Alzheimer’s or Dementia Medications

What drugs are approved for Alzheimer's disease?
see link above for a NIH fact sheet.

Five drugs have been approved by the U.S. Food and Drug Administration (FDA) for treating the cognitive symptoms of Alzheimer's disease. (See box.) Reminyl, Exelon, Aricept and Cognex belong to a class of drugs known as cholinesterase inhibitors. Each acts in a different way to delay the breakdown of acetylcholine, a chemical in the brain that facilitates communication among nerve cells and is important for memory. Alzheimer's disease is associated with inadequate levels of this important neurotransmitter. Namenda acts by a different mechanism. It shields brain cells from overexposure to another neurotransmitter called glutamate, excess levels of which contribute to the death of brain cells in people with Alzheimer's.

DRUGS APPROVED FOR ALZHEIMER'S

Brand Name	Generic Name	When Approved	More Information
Namenda®	memantine	2003	Fact sheet
Razadyne, Reminyl®	galantamine	2001	Fact sheet
Exelon®	rivastigmine	2000	Fact sheet
Aricept®	donepezil	1996	Fact sheet
*Cognex®	tacrine	1993	Fact sheet

* Cognex is rarely prescribed due to serious side effects, including possible liver damage.

In general, Reminyl, Exelon and Aricept are most effective when treatment is begun in the early stages. Namenda is the only drug shown to be effective for the later stages of the disease. They have all been shown to modestly slow the progression of cognitive symptoms and reduce problematic behaviors in some people, but at least half of the people who take these drugs do not respond to them. While the overall "treatment effect" of these medications is modest, studies show that when they do work, they can make a significant difference in a person's quality of life and day-to-day functioning ("activities of daily living"). The drugs have different side effects. Some are taken once a day (Aricept), others twice a day (Exelon, Reminyl and Namenda).

Estrogen Balance

SCRUNCH!

Seven Practical and Proven Ways to Maintain Estrogen Balance

1. Go organic ­Assures minimum exposure to toxic chemicals like pesticides and bovine growth hormones that mimic estrogen in a woman’s body.
2. Maintain normal weight ­Fat cells actually produce and store estrogen.
3. Eat broccoli ­Broccoli contains an estrogen-balancing chemical called indole-3-carbinol. Try to get 4 or more servings per week. If raw broccoli is too crisp for your taste, lightly steam a pot of it so that it has just a slight crunch to it; then refrigerate it and include in a daily salad. Steaming actually opens up the cell wall to release nutrients. Just don’t oversteam or microwave the broccoli, which will destroy most of its nutrients. You can also try an indole-3-carbinol supplement like BioDIM.
4. Exercise ­A significant factor that places the odds in your favor of maintaining female health. Exercise reduces stress, improves sleep and helps excrete surplus hormones.
5. Get to sleep by 10 pm­ The sleep hormone melatonin decreases the amount of estrogen the body produces. If you go to bed late, your melatonin levels don’t rise as high because you’re exposed to darkness for a shorter period of time.
6. Eat foods that have a low Glycemic Index (GI)­High insulin levels trigger an increase in estrogen. Check the GI of your favorite foods at www.glycemicindex.com and aim for foods with a GI of 50 or less. To lower the GI of your entire meal, try a supplement like FenuLife.
7. Drink water and limit consumption of alcohol­ Water keeps the liver cleansed of toxins so that it can excrete hormones efficiently. Drink an ounce for every 2 pounds of body weight. Conversely, alcohol significantly compromises the liver’s ability to metabolize estrogen.

Important Supplements for Estrogen Balance

• Turmeric­ Regulates estrogen receptors and also enhances soy’s estrogen blocking properties.
• Green Tea ­Important antioxidant that helps keep the immune system strong, with emphasis on benefits for women’s health issues.
• BioDim ­Helps the body effectively metabolize estrogen with the same chemical compound found in broccoli.

"....... But I feel that as a woman of a certain age, the deck is stacked against me. A woman's metabolism typically slows down as she ages (a 2 to 8 percent decrease per decade beginning in her 30s), so that even if I ate the same amount I'd gain weight. Then the hormonal imbalances that come with menopause do their dirty work, the main culprit being the thyroid, that fickle gland that regulates how quickly cells burn calories.

During menopause the thyroid is already functioning less effectively," says Keith Berkowitz, M.D., founder of The Center for Balanced Health in New York City. "If you cut fat and carbs to extremely low levels, as dieters may be inclined to do, you can further inhibit the thyroid from functioning appropriately, in addition to inhibiting the production of sex hormones." So, though I need to eat less to lose weight, I can't each too much less or my thyroid will mess with my metabolism. No wonder I am getting fatter by the minute.

I also recently learned why my fat is in my belly. During menopause, which I am experiencing, a woman's predisposition for tummy fat becomes even more dangerous. Abdominal fat is visceral fat, the kind that's more active metabolically and can wreak more havoc by contributing to higher cholesterol, higher blood fats, and higher blood pressure. In the ongoing Iowa Women's Health Study, women with the greater amounts of tummy fat had higher rates of diabetes, heart disease, and high blood pressure. Even with a low BMI, a woman with belly fat is more likely to die early. That's bad news for somebody like me who has a belly and a high BMI. " (comment on AARP newsletter)
http://www.msnbc.msn.com/id/12919730/site/newsweek/

Fight back the bulge

Since visceral fat is buried deep in your abdomen, it may seem like a difficult target for spot reduction. As it turns out, visceral fat responds well to a regular exercise routine and a healthy diet. Targeted tummy exercises can help to firm the abdominal muscles and flatten the belly.

Exercise. Daily, moderate-intensity exercise is the best way to lose belly fat ­ when you lose weight and tone your muscles, your belly fat begins shrinking, too. In fact, you may notice that your tummy bulge is the first area to shrink when you start exercising. The amount and type of exercise you should get varies depending on your current activity level and your health goals. Talk to your doctor about the right exercise program to promote good health and specifically combat abdominal fat.

Strength training. Some research has shown that exercising with weights is effective in trimming tummy fat. Talk to your doctor about how to incorporate strength training in your exercise routine.

