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Panic disorders can be treated

Millions of people suffer from illnesses such as anxiety disorder, panic disorder, agoraphobia, depression, bi-polar disorder (manic-depressive illness), obsessive compulsive disorder (OCD), eating disorders, schizophrenia, Alzheimer's disease.

Much progress has been made in the last decade in understanding the origin, progress and treatment of these conditions.

Uncontrolled or untreated mental illness can result in complications such as family violence, alcohol or drug abuse, suicide.

And depression and work-related stress lead to extended periods of sick leave - leading to significant loss of productivity.

Probably the disease talked about most frequently in the last few years has been panic disorder.

Panic disorder (PD) is one of the most common diseases seen in medical practice. The incidence is much higher in females than in males.

It is a unique disease, as it can affect many physiological systems of the body.

Hence, the patient can complain of anxiety, heart palpitations, fainting, breathing difficulties, sweating, chest pain or discomfort, numbness or tingling sensations, nausea, abdominal discomfort, etc.

The patients can attend various physicians, such as family doctors, psychiatrists and cardiologists, with their problems.

THE TYPICAL patient could say "I was quite well until two months ago, when I had a fainting attack in the mall and had to rush out. My heart started beating fast, I felt dizzy, had to gasp for breath and thought I was going to pass out or have a heart attack."

The patient then could be quite well until some time later, when there can be another attack at a public place or even at home.

Some patients will go to hospital emergency departments, only to be told the electrocardiogram (ECG) is normal and there is nothing wrong medically. Some undergo repeated investigations and get frustrated.

If the panic attacks occur at a public place such as a mall, the patient might develop agoraphobia - a fear of visiting public places - and even get house-bound.

Some patients are too shy to seek treatment, thinking they have "gone crazy," as they have been told repeatedly that there is nothing wrong medically.

The panic attacks can occur two to six times daily, once a week or even once monthly.

In between the attacks, the person can be quite normal or have some degree of anxiety and fear. If PD is untreated, it could also lead to depression and alcohol and drug abuse.

THE CAUSE OF PD is said to be a chemical imbalance of the general nervous system, although there are other theories too.

But PD is treatable. Most recover completely, while some can have a prolonged course.

Counselling helps with explanations regarding the condition and reassurance. Understanding the condition and eliminating fear is the first step to recovery.

Anticipatory fear of panic attacks and stress aggravates PD, while the more severe conditions require medication for quick recovery.

The commonest medication used is Alprazolam (Xanax). Others include Imipramin (Tofranil) and Desipramine (Norpramin).

Most patients require medication for two to six months, but some need it for longer periods.

Relaxation techniques and behavior modification can also help these patients, along with the other interventions.

If work is making you depressed or anxious, it's time to seek help

Q: I am on stress leave from my job because of depression and anxiety. How common are these two problems in the workplace?

A: Depression and anxiety afflict more employees than any other mental illness in the workplace, according to the Global Business and Economic Roundtable on Mental Health.

Looking at the Numbers

On any given day, about 10 to 15 per cent of Canadians are suffering from a mental illness, with depressive and anxiety disorders being the most common conditions.

According to Statistics Canada, the average age of onset for anxiety disorders is 12, and for depression, 21.

Those between the ages of 18 and 44 may be the highest risk group for experiencing impairment from depression and anxiety.

A 2005 study by Dr. M.A. Buist-Bowman estimated that close to 29 workdays are lost per year by employees suffering from depression. Employees with anxiety disorders lost 18 days.

Health Canada, in a 2001 report, estimated the economic burden of mental illness on the health system was about $11 billion per year.

According to the Global Business and Economic Roundtable on Mental Health, about 20 to 25 per cent of Canadian employees suffer from a mental illness in a given year. The cost of lost economic productivity is about $35 billion per year, it calculates.

What Is Depression?

Clinical depression usually refers to major depression. The presence of daily low mood or loss of interest, in addition to decreased appetite, changes in sleep patterns, decreased energy, decreased self-esteem, poor concentration, increased feelings of guilt and self-blame, decreased sexual desire and feelings of hopelessness and helplessness characterize the disorder.

Depression can be of a lesser intensity and chronic -- in other words, dysthymia.

Depression may also be part of a manic-depressive illness, occur after childbirth, or in the winter. It can be secondary to medical conditions, medications, life stresses or genetics.

What are Anxiety Disorders?

