Living with Anxiety Disorders

Living with anxiety can be very difficult for Christians, especially as we are called to "rejoice" in all things.

If you or your spouse is living with an anxiety disorder, it can be a challenge, but it doesn't mean life isn't worth living.

According to Mayo Clinic, anxiety disorders can appear at any time of life, but often will appear fairly early. Was your spouse anxious from an early age? It may have been an undiagnosed anxiety disorder. These disorders are often especially challenging because they are often found hand-in-hand with other disorders like depression.

Some of the symptoms include:

• constant worry over small or large concerns
  
  
• feeling keyed up or on edge



• difficulty concentrating



• muscular tension or aches



• trouble sleeping



• fatigue



• trying too hard to fit in



• perfectionistic tendencies



• need for reassurance and approval

The symptoms don't have to be there all the time. But they will be there much of the time, and they will pop up again in times of change or stress.

Anxiety disorders are also related to:

• depression



• drug addiction



• alcohol addiction



• teeth grinding

This means anxiety could cause these, or lead to these, or make them worse if they're already there. Note: if your spouse is already addicted to drugs or alcohol, quitting will probably make them more anxious. Talk to a doctor.

If your spouse starts showing these symptoms, it is often better to get treatment early. If you wait to symptoms are too severe, it will be harder to treat.

Other than the obvious answers (therapy and medication), how can you help a spouse who suffers from anxiety disorder?

• tell them to relax. Just kidding.




• keep a balanced diet




• go with them to get daily exercise. Exercise reduces anxiety.




• make sure they get enough sleep.




• look into relaxation techniques and coach your spouse in them. A panicking person can't do relaxation.




• Buy them Vitamin B and folic acid supplements.




• When they get anxious, have them do a hobby or distract them.




• Keep them social. Get out of the house!

You should also be familiar with the symptoms of a panic attack, so you can realize when one happens before it gets too bad. While generalized anxiety disorder is a long-term illness characterized by feeling overly worried and anxious, an actual panic attack is shorter (usually 10-30 minutes) and much more intense. Your partner will need more support during these times. Here's what a panic attack looks like:

• feeling of losing control



• feeling of going crazy



• feeling of overwhelming panic



• trouble breathing



• feeling like you're going to pass out



• hyperventilating



• shaking



• stomach cramps



• nausea



• feeling detached or unreal

If you suffer from anxiety, here are some things you should try to do:

• focus on what positive things you are working toward, not what terrible things you are running from.



• keep a list of 3 good things that happen every day... even if you have to stretch.



• do things that make you feel good, even if you don't feel like it.



• do nice things for others without expecting anything back. Giving kindness makes you happier, too!

Living with anxiety can be hard... but it's not impossible. With a loving, supportive partner and hard work, living with anxiety can be done.

Understanding Abuse Survivors

If your partner has been abused, either as a child or an adult, it will affect your relationship. If you were not the partner who was abused, it will be difficult--maybe even impossible--for you to completely understand your partner's trauma, but research can help. Read the memories of one victim of abuse, Courtney:

My psyche and boundaries were very damaged and I did not realize that because of my upbringing and appearance I attracted sexual predators.

Sometimes I worry when I tell my husband or counselors about the many, many instances of small and large sexual abuses that people will assume I'm exaggerating what happened to me. How could one woman be the recipient of so much negative sexual attention? Well, perhaps I'm not crazy, maybe I don't imagine it (something I sometimes used to fear), maybe it's not my fault. Maybe, like Courtney, I attract a certain type of man.

When I was an adult, I was sexually assaulted in Greece. When I got out of the room, thanks to the intervention of God, I changed clothes immediately and called my mother. When I told her what happened, including that for a moment he let me go and changed out of his clothes, she said with a sigh and utter disappointment, "Oh, [my name], why didn't you run?"

I love my mother, but that right there solidifies everything we abuse survivors secretly fear might be true about ourselves: that we did something wrong, that we should have run when we had the chance, or dressed differently, or screamed, or not trusted the man to be alone with us, or not willingly gone into the hotel room, or that we did something to deserve this, at least partly. It's the most damaging thing our loved ones can say or do to us.