Healthy diet. Changing unhealthy eating habits can help fight belly fat. Read nutrition labels, and replace saturated fats with polyunsaturated fats. Increase portions of complex carbohydrates like fruits and vegetables, and reduce simple carbohydrates like white bread and refined pasta. If you need to lose weight, reduce your portion sizes and daily calorie intake.

Tone your tummy. While you can't "spot-burn" belly fat, you can firm up your abdominal muscles and get a flatter belly. Traditional sit-ups aren't the most effective way to firm your tummy, however. Instead, use these exercises to target both deeper and lower abdominal muscles:

• Deeper abdominal muscles. Target deeper abdominal muscles by doing "abdominal hollowing" or "drawing in the belly button." First, get down on all fours. Let your tummy hang down as you take a deep breath. Let your breath out, and at the end of your exhalation, gently draw your belly button inward and upward toward your spine. You should feel a slight tightening around your waist ­ think of it as trying to squeeze through a partially closed door. Hold for 10 seconds, then rest for 10 seconds. Work up to 10 repetitions. During each effort, your spine position shouldn't change and you should breathe freely. Eventually, you'll be able to do this exercise standing up. It's so subtle, no one should be able to tell you're doing it.
• Lower abdominal muscles. Tone your lower abdomen by doing pelvic tilts and pelvic lifts. To do a pelvic tilt, lie on your back on the floor with your knees bent. Flatten your back against the floor by tightening your abdominal muscles and bending your pelvis up slightly. Hold for 5 to 10 seconds. Repeat five times and work up to 10 to 20 repetitions. For pelvic lifts, lie on your back with your knees bent up toward your chest and your arms relaxed by your sides. Tighten your lower abdomen and lift your buttocks up off the floor, with your knees aimed toward the ceiling. Hold for 5 to 10 seconds. Repeat five times and work up to 10 to 20 repetitions.

Help!

Anxiety, more or less.

Please see a clinician if you feel that you might have anxiety or panic, getting an adequate physical assessment is essential.

• Anxiety normally starts to peak about half an hour after you get up. Anticipate it by doing some simple breathing exercises.
• Eat little and often – learn to watch and pay attention to what your body is saying. Even fill in a ‘body clock’ to chart mood and physicality.
• Smoking is supposed to calm the nerves, but researchers have found evidence that it might have the opposite effect.
• The body will have a transition at roughly 4:00am and 4:00pm – learn to nurture at those times.
• Remember that most people have panic/anxiety attacks when they are NOT stressed and when the crisis is over.
• Each day stop and breath several times. In breath to the count of five (tensing your whole body gradually - finishing with tensing your shoulders) and then as you exhale to the count of five let your body relax down and outwards towards the tips of the fingers and toes.
• If you think you have a task that is worrisome -- work out the steps beforehand. Then you are “chunking" it into manageable proportions that are not as stressful.
• If you feel like you are going to stress out.... stop, shut everything down, breath and stretch, put your hands behind your head.... then think about what you want to do and go back to it.
• Remember, work at a task in manageable 'bites' of around twenty minutes. Then stop, do something else or look up and away from the task, before returning. This means that you are rolling WITH your attention and learning curve instead of getting stuck on the plateau.
• When your mind wanders to something that provokes anxiety – write it down and then defer dealing with it until a specific time later in the day. Write a short phrase – not a journal! Normally come back to your short list at a time when you are distracted, for example watching television, and can look at the issues without stressing out. Do not try for solutions - let your mind percolate naturally and with a night's rest you will find things easier the next day.
• Don't stress about sleep - rest can be enough. Let your body do the 'talking'.
  
• Describe your physical sensations both to yourself and to someone who is trying to help. Feeling anxious or panicked is about the body not the mind. So validate the sensations and that means that the feelings of helplessness and hopelessness are lessened by treating this as something that will eventually be managed.
• Eat something carbohydrate at 4:00pm with some liquid - even when you are off work
• put hands behind head in a basket to disable chest wall muscles and calm down anxiety - several times a day. Simple chair stretching helps.
  
• Change task every twenty or thirty minutes - this can mean just stop and look up and straighten your back but preferably do the hands as a basket exercise.
• Try not to drink cold milk after 6:00pm. Warm milk releases tryptophan which is a natural ‘de-compressant’.
• think of " anxiety " as physiological stress not paranoia/ in your head
• at night take a shower and then stretch in the shower
• Clench your body and breathe in to the count of five, then hold for one and breathe out for the count of five relaxing the muscles out towards your finger tips and toes. Do this several times a day.
• SING in the car to music
• Each night have ten minutes quiet time and DOODLE - teach the kids to do this too.... - take a half hour to unwind some time in the evening.
• MINDFULNESS:

Mindfulness is about being in the 'now': being present in this body, at this time, doing this thing. It has a quiet, unassuming and unobtrusive nature. It is also non-judgmental and not characterized by emotional reactions. It is often linked with compassion¹.

The simplest form of mindfulness, which can be practiced very easily without anyone noticing, is to focus on the breath for three inhalations and exhalations. Some people do this hourly. It involves taking in a deliberate breath and noticing the quality of the air as it enters the body through the nostrils and making its way to the lungs. Then, when exhaling, you focus on the air as it leaves your body.

It's worth taking a look at the way you breathe. Most people breathe quite shallowly, using only the top part of their lungs. For the purposes of mindfulness breathing, you should use the whole of your capacity. This means inflating the bottom part first, which can be done by allowing your belly to swell (a bit like a balloon). Next, fill the mid-section by expanding your ribs sideways. Finally fill the top part of your lungs.

If you are sitting down, you can augment this by noticing the feel of the chair underneath your buttocks and the ground on your feet.

This practice will bring you back to the present moment and is very grounding.

Another form of meditation is the Walking Meditation. This can be done alone or in company. The walking can also be described as intentional. Walking mindfully entails focussing on the breath (as described above), placing and planting the feet purposefully and intentionally and being conscious of the ground, the surroundings and staying in the present moment.