Anxiety disorders are characterized by a sense of fear or worry, accompanied by physical symptoms. This is essentially an out of control "fight or flight" response. There is a pattern of avoidance and anticipatory anxiety. The anxiety disorders include:

- Simple phobias, such as fear of cats or dogs;

- Panic disorder with agoraphobia, such as sudden panic attacks and being afraid to go to public places;

- Obsessive-compulsive disorder, such as the need to wash your hands 50 times per day;

- Social anxiety disorder, which includes debilitating shyness;

- Generalized anxiety disorder, such as the chronic worrier;

- Post-traumatic stress disorder, which entails experiencing panic attacks when you think about an assault or accident.

Illness, medications, life events and family genetics can precipitate and perpetuate anxiety disorders. About half of people who have an anxiety disorder may suffer from depression and vice versa.

Workplace Disability

Most people are familiar with the term absenteeism, which refers to days lost from work. Presenteeism is a newer concept. It refers to producing lower quantities of work of poorer quality.

There appears to be a strong association between presenteeism and depression and anxiety disorders. A 2003 study by Dr. W. F. Stewart found 86 per cent of total lost time by workers due to major depression was due to presenteeism.

Job Control Model

Dr. M. Van Der Doef described the job control model in 1999. Jobs with high demand and low control can be detrimental to your mental health. High-demand components include excessive workload, constant time pressure and elevated levels of conflict.

The low-control component consists of low autonomy and authority. Other studies, as stated by Dr. Kristy Sanderson in a 2006 publication, confirm this finding and estimate the risk of a psychiatric disorder in a high-demand, low-control setting at 24 to 63 per cent.

Effort Reward Model

This concept refers to the rewards you receive for your work efforts. In other words, you take on certain responsibilities, have to meet deadlines and accept a specific workload.

The reward can be in the form of money, holiday time, advancement opportunities and acknowledgement of your work. A mismatch in the ratio can lead to mental illness. An imbalance in the effort-reward model seems to affect men more than women.

Organizational Justice

This term, as defined by Sanderson, refers to fairness of workplace processes. There are two components. The first, procedural justice, refers to whether your organization does what it says and to what degree you are included in the process. The second is relational justice, which refers to how your workplace goes about carrying out its policies and procedures.

Do you receive considerate and respectful treatment by management? Inadequacy in both these areas seems to affect women more than men.

How Can You Help Yourself?

Safeguard your health. Working impaired can cause you to have poor evaluations because employers assume that when you are at work, you are fit.

Be careful about sacrificing your health for a job. It is nice to feel indispensable. Who is going to look after you when you are redundant? You cannot take care of yourself or anyone else without your health.

Try to remain socially integrated. This may have a protective effect against mental illness. Do not give up your friends and family if they have been supportive.

You can work hard, but be sure to maintain a life balance. Take the time to cultivate your emotional needs, maintain your physical health, pursue spiritual well-being and advance your intellectual capacities. You may not be able to outrun the impending emotional storm living a skewed life. Your body is less forgiving as you age.

Focus on what is within your control. You can do this by educating yourself about mental illness and mental health. Take time to reflect on what is happening at home and at work.

Anxiety and depressive disorders are disabling medical conditions. As medical conditions, they require active treatment. Taking stress leave from work can be a crisis intervention technique, but it is not a long-term treatment for an anxiety or depressive disorder.

Avoid medicalizing workplace problems. Address them with the appropriate occupational professionals.

Psychiatry has come long way from the 'couch'

Although you would have meant it in a colloquial sense, the term "psychiatrist's couch," could be misleading and in fact keep patients away from seeing a psychiatrist.

The stigma of mental illness is less now, yet some people are embarrassed or even humiliated at the thought of seeking help for mental illness.

Ironically, the very couch that was ubiquitous in the past has fallen into disrepute and has become almost extinct. Hence, it is almost impossible to find a couch now apart from those seen on TV, in cartoons and in the offices of some psychoanalysts. (Therapists exploring the mind to uncover conflicts, inadequacies, fantasies, etc.).

THANKS TO THE media, the public still thinks that the typical psychiatrist sits beside the couch, taking down notes, scratching his beard and analysing dreams and sexual fantasies. Some think Freud, Jung and their disciples' teaching is the basis of psychiatric treatment.

Their teaching was the basis of psychoanalysis and this procedure is not quite effective in treating many mental conditions and is not cost effective (Some analysts take 1-5 years or even a lifetime to "treat" patients).

