THIRD-GENERATION AND SPECIAL ANTIDEPRESSANTS

BRAND NAME (GENERIC NAME)	HOW THE DRUG WORKS	SPECIAL USES	DAILY DOSE
Desyrel (Trazodone)	Serotonin 2 antagonist	Insomnia—the drug of choice for insomnia because it is not addicting and boosts serotonin which often is the reason for insomnia. Very useful for alcoholics and drug abusers.	50-600 mg
Effexor XR (venlafaxine)	Boosts serotonin (and norepinephrine in doses greater than 150 mg)	Energizing antidepressant, generalized anxiety, panic disorder, chronic pain (at doses of 225 mg or higher). Taper dose slowly when discontinuing med.	75-300 mg
Cymbalta (duloxetine)	Boosts serotonin and norepinephrine in equal amounts	Energizing antidepressant, peripheral neuropathy, fibromyalgia, chronic pain, stress urinary incontinence	60 mg
Wellbutrin XL (bupropion)	Boosts dopamine and norepinephrine	Activating and motivating antidepressant, useful in cocaine-induced depression, improves cognitive slowing, reverses SSRI-induced sexual dysfunction, reduces craving during smoking cessation	150-450 mg
Remeron (mirtazapine)	Blocks alpha 2 adrenergic presynaptic receptors, blocks 5HT2A, 5HT2C, 5HT3 serotonin receptors	Boosts usefulness of Effexor XR, improves appetite, insomnia and anxiety. Good med for nausea because of 5HT3 effects. Ideal patient for this med is depressed, skinny, sleepless and anxious (or sad, skinny, sleepless and scared).	15-45 mg

CHOOSIING AN ANTIDEPRESANT BASED ON NEUROTRANSMITTER FUNCTION

            Currently three neurotransmitters—serotonin, norepinephrine and dopamine—have been implicated as the most important neurotransmitters in depression. Depletion of these neurotransmitters cause specific symptoms that can help the physician choose which antidepressant would be the first choice for each patient.

Symptoms of Neurotransmittor Depletion

SEROTONIN LOSS	NOREPINEPHRINE LOSS	DOPAMINE LOSS
Anxious depression	Lethargic depression	Joyless depression
Waking during night	Restless sleep	Sleeping too much
Panic symptoms	Worry	Apathetic
Obsessions and compulsions	Feeling tired all the time	No motivation
Anger, irritability	Lethargic	No pleasure
Traumatic dreams	Run down feeling	Decreased sexual drive and function
Flashbacks	Chronic pain symptoms	Poor concentration & attention

Specific Medications that primary work on the “Big” three neurotransmitters

SEROTONIN	NOREPINEPHRINE	DOPAMINE
Prozac	Effexor XR (“pure” serotonin med at doses below 150 mg daily; in doses higher than 150 mg increases both norepinephrine and serotonin)P	Wellbutrin XL
Paxil-CR	Cymbalta (Boosts serotonin & norepinephrine in equal amounts)	Vivactil
Zoloft	Norpramin
Celexa	Pamelor
Lexapro	Vivactil
Remeron

The Unseen

Although on the outside it looks like things are falling apart, on the inside God is making new life. The things we see now will be gone tomorrow, but the things we can't see will last forever. Christ's love surpasses anything any of us can do. He included everyone in his death so that everyone could also be included in his life, a resurrection life, and a far better life than people ever lived on their own. The love of Jesus comforts us with the assurance that the horrible times we experience on earth are temporary, but the unseen times are eternal and glorious.

The Power of the Unseen

While I was showering, a persons name popped into my head. I didn’t know this person well at all, had met her a few times at church, had seen her in the church choir, but her name suddenly came to mind. After I had finished showering and toweling off, I decided, feeling rather foolish, to give her a call. With some trepidation, I found her phone number in the church directory, and punched in the numbers. When she answered the phone, I introduced myself. I told her that her name had inexplicable come into my mind, and I wondered if she might be having trouble in her life. She immediate broke into tears and told me that her mother had died last night.

 

What is seen is temporary what is unseen is eternal

A Prose Ode

I am going to miss you so much. I can always depend on you for the truth (kindly told). I can count on your devotion to follow through and your good cheer when helping me. No one is irreplaceable, but you come close. The work you do for the clinic is unbelievably difficult, but you carry it off with the panache of a Musketeer (per Dumas, not Disney). 

Therapies for Treatment Resistant Depression

Therapies for Treatment Resistant Depression

Approximately 17% of individuals—nearly one out of five people— experience a major depressive episode during their lifetime. Many of these patients are unrecognized or receive inadequate treatment. A few definitions will help in understanding treatment-resistance:

Nonresponse—no clinically meaningful response. One-third of patients given one antidepressant will fail to show any meaningful improvement.

