What to do when your Partner is depressed

- It is important that the non-depressed partner realize that depression can be selfish and manipulative. Depressed partners build a safety net around themselves. They will grant their non-depressed partner access to their cocoon-like existence when they’re up to it, but will often inappropriately rebuff the partner at other times. The important issue here is for the non-depressed partner to choose to not take the inappropriate behavior personally. Inappropriateness comes with the territory in depression.

- The non-depressed partner should set clear and specific boundaries. A core symptom of depression is a decrease in energy levels. So it’s acceptable to help out with chores that would ordinarily be the depressed partner’s responsibility, but unacceptable, for example, to place a sick call to their work for them. This crosses the line into enabling, and enabling behaviors fuel co-dependency. When this happens, neither partner is healthy.

- The healthy partner should encourage and support the depressed partner, but resist the urge to badger or chastise them. If the depressed partner is not seeking help for their depression, it is perfectly acceptable to broach the issue of them doing so. However the decision to follow through has to be made by the depressed individual. Patience is the key here, so badgering and chastising behaviors will inevitably lead to the depressed person digging in their heels and resisting any further offers of help.

Non-Pharmacological Options for Managing Depression: What the Pharmaceutical Companies Will Never Tell You

- Bright light exposure represents a proven strategy for managing depression. Light receptors in the retina connect to circuits in the brain that regulate circadian rhythm. Sunlight is the prime stimulator of the eyes’ photoreceptors: it triggers a cascade of neurochemical reactions that aid in keeping the “body clock” in synch. Regular bright light exposure – either via sunlight or specially designed light boxes – can restore healthy circadian function to the brain and improve mood.

• - Bright light exposure represents a proven strategy for managing depression. Light receptors in the retina connect to circuits in the brain that regulate circadian rhythm. Sunlight is the prime stimulator of the eyes’ photoreceptors: it triggers a cascade of neurochemical reactions that aid in keeping the “body clock” in synch. Regular bright light exposure – either via sunlight or specially designed light boxes – can restore healthy circadian function to the brain and improve mood.
• - Yes, I must mention the dreaded “e” word. Two landmark studies have shown that just moderate physical activity – walking three times a week – is as effective as prescription antidepressants such as Zoloft. Physical exercise stimulates the synthesis of growth hormone that initiates the sprouting of new nerve connections. Simply put, exercise helps reverse the neurotoxicity of depression.
   
• - How we feel is critically affected by diet. A deficiency of omega-3 fatty acids – some of the key building blocks of brain tissue – is now strongly linked to depression. Omega-3 fats facilitate the brain’s use of the “feel-good” nerve chemicals – norepinephrine, serotonin and dopamine. Omega-3 supplements, typically in the form of fish oils, have demonstrated in multiple trials to have a considerable antidepressant effect.
• - Ever heard the expression “if you want to change the way you feel, change the way you think?” Modification of negative, pessimistic thinking is definitely reflected in corresponding shifts in brain activity for the better. You can often accomplish this free of charge by befriending positive, optimistic people or seeking out a mentor. Positive people typically won’t let you slip into apathetic thinking patterns when you’re in their presence. You can then model their upbeat attitude when you’re on your own.

Low Sex Drive in Men

A reporter for a major national Men’s magazine recently contacted me and asked if I would comment on some of the surprising and common causes of low sex drive in men. Here are my responses:

• - A frequent, and I would say surprising cause of low male libido is anger toward their wives or significant others. Anger sucks the energy out of a man’s desire for sex. When men make a statement in therapy such as, “I just don’t want to be anywhere near her,” this translates into not wanting to have sex with her either. Anger activates the “fight or flight” response, and most men are more comfortable fleeing conflict with the women in their lives. They become very ashamed of speaking up about their low sexual desire, and retreat to their “man cave.”

 

• - Low male libido is influenced by the biological condition known as “andropause,” the counterpart of menopause in women. This most often occurs in men whose testosterone counts have decreased with age. Testosterone fuels sex drive in men, so low levels of this hormone equates with low sexual desire.

 

• - Physical illnesses, such as heart disease, stroke, certain cancers and hypothyroidism are responsible for low male libido. The same is true for prescription medications such as antihypertensives, (medications used to treat high blood pressure), and antidepressant drugs such as Prozac, Lexapro and Effexor. Physical illnesses and prescription medications cause low sex drive in men because of decreased blood flow to the genitals. This strikes terror into the heart of a guy to even think that he might not be interested, because his sense of self is usually tied up in his virility.

