takster.com

Anti Depressants-Sleeping Aid


“BDD is the absolute core of what led to my alcohol and drug use. “I slept too much and did alcohol and drugs as an escape, to try to forget my scars,” he said. “Sometimes drinking decreased my concern temporarily. But sometimes the alcohol could make my symptoms worse, and it became a problem in its own right. After his BDD improved with the medication fluvoxamine (Luvox), he stopped using alcohol and heroin. In fact, he’d been selling heroin to support his habit, and had been in jail several times. This, too, stopped when he was treated with Luvox.
Emily described her experience as follows. “The only thing that brought relief was drinking…. My symptoms were totally debilitating, so intensely painful, and they were making me more and more depressed. Even though I was suffering so much, and drinking too much, no one knew I was suffering from BDD because I managed to look as though I was doing okay. I pulled it together, but the agony inside was totally overwhelming. I couldn’t talk about it with other people.
“I finally went to my doctor and told him about the situation because I was worried about my drinking. He told me when I stopped drinking I wouldn’t be depressed. But that wasn’t true for me. I drank because of body dysmorphic disorder…. I drank and slept to deal with it. What causes me the most pain now is the effects of my drinking on my son. I wasn’t there for him. That’s the part that hurts me the most.”
Some men with muscle dysmorphia use anabolic steroids to bulk up. This is a family of drugs that includes the male hormone testosterone as well as numerous synthetic derivatives of testosterone. Unless prescribed for specific medical treatment, anabolic steroids are illegal in the United States and many other countries. They may increase the risk for heart disease, stroke, and possibly prostate cancer. They can also cause irritability, aggression, depression, and physical dependence. And to shed pounds or body fat, some people use ephedra-related products (such as ephedra, ephedrine, or ma huang), dietary supplements which are chemical relatives of speed. In high doses, ephedra may have very serious health risks. It can cause heart attacks, strokes, seizures, and even death.
*139\204\8*
The delusional-nondelusional issue is relevant to other disorders, such as  and social fobia. Like BDD these disorders appear to span a spectrum of insight, with insight sometimes fluctuating along a continuum. This interesting issue needs to be further studied and has important implications for the classification and treatment of a number of psychiatric disorders.
From a clinical perspective, I’d consider delusional and nondelusional BDD to be the same disorder and would generally treat them the same way. In particular, I’d recommend treating delusional BDD with an SRI, even though this isn’t how other disorders characterized by delusions are usually treated. I’d also recommend that delusional BDD (and nondelusional BDD) not be treated with a neuroleptic (antipsychotic) alone. CBT treatment for these forms of BDD is generally similar, although people with delusional BDD might benefit from a heavier emphasis on cognitive restructuring and behavioral experiments (although this issue hasn’t been studied). Despite similarities between BDD’s delusional and nondelusional forms, it’s important to keep in mind that delusional people with BDD are typically more severely ill and suicidal, and may be less likely to accept psychiatric treatment.
*390\204\8*

THE DELUSIONAL VARIANT OF BDD: THE DELUSIONAL-NONDELUSIONAL ISSUEThe delusional-nondelusional issue is relevant to other disorders, such as  and social fobia. Like BDD these disorders appear to span a spectrum of insight, with insight sometimes fluctuating along a continuum. This interesting issue needs to be further studied and has important implications for the classification and treatment of a number of psychiatric disorders.From a clinical perspective, I’d consider delusional and nondelusional BDD to be the same disorder and would generally treat them the same way. In particular, I’d recommend treating delusional BDD with an SRI, even though this isn’t how other disorders characterized by delusions are usually treated. I’d also recommend that delusional BDD (and nondelusional BDD) not be treated with a neuroleptic (antipsychotic) alone. CBT treatment for these forms of BDD is generally similar, although people with delusional BDD might benefit from a heavier emphasis on cognitive restructuring and behavioral experiments (although this issue hasn’t been studied). Despite similarities between BDD’s delusional and nondelusional forms, it’s important to keep in mind that delusional people with BDD are typically more severely ill and suicidal, and may be less likely to accept psychiatric treatment.*390\204\8*