STRESS SYMPTOMS:

• General - sweating, hot flushes or cold chills.
• Heart- pounding heart, increased heart rate.
• Lungs - difficulty breathing or feeling of choking, chest pain or discomfort, hyperventilation.
• Abdomen - difficulty swallowing, nausea or abdominal distress.
• Arms and legs - numbness or tingling sensations, muscle tension with associated aches and pains.
• Psychological - feeling 'keyed up' or on edge, fatigue, mind going blank, difficulty sleeping.

All of the anxiety disorders have these symptoms in common. As we'll see, however, they can occur under different circumstances.

Types of Anxiety Disorder

The 'purest' anxiety disorder is known as generalized anxiety disorder (GAD). This is characterized by out-of-control stress and worry over many aspects of the individual's life. The anxiety can be 'free-floating', which means that it isn’t connected to any particular situation. It is chronic and low grade, although it can occasionally flare. People with GAD primarily have problems with sleeplessness, fatigue, muscle tension and headaches.

Panic disorder is slightly different in that sometimes, for no apparent reason, the affected individual will have a full-blown panic attack, including many of the symptoms mentioned above. In between attacks, the individual will be anxiety-free, but over time they can (understandably) develop continuing anxiety about when the next attack will occur.

Phobias are anxiety disorders which are brought on by specific, identifiable situations. When in the situation, anxiety will lead to the individual trying to escape it by any means possible.

Obsessive Compulsive Disorder consists, as its name suggests, of unpleasant and distressing obsessive thoughts linked to the individual's compelling need to perform particular actions to compensate for them in some way. An example of an obsession might be the recurring thought that something horrible has happened to a loved one, a compensating compulsion might be checking that the oven is off every five minutes. Failing to act on the compulsion results in extreme anxiety of the sort outlined above.

Post Traumatic Stress Disorder, or PTSD, is similar to GAD but occurs after an identifiable stressor (such as war, child abuse, or a traffic accident). The individual can have flashbacks to the event in question, but why some individuals develop this after trauma and others don't is unknown.

Unfortunately, the situation is seldom as clear-cut as the above syndromes suggest. Each disorder can co-exist with any of the others – GAD for instance often co-exists with social phobia and/or other phobias.

Sugar Addiction anyone?

Avoid self-diagnosis; see your MD if you think anything might be giving cause for concern.

Possible hyperinsulinemia: in very simplistic terms this means that your pancreas over-produces or builds resistance to insulin in response to carbohydrate foods or nutritional imbalance. This can also include over-exercising and eating insufficiently to meet the needs of your body. Keep in mind that sugar addiction is not just a problem of the obese. If your goal is to manage the sugar cravings, as well as stay off the family disease path, it is imperative that you learn to eat to meet the special needs of your body. Believe it or not, this is probably the easiest part of self-management!

There are two powerful tools designed for managing psycho- biological problems such as sugar addiction: Interactive Awareness and Interactive Self-Hypnosis.

The first tool, Interactive Awareness, works as an alarm clock, it's job being to wake you up to specific moments that would benefit from your full attention, evaluation and perhaps a change of direction. Some may be obvious to you, but others may live below the surface, only known to your subconscious librarian. Keep in mind that the subconscious mind is a vast library, filled with assets with some out of conscious reach. Start to keep a food diary with times and types of food. Do the relaxation exercises and stretches to loosen the body and focus your mind in the moment. Try to capture a realistic picture of yourself as you become more in the habit of relaxation.
http://phenomenologyexistent.blogspot.com/2007/07/relax.html

Stretch in the shower and feel the water on your skin. Try and adapt these for the shower http://phenomenologyexistent.blogspot.com/2007/07/exercises.html

Once you are fully awake to the moment, you can begin to work with Interactive Self-Hypnosis. What you choose to do will depend on the moment, as well as your desired goals or outcomes. Get in a relaxed state and start to visualize --- It could be as simple as seeing yourself walking past the chocolate cake on the buffet, noticing a framed picture of yourself appearing very obese, or wearing a tee shirt with diabetes written on the front, cueing into what it feels like to be blind. If you are tired of the same old self-arguments, you might decide to use Interactive Self-Hypnosis to build up resilience from your past experiences, applying them as power stamps to your current experience. You could even choose to diminish the experience permanently, simply refusing to have this life experience at all.
Imagine yourself as you felt best in yourself and replace the poor picture of yourself with the memory 'snapshot' of the best of you. At work, being effective, at the age and place where you felt your best.

Being with food: Slow down enjoy the sensations in your mouth. Stop every so often and put down the plate and feel how you are. Once a week indulge yourself with something delicious, but see the reward as being and feeling healthier.

Women's Canadian Airforce Exercise Program XBX

XBX

Male Menopause?

The medical community is still trying to decide on whether men experience some type of hormonal phasing at midlife. Although it is not as sharply defined as for women, it is possible that males experience dips in hormones that are involved in the energetic body and the sharpened mind. Fatigue, weakness, memory deficits and an absence of joy in life may indicate a trip to the doctor. Erectile dysfunction is only part of this equation that should include evaluations for all sorts of conditions associated with aging.

Since men do not go through a well-defined period referred to as menopause, some physicians refer to this problem as androgen (testosterone) decline in the aging male. Men do experience a decline in the production of the male hormone testosterone with aging, but this also occurs with some disease states such as diabetes. Along with the decline in testosterone, some men experience symptoms such as fatigue, weakness, depression and sexual problems. The relationship of these symptoms to the decreased testosterone levels is still controversial.

Unlike menopause in women which represents a well-defined period in which hormone production stops completely, male hormone (testosterone) decline is a slower process. The testes, unlike the ovary, does not run out of the substance it needs to make testosterone. A healthy male may be able to make sperm well into his eighties or longer.

However, as a result of disease, subtle changes in the function of the testis may occur as early as 45 to 50 years of age, and more dramatically after the age of 70 in some men.

How Is Male Menopause Diagnosed?

To make the diagnosis, the doctor will perform a physical exam and ask about symptoms. He or she may order other diagnostic tests to rule out any medical problems that may be contributing to the condition. The doctor will then order a series of blood tests which may include several hormone levels, including a blood testosterone level.

Can Male Menopause Be Treated?