It made me feel better to read what Courtney said when she was in my situation:

Why I did not run out of the room I am not sure. Part of me felt immobilized.

In every survivor there is a child living in the adult. The child is hurt. The adult is trying to protect her, and often this means hiding her. We react with hostility when others try to get access to our inner child. Says the Soul Self Help:

It's the child in us who was hurt. It is the adult who remembers.

Because we try to protect that inner child and keep her from contact with the outside world, even people we love and trust, our boundaries can be blurred. That same article goes on to say:

The more often our boundaries have been violated in childhood, the greater difficulty we have differentiating ourselves from others and the more likely we'll become victims of continued sexual abuses. Blurred family boundaries in our...families cause us to feel stressed and confused when we try to identify our own limits and goals in relationships. Plagued with an identify a solid sense of ourselves, we doubt our own rights in relationships. We feel unsure. That uncertainty and lack of self often leaves us even more vulnerable to sexual, physical and emotional attack from others.

If your partner was abused, it's possible he or she has a difficult time understanding boundaries. She may worry too much about what other people think, or be unable to form her own opinion of herself without help from loved ones, acquaintances, or even strangers. Her self-esteem may fluctuate wildly because it depends on outside approval, not inner strength. On the other hand, she may have too strict of boundaries and be too rigid or unflexible with other people. Abuse survivors can become control freaks and perfectionists. They may prefer relationships with unhealthy levels of control or even abuse, and they may seek out codependent relationships.

A very major issue for survivors is that of boundaries. When one is so completely violated at a young age, at any age, for that matter, one is less aware if at all aware of one's right to individuation. One's sense of self and others is usually very blurred.

Do any of the following from Self Help Magazine sound like your partner?

I hate sex. It feels like invasion of myself and my body by someone else. Life would be great if no one ever expected me to be sexual again. --Tina, raped by her father as a child.

"My penis and my heart feel disconnected. I use sex as a way to blot out pain when I'm feeling down. Masturbation is a lot easier than having sex with my wife. She wants a lot of kissing and hugging and I'm uncomfortable with all that closeness. --Jack, molested by a neighbor as a young teen.

Victims of past sexual trauma will often show these symptoms:
•avoiding or being afraid of sex
•approaching sex as an obligation
•experiencing negative feelings such as anger, disgust, or guilt with touch
•having difficulty becoming aroused or feeling sensation
•feeling emotionally distant or not present during sex
•experiencing intrusive or disturbing sexual thoughts and images
•engaging in compulsive or inappropriate sexual behaviors
•experiencing difficulty establishing or maintaining an intimate relationship
•experiencing vaginal pain or orgasmic difficulties
•experiencing erectile or ejaculatory difficulties

Symptoms may not all be present, or they may come and go. They may go away for a while and then reappear.

The sex-ed section of the website Fascinations
has a good article that describes abuse:

When stuck inside the world of a trauma survivor, it can seem like nothing one can do will make any difference. It’s not going to be easy. There will be messiness, crying, and uncomfortable feelings, but those are all important steps in the process of healing. They just generally don’t feel good.

People who have been sexually assaulted may find that their minds and bodies don’t connect.

Marriage Teaching
goes on to say:

Most women who've been abused have trouble trusting their husbands. Basically, a man abused them, and so they don't trust any man. As part of the renewing of your mind, realize that your husband isn't the one who abused you. Therefore, you can trust him.

A very powerful Christian website that offers help and healing for Christian women (and men) who've been abused offers articles like Cure for Self Hate and The Dilemma of Feeling Pleasure When Abused.

Whether you or your partner was the one who was abused, I would highly recommend checking them out. Sexual abuse can cause pain that will last for years and years; even if it isn't always there, it can come back.

If there is healing to be found, it will be found in Christ. Good luck on the journey!

Of course, this is easier said than done, but with counseling and self help and research on the subject, perhaps you can eventually heal.