Some feel there is no scientific basis at all in psychoanalysis. Nowadays, psychiatrists deal with patients with severe depressive illness, anxiety states, panic disorder, agoraphobia, schizophrenia, manic depression, Alzheimer's, etc.

In addition, psychiatrists have to assess patients at emergency departments suffering from overdoses, confusional states, etc. and assess patients who are hospitalized and develop mental abnormalities secondary to medical, surgical conditions, following childbirth or as complications of medications given for various illnesses.

ALL PSYCHIATRIC conditions require thorough assessments and may need treatment with a combination of counselling, psychotropic medications, behavior modification (changing maladaptive behavior) and cognitive therapy (changing negative thinking, poor self-image).

This is the real world and psychiatrists in a city such as Windsor, which is understaffed, have to treat numerous patients on a daily basis.

In the past few years, management has become difficult with the mental health legislation. Severely disturbed patients have the right to refuse treatment and the public wants some patients to be locked up, others released to the community and the decisions taken in these instances won't please all affected parties.

TREATMENT OF mental illness is complex, time consuming and can be frustrating. Most patients with appropriate treatment "recover" anywhere from two weeks to three months, so that they can function in society and possibly return to employment. This category of patients include those with suicidal acts, stress states, minor depression, anxiety states and panic disorder.

Those suffering from more severe conditions such as major depression (chemical depression) bipolar disorder (manic depression), confusional states and severe anxiety states may take a longer time to recover. Unfortunately, some patients never make a recovery so as to return to productive employment, but with rehabilitation they can function in society.

There has been a revolution in psychotropic medications in the last decade. A number of medications are available to control the symptoms of schizophrenia and other psychotic states. More than a dozen anti-depressants are available with fewer side effects.

A NUMBER OF medications are used to treat anxiety states and panic disorder. Medications can also be useful in the treatment of obsessive compulsive disorder (OCD), agoraphobia, eating disorders (anorexia and bulimia), confusional states (Alzheimer's disease and others), etc: Research is conducted worldwide to find newer drugs that are more effective, more specific and with the least side effects.

Some medications have received bad publicity, like the recent cases involving Fluoxetine (Prozac) and Triazolam (Halcion). Some people have the misconception that medications are "pep pills," "uppers," "downers," etc.

The current view is that major psychiatric illnesses such as schizophrenia, major depression and panic disorder, arise as a result of abnormalities of neurotransmitters (chemicals that conduct nerve impulses) and not because of childhood or environmental factors although these could modify the course of illness.

Prior to the discovery of medications there was no "cure" for conditions such as schizophrenia or manic depression. These patients were either locked up in institutions, kept at home by the family or drifted down the social scale ending up homeless and with some committing suicide.

Although the arrival of medications brought new hope to suffering patients it also brought gloom to certain therapists whose ineffective therapies were threatened with a fear of losing their business. Hence the demise of psychoanalysis and "treating patients on the couch."

Fortunately there has been a renaissance in psychiatry with the arrival of new treatment strategies and the emergence of a new generation of psychiatrists who have an eclectic approach using a combination of all modes of available treatment.

The public can be reassured that when visiting a psychiatrist now, you would not be "put on the couch and analysed," as in the past, but a practical approach will be taken to cure the emotional problems quickly.

The ideal treatment of mental illness requires a multidisciplinary approach where psychiatrists, psychologists, social workers and other professionals have to work together for the welfare of the patient.

Teen depression: Many factors lead to anxiety, sadness

Heredity, family relationships, anxiety and tragic events can all contribute to a teenager's spiral into depression.

That's why all of those elements must be examined in treating a teen diagnosed with depression, says child psychiatrist Dr. Sheik Hosenbocus.

"It used to be very hard to treat depression. It's still a grey area," he said.

"It's not just drug therapy. You have to look at all the issues. So to treat a depressed adolescent you may need a whole team."

Some teens have a lot of anxiety, which can make them more vulnerable to depression because their fears are intensified and their failures seem greater.

Others inherit their anxiety and depression or can develop these characteristics as a result of a family that's too distant or too close.

Teens are at a point in their lives where they feel a need to rely on parents while being pulled to develop on their own. They need positive reinforcement, and problems at school or with their peers can be devastating.

Hosenbocus said an honor roll student can suddenly slide into sadness in the higher grades, when it gets difficult to keep up the same marks that have become expected.

