Antidepressants Blog

At least two million Americans have glaucoma, the second leading cause of preventable vision loss after diabetes. The disease – a result of extra pressure on the optic nerve from improperly draining eye fluid – isn’t curable, but it’s treatable, often with pressure-reducing eye drops.

In other words, you don’t have to go blind if you get glaucoma. But some people do.

“There’s no excuse for vision loss from glaucoma other than personal neglect,” insists Richard Bensinger, M.D., a spokesman for the American Academy of Ophthalmologists in Seattle. “Either you never got your eyes checked or your physician didn’t nag you hard enough to follow the medical regimen.”

Why should you have to be nagged into not going blind? According to Dr. Bensinger, it’s not just the mild inconvenience of an eye drop routine but also the lack of immediate payoff. “We don’t have to encourage people with arthritis because they’re hurting, and when they take their medicine, the pain goes away,” he says. “But with glaucoma the results seem like nothing. You don’t see any better or feel any better after you take the drops.”

There’s a similar reluctance about eye checkups, even though if you catch glaucoma in the bud via an eye-pressure test, you keep most of your sight. “The problem is that garden-variety glaucoma doesn’t have any symptoms,” Dr. Bensinger says.

So don’t wait till it’s too late. Dr. Bensinger recommends that you get your eyes examined every five years from age 25 to 50, and every two years after that. And you should have your eyes checked more often if there is a history of glaucoma in your family.

And please, take your medicine.

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The DSM-HI-R (Diagnostic and Statistical Manual of Mental Disorders) is more than just a psychiatric cookbook. No mere list of diagnostic criteria can describe the many ways a mental disorder affects people, while diagnosing by symptoms alone will not fully explain a condition. To enhance its usefulness, the manual describes some of the other features of anorexia nervosa.

For example, it notes the different ways weight loss can occur. One woman might rely on reduced food intake alone. Another might reduce intake but exercise excessively as well. Others use self-induced vomiting or laxatives or diuretics. The manual thus acknowledges that bulimia and anorexia may indeed coexist.

The compulsion to exercise is very common in anorexia. Even doctors a century ago recognized the symptom.

Many anorexics feel they have to run everywhere, that walking is just a missed opportunity to burn off more calories. Parents often tell me that their anorexic daughter “never stands still” or that she “always runs up the stairs” or that she “pedals her exercise bike until after midnight.”

Anorexics aren’t driven to exercise because they want to be physically fit. They simply want to burn off energy (and thus weight) in any way possible. Excessive exercise may also trigger some pleasurable changes in brain chemistry, producing effects such as the “runner’s high” that many joggers report. Thus anorexics may exercise to experience a neurochemical “reward.”

Besides exercise, other weight-loss methods include use of laxatives to stimulate bowel movements or diuretics to decrease water in the body. Anorexics frequently resort to such tricks to speed up the removal of food from the body.

The results can be disastrous. Many patients-some of whom use between thirty and a hundred laxative tablets a day-report cramps and abdominal pain. What’s more, the body, robbed of its ability to regulate elimination on its own, can become dependent on a laxative. I find that weaning patients from laxatives is one of the hardest tasks in treating eating disorders.

Laxatives and diuretics can produce severe dehydration and electrolyte imbalance. Electrolytes are chemicals such as sodium and potassium that help transmit electrical signals within the body. An insufficient supply of electrolytes puts tissues and organs, particularly the heart, at risk of failure. Patients who abuse laxatives and diuretics risk problems with their hearts and other organs, problems that in some cases lead to death. Ironically, laxatives don’t even help that much. A laxative abuser loses no more than 10 percent of available calories through this method, and most of the weight loss is merely “water weight” anyway, as I mentioned earlier.

Of course, the problem with starving yourself is that you’re always hungry. No matter how carefully you defend yourself against food, sooner or later you will have to eat something or die. Because the hunger can be overwhelming, eating even small amounts can trigger a binge.

For people with these disorders, eating anything, especially when it leads to a binge, represents loss of control. Vomiting restores control-at least until the next urge to eat comes along.