Partial response—25-50% improvement in symptoms.

Treatment response—50% or greater improvement in symptoms.

Remission—absence of virtually all psychopathology.

Inadequate epidemiological research obscures the number of patients who experience a partial response or a treatment response. Patients may be satisfied with a partial response because the think “this is as good as it can get.” The goal for all treatment, however, should be full remission.

A simple test can help the physician follow the response to treatment. The physician can ask,”On a scale of zero to ten with zero being the worst you have ever felt and 10 being the best you have ever felt, how would you rate yourself?” The goal—a nine or a ten following an adequate course of treatment. If the patient fails to progress the physician has several options to improve outcome:

1. Raise the dose of the antidepressant. Unfortunately some antidepressants have a flat dose-response curve, so after a certain dose has been reached, raising it will have no further effect on symptoms.
2. Switch to another antidepressant. Switching from an SSRI to a different type of agent may be effective. Switching from one SSRI to another may be effective as well.
3. Add psychotherapy. For mild to moderate depression, Cognitive Behavior Therapy has been show to be just as effective as antidepressant medication. CBT in combination with medication is powerful.
4. Switch to a dual-mechanism antidepressant. A decrease in the firing activity of noradrenergic locus ceruleus neurons has been noted after three weeks of SSRI administration. This action may explain why the SSRIs are effective treatments for anxiety disorders. This decrease may also explain why some depressed patients respond to dual-action antidepressants or augmentation with other agents.
5. Combine two antidepressants. Disadvantages of combination (and augmentation) include increased cost and decreased compliance.
6. Augment with another medication.

·      Add a second generation neuroleptic. Atypical antipsychotics may augment antidepressants by increasing norepinephrine activity.

·      Add a mood stabilizer. Depressed patients may have a bipolar disorder and the manic phase of the illness has not yet emerged.

7. Recommend ECT.  ECT remains the most effective treatment for severe depression but is seldom used because of stigma and misinformation.
8. Emerging therapies. Transcranial magnetic stimulation, vagus nerve stimulation and deep brain stimulation may prove effective.

Life Is Difficult

Over the course of a lifetime almost 1 of 3 experience a major mental disorder.

U.S. employers spend $150-$200 Billion annually on stress and anxiety.

52% of Americans say work is the main cause of stress in their lives.

48% say home stress is the main cause of decreased work productivity.

Paper Shred Work

Authorities told a friend who was president of a bank (I believe it was Conroe) that he had to keep real estate records for 15 years, but he could destroy the others by shredding. (for some reason authorities disallowed incineration). Anyway, he started shredding records that were 15 years old or older. It took the shredding company using a huge industrial shredder working 8 hours a day Monday-Friday five (yes, five) months to shred all the records. This was a relatively small bank--think of all the records in Houston, say, that are over 15 years old--what a massive task; could they ever finish? 

One other question—who were those authorities?

The authorities I know always increase paperwork. The Joint Commission of Health Care Paperwork always find some sort of record keeping that must be added every time they inspect a hospital. If a hospital is found in total compliance with all the rules and regulations, never mind. The joint commission will invent a regulation that must be added to the rules. After all, the Joint Commission members have to justify their jobs. If they find nothing out of compliance, they may be deemed useless. I already deem them useless, but I am no bureaucrat.

 

 

Utility Numbers for New MOVE

UTITLITY INFO

Water, sewer, and garbage = will be turned on

           

            Town of Christiansburg                         540-382-6128

            100 East Main St.

 Water                                                                        540-382-9519

 

Atmos Energy (Gas)                                                540-951-9184

                                                                        540-639-1662 (local)

 

All connect                                                            866-269-4825

Ø    Account number = 8785582

 

AEP (Power) will be turned on Sept 23            800-956-4237

Ø    AEP account number = 02462166832

 

Verizon Phone                                                            540-954-6222

Ø    Our land line number is 540-381-2898

Ø    Cost = $49.99

Ø    Verizon Internet confirmation number = 779218096

 

Direct TV                                                            800-488-5069 or 628-5175

Ø    Account number = 81655270

Ø    Will be connected from 0800-1200 AM on October 1

Ø    Will get about 200 channels for $39.95 if file for two rebates

o      After activation of TV go to internet and enter DirectTV.com/rebate give the account number (81655270) and apply for rebate

o      The go to www.dstvgift.com and print off a form and complete form and mail in and will get first 6 months of free internet for $29.99 after that

 

Mowing = Harvey @ First Impressions            540-392-7783

 

Roanoke Times                                                540-381-1655

 

Jet Broadband Cable                                                1-877-743-8538

 

Internet NRV Unwired                                    540-239-0318           

 

$1300 rent due the first of each month to Oak Tree Town Homes

Ø    I E-mailed Wende this info

Ø    Jim Wesel 540-382-5885                        

Vacation Day-By-Day

            Vacation, a time of rest and freedom from work, can be experienced each and everyday. Duke University psychiatrist, John Rhoads, MD, studied successful, effective, and healthy executives who worked at least sixty hours weekly and compared these individuals with executives who developed burnout from working over sixty hours weekly. The following table summarizes those findings.           