Coping Mechanisms for Victims of Abuse

If you or your partner has suffered from physical, emotional, or sexual abuse as a child, teen, or adult, you can bet that past trauma will affect your relationship now. Both children and adults have coping mechanisms to deal with stress. Some are positive coping mechanisms, such as exercise, meditation, or talking about conflict. Others are negative coping mechanisms, like drugs, alcohol, depression, or self-harm.

What are some of the symptoms of past abuse? These are also the coping mechanisms the victim has learned to rely on to deal with the stress. They may be (and often are!) unhealthy for that person and/or for the people around that person, but they are the only way the victim knows how to cope with the huge amounts of stress caused by abuse, and so the victim keeps doing it. Sometimes they may even become an abuser themselves.

Here are some of the coping mechanisms commonly used by abuse victims. See if any sound like you or your partner.

• Mental illnesses. Past victims of abuse may learn to direct all that negative energy inward (depression, anxiety, panic, self-harm) or outward (violent temper, bi-polar, borderline personality disorder). They may also simply separate themselves from reality (social anxiety disorders, schizophrenia, psychosis).
• Addictions. Abuse victims may turn to outside sources to deal with negative feelings and anxiety. The most obvious ones are drug and alcohol abuse, but they may also develop more "socially acceptable" addictions, such as addictions to relationships, shopping, food, smoking, workaholics, gambling, etc. When victims start relying on one of these to alleviate their stress, it is often a coping mechanism.
• Exaggerated Fight/Flight Response. It's a normal reaction to stress to have a burst of adrenaline that tells your body either to flee or fight. However, abuse victims develop an overactive fight/flight response. They are so prepared for something traumatic to happen that they overreact to everyday stressors or conflict. If your partner consistently overreacts to stress (yelling, screaming, fighting, loss of temper) or underreacts (becoming motionless, having panic attacks, abandoning a conversation at the first sign of conflict), their body is telling them that a small problem is really a Very Big Problem.
• Distorted Reactions to the World. Abuse victims often learn to cope with abuse by reacting against the abuse. Perhaps they will become distrustful and suspicious, paranoid, or afraid of being alone. Perhaps they fear any conflict or sense abandonment when there is none present. They may worry too much about what other's think of them or obsess over small details. These are all ways victims have developed to try to keep themselves safe from more abuse.
• Denial. Pretending the abuse didn't happen or was not serious, or denying their own strong negative feelings (like anger, rage, neediness, insecurity, or jealousy). The victim does not know how to deal with such strong negative emotions in a productive way because that was never modeled, and they simply try to pretend they don't occur.
• Splitting. This is a tendency to "polarize" others. They cannot be both good and bad at the same time, so a person is seen as either 100% good or 100% bad, depending on how the person acts and how the victim feels about the person.
• Passive-Aggression. Some victims get very aggressive, but others learn to show resentment and anger without appearing to show it. For instance, sulking, refusing to do something, or doing things to anger your partner but pretending you didn't know are all examples of this.
• Impulsiveness. Some victims become very impulsive, making spur-of-the-moment decisions without thought for the future. This can lead to promiscuity or dangerous decision making.
• Avoidance. If the victim can't deal with a problem or conflict, they will just ignore or avoid it. They may physically leave or avoid going home to see their parents for months, or they may pretend nothing is wrong to "cover up" the conflict.
• Rationalizing. This occurs when the victim intellectualizes or rationalizes the abuse. It wasn't so bad, or it only occurred because (insert reason here) occurred.
• Minimizing. The victim attempts to make the abuse seem less serious than it was, either through words or actions (such as smiling when talking about abuse).
• Control. Coming from an environment where the victim felt so completely out of control, the victim will often engage in a lifelong struggle to control everything! They hope this will make them safer. They want to control their environment (no surprises!) and the people around them and their own emotions. They want everything to be structured, controlled, and manageable. Strong emotions, either positive or negative, can be frightening to abuse victims.
• Low Self-Esteem. This one may seem obvious, but if someone else thought you were so worthless that they could abuse you for their own benefit, of course you might feel worthless as well. Many victims suffer from low self-esteem and worry a lot about what other people think of them, taking it very personally if one person dislikes them.
• Compliance. Some victims try to avoid conflict or being abandoned by giving in to everyone around them. These people are people pleasers to the extreme! They give in to their loved ones just so they will feel happy and not abuse or abandon the victim.
• Forgetting. Some abuse victims will temporarily forget the abuse even happened. When they remember, that can be very traumatic.
• Super-alertness. This symptom means the abuse victim is on high alert, all the time, waiting for something bad to happen! Their stress "fight or flight" syndrome is always going, ready for something bad to happen. This added stress can make them prone to being sick and tired from a lowered immune system.
• Busyness. Some victims keep themselves constantly busy so they don't have to deal with negative feelings. They lose themselves in their work or hobbies. This is also similar to workaholics, people who become addicted to their work.
• Manipulation. This is related to control. Abuse victims will sometimes attempt to manipulate or control those around them. They are trying to keep themselves "safe" by controlling the actions of those close to them.
• Lying. Some abuse victims become compulsive liars, especially if they were required to lie about the abuse during their childhood.
• Isolation from others. While some victims do to the other extreme, bouncing from relationship to relationship, others keep themselves "safe" by remaining isolated. They don't get very close to anyone and they may prefer to be alone where they know they can't be hurt.
• Nightmares or Lack of Sleep: Some people become so good at controlling their negative emotions when they are awake that they suffer from them coming out at night.
• Spacing Out. Some victims will actually have an "out of body" experience where they disconnect from their bodies during abuse (or perceived danger of abuse). They may feel like they're floating above their body, even watching the abuse happen to another person.
• Self-harm: People who attempt to self-harm may not be trying to hurt themselves, but just find a physical release for pent-up emotional baggage. This self-destructive behavior is, of course, not healthy, but some victims will feel so numb or negative that physical pain gives them release.
• Suicide. Suicide attempts are the final "coping mechanism" when all others fail and the victim sees no hope.

