"Progressively, since abortion I was having bouts of depression, guilt, and anxiety."

I had an abortion on May 30, 1999. Progressively, since then I was having bouts of depression, guilt, and anxiety. By Christmas, I had officially had my first panic attack after months of generalized anxiety. I had numb hands and feets and my first night of sweating. My doctor did blood work and said everything was normal except for a slightly off thyroid test. He prescribed 10 mg of paxil per day which I was to take for 1 week and then up the dosage to 20 mg. I could not tolerate 20mg. It made me extremely agitated and jumpy...almost worst than the reason I was on the medication in the first place. My doctor told me to go back to 10 mg. I continued this for a month and found that my anxiety and depression had only minorly improved. My doctor then took me off the paxil and told me to take 15mg of Buspar per day. I have taken the buspar 4 days now and have been extremely fatigued and lightheaded. I also cry very easily and I am extremely sensitive and irritable. I don't know if these reactions are due to the Buspar or due to the paxil withdrawal. I would recommend to anyone suffering anxiety or depression to avoid medications at all costs. It is better to work through your problems and if you are religious, to seek spiritual guidance and counseling. Medications can compound the problem and sometimes doctors don't tell you this. Remember, you are one of many, many patients that they see and your symptoms are probably just like many other people out there (even though we tend to feel like we are alone). Doctors are just trying to do their job as quick as possible with hope for success. Medicine is trial and error sometimes. Therefore, consider all of these things before you decide to start antidepressant medications. It can prolong your suffering in the end.

-- submitted by Jane, 26

"My symptoms involve anxiety, depression, mood swings, appetite changes, in varying levels 7 - 10 days before my menstrual cycle"

I was about to partake in a controlled study to investigate the efficacy of the treatment of paxil (10-20 mg) in patients with premenstrual syndrome. I suffer from PMS, as millions of women do across the world. My symptoms involve anxiety, depression, mood swings, appetite changes, etc., in varying levels 7 - 10 days before my menstrual cycle. I have never subjected myself to prescribed drugs as I am an advocate of cognitive and/or herbal therapy over chemical therapy, however I was curious as to the effects of such chemical therapy and decided to volunteer as a candidate for this study.

Well I'm glad I did my research before starting the program!!! There seems to be an overwhelming majority whom have experienced negative effects and results from PAXIL! I am grateful for your responses as it warned me of the detrimental effects that this drug can cause, and as a result I have decided not to be a mule for the pharmaceutical companies!

An interesting fact...The sponsor behind this PMS study is the pharmaceutical maker SmithKline Beecham. They provide the doctors with the funding to do the research, knowing that if the results prove beneficial (even slight and/or short-term) then this drug will be overly prescribed to the millions of women who suffer from PMS, thus making the pharmaceutical company millions and millions of dollars in profit, and we will have a society of drug dependent women!!!!!!!!!!

There seems to be a cultural crusade to medicalize any trait - physical or behavioral - that does not measure up to the elusive ideals generated by pop culture, advertising, and the shifting moral and political norms. We have become a society that runs for a chemical relief for any little idiosyncrasy that we experience!

What do we do and where do we turn?

-- submitted by natalie, 32

"he was not concerned about rebound depression or anxiety"

I chose to go on Paxil in February of 1999 due to high levels of stress and anxiety that were related to being in my third year of graduate school. I intended to take it for one year and then discontinue. I went off the Paxil on 2/6/00 after consulting with my prescribing physician who told me that he was not concerned about rebound depression or anxiety (neither was I). On Thursday, 2/10/00, I began to experience a headache, not unlike those I have had in the past due to sinus pressure from weather changes. This headaches did not discontinue, rather, it increased in severity and by Saturday I was ready to do anything to stop the pain. On Monday I saw my physician who prescribed migraine medication. I spoke to him the next day to inform him that it was not working and was encouraged to continue using the Midrin. On Tuesday (2/15/00) evening, I was taken to the ER by a friend of mine, was checked out, and was given a shot of narcotics. The ER physician told me to come back the next day if my headache was not gone. I returned to the ER the next day and had a head CT Scan. The CT reading resulted in no evidence of any problems, including my sinuses being clear. I now have a prescription for Metaxalone which is a muscle relaxer. While the severity of my headache has reduced somewhat, I am still experiencing pressure and discomfort behind my eyes which is exacerbated by reading, driving, etc. making it difficult for me to function as I need to. I am currently convinced that these symptoms are due to withdrawal from the Paxil and would welcome any solution that does not require me to go back on an SSRI.