If testosterone levels are low, testosterone replacement therapy may help relieve such symptoms as loss of interest in sex (decreased libido), depression and fatigue. But, as with hormone replacement therapy in women, testosterone replacement therapy does have some potential risks and side effects. Replacing testosterone may worsen prostate cancer, for example.

If you or a loved one is considering androgen replacement therapy, talk to a doctor to learn more. Your doctor may also recommend certain lifestyle changes, such as a new diet or exercise program, or other medications, such as an antidepressant, to help with some of the symptoms of male menopause.

Diet Supplements and PMS

A week before your period starts, make sure that your diet isn't too heavy in salts, alcohol and caffeine - this will keep water retention and bloating down. Also make sure you eat plenty of foods containing iron and vitamins. Certain foods seem to help alleviate the symptoms. Monitor closely and you could work out what's best for you:

Evening Primrose Oil, Starflower Oil and Blackcurrant Oil

Evening primrose oil, starflower oil and blackcurrant oil all contain gamolenic acid (GLA). You should be able to get any of them from most high-street pharmacies or health food shops. Starflower oil is more expensive than evening primrose oil, but has a higher concentration of gamolenic acid. GLA has been shown in a couple of studies to help with breast pain (or mastalgia if you want to give it a fancy medical name). For some women it can help with PMS. One of the advantages of it is that it has virtually no side effects.

However, despite anecdotal evidence that GLA works with other symptoms of PMS, no other study has proven that they are better than the placebo effect. On saying that, the studies carried out on the effects of GLA on the symptoms of PMS are small, and potentially, GLA can have a small beneficial effect, although, no study large enough, or good enough has been carried out to definitively show this. The reason it is believed to work is that it is a rich source of long-chain fatty acids, which are the precursors of prostoglandins. As PMS is associated with low plasma levels of prostoglandins, the theory is that if you increase what it is made of, more of the required stuff will be made. It's certainly doing something for some of us, as this Researcher tells us:

Ten minutes after taking evening primrose oil capsules I suddenly feel like sighing and everything is all right. It's magic. I suggest all sufferers give it a go.

Chocolate

Chocolate, a marvellous substance which deserves to be in a food group all of its own, can be a fantastic cure-all for everything from being dumped to exam stress - it also has it's enthusiastic supporters at times when PMS and period pain are rearing their ugly heads. Accompanied by caffeine and a good book there's no better comfort.

Some believe that you should give into the cravings leading up to your period. After all, if you're craving it, your body probably needs it. This feeling may be all in the mind, but denying yourself something you want doesn't help for those few days. Others say, avoid chocolate completely, as it only makes things worse.

But what is the magic ingredient in chocolate that your body needs? It contains iron and magnesium. Iron helps with tiredness and irritability and magnesium is said to regulate mood. Chocolate also contains milk, and consequently, calcium. Back in the 1930s it had already been noted that levels of calcium in the blood were significantly lower in the week preceding menstruation. Also, the symptoms of hypocalcaemia (low blood calcium) are remarkably similar to PMS. Large studies in the early 1990s were carried out to see if it did, indeed, have any effect, and to date, calcium is the only supplement which has been shown to have any positive effect on the symptoms of PMS².

The Vitamin B6

The vitamin B6 has reportedly changed the lives of a number of h2g2 Researchers with regard to dealing with PMS:

Amazingly enough, a bloke told me about it first. I've been spreading the word ever since and swear it has saved a friends' marriage.

In high enough doses, vitamin B6 can suppress the actions of a steroid hormone called aldosterone. This results in a diuretic effect, making you wee and should consequently prevent bloating. In addition, as PMS is associated with an increase in blood oestrogen levels and low blood progesterone, high doses of vitamin B6 decrease blood oestrogen and increase blood levels of progesterone, providing symptomatic relief³.

You should start taking the recommended daily dose 5 to 7 days before your period begins (or as soon as you start getting symptoms) and can continue on until the end of your period, but then you must stop until your next period. B6 should not be taken continuously and there are a few poor souls, approximately 1 in 10,000, who are allergic to taking B6, so if you notice any big spots on your skin soon after taking it, please stop and consult your doctor. , brazil nuts and bananas contain significant levels of B6 if you would prefer to take the vitamin in a natural form, rather than as a supplement.

Carbohydrates

It has been suggested that you should eat carbohydrates every few hours in the week before and during your period. The theory goes that complex carbs help the body dispose of excess progesterone, which is the hormonal culprit of PMS. Carbohydrates may well be another food that you crave in the run up to your period. Pasta and any other foods which are high in carbohydrates also increase the levels of serotonin in the brain resulting in a calming effect.

Vitamin C

Vitamin C can also help. Take 1000mg a day instead of the recommended 500mg. It can't hurt you - excess Vit C is flushed out of the system automatically. Or you can boost your intake of foods containing high doses of vitamin C such as pineapple and strawberries.

Alcohol

Curling up with a bar of Dairy Milk and a bottle of red wine certainly makes you feel better. We've explored the benefits of chocolate already, but what about alcohol? In actual fact, alcohol acts in a very similar fashion to benzodiazapines and barbiturates, by potentiating the effects of a inhibitory neurotransmitter in the brain called GABA. Increased action of this transmitter in the brain has a calming and relaxing effect, as anyone who has downed a shot of vodka during a very stressful lunchtime will testify.

Magnesium

Magnesium is actually good for paranoia and all sorts of fears as it is involved in the activation of the neurotransmitter serotonin; which helps regulate mood. Natural magnesium occurs in all the foods you 'should' eat - green veggies, fruit, wholewheat stuff, nuts a

Water and Fluids

Drink plenty of water to get rid of that bloated feeling. Your body will retain water, if your intake is short of what your body needs. If you drink loads, your body will flush through and you won't feel bloated.

Why not drink replacement plasma? It's recommended for other types of fluid loss. You could buy a bottle of isotonic sports drink, but making your own is much cheaper. Mix 5 teaspoons of sugar and 1 teaspoon of salt with 1 litre of water. It tastes grim, but it doesn't taste too bad mixed with orange juice and that way you can replace fluid and give yourself a valuable hit of vitamin C, too.

nd seeds. There is also a fair amount of magnesium in comfort foods such as bananas, chocolate and peanut butter.

