Category: Emotions, Anxiety and Mood

by Marcelle Pick, OB/GYN NP

If you have been experiencing feelings of depression or anxiety or have had symptoms of other mood disturbances, please know that you’re not alone. Up to 70% of the women who come to the Women to Women clinic are already taking prescription medications for symptoms like yours. Some women may experience relief from their symptoms initially, but the side effects of antidepressant medications are not all beneficial. There is hope though – a natural approach can work to treat the underlying cause of your symptoms (for more information, read our article, “Diagnosing The Symptoms Of Depression“.

Why do women so commonly suffer from problems with their moods? What makes our approach different and effective? Our approach is based on the belief that our bodies interact with our biological makeup in unique ways, based on our emotional experiences. Current research backs this up.

As an example, many women I see grew up in homes where physical as well as emotional pain and anxiety pain prevailed, so they duplicate these circumstances in their adult lives; this is what feels “normal” to them. Many women with mood disorders had dysfunctional families of origin, setting the stage for what they consider to be normal.

Other women may have been subject to various factors during their lives that set off mood dysregulation in many different forms. Thinking about a chemical imbalance, poor diet alone can be the final straw for a woman who is already stressed-out. Our daily lives are filled with potential stressors in the form of toxins, pollutants and endocrine disruptors that have changed our overall neurochemistry.

Today’s culture also adds insult to injury. In order to be winners, we’re told to censor any negative psychosocial issues; those who don’t are considered to be weak and undeserving. We’re reminded “Don’t worry, be happy.” In other words, don’t be a nut job.

Looking at all these factors helps to explain the prevalence of depression and anxiety in our country. It’s easy to understand why women want to “fix” their mood troubles quickly and quietly by taking a pill. Conventional methods tell us we can either medicate our mood or “learn to live with it.”

I know we’re smarter than that. We know by intuition that life isn’t that easy. We try so hard to do everything “right” but sometimes life just isn’t pretty and picture perfect. In all of our striving for success externally, we avoid the internal work that allows us to reach developmental goals with our body, minds and spirits intact.

Making a journey through our life’s pleasure and burdens requires self-care and inner discoveries. There are alternative choices, apart from drugs to help along the way; options that are safe and natural. Many have been shown by research to be equally, if not more effective than prescription medications.

Depression, anxiety and other mood disorders are not all in your head. These issues develop as a result of neurochemical imbalances. These imbalances disrupt the pathways that regulate your mood. What causes the imbalance is usually a combination of many factors: life stress, environmental issues, toxicity, emotional history, biochemistry and genetics. When a woman comes to me with physical and emotional symptoms, we look together at her whole story to see what could be causing her problems.

There is hope. Each of these stressors can be addressed. You can take one small step at a time to personally make changes. Begin to see yourself as a whole person, who has value and great worth as a woman.

By using an individual plan that measures dietary approaches, nutritional supplements, exercise, body work, and sometimes talk therapy or bioidentical therapy, most women can begin to rewrite their emotional stories. You can have a new story too, with chapters that include a dynamic and emotionally fulfilling life.

by Marcelle Pick, OB/GYN NP

This is probably the most important single article on our website. Please make the time to read it.

The conventional theory of medicine says that your health is a matter of your genetics, exposure to infection and lifestyle. But with rare exceptions, your emotional experience is a greater factor than any of those. That’s not just our assertion — there’s now solid science behind the correlation of emotional experience and a host of diseases and health conditions, from heart disease and depression to obesity and chronic pain.

At Women to Women, we learned long ago that no one can really be well without dealing with their emotional health. This may seem like a radical idea, but for so many women with intractable health problems, there won’t be any progress on a physical level — no matter what therapy is used — until there is progress at the emotional level. As Alice Miller expresses it in the title of her book, The Body Never Forgets — even if the emotional problem developed 50 years ago.

The good news is that you can do so much to heal your emotional self. And if you are at mid-life, you should know that in menopause your body is asking you to deal with unresolved emotional issues. This is the time to work on your emotional and physical health — together. So let’s explore the role of your emotional experience and how to use it to reclaim your self.

Proof of the link between emotions and health

While there are hundreds of studies that explore the emotional roots of disease, the most insightful place to start may be the breakthrough ACE Study.

In the 1990’s over 17,000 patients of a large health plan were enrolled in a study to assess the link between emotional experience and adult health. (The federal Centers for Disease Control co-designed the study). The results were stunning; as the authors wrote, “…they have given us reason to reconsider the very structure of primary care medical practice in America.”

Participants were asked whether they had experienced any of eight forms of personal abuse or dysfunctional family behavior before the age of 18 (each called an “adverse childhood experience,” or ACE). More than half of the patients had one ACE or more.

Even more surprising was the correlation to health outcomes: those who had experienced an ACE were between 4 and 50 times more likely to have an adverse health condition or disease as an adult. The adverse health outcomes covered a surprisingly wide range, including heart disease, fractures, diabetes, obesity, alcoholism, and more.

The authors concluded that the ACE Study “…documents the conversion of traumatic emotional experiences in childhood into organic disease later in life.”  How does that conversion occur? Before we explore that central question, let’s dwell a moment on just what we mean by adverse emotional experience.

We’re all affected by adverse emotional experience

The ACE Study focused on a relatively narrow set of easily-measured adverse emotional experiences from childhood and found that half of the adults in the study had suffered one. But if we include all dysfunctional family behaviors, plus other emotional traumas (such as death of a loved one) and adult experience, it’s obvious that virtually everyone has suffered an adverse experience by the ACE standard.

So if the ACE Study found that adverse emotional experience was the biggest single factor in predicting adult health, and virtually all of us have had such experiences, what does that say about our approach to preventative health?

The truth is that all emotional experience affects our health, whether positive or negative, and whether it occurs in the past or the present. But negative experiences appear to have more lasting health effects, perhaps because we don’t deal with them.

Let’s back up a step. A feeling is the body and mind’s response to any given situation. Some psychologists and scientists believe we have five basic feelings:  joy, fear, anger, grief and love, with other feelings being variations on these five states. An emotion is what your body does with one of these feeling states.

What we all learn from our families, abusive or dysfunctional or loving, is how to take action with our feelings. If our mothers responded to grief or loss by withdrawing, or dealt with suppressed anger by becoming hypercritical of those they loved, chances are our own responses will be similar. We tend to model our own emotional habits after our parents’ or family’s emotional habits.

What’s the health significance of this emotional modeling? Consider the subject of stress. That’s something we all have, right? The Center for Disease Control estimates that 90% of all visits to the doctor are stress-related, and there are hundreds of medical studies linking stress to a host of diseases. But what exactly is stress?

Most women think of stress as the demands on them that they can’t do anything about, like an unreasonable boss or taking care of an aging parent. But why do some women find those factors stressful and others don’t?

I believe it’s because stress is personal — I find something stressful because of my personal emotional history. So do you. Moreover, each of us tends to recreate stressful emotional situations in our lives — at least until we resolve the old emotional issues that give the stress its power over us.

There’s a commonplace idea that women have greater emotional health than men because women surface and talk about their feelings so much more. That’s true, but it doesn’t mean women’s emotional patterns are healthy. My patients (all women!) have almost all been conditioned to put others ahead of themselves, to “stuff” their emotions (especially anger), to feel unworthy of love, to feel responsible for making others happy, to demand perfection of themselves, and so on. None of those patterns are good for our emotional well-being or our physical health.

Let’s return to how adverse emotional experience translates into health problems. Then we’ll talk about how to turn things around.

Your biography becomes your biology

Our language is filled with expressions of how emotion affects the body: tension and stress gives me a knot in my stomach, overwhelming sadness makes me feel all choked up, a difficult person is a pain in the neck.

More seriously, a recent study showed that sudden emotional shock can cause heart attacks even in healthy people. Called “broken heart syndrome,” these heart attacks were related to the loss of a loved one, fear of an event or activity, or sudden accidents. Notably, most of the sufferers were women.

How does a fleeting feeling have lasting health effects? Research on this is still in its infancy, but there are at least four paths we already know about.

