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Depression Is Not An Illness: It is an Adaptive Mechanism
by PHIL HICKEY on JULY 28, 2009

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Post edited and updated March 9, 2013, to reflect additional thoughts as a result of interactions with the many people who left comments. I thank them for their input.

DEPRESSION – AN ADAPTIVE MECHANISM

Contrary to the APA’s assertion, depression is not an illness. In fact, depression is an adaptive mechanism which has served humanity well for millions of years. When things are going well in our lives, we feel good. This good feeling is nature’s way of telling us to keep doing what we’re doing. When our lives are not going well, we feel down or depressed. This is nature’s way of telling us to make some changes.

This is very similar to pain. Pain is a signal that tissue is being damaged and that urgent action is needed. For instance, if you touch a hot stove, the pain induces an immediate reaction to pull your hand away. Usually this is accomplished with minimal damage to the skin. Without pain, we would not respond as quickly to these kinds of situations, and we would incur a great deal more tissue damage than is actually the case.

Depression or despondency is not as acute a sensation as pain. It is more generalized and it signals – not imminent tissue damage – but problems of a more general nature. In order to feel good, the following eight factors must be present in our lives.

– good nutrition
– fresh air
– sunshine (in moderation)
– physical activity
– purposeful activity with regular experiences of success
– good relationships
– adequate and regular sleep
– ability to avoid destructive social entanglements, while remaining receptive to positive encounters *

SOURCES OF DEPRESSION

When any of these factors are missing, or are present to only a slight degree, we begin to feel despondent or depressed. When many of these factors are missing to a large degree, we become very depressed. Over the years, I have worked with hundreds of people who were depressed. To all of these people – without exception – I could say, “If I were in your shoes, living the life you are living, I would be depressed too.”

Many of these individuals lived on a diet which was generally poor. Others drank enormous quantities of alcohol. Few ate fruits or vegetables regularly. Many stayed indoors a good deal of the time. Physical activity was low. Purposeful activity – i.e. activity directed towards some kind of goal – was seldom present, and good honest, open relationships often non-existent.

The point here is not to disparage or castigate people who are depressed, but rather to point out that depression is essentially and fundamentally a function of what we are doing – how we are living our lives. It is not an illness. It is the body’s natural feedback system. It is nature’s way of trying to induce in us some motivation to make changes in our lifestyle – to eat better; to abstain from toxic substances; to get out in the fresh air and sunshine; to identify goals and pursue them; and to talk to friends and family honestly and openly about the things that trouble us. If we do these things consistently and regularly – if we integrate these things into our daily routines, then we will start to feel good. If we don’t do these things, we will feel depressed. Or as Peter Breggin, MD, puts it in Antidepressants Cause Suicide and Violence in Soldiers: “The principles for overcoming depression are exactly the same principles required for living a good and happy life.”

Everybody experiences an occasional down day. But we also know what to do about it – get out for a walk; start a project; talk to a friend or loved one, etc. Chronically depressed people, however, are individuals who have been neglecting these areas for years. They spend most of their lives indoors. They are often over-weight, have no goals other than the next TV show, and although they may have many acquaintances, they tend not to share their concerns and worries in an open and honest manner.

Of course, not all depressed people are deficient in all these areas. Some depressed people eat well, but never share their worries or concerns with anybody. Others share their worries, but have no purposeful activities. Others have purposeful and rewarding jobs, but never get outdoors and never engage in physical activity, and so on.

To feel consistently good, we need to have all of these factors present in our lives to a substantial and significant degree. Nor is this such a daunting proposition. A person who eats moderately from the five main food groups; who controls his intake of sugar and alcohol; who doesn’t smoke; who has a job or hobby that provides challenges and a sense of fulfillment; who gets outdoors most days for exercise or even for a brisk walk; and who has at least one other person with whom he is open and honest, will feel generally positive. A person whose life is lacking in one or more of these areas will feel generally negative. This latter is not an illness – it is not an instance of something going wrong in our bodies. Rather it is an instance of something going right. Depression is a message from the organism calling for change. Induction of negative feelings is the only language the organism has to express the need to make changes.

DEPRESSION DUE TO LOSS

Severe losses can, of course, precipitate depression even in otherwise very orderly and functional lives. Even when all eight factors are present to a substantial degree, the loss of a loved one will usually result in profound feelings of depression. Similarly, the loss of one’s career, health, home, etc., will generate some measure of depression regardless of previous lifestyle. People who have been living functional and productive lifestyles, as described above, however, will normally come to terms with the loss in a reasonable time frame. They will talk about the loss to the people in whom they confide; they will continue to eat well and to exercise, and will continue with the various purposeful activities they have always pursued. Gradually the sense of loss will recede and the ability to enjoy life will return. When it seems as if life is coming apart at the seams, it is our routines that save us – provided we have established good functional routines which incorporate the eight factors mentioned above.

However, for people whose lifestyles are deficient, or only marginal, in terms of the eight factors mentioned earlier, a major loss can put them “over the edge,” and they sink into a state of chronic long-term despondency. In this regard it is worth noting that all human lives are, sooner or later, touched by major tragic losses. What matters is: how equipped are we, in habits and lifestyle, to handle these losses. When a person goes to a mental health center and asks for help with depression, the first priority should be a detailed assessment of the person’s lifestyle, habits, relationships, history, etc., to determine the source of the depressive feelings. From this assessment, a remedial program should be developed and active support and assistance provided to the client in the implementation of this program.

In practice this almost never happens. The client who mentions depression is routinely shuffled off to the psychiatrist. He gets a prescription for an antidepressant and is told (falsely) that his depression is an illness “like diabetes,” and that he must take his pills in the same way that a diabetic must take insulin. If supportive or adjunctive therapy is provided at all, it usually takes the form of patronizing pats on the back or reminders to take the “medication.”

DEPRESSION AND NEUROCHEMICAL DEFICIENCIES

Despite decades of highly motivated research on the part of pharmaceutical companies and university departments funded by pharmaceutical companies, no evidence has ever been presented that depression is caused by a physical problem in the brain. Yet this assertion is routinely presented to clients and their families as justification for the drug prescription. Elliot Valenstein, Professor Emeritus of Psychology and Neuroscience at the University of Michigan, having reviewed the various biological theories of depression, summarizes the results as follows in his book Blaming the Brain:

“Although the often-repeated statement that antidepressants work by correcting the biochemical deficiency that is the cause of depression may be an effective promotional tack, it cannot be justified by the evidence.” (p. 110)

The fact is that antidepressants are mood-altering drugs (essentially in the same general category as alcohol, cocaine, amphetamines, etc.). All of these drugs have in common that they alter people’s moods. They make people feel better. That’s why people take them! But it doesn’t mean they are a good idea. There are two ways to get drugs in the United States. You can go to the street corner and buy them illegally; or you can go to a physician and tell him you are depressed, or anxious, or both. Either way, you’ll get something that will give you a temporary “fix” for whatever negative feelings are troubling you. But you will not get any real help with your problem. In this regard it is worth noting that anti-depressants are only about as effective as placebos (sugar pills). Whatever lift people get from these products actually comes from within themselves, not from any pharmaceutical correction of brain chemistry.

FREE DEPRESSION SCREENINGS

In recent years many hospitals and clinics have been offering free depression screenings. If you go in for one of these screenings, it’s obvious that you have been experiencing some depression, and the interviewer will quickly establish (through insultingly simplistic questionnaires) that, yes, you are indeed depressed, and that you would benefit from one of the many wonderful antidepressants currently available, and wouldn’t you like an appointment to see our psychiatrist. These “free” screenings are almost invariably paid for by a pharmaceutical company. They are a form of marketing and have been a major factor in the promotion of psychotropic drugs. The hospital staff who participate in these charades are well-intentioned, but in fact are mere cogs in an enormous drug-marketing scheme.

The purpose of the DSM is to promote the false notion that depression is really an illness, and to legitimize the prescription of mood-altering drugs. The manual lists several different kinds of depression. Acute, severe depression is called Major Depressive Disorder. Persistent though less severe depression is called Dysthymia. Depression that comes and goes and is interspersed with periods of mild mania is called Cyclothymic Disorder. And so on. And, of course, if a client doesn’t meet the criteria for any of these – there’s always Depressive Disorder Not Otherwise Specified: a residual category to broaden the scope of the diagnostic net. In fairness to the APA, all of the several diagnoses require a fairly significant level of severity. In practice, however, the precise criteria are routinely ignored. In fact, most of the staff working in the mental health system have only a vague notion of the criteria. A client who says he’s depressed is assigned a diagnosis and is given antidepressant drugs.

There are, of course, small numbers of mental health staff who although constrained by regulatory agencies to work within the DSM context, nevertheless ignore the implications of the sickness model and provide real help to their clients. These staff members are a very small minority and, the vast majority of mental health workers embrace the DSM taxonomy wholeheartedly and believe unquestioningly in the ontological validity of the diagnostic categories.

DEPRESSION’S MESSAGE: GET UP AND GET GOING

It is sometimes argued that depression can’t be an adaptive mechanism, encouraging us to make changes, because many depressed people, in fact, sink into inactive, lethargic despair. What’s being missed here, however is that in almost all cases, feelings of boredom, blues, depression etc., do in fact serve as a spur to action. A person sitting around sluggishly on a rainy Saturday afternoon, for instance, starts to feel down and shakes it off by getting up and doing something, or calling his mother, or putting on a raincoat and taking a walk, etc., etc… But all the messages we receive from our bodies can be eclipsed by counter-productive training. We are all born with a strong drive to preserve our own lives. But soldiers, through training and various pressures, can overcome this drive and continue fighting even though the message from within is to run. Similarly, when our stomachs are full, we get a message from our bodies to stop eating. It’s clear that this message often gets eclipsed.

Whether the depression message gets eclipsed or not depends largely on our childhood experiences. If we grow up in a family where depressive feelings are dealt with by getting up and getting going, then that’s probably how we will respond to these feelings as adults. But if we grow up in a situation where the depressive nudge is routinely ignored, then there’s every chance that we’ll continue to ignore these nudges in later life.

When a person’s life is characterized by strong functional routines, episodes of depression are rare, but when they occur, they are responded to in a positive manner. But when functional routines are largely absent, and where the depression message is generally ignored, then people sink deeper into despondency.

A good analogy here is our response to cold weather. If I’m outdoors working in the yard, and it starts to get cold, my body encourages me to take some action. So let’s say I go get a jacket and continue with the job. If it now gets a good deal colder, perhaps I’ll go in and get a heavy coat, then continue work. If the temperature continues to fall, I may simply give up and come inside. What I’m doing here is responding appropriately to messages from my body, and it is clear that the precise nature of my responses were shaped by my earlier training and experience. If I ignore the messages from my body, however, and stay outside as the temperatures falls, I become hypothermic and perhaps die. But nobody would conclude from this that the sensation of cold is an illness! The sensation of cold is an adaptive mechanism that encourages us to take appropriate action in response to falling temperatures. Similarly, the sense of depression is an adaptive mechanism that encourages us towards greater functionality in our daily routines. It is not an illness.

* added on August 27, 2013 at the suggestion of Nadia, a reader of the blog



Tagged as: depression, dysthymia

Odpri sliko ➜


http://www.behaviorismandmentalhealth.com/2009/07/28/depression/

Is Sex an Antidepressant?
By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH
A recent study found mood-boosting compounds in a surprising source: semen. So should you undress if you're feeling depressed?

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The relationship between depression and sex is complex. Depression can steal your sex drive, make off with your motivation, and deplete any desire you once had to feel attractive. On the flip side, many aspects of sex can help boost your mood and act as a buffer against depression’s effects.

How? One surprising recent study actually suggests that exposure to semen may help fight depression. Beyond sperm, the research found that semen may provide mood-boosting hormones and chemical compounds for women.

Researchers curious about the depression and sex (specifically semen) link tested the theory with college-age women. They found that those who used condoms (and were therefore less exposed to semen) were more likely to be depressed than those who did not use condoms. On the other hand, among women who did not use condoms, the longer they went without having sex (or being exposed to semen), the more likely they were to be depressed.

These results speak specifically to the mood-boosting benefits of sex for women, who are more likely than men to suffer from depression. But a romp in the hay may keep men upbeat as well.

“Our data on males indicate that the sex act elevates mood,” says Rebecca Burch, PhD, a researcher in the department of psychology at the State University of New York in Oswego, and one of the authors of the semen study. “The condom groups did not differ in depressive symptoms, but the males who were not having sex were significantly more depressed.”

Dr. Burch and her colleagues acknowledge that there are still many unanswered questions surrounding the relationship between depression and sex. For example, are men who aren’t having sex depressed because of the lack of sex, or are they not having sex because of depression’s side effects? Are women with mood disorders basically self-medicating with unprotected sex? More research is needed to find the answers.

But the semen study doesn’t mean throw all caution to the wind. In fact, risky sex has been associated with negative self-esteem. Burch stresses that, despite the possible mood enhancing effect of semen, “unprotected sex can lead to plenty of depressing conditions like sexually transmitted diseases or unwanted pregnancy.”

Even with a condom, she notes that women and men can still benefit from the mood-enhancing effects of orgasms, as well as the emotional bond that come from an intimate relationship.

Is depression keeping you or your partner from lovemaking and its mood-lifting benefits? Revive your sex drive with these steps:

Deal with depression. Although it’s no quick fix, treating your depression or your partner’s depression with therapy, lifestyle changes, or medication is the surest way back to an active sex life.
Nip side effects in the bud. Low sex drive or lack of response is a side effect of certain antidepressants, so talk to your doctor about other options. Low libido can also be the side effect of lifestyle choices, such as regular alcohol consumption.
Seduce him (or her). You may find that a little seduction is all that’s needed. Experimenting with erotica or sticking with some of the old stand-bys (flowers, candles, and sexy clothing) could get you both in the mood.
Make it a date night! Depression can leave you with little motivation to dress up for a night on the town. Schedule a date night — it’ll force both of you to make an effort. Be sure to plan an activity you both find enjoyable and relaxing — you may even find that the anticipation itself is an aphrodisiac.
Unwind. Stress and depression too often go hand in hand. A couples’ massage could be the ticket to helping you both feel sexy.
With a little creativity and effort, you’ll soon be able to reconnect and enjoy the mood-enhancing effects of sex.