Iron

Not to put too fine a point on it, you lose some blood during your period, which can contribute to making you anaemic. The symptoms of anaemia are tiredness, weakness and, in severe cases, breathlessness and dizziness. It can make you more prone to picking up infections, and it may also explain that feeling of not quite being with it:

PMDD

Twenty to fifty percent of women between the ages of 30 to 40 with regular menstrual cycles experience premenstrual syndrome (PMS) as a regular physiological occurrence every month. In more severe cases, affecting three to five percent of menstruating women, this syndrome is labeled as premenstrual dysphoric disorder (PMDD) . Patients with severe PMDD are at risk for developing postpartum depression. Furthermore, women successfully treated with antidepressants often show breakthrough symptoms of depression in the premenstrual phase of their menstrual cycle. All that is needed is a small increase in the dosage of the antidepressant premenstrually.

PMDD Symptoms

Women with PMDD complain of irritability, anger, tension, marked depressed mood, and mood lability (crying spells for no reason, verbal outbursts, or tantrums ) to such a severity that quality of life is seriously compromised. In addition to these symptoms, some women complain of lethargy, sleep disturbance, limited concentration and a host of physical symptoms such as breast tenderness, headaches, joint and muscle pain, bloating and weight gain.

The primary symptoms that distinguish premenstrual dysphoric disorder from other mood disorders (i.e., major depression) or menstrual conditions is the onset and duration of PMDD symptoms -- with symptoms appearing during the week or so before and disappearing within a few days after the onset of menses -- and the level by which these symptoms disrupt daily living tasks. (This diminished level of functioning is generally in great contrast with the same woman's interactions and abilities at other times during the month.)

The symptoms of PMDD may resemble other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Consult a physician for diagnosis.

What PMDD Is Like

Kym says, "on my last bad day, I got very suicidal. I felt like I couldn't take being like this anymore. The worst part of it was knowing that on any other day, I liked my life, that it was this illness making me feel so worthless. I couldn't help myself, though. The feeling was so strong. I didn't attempt to act on my impulse. I pray I never do. It's just that it feels overpowering. I'm afraid on those days. Afraid that maybe next time I won't win the PMDD battle." "On that day, my two beautiful girls watched me lay in bed and cry uncontrollably. They even made me little cards to tell me they love me. I felt ten times worse because in my heart, I wanted to jump out of that bed and be normal. I didn't want them to see that. I love my children and I want to protect them from stuff like that, but my hormones had a stranglehold on me. They didn't know I was suicidal, depressed, or anything else. Just that mommy gets this way every month, that mommy is sick. And in a few hours, mommy will be back in the kitchen baking a pie like nothing ever happened." (Used with permission. © 2003 Kymberlee Hose)

What Causes PMDD

Although the exact cause of PMDD is not known, several theories have been proposed. One theory states that women who experience PMDD may have abnormal reactions to normal hormone changes that occur with each menstrual cycle. This may include the fluctuation of estrogen and progesterone levels that normally occur with menstruation causing a serotonin deficiency, in some women (Serotonin is a substance found naturally in the brain and intestines that acts as a vessel-narrowing substance, or vasoconstrictor). Additional research is necessary.

How is Premenstrual Dysphoric Disorder Diagnosed?

• over the course of a year, during most menstrual cycles, five or more of the following symptoms must be present:
  • depressed mood
  • anger or irritability
  • difficulty in concentrating
  • lack of interest in activities once enjoyed
  • moodiness
  • increased appetite
  • insomnia or hypersomnia
  • feeling overwhelmed or out of control
  • other physical symptoms

• symptoms that disturb social, occupational, or physical functioning

• symptoms that are not related to, or exaggerated by, another medical condition

What is the Difference Between PMS and PMDD?

The physical symptom list is identical for PMS and PMDD; while the emotional symptoms are similar, they are significantly more serious with PMDD. In PMDD, the criteria focus on the mood rather than the physical symptoms. With PMS, sadness or mild depression is not uncommon. With PMDD, however, significant depression and hopelessness may occur; in extreme cases, women may feel like killing themselves or others. Attributing suicidal or homicidal feelings to “it’s just PMS” is inappropriate; these feelings must be taken as seriously as they are in anyone else and should be promptly brought to the attention of mental health professionals.

Women who have a history of depression are at increased risk for PMDD. Similarly, women who have had PMDD are at increased risk for depression after menopause. In simplest terms, the difference between PMS and PMDD can be likened to the difference between a mild headache and a migraine.

PMDD Treatment

Treatment for PMS depends on the severity of the symptoms. For mild cases, treatment recommendations include diet modifications such as high carbohydrate meals and reducing salt, caffeine and alcohol, as well as a variety of methods for stress reduction and relaxation such as exercise, counselling and stress/behaviour management strategies.

For severe PMDD, treatment is more aggressive, often requiring pharmacological intervention in addition to nonpharmacological treatments. The selective serotonin reuptake inhibitor class of antidepressants are effective in the treatment of PMDD. Fluoxetine (Prozac - Serafem) has been widely studied and found to be effective in reducing symptoms of tension, irritability and dysphoria. These results have been replicated with sertraline (Zoloft) and paroxetine (Paxil). Use of the SSRIs is positive as well in that side effects, such as nausea, diarrhea, headache, and insomnia, to name a few, are minimal and reportedly tolerable by the majority of women.

For some women, even more drastic measures must be taken to ameliorate the symptoms of PMDD. For these women, hormonal therapies are necessary that work by suppressing the menstrual cycle. Effective hormonal therapies include gonadotropin releasing hormone (GnRH) agonists, estradiol and danazol. With respect to the GnRH agonists, women may not be able to continue with this form of therapy in that side effects are similar to symptoms of menopause. This, then, can increase the occurrence or severity of osteoporosis. With estradiol treatment, women must be concurrently treated with progestogen to prevent endometrial hyperplasia. Danazol is effective, however, that has quite a severe adverse effect profile due to its androgenic and anti-estrogen properties. In addition, danazol treatment affects menstrual cycle length. Thus, the side effect profile of hormonal therapies makes them less tolerable in the treatment of PMDD.