First is the general effect of stress, which triggers the adrenals to produce cortisol and adrenaline. Cortisol is very helpful in small doses (as part of the fight or flight response) but sustained high cortisol levels (the result of unremitting stress) have very destructive effects on the body, including weight gain, high blood pressure, high cholesterol, suppression of immune function and acceleration of aging. For more on cortisol, read our articles on adrenal fatigue.

Second is the effect of unresolved emotional issues on systemic inflammation. Medical research has recently implicated inflammation as a contributing factor in a host of diseases, including cancer, heart disease and Alzheimer’s.  For more on systemic inflammation, read our other informative articles.

Third is the effect of emotions on particular organs. Many alternative practitioners attribute illness in a specific organ to a specific cause. While this is controversial in Western medicine, it has been well documented in medical literature that “Type A” personalities have much higher rates of heart disease, and that women who suffered childhood sexual abuse have higher rates of dysmenorrhea and pelvic pain. The mechanism of action may be peptide chains formed as part of the biochemistry of emotion that bind to receptor sites in specific organs, a concept pioneered by the renowned biochemist Dr. Candace Pert. We believe many more links will be discovered as research in this area continues.

Fourth is the effect of emotions on behavior. The ACE Study revealed a cause and effect link between adverse childhood experience and negative health habits like drinking, smoking, overeating and sexual promiscuity. The authors recognized these negative habits as self-medication for unresolved emotional pain. But over time the suppression of all that pain through these self-destructive habits has terrible consequences.

The myopia of Western medicine regarding emotions

Despite research like the ACE Study and hundreds of others, conventional medicine is blind to the causal role that emotional experience plays in the development of illness and disease. Instead of looking at root causes, it only treats symptoms. No wonder so many patients find themselves going steadily downhill despite the best conventional treatment.

I was once asked in what percentage of my patients were the problems purely physical, that is, lacking any emotional component. After a moment’s thought, I answered “about 1%.” That’s not a statistic, but it conveys the truth – very, very few women’s health problems are just about a physical problem.

Western medicine insists on dealing with each disease or condition as a separate and distinct issue. But that’s just not how the body works. That’s why at Women to Women it takes two hours for your first appointment — we need to know your full history — including a full hour with your practitioner.

Western medicine used to emphasize the full history. But specialization has pushed us to dissociate each aspect of the body from the whole, and managed care has pushed the average appointment time down toward six minutes — and too many people don’t get even that.

Like conventional doctors, many of my patients are so conditioned to think of health as a purely physical issue that they are floored when I suggest their symptoms may have an emotional component. I hope this article helps you connect the dots. Like so many other parts of your life, you are going to have to take responsibility for your emotional health. And if you are at mid-life, this is the perfect time to deal with it.

Menopause and emotional health

Christiane Northrup, MD — one of Women to Women’s co-founders — has written that menopause is largely about “the reclaiming of self.” After a lifetime of taking care of others, “stuffing” our emotions, finding fault with ourselves, and ignoring our feelings of hurt and anger, our biology requires us in menopause to straighten things out, to find our voices, and to reclaim our lives. That’s one reason why so many women are motivated to take control of their health at this time.

Let me give you an example. A patient came in to see me describing constant heavy bleeding (menorrhagia). We tried dietary changes, supplements and other purely physical approaches, with only minimal improvement. I began to probe for the emotional basis of her condition. She shared a description of her marriage to a man who did not support her emotionally and was often verbally abusive. I helped her see the connection between her relationship and her symptoms. One day a few months later, she came into my office and told me she had finally found the courage to leave the relationship. Her heavy bleeding stopped the next day, and has not returned. It was tough to face — but she took control of her life and reclaimed her self.

Menopause provides a natural venue for this work of exploring your emotional environment and your history. It’s like adolescence in reverse: your body asks you to question who you are, what you’re passionate about, and what’s working or not working in your life. All the pieces that haven’t been resolved come up now for healing and transformation. Depression, mood swings, hot flashes, and other symptoms of menopause have a physical origin but also an emotional root — and you need to deal with both at the same time.

The intractable medical condition – no such thing?

The role of the emotions is a big reason for two problems we see every day: the woman who goes to a conventional doctor for her symptoms and is given antidepressants; and the woman with a condition that resists conventional treatment. Many of these women are not going to feel better until they begin to deal with the emotional root of their illness.

In a monograph on the long-term medical consequences of childhood trauma, Stephanie Dallum, FNP, talked about the connection between emotional experience and unexplained physical symptoms. The medical term is somatization — physical symptoms with no medical diagnosis. But the insomnia, headaches, obesity, gastrointestinal distress, palpitations, chronic pain and fatigue caused by adverse emotional experience in her study are very real.

With new patients at our medical practice, we generally begin with the physical issues and treat with dietary changes, nutritional supplements, exercise and other lifestyle changes. We tend to use prescription drugs as a bridge to a more balanced natural state, rarely as an on-going solution. The more severe or intractable the symptoms, and the more receptive the patient, the sooner we introduce the connections to emotional issues. The good news is that those who are willing to tackle both the physical and emotional aspects of their health almost always see the improvement they want.

Mapping your emotional inheritance

At Women to Women we have a shorthand expression for this process of exploring your emotional inheritance and resolving issues. We call it “your work,” as in “she’s just begun to do ‘her work’ but she’s already feeling so much better.”

There is a tool called a genogram that therapists use that may be helpful to you as well. A genogram is a specialized family tree that lets you explore the patterns and relationships running through your family history. We’ve found free genogram software on the internet if you’d like to try it.

As you use the genogram to map out your emotional inheritance, ask yourself questions to find the parallels between you and your family members. For example, if certain interactions with your husband affect you badly, ask yourself who he is being like in your family — and who are you being like?  What emotional patterns can you see from generation to generation?  What family conflicts or secrets have never been resolved — and why not?  What emotions have been “stuck” — like grief or anger or pain — and how might they be dealt with now?

How do you heal past emotional experience?

There’s plenty of evidence, both from our clinical experience and from medical research, that emotional healing creates positive physical changes in the body. So how to accomplish that?

In a perfect world we would all be able to afford a few years of therapy — and with the right therapist! We do ask women to view that cost as an investment in their health. We especially recommend therapies based on family of origin. But not all of us can make that investment.

There are group therapy options that are affordable and can be helpful. You may be able to make progress with a like-minded friend or family member. The Emotional Freedom Technique (EFT) has been helpful for many women; there is free online information about EFT as well as reasonably-priced EFT workshops.

Yoga, meditation, exercise and other stress-relieving techniques are helpful as part of your overall health plan, but unfortunately they are not a substitute for “your work.” You may also benefit greatly from books. We recommend No One Is To Blame by Robert Hoffman, creator of the Hoffman Process that underlies the therapeutic method now known as the Quadrinity Process. We also suggest using The Whole Person Fertility Process by Niravi Payne as a workbook for exploring your emotional inheritance.

Unfortunately reading is not a very emotional experience, and thinking about your emotional issues isn’t going to resolve them. That’s why therapy — one on one, in a group, or with a self-help method like EFT — is so important. We suggest you think of this as an on-going process, just like the other parts of your health strategy.

Deal with the past and move on

It may take courage and faith to examine your own life, to face the past with kindness and gentleness for the person you have been and the people who have caused you pain, and to support the person you feel yourself becoming. Healing your past emotional experience helps create a joyful, healthy present moment and opens the doors to the life you want for yourself.

We love the study of centenarians (those who live to be 100) done at Harvard Medical School a few years ago. The oldsters were found to be surprisingly healthy and active. Dr. Margery Silver, one of the authors, said in an interview, “…there is a particular characteristic that is typical of centenarians. And that is that they are able to manage stress very well. And this doesn’t mean that they’ve had stress-free lives…some of them have had really very difficult, and even traumatic lives. There are holocaust survivors, there are women who were widowed at an early age and scrubbed floors to raise their children, and yet they seem to have the ability to roll with the punches…they seem to accept their losses, grieve them and then move on.”

This is a vision of emotional health we wish for all of us — to face our emotional pain with honesty and openness, and get on with our lives.

by Marcelle Pick, OB/GYN NP

As winter approaches, many patients come to see me to talk about changes they are experiencing in energy, sleep habits, hunger patterns and even sadness. Although this may be a common reaction to the shorter days of winter, as a culture, we’re conditioned to keep our fast pace steady and move past sadness.