-- submitted by Ann, 26

"I had decided to stop taking paxil 7 months later"

my obgyn put me on paxil 10mg. after diagnosing me with pre-menopausal symptoms on July 12,1999(even after my blood level was checked and hormone level was normal) I had decided to stop taking paxil 7 months later because of the expense and on the 3rd. day I thought that I was going to jump out of my skin.I was extremely nervous and could not fall asleep that night. I also had bouts of diarrhea with severe stomach pain.I called my doctor and she asked me if I still had any klonopin left over from months back, I said yes and she told me to take 0.5 mg. to combat the symptoms. In 1 hour I felt fine again but I had to ask myself,do I want to become addicted to klonopin as well?? NO>>>>> I started back on the paxil the next morning and have felt fine since. I have to wonder if the doctors and Pharmaceutic Companys realize what this drug is doing to people or if they even care.

-- submitted by scsun, 45

Your Physical Environment and Stress

If you are under stress, then it’s not only your personality that is to blame. It’s the physical environment of your workplace that is a significant contributor to stress. You might not be in a potentially dangerous job, but there are stressors even in buildings. Watch out for these environment stressors at your workplace:

• Closed, congested office spaces: Ever notice how uncomfortable you feel if a stranger comes too near to you while talking? This is because there is a personal space of every human being in which very few people are allowed entry. Going by the same logic, congested rooms do not allow people to have a certain level of privacy and tend to produce stress.
• An unclean environment: Messy and disorganized offices and neighborhood tend to distract from work and thus function as stressors.
• Noise pollution: Besides contributing to noise pollution, a cacophonous environment can affect your ability to concentrate and think effectively. It also causes mood swings. In fact, the higher the level of skill and speed required in a job, the more is the damage caused by the noise.
• Inappropriate lighting: If a room is either too dimly or too sharply lit, a person may suffer from headaches due to the constant screwing up of the eyes. Very little light can make you feel stressed, lethargic or bored. Low natural light causes both energy levels and morale to fall, thus affecting your work and satisfaction levels.
• Air pollution: When there is poor air circulation or improper ventilation, the stale air in the room is capable of causing stress. It can increase irritability, cause headaches and affect performance adversely. Working in a smoke-filled room can lead to claustrophobia.
• Uncomfortable temperature: While hot and humid environments make it difficult for a person to focus on the task at hand, noisy air conditioning can also be quite stressful.
• Lack of storage and filing space: In the absence of sufficient storage and filing space, files and work get piled up, collecting dust. Too much of clutter is stressful, as it distracts and annoys.
• Lack of sophisticated office equipment: It is extremely stressful to work with inadequate equipment. This multiples effort and creates dissatisfaction.
• Absence of support system: In case of failure of the computer, electrical or other systems, does your office have a support network in place? If not, then the knowledge of it is as stressful to the worker if not more, then the actual scenario of a breakdown of the machinery. A poor working environment can thus be a major cause of stress, not only because it can influence the way you work, but more importantly, because it can damage your health.

You Could Be Stressed Out Because...

Believe it or not, but stress begins at your doorstep. A difference of opinion, high expectations, death of a loved one can all contribute in some little way to causing you stress. Domestic stress can be because of personal, economic, social/religious and situational/external factors or events.

Personal Factors: that can cause stress include personality characteristics and coping skills, expectations that one has from family and oneself, understanding with spouse, emotional attachment, feeling of guilt for not being able to spend time at home, eating and sleeping habits and rigidity. If your income cannot support your family, your job prospects are low or if you have sudden expenses, you could be under stress due to economic reasons.

Situational factors: over which you may have no control, such as deaths or births, divorce, altercation with neighbours, illness or retirement, financial loss, or unsuccessful completion of daily activities could all lead to domestic stress.

Changing value systems: a lack of effective leadership, corruption, and bureaucracy affect both your economic and social lives directly, thus directly or indirectly causing stress. Increasing ambitions, growing desires and a tendency to become more and more materialistic has become the order of the day. We all want to be rich and successful and for that we struggle very hard. Beware, for this can take a toll on your health and consequently increase stress.

Your personality: can also determine how stress prone you are. If you are constantly worried about what will happen and what could happen, there will be no end to your stress. Another factor that adds to your stress is your belief systems. These affect your personality directly.
Beliefs are what you have acquired from your family and society and these affect your characteristics, behaviour and thoughts. The way you perceive stress, your lifestyle, your working style, relationship with your family, perception of others, attitude towards others and priorities all depend on your personality. Whether the stressors are environmental or social will depend upon the personality they effect.

Stress and Tension Can Batter the Brain

Imagine yourself running from a hungry tiger. Your blood pounds and adrenaline flows as you flee.