For some women, the severity of symptoms increase over time and last until menopause (when menses ceases). For this reason, a woman may require treatment for an extended period of time, and may require several reevaluations to adjust medication dosages throughout the course of treatment.

Overcoming Stigma

In the 1999 consensus paper published in the Journal of Women's Health and Gender-Based Medicine, a 14-member panel of health care experts concluded that PMDD is a distinct clinical entity and that specifically evaluated and approved medications are needed to treat this disorder. They agreed that strong data exist to support the use of SSRIs in treating PMDD.

Women, however, do face barriers to diagnosis and treatment. There is often a stigma attached to any condition that is associated with the menstrual cycle. Many women who do not seek treatment for the mood and physical symptoms of PMDD accept their symptoms as an inevitable consequence of the menstrual cycle which cannot be addressed.

Some women view seeking treatment for PMDD as a sign of weakness. Additionally, physicians aren’t traditionally trained to recognize the signs and symptoms of PMDD—symptoms are often dismissed as just a “part of being a woman.” Therefore, help is often neither sought nor offered.

If you find that your doctor is unfamiliar with PMDD, print this information and bring it with you to your visit. An alternative is to get a second opinion from another OB-GYN or psychiatrist.

RELATED LINKS AND INFO

Depression and the Lifetime Reproductive Cycle
The Role Hormones Play in Mood Disorders
Women and Depression
Postpartum Depression

Alzheimer’s or Dementia Therapy Options:

Reality orientation is a technique in which people caring for others with this type of disorder take every opportunity to orientate the person. This might be to remind the person where they are and what time and day it is. It is important to validate accurate perceptions and disagree when the person says something incorrect.

Reality orientation does help people make changes and to respond realistically to their environment. But, this should be sensitive to the person’s emotional state and to any care plan that is in place.

Reminiscence therapy involves stimulating the recollection of events and memories from the past. This is achieved by using music, DVD, pictures, movies (that the person may have seen in their past) or food and clothing from past times.

People often enjoy this process and it does tend to make them feel empowered. Older people love telling stories and younger people love hearing them. Grandchildren will want to know stories about their parents as children. Effective as this can be, it is still not going to prevent the memory getting worse in the long run. Creative application of long term reminiscences can be comforting by being about situations that are familiar.

Validation therapy emphasizes the emotional world of the person and offers useful techniques for communication. One may play a game of “tuning in” to a particular person or situation and guess strategies for handling or recognizing what is familiar.

It is important to listen to the person but not get into protracted negotiation or arguments about dates, facts or realities. Validate what is useful and concrete knowledge and perception but try to minimize the effects of failure.

This may bring sense out of less clearly articulated communication. The idea is not to impose our reality but to let them express a more real version of theirs.

Memory training by using external aids, mnenemonies, photographs, and a written list of routine functions can be effective.

Going over self care tasks helps the person to feel empowered and less needy. Short daily training classes with a lot of stimulating interaction may prove useful. Emphasis can be place on how the tasks feel rather than relying on verbal or written instruction. This appeals to the person’s felt-sense experience.

Stimulate the individual by conversation, books, dance, art and movement. Going shopping or for a drive while noticing the environment and sounds. Use of exercise programs, and calming by stretching or relaxation all bring a sense of awareness which brings comfort and confidence.

Behavioral approaches promote a sense of achievement:

• Increase the person’s level of independence including relearning of lost skills and maintaining existing skills. The use of caring verbal prompts helps as a reminder when short term memory is lacking.
• Reduce the level of behavioral disturbance and difficulty. This would include independence in mobility and such basic issues as continence. The person might be encouraged to void often and at regular intervals.

Cognitive-behavioral therapy with a trained professional has been found useful. Weekly sessions may include caregivers as well as the person in need. Thus, everyone learns to be more observant of change and more able to support. This can assist with depression and burn out. Therapy can include progressive relaxation techniques and strategies for anger and stress management. Successive tensing and relaxation of muscle groups relies on procedural memory which is relatively spared in dementia.

Even after all of this it may be necessary to place the person in long term residential care. But the early adoption of interactive strategies can slow down the frustrations of impairments and support more active involvement in the community or family, and thus enhance quality of life.

Complementary Alternative Medicine should be explored as well as psychopharmacology of a more traditional ‘Western’ kind. There have been many advances in geriatric care and prescription drugs. As with everything, information brings power and safety. Seek professional trained consultation at all times.

I believe that old age begins when people settle into a rut and stop learning new things. Both the mind and body lose their agility when not given fresh challenges to master.

For the past decade, I've been making it a point to learn at least one new thing every year, and pursue it with passion. I try to do something different from the things I already know, so I can develop new ways of learning. Since I've always been a klutz, I've been focusing on developing grace and physical coordination through activities like darts, rollerblading, tennis, yoga and most recently belly dancing. Who knows what next year will bring...

And for my mind, I've been working on musical instruments (can successfully torture anyone with the accordion now), writing little stories, learning to colour with oil pastels, trying to master computer graphics, and generally making it a point to learn enough about new things to give me a bit of an understanding of them. I'm thinking my next project might be geometry, as I haven't messed with maths for 20 years.

I work really dilligently at these things until I reach a certain level of proficiency, then move on to the next project while still giving the old ones just enough attention to maintain them.

Another benefit is that once I finally have the time to spend doing what I please (quite a way off, still), I'll have begun plenty of hobbies that I can occupy myself with, rather than sitting in front of a TV, anticipating my next meal. And meanwhile, life is awfully interesting. h2g2

Cortisol

Amino Acids

Acetyl L-carnitine

Acetyl L-carnitine is a molecule composed of acetic acid and L-carnitine bound together. This amino acid, which is structurally similar to acetylcholine (a neurotransmitter in the brain responsible for memory and normal brain function), plays an important role in treating diseases like Alzheimer's disease, senile depression, and age-related memory defects. Many studies have shown that Acetyl L-carnitine can have the same benefits and effects of acetylcholine in stimulating brain cell production, in stabilizing cell membranes, and in acting as a powerful antioxidant to the brain.

