i-Recover

My Condition

Depression and anxiety are common. Often people suffering from one will also have symptoms of the other.

How common is my condition?

Depression
It is thought that one in five people worldwide will develop depression during their lifetime. The World Health Organisation estimates that every year 5.8% of men and 9.5% of women will become depressed at some time.
Most of us know someone who suffers from or will develop depression because it affects so many people.

Anxiety
Anxiety is one of the most basic emotional reactions and is common to all people. It is natural to feel anxious in threatening or uncomfortable situations. Anxiety can become an illness however when you become anxious about minor matters and when worrying and nervousness are so prominent and bothersome that you have to change and restrict your life.
Often people suffering from depression will also experience anxiety - 60% of patients with depression have anxiety in various degrees. One in 5 will suffer significant panic attacks and many others will have phobias. Anxiety disorders themselves are the most common psychological illnesses.

What are the symptoms of depression?

It is natural to feel sad and melancholy when things go wrong. The pain of an unhappy relationship, unemployment or bereavement can spoil your mood for some time. When you are sad for any of these reasons, you don't normally come to a complete stop. Even though ‘your heart isn't in it’, you still manage to carry on with everyday activities and enjoy the positive things in life. Sadness and bad moods will eventually pass. If you experience serious grief, sharing your problems with others can help you to come to terms with and cope with the grief.
Feeling sad in this way is not a disease, but depression is.  Depression is a profound sadness that can destroy your quality of life:

• you are not just sad - but very sad!
• you are not just sad often - but sad all the time!
• you are not just sad about something - but sad about nearly everything!
• you are not just sad about it for a while - but sad about it for a long time (it can last for weeks, months or even years if not treated)!
• you most likely suffer from clinical depression when you are depressed for more than 2 weeks in a row.

Your sadness continues, even though you sometimes see no reason for it. Everything still seems unimportant or threatening, you may feel out of control and that something terrible is going to happen.


Depression normally affects your:
Feelings
If you are affected by depression, you find it very difficult to enjoy things that once gave you pleasure.
Thoughts
Your sadness may mean that you find it difficult to think positively about things. Most people who suffer from depression may have negative thoughts such as:
"I'm not good at anything"
"I'm hopeless"
"Nobody understands me"
"Life is unfair"
"I deserve everything that goes wrong"
"I deserve to be punished"
"Death would be an escape".
Perhaps you feel that you don't live up to your own or others' expectations. You may feel that you are bad at, or unsuitable for, the work you do. You can also feel that you are lazy, indulgent, too hard on your family, or perhaps you label yourself as a bad person. Always remember that these thoughts are part of your disease, not an explanation or a reason for it!
You might feel guilty for things that you have done or equally guilty for things that you should have done but have failed to.
These negative thoughts may contain real substance, but your feelings of guilt are exaggerated. Sometimes they are completely unrealistic and out of touch with reality.
Behaviour
Mood swings, particularly in men, may show as increased irritability rather than sadness. You might become unhappy, touchy, quick-tempered, restless or aggressive. Instead of becoming passive you are active, but you don't achieve a sense of accomplishment or satisfaction from your activity.
If you are suffering from depression, you don't feel like being with other people or you just don’t have the energy. If you need to go out, you have to force yourself to do it. You keep to yourself and you are definitely not an entertaining or funny person. Even little things make you feel tired, worn out and sad. What you do achieve you don’t rate as worthwhile. Even with milder depression you feel tired and lack energy, and are therefore not up to the company of others. Even simple things such as looking after your appearance can seem like a real chore.
Body's functioning
When you are depressed you think, speak and act more slowly than normal. Your so-called ‘psychomotor function’ (how you think and act) is often significantly reduced.
You may notice some of the following:

• reduced facial expression
• lack of smiles
• less eye contact with others
• slow and brief speech; hardly saying anything
• long pauses and periods of waiting when you speak
• moving hands and arms much less when you speak
• sitting motionless for a long time
• moving at a reduced pace and without big movements

You might also:

• think more slowly
• have difficulties remembering and concentrating
• have difficulties making a decision
• no longer take an interest in yourself or the people around you.  You might therefore risk becoming unfit for work.

The physical symptoms of depression can also occur in connection with other disease like e.g. Parkinson's disease and dementia.
The most prominent symptoms of depression are:

• depressed mood (you are sad)
• lack of interest (nothing you do gives you pleasure)
• tiredness and lack of energy.

Most depressed people are tired and complain about reduced energy levels. Tiredness and lack of energy can be so overwhelming that you might not even be able to do everyday things such as getting out of bed or having a bath . You might even lose contact with people because you can’t manage to pick up the telephone, have visitors or talk to other people, even those closest to you.
However, there are many other symptoms that can suggest depression including:
Anxiety
When suffering from depression, you will often be very worried and anxious. This anxiety may be there for no reason but is often connected to financial circumstances, everyday problems (worrying over trivial matters), catching a serious disease, getting panic attacks or becoming one of these people who does things repeatedly for no obvious reason. If you are suffering from very severe depression, you might be terrified of catastrophes, which you think are inevitable. In a so-called agitated depression, anxiety, perplexity and restlessness are the obvious symptoms. In these depressions, the suicide risk can be high and the treatment should be carried out in hospital.
Reduced appetite
If you are depressed, it is quite common to be less hungry. You don't feel any pleasure in eating and the food doesn't seem tasty.  If you do eat, it is more out of a sense of obligation. You are eating too little and might lose a significant amount of weight. You are even more tired and less energetic, and you don’t feel like eating anything. Again, a vicious circle continues.
If you suffer from an atypical depression, you might actually be more hungry. You feel better when eating, and you may gain some weight.
Be aware that appetite and weight changes without any other explanation can be symptoms of depression.
Sleep disturbances
Nearly everyone who suffers from depression experiences changed sleep patterns. You might experience the changes as:

• having difficulty falling asleep
• sleeping less in total
• never feeling refreshed
• sleeping lightly
• waking several times during the night
• waking up early in the mornings.

During a normal night’s sleep, there are distinctly different phases. One of them, the so-called REM sleep (named after the Rapid Eye Movements that are visible during these phases) is often disturbed during a depression. This is one of the reasons for the lack of concentration and for memory and learning impairment during depression.
Physical symptoms
Depression can have a number of physical symptoms as well. It may, for example, cause different pain symptoms such as sore muscles and joints, stomach-ache or other stomach problems and headache or worsen symptoms of rheumatism or back pain..
It is therefore important that doctors have depression in mind when dealing with any otherwise unexplained physical symptoms - new, existing or worsening. Pain and other symptoms of long-term illnesses increase your risk of developing a depression (see later section on co-morbid disease).
It is not always easy to detect the real cause of symptoms. Physical symptoms may point towards a physical illness instead of depression and vice versa; many physical disorders can have symptoms very much like a depression.

Mild depression

The severity of depression varies and can be mild, moderate or severe. Despite its name, mild depression is still a significant illness. If you have mild depression:

• you generally feel sad and lack energy to carry out normal daily activities - while you might be able to overcome it without treatment, the depression may come back
• you are no longer interested in the activities you once enjoyed
• you are markedly tired and getting a good night's sleep doesn't help -   the tiredness may make you worry that you have some other illness
• sometimes you might have a variety of physical symptoms which you find difficult to describe, for example you might feel pain ‘here and there’, feel dizzy, or have ‘a weight on your chest’.

These might be the first signs of mild depression and you should therefore go and see your family doctor.

Moderate depression

The symptoms of moderate depression are worse than those of mild depression and are present almost all the time:

• you only get relief from the symptoms for very short periods at a time
• you are sad, lack energy and you are not very interested in the people around you
• you have low self-confidence and you feel guilty about many things; even though your family and friends do not share your view
• you can no longer enjoy meeting people or doing things that used to be a source of pleasure
• you have no interest in your family and your work
• your concentration may be affected so much that you are no longer able to watch TV and films, read books or newspapers
• the small decisions that daily life presents seem impossible to deal with, for example it might be difficult to decide what you should buy for tonight's meal
• you don't feel like going out or having visitors and just want to be by yourself at home
• it is common for your mood to vary throughout the day (this is called ‘24-hour variation’) - mostly you feel lousy in the morning and start feeling better towards the evening
• you don't sleep very well and don't feel refreshed; perhaps you find it relatively easy to fall asleep but you wake up after a few hours and cannot get back to sleep - many people find lying awake in the early hours of the morning the biggest strain, as you feel completely alone with your sad thoughts
• you have a reduced appetite and might lose 5-10% of your normal weight
• you also lose your sex drive - you might have a need for closeness and touch, but your lack of sex drive can cause you even more feelings of guilt

Severe depression

In severe depression you have the same symptoms as mild and moderate depression. The symptoms are even greater and it is often impossible for you to find the motivation to do anything.
If you are suffering from severe depression, you view situations, thoughts and feelings as ‘black’ instead of ‘grey’ as associated with moderate depression. Some people cry a lot during a depression whilst others are not able to cry at all.
Some people suffering from severe depression find that life is so hopeless that they will think about killing themselves.  Tragically, modern treatments and interventions could have prevented many deaths if only they had been used in time. If you, a friend or relative shows these signs, seek help as soon as possible.
Someone suffering from severe depression may not be able to think rationally and even suffer from the following:

• destructive thoughts
• thoughts which have become unrealistic and difficult for others to understand, as they bear no resemblance to reality
• thoughts about being to blame for serious accidents and catastrophes
• feel certain that they are a bad person, and can feel so sinful that they believe they deserve to die or be severely punished
• appetite and thirst can become so reduced that it becomes critical, and in a few cases a person might stop eating and drinking altogether
• become paranoid and feel persecuted, convinced that certain people or secret organisations are out to hurt or punish them.
• hallucinations, maybe hearing voices that say bad things or encourage the person to punish themselves - perhaps commit suicide.
• serious suicidal thoughts without having hallucinations.

