Tag Archives: anxiety

Straight talk about antidepressants

19 Apr

Women with PCOS have a higher rate of depression than the rest of the population. (And, according to the National Institute of Mental Health, 6.7% of adults suffer depression in a given year–that’s a huge proportion!) I have talked about how to identify depression and how to manage it, but I haven’t talked about antidepressants specifically.

Most people who suffer depression over a long period of time will consider antidepressants, even though some people still feel uncomfortable about taking these kinds of drugs. They can help a lot. But it’s important to know what you’re getting; there can be side effects and withdrawal problems, too.

Personally, I’ve tried a number of different antidepressants. Some were awful for me; some worked well. I’m not going to discuss which ones might be best for you, beyond a couple of general statements, because one of the biggest challenges for doctors who treat depression is that every sufferer responds to these drugs differently.

I am discussing newer types of antidepressants–SSRIs, NDRIs, and SNRIs–because these are the drugs of choice today. There are some others, but chances are that your doctor will consider these first. Most of the drugs you hear about (Prozac, Zoloft, Paxil, Effexor, Wellbutrin, Lexapro, etc.) fall into these categories. Tricyclic antidepressants and MAOIs are not used very often because of the higher likelihood of serious or dangerous side effects.

TIPS AND HINTS
1. These drugs are life-saving and medically useful. If you are resisting trying them, even though you’re miserable, because you think you should be able to “just snap out of it,” or because you think that antidepressants are for wimps, rethink it. At least consider it. There are good reasons that some people may not want to take them, but this particular reason is silly.

2. Be aware that the first one you try may not help you. Finding the right medication for you takes trial and error. Work with your doctor and be prepared for the possibility that it will take time.

3. In a related vein, don’t expect these medications to help overnight. It can take up to six or even eight weeks to feel better, in some cases. (Some people do see a lot of improvement very quickly. It varies.)

4. Take them conscientiously. These are not drugs that you want to take “when you need them” or forget to take. A missed dose now and then is not a crisis, but they really do work best–and have the fewest side effects–when you take them every day, exactly as directed.

5. Antidepressants can also be extremely helpful for anxiety problems or make anxiety worse. Again, it varies. Be aware that if you suffer anxiety as well, you may have to adjust your medication based on that.

6. Tell your doctor about ANYTHING else that you take–other prescription drugs, over-the-counter drugs, supplements.

SIDE EFFECTS
Some common side effects of antidepressants include:
* drowsiness
* dry mouth
* nervousness, anxiety
* insomnia or hypersomnia (that is, too much or too little sleeping)
* decreased or increased appetite
* weight gain (this is long-term–not immediate–but it’s a big problem for some women and something to remember if you already struggle with your weight because of PCOS symptoms)
* sexual dysfunction, including anorgasmia (aka the inability to have an orgasm)

WHAT TO DO ABOUT SIDE EFFECTS
In some cases, if you can ride it out for a week or two, the side effects will go away. In other cases, not. In particular, weight gain and sexual dysfunction tend to be the ones that cause long-term problems. If the side effects are untenable, don’t give up. A different drug might be better for you. Wellbutrin might be something to ask about; for most people, it actually produces a small increase in libido, and it doesn’t contribute to weight gain (indeed, some people find it easier to control their weight or lose weight while they’re taking Wellbutrin). Some people also take Wellbutrin with their other antidepressant to help ameliorate the side effects.

DISCONTINUATION SYNDROME
When you stop taking an antidepressant, you can suffer symptoms. (People sometimes call these “withdrawals” but the technical term is “discontinuation”–that’s because these drugs are not addictive in the sense that animals–or people–given free access to them are not driven to take them. They do, however, cause symptoms when you stop taking them.)

These symptoms can be very, very unpleasant, although not everyone experiences them. The most notorious antidepressant for causing these symptoms is Effexor (and I can attest that it can be extremely unpleasant indeed to stop taking it!), but any of them can cause these problems:
* depression
* irritability or agitation
* aggressiveness
* dizziness
* sensory disturbances (e.g., paresthesias such as electric shock sensations–a lot of sufferers call these “brain zaps,” and all I can say is, if you experience them, you’ll recognize the description)
* anxiety
* confusion
* headache
* lethargy
* nausea
* vertigo
* bizarre and vivid dreams
* seizures (rare)

Some of the specifics here depend on your specific drug. The half-life of your medication (that is, how long it stays in your body) affects the severity and duration of the symptoms. If you are on a med that has a short half-life, you may see these more quickly and they may be worse. (Effexor, which has a very short half-life, can produce these symptoms even if you miss a dose.) It is a good idea to cut your dose down gradually, as your doctor directs. Some doctors also prescribe Prozac, which has a long half-life, while you are discontinuing your other medication. Sometimes taking a short course of Prozac can make the symptoms less severe.

