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Q&A Topics

Depression


Yesheen (dr.) Singh Medical Doctor View profile

Dear T



Thank you for your question. I empathise with what you are going through. It is often quite traumatic to have one's trust broken. That said it is impossible for me to advise you on an appropriate course of treatment, be it pharmaceutical or alternative, without doing a proper history clinical examination first. This is especially important given your previous history of depression. I can advise that you ensure that you take in high quantities of good quality omega 3 fatty acids as these have been found to be beneficial to most people with mood disorders but anything more will have to follow a consultation.



You are welcome to contact me via www.healthnation.co.za to make an appointment.



Many thanks and warm regards

Yesheen Singh

Yesheen (dr.) Singh Medical Doctor View profile

Dear B

Thank you for your question. I have to say that it is quite difficult to offer a sound opinion because I do not have access to your entire past history. Specifically the reasons why your psychiatrist felt the need to continue with an anti-depressant such as Prozac. If it was for something that was quite temporary then I see no reason why you should wean yourself off the medications once you have built up enough of the personal coping mechanisms to begin engaging with the up's and down's of today's world without the need for a pharmaceutical.

The fact that you are on one pill every second day without any return of negative symptoms is encouraging. I would continue easing yourself off the pills, removing an additional pill per week every two to three weeks. For example if in week one you were using four pills per week on Sunday, Tuesday, Thursday and Saturday, in week four remove the pill used on Saturday, in week seven remove the pill used on Tuesday and so forth.

I always prefer a slow and steady approach to weaning anyone off chronic medication and the slower the process moves the more opportunity your body has to acclimatise to a state without the influence of the pharmaceutical.

One major oversight in your plan of action though is the use of a strong Omega 3 product. We're talking extra-high doses of high-grade EPA and DHA used for the duration of your weaning off process and at a lower dose for the rest of your life. Metagenics make an excellent product called "EPA:DHA Extra Strength" which you can get from your local Wellness Warehouse.

If you need a more detailed plan of weaning off your antidepressant please don't hesitate to make an appointment at www.healthnation.co.za

Many thanks and warm regards

Yesheen

Yesheen (dr.) Singh Medical Doctor View profile

Dear M

Thank you for your question. Both Serlife (Sertraline) and Cilift (Citalopram) are what we call SSRI's, a particular group of antidepressants that have been formulated to have less of a side-effect profile than older generation antidepressants like Fluoxetine. They have also been used in some cases to manage anxiety disorders but mostly those associated with a depressive component.

As with most pharmaceuticals your body will invariably build up a tolerance to the drug, and eventually you will require higher doses of the drugs in order to achieve a similar level of effect to that which you experienced when you first began the drug.

New research has shown though that many of these drugs have little benefit over a placebo, and that they show no long-term benefit in terms of management of the underlying problem or cause of the condition and in many of the cases result in a loss of functionality at work, socially and with family.

From a functional medicine perspective I would begin by adding in an appropriate Omega 3 supplement and consider the use of a nutraceutical supplement tailored for your specific needs and that help balance the deficiencies and excesses of serotonin, dopamine, adrenalin, noradrenalin and GABA that result in the symptoms you are experiencing. Exercise is also of great benefit and activities such as yoga have been shown to be more beneficial than Sertraline in the management of psychological disorders.

If you would like more assistance on formulating a plan to manage your condition with out the reliance on pharmaceuticals please contact me on www.healthnation.co.za

Many thanks and warm regards

Yesheen

Nicola Webster Psychologist View profile

It sounds like your girlfriend has had a very difficult year, and the stress of having to visit a number of doctors and go on and off medications must add to this. I would imagine it has also been a challenging year for you, and it is great that you have been so supportive of your girlfriend during this time. When someone we love suffers from depression we may want to help but are often unsure as to what we should do and this can lead to feelings of helplessness and frustration.It helps to remember that depression is a mental illness and the person suffering cannot just 'snap out of it'. Because of the lack of energy and motivation which come with depression it can be difficult for someone with depression to get the help they need. People with depression may also struggle to see the problem or to realise that they need help. It is useful that your girlfriend has realised that she needs the help but she may still need your support in finding the right doctor and getting onto the correct medication.

I agree with you that it would be best to see a psychiatrist in order to sort out the medication. Psychiatrists specialise in mental illness and will thus be able to prescribe the correct medications and dosages for your girlfriend’s depression and anxiety. A psychiatrist will also carefully monitor her reactions to these medications. I can recommend Dr Stephanie van Niekerk (021 6850308) or Dr David Kibel (021 4230890), both of whom practice in or around the Cape Town CBD. Alternatively you can call The South African Depression and Anxiety Group (SADAG) on 011 262 6396 or 0800 20 50 26 to get the numbers of other psychiatrists close to you.