Pediatric Anxiety Disorders

According to the National Mental Health Information Center, anxiety disorders are among the most common mental, emotional and behavioral problems to occur during childhood and adolescence. About 13 out of every 100 children and adolescents ages 9 to 17 experience some kind of anxiety disorder; girls are affected more than boys. If left untreated, these disorders can lead to the inability to finish school, impaired social relations, low self-esteem, and eventually, anxiety disorders in adulthood.

The onset of childhood anxiety usually begins between the ages of six and eight. Children at this age typically become less afraid of the dark and other imaginary dangers, and they become more afraid and anxious about performance in school and interactions with friends.

Some studies suggest that anxiety disorders in children are heritable, particularly from parents that have met anxiety disorder criteria themselves. But there is no way to prove whether the disorders are a result of biology, the environment, or both.

Below is a brief description of several types of anxiety disorders diagnosable in children and adolescents:

Overanxious disorder of childhood: This is similar to adult generalized anxiety disorder (GAD). Children and adolescents with this disorder engage in unrealistic and extreme worry about almost everything – their academic performance, athletic capability, even punctuality. Tense, self-conscious and having a strong desire for reassurance, these young people may complain about aches and pains that have no physical cause.

Panic disorder: In children and young teenagers, panic is rare. Rates begin to rise in older adolescents, particularly girls. As they can for adults, repeated panic attacks can be a sign of panic disorder. These attacks may be accompanied by symptoms that include a pounding heartbeat, dizziness, nausea, and feelings of imminent harm or death, accompanied by intense fear.

Obsessive-compulsive disorder (OCD): Like OCD adults, children and adolescents with OCD become trapped in patterns of repetitive thoughts and actions that are difficult to stop. These actions may include repeated hand washing, counting, hair pulling, nail biting, repetitive questioning, arranging and rearranging objects, and a strong need to control others and their environment. Children and adolescents often have much higher rates of aggressive obsessions, such as thoughts of harming themselves or others, and sexual acting out. Childhood and adolescent OCD is highly co-morbid with mood, anxiety, tic and disruptive behavior disorders.

The National Institute of Mental Health (NIMH) suggests that nearly 10 percent of adult OCD sufferers have had symptoms since the ages of five to 10. More than 20 percent have had them by ages 10 to 15. And more than 40 percent had them by ages 15 to 20. In all, approximately 2 percent of the general population of children and adolescents meet OCD criteria.

Separation anxiety disorder: Most often, this disorder manifests as school phobia, not wanting to attend camp, or even stay at a friend’s house for fear of leaving their parents. These children are frequently described as “clingy.” This disorder can be accompanied by sadness, withdrawal or a baseless fear of losing a family member to death or other permanent separation.

PTSD. The symptoms of post-traumatic stress disorder in children are similar to those in adults, with the addition of manifestations such as “monster nightmares,” and re-enacting a stressful event through play. Children and adolescents can develop PTSD after experiencing physical or sexual abuse; being a victim of or witnessing violence; and living through a natural or manmade disaster (hurricane, bombing, etc.). In young children, domestic violence is the most common cause of PTSD.

Medication Management of Pediatric Anxiety Disorders

Studies on the medication management of anxiety disorders in youth are sparse and inconclusive, and there are few specific guidelines for treating them. While benzodiazepines are used to treat anxiety and sleeplessness in children, the data supporting their use is sparse. While some anecdotal evidence has suggested possible benefit from Buspar (buspirone) in children, this continues to be unproven. Antihistamines such as Benadryl (diphenhydramine) and Vistaril (hydroxyzine) have been used for decades to ameliorate anxiety symptoms in psychiatrically disturbed children. Anafranil (clomipramine), Luvox (fluvoxamine) and Zoloft (sertraline) have FDA indications for children and adolescents with OCD. Experience with the SSRIs in controlled pediatric studies has led clinicians to consider these agents for treating non-OCD anxiety disorders as well. Controlled studies and supportive data are significantly lacking in the treatment of pediatric anxiety disorders with the beta-blockers.

Cognitive-behavioral interventions have proven to be effective for a majority of children and adolescents with anxiety disorders. Between 50 and 80 percent of children respond to well designed and effectively employed CBT treatment models, and at the completion of treatment, no longer meet diagnostic criteria for the presenting anxiety disorder.