Depressed people

 Abraham Lincoln endured recurrent episodes of depression during the years he practiced law and later as President of the United States. When a young man he refused to carry a pocketknife for fear he would kill himself with it. In the play, Hamlet, Shakespeare wrote the famous line describing depression "How weary, stale, flat, and unprofitable seem to me all the uses of this world Edwin E. "Buzz" Aldrin, Jr., the second man to walk on the moon became depressed from the stress of post-flight publicity. In 1972, Senator Thomas P. Eagleton withdrew as a candidate for Vice-President after it was revealed that he had been hospitalized three times for depression and received shock therapy twice. 

Laughter

Have you ever noticed how some golfers 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. In addition, humor can be a beneficial antidote against anxiety, stress, tension, and depression that contributes to physical ill­ness.

    Here are some suggestions for playing better golf and living a better life:

v     Decide to be hopeful and fun loving.

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

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

v    Be an inverse paranoid—think the world is out to do you good.

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

v    Read or listen to humor regularly.

v    Keep a humor scrapbook.

v    Marry someone who thinks everything you say is funny.

v    Understand that few things are absolute or sacred.

v    Think funny.

v    Be a little sillier.

v    Find the absurdity in life.

v    Watch funny movies and DVDs.

v    Don't take yourself so seriously.

v    Remember: He who laughs, lasts.

v    Laugh out loud—laughter is internal jogging.

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

Psychopharmacology Update Vol 1 No 2

LifeWorks Vol 1 No 2

LifeWorks Vol 1 No 1 page 2

What I've been teaching my kids (and myself) today

Now that the election is behind us (thankfully), this morning I've been thinking
about how it has affected our homeschooling this year. I'm realizing that we have much to
be thankful for, and I'm so grateful for all of the deep discussions I've had with
my family lately. I'm thankful for all of the teachable moments that I've been able to
take advantage of during the last few months. Here are a few thoughts I've shared with my
children today, and where I think we all need to think about going from here:

1) I am so thankful that we live in a country where we are free to vote, free to
homeschool, and free to worship. It was great to see the turnout yesterday. The process
worked. As far as we know, there was very little violence and corruption, and despite a
huge division of beliefs, for the most part the voting went very smoothly and
peacefully. For this we can be thankful!

2) We need to be diligent to continue to pray for our country and for
President-Elect Obama. 1 Timothy 2:1 "I urge, then, first of all, that requests, prayers,
intercession and thanksgiving be made for everyone - for kings and all those in authority, that
we may live peaceful and quiet lives in all godliness and holiness." We may not all agree
with Obama's politics, but we can -- and should -- pray for God to guide his leadership and
for God to bless his time in office.

3) It's time to come together as a country. We have deep differences in
political beliefs, but now that the election is over and the people have spoken, we need to support
and respect our leaders. Romans 13:1-4a "Everyone must submit himself to the
governing authorities, for there is no authority except that which God has established.
The authorities that exist have been established by God. Consequently, he who
rebels against the authority is rebelling against what God has instituted, and those who do so
will bring judgment on themselves. For rulers hold no terror for those who do right, but
for those who do wrong. Do you want to be free from fear of the one in authority? Then
do what is right and he will commend you. For he is God's servant to do you good."
Again, despite political differences, Obama is the man that God has placed as our leader for a
time. We need to respect him and respect the office of the Presidency.

4) Our family has been studying the civil rights issues of the pre-Civil War
period for a few weeks now. We have been reading about the terrible existence of slavery and
the divisions it caused in our nation. How wonderful it is, in light of this study,
to know that we are now at a time in our nation's history where it is possible for a person
of any race or gender to be in the highest office in the land. Despite how you may feel about
Obama, isn't it wonderful to know that we live in a truly free nation? Yes, racism
still exists, unfortunately. Hatred still exists. But this is truly a historic day that
should be celebrated.

5) Finally, this is a wonderful opportunity to show ourselves, as Christians,
as those who are truly full of God's love and grace. Let's walk the talk. In sports, we
teach our children to not to be sore losers. If your choice of candidate did not win last night,
we should at least be graceful, peaceful, and loving to the winners. I think that's what
Jesus would have us do.

