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Your Health
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What Is Menopause?
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As many of us know, depression is a common complaint during menopause. I have spoken to hundreds of women's health experts, physicians, medical journalists, authors, researchers who claim that depression is "not a symptom" of peri or postmenopause. That the depression women suffer during their menopausal years is more likely related to the aging process, or to the kids growing up and, therefore, empty nest syndrome, or to changes in their marital relationship. I am not a doctor. However, after having communicated with tens of thousands of women in various stages of menopause, it would seem apparent that depression can be and is a very definite symptom of raging hormone levels just as mood swings, anxiety and other psycholgical disorders are caused by an imbalance of hormones.

There are numerous natural remedies for treating mild to moderate depression, such as St. John's Wort You will find many listed on the Power Surge Recommendations page. I also suggest visiting the Power Surge Depression forum to exchange experiences and ideas with other women suffering from depression, whether it's menopause-related or depression that existed prior to the beginning of perimenopause. I also highly recommend the transcripts of Stuart Shipko, M.D. -- a psychiatrist and neurologist who has provided invaluable information about depression, anxiety, panic and the various medications being used to treat these disorders and Psychotherapist, Dr. Lee Baer -- Dearest.

As many as 25 percent of all Americans will suffer from depression this year. And depression impairs people's ability to function more than any other disease except heart disease. However, depression is one of the most treatable illnesses known. Drug therapy and psychotherapy can help victims of depression feel better, become more productive and improve their relationships.

Depression will strike up to 25 percent of all Americans this year, and many of them will fight the disease with drugs like Prozac. One of the most widely prescribed drugs for depression, Prozac has sales that top $1 billion annually. Prozac falls under a family of antidepressants developed in the late 1980s called the selective serotonin reuptake inhibitors (SSRIs). "SSRIs work by increasing the availability of the neurotransmitters erotonin between the nerve cell endings in the brain. Enhancing serotonergic neurotransmission usually results in improvement in the symptoms of depression," says Lawrence R. Gulley, M.D., a psychiatrist affiliated with West Paces Medical Center, a Columbia affiliate in Atlanta, Georgia. SSRIs including three relatively new drugs, Zoloft, Paxil and Effexor - help lift the symptoms of depression quickly. Some SSRIs also help people whose depression is coupled with anxiety.

If side effects do occur, they are usually minor. The SSRIs may make people feel "speedy" at first, and a few people experience this feeling as a need to "get out of their skin." The drugs also may suppress the appetite. These symptoms usually subside in several weeks. SSRIs may also lower sexual desire for as long as the patient takes the drug.

Doctors recommend that most people should be on any antidepressant for a minimum of six months to prevent a recurrence. In fact, although SSRIs are not addictive, many people taking them feel so much better that they are hesitant to come off them.

The Prozac Controversy

Some reports claim that Prozac and the other SSRIs make some people suicidal or cause violent, aggressive behavior. Studies thus far do not support these claims, and a recent jury verdict upholds those findings. In November 1994 the first of 160 lawsuits filed against Eli Lilly, Prozac's manufacturer, reached trial. (Currently, 92 of those cases have been dismissed.) A Louisville, Kentucky, jury ruled that Prozac was not responsible for pushing a man into a homicidal rage that left eight people dead, including the man responsible for the attack, and 13 wounded.

Eli Lilly claims that Prozac is not linked to violence and may actually inhibit aggression. There have been reports of people committing suicide while taking Prozac, but those people had prior histories of suicidal thoughts or even prior suicide attempts. See Important Note.

Other Solutions

Before the SSRIs were introduced only two types of antidepressant drugs were available: monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants. MAOIs work well, but people have trouble staying on them because they interact dangerously with many foods. People who do not respond well to other drugs may use MAOIs. For many others, the tricyclic antidepressants are the drugs of choice, although they may cause a number of side effects, including dry mouth, dizziness and blurred vision.

For many people, psychotherapy offers relief from depression's grip without any of the side effects drugs may cause. Psychotherapy can help give people hope, and usually does so relatively quickly. Still, it can be several weeks to several months before the depression lifts - and by that time, it may well have lifted on its own. But good psychotherapy can help prevent depression from recurring, or keep a recurrence less devastating.
Often, a psychotherapist will refer a person to a psychiatrist for drug
treatment and continue to see the person for psychotherapy.

Signs that "Sadness" Is Serious

Depression's victim's need to seek some sort of treatment - willpower alone usually can't conquer depression. If you suspect that someone you know suffers from depression, call your local Columbia/HCA hospital for help. Several of the following symptoms lasting for more than a few weeks are cause for concern:

  • Feelings of worthlessness, helplessness or hopelessness.
  • Lack of interest in things that formerly gave him or her pleasure.
  • Difficulty sleeping or a need to sleep much more than before.
  • Major changes in appetite, leading to weight gain or loss.
  • A desire to be alone and to stay away from other people.
  • Becoming easily irritated by little things or tearful for no reason.

