Be Happier Than Before

[Lowell]

As I move into my forties, I find myself getting more and more tense, nervous and jittery even about trivial matters. I get worried and anxious even with the small things like family members coming home late, the kids’ not getting great results in school. The palms of my hands and the soles of my feet start sweating and I feel so stressed and really down. I need a remedy.

[HEATHROW DIRECTOR]

I'm nearly 65 and have been like that for about 15 years, and it's getting worse so I'll watch this with interest.

I never worried about our kids's school results - encourage them, but it's their life. As for them getting home late... our youngest son is 37 and still lives with us and if he's late coming home I ring his mobile. I just can't relax (what's that?) otherwise.

[GANNET FAN]

Lowell, somewhere on Pprune there is a very witty and cleverly written
piece about "My thoughts on reaching 40". Sadly I can't find it, maybe someone can remember where it is.

GF

[Abu Bebo]

Anxiety problems may be psychological and they may be physiological; they may even be sociological. We are living in a stressful economic climate at the moment in which, while not necessarily affecting you directly, contact with others seriously affected may have upset your balance. Maybe you are becoming intolerant to caffeine. Whatever the reason, try making a simple change and be scientific about the result, giving it chance to take effect and taking notes. It may take a while. Of course, you have already taken the best step in communicating your problem, and I'm sure you will include your family in this process.
All the best,
AB

[Lancastrian]

If you take the stance that anxiety is a rather thin presentation of fear, then the self help is under way. Within our working years, anxiety has a part to play as a spur, a force that drives us to seek perfection,timing,presentation etc. If it comes "out of the blue" for no apparent reason then its role is reversed to that of an anchor holding a person back from achieving, doing. Initially it distracts but can move to domination. At some point you will realise that the "what if" part of the anxiety rarely happens and when that event is passed the tendency is to search for a new "what if". As has been suggested already, look to curtail the caffeine consumption, a food intolerance, over indulgence in alcohol etc. But,...take a rational look at your self. Have you too much time on your hands, do your days feel unfulfilled, have you a goal in life or...do you cater solely to others! Exercise as often as you can...outdoors...not in. Take up doing something of interest which can not be completed in a short span of time. Allow yourself time to be you. Talk about your feelings with others...you are not alone. Write down the good things you have been involved in and savour the feelings of that time. My personal panacea was to take up painting in water colours....it worked for me. Wish you well Lowell.

[Mac the Knife]

These are symptoms of true anxiety.

While "self-help" is widely advocated (and can be effective to some extent) do not hesitate to contact a reputable psychologist/psychiatrist if this does not work.

One of my close colleagues struggled with anxiety for years until she was put on Prozac - now she feels "normal again" and regrets she did not start on it sooner.

:ok:

Mac

[nannodnai]

until she was put on Prozac - now she feels "normal again"

One hopes she is not a pilot, especially not a commercial one !

[gingernut]

It's certainly worth having a chat to someone professionally, even if it's a matter of someone giving reassurance that you aren't "going mad."

There is a caveat of course, that this may have some bearing on your career as a pilot-although experience on this forum suggests that the authorities are on the whole sympathetic. (I guess that their concern would be if your state of mind affects your ability to fly the plane, or whether you ever feel like hurting yourself/others).

Reading between the lines, and making a lot of assumptions, it does sound like your symptoms are pretty "low level," and, if we were all honest, probably affect all of us at some time or other.

The good news is, there are some interventions which can help. Simple stuff, like aerobic exercise, seems to mop up some of chemicals which can cause the problems. Simply talking to people can help, avoid alcohol, and as my learned friends suggest, the chemical cosh can help in some cases.

Keep us posted, ginge:)

[gingernut]

ps, have used this before with my patients.

Anxiety - A Self Help Guide (http://www.patient.co.uk/showdoc/27001314/)

a lot have found it useful.

[mightynimbus]

I struggeld with this for a number of years and eventually discovered the wonders of Citalopram, its an SSRI so possibly indicated a physiological root cause but it was also suggested PTSD from an earlier part of my life in baggy green nomex.

My strong advise is not to suffer in silence and get help with it, the lady in the earlier thread who said she feels 'normal again' - I know exactly what she means.

