Depression can certainly be an extremely serious and, in some cases, even a fatal condition. But the symptoms of depression range in severity from severe cases to milder instances of feeling stressed and overwhelmed or lacking in energy and enthusiasm. In this regard, depression is like many medical problems, for example headaches, which can range from tension headaches to the intense throbbing pain of migraine or the pressure headaches that may signal the presence of a brain tumour. While tension headaches can be treated simply with painkillers, the more severe headaches need the help of a neurologist. Just as you might not consider going to a doctor if you suffered from mild tension headaches, so you might not feel the need to get medical help for mild symptoms of depression or stress.

Regardless of what one believes the ideal course of action in dealing with depression to be, a simple inspection of the numbers will indicate that it is impossible for all people with depressive symptoms to be taken care of by doctors. According to one estimate, 17.6 million people in the US alone suffer from major depression. There are approximately 38,000 psychiatrists and 17,000 GPs in the US. If all the depressed people were evenly divided among these providers, that would mean approximately 320 depressed patients for each doctor. Such numbers would pose an overwhelming case load for a practitioner, who would also be expected to care for patients with other types of disorders as well. In addition, patients with major depression constitute only a fraction of individuals with depressive symptoms. According to one widely respected population study, more than one in five adults complained of depressive symptoms in the month before they were surveyed. Many of these were regarded as suffering from what is known as subsyndromal depression, a less marked form of the condition but one that is nevertheless responsible for considerable misery and suffering. Clearly it is unrealistic to imagine that all of these people could be properly taken care of by the mainstream medical establishment and the evidence bears this out.

In a recent consensus statement in the authoritative Journal of the American Medical Association, a group of leading researchers pointedly observed:

In the Epidemiological Catchment Area study, a nationwide community survey of psychiatric illness that was conducted around 1980, approximately one third of people suffering from a major depressive disorder sought no treatment for it. Of those who sought treatment, few received adequate treatment. In fact, only about one in 10 of those suffering from depression received adequate treatment.

R Hirschfeld and colleagues,

Journal of the American Medical Association, 1997

These same authors reviewed the psychiatric histories of people who entered various depression research studies even more recently than the 1980 study mentioned above, during the years when the SSRIs became very popular. Even so, the researchers concluded:

The lack of any prior anti-depressant treatment of patients is striking, ranging from 67 per cent to 48 per cent, who despite being ill for a median of … 20 years never received any anti-depressant medication. The range of patients who received adequate treatment is also sobering: from a low of 5 per cent to a high of 27 per cent.

Experts in public health have pondered the reasons why people have not received treatment for their depressive symptoms. In some cases, medical personnel may fail to make the correct diagnosis or to treat the problem adequately. In other instances, the depressed person may not recognize the problem, may be embarrassed to seek help for it, may feel afraid of going to a psychiatrist or deterred by the stigma associated with the diagnosis.

Whatever the reasons for the failure of mainstream medicine to take adequate care of depression in a large proportion of affected individuals, there is general agreement that depression is common, exacts a serious toll on the lives of those who suffer from it, is underdiagnosed and undertreated, and that there is a great deal of room for improvement in the situation.

*42/75/2*

Tags: Anti Depressants

Interestingly, the earliest systematic 20th-century study of the effects of St John’s Wort on depression was inspired by the observation that Hypericum is a light-sensitive substance and that rats given Hypericum and then placed in bright light appeared to become more activated. To date there is only one study on the use of St John’s Wort in SAD patients. In this study, Dr Siegfried Kasper’s group in Vienna compared two groups of 10 SAD patients, one exposed to bright light in the morning for two hours a day for four weeks and one to much dimmer light for the same amount of time. Both groups received St John’s Wort 900 mg per day, and both groups responded very well over the four-week interval.

Given the way in which the study was designed, it is difficult to draw definite conclusions from it. Because there was no placebo group, the evidence for a specific effect for St John’s Wort was not completely clear-cut. Nevertheless, the anti-depressant results of St John’s Wort were promising. In addition, light therapy enhances the effects of the anti-depressant and the antidepressant cuts down the amount of time needed in front of the light box. There is no reason to suppose that the same beneficial interaction will not occur when it comes to the use of St John’s Wort. In my opinion, Sarah’s happy experience with using these two treatments in conjunction will prove to be the norm.