Last Updated: 5/6/2011

http://www.everydayhealth.com/depression/is-sex-an-antidepressant.aspx

Koliko ur spanja potrebujes?

Attention, Ladies: Semen Is An Antidepressant
Vaginal exposure to semen elevates women's mood.
Posted Jan 31, 2011
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Perhaps you're familiar with the McClintock effect, the observation that when groups of reproductive-age women live or work together (in college housing, the military, all-female workplaces, etc.), over time their menstrual periods tend to become synchronized. The accepted explanation is that the women detect each other's pheromones, subtle scents that each of us produce, and somehow these only-faintly aromatic but powerful compounds influence the women's hormones and make their menstrual periods arrive around the same time.

But at the State University of New York, two evolutionary psychologists were puzzled to discover that lesbians show no McClintock effect. Why not? Gordon Gallup and Rebecca Burch realized that the only real difference between lesbians and heterosexual women is that the latter are exposed to semen. They speculated that maybe semen chemistry has something to do with the McClintock effect. But if that were true, the vagina would have to absorb compounds in semen that affected the women's pheromones.

Semen is best known for what's not absorbed by the vagina, sperm, which swim through it on their way into the fallopian tubes where fertilization takes place. But sperm comprise only about 3 percent of semen. The rest is seminal fluid: mostly water, plus about 50 compounds: sugar (to nourish sperm), immunosuppressants (to keep women's immune systems from destroying sperm), and oddly, two female sex hormones, and many mood-elevating compounds: endorphins, estrone, prolactin, oxytocin, thyrotrpin-releasing hormone, and serotonin.

Vaginal tissue is very absorptive. It's richly endowed with blood and lymph vessels. Given vaginal absorptiveness and all the mood-elevating compounds in found in semen, Gallup, Burch, and SUNY colleague Steven Platek wondered if semen exposure might be associated with better mood and less depression. They surveyed 293 college women at SUNY Albany about intercourse with and without condoms, and then gave the women the Beck Depression Inventory, a standard test of mood. Compared with women who "always" or "usually" used condoms, those who "never" did, whose vaginas were exposed to semen, showed significantly better mood--fewer depressive symptoms, and less bouts of depression. In addition, compared to women who had no intercourse at all, the semen-exposed women showed more elevated mood and less depression.

Meanwhile, risky sex is usually associated with negative self-esteem and depressed mood. Among college women, risky sex includes intercourse without condoms, so we would expect sex sans condoms to be associated with more depressive symptoms, and more serious depression including suicide attempts. However, in the Gallup-Burch-Platek study, among women who "always" or "usually" used condoms, about 20 percent reported suicidal thoughts, but among those who used condoms only "sometimes," the figure was much lower, 7 percent, and among women who "never" used condoms, only 5 percent reported suicidal thoughts. (This study controlled for relationship duration, amount of sex, use of the Pill, and days since last sexual encounter.) So it appears quite possible that the antidepressants in semen might have a real mood-elevating effect.

Finally, recall that in addition to antidepressant compounds, semen also contains two female sex hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH spurs egg maturation in ovary. LH is involved in triggering ovulation. Why would semen contain compounds that encourage ovulation? From an evolutionary perspective, this makes perfect sense.

Consider our closest biological relatives, the chimpanzees. Chimp semen contains no FSH or LH, but ovulating females develop a red buttocks, clearly signally reproductive readiness. In contrast, human women have concealed ovulation. Men don't know when women are most fertile. Compared with men whose semen lacked ovulation-triggering hormones, those whose semen contain these hormones would gain a small reproductive advantage. Their semen would encourage ovulation, and their sperm would be more likely to fertilize eggs.

Now, I'm not advocating that reproductive-age people shun condoms to elevate women's mood at the risk of unplanned pregnancy. But this effect might come in handy for women over age 50, who are experiencing menopausal blues.

I'm fascinated by the chemical complexity of semen. Until recently, scientists believed that its sole purpose was to nourish and protect sperm on their way to fertilization. But now it appears that semen spurs ovulation and makes women feel happier. That might explain why many women report increased interest in sex around the time of ovulation.

Source:
Bering, J. "An Ode to the Many Evolved Virtues of Human Semen," Scientific American, Sept. 22, 2010.

https://www.psychologytoday.com/blog/all-about-sex/201101/attention-ladies-semen-is-antidepressant

'Oral sex helps women fight depression' claim
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Behind the Headlines
Wednesday August 22 2012

News that semen contains antidepressant hormones is based on flawed, dated study
“Oral sex is good for women’s health and helps fight depression”, was the Daily Mail’s lurid headline today, while The Sun opted for a more straightforward “Semen is good for you”.
The “news” is based on research that is more than 10 years old. The facts used to support the lascivious claims come from a small study looking at depression scores of women students who used condoms during sexual activity compared with those who did not. It found that sexually active women who did not use condoms reported fewer depressive symptoms than those who did. From this the researchers seem to assume that semen may have antidepressant qualities.
This study is full of holes – and extreme caution should be used when interpreting anything from it. Researchers only gleaned information about depression symptoms (not diagnoses of depression), how often the women had sex, and whether they used condoms, via an anonymous questionnaire. All of these facts greatly limit the reliability of the results.
This type of cross-sectional study (symptoms and sexual behaviour assessed at the same time) cannot prove cause and effect – as the authors acknowledge. There are likely to be many other unmeasured personal factors in a woman’s life that influenced her depression scores and sexual behaviour. The researchers’ theory that semen may contain antidepressant compounds is speculation and is not supported by this study.
If the Mail’s report is taken seriously it could be seen as a green light for unsafe sex, leading to unwanted pregnancies and sexually transmitted infections – neither of which are normally associated with feeling more cheerful.
Where did the story come from?

Take home point
“This study is full of holes and extreme caution should be used when interpreting anything from it”.
The study was carried out by researchers from the State University of New York. The paper gives no information about any external funding.
The study was published in 2002 in the peer-reviewed journal, Archives of Sexual Behaviour.
Predictably, the Daily Mail and The Sun were determined not to let the study’s flaws get in the way of a good story. Both illustrated the story with photos of glamorous couples cavorting in their underwear. The Mail’s introduction claiming that oral sex is good for women’s health confused the issue further, since the study did not look at oral sex. It is also unclear why it has taken more than 10 years for the research to make it to the news pages.
Both papers only published the story on their websites, not in their print editions.
What kind of research was this?

This was a cross-sectional study of women students, which looked at their condom use as an indirect measure of semen in the reproductive tract. It compared both condom use and sexual activity to how the women scored on a standard depression questionnaire. The researchers say that previous researchers have hypothesised that semen may have an effect on mood in women – and that many of the hormones found in semen, including testosterone, oestrogen and prostaglandins, can be absorbed into the body through the vagina. They set out to test this hypothesis by measuring depressive symptoms in women and how it related to sexual activity and condom use.
A cross-sectional study provides a “snapshot” of certain factors in people’s lives at one point in time, but cannot show cause and effect. Viewing condom use as an indirect measure of the presence of semen in the vagina, or in the bloodstream, may sound logical but is unreliable. It is even possible that sexually active women who did not use condoms used a contraceptive method called coitus interruptus, in which the penis is withdrawn from the vagina before ejaculation. The researchers did not take account of this, or many other possible explanations for their results.
What did the research involve?

The researchers recruited 293 women undergraduates who answered an anonymous questionnaire designed to measure various aspects of their sexual behaviour, including:
frequency of sexual intercourse
number of days since their last sexual encounter
types of contraceptives used
Among the sexually active women in the sample, the use of condoms was taken as an “indirect measure of semen in the reproductive tract”. Each woman was also asked to complete a standard questionnaire (the Beck Depression Inventory) which is widely used to measure depressive symptoms, including suicide attempts. Researchers then analysed the results using standard statistical methods.
What were the basic results?

Of the women participating in the research, 87% were sexually active. Their depression scores were found to vary in relation to their condom use.
Women who had sexual intercourse, but never used condoms, had significantly lower depressive symptoms than those who usually used condoms.
Women who had sexual intercourse, and who did not use condoms, had significantly lower depression scores than those who “abstained from sexual intercourse”.
However, depression scores between women who used condoms and those who did not engage in sexual intercourse were not significantly different.
For women who did not use condoms, or only used them some of the time, depression scores went up as the amount of time since their last sexual encounter increased.
Of the women who had never used condoms, 4.5% had attempted suicide, compared to 7.4% in the “sometimes use” group, 28.9% in the “usually use” group and 13.2% in the “always use” group.
The researchers also found that women who did not use condoms had sex more often than those who used condoms most or all of the time.
Researchers also examined whether being in a relationship might be a factor which affected depression scores. They subdivided participants into two groups – those who were currently in a relationship with a member of the opposite sex and those who were not. They found no significant difference in depression scores between the two groups. Nor did the length of the relationship correlate with depressive symptoms.
They also found that use of oral contraceptives (used by 7 in 10 of the sexually active “never users” of condoms) made no significant differences to depression scores.
How did the researchers interpret the results?

The researchers say that although their study is only preliminary, the data is consistent with the possibility that semen may “antagonise” depressive symptoms. They also point out that the finding that women having sex without condoms scored lower on depression than those abstaining from sex shows that it is not sexual activity in itself that is associated with an antidepressant effect.
They say there is other evidence which shows that the vagina absorbs a number of components of semen into the bloodstream, some of which may have antidepressant properties. The researchers also suggest that it would be “interesting” to investigate the possible antidepressant effects of oral or anal ingestion of semen (or both) among both heterosexual couples and homosexual men.
Conclusion

It is difficult to know what to make of the study that the stories are loosely based on: why it was undertaken and what usefulness it could have in the real world. And apart from pure titillation and appealing to fans of ‘Fifty Shades of Grey’, it is difficult to see how these stories could be construed as news. It is possible that this story will become yet another of the many myths about sexual activity. If you’re not sure what to believe about what you’ve heard about sex, you can get simple explanations from our sex myth buster application.
As a cross-sectional study it provides a snapshot of both women’s sexual activity, condom use and their reported depressive scores at one point in time, but it cannot show that not using condoms or having semen in the reproductive tract causes women to feel less depressed. Although the researchers did try and take account of other factors that might affect both depression scores and sexual behaviour – such as how often women had sex and whether they were in a relationship – there are many unmeasured factors which might have affected both of these things and influenced the association, including family and study problems, illness and personality.
Even though they questioned whether the women were in a relationship or not, it is still difficult to assess from this the stability or security of the relationship, which could be associated with reduced depression symptoms and increased likelihood of using alternative, or longer term, methods of contraception.
It is also worth noting that the study has also not assessed diagnoses of depression, only depression scores.
Overall, the researchers have not shown in this study that semen contains compounds with antidepressant qualities. They consider that both the oestrogen and prostaglandins found in semen may have this effect, but this is only speculation. Whether self-reported condom use is an accurate indicator of semen in the reproductive tract or the bloodstream is also open to doubt, because some couples may have practised “withdrawal”. As the authors point out, to investigate whether semen had any effect on mood would require a study which directly measured semen in the reproductive tract or ideally, in the bloodstream, and correlated this with women’s moods. Whether this would be a useful exercise is questionable, to say the least.
Most importantly, condoms protect against unwanted pregnancy and are the best way to protect against sexually transmitted infections. Even if further study were to demonstrate that semen did have some direct influence upon depression symptoms, this minor benefit would almost certainly be outweighed by the increased risk of unwanted pregnancy and sexually transmitted infections.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on twitter.

Odpri sliko ➜


http://www.nhs.uk/news/2012/08august/Pages/semen-oral-sex-helps-women-fight-depression-claim.aspx

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Antidepressants and Natural Alternatives
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by Marcelle Pick, OB/GYN NP

Depressed Woman Antidepressants Natural AlternativesGrace was in her 40’s when she first came to see me. She was juggling a career and a family, caring for her aging father, and helping her husband start his own business. Finances at home were tight since he’d quit his job, putting a strain on their marriage. She was feeling low and tired all the time, so she went to her doctor for help. She left the office with a prescription for an antidepressant. Four days later, she came to the clinic with her unfilled prescription in hand to ask me, “Do I really need this?”

It’s hard to believe antidepressant prescriptions have more than quadrupled in the past couple of decades, with twice as many women as men — by some estimates over 1 in 10 women in America — now taking one. Advertisements for Prozac, Paxil, Zoloft, Wellbutrin, Celexa, Cymbalta, Effexor, and others bombard us everywhere we turn — there’s even a designer antidepressant for menopause symptoms called Pristiq, and another one for PMS symptoms called Serafem. But advertising doesn’t portray the full picture about these prescription drugs, just images of happy people relaxing in the sun. We all want that, right? So why not fill the prescription when your doctor offers it?

Woman Choosing Path Antidepressants Natural AlternativesWhile antidepressants can help some women immensely, especially those with major depression, the sad truth is that they’re just not very effective for a lot of people. And they certainly aren’t free of side effects. Like many women I see, Grace was reluctant to take a prescription drug, and wanted to know if she had any alternatives. I always tell my patients that there are many ways to navigate these difficult periods in life, and numerous options that can help improve mood and outlook naturally. It may take some time to figure out which path is right for you, but I promise, you can feel better. And the fact is, antidepressants will still be there, should you decide you need them.

Let’s take a closer look at antidepressants and some natural alternatives.