In psychotic depression, a person believes things to be real which are not. The sufferer is not fully capable of taking care of them self - and the situation can become dangerous. Such a condition can quickly become life threatening and the person should therefore be admitted to a psychiatric hospital as quickly as possible, in order to be protected and treated.

Recurrent depression

The length of time that people suffer from depression varies. A single depressive episode will pass and in most cases not come back. This is the case for about half of all first depressive episodes. In a periodic depression the typical symptoms come back after a period of well-being. In the very few cases of a chronic (long-term) depression, the symptoms will come back fairly regularly or remain constantly.
People suffering from recurring depressions, are more likely to commit suicide. Many people attempt suicide but fortunately only a small number are successful. Women generally try to commit suicide 2-3 times more often than men, while men are 2-3 times more successful than women.
People have a greater risk of committing suicide if they:

• have no support from family and friends
• suffer from recurring depression
• previously attempted suicide
• have a family member who has previously attempted suicide
• suffer from depression and abuse alcohol or medicine at the same time
• suffer from depression and a serious physical disease
• are alone without family, friends and other social support
• do not work
• are having one of the first depressive episodes
• have recently been discharged from a psychiatric ward
• suddenly stop taking antidepressants or mood stabilising medicine 

When you see yourself at increased risk or if you actually think about taking your own life, find someone to talk to immediately. See your doctor or call your local crisis intervention service. You must not keep these thoughts to yourself, they are part of your disease and when receiving treatment, they should be greatly reduced and go away.

Symptoms of anxiety

People who are anxious may feel fearful and tense and may experience several unpleasant physical symptoms. These might include:

• a fast or racing heart
• shaking or trembling
• having a ‘knot’ in the stomach
• feeling nauseous or having diarrhoea
• rapid breathing
• feeling pain in the chest
• having a dry mouth
• tingling or ‘pins and needles’ in the arms and hands
• feeling dizzy, light-headed or unsteady
• tense muscles
• headache, back and neck pains
• sweating and flushing

Anxiety can also lead to racing thoughts. Anxious people often spend a great deal of time thinking and worrying about potential future problems and usually expect the worst to happen.  When anxiety is severe, people may find it difficult to concentrate or may even find that their mind goes blank.
Experiencing anxiety often also affects the way people behave. They may begin to avoid certain situations that make them anxious or ask for reassurance from others. By avoiding the things that make them anxious they change the way they live their lives and this often leads to more problems than it solves. For example patients with panic attacks may stop going out and become agrophobic (scared to go outside), isolated and depressed. Without treatment, feelings of anxiety may persist for long periods or develop in response to situations that most people would not find stressful. As a result, there are things you are unable to do and there can be places where you are unable to go. In severe cases you can be anxious in so many ways that the anxiety affects every aspect of your life and causes severe disability. If this is the case you definitely need to seek treatment or get help.

What are the different types of anxiety?

Like depression, anxiety disorders can be divided into different diagnoses. An overview of a number of anxiety conditions is given below. Often a person can suffer from more than one type of anxiety.

Natural anxiety
Natural anxiety is one of our most basic emotional reactions and we all are familiar with it. For example, you may have felt uneasy or unwell in the hours before an exam, or before giving a speech at a big celebration; symptoms include clammy, shaking hands; rapidly beating heart; and dry mouth. You don't think clearly and easily lose your nerve. Anxiety generally feels the same, no matter what the reason is.
Normally these symptoms do not persist. They disappear once the problem or situation is resolved, however, counselling and talking therapies are also found to be helpful in cases like these.

Phobic disorders
A phobic disorder is strong fear, terror or dread of a specific situation, event or thing. Many people suffer from a phobia and the situations causing anxiety are varied, such as fear of:

• dentists
• heights
• animals such as dogs, cats, snakes or spiders
• water
• small enclosed spaces
• injections or needles
• flying
• dark

Many people don't seek treatment for their phobia; they simply avoid the triggers. If however your phobia is a big part of your everyday life and you have severely changed or restricted activities, you should seek treatment. You will feel better with medicine and psychotherapy.

Generalised anxiety
If you are suffering from a generalised anxiety condition, you are often constantly anxious and nervous about everyday things. Problems in your daily life all really worry you at the same time, making it hard for you to concentrate on other things. You also have a number of physical anxiety symptoms. Generalised anxiety can be treated effectively with medicine and psychotherapy.

Panic disorder
Panic disorder causes sudden intense feelings of anxiety also known as panic attacks.
The symptoms are both physical and mental. You might get the feeling that you are about to faint or die, and fear that these attacks are a sign of insanity or emotional weakness. You get physical symptoms such as breathing problems, chest pains, sweating and trembling. A panic attack often begins without warning and lasts a few minutes. When you have recovered, you feel exhausted but no longer anxious.
If you experience attacks or suspect certain situations to cause them, you may become nervous about when another attack might occur. Many people start avoiding situations that they fear may cause another attack, which substantially affects their ability to get on with their day-to-day life. It is unfortunate that it often takes patients suffering from anxiety and panic attacks a long time to get a proper diagnosis and treatment, as panic attacks can be treated effectively with medicine and psychotherapy.

Post-traumatic stress disorder (PTSD)
Post-Traumatic Stress disorder (PTSD) – is the only psychiatric disorder with a specific time of onset – the time of the trauma. It is a stress reaction caused by experiencing a traumatizing event such as a car accident, violence, rape, combat etc. The symptoms of PTSD include re-experiencing of the trauma during waking hours and during sleep (nightmares), avoidance of anything that reminds of the trauma, and a feeling of being hyper-vigilant, jumping from a door slamming, heart racing from a loud voice etc.
Four out of five people that develop PTSD will recover without medical treatment within four weeks of the traumatic event. Mood will improve; sleep gradually improves until life returns almost to normal with the trauma remaining as a memory.
For a small minority of patients, the symptoms remain and these require medical intervention which can include pharmacotherapy, psychotherapy or both.

Obsessive-compulsive disorder (OCD)
Obsessive-compulsive disorder is commonly referred to by the abbreviation OCD. In OCD, anxiety is linked to fixations on certain things and leads to obsessive thoughts, compulsive behaviour or both.
You might have an extreme urge to repeat a certain action or you get trapped in a pattern of revolving thoughts. You are aware that you are excessively repeating a certain action over and again. You might for example wash your hands again and again until your skin is damaged; or you might think of certain long strings of words or sentences, in order to calm yourself down. Others have to carry out time-consuming rituals such as walking to the front door many times a day to check that it is locked. OCD can often be effectively treated with medicine and psychotherapy.

Fear of diseases (hyphochondria)
People suffering from hypochondria interpret mild or infrequent symptoms as the signs of a serious disease. Hypochondria and physical symptoms not caused by any form of disease are widespread.
Many of us have felt pain and other physical symptoms when we are stressed or worried. We have also experienced how it no longer hurts when something more urgent gets our full attention. The same can apply to physical sensations that we experience depending on how we feel mentally. These symptoms and sensations do not have to be related to a serious physical disease but you may still be worried about possibly being seriously ill. You might even see your doctor for a thorough check-up and when sent home healthy, still be dissatisfied that your doctor may have overlooked something crucial.
In some mental diseases you exclusively feel physical symptoms, even though a thorough examination and tests reveal no physical disease. You might be worried about suffering from something serious, but it is another way of your anxiety disorder presenting itself. Hypochondria can be treated effectively with psychotherapy and medicine.

Somatisation
Some people may experience physical symptoms that are not caused by any underlying medical condition. Unexplained symptoms like these are called ‘somatisation’. You can have many different symptoms all over your body such as:

• muscle pain
• pain in your joints
• reduced strength in your muscles
• difficulty in walking
• memory difficulties
• visual disorders (eyesight problems)
• hearing problems
• problems with speaking
• dizziness
• tiredness
• sensation of cold and heat
• heart symptoms
• difficulty in breathing
• nausea
• stomach ache
• indigestion
• problems passing urine
• abdominal problems

In most cases you will calm down and feel better once your doctor has examined you and explained that you are not suffering from a serious disease. However, some people will still continue to have symptoms and a fear of diseases, although they have been examined many times.
In individual cases, somatisation can be a prolonged disease that makes it difficult for you to go to work or be active in your spare time. If you have long-lasting unexplained physical symptoms, you are suffering from a somatic condition and should seek treatment.
As with other diseases, you may also develop other types of anxiety and depression if the fear of diseases and the somatisation is left untreated.

What causes depression and anxiety?

There is no simple answer, as these can occur in many different ways:

• suddenly without warning
• slowly emerges over time
• triggered by psychological trauma, stress or serious problems
• there is a family history of depression and/or anxiety

We do know that occurrence of depression and anxiety involves an interaction between a genetic disposition (meaning that a person is more likely to develop the disease because of information carried in their genes) and events that have happened during adolescence.