There are different ways in which light therapy and St John’s Wort can be combined. You could reason that since light therapy is the more established of the two treatments for SAD, it would make sense to begin to use light treatment as you enter the usual season of risk. As soon as it feels as though the light therapy is not fully doing the job, you could then add St John’s Wort. Another approach would be to start with St John’s Wort and add in light therapy only if it is necessary.

Although Kasper’s group found no harmful effects to the eye after four weeks of light therapy used in conjunction with St John’s Wort, there is a theoretical concern that the light-sensitizing effects of the herbal anti-depressant may produce harmful effects to the eyes over the long haul. Since such speculations by definition involve watching people over long periods, it will not be possible to answer them definitively for years to come. Even so, it is good to be aware of this possible interaction and to use less light if you are also taking St John’s Wort than you would if you were only using the light treatment. This should be easily managed as you will be benefiting from two remedies rather than just one. In addition, we have a natural inclination to do with as little light therapy as is needed to obtain an anti-depressant response.

One tip worth bearing in mind whenever you use an antidepressant to treat SAD or the winter blues is that the dosage needed usually varies depending on the season. For example, 300 to 600 mg of St John’s Wort might be sufficient in the autumn and spring, but larger doses may be necessary to combat the more severe symptoms that may occur in the depths of winter.

*29/75/2*

Tags: Anti Depressants

In the early 1980s my colleagues and I found that the symptoms of winter depression could be greatly alleviated by exposing the SAD sufferer to bright environmental light. Many controlled studies have by now demonstrated beyond question that light therapy is an effective treatment for this condition. Light therapy has been accomplished most successfully by means of special light boxes or fixtures. A typical light box is a square or rectangular metal apparatus that contains fluorescent light tubes behind a plastic diffusing screen. The user generally places it on a flat surface, such as a desk or table top, and sits a certain prescribed distance away from it. In order for light therapy to be effective, the user’s eyes must be open, but it is not necessary to stare at the light. Instead, people often choose to read, eat their meals or do anything that can be done while sitting in one place. I used to recommend that people use this time for paperwork or chores, but then I found that they were avoiding doing their light therapy because they associated it with unpleasant matters. So now I advise them to do whatever will succeed in helping them to use their light therapy regularly throughout their winter depressions. Just as with anti-depressant medications, if a person is still in a vulnerable phase, for example during the short dark days of winter, light treatment must be continued even if symptoms are under good control in order to avoid a depressive relapse.

Light boxes may stand upright or be tilted forward, an arrangement that reduces glare and brings the light source closer to the face, resulting in greater amounts of light entering the eyes. Light intensities are measured in units called lux. Average indoor lighting is about 500 lux; modern light therapy fixtures result in levels of approximately 10,000 lux, about 20 times as much light as ordinary indoor lighting provides. Properly designed light boxes include special filters that remove potentially harmful ultraviolet rays from the light source. If used as recommended, light therapy appears to be very safe and, out of thousands of people treated with light therapy over the past 15 years, no evidence of any harm to the eyes has been reported. Even so, if you have any history of eye problems you should have your eyes checked out by a qualified professional before initiating light therapy, as some serious conditions of the retina can be exacerbated by exposure to bright environmental light.

The duration of light therapy needed varies with the time of year and the individual, and depends also on what is convenient and feasible. The worst elements of the depression can often be prevented if the problem is tackled early in the season. During the autumn or early winter, just before the usual time of onset of symptoms, it is reasonable to begin with 15 to 30 minutes of light therapy in the morning. Studies have shown that light therapy can be most effective when given in the morning hours, though many people find it to be beneficial no matter when they use it during the course of the day. I therefore often recommend that people start by using light therapy whenever it is most convenient. As the winter deepens, it is often helpful to add a second dose of light (such as 15 to 30 minutes in the evening) to the morning dose. After using light therapy for some time, people often become skilful at calculating how much works for them. Some people require up to 45 minutes of light therapy twice a day in order to obtain optimal effects. This amount of light therapy might seem like a very burdensome time commitment, but it is important to remember that one is often sitting down in one place anyway, and it is often quite convenient and actually pleasant to have the bright, cheerful light of the box shining down on you while you are doing so.