Depression takes different forms, including a mild, chronic type known as dysthymia, major depressive disorder, bipolar disorder and seasonal depression.

There are criteria used to diagnose clinical depression. Generally, the symptoms include at least two weeks of a depressed or irritable mood, or loss of interest in most things.

This is coupled with at least four of the following signs: Change in appetite or weight, insomnia or oversleeping, agitation or slowing down, fatigue or loss of energy, sense of worthlessness or guilt, decreased concentration or indecisiveness and recurring thoughts of death or suicide.

Psychotherapy and medication are often used in combination to treat depression.

Debbie Nordin, a child and youth therapist with Mental Health, said kids face a different world than the previous generation and don't have time to cope with all the changes.

More parents are separating or divorcing, families move more frequently, jobs are hard to get, universities and colleges are raising tuition and requirements and teens are more likely to face the deaths of loved ones because people live longer, she said.

Along with therapy, friends and family can help a teen who has sunk into depression.

First, tell the teen you're worried.

"Half the time, they're relieved someone's noticed," said Nordin.

Therapists also recommend parents be good listeners and try to help find solutions.

Overweight people not so jolly: suffer depression, live shorter lives

Unlike the stereotype that heavy people are jollier, obese people are more likely to suffer a range of psychiatric disorders, a large new study concludes.

U.S. researchers who studied more than 9,000 people found obesity was associated with a 25-per-cent increase in odds of major depression, bipolar disorder (manic-depressive illness) and panic disorder.

There were no significant differences between the sexes, but the relationship between obesity and mental illness was strongest in people with more education and higher incomes.

"We conclude that obesity is meaningfully associated with a range of common mood and anxiety disorders in the general U.S. population," the team, which included researchers from Harvard Medical School, reports in this month's issue of the journal, Archives of General Psychiatry.

What the study doesn't answer is what comes first -- obesity, or the mental illness. But, "it probably goes in both directions," lead author Dr. Gregory Simon, a psychiatrist at Group Health Co- operative in Seattle, said in an interview.

According to the study, rising rates of obesity are expected to produce an "unprecedented decline in life expectancy in the United States."

Nearly half of all adults in Canada are overweight or obese, and 26 per cent of Canadian children and teens aged two to 17 are overweight or obese.

Obesity has been linked to a litany of physical problems, including heart disease, stroke, type 2 diabetes, high blood pressure, arthritis, aggressive prostate cancer, kidney stones and certain cancers.

Less well known is its impact on the psyche.

The study was part of a large national survey of mental disorders in the U.S. Researchers conducted in-person interviews with 9,125 people between February 2001 and February 2003. Mental disorders were assessed using a World Health Organization diagnostic interview, and diagnoses included major depression or bipolar disorder, anxiety disorders, such as panic disorder, agoraphobia without panic, or generalized anxiety disorder and substance-use disorders.

The average age was about 45. People with a BMI, or body mass index, of 30 or higher, based on their self-reported height and weight, were about 25 per cent more likely than those with a BMI under 30 to have a mood disorder, "which indicates that nearly one- quarter of the cases of obesity in the general population are attributable to the association with mood disorder," the researchers report.

The absolute increase was modest. The lifetime risk of depression is about 20 per cent. Among those who are obese, that likelihood jumps to 28 per cent.

The finding is statistically significant, Simon says. "It was not a chance finding."

As well, "even these modest associations carry public health significance," according to the researchers, given the high rates of obesity and mood or anxiety disorders in the general population.

Among people with post-secondary education, "the association may be as high as 44 per cent."

Common symptoms of depression include increased appetite and weight gain, and drugs used to treat depression or anxiety disorders can also lead to weight gain.

It's also true that the effects on self-esteem and the stigma attached to obesity may lead to depression, especially in women and groups where obesity is less socially acceptable, Simon says.

"But in groups where it is less stigmatized, obesity doesn't seem to be as depressing."

It's also possible that depression and obesity may be linked "through some common cause or third factor, either environmental (child abuse, for example) or biological," his team reports.

Simon says that if a doctor sees someone in his or her office who is overweight or obese, "there is a significant likelihood this person may have depression or anxiety problems" that may make it tougher for them to lose weight.

The study found obese people were 25 per cent less likely than the non-obese to have a substance-use disorder. It may be the overweight people are more likely to respond to stress by overeating, Simon says.