Risk factors

You are a greater risk of developing depression and/or anxiety if:

• your parent, child or siblings have had depression or anxiety
• you are female aged between 40 and 50
• you have suffered psychological stress or trauma
• you have suffered bereavement
• you suffer from a serious physical disease
• you suffer from long-term stress, regardless of the reason
• you just have delivered a child you might get the ‘baby blues’

Triggers

Certain psychological circumstances can make you vulnerable to depression and/or anxiety. These ‘triggers’ can be either external or internal. External triggers can be recent events but they are often rooted deep into the past and go back to psychological influences during childhood. Internal circumstances stem from your psyche, your personality and thought patterns.
For many external and internal contributing factors, talking therapy such as cognitive behavioural psychotherapy (CBT) can often help. Psychotherapy may be used as a treatment for your current condition or as long-term help in managing your symptoms. Working on known or suspected triggers can reduce the risk of developing depression and/or anxiety.

Childhood
The relationship with parents during childhood is of great importance for healthy psychological development. Disturbances in this relationship may increase the risk of developing depression and/or anxiety later in life. During childhood there can be more contributory causes for developing depression such as:

• physical and sexual abuse
• conflicts and trouble at home
• parents who used feelings of shame as a means of upbringing
• parents who openly favoured other siblings
• parents who were unreasonably demanding, for instance with regard to school performances

Current circumstances
Current external circumstances that wear you down over a long period of time may trigger depression and/or anxiety if it is in your nature. Long-lasting stress factors known to increase your risk of developing depression and/or anxiety are:

• an emotionally dissatisfying or conflict-stricken relationship
• a stressful divorce
• a stressful or dissatisfying work environment
• long-term unemployment
• loneliness

These factors can in some cases be contributory to triggering depression and/or anxiety. Of these factors, loneliness is one of the most important. You are at the greatest risk if you don't have someone in whom you can confide. Superficial acquaintances cannot replace the one person you are closest to.

Personality traits
Internal psychological factors can increase the risk of developing depression and/or anxiety. These range from ordinary nervousness, to a very negative way of thinking and a passive behavioural pattern (shying away from saying what you really mean and not seeking to achieve your needs, particularly if someone else has conflicting needs).
Nervousness is like other personality traits determined both by your genes and your personal development. If you are easily moved and emotionally vulnerable, you are at greater risk of becoming depressed and/or anxious.
If you tend to react with strong negative feelings, you can easily get very emotional when facing external strains like divorce or losing your job.
You probably have a negative way of thinking, if you have:

• an inclination to take the blame for unpleasant events
• an inclination to believe that unfortunate events spread to large parts of life
• a belief that nothing will improve and that you will be subjected to unpleasant events for the rest of your life.

Your behavioural pattern is called ‘passive’ when you react to adversity by:

• coming to a complete stop
• giving up solving the problems
• escaping the problems

Actively solving problems reduces your risk of becoming depressed and/or anxious. One way to solve problems is talking about them.
A lot of thoughts, feelings and behaviour connected to and occurring during episodes of depression and anxiety actually prolong and worsen the disease.
Feeling down changes your memory; you are more likely to recall negative thoughts and experiences and to forget all positive ones. This distortion of your memory can also strengthen and prolong your depression and anxiety.
During periods of depression and anxiety, your relationship with others may deteriorate due to changes in your behaviour. By becoming more passive or more ‘negative’, contact with members of your family or work colleagues, for example, could be spoiled.
These two circumstances create a ‘vicious circle’ of negative thoughts and feelings and negative relationships with others.

What is co-morbid disease?
Everyone knows that you can suffer from more than one disease at a time. Your doctor may call this a secondary or co-morbid disease. It is not a worsening of the initial illness but the development of a new disease on top of the first one.
Unfortunately every serious or lengthy physical disease has a risk of the patients developing co-morbid depression and/or anxiety. There can be several reasons for this.
Physical reasons
No one likes to suffer from pain or to suddenly be unable to fully function. Becoming unhappy and even developing depression and/or anxiety is quite understandable, and even more likely if you are suffering from a disabling or even fatal disease.
Pain
Pain and tiredness are the most common symptoms reported. One in three patients complain about pain and 4% have suffered serious pain for over a week.
If you suffer from depression, you often also suffer from pain. Your pain can intermittently be the most prominent symptom of your depression.
Patients with long-term pain have an increased risk of suffering from depression, regardless of the reasons for the pain. Approximately every second patient reporting pain has depressive symptoms and every third patient reporting pain suffers from clinical depression needing treatment. You also have an increased risk of getting long-term pain later in life if you have had depression.
Depression and long-term pain have a number of common features. Some antidepressants are effective in treating depression with pain.
Cancer
Patients suffering from cancer have a greater risk of developing depression. On average, 25% of all cancer patients will develop depression at some point during their disease.
Recent scientific studies showed that it is important to treat this co-morbid depression. The chance of recovery from an underlying serious physical disease is greater if the depression is treated.
You feel twice as ill if you are suffering from both a physical and psychological disease. It will take you longer to recover. If you have both cancer and depression, you can be treated for depression while receiving cancer treatment.
Heart disease
Patients who have had a heart attack have a greater risk of developing depression. Between 15–20% of patients develop depression following a heart attack.
Depression can prolong and complicate heart disease. It is therefore important that you get treated for your depression. The treatment of such depression helps you to more easily recover and you have a greater chance of avoiding future heart problems.
Psychological disease (e.g. schizophrenia)
Some diseases directly interfere with your brain’s function and can trigger depression and/or anxiety. Well-known conditions which do this include stroke, Parkinson’s disease, dementia and multiple sclerosis. If a disease changes your chemical balance or your hormone levels, this can be another way in which depression or anxiety are triggered.
Stroke
A stroke is one of the most common causes of death in the western world. Prevention and the speedy start of treatment have helped more people to survive a stroke.  Many have prolonged mental and physical after-effects from a stroke. Approximately 35% of people will develop depression after a stroke.
If you develop a psychiatric disease after a stroke, your chances of rehabilitation will unfortunately be reduced. You will be less able to carry out everyday activities.
Unfortunately after a stroke, depression has a tendency to be prolonged.
Treating the post-stroke depression helps recovery and rehabilitation.
Parkinson’s disease
Parkinson's disease is a common brain disorder in the elderly. Typical symptoms include:

• shaking
• stiff muscles
• reduced ability to speak and move
• mental symptoms, particularly depression and anxiety

Nearly 70% of patients with Parkinson's disease will develop depression. The symptoms of Parkinson's disease can be like those of depression. It is therefore important that you are aware that both symptoms can appear at the same time.
Dementia
Dementia is one of a number of diseases affecting memory, language and alertness but not consciousness. You are still awake when you are demented.
Of all people aged 65 and over, 5% suffer from severe dementia, and 15% suffer from a milder form. Dementia often develops gradually and the most common type is Alzheimer's disease, the symptoms of which include:

• bad memory
• speech difficulty or difficulty understanding and finding words (aphasia)
• difficulty carrying out tasks such as tying shoelaces (apraxia)
• difficulty recognising things and people (agnosia)
• difficulty seeing things in wider context, planning and structuring things
• difficulty with abstract reasoning (the ability to analyse information and solve problems)

Dementia often causes passiveness, bad moods and change in personality. In the early phase of dementia it is sometimes mistaken for depression. Approximately 12% of all people with dementia will actually develop depression.
Some patients suffering from depression are so inhibited and passive that they appear demented. This is called hysterical pseudo dementia, which can be very successfully treated with antidepressant medicines.
Multiple sclerosis
Multiple sclerosis is a neurological disease which gradually and often causes invalidity and dementia. The first symptoms are often seen in people between 20 and 40 years of age.
Between 25- 50% of all multiple sclerosis patients will probably at some time develop depression, with just as many developing an elevated mood, seeming inappropriately hyped-up.

Medical treatment
The medical treatment that is necessary to improve or cure your physical disease can, in some cases, cause or maintain depression, anxiety or other psychological diseases. A common example is a certain type of heart medication called beta-blockers.  Another example is interferons, which also carry warnings of the risk of developing or maintaining depression. If you develop a depressed mood while being treated for another disease, ask your doctor to carefully look at your medication, which may be the cause of your symptoms.

Will I get better?

Seeking help when depression or anxiety is suspected is the most important first step on the road to recovery. People suffering from depression, anxiety or both need treatment. There is a wide range of effective treatment options for depression and anxiety. It is important for your treatment and recovery plan that your doctor can diagnose the condition and select the appropriate treatment for you. Patients normally make a full recovery.
If you suspect that you or someone you know suffers from these conditions it is important that treatment is sought. Make an appointment to see your doctor, talk to a friend or family member.

What treatment is available?

Even though depression and/or anxiety can be a serious and painful disease, there are a number of effective treatment options. You may be given medicine, a non-medicinal treatment such as psychotherapy, or a combination of these.
The first step will always be to see your doctor, who will make a diagnosis and suggest the particular treatment that would be best for you.

Medicinal treatment
When you suffer from depression and/or anxiety, the amount of signalling chemicals (neurotransmitters) in your brain are reduced. The most important signalling substances are serotonin, noradrenaline and dopamine.
Medicines available to treat depression (called antidepressants) or anxiety (called anxiolytics) normalise the amount of signalling substances in the brain, which re-balances your mood. Some medicines are effective in the treatment of both depression and anxiety.
Medicinal treatment of depression has developed rapidly over the last 50 years. Many new types of effective antidepressants have been discovered. Taking this medicine correctly will almost always improve your condition within a relatively short time.
Generally speaking, current antidpressants:

• are effective against depression
• are effective after a relatively short time
• often have few or short-term adverse effects
• are not addictive
• don’t require that you go for regular checkups with blood tests etc.