[Zamfire]

I am in no way qualified in a medical sense to comment on the use of Prozac and the like, but I have had several years of personal experience with two (ex - guess why...) girlfriends who used it.

Once you're on it, you'll likely be on it forever. Whoever prescribes it to you has no reason to help you get off it. You won't want to get off it. If you do try to get off it, it is not pretty, I can tell you that; violent mood swings and irrational behavior, heightened responses to trivial matters etc. Eventually you should get back to normal, but most people don't want to deal with the withdrawal symptoms and just go back on it.

Will it make you "normal" again? It will numb you emotionally and your highs and lows will even out. "Normal" people experience highs and lows and deal with them. It is part of life. I am appalled how easily people resort to fixing their lives with a pill. Almost anyone who goes to their doctor and describes symptoms of depression or anxiety and asks for it will end up dependent on these miracle cures for what is really nothing more than, well - life.

Sure, there are cases when Prozac or some such drug makes the difference between a person going on with life or blowing their brains out, but that is the only time it should be used, not as a cure all for all of life's problems.

Some people who are users will wholeheartedly recommend them - well, frankly, I'd get a second and third opinion first....

[Fly-by-Wife]

Wow, Zamfire, for someone whose experience of Prozac (and the like) is 2nd hand at best, you sure make some strong generalities!

I used Prozac for a while for a major depressive episode - it didn't work for me, so I was moved on to another - one of many SSRI / SNRIs I was on over a 3.5-year period.

Prozac is actually relatively mild in terms of discontinuation effects, as the "half-life" is quite long in comparison to many anti-depressants. I did actually suffer some very severe withdrawal effects - but not from Prozac - despite careful lowering of dosage over time.

Whoever prescribes it to you has no reason to help you get off it. You won't want to get off it.

Not my experience at all - you must know some pretty uncaring medical professionals. It is perhaps true though that the desire for getting off anti-depressants needs to come from within the sufferer, rather than their carer.

I successfully "got off" all anti-depressants and back to normal - I suppose I had the motivation of needing to do so to get my class 2 medical back, but I also know many, many others without such a specific reason who also wanted to and succeeded in eliminating their need for anti-depressants.

Almost anyone who goes to their doctor and describes symptoms of depression or anxiety and asks for it will end up dependent on these miracle cures for what is really nothing more than, well - life.

It is clear that you fly in the face of the psychiatric profession and deny the existence of depression as an illness. You may be one of the lucky ones who do not suffer from it, but it is very real, believe me. Your attitude is sadly typical of today's society and does nothing to help remove the unwarranted stigma of mental illnesses.

FBW

[Zamfire]

It is clear that you fly in the face of the psychiatric profession and deny the existence of depression as an illness. You may be one of the lucky ones who do not suffer from it, but it is very real, believe me. Your attitude is sadly typical of today's society and does nothing to help remove the unwarranted stigma of mental illnesses.I did suspect I would ruffle some feathers with this. I spoke only from personal experience and the research I did to figure out why these people I knew acted the way they did. Your mileage may vary.

If I fly in the face of the psychiatric profession - you're dead right.

I do not deny the existence of depression or anxiety - we all suffer from it at some point in our lives. Whether depression is illness depends on who you ask. Like virtually all "Mental Illnesses" there is no physiological test that you can take to determine if you have such an illness. Your psychiatrist will tell you about "chemical imbalances" (Has anyone taken a sample of the fluids of your brain and anlayzed these chemicals??) and the like and "research suggests..." but there is no physiological basis for calling anxiety or depression and illness. All mental illnesses are diagnosed by listening to what the patient tells the doctor. The diagnosis is based purely on that and on nothing physiological. Any "mentally healthy" person could walk into a psychiatric office and tell them certain things and be diagnosed as "mentally ill". Try that with pneumonia or athritis or a broken leg. (Please do a google search on the "Thud" experiment - you may find it interesting.)

Psychiatrists have one over-riding fear and that is that one of their patients (I prefer to say "client") loses it and kills themselves on their shift, so to speak. If in doubt, they will dose you up with anti-depressants almost as a matter of course. Then to keep getting the prescription, you will need to keep seeing them every couple of weeks or so (at $150-$200 each time) - of course they have some kind of interest in keeping you on these drugs. Maybe that is a cynical attitude, but I only got that way from knowing people who went through this. The people I knew had been on these drugs between 7 and 19 years. No attempt was ever made to gradually reduce the dosage or, heaven forbid, get them off it.