BOTTOM LINE
Antidepressants may be very useful to you. While the big lists of scary side effects can be intimidating, these drugs have changed the lives of a lot of depression sufferers. The most important thing is that you have a good care provider: one who listens to you, will help you tweak your regimen, and has a lot of experience dealing with antidepressants. I recommend, if you can, that you visit a psychiatrist. They do nothing but psychiatric medication management (mostly–a few of them also provide therapy), and they’re very good at it. If you can find a doctor who knows a lot about these drugs, it will make the process a lot easier and you might see some excellent results.

THREE MORE NOTES
1. If you are pregnant, breastfeeding, or planning to get pregnant, be sure to discuss this with your doctor. There is considerable evidence that the advantage of treating depression in a pregnant or nursing mother may outweigh the risks, but it should be an educated decision–and there are some drugs that are much better-tested in pregnancy than others.

2. If your medication tells you not to drink alcohol, don’t. Talk to your doctor if you want more information. I have a glass of wine often even though I take Wellbutrin, but I would not drink more than one drink while I’m taking it. It’s very important because alcohol can affect you more when you’re on an antidepressant, which means both that you may end up more intoxicated than you had planned or expected, and that any side effects of your medication may get worse. Plus, in a more general sense, alcohol is a depressant, which is not what you want if you suffer from depression!

3. Sometimes, an antidepressant that works well for you might stop working. This just happens occasionally. For example, I found that after my pregnancy, when I went back to my old antidepressant, it no longer worked well for me. That can happen even if you don’t stop taking it or have an obvious physical change such as pregnancy and birth. If it happens to you, don’t panic–talk to your doctor, and try something else.

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stress reduction

20 Sep

One of the big recommendations for dealing with PCOS is to reduce stress. This has a number of benefits for PCOS ladies in particular (though it is a good idea for anyone). Stress reduction can:

* Reduce cortisol (the stress hormone), which can help cut back on the tendency to put on abdominal fat–a problem for PCOS women that can lead to heart disease and other health problems…as well as muffin top.

* improve sleep, which can in turn help with weight control.

* reduce depression and anxiety.

* help you deal more easily with the curveballs that life throws you, including PCOS-related problems such as breastfeeding woes or fertility issues. They are big problems, but reducing your overall stress level will reserve your energies for dealing with these instead of panicking over the little things.

I’ve recently started reading zen habits, a great blog with many different approaches to stress reduction, simple living, and enjoying the moment. While you might not want to give up shoes or even declutter your house, some of the suggestions on this blog are easy to implement and great for stress reduction.

A couple of my favorite posts are this one on not hurrying and this one, which offers 12 ways to decompress after a high-stress situation.

Take a look–it’s worth it! The post about slowing down is especially useful, in my opinion–because most of us don’t allow enough time for any task we “need” to complete. Which things do you really need to do? What do you really want to do? Can you cut back enough that you’re not rushing?

seven steps to help you deal with anxiety

29 Jun

If you have anxiety, there are many options open to you to improve your life! Here are my recommendations for the first things you might try.

1) Make sure it’s anxiety.
See your doctor to rule out the possibility that your symptoms are caused by something else. Some of the manifestations of anxiety are very similar to other health problems, and a physical is a good idea. Take a list of your symptoms to the appointment, and tell the doctor that you think it may be an anxiety problem but that you’d like some help differentiating between that and some other health problem.

2) Write down your experiences.
If you and your doctor think that anxiety is the problem, the next thing I recommend is a bit complicated, but worth it: keep a journal for a week that records your symptoms with the date, time, and any comments you have. Use the journal to record, as well, the following things: how much sleep did you get? How much exercise? What did you eat and drink? Did you have any major stressful events?

3) Look for patterns.
Once you have a week’s worth of observations to examine, sit down with your journal and look for patterns. Are you very tense on days when you haven’t gotten enough sleep? Do you have a panic attack before every big work meeting? These correlations can help you find the best treatments for you.

4) Evaluate your lifestyle. Things that can reduce anxiety include getting enough sleep (easier said than done for many of us); getting plenty of exercise (also great for fighting depression); cutting out caffeine; and reducing your intake of sugar and other simple carbs. You will have to decide which of these changes you are willing and able to make. It is not always feasible to overhaul everything in your lifestyle, especially all at once. But making a few changes (such as switching to decaf coffee or iced tea, adding a walk to your lunchtime routine, or doing a bit of gardening every night for exercise and relaxation) can help, too. It isn’t all or nothing.