Of course, there are other coping mechanisms that victims can use to channel these negative emotions in a more positive way. For instance, meditation, calm breathing exercises, relaxation exercises, exercise, support groups, counseling, talking through problems, positive religion, and others can all be good ways victims can learn to handle their past abuse in a constructive and self-helping way.

Resouces:

http://www.wisegeek.com/what-are-coping-mechanisms.htm
http://www.power2u.org/articles/trauma/ment_cope.html
http://www.aaets.org/article184.htm
http://www.mentalhelp.net/poc/view_doc.php?id=9791&cn=353
http://www.csom.org/train/victim/2/material/Sect%202%20Handout%20-%20Coping%20Mechanisms.pdf
http://www.theawarenesscenter.org/CommonCoping.pdf
http://www.alcohol-addiction-info.com/Coping_Mechanisms_of_Codependents_of_Alcohol_Addiction.html

What Depression Feels Like

If you have a spouse or loved one who is depressed, please don't make the mistake of telling them to "snap out of it" or "pray harder." You wouldn't tell someone with cancer to snap out of it and pray harder, would you? The Christian stigma that depression is only imagined, or is the cause of some unforgiven sin, has kept many Christians from seeking treatment.

What happens when severe depression is left untreated and unchecked? Suicide.

In fact, many studies show depression has genetic and environmental causes (see one example here.) Depression is as real as cancer, and in many ways just as terrifying and life-changing.

Someone who has been depressed can tell you unequivocably that depression IS real. However, unless you've suffered from this mental illness yourself, you cannot really understand.

How does depression feel?