Now imagine yourself stuck in a traffic jam for two hours on a hot summer day. Once again, your blood pounds and the adrenaline flows. Even more infuriating, a woman in a sport-utility vehicle, distracted by her cell phone, has cut you off from the exit ramp.

Which would you prefer, the lady or the tiger? Both situations cause similar reactions in the body, but you may be better off with the tiger, says Bruce McEwen, endocrinologist at Rockefeller University in New York.

The reason? Running from a tiger inspires a very short stress response, the kind the body is designed to handle. But long-term, chronic stress might damage your brain.

“The wear and tear of daily life, the different kinds of everyday stress, it all has an impact,'' says McEwen, echoing an argument he made in a review article earlier this year in the New England Journal of Medicine.

Stressful events, whether physical or psychological, set off an avalanche of chemical reactions in the body. As soon as a person perceives that something stressful is happening, the brain tells nerves to release adrenaline and related chemicals, sending quick energy to the muscles.

More important, a small part of the brain, the hypothalamus, sends a signal to the pituitary gland to start shipping a hormone called corticotrophin into the bloodstream. In turn, corticotrophin tells your adrenal glands, located atop the kidneys, to release more stress hormones, called glucocorticoids.

Glucocorticoids act like the Jekyll and Hyde of stress biology, McEwen says. These stress hormones tell the body to dump sugar into the bloodstream, providing quick energy for a sprint away from danger. During an emergency, glucocorticoids also suspend bodily processes not needed for immediate survival.

Stress hormones seem to particularly electrify a part of the brain called the hippocampus, which sits in right and left halves just above the hypothalamus. Researchers have determined that it plays a large role in forming memories.

This makes sense, because if you survive a stressful encounter, you'll want to remember it in order to avoid it next time, says Robert Sapolsky of Stanford University, author of a stress guidebook titled Why Zebras Don't Get Ulcers. Therefore, memory sharpens during a shocking moment -- one explanation for why people can still recall where they were when they learned of President Kennedy's assassination.

Once glucocorticoids have flooded the bloodstream, the hippocampus starts signaling the hypothalamus to stop making stress hormones, completing a feedback loop that keeps the body from burning itself out.

Repeated stress

The dark side of the helpful stress hormones emerges when someone repeatedly experiences stress, McEwen says. In those situations, glucocorticoids pound the brain like storm waves battering the shore. Over time, the beneficial effects of stress hormones are reversed: Memory worsens, energy levels droop and other health problems emerge.

For the past two decades, Sapolsky, McEwen and other researchers have shed light on how this brain battery occurs. Even a few days' exposure to high levels of stress hormones can weaken hippocampal brain cells, or neurons, leaving them more likely to die if their oxygen supply is interrupted, which happens during a stroke or heart attack.

And weeks of exposure to high levels of glucocorticoids can wither the fragile connections between neurons in that part of the brain.

Studies of rats placed under stress indicate that hippocampal brain cells die after years of elevated stress levels. But if the high levels of stress stop, the shriveled connections between neurons grow back. And the hippocampus retains a unique ability to grow replacement brain cells.

''The adult brain is more versatile than we ever imagined,'' McEwen says.

Very cautiously, researchers such as J. Douglas Bremner of Yale University School of Medicine have raised the idea that ''recovered memories'' experienced by some survivors of sexual abuse may result from this regrowth, liberating memories locked away in isolated brain cells.

Brain shrinkage

Bremner and his colleagues have led a pioneering effort to gather pictures of the effects of stress on the brain. He describes his research team's findings in a recent article in the journal Biological Psychiatry.

In their earliest study in 1993, the researchers examined the memorizing abilities of 26 Vietnam combat veterans suffering post-traumatic stress disorder (PTSD), a psychological ailment characterized by flashbacks, amnesia and psychic distress. Events threatening to your life, or the life of someone close to you, can trigger the disorder, according to the American Psychiatric Association in Washington, D.C.

''Traumatic stress is bad for the brain,'' Bremner says.

He and his colleagues discovered that the PTSD-afflicted veterans suffered deficits in recalling words and paragraphs on tests, compared with healthy individuals with similar backgrounds and intelligence. A follow-up 1995 study published in the American Journal of Psychiatry used magnetic resonance imaging (MRI) to look at the combat veterans' brains. The traumatized individuals averaged 8% smaller hippocampi on the right side of their brains.

Childhood sexual abuse also can set off the same type of brain damage. In a 1997 study, Bremner's group compared 18 male and female PTSD-afflicted victims of sexual abuse with 17 healthy peers. Again, they found shortfalls in recalling words among the traumatic stress patients -- deficits that increased with the severity of abuse.

An MRI study of the survivors revealed an average 12% reduction in hippocampal size on the left side of the brains, compared with healthy study participants.