How depressed are you?

Depression involves a range of normal negative emotions. But “clinical depression” differs significantly from minor situational depression or mood disorders, even though the symptoms can be similar or the same. The difference is that in mild depression, symptoms ebb and flow, and eventually do lift, while in major depression they tend to spiral downward toward a more entrenched mental health crisis. Most forms of depression are characterized by:

Overwhelming feelings of grief, anxiety, guilt, or despair
A sense of numbness or hollowness
A loss of interest or pleasure in activities that were once enjoyed, including sex
Dullness, decreased energy, difficulty concentrating or making decisions
Disrupted sleep patterns
Overeating, weight gain, loss of appetite, or weight loss
Compassionate Gesture Woman Antidepressants Natural AlternativesIf you’ve noticed symptoms consistently for over a month, we urge you to see a medical professional, preferably a trained psychiatrist, psychologist, or social worker. Suicidal thoughts or attempts and obsessing about death are serious warning signs that need to be addressed immediately.

The depressing truth about antidepressants

Most healthcare practitioners have an average of seven minutes to spend with each patient. As you can understand, seven minutes isn’t nearly enough time to talk about a person’s emotional state. We can’t blame conventional doctors for how over-reliant on antidepressants our society has become — our medical system is broken, and antidepressants are a Band-Aid attempt to alleviate miserable symptoms. But in the end, any emotional concerns, including depression, anxiety or mood changes deserve more attention than seven minutes, and I encourage you to give yourself that attention.

There’s good reason to take some time with this decision. For one, antidepressants can cause several surprising side effects, such as restlessness, anxiety, sexual dysfunction, increased sweating, and more (refer to the following list).

What’s more, there’s been ongoing debate for years about whether they are even effective for people with mild to moderate depression. A 2010 meta-analysis revealed minimal or nonexistent benefits as compared to placebo for mildly to moderately depressed people, although people suffering from severe depression showed more substantial benefit.
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https://www.womentowomen.com/emotions-anxiety-mood/antidepressants-alternatives/

Sex and chronic depression share a complicated relationship. Depression robs you of your sexual desires and drains you of your motivation as it steals your ability to find yourself attractive. However, did you also know that sex may act as a buffer against the effects of chronic depression? Yes - It's possible!

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The Research

Researchers in the department of psychology at the State University of New York in Oswego conducted a recent study on how human physiology is impacted by exposure to semen. They tested their theory that exposure to semen may help serve as a natural antidepressant, and the results of their study suggest that exposure to semen may stimulate the release of hormones that boost your mood. Especially for women.

The study involved college-age women and their use of condoms during sex. The researchers concluded that the women who did not use condoms were less likely to be depressed. They also learned that these same women were more likely to become depressed, the more time they went without having sex.

This study was targeted towards women, but the researchers collected data on men too. They found that sex can boost their mood as well, but upon analyzing men who both use and do not use condoms the researchers found no difference in their symptoms of depression. However, they also discovered that men who did not have sex showed significant signs of depression. The researchers acknowledge that the relationship between sex and depression still has many questions left to be answered.

Mood-Boosting Semen?

For Men: Is lack of sex causing depression or is lack of sex caused by depression symptoms?

For Women: If they are suffering from clinical depression, is having unprotected sex a form of positive or negative self medication?

With this study discovering the possible mood boosting effects of semen, caution needs to be noted to the dangers of unprotected sex. In addition to obvious dangers of exposure to sexually transmitted diseases and unwanted pregnancies, low self-esteem is associated with risky sex. It is important to know that even while wearing condoms, both men and women alike benefit from the effects of orgasms to their moods. They can also both benefit from the emotional bond that comes from an intimate relationship.

Tips to Breakthrough Depression

If depression is stopping your sex life and robbing you of the benefits it can have on your mood, revive it! Make some lifestyle changes such as limiting your regular consumption of alcohol, and look into medication as an option to deal with your depression. Be conscious to address any sexual side effects of antidepressants early in treatment.

Get creative and put forth effort. Not only to enjoy sex and its benefits, but to reconnect with your partner. Get in the mood with candles and sexy clothing. Make plans for a date and seduce your partner with erotic music. This will force you to put forth effort to connect when you feel less motivated due to your depression. Plan a relaxing and fun date activity. The anticipation alone is an aphrodisiac. Remember that stress and depression are linked, so relax, have fun, and feel sexy. A candle light dinner, romantic music, a beautiful location, and the two of you together. Such an ambience may turn your sex life up.
Why not also try some foods to enhance your sexual mood as well. Chili Peppers are hot! They not only spice up your taste buds, but your sex life too. Avocados and almonds enhance your mood because they are full of energy, and chocolate's sweetness is can stimulate thoughts about love and sex. Strawberries are historically connected with Venus, the mythological goddess of love, while the sight and taste of them can serve to stimulate your sexual appetite.

There are plenty of ways to get back into the right mood again. Share your sexual fantasies with your partner. Your brain is your biggest sexual organ. Don't just rely on the physical stimulation of sex. Take advantage of its mental power too.

Exercise will get your endorphins flowing and put you more in the mood for sex, and this will also feel good about yourself and your body. Working out with your partner is also a great way to squeeze in some extra time together. Also, it's an easy way to check out your partner's body and get turned on!

Sex doesn't have to be serious. Get silly and laugh and laughter is a stress reliever. You'll have a much better chance of getting in the mood if you you're relaxed and giggling rather than stressed out and angry. Even if you feel stressed and not into it at the beginning, you just might find yourself having fun and loosening up as you go. Sometimes just going for it will get you in the mood. Don't over think things, just jump in the sack, and see what happens.

- Jeff Stein

Insightful Comments:

Sexual desires are the most potent and most powerful physiological drivers for both men and women. Sexual desires are not just physical but oh so emotional and mental. They challenge every fiber of our individual beings, yet they are more comfortable and dependent upon the responses of others.

In my relationship with my spouse, I believe it is very evident, even to our now older children, when we have not had sex for an inordinate amount of time. I become cranky. I become aloof. I can easily become self-absorbed and then lack confidence in the relationship I have with my wife.

Likewise for her, when we have not made time for intimacy, the spiritual and mental demons attack to say, “You are getting older. He isn’t interested in you any more. You’re not as pretty as you once were.”

All of these characteristics combined with the busyness of life can result in a very exhausted couple, which has become even more exasperated with life and one another. This leads to little or no effort being made to nourish and fertilize the relationship. The outcome is two discouraged, depressed, and tired people who just need to intentionally express their love, appreciation, compassion, and perhaps more so their carnal desires for one another.

No matter how far we as a couple drift apart over any amount of time. It is always amazing and exciting how close we become after just one morning, afternoon, or night of sexual intimacy. It seems to wipe away all of the distress and depression, at least for the moment.

- Bergen

Is Sex an Antidepressant? (n.d.). Retrieved December 3, 2014, from http://www.everydayhealth.com/depression/is-sex-an-antidepressant.aspx
- See more at: https://www.breakthroughpsychologyprogram.com/sex-a-powerful-antidepressant.html#sthash.aemRGz9u.dpuf








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6 Natural Alternatives To Antidepressants
06/04/2015 06:18 am ET | Updated Jun 04, 2015
Sara Schwartz

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SPECIAL FROM Grandparents.com

Whether you talk about it or not, chances are you or one of your friends takes an antidepressant to combat depression. A recent report by the Agency for Healthcare Research and Quality (AHRQ) found that in 2010, 16% of adults ages of 45 to 64 take at least one antidepressant — a 91% increase since 2000. And among adults age 65 and older, the same percentage use antidepressants, up 72% from 2000.

If you segment women only, the numbers are even more dramatic: Nearly one in four women aged 40 to 59 takes at least one antidepressant and nearly one in five women aged 60 and older, according to the National Center for Health Statistics.

Antidepressant use is on the rise as more people are turning to medication to treat their depression. "[Depression] is one of the most common mental health illnesses of our time," says Marie A. Bernard, M.D., Deputy Director of the National Institute on Aging (NIA).

The Lowdown on Antidepressants
Thirty years ago, most mental health researchers believed that depression is caused by a "chemical imbalance" of neurotransmitters in the brain. But the current prevailing theory is more holisitic than just blaming brain chemicals. According to Understanding Depression, a health report from Harvard Medical School, depression is brought on by a diverse cocktail of causes that includes nerve cell and nerve circuitry problems, genetic predisposition, stressful life events, certain medications, and underlying medical issues.

Decades of research have shown that antidepressants can help alleviate the symptoms of depression in some patients. "Depression is a condition we now have means of treating which are way beyond the primitive ways of approaching mental health problems," says Dr. Bernard. "Antidepressants can really make a difference in a person’s life." However, antidepressants don't work for everyone. The medical community agrees that SSRIs shouldn't been seen as a one-size-fits-all solution. Moreover, some researchers suggest that antidepressants do little more good than non-drug therapies and even placebos when treating anything other than very severe depression. Add to that the high incidence of antidepressant side effects (which can range from headache, agitation, and nausea to sexual dysfunction, dry mouth, and bladder problems), and you may think twice about taking that pill.

After more than 30 years of experience treating patients with depression, Joyce Mikal-Flynn, Ed.D, M.S.N., a nurse practitioner and associate professor at California State University, Sacramento, School of Nursing, has found that antidepressants help some people, but in some cases a placebo therapy works better. "With situational or minor depression, people are going to get better on their own," she says. "[Their mood] is naturally going to lift and shift, but the side effects of antidepressants may make them feel worse in the end." The best way to help yourself through a difficult time, she adds, is to tell yourself that depression is normal—that feelings ebb and flow.

“If the person is not having an issue with a chemical imbalance, then adding an antidepressant may not make much of a difference in their overall functioning,” says Lisa Strohman, J.D., Ph.D., clinical psychologist and founder of Technology Wellness Center in Scottsdale, Arizona. “[Antidepressants] help people who are in current severe stress that have an actual imbalance or need for pharmacological intervention.” She and other mental health professionals believe SSRIs can be a viable short-term strategy for kicking someone out of a depressive slump, but that drugs should eventually be tapered off in favor of healthy living strategies. “While antidepressant drugs can help improve mood, they cannot solve problems in people’s lives,” she says.

So if you can't tolerate medication or you tried antidepressants but they don't work for you, consider trying one of these...

Proven alternative methods that lift your mood

Practice mindfulness
What if you could retrain your brain to respond differently to your thoughts? That’s the basis of mindfulness-based cognitive therapy (MBCT), a method recently proven to prevent relapse into depression in a two-year study of depressive participants in the United Kingdom. Half the group was weened off of maintenance antidepressants and introduced to a system of daily homework assignments and group mindfulness therapy sessions that helped them overcome relapse when they were exposed to depression triggering scenarios. The other half continued taking antidepressants only. Researchers found that the the rate of relapse was slightly lower for the MBCT group (44%) than for the antidepressant group (47%), but that both therapies resulted in positive outcomes.

Take roseroot herb
Researchers who conducted a study at the University of Pennsylvania’s Perelman School of Medicine have promising news for people who suffer from depression, but react poorly to prescription medicine. After 12 weeks of receiving either Rhodiola rosea (roseroot), the conventional antidepressant sertraline, or a placebo, patients taking roseroot had 1.4 times the odds of improvement vs. 1.9 times with sertraline — a marginal difference. But in terms of side effects, the study was a blowout. Sixty-three percent of the sertraline group reported side effects, most commonly nausea and sexual dysfunction, while only 30 percent of the patients taking roseroot reported any side effects at all.

Work up a sweat regularly
There have been so many studies examining the effects of exercise on depression that in 2013, researchers at the University of Toronto undertook a study of all the studies from the past 26 years—6,363 of them to be exact! They ended up focusing on 30 high-quality studies, and discovered that 25 demonstrated regular physical activity lowers your risk of depression. Physical activity in the studies ranged from 20 to 30 minutes a day of walking and gardening to more intense cardiovascular exercise.

Get a massage
Not all depression remedies have to be hard work. In an analysis published in the Journal of Clinical Psychiatry in 2010, Dr. W.H. Hou examined 17 different studies and found that massage therapy is significantly associated with alleviated depressive symptoms.

“One of the things that can bring on depression is chronic pain,” says Dr. Mikal-Flynn. “Anything you can do to reduce the pain—acupuncture, massage, etc.—will also help with depression.”

Spend time in the sun
Here’s a two-for-one special for you: Plain, old sunshine has been proven to ease depression and protect your brain function. A 2009 study published in the journal Environmental Health followed 16,800 participants aged 45-plus and found that sunlight exposure both regulated serotonin and melatonin, and had a positive effect on cognitive function.

In related news, a 2011 study of more than 80,000 post-menopausal women found that participants who ate foods with more vitamin D, a compound your body produces naturally in response to sun exposure, had a 20 percent lower risk of depressive symptoms.

Try pet therapy
Nearly 80 million households in the U.S. own a cat or a dog or both, which means they probably already know that animal companions are seriously good for your health. A 2012 study found that hanging with Fido reduces stress and improves trust, empathy, and mood, among other benefits. Researchers believe the beneficial effects are due to increased oxytocin, the powerful hormone your body releases during hugging, touching, and orgasm that promotes trust and generosity.

“I recommend pet therapy,” says Dr. Mikal-Flynn. “Get a cat or dog. Petting them affects your brain chemistry. I always say, ‘The best pharmacy you have is between your ears.’ You just need to know how to access the drugs that are in your brain.”

Wondering if you're depressed?
Everyone gets down in the dumps periodically. So how do you tell the difference between being down and clinical depression? Try a self-assessment and determine whether you have several of the following symptoms of depression identified by the National Institute of Mental Health:

Wondering if you're depressed? Everyone gets down in the dumps periodically. So how do you tell the difference between being down and clinical depression? Try a self-assessment and determine whether you have several of the following symptoms of depression identified by the National Institute of Mental Health:

Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making decisions
Difficulty sleeping, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms
“Usually, what would lead to a clinical diagnosis, would be if you have multiple symptoms for more than a couple of weeks,” says Dr. Bernard.