Of course depression and anxietyt exists and it has causes and remedies. Drugs like Prozac, Welbutrin and others alter your behavior and your perception of your own environment, they do not address the causes. They will not "cure" your "illness".

Perhaps living in Southern California has skewed my views a little but everyone and their dogs and kids seem to be on anti-depressants here.

[VH-MLE]

Hi all,

In the lead up to and subsequent passing of my wife, my GP prescribed me Alepam (15mg) which is a mild sedative to help with with day to day living. I'm still on them and my wife passed away 2 years ago - I guess you could say I'm addicted to them although obviously I don't take them if I'm flying (which is a rare event these days).

My GP wants me to stop using them and I know that I need to stop too, however I am finding it difficult to give them up.

Cheers.

VH-MLE

[Mac the Knife]

"I do not deny the existence of depression or anxiety - we all suffer from it at some point in our lives. Whether depression is illness depends on who you ask. Like virtually all "Mental Illnesses" there is no physiological test that you can take to determine if you have such an illness. Your psychiatrist will tell you about "chemical imbalances" (Has anyone taken a sample of the fluids of your brain and anlayzed these chemicals??) and the like and "research suggests..." but there is no physiological basis for calling anxiety or depression and illness."

The World Health Organisation (ICD-10) and just about every reputable health body on the planet do not concur with your opinion, but hey, your "personal experience and the research I did" obviously trump them.

:ok:

[Zamfire]

OK, this is an aviation forum and I guess we are drifting into realms outside it, but I am glad that no person using psychotic drugs, anti-depressants or anxiety medication is allowed to control an airplane. I'll make this my last point on the matter:

The World Health Organisation (ICD-10) and just about every reputable health body on the planet do not concur with your opinion, but hey, your "personal experience and the research I did" obviously trump them.

Really? My point was depression is not an illness that can be diagnosed or treated like a physiological illness:

From Sadock, Benjamin J.; Sadock, Virginia A. (2002). Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry (9th ed.). Lippincott Williams & Wilkins. ISBN 0781731836 (http://en.wikipedia.org/wiki/Special:BookSources/0781731836). Look at page 260:

"No biological tests confirm major depression." (http://en.wikipedia.org/wiki/Clinical_depression#cite_note-90)

[Loose rivets]

VH-MLE

Just a quick comment (Well, it was going to be, but I'm kind passionate about this subject.) .........a quick comment on your prescribed medicine. Alepam is a benzodiazepine derivative, and 'coming off' any drug in that group should be done very carefully.

I'm not sure if this 'derivative' would cause the same problems, but my guess is that it would. In every case, the kick-back reaction has a lot to do with the nature of the patient.

While in my 30s, I was prescribed Valium after nothing else worked. I had a sports injury that wound up during the day and became an aching spasm by the evening. When the Valium unlocked it withing 30 minuets, it was like Heaven. I felt rather good while taking them as well, and frankly, it got into a bit of a habit. (I wasn't flying during this period.) I would be the life and soul of parties and at the pub, but my wife saw the different side all too often.

I posted a huge amount about benzodiazepines, mostly about Valium, and it was made a Sticky for a while. I claimed that in some people it was plain b:mad:y dangerous for them to take it.

In my case my life was also being made a misery by a sense of injustice. Several of life's lessons had poked me in the eye over one short period, and I was very, very angry underneath. The drug would let loose the reaction a day or so, sometimes more, after taking quite small amounts.

Also, I was prescribed Temazipam which blurred the facts, and not knowing the connection, stopped me realizing what was going on for longer.


I was a bigish bloke, and practicing Judo and Karate a minimum of 3 times a week...and God help me, I had one of the biggest holdings of handguns in the UK. However, there seemed to be an underlying side that was not affected. While unleashing this rage, part of my mind was looking round for something cheap to break. This may sound funny, but it's true, and spells out the mulit-faceted way our brains operate; which bits are affected, and also implying that there is some ultimate level that is protected from some of the drugs that can easily pass through normal blood/brain barriers.