• You feel achy, like you have a cold all the time. Your joints ache, your muscles ache, your head aches, your eyes ache. You have chronic back, muscle, and joint pain, and may need constant massages from a loved one. You ache and feel under the weather.
• You feel tense, worried, and despairing. You can't imagine why you ever thought you were a good person or your life would work out well. You are a failure and there is nothing to do about it. You are overpowered completely by feelings of unworthiness and despair. Any attempts to cheer yourself up are quickly crushed by some outside force that seems to weight eight billion tons.
• You don't enjoy anything. Activities you used to enjoy, like sex, singing, music, golf, and exercise, now make you feel bored and depressed. You don't have the energy to do them.
• You have no energy. You feel listless and lifeless. You don't have the energy to get out of bed more often than it takes to use the restroom. You make yourself eat small amounts and shower occasionally, but overall you don't really care about those, either. Hygiene is a chore and you prefer to stay in bed. Even when you slept well, you feel tired and like you have no energy.
• You suffer from sleep problems. You may have nightmares that are so vivid you begin to wake up even more stressed and exhausted than when you went to sleep; this may eventually make you terrified of falling asleep and you may dread sleeping. You could sleep too little, tossing and turning and staring at the ceiling, or you might sleep too much, delving into a heavy sleep for long over 8 hours but still waking up tired and groggy.
• Everyone is an enemy. Other people are annoying and irritating. You wish they'd go away and leave you alone, because your patience is thin. At best, you tolerate them and ignore them; at worst, you can see they are ruining your life and making you unhappy and you attack and berate them.
• You want to weep at the smallest thing.
• Your life is hopeless and no one else understands why or even sees this.
• God has abandoned you, you have fallen out of His favor, and you don't even have the energy or desire to pray about it, anyway. The solace you once received from Him now seems empty and pointless.
• You are not hungry, although you feel weak and tired. Food holds little appeal for you, and when you eat it doesn't even taste that good. You may feel nauseated by the thought of food. You probably only eat what tiny amounts you need to keep going.
• Comfort from others will not console you, because their voice is like a tiny, insignificant point against the millions of heavy, dark points you know to be true.
• You are terrified but you cannot protect yourself from whatever danger is near. Your body is on full alert, which is exhausting for you. Your heart thumps, your blood rushes, you feel terrified and anxious. SOMETHING bad is about to happen, and you are helpless and powerless and alone.
• You have no energy to go to work or even to get out of bed.
• You want to lie in the dark, and avoid light, which hurts your eyes and annoys you.
• When lying down, you can feel a solid weight pushing on your chest. Although you see that nothing is there, you can feel it, and it is heavier than you are, preventing you from moving or getting up. You have no choice but to lie there with this external weight.
• You find yourself thinking darkly about murder, blood, and suicide. The only thing that calms your mind and gives you a reprieve from the darkness is to picture hurting yourself, seeing your blood run, or hurting someone else. You darkly wonder who would even care if you drove away and never came back, or how long it would take someone to notice if you died today. You figure it would serve them all right, anyway.

Imagine feeling like that, but worse, and you can understand how a depressed person may feel. They do not need your advice, your pity, or your anger, but only your patience and understanding. Do not try to lift them out of depression, but listen and suggest a doctor.

For more tips on what to say to someone who is depressed, see here.

Depression and Suicide Linked

The recent death of writer Sylvia Plath's son has prompted many news agencies to write about the growing evidence of a genetic cause for depression.

Several studies have shown that suicide rates (and therefore presumably depression) are higher among identical twins than fraternal ones. Suicide has been proven to be about 30-50% genetic. Additionally, the close family members of suicide victims are more likely to commit suicide. Parents, siblings, and children are at special risk. Some studies suggest the families of suicide victims are two times more likely to commit suicide than the rest of the population.

It's a sobering thought.

What causes suicide? Obviously, there are many factors. But studies suggest anywhere from 60 to 90% of those who commit suicide are affected by depression. In fact, depression is the most common factor to lead someone to kill themselves.

Studies have shown the brains of depressed suicide victims have fewer neurological receptors for the chemical GABA in their cerebral cortex. This affects decision making and thought processes.

