room are a bunch of Keebler-like elves whose job it is to make sure that I don't get too emotional for my own good. Whenever I feel anything too strongly (including Joy, happiness, self-love) the lights start flashing and the sirens start wailing and the elves go crazy running around trying to get things under control. They start pushing some of the old survival buttons: feeling too happy - drink; feeling too sad- eat sugar; feeling scared - get laid; or whatever.

To me, the process of recovery is about teaching those elves to chill out. Reprogramming my ego-defenses to knowing that it is ok to feel the feelings. That feeling and releasing the emotions is not only ok it is what will work best in allowing me to have my needs fulfilled.

We need to change our relationship with ourselves and our own emotions in order to stop being at war with ourselves. The first step to doing that is to detach from ourselves enough to start protecting ourselves from the perpetrator that lives within us.

next: Positive Affirmations

Welcome to my Obsessively Clean Den

Hi there!

My name's Sani, welcome to My OCD Den: A UK - OCD Web Site! I live in the UK and I have OCD.

Obsessive Compulsive Disorder can be a very isolating illness and hard to understand, both for the sufferer and for their family and friends. It can often be an embarrassing condition to talk about, and so, very often it isn't discussed. This can make the sufferer feel like an outcast, even within their own family! - I know because that's how I have felt.

So! I had the idea of setting this web site up as a meeting place for people with OCD and their family & friends, to chat, exchange info about medication, therapy etc, and to maybe gain confidence and motivation from each other. There is a light at the end of the OCD tunnel.

I have a snippet of my OCD Diary, which I kept for 2 years, to give others a look at what life with OCD is like. And I am constantly thinking of new things to add to the site, so please make sure you check this page often.

next: My Obsessively Contaminated World
~ ocd library articles
~ all ocd related disorders articles

A guide to the treatments and medications for OCD

• There are two methods of treatment for sufferers of OCD. The first is the use of Drug Therapy. Mainly SRI's (Serotonin reuptake inhibitors) and SSRI's (SELECTIVE Serotonin reuptake inhibitors) are used to increase the levels of Serotonin - a chemical messenger in the Brain. The other is Cognitive Behavioral Therapy (CBT).
• Serotonin is used by certain nerve cells in the brain to communicate with other brain cells. Under the right conditions, these nerve cells (called neurons) release Serotonin neurotransmitters, which then affect neighboring cells. After the Serotonin is released, it is taken back up into the cell so that it can be used again.
• Each of the Anti-OCD drugs interfere with the Serotonin being recycled once it has been released, and this allows it to spend more time outside the cell, where it can continue affecting neighboring cells, thus doing its job longer. How or why this reduces obsessions and compulsions is still unknown. Anti-OCD medications control symptoms, but do not "cure" the disorder.
• The main SRI is ANAFRANIL (Clomipramine) an older Trcyclic anti-depressant, that has an effect on other Neurotransmitters beside just Serotonin - therefore it's not selective. The main SSRI's are PROZAC (Fluoxatine), LUVOX (Fluvoxamine), , PAXIL (Paroxatine), and CELEXA (Citalopram).
• The other method of treatment, CBT (Cognitive-Behavioral Therapy), often referred to as exposure and response prevention, exposes the patient to her or his obsessional fear (for example, making a germ-obsessed person touch a dirty floor) and then delays their compulsive response (immediately washing their hands). The aim is to ease distress. Over a period of time the person learns to become less and less afraid and anxious by their fears - they learn to handle the anxiety.
• This type of behavioral treatment is advocated and studied by Dr. Jeffrey Schwartz, a leading authority on OCD and the author of a book, Brain Lock. He believes that OCDers must learn NOT to give in to their gut feelings and obsessions. By resisting the rituals - no matter how hard that is to do - the OCDer is learning a proper response to normal behaviour, where as giving in to the obsession actually makes the person worse.
• Whatever the person does regularly, good or bad behavior, the brain picks up and does automatically. So, if that behavior is good behavior the brain's chemistry will start to change. He suggests there are four basic steps which allow an OCDer to do behavior and response prevention on their own without a therapist. These are as follows:

• Step 1. Relabel

Learn to recognize obsessive thoughts and compulsive urges - and do so assertively. Start calling them "obsessions" and "compulsions." Realize they are symptoms of your illness and not REAL problems. For example, if your hands feel dirty or contaminated, train yourself to say "I don't really think my hands are dirty; I'm having an obsession that they are. I don't really need to wash my hands; I'm having a compulsion to do so." After a while the brain learns to realize that these are just false alarms - false messages caused by the imbalance. You can't make the thoughts and urges go away because they are caused by this biological imbalance, but you can control and change your behavior response.

• Step 2. Reattribute

"It's not me, it's my OCD." Learn to reattribute the cause of these thoughts and urges to their real cause. This will increase your willpower and enable you to fight off the urge to wash or check.

• Step 3. Refocus

This is where the real hard work is done. Learn to refocus your mind on something else. Choose something pleasant like a hobby - listen to music, play sport, go for a walk, whatever it takes to make your mind think of something other than the obsessions and compulsions that it WANTS to think about. Say to yourself, "I'm experiencing a symptom of OCD. I must refocus and do another behavior." This is not easy, and a person should adopt a FIFTEEN MINUTE RULE. They should delay their response by letting some time elapse, preferably fifteen minutes, but a shorter waiting time at first.

During this time they should re-check through all the steps. Be aware that the intrusive thoughts and urges are a result of OCD and that this is an illness, a biochemical imbalance in the brain. Try to focus on something else. After the fifteen minutes, reassess the urges. Take note of any change in their intensity and this will give the person courage to wait longer next time. The longer it's left the greater the decrease in intensity.