Just as people often learn how much light they need in order to overcome winter’s doldrums, so they frequently learn to detect when they are being exposed to too much light. Side-effects of excessive light treatment include feelings of restlessness and overstimulation, headaches or eyestrain. These effects frequently respond to decreasing the duration of light exposure or sitting a little further away from the light fixture. Using light therapy late at night may cause difficulty falling asleep, in which case it often helps to move the light therapy to an earlier hour during the evening or late afternoon.

When spring arrives, people naturally find themselves using their light boxes less and not missing them. But spring tends to be an erratic season and it is prudent to watch out for rainy or cloudy days – especially a string of them – and be ready to bring out the light box at a moment’s notice.

An innovation developed to help people who want to move around while receiving their light therapy is a head-mounted light delivery system called a Light Visor. This device is also handy for those who need light therapy while travelling. While many people swear by the benefits of the Light Visor, data from controlled studies of the anti-depressant effects of light therapy are not as convincing for the Light Visor as for the light box.

*27/75/2*

Tags: Anti Depressants

In the early 1980s my colleagues and I found that the symptoms of winter depression could be greatly alleviated by exposing the SAD sufferer to bright environmental light. Many controlled studies have by now demonstrated beyond question that light therapy is an effective treatment for this condition. Light therapy has been accomplished most successfully by means of special light boxes or fixtures. A typical light box is a square or rectangular metal apparatus that contains fluorescent light tubes behind a plastic diffusing screen. The user generally places it on a flat surface, such as a desk or table top, and sits a certain prescribed distance away from it. In order for light therapy to be effective, the user’s eyes must be open, but it is not necessary to stare at the light. Instead, people often choose to read, eat their meals or do anything that can be done while sitting in one place. I used to recommend that people use this time for paperwork or chores, but then I found that they were avoiding doing their light therapy because they associated it with unpleasant matters. So now I advise them to do whatever will succeed in helping them to use their light therapy regularly throughout their winter depressions. Just as with anti-depressant medications, if a person is still in a vulnerable phase, for example during the short dark days of winter, light treatment must be continued even if symptoms are under good control in order to avoid a depressive relapse.

Light boxes may stand upright or be tilted forward, an arrangement that reduces glare and brings the light source closer to the face, resulting in greater amounts of light entering the eyes. Light intensities are measured in units called lux. Average indoor lighting is about 500 lux; modern light therapy fixtures result in levels of approximately 10,000 lux, about 20 times as much light as ordinary indoor lighting provides. Properly designed light boxes include special filters that remove potentially harmful ultraviolet rays from the light source. If used as recommended, light therapy appears to be very safe and, out of thousands of people treated with light therapy over the past 15 years, no evidence of any harm to the eyes has been reported. Even so, if you have any history of eye problems you should have your eyes checked out by a qualified professional before initiating light therapy, as some serious conditions of the retina can be exacerbated by exposure to bright environmental light.

The duration of light therapy needed varies with the time of year and the individual, and depends also on what is convenient and feasible. The worst elements of the depression can often be prevented if the problem is tackled early in the season. During the autumn or early winter, just before the usual time of onset of symptoms, it is reasonable to begin with 15 to 30 minutes of light therapy in the morning. Studies have shown that light therapy can be most effective when given in the morning hours, though many people find it to be beneficial no matter when they use it during the course of the day. I therefore often recommend that people start by using light therapy whenever it is most convenient. As the winter deepens, it is often helpful to add a second dose of light (such as 15 to 30 minutes in the evening) to the morning dose. After using light therapy for some time, people often become skilful at calculating how much works for them. Some people require up to 45 minutes of light therapy twice a day in order to obtain optimal effects. This amount of light therapy might seem like a very burdensome time commitment, but it is important to remember that one is often sitting down in one place anyway, and it is often quite convenient and actually pleasant to have the bright, cheerful light of the box shining down on you while you are doing so.

Just as people often learn how much light they need in order to overcome winter’s doldrums, so they frequently learn to detect when they are being exposed to too much light. Side-effects of excessive light treatment include feelings of restlessness and overstimulation, headaches or eyestrain. These effects frequently respond to decreasing the duration of light exposure or sitting a little further away from the light fixture. Using light therapy late at night may cause difficulty falling asleep, in which case it often helps to move the light therapy to an earlier hour during the evening or late afternoon.