If you have any concerns regarding your treatment, please do not hesitate to consult your doctor for advice.

When the time comes for you to stop taking your medication, it is important to first discuss this process with your doctor. In most cases, a gradual reduction in your dose over a period of weeks will be recommended.

Antidepressants are categorised by their pharmacological action. The most commonly used groups are selective serotonin reuptake inhibitors (SSRI), serotonin noradrenaline reuptake inhibitors (SNRIS), tricyclic antidepressants (TCA). There are also other pharmacological treatment options such as monoamine oxidase inhibitors (MOAI).

• Selective serotonin reuptake inhibitors (SSRI)

Escitalopram belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRI)

• Serotonin and noradrenaline reuptake inhibitors (SNRI)

SNRIs, venlafaxine and duloxetine are another type of medicine currently used. They are thought to boost the effect of the signalling substances serotonin and noradrenaline in the brain. They are similar in effect to SSRI’s.

• Tricyclic antidepressants (TCAs)

TCAs boost the signalling substances serotonin and noradrenaline in the brain and also block a variety of other receptors in the brain's nervous system. They therefore have a slightly different effect to the SSRIs but also have more side effects. This group comprises, amongst others, nortriptyline, clomipramine and imipramine. TCAs are seldom used as a first-choice treatment. TCA treatment should be used with caution in the elderly and people with heart problems.

• Monoaminoxidase inhibitors (MAOI)

MAOIs are now used very rarely. The non-selective MAOIs are normally only prescribed by psychiatry specialists, as very serious side effects can occur during treatment.
Benzodiazepines
Benzodiazepines are another type of medicine that can be used to treat some anxiety disorders. These medicines can provide rapid relief from symptoms but should only be used to treat anxiety that is severe, disabling or causing you extreme distress. It is possible that you could become dependent on benzodiazepines and suffer from withdrawal symptoms when the treatment is stopped. Therefore it is recommended that these medicines should only be given at the lowest effective dose for the shortest period of time.

Non-medicinal treatment options
The treatment of mental illness such as depression and anxiety by verbal or non-verbal communication is known as psychotherapy. There are many forms of psychotherapy but all are based on clinical observations and equal cooperation between patient and therapist.
The best scientifically supported and most effective psychotherapeutic method of treating depression and anxiety is cognitive therapy. It is clearly superior compared to other therapies when it comes to treating acute symptoms and preventing relapses.
With cognitive treatment you will learn to analyse the connection between thoughts, feelings, behaviour and the body's physical reactions.
Cognitive therapy for treatment of depression and/or anxiety can focus on:

• changing negative and destructive thought processes
• changing inappropriate behaviour, which aggravates the problems
• easing traumatic experiences and reducing psychological pain
• activating and solving problems
• building up self-worth and social skills
• improving communication
• providing acute help with suicidal thoughts and threats of suicide
• reducing the probability of relapses

During the treatment sessions you will learn to:

• use methods that will reduce anxiety
• distinguish between symptoms and real events
• build up your self-esteem
• regulate your feelings
• solve problems
• build up your social skills
• handle life's difficulties
• control episodes of bad and depressed moods

There are different cognitive therapy methods corresponding to different mental problems and conditions. It depends on the individual and how much therapy is needed. On average a course of therapy for moderate depression or anxiety takes approximately 12-20 sessions.
Psychological therapy is often used as first-line treatment for anxiety disorders. The best treatment for depression is often a combination of antidepressants and cognitive behavioural therapy. The medicine increases your motivation, energy, appetite and concentration level as well as it helps you distancing yourself from negative thoughts. All of that will help you to benefit more from the psychotherapeutic treatment.
Apart from antidepressant medication and psychotherapy there are other treatment options for depression. Electroconvulsive therapy (ECT) is potentially the most controversial method. The controversy goes back in history and is reflected in the colloquial term ‘electroshock’.
‘Electroshock’ sounds like an old-fashioned and dangerous treatment but, despite all rumours, ECT today is a fast-working, effective treatment for severe, treatment-resistant depression. Suffering severe depression can be painful and sometimes dangerous, and ECT is a good choice, even though you might be nervous about it. It is carried out under general anaesthetic. Most patients who have received ECT would opt to receive ECT again if they develop another depression.
ECT works quickly in emergency situations where people have come to a complete stop. If you drink or eat so little that your situation is life threatening or if you have serious suicide thoughts, ECT can be life saving.
ECT treatment also can be the last resort if antidepressant medicines and psychotherapy have not had any effect.
If both ECT and preventive antidepressants are used, the frequency of relapses is reduced. ECT is therefore not a curative treatment. It always needs follow up with preventive medicinal treatment and monitoring.
Other treatment options include physical treatments for depression, such as transcranial magnetic stimulation (TMS). Seek advice from your HCP if you would like to learn more about what is available for you.

What to expect during antidepressant treatment?

Remember that although called antidepressants these drugs, including Lundbeck antidepressants are effective at treating both depression and also anxiety disorders. Most patients with depression or anxiety will be treated by their family doctor. He will see you on a regular basis and inform you about the advantages and adverse effects to be expected when taking the chosen medicine. Make sure you keep in contact with your doctor and follow suggestions, and more importantly, instructions.
The goal of treatment is to make you feel well and get back to normal, free from symptoms so that you can work as normal and enjoy all your usual activities. These drugs only work if taken regularly. Your doctor will tell you how much and how often you need to take your medicine. Make it a habit to take your pills everyday around the same time; set an alarm clock, or coincide it with the news for example. Don’t stop taking your medicine without first discussing it with your doctor.
Like anyone receiving medicinal treatment, you should see your doctor for regular checkups. He or she will monitor how the treatment is working and your recovery progress. In most cases any side effects will be mild and settle within the first couple of weeks. It might be 2-3 weeks however before you begin to notice the effect of the medicine. In rare cases the medicine and the dose that your doctor has prescribed doesn't work effectively. If this is the case, your doctor has other options for improving your treatment by choosing to:

• continue your treatment for a while longer without making any changes to it
• give a larger dose of the same medicine
• change to another antidepressant
• combine antidepressants with other forms of medicine
• combine antidepressants and psychotherapy (hyperlink to psychotherapy section) 
• combine antidepressants with physical treatments such as ECT (hyperlink to ECT section) although this is extremely rare and reserved for the most severe or chronic cases

Phases of antidepressant treatment

Treatment of depression always has these three important phases:
Acute treatment
Acute treatment covers the period from starting your medication until the symptoms have fully disappeared. After the acute treatment you should feel completely well. The acute treatment typically lasts 1-2 months. It tends to take longer for anxiety symptoms to settle completely than for depression.
Remember that the symptoms disappear gradually over several weeks or even months. Don’t stop taking your medicine prematurely. Just because you haven't felt any effects after one week, doesn’t mean your treatment is not working. Be patient – and if you are in doubt, speak to your doctor.
Your family will often notice the effect of your treatment first. Listen to them and try to involve them in your recovery! After 4-6 weeks you should definitely feel better but improvement will often continue over many weeks or months.
After a successful acute treatment you should feel completely well. Your mood, energy and interest in the people around you have returned. You will be able to resume work and other activities. You can live your life the way you used to before your illness.
Maintenance treatment
If treatment isn’t continued after the acute phase it is possible that your illness come back. Therefore continue the treatment and take your medicine as prescribed by your doctor until advised to stop. Continuing to take treatment for some time after getting better is really important in preventing symptoms coming back.
For your own good, therefore, it is important that you don’t stop taking your medicine whilst under maintenance treatment. You risk becoming depressed and/or anxious again! Continue treatment and keep the dose unchanged until your symptoms would have ceased of their own accord.  This can be up to a year after your symptoms have disappeared.  Again, continue your treatment and take your medicine as prescribed by your doctor.
If your doctor recommends stopping treatment after maintenance, this is normally done gradually over a month or two. Suddenly stopping treatment can cause you to relapse and increase the risk fo rdiscontinuation symptoms.
Preventive treatment
After maintenance treatment, you and your doctor must decide whether or not you need to continue with preventive treatment. If you have had one episode of depression, the risk of developing a further episode at a later stage is about 50% but of course you may never have it again and provided you get treatment quickly if it seems to be coming back it is unlikely that you will need prolonged preventive treatment. If you have had three or four previous episodes, the risk of further episodes is much greater (90%) and your preventive treatment could last up to 5 years.  In severe cases it may be best to continue indefinitely. Your treatment should be the same in terms of medicine type and dose to the one that was effective in your acute treatment. “The treatment that got you well will keep you well” During your preventive treatment, you can lead a normal life, look after your family and carry on with your education and work.

Your first step towards recovery

Recovering from depression or anxiety takes time. Do not be afraid to ask for help.
This is the first step on the road to recovery.
Well done. You have taken the first and most important step on the road to recovery. Asking for help is the first step towards recovery.
Depression and anxiety are serious illnesses and asking for help is the right thing to do.
It is often difficult to admit to having depression or anxiety and to talk about your problems. But remember that you are not alone. These illnesses are very common.
Now that you have started treatment with your medicine, take it one step at a time. It takes time to recover from these serious illnesses. Depression and anxiety can affect every part of your life, so it is important not to expect miracles.
You may need a break from work. You can discuss this with your doctor, who could give you a medical certificate and answer any additional questions you have about your recovery. Other people feel that continuing the routine of going to work is important, even if it has become difficult.