5) Learn a few simple relaxation techniques
. Deep breathing can help, and it’s easy to learn. Anxieties.com has excellent information about this, so I won’t try to reinvent the wheel by listing them here–but deep breathing, muscle relaxation, and other techniques can help a lot, even if it doesn’t seem likely to you right now. Give it a try and see if it helps you!

6) Counseling can also be useful. Depending on what your brain is saying to you when you’re feeling anxious, learning different kinds of self-talk can help a lot. Cognitive-behavioral therapy, or CBT, is great for this. You also might find that counseling can help you resolve whatever issue is causing you the stress in the first place (a problematic relationship, a bad work situation…whatever it is that’s leading you to feel so anxious, if you suspect that your anxiety is situational).

7) Finally, medication can help. There are two basic ways of medicating anxiety. Some people do both.

The first is the use of antidepressant medication, which often also has an anti-anxiety effect. You may have to try several before you find one that works for you, and because it takes a while to see results, this period can be frustrating. Popular choices for medicating anxiety include Zoloft, Lexapro, and Paxil; some other antidepressants, such as Wellbutrin, are less likely to help with anxiety. That said, Wellbutrin is what I take and it does help me a lot, so patients vary in this respect!

The second class of medications for this problem is the benzodiazepines. (Some of the newer drugs in this group are not actually benzos; however, I’m not quite sure what else to call them.) These include Xanax, Klonopin, Valium. There are definite up sides to using these drugs: they have measurable, quick, and reliable effects on anxiety. Most people who take them will see a reduction in anxiety. These effects take only a half an hour to an hour to appear. There are also some down sides, though–notably the fact that they can be habit-forming and that they can be too sedating, leading to excessive sleepiness, uncoordination, and inability to focus. (Some people take them at night to help initiate sleep, which cuts back on the sleepiness problem, but may exacerbate the addiction problem.)

Benzodiazepines can also be dangerous when combined with alcohol or other prescription drugs (including painkillers and sleeping pills). Be sure that your doctor knows everything else that you are taking, and avoid alcohol when you’re using them (or at least limit it to minimal amounts).

Many studies have shown that benzos lose their effectiveness when used routinely.

The bottom line on anti-anxiety medications is that antidepressants are safer; these can be excellent choices. It takes some time for these medications to work, though. In my opinion, there are some situations where benzodiazepines are very useful: to have on hand for major stressful events that exacerbate your anxiety disorder; to use when needed until your antidepressants start to kick in; or to help augment your antidepressants during a panic attack if you have occasional panic attacks. I do not think that taking them daily is a good idea–if nothing else, they will lose effectiveness over time, and then you won’t have that in your toolkit in case you have a major anxiety-causing event.

anxiety: what it is

16 Jun

I have written about depression on this blog, but not about anxiety. The two problems sometimes go hand in hand; however, you can have one without the other. Both are correlated with PCOS.

Anxiety, in particular, can be misdiagnosed or written off as “stress.” But it’s a real problem and it can affect your quality of life. There are things you can do, both on your own and with a therapist or your doctor, to minimize your anxiety and lead a happier life.

Do any of these symptoms sound like you? If these sound familiar, you may have an anxiety disorder.

* difficulty sleeping

* mind racing

* heart pounding; uncomfortable awareness of heart beating (technically, the latter are palpitations)

* insomnia

* fatigue (feeling like stress is wearing you out)

* nausea or diarrhea; heartburn

* stress eating or loss of appetite

* lack of interest in sex

…and one more that I have noticed, though it’s not usually listed with the symptoms: weight gathered around midsection. I think this is because central obesity can be caused by excess cortisol, and stress and anxiety produce cortisol. In any case, take that last one with a grain of salt, as it is just my observation.

There are several common forms of anxiety. Generalized anxiety disorder, or GAD, causes the sufferer to be tense or anxious over the course of most of the day. While there is often a situation (or several situations) that exacerbate the anxiety, sufferers of GAD are anxious even when there is no immediate cause.

Panic disorder (which may be concurrent with GAD) causes panic attacks. A panic attack has similar symptoms to general anxiety, but they are much more severe and compressed into a shorter time. During a panic attack–which may last a few minutes or up to half an hour–the sufferer feels frightened and out of control. Some people who have panic attacks fear that they will die or that they are going crazy. Others have difficulty breathing, feel dizzy or sick, or become confused.