“There aren’t enough days on a calendar to tell you how many times I’ve wanted to leave my wife,” Sam told me. “I’m a very loyal person, and I love her. But at times it gets to be too much. She’s late when we go out, and sometimes she won’t go at all. She can get so wrapped up in her obsessions that she ignores me completely. She doesn’t give the children the attention they need. BDD is the selfish disease.”
Sam sometimes accompanied his wife, Beth, to her sessions with me and told me about how he tried to cope with her illness. “My wife has had this problem for decades,” he said. “No one knew what it was.” I heard about Beth’s fixation on her nose and the many unsuccessful surgeries she’d had. Her preoccupation had made it difficult for her to raise her children. Later, after they’d grown, she had a hard time focusing on a job; she wanted to work, but had been largely unemployed.
“This is a problem that affects family members, too,” Sam told me. “I know
how hard it’s been for her. But it’s also had a major impact on me. I hope this doesn’t sound too selfish, but sometimes I think I’ve suffered as much as my wife!”
Sam and Beth had been married for ten years. Beth’s previous husband had left her because of her symptoms. “You might be skeptical that that was the reason, that it was because of my nose obsession,” she told me. “Some people think it’s an excuse—that he really left me for some other reason. But it was mostly because of the BDD. I hounded him all day long. I’d plead with him to help me find another surgeon, and I’d constantly talk about how surgery would solve my appearance problem. We hardly had a social life. When we went out, I’d be late a lot of the time. I’d be in the mirror putting on makeup and styling and restyling my hair to make my nose look smaller. Sometimes I wouldn’t go to social events at all because I thought I looked so bad. That really drove him crazy.
“I did manage to raise my children and actually did a pretty good job, I think, but it was very hard. I don’t know how I did it. I was so focused on my nose. I couldn’t stop thinking about it. It was really hard for my husband, because he ended up working two jobs and doing a lot of the child care too. I don’t want you to think I was a total basket case—I wasn’t—but life was a lot harder with my problem. My husband finally got fed up, and he left me.”
Like Beth’s first husband, Sam had gotten very involved in her disorder. At her insistence, Sam held magnifying mirrors and bright lights so she could get a better look at her nose, a ritual that could take more than an hour a day. Beth talked to him incessantly about her nose, saying she wanted surgery and asking if her nose looked okay. “The questioning is especially hard,” Sam told me. “No matter what I say, she doesn’t really believe me. She just asks me again and again! I don’t know what to say.” They’d missed family get-togethers and had few friends because his wife felt too ugly to be around other people. A few times Sam even drove her to an emergency room because she’d looked in the mirror and considered suicide.
“There’s no worse illness on earth than BDD,” Sam told me many times. “People who haven’t lived with it probably wouldn’t understand, but this is the most devastating thing in the world. I’ve seen death. I’ve seen murder. This is as bad…. Maybe it’s harder for me than my wife because I’m more helpless than her. I can’t do anything about it.”
One of the most difficult things for Sam was the isolation. “I’ve felt very alone because friends and family don’t understand. I’ve mostly dealt with this on my own. I took a risk and told a few relatives, but they don’t understand it; they think it’s strange. But it’s the most devastating illness there is.”
Like Beth’s first husband, Sam had thoughts of leaving his wife. Nonetheless, he resolved to stand by her. Beth eventually got much better with sertraline (Zoloft), and the strain on their marriage diminished.
Sam’s story isn’t unusual. I’ve met countless husbands, wives, girlfriends, boyfriends, parents, and friends who’ve lived with BDD. They’ve been deeply affected by the disorder and have struggled to find ways to cope.
of my skin obsession,” he told me. “I was totally obsessed. Sometimes it wasn’t so bad, but when it got really bad, I’d miss work and I wouldn’t go out. I’d even spend entire weekends in bed. I’d feel that life wasn’t worth living and I totally ignored my wife. I was completely wrapped up in the obsession.
“We couldn’t agree about whether to have children. My wife wanted to, but I was afraid that with my symptoms I wouldn’t be able to take responsibility for a child. I had a hard enough time taking care of myself. My wife stuck it out with me for a couple of years. But eventually she couldn’t take it anymore, and she left me. If I didn’t have the disorder, I think we’d still be together today.
*395\204\8*