THOSE WHO EXPERENCE WORK SUCCESS	THOSE WHO EXPERIENCE WORK BURNOUT
Postpone thinking about problems	Ruminate about work problems
Take time off when productivity begins to diminish	Take their computer and cell phone on their vacations to keep-up with work activities
Use exercise, hobbies, and sports to deal with work stress	Use drugs or alcohol to deal with work stress
Enjoy scheduled vacations	Tend to postpone vacations
Cultivate a stable family life	Spend very little time with their family
Maintain friendships	Have a difficult time cultivating friendships
Exercise regularly	Watch television regularly
Have varied interest outside of work	Feel uncomfortable away from work
Can laugh at themselves	Take life and themselves too seriously

The Self-induced Workload

A self-induced increased workload causes deterioration in marriage and family life, undermining the main source of non-work related support. Likewise, avoiding vacation time leads to a decline in efficiency and initiative resulting in an increasing spiral of mistakes and complaints from associates and customers. Paradoxically, those people who overwork rather than earning praise for their dedication eventually receive criticism from family, colleagues, and employers.

Usually those who fail to take regular vacations become unproductive, cynical, negative, rigid, and inflexible. Accompanying poor work performance is the inability to have fun. The harder one works the more difficult it is to relax.

Fun at Play

There are individual differences for the need for vacation time. Some people become bored when they are away from the office too long. Others begin to lose a sense of worth when on extended vacations. Balance is the key to the successful use of vacations. Here are some ideas both for benefiting from vacation time:

Ø    Schedule vacations and keep them.

Ø    Quit work early or take time off when fatigue builds. Sustained effort toward a goal is best balanced with laughter and play.

Ø    Plan an occasional long weekend away from work.

Ø    Returning to work tired after a vacation or time off indicates the wrong approach to leisure time.

Ø    Have you ever noticed how people on the tennis court or the golf course shout and act as if they are fighting allieverybody around them. Those who enjoy life, play for the fun of playplaying for the fun, they play better. Play—-free and spontaneous activity—-emphasizes enjoyment not achievement.

o     Emotion, not effort, enhances play. Attitude, not activity, determines whether we work or play.

o     Leisure activity should be fun, not a drain on the emotions.

o     Sports and games should bring more laughs than frowns.

Ø    Every day ask yourself, "Am I having fun yet?"

o      Surround yourself with people who fill you with joy and laughter.

o      Be an inverse paranoid-think the world is out to do you good. Decide to be hopeful and fun loving.

o      Don't take yourself so seriously. Those people who have a cosmic view of life cultiallows them to tolerate outrageous fortune. They laugh at themselves and their situations. They develop a "hang-loose" philosophy of life.

o      Read or listen to humor regularly.

o      Keep a humor scrapbook.

o      Marry someone who thinks everything you say is funny.

o      When a situation becomes stressful, pretend it's all a Candid Camera episode.

o      Practice LOL—it's internal jogging.

o      Remember: He who laughs, lasts. A sense of humor - that goes beyond joke telling at oneself and life's absurdities. When we learn to "think funny" our life becomes enriched with friends and fellowship.

o      Play golf. Golf is just like life: Difficult and unfair. Par is 18 laughs a round.

Ø    Cultivate creativity. Creative people see connections between things when others see separation. Creativity requires knowledge, for many creative ideas come from old concepts rearranged in a new way.

o      Break the rules by questioning the reasoning behind them. Alexander untied the Gordian knot by chopping it in half while others had failed for centuries because they followed the rule and tried to untie it.

o      Ask "what if' questions. Einstein conceived the theory of relativity by asking, "What if I could ride a light beam?"

