Relieve your Anxiety

Almost everyone experiences anxiety which may be described as any feeling of worry or dread, usually about events that might potentially happen. Anxiety about stressful events is normal, however, if you feel anxious without reason and your worries persist and affect your day-to-day life you may have generalized anxiety disorder.

Symptoms of generalized anxiety disorder may include restlessness, felling tense or on edge, irritability, impatience, or poor concentration. You may also notice changes in your physical health such a s bloating, chest tightness, dry mouth, excessive sweating, fatigue, headaches, indigestion, insomnia, jaw pain and muscle tension.

Although it is important to be evaluated by your doctor for a proper diagnosis and to rule out other medical problems that may resemble anxiety, there are ways in which you can take control of your anxiety.

Here’s how:

Address the cause(s) of your stress.

Physical exercise, yoga, tai-chi, self-hypnosis and meditation are just some stress reduction techniques for anxiety. Try different techniques and determine which routine you can stick to keeping in mind your schedule.

Avoid stimulants such as caffeine.

Take a multivitamin cone a day. This may help reduce anxiety and feelings of stress.

Physical stimulants such a caffeine

Take a multivitamin once a day. This may help reduce anxiety and feelings of stress. Increasing your intake of calcium, magnesium and the rage B-vitamins will also help.

Calm the nervous system by taking an herbal combination of valerian (valeriana officinalis) (100 to 200 mg) and passionflower (Passiflora incarnate) (45 to 90 mg) three times a day. While passionflower has been used as folk remedy for anxiety and insomnia, valerian will help reduce your insomnia. Be careful, as passionflower should not be taken with other sedatives without medical supervision, and the use of valerian should be limited to three months at a time.

Kava, which is native to Polynesia and has been found to have anti-anxiety effects in humans.

Plant essential oils can be added to baths, massage oil, or infusers. Essential oils that are used for anxiety and nervous tension are: bergamot, cypress, geranium, jasmine, lavender, Melissa, neroli, rose, sandalwood, ylang-ylang. Lavender is the most common and forms the base of many relaxing blends.

Massage therapy, shiatsu, and other forms of bodywork are widely used to diminish muscle tension, relieve stress and improve sleep.

By Dr Aftab Saeed

The writer is Research Professor, HIASR, Faculty of Eastern Medicine, Hamdard University, Karachi.

The Antidepressant Debate

In 1990, depression was determined to be the fourth leading cause of the global burden of disease (death and disability caused by an illness) amongst all diseases. By 2020, it is projected to jump to second place.

Antidepressants and psychotherapy are the two firs line treatments for most patients with depression. The Royal College of Psychiatrists (www.rcpsych.ac.uk/info) recommends that psychotherapy is effective in mild and moderate to server depression. However on a practical level, because of a global shortage of trained psychotherapists, and the cost and time involved in psychotherapy, perhaps more than 95% of depressed patients are treated with antidepressants the world over.

In this scenario, when a respected psychologist from the university of Hill, Irving Kirsch (Kirsch et al. 2008) initial severity and antidepressant benefits: a meta analysis of data submitted to the FDA. PLoS Med 5(2) suggests that there seems little evidence to support the prescription of antidepressant medication to any but the most severely depressed patients. How does one reconcile the above piece of research with the daily observation of psychiatrists and patients that many people, who have been low and depressed of months, and sometimes years recover within four to six weeks of taking antidepressant medication?

The answer probably lies in the way psychiatric research is conduced, reported and interpreted. Without going into too much jargon, Kirsch et al calculated an effect size (a statistical measure of how well a drug works) of .32 while another study done by Erick Tumer, an Assistant Professor of Psychiatry at the university of Oregon, USA reported an effect size of .31. Interestingly, Kirsch’s conclusion was that antidepressants don’t work while Turner’s conclusion was that they do!

And this is where the confusion arises in that different studies have reached different conclusions because they have interpreted almost identical results differently. To summaries, as the current knowledge stands, psychotherapy works well in mild to moderate depression, while antidepressants should be used for moderate to severe depression. However, if you have any personal choices for or against drugs or psychotherapy make sure you discuss it with your psychiatrist.

By Dr Syed Ahmer

The writer is Assistant Professor, Department of Psychiatry, Aga Khan University Karachi.

An Experience in Psychoanalytical Psychotherapy

It was a dull Wednesday afternoon when I heard a scream from my patient’s room. Kylie, a sweet teenager had tied to take her life one again by cutting both her wrists in different areas.  Her mother was crying profusely and blamed herself for trusting Kylie to go to the bathroom alone.  To Kylie, her life didn’t matter as much as converting the inner pain into physical pain did. To her mother no place was safe. 

Kylie had undergone series of traumatic incidences in her life, due to which she suffered from one of the most serious personality disorders, known as the borderline personality disorder.  She had server mood swings; avoided close relationships most rusted men and suffered from a poor self image and a chronic feeling of emptiness. 

Kylie considered my role in her life as that of a demon. Every time t tried to interne she would plan a self sabotaging behavior. 

All my efforts to treat her with supportive psychotherapy had failed and I was unable to build a therapeutic alliance until I introduced a form of modified analytical procedure known as psychoanalytical psychotherapy. 

Gradually introducing the new technique, I tried to deflect her negative behaviors and restructured our sessions into meaningful, analytical conversations.  I tried to find meaning behind each aggressive step she would take and introduced measures to block those actions.  I helped her transfer he feeling, thoughts and behavior originally experienced on to a person involved in her current interpersonal relationship.  Slowly she transformed into a more cooperative person.  It took time and perseverance but finally I changed in her eyes from a demon to an angel.  She no longer cut herself.  At the time of discharge, Kylie smiled and said, I will never be back.