Seasonal Affective Disorder (SAD) was first written about in medical journals in the mid 1800’s , but wasn’t studied seriously until the 1980’s. Recent literature reports that up to 80% of American’s suffer with some degree of SAD – the more shocking fact is that more than 70% of that group are women! It’s also very interesting to note that women may first notice SAD symptoms between her mid 20’s and mid 30’s – which is about the same time when women will report changes in hormone balance.

There isn’t a very clear cut answer to the cause of SAD. Like many depressive disorders, SAD can stem from a variety or combination of imbalances or may even have a genetic component.

The symptoms of SAD are wide and varied. They include: irritability, carbohydrate cravings, a disinterest in social activities, irritability, sleepiness, and fatigue. For some women there is a tendency to compartmentalize their lives by season – actually experiencing very different emotional states and activities with each season.

Our great grandparents accepted that their sleep was regulated by the light of day – when the sun rose the day started and when the sun set the day ended. Light affects the neurotransmitter serotonin which is responsible for the production of melatonin.

It’s always best to check with your healthcare practitioner if you find that your mood and interest in activities change. If you have SAD, there are things you can do to help relieve your symptoms. If you have been diagnosed with severe depression or if you have ever been diagnosed with a major depressive disorder, it’s important for you to work with your healthcare practitioner. For some people, prescription anti-depressants are helpful. If you have worked with a healthcare professional on a plan of care which works for you, we do not recommend changing your treatment plan without the close guidance of a healthcare professional.

For more information, read our informative articles in our Emotions, Anxiety and Mood section.

I have worked with many women who find great success in using one or more alternative treatments to successfully alleviate their symptoms. You may utilize one or a combination – the goal is to relieve any symptoms you have – irritability, fatigue, carbohydrate cravings, and seasonal sadness.

You may want to have your Vitamin D level tested. Vitamin D is fat soluble, and your body doesn’t have a way to rid itself of excess Vitamin D, so it’s important to work with a healthcare practitioner to be tested. If your vitamin D level is low, dietary supplementation is recommended. I have many patients report that Vitamin D supplementation makes a world of difference for them.

If you are experiencing lethargy or fatigue, it’s important to establish a regular schedule to support your internal scheduling meshing with the nature’s schedule. Set a schedule of rising and going to bed at the same time each day. Its best to get seven to nine hours of sleep per night.

Try to get outside every day. Just fifteen minutes per day can help ease symptoms of SAD. There are also added stress relief benefits. If you aren’t able to get outside, try to spend time near windows, so that you are exposed to natural sunlight.

Many people find symptom relief using light therapy. Light therapy has no known side effects (other than a potential for overuse). A Canadian study tested Prozac against light therapy and found that both treatments relieved symptoms equally well. The light therapy showed positive results in less than one week! This, combined with the cost and multiple potential side effects of anti-depressants, makes light therapy a wonderful option for many!

Women with SAD may crave sugar and carbohydrates for serotonin. These will set you up on a roller coaster of ups and downs. Whole grains and complex carbohydrates will give your body what it needs and will keep you more balanced. Good food choices will help alleviate afternoon fatigue, weight gain, fatigue, depression and cravings. Read our article, “Understanding Carbohydrates – Let’s Take Away The Confusion,” for information and ideas.

Exercise is a key factor in increasing your serotonin and in your well-being if you are feeling depressed. I tell my patients to find an activity they enjoy doing –a brisk walk, a yoga class or a vigorous dance class. You don’t have to spend hours a day or even do the same thing every day! Start slowly, increase moderately and notice the difference in how you feel.

I encourage all my patients to take a high quality multivitamin and omega-3 fatty acid dietary supplement and evaluate their needs for vitamin D. When you are supporting your body through the transition changes of SAD, you will benefit from adding extra vitamins and minerals. It’s so difficult in today’s world to take in all the nutrients we need from our diet. Modern food processing and farming practices have negatively impacted our food supply’s nutritional value. New research is shows Omega-3 fatty acids as effective antidepressant support.

Women to Women offers these high-quality, pharmaceutical grade supplements to enhance your health. Click here to find out more.

In treating SAD, it is important to listen to what your body needs. You have your own unique needs and rhythms – try several suggestions and listen carefully to what’s working – you may be very surprised!

by Marcelle Pick, OB/GYN NP

What Is depression?

As humans, too often we seem to be struggling to maintain our balance. While modern medicine has vanquished most of the acute infectious diseases that were once our greatest threat, depression is still prevalent. I know that many of you may have had bouts of depression in your life. It’s overwhelming, but there is hope!

For example, let me tell you about Sarah. She’s a busy physician and a 46-year-old mother of two small children. When she first came to me, she was complaining of anxiety, fuzzy thinking, premenstrual syndrome (PMS) symptoms, and significant depression. She was also struggling unsuccessfully to lose about 15 pounds that she gained with her pregnancies. Sarah had a very demanding job and admitted to me that her life “was not going well.” This sounds like so many women today, as we attempt to juggle our relationships with our family, our friends, our work, and make time to take care of ourselves! That, unfortunately, comes last.

Let’s review what I told Sarah about her symptoms of depression. One of the primary things to assist you with your symptoms is for you to understand the symptoms and treatment options and see if they apply to you.

Understanding the symptoms of depression

The symptoms of depression can include a variety of normal negative emotions, and most women will experience symptoms of depression at some time in their lives. However, clinical depression is drastically different from situational or mild depression, even though some of the symptoms can be the same. There are a numerous of types of depression. But it is important to understand where and if your symptoms fit in so that you can find the best help for depression. So lets look at some of the symptoms of depression.

Symptoms of depression some may experience

•  Overwhelming, persistent feelings of grief, anxiety, guilt or despair
•  Feelings of worthlessness, feelings of never being enough
•  A sense of numbness or hollowness, nothing makes you happy
•  A loss of interest or pleasure in activities that were once enjoyed
•  Decreased energy, dullness
•  Difficulty concentrating or making decisions
•  Irritability, small things make for huge reactions
•  Disrupted sleep patterns, including insomnia or not being able to get out of bed
•  Overeating and weight gain
•  Reduced appetite and weight loss
•  Lack of interest in sex, complete and utter loss of desire
•  Sense of not wanting to get up to do your day

Mild or situational depression

In mild or situational depression these symptoms usually go back and forth and eventually they are gone. For example, this is an appropriate reaction to something that happened, such as going through a major life transition; experiencing a crisis, loss, such as a death of a loved one or trauma; or placing too much physical stress on the body. Working 15 hour days without a break. Women may experience postpartum depression or depression as one of the symptoms of premenstrual syndrome (PMS). Many women, especially in the north are affected by seasonal affective disorder (SAD), in which their symptoms of depression consistently follow a seasonal pattern.

Mood disorders

The difference between mild depression and clinical depression is that the mood symptoms are more severe and perhaps extreme, and there isn’t a clear cause of the severity of the depression. For people with clinical depression (called major depressive disorder or MDD), the symptoms are incapacitating and often occur spontaneously. Mood disorder symptoms do not go away, in spite of many changes and they often spiral into a mental health crisis.

Major depression can be accompanied by suicidal thoughts, obsession with death, or suicide attempts. If you have a general feeling of hopelessness, or if you or someone you know seems to have these symptoms or thoughts, especially if they have attempted suicide or considered it have even considered suicide you should find help immediately! Don’t wait to see if the symptoms improve. Seek the advice of your doctor or a psychiatrist, psychologist, or social worker. People with severe MDD can experience psychotic symptoms. In this case, medical treatment is absolutely necessary.

A variant form of clinical depression is dysthymia, also known as double depression. Dysthymia is recognized as chronic depression that lasts for more than two years. The symptoms are not as severe as those of MDD, but are more definitely more persistent.

Some people experience bouts of depression, but they may be mild or severe, interspersed with periods of intense energy or impulsivity. This is a sign of a more complicated disorder known as manic depression or bipolar disorder. Bipolar disorder is rare, but, we are seeing this disorder more often. You certainly hear about it more often in the media. It can become debilitating without treatment. If you are having or have had symptoms that make you question that perhaps this may be true for you, you should seek help from a mental health expert. These symptoms may include feelings of mania, excitement, excess energy, need for little sleep, and feelings of being invincible or better than others and then followed by periods of extreme depression.