While medication may be important in treating the symptoms of depression, I would always recommend a combination of medication and psychotherapy when addressing depression. Speaking to a psychologist will give your girlfriend the chance to talk about and process some of the challenges she is facing, many of which may be contributing to her depression. SADAG will also be able to provide the names of psychologists in your area.

I do hope that this information helps you and your girlfriend to find a treatment solution which works for her.

Kind Regards,

Nicola

Nicola Webster Psychologist View profile

While the anti-depressant Cilift will probably not affect your ability to conceive, I would always advise speaking to your doctor before trying to fall pregnant. Some antidepressants, if taken during pregnancy, can cause problems with the development of the foetus. It is thus very important for your doctor to assess you, and inform you of the risks and benefits of taking the medication while trying to conceive and during pregnancy. If you are going to come off the medication he will also advise and monitor this process. As stopping antidepressants may lead to a relapse of depression or anxiety, do not stop taking them without first speaking to your doctor.

Yesheen (dr.) Singh Medical Doctor View profile

Dear L

Thank you for your question. Cilift, or Citalopram, is an antidepressant and forms part of the SSRI family of anti-depressants. It is most commonly used to treat depression and anxiety-associated disorders. In general is is best advised to not fall pregnant while using a drug from this class of antidepressants. Although animal studies have not shown teratogenicity there are several studies that have found an increased incidence of the following symptoms in babies born to mothers who have used Citalopram during pregnancy: respiratory distress, cyanosis, apnoea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycaemia, hypertonia, hypotonia, hyperreflexia, tremor, jitteriness, irritability, lethargy, constant crying, somnolence and difficulty sleeping. These symptoms could be due to either serotonergic effects or discontinuation symptoms. In a majority of instances the complications begin immediately or soon (<24 hours) after delivery.

If you would like to experience conception and pregnancy I would strongly suggest discussing this need with your attending psychiatrist who may be able to recommend a plan to either swop medications or to more closely monitor you and the baby during the pregnancy and after. Citalopram is also passed into breast milk.

Many thanks and warm regards

Yesheen

Nicola Webster Psychologist View profile

There are many reasons one may gain weight and weight gain (or loss) can be a side effect of Cilift for some people. However, as you have been using Cilift for a couple of years with no mentioned problems, it seems unlikely that this is what would be causing your weight gain. It sounds like you live a healthy lifestyle which includes some daily exercise and you say that you have not changed your eating patterns. It may be useful to consult with the doctor who monitors your Cilift and ask him or her to reassess your medication and look for other possible causes of weight gain. Best of luck with this.

Hi there

I would like to ask your advise. I am very concerned about my older sister, she has been acting very strange the past few months. She has terrible moods where she wouldn’t speak to anyone for days on end. She then stays in her room on weekends, she hardly greets us. At work it’s even worse, she is rude to everyone, she doesn’t greet her friends and colleagues. She seems like she is very depressed, but she wouldn’t go see someone to help her. We as her family are suffering because of her moods. I can’t invite my best friend over to our house anymore because my sister told me she doesn’t like him and that he irritates her. She ignores him whenever he is at my house and hardly greets him, not alone ignore his attempts to speak to her. I am feeling very frustrated and this is driving me insane as I don’t know how to help her. She is pushing everyone away and I am afraid that this is making her even more depressed as she doesn’t know how to deal with this. I’m afraid that she might lose her job as she has been rude to her mangager as well. Please would you advise me what is the best way to help her. She isn’t easy to talk to and I know if I tried to speak to her, she would just deny that there’s anything wrong or she would just push me away. She has told me once that when she feels depressed like that, she wants people to speak to her and ask her what is wrong, but trust me it is not possible to do so. She is highly unapproachable when she is in this deep depression phase. I miss my sister, we used to be best friends.

Please help!

Nicola Webster Psychologist View profile

I can hear that you are very concerned about your sister and your relationship with her. It can be difficult when someone we love suffers from depression as often we, ourselves, are left feeling helpless, frustrated and hurt as we are unsure as to what we should do. It is important to remember that depression is a mental illness and the person suffering cannot just 'snap out of it'. Withdrawing, as you mention your sister has done, is a very common sign of depression. As difficult as it may be at times, it is useful to try to remain non-judgemental and empathic toward her. Try to validate your sister's feelings, showing that you care and are there to support her. This does not mean you need to know how she is feeling, just that you show you are trying to understand how she may be feeling. You say that your sister has said she would like people to talk to her and ask her what is wrong, and perhaps this is the best place to start. You could try reminding her of her own words while reassuring her of your love and support.