About half of all anorexics practice self-induced vomiting. I’ll have more to say about the physiological impact of vomiting in the discussion about bulimia in the next chapter.

By acknowledging these weight-loss practices, the DSM-III-R recognizes the differences between anorexics who attempt to starve themselves exclusively through reduced food intake (restricting anorexics) and those who reduce weight by extraordinary means (bulimic anorexics).

The manual goes on to describe some of the other common features of anorexia nervosa-for example, the “magic power” that food has over its victims.

Once I discovered that a patient named Debbie had stuffed whole packages of cookies, cheese, fruit, and candy into her underwear drawer in her hospital room. When I asked whether she was preparing for an eating binge, she replied, “Oh, no. I’m not going to eat that stuff. I just keep it there to show myself how much control I have over it. The more food I can lay my hands on, the greater the temptation to eat. And the more I can hold out and not eat, the stronger I feel.”

Like Debbie, many anorexics exhibit peculiar behavior connected to food. They imbue food with enormous, almost supernatural force. Some prepare elaborate meals for their families, but eat nothing themselves. Or they toy with the food on their plate, poking it around with their forks, and finally throwing the whole meal away.

Anorexics see their starvation not as a defect, but as something that makes them special. “Look at me,” they seem to say. “See how much control I have over my body.” Almost every one of my patients, at one time or another in the course of her illness, will feel something to the effect that “Not everyone can do this.”

Because they deny the problem, anorexics feel that therapy, or any attempt to intervene, constitutes a deadly threat, a plot to rob them of their “specialness.” Needless to say, such an attitude makes my job as their doctor much more difficult..

*25/35/5*

Marlene Dropp was so out of shape that she couldn’t even walk around the block. Seven years later, at age 51, she walked a marathon.

A veteran dieter, Marlene had struggled with her weight all of her life. Sometimes she’d lose a few pounds, but they would always come back.

Then one day, as she looked in the mirror, Marlene realized how much she disliked the image that she saw. “I was a frumpy 200-pound matron,” says the mother of four. “My dress had stripes, a frilly collar, and fluffy sleeves, like something my mother would have worn. I couldn’t fit into more fashionable clothes. That’s when I started feeling like a blimp.”

That’s also when she decided to do something about it. Because of her weight, Marlene had always felt too self-conscious exercise in public. But this time, she was determined.

So one beautiful morning in 1989, with her husband at home to watch the kids, Marlene decided on impulse to take a walk around her Hibbing, Minnesota, neighborhood. To her surprise, she arrived home energized. “That’s when I decided to make walking part of my daily routine,” she says.

Immediately, Marlene set a goal for herself. She wanted to advance from walking around the block to walking 5 miles a day. Her neighborhood is laid out in half-mile circles, so she just kept adding circles to her route. Within 2 months, she achieved her goal. So she set her sights on a new objective: She wanted to cover a mile in 13 minutes. A year later, she could do it with ease.

Within 2 years of starting her exercise program and making some changes in her eating habits—primarily avoiding fats and sweets—Marlene lost 50 pounds. As she got faster, she began entering racewalking competitions—milers, 2-milers, and 5Ks. In 1996, she celebrated her 51st birthday by entering a marathon. She completed the 26-mile course in less than 6 hours.

Even though she continues to compete, Marlene credits those daily walks around the block with jump-starting her weight-loss efforts. Today, at age 55, she maintains a healthy weight of 150 pounds.

WINNING ACTION

Follow the 10 percent rule. Just as Rome wasn’t built in a day, neither is an exercise program. Whatever activity you choose—walking, running, cycling, swimming, or something else—start slow and easy. Gradually build to

your desired duration and intensity A good rule of thumb is to increase your level of activity by 10 percent a week. So if you’re able to walk for 10 minutes your first time out, stay at that level for 1 week. Then add 1 minute—10 percent—to your workout the next week. Continue until you’re walking for 30 minutes a day.