Try not to despair, your illness will improve. No matter how hopeless your situation may seem things will get better soon.
Don’t lose hope. You are on the road to recovery.

Try not to expect the worst!

Depressed and anxious people often overlook or play down positive things and focus on the negatives instead. Thinking that everything has gone wrong is likely to make you feel even worse. Although it might feel that everything goes wrong for you, this is pretty unlikely!
In depression and anxiety, you may often find yourself expecting things to go badly and assuming that the worst will happen. For example, you might say to yourself:  “I’ll never get that job” or “I’m not going out tonight, I won’t enjoy it at all”.
Expecting that the worst thing will always happen is also known as Catastrophic Thinking (always expecting a catastrophe i.e. the worst, to happen).
Assuming the worst will make you feel bad and can make you give up before you even start. Although it might feel like everything will go wrong for you,  ask yourself how often has this really happened and you’ve worried unnecessarily? 
Try to keep a realistic view of the future!
Remember that no one can really be certain what will happen in the future – it is usually a mixture of good and bad things. Rather than expecting the absolute worst, try to be realistic. Things may not be perfect but they may be OK.
After all, if you give up trying, you won’t get anywhere!  It’s important to stay hopeful and to keep looking forwards. Have a go and see what happens!
Motivate yourself!
Low motivation or being unable to find the time to do anything are very common problems in depression and anxiety. This results in people cutting down their usual activities and social events, so that they become increasingly isolated. Being less active also makes people become even more tired and lethargic.

Why not make a note of things that have gone well in a diary?  Then, when you are feeling low or anxious, read through this list and remind yourself that the worst didn’t happen. This will help you to feel better and will also help you to find positive solutions for any problems that you face.
Imagine how you would like your life to be…

A good way to motivate yourself is to focus on your future goals. Imagine life without depression and anxiety, without feeling constantly low or worried. Remember that you can get to this point.

Then think about what helpful things you can do to get your life back on track. By continuing to motivate yourself to make positive changes in your life then you have a great chance of achieving your goals.

And then just do it…!After you have decided what might help you to make forwards progress, the next step is to just do it, no matter how tired or worried you might feel at the time. By doing it anyway, you will generate energy and confidence in your own ability to make positive changes in your life. Have a go!  What are you waiting for…?!
If you are in doubt about any of our proposals, please seek advice from your doctor.

Depression and anxiety are serious illnesses

Depression and anxiety are serious illnesses. They affect every single aspect of people’s lives including work, social activities and relationships with friends and family. For some people, even simple tasks such as taking a bath or meeting a friend can seem like impossible obstacles.
Depression and anxiety will go away with the right treatmentWith the right treatment, people with depression, anxiety or both are able to fully recover. Their low mood, physical exhaustion and feelings of anxiety gradually improve and they become able to cope with those seemingly impossible tasks once more.
The treatment for depression and anxiety often involves taking medication. It is often also helpful to use psychological approaches to maximise the benefit of the medication. This could include learning to think more positively about things as well as behaving in more helpful ways.
Ask yourself:  ‘What things have I stopped doing now that I am depressed or anxious?’  Is it possible to try doing some of these things anyway, even if you are still depressed or feeling anxious?
Your doctor and those close to you will support you along the road back to normality, which may often be difficult.
Look on the iRecover website to discover how treatment can help you. The website will also give you tips and advice from time to time to help you learn to think more positively to maximise the benefit of your medicine.

Get into the habit of taking your medicine regularly!

To get the maximum benefit from your medicine, it  is important to take your medicine regularly, at the same time every day. This means that you will get the maximum benefit from taking it. There are some tips to help you remember to take it.
What time of day is best for you to take your medicine?  Different times suit different people. If you find that the medicine is stimulating or makes you feel wakeful, it is often best to take it early during the day, perhaps first thing in the morning. If taking the medicine causes nausea or any discomfort in your stomach, try taking it right before going to sleep. Many people sleep through their medicine’s most common side effects.
Take your medicine with a large glass of water. The water quickly dissolves the tablet and helps your stomach to absorb the medicine. Try to avoid taking your medicine with milk, yoghurt or other dairy products as these might reduce its absorption. As you are probably aware, taking your medicine with alcohol is best avoided.
Don’t worry if you miss one tablet. Just take the next one as planned; do not take a double dose. Any changes in your dose of medicine should be discussed with your doctor before making them.

Keeping a diary is a good idea

Have you thought about keeping a diary? Many depressed or anxious people find it helpful to keep a diary. It provides a safe place to express your thoughts, fears and feelings. This can help you to think about your difficulties and may help to find some new solutions to problems.
The diary can also help to keep track of your progress. It is really helpful to keep a note of any improvements, positive achievements or steps forward, no matter how small. Keeping all your successes in mind will boost your confidence and help you to keep going if you have a bad day.
How about making an entry in your diary today?  You might like to make a note of anything that has helped you cope with your symptoms.
Remember that taking your medication as prescribed by your doctor will also improve your chances of getting better. 

Walk away from your depression and anxiety. You can do it!

We know you may feel too tired for any activity or think you have no time to exercise.  However, physical activity has been shown to improve mood and reduce people’s feelings of depression and anxiety. It gives a great energy boost but can also be calming.
Depression can make you feel tired and lethargic, whilst anxiety can make it hard to organise your time to plan any physical activity. People with these illnesses feel exhausted and the thought of physical activity seems impossible.
In depression and anxiety, resting makes you feel even more tired and lethargic!
Even though you may feel tired or seem unable to find the time to exercise, it is still important to make the effort to increase your physical activity because excessive rest or sleeping actually makes things worse.
Physical activity will boost your energy!Walking is a great way to increase your activity. After all, your body needs a certain amount of natural light and sunlight in order to stay healthy.
Why not try taking a walk outdoors today?  You can do this even if you feel tired or feel that you can’t be bothered. Do it anyway!
You don’t need to overdo things at the start. Even 10 minutes of walking can be very beneficial. Then you can build up from there. It is ideal to aim to walk for around 30 minutes at least 3-4 times a week.
Don’t be put off if the weather is not so good. You can always take an umbrella! 
Healthy physical activity helps to generate more personal energy and confidence. So it is important to remain active, even though you may not always feel like it.

Learn the key facts about depression and anxiety!

Depression and anxiety are serious illnesses. The low mood and feeling of anxiety can be overwhelming, almost developing a life of their own. Sufferers can feel so miserable that they consider suicide. The diagnosis of depression is very likely when you feel depressed most of the day, every day, for two weeks or more in a row. To be diagnosed with anxiety you are likely to have been very worried or stressed about everyday events on most days for at least six months.
Depression and anxiety seriously interfere with almost every aspect of people’s lives. The following are key examples of how people are affected by depression and anxiety:

• Feelings  – depression often makes people feel sad, guilty, angry, irritable or empty. Anxiety makes people feel fearful and tense.
• Thoughts – people with depression, anxiety or both may find it difficult to concentrate or find that their mind goes blank. They tend to think negatively about themselves and the world and spend a lot of time thinking, worrying and expecting the worst to happen. Thinking negatively about the future makes people feel hopeless and may lead to thoughts of suicide.
• Behaviour – people with these illnesses tend to cut down activities, particularly enjoyable ones or those they find particularly stressful. They tend to avoid social situations. They may stop working, cut down household jobs and even stop caring for themselves properly.
• Physical reactions – people with depression, anxiety or both many experience many physical reactions. These include: tiredness / lack of energy, changes in appetite, difficulty sleeping, restlessness or agitation, loss of sex-drive, racing heart, shaking or trembling, rapid breathing, chest pain and a dry mouth.

Depression and anxiety are common – you are not aloneThe World Health Organisation (WHO), fact sheet 265, estimates that 121 million people suffer from depression at any one time. During a lifetime, roughly 25 % (1 in 4) of the world's population will develop a mental illness such as depression or anxiety.
Depression also affects many families. About half of all families with a father, a mother and two children will at some point in time see a clinical depression in their homes.

Often people suffering from depression will also experience anxiety - 60% of patients with depression have severe anxiety. One in 5 will suffer significant panic attacks and many others will have phobias.

It is important that people with depression and anxiety receive proper treatment
If you think you are suffering from depression, anxiety or both go and see your doctor. There are many effective treatments for depression and anxiety, including medication. Other important treatments might include counselling or psychological therapies, such as cognitive-behavioural therapy.
What will happen to me in the future?The first time that people suffer from depression or anxiety can be unpleasant and frightening, as people may not fully understand what is happening to them. It can be hard to believe that you will ever get back to normality. But most people do respond to the correct treatment and are able to return to their old selves.
After treatment, many people stay well and do not become depressed or anxious again. Taking medication for at least six months after you have recovered can reduce the risk that these illnesses will come back.
Some people do suffer from depression and anxiety more than once. However, further episodes may be less severe as people can learn to recognise their symptoms early. They quickly take the next steps to help overcome the depression and anxiety. This might include seeing their doctor and re-starting their medication. Re-reading self-help books and personal diaries can also help. This all helps to overcome the illnesses more quickly, enabling people to return to normal life once more.