When spring arrives, people naturally find themselves using their light boxes less and not missing them. But spring tends to be an erratic season and it is prudent to watch out for rainy or cloudy days – especially a string of them – and be ready to bring out the light box at a moment’s notice.

An innovation developed to help people who want to move around while receiving their light therapy is a head-mounted light delivery system called a Light Visor. This device is also handy for those who need light therapy while travelling. While many people swear by the benefits of the Light Visor, data from controlled studies of the anti-depressant effects of light therapy are not as convincing for the Light Visor as for the light box.

*27/75/2*

Tags: Anti Depressants

Sarah suffers from a typical case of seasonal affective disorder, or SAD. People with this condition are very sensitive to the amounts of environmental light and become depressed when these levels fall below a certain threshold, such as during the short dark days of winter. Although the problem probably has a genetic basis, the severity of winter depressions depends on the amount of light in a susceptible person’s environment. Often people with SAD who have lived in different locations report that their problem is worse the further away they live from the equator, with depressions lasting longer and being more severe than when they live in more tropical climes. For some reason not yet understood, women are more susceptible than men to SAD, especially when they are in their reproductive years.

When depressed, people with SAD tend to oversleep. Often they just feel like curling up in bed and being left alone. They empathize with hibernating bears who are free to laze away the winter without the responsibilities that beset us humans all year round. Such responsibilities often overwhelm the person with winter depression, who can barely rouse herself and get going, let alone tackle the chores, work and personal commitments that are part of ordinary living. Overwhelmed by these demands, the person with SAD feels like a failure and anxiety and depression are always close at hand. One source of comfort is often food, especially sweets and starches, which are consumed in great amounts, resulting in unwelcome weight gain.

Seasonal affective disorder is extremely common and has been estimated to affect about 5 per cent of adults. Another 15 per cent are estimated to suffer from a milder form of the condition, subsyndromal SAD or the winter blues. Although most people with the milder version of SAD do not seek out medical attention, the dark short winter days nevertheless interfere with their productivity and creativity and make life feel dreary and dull. It is estimated that approximately one in five people suffers from emotional or behavioural disturbances as a result of the winter.

Light deprivation for any reason will tend to depress these susceptible individuals. Two or three cloudy days in a row, a windowless office or the scarcity of light in their ground-floor flat are all quite likely to lead to a lack of energy and a slump in mood.

Once the connection is made between the amount of environmental light and the drops in mood, however, the condition feels immediately less burdensome. As Sarah put it, ‘understanding the problem is half the battle.’ The other half of the battle can be won with the help of light therapy, St John’s Wort and other antidepressant strategies.

*26/75/2*

Tags: Anti Depressants

Every November, as the days became shorter and daylight began to fade, Sarah, now in her early fifties, would feel an old familiar affliction come over her. An artist, she sees the world in colours. Autumn was a grey season. She would have difficulty waking up in the morning and would sense her energy ebbing away from her. Although normally a competent person, even simple tasks would now feel impossible and preparing for Christmas seemed like a mountainous chore to her. One of her few pleasures was eating – comfort foods such as cheese on toast, scones or buttered toast. She would gain have a stone every winter and lose it again the following summer.

Her depression would deepen in December, made worse by memories of a child she had lost in that month many years before and the departure of her children, who would spend time with her ex-husband during part of the holiday season. The approach of the holidays compounded her misery, making her anxious that she would not be able to celebrate Christmas properly with her two children. At times she was unable to get her Christmas cards out and make all the necessary preparations for the holidays, which would leave her feeling guilty and inadequate as a mother and despairing that things would ever turn out as she wanted them to. She would become reclusive and not want to venture out at all. When she did go out, she would hide in a corner and if someone spoke to her, would nod her head but not really participate. At these times, the world would look completely black to her and at times suicide would beckon to her as a welcome relief from her pain.

Things would improve in January, which was lighter and brighter in part because of the sunlight reflected off the snow, and she found it easier to get through. February, on the other hand, was dark once again and she would only begin to emerge from her depression in a solid and predictable way when March arrived. For the rest of the year she was fine.