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Andrew, aged twenty-nine, was prescribed Ativan eight years before for examination nerves. He was not sure why he carried on taking them. He had increased the dose twice during those eight years, but had not changed it during the past two years. He was then on 6 mg per day.

He complained to a friend (a dentist) that he had burning spinal pain, numbness, pins and needles in his limbs, and blurred vision. The friend said that it sounded like multiple sclerosis, and urged him to seek medical help. His doctor sent him to a neurologist who said he could find nothing wrong.

The doctor and neurologist suggested a holiday. During Andrew’s second miserable week, he saw a report in a local paper about a support group for people having trouble with tranquillizers. It was explained to him by the group that his body had become accustomed to the drugs, and that he was having withdrawal symptoms, even though he was still taking the tablets.

Three months after complete withdrawal, the spinal pain and other symptoms had disappeared. He made a weekly telephone call to the support group for reassurance when he felt down, or had the occasional panic attack. He cut down on coffee and cigarettes, and ate a balanced diet with vitamin and mineral supplements. He feels that swimming helped him to recover, although he admits it was a tremendous effort at first to go to the local pool twice a week. He is now very well, and supporting (by telephone) several people in his area who are withdrawing.

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Sound

The hypersensitivity to sound causes many family arguments. The sufferer has to turn the sound on the television so low that no one else can hear it. Doorbells are often disconnected, and telephones covered with blankets or cushions. Sounds not normally noticed, like the click of a light switch, or a clock ticking, can be distressing to some.

Touch

Some people complain of pain when they are touched, or of discomfort when they touch a rough fabric. Others do not feel pain, but say everything feels odd—water feels like slime, objects that should feel rough feel smooth. For a time, one woman could not cook because everything felt like jelly. Even if the joint of meat was burnt black, it still felt like jelly when she put a knife in it.

Taste

Loss of taste or altered taste sensation is common. It may be a surprise to find chocolate tasting salty or something savoury tasting sweet, but it is only a temporary nuisance. Enormous numbers complain of a metallic taste in the mouth, others say it tastes bitter, sweet or creamy.

After several months of loss of taste, one woman was delighted when she could taste sprouts. Gradually the number of foods she could taste increased (so did her weight).

Smell

Some users report loss of smell, but others say even pleasant smells like perfume become unpleasant. One man had a smell like petrol in his nose for several weeks.

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This means using your imagination in a positive way to cure symptoms of depression (or any illness). You may wonder how this simple measure could help, but try it and see—it takes time for the body to react to the positive images but it does work. By imagining scenes where you look well and confident, you are stimulating the chemicals necessary for your well-being. A woman in hospital who was immobilized after an accident, made a remarkable recovery when she started using this technique. In most of her waking hours she imagined she was playing tennis and her body responded to these positive images.

*35\49\8*

We all have a part of the brain that works to keep us normally restless and anxious at an acceptable level. During stress and illness, this mechanism may become over-stimulated, so we become over-anxious.

The body reacts to the chemicals poured into the bloodstream, and this gives us the distressing physical feelings which we associate with anxiety: heart beating wildly, stomach churning, shaking and sweating.

If your arm was injured and needed rest, you would put it in a sling. You can learn to give your exhausted nervous system the same kind of comfort and rest.

Dr Claire Weekes gives excellent advice in her books and tapes. In Self-help For Your Nerves, she asks you to accept your nervous illness, float through, and not fight against the physical symptoms and let time pass. This may sound difficult, particularly if you are coping with misery in your life. However, her advice is sound. If you fight your symptoms, you will further stimulate your over-sensitized nerves, and end up even more exhausted and ill. Accepting your fear may be the hardest thing you have ever done, but think of the rewards.

If you have a weak chest, catching a chill, or getting over-tired, could result in bronchitis. In the same way, if your nerves are over-strained, an unexpected gas bill or even a door banging may make you feel ill.

It could be that the anxiety feelings are too much for you to cope with so you retreat (although not consciously) to ‘not being you’. If this is very severe the sufferer may hallucinate, ‘seeing’ themselves or their faces. As anxiety decreases the feelings and hallucinations completely disappear.

