What is Generalized Anxiety Disorder?

People with generalized anxiety disorder (GAD) go through the day filled with exaggerated worry and tension, even though there is little or nothing to provoke it. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. Sometimes just the thought of getting through the day produces anxiety.

GAD is diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months. People with GAD can't seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can't relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes.

When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don't avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.

GAD affects about 6.8 million adult Americans and about twice as many women as men. The disorder comes on gradually and can begin across the life cycle, though the risk is highest between childhood and middle age. It is diagnosed when someone spends at least 6 months worrying excessively about a number of everyday problems. There is evidence that genes play a modest role in GAD.

Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. GAD is commonly treated with medication or cognitive-behavioral therapy, but co-occurring conditions must also be treated using the appropriate therapies.

For more information about anxiety disorders, visit the National Institute of Mental Health website @ Anxiety.

FDA Proposes Expanding Antidepressant Suicide Warning

Provided by: Associated PressWritten by: ANDREW BRIDGES Dec. 13, 2006

WASHINGTON (AP) - Antidepressants increase the risk of suicidal behaviour for people up to age 24, the government said Wednesday. It plans new warning labels, and says users of all ages should be closely monitored.The label change proposed Wednesday would expand a warning now on the antidepressants that applies only to children and adolescents.The Food and Drug Administration presented its plan to update the drug labels at a meeting of outside advisers on the issue. They endorsed the plan.The FDA also stressed that patients of all ages should continue to be carefully monitored for signs of suicidal tendencies when they are beginning treatment on the drugs.

Public reaction was split, with some saying the changes were overdue and others arguing they could keep drugs from those who need them.In emotional testimony illustrated at times by slides of family photos, relatives of suicide victims pleaded for the new warnings.Suzanne Gonzalez, shouting and in tears, goaded the panel to action, telling the experts that her 40-year-old husband who had been taking Paxil shot himself."I wake up every morning thinking, 'Oh my God, he's dead. He is freaking dead.' Do you wake up and think, 'How many people are going to die today because I am doing nothing?"' Gonzalez asked.Still, mental health experts worry that additional warnings could curtail use of the drugs and ultimately do more harm than good.Dr. John Mann, a Columbia University psychiatrist, suggested simply replacing the proposed expanded warnings with the recommendation that doctors more closely monitor their patients."We can do more good by providing more treatment for depressed children and adults," Mann said.

The FDA proposed the changes after completing a review that found use of the drugs may increase the risk of suicidal thoughts and behaviour among young adults 18 to 24, as well as among younger patients.Psychiatrists testified Wednesday that the 2004 addition of a warning for children led to a falloff in antidepressant prescriptions being written for patients under 18 - and an increase in suicides in that age group.Still, overall use of antidepressants continues to grow, with nearly 190 million prescriptions dispensed in the United States last year, according to IMS Health, a health care information company.

That suggests doctors have placed more weight on the long-term benefits of the drugs than on any short-term risks, said Dr. Thomas Laughren, director of the FDA's division of psychiatry products.Expanding the "black box" or other warnings on the drugs could dissuade patients from seeking or starting treatment, mental health experts said. They warned that people with untreated depression - about half of those who suffer from the disease - face an estimated 15 per cent greater likelihood of death by suicide.

Dr. Joseph Glenmullen, a Harvard Medical School clinical instructor in psychiatry and author of "Prozac Backlash," said expanding the warnings wouldn't scare off patients, but instead would allow them to make informed choices.The FDA recently completed a review of 372 studies involving about 100,000 patients and 11 antidepressants, including Lexapro, Zoloft, Prozac and Paxil.When the results were analyzed by age, it became clear there was an elevated though small and short-term risk for suicidal thoughts and behaviour among adults 18 to 24, the FDA said in documents released ahead of Wednesday's meeting of its psychopharmacologic drugs advisory committee.The FDA's analysis of the multiple studies suggests an age-related shift in the risk of suicidal thoughts and behaviour associated with treatment with the drugs. For instance, antidepressants seem to protect against suicidal thoughts and behaviour in adults 30 and older, with the effect most pronounced in patients over 65.

The FDA said the increased risk could mean as many as 14 additional cases of suicidal thoughts or behavior in every 1,000 children treated with antidepressants. For adults 18 to 24, there could be four additional such cases per 1,000.

In May, GlaxoSmithKline and the FDA warned Paxil may raise the risk of suicidal behaviour in young adults and added that to the drug's label."Anytime suicide is involved it is a tragic outcome. It is one of the things that keeps us motivated to search for better treatments because depression can be treated.

Self-Disclosure & Healing

As therapists, we generally are cast as the support-person, the listeners, the helpers, the objective re-framers and other client-focused “providers”. Clinicians, some more than others, tend not to self-disclose much with their clients; some prefer to keep their own feelings, life trials and even personal mental health experiences separate from the therapy relationship. Like most aspects of the client-therapist relationship there are no real hard and fast boundaries about how to act, what to say, what to reveal, when to set limits, etc; it is the art of therapy and the clinician experience that determines how the relationship develops.