The lack of GABA receptors in the brain is caused by the presence of methylation, a molecule that attaches to a gene and basically "hides" it from cells that would normally sense it and produce GABA receptors for it. The end result? The cells do not produce GABA receptors, and GABA cannot be filtered into the brain system as it should.

Even more striking is that this cause is not necessarily genetic. While the methylation does seem connected to depression and suicide, it is caused not be genetics but by environmental factors--factors such as childhood abuse, according to one study. Factors in childhood basically "program" the brain... and in this case, the lack of protein means the lack of synapses ("bridges" in the brain for neurons). When neurons cannot travel, gradually a person becomes starved of brain chemicals important for feeling happy and content, because these chemicals cannot travel as well with fewer bridges than in a healthy brain.

These environmental factors that basically seem to program the brain to be predisposed to depression and eventual suicide seem to happen prior to birth and in early childhood. Babies born with low birth weight and height were more likely to commit suicide as adults, as were children with abusive histories.

Of course, being at risk of suicide does not mean a family member will commit it. It simply means these people are in need of extra care and support. And, as always, if you feel like committing suicide, talk to a friend or call 1 800 SUICIDE.

http://www.sciam.com/podcast/episode.cfm?id=sylvia-plaths-son-and-suicide-in-fa-09-03-24
http://www.sciam.com/article.cfm?id=the-origins-of-suicidal-brains

Dealing with Antidepressants in a Relationship

Depression (also known as "depressive disorder") is one of the fastest-growing mental disorders in the United States. According to a CBS survey, almost 18.8 million Americans suffer from major depression (this does not include those who suffer from minor or occasional depression, so the numbers are even higher!). There are 190 million prescriptions given out each year for the treatment of this mental disorder. And while the causes of depression are still not known, the staggering numbers alone attest that for millions of Americans, having a partner on antidepressants is a fact of life.

First, depression is a mental disorder. It can be hereditary, due to past abuse, caused by a severe event, or a mixture of all three. Also, people diagnosed with one mental disorder are more likely to suffer from others (multiple diagnoses). Other mental and psychiological disorders that often accompany depression are panic disorder, anxiety disorders, manic-depression, and PTSD. For these people's partners, lots of patience and a vigilant, watchful eye for additional symptoms are necessary.

On the other hand, depression can not be self-diagnosed. I've heard of many people who have self-diagnosed (or been diagnosed by family or friends) and "decided" they are depressed. The truth is, no one but a medical doctor can tell you that. Many of the symptoms of depression are exactly the same as the symptoms of thyroid trouble, low blood sugar, severe mental disorders, past sexual, physical, or emotional abuse, or drug and alcohol abuse. In addition, many people use it as an excuse for their behavior ("I'm too depressed to go to work") or as a way to get attention. If your spouse won't go get checked by a doctor, there is no reason to think he is actually depressed. A doctor or phychiatrist is needed to determine the causes of all symptoms.

In fact, I'll go so far as to add that all the people I've know who are clinically, medically-verifiably depressed, did not realize they were depressed until a doctor examined them. A truly depressed person has no concept of "normal" and thus does not realize she is "depressed." And in all the cases I've seen where people without a medical diagnosis were touting depression as the source of all their troubles, they were generally seeking attention or making excuses for their own terrible behaviors.

But if your spouse is one of the 18.8 million Americans suffering from real depressive disorder, antidepressants are going to have an effect on your relationship. What can you expect from a partner on antidepressants?

First, antidepressants chemically alter the brain to rectify an imbalance of chemicals. Often they keep healthy chemicals that cause happiness from being sucked back up by the brain too soon. But any medication that chemically alters the brain can be dangerous, and you need to watch for side effects.

One common side effect, especially in children and young adults up to 25, is an increase of suicidal thoughts. Young people on medication need to check in with a doctor regularly, and you need to watch your child or spouse carefully to monitor for suicidal thoughts. You also need to be prepared and know how you will react if they should actually attempt suicide.

Of course, side effects depend upon the particular medicine given. But many antidepressants have some things in common.

