Might Net Better Results
For Experienced Workers
July 31, 2007; Page B6
Posted at 05:16 PM in Careers | Permalink | Comments (0) | TrackBack (0)
Antidepressants are often the first treatment choice for adults with moderate or severe depression. Although antidepressant medications don't cure depression, they can help you achieve remission — the disappearance or nearly complete reduction of symptoms. Sadness, anxiety, depression-related sleep and appetite problems, concentration, and energy levels all can improve with antidepressant medications.
With scores of antidepressants available, though, finding the right one for your situation can be challenging. Understanding what a treatment plan entails and what goes into determining the right medication for you will help you sort through your options.
Precisely how antidepressants work to treat depression remains speculative. Scientists do know that antidepressants can influence brain activity through the effects they have on mood-related brain chemicals called neurotransmitters and certain nerve cell receptors. Nerve cells release neurotransmitters to communicate with other nerve cells in the brain. Neurotransmitters transmit signals across a gap (synapse) between the nerve cells.
Neurotransmitters associated with depression are serotonin (ser-oh-TOE-nin), norepinephrine (nor-ep-ih-NEF-rin) and possibly dopamine (DOE-puh-mene). Research suggests that people with depression have lower levels of one or more of these neurotransmitters.
Nerve cells send a signal and then reabsorb (reuptake) the neurotransmitters after they've communicated with other nerve cells. Antidepressants interfere with this reuptake. This results in a greater quantity of a particular neurotransmitter remaining in the synapse. This can change the activity of certain nerve cells and influence brain activity. Maintaining a higher level of neurotransmitters improves neurotransmission — the sending of those nerve impulses — which, in turn, improves your mood.
In addition, a type of antidepressant called tetracyclic antidepressants are thought to work by preventing neurotransmitters from binding with certain nerve cell receptors. This indirectly increases the levels of norepinephrine and serotonin in your brain.
Dozens of antidepressants are available, each affecting neurotransmitters in a different way. Antidepressants are typically grouped into categories, either based on when the medications came into use, their chemical structure or how they affect brain chemistry.
Here are the antidepressants that have been approved by the Food and Drug Administration (FDA) specifically to treat depression, with their generic or chemical names followed by available brand names in parentheses, and grouped by how they affect brain chemistry.
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
Norepinephrine and dopamine reuptake inhibitors (NDRIs)
Tetracyclic antidepressants
Combined reuptake inhibitors and receptor blockers
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
The FDA normally approves a drug to treat a specific condition in a particular population. Many drugs used to treat depression in adults have been FDA approved specifically for that use.
But doctors may also prescribe drugs to treat depression that haven't actually been approved to treat depression — a practice known as off-label use. For instance, doctors often prescribe clomipramine (Anafranil) because it may improve depression even though it's FDA approved for obsessive-compulsive disorder. The same may be true of other psychiatric drugs, as well.
So among the dozens available, which antidepressant should you take?
Finding the right one might take time. Each medication has its own pros and cons, and until you try one, you won't know how it'll affect you or how well it'll work. You may need to try several antidepressants before finding the one, or the combination, that's most effective for you with the fewest side effects.
Consider your health profile
Your family doctor or psychiatrist will take into account your symptoms and their severity, your health history, other illnesses you have and lifestyle factors when determining which antidepressant to prescribe.
Your doctor will also consider your age, sex, weight and diet, mostly because of concerns about side effects. Older adults, for instance, generally tolerate the side effects of the newer antidepressants better than the side effects of the older tricyclic antidepressants. However, for some people, the older medications are more effective in treating depression.
Pregnancy also is an issue. Some psychiatric medications may pose a risk to the developing baby. Other medications may be excreted in breast milk to infants.
If any close relatives, such as a brother or sister, have taken antidepressants, their experiences could predict how well a medication will work for you or what side effects you may experience. Tell your doctor if any of your close relatives have taken antidepressants.
Make your personal preferences known
How you take an antidepressant also may influence your medication choice. Some medications come in pill form, while others come as solutions or injections. You may not be comfortable taking an antidepressant that must be injected, for instance. Or you may prefer a once-a-week medication, while someone else doesn't mind taking several doses a day.
Cost is also a consideration. Some antidepressants are available in a generic form, which is generally cheaper than a brand-name version. Newer versions of a drug are sometimes more expensive than the original. But watch out — those newer versions aren't necessarily more effective.