Anxiety and panic have real, important roles in human life. When you are anxious or frightened, your body kicks in its emergency response system, which has evolved to do a number of things that help you avoid or escape danger:

* increases your breathing rate to get more oxygen to your blood

* increases heart rate to get more blood to vital organs

* muscles tense to allow you to run or dodge quickly

* eyes dilate, which improves your vision

As you can see, all of these things are assets if you’re a hunter-gatherer from 500 B.C., but not so much if you’re trying to conduct a meeting. Even in modern life, you want these instincts to kick in if someone tries to mug you or if you accidentally walk in front of a moving car; it’s not the set of responses that is wrong, but the stimulus required to get the responses rolling.

If you are anxious, these “stress hormones” (adrenaline among them–remember how you’ve felt after a close brush with danger? jittery, a little “high,” unable to settle down? that’s adrenaline) work overtime and cause you to feel the symptoms and results of fear even when there’s nothing to cause it. Some people experience anxiety and panic in social situations, some when they drive; some people are anxious all the time, regardless of what they’re doing.

If this describes you, you may suffer from an anxiety disorder. There are some basic things that you can do to help; I’ll be back with a post on self-help, therapy, and medications tomorrow.

some notes about birth control pills as PCOS treatment

2 Jun

One of the first lines of treatment for PCOS for women who are NOT trying to get pregnant [and for a few who are] is usually hormonal contraceptives. This has the superficial result of regulating your period, though it doesn’t actually improve your cycle in a meaningful way; you have an artificially-induced period, called a “withdrawal bleed,” when you switch to the week of placebo or iron pills in your pack. [In this post, I am discussing “birth control pills”–but this info applies also to the NuvaRing and the birth control patch.]

There are benefits to this for some women:

1) Obviously, it is more convenient to have a regular period instead of the erratic cycles or spotting that some PCOS ladies get.

2) Birth control pills can also improve bone density if you are otherwise not having cycles [estrogen is important for bone density, and most birth control pills provide it].

3) They also reduce testosterone, which can, in some cases, reduce other symptoms of PCOS–hirsutism [that would be the unwanted hair] and acne. If this is important to you, you might ask your doctor about Yaz, which also contains drospirinone, a drug that can help with those problems.

4) Some women find that hormonal birth control reduces PMS.

5) Having a period can decrease your risk of endometrial problems, including endometriosis, which can be painful and may reduce fertility.

6) Birth control pills can also increase fertility–yes, INCREASE. They are sometimes used as part of a program for treating infertility, as especially the first month after you stop using them, you may experience increased fertility. If your doctor recommends this line of treatment, there is probably more benefit to using them than there is reason to avoid them.

That said, there are also some compelling reasons to avoid hormonal birth control as a first-line treatment for PCOS. They carry risks: not just the standard “increased risk of stroke and blood clots” and less-serious side effects such as nausea or headache, which you always hear about and will see on the monograph that accompanies your prescription, but also the possibility of weight gain, which can make PCOS worse.

In addition–and this is my completely non-medical opinion–using hormonal contraceptives falsely regulates your cycle, which means that it masks one of the most significant measures of your health. At least for me, my menstrual cycle is a sort of litmus test for how well my lifestyle is working to control PCOS. When I eat well and exercise, my cycle is quite regular. If I don’t–well, my body will remind me, through irregular cycles, that it needs better care. This is a valuable way that my body reflects the success or failure of management, and I don’t want to obscure it. It would be a bit like taking ibuprofen every day because you have been prone to headaches: you wouldn’t know whether the headache was still there if you took it every time your dose was up! I would rather commit to treatments that are really treating my insulin resistance problem.

Finally–and let me emphasize that this is only my experience and that many women have excellent experiences with birth control pills–I no longer use hormonal contraceptives because they contribute a great deal to the depression that I have always suffered. Depression and anxiety are common adjuncts to PCOS. If you suffer either of these disorders, it’s important that you track your response to ANY drug you take, including contraceptives, to see whether they contribute to your problem. For me, it’s not worth it.

One final note about hormonal contraceptives AS contraceptives: I had a great experience with NuvaRing and used it for years, and I felt good while I was using it; however, I also got pregnant while I was using it. My doctor at the time said that women with PCOS often seem to have failures of hormonal contraceptives; in retrospect, I believe this to be true because many women with PCOS are overweight, and women over about 150-175 pounds in weight have decreased rates of effectiveness with hormonal birth control. Food for thought, eh?