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Archive for December, 2009

 

Treating depression early and effectively can prevent it from becoming more severe and lasting longer. The type of depression a person is suffering with will determine the best choice for treatment.

Major Depression and Dysthymia can be treated with both psychotherapy and medication. Most people respond well to these in combination. Psychotherapy should focus on learning coping strategies, problem solving skills, challenging negative mindsets and changing critical as well as pessimistic thought patterns. Improvement comes when a person begins to feel empowered and more in control of his life (and emotions).
Supportive therapy should also be used to help address painful feelings of hopelessness and despair. However this type of therapy should be a part of the treatment and not the only method.

Medication is an option with major depression. Antidepressant medication can often help to relieve the painful impact of symptoms such as the inability to concentrate or sleep, inability to work, control emotions or make decisions necessary to effectively conduct everyday life.

Antidepressants work by increasing the availability and level of certain neurotransmitters in the brain. Neurotransmitters carry information to the different parts of the brain.  These chemicals and their levels of availability affect the range of moods we experience.

In severe cases of depression where other forms of treatment have not helped, electroconvulsive therapy (ECT) may be recommended. In this type of therapy electric current is passed through the brain of the patient while under anesthesia causing convulsive seizures to occur for about 15 seconds each. ECT has been shown to be effective, especially as a treatment of last resort, but its side effects can include some memory loss and disorientation.

The treatment of Bipolar Disorder will most likely include medication. As explained in the previous article, this is a very serious and disabling mental illness. It is chronic and manic episodes followed by depressive episodes are likely to recur if treatment is not ongoing.

Lithium and anti-convulsive medications such as Depakote, Lamictil and Neurontin are often used in combination to achieve mood stabilization. Getting the patient on the best combination of medication is both science and art and can be trying for the patient and his family.

People with bipolar disorder are sometimes discouraged by the difficult task of keeping their moods in check over long periods of time. The patient sometimes complains that the edge or “high” he used to enjoy feeling has been replaced by a different mood, one he may interpret as being flat and boring.

When this occurs he may stop taking the medication and go back to “cycling” through his moods again. That is why long-term counseling that includes the monitoring of the patient’s medication, moods, sleep patterns and general health is often critical in maintaining control over bipolar disorder.

Postpartum Depression has similar symptoms to major depression. If left untreated the consequences of postpartum depression can be dire. The attachment bond that is so important for a child’s healthy development will likely not occur if mother is not getting the help she needs.

Treatment here should be multifaceted and involve the entire immediate family. Counseling should educate the family members and enlist them to help more around the home. Individual therapy is necessary to help the mother learn and implement the coping skills that are so important for her new role.

The option for medication needs to be weighed against the severity of the depression. If a mother is breast feeding for example, taking medication can be dangerous to the health of the baby. The same problem exists when hormone replacement therapy is recommended.

With proper treatment postpartum depression will often lift in a matter of months.

Self help

In addition to getting professional help there are several things a person can do to improve his mood.

Exercise: Any activity, however mild it might be, can lift the spirit.

Friends & Family: Having one or more close friends or family members to confide in and spend time with helps to prevent isolation.

Reduce stressors: Limit your responsibilities and only do tasks that won’t overwhelm you. (See article on Stress Busting Basics)

Postpone making big decisions: Your objectivity and judgment are most likely to be affected by your depression. Refrain from making important decisions until you feel better.

Force yourself to do things with friends.

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I recently had the opportunity to do some research on Gender Identity Disorder (GID). It is a fascinating subject and one that often goes unnoticed by many until it is discussed on a news magazine show or a documentary. It is fascinating because the human condition and the human experience, especially as it relates to sex and sexuality, are so varied yet most of us are only exposed to a very small part of it.

There is a distinction between having a Gender Identity Disorder (GID) and some of the other types of sexual/behavioral disorders. Some individuals with GID may ultimately decide to have Sexual Reassignment Surgery (SRS) thereby becoming transsexual.

People will sometimes confuse transvestites with transsexuals. The difference is significant.

Transvestites and Fetishism

A transvestite is a heterosexual male who dresses in women’s clothing (cross-dresser). Some men dress this way to earn their livings as female impersonators. They perform in drag in nightclubs and cabarets around the world but might very well dress as men when they are not working. They may or may not be gay or homosexual.

However, those transvestites with a fetish (a sexual or emotional attachment to an inanimate object) get a strong sexual arousal when they dress in women’s clothing. They will frequently be married men and are sexually attracted to females.

Technically they are considered to have a Transvestic Fetish, which means that they experience strong sexual urges and a compelling need to wear women’s clothes. A transvestite with this type of fetish will often desire to be seen in public as a woman, even though he does not identify himself as female.

Married transvestites will frequently wear their wives’ clothing but may also have a secret stash of their own. They are generally plagued with shame and guilt about their behavior and terribly fearful of being discovered and rejected by their spouse.

Treatment for this type of disorder is rarely sought by the individual. It is usually when the spouse becomes aware and is conflicted about accepting her husband’s behavior that the couple may decide to seek therapy.

Gender Identity Disorder and Sex Change

A person with Gender Identity Disorder has strong and persistent cross-gender identification.

Early onset of symptoms such as: behaving and/or dressing more like a member of the opposite sex; expressing a desire to be a member of the opposite sex; hating one’s own genitals; being rejected from one’s peer group because of behavior that is different from same sex peers can lead to withdrawal and depression early on in a person’s life.

This problem seems to occur more in males than females. It also appears early in childhood often about 4 or 5 years of age, strongly suggesting chromosomal and/or hormonal abnormalities during fetal development.

The person with GID is conflicted or disgusted with his own body. He has a persistent and compelling desire to behave and identify with the opposite sex. If he dresses like a female it is not because of sexual arousal like the tranvestic fetish but more because he sees himself as female and rejects his male sexual parts.

As he grows older his depression over being trapped in the wrong body may cause him to seek Sexual Reassignment Surgery.  This type of surgery can be both from male to female or from female to male.

This process, if done clinically correct, should take a long time, perhaps 2 or more years before SRS is approved. It would include intense counseling or psychotherapy, education, hormone treatments, and time for the patient to experience what it would be like to be a member of the opposite sex by “passing” as such in everyday life.

This treatment is often expensive and demands patience and commitment. A therapist will generally work with a physician to insure that all aspects of the process, including hormone treatment are being appropriately addressed.

If the patient is hasty and chooses to have SRS before he is ready he may end up regretting his decision, potentially causing himself irreversible harm.

If you or anyone you know needs more information on this issue please contact me.

Some websites that offer information and support for anyone dealing with this issue are:

http://www.transalliancesociety.org/index.html
http://www.genderadvocates.org/links/national.html
http://www.masstpc.org/mediawiki/index.php?title=Transgender_Specific_National/Statewide_Activist_Organizations

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