Want another opinion? Ask a friend. If you're severe depressed, your loved ones will probably notice, says Dr. Strohman. Being around a severely depressed person “feels like you have the wind taken from you, that the (depressed) person steals away any energy, joy or pleasure you may be having," leaving you feeling exhausted and drained.

To truly suss out your emotional status, your best bet is to visit your trusted family doctor or internal medicine practitioner, “but if you think he or she isn’t picking up on it, go to a specialist,” says Dr. Bernard.
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HEALTH WATCH...




Do Anti-Depressants Result in Anti-Love and Anti-Passion?

For the more than 121 million people worldwide suffering from depression, medicating their disease with prescription drugs has almost become commonplace. In fact, the American Journal of Health reports that there are more than 2.7 million prescriptions written for antidepressant drugs each year in the United States alone.

When depressed patient’s consult with a doctor or mental health professional, oftentimes the first treatment option they are presented with is an anti-depressant medication. This is an alarming trend; one that is especially scary as the side effects of these medications become more apparent and publicly documented.

The latest issue raised by the scientific community questions the effect anti-depressants have on our overall emotional state. These drugs may actually affect us in ways other than simply relieving feelings of depression.

In their new book, evolutionary anthropologist Helen Fisher of Rutgers University and psychiatrist J. Anderson Thomson of the University of Virginia propose that anti-depressants not only curb our depression, but they also blunt our other emotions, including feelings of passion and love.

Building on the established notion that anti-depressants can curb the sex drive, their studies have taken it much further.

They believe that anti-depressants work to blunt the natural human desire to seek a mate, and that they may even eliminate the mind’s capacity to “fall in love”, or experience feelings of love and passion.

To understand how this effect is possible, you must first understand how anti-depressants work. When the mind experiences depression, it is most commonly related to an imbalance in the brain’s serotonin levels.

Serotonin is a chemical that controls our moods. When Serotonin levels are low, or our brains lack the ability to stabilize our Serotonin supply, this can lead to drastic mood changes, as well as feelings of sadness, malaise, worthlessness, guilt and general emotional pain. Collectively, they make up the general condition we commonly know as depression.

Fisher and Thomson’s study focused on a specific type of anti-depressant called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs work by disabling the body from reabsorbing serotonin after it is released, thus flooding the brain with it in an attempt to elevate mood. However, they are careful to note that all anti-depressant drugs are designed in some way to manipulate the brain’s “feel-good” chemicals, like Dopamine and Serotonin.

Since these chemicals are also so involved in our feelings of sexuality, one of the biggest complaints from users of anti-depressants is a major loss of sex drive or libido. In 2001, an estimated 73% of users of anti-depressants experienced some sexual side effects. Fisher and Thomson are also careful to point out that these same chemicals are involved when we feel that first rush of excitement at romance.

Much of the study is based off of first person accounts—stories of people who have taken anti-depressants and lost all interest in dating or romance. Fisher and Thomson’s study spans across thousands of first person accounts, including the story of Jerry Frankel’s experience with anti-depressants.

Frankel said "My usual enthusiasm for life was replaced by blandness," he wrote. "My romantic feelings for my wife declined dramatically."

Above all, Fisher’s concern is that people taking anti-depressants are unwittingly sacrificing their natural ability to fully experience their other, more pleasant emotions. She says, "I'm concerned about well-adjusted men and women who go through a crisis and start taking antidepressants. They continue taking them, not realizing they may be suppressing these other systems."

They also point out that a major goal of anti-depressants is to stop obsessive thinking and harping on negative issues or thoughts. Thomson notes that it is exactly this obsessive thinking that makes dating, relationships and love so exciting.

For those individuals who are taking an anti-depressant medication and displaying similar side effects, Fisher and Thomson encourage them to raise the issue with a doctor.

Although this study is intended to pave the way for further inquiry into the problems they identify, Fisher and Thomson believe that patients should be sure to stay on top of how anti-depressants affect all of their emotions, including their romantic feelings and sentiments towards love and attraction.

Patients should be sure to keep track of how the drugs affect their relationships, as this can speak volumes about whether or not the positive effects outweigh the negatives.

Thomson stresses the importance of evaluating these anti-depressants and reminds patients to regularly ask as their doctor, “Do I still need to take these?” Since many people are prescribed anti-depressants to deal with traumatic life events, it is important to keep track of how well they are working so they can learn to deal with their emotions without the use of drugs.

Natural alternatives to anti-depressants can be very effective at curbing sadness and guilt and promoting energy and well-being, without the high risk of side effects that accompany many prescription medications.

In fact, many herbs and homeopathic treatments have been successfully used for centuries, and can still be very effective at fighting the symptoms of depression.

Rather than work to inhibit the brain from the uptake of Serotonin or other neurotransmitters, natural remedies work to treat the body as a whole by encouraging not only the mind to heal itself, but also to promote overall balance and health. This can work to provide a more comprehensive approach to the treatment of depression rather than just treating the symptoms in isolation.

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nowadays, there isn't a single problem cured by something other than meds, but that's the problem. is there a pill for that, too? More
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..... 😆

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Bipolar Disorder Is Not An Illness
by PHIL HICKEY on SEPTEMBER 6, 2009

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This post was edited and updated on June 24, 2013, to address comments received from readers. I thank them for their input.

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DSM-IV’s criteria for a manic episode are given below:

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).


B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
(1) inflated self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
(6) increase in goal-directed activity (either socially, at work or school, or sexually)
or psychomotor agitation
(7) excessive involvement in pleasurable activities that have a high potential for
painful consequences (e.g., engaging in unrestrained buying sprees, sexual
indiscretions, or foolish business investments)

C. The symptoms do not meet criteria for a Mixed Episode
D. The mood disturbance is sufficiently severe to cause marked impairment in
occupational functioning or in usual social activities or relationships with others, or
to necessitate hospitalization to prevent harm to self or others, or there are psychotic
features.

E. The symptoms are not due to the direct physiological effects of a substance (e.g., a
drug of abuse, a medication, or other treatment) or a general medical condition (e.g.,
hyperthyroidism).


Note: Manic-like episodes that are clearly caused by somatic antidepressant
treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count
toward a diagnosis of Bipolar I Disorder.
The manic episode is an important part of the DSM system because it acts as the basis for a diagnosis of Bipolar Disorder. DSM lists several variations of Bipolar Disorder, each with its own specific criteria, but in general, if a person has had a manic or hypomanic episode, he has bipolar disorder.

Let’s take a look at criterion A. This criterion calls for a distinct period of abnormally and persistently elevated expansive or irritable mood, lasting at least a week… The DSM defines elevated mood as: an exaggerated feeling of well-being or euphoria or elation. Expansive mood is defined as a lack of restraint in expressing one’s feelings, frequently with an over-evaluation of one’s significance or importance. Finally irritable mood is defined as being easily annoyed and provoked to anger.

So the very basis for a diagnosis of Bipolar Disorder is either feeling particularly good about everything or feeling particularly grumpy and angry. How can the same illness manifest itself in such completely different ways? And bear in mind that these are not relatively trivial, incidental aspects of the so-called illness. These are the defining features. The very essence of bipolar disorder – according to DSM – is an episode of profound happiness or an episode of profound grumpiness and irritability. This is indeed a strange illness.

But let’s move on to criterion B. This provides a list of seven specific “symptoms,” three of which must be present for a positive diagnosis. (Incidentally, if the mood problem in criterion A is “only irritable,” then four items are needed from the list.)

This practice of providing a list of symptoms and specifying how many must be present in order to provide a diagnosis is very common in DSM and raises obvious difficulties. First is the arbitrariness of the number chosen. Why three? Why not two or four? The answer, of course, is because the APA says so. The second objection is that different groupings of three will generate very different presentations. For instance, a person meeting criteria 1, 3 and 4 will be grandiose, overly talkative, and somewhat scattered in his choice of topics. Whereas a person who meets criteria 2, 5, and 7 will be sleeping very little, very distractible, and will be maxing out his credit cards in unrestrained buying sprees. The notion that these two presentations are in fact manifestations of the same illness is untenable. This is particularly so in that the only justification for this position is that the APA say so.

A more important difficulty stems from the question: Why should these problems be considered indications of illness? Let’s look at each of the so-called symptoms in turn.

1. inflated self-esteem or grandiosity.
In this context it is worth noting that one of the “symptoms” of a major depressive episode is “feelings of worthlessness…” So if you haven’t got enough self-esteem, you’re depressed, but if you have too much, you’re manic. This raises the question: how much self-esteem is OK, and how much (or how little) is pathological? Who decides? In practice, of course, intake workers at mental health centers and hospitals make the decision, and the decision-making is intrinsically subjective and unreliable. In an informal way, we have all encountered individuals who are “full of themselves” to an obnoxious degree. Intuitively we attribute this kind of behavior either to an attempt to mask a marked sense of inferiority or to poor socialization training during childhood. The notion that this character trait is really a symptom of an illness is an extreme position for which the APA offers no proof. Indeed there isn’t even an argument. The APA simply says so.

2. decreased need for sleep…
This is a complex subject. A great deal has been learned about sleep but much remains unknown. Sleeplessness might well be an indication of some neurological damage or illness, but might on the other hand be simply a reflection of individual differences. There are numerous reports in history of prominent individuals who managed perfectly well on four or five hours sleep each night. Others need eight or nine. It would require a neurological examination to determine if a particular sleep pattern were pathological or a variation of normal. But even if a pathological condition were established, this would indicate a neurological condition, not a so-called mental illness. It is also worth noting that a “decreased need for sleep” very often is nothing more than excessive intake of caffeine or other stimulant drugs.

3. more talkative than usual or pressure to keep talking
We’ve all encountered individuals who talk too much – who hog the conversation. This phenomenon is best conceptualized as rudeness, i.e. a disregard for the normal conventions that direct social intercourse. This particular form of rudeness is usually the result of poor training during childhood. Small children sometimes talk excessively and try to dominate social relationships in this way. If steps are not taken to train them towards a more give-and-take approach to conversation, they often carry this trait into adult life.

4. flight of ideas or subjective experience that thoughts are racing
DSM defines flight of ideas as: “A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may be disorganized and incoherent.”

It’s clear from this definition that the real issue here is not so much flight of ideas as flight of speech. Most people in fact experience flight of ideas on a fairly regular basis. It’s called stream of consciousness, and it flows like a babbling brook, swishing and eddying around twists and turns, over rocks and sand banks, endlessly changing and shifting. Even as I write these words, for instance, my thoughts have flitted to actual streams and rivers I have known. The problem is not that the person experiences a bewildering array of successive ideas, but rather that he puts these ideas into words. Most of us learn to censor stream of consciousness material at an early age and to confine our speech to items that have meaning and relevance for our listeners. A small number of poets and song-writers have managed to make a good living by dispensing with this kind of censorship, but most of us confine our verbal utterances to those ideas that have cogency and relevance for others. We call it discipline or self-control. Once again, it is lacking in small children whose early speech does indeed reflect stream of consciousness material. Proud parents are usually delighted with this initially, because it represents a major developmental breakthrough. Most parents, however, fairly soon begin the process of training and coaching that results in what we would call normal speech. If this training does not occur or is thwarted or frustrated for whatever reason, then the individual grows up without acquiring this skill. As with many skills normally acquired in childhood, it can be extremely difficult to learn in later life.

This facet of the manic presentation then is best conceptualized as a deficit in training and socialization, rather than a symptom of a medical condition.

5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
This is essentially the same thing as the flight of ideas discussed above. The effect of splitting this phenomenon into two separate “symptoms” is to increase the likelihood of a positive “diagnosis.” Remember, it takes three (or more) symptoms for a diagnosis. If a person displays flight of ideas, he will almost certainly also meet the criteria for distractibility. So you get two hits for the price of one. The primary purpose of DSM is to generate business for psychiatrists.

6. increase in goal-directed activity (either socially, at work, or school, or sexually )or
psychomotor agitation
Most people would probably see an increase in goal-directed activity as a good thing. Painting the garage or mowing the yard is better than vegetating in front of the television. But this is not quite what the APA has in mind by “goal-directed activity.” Elsewhere in the text they describe goal-directed activity that is “excessive” and as examples they mention: “ taking on multiple new business ventures…without regard for the apparent risks…,” “…calling friends or even strangers at all hours of the day or night…;”
“…writing a torrent of letters on many different topics to friends, public figures, or the media.”

It is clear that the real issue here is not goal-directed activity as such but rather irresponsible and inconsiderate activity. Once again, responsibility and consideration for others are attributes that we acquire during childhood through the normal methods of parental discipline, coaching, role modeling, etc.. When we see a person displaying a marked deficit in these areas the most parsimonious assumption is that his/her training and discipline in these areas was for some reason neglected or deficient. The notion that the person is ill is certainly not obvious. The APA offers no proof or even arguments for this position.

7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Once again, what’s involved here is what most people would call irresponsibility: the kind of behavior we try to discourage in our children through the normal time-honored methods of discipline and example. The notion that these kinds of irresponsible and self-indulgent behaviors are in fact caused by a diagnosable illness is quite a reach. Bipolar disorder, like most of the other DSM diagnoses, is not something a person has, but is rather something that a person does. It is constantly presented by the APA, and by practitioners in the field, however, as something a person has (like diabetes) and something that is best treated with drugs.

I realize that many people reading this post will say that I’ve got it all wrong – that I’ve misrepresented the reality of the condition called bipolar disorder. They might say that people with this “diagnosis” are “crazy” – not just irresponsible or self-indulgent. And there is a measure of truth in this. Some of the individuals who are assigned this label do sometimes behave in a “crazy” fashion. But it’s important to note that in the DSM, this aspect of the matter – “psychotic features” – is included almost as an afterthought. It is not one of the defining features of a manic episode. Rather, it is something that may be present.