Feelings that he or she would better off dead, or an inability to foresee himself or herself in the future.

Although most depressions have several of these typical signs, some depression sufferers don't show the major symptoms. Instead, they may show signs of "irritability, low energy, poor concentration and diminished interest in usual activities," says Gulley. If these symptoms are present schedule an evaluation with your doctor to rule out depression as a possible cause.

Depression affects the body as well as the mind. Its victims sometimes gain or lose large amounts of weight. And "some medical problems, such as thyroid disease, may be associated with depressed mood," says Gulley. It is important for depression sufferers to see their doctors to rule out the possibility of an underlying physical illness.

Depression's victims need to seek some sort of treatment-willpower alone usually can't conquer depression.

Sorting Through the Names

Type of Antidepressant Generic Name Brand Name
Monoamine oxidase phenelzine Nardil
inhibitors (MAOIs) tranylcypromine Parnate
Tricyclic antidepressants desipramine Norpramin
imipramine Tofranil
SSRIs citalopram Celexa
escitalopram oxalte Lexapro
fluoxetine Prozac
paroxetine Paxil
sertraline Zoloft
venlafaxine Effexor
Aminoketone bupropion hcl Wellbutrin

Who Should I See for Help?

A variety of mental health professionals can provide treatment for depression. Here are the differences between them:

Psychiatrist: A medical doctor (M.D.) specializing in medical treatment of mental illness. Prescribes drug treatments and may or may not also offer psychotherapy.

Psychologist: Licensed with a Ph.D., Ed.D. or Psy.D. Provides psychological testing and assessments for treatment planning and does psychotherapy. Some have hospital admitting privileges.

Psychiatric Nurse: R.N. with special training in mental health who provides psychotherapy.

Social Worker: Certified or licensed with a master's degree. Provides psychotherapy and also offers case management and assistance with navigating through social service agencies.

Counselor: Certified or licensed with a master's or doctoral degree. Provides psychotherapy.

Marriage and Family Therapist: Certified or licensed with a master's or doctoral degree. Provides psychotherapy, focusing on issues in relationships and the family system.

Important Note: When any of the drugs we've been discussing are prescribed, they should be done by Pyschiatrists, not GP's, Gyn's or Internists because they have to be monitored and it's a Psychiatrist's area of expertise. Also, be advised that although these prescription medications are given by your doctors, you may not be advised upon starting these SSRI's or anti-depressants of the potential side effects and that dependency is possible. According to Psychiatrist, Neurologist and acknowledged psychopharmacalogical expert, Stuart Shipko, M.D., "Antidepressants, all of them to a greater or lesser degree, cause both physical dependency and to a lesser extent psychological dependency. They should also be prescribed with warnings about dependency, mania, loss of judgment, suicidality, weight gain, dystonia (neurological movement disorder characterized by involuntary muscle contractions, which force certain parts of the body into abnormal, sometimes painful, movements or postures), tremors and sexual numbing."

Stopping these medications can be extremely difficult for many, just as is the case with various tranquilizers, such as Valium and Xanax. These drugs have the potential to cause either or both physical and psychologoical dependency. People experience physical withdrawal when stopping these drugs, especially if they're stopped abruptly. Therefore, if you're anticipating stopping these medications, it should be done under a doctor's care and you should taper off the drugs slowly, so that your body can adjust to being without it.

Additional reading about a class action suit brought against GlaxoSmithKline, manufacturer of the SSRI, Paxil:

"Los Angeles, August 19, 2002 - - A U.S. Federal Court in Los Angeles has ordered GlaxoSmithKline (GSK) to pull all of its television commercials that claim Paxil is "non habit-forming." The ruling was requested by representatives of a nationwide class action claiming that the antidepressant drug, Paxil, causes severe withdrawal reactions which are inconsistent with the "non-habit forming" language in GSK's advertising material. Prior to the hearing, GSK also stipulated with class counsel that it would stop distributing promotional brochures stating that Paxil "may cause mild, usually temporary side effects in some individuals" and "Paxil has been studied both in short-term and long-term use and is not associated with dependence or addiction." Read more here.

Recommended reading -- the transcripts of Psychiatrist, Neurologist and psychopharmacological expert, Stuart Shipko, M.D. and Ask Power Surge's Anxiety/Panic Disorder Expert, Stuart Shipko, M.D. Also, read the transcripts of Psychotherapist, Dr. Lee Baer, and the excellent series of chats with Stephanie Marston about Reclaiming Ourselves At Midlife. Additionally helpful transcripts about panic attacks/anxiety are those of Bronwyn Fox.

Share your concerns and experiences with depression and menopause on the Power Surge Depression forums (Registraton for the Power Surge forums is required).

Numerous transcripts and other areas of the site address the issue of depression and menopause. The comprehensive Power Surge Search Engine will provide more links to information about depression.





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