Treatments for depression

For people with major depressive disorder, dysthymia, or bipolar disorder, antidepressants or mood stabilizing drugs are a very important part of their treatment. However, patients with these diagnoses will benefit greatly from additional, more integrative approaches that must include lifestyle and dietary interventions. Be sure to discuss your symptoms of depression with your practitioner or mental health provider.

Women who experience common types of mild depression can often find significant relief through alternative treatments. For more information on depression relief using a more natural approach without medications, and why this may be the best choice for you, read our full article on antidepressants.

Finally, chronic unrelenting physical symptoms that don’t seem to respond to treatment, such as headaches, overall body aches, sleep disturbances, digestive disorders, and pain can be an indication of depression, but these symptoms might be caused by an underlying physical condition that needs to be tested. Before taking antidepressants for these symptoms, you may want to get get a second opinion. Functional medical practices (those that combine alternative and conventional medicine) are extremely successful at finding the true source of these seemingly disconnected ailments. For more information, see our article on how to make alternative/functional medicine work for you.

Conclusion

Let’s see what happened in Sarah’s case. All of her conventional tests were normal, so we had Sarah take a neurotransmitter test and found that her serotonin was severely depleted and her dopamine was elevated. We also discovered that her adrenals were suffering and needed support. Our first step was to start Sarah to begin to heal by removing caffeine, sugar, gluten, and wheat from her diet; and we added a few targeted nutrients to support her body’s ability to replenish her neurotransmitters and hormones naturally.

On the lifestyle front, Sarah vowed to start putting more limits on her practice and to take more time for herself. I also recommended more exercise, at least three times per week, intense enough to break a sweat and get her endorphins going. Sarah entered psychotherapy and carved out time to exercise regularly. She was strict with herself about meals and sleep, and she reduced some of her work demands. Within a month, Sarah reported a huge shift in her mood and energy levels and began losing weight. She felt inspired to stay with her clean diet and lifestyle changes and continued on neurotransmitter supplemental support. Now, six months later, she feels that her life is back on track. She’s lost all the weight, her mood is great, and she has all the resilience and energy she needs to take care of her kids and her medical practice. But best of all, Sarah is back in control and happy with her life. Now she can be more present for herself, her patients, and her family.

Sarah’s depression and neurotransmitter imbalance was on the low end of the scale. If you have a diagnosed clinical biochemical imbalance – such as clinical depression or post-traumatic stress disorder – it may take more work – and with the help from a team of trusted health-care practitioners and therapists, I hope.

by Marcelle Pick, OB/GYN NP

A list of antidepressants and their side effects

Depression includes a wide range of normal negative emotions and often manifests physically in symptoms that won’t respond to treatment, including but not limited to weight gain, chronic pain, and digestion disorders. But clinical depression differs significantly from minor or situational depression or mood disorders, even though the symptoms can be the same. How can you tell which you have? The difference is that in mild depression the symptoms ebb and flow and eventually lift, while in major depression they spiral down into a full-blown mental health crisis. Patients often describe the sense that they are on the edge of, or slipping into, a deep, dark hole. If you’ve been feeling any of the following symptoms consistently for over a month, you should immediately seek medical advice, preferably from a trained psychiatrist, psychologist, or social worker.

•  Overwhelming, persistent feelings of grief, anxiety, guilt, or despair
•  A sense of numbness or hollowness
•  Feelings of hopelessness
•  A loss of interest or pleasure in activities that you once enjoyed, including sex
•  Dullness
•  Decreased energy
•  Difficulty concentrating or making decisions
•  Disrupted sleep patterns
•  Loss of appetite
•  Suicidal thoughts or attempts and obsessing about death—these are serious warning signs that need to be addressed immediately

If this sounds like you, please don’t worry. You can get better. Depression is a physical and mental condition that responds very well to treatment, both conventional and integrative. The most important thing is to get some help. You may be asked to take medication as part of your treatment plan. If so, then you’ll want to know what some of these are, so you can help choose what’s best for you. Following is a list of the many antidepressant medications that are used in conventional medicine. The listing is not comprehensive as the medications change rather quickly with new ones coming out all the time but it will let you know the medications used for depression and their biochemical family. Some side effects of antidepressants are listed below, just look for the headings for the various types of antidepressants. Many side effects can occur even with short-term use. Relatively little is known about the long-term effects of most drugs for depression as they were never studied for long term use, or their interactions with other drugs. For a more comprehensive discussion about antidepressants, or if you’re curious about natural alternatives to antidepressants, be sure to read our articles on antidepressants and alternative treatments for depression.

Common Antidepressant Medications

 

Tricyclics

These drugs have been around for a long time and they affect norepinephrine and serotonin. They are as effective as SSRIs in many people, but they do have a much stronger side effect profile. Thus they are usually suggested as a second or third level option of treatment. Some of the common side effects of include dry mouth, constipation, bladder problems, sexual dysfunction, blurred vision, dizziness, drowsiness, and increased heart rate.

MAOIs

Monoamine oxidase inhibitors (MAIO) are really helpful for some people, with major depression, who don’t react to other antidepressants. They can also use to treat panic disorder and bipolar depression. People who take MAOIs have many things to remember as they have to avoid taking decongestants and eating many foods that contain high levels of the monoamine tyramine, including fish, chocolate, and fermented foods (such as alcoholic beverages, cheeses, soy sauce, processed meats, and pickles).There are also many vitamins and nutrients that can interact with MAOIs. So if you are on an MAOI remember to read labels of the interactions. One of the most notably interactions of tyramine with MAOIs is they can bring on a sharp increase in blood pressure that can lead to a stroke.

SSRIs

The side effects of serotonin reuptake inhibitors (SSRI) include sexual dysfunction, nausea, nervousness, insomnia, agitation, and decreased sweating with increased body temperature. These side effects may be enhanced when an SSRI is combined with other medications or herbs that affect serotonin (such as St. John’s Wort and SAM-e). There are many people however, that do very well with these herbs, just remember that we are all different with different reactions. In extreme cases, the combination of medications (for example, an SSRI and an MAOI) may result in a potentially serious or even fatal serotonin syndrome, characterized by fever, confusion, muscle rigidity, and cardiac, liver, or kidney problems.

Newer drugs

There are new classes of antidepressants being developed and being made available for use. Classifying them is not always clear, because of their combined biochemical action. One of the new classes is serotonin/norepinephrine reuptake inhibitors (SNRI), such as the tricyclics. This class of drugs affects both norepinephrine and serotonin levels but has a fewer side effect profile.. SNRIs include Effexor (venlafaxine) and Serzone (nefazadone). Cases of life-threatening liver failure have been reported in patients treated with Serzone, and this trade name was actually discontinued in 2003; however, the generic version of Serzone (nefazodone) remains available. Some of this is probably related to a genetic SNP affecting how drugs are detoxified by the liver. Patients should call their doctor if they have the following symptoms of liver dysfunction: yellowing of the skin or whites of the eyes, unusually dark urine, loss of appetite that lasts for several days, nausea, severe lethargy or abdominal pain. In addition, there are other new medications that are not chemically related to the other antidepressants, however, they have similar side effects to SSRIs. These include Remeron (mirtazepine) and Wellbutrin (bupropion). These drugs must not used by anyone who has, or might be at risk for, seizure disorders.

by Marcelle Pick, OB/GYN, NP

Postpartum depression’s silver lining

Women who have had a baby know that pregnancy and childbirth are most often not the picture-perfect image that we see displayed in the media (for example magazines, movies, television, and the internet). One of the most common instances of this difference is when a new mother experiences postpartum depression (PPD), especially if she’s had a terrific, even enjoyable pregnancy and then has symptoms of PPD. However, for me, a story of a good prenatal experience that is followed by a bad case of postpartum depression points to a specific health issue that might otherwise go unnoticed – a hormonal imbalance that can resurface or persist all the way through your life especially into menopause.

Maybe you’re way past your childbearing years, or perhaps you’ve just recently had a baby. Either way, you should understand that it’s important for you to pay attention to your postpartum emotions. If you are a new mom who is feeling mildly depressed, or even if you felt that way when your now-teenage son or daughter was still in diapers, please understand that there are physical issues related to these emotions. Even years later, these symptoms are important to recognize.

