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WHY YOU CAN’T STAY AWAKE: NARCOLEPSY

After apnea, narcolepsy is the next most frequent cause of excessive daytime sleepiness. People with this disorder are prone to transient, overpowering attacks of sleepiness lasting from a few seconds up to thirty minutes, with the average spell lasting about two minutes. Narcoleptics may have up to two hundred such attacks in a single day, even if they have slept well the night before. During an attack the victim’s jaw may grow slack, or the head may drop forward onto the chest. In some cases victims may completely black out, appearing to be asleep or unaware of their actions. In less severe attacks, they are alert but may experience some form of muscle paralysis—their knees may buckle, or they may lose all control over their voluntary muscles. (Some people mistakenly refer to narcolepsy as sleeping sickness. The two are by no means the same: sleeping sickness is a parasitic infection transmitted by insects, including the tsetse fly and the kissing bug. Narcolepsy is also distinguished from seizure disorders like epilepsy in that such symptoms as repetitive movements (lip smacking, for example) and perceived visual auras are rarely present.The term “narcolepsy” was first used more than a century ago,1940s. Today an estimated 250,000 Americans suffer from the condition—more than the number of people afflicted with multiple sclerosis. Although narcolepsy accounts for less than 1 percent of all cases of sleep disorders, sleep laboratories report that narcoleptics make up the second largest group of patients who come to them for help.*150\226\8*

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QUESTIONS ON STRESS BREAKDOWN: HAVE I HAD ENOUGH SLEEP?

Sleep is essential for the proper functioning of the nervous system. The nerve cells most easily affected by lack of sleep are the inhibitory neurons which are responsible for our inhibitory reserves. We need our inhibitory functions to make u tolerant, patient and able to forgo our needs temporarily so as to fit in with the needs and rights of others. We know from personal experience how just being without sleep for a day or two can   make   us   impatient   and   irritable   and,    later,   quite disinhibited.
Without adequate sleep the nervous system is unable to process information adequately; anxiety symptoms will occur when we try to get through our usual workload without having had sufficient sleep. People who say they’re becoming ‘unraveled’ ‘frayed at the edges’ from lack of sleep, are using imagery similar to William Shakespeare’s, in Macbeth, Act II, where he has Macbeth saying:
Sleep that knits up the raveled sleeve of care,
The death of each day’s life, sore labour’s bath,
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast. . .
Shakespeare says it all, really, in describing the recuperative function of sleep and its relationship to stress breakdown.
But how much sleep is enough sleep? I think it is best for the body to decide. If a person needs an alarm clock to wake up in the mornings, that person is not having adequate sleep.

*10/129/5*

LEARNING ABOUT ANTIDEPRESSANTS

Antidepressant drugs are derivatives of major tranquillizers, which in turn are derivatives of sedating antihistamines. Antidepressants make profoundly unhappy and often suicidal people much happier. This transformation takes place after two to four weeks of therapy.
Side effects of the antidepressant drugs are legion and include dry mouth, blurred vision, tremor and constipation. Hallucinations, excitement and confusion can also occur and the antidepressants may be responsible for the precipitation of epilepsy and jaundice. Occasionally the antidepressant drugs become a cardiac hazard. Sometimes sudden death occurs in people with coexistent heart disease. Sometimes death occurs in people with apparently healthy hearts.
Doctors frequently provide this potentially lethal group of drugs to the very people that may consider the use of the same drugs as a means of suicide. In such cases, it is customary to prescribe only a small number of tablets and to review the patient very frequently over the first few weeks of therapy. An antidepressant called Tolvon better suits depressed people with heart conditions. The manufacturers of Prothiaden also claim greater safety in that regard, while two new drugs called Prozac and Aurorix are thought to be even safer again.
Commonly prescribed antidepressants include the following list of drugs: Anafranil, Deptran, Nortab, Pertofran, Prothiaden, Sinequan, Surmontil, Tofranil, Tolvon and Tryptanol.