Sarah first saw a psychiatrist for treatment of her depression when she was in her twenties. A major factor contributing to her difficulties was the death of her father at age 13 and unresolved feelings around that. Later troubles included the death of a child when she was 31 years old and a ‘horrendous’ divorce. Despite helpful psychotherapy, her cyclical depressions persisted and she was given anti-depressant medications to deal with them. Unfortunately she was unable to handle any of the synthetic antidepressants that were tried. Prozac and other medications caused her heart to beat rapidly and did not feel right for her body. She had always been very sensitive to medications of all kinds; even extra-strength paracetamol would make her feel ‘high’, spacey and giddy.

One type of treatment that helped her a great deal, without any side-effects, was light therapy. She obtained a special light box and would begin to use it from the end of October. She would sit in front of the light, for half an hour in the morning while eating breakfast and half an hour in the evening at dinner-time. The first year she used the light box she managed to get her Christmas cards out on time and was actually able to plan a New Year’s party. But even though the light box prevented her from hitting the bottom of her depression, she still felt low and the world still looked dark and grey to her.

About 18 months ago Sarah, who describes herself as ‘a child of the 1960s’, heard about St John’s Wort, which appealed to her because of its herbal nature. She began using it during one of her depressions. Almost immediately she noted a levelling out of her moods and enjoyed not being seesawed by her customary highs and lows. For the sake of convenience, she changed her dosing schedule so that rather than taking the St John’s Wort in two lots she took a day’s dosage just once in the morning, and found that to work equally well for her. Now she was able to deal with her problems and feel in a stable and upbeat mood, free of depression all year round. She sings the praises of St John’s Wort to ‘all kinds of people’.

St John’s Wort clearly helped Sarah’s winter depressions enormously and she was now able to get her cards out early and look forward to the Christmas season. Christmas time, which had formerly been so very difficult for her, now no longer seemed like a black season. She still sits in front of her light box during the winter even though she doesn’t feel it is really essential.

*25/75/2*

Tags: Anti Depressants

A number of factors may combine to cause bronchial asthma. Of these, allergy, infection, genetic constitution, and emotional influences are the most important. However, as is often the case in the history of medicine, the last twenty or thirty years have seen an overemphasis on one of these factors at the expense of the others. There has been a remarkable preoccupation with the allergic factors of asthma. The preparation of antigens and their Use in skin testing and desensitization has all the appeal of being scientific. However, this preoccupation with allergy has led to the neglect of the emotional factors, which are much more elusive and harder to appreciate as an aspect of science. But the importance of the emotional influence is beyond all doubt.

I have bad a number of patients who suffered for years from classical asthma with proven sensitivity to common pollens and dusts. They ceased to have attacks of asthma after being treated by relaxing methods, even though they were still exposed to the same pollens and dusts which in the past had caused the attacks. Furthermore these patients have shown no formation of substitute symptoms, such as skin rashes, that have been reported by some authorities when hypnosis was used to stop asthma by direct suggestion. I could quote histories of a great number of patients whose asthma was either completely relieved or at least greatly improved following the practice of relaxing mental exercises.

Perhaps one of the most remarkable was a woman of forty-six who had suffered from severe asthma for thirty years. She seemed to live by repeated use of her spray. After practising the relaxing exercises, the woman simply ceased to have attacks, and her spray was completely abandoned. I am sure that if there had been any recurrence she would have returned to me, but she has not done so.

A lad of eighteen was incapacitated by asthma. He ceased to have attacks, and I lost contact with him until a relative came to consultation a few weeks ago, and reported that the lad had remained free of asthma since seeing me five years ago.

A young married woman was extremely sensitive to house dust, and any housework always produced a severe attack. After some relaxing treatment she came to be able to dust the house in the normal way without any ill effect.

The significant finding of my work in this field is that many patients who suffer from classical bronchial asthma cease to have attacks when the general level of their anxiety is reduced. Some other patients have continued to have attacks, but they have been much less frequent and much less severe. Other patients have remained uninfluenced by this approach. Approximately one third of the patients so far treated fall into each of these three categories. It would therefore seem that anyone suffering from bronchial asthma should at least try the method of relief through the principles of self-management. The method reduces the general level of anxiety in a way similar to the relaxing method I have used in my office treatment.

*24/57/2*

Tags: Anti Depressants