Red Flags

RED FLAG: DON’T MISS THESE WARNINGS

[SB-2]

SIGNS AND SYMPTOMS   Dysphoric mood or loss of pleasure in usual activities   At least four of the following:    Change in appetite    Sleep difficulty    Loss of energy    Psychomotor agitation    Decrease in sexual drive    Inappropriate guilt    Indecisiveness    Suicidal thoughts   Duration of symptoms for at least 2 weeks   No evidence of schizophrenia or organic brain disease

ILLNESSES OFTEN MISTAKEN AS DEPRESSION   Thyroid disease and other endocrine diseases Parkinson’s disease Sleep apnea Nutritional illnesses Drugs or drug withdrawal Cerebral tumors Coronary artery disease Renal or hepatic failure AIDS Syphilis Mononucleosis Tuberculosis Hepatitis Pneumonia Cancer of the head of the pancreas Complex partial seizures Multiple sclerosis Left frontal stroke Dementia Alcoholism

Famous Depressed People

FAMOUS DEPRESSED PEOPLE

[Side Bar–1]

           

Terry Bradshaw	After leading the Pittsburg Steelers to four Super Bowl wins and divorcing his third wife, he became depressed—characterized by weight loss, crying spells, insomnia, and anxiety.
Jim Carrey	Comedian and movie star, he is best known for his rubber-like facial expressions and his over-the-top physical comedy. Although he became successful, he continued to suffer from depression that began when Carrey was 16-years old when his father lost his job.
Brooke Shields	Actress and model, she wrote a book—Down Came the Rain—that documented her postpartum depression.
Billy Joel	Winner of six Grammys, he attempted suicide by drinking furniture polish.

Pyruvate dehydrogenase deficiency

Pyruvate dehydrogenase complex deficiency (PDCD) is a rare disorder of carbohydrate metabolism caused by a deficiency of one or more enzymes in the pyruvate dehydrogenase complex. The age of onset and severity of disease depends on the activity level of the PDC enzymes. Individuals with PDCD beginning prenatally or in infancy usually die in early childhood. Those who develop PDCD later in childhood may have mental retardation and other neurological symptoms and usually survive into adulthood. Approximately 25% of individuals with PDCD have an abnormality in the PHE1A gene located on the X chromosome. Approximately 75% of affected individuals have a form of the disorder that follows autosomal recessive inheritance.

The Cause of High Ammonia Levels

Ammonia is a byproduct of a step in protein metabolism that ordinarily takes place in the liver. When that metabolic function is working normally, the ammonia does not accumulate to any significant extent. The ammonia can however rise to a dangerous or worrisome level most commonly in people with severe liver disease or less commonly in some people with rare metabolic disorders. The ammonia becomes a marker of the severity of the impairment of the liver in a setting like your husband`s. In people with liver disease, we use a drug called lactulose during an acute situation to reduce the amount of protein breakdown in the intestine by bacteria and indirectly reduces the ammonia level. Over the longer term, the key is better liver function, whether by some healing and recovery of the liver or in extreme situations by liver transplantation. 

LifeWorks Vol 1 No 1 page 2

Commens on Why People Change

Anonymous has left a new comment on your post "WHY PEOPLE CHANGE (complete article)": 

This is my 2nd attempt at leaving a comment. Evidently I have trouble with remembering my passwords. I want to thank you Cletus for your words of wisdom. I have been following you and once again you have inspired me. I feel strength from your words. My 25 yr. old daughter and I are now physically parted and although the separation anxiety has been difficulty I have been takin One day at a time and each day seems a bit easy. My new mantra is Stop worrying, trust is God. 

Pscyhopharmacology Update Vol 1 No 1

September 2008 PSYCHOPHARMACOLOGY UPDATE Volume 8 No 9

NEUROPSYCHIATRIC ASPECTS OF ANXIETY DISORDERS

Recent research advances allow neurochemical hypotheses for each of the different anxiety disorders.