*1/131/5*

ANXIETY DISORDERS: IN SEARCH OF SELF

Over the years we built the image of who we thought we should be. We lived our lives with an uneasy feeling that we were not who we appeared to be. If we were not who we appeared to be, then who were we? We didn’t know. We were never able to answer the question.

The anxiety and/or the attacks blasted into our lives. They pushed past our control and steamrolled our defences. The image we had of ourselves crumbled with the weight of its own illusion. The disintegration of ourselves continued and our seemingly solid foundations of our self and our life were torn down.

Suddenly we were thrown back onto ourselves and we had nothing left as an identity. Our sense of inadequacy, our lack of confidence and lack of self-esteem became predominant. We felt helpless and isolated. Our need to be in control was the only defence we had left. We tightened our grip on it because we felt that total annihilation of ourselves was only an attack away.

We became separated from our real selves through a lifetime of suppression and, when we needed it most, we felt that we had nothing to give us strength or support. Our sense of helplessness and isolation increased dramatically. These feelings of helplessness and isolation are a measure of the degree to which we are separate from our self. It is the ultimate separation anxiety.

All of us search for external answers to our difficulties, but we don’t realise we are looking in the wrong direction. Although we may find temporary measures to sustain us, we don’t recognise or feel the enormous potential of our self which is waiting to assist us.

*99\94\8*

ST JOHN’S WORT AND PANIC DISORDER: ADDING AN SSRI TO ST JOHN’S WORT

Vanessa is a scientist in her mid-forties who has suffered from recurrent depressions for as long as she can remember. During her depressed periods, which can last for months at a time, Vanessa withdraws from others, needs to sleep a great deal of the time, has difficulty concentrating and feels sad and worthless. Although a highly intelligent woman, she lacks confidence in her abilities and for many years worked in a job that was beneath her skills and qualifications. She was reluctant to ask her boss for a promotion, however, as she questioned whether she deserved it and feared that her request would be denied, which would confirm her sense of worthlessness.

In the past, Vanessa was treated with Lustral during the worst parts of her depression, requiring dosages of as much as 150 mg per day in order to obtain therapeutic effects. Although the medication removed the most painful aspects of her depressions, it also sedated her. In addition, she felt that it took away her range of feelings so that she was unable to respond fully to the events in her life, unable to muster great joy in response to good news or feel appropriately sad when bad things happened. As she described it, T felt zombified,’ and for this reason she would discontinue the medication shortly after emerging from her depression.

Vanessa happened to be in one of her depressions when St John’s Wort was becoming widely publicized in the US and she decided to try the herbal remedy at the dosage of 300 mg three times a day. After a few weeks she felt it was helping her – but now, instead of her feelings being flattened out, she felt greater swings in mood than before. Within the same day her mood would fluctuate several times from good humour to despair and discouragement. On the advice of a psychiatrist, Vanessa added Lustral to the mix, trying only 50 mg per day, one-third of the amount that she had previously required. For the first time in her life, she felt good in a sustained way without feeling medicated. As she put it, T feel like myself at my best all of the time. I get upset when things go wrong and happy when they go right, but they feel like normal feelings, not depression nor like being a dull zombie.’

Since feeling better, Vanessa has managed to travel and socialize much more freely and happily than had ever previously been possible. She has also plucked up the courage to ask her boss for a promotion, which he readily agreed she deserved and promptly took the necessary steps to make happen.

In another patient of mine, a combination of Prozac and St John’s Wort appears promising. The young woman in question wanted to switch from Prozac 20 mg per day to St John’s Wort because she had gained weight while on Prozac. Several weeks after the switch she began to feel depressed and we decided to restart her Prozac at a lower dosage of 10 mg per day in conjunction with the St John’s Wort. This combination appeared to hold her depressive symptoms in check, but we have yet to see whether it helps her to lose the weight she gained on the higher dose of Prozac.

The lesson to be learned from this young woman and from Vanessa is that one does not have to choose between herbal and pharmaceutical anti-depressants. The best outcome may come from mixing the two. I would not, however, recommend trying such mixtures on your own, since medications can interact adversely as well as favourably and one is best off having a doctor involved to minimize the chance of that happening.

*14\75\2*



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