*16\49\8*

The question of whether foods might produce excess immune complexes in the blood and thus cause the same sort of damage to the kidneys is a highly controversial one. Two groups of doctors, one working in Japan, the other in Miami, Florida, have made a special study of children with kidney disorders, and they believe that food is the source of the problem for some of these children. When put on an elemental diet (a synthetic food mixture that contains a minimum of antigens, children with certain types of kidney disease may improve. Those who do recover are then challenged with various foods and some reproduce their original symptoms – protein loss in the urine, and retention of water leading to puffiness in various parts of the body.

The food most often implicated is cow’s milk – the most common allergen of childhood. But the majority of these children appear to be sensitive to several foods, and to various airborne allergens, such as pollen. By putting these children on restricted diets, their symptoms have been fully or partially controlled. There are reports that neutralization treatments are also useful, where the food or foods concerned are difficult to avoid.

It must be emphasized that children such as these are rare, and the vast majority of cases of kidney disease are due to other causes. Nevertheless it does seem that food allergy can cause kidney damage in some children. Whether it can affect adults in this way is an open question.

Almost all the children affected in this way are atopic – that is, they show one of the classical allergic disorders, such as asthma or eczema. This raises the possibility that IgE and mast cells are somehow involved in the damaging reactions in their kidneys. While this is possible, it does not seem that IgE has a central role. Neither is it entirely certain that deposition of immune complexes is to blame. Some of the available evidence suggests that it is, but other studies point to different forms of immune reaction producing the damage.

Finally, Type-I allergic reactions to airborne allergens, such as pollen, may sometimes be linked with kidney disorders. Reactions of this type are thought to be extremely rare. It is not known whether IgE and mast cells are responsible for the damage in the kidney, or whether some other mechanism is at work.

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Every time sensational articles about pollen appeared in newspapers and magazines, the questions would be asked. ‘What actually is pollen? Is it a product of the food industry or of nature?’

According to the biblical account of the Creation, pollen existed long before man. The earth had to be thoughtfully prepared for man’s existence. For this reason, the plant world had to be made first, then came the animals and finally, man. So pollen existed even before the bees started flying from flower to flower. Pollen contains the male gametes of plants, which are essential to their propagation. Perhaps the wind carried these reproductive cells; otherwise the plants could not have been fertilised or pollinated before the arrival of insects. Today, bees are especially responsible for pollination, together with the wind. We have probably watched these busy insects in their constant activity many times. When bees visit individual flowers with their untiring zeal in gathering nectar, they collect something else at the same time. Their little legs touch the pollen, which in turn sticks to them in tiny grains, making the bees look as if they were wearing tiny yellow pants.

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The marvellous effect of cabbage leaves is truly remarkable and no doctor or medical practitioner who has the well-being of his patients at heart should ignore this lowly plant.

Here is another example, taken at random from the many testimonials I have received. A worried mother wrote asking for advice on how to deal with her child’s swollen neck glands. Having followed the prescribed treatment, this is what she wrote:

‘The trouble was soon put right by the remedies and cabbage poultices. Cabbage, in general, seems to be a marvellous thing. It seemed our thirteen-year-old son, who is 175 cm [5'9"] tall and whose voice has already broken, would not be able to get rid of a cold before having to go back to school the following Monday. He then complained of a really bad headache and yesterday afternoon, of a pain in and above his right eye. I was afraid of sinus trouble, so I put a cabbage poultice on his head just above the eyes and left it on for two hours. Monday came and off he went to school, returning in the evening still cheerful. The pain had completely gone.’

It is quite peculiar that the humble cabbage should have such outstanding healing powers and can give unexpected relief without any harmful side effects. What explanation is there? Well, cabbage not only supplies curative elements to the tissues but also eliminates toxins and other harmful substances from these same affected areas. This kind of remedy fills an important place, especially where nothing else seems to be effective.

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