Bremner suspects that people's ages at the time they suffer severe trauma influences which side of the brain is damaged. ''It's a developmental effect,'' he says.

Not every neuroscientist accepts the premise that traumatic stress shrinks the brain. Tamara Gurvits of the VA Medical Center in Manchester, N.H., also found smaller hippocampal size in a 1996 Biological Psy- chiatry study of PTSD-afflicted combat veterans. She keeps open the possibility that smaller hippocampal size may leave some people more susceptible to the ailment.

The 'common cold'

However, depression, a condition not commonly associated with traumatic stress, also appears to cause brain damage. Known as the ''common cold'' of mental illness, depression afflicts almost 10 million adults nationwide every year, according to the American Psychiatry Association. One in four women and one in 10 men can expect to develop this ailment, which causes stress-filled feelings of sadness and hopelessness, during their lifetime.

Bremner says MRIs of patients with depression, to be published in the American Journal of Psychiatry, found large reductions in hippocampal size, an average 19% shrinkage compared with healthy people.

McEwen goes beyond other researchers in describing the brain-damaging effects of everyday stress. He and some others suggest that stress over a lifetime wears out the hippocampus and hinders its ability to tell the hypothalamus to stop calling for more stress hormones. As a result, more glucocorticoids flood the bloodstream, causing additional degradation of the hippocampus and wrecking the stress mechanism. Thus, people who experience more stress may have brains more aged than their relaxed peers.

''In a broad sense, life experience may affect longevity,'' McEwen says. For evidence, he points to research conducted at McGill University in Montreal, where scientists followed a group of elderly women over four years. They found that women whose stress hormone levels increased over time suffered from hippocampi 14% smaller than their peers who were not as stressed.

McEwen speculates that kind of loss may dispose people to mild cognitive impairment, a condition of severely reduced memory found in the elderly that substantially raises the risk of developing Alzheimer's disease. People suffering this disorder typically suffer from a shrunken hippocampus, at least 10% smaller on average, similar to the reductions seen in victims of traumatic stress and depression.

Some researchers don't believe that everyday traffic jams and office politics can cause the types of brain damage seen in studies of the hippocampus. But even if normal stress doesn't cause brain damage, traumatic stress and depression still affect a significant number of people, Bremner says. ''There's enough traumatic stress to go around.''

In surveys conducted by the Centers for Disease Control and Prevention, for example, more than one in five women reported suffering some form of sexual abuse.

''We're just beginning to understand the individual things that stress can do to the brain,'' McEwen says.

He hopes researchers may someday capitalize on the ability of the hippocampus to grow new neurons to reverse stress-related brain damage. ''Very long, severe periods of stress may permanently damage the brain, but it's not a sure thing,'' he says.

And use of the epilepsy drug Dilantin appears to block stress-related brain cell death in the hippocampi of lab animals, according to a 1997 study led by McEwen and published in the Annals of the New York Academy of Science. Pharmaceutical researchers have increasingly honed their ability to deliver drugs to the brain, raising the possibility of anti-stress drugs. ''Someday, we might take something related to an antidepressant for aging,'' McEwen says.

Thought patterns hurt hearts

Cardiologists have long wondered why people with heart disease seem particularly vulnerable to stress. One researcher, basing his theory on pictures of brains in action, suggests these people think differently than healthy people, putting them at special risk.

''We use all the different parts of the brain to handle stress,'' says Robert Soufer of the VA Positron Imaging Center in West Haven, Conn., who led a study that peered into the brains of people with heart disease while they endured mental stress testing. His research team subjected 10 male heart patients and six healthy men to a series of math questions while a positron emission tomography device took pictures of their brains.

During testing, the men were asked to steadily subtract seven from a starting number. The questioners urged the men to speed up their responses until they made a mistake, then ''errors were corrected in a harsh tone, thereby providing an element of harassment,'' says the report published in the Proceedings of the National Academy of Sciences.

''Heart disease patients, compared to normal patients, use less of the right side of their brain,'' Soufer says.

The 10 heart patients displayed hyperactivity in left-side parts of the brain associated with mental calculation, according to the study. Three of them suffered decreased delivery of oxygen-rich blood to the heart during the testing, a condition called mental ischemia. Blood flow decreased to portions of the brain associated with pain perception.

''There's no warning system to these people of heart damage,'' Soufer says. ''It's diabolical.''

Between 3 million and 4 million Americans suffer these ''silent'' ischemic episodes, according to the American Heart Association.

From previous research, Soufer suspects that behavior, particularly a tendency toward anger and hostility, predisposes some people to mental ischemia.

''Certain people confront stress immediately,'' he says, which might trigger silent heart damage.