What the APA is doing here is trying to have their cake and eat it too. By including the possibility of psychotic features, they create the impression that this is a very serious matter; but by not making psychotic features a requirement, they manage to extend the diagnostic net to include people with relatively mild problems.

I will discuss psychotic features in later posts on the topic of “schizophrenia.”

The fact that lithium has a calming affect on individuals who behave in this manner is often cited as proof that the behavior in question really does stem from an illness. The logic is untenable. A couple of beers can be very effective in helping shy people overcome their inhibitions. Very few rational people would conclude from this that shyness is an illness and alcohol a “medication.” In addition, lithium has a calming effect on all people – not just those who carry a diagnosis of bipolar disorder.

Lithium carbonate is a salt – found widely in nature – and until 1949 was sold openly in the United States as a substitute for table salt. Besides having a salty taste, lithium salt has a calming effect on people’s behavior. With regards to the latter, the mechanism of action is unknown. There have been numerous proposed theories, but none has produced conclusive evidence or gathered much support.

In some respects the shyness/alcohol analogy mentioned earlier is even more apt. The chronically shy person can acknowledge his problem and take corrective action using the normal time-honored methods of effecting personal change. Or he can simply drink a couple of beers before every social situation. Either solution to the problem will work. Similarly the manically irresponsible person can acknowledge his problem behaviors and tackle them in the normal way – or he can take lithium carbonate. The latter is often quite effective in dampening the behavioral excesses, but like the alcohol, it also has some long-term side effects.

The central point of this and my earlier posts is that there are no mental illnesses. There are problems of living – problems that human beings encounter, sometimes resolve, sometimes live with. The so-called mental illnesses are an attempt to explain or understand these phenomena, but as explanations they are spurious, unhelpful, and indeed, counter-productive. They are merely labels.

A perfect analogy to the mental illness explanation of human problems is the phlogiston explanation of fire or the witchcraft theories of illness and crop destruction. The popularity of a concept is often independent of its validity. The phlogiston theory of fire is a good example. This theory, which held sway among scientists during the 1600’s and most of the 1700’s, maintained that combustible objects contain an element called phlogiston which was released when the object was burned. Non-flammable objects simply didn’t have this substance. Towards the end of the 1700’s evidence was gradually amassed to debunk the theory in favor of the oxygen-combination ideas of today. Many scientists, however, including Joseph Priestley (the discoverer of oxygen!), tried to cling to the older theory. Similarly, in former years, sickness and crop failures were often attributed to witchcraft. Here again, we have a spurious theory, i.e. that sickness and crop failures are caused by the actions of these so-called witches. Such thinking – back in the days – was very widespread, and witch-burnings were popular events. But the concept was nonsense, and today, thanks to science, we have a better understanding of the causes of illnesses and crop failures. Popularity is a very unreliable barometer for conceptual validity. Phlogiston doesn’t exist. There’s no such thing as witchcraft. And there are no mental illnesses. Fire, however, does exist. Crop failures and illness are realities. And human problems of living are real. People are complex and diverse and the problems we encounter on our journey through life are also complex and diverse. Some of the problems we meet are relatively minor and easy to deal with. Others can be truly overwhelming. Some are indeed medical problems and require medical help. Others do not.

The so-called mental illnesses are problems that do not require medical help. The medicalization of all human problems of living is as spurious as the phlogiston and witchcraft theories mentioned earlier. It is also counter-productive. Drugs are not an effective solution to life’s problems any more than the burning of so-called witches was a solution to crop failures or illness.

The medicalization of all human problems is about turf. The American Psychiatric Association is the psychiatrists’ trade union, and has as its primary agenda the promotion of its members’ interests. There’s nothing intrinsically wrong with this – all trade associations do the same. That’s why they exist. The problem with the APA, however, is that they have been so successful. At the present time one would be hard pressed to identify any problem of human living that is not covered by a DSM “diagnosis.” The purpose of these diagnoses is to legitimize psychiatric intervention and the prescription of drugs in any and every human problem.

At the risk of repetition, I am not saying that people should not use drugs. It is not for me to tell people what they should or should not ingest. These are decisions that people have to make for themselves. What I do object to, though, are the spurious notions that these pharmaceutical products are medicines, and that they are being prescribed to combat illnesses.

Odpri sliko ➜


http://www.behaviorismandmentalhealth.com/2009/09/06/bipolar-disorder-is-not-an-illness/

Psychiatry: A Protected Cartel
by PHIL HICKEY on DECEMBER 29, 2015

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On December 27, 2015, Richard Lewis, a regular contributor to Mad In America, posted on that site Deafening Silence: What Happens When the Whistle Blows and Nobody Hears? Here are the first two paragraphs:

“What happens when someone finally ‘blows the whistle,’ exposing potential harm and possible death caused by today’s mental health system? Is there any government agency or designated persons who are prepared to hear the whistle or even investigate and/or act on the nature of a serious complaint? Are all whistle blowers fired, or are some just ignored and easily dismissed as just an isolated voice in the wilderness? Just how broken is ‘Broken’? Is it even worth the effort of going through official channels to file formal complaints within the current ‘System’? Here is my story and I will let you ponder some of the possible answers to these provocative questions.

September 11th 2015 was my last day working as a counselor/therapist in the U.S. community mental health system. After 22 years working within that system I resigned out of protest having waged a concerted effort (2½ years) to challenge potentially dangerous psychiatric drug prescribing patterns at my workplace. In late April of this year these challenges led to the filing of a major complaint with the Massachusetts Dept. of Mental Health and eventually the Dept. of Public Health. Here is a brief summary of how these events unfolded and ultimately reached a disappointing, but not surprising, final conclusion:”

And here are some more quotes from the body of the article:

“However, I never expected to discover just HOW unprepared, dysfunctional, and totally oblivious the entire state bureaucracy is when it involves any serious complaints detailing possible abuses and harm being done to its citizens by a branch of medicine called Psychiatry.”

“I soon discovered that any supposed “checks and balances” regarding medical safety, as it applies to psychiatric drugs, are nonexistent and the government agencies entrusted with protecting the public in this area of medicine are virtually clueless and totally unprepared to act with any authority. The bottom line is that the overall situation is far worse than even the most cynical critic could ever imagine.”

“…the Massachusetts Department of Public Health is not willing or prepared to even investigate, let alone challenge Psychiatry when it comes to any of the categories of mind altering and often dangerous drugs they prescribe.”

” The entirety of my experience in this endeavor reconfirms my long-held belief that the current ‘System’ is truly broken FAR beyond repair.”

Richard also makes the point that those of us who criticize psychiatry need to

“… work towards developing a broader base of support to maximize the sound and effect of the blown whistle.”

Odpri sliko ➜


http://www.behaviorismandmentalhealth.com/2015/12/29/psychiatry-a-protected-cartel/

Odpri sliko ➜

Odpri sliko ➜

Pa ne se jutri v nedeljo 🙂

Tolk vas mam že poln kufer, ker ne razlikujete med AP-ji in AD-ji. Kar naprje nekaj limate tle gor o AD-jih.

Sam trpim za mentalno boleznijo in sem bil že na marsikateri delavnici, skupini,...videl sem ljudi, ki niso mogli več funkcionirati. Lahko je tukaj limati neke videje o tem kako farmacevtska industrija nekaj okoli prinaša folk s temi tabletki samo če bi vi sedeli v skupini ljudi, ki so vsi na tleh, predebeli, nenaspani,...kaj bi va vi jim rekli? Če jo človek čisto pri tleh lahko tudi naredi samomor. Ali ni bolje, da vzame kako tabletko?

Seveda je bolje in v tem je tudi poanta. Ce je clovek akutno psihoticen, bodo zalegle in nic hudega ne bo, ce jih jemlje mesec ali dva.
Vzdrzevalna terapija pa ne primese dobrih rezultatov.
V vec videih dr. mocrieff , ki je psihiatrinja in predavateljica, omeni, da tudi ona predpise AP / AD
Vendar - delujejo kratkorocno to je glavna stvar.
Dolgorocno je vec skodljivih ucinkov kot koristnih,
Torej, tablete niso ( edina) resitev in tablete ( tako AD, kot Ap) so precej bolj strupene, kot nam zeli vecina psihiatricne stroke
prikazati.

Par strani nazaj je tocno navedeno, kateri so AD ji in kateri AP ji. Pa tudi mehanizem akcije.,. Ad ji dvignejo serotonin ( in druge nevrotransmiterje, kot je noradrenalin ) medtem ko AP ji blokirajo dopamin ( delujejo tudi na hi staminske, serotoninske in se druge receptorje.)

Ce se pocuti clovek res skrajno slabo in samomorilno, bo seveda vzel tablet. Brez razmisljanja.
Vsakemu kdaj prekipi.
Vsak tudi kdaj zboli za gripo ali vnetjem, in takrat jemlje coldrex ali pa antibiotike.
Ali pa pije caje in jemlje aspirin.
Norost pa bi bila jemati coldrex ali antibiotik preventivno, potem ko je gripa ze minila.
Ta analogije zdrzi tudi pri ( anti) depresivih in ( anti) psihotikih.
Vzdrzevalni tretman potem, ko se je bolezen pomirila, je zgolj samemu sebi namen ( oz. namen pharmacevtske industrije)
na pacienta pa scasoma deluje kontrproduktivnp.
Telo se scasoma navadi na umetno zvisan serotonin in umetno blokiran dopamin,- pridobi odporno, prav tako
kot pri antibiotikih - odzivnost se zmanjsuje - i.e. telo se preneha odzivati na kemikalije....

in ucinki zdravil se vcasih
obrnejo v svoje nasprotje - i.e. disforija zaradi jemaanja Ad jev in psihoza zaradi jemanja Ap jev.

Saphire sam da te pozdravim.

Pozdravcek nazaj 🙂)

Atipični antipsihotiki se jemljejo prepogosto

zdravje > raziskave in novice
▶ [ ]
Atipični antipsihotiki se jemljejo prepogosto

Raziskava v ZDA je pokazala, da je več kot polovica predpisanih atipičnih antipsihotikov v letu 2008
predpisanih na temelju šibkih dokazov o njihovi učinkovitosti pri določeni indikaciji.

Na začetku so se jemali samo pri zdravljenju shizofrenije, v današnjem času pa se uporabljajo

za zdravljenje bipolarne motnje, depresije, delirija, motnje osebnosti in celo avtizma, piše revija Pharmacoepidemiology and Drug Safety.
Piše: J.R.




Čeprav so nekateri atipični antispihotiki odobreni za zdravljene omenjenih bolezni, jih
zdravniki predpisujejo tudi ob neodobrenih indikacijah.

Atipični antipsihotiki nisO nenevarna zdravila, saj lahko povzročajo prekomerno telesno težo, diabetes in srčne bolezni.

Po drugi strani pa so precej dražji od starejših konvencionalnih antipsihotikov.

V ZDA so omenjeni atipični antispihotiki v letu 2008 predstavljali kar 5% stroškov za zdravila.

Najbolj znani se skrivajo pod komercialnimi imeni risperidon, olanzapin, kvetiapin in aripiprazol.

Nekatere zdravnike skrbi povečana uporaba atipičnih antipsihotikov pri zdravljenju bipolarne
motnje in depresije, saj ni dokazov, da je ta skupina zdravil dovolj varna in učinkovita,
po drugi strani pa je ta medikamentna terapija precej draga.

Uporaba teh zdravil hitro narašča, cenejše terapije, ki so sicer dobro sprejete, pa potisnila v kot.

Zdravljenje depresije z atipičnimi antipsihotiki se jemljejo za krepitev antidepresivnega učinka,

čeprav obstajajo še druge opcijo kot npr. predpisovanje drugega cenejšega in enako učinkovitega antidepresiva.

Prav tako ni nobenih kliničnih dokazov, da so atipični antipsihotiki učinkovitejši od drugih terapij zdravljenja depresije.

Odpri sliko ➜

Raziskovalci so opazili, da zdravniki predpisujejo uporabo najnovejših medikamentnih terapij,

čeprav ne prinašajo velike prednosti. Še vedno obstaja zdravniška miselnost, da so najnovejša zdravila boljša zdravila.


http://www.bambino.si/atipicni_antipsihotiki_se_jemljejo_prepogosto

http://www.viva.si/Psihiatrija/9263/Dve-tretjini-bolnikov-z-shizofrenijo-lahko-normalno-%C5%BEivi

Dve tretjini bolnikov z shizofrenijo lahko normalno živi
Avtor: Maja južnič Sotlar
Asist. Jure Koprivšek, psihiater z Oddelka za psihiatrijo UKC Maribor: "Boljši uvid
v bolezen se lahko kaže kot boljše sodelovanje, bolnike, ki izrazito slabo sodelujejo,
pa lahko zdravimo z dolgodelujočimi antipsihotiki v obliki injekcij, ki jih prejmejo enkrat do dvakrat na mesec in se ves čas enakomerno sproščajo v telo."
Asist. Jure Koprivšek, psihiater z Oddelka za psihiatrijo UKC Maribor: "Boljši uvid v bolezen se lahko kaže kot boljše sodelovanje, bolnike, ki izrazito slabo sodelujejo, pa lahko zdravimo z dolgodelujočimi antipsihotiki v obliki injekcij, ki jih prejmejo enkrat do dvakrat na mesec in se ves čas enakomerno sproščajo v telo." (Foto: Diana Anđelić)

Povezano

Paranoidna shizofrenija in jemanje zdravil
Zdravljenje shizofrenije poteka večplastno – medikamentozno ter z različnimi psihoterapevtskimi in psihosocialnimi intervencami. Temelj je zdravljenje z zdravili, večinoma v obliki tablet, ki jih bolnik jemlje redno vsak dan, ali v obliki dolgodelujočih injekcij, ki jih bolnik prejema v dvo-, tri- ali štiritedenskih razmikih v mišico. Tako pri akutnih epizodah kot pri nadaljevalnem in vzdrževalnem zdravljenju bolezni se zdravniki odločajo med različnimi antipsihotiki – starejšimi oziroma klasičnimi in novejšimi, atipičnimi antipsihotiki. Odvisno od simptomov, ki so lahko pridruženi psihotičnim, lahko dodatno uporabijo še zdravila iz drugih farmakoloških skupin, razlaga asist. Jure Koprivšek, psihiater z Oddelka za psihiatrijo UKC Maribor.
Tako klasični kot atipični antipsihotiki delujejo na simptome shizofrenije. Med seboj se razlikujejo po načinu delovanja in tudi po neželenih učinkih. Zato na začetku zdravljenja pri izboru zdravila ne upoštevajo le obstoječih simptomov, temveč tudi konstitucijske lastnosti in sočasna telesna obolenja vsakega posameznega bolnika. Za bolnike, pri katerih se denimo kažeta izrazita agresivnost in razdražljivost, njihovo vedenje pa je močno spremenjeno, predpišejo antipsihotik, ki ima poleg antipsihotičnega še pomirjevalni učinek. Če se simptomi ne umaknejo, antipsihotiku dodajo denimo anksiolitik, s čimer bolnika dodatno umirijo.