I have patients tell me all the time, “I haven’t felt quite right ever since I gave birth,” long after her child has grown out of babyhood. This makes complete sense: if there was an imbalance in your body before you had a baby and that manifested itself with PPD symptoms, then it’s highly likely that it’s still with you even after PPD resolves.

And here’s the good news – that’s the silver lining to PPD. Having PPD symptoms can highlight a hormonal imbalance problem that you can do something about before it starts causing you major difficulties with your menopausal transition. This is especially important if you’re an older mom who might already be starting perimenopause. When you try to balance your hormones while you are chasing a toddler around, it can be a challenge, to say the least! The two simply do not seem to go together. So let’s discuss what happens to your hormones after you have a baby (postpartum) and how PPD can act as a signpost for regaining your hormonal balance afterward.

It’s not just a “mood” you’re in—your hormones after pregnancy

As we so often tell our patients who come to see us at Women to Women, your endocrine system is inextricably linked with your brain and nervous system. It is like an orchestra, that needs to have everything in balance or the overall effect is off. This explains why women are more prone to problems with mood during their hormonal fluctuations. These periods of vulnerability include puberty (menarche), premenstruation, pregnancy, childbirth, and menopause.

I don’t think many people would disagree that having a baby is near the top of the list of hormonal transitions, when it comes to how “big” its impact is in our lives! Mother Nature gives many amazing ways to maintain our wellness through change, however historically; childbirth has been the biggest risk to survival that a woman may face. The hormonal tides of adolescence, perimenopause, and menopause usually appear in our lives in a more gradual way, but the hormones in childbirth act like a tsunami, flooding us all at once. In the world of today, a mother’s survival through childbirth is not usually a big concern. However, the risk of depression and other mood problems does rise during these unique times in a woman’s life, especially when she is under stress of any kind (as most of us usually are). The transition post pregnancy with respect to the hormones is actually quite drastic. One moment you are pregnant the next you are not. Postpartum emotions can make you feel as if something is really wrong. In fact, your feelings are normal and natural—in the sense that they reflect the hormonal changes that are happening in your body and brain—but that doesn’t mean that they are the most favorable for keeping you and your child healthy. Most likely, the message they are sending is, “Send more support!” And that can mean emotional support, help with caring for the baby, and most importantly, support for your physical healing.

If your symptoms of PPD are long gone, you might be saying, “NOW you tell me!” — but hear me out, because it’s still not too late to benefit from your PPD experience.

What PPD tells us about our hormones

One of the most significant hormones related to PPD is progesterone. During pregnancy, the levels of progesterone in a woman’s body are at there highest. Progesterone helps to prevent lactation (secretion of milk from your breasts) during pregnancy, and then a sudden drop in its level takes place just before birth. This allows labor to begin and lactation to start. Isn’t it amazing what our bodies can do? However, a few women will have symptoms of depression that include, severe irritability, poor sleep, and agitation, restless behavior (these are the women who go down to the basement to clean it when they feel out of sorts, some have more severe symptoms). Alternatively, progesterone has a calming effect on your brain, and if you’re one of the women affected this way, your mood can change following childbirth, as it returns to your prepregnant levels. This will be around day five after delivery. For you, and women like you, a deficiency of progesterone is an important characteristic of PPD.

But what’s complicated about progesterone is that it’s not always that the hormone is deficient. Some women are extremely sensitive to fluctuations in progesterone levels. That means that even if the hormone level is what is considered a “normal” level, these women’s bodies and brains respond as if they’re experiencing abnormally low progesterone. For them the balance of the hormones, the orchestra is out of tune. So in response, we cannot simply perform a test to determine if the progesterone level is low—we also must find out if a woman has a history that points to this kind of sensitivity.

So how can you find out if you’re one of the women who is highly sensitive to fluctuations in progesterone levels? As I encourage all women to gain more knowledge about their bodies, I suggest that you understand your personal reproductive rhythms. In your menstrual cycle, progesterone is at its highest after ovulation, and then it drops just before menstruation. There are mood changes that you might feel that are associated with this drop in progesterone. These changes are similar to those seen in PPD—it’s almost as if PPD is a magnified form of your PMS moods. If you have major mood changes before, during, or after your menstrual cycle, it could indicate that you are highly sensitive to the changes in your progesterone levels. This means that you’re more likely to develop PPD. And if any of the above sounds an alert for you—“This is me!”— then more than likely, you could have a hormonal imbalance when you reach menopause.

When motherhood and menopause converge

We’ve heard over and over that many women who are age 35 and above are becoming first-time mothers. This is often seen as a challenge to determine what this increase of mothers in their late 30’s and 40’s means for maternal health during and after pregnancy. For many they are considered advanced maternal age patients. We think that concern is overstated, and that there are advantages for women who choose to delay their families until their 30’s or 40’s. One of these is the lower incidence of PPD. A healthy 40-year-old woman actually has less risk than some younger mothers for PPD, because she probably has a stable family life and a social support system, in addition to a stronger sense of self. Mothers in their late 30’s and 40’s have probably spent more time planning for motherhood, and they may be better prepared for the challenges of caring for a newborn. They are also much more aware of themselves and are able to sustain many challenges with more grace than when they were younger. Studies show that women who are over 35 will more likely seek help for their symptoms of depression.

One area of concern for mothers in their 40’s (compared to younger moms) is their hormonal balance. It’s not unusual for a later-life mom to go right into menopause after childbirth without any interlude. If you’re a new mom nearing (or in) perimenopause, it’s very important that you do your best to take care of your overall health to try to avoid PPD, in addition to decreasing your menopause symptoms while caring for your young children (particularly if you’re breastfeeding). Remember perimenopausal changes can occur 10 years prior to official menopause.

So let’s review some options that you can do right now, whether you want to address PPD or if you want to restore hormonal balance long after childbirth:

• Think nutrition, nutrition, nutrition. Food is the most powerful drug we have. If you’re a new mom and are breastfeeding, I hope that you are taking the prenatal vitamins offered to pregnant women. You should definitely keep taking them! I would also like you to consider adding a high-grade omega-3 fatty acid supplements if it is not already in your prenatal nutrients. Studies show that it can act as a natural antidepressant. However, if you’re not breastfeeding, or if you’re long past childbirth, then it’s still important to get your key vitamins and minerals. The old days of us being able to get all of the necessary nutrients just from our food is long gone. I can’t stress enough how important a pharmaceutical-grade multivitamin is as a first step—but understand it is not the only step to good nutrition. Food sends messages to your bodies’ biochemistry which in turn help to restore your body’s balance. the suggestions we offer in our article on eating to support your adrenal glands are just as effective in helping to heal your hormonal imbalances uncovered by PPD.

•  Include movement into your routine. Most of us need some sense of routine in our life to feel “normal.” If you’re a new mom and you’re feeling not quite right, remember to add a new routine for yourself. It needs to be flexible enough to work with your baby’s changing schedule. Just the regimen of getting up each morning, bathing, and getting dressed will help you feel better, but the more you can do to move your body, the better you’ll feel. Start with a gentle, simple exercise that can help you build and tone your muscles slowly, something such as yoga, t’ai chi, or walking taking your newborn for a walk—these are relatively easy to include in your schedule, even with a new baby. And do what you can to get outside and enjoy the sunshine and fresh air every day! That’s free and easy for everyone. Even if PPD is in your past, you might find it helpful to make changes to your existing routine to improve your hormonal balance. For example, if you’re not already into an exercise routine, make an effort to move your body daily. It doesn’t have to be an ambitious, hour-long, high-impact aerobics class! Just go for a walk, get out in the garden, stretch your body, or think of some other activity will give your health a boost. Exercise promotes mood-stabilizing hormones and relieves stress—which are both important components to regain hormonal balance. Most gyms now have babysitting services, this is something you can ask about when looking at your options.

• Prioritize your health. Busy moms sometimes forget to take time for themselves, as their focus is on the new baby. You might not realize that when you neglect your health, you and your whole family suffers. One of the best things you can do is to take care of yourself, as much for you as for your children and your family. You will find you have more to give when you are filling up your needs first. If you’ve been feeling physically out of sorts since childbirth—even if years have passed—talk to your healthcare practitioner about what’s been going on. There may be simple things that need to be adjusted. Look at our articles on adrenal health and fatigue to see if you see a pattern in your life, and take steps to correct these problems. Above all, don’t feel badly about taking care of yourself! You have to have the stamina and energy to run the show as many mothers do.