Therapist self-disclosing can be an effective teaching opportunity that has real, human information and it can be a tremendously powerful client-therapist relationship building tool, remembering always that self-disclosure has its limits and the therapy session is for the client. I have personally known clinicians that quickly get caught up in self-disclosure to the degree the roles in therapy become reversed and therapist’s personal issues become the primary focus of the sessions; not good.

For example, recently my family learned my mother has been diagnosed with cancer; she is 76 years old. I am very fortunate to have a loving family with generally healthy siblings and parents; none of us really ever experiencing any tremendous life tragedies. Perhaps this is one reason the “news” has been emotionally devastating to me. My emotions have been flooding in since learning of her cancer diagnosis. I am scared for her, scared for me, scared for my Dad, wondering how I will balance being the ever-supportive “helper” and at the same time taking care of myself. I am preoccupied with all of this, at times finding myself in a daze when driving down the road or other times when I am generally attentive and focused. I have this ever-streaming thought process going on, saying to myself, “I want to know the outcome, I want to fix it, I know I can’t fix it, she’ll pull through this, am I ready to deal with this, how will I deal with this, why?, I will be there for her, she can count on me” and on and on. I know my Mom wants to fight for a cure, fight for more time. I want more time with my Mom yet I want to be unselfish as well. This is one of my life trials, perhaps the biggest yet for me. Deep down I know I can’t control this outcome, I am trying to settle for “maybe I can influence the outcome” through my support to her, my love for her, to my Dad, staying optimistic, praying for her/for us. My partner once told me, “Thoughts are things”. I will be trying to center on healing thoughts.

I hope you can see that struggling is part of our humanness, even healers need to heal and self-disclosure can open the path for others to become helpers too. When you may think that your life-challenges are overwhelming, unbearable or misunderstood, let someone know your pain, your struggle. By allowing ourselves to share our experiences we may influence the nature of our relationships and perhaps even the outcome of our struggle.

New Mother's Suffer from More Than Postpartum Depression

By Lindsey Tanner, Associated Press December 6, 2006

CHICAGO -- New mothers face increased risks for a variety of mental problems, not just postpartum depression, according to one of the largest studies of psychiatric illness after childbirth.

New fathers aren't as vulnerable, probably because they don't experience the same physical and social changes associated with having a baby, the researchers and other specialists said.
The study, based on medical records of 2.3 million people over a 30-year period in Denmark, found that the first three months after women have their first baby is riskiest, especially the first few weeks. That's when the tremendous responsibility of caring for a newborn hits home.
During the first 10 to 19 days, new mothers were seven times more likely to be hospitalized with some form of mental illness than women with older infants.

Compared with women with no children, new mothers were four times more likely to be hospitalized with mental problems.

New mothers also were more likely than other women to get outpatient psychiatric treatment.
However, new fathers did not have a higher risk of mental problems when compared with fathers of older infants and men without children.
The prevalence of mental disorders was about 1 per 1,000 births for women and just 0.37 per 1,000 births for men.

Mental problems included postpartum depression, but also bipolar disorder, with alternating periods of depression and mania; schizophrenia and similar disorders; and adjustment disorders, which can include debilitating anxiety.

The study underscores a need for psychiatric screening of all new mothers and treatment for those affected, said an editorial accompanying the study in today's Journal of the American Medical Association.

Two of the three authors of the editorial reported financial ties to the psychiatric drug industry. The researchers said they had no financial ties to the industry.
They examined national data on Danish residents from around 1973 to July 2005. About 1.1 million participants became parents during the study.

A total of 1,171 mothers and 658 fathers -- none diagnosed with any previous mental problems -- were hospitalized with a mental disorder after childbirth.

Lead author Trine Munk-Olsen, a researcher at Denmark's University of Aarhus, said similar risks for psychiatric problems probably would affect new parents in other developed nations including the United States.

However, differences in screening practices and access to healthcare might influence whether parents elsewhere are hospitalized, she said.
Physical changes after childbirth might partly explain why women are vulnerable, including fluctuating hormone levels, Munk-Olsen said.
These, alone or combined with sleep deprivation and the demands of breast-feeding, could trigger mental problems, she said.

Hard data on the number of women worldwide affected by postpartum mental illness are scant, but postpartum depression alone affects about 15 percent of US women.
The condition made headlines last year when actress Brooke Shields acknowledged taking antidepressants after her first child was born -- and Tom Cruise publicly criticized her for it.
Postpartum mental illness also has been cited as a factor in shocking cases of mothers killing their children, including Andrea Yates's drowning of her five children in Texas in 2001.
Dr. Nada Stotland, a psychiatry professor at Rush Medical College in Chicago, said gender differences in postpartum mental illness are not surprising.
Mothers generally bear the brunt of sleep deprivation, and many new mothers are socially isolated or live far from relatives who could provide support, Stotland said.

© Copyright 2006 Globe Newspaper Company.

Bending without Breaking

As we grow older we become more set in our ways. We can have a tendency to be inflexible and lack the ability to see the world from someone else's point of view. If we can bend our thoughts some and become more flexible we can find more compassion and synchronicity in the universe. Harmony is not created by one musical tone it is created by a blending of tones.

- Jamie Sams

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