BDD – “THE SELFISH DISEASE”: A HUSBAND’S PERSPECTIVE”There aren’t enough days on a calendar to tell you how many times I’ve wanted to leave my wife,” Sam told me. “I’m a very loyal person, and I love her. But at times it gets to be too much. She’s late when we go out, and sometimes she won’t go at all. She can get so wrapped up in her obsessions that she ignores me completely. She doesn’t give the children the attention they need. BDD is the selfish disease.”Sam sometimes accompanied his wife, Beth, to her sessions with me and told me about how he tried to cope with her illness. “My wife has had this problem for decades,” he said. “No one knew what it was.” I heard about Beth’s fixation on her nose and the many unsuccessful surgeries she’d had. Her preoccupation had made it difficult for her to raise her children. Later, after they’d grown, she had a hard time focusing on a job; she wanted to work, but had been largely unemployed.”This is a problem that affects family members, too,” Sam told me. “I knowhow hard it’s been for her. But it’s also had a major impact on me. I hope this doesn’t sound too selfish, but sometimes I think I’ve suffered as much as my wife!”Sam and Beth had been married for ten years. Beth’s previous husband had left her because of her symptoms. “You might be skeptical that that was the reason, that it was because of my nose obsession,” she told me. “Some people think it’s an excuse—that he really left me for some other reason. But it was mostly because of the BDD. I hounded him all day long. I’d plead with him to help me find another surgeon, and I’d constantly talk about how surgery would solve my appearance problem. We hardly had a social life. When we went out, I’d be late a lot of the time. I’d be in the mirror putting on makeup and styling and restyling my hair to make my nose look smaller. Sometimes I wouldn’t go to social events at all because I thought I looked so bad. That really drove him crazy.”I did manage to raise my children and actually did a pretty good job, I think, but it was very hard. I don’t know how I did it. I was so focused on my nose. I couldn’t stop thinking about it. It was really hard for my husband, because he ended up working two jobs and doing a lot of the child care too. I don’t want you to think I was a total basket case—I wasn’t—but life was a lot harder with my problem. My husband finally got fed up, and he left me.”Like Beth’s first husband, Sam had gotten very involved in her disorder. At her insistence, Sam held magnifying mirrors and bright lights so she could get a better look at her nose, a ritual that could take more than an hour a day. Beth talked to him incessantly about her nose, saying she wanted surgery and asking if her nose looked okay. “The questioning is especially hard,” Sam told me. “No matter what I say, she doesn’t really believe me. She just asks me again and again! I don’t know what to say.” They’d missed family get-togethers and had few friends because his wife felt too ugly to be around other people. A few times Sam even drove her to an emergency room because she’d looked in the mirror and considered suicide.”There’s no worse illness on earth than BDD,” Sam told me many times. “People who haven’t lived with it probably wouldn’t understand, but this is the most devastating thing in the world. I’ve seen death. I’ve seen murder. This is as bad…. Maybe it’s harder for me than my wife because I’m more helpless than her. I can’t do anything about it.”One of the most difficult things for Sam was the isolation. “I’ve felt very alone because friends and family don’t understand. I’ve mostly dealt with this on my own. I took a risk and told a few relatives, but they don’t understand it; they think it’s strange. But it’s the most devastating illness there is.”Like Beth’s first husband, Sam had thoughts of leaving his wife. Nonetheless, he resolved to stand by her. Beth eventually got much better with sertraline (Zoloft), and the strain on their marriage diminished.Sam’s story isn’t unusual. I’ve met countless husbands, wives, girlfriends, boyfriends, parents, and friends who’ve lived with BDD. They’ve been deeply affected by the disorder and have struggled to find ways to cope.of my skin obsession,” he told me. “I was totally obsessed. Sometimes it wasn’t so bad, but when it got really bad, I’d miss work and I wouldn’t go out. I’d even spend entire weekends in bed. I’d feel that life wasn’t worth living and I totally ignored my wife. I was completely wrapped up in the obsession.”We couldn’t agree about whether to have children. My wife wanted to, but I was afraid that with my symptoms I wouldn’t be able to take responsibility for a child. I had a hard enough time taking care of myself. My wife stuck it out with me for a couple of years. But eventually she couldn’t take it anymore, and she left me. If I didn’t have the disorder, I think we’d still be together today.*395\204\8*