"Pogosto opazimo, da se začne vedenje, ki je navzoče ob uvedbi zdravljenja, umirjati že po antipsihotiku, tako da ni treba dodajati še anksiolitikov ali pa jih bolnik potrebuje zelo kratek čas. V nadaljnjem zdravljenju jih predpišemo le – spet za krajši čas – če opazimo nespečnost, tesnobo ali agitacijo, vendar pa je najprej treba ugotoviti, kaj je povzročilo nastop teh simptomov. Če gre za neredno jemanje antipsihotikov, dodatna zdravila niso na mestu, pač pa ukrepi, ki zagotovijo redno jemanje predpisanega zdravila," pove sogovornik.

"Glede na pridružene simptome se pri posameznih bolnikih odločamo za dodatno terapijo, denimo z antidepresivi in stabilizatorji razpoloženja. Ta skupina zdravil pride v poštev zlasti v primerih, ko so shizofreniji pridruženimi simptomi na področju razpoloženja (na primer depresija) ali simptomi shizoafektivne motnje, ki je na meji med shizofrenijo in bipolarno motnjo. V takih primerih uvedemo dvotirno terapijo z antipsihotikom in stabilizatorjem razpoloženja."

Ocena zdravljenja
Po uvedbi zdravljenja zdravniki ocenijo, v kolikšni meri so se simptomi umaknili in kako pacient funkcionira. Če so rezultati zadovoljivi, če bolnik sodeluje in se njegovo stanje pomembno izboljša ter zaradi zdravil ne trpi zanj motečih neželenih učinkov, zdravljenje nadaljujejo z istim zdravilom in odmerkom. Če je zdravljenje dalo zgolj delen odgovor in so simptomi še prisotni, četudi v zmanjšanem obsegu, prilagodijo odmerek zdravila ali pa izberejo drugo. Če se tudi po menjavi zdravila in prilagoditvi odmerka simptomi ne umaknejo, je mogoče govoriti o rezistentni shizofreniji.

Rezistentna shizofrenija
Pri tako imenovani rezistentni (na zdravila neodzivni) shizofreniji je mogoče z zdravljenjem doseči le nepopoln umik psihotičnih simptomov. V tem primeru je za bolnika nadvse pomembno, v kolikšni meri ga obstoječi simptomi motijo in ovirajo v vsakodnevnem življenju ter kako zelo vplivajo na kakovost njegovega življenja. Kot pravi sogovornik, nekateri bolniki z rezistentno obliko bolezni sprejmejo simptome, ki jih spremljajo, in se naučijo z njimi živeti do te mere, da njihovega življenja ne obvladujejo v celoti. Žal je med bolniki, ki nimajo rezistentne shizofrenije, tudi nekaj takih, pri katerih se simptomi ne umaknejo povsem. Če jih bolniki ne morejo prepoznati kot simptomov, jih morda tudi zanikajo; tem bolnikom je v vsakodnevnem življenju seveda znatno težje, pojasnjuje dr. Koprivšek.

Slabo sodelovanje
Simptomi shizofrenije lahko ostanejo različno izraziti zaradi več razlogov. Eden od njih je neodzivnost na terapijo, pogosto pa je tudi nesodelovanje bolnikov. Zdravniki v prvem primeru zamenjajo zdravila, sicer pa uporabljajo različne oblike psihoedukacije, pri kateri z vedenjsko kognitivnimi pristopi skušajo izboljšati bolnikov uvid v bolezen in njegovo sodelovanje. Boljši uvid se lahko kaže kot boljše sodelovanje, bolnike, ki izrazito slabo sodelujejo, pa lahko zdravijo z dolgodelujočimi antipsihotiki v obliki injekcij, ki jih prejmejo enkrat do dvakrat na mesec in se ves čas enakomerno sproščajo v telo.

Umik simptomov različen
Za zdravljenje shizofrenije so na voljo učinkovita zdravila, ki pa pri vseh bolnikih ne delujejo enako. Kot pojasnjuje dr. Koprivšek, pri približno tretjini bolnikov simptomi bolezni izginejo ali ostanejo v zelo blagi obliki – prisotni so morda kognitivni primanjkljaji in negativni simptomi. O tej skupini je mogoče govoriti kot o funkcionalnih bolnikih, saj lahko normalno živijo in delujejo v okolju, v katerem so živeli pred izbruhom bolezni.

Pri drugi tretjini bolnikov je mogoče zaradi ostanka razpoloženjskih simptomov ter kognitivnih in negativnih simptomov opaziti primanjkljaje v vsakodnevnem delovanju, vendar je njihovo življenje kljub temu dokaj funkcionalno in podobno tistemu pred boleznijo. Potrebovati utegnejo nekatere prilagoditve, denimo menjavo težjega študija z lažjim ali manj naporno delovno mesto z manj stresa.

V tretji skupini so bolniki s trajno prisotnimi simptomi, ki tudi po zdravljenju v vsakodnevnem življenju delujejo znatno slabše kot pred boleznijo: težko opravljajo dnevne obveznosti, imajo težave z okolico, bolezen pa dolgoročno nima najboljšega poteka in napovedi.

Mit o nevarnih bolnikih

V javnosti je žal še vedno trdno zasidran mit o tem, da so bolniki s shizofrenijo nevarni in agresivni ter da utegnejo postati celo hudi kriminalci. Sogovornik ta mit odločno zavrača in pojasnjuje, da večina teh mitov velja za obdobje akutne psihoze, ko je bolnikovo vedenje izrazito spremenjeno. Toda ta del simptomov se z začetkom zdravljenja umakne najprej in bolniki lahko delujejo bolj ali manj ustrezno, nikakor pa niso pomembneje nevarnejši za okolico, kot to velja za splošno populacijo.
Zanje veliko težja in bolj obremenjujoča je kognitivna in negativna simptomatika bolezni, saj jim zelo okrni kakovost življenja.

Antipsihotiki
nov 2012 | Zdravila


ANTIPSIHOTIKI
Antipsihotike uporabljamo predvsem za zdravljenje shizofrenije in nekaterih drugih psihoz (motena dopaminergična aktivnost v mezolimbičnem sistemu CŽS; udeleženi tudi drugi transmiterji). Osnovno delovanje je blokada dopaminskih receptorjev.



Klasični ali tipični nevroleptiki:
- FENOTIAZINI:

So najpogostejša antipsihotična zdravila. Delimo jih na alifatske FT (KLORPROMAZIN: danes ni več v rabi zaradi močnih sedativnih in vegetativnih učinkov), piperazinske FT (TRIFLUPERAZIN, FLUFENAZIN: učinkovitejši z manj stranskimi učinki) in piperidinske FT (TIORIDAZIN).

- TIOKSANTENI: podobni fenotiazinom

- BUTIROFENONI: podobni fenotiazinom



Centralno delovanje FT:

antipsihotično delovanje (delovanje na D-receptorje v mezolimbičnem sistemu); diskinezije (delovanje na D-receptorje v nigrostriatnem sistemu); antiemetično delovanje (inhibicija kemoreceptornih con v podaljšani hrbtenjači z blokado D-receptorjev); termoregulacija (hipotermija); efekti na endokrini sistem (dopamin je v hipofizi prolaktin inhibirajoči faktor (PIF); zaradi blokade efekta dopamina se poveča konc. prolaktina, kar povzroči galaktorejo)

Periferno delovanje FT:

Antiholinergično in antiadrenergično delovanje; lokalni anestetični učinek; antihistaminski (H1) in kinidinu podoben učinek

Stranski učinki antipsihotikov:

Ekstrapiramidni učinki; zmanjšana aktivnost avtonomnega živčevja (zaradi kompetitivne inhibicije holinergičnih muskarinskih receptorjev, a-adrenergičnih receptorjev, H1-receptorjev in serotoninskih receptorjev); povečano izločanje prolaktina; drugo (holestatski ikterus; ortostatska hipotenzija; suha usta; obstipacija; retenca urina; motorični nemir; nevroleptični maligni sindrom, itd.)

Atipični nevroleptiki:
- BENZAMIDI (npr. SULPIRID)

- DIFENILBUTILPIPERAZIN (npr. PIMOZID)

- DIBENZODIAZEPINI (npr. KLOZAPIN)


http://www.emedicina.si/antipsihotiki/

Tabela 1:
Struktura pacientov glede na bolezenske skupine v letu 1992 in letu
1995 (v odstotkih)
0 - 25 26 - 50 51 - 75 76 - 100
1992 1995 1992 1995 1992 1995 1992 1995
bolezenska sk.
PSIHOZE 38 32 33 27 21 29 8 11
NEVROZE 44 48 28 23 22 26 6 3
ORGANSKA ST. 76 81 22 16 1 2 - -
ODVISNOSTI 80 76 7 11 3598
To ugotovitev lahko razlagamo na razli~ne na~ine, toda prevladujo~a
"polivalentnost" nedvomno dokazuje, da je nujno potrebno informiranje
skorajda vseh psihiatrov o prav vseh zdravilih iz skupine psihofarmakov.
Ve~ina psihiatrov porabi ve~ji dele` delovnega ~asa za razne oblike
psihoterapije kot pa psihofarmakoterapije
To je pri~akovano,
ker je pa~ psihoterapija bolj zamudna metoda. Ali bo to imelo vpliv na
tiste psihiatre, ki slu`ijo denar kot zasebniki, ne vemo, je pa mogo~e.
Posredno taki podatki tudi opozarjajo, zakaj mnogi splo{ni zdravniki na
hitro predpi{ejo recept, namesto da bi si vzeli ~as za psihoterapevtsko
vplivanje.
Tabela 2:
Dele` delovnega ~asa za psihofarmakoterapijo in psihoterapijo v letu
1992 in 1995

Najbolj pogosto predpisujejo psihiatri flufenazin, na drugem mestu
je haloperidol, na tretjem pa tioridazin in klozapin (tabela 3).
^e bi ne
uporabljali nobenega drugega antipsihotika kot te {tiri, bi se pribli`no pri
treh ~etrtinah pacientov njihovo antipsihoti~no zdravljenje najbr` ne
spremenilo v ni~emer (tabela 4). Tako ni le sedaj, tako je `e pribli`no do
10 let in v zadnjih letih je novost le pogostej{a uporaba klozapina in
redkej{a uporaba levomepromazina .

Zdravljenje z antipsihotiki je na~eloma dolgotrajno. Pacientov, pri
katerih je predvideno kratkotrajno zdravljenje, je mnogo manj kot tistih, pri
katerih je predvideno takoimenovano dolgo(trajno) zdravljenje.
Tem na~elnim izhodi{~em ustreza tudi praksa v predpisovanju
antipsihotikov (grafikon 1). A poka`e se pomembno strokovno izhodi{~e,
da mnoge paciente zdravijo z antipsihotiki od 6 do 12 mesecev. Iz zbranih
podatkov bi bilo mogo~e domnevati, da je v zadnjih letih celo ve~ tistih
pacientov, pri katerih traja zdravljenje okoli enega leta, in hkrati ve~
tistih, pri katerih je predvideno trajno zdravljenje. Razlaga take prakse v
predpisovanju antipsihotikov ni preprosta, a ta praksa vsekakor ni v
nasprotju s tistim, kar je znanega o poteku funkcijskih psihoz.