It is important to then listen to what she has to say. It may be useful to suggest she speak to a psychologist or counselor (you or she can call The South African Depression and Anxiety Group (SADAG) on 011 262 6396 or 0800 20 50 26 to get a referal to someone in your area). It is common for people with depression to deny that there is a problem but try to persevere with this as she may need your help in admitting there is a problem. You can reassure her that getting help is a sign of strength rather than of weakness. It may also be helpful to assure her that with the help of a professional she will begin to feel better.

Lastly be sure to take care of yourself. It can be very emotionally draining trying to help a loved one with a mental illness and you need to ensure that you have the support that you need. Don't neglect the other areas of your life, particularly your other family members and friends. Perhaps if your sister continues to refuse to see a professional you could have a couple of sessions with a counsellor or psychologist yourself. This could help you to understand her condition more and could give you the support that you need. Helping someone you love can be a long and at times challenging process, I hope that this helps you in some way

Nicola Webster Psychologist View profile

The Elexoma device is a small, handheld device which claims to use
small electrical impulses (Microcurrent Electro-biologic Treatment
(MET)) to stimulate nerve cells in the brain. This is called Cranial
Electro Stimulation (CES).

The device is relatively new and not yet widely used in the treatment
of depression. I had not heard of it before your query.

Some research
has been done and published in reputable medical journals which
suggests that what is called Cranial Electrotherapy Stimulation (CES)
is helpful in the treatment of depression, but there do not seem to be
enough studies to prove the effectiveness of this specific device.
Most of the information available about the device appears to be based
on people’s personal experiences with using it rather than reliable
research. It may help in the treatment of depression but I would be
cautious about using it as the only treatment
for your depression, particularly if it is severe.

There are many factors which may cause or influence depression,
including genetics, biochemistry and life stresses or trauma.

The
treatment approaches for depression are varied and may include medication and
psychotherapy. Your particular case will determine what would be
best for you. While the research may suggest a possible positive
effect from the Elexoma I feel that any treatment for depression
(including anti-depressant medication) is most effective when it
includes psychotherapy or counselling to deal with the underlying
causes. This has been been shown in a number of studies.


My recommendation would be that you discuss you treatment options with
your GP or a psychologist. They would be able to assess the severity
of the depression and refer for further medical treatment if
necessary. The South African Depression and Anxiety Group (SADAG)
offer telephone counselling and help in finding psychological and
psychiatric services. They can be contacted on 011 262 6396 or 0800 20
50 26, 7 days a week from 8am – 8pm.

It may also be useful to contact a medical professional who has worked
with the Elexoma device to get more information about its effects.

Regards Nicola

Sean (dr.) Gomes Medical Doctor View profile

I would recommend that you see your doctor to ascertain the degree of your depression, and whether you require any prescription medications. For natural supplments that will assist, I refer you to a previous question answered by our Naturopath:

“There are many natural products available to help with depression as
well as with anxiety and mood disorders. Solal has a really good
product called Naturally High which elevates 3 neurotransmitters in the
brain. These help improve mood, anxiety and willpower. It has a blend
of herbal and nutritional extracts. I am unsure as to whether you are
taking any prescription medication (oral contraceptive pill or asthma
medication etc.) as this product does contain St. John’s Wort, which
can lower the effectiveness of your medication. It is therefore
advisable to use this product under the supervision of your health care
practitioner.


If Naturally High is not suitable for you, then
5-HTP will be the alternative. It helps with mild depression by
elevating serotonin levels. You can take a high dose vitamin B complex
(Enzyme Process B-50 complete) together with 5-HTP. It helps with the
conversion of 5-HTP to serotonin and also with stress and anxiety.


For anxiety, use GABAtropin (also from Solal) which provides you with anti-anxiety, calming and stress-coping effects.

It
will also be best for you to use adaptogens like the herbs Rhodiola,
Ginseng and Ashwaganda because they help you cope better with your
stressful lifestyle.


If you need any further advice or would
like to have a chat about these options, please feel free to visit the
Natural Medicine Dispensary at our stores.