This can help you get your thinking straight before you go into the anxiety-provoking situation. You can also do cognitive restructuring during the exposure, while you’re actually in the situation, by identifying your cognitive errors and thinking alternative, more realistic thoughts. Filling out a thought record after the exposure may also be helpful, especially if the situation made you very nervous. This can help you reappraise what happened in a more accurate way.
If exposure therapy is too anxiety provoking, move back down to a lower-rated activity on your hierarchy. If this, too, is too anxiety provoking, you may need to modify the hierarchy, so less anxiety-provoking situations are included. Sometimes the SUDS levels need to be reevaluated and modified because you may underestimate the actual anxiety level you’ll experience in the situation. The important thing is not to give up! If you do it right, exposure will make you somewhat anxious, but the more you do it, the easier it will get. And the rewards can be enormous: you’ll be able to live a much freer and more enjoyable life.
*322\204\8*

COGNITIVE-BEHAVIORAL THERAPY FOR BDD: COGNITIVE RESTRUCTURING (COGNITIVE THERAPY)  - IT CAN ALSO HELP TO DO COGNITIVE RESTRUCTURING BEFORE, DURING, AND AFTER THE EXPOSURE  This can help you get your thinking straight before you go into the anxiety-provoking situation. You can also do cognitive restructuring during the exposure, while you’re actually in the situation, by identifying your cognitive errors and thinking alternative, more realistic thoughts. Filling out a thought record after the exposure may also be helpful, especially if the situation made you very nervous. This can help you reappraise what happened in a more accurate way.If exposure therapy is too anxiety provoking, move back down to a lower-rated activity on your hierarchy. If this, too, is too anxiety provoking, you may need to modify the hierarchy, so less anxiety-provoking situations are included. Sometimes the SUDS levels need to be reevaluated and modified because you may underestimate the actual anxiety level you’ll experience in the situation. The important thing is not to give up! If you do it right, exposure will make you somewhat anxious, but the more you do it, the easier it will get. And the rewards can be enormous: you’ll be able to live a much freer and more enjoyable life.*322\204\8*