Many cannot be mixed with other medicines, even over-the-counter herbs and pills. Be very careful with tylenol and ibuprophen, and read the back of the box. Cold, allergy, and sinus pills are often very dangerous when mixed with these pills; I once nearly passed out from inadvertently mixing these two. I would never recommend this! Alcohol, sleeping pills, and other sedatives are also very dangerous for people already on antidepressants, as the chemicals in the pills will change the body's natural reaction and will often compound the effect of the sleeping pills or alcohol.

Another quite terrible effect of some antidepressants is a blurring between reality and dreams. These pills can actually cause people to have nightmares, and more terrible and vivid nightmares than ever before. Others will just increase the vividity of all dreams. For nightmares, this is often terrifying, but even for normal dreams it can be confusing. The dreamer may wake up confused, thinking she was already awake, or she may have a hard time remembering which conversations she had in a dream and which she actually had. She may have to ask you, "Did we talk about this...No?...I must have had another dream..."

This may also take extra patience on your part, as often the vividity of the dreams can cause very real emotions that stay with the dreamer all day. And so, day after day, you may wake up, through no fault of your own, to find your spouse mad at you for something you did in a dream. Just be patience and understanding; no matter how hard your spouse tries to convince herself that it was just a dream, the accompanying emotins are completely out of her control. I know I once spent months angry at a boyfriend, no matter how hard I tried to surpress the feeling, because I had such terrible dreams about him nightly. When he got frustrated or angry at me for this, it just made things worse.

If your partner is suffering from vivid dreams or nightmares, be patient! Remember that he cannot remember if you said something for real or in his sleep. Be aware that he may still feel genuinely hurt and angry at you, even after you've calmly explained something was only a dream. And I know when I have those terrible nightmares, the awful feeling of dread does not go away when I wake up. I will sometimes wake up my partner, needing to be comforted and held, but if he just rolls over and goes back to sleep, it just makes me feel more hurt and abandoned than before. Try to remember that this isn't any more fun for your partner, either, and it is neither of your faults, but just something you have to work through together.

Many antidepressants cause weight gain. This, of course, affects self esteem, self image, and sex life (for both partners). Others can cause weight loss.

Antidepressants are sedatives, and can dramatically increase the effect of feeling sleepy. This is why sedatives and alcohol should never be mixed with the pills. Also, especially at the very beginning, expect your partner to feel tired and drowsy waaaay beyond the normal proportions! She may drift to sleep during work or while driving a car, so be very careful until you know how it affects her. Or he may fall dead asleep in the middle of the afternoon, right in the middle of your sentence! I once struggled through 8 hours of work, drowsy and almost incoherent, and then fell promptly asleep on my boyfriend's bed as he was talking to me, lights fully on and in the middle of the evening!

Antidepressants are intended to change the chemistry of the brain (for the better!), but sometimes this can have unintended affects. You may notice slight personality changes; these are annoying but normal. But if you notice a big change, your loved one needs to see a doctor. Small changes that are to be expected when taking a new medication are changes in mood, moodiness, irritability, or sudden mood fluctuations. Sometimes appetite changes will occur. Other times, they will become more emotional (sudden flares of temper, crying more often, more likely to scream or yell). Sometimes pills cause them to be less emotional all around, so while they are indeed less anxious and depressed, they are also less happy and excited. This is normal at the beginning and will usually go away as their body adjusts.

Antidepressants also change libido. They can decrease libido and sexual desire in both men and women. In men, it can cause erectile dysfunction. Or, sometimes, the pills will not affect the desire, but will affect the ability to orgasm. On the other hand, if your partner was truly depressed, there probably wasn't much interest in sex anyway, so the pills may not change anything or may actually increase their interest in sex as they slowly get happier!

There can also be physical side effects as your lover's body adjusts to a new drug. They may get sick to their stomach (having them eat the pills with a meal will help). Any new medicine can cause digestive troubles, such as constipation or diahrrea, until their body adjusts.