Zdravil, ki ne bi imela neza`elenih u~inkov, stranskih u~inkov in
komplikacij, na splo{no ni, med psihofarmaki zagotovo ne. Nekdanje
priporo~ilo, da naj zdravnik seznani vsakogar, ki mu predpi{e kakr{nokoli
zdravilo, tudi z neprijetnostmi in tveganji, je v zadnjih dveh desetletjih
postalo obveznost.
Odgovori v anketi, kako pogosto opozarjajo psihiatri na razne u~inke,
stranske u~inke in komplikacije antipsihotikov, dokazujejo, da te
obveznosti mnogi ne izpolnjujejo (tabela 7).
Razumeti je mogo~e, zakaj
neradi opozarjajo bolnike na mo`ni vpliv na spolne funkcije, saj smo vsi
prebirali S. Freuda.
Prav tako je mogo~e razumeti previdnost pri
opozarjanju na komplikacije, saj utegne tako opozorilo odvrniti posamezne
paciente od jemanja zdravil,
~eprav je zdravljenje z njimi potrebno. Toda
za razlago, zakaj bolj pogosto ne opozarjajo na stranske u~inke ali recimo
na vpliv na vozni{ke sposobnosti, zmanjka prepri~ljivih pojasnil.

http://www.pb-begunje.si/gradiva/Lokar1351439672202.pdf

Depresivno razpolo`enje in ostali znaki depresivnega reagiranja so
pri funkcijskih psihozah sorazmerno pogosti. Pri nekaterih bolnikih so
sestavni del psihoze (recimo depresivna "faza" pri shizoafektivni psihozi),
pri nekaterih ga spodbudijo antipsihotiki (recimo "depresivni pomik" pri
flufenazinu), pri nekaterih ni mogo~e spregledati, da samo spoznanje o
du{evni bolezni povzro~i depresivno reakcijo. Oslabljena ~ustvena
odzivnost, ki se ka`e pri nekaterih bolnikih s shizofrenskimi psihozami,
na~eloma ne prepre~uje depresivnega reagiranja, temve~ kve~jemu
povzro~i, da ga te`je prepoznamo. [e vedno je strokovna zagonetka, ali
je mogo~a "prava komorbidnost" shizofrenije in depresije, ~eprav tisti z
bogatimi klini~nimi izku{njami ne dvomijo, da je mogo~a.
Vzrokov za hkratno predpisovanje antipsihotikov in antidepresivov je
torej ve~ in so pogosti. Kljub temu je teoreti~nih pomislekov zoper hkratno
predpisovanje antipsihotikov in antidepresivov razmeroma veliko. Ve~ jih
imajo tisti, ki se ukvarjajo s teorijo, kot tisti, ki zdravijo. Oboji imajo za
svoje stali{~e tehtne argumente.
Oboji, antidepresivi in antipsihotiki, so zdravila, pri katerih so
neza`eleni stranski u~inki ne le pri~akovani, temve~ celo nujni, a niso pri

obeh skupinah zdravil enaki. Zato je treba resno upo{tevati mo`nost, da

je taka kombinacija marsikdaj res zdravilna, toda vselej - vsaj nekoliko -

neprijetna za pacienta, v~asih celo tvegana, zlasti pri starej{ih. Na drugi

strani je treba upo{tevati realno dejstvo, da je antidepresivni u~inek

nekaterih antipsihotikov ponavadi mnogo mo~nej{i v knjigah in v

prospektih o njih, kot pri pacientih.

Kakorkoli `e, kombinacije antipsihotikov z antidepresivi so

terapevtska realnost, ki se je psihiatri ne odrekajo. Podatki iz ankete

ka`ejo (tabela 9), da mnogo psihiatrov pogosto uporablja to kombinacijo

zdravil, morda sedaj celo bolj pogosto kot nekdaj. Ker ni verjetno, da bi

bilo sedaj ve~ ljudi, pri katerih je potrebno zdravljenje z antipsihotiki,

hkrati tudi depresivnih, je vzrok ve~je naklonjenosti taki kombinaciji najbr`

uvedba novih antidepresivov, ki imajo manj tvegane stranske u~inke.

Podatki iz ankete vseeno opozarjajo (morda resno opozarjajo) na

mo`nost, da se - vsaj nekateri - preve~ lahkotno odlo~ajo za kombinacijo
antipsihotikov z antidepresivi.
Tabela 9:
Hkratno predpisovanje antipsihotikov z antidepresivi (v %)
ANTIDEPRESIVI
dele` pacientov 1985-1990 1995
0-25 54 52
26-50 39 41
51-75 2 7
76-100 5 -

Poraba benzodiazepinov je pri nas prevelika, ~eprav je manj{a kot v
mnogih razvitih dr`avah (vendar se tam ponekod `e zmanj{uje).
Zelo
raz{irjena splo{na raba benzodiazepinov vsekakor vpliva tudi na uporabo
benzodiazepinov pri ljudeh, ki jih zdravimo z antipsihotiki.
Zakaj bi bili oni
izjema? Poleg tega splo{nega pojava je treba upo{tevati {e specifi~nosti.
Sestavni (celo nujni sestavni) del funkcijskih psihoz so tudi simptomi, ki

jih benzodiazepini omilijo. Na~eloma je sicer to~no, da nekatere od teh

simptomov omilijo tudi antipsihotiki, vendar nekatere manj kot
84
KOMBINACIJA ANTIPSIHOTIKOV Z BENZODIAZEPINI

benzodiazepini, nekaterih sploh ne, nekateri simptomi pa so - vsaj pri

nekaterih pacientih in pri nekaterih antipsihotikih - po antipsihoti~ni

terapiji celo bolj mote~i.
Tabela 10:
Hkratno predpisovanje antipsihotikov z benzodiazepini (v%)
BENZODIAZEPINI
dele` pacientov 1985-1990 1995
0-25 46 46
26-50 29 25
51-75 22 20
76-100 3 9
^e bi izhajali le iz teoreti~nih izhodi{~, bi smeli postaviti nenavadno

trditev, da skorajda ni pacienta s psihozo, ki ne bi imel vsaj posameznih

simptomov, kakr{ni so teoreti~na indikacija za zdravljenje z

benzodiazepini. V praksi so psihiatri vendarle mnogo manj zavzeti za

kombinacijo antipsihotikov z anksiolitiki (tabela 10). Za~udenje nad tem je

{e ve~je, ker ni dvoma, da benzodiazepini omilijo nekatere neprijetne

stranske u~inke nekaterih antipsihotikov. Enako pa ni dvoma, da

nekatere stranske u~inke antipsihotikov okrepijo, in tudi ni dvoma, da je

zloraba benzodiazepinov ali celo odvisnost od njih kar pogosta.

V tehtanju za in proti kombinirani terapiji z antipsihotiki in

benzodiazepini se zdi zadr`ano ravnanje psihiatrov, kar ka`ejo podatki iz

ankete, upravi~eno in primerno.

Anketne podatke lahko primerjamo z ogledalom, ki daje popa~eno
sliko: ne ka`e realne podobe, lahko poudari ali prikrije skrivljenosti.
http://www.pb-begunje.si/gradiva/Lokar1351439672202.pdf

Forum
Forum je moderiran. Žaljivi komentarji oz. komentarji, ki bodo vsebovali sovražni govor, ne bodo objavljeni.
Neprimerne teme bodo izbrisane oz. prestavljene v ustrezno kategorijo.
Forum // Duševno zdravje // Depresija // Ali antipsihotiki škodijo možganom?
zrtev-usode

Število vnosov: 5
05.04.2010 ob 07:29OdgovoriCitiraj Lepo pozdravljeni, star sem 18 let in si vsakdan postavlam zelo obremenlivo vprašanje in ne mine en dan, ki ga nimam nenehno v glavi, zelo toplo lepo bi prosil za odgovor, ker se nepočutim varen brez njega. Torej moje bremenitveno vprašanje v glavi je:

Ali je možno, da antipsihotiki, antidepresivi, anksiolitiki itd. škodijo možganom? Star sem bil 12 let in so me nasilo priprl zaradi tega, ker sem se lagal moji materi, da bom storil samomor, ker mi je bilo pač pretežko, a nisem seveda resno mislil. Nekaj čisto normalnega je v teh letih občutit stresno spremembo. Potem mi je tamkajšnja psihiatrinja predpisala risperdal. Imel sem tudi komaj 12 let, tako da nevem kako je s tem da mi na taka leta predpisujejo taka zdravila, ki se ukvarjajo z možgani? Jemal sem jih 6 mescov, potem naslednje leto (bil star 13 let), ko so me spet prisilno tja pripeljali, so mi za 6 mescov dajali risperdal. Bil sem nemočen, da zavrnem. Razlog, da so mi to delal naj bi bil tudi v tem, da sem kazal hitra razburjenja, kar je bilo pa posledica posnemanja staršev in takšnem prilaganju, saj dobesedno en dan ni šel čez, ne da bi se prepirali in da bi me vedno toliko bolj prepričevala, da nenormalno vedenje je normalno. Ona 2 sta me tako oblikovala. Torej sem bil tako '"naučen'" in ne '"bolan'", pač pa temu prilagojen. To nič nepomeni, da je bilo kaj narobe z mojimi možgani, ali kaj prirojene napake. Potem mislim da sem en čas prenehal in potem sem spet jemal eno leto pa pol risperdal. Proti koncu tega leta, sem jemal še kako leto torrendo q-tab pa zipralex skupaj. Prišli so trenutki, ko sem vzel zyprexo do 2x največ vse skupaj. V naslednjem letu, so me prisilili jemati še prazine za 3 mesce, vse 12-16 leta je bilo jemanje teh vseraznih zdravil precej pogosto.
Kakšne so bile doze teh zdravil se nespomnim približno, vem da so bile kar pogosto večje in večkrat na dan. Večkrat do 3x in to vse skupaj je ogromno uživanja kemičnih drog in se nenehno sprašujem, ali mi je pustilo kakšne trajne posledice in bi se resnično rad seznanil o tem. Tudi spat nemoram ker se kar naprej obremenjujem če je z mano biološko vse v redu. Nepočutim se varen brez odgovora resno. Ali uničijo te zdravilo celice v možganih? Ali kaj trajnega pustijo? Ali se po dolgotrajnemu prenehanju jemanja vseh teh zdravil za mentalne namene, stanje osebe vrne kot na osebo, ki nikoli prej ni vzela nič teh zdravil? To so odgovori, resnično močno zaželjeni in bi močno cenil vsakršn nasvet in odgovor,
lepo prosim!smileysmileysmileysmiley
http://vizita.si/forum/?topic_id=54779

Skupaj razkrivamo
28.3.2012


Zdravnik že ve!?
Besedilo: Sabina Topolovec

Če bi vedeli, da lahko vaše zdravilo povzroči tudi smrt, bi ga jemali? Ste seznanjeni z vsemi možnimi stranskimi učinki zdravila, ki ga jemljete? Ali bi jemali naravne pripravke/zdravila, ki bi pomagala odpraviti bolezen brez kakršnih koli neželenih posledic, če bi vedeli zanje? Ste pripravljeni odkriti vzrok svoje bolezni in ga odpraviti? Kdo je prej, zdravnik ali vest?

Če verjamete, da bolezen pozdravijo zdravila, vas utegne besedilo, ki ga pravkar
berete, šokirati! Na takšni domnevi danes temelji zdravstvo, ljudstvo pa temu slepo verjame
. Sicer je vsakomur vsaj približno jasno, da smo vedno bolj bolni, vendar pa statistika, ki se hvali z vedno
višjo življenjsko dobo prebivalstva, prikrije to neprijetno dejstvo. Poleg tega danes velja za povsem normalno,
da otrok preboli šest prehladov na leto, da se isti tip raka pojavlja znotraj družine, pa naivno pripisujemo zgolj genetiki.
Danes farmacevtski velikani skupaj z medicino bodisi znižujejo kriterije za določene bolezni (in tako že kmalu
po tridesetem utrpimo povišan holesterol, krvni pritisk, osteoporozo itd.) ali pa iz stotine simptomov,
ki jih povzročata prehiter življenjski ritem in predvsem razdvojenost uma in zavesti, ustvarjajo nešteto kombinacij
in jih poimenujeta s tem ali onim sindromom. Na koncu vsi pademo v kategorijo bolnih, pristanemo „na zdravilih“,
obenem pa vedno bolj verjamemo, da je to normalno!

Psihične težave ali kura, ki nese zlata jajca!
Psihične težave za farmacijo pomenijo zlato jamo brez dna. Depresije, „burn-out“ sindromi, nespečnost,
vedenjske težave, kajenje, odvisnosti, ..., omogočajo nastanek tisoč in ene bolezni, ki jih še včeraj nismo poznali.
Na trgu se pojavljajo nova in nova zdravila, farmacevtska industrija pa tudi v času recesije beleži rast.
Vendar Slovenija kljub temu ostaja na vrhu samomorilnosti! Zato smo se pri tokratnem pregledu
morebitnih nevarnosti posvetili prav tej kategoriji zdravil.

Zdravila proti nespečnosti
Iz nedavno objavljene, zelo natančno izvedene študije izvemo, da imajo ljudje, ki jemljejo hipnotike
(zdravila proti nespečnosti), z učinkovinami zolpidem, temazepam itd., kar trikrat več možnosti, da umrejo ali zbolijo za rakom (1). Tudi prenehanje jemanja tovrstnih zdravil mora biti izvedeno pod strogim zdravniškim nadzorom, če ne želite resnih posledic zaradi takšne odločitve (npr. izgube apetita, izgube telesne teže, tresavice, zmedenosti, ...). V Sloveniji je bila leta 2009 daleč najpogosteje predpisana učinkovina iz skupine hipnotikov in sedativov z 202.000 predpisanimi recepti z vrednostjo 1,9 milijona evrov, zolpidem (3).

Antipsihotiki
Psiholeptiki (kamor sodijo tudi antipsihotiki) so druga najpogosteje predpisana

skupina zdravila skupine N (zdravila z delovanjem na živčevje).

Med njimi občutno prednjačijo antipsihotiki (3). Na spletni strani zdravila Abilify (6),

ki sodi v to skupino, je navedeno, zakaj vse se to zdravilo uporablja (celo kot dopolnilno

zdravilo, ko antidepresiv ni dovolj učinkovit). Na isti strani so navedeni tudi zelo hudi stranski učinki,

vključno s smrtjo! Nasvet, ki ga tisočkrat dnevno slišite pred vsakim pregledom novic,

in sicer, da je pred uporabo zdravila treba prebrati navodila za uporabo oziroma se o jemanju pogovoriti

z zdravnikom ali s farmacevtom, vsekakor ni iz trte zvit.

Težava je v tem, da smo raje prijazni (beri: tiho) kot zoprni (beri: postavljamo vprašanja zdravniku).