Once you and your doctor have selected an antidepressant for you to try, it may take four to eight weeks to determine its full effectiveness. With some medications, you can take the full dosage immediately. With others, you may need to gradually increase your dose.
If you have no improvement at all in your symptoms after six weeks, it may be time to try a different antidepressant or add a second medication to augment your treatment. You may have to taper off of one medication before starting another, because potentially dangerous drug interactions and withdrawal-like symptoms can occur from an abrupt switch.
In rare cases, antidepressants simply might not work for you. You may need to consider other forms of treatment, such as psychotherapy to help cope with social or other life stressors, or electroconvulsive therapy if your depression is severe or life-threatening.
Finding the right antidepressant and the correct dosage can take time. Talk to your doctor if you're having trouble coping with the wait.
(Reprinted from The Mayo Clinic website, http://www.mayoclinic.com/health/antidepressants/HQ01069)
Posted at 01:02 PM in Depression | Permalink | Comments (0) | TrackBack (0)
From David: Hey all--I try to avoid technical articles from psychology, but I think this is very informative...if you have any questions about how attachment styles play a role in relationships, drop me a line or bring it up in group.
Attachment style can predict a person's physical stress response to conflict with a romantic partner, but the specific vulnerable attachment styles are different in men and in women, according to an April study in the Journal of Personality and Social Psychology (Vol. 90, No. 4).
The study, part of a larger National Institute of Mental Health-funded investigation, involved 124 couples between the ages of 18 and 21 who had been together for at least two months. Powers and her team assessed participants' self-reported avoidance of intimacy and dependence on their romantic partner, and anxiety about rejection and abandonment. "Secure" types had low levels of anxiety and avoidance, "anxious-ambivalent" had high levels of anxiety and low levels of avoidance, "fearful-avoidant" had high levels of both anxiety and avoidance and "dismissing-avoidant" had low anxiety and high avoidance.
After filling out the questionnaires, couples spent 15 minutes discussing an issue that caused heated and unresolved discussions in the past month. The researchers collected seven cortisol samples assessing physiological stress in anticipation of the conflict, throughout the conflict and during a 40-minute recovery period.
The researchers found that although both men and women have a physiological response to relationship conflict, the response is much more pronounced in men than in women and involves different attachment factors. Anxiety was a strong predictor for response in men, but in women, only highly avoidant types showed significant cortisol changes.
"Men and women may face different demands in the conflict-negotiation task," Powers explains. In a relationship, women are often expected to initiate and guide conflict discussions, says Powers. For avoidant women, who prefer to distance themselves in conflict situations, the study's task may be particularly difficult, she believes. Indeed, avoidant women in the study showed high reactivity before and during the conflict, but recovered rapidly after leaving the discussion. For these women, avoiding sustained conflict appears to be physiologically rewarding.
Men, on the other hand, are often expected to be more passive participants, so Powers surmises that although they may want to resolve issues, anxious men feel particularly uncomfortable actively confronting relationship conflicts.
However, men in the study who had secure female partners showed the lowest levels of cortisol reactivity, indicating that their partners were helping to regulate their physiological stress levels. The converse was true for women—their partners' attachment style did not have a regulating effect on their stress levels.
L. Meyers
Monitor on Psychology
Volume 37, No. 5 May 2006
Posted at 11:47 AM in Relationships, Stress | Permalink | Comments (10) | TrackBack (0)
Better Than Ever! is a confidential support group. Each group meeting is safe, non-critical and non-judgmental. At no time should the content of any meeting be discussed outside of the meeting space.
While Better Than Ever! meetings may provide insight and strategies with regard to personal issues; it is not intended to be a substitute for medical, therapeutic or other professional advice. If professional therapy is required or desired, the services of a competent, licensed professional should be sought. The group facilitator can make referrals upon request. The owner, employees of neither the organization nor the group assume no responsibility for consequences resulting from the use of the information obtained during a Better Than Ever! meeting, or via the websites affiliated with it.
Attendance is a crucial part of Better Than Ever! meetings. Lack of attendance not only effects the member who is absent but the other members as well. In order to insure participation and to allow members to have a life outside of the group, members are allowed one excused absence per quarter. Members should notify the group facilitator by e-mail at least 24 hours prior to a missed meeting in order to use their excused absence. Any meeting missed beyond the excused absence will be charged full dues.