•  Explore your emotional story. We have previously discussed the link between stress and health in our articles on emotions, health, and stress. Where PPD is concerned, some of what happened to you as a child might be enhancing your emotions about being a parent. Think back on these questions. Were your parents loving and present in your life, or were they detached and absent, or even abusive? Sometimes we try to overdo what we saw as a lack in our own childhood. Do you feel confident about your capabilities as a mother, or are you frightened, confused, and unsure if you’ll be able to properly care for your child? (We don’t have classes on parenting in high school or college). These factors can affect your physical well-being more than you might imagine, and if they’re part of your circumstances, consider talking with a therapist or using emotional healing techniques to address them. Even if your child is grown, it’s still wise to look at your feelings about being a parent, if this is a source of stress for you. This for some can transform how they parent.

•  You many want to consider bioidentical progesterone therapy. When we see women at our clinic with PPD, we often check their progesterone level. If it is unusually low, we recommend bioidentical progesterone therapy. Though there are no controlled studies to date of progesterone in the prevention or treatment of postpartum depression, at Women to Women we have used prescription-strength bioidentical progesterone replacement to help women whose levels remain very low postpartum, with fantastic results. We sometimes use this practice in women whose depression shows up in symptoms of restlessness, sleeplessness, or agitation, even if their progesterone levels are normal, as these are the women who seem to be unusually sensitive to hormonal fluctuations (as was mentioned previously). We especially use this if we see a cyclic nature to the symptoms. Natural progesterone has a known effect on the GABA receptors in the brain—the same receptors that opiate drugs (narcotics) bind to. I will say that this protocol is somewhat controversial; so many conventional practitioners may be unwilling to try it. We and our contemporaries, however, regularly see dramatic improvement in these women’s depression and anxiety, and although there have been no large trials to date that prove its efficacy, we have used this protocol with great effect many times for many years.

Progesterone Protocol for PPD 400 mg of bioidentical progesterone in divided doses: 100 mg in the a.m., 100 mg at noon; and 200 mg in the p.m. This regime is used from mid-cycle until menses resumes. We have reliable compounding pharmacies, such as Northern New England Compounding Pharmacy, locally we have Apothecary by Design or Women’s International Pharmacy, that make this up for our patients as sublingual troches or capsules. We are not as apt to use the creams as it is hard to get that dosage in a cream form without having to use large amounts of cream three times a day. We divide the dose to prevent associated fatigue or “spacey” feelings that may sometimes be associated with a rapid increase in progesterone levels.

•  Reduce inflammation. Inflammation is one of the key factors in depression, and studies show that mothers with PPD have higher levels of inflammation. Other physical and psychosocial stressors — (of notes is that stress is a leading issue here), risk factors for depression — also increase inflammation. Anxiety in first-time mothers, for example, is strongly linked with activation of the inflammatory response. So anything you can do to decrease anxiety and inflammation in your body is a good first step toward treating or avoiding PPD naturally. It’s really good for your health, even if you’re long past the likelihood of PPD. One good approach is to discontinue the use of foods that are known causes of inflammation, such as refined sugar or flour, caffeine, and alcohol. At the same time, you can increase your intake of nature’s best anxiety-dissolvers and anti-inflammatories, such as omega-3 fatty acids and safe, gentle herbs (good for moms and babies) such as turmeric, boswellia and motherwort.

Exercise, cognitive therapy, and the herbal antidepressant St. John’s Wort have also been revealed to help decrease inflammation. You have many choices, but for best results, consult with a professional, particularly if you’re breastfeeding— there are some herbs that are not particularly good for your babies, and these should be avoided until you want to wean your baby. See also our articles on natural anti-inflammatories.

If you’re a new mom, these additional points apply to you

• Seek help now if you’re currently in PPD or have the baby blues. The help that you get can make being a mother such a different experience. The earlier advice to prioritize your health goes double if you’re actually suffering from PPD right now. This is the hard part about PPD – understanding that it’s a physical problem that may need medical intervention. There seems to be a stigma associated with any sort of mental illness that new moms might have – you may not want to let on that anything is wrong. It’s our tendency as women to continue to try to do everything and we hide our symptoms and pretend that we have everything under control, when it’s not. Whether your symptoms are mild and go away in the first few weeks, or if you realize that there is something deeper going on, don’t think that taking care of yourself comes second to baby. It is essential and equally important that you take care of yourself and that you are whole and healthy to continue being a good mother. That is the best thing you can do for your baby. If you’re feeling exhausted, overwhelmed, and teary, don’t wait to seek help. Talk to your healthcare practitioner about ways to reduce your burden, and then you can start the process to heal. If for any reason, you have thoughts about harming yourself or your baby, get help immediately! Your practitioner will understand that these thoughts are a sign of postpartum depression and you can start on a treatment plan that will help. Intervention needs to happen immediately. Most importantly, you should not feel embarrassed or ashamed about it – an imbalance in your hormones doesn’t make you a bad mother! And the best news is you can do something about it.

•  Breastfeed to reduce maternal stress. We recommend breastfeeding for two important reasons. First, it’s been proven that it’s better for the baby (except in unusual situations) as it provides essential nutrients but also, just as important, it’s good for you!. Breastfeeding can protect your mental and emotional health, because it lowers stress hormones such as cortisol, ACTH, epinephrine, and norepinephrine. Women who nurse their baby also have a higher level of oxytocin, the wonderful “cuddle” hormone. The hormone that is also excreted with love making. Breastfeeding may promote faster weight loss, which will improve your mood as you adjust to your body’s changed appearance after the birth of your baby. It also encourages you to stay well-rested and hydrated—you can’t nurse your baby effectively if you’re always on the go, nor will your milk supply hold up if you don’t drink enough water. The other side is that if you’re having challenges with breastfeeding your baby, you can become frustrated and stressed about it, but remember that you don’t have to figure out the problem alone. Most hospitals and birthing centers have lactation consultants who will assist you in learning how to breastfeed effectively. Many of them will come to your house if need be. Contrary to popular belief, breastfeeding is not something that comes naturally to every mother, and most new mothers need to learn the best ways to offer this important nutrition to their child. In addition, you can contact the La Leche League for support. Alternatively, please understand that if breastfeeding is not an option, if it becomes a source of extreme stress for you, or if you’re too depressed, it is acceptable to give your baby formula. Don’t feel that you need to always put what’s best for your baby ahead of your own needs. Sometimes doing what you need to do to improve your health and emotional welfare is far more important to the baby’s well-being than any benefit that might come from breastfeeding. Babies are very sensitive to their mother’s energy, so by making a change that will help you will also have a helpful impact on the baby.

•  Don’t be alone any longer. Reaching out to your family, friends, and healthcare practitioner for additional support does wonders and is so simple. One of the characteristics that are different for women with PPD as compared to other forms of depression is that they feel guilty. The first thing I tell new mothers concerned about postpartum depression is that it is an “amplification” of all our feelings—joy or sadness, sheer bliss or emotional upheaval—and it is very common after giving birth in minor or major ways. It is also perfectly normal and natural. I also remind the new mom that they need a tremendous amount of support. It’s never your “fault” for needing more support through this transition. Remember we are not taught to be mothers. In our past the family was around to provide support and the information was passed on through the generation. This is no longer the case. This is also the time when a baby support group—though it may have seemed a little silly before baby arrived—can really save your day. Reach out and ask someone—your neighbor, your friend, your family to be there to help you. Most people want to help, but don’t want to intrude. If you make the first step, they will respond!

Putting the Pieces Together

When a woman comes to me experiencing what I think may be perimenopausal symptoms, there’s often an “Aha!” moment that comes when she tells me she experienced PPD after childbirth. Those dark days after giving birth, whether just recently or long ago, can become a beacon that will show you the way to changes that can transform your health. Even if you’re just now reading this information long after you had PPD, and you might have never even known that’s what it was, it’s okay. At Women to Women, we know firsthand that it’s never “too late” to restore your body’s balance and make a change. It is really the first step that counts.