Add some enjoyment to life!

When you are suffering from depression or anxiety, it is extra important to take really good care of yourself, physically to help recovery.
Pampering yourself a little can be relaxing and will help you feel better.
Start today! Think about one special thing you can do that would make you feel good. Write it down, and do it this week. You are worth some special treatment!
How many of the activities that you do each week are enjoyable or relaxing?  It’s really important to include some fun activities in your daily life.
What did you enjoy doing before you became ill?  How about trying out some of these activities over the next week? 

Plan out what to do and when to do itIt’s helpful to plan exactly when you will try each activity. That way you are less likely to forget or simply ‘not get around to it’. You could use an activity chart or diary to plan your activities.

So, over the next week, which activities will you try?  Be specific about exactly what you plan to do. It need not be too time-consuming or difficult – even simple activities can be very helpful.
Here are some examples of enjoyable activities. How about making a list of your own suggestions? 

• On Tuesday evening I will have a relaxing aromatherapy bath – even men can enjoy that! 
• On Thursday lunchtime I will meet my friend for a coffee.
• On Saturday afternoon, I will sit down with a magazine for half an hour.
• On Sunday lunchtime, I will go for a walk with my partner or friend.
• On Monday evening I will spend half an hour listening to my favourite music.
• I will make an effort to put on some nice clothes and look good.

Just do it!  The enjoyment will come back with time
Once you plan to do a particular activity, try to stick to it, no matter how you feel at the time. By gradually increasing your levels of activity, the enjoyment will slowly start to come back too.

Be patient!  Remember that this can take some time, but being active is one of the best ways to improve your mood.
If for some reason you are unable to do a particular planned activity, remember to re-schedule it for another day.
Take good care of yourself!If you are depressed, it becomes extra important to take really good care of yourself.
Have you stopped taking such good care of yourself? Do you put everyone else’s needs before your own?  Perhaps you have so many demands from other people that you feel that there is just no time to take care of yourself.
Take time to care for yourself as well as for other people
Remember that unless you take good care of yourself, it becomes impossible to help other people as well. So you must always make time for yourself as well as caring for others. Spending some time on yourself will give you a renewed energy and enthusiasm to offer to other people.
Start today!  Think about one special thing you can do that would make you feel good. Write it down, and do it this week. You are worth some special treatment!
If you are in doubt about any of our proposals, please always seek advice from your doctor.

Lexapro / Cipralex (escitalopram)

http://cipralex.blogspot.co.uk/

http://cipralex.blogspot.co.uk/

My Life With Cipralex: Cipralex Day 1 - Starting with 5 MG...

My Life With Cipralex: Cipralex Day 1 - Starting with 5 MG...: Feeling a bit chilled, a bit tired, mouth little bit dry, Breathing is a bit slower, feeling of a little bit electricity or brainwaves down ...

How Vitamins and Minerals Affect Your Moods

  It’s not all in your mind

How Vitamins and Minerals Affect Your Moods
The first scientifically documented discovery to relate mental illness to diet occurred when it was found that pellagra (with its depression, diarrhea, and dementia) could be cured with niacin. After that, it was shown that supplementation with the whole B complex produced greater benefits
than niacin alone.
Evidence of biochemical causes for mental disturbances continues to mount. Experiments have shown that symptoms of mental illness can be switched off and on by altering vitamin levels in the body.
Dr. R. Shulman, reporting in the British Journal of Psychiatry, found that forty-eight out of fifty-nine psychiatric patients had folic-acid deficiencies.

Even normal, happy people can become
depressed when made deficient in
niacin or folic acid.

Nutrients That Combat Depression, Anxiety, and Stress

Vitamin B1 (thiamine) Above-average amounts can help alleviate depression and anxiety attacks

Vitamin B6 (pyridoxine) Aids in the proper production of natural antidepressants such as dopamine
and norepinephrine.

Pantothenic acid A natural tension-reliever.

Vitamin C (ascorbic acid) Essential for combating stress.

Vitamin B12 (cobalamin) Helps relieve irritability, improve concentration, increase energy, and maintain a healthy nervous system.

Choline Sends nerve impulses to brain and produces a soothing effect.

Vitamin E (dry form) (alpha-tocopherol) Aids brain cells in getting needed oxygen.

Folic acid (folacin) Deficiencies have been found to be contributing factors in mental illness.

Zinc Promotes mental alertness and aids in proper brain function.

Magnesium The antistress mineral, necessary for proper nerve functioning

Manganese Helps reduce nervous irritability.

Niacin Vital to the proper function of the nervous system.

Calcium Alleviates tension, irritability, and promotes relaxation.

Tyrosine Helps increase the rate at which brain
neurons produce the antidepressants dopamine and norepinephrine.

Tryptophan Works with vitamin B6, niacin, and
magnesium to synthesize the brain chemical serotonin, a natural tranquilizer.

Phenylalanine Necessary for the brain’s release of
the antidepressants dopamine and norepinephrine.

Other Drugs Can Add to Your Problem

Alcohol is a nerve depressant. If you take tranquilizers and a drink, the combination
of the two can cause a severe depression—or even death.

If you take a sedative with an antihistamine (such as any found in over-thecounter
cold preparations) you might find yourself experiencing tremors and
mental confusion.
Oral contraceptives deplete the body of B6, B12, folic acid, and vitamin
C. If you’re on the pill and depressed, it is not surprising. Your need for B6,
necessary for normal tryptophan metabolism, is fifty to a hundred times a
non-pill-user’s requirement.

                                   DRUGS AND MEDICATIONS THAT YOU MIGHT
                                                        NOT THINK WOULD
                                               CAUSE DEPRESSION—BUT CAN

The following list is not all-inclusive, but all mentioned deplete the body—in varying degrees—of important mood-regulating nutrients. So if you’re taking medication to get well and feeling down,
there’s a good chance that it’s not all in your mind!

• Adrenocorticoids
• Arthritis medicines
• Antihistamines
• Antihypertensives
• Baclofen
• Barbiturates
• Beta-blockers (Inderal™)
• Diuretics
• Estrogens
• Fluorides
• Indomethacin (Indocin™)
• Isoniazid (INH, Nydrazid™)
• Laxatives, lubricants
• Meprednisone (Betapar™)
• Methotrexate (Mexate®)
• Nitrofurantoin (Furadantin®, Macrodantin®)
• Oral contraceptives
• Penicillamine (Cuprimine™)
• Penicillin (all forms)
• Phenytoin (Dilantin™)
• Potassium supplements
• Prednisone
• Procainamide
• Propoxyphene (Darvon™)
• Pyrimethamine (Daraprim™)
• Tetracyclines
• Trimethobenzamide (Tigan®)

Personality Disorder

Personality Disorder: key facts

What is a personality disorder (PD)? 

• A “personality” is the collection of ways that we think, feel and behave  that makes each of us an individual.
• Most of the time, our personality allows us to get on reasonably well with other people but for some of us, this isn't true.
• If you have a personality disorder, parts of your personality make it hard for you to live with yourself and/or other people. You don't learn from experience how to change the unhelpful parts of yourself

You may have a personality disorder if you find it difficult to:

• make or keep relationships
• get on with people at work or with friends and family
• keep out of trouble
• control your feelings or behaviour.

and

• you are unhappy or distressed and/or find that you upset or harm other people.

How common is PD

Probably about 1 in 10 people has a PD.

Personality disorders tend to fall into three groups:

Cluster A -  'Suspicious' – includes:

• Paranoid

You are suspicious of other people – you feel that they are being nasty to you. You are sensitive to rejection and tend to hold grudges. 

• Schizoid

You don't have strong emotions, don't like contact with other people and prefer your own company. You have a rich fantasy world.

• Schizotypal

You have odd ideas and difficulties with thinking. Other people see you as eccentric. You may see or hear strange things.

Cluster B -  'Emotional and impulsive' - includes

• Antisocial

You don't care about the feelings of others, get easily frustrated, fight, commit crimes and find it hard to have close relationships. You do things on the spur of the moment, don't feel guilty and don't learn from unpleasant experiences.

• Borderline, or Emotionally Unstable

You do things without thinking, find it hard to control your emotions, and feel empty. You feel bad about yourself and often self-harm. You make relationships quickly, but easily lose them. You can also feel paranoid or depressed and, when stressed, may hear noises or voices.

• Histrionic

You over-dramatise events and tend to be self-centered. Your emotions are strong, but change quickly. You worry a lot about your appearance and crave excitement.

• Narcissistic

You feel very important and dream of success, power and status. You crave attention, tend to exploit others and ask for favours that you don’t return.

Cluster C -   'Anxious' – includes:

• Obsessive-Compulsive (aka Anankastic)

You are perfectionist, worry about detail and are perhaps rigid. You are cautious and find it hard to make decisions. You have high moral standards, tend to judge other people and worry about doing the wrong thing. You are sensitive to criticism and may have obsessional thoughts and behaviours.

• Avoidant (aka Anxious/Avoidant)

You are very anxious and tense, you worry a lot, feel insecure and inferior. You want to be liked and accepted and are sensitive to criticism.

• Dependent

You rely on others to make decisions for you and do what others want you to do. You find it hard to cope with daily tasks, feel hopeless and incompetent and easily feel abandoned by others.

Professional help

This can include:

• Individual Therapy

Counselling and dynamic psychotherapy, cognitive therapy, cognitive analytical therapy and dialectical behaviour therapy.