Taking the Worry out of Work: Setting the Pace for Success

Attitude is everything

Enjoy your work

Determine your destiny

Make the most of your time

Cultivate good habits

Help others feel important

Sparkle spiritually

Causes of the Vacation-less Life

A vacation-less life may be caused, in part, by cultural factors. Emotional conflicts that contribute to the overwork syndrome may be associated with the following:

Ø    Compensation for feelings of inferiority or insecurity

Ø    Identification with a demanding parental expectations

Ø    Recompense for physical limitations such as poor health or aging

Ø    A solution for prob lems of aggression and guilt

Ø    A need for approval

Ø    Excessive competitive drive

Ø    An attempt to enhance self-esteem

Ø    The desire to improve social status

Ø    The need for excessive financial gain

Ø    A fascination with the accumulation of material objects

Ø    The inability to refuse the requests of others

Ø    Self-imposed demands for perfection     

Attitude

Emotion is created by motion

Always verbalize the positive

Act “as if”

Change your environment so your environment is empowering

Vacation Poor

Research clearly demonstrates that an annual vacation significantly cuts risks of most diseases by 20-30 percent. The Multiple Risk Factor Intervention Trial of 12,000 American men revealed that during a 5-year study period those who took the most vacations had 20 percent less risk of dying from any cause than those who took the fewest vacations. A 1999 Dutch study found that overcommittment to work without an annual vacation increased physical and emotional illnesses.

A study by the World Tourism Organization study showed that vacation time for Americans lags well behind other industrialized countries. The WTO listed the average annual vacation days by country as follows: Italy (42), France (37), Germany (35), Brazil (34), Britain (28), Canada (26), South Korea (25), Japan (25), the United States (13).                         

More than one third of Americans fail to use their full vacation times. Of those who do take full time away from their regular jobs much of their vacation time is spent on activities other than rest and relaxation:

Ø    19 percent spend their vacation time on family or personal responsibilities, including illness, funerals, caring for sick children or parents

Ø    Another 13 percent spend vacation time going to school, working at another job, or participating in reserve military service.

Ø    One in five vacationers are contacted about work matters during non-work times

Ø    23 percent of employed adults in the United States report checking work email or voicemail while vacationing    

Enjoy Your Work

Three secrets of a long and happy life

1.Do you enjoy your work?

2.Do you have something to look forward to?

3.Does someone love you that you love in return?

The difference between happiness and joy--happiness depends on happenings, joy depends on spiritual contentment

The greatest risk is not taking one

VACATION VALUES

            Research clearly demonstrates that an annual vacation significantly cuts risks of most diseases by 20-30 percent. The Multiple Risk Factor Intervention Trial of 12,000 American men revealed that during a 5-year study period those who took the most vacations had 20 percent less risk of dying from any cause than those who took the fewest vacations. A 1999 Dutch study found that overcommittment to work without an annual vacation increased physical and emotional illnesses.

            A study by the World Tourism Organization study showed that vacation time for Americans lags well behind other industrialized countries. The WTO listed the average annual vacation days by country as follows: Italy (42), France (37), Germany (35), Brazil (34), Britain (28), Canada (26), South Korea (25), Japan (25), the United States (13).                         More than one third of Americans fail to use their full vacation times. Of those who do take full time away from their regular jobs much of their vacation time is spent on activities other than rest and relaxation:

Ø    19 percent spend their vacation time on family or personal responsibilities, including illness, funerals, caring for sick children or parents

Ø    Another 13 percent spend vacation time going to school, working at another job, or participating in reserve military service.

Ø    One in five vacationers are contacted about work matters during non-work times

Ø    23 percent of employed adults in the United States report checking work email or voicemail while vacationing           

Causes of THE VACATION VOID

            A vacation-less life may be caused, in part, by cultural factors. Emotional conflicts that contribute to the overwork syndrome may be associated with the following:

Ø    Compensation for feelings of inferiority or insecurity

Ø    Identification with a demanding parental expectations

Ø    Recompense for physical limitations such as poor health or aging

Ø    A solution for prob­lems of aggression and guilt

Ø    A need for approval

Ø    Excessive competitive drive

Ø    An attempt to enhance self-esteem

Ø    The desire to improve social status

Ø    The need for excessive financial gain

Ø    A fascination with the accumulation of material objects

Ø    The inability to refuse the requests of others

Ø    Self-imposed demands for perfection           

PROBLEMS ENGENDERED BY LACK OF VACATION TIME

            A self-induced increased workload causes deterioration in marriage and family life, undermining the main source of non-work related support. Likewise, avoiding vacation time leads to a decline in efficiency and initiative resulting in an increasing spiral of mistakes and complaints from associates and customers. Paradoxically, those people who overwork rather than earning praise for their dedication eventually receive criticism from family, colleagues, and employers.

             Usually those who fail to take regular vacations become unproductive, cynical, negative, rigid, and inflexible. Accompanying poor work performance is the inability to have fun. The harder one works the more difficult it is to relax.