 

by Marcelle Pick, OB/GYN NP

The May/June 2005 issue of Menopause: The Journal of the North American Menopause Society reports that standards of living factors, including anxiety levels, play a significant part in a woman’s occurrence of hot flashes through perimenopause.

Women who described themselves as “somewhat anxious” as a result of life stresses encountered 3 times more hot flashes in comparison to women who happen to be inside “normal” anxiety spectrum. The women with “higher” anxiety ratings experienced 5 times as many hot flashes. Exactly how would you clarify this?

Think back to the last time you felt good from the moment you opened your eyes in the morning to the minute you closed them to sleep. This doesn’t mean no aches and pains and hassles, but the feeling that life is good, that you can cope, that you have the energy, stamina, and resilience to deal with whatever the day—or the future—has in store. You feel content with the way you look. Even your hair looks great. You’re on top of the world.

I sincerely hope that you have experienced this at some point in your life. If so, you have an idea of your potential. If not, you have a lot to look forward to.

Recently, a study by Wayne State University School of Medicine followed pre-, peri- and post-menopausal women older than 25 years old, and found out a fascinating difference among women who suffer from hot flashes and those who do not. They found that women who have a narrow thermoneutral zone (the core temperature range the body maintains by sweating or shivering) suffer additional hot flashes.

Exactly what narrows a thermoneutral zone in animals? Norepinephrine, the neurotransmitter connected to anxiety. Consequently, the same might be thought to be true in humans.

This claim is supported by the reality that the drug clonidine lowers norepinephrine levels in humans as well as widens the thermoneutral zone — along with estrogen plus a number of anti-depressant medications. However, even now we don’t understand exactly why. Deep, paced breathing has a tendency to reduce the severeness of a hot flash as well as helps to alleviate symptoms of panic — once more, they appear to be related, but additional research needs to be done.

For more information on how to alleviate your symptoms, read our article, “Nutritional Relief For Hot Flashes.”

To evaluate your symptoms, take our on-line Hormonal Health Assessment.

by Marcelle Pick, OB/GYN NP

Feelings and sensations: awakening to the full range of emotional expression

Negative Feelings

Annoyed

• bitter
• edgy
• exasperated
• fractious
• frustrated
• impatient
• irritable
• irked
• peeved

Discomfort

• agitated
• alarmed
• discombobulated
• disturbed
• perturbed
• rattled
• restless
• shocked
• startled
• surprised
• troubled
• turbulent
• uncomfortable
• uneasy
• unsettled

Sad

• depressed
• despondent
• disappointed
• discouraged
• disheartened
• dismayed
• gloomy
• heavy-hearted
• hopeless
• troubled
• unhappy
• wretched

Angry

• agitated
• enraged
• exasperated
• furious
• irate
• outraged
• quarrelsome
• resentful
• upset
• vengeful
• vindictive

Disconnected

• ambivalent
• apathetic
• bored
• complacent
• distant
• distracted
• indifferent
• numb
• uninterested
• withdrawn
• “checked-out”

Stressed/Tired

• burned-out
• depleted
• drained
• drawn
• edgy
• exhausted
• listless
• overwhelmed
• restless
• spent
• weary
• worn out

Aversion

• appalled
• contempt
• disgusted
• dislike
• disdain
• horrified
• repulsed

Embarrassed

• ashamed
• flustered
• guilty
• self-conscious
• chagrined
• humiliated

 Vulnerable

• fragile
• guarded
• helpless
• insecure
• leery
• reserved
• sensitive
• shaky

Confused

• baffled
• bewildered
• dazed
• dumbstruck
• hesitant
• lost
• mystified
• nonplussed
• perplexed
• puzzled
• torn

Fearful

• afraid
• apprehensive
• anxious
• distressed
• frightened
• guarded
• hesitant
• nervous
• panicked
• paralyzed
• petrified
• querulant
• scared
• suspicious
• tense
• terrified
• watchful
• vigilant

Yearning

• envious
• jealous
• longing
• pining
• wishful

Positive Feelings

Affectionate

• compassionate
• friendly
• inclusive
• kindly
• loving
• receptive
• sympathetic
• tender
• warm

Grateful

• appreciative
• moved
• thankful
• touched
• hopeful
• encouraged
• expectant
• optimistic

Rested

• alert
• alive
• energized
• invigorated
• refreshed
• rejuvenated
• relaxed
• renewed
• replenished
• restored
• strong

Interested

• absorbed
• alert
• amazed
• awed
• curious
• enchanted
• engaged
• fascinated
• intrigued
• inspired
• invigorated
• motivated
• rapt
• spellbound
• stimulated
• transported

Hopeful

• confident
• encouraged
• expectant
• optimistic

Glad

• alive
• amused
• cheerful
• encouraged
• energetic
• enthusiastic
• excited
• grateful
• happy
• hopeful
• joyful
• optimistic
• pleased
• thrilled
• wonderment

Peaceful

• balanced
• calm
• comfortable
• centered
• composed
• content
• equanimitous
• fulfilled
• relaxed
• relieved
• satisfied
• serene
• tranquil

Feelings based on the book by Marshall B. Rosenberg, PhD, titled Nonviolent Communication: A Language of Life, published in 2003 by Puddledancer Press.

Sensations

The following words are examples of sensation words, that is, a sense felt within the physical body more than felt as an emotional response. It is best to be alert to temperature, texture, movement, and/or image to determine the description of sensations.

• bubbly
• buzzy
• chilled
• clammy
• cold
• contained
• expanded
• flowing
• gentle
• hard
• heavy
• hot
• icy
• jittery
• jumpy
• loose
• numb
• quiet
• pounding
• pulsing
• quiet
• relaxed
• rhythmic
• rigid
• ringing
• settled
• slow
• smooth
• snappy
• soft
• sparkly
• stiff
• still
• stuck
• streaming
• tingling
• twitchy
• uplifted
• vibrating
• warm

Adapted with permission from the Hoffman Institute Foundation, based in San Rafael, California.

by Marcelle Pick, OB/GYN NP

Listed below is a list of the most popular anti-anxiety medications (also known as anxiolytics) grouped by category:

Antidepressants. These drugs, particularly the selective serotonin reuptake inhibitors (SSRIs), are most frequently prescribed by health care practitioners for the treatment of generalized anxiety disorder, because they are not known to be addictive. For additional information and facts about these medications and drugs, please see our articles on antidepressants.

Antihistamines. Brand names: Atarax, Benadryl. These mild sedatives can be used to calm periodic anxiety. They are used off label when used in this way.

Azaspirones. Brand name: BuSpar. This medication is utilized in the therapy of generalized anxiety disorder. It reportedly has fewer negative effects than the benzodiazepines and will not worsen the effects of alcohol. It works steadily for the duration of a period of two to four weeks and it should be stopped gradually and steadily.

Benzodiazepines. Brand names: Ativan, Centrax, Dalmane, Klonopin, Librium, Paxipam, Restoril, Serax, Tranxene, Valium, Xanax. These medications are used to treat panic disorder, generalized anxiety disorder,and social phobia. They’re quite habit-forming, thus, long-term use is not encouraged, because of the addiction tendencies, which can result in dependency and withdrawal reactions when stopped. You should never suddenly stop taking these medications if you have been taking them for more than two weeks; It is suggested that you always taper off slowly and gradually. These medications preferably should be taken with appropriate supervision by a health-related professional. Side effects include drowsiness, dizziness, headache, and nausea. Don’t mix along with other medication without talking about potential hazards together with your health care provider. Be careful when operating machinery or heavy equipment if you are taking these prescriptions.

Beta blockers. Brand names: Inderal, Tenormin. These cardiac drugs counteract the effect of adrenaline and alleviate certain anxiety symptoms,such as shaking, palpitations, and sweating. These medications should only be used under direct medical supervision, as they reduce blood pressure and slow the heartbeat. Beta blockers are non-habit forming but should not be taken with other pre-existing medical conditions (such as asthma, congestive heart failure, diabetes, vascular diseases, hyperthyroidism, and angina). They are meant to be used for a short term for anxiety and they are not approved by the U.S. Federal Drug Administration (FDA) to treat anxiety, however they are sometimes prescribed for that purpose.

