Medsarticles. Medical Weblog

A 50-year-old American woman writes to me as follows:

I first heard about St John’s Wort as a treatment for depression when I was reading about natural remedies for menopausal symptoms. I began taking 300 mg but did not find it all that helpful. This past summer my husband suggested I up the dosage to 600 mg and that was the magic amount for the summer Now that we have turned the clocks back again [at the onset of autumn] I am taking an additional 300 mg in the afternoon, which helps.

I have been in and out of therapy since I was 25. Therapy with the right therapist(s) is helpful, but it is also expensive and time-consuming. My employer has a cap on the number of hours of therapy a person can undergo, and I am getting closer to that cap every week. I am hoping that this next calendar year is my last year of needing therapy. I was not in therapy for several long periods of my life. Often, a tragedy such as a death in the family or major surgery would send me back in.

I prefer natural herbs to drugs wherever I can. I have refused to take Prozac or Lustral. I really don’t want to rely on a drug to control my mood.

Whether or not one agrees with Shirley’s opinions about psychotherapy, herbal remedies or anti-depressant medications, she does seem to embody the trend that Naisbitt mentions in his book. I do believe that she speaks for a very large number of people who are concerned about the cost of mental health care, interested in natural remedies and eager to take their lives into their own hands as much as possible. St John’s Wort provides a solution to all of these concerns. Relatively inexpensive, highly effective, safe and mild in terms of side-effects, it offers millions of people the opportunity to help themselves.

It is, of course, critical to know when self-care has reached its limit and when to seek the help of an expert. Shirley appears to be able to make this distinction. It is an important caveat for others to bear in mind as well.

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Laura began to suffer from depression when she suspected that her husband was being unfaithful to her. He said she was imagining things and should see a doctor. Her GP agreed she was depressed and sent her to a psychiatrist who, after talking to (and believing) her husband, told her that her problems were due to an unhappy childhood, and that she needed psychotherapy. Laura accepted this, although her doubts about her husband persisted.

Two years later, her sister-in-law told the psychiatrist that Laura’s suspicions about her husband were correct. But by then Laura had been prescribed a range of antidepressants and tranquillizers, had had electroconvulsive therapy (ECT), and had become convinced that she was a mentally sick person. Her psychiatrist’s diagnosis was to haunt her for many years. A painful divorce followed and due to the periods which Laura had spent as an inpatient, care and custody of her children was given to her ex-husband.

The next ten years Laura describes as ‘living in a void’. Although she tried to build a new life for herself, and discharged herself from the psychiatrists’ care, she was prescribed the same drugs by her GP. Because of her efforts to give them up, and not understanding her physical dependence on them, she went in and out of withdrawal as her medication was changed or suspended.

Although before her marriage she had never suffered from anxiety, she now complained of phobias, insomnia, stomach discomforts, eye problems and skin rashes. She had little contact with her children and often wondered if her psychiatrist had been right about her. Her medical record read like a disaster, describing her as ‘neurotic’, unable to cope with life, and ‘possibly schizophrenic’. Eventually her prescriptions for Valium and Mogadon were handed to her by her doctor’s receptionist with no review or consultation.

Two years ago, her sister-in-law intervened again and persuaded her that her pills could be the main cause of her present condition and took her to a tranquillizer withdrawal group. She checked with her GP and he said there was no reason why she should continue with the drugs if she did not want to.

Laura was impatient to finish her drugs, and came off them more rapidly than she was advised. Her withdrawal was ‘a nightmare’, but she was also very excited by it because she was experiencing emotions that she had not felt for years. Symptoms that she had experienced over the years worsened, and new ones appeared, but with group support she continued. She became aggressive and hostile. Her restlessness and alternating agoraphobia and claustrophobia increased until she was staying first with one friend and then another, packing her bags every few days to move on again.

Fear of riding in cars (her lack of co-ordination and judgement had relegated her to the passenger seat), nightmares, hallucinations, constant throbbing headaches, heightened perception, and all the time the nagging fear that she was either mad, or the victim of a serious physical illness, made life hell.

As the symptoms eased and the depression lifted, Laura saw that her problems started with her first misdiagnosis. She learned to ‘let go’ of the sadness of the past and have hope about the future. It is a great joy to her that she sees more of her children who now see her as a ‘real’ person, and are impressed that she has a full-time job.

Her image of herself as a sick person has gone.

During the years that Laura was dependent on the benzodiazepines she had investigations for suspected ulcer, heart disease, skin rashes, dry eye problems, and arthritis. None of the tests proved positive and since she has come through withdrawal all the symptoms have gone.

She now looks forward to being a grandmother, has found that her old interest in photography is still there, and has joined her local historical society.

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If you lower your gaze your head will assume a better position. Sit with the spine straight but not rigid. Imagine you have heavy weights in your hands, and let them droop towards the floor. This will bring your shoulders down. Now place your hands, palms upwards, on your lap.

Shake each leg in turn then place feet (without shoes) on the floor. Imagine you are wearing heavy boots.

It is a good plan to start all group meetings in this position, even if you are in easy chairs. It may take some persuasion. People often feel vulnerable in this position and ‘protect’ themselves by tightening the shoulders, crossing the arms over the chest and crossing the legs, the moment they say anything involving feelings, e.g. ‘My wife does not understand panic attacks’, or ‘I saw my psychiatrist yesterday’.

Try to be aware of how you are holding yourself whatever you are doing. It is possible to iron without fiercely gripping the iron, to drive without grappling with the steering wheel. Dishes still get washed if you don’t press your knees back and tense your neck.

Even confrontation is possible without tightening up. You will feel much more in control facing an angry boss if you are aware of your muscles and breathing. An afternoon spent entertaining a tiresome relative will affect you much less if you make a conscious effort to relax.

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If you are cutting down slowly, these should not trouble you. Some people prefer a more rapid withdrawal and are prepared to tolerate these symptoms when they understand why they are happening, and that they are not an indication that they are going mad. The looming faces so often seen are really an exaggeration of what normally happens just as we are about to drop off to sleep, although we are rarely aware of it, just as in alcohol withdrawal, spiders, reptiles, devils, etc. have been ’seen’. One woman ’saw’ her father (who was three hundred miles away) so clearly that she made him a cup of coffee. She slowed down her withdrawal and had no further hallucinations. Hearing music, telephone ringing, and voices is often reported, but these too disappear as withdrawal is slowed down.

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The following article shows that severe symptoms including panic attacks can arise from simply not breathing correctly.

‘Hyperventilation [shallow breathing] as a Cause of Panic Attacks’, Dr Hibbert, British Medical Journal, Vol. 288, 28.1.84.

The syndrome [collection of symptoms] characterized by repeated panic attacks has been known by several names, including muscular exhaustion of the heart, neurasthenia (nervous exhaustion), irritable heart, anxiety neurosis, effort syndrome, and cardiac neurosis. The manual’s definition of panic disorder states that attacks are manifested by the sudden onset of intense apprehension, fear, or terror, often associated with feelings of impending doom. The most common symptoms experienced during an attack are dyspnoea (difficult breathing), palpitations, chest pain or discomfort, choking or smothering sensations, dizziness, vertigo, or unsteady feelings, feelings of unreality, paraesthesias (disordered sensation such as tingling and pins and needles) hot and cold flushes, sweating, faintness, trembling or shaking and fear of dying, going crazy or doing something uncontrolled during the attack. Attacks usually last minutes; more rarely hours.

Remember it is essential to breathe slowly if you feel a panic attack coming on.

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