• Treatment in a therapeutic community

A place where you can attend (or sometimes stay in) for several weeks or months. Most of the work is done in groups. You learn from being with other people in a unit. It differs from 'real life' in that any disagreements or upsets happen in a safe place. The staff and other patients help you to get through such problems and learn from them.

• Medication

Antipsychotic drugs can reduce the suspiciousness of cluster A personality disorders (paranoid, schizoid and schizotypal). They can also help with borderline personality disorder if people feel paranoid, or are hearing noises or voices. 

Antidepressants can help with the mood and emotional difficulties of people with cluster B personality disorders. Some selective serotonin reuptake inhibitor antidepressants can also reduce anxiety in cluster C personality disorders.

Mood stabilisers such as lithium, carbamazepine, and sodium valproate may also reduce impulsiveness and aggression. 

How effective is treatment?

The evidence is weak because treatments are usually quite complicated, so it is hard to know what part actually worked. The studies are also usually small and rather too short, and the ways of measuring improvement are poor.

Which approach is best for me?

This depends on what you prefer as well as the type of personality disorder that you have. However, a lot depends on what is available in your area.

What is Perfectionism??

Perfectionism Defined

Perfectionism is not necessarily about being ‘perfect’. Ask yourself this question… Is it ever really possible to be 100% ‘perfect’? So, if it’s not about being ‘perfect’, then what do we mean when talk about perfectionism? Although there’s no perfect definition,

we understand perfectionism to involve:

1.The relentless striving for extremely high standards (for yourself and/or others) that are personally demanding, in the context of the individual. (Typically, to an outsider the standards are considered to be unreasonable given the circumstances.)

2. Judging your self-worth based largely on your ability to strive for and achieve such
unrelenting standards.

3. Experiencing negative consequences of setting such demanding standards, yet continuing to go for them despite the huge cost to you.

The Paradox of Perfectionism
Many people think of perfectionism as something positive. It is often seen as the pursuit of excellence, setting high standards, and working hard to challenge one’s self.
People often have good reasons for being perfectionists.
They may say that it allows them to be efficient, organised, or prepared for anything. Although having high standards and goals may help us achieve things in life, sometimes these standards get in the way of our happiness and can actually impair performance.
This is the paradox of perfectionism!
The excessive drive to achieve ever-higher levels of performance is self-defeating as it leaves you little chance of meeting your goals and feeling good about yourself.
This kind of pressure is likely to cause you to feel constantly on edge, tense, and stressed out.
Perfectionism can also make your self worth particularly vulnerable as not reaching the (possibly unachievable) standards you set for yourself may result in you feeling like a failure.
Pursuing these personally demanding standards can have a significant impact on your wellbeing, and can lead to frustration, worry, social isolation, depression and a persistent sense of failure.


When am I a Perfectionist?
Being a perfectionist doesn’t necessarily mean you have unrelenting high standards in every area area of your life. It is possible to be a perfectionist in one area of your life (e.g., work), but not another (e.g., grooming).
Areas of life in which your perfectionism may flare up
include:
◊  Work,
◊  Study,
◊  Housework/cleaning,
◊  Close relationships,
◊  Eating/weight/shape,
◊  Grooming/personal hygiene,
◊  Sport,
◊  Health & fitness.

How am I a perfectionist?
Some common types of perfectionistic behaviours include:

◊  Struggling to make decisions in a timely manner (e.g., not being able to decide what to wear to work each morning).

◊  Reassurance seeking. (E.g., asking others to check your work to ensure it is acceptable).

◊  Excessive organising and list making. (E.g, repeatedly writing and re-writing lists of the tasks you want to get done in the day).

◊  Giving up easily. (E.g., giving up flamenco after two lessons because you can’t keep up with the teacher (even though nobody can)).

◊  Procrastinating. (E.g., putting off starting an assignment for fear that it won’t be good enough).

◊  Not knowing when to stop. (E.g., arguing a point over and over, long after others have lost interest).

◊  Checking. (E.g., repeatedly looking in the mirror for facial blemishes).

◊  Hoarding. (E.g., keeping your bank statements for 20 years just in case you might need them).

◊  Slowness. (E.g., speaking slowly to ensure you say the right thing).

◊  Avoiding situations in which you may ‘fail’. (E.g., not applying for jobs for fear that you will not get them).

Perfectionism involves:

The relentless striving for extremely high standards; Judging your self-worth based largely on your ability to achieve these standards; And continuing to set demanding standards despite the cost
associated with striving for them. Sometimes when a person’s self worth depends on their achievements they push themselves to attain unrealistically high standards. They may act in ways
intended to ensure that they meet these standards (e.g., checking, correcting); judge themselves harshly and focus on their mistakes. They may criticise themselves when they fail to meet their standards, affecting their self worth. If they meet their standards they may suggest that they were too low and set higher ones.

Underlying Rules & Assumptions
Rules and assumptions that are flexible and accurate provide helpful guides for living. However, rigid rules such as “the job is not done unless its perfect” and inaccurate assumptions such as “if I make a mistake the business will fail”, tend to cause people to focus single-mindedly on doing things ‘perfectly’.

Unrelenting Standards
Unrelenting high standards are so unrealistically high and inflexible that we are unlikely to be able to meet the standard, or will only be able to meet the standard at considerable cost.
When an unrelenting high standard is not met, instead of concluding that it was unrealistic, perfectionists will conclude that they did not work hard enough or failed. In future, some will give up altogether while others will try even harder. Unfortunately, even if a high standard is achieved, most perfectionists do not feel happy about this for very long. Some might see it as a “fluke” or decide that the standard set was not high enough, and set a higher standard the next time.

Perfectionism Behaviours
Perfectionists also engage in a range of unhelpful behaviours to make sure they continue to meet the high standards they set for themselves. E.g., procrastinating, avoidance, checking, correcting, list-making, slowness etc.
These behaviours keep perfectionistic thinking going because, if you keep behaving this way, you never have the opportunity to test out whether your perfectionistic thinking is true. These behaviours may be timeconsuming, done at the expense of other important activities and may even delay or interfere with attempts to meet the standard set.

Perfectionistic Thinking
We usually to attend to and interpret things according to what we expect. Perfectionists tend to pay attention to any evidence that they are not achieving so they can correct these immediately. Perfectionists also have an extreme view of what success and failure is, with no middle ground, causing them to judge themselves more harshly than others would.




Often perfectionists evidence a pattern of unhelpful
thinking styles, including:

◊  Black & white thinking: seeing only extremes - no shades of gray;

◊  Shoulding & Musting: putting unreasonable demands on self and others;

◊  Catastrophising: blowing things out of proportion;

◊  Jumping to conclusions: assuming that we know what others are thinking, or can predict the future.


Reducing Perfectionist Behaviours
A hallmark of perfectionism is the tendency to judge your self worth largely on your ability to achieve high standards. To meet their unrelenting high standards, perfectionists tend to engage in a number of perfectionism behaviours
(e.g., repeatedly checking work for mistakes), which may serve to maintain perfectionistic beliefs.

Perfectionism Behaviours
Perfectionism behaviours can be divided into two categories - the things you actively do as a result of
your perfectionism and the things you avoid doing as a result of your perfectionism.

Perfectionism Active Behaviours
Most perfectionists engage in actions aimed at reaching the unrelenting standards they have set for themselves, and perhaps others. They are so concerned about reaching these high standards that they engage in behaviours that they see as necessary but that often seem excessive to other people.

Examples include:
◊  Excessive checking,
◊  Excessive organising,
◊  List making,
◊  Correcting others.

Perfectionism Avoidance Behaviours
Many perfectionists also attempt to meet their unrelenting standards and avoid ‘failure’ by avoiding doing tasks. Although this may not seem like perfectionism, it is really the other side of the same coin as engaging in actions aimed at meeting your unrelenting standards. When perfectionists fear that they will not be able to reach their high standards, they may be too afraid of failure to try. Some may procrastinate by putting off a task, often indefinitely, while others will wait to the last minute before doing a task.

Other examples include:
◊  Giving up too soon,
◊  Indecisiveness,
◊  Avoiding tasks you fear you are unable to do adequately.

How these Behaviours maintain Perfectionism
Perfectionism behaviours keep you from learning whether or not your perfectionistic beliefs are true. For example, a person who has difficulty delegating tasks to colleagues may hold the belief that this is necessary to maintain their high standards in the work place. By continuing to not delegate work, the perfectionist is unable to test our whether their beliefs are accurate.
Perfectionism Behaviours can also be problematic in that: they are often time consuming; they are sometimes done at the expense of other important activities; they can impair relationships; and sometimes can actually interfere with attempts to meet the standard set.

Reducing Perfectionism Behaviours*
One way to test the accuracy of perfectionistic beliefs is to see what happens when you behave differently.

Stepladders Towards Change
◊  Choose a specific goal behaviour to change,

◊  Break the goal down into small steps by changing who is there, what you do, when you do it, where you do it, and how long you do it for.

◊  Complete each step, one at a time, beginning with the least difficult and working your way up.

◊  Do a step frequently and repeatedly, to make sure you are comfortable with it before you move on.

Behavioural Experiments
Behavioural Experiments help loosen the grip of your perfectionism and test out the accuracy of your perfectionistic beliefs by seeing what happens when you change your perfectionism behaviours.
We encourage you to try reducing your perfectionism
behaviours. You may be pleasantly surprised at how much more time you have, and how little it affects your performance!