For additional info on slight to moderate anxiety, as well as on natural techniques to alleviate both severe and generalized anxiety, read our other articles about this topic.

 

by Marcelle Pick, OB/GYN NP

• How to start your exceptional day
• Make the mirror your ally
• Guiding your dreams toward the positive

How often do you look in the mirror and notice something wrong instead of something right? From an early age, we are taught to see our own flaws and the flaws in our lives much more readily than the beauty. We internalize the criticism we may have received as a child and then criticize ourselves as we get older. But Louise Hay has taught us that we can change this kind of negative thinking and when we do, miracles can happen in our lives and our health. I had the privilege of interviewing bestselling author, publisher, speaker, and gifted teacher, Louise Hay as well as her dear friend, fellow bestselling author and life coach, Cheryl Richardson. They have just co-written a book called, You Can Lead An Exceptional Life, and I was honored to read it before it hit the shelves. Join us for this great conversation and take home the tips these tremendous women offer to turn your thinking and your life around.

Start with the morning

Marcelle Pick: One concept you bring up in your new book is how we start our day is so important in terms of what happens for the rest of the day. Can you talk a little bit more about that?

Louise Hay: Most of us just sort of bumble through life. And those of us who are partly aware say, Oh yes! I must do my affirmations, and we sit down once a day and we do our affirmations. And then we get up and we bumble through life for the rest of the day. And the whole point of this book is to bring awareness to where you are, and who you are, and what you are actually doing. The place to begin is the first thing when your eyelids start to twitter in the morning. And if you can catch yourself at that point and really make it a positive, comfortable, joyful, easy moment, then your day begins on that. You don’t have to do that whole day all at once, but start with the morning. That, in itself, will create a miracle.

Affirmations for throughout the day:

• I love my life.
• I love this day.
• Life loves me.

Going to work in the morning

“I think it’s important when you go to work in the morning to program what you would like to happen in the day in a positive way. You never want to say, Oh, I don’t want this to happen, because then you’re putting too much energy on it. But say what you do want to happen. It’s a wonderful day. I have harmonious interactions with all the employees at work. We all get along so well. Each and everything I touch and every phone call I have today is positive. And always send love ahead of you. Send love to the building, to the people in it, to your desk or your cubicle or whatever you have and also to the customers. And if you start doing that, it’s amazing how things shift in a more positive way.”  – Louise Hay

Cheryl Richardson: When Louise and I first started having this conversation, I was amazed at the things I discovered about myself. For example, as I wrote about in the book, I would be taking a shower and for some reason the shower became a place where I would ruminate about problems or worry about something that I needed to handle that day. I started to notice that I wasn’t that thrilled about taking a shower because I was making it a miserable experience. Bring awareness to what your thoughts are first. And the trick is to catch yourself sooner and sooner so you begin to shift your thinking from whatever isn’t working to good thoughts that will work.

How to begin: mirror, mirror on the wall

MP: If somebody wants to begin changing the way they think, how can they start?

LH: With the mirror. I think it’s the most powerful thing and it works very quickly. Within a week big changes happen. Looking in the mirror, saying your name, and saying, I love you. I really, really love you. It’s a powerful step. It works magic. Use the mirror instead of having it be something you shun, or every time you look at it, you say something negative about your body, or your looks, or whatever. Those are terrible affirmations. Every time you face the mirror you’ll start to shudder because you know you’re going to get a negative message. So if you can turn that around and make the mirror your friend, and the person in the mirror your dearest friend, then things change enormously. When Cheryl started to do mirror work she was like most people and thought, Oh no. I can’t do this. But as she did it for a while she made big changes.

CR: In the beginning, I really felt awkward. I thought it was kind of like a Saturday Night Live skit. Both Louise and I hear that a lot from people. They say, “It doesn’t feel true for me when I look in the mirror and say I love you. I think, no I don’t — look at my wrinkles around my eyes, or look at the fat on my stomach, or whatever.” But just do it anyway. When I first started doing Pilates, I was awkward. I was clumsy. And I would catch myself saying, “Oh my God, look at my stomach. Look at my legs. I can’t stretch. I’m so uncoordinated.”

I’m sure my Pilates teacher wonders what the hell I’m doing now, because I have a big smile on my face and I’m looking in the mirror and I’m saying things like, “I love your beautiful shape, look at how strong you are, thank you so much for carrying me through life the way you do, I have the most perfect core,” whatever I can think of. And you know what? I can’t wait to exercise. I can’t wait to get to Pilates because I created a positive association.

Louise talks about making the mirror your friend instead of your enemy — and the person in it. I can’t stress enough how powerful a practice it is because the person we’re most afraid of in life is us. We’re afraid of the way we beat ourselves up, judge ourselves, speak to ourselves in an unloving and critical way. When you make yourself a dear, dear friend, you can do anything because you’re no longer afraid of being judged mercilessly by that internalized critical parent. So we’re really creating a new parental voice if you will, a new peer voice that speaks lovingly.

As we think, our cells are listening

“… A lot of women will use fantasies in their sexual relationships to become aroused. So if a human being, a man or a woman, can think a sexual thought and feel a physiologic response in their body, isn’t that evidence that thinking a good, powerful thought is going have some kind of a physiological effect?” – Cheryl Richardson

MP: This is especially important for women. From the time that we’re very small until we’re older, many women are being so critical of themselves because they’re judging themselves with an outside eye.

CR: Well, they’re judging themselves with an internalized critical parent. And they’ve been objectified. But what we do is internalize that objectification. See, it’s important to make the distinction. It is an internalized voice that we give a tremendous amount of power to. It’s the voice that doesn’t serve us that lives inside and needs to be transformed by love.

LH: We all have those voices within us. And we need to be aware of them to recognize them and realize where they came from. They really have nothing to do with the truth of our being. We are all divine, magnificent expressions of life, and when we recognize this then life flows more smoothly. You know, one of the affirmations that I’ve been using for the last 2 years a lot is: Life loves me. Life loves me. Life loves me. And I get more and more and more examples of how life loves me because this is my affirmation. This is what I am choosing to believe.

You know, a lot of people think life sucks. Now, if that’s your affirmation, how can you possibly bring on good experiences? See, we have the choice of deciding what we want to feel about ourselves and about life. And what we choose to feel and think is what we are going to get.

What we are offering in this book are simple, easy ways of doing small steps. We don’t have to heal the whole world today. We can do small steps. First, make our mind feel comfortable, get our heart warm and glowing, start to allow our body to work well, and have the atmosphere around us full of people responding in a much more kind way. When we get these things, everything starts to fall into place. It’s the tiny little steps that we are willing to make that begin the process.

Take good thoughts into your dreams

MP: One of the things you suggest in the book is that we don’t watch TV, especially the news or anything disturbing before going to sleep. Can you talk about how to prepare for sleep?

LH: Closing the day is very important because whatever you’re doing at night before you go to sleep, you’re going to take into dream land. And that’s where a lot of healing things can happen. But if you take in the news and frightening thoughts, you’re not going to have a good healing sleep.

It’s just like in the morning. I thank the bed and I just know it’s going to be a good day and all the experiences will be wonderful. I give myself a little pep talk. I also give myself a little slowing down talk at night and I thank the day for being what it was and the things I’ve learned from it. And I know that is over and done now and I can just release everything and I am now nuzzling into my bed and I’m going to have a wonderful deep restful sleep for the night. And then I drift off knowing that life loves me. Life loves me. Life loves me. And to me that is a wonderful way to go to sleep.

Life is paying attention

What struck me most about You Can Lead An Exceptional Life is that it isn’t just about positive affirmations. Leading an exceptional life is about changing your thinking from your core. And you can start with small steps like positive affirmations when you first wake up in the morning, mirror work, and drifting to sleep with positive, healing thoughts.

As Cheryl said to me, “Just from the small steps, life gives you evidence that it is paying attention… As you get the evidence, you’re inspired to pay more attention… Before you know it, you really are changing the framework of how you operate in the world…You’re influencing the state of health and balance in the body as well as your life.”

After talking to Louise and Cheryl, I am reminded of how utterly important it is to find the love, peace, and good in ourselves and those around us. As Louise says at the end of the book, “…When you reach out to Life, Life always seems to reach back.”