One horrible memory I have is of scalding my mouth on a cup of tea. I suppose I could blame the sport as well, because pain has to be turned into aggression if one is to win, but the fact is, that without the drug, I would have just cussed and forgotten about it. After Valium, my reaction was to spin round with the teapot, a vast earthenware thing, and punch it. It exploded into tiny pieces. It was a lot stronger than a man's skull. You'll get my drift.

This is one of the worst memories. My daughter had bought me the teapot for my birthday, and she and my wife and her siblings all sat there...quite silent, witnessing me in 'one of my rages.'


It took a while, but I finally realized what was happening, one of the listed reactions is 'rage', but then, there are always lists of horrible reactions to modern drugs. Who reads those?

I can not stress strongly enough, I simply did not react like that without taking drugs. The loss of control could happen a week after taking 5mg of the stuff.

By chance, I was Skyping a friend yesterday who's wife's life had been runined for 8 hellish years by Valium. Taking them made her feel better, but the drug was the cause. (She couldn't even drive to the next village without overwhelming anxiety.) It took several years to normalize.


A while back I asked for Valium as a diagnostic tool. I suspected some eye muscles were going into spasme following a PVD. It worked like magic. I took minute amounts only twice...the rage was there again. Other motorists, pushy people in ques...just the same, but now I knew what was happening.

Well, this has been about Benzodiazepines, but I feel that any of these type of advanced drugs can affect people in incredibly different ways. They should all be taken only when it's the lesser of two evils, and the long term reaction is taken into that equation.

[gingernut]

"No biological tests confirm major depression."

Interesting point, but actually, you can say that for a lot of things in medicine. And I think it's important to remember that the concept of "health" doesn't (and shouldn't) consist of solely "biological" factors.

In fact, some of the patients who I regard to be very "unhealthy" consider themselves to be very healthy thank you. (And vice versa).

As one who has initiated, and monitored, drug therapy for depression, many times, I have to admit, it can sometimes be a difficult call. We try and make the process scientific, but it isn't always easy.

I suspect many prescribers turn to the pad, when actually they'd rather be able to prescribe 2 weeks surfing, a new boss, someone to talk to, or someone to look after the kids once in a while.



Funny thing mental illness- as common as asthma, (which is also difficult to prove through biological tests), yet still remains stigmatised and not well understood by people.

Walk down the road with one leg (!) and people sympathise, having mental health problems is less understood.

[Panther]

Some time ago I posted on this forum my experiences following an extended period of use of Tramadol which is a very effective pain killer. I took the drug over a 9 month period at pretty hefty rates (whilst NEVER abusing my prescription) whilst surgeons tried to piece together my left arm which had been cat 5'd after a ladder I was up collapsed from under me at home.

What I did not know when I took it was that it is a SNRI as well, in other words an anti-depressant. I found when I skipped, missed or tried to stop I ran into really bad problems ( I became dependant on this poison) and this culminated in post acute withdrawal syndrome (PAWS) and a whole heap of psychological effects which the man on the street would term a nervous breakdown.

I ended up with all sorts of care but today I have recovered from that awful experience. I totally echo what loose rivets has posted above. The effect on me destroyed a beautiful marriage to a woman who I will always love.

Again I can honestly say that I was DEFINITELY not myself whilst I was on this devil of a drug.

Like others I have experienced mixed reactions to my diagnosis of clinical depression as against peoples reaction to my shattered arm. With the arm, people were universally sympathetic. With my depression (definitely brought on by the tramadol in my view) the reaction was very much more mixed, Some people I found incredibly simply did not even believe it.

There is a stigma against those folk who are diagnosed with depressive disorders I regret to say.

In my experience the best policy is to get early medical advice, but do everything you can to steer clear of these mind bending drugs. I was put on anti-depressants and frankly that just caused another raft of problems for my dearest friends to have to cope with.

My advice is do everything you can do to avoid taking them but sadly doctors seem only too ready to dish them out with the cornflakes.

A healthy lifestyle with lots of physical exercise, a relaxing hobby (flyfishing for me) and surrounding yourself with non-judgemental people is the way ahead.

And loose rivets you say it how it really is. Thanks.

[VH-MLE]

Thankyou for your post Loose rivets (and others),

I am almost at the crossroads as far as taking my alepam is concerned. I know I need to stop taking them (a bit like stopping smoking - there is never a good time!!) but it is finding the right time that is important.