Generalized Anxiety Disorder

Ø    Neurochemical abnormalities

o      Suppressed serotonergic mediation

§       SSRIs increase serotonin

o      Decrease in GABA, the brain’s predominant inhibitory neurotransmitter

§       Benzodiazepines improve GABA effects

§       Depakote increases GABA concentrations

o      Activation of the locus coeruleus-norepinephrine-sympathetic system

§       Effexor modulates

Obsessive-Compulsive Disorder = the tenth most disabling of all medical conditions worldwide

Ø    Increased activity in the ventromedial-cortico-striatal-thalamic-cortical circuit

Ø    Neurochemical abnormalities

o      Region specific serotonergic abnormality

§       Only 50% of OCD patients respond to SSRIs alone

o      Abnormal dopamine striatal circuits

§       Augment SSRIs with antipsychotics

o      Decreased GABA and increased glutamate

§       Add Depakote (calms by increasing GABA) and/or Lamictal (calms by suppressing glutamate)

Panic Disorder

Ø    The amygdala plays a central role in conditioned fear sending out efferents to:

o      The lateral nucleus of the amygdala—autonomic arousal

o      Hypothalamus —increases adrenocorticoid release

o      Locus coeruleus—increases norepinephrine release

o      Parabrachial nucleus—increases respiratory rate

Ø    Treatment—there is no integrated treatment for the neurochemical complexity of panic. Currently the treatment for panic remains SSRIs and benzodiazepines

Posttraumatic Stress Disorder

Ø   The amygdala and limbic regions play a particularly important role in the final common pathway of chronic hypersensitivity to post traumatic events

Ø   The hypothalamic-pituitary-adrenal system results in decreased cortisol and increased glucocorticoid receptor responsiveness found in chronic stress and in neuronal damage of  the hippocampus that could account for some of the cognitive impairments found in PTSD

Ø   Treatment—multiple medication combinations can help relieve specific symptom complexes

 

October 1, 2008 I will begin a position at Carilion New River Valley Medical Center, Virginia. You can find Psychopharmacology Update on the Blog, Relationship Solutions: LifeWorks or you can receive a hard copy by sending $12 to cover printing/postage for one year to Wende Whitus, 2820 Huckleberry Hill Dr, Fort Mill, SC 29715. 

www.glenstonechapel.org

Listen to Sermon by Greg Whitus

http://www.glenstonechapel.org/sermon/rebel-with-a-cause/

The Waiting Place

LifeWorks            Volume 12 No 9                                    September 2008

When you are getting ready to move time passes with the gush and ripple of a snow-fed mountain stream. It was like that for him as summer passed and the days shortened. Like an ageless schoolboy, he still measured time in sequential fashion, by use of clocks and calendars, by the passing seasons and the sports they brought. There was basketball in the winter, tennis in the spring, baseball in summer, and football in the fall. But with letters to write, notices to post, charts to duplicate, forms to complete, property to lease, furniture to pack, work to complete, and farewells to bid, there was no schedule for him this fall. The press of the move brought unexpected blessings—there was no time to grieve the pain of departing and those friends soon departed.

He had come here October 1, 2000 to take a position no one else wanted. He was the only psychiatrist on a ten-bed unit in a rural hospital. This unit, considered inconsequential to academic centers, serviced an area bordered by Houston to the south, Austin-Temple to the west, Waco to the north, and Lufkin to the east.

He worked seven days a week, Monday through Sunday. Everywhere he went he carried a cell phone. Calls for his services came throughout the day and night. After 343 days, he persuaded the administrator to find a locum tenens doctor to give him a break for a few days. When the hospital bureaucracy realized that no one else would work such onerous hours, the administrators became a little kinder and gave him a few more days off each year.

For the first time in his life, he sensed that he was filling a void that few in his profession would consider worthy of their efforts. He felt blessed by a wonderful staff—Jeff Baker, Susan Bice, Felicia Carmouche, Jan Childress, Barbara Courser, Sharon Davila, Shirley Higginbotham, Carroll Johnson, Kelly Kyle, Donna Patterson-Paddock, Liz Peterson, Carol Davis-Rios, Norma Rivas, Lyne’ Taylor, Brigitte Turner, and Stephanie Quintanilla—all took pleasure in helping each other help others. The administrator, Michelle Comeaux, who made certain that the unit received the highest praise from the Joint Commission and other hospital inspectors by precise dedication to bureaucratic rules and regulations, epitomized the staff’s diligence.

