About Health & Medicine

Anna was 78 when she was first referred to Dr Volz by a local consultant. By that time, her experiences with recurrent episodes of depression went back a quarter of a century. In the early 1980s she was treated with lithium carbonate, which was discontinued when it resulted in thyroid troubles. In the early 1990s she was treated with amitriptyline, one of the older anti-depressants, which caused her severe dry mouth and, on one occasion, an episode of fainting when she got up one night to go to the toilet. Then Prozac (20 mg per day) was tried, and even though it helped her depression to some degree, it caused unbearable sleep problems. Sometimes it would take her as long as two hours to fall asleep at night and then she would wake an average of three times during the course of the night.

When Anna consulted Dr Volz, he judged her to be moderately depressed while on Prozac, scoring 21 points on the well-known Hamilton Depression Rating Scale, on which the higher the score the more depressed the individual. Because of the severe sleep difficulties, Dr Volz decided to switch Anna to St John’s Wort. He did this without any overlap between medications, immediately discontinuing her Prozac and starting St John’s Wort (900 mg per day). Four days later Anna reported an improvement in the quality of her sleep, but her mood had deteriorated slightly and she now scored 24 on the Hamilton Rating Scale. Her dosage of St John’s Wort was increased to 1,800 mg per day. After three weeks her Rating score dropped to 20, after six weeks to 15 and after another four weeks to 10. Anna’s depression continues to improve. Once again, St John’s Wort triumphed where other medications had failed.

There are several lessons to be learned from Dr Volz and his patients. For many people, like Greta, herbal remedies are simply more acceptable than synthetic drugs. Perhaps it is because we are used to eating plants that they seem more natural than pills do. Even though we need double-blind studies, which include placebo controls, to make sure that any effects of a medication are specific and not just due to a placebo effect, it is hard not to become a believer in the anti-depressant effects of St John’s Wort when one encounters patients such as Greta. Adamantly opposed to the very idea that she was depressed and uninformed about the purported anti-depressant effects of St John’s Wort, her symptoms nevertheless responded completely, suggesting a specific effect of the herbal anti-depressant. An added advantage of St John’s Wort over the older anti-depressants is that, like the SSRIs, it does not appear to have any adverse effect on electrical conduction in the heart. For this reason, Dr Volz felt quite comfortable in using it to treat Greta’s depression even though her EKG had revealed some abnormalities in her cardiac conduction.

In Anna’s case, we see the importance of persevering with an anti-depressant treatment. After she was switched from Prozac to St John’s Wort, she initially appeared to get worse before her slow but progressive improvement over the course of the next several months. Her depression was moderately severe when she first consulted Dr Volz and had apparently been somewhat worse before she started Prozac. Nevertheless, St John’s Wort successfully turned it round, indicating once again the potency of the herbal remedy. Despite this potency, the mildness of the herbal antidepressant was apparent in the ease with which this elderly woman was able to tolerate it in dosages that are very much higher than those widely recommended for the treatment of mild-to-moderate depression. This was in marked contrast with the synthetic anti-depressants she had previously taken and on which she had developed unacceptable side-effects.

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Most ill people need to be dependent for a time. As they recover, they gain confidence and self-esteem, and reliance on the helper disappears. The odd time that this is not the case, it is up to the helper to encourage independence by gradually withdrawing attention unless really positive moves are made by the user.

Caution for Helpers

No matter how sincere you are in your efforts to help, there will always be someone who will direct their anger at you. Try not to be hurt by this, however unjustified you feel it to be. You may be serving a useful purpose. The person may feel it safer to express anger outside the family circle. It will be upsetting, particularly if you are not feeling completely recovered yourself. Get used to it—it will happen again.

It is good to have positive talk times, when all talk of withdrawal symptoms is banned, or to have social outings away from where the group usually meets. Marvellous things happen when people get together to work towards being well. It is touching to see how much strangers can care about each other if they are given the opportunity. If someone weeps, don’t be in a hurry to make tea—that may only be to save your own embarrassment. A box of tissues in one hand and the other on the shoulder of the distressed person usually means more.

Even if you do get a bit discouraged at times, the work in groups is very rewarding. It is exciting to see people looking healthier as they cut down their drugs, and to see confidence and animation return.