Perfectionistic Thinking
Perfectionists tend to determine their self worth based on their ability to achieve unrealistically high standards. As a consequence, they may focus on information in their environment that they interpret as evidence that they are not achieving, and criticise themselves harshly when they fail to meet their standards. Such patterns of thinking serve to maintain the importance of attaining extremely high standards.

Biased Information Processing
The way we make sense of what goes on around us plays a big part in maintaining perfectionism. Since there is so much happening in our environment at any one time, our brains choose what we pay attention to and how we make sense of things. We tend to pay attention to and interpret things according to what we expect. Since achieving extremely high standards provides the basis for a perfectionist’s self worth, they tend to pay careful attention to any evidence that they take to
mean that they are not achieving. For example, if a perfectionist believes “I must never make mistakes”, they will probably quickly pick up errors in their work that other people may not notice.

Perfectionists also have a tendency to interpret information in a way that demonstrates that they are
not achieving. They often have an extreme view of what success and failure is, with no middle ground.
For example, they may say “missing out on an A for this assignment means that I might as well have failed”.

Self Criticism & Unhelpful Thinking
Perfectionists tend to be extremely self-critical, especially if they are unable to meet their high
standards.
They might say to themselves: “I am such an idiot” or “I should have done better”. This selfcriticism
can cause people to feel a range of negative emotions including anger, anxiety, depression and guilt.
Often these negative thoughts reflect an unhelpful style of thinking such as:

◊  Black & white thinking: seeing only extremes - no shades of gray;

◊  Shoulding & Musting: putting unreasonable demands on self and others;

◊  Catastrophising: blowing things out of proportion;

◊  Jumping to conclusions: assuming that we know what others are thinking, or can predict the future.


How Biased Information Processing and Unhelpful Thinking maintain Perfectionism
When people repeatedly focus on information in their environment that is consistent with their beliefs and ignore information that does not fit with their beliefs, it can appear as if their beliefs are
well supported. Likewise a person may perceive that there is a lot of support for their beliefs if they
repeatedly interpret information in a way that is consistent with their beliefs. When perfectionists pay attention only to evidence that they are not achieving, or interpret neutral information as showing that they are not achieving, they tend to feel bad about themselves.
For the perfectionist, this then underlines the importance of striving to achieve, thereby
keeping their perfectionism going.
Perfectionists’ repeated criticism of themselves not only causes them to feel uncomfortable emotions, it also emphasizes the importance of achieving their unrealistically high standards.
The negative thinking styles that they rely on cause them to place unreasonable pressures on themselves, see only the extremes and not accurately perceive situations.
Such negative thinking styles underlie perfectionists’ unreasonable standards and harsh self criticism.

Reducing Unhelpful Thinking*
One way to check out the accuracy of perfectionistic thoughts and find more helpful and balanced ways of thinking is to use a thought diary.

Thought Diaries
Thought diaries are designed to help you become aware of your negative thoughts and notice how these thoughts affect how you feel and behave. Thought diaries can also help you investigate the accuracy and helpfulness of your negative thoughts and develop new more balanced thoughts.



Perfectionism Unhelpful Rules & Assumptions
Since perfectionists tend to judge their self worth largely on their ability to achieve high standards, they often develop rules and assumptions designed to ensure that they meet these standards. Although many rules are healthy and useful, rigid rules and inaccurate assumptions can cause people to hold unrealistic expectations about themselves and others, which if unmet may bring about disappointment and criticism.

Helpful & Unhelpful Rules
We all need rules for living to help us make sense of the world and to cope with our everyday lives. So having rules, in itself, is not a bad thing. Helpful rules are realistic, flexible and adaptable. For example,
the rule “it is good to try to eat healthy food” is helpful since it is based on evidence that shows that people who eat healthily have fewer health problems, and since it is flexible as it allows for times when it is preferable to eat less healthy foods (e,g, birthdays).

Unhelpful rules are inflexible, rigid, and unreasonable. For example, the rule “I must never
make mistakes” is unhelpful because it not possible or reasonable that we would be able to maintain this standard and this means we are likely to feel bad when we make a mistake.

Unhelpful Rules & Perfectionism
Perfectionists’ self esteem is based heavily on their ability to attain extremely high standards. Consistent with their belief in the importance of achieving these high standards, their lives are often directed by a number of rules and assumptions designed to ensure that they meet their high standards.
Some rules commonly held by perfectionists include:

◊  Fear of failure (e.g., “I must do things perfectly”, or “If I try, then I will only fail”).

◊  Shoulds & musts (e.g., “My house must be tidy at all times”).

◊  All-or-nothing (e.g., “There is a right and a wrong way to do things”).

◊  Constant checking (e.g., “I must weigh myself several times a day to make sure I’m not gaining weight”).

◊  Control (e.g., “I must be prepared for anything”). Such unhelpful rules often form the basis for the
unrealistically high standards that perfectionists set for themselves.

Identifying Unhelpful Rules & Assumptions
To identify the unhelpful rules and assumptions that underlie your unrealistically high standards, ask yourself:

◊  What do I expect of myself at work or school?

◊  What standards do I expect myself to meet?

◊  What do I expect of myself in my various roles – child, friend, partner, parent, staff member/supervisor?

◊  What might happen if I relax my standards?

◊  What do I criticise in other people? What standards do I expect them to live up to?

Adjusting The Rules
Generating a more helpful rule or assumption involves thinking of another way to see yourself and the world that is balanced, flexible to different circumstances, and realistic given the real state of affairs. When thinking of how to put the new rule or assumption into practice, work out how you would act in everyday life if you already believed the new helpful rule or assumption, and then making a point of acting that way. Often when we act as if something were true, we actually start to take it on board and believe it.

To challenge your unhelpful rules and assumptions about
your perfectionism, there are six steps to take:

1. Identify your unhelpful rule or assumption

2. Work out where it comes from or how it developed

3. Question whether your rule is realistic or reasonable or achievable

4. Recognise the negative consequences of having and keeping this rule

5. Develop a more helpful rule or assumption

6. Plan how you would need to act in every day life to put this new helpful rule or assumption into practice

Remember, practice is very important for challenging your perfectionism.
We urge you to practice, and remind you that you don’t have to achieve change ‘perfectly’ or even quickly.


Re-evaluating the Importance of Achieving
People who are perfectionists tend to be overly concerned with achievement and the pursuit of unrelenting standards. They often rely on their ability to achieve unrelenting
standards as a basis on which to judge their self-worth. In turn, this can have a big impact on the
balance of their lives.

How can Over-evaluation of Achieving affect an Individual’s Self Worth?
Most people evaluate their self-worth based on a variety of things. When judging their self-worth, they might consider their personal qualities such as kindness, loyalty, willingness to help people, sense of humour, relationships with family, friends, partner, and skills such as achievements at work or school, ability to play sport, cook, or play a musical instrument. They might evaluate how happy they are based on how well important things in their life are going.

Perfectionists tend to judge their self-worth based almost entirely on achieving their unrelenting standards. They overvalue achieving and achievement. They may have other interests, but over time these seem to take a lesser place in their lives. This system of self-evaluation may have developed
through particular life experiences and/or positive reinforcement from people around them. People who try hard and are successful are often rewarded by others (e.g., praise, high marks, promotion at work)
so achieving can become equated with being hard-working, conscientious, and intelligent – in short, being of worth. Perfectionists come to believe that they are only of worth if they are pursuing or achieving the high standards they set for themselves.

The Impact of overly-relying on
Achievement to Judge Self Worth
Since perfectionists base their self worth on their ability to achieve unrelenting standards, they tend to work extremely hard to achieve these standards. Perfectionists often perceive this as highly beneficial. They may argue that by focussing all their energy on one area they are more likely to achieve their standards. Indeed, because of their hard work they
have the potential to perform well.
However, when people base much of their self-worth on only one thing in their lives, they are putting a tremendous amount of pressure on themselves to make sure that it works out. That’s why it’s not
surprising that perfectionists tend to be overly focused on achieving the high standards they set themselves. And they often feel stressed, irritable, depressed, anxious or guilty, and think negatively about themselves.
When a goal is achieved they may feel relieved, but they don’t tend to feel happy for very long. In fact, perfectionists tend to dismiss their success (“I was just lucky”) or conclude that the standard
set was too low (“anyone could have done that”) and re-set the standard higher for next time.

Tackling the Over-evaluation of Achieving
You may find it helpful to think about the amount of importance you place on each of the areas of your life that contribute to your self-worth. If you find that your self esteem overly relies on your ability to achieve, you may want to consider broadening your
interests. This will give you a chance to develop other ways of feeling good about yourself, apart
from the pursuit of those relentless high standards.
Identify the other areas of your life that may have once been important to your self-worth but have now taken a lesser place. Choose one area you would like to start with and then think of some activities you could engage in to help you do that.
You might find yourself thinking that you don’t feel like doing this activity and want to put it off until you feel ready. Don’t — act now!
People often want to wait until they feel motivated before they act. However, an important thing to bear in mind is, motivation may not come on its own, but when you ACT first,
motivation will then follow.
Remember, ACTION beforeMOTIVATION, and you‘ll soon find that your life will be more balanced. You will be less preoccupied with only one aspect of your life, and less dependant on that
success and achievement for your self-evaluation.