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Posts Tagged ‘Research Evidence’

When the xanax kicks in, go for cognitive behavioral therapy

Friday, April 9th, 2010

Putting aside all the arguments about whether people should get so anxious, the practical reality is that they do. If this seriously disrupts their ability to lead normal lives, then something should be done. Common humanity requires that society makes reasonable provision for their treatment. The pharmaceutical industry would have us believe drugs are the best answer to all our problems and, when it comes to dealing with anxiety disorders, our doctors have a big choise of them. We start of with antidepressants. Yes, the name apparently suggests their function is limited to treating depression, but they can be just as useful in treating anxiety disorders. So now your doctor decides which medication to try out on you. There are the SSRIs and the tricyclics, and do not forget the MAOIs. Then we get into the anti-anxiety drugs, most often derived from the benzodiazepines. If those do not take your fancy, there are always the beta-blockers. The cabinet in your bathroom can be filled to overflowing (subject to deciding whether all these options are covered by your health plan). But, there is one inconvenient truth. All the independent research evidence (that’s the research not paid for by the pharmaceutical industry) shows psychotherapy to be more effective than medication. The problem with trying to treat an emotional problem with a pill is there cannot be a conversation about why you are feeling the emotion and how you are going to deal with its consequences. Talking through the problems with a mental health specialist has the best success record in restoring quality of life and avoiding a relapse into an anxiety state. For a start, it treats you as a human being. You become the focus of attention. People listen to you and advise you on how to improve the quality of your life. In the current healthcare market, you see your doctor for a few minutes, collect a prescription and pick up the bill on the way out. People respond well when they believe their interests are being taken seriously. Their treatment is progressed rapidly if the advice they receive is seen to be useful. There is no point in advising people out of books. This has to be a hands-on approach to changing each person’s attitudes and habits. The best form of psychotherapy is cognitive behavioral therapy (CBT). “Cognitive” because you want people to understand their emotional responses to different situations. Only if they understand why they feel anxious can they begin the process of changing their responses. “Behavioral” because the therapist will train people to change the way they behave. This means forcing people to confront the situations in which they feel anxious or fearful, and teaching them how to react more positively. CBT usually lasts over a period of about twelve weeks. For most people, it works best on a one-to-one basis but, in cases of social phobia, part of the training can be in groups to help people become more used to social gatherings. Before starting on the course, it is useful for people to take xanax. This brings the anxiety levels down and provides a window of opportunity when they may learn new habits. But, for the majority of people, the use of xanax should be quickly tapered off. The aim is to enable people to respond more confidently without having to rely on a drug. Only then can people actually begin to feel confident about their own abilities rather than as people propped up by pills.

No phentermine for weight loss during pregnancy

Thursday, March 4th, 2010

According to Sarah Palin, the European healthcare service operates like the Canadian cull of seals. On a regular basis, men armed with clubs go out among the unhealthy and older members of society, and put down those who no longer contribute to the strength of the group. Death panels decide who shall live and die. That means, by her standards, one of the leading panels is UK’s NICE – the National Institute for Clinical Excellence. This group of so-called experts draws up guidelines to be used by the medical profession. Whenever there is good research evidence that a particular treatment is effective, it is incorporated into the national practice standards. But if a given treatment or drug is not shown effective, the medical profession and hospitals are instructed not to use them. So, many of the procedures that are standard in the US are not allowed in the UK, and many of the drugs routinely prescribed in the US are either not available in the UK or only available if the patient pays privately. Despite this, people in the UK live longer and enjoy better health than Americans.

Anyway, NICE has just launched a consultation process to decide what advice to give pregnant women about weight loss. If you want to offer an opinion, you can do so during the next month through http://guidance.nice.org.uk/PHG/Wave18/3. NICE offers the opinion that women do not need to increase the amount they eat during the first six months of pregnancy. The idea that pregnant women are “eating for two” is a myth. The most needed is an extra 200 calories a day during the last three months. That said, it is always better for women not to get pregnant if they have a BMI of 30 or more. This is not to suggest there is a high risk to the fetus. But the evidence shows there are fewer complications during pregnancy if women lose weight before getting pregnant. In general, trying to lose weight during pregnancy is not advisable. Stability and consistency of behavior are more important. That means women who routinely exercise before pregnancy should continue. Finally, women should not be misled by celebrities who slim dramatically after giving birth. It is better to lose weight gradually. Even so, there is no evidence that the quantity or quality of milk is affected in women who do crash diet after giving birth. NICE simply suggests women do what feels right for them. If they are tired, they should rest. Hopefully, they are eating a healthy diet anyway. As long as they get back to their pre-pregnancy weight at some point, this will be good for their long-term health.

There have been no tests performed in the UK or the US to determine whether it is safe for women to take phentermine hcl during pregnancy. So applying the precautionary principle, it better if you do not take this drug during pregnancy unless your doctor has specifically approved it. What can be said with certainty is that the active chemicals do enter the mother’s milk and can have an adverse effect on nursing babies. Thus, if you do want to lose weight after giving birth, do not buy phentermine online and take it while breast-feeding. You should either wean the baby or find another drug that suppresses your appetite without endangering your child.