MANAGING STRESS IN OUR LIVES

Sunday
Feb242013

MEDICATION FOR PTSD

A number of different medications have been prescribed for PTSD.  These mostly include antidepressants. At times this can be helpful as chronic stress associated with PTSD can lead to depression that can be relieved, at least in part, by medication.  I say in part because if the stress connected to PTSD is ongoing then depressive symptoms can be precipiated again or never resolved with medication and therapy.  

Anxiety triggerd by events that remind the brain of past traumas is the main symptom of PTSD.  This anxiety is related to the almost instantaneous alarm response of the brain as it tries to avoid a catastrophic response.  It seems that frequent alarm reactions is better than being completely overwelmed.  Anything that can reduce the intensity of the anxiety response or reduce the frequency of anxiety responses will be helpful.  Medications targeting this have included propranolol, atypical antipsychotic medications and benzodiazepines.  Propranolol reduces the physical reactions to stress and thus can reduce the intensity and frequency of these reactions.  Atypical antipsychotic medications are also able to significantly reduce anxiety reactions and at lower doses are usually well tolerated without side-effects.  It may be difficult to explain why an antipsychotic medication is helpful and yet the intensity of the anxiety response in PTSD benefit from this type of medication. Benzodiazepines can temporarily reduce anxiety but often have side-effects and will over time be less effective.  There can also be dangerous withdrawal symptoms for the shorter acting benzodiazepines.

Tuesday
Feb192013

ADHD AND IRRITABILITY

Irritability is frequently seen along with problems focusing and concentration in people with ADHD.  The irritability may reflect the stress associated with having to force concentration using energy in parts of the brain that is supposed to be reserved for emergencies or novel learning experiences or the irritability could be a way that the brain copes with the drain on concentration that people represent by keeping people with ADHD away from other people.

Regardless, irritability is important to address as often it is seen as an indication of mood swings and there is a reluctance to prescribe Rx for ADHD.  Daily irritability is related to ADHD and not to mood swings. If ADHD is treated, often the irritability will be reduced significantly.  At times, the irritability will continue after the ADHD symptoms are treated.  I have found that often Lamictal will stop the irritability.  The dose of Lamictal has to be adjusted for each individual person to get optimal results.  After a year of doing well with irritability well controlled, the Lamictal can be stopped with no return of irritability.

Remember, daily irritability is associated with ADHD and not with mood swings.

Wednesday
Feb132013

WATCH OUT FOR ENDOCRINE DISRUPTING CHEMICALS

What now?! I suspect that most of us are tired of hearing about new dangers that we face.  However, now that the Taliban is apparently not as much of a threat, maybe we can learn about something that is actually more of a threat to our health than the Taliban.  What is this?  They are chemicals in our environment [food, couches, machine receipts and shampoos, etc.] that disrupt our endocrine systems and may be a significant factor in the increasing obesity in the industrialized world.  

Research studies [initially from Bruce Blumberg at UC Irvine and now his findings have been replicated a number of times] have identified 20 substances that are called [after Blumberg] obesogens. This problem is now recognized by the Presidential Task Force on Childhood Obesity and the National Institutes of Health.  Chemicals identified include materials in plastics, canned food, agricultural chemicals, foam cushions and jet fuel.  Mice exposed at birth to very small amounts of some of these chemicals became obese and passed on this to future generations.  Another study found that women with pesticide residue in their blood gave birth to babies who were more likely to be overweight by 14 months.  The most vulnerable periods seem to be in utero and in prepubertal children.  

One survey cited by the Scientific American, found that only 19% of physicians cautioned pregnant women about endocrine disrupting chemicals found in pesticides and less than 10% warned about BPA that is found in some plastics and receipts and phthalates that are found in cosmetics and shampoos. 

So why aren't these chemicals being regulated?  Well, apparently similar to the delayed regulation of cigarettes, the chemical industry is resisting it.  Congress has yet to pass the Safe Chemicals Act that would require more stringent testing of potentially toxic chemicals.  We all have to pay for obesity and that does not include all the suffering that occurs related to obesity.  So, pesiticide free food, no plastic containers for food and no cosmetics or shampoos with dangerous chemicals.  

It would seem a good time to let others know about this as well as telling our representatives and senators that we want these endocrine disrupting chemicals gone.

Sunday
Jan272013

JUST BREATHE

Breathing is essential for life and seems fairly automatic. However, when we are stressed we often will hold our breath [briefly] and then have shallow and more rapid breaths. Our brains are preparing us for action to avoid some danger.  Often, there is no real danger, just our anxious or feaful reaction to something that might remind us of a past dangerous situation.  Our breathing change indicates that we have shifted into crisis mode and the stress that goes along with this.  If we can keep our breathing calm and even, we will be calm.  Many different spiritual practices promote relaxed, deep breathing as part of their meditation practices.

Learning to breathe more slowly can help us to calm down. Of course, when we are stressed and worried, it can be very difficult to calm our breathing.  Focusing on making our hands and feet feel warmer can help us to feel calmer.  This requires that we focus on our hands and feet, seeking a sensation of warmth in them.  If we do this, our breathing will automatically be calm, without having to focus on our breathing.  Then, during times when we are not feeling stressed, we can practice taking slow deep breaths while being aware of the air moving through your nostrils and into your lungs and out again. Focusing on our breathing and just being aware of it can help us to feel calm and not worried. Exhaling more slowly than you are inhaling can add to your sense of being calm and relaxed.

If we just breathe, we'll like it.

Sunday
Jan202013

THE RIGHT DOSE OF MEDICATION FOR YOU

How do you know what is the right dose of medication?  I've already talked about the fact that doses are often established based on statistical averages.  This means that a percentage of people [32%] are more than one standard deviation above and below the mean.  These people will need doses that may not fit the usual dose range for a medication. Also, even if your dose is within the normal dose range, your specific dose is still important to determine as the success of the medication will depend on determining the optimal dose for you.  

So, what can you do to help your physician find the best dose of medication for you? You can write down symptoms you are having and check the internet to match your symptoms with specific diagnoses.  You can then share this information with your Doctor and then see which symptoms your Doctor feels are related to your diagnosis. Then you can keep track of the symptoms as you take the medication. You can then see if there is a dose that reduces or eliminates your symptoms.  If no dose is helpful, let your Doctor know so you can try a different dose until you find the right dose for you. Sometimes you might need to go down again with a dose and then raise it again to determine the best dose.  As a 23 year old patient of mine said recently: "I'm the best person to determine the optimal dose for me because I'm the only person who is me."  

The optimal doses of the vast majority of medications are based on the clinical response to the medication.  Your clinical response is what we've been talking about.  Your role in determining your response to medications is critical.  If your Doctor does not listen to your input regarding your response to medications, you may need to change Doctors.