It is however
important that you ensure that you do receive treatment and that you
begin your road to recovery, as your symptoms can get worse if you do
not address them


Wish you well. Dr Sameera Abbas (Naturopath, Cavendish Store)”

Kind Regards



Dr Sean Gomes



Sameera (dr.) Abbas Naturopath View profile

The natural anti-depressant that I think you are referring to is called 5 HTP, an amino acid. In the body it converts to serotonin, our “feel-good” hormone. It is used for mild depression as well as anxiety. This is available at our stores If you are still on prescription anti-depressants please consult your medical doctor before discontinuing your medication. You are also welcome to consult one of our practitioners at our natural dispensary for further advice.

Regards Sameera (Naturopath).

Sean (dr.) Gomes Medical Doctor View profile

This sounds like there could be a number of factors at play. Most likely, you are sleeping with your mouth open and possibly snoring excessively. I am not sure whther your partner or friends have previously mentioned to you that you are snoring? Sleeping with your mouth open will result in drying of the mucoud membranes whcih can result in slight damage and bleeding when you wake in the morning. This is nothing to worry about too much, but I can appreciate that it is uncomfortable and a nuisance for you. The bad odour is also related to sleeping with your mouth open. The dry air allows for bacteria in your mouth and teeth to be more active and hence resulting in the bad breath. I would suggest that you look at the way you sleep and try and adjust this. Sleeping on your side helps to stop sleeping with your mouth open. You can also try specialist pillows such as Tempur and Spine Align which could help the correct alignment of your airways. I would also suggest ensuring that you brush your teeth in the evenings and use a good mouthwash. This will help control some of the bacteria. You can also use a saline nasal spray before going to bed and when waking in the morning to help lubricate your airways. Hope this advice helps. Kind regards. Dr Sean Gomes

Sameera (dr.) Abbas Naturopath View profile

There are many natural products available to help with depression as well as with anxiety and mood disorders. Solal has a really good product called Naturally High which elevates 3 neurotransmitters in the brain. These help improve mood, anxiety and willpower. It has a blend of herbal and nutritional extracts. I am unsure as to whether you are taking any prescription medication (oral contraceptive pill or asthma medication etc.) as this product does contain St. John’s Wort, which can lower the effectiveness of your medication. It is therefore advisable to use this product under the supervision of your health care practitioner.

If Naturally High is not suitable for you, then 5-HTP will be the alternative. It helps with mild depression by elevating serotonin levels. You can take a high dose vitamin B complex (Enzyme Process B-50 complete) together with 5-HTP. It helps with the conversion of 5-HTP to serotonin and also with stress and anxiety.

For anxiety, use GABAtropin (also from Solal) which provides you with anti-anxiety, calming and stress-coping effects.

It will also be best for you to use adaptogens like the herbs Rhodiola, Ginseng and Ashwaganda because they help you cope better with your stressful lifestyle.

If you need any further advice or would like to have a chat about these options, please feel free to visit the Natural Medicine Dispensary at our stores.

It is however important that you ensure that ou do receive treatment and that you begin your road to recovery, as your symptoms can get worse if you do not address them

Wish you well.

Dr Sameera Abbas (Naturopath, Cavendish Store)

Sean (dr.) Gomes Medical Doctor View profile

This is a very delicate issue & depends on many factors including the diagnosis and initial reason your medical practitioner prescribed the medication.
However, in order to go off the medication, you need to wean yourself off under supervision, i.e. reduce dosage & then frequency. It would be worth visiting the practitioner that initially prescribed you the medication for them to make a further assessment as to how your condition has changed.
Please feel free however to come into the store so I may be of assistance to you to help way up your options.
There are also many natural remedies that can help support Serotonin function, which can assist with long term management of any imbalances.
Kind Regards, Felicia (Senior Pharmacist, Kloof Street)

Reena Sukdev Homeopath View profile

Based on the side effects you are experiencing since using the medication I would suggest you speak to your doctor about it. There are plenty of alternative options out there for you. The treatment of depression is best considered in a holistic manner. Psychological, social, spiritual and physical factors need to be considered if you are to become unstuck of this feeling. Homeopathic remedies once determined work wonderfully here but needs to be based on a careful analysis of your complete picture. The following supplements are useful for depression: Essential Fatty Acids are required to aid normal brain function. High B vitamins are necessary for normal functioning of the nervous system. 5 HTP increases the body’s production of serotonin. L-Tyrosine boosts dopamine levels thereby alleviating depression. St Johns Wort has also been used for the treatments of depression. Sam-E also works as an anti-depressant. As you can see there are many natural options, however, these products should not be used if you are on prescription antidepressants and should be used under the supervision of a practitioner. for further advice, please feel free to visit me at the Natural Medicine Dispenary at our Cavendish Store. Regards Reena

Garth (dr.) Roberts Chiropractor View profile

Dear Customer

At this time of the year when seasons are changing mild throat infections and blocked ears are common. The best defence is often ensuring your immune system is optimally supported thus allowing your body to heal itself.