• Step 4. Revalue

Begin to realize that these thoughts and urges are a result of OCD, and learn to place less importance on them and less importance on the OCD. Learn to take back control, take charge. In the short term, feelings can't be changed but behavior can be, and in time the feelings change too. Dr Schwartz, in his conclusion, says, "We who have OCD must learn to train our minds not to take intruding feelings at face value. We must learn that these feelings mislead us. In a gradual but tempered way, we must change our responses to the feelings and resist them."

Brain Lock by Dr. Jeffrey Schwartz.

next: Compulsive Thinking
~ ocd library articles
~ all ocd related disorders articles

Gold Standard for Treating Depression (part 37)

1. Stahl, S. M. (2000) Essential Psychopharmacology of Depression and Bipolar Disorder. Cambridge University Press

2. Keller, , M.B., et al. (2000) A comparison of nefazodone, cognitive behavioral analysis system of psychotherapy, and combination therapy for the acute treatment of chronic depression. New England Journal of Medicine. 18, 342: 1462-1470

3. March, J., Silva, I., Petrycki, S., Curry, J., et al. (2004) Fluoxetine, cognitive-behavioral therapy and their combination for adolescents with depression. JAMA, 292: 807-820.

Interview participants:
Dr. John Preston. Professor at the California School of Professional Psychology at Alliant International University, Sacramento, California Campus. Author ofHandbook of Clinical Psychopharmacology for Therapists, Psychopharmacology Made Ridiculously Simple, You Can Beat Depression: A Guide To Prevention & Recovery and The Complete Idiot's Guide to Managing Your Moods

Dr. John Rush. Principal investigator in the Star*D research project. Professor of Clinical Sciences and Psychiatry at the University of Texas Southwest Medical Center in Dallas, Texas USA.

Suggested Reading:

The Idiot's Guide to Managing Your Moods

by Dr. John Preston; Feeling Good: The New Mood Therapy

Revised and Updated by David D. Burns

Website References:

www.star-d.orgInformation on the Star*D research project

www.dbsalliance.org-- Depression and Bipolar Support Alliance

video: Depression Treatment Interviews w/Julie Fast

next:  NIMH says that up to 80% of people with major depression can be effectively treated if they get the right treatment (part 1)
~ all articles on Gold Standard for Treating Depression
~ all articles on depression treatment
~ all articles on depression

Even when you feel too depressed to help yourself, there are still things you can do to treat your depression.

Gold Standard for Treating Depression (part 36)

Because you are on the HealthyPlace.com website, you are taking the first step to getting better. Even when you are significantly depressed, you have more control over your treatment than you think. If you are completely overwhelmed by the amount of information on the site or feel that you will never successfully manage the illness, you may need help from others before you can start to manage the illness on your own. Your next step can be reading all you can from the website and then deciding your next step. It's important to remember that depression makes it feel impossible to make decisions, but this is only a symptom of the illness. You can make decisions on your own, no matter what depression is making you feel. Small steps are fine.

Don't Give Up Hope

You have control even when you are very sick. Remind yourself that it's an illness and that you can get better. It may take more time than you wish or require a lot of effort on your part and the people in your life, but the results are worth it.

No matter how depressed you are today, there is a very good chance that with the right comprehensive treatment you can be significantly better in the future. There is hope. By using the ideas presented on this webpage, you can make daily changes that directly affect the symptoms of depression. Responding to treatment and ultimately achieving remission takes time. If you start today, you can have a much brighter future.

video: Depression Treatment Interviews w/Julie Fast

next: References for The Gold Standard of Treating Depression (part 37)
~ all articles on Gold Standard for Treating Depression
~ all articles on depression treatment
~ all articles on depression

Because the stigma of depression still exists, many with depression wait too long to get treatment.

Gold Standard for Treating Depression (part 35)

The stigma that still surrounds depression is a sad indication that depression is not given the respect it deserves. It's an often life-threatening illness that needs careful medical treatment and yet many people sweat it out at home because they think they should be able to correct their mood on their own. They may exercise more and change their diet, but the depression remains. This often means that a person who could benefit from antidepressant medications and other therapies often waits until they become even more depressed to finally 'give in' and get the help they need.

Another issue that prevents some people from getting proper treatment is the misconception that antidepressants are 'handed out like candy,' or that these drugs are addictive. There is no evidence of addiction and despite what you may hear from the people in your life or society in general, this does not mean you are just using medications as a crutch. You don't have to be embarrassed to get the help you need.

video: Depression Treatment Interviews w/Julie Fast

Here are the steps to take to live a life free of depression ... or as depression-free as possible.

Gold Standard for Treating Depression (part 34)

The goal of any depression treatment is a significant reduction and ultimately a remission of symptoms. You may have to work on this for years, but it is an achievable goal. There are steps you can take and continue to take in order to live a life free from depression:

• Immediate treatment of symptoms by an experienced healthcare professional
• Medications
• Psychotherapy
• Personal changes in lifestyle and behavior
• Alternative and complimentary treatments
• Consistently maintaining depression treatment

The more you treat your depression comprehensively, the better chance you have of remaining stable. When you start to miss medications or find yourself worn out from taking them, this is when you need to speak to your healthcare professional. When you see that your sleeping routine is disrupted or that you are having trouble with your relationships, this is when you have the chance to prevent relapse by getting help before the depression becomes more serious.

What is the Outlook for Depression Treatment?

The future looks brighter today considering the positive information from the Star*D research as well as society becoming more knowledgeable regarding depression. As people accept that depression is a serious illness that needs medical attention as well as lifestyle and behavioral changes, people are more likely to seek treatment and ask for help from the people around them. Your future depends on how well you can treat your depression and the people you have in your life who can help.

video: Depression Treatment Interviews w/Julie Fast