At a point, after about 3 months, when the sober alcoholic reaches some level of comfort with the new state of affairs, the focus can shift. The attention has been virtually at the level of the mechanics of daily living. With that out of the way, or reasonably under control, the focus can move on to sorting out the alcoholic’s stance in the world, feelings, and relationships. Though 3 months is a somewhat arbitrary designation, it is not wholly so. Recall the subacute withdrawal syndrome. The alcoholic may pass through the acute withdrawal period within 5 days, but a longer period is required to regain the ability to concentrate, for example. Thus, there is a physical basis for what the alcoholic can focus on productively. This does not mean that all the problems previously discussed are totally overcome, or that work is not proceeding along some of the above paths. It simply means that other problems may now be surfacing. It is also at this point that some assessment should be made as to whether to refer the client to other professionals if the present caregiver is not equipped to handle this next phase. Some problems are fairly common and counselors must be alert to them. Most of these basically require finding a balance point between two extremes of behavior that are equally dangerous. John Wallace, a psychologist who has had long experience working with alcoholics, has neatly described his observations. He compares these extremes to rocks and whirlpools that must be avoided in the recovery “voyage.”*103\331\2*
Archive for the ‘Anti Depressants-Sleeping Aid’ Category
The use of the term ‘stress’ has been changing, in recent years. In engineering physics, stress means something like ‘load’ or ‘burden’. However, this word has been increasingly used as synonymous with ‘distress’. People have been therefore described as ‘suffering stress’, or ‘experiencing stress’.
To be consistent with the meaning of the term, we should describe people as suffering from the effects of excessive stress. Whenever we use the term stress as synonymous with distress, we tend to confuse the concepts of load on the person, with that of reaction experienced by that person.
‘Stress breakdown’ is therefore synonymous with ‘nervous breakdown occurring in response to too much load on the nervous system’.
The use of the term ‘nervous breakdown’
Different cultures use different ways of describing a person’s sudden inability to function normally owing to the presence of abnormal emotions, overwhelming anxiety or abnormal thinking. Our society uses the term nervous breakdown to apply to disruptions in human behaviour severe enough to inter with a person’s ability to carry on normal daily activities с require hospitalization. The term can apply to any psychiatric problem such as severe depression, acute mania, acute о whelming grief, and acute psychosis.
I use the term nervous breakdown because widely understood in Australia. Stress breakdown refers to a situation where a person has been so affected by stress that he or she experiences some incapacity to function normally. The stress-breakdown symptoms may be mild, when the person might be able to continue working or severe, requiring admission to hospital for treatment. The word ‘breakdown’ does not necessarily convey any notion of how severe the reaction to excessive stress might be; only that it is enough interfere with normal everyday activities.
*2/129/5*
As we begin to practise awareness, we become aware of our own behaviour and our subtle motivations. Slowly and subtly these insights into our self break through. What was initially destruction can become construction.
When the insights first come they are fleeting glimpses of how we could be. They disappear and reappear as we begin to assimilate them and begin to build on them. We begin to see that responsibility for our peace and happiness is ours, and ours alone. We cannot shift the responsibility of ourselves to other people or to other factors.
Sometimes we are able to assimilate the insights easily, at other times it calls for hard work. Sometimes the insights can herald changes so basic they are accompanied by fear.
As we become aware of these insights we begin to see we are letting go of more than the disorder. Life begins to take on a different meaning. Our ideals and values change. Things which were once important to us no longer seem so, yet it appears there is nothing else to take their place.
This can be very threatening and disturbing, despite our desperate longings to be ourselves. The pre-disorder identity has gone; its place was taken by the ‘disordered’ identity. This in turn is breaking down, leaving us no sense of identity, no sense of self, to take its place. The feeling of total annihilation can seem closer than ever before.
*102\94\8*
If one treats a large number of depressed patients, as I do, the use of anti-depressant combinations is standard operating procedure, as the anti-depressants frequently don’t work when administered individually. If one has to be depressed, the late 20th century is not such a bad time for it as there is an ever-increasing array of available medications that act on different elements of the neurones responsible for transmitting the signals that regulate our moods. The skilful clinician, working in collaboration with an observant patient, can mix and blend these medications in such a way as to maximize their benefits while minimizing their side-effects.
St John’s Wort appears to work very well in combination with all anti-depressants except for the MAOIs, such as Parnate or
Nardil, where adding them can be dangerous. This is not to say that medications should be mindlessly shaken into a cocktail in full dosage. After all, if these medications can interact with one another in positive ways that enhance their anti-depressant effects, they also have the potential to enhance one another’s side-effects. When mixing medications it is important therefore to move more cautiously with dosages and timing. Certainly, such medication combinations should not be tried on one’s own but rather under the supervision of a good doctor.
When properly handled, I have seen people manage to decrease the dosage of anti-depressants that were giving them unpleasant side-effects, and add in St John’s Wort instead. For example, Fred, a 52-year-old computer scientist, wrote to tell me that he had added St John’s Wort to the anti-depressants he was previously using, which had been helpful in removing his feelings of ‘doom and gloom’ but did not completely resolve his problems. According to Fred, St John’s Wort ‘takes the edge off feelings of anxiety and depression and flips the switch from negative to positive’. He was able to reduce his dosage of anti-depressant medication from 450 mg to 300 mg per day and, in addition, noticed that he did not need to be quite so precise as to when he took it. Before starting St John’s Wort he had observed that ‘If I missed a pill by one or two hours, I’d get very tired and the glass started looking half empty instead of half full. By taking 250 mg of St John’s Wort with 150 mg of my usual anti-depressant, I can delay taking the next dose by two to four hours.’
Besides helping Fred get by with less anti-depressant medication and space the pills out at wider intervals, the addition of St John’s Wort also gave him a more sustained feeling of well-being. As he put it, T feel like good things will happen – a feeling that I am OK – not perfect – but me. I sense life is going to get better.’
I have similarly observed in my own patients the highly beneficial interactions between St John’s Wort and other antidepressants, sometimes subtle, sometimes very robust. Although I have read of people who have experienced problems with such combinations, such as jitteriness or increased blood pressure, to date I have not observed them in my own patients, perhaps because of my practice of altering dosages of medications gradually, which enables one to detect potential problems early before they become too unpleasant.
Many of my patients are on complicated combinations of anti-depressants and I have been pleasantly surprised to find that the addition of St John’s Wort may nevertheless provide additional anti-depressant protection even in people with depressions that have been hard to reverse. Sometimes the addition of the herb has been so helpful that it has been possible to decrease the dose of some of the other medications or even to remove one or more of them, thereby simplifying the overall medication regimen. As always, the key to successfully combining medications – and St John’s Wort is no exception in this regard – is to change dosages slowly and observe carefully for any untoward effects.
Remember: If you are on a MAOI such as Parnate or Nardil, do not take St John’s Wort. Also, if you have discontinued an MAOI, wait at least two weeks before starting St John’s Wort.
*17\75\2*