Meeting dues are paid in four session increments; the week a member's account reaches a zero balance you will be sent an e-mail reminder that due payments are due that week. The facilitator reserves the right to charge a 5% late fee for all dues not paid in a timely fashion.
PayPal is an option for payment; if you choose to pay in the way a $6.00 fee will be applied each time to cover processing fees deducted by PayPal.
As the group takes advantage of technology to make announcements, discuss issues and disseminate information, all members must have an active e-mail address they regularly check and a cell phone capable of receiving text messages. All communications are confidential and should be given the same respect as conversations in group.
Better Than Ever! is a private support group. We reserve the right to refuse or revoke membership to any individual at any time. Appropriate referrals for private work and/or other support groups or 12-step programs will be made in such a case.
When a member feels he or she ready to leave Better Than Ever!, we ask that the member notify the group facilitator, via e-mail and not in-group, at least three weeks in advance of her/his departure. In that way the group can process the departure and express how they feel.
Questions about any of these policies or any other matter should be directed to david@betterthanever.info.
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By DANIEL GOLEMAN
New York Times
20 February 2007
Jett Lucas, a 14-year-old friend, tells me the kids in his middle school send one other a steady stream of instant messages through the day. But there’s a problem.
“Kids will say things to each other in their messages that are too embarrassing to say in person,” Jett tells me. “Then when they actually meet up, they are too shy to bring up what they said in the message. It makes things tense.”
Jett’s complaint seems to be part of a larger pattern plaguing the world of virtual communications, a problem recognized since the earliest days of the Internet: flaming, or sending a message that is taken as offensive, embarrassing or downright rude.
The hallmark of the flame is precisely what Jett lamented: thoughts expressed while sitting alone at the keyboard would be put more diplomatically — or go unmentioned — face to face.
Flaming has a technical name, the “online disinhibition effect,” which psychologists apply to the many ways people behave with less restraint in cyberspace.
In a 2004 article in the journal CyberPsychology & Behavior, John Suler, a psychologist at Rider University in Lawrenceville, N.J., suggested that several psychological factors lead to online disinhibition: the anonymity of a Web pseudonym; invisibility to others; the time lag between sending an e-mail message and getting feedback; the exaggerated sense of self from being alone; and the lack of any online authority figure. Dr. Suler notes that disinhibition can be either benign — when a shy person feels free to open up online — or toxic, as in flaming.
The emerging field of social neuroscience, the study of what goes on in the brains and bodies of two interacting people, offers clues into the neural mechanics behind flaming.
This work points to a design flaw inherent in the interface between the brain’s social circuitry and the online world. In face-to-face interaction, the brain reads a continual cascade of emotional signs and social cues, instantaneously using them to guide our next move so that the encounter goes well. Much of this social guidance occurs in circuitry centered on the orbitofrontal cortex, a center for empathy. This cortex uses that social scan to help make sure that what we do next will keep the interaction on track.
Research by Jennifer Beer, a psychologist at the University of California, Davis, finds that this face-to-face guidance system inhibits impulses for actions that would upset the other person or otherwise throw the interaction off. Neurological patients with a damaged orbitofrontal cortex lose the ability to modulate the amygdala, a source of unruly impulses; like small children, they commit mortifying social gaffes like kissing a complete stranger, blithely unaware that they are doing anything untoward.
Socially artful responses emerge largely in the neural chatter between the orbitofrontal cortex and emotional centers like the amygdala that generate impulsivity. But the cortex needs social information — a change in tone of voice, say — to know how to select and channel our impulses. And in e-mail there are no channels for voice, facial expression or other cues from the person who will receive what we say.
True, there are those cute, if somewhat lame, emoticons that cleverly arrange punctuation marks to signify an emotion. The e-mail equivalent of a mood ring, they surely lack the neural impact of an actual smile or frown. Without the raised eyebrow that signals irony, say, or the tone of voice that signals delight, the orbitofrontal cortex has little to go on. Lacking real-time cues, we can easily misread the printed words in an e-mail message, taking them the wrong way.