By Dr Faisal Mamsa

The writer is a physician trained in Psychiatry from the USA.  He is currently Practising at South City Hospital Karachi.

Alternative Therapies for Headaches

The medical term for a headache is cephalgia, and is defined as a pain that occurs above the eyes or ears, behind the head, or in the upper neck. Headaches are either classified as primary or secondary. Primary headaches include migraines, tension headaches and cluster headaches; secondary headaches are caused by other diseases.

Tension headaches are the most common type of primary headaches with up to 90% adults suffering from them at one time or another; these headaches are more common among women than men. Similarly, migraines mainly affect women, and cause a throbbing headache that is usually accompanied with nausea and disturbed vision.

Cluster headaches, which cause extreme pain in one side of the head, are rare and mainly affect men.

Secondary headaches may result from innumerable conditions, ranging from life threatening ones such as brain tumors, strokes, meningitis and sub-arachnoid haemorrhages to less serious conditions such as withdrawal form caffeine and discontinuation of pain killers. Many people suffer from mixed headache disorders in which tension headaches or secondary headaches may trigger migraines.

The treatment of the headache depends on its type and severity and other factors such as the age of the patient.

There are a number of different complementary and alternative Medicine (CAM) treatments for headaches, which fall into two major groups: those intended a prophylaxis or pain relief, and those that reduce the patient’s stress level.

Those CAM therapies that help to reduce stress include the likes of Yoga and Tai Chi, medication, aromatherapy. Swedish massage, aromatherapy and music therapy amongst others.

CAM therapies intended to prevent or relieve discomfort include:

1. 
   
   Feverfew (Tanacetum parthenium). Feverfew is an herb related to the daisy that is traditionally used in England to prevent migraines. Published studies indicate that feverfew can reduce the frequency and intensity or migraines, it does not, however, relieve pain once the headache has begun.
   

2. 
   
   Butterbur root (petasites hybridus). Petadolex is a natural preparation made from butterbur root that has been sold in Germany since the 1970s as a migraine preventive.
   

3. 
   
   Brahmi (Bacopa monnieri). Brahmi is an herb used in Eastern / Unani medicine and Ayurvedic medicine to treat headaches related to anxiety
   

4. 
   
   Acupuncture. Studies funded by the National Centre for Complementary and Alternative Medicine (NCCAM), USA, have found that acupuncture is an effective treatment for headaches.
   

5. 
   
   Naturopathy. Naturopaths include dietary advice and nutritional therapy in their approach to treatment, which is often effective for patients with episodic or chronic tension headaches.
   

6. 
   
   Chiropractic. Some patients with tension or migraine headaches find spinal manipulation effective in relieving their pain.
   

By Dr Aftab Saeed

The writer is Research Professor, HIASR, Faulty of Eastern Medicine, Hamdard University Karachi

Sleep well..

Almost everyone experiences insomnia or sleeplessness. Factors such as continuous worries, depressions, irregular hours, noise, pain, too much coffee or unfamiliar surroundings can lead to restless nights.

In addition, if you suffer from insomnia you might find it difficult to relax sufficiently to fall asleep. And if you are in the habit of staying up late surfing the Net or watching television, this can easily turn into a vicious cycle of overtiredness and insomnia which can lead to exhaustion.

Because time drags when you are trying to sleep, you might overestimate the length of your sleeplessness. Remember there are no rules about how much sleep is necessary, everyone’s needs are different. Babies and some teenagers may sleep for up to 18 hours, while older people may require only five or six hours.

Also remember that your body can make up for sleep loss without catching up on every lost hour. For example if you have had several night’s broken sleep you can recover after a single sleep lasting about 12 hours.

Here are a few ways that might help in ensuring that you get a good night’s sleep.

Note your sleep patterns to help you find out the cause of your insomnia.

Drink a glass of warm milk with a teaspoon of honey before going to bed.

Establish regular sleeping hours and have a warm bath before going to bed.

Exercise regularly either in the morning or evening but not before going to bed.

Keep your bed room well ventilate and quiet and ensure that your bed is comfortable i.e. gives your body proper support.

Place the table clock out of sight and while trying to sleep, think about something you find enjoyable.

Go to bed at least two hours after dinner.

If your insomnia is not caused by indigestion or a medical condition, a soothing massage can work wonders before bedtime.

Herbs with a natural sedative action such as Passion Flower (Passiflora Incarnata), hops (Humulus lupulus), Sunbul at teeb (Valeriana officinalis), skull cap (Scutellarea latriflora) and Chamomile (Matricaria Chamomilla) are natural sedatives and are also known to have analgesic and antihypertensive qualities. They can be taken in liquid form mixed in a bit of cold water.

The infusion of chamomile (Matricaria Chamomilla Babuna), valerian (Valerian officinalis) as well as a cooled down light decoction of dill (Soya) and rauwolfia root (Rauwolfia serpentine) with dried coriander (Coriandrum sativum) are relaxing.

Eastern medicine treats insomnia (Sahar/Bedari) with the administration of Musakkinaat (Sedatives). Munawwemaat (hypnotic/somnifacient), Murattibaat (moistening) and Maghziyaat (tonics for brain). There is a long list of drugs under these headings of Mufredaat (herbs) with Sunbul at teeb and Babuna being frequently used in different forms. The most popular compound drugs include somina and Besha’shaa.

The writer is Research Professor, HIASR, Faculty of Eastern Medicine Hamdard University.