I can see the right time is almost here and I do plan to start reducing my doseage over the coming weeks rather than try and stop "cold turkey".

I initially took Alepam to try relax/cope a bit more with my wife's terminal illness. After she died there was always a reason to stay on them and I've since been engaged in deep and intense psychological warfare with my (now 13 year old) daughter which has been a further excuse to stay on them.

However, I can see for myself that I'm using them as somewhat of a crutch to help me through the day and that I do need to stop taking them. If I haven't had a tablet at the "normal" time, I do start getting "edgy" which is a sure sign of addiction.

The only plus is that both my GP and myself know I have to stop taking them sooner rather than later - it's really a case of biting the bullet and making a plan to stop.

As far as rages go, my kids will tell you I do get angry unnecessarily - maybe there is merit in that and maybe there isn't as we have had a very hard past few years.

I'll keep you posted on how things go.

Regards to all.

VH-MLE

[Loose rivets]

I'll keep you posted on how things go.
Yes, please do.


The funny thing is that I almost deleted my post a short while after writing it. I felt that it perhaps contained too much personal baggage, but now I'm glad I didn't.

I think that many medical problems have to take into account life's brick-bats to know how to treat them correctly.

One of my kids is a published expert on the effects of stress on the immune system. I don't quote him just in case I make mistakes in my interpretations of his work, but suffice it to say the mind's control over our physical wellbeing is, or can be, profound. So often we pay twice for our mental stresses.

[Brian Abraham]

I am glad that no person using psychotic drugs, anti-depressants or anxiety medication is allowed to control an airplane
That is true in FAA and CAA land but not the case in Australia. The aviation medical authorities treat these medications and illness as they do many others. That is on the particular cases merits. Aircrew may be given the OK to continue flying and the research they have done tends to show that pilots on medication have a better safety record than their peers. They have moved beyond the notion typical in the population at large that a person on anti depressants is one breath away from being an axe murderer. A 30 page document used by the AME in assessing cases is here

http://www.casa.gov.au/wcmswr/_assets/main/manuals/regulate/dame/080r0206.pdf

A brief excerpt
Use of Antidepressant Medication by Depressed Pilots and Air Traffic Controllers
CASA may, on a case-by-case basis, certificate applicants who are prescribed (and are taking) the antidepressant medications Sertraline, Citalopram and Venlafaxine as treatment for their depression. CASA is reviewing the antidepressant Moclobemide for possible approval for use by aviators and ATCs. An “as or with co-pilot” or “with direct air traffic controller supervision” condition, as appropriate, may be imposed. Pilots and ATCs taking other types of anti-depressants will not usually be considered for certification.

CASA certification of pilots and ATCs taking CASA authorised medications is conditional on:
_ Such applicants being under the care of a medical practitioner experienced in the management of depression—the applicant must:
❍ Be stable on an established and appropriate dose of medication for at least four weeks before returning to flying/ATC duties and exhibiting:
❍ Minimal acceptable side-effects
❍ No drug interactions or allergies
❍ Be subject to clinical review monthly or more often, with progress reports to CASA at 6 monthly intervals (for at least the first year). The applicant may be involved in other concurrent treatment (e.g. psychotherapy).
❍ Have an absence of other significant psychiatric co-morbidities
❍ Have no other psychoactive medications
❍ Have precipitating factors removed/controlled.
_ Symptoms of depression being well controlled, without evidence of psychomotor retardation
_ An absence of suicidal ideation or intent
_ An absence of features of arousal (e.g. irritability or anger)
_ The presence of a normal sleep pattern.

Pilots or ATCs authorised to fly or perform duties when taking Selective Serotonin Reuptake Inhibitor (SSRI) or related antidepressant medications must cease exercising the privileges of their licences if their antidepressant medication is altered or the dose changed. Their supervising medical practitioner may return them to duty when they are assessed as stable and without unacceptable side effects.

Pilots and ATCs whose medication is being reduced must cease exercising the privileges of their licences for the entire period during which they are weaned off medication plus an additional period of two weeks. Their supervising medical practitioner may return them to duty when they are assessed as stable and without unacceptable side effects.

Its a pity other countries have not been a little more pro active in this area.