They were an informal and loving group who put patient care first, helped each other be the best they could, and had fun working together. Almost all the staff had a strong non-judgmental Christian faith. While they respected other religious faiths and those with no spiritual beliefs, they felt unreluctant to pray for and with their patients.

Mornings were spent in staffing. He would sit at the head of the conference table, the social worker to his left, and the nurse across from him. The patient would sit on his right. The patient’s case would be reviewed each day. Suggestions for therapy were completed and medication adjusted. Many times family members of the patient joined the group.

He felt confident with the nurses and clinicians, because each had the knowledge and assurance to suggest approaches to treatment and changes in procedure. They all recognized nuances in human behavior. The night nurses, those lonely, loyal warriors who had the awesome responsibility of protecting the patients’ health while the day staff enjoyed home and hearth, received the highest respect. The skill of the staff persuaded him to remain year after year despite the pull toward family and beautiful vistas.           

Neighbors and friends provided consolation for family separation. God and her church comforted his wife. Bible study groups and the renewal of the church vows to uphold worship with “prayers, presence, gifts, service, and witness” sustained her. She received special joy from the choir and their music. The warmth of friends that seemed irreplaceable kept them rooted to a spot they considered impermanent.

This staying thing was odd. He and his wife wanted to return to the Mid-Atlantic States to be closer to their family. The pull toward their children made sense. Staying at a provincial hospital didn’t. He interviewed at several eastern medical centers, but couldn’t find a hospital—large or small—in the Carolinas that satisfied him.           

Ambivalence overpowered him. Each time he was on the verge of moving, he remembered his staff, his friends, and his church, and stayed. Eight years after he had come to this rural hospital, he could look back upon his experiences with a deep and sumptuous tranquility blemished by a reluctant conscience to return to a cool and verdant land.           

He sat in his front parlor on a Sunday afternoon. It was cold and foggy that February afternoon and he had no desire to go out. A light drizzle penetrated the air. He had not felt too well since he played tennis with his son during the Christmas holidays. He fancied that the clock ticking in the kitchen, tolled for him.

The thought of his children wrapped a cold vapor around his heart. He could no longer tolerate his selfishness at keeping his wife from her loved ones. She brought him a cup of tea. “Please sit with me for a while, he said. “I want to read you something.”

You’re off to Great Places! You’re off and away!

You have brains in your head. 
You have feet in your shoes.


You can steer yourself 
any direction you choose. 


Do you dare to stay out? Do you dare to go in? 


How much can you lose? How much can you win? 



Simple it’s not, I’m afraid you will find, 
for a mind-maker-upper to make up his mind. 


You can get so confused
 that you’ll start in to race
 down long wiggled roads at a break-

necking pace
 and grind on for miles across weirdish wild space, 
headed, I fear, toward

a most useless place. 


The Waiting Place…for people just waiting. 


Waiting for a train to go 
or a bus to come, or a plane to go
 or the mail to come, or

the rain to pour or the phone to ring, or the snow to snow
.

You’ll escape
 all that waiting and staying.

You’ll find the bright places
 where Boom Bands are playing

There is fun to be done! 
There are points to be scored.

There are games to be won. 
 
Today is your day! Your mountain is waiting. 
 

Outside the drizzle had stopped. The setting sun gave the sky a pink luminescence. Raindrops dripped off  the philodendron. She sat very still looking at far away places. “We’re moving back home to the kids, aren’t we?”

 

Time's Friend

What a friend we have in time--gives us children, makes us wine, tells us what to take or leave behind. Friends I will remember you, think of you, pray for you, and when another day is through I'll still be friends with you.

 

In Times of Distress

Remember, in times of economic distress, keep your cool and be thankful for your blessings--good health, good friends, and supportive family.

A Checklist for Doctors Moving Their Medical Practice

A friend is moving his Medical practice from one state to another. He was amazed at the requirements for making a move. He has to:

1. Notify his patients that he has seen in the past two years by letter that he is changing his practice
2. Notify the Texas Medical Board 
3. Publish a notice in the newspaper of the greatest general circulation in each county in which the physician practices
4. Place a written notice in his office
5. Notify the DEA
6. Notify the Texas Department of Public Safety
7. Notify Medicare
8. Notify Medicaid
9. Notify Champus
10. Provide medical records to physicians/and or the patient