And if we are typing while agitated, the absence of information on how the other person is responding makes the prefrontal circuitry for discretion more likely to fail. Our emotional impulses disinhibited, we type some infelicitous message and hit “send” before a more sober second thought leads us to hit “discard.” We flame.
Flaming can be induced in some people with alarming ease. Consider an experiment, reported in 2002 in The Journal of Language and Social Psychology, in which pairs of college students — strangers — were put in separate booths to get to know each other better by exchanging messages in a simulated online chat room.
While coming and going into the lab, the students were well behaved. But the experimenter was stunned to see the messages many of the students sent. About 20 percent of the e-mail conversations immediately became outrageously lewd or simply rude.
And now, the online equivalent of road rage has joined the list of Internet dangers. Last October, in what The Times of London described as “Britain’s first ‘Web rage’ attack,” a 47-year-old Londoner was convicted of assault on a man with whom he had traded insults in a chat room. He and a friend tracked down the man and attacked him with a pickax handle and a knife.
One proposed solution to flaming is replacing typed messages with video. The assumption is that getting a message along with its emotional nuances might help us dampen the impulse to flame.
All this reminds me of a poster on the wall of classrooms I once visited in New Haven public schools. The poster, part of a program in social development that has lowered rates of violence in schools there, shows a stoplight. It says that when students feel upset, they should remember that the red light means to stop, calm down and think before they act. The yellow light prompts them to weigh a range of responses, and their consequences. The green light urges them to try the best response.
Not a bad idea. Until the day e-mail comes in video form, I may just paste one of those stoplights next to my monitor.
Daniel Goleman is the author of Social Intelligence: The New Science of Human Relationships.
Posted at 10:09 AM in Communication | Permalink | Comments (0) | TrackBack (0)
March 6, 2007
By BENEDICT CAREY
New York Times
The domestic scenes that would slowly suffocate the marriage were not scenes at all, in the usual sense, but silences, imagined slights, private fears that went unspoken. She would ask him to do the dishes after dinner and feel a shudder when he put off the chore, as if it were a rejection. Or she would dress up to go out, and then struggle against a growing dread as the moments passed and he did not comment on how good she looked. “I never once said anything, but I had this need for approval, this terrible dependence that he had no way to understand,” Ronni Weinstein, 61, a therapist living near Chicago, said about her former husband. Indeed, she added, she has since learned that her dependent urges might have been used to bind the marriage rather than undermine it. “That’s what healthy couples learn to do,” she said, “to voluntarily depend on one another and decide who is doing what for the relationship.”
Neediness has a familiar face: the close friend who is continually asking for reassurance, for advice, for help with the wireless connection. The accomplished adult who lurches from one relationship to another, playing geisha for each new partner. The abused spouse who is afraid to walk out. Yet only in recent years have researchers begun to realize that while in some guises dependence can undermine mental health, in others it can provide valuable social support. At one extreme is an ingrained, helpless need to be cared for — a stubborn problem that psychiatrists diagnose as dependent personality disorder. In milder forms, dependency can come across as an annoying clinginess. But it can also be a protective warmth that cements romantic relationships in times of stress. It is the way people manage dependent urges, researchers are finding, that determines the effect of needy behavior on relationships. “There are the dependent people who panic easily, who are calling a friend or spouse 15 times a day, undermining the relationship, and then there are those who have learned to modulate their impulses,” said Dr. Robert F. Bornstein, a psychologist at Adelphi University in Garden City, N.Y., and co-author, with his wife, Mary A. Languirand, of “Healthy Dependency” (Newmarket Press, 2003).
“These people may have dependency needs that are very intense,” he continued, “but they have developed social skills, learned to make others feel good about helping them. That makes all the difference.” A tug-of-war between headstrong independence and needy vulnerability is visible as early as infancy. In so-called attachment studies, young children or primates who are confident in their mother’s affections tend to be confident when exploring an unfamiliar room or meeting a stranger. Those who are less secure often cling to their mothers in new situations, noticeably fearful. “This is an absolutely fundamental dynamic that underlies all of our interpersonal relations, as well as psychiatric diagnoses,” said Dr. Sydney Blatt, a professor of psychology and psychiatry at Yale University. Researchers measure the strength of dependency traits by having people rate how highly they endorse certain beliefs, like, “After a fight with a friend, I must make amends as soon as possible”; “I am very sensitive to others for signs of rejection”; or “I have a lot of trouble making decisions for myself.” In studies, people who score highly on these tests also tend to rate their parents as either authoritarian or overly protective (or one of each). “The message growing up is: You’re fragile, you’re weak, you need someone powerful to look after you,” Dr. Bornstein said.