My advice is the following :

- Viral choice as often as the dosage indications allow
- Traumeel ampoules - 2-3 drops in the ear x3/day
- 3 litres of filtered water per day
- wedge a peeled raw garlic glove in the affected ear while sleeping (garlic has strong antibiotic ,antiviral and antifungal properties and has worked for my patients numerous times)
- make sure you are having early nights and avoid smoke and other allergens/irritants to the mucous membranes. Avoid alcohol which can also congest the sinuses.
- probably most important is to wash your sinuses with a home made solution of bicarbonate of soda and salt or alternatively purchase a saline nasal wash from our Wellness pharmacy and wash your nasal passages and sinuses four times a day with the solution. The Netti Pot can be used to assist.
-purchase a good probiotic at the same time to repopulate your gut with the good bacteria that have been killed off by the antibiotic you have taken ,this will get your immune system back on track.
- gargling with salt and garlic will be highly beneficial for the sore throat
- avoid taking baths ,shower where possible

- ear candling is something that will remove excess wax and debris from the ear and may succeed in de pressurising it, swallowing or gently equalising as on an aeroplane or when scuba diving will be effective once you have addressed some of the congestion. Ear candling is available at the WellClinic with our Nurse Practitioner.

- Dr John Steer ( 021 - 797 4245 ) is a very experienced and respected ENT specialist ) ,alternatively the Wellness Clinic in Cape Town has a medical /naturopathic/ayurvedic doctor, Dr Jaimini Raniga, who would prescribe the appropriate remedy and give much of the advice above. You can make an appointment at the Natural Medicine Dispensary, 021 - 4875425.

Hope this helps

Regards

Dr Garth Roberts
(chiropractor)

Melissa Usher Dietician View profile

Thank you for your query. As you have mentioned there is a lot of emerging evidence for the role of nutrition in depression. Of significant importance is the role that carbohydrates and certain vitamins and minerals play in the disease. Carbohydrate triggers certain chemicals in the body, namely tryptophan and serotonin, that leads to feelings of well-being. For this reason I would recommend a carbohydrate source at each meal. As complex carbohydrates have a more lasting effect than sugars, I would encourage wholegrains, cereals, bread, pasta, rice, fruit and vegetables rather than sugar and sugary foods. A symptom of depression is loss of appetite – small frequent meals may be better tolerated than 3 large ones. The B Vitamins (especially Vitamin B6) play an important role in depression and neurological disturbances. I would recommend supplementation with a B Vitamin complex. Certain minerals play a role too. A Selenium deficiency may lead to neurological disturbances, while low levels of Zinc may lead to loss of appetite and apathy, and Iron deficiencty results in weakness and fatigue. I would therefore recommend a well-balanced diet with plenty of wholegrains (to enhance B vitamin, Zinc and Selenium levels), legumes (important source of Folic Acid and Iron), fruit and vegetables (source of Iron, Selenium and B vitamins) as well as animal protein at main meals (to maintain B Vitamins, Iron, Selenium and Zinc levels). I am not aware of anyone in Johannesburg who specialises in this area, but you may want to consult with a Dietitian to discuss this further. The South African Dietetic Association (ADSA ) has a list of private practising dietitians in your area. Try - http://www.adsa.org.za and look under ‘Find a dietitian’. Good luck


Please Note:

The Wellness Q & A is for informational purposes only, and is not intended to diagnose or provide treatment for any condition. If you have any concerns about your health, you should always consult directly with your healthcare professional. Wellness Warehouse will not be liable for any errors in the Wellness Q & A, or for any actions taken in reliance thereon. The advice on the Wellness Q & A is not comprehensive and does not replace the assessment and advice of your own healthcare professional. Consultation with your healthcare professional is extremely important if you are experiencing persistent or severe symptoms.

Caution:

Consult your doctor, healthcare professional, and/or pharmacist before using any supplements or before making any changes in prescribed medications. If you have a chronic illness or routinely take prescribed or over-the-counter (OTC) medication, or you are pregnant or breastfeeding, it is extremely important to consult your doctor, healthcare professional, and/or pharmacist before taking any new medication. Do not stop taking any prescription medication without consultation and guidance from your doctor.

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