One study of Alzheimer's sufferers showed that patients who took two grams of Acetyl L-carnitine daily for one year scored better on fourteen different tests than those who took the placebo. In another study of elderly patients with mild memory deterioration, the patients demonstrated significant improvement in mental function after taking 1,500 mg of Acetyl L-carnitine on a daily basis. Another group of elderly patients suffering from depression also saw significant improvement when they took 500 mg of Acetyl L-carnitine three times daily.

An important source of energy for muscle tissue, the brain and central nervous system; strengthens the immune system by producing antibodies; helps in the metabolism of sugars and organic acids.

Arginine

Arginine significantly contributes to insulin production, muscle metabolism, liver lipid metabolism, and is a component of collagen. It enhances the immune system, specifically by stimulating the thymus gland and the manufacture of T cells. This increase in T cell activity can be effective in fighting bacteria, viruses, cancer tumor cells, AIDS, chronic fatigue, and other immune system related health challenges.

Arginine is a factor for maintaining the nitrogen balance in muscles; and can enhance the lean tissue to fat tissue body fat ratio; a great factor for weight management.

Arginine also neutralizes ammonia, which helps in liver detoxification and regeneration. As a component of collagen, it can assist with wound healing, skin problems, arthritis, and connective tissue problems.

Asparagine

This amino acid is found mostly in meat sources, so vegetarians might need to consider supplementation. Asparagine balances the central nervous system and prevents excess nervousness/anxiety or excessive calmness/depression.

Aspartic Acid

Aids in the expulsion of harmful ammonia from the circulatory system. When ammonia enters the circulatory system it acts as a highly toxic substance which can be harmful to the central nervous system and cause neural and brain disorders. Aspartic acid deficiency decreases cellular energy and may likely be a factor in chronic fatigue.

Plants, especially sprouting seeds, are abundant in aspartic acid.

Carnitine

Anyone concerned with decreasing body fat will want to assure their daily level of carnitine, because carnitine helps TRANSPORT FAT from fat cells to the mitochondria of muscle cells so it can be BURNED UP FOR ENERGY. It is hard to imagine how a weight loss program could ever be effective with a deficiency of carnitine.

Current levels of excessive body fat in the general population indicate a high level of carnitine deficiency. Interestingly, carnitine is not part of the "essential" nutrient group because the body manufactures it. But the manufacturing process requires adequate iron, Vitamin B1, B6, and C, and the amino acids lysine and methionine (neither of these amino acids are obtainable in sufficient amounts from vegetable sources). Carnitine deficiency will result if any of those nutrients are at inadequate levels, so supplementation is absolutely essential, especially for vegetarians.

Carnitine is great nutrient for diabetes prevention since poor fat metabolism is a causative factor for the development of diabetes. It is also great for heart disease prevention because it lowers triglycerides, improves organ muscle strength and enhances the antioxidant effectiveness of Vitamins C and E. Also, studies indicate that cardiac surgery damages to the heart can be reduced with carnitine treatments.

Recent research has shown that at high doses (1,000- 3,000 mg. daily), carnitine acts as an agent to reduce blood triglycerides. ELevated triglycerides can lead to an increased risk of small vessel diseases, including poor circulation in the hands and feet as well as kidney problems.

Citrulline

Functions primarily in the liver. Like other amino acids, citrulline detoxifies ammonia is involved in the energy cycle, and enhances the immune system.

Cysteine and Cystine

These amino acids are structured very closely and convert into each other as needed. They are involved in collagen production for skin elasticity and texture, and for alpha-keratin for fingernails, toenails, and hair. In fact, hair and skin are made up of 10-14% Cystine. This makes supplemental cysteine great for burn and surgery recovery, it is also recommended in treating rheumatoid arthritis.

Cysteine is a powerful free radical destroyer by itself, but works best when vitamin E and selenium are present. It helps detoxify and protect the body from radiation damage, so it is often used in conjunction with chemotherapy and radiation cancer treatments.

Cysteine is a precursor to the liver detoxifying and antioxidant amino acid glutathione. This functionality provides an anti-aging effect on the body—even reducing the accumulation of age spots. Another impressive function is the break down of mucus in the respiratory tract which can help in bronchitis, emphysema, and tuberculosis.

N-acetylcysteine is the best form of cysteine supplementation and has been proven more effective at increasing glutathione levels than supplements of glutathione itself, or supplements of just L-cysteine.

Caution: Cystinuria is a genetic disease where cystine kidney stones are formed. People with this disease should not take supplemental cysteine.

Dimethylglycine (DMG)

Participates in formation of methionine, choline, DNA, and several neurotransmitters. DMG is good for the heart. It has been found to lower blood cholesterol and triglycerides, and help normalize blood pressure and blood glucose.

Gamma-Aminobutyric Acid (GABA)

GABA functions in the central nervous system as a neurotransmitter; it occupies the nerve receptor sites for anxiety or stress related messages so that they are restrained from reaching the brain.

GABA can be taken as a tranquilizer to calm the body, but without the addiction that can come with usage of Valium™ or Librium™. GABA is also used for epilepsy, hypertension, and ADD-ADHD.

Balanced supplementation is important because too much GABA can increase anxiety, and cause numbness in the face and tingling in the fingers and toes.

Glutamic Acid

Glutamic Acid is the precursor of GABA but has somewhat the opposite function; it is an excitatory neurotransmitter. It is one of the few nutrients that crosses the blood-brain barrier and is the only means by which ammonia in the brain can be detoxified.

It is considered to be nature's "Brain food" by improving mental capacities; and is used in the treatment of depression, ADD and ADHD, fatigue and chronic fatigue, alcoholism, epilepsy, muscular dystrophy, mental retardation, and schizophrenia.

Glutamine

Glutamine readily passes the blood-brain barrier and increases the amount of glutamic acid and GABA; thereby enhancing normal nervous system function. As amino acids chemically change, ammonia is released. Glutamine plays a role in the removal of this toxic ammonia from the brain.

Because glutamine's role in the nervous system is so important, during times of stress, illness, or surgery up to one third of the muscle stores of glutamine are released for nervous system usage; causing extensive muscle deterioration and loss. The muscle glutamine release is much lower if glutamine levels are increased through supplemental L-glutamine.