For the first half of this century, barbiturates were the only pharmacological option available for insomnia. Veronal, the first barbiturate, was introduced in 1903. In the years following, about fifty drugs of this class reached the market (out of nearly twenty-five hundred barbiturate compounds developed in the lab). However, barbiturates were found to have two dangerous drawbacks: a high potential for addiction and a great risk of lethal overdose. Today only a dozen or so are still available; those used primarily for sleep are secobarbital (Seconal), amobarbital (combined with secobarbital in a product called Tuinal), and pentobarbital (Nembutal). Other uses for barbiturates are as antianxiety agents, anesthetics, and anticonvulsants.
In the late 1950s tricyclic antidepressants came on the market. In addition to their effect on serious depression, some of these drugs also possess sedative effects, although just how they work is not completely understood. Antidepressants offered an alternative to the potential dangers of barbiturates, but they too have undesirable side effects. While not considered the drug of first choice today, antidepressants may be used to alleviate insomnia—especially if the insomnia is associated with depression.
A major breakthrough in the drug treatment of insomnia was achieved with the arrival of benzodiazepines in the early 1960s. Compared to their prescription drug predecessors, benzodiazepines—primarily flurazepam, temazepam, and triazolam—have a greatly improved safety profile and are much more effective, particularly in disorders of initiating and maintaining sleep in individuals whose insomnia lacks an identifiable physical cause. Their improved ratio of therapeutic dose to lethal dose means a much lower risk of abuse or dangerous adverse effects. Some research does indicate, however, that there is a potential for addiction in patients taking the drugs over long periods of time. Benzodiazepines fall into several subcategories, usually depending on how quickly and for how long the drug works.
Of course, there are also several nonprescription sleeping aids available (brand names include Nytol, Sominex, and Sleep-Eze).
In all of these the active ingredient is the same: diphenhydramine, a form of antihistamine. As you may know, antihistamines are used to dry up secretions in the eyes, nose, and throat, thus relieving some symptoms of colds and allergies. The drowsiness caused by antihistamines is really only a side effect; makers of over-the-counter sleeping aids have thus taken a drug liability and marketed it as an asset. Antihistamines may prove especially useful in the treatment of insomnia complicated by a history of drug or alcohol abuse, since they do not have the potential for abuse that is associated with other drug therapies (such as benzodiazepines and barbiturates).
*270\226\8*

THE EVOLUTION OF INSOMNIA DRUG THERAPYFor the first half of this century, barbiturates were the only pharmacological option available for insomnia. Veronal, the first barbiturate, was introduced in 1903. In the years following, about fifty drugs of this class reached the market (out of nearly twenty-five hundred barbiturate compounds developed in the lab). However, barbiturates were found to have two dangerous drawbacks: a high potential for addiction and a great risk of lethal overdose. Today only a dozen or so are still available; those used primarily for sleep are secobarbital (Seconal), amobarbital (combined with secobarbital in a product called Tuinal), and pentobarbital (Nembutal). Other uses for barbiturates are as antianxiety agents, anesthetics, and anticonvulsants.In the late 1950s tricyclic antidepressants came on the market. In addition to their effect on serious depression, some of these drugs also possess sedative effects, although just how they work is not completely understood. Antidepressants offered an alternative to the potential dangers of barbiturates, but they too have undesirable side effects. While not considered the drug of first choice today, antidepressants may be used to alleviate insomnia—especially if the insomnia is associated with depression.A major breakthrough in the drug treatment of insomnia was achieved with the arrival of benzodiazepines in the early 1960s. Compared to their prescription drug predecessors, benzodiazepines—primarily flurazepam, temazepam, and triazolam—have a greatly improved safety profile and are much more effective, particularly in disorders of initiating and maintaining sleep in individuals whose insomnia lacks an identifiable physical cause. Their improved ratio of therapeutic dose to lethal dose means a much lower risk of abuse or dangerous adverse effects. Some research does indicate, however, that there is a potential for addiction in patients taking the drugs over long periods of time. Benzodiazepines fall into several subcategories, usually depending on how quickly and for how long the drug works.Of course, there are also several nonprescription sleeping aids available (brand names include Nytol, Sominex, and Sleep-Eze).In all of these the active ingredient is the same: diphenhydramine, a form of antihistamine. As you may know, antihistamines are used to dry up secretions in the eyes, nose, and throat, thus relieving some symptoms of colds and allergies. The drowsiness caused by antihistamines is really only a side effect; makers of over-the-counter sleeping aids have thus taken a drug liability and marketed it as an asset. Antihistamines may prove especially useful in the treatment of insomnia complicated by a history of drug or alcohol abuse, since they do not have the potential for abuse that is associated with other drug therapies (such as benzodiazepines and barbiturates).*270\226\8*