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Most of the hormonal symptoms are at their worst when the user is taking the full dose of tranquillizers. They may change during withdrawal, but return to normal when withdrawal is completed. For instance, all interest in sex may be lost whilst taking tranquillizers. The reverse may happen for a time during withdrawal before normality returns.

Some women who suffered heavy periods for years when they were on the pills, find they have a normal flow after withdrawal. Vaginal discharge, burning vulva, and increased pre-menstrual tension can also cause temporary discomfort.

Research has shown that a hormone called prolactin is increased whilst tranquillizers are taken. This stimulates lactation, and reports of breast symptoms are common. They range from a slight pale brown discharge to considerable quantities of milk. This has happened up to sixteen years after the last pregnancy. After you have been examined by your doctor, be patient and the symptoms will disappear when you are through withdrawal.

Men too report swollen tender breasts and slight discharge. They also complain of impotence, loss of seminal fluid, and pain in the testicles. Some have eruptions of adolescent acne.

When the hormone levels return to normal all the symptoms disappear.

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The main principles of the diet are: Avoid or cut down on all quickly absorbed carbohydrate including sugar, chocolate, sweets, white bread, white flour, cakes, biscuits, pastry, alcohol, soft drinks and anything with added sugar. Man’s natural diet did not include these—you would be better off without them.

Reduce the intake of animal fat. Vegetable oils (corn or sunflower seed oil) may be used.

Eat whole meal bread, wholegrain cereal, vegetables and fruits. This can be lean meat, poultry, dairy produce, pulses, peas, beans, nuts and seeds.

Five or six small meals should be taken at regular intervals. Eat before going to bed, and as early as possible in the morning, to cut down the fasting time.

As soon as you get up: small glass of unsweetened fruit juice/half a grapefruit/ medium orange. Breakfast: more fruit juice or fruit.

Choose from:

Egg / bacon / kidney / baked beans/black pudding/kippers (or any fish)/cheese/cottage cheese/yogurt. Also whole meal bread or toast with butter. Milk or weak tea without sugar.

Two hours after

breakfast:

Lunch: small glass of fruit juice, milk or yogurt.

Choose from:

any cold or hot lean meat/ chicken/fish (fresh or tinned), sardines, tuna, etc., salads/ vegetables. Wholemeal bread or crispbread if desired.

Three hours after lunch: small glass milk/tea with crisp-bread/yogurt One hour before dinner: small glass fruit juice.

If you are hungry between meals, eat a handful of unsalted nuts.

Don’t try this diet for just a few days then revert to your sugar-laden diet—try it for several weeks—many have found it very helpful.

Digestive problems are common in withdrawal. If you cannot manage the diet because you feel sick, or have diarrhoea, try to eat steamed fish, minced liver/chicken/ meat or high protein baby food. To increase protein intake have Sanatogen powder or Complan in milk several times a day and particularly before bed. Vegetables will be easier to digest if sieved or liquidized.

Remember to eat often and avoid sugar and fat.

Note: Vegetarians can substitute all vegetable protein.

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Some doctors prefer to change their patients from Ativan to Valium, then withdraw the Valium—10 mg Valium are substituted for 1 mg Ativan. Others prefer their patients to cut down their Ativan as far as they can, and then change over to Valium for the last part of withdrawal. If side-effects are a problem it is sensible to change over at the beginning.

If you are on 6-8 mg Ativan you may be able to cut down to half the dose quite quickly, giving up 1 mg per 1 to 2 weeks and then proceed with slow withdrawal for the rest.

Ativan tablets are difficult to cut into small doses. Some chemists are willing to make up ? mg doses into capsules.

Some people prefer to dissolve ? mg Ativan in 10 ml of water, then divide it into 2?5 ml doses. Plastic 5 ml spoons are available from chemists.

Librium (Chlordiazepoxide)

Some capsules can be taken apart and fitted together again. If not, ask the doctor to prescribe empty capsules. Divide powder and put it into empty capsule.

Some powders are irritants. Avoid taking powder without capsule. When 2l/2 mg ( ? capsule) daily dose is reached, you may wish to ask your doctor to substitute an equivalent amount of Valium. It will be easier to complete withdrawal by cutting up tablets rather than dividing tiny amounts of powder.

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