I'm happier...I guess I made up my mind to be that way.

--Merle Haggard

The May 2005 issue of the Harvard Mental Health Letter examined the recent controversy regarding Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant medication and charges that a possible side effect could be increased suicidality. The article presented a complex set of variables that can make one group more vulnerable to specific side effects.

Here are some general findings from the article: taking NSAIDs (aspirin, ibuprofin, naproxen, COX-2 inhibitors) more than doubles the risk for stomach or uterine bleeding, the elderly do better with tricyclic antidepressants, many report a lessening of effectiveness after many months or years, many experience symptoms when trying to discontinue the medication (dizziness, loss of coordination, fatigue, tingling, burning, blurred vision, insomnia, and vivid dreams, which peak in the first week and then fade), a possible risk for lower birth rate and premature delivery when taking these medications during pregnancy (the studies are inconclusive, but paroxetine seems to be most likely to cause side effects), and studies show that all SSRIs double the risk of suicidal thinking (from 1%-2% to 2%-4%).

Regarding suicidal thoughts, the article suggests that clinicians make sure that they have ruled out Bipolar Disorder (SSRIs may trigger a manic episode), that they account for possible anxiety as a side effect, and that they factor in that the antidepressant may give the patient energy to think or act on suicide (suicidal thoughts are a symptom of the condition being treated by the medication).

As with any medication, consult with your physician thoroughly before making any decisions. And, given the range of side effects and other factors (especially the unpleasant side effects when trying to taper off the medication), you may want to consider trying non-medical approaches to emotional well being—such as Therapeutic Teaching—before considering medication.

Additional Resources:

• U.S. Food and Drug Administration
• National Institute of Mental Health
• American Academy of Child and Adolescent Psychiatry

An recent study published in December 2004 issues of the Proceedings of the National Academy of Sciences indicate that prolonged stress can accelerate the aging of body cells, with obvious implications for health and longevity.

The study examined the Leukocytes (infection fighting white blood cells) of 58 healthy young women, 19 with healthy children, and 39 who were under long-term stress because they were caring for a chronically ill child. After controlling for age and height-weight ratio, the longer a woman had been caring for a sick child, the shorter her telomeres (a stabilizing structure) and the less active her telomerase (an enzyme that maintains the telomeres).

Everyone is familiar with the idea that stress can cause premature aging and disease. The relationship between chronic depression and heart disease is well known, and there is evidence that chronic stress weakens the immune response.

Given that stress is an internal reaction to external events, approaches such as Therapeutic Teaching can help you to learn how to generate less stress in your life. Contact me for more information about the relationship between this type of skill building and stress reduction.

In the July 2004 issue of Psychology Science, psychologist George Bonanno found that people with a wide repertoire of emotional expression adjust to stress much better than people who tend to react the same way repeatedly. He tracked 101 college students for two years from the time they entered Columbia University (to add to the stress factor, the 9/11 attacks happened during this time frame).

Students who could consciously alter their emotional responses showed the best long-term adjustment to stress, while those with a more limited repertoire showed the poorest adjustment. He found that neither expressing nor suppressing emotions reliably led to an effective emotional response. It's more accurate to view emotions as reactions rather than as internal forces. Bonanno stated, "An emotion is really a response. And that response can be appropriate or inappropriate."

Teaching, mentoring, practicing, and mastering skills related to emotion management can provide the flexible repertoire described by Bonanno. Contact me for more information about how Therapeutic Teaching can assist you in learning and developing such a repertoire.

Happy families are all alike; every unhappy family is unhappy it its own way..

--Leo Tolstoy

The June 2005 issue of the Clinical Psychiatry News makes a strong argument that cognitive-behavioral treatment (CBT) is a powerful adjunct to the medical treatment of pain. In the context of pain, CBT can be particularly effective in helping people to reconceptualize problems, making seemingly overwhelming hurdles become manageable. It transforms the person from being passive to being "active, resourceful, and competent" in the attempts to manage pain in their lives.

The article states that the exact type of CBT is not as important as long as it is:

• Problem oriented
• Time limited
• Educational
• Collaborative
• Practical (providing home exercises for practice)
• Able to assist the person cope with setbacks and lapses

Articles such as this one reinforce the need for approaches that emphasize teaching (which empowers the individual to take what they've learned and use it in their lives) and a holistic approach. Therapeutic Teaching is an advanced CBT program that builds skills needed to integrate a variety of approaches (such as shifts in thinking, mood management, goal setting, and strategic activity) as a means to health, peacefulness, and happiness. Contact me for more information about how Therapeutic Teaching can assist with pain management.

The June 12, 2005 edition of the Boston Globe provided a brief interview with Dr. Aaron Lazare, dean of the University of Massachusetts Medical School, whose book On Apology was recently published by the Oxford University Press. Dr. Lazare conducted a decade-long study on what makes for a perfect apology and observed how apologizing can instantly heal relationships.

Dr. Lazare states that there are four parts to a well-formed apology: providing a specific acknowledgement of what you did, a reason why you did it, an expression of remorse or shame, and a reparation. He also warns against apologizing too soon, while the other person is still too angry and having difficulty hearing you. Finally, he states that it is hardest to apologize for betraying the trust of a loved one. He states that sometimes a betrayal cannot be fixed.

Inherent in the description of the healing power of forgiveness is the need that people have to make meaning out of what happened to them in a way that is consistent with their notions of themselves, other people, and how the world is supposed to work. One of the basic tenants of Therapeutic Teaching is to help people learn how to form personal meaning in ways that are more likely to generate peace and emotional well being in their lives. Contact me for more information about how my approach can assist with offering or accepting forgiveness.