Supplemental L-glutamine is also used therapeutically for arthritis, autoimmune diseases, developmental disabilities, impotence, schizophrenia, and for tissue damage from cancer radiation treatments.

Caution: Supplemental glutamine should not be taken by anyone with a disproducts/productsindex that causes an accumulation of ammonia in the blood (kidney or liver problems, Reye's syndrome, etc.)

Glutathione

The liver produces glutathione from the amino acids cysteine, glutamic acid and glycine. Glutathione deficiency results in early aging and in the loss of coordination, balance, tremors, and mental disorders.

Glutathione levels decline with age and if not corrected will accelerate the aging process; so supplementation is important. But the assimilation of supplemental oral glutathione is questionable. Instead it is best to supplement with cysteine, glutamic acid and glycine and have the body use those raw materials to manufacture needed glutathione.

Glycine

Glycine supplies additional creatine to muscles and is used to construct DNA and RNA. It functions in skin, connective tissues, the central nervous system and prostate.

A proper level of cellular glycine produces more energy, but too much glycine can cause fatigue.

Histidine

Is found abundantly in red and white blood cells and is a component of the myelin sheaths that protect nerve cells. It is used in the treatment of arthritis, allergies, and ulcers.

Histamine, a chemical that functions in the immune system, is derived from histidine. Besides functioning in the immune system, histamine aids in sexual arousal, functioning and pleasure. To form histimine, histidine requires vitamins B₃ and B₆.

Caution: Histidine levels that are too high may lead to stress and psychological disorders like anxiety and schizophrenia. Individuals with manic (bipolar) depression should not take supplemental histidine unless prescribed by their health care provider.

Isoleucine

One of three branched-chain amino acids (the others are leucine and valine) that enhance energy, increase endurance, and aid in muscle tissue recovery and repair. This group also lowers elevated blood sugar levels and increases growth hormone production. Supplemental isoleucine should always be combined with leucine and valine at a respective milligram ratio of 1:2:2.

Caution: Megadosing causes symptoms of hypoglycemia, pellagra, and may result in excessive levels of ammonia in the body.

Leucine

One of three branched-chain amino acids (the others are isoleucine and valine) that enhance energy, increase endurance, and aid in muscle tissue recovery and repair. This group also lowers elevated blood sugar levels and increases growth hormone production. Supplemental leucine should always be combined with isoleucine and valine at a respective milligram ratio of 2:1:2.

Caution: Megadosing causes symptoms of hypoglycemia, pellagra, and may result in excessive levels of ammonia in the body.

Lysine

Lysine is especially needed for adequate absorption of calcium and bone development in children. It aids in the production of antibodies, hormones & enzymes. Recent studies have shown that Lysine may be effective against herpes by improving the balance of nutrients that reduce viral growth.

A deficiency may result in tiredness, inability to concentrate, irritability, bloodshot eyes, retarded growth, hair loss, anemia & reproductive problems.

Methionine

This amino acid is a principle supplier of sulfur, which inactivates free radicals. Adequate methionine prevents disorders of the hair, skin and nails; helps lower cholesterol levels by increasing the liver's production of lecithin; reduces liver fat and protects the kidneys.

Methionine is a natural chelating agent for heavy metals and helps detoxify the body of these metals. It regulates the formation of ammonia and creates ammonia-free urine which reduces bladder irritation. It also influences hair follicles and prevents brittle hair.

Ornithine

Ornithine participates in the release of growth hormone, which then prompts the metabolism of excess body fat. This process is enhanced by the presence of arginine and carnitine.

Caution: Children, pregnant or nursing women, or anyone with a history of schizophrenia should only use supplemental L-ornithine under the direction of a physician.

Phenylalanine

Used by the brain to produce dopamine and norepinephrine, chemicals that promote alertness, elevate mood, decrease pain, aid in memory and learning, and reduce hunger and appetite.

Caution: Phenylalanine should not be supplemented by individuals with anxiety attacks, diabetes, pigmented melanoma (skin cancer), high blood pressure, or if pregnant.

Proline

Is obtained primarily from meat and aids in maintaining collagen (skin protein). Proline deficiency will cause an uncareful vegetarian to have early signs of skin aging. Proline also strengthens joints, tendons, connective tissue, and cartilage.

Serine

A storage source of glucose by the liver and muscles; helps strengthen the immune system by providing antibodies; synthesizes fatty acid sheath around nerve fibers.

Taurine

Helps stabilize the excitability of membranes which is very important in the control of epileptic seizures. Taurine and sulfur are considered to be factors necessary for the control of many biochemical changes that take place in the aging process; aids in the clearing of free radical wastes. A deficiency of zinc and taurine may impair vision.

It is used theraputically for people with hypertension, aterosclerosis, edema, cardiac arrhythmias, anxiety, epilepsy, hyperactivity, seizures, breast cancer, Down syndrome, muscular dystrophy.

Taurine is in eggs, fish, meat, and milk, but not in vegetable proteins. It can be synthesized from cysteine and methionine as long as sufficient quantities of vitamin B₆ are present.

Threonine

Is an important constituent of collagen, elastin, and enamel protein; helps prevent fat build-up in the liver; helps the digestive and intestinal tracts function more smoothly; assists metabolism and assimilation.

Tryptophan

A natural relaxant, helps alleviate insomnia by inducing normal sleep; reduces anxiety and depression; helps in the treatment of migraine headaches; helps the immune system; helps reduce the risk of artery and heart spasms; works with lysine in reducing cholesterol levels.

Tyrosine

Promotes the healthy functioning of the thyroid, adrenal and pituitary glands. Supresses the appetite and helps to reduce body fat. Research indicates tyrosine may help chronic fatigue, narcolepsy, anxiety, depression, allergies, headaches, and Parkinson's disease.

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Valine

One of three branched-chain amino acids (the others are leucine and isoleucine) that enhance energy, increase endurance, and aid in muscle tissue recovery and repair. This group also lowers elevated blood sugar levels and increases growth hormone production. Supplemental valine should always be combined with isoleucine and leucine at a respective milligram ratio of 2:1:2.

Caution: Megadosing can be dangerous, and cause hallucinations and tingling skin.