That upbringing primes many people, as they grow, to seek similarly dependent pairings, with friends, colleagues and romantic partners. The pattern persists at least in part because it is frequently rewarded. In one recent study, psychologists rated 48 men and women attending Gettysburg College in Pennsylvania on measures of dependency, and calculated their grade-point averages. After controlling for the students’ SAT scores and the difficulty of their course schedules, among other factors, the researchers found, to their surprise, that those students who scored highly on measures of dependency were doing significantly better, on average, than those who were more self-sufficient.
One likely reason, the authors found, was that dependent students were much more likely to say they sought help with course work from their professors. In another experiment, presented in January at the American Psychoanalytic Association’s annual meeting, psychologists at the University of Leuven in Belgium measured dependency traits, relationship satisfaction and levels of conflict in 266 adults in long-term relationships. The researchers found that dependent partners scored significantly higher on satisfaction than more self-sufficient ones — but only when couples were struggling. At least in the short run, dependent traits seemed to buffer the relationships in times of crisis, the authors suggest. Afraid of losing the relationship, “individuals high on dependency may actually behave in a more positive way to their partner, like being more complying, being more loving,” said Bénédicte Lowyck, the psychologist who led the study. In the long run, Ms. Lowyck said, it is not at all clear whether such protective instincts nourish a relationship or smother it.
The answer will depend on the couple, experts say, and likely on the content of a partner’s dependence: how it is expressed, whether the person is generous as well as needy, flexible as well as anxious. To distinguish different shades, or varieties, of dependency, two psychologists, Aaron L. Pincus of Pennsylvania State and Michael B. Gurtman of the University of Wisconsin, Parkside, administered an exhaustive battery of dependency-related questionnaires to 654 psychology students. The scales rated everything from social confidence to preference for solitude to urges to please others. The psychologists’ analysis of the answers suggested that there were three distinct varieties of dependent behavior patterns.
One was defined predominantly by submissiveness (“I don’t have what it takes to be a good leader” or “I am easily downed in an argument”). Another was characterized principally by exploitability (“I am afraid of hurting people’s feelings” or “I do things that are not in my best interest in order to please others”). And a third, which the psychologists call love dependency, was based on a longing for social connection (“Being isolated from others is bound to lead to unhappiness” or “After a fight with a friend, I must make amends as soon as possible”). People who struggle with an exaggerated need for the comfort of others may show flashes of all three types. “But it is this love dependency that is the most adaptive,” Dr. Pincus said. “These are people that form very strong attachments, who are not happy unless surrounded by friends and family” and least likely to stumble over their own anxieties.
Dr. Weinstein, the Chicago-area therapist, said that in more than 30 years of practice she had seen dozens of couples in which submission and exploitation have ended marriages. And studies now suggest that in severely troubled, abusive relationships, the aggressor, as well as the victim, often have a dependent fear of losing the relationship. “This is the kind of couple where maybe the husband says: ‘You’re going to the store by yourself? You’re going to leave me here alone? You can’t do that — here, I’ll drive you,’ ” Dr. Weinstein said. “And this kind of trivial-sounding exchange can turn very demanding and even violent, because of this unreasonable fear of abandonment.”
Skilled therapists can help people manage such fears, but there is little research to guide treatment. In one approach, people learn to identify, and alter, some of the conversation habits that make their interactions with others so volatile. For example, they learn to reduce the number of times they seek reassurance in a conversation — “You’re not just saying that, right?” “Do you really mean that?” — and, eventually, to shift the focus of the conversation to the other person. The patient can also learn to defuse his or her fears of losing a relationship by taking some of the hard evidence of a partner’s commitment at face value: flowers, romantic dinners, back rubs. The partner can help, too, at least in cases of garden-variety neediness.
Psychiatrists often advise a kind of sympathetic distancing: acknowledge the person’s fears; offer some reassurance; but nudge (or push) the person to at least experiment with interests, hobbies or habits that don’t revolve around the relationship. And then turn off the cellphone for a few hours.
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