FINDING BALANCE BETWEEN WORK AND VACATION TIME

There are individual differences for the need for vacation time. Some people become bored when they are away from the office too long. Others begin to lose a sense of worth when on extended vacations. Balance is the key to the successful use of vacations. Here are some ideas both for benefiting from vacation time:

Ø    Schedule vacations and keep them.

Ø    Quit work early or take time off when fatigue builds. Sustained effort toward a goal is best balanced with laughter and play.

Ø    Plan an occasional long weekend away from work.

Ø    Returning to work tired after a vacation or time off indi­cates the wrong approach to leisure time.

Ø    Have you ever noticed how people on the tennis court or the golf course shout and act as if they are fighting alli­gators in a swamp? If they aren't having a terrible time, they're certainly making life miserable for everybody around them. Those who enjoy life, play for the fun of play­ing. Paradoxically, when they're playing for the fun, they play better. Play—-free and spontaneous activity—-emphasizes enjoyment not achievement.

o     Emotion, not effort, enhances play. Attitude, not activity, determines whether we work or play.

o     Leisure activity should be fun, not a drain on the emotions.

o     Sports and games should bring more laughs than frowns.

Ø    Every day ask yourself, "Am I having fun yet?"

o      Surround yourself with people who fill you with joy and laughter.

o      Be an inverse paranoid-think the world is out to do you good. Decide to be hopeful and fun loving.

o      Don't take yourself so seriously. Those people who have a cosmic view of life culti­vate a lifestyle that allows them to tolerate outrageous fortune. They laugh at themselves and their situations. They develop a "hang-loose" philosophy of life.

o      Read or listen to humor regularly.

o      Keep a humor scrapbook.

o      Marry someone who thinks everything you say is funny.

o      When a situation becomes stressful, pretend it's all a Candid Camera episode.

o      Practice LOL—it's internal jogging.

o      Remember: He who laughs, lasts. A sense of humor - that goes beyond joke telling ­embraces laughing at oneself and life's absurdities. When we learn to "think funny" our life becomes enriched with friends and fellowship.

o      Play golf. Golf is just like life: Difficult and unfair. Par is 18 laughs a round.

Ø    Cultivate creativity. Creative people see connections between things when others see separation. Creativity requires knowledge, for many cre­ative ideas come from old concepts rearranged in a new way.

o      Break the rules by questioning the reasoning behind them. Alexander untied the Gordian knot by chopping it in half while others had failed for centuries because they followed the rule and tried to untie it.

o      Ask "what if' questions. Einstein conceived the theory of relativity by asking, "What if I could ride a light beam?"

A DAY-BY-DAY VACATION: PREVENTING OVERWORK

            Vacation, a time of rest and freedom from work, can be experienced each and everyday. Duke University psychiatrist, John Rhoads, MD, studied successful, effective, and healthy executives who worked at least sixty hours weekly and compared these individuals with executives who developed burnout from working over sixty hours weekly. The following table summarizes those findings.           

THOSE WHO EXPERENCE WORK SUCCESS	THOSE WHO EXPERIENCE work burnout
Postpone thinking about problems	Ruminate about work problems
Take time off when productivity begins to diminish	Take their computer and cell phone on their vacations to keep-up with work activities
Use exercise, hobbies, and sports to deal with work stress	Use drugs or alcohol to deal with work stress
Enjoy scheduled vacations	Tend to postpone vacations
Cultivate a stable family life	Spend very little time with their family
Maintain friendships	Have a difficult time cultivating friendships
Exercise regularly	Watch television regularly
Have varied interest outside of work	Feel uncomfortable away from work
Can laugh at themselves	Take life and themselves too seriously

 

DO YOU KNOW HOW TO HAVE FUN?

	LITTLE OF THE TIME 1-pt/each √	SOME OF THE TIME 2-pt/each √	A LOT OF THE TIME 3-pt/each √	MOST OF THE TIME 4-pt/each √
I enjoy hobbies without feeling guilty about not working.
I am optimistic and cheerful.
I surround my self with happy, positive, and fun-loving people.
I correct my mistakes and blunders, but don’t continue to worry about them
I take a long weekend away from work when I begin to feel burned out and tired.
Leisure activity helps me feel rested.
Sports and games bring me more laughs than frowns because I play to have fun not necessarily to win.
I enjoy creative play—dancing, painting, party games, playing a musical instrument, etc.
I laugh at least once a day.
I take vacations without worrying about the job.
Multiply √ by the value given in each column

 

Add the total for each column to get the GRAND TOTAL = ________

Scoring

10-14 points = President of Eeyore International

15-24 points = Party pooper

25-34 points = Fun to be around

34-40 points = Life of the party