Antidepresivi
Največji delež psihoanaleptikov v številu receptov in v vrednosti so v letu 2009 v Sloveniji predstavljali antidepresivi (3).

Tudi ti se danes jemljejo kot nekaj samoumevnega. Če ne poznate nikogar, ki jih uživa, pokukajte na spletne forume.

Prozac, eden najbolj razvpitih antidepresivov, ki so mu že mnogokrat očitali zelo hude stranske učinke,

vključujoč nagnjenje k samomoru v zameno za boljše razpoloženje, lahko povzroči tudi zelo resne zaplete,

kjer je nujno takoj stopiti v stik z zdravnikom.

Navajam jih zgolj nekaj (4): hude alergijske reakcije (oteženo dihanje, tiščanje v prsih,

otekanje obraza), krvavo blato, zmanjšana koncentracija, hitro ali neredno bitje srca,

halucinacije, izguba spomina, napadi panike, agresija, nespečnost, samomorilne misli, še hujša depresija, ...


Zdravila za odvajanje od kajenja
Čeprav obstajajo ljudje, ki od danes na jutri za vedno prekinejo s kajenjem, je to za mnoge misija nemogoče. Farmacija je v ljudski šibkosti prepoznala tržno nišo, ljudje pa so hitro preglasili svojo vest in zapleteno nalogo raje prepustili čudežni tabletki. Tudi ta ni brez posledic, pravzaprav bi se morali vprašati, ali koristi resnično presegajo tveganja, ki jih prinašajo?
Zyban je bil sprva registriran kot antidepresiv, nato pa so po naključju odkrili, da je mnogo ljudi, ki so ga jemali, prenehalo s kajenjem. FDA je proizvajalca opozorila, da mora nositi jasno opozorilo, da lahko povzroča resne nevropsihične simptome.
Ti simptomi so med drugim lahko: sprememba obnašanja, sovražnost, razdraženost, depresija, samomorilne misli in poskusi samomora (5). Kljub vsemu ne priporoča ukinitev zdravila, saj naj bi bilo učinkovito pri odvajanju od kajenja. Je za zdravje torej škodljivejše kajenje
ali samomor?
http://www.zazdravje.net/razkrivamo.asp?art=614

Klinične študije
Kognitivna terapija kot alternativa antipsihotikom

zdd
6. februar 2014 6. februar 2014 0:00
Za ljudi s shizofrenijo, ki ne želijo ali nočejo jemati antipsihotikov,
lahko varno in sprejemljivo alternativo predstavlja kognitivna vedenjska terapija,
nakazuje študija, katere izsledke so objavili v ugledni medicinski reviji The Lancet.


Fotografija je simbolična. (Foto: Jaka Gasar)
»Antipsihotiki so standard zdravljenja shizofrenije, toda veliko bolnikov jih
ne želi prejemati zaradi neželenih stranskih učinkov, ki vključujejo resno povečanje telesne teže,
razvoj metabolnih motenj in povečano tveganje nenadnega srčno-žilnega obolenja.

Drugi čutijo, da zdravljenje ni učinkovito, ali preprosto menijo, da tega ne potrebujejo.
Zaenkrat pa nismo imeli nobene dokazane, varne in učinkovite terapevtske alternative,
« je pojasnil vodja študije prof. Anthony Morrison z Univerze Manchester v Veliki Britaniji.

Čeprav so kognitivno terapijo že uporabljali v kombinaciji z zdravili, do zdaj ni dokazov, da ta učinkuje kot samostojna terapija pri bolnikih, ki ne jemljejo zdravil.

Študija je vzela pod drobnogled 74 bolnikov s shizofrenijo, starih od 16 do 65 let, ki so se odločili,
da antipsihotike zavrnejo, ali so jih nehali jemati pred najmanj šestimi meseci.
Vključili so jih v skupinsko terapijo, ki si je za cilj zadala ovrednotiti psihotične izkušnje
in spreminjati nekoristne miselne vzorce in vedenja. Eno skupino so vključili v terapevtske skupine
in je obenem prejemala običajno obravnavo, druga skupina pa je prejemala zgolj svojo običajno obravnavo. Spremembe znakov bolezni so redno spremljali in ocenjevali 18 mesecev s pomočjo lestvice pozitivnih in negativnih simptomov (Positive and Negative Syndrome Scale – PANSS).

Povprečne ocene na lestvici so bile konsistentno nižje v skupini,
ki je bila deležna tudi kognitivne terapije. Po 18 mesecih je sedem (41 odstotkov)
izmed 17 udeležencev, ki so se udeleževali kognitivne terapije, pokazalo izboljšanje
za več kot 50 odstotkov po lestvici PANSS. V drugi skupini z običajno obravnavo je
to uspelo trem (18 odstotkov) izmed 17.

Kognitivno terapijo so bolniki tudi dobro prenašali in je skoraj niso opuščali.

Profesor Morrison na podlagi pozitivnih rezultatov s kolegi že načrtuje nadgradnjo študije,
v kateri bo primerjal učinke treh možnosti: kognitivne terapije, antipsihotikov in kombinacije obeh.
Če bodo rezultati podobno spodbudni v prid kognitivne terapije, bi to lahko pomenilo
prelomnico v obravnavi shizofrenije.zdd
https://www.dnevnik.si/1042622143/zdravje/arhiv/kognitivna-terapija-kot-alternativa-antipsihotikom

http://www.mojvideo.com/video-direkt-antipsihotiki-20-14-jan-15/eb087c5ba4f7ef60cfca

http://www.mojvideo.com/video-antipsihotiki-ali-nevroleptiki-20-11-jun-02/3f20b36193e96dc20f19

http://www.mojvideo.com/video-04-03-11-uboji-in-antipsihotiki/cb39b9c9ff4c16095230

http://www.mojvideo.com/video-zyprexa-nevarnosti-20-11-apr-07/72cb4b1a8f51b766c8d1

EMA/60300/2014
EMEA/H/C/002713
Povzetek EPAR za javnost
Latuda
lurasidon
To je povzetek evropskega javnega poročila o oceni zdravila (EPAR) za zdravilo Latuda. Pojasnjuje,
kako je agencija ocenila zdravilo, na podlagi česar je priporočila njegovo odobritev v EU in pogoje
njegove uporabe. Povzetek ni namenjen zagotavljanju praktičnih nasvetov o njegovi uporabi.
Za praktične informacije o uporabi zdravila Latuda naj bolniki preberejo navodilo za uporabo ali se
posvetujejo z zdravnikom ali farmacevtom.
Kaj je zdravilo Latuda in za kaj se uporablja?
Latuda je zdravilo, ki vsebuje zdravilno učinkovino lurasidon. Uporablja se za zdravljenje odraslih s
shizofrenijo, ki je duševna bolezen z vrsto simptomov, med katerimi so nepovezano razmišljanje in
govorjenje, halucinacije (bolnik sliši ali vidi stvari, ki jih ni), sumničavost ter blodnje (zmotna
prepričanja).
Kako se zdravilo Latuda uporablja?
Zdravilo Latuda je na voljo v obliki tablet (18,5, 37 in 74 mg) in se izdaja le na recept. Priporočeni
začetni odmerek je 37 mg enkrat na dan, ki se jemlje skupaj s hrano vsak dan ob približno istem času.
Odmerek se lahko na osnovi bolnikovega odziva in presoje lečečega zdravnika poveča do največjega
odmerka 148 mg enkrat na dan. Pri bolnikih z zmerno ali zelo zmanjšanim delovanjem ledvic ali jeter
in pri bolnikih, ki jemljejo nekatera druga zdravila, ki lahko vplivajo na ravni zdravila Latuda v krvi, je
treba uporabiti manjše odmerke.
Za več informacij glejte navodilo za uporabo.
Latuda
EMA/60300/2014 stran 2/3
Kako zdravilo Latuda deluje?
Zdravilna učinkovina v zdravilu Latuda, lurasidon, je antipsihotik. Lurasidon se veže na več različnih
receptorjev za živčne prenašalce na površini živčnih celic v možganih ter vpliva nanje. Živčni prenašalci
so kemične snovi, ki omogočajo medsebojno komunikacijo med živčnimi celicami.
Lurasidon večinoma prepreči delovanje receptorjev za živčne prenašalce dopamin, 5-hidroksitriptamin
(imenovan tudi serotonin) in noradrenalin. Dopamin, 5-hidroksitriptamin in noradrenalin imajo
pomembno vlogo pri shizofreniji, zato lurasidon z blokiranjem teh receptorjev pomaga normalizirati
aktivnost možganov, s čimer se zmanjšajo simptomi bolezni.
Kakšne koristi je zdravilo Latuda izkazalo v študijah?
Zdravilo Latuda so proučevali v šestih glavnih študijah. V treh kratkoročnih študijah so 6-tedensko
zdravljenje z zdravilom Latuda primerjali s placebom (zdravilom brez zdravilne učinkovine) pri skupno
1 466 bolnikih. Glavno merilo učinkovitosti je bila sprememba bolnikovih simptomov, ki so jo izmerili s
standardno lestvico za shizofrenijo, imenovano „lestvica pozitivnih in negativnih sindromov“ (positive
and negative syndrome scale – PANSS). Te študije so pokazale, da so bili različni odmerki zdravila
Latuda učinkovitejši od placeba, saj so oceno po PANSS znižali za do 16 točk več kot placebo, vendar
tega učinka niso dosledno dokazali pri vseh odmerkih, prav tako ni bilo mogoče opaziti dosledne
povezave med odmerkom in odzivom. Družba je izvedla dodatne analize rezultatov, ki so potrdile
kratkoročne koristi zdravljenja z zdravilom Latuda.
Eno od kratkoročnih študij so podaljšali na 12 mesecev (podaljšana študija), da bi proučili vzdrževanje
učinka zdravila Latuda pri 292 bolnikih v primerjavi s kvetiapinom. V dveh drugih študijah, v katerih je
sodelovalo 914 bolnikov, pa so proučevali dolgoročne učinke zdravila Latuda v primerjavi z drugim
zdravilom za shizofrenijo, imenovanim risperidon, oziroma s placebom. V teh dolgoročnih študijah so
učinkovitost zdravila Latuda merili na podlagi odstotka bolnikov, pri katerih so se shizofrenija in njeni
simptomi med zdravljenjem ponovno pojavili. V podaljšani študiji se je v enem letu bolezen ponovno
pojavila pri 21 % bolnikov, zdravljenih z zdravilom Latuda, in pri 27 % bolnikov, zdravljenih s
kvetiapinom, kar kaže na to, da je bilo zdravilo Latuda vsaj tako učinkovito kot kvetiapin. Druga študija
je pokazala, da zdravilo Latuda ni bilo tako učinkovito kot risperidon, čeprav so razpoložljivi podatki
potrdili dolgoročno korist. Zadnja študija pa je pokazala, da se je v enem letu bolezen ponovno pojavila
pri 30 % bolnikov, zdravljenih z zdravilom Latuda, v primerjavi z 41 % bolnikov, zdravljenih s
placebom.
Kakšna tveganja so povezana z zdravilom Latuda?
Najpogostejša neželena učinka zdravila Latuda (ki lahko prizadeneta več kot 1 osebo od 10) sta
akatizija (neprestana potreba po gibanju) in somnolenca (zaspanost). Za celoten seznam neželenih
učinkov, o katerih so poročali pri uporabi zdravila Latuda, glejte navodilo za uporabo.
Zdravilo Latuda se ne sme uporabljati skupaj z drugimi zdravili, imenovanimi „močni zaviralci CYP3A4“
in „močni induktorji CYP3A4“, saj bi lahko vplivali na ravni lurasidona v krvi. Za celoten seznam
omejitev glejte navodilo za uporabo.
Zakaj je bilo zdravilo Latuda odobreno?
Odbor za zdravila za uporabo v humani medicini (CHMP) pri agenciji je zaključil, da so koristi zdravila
Latuda večje od z njim povezanih tveganj, in priporočil, da se odobri za uporabo v EU. Odbor CHMP je
upošteval, da sta bili kratkoročna in dolgoročna učinkovitost zdravila Latuda zadovoljivo dokazani,
vendar pa so kratkoročne študije pokazale zmerno učinkovitost zdravila. Kar zadeva varnost, je menil,
Latuda
EMA/60300/2014 stran 3/3
da ima zdravilo Latuda podobne neželene učinke kot druga zdravila iste vrste, vendar ima manj
učinkov na presnovo (kot so na primer učinki na ravni sladkorja in maščob v krvi ter telesno maso) in
lahko v manjši meri vpliva na aktivnost srca kot nekatera druga razpoložljiva zdravila.
Kateri ukrepi se izvajajo za zagotovitev varne in učinkovite uporabe
zdravila Latuda?
Za zagotovitev čim varnejše uporabe zdravila Latuda je bil pripravljen načrt obvladovanja tveganj. V
skladu s tem načrtom so bile v povzetek glavnih značilnosti zdravila Latuda in navodilo za njegovo
uporabo vključene informacije o varnosti, vključno s previdnostnimi ukrepi, ki jih morajo upoštevati
zdravstveni delavci in bolniki.
Dodatne informacije so na voljo v povzetku načrta obvladovanja tveganj.
Druge informacije o zdravilu Latuda
Evropska komisija je dovoljenje za promet z zdravilom Latuda, veljavno po vsej Evropski uniji, izdala
dne 21. marca 2014.
Celotno evropsko javno poročilo o oceni zdravila (EPAR) in povzetek načrta obvladovanja tveganj za
zdravilo Latuda sta na voljo na spletni strani agencije: ema.europa.eu/Find medicine/Human
medicines/European public assessment reports. Za več informacij o zdravljenju z zdravilom Latuda
preberite navodilo za uporabo (ki je prav tako del EPAR) ali se posvetujte z zdravnikom ali
farmacevtom.
Povzetek je bil nazadnje posodobljen 03-2014