Generally, all side effects are mild and decrease as you get used to the pill. So just be patient and wait, and they will probably go away! Of course, if the effects are too intense or get worse, you should see a doctor! It takes the average person 3 different types of antidepressants before they can find the right one for their body. I know I went through 5 different medicines and about 8 different possible medicine changes, and am still not on a medicine my doctor is entirely happy with.

Also, it takes antidepressants about 4-6 weeks to really start working. This can be really difficult for someone who is sad and depressed, maybe even not wanting to be alive, and be told you have to wait 4 whole weeks to start feeling better. And since most of us have to be put on several different pills, and at several different dosages, to find the right brand and amount, it often takes months or years to find the correct balance. It took about 7 months for my doctor to finally put me on the correct pill and dosage, and even now he wants to change it again because it doesn't seem to working 100%.

Finally, we need to discuss getting off antidepressants. Because your body is relying on these pills to help it maintain a healthy chemical balance, you should never take yourself off the pills suddenly. Even missing a dosage can affect me and make me an emotional wreck. I took myself off pills once, and survived, but I wouldn't recommend it. You can send yourself into a terrible withdrawl, or often send your body spiraling back down into an even deeper depression than before. If you need to get off a medication, let your doctor know so he can give you the correct dosage and monitor you for problems as you taper off. And if your partner is stopping medication, you should be very vigilant to watch for mood changes, problems, or signs of returning depression/suicidal tendencies.

Most antidepressants have also not been studied as to their effects on pregnant women and fetuses. Therefore, you are usually never advised to take them when pregnant. For those of you at wanting to start a family, talk to you doctor. He can help you find the right pills for you during pregnancy, or help you get off them before you conceive. And if your partner is childbearing age and sexually active, you should be very, very careful about antidepressants. Even if you are using birth control, pregnancy is a possibility. Should you accidentally get pregnant, you run the risk of doing damage to the baby before you realize you're pregnant, or worse, forcing your wife to quit cold turkey for the sake of the baby. Needless to say, this is highly dangerous for your wife, and could send her into withdrawl and a more acute depression than before. This is not what you want for a pregnant mother or baby!

So what should you do if you are in a relationship with one of the millions of people suffering from depression? First, be patient and understanding. Second, arm yourself with information. Research it. The more you know about the disease, the medicine, and the side effects, the more help you will be and the more prepared you will be for problems. And last, watch, watch, watch! Mental illness is such a debilitating disease because it has the unique effect of blinding the victim from seeing that something has gone wrong. You can help your loved one by staying up-to-date on current research, knowing what to look for, and watching her carefully. Good luck!

In the Shadow of the Past: When a Loved One Has Been Abused

"Victims by chance...

survivors by choice!"

If your partner was one of the many men or women today who suffered abuse as a child or adolescent, I can tell you now that your relationship is going to be harder and more difficult. I can also assure you that it can be worth it.

Contrary to popular belief, children who were abused do not outgrow their victim mentalities. They sometimes turn in to abusers themselves, or more often seek out friends and spouses who are abusers, hence remaining in a perpetual "victim" state. Without outside help, they often fall into a trap of drugs, alcoholism, prostitution, promiscuity, and addiction. Those of us who manage to choose a healthier lifestyle will still be drawn toward these unhealthy behaviors, and our lives are a daily battle against our pasts. To understand what we are going through on a daily basis, you need to better understand abuse and how it follows its victims into their adult lives.

First, there are many types of abuse; you've probably heard of most of them. Sexual, physical, and emotional are the most common. There can also be financial and social abuse. Many times, abused children are not just the victims of one, but of a combination of several; abusive parents don't just stick to one form of abuse. And contrary to popular belief, how often the abuse happened or how bad it was do not matter: someone who was touched inappropriately a few times by a cousin can be just as psychologically damaged in adulthood as someone who was raped nightly by her father for 10 years.

People who were abused show several symptoms of this in adulthood. Often, we blocked out the abuse as children, and so it is as adults that we begin the slow, painful process of healing. If your partner was abused, the good news is, you can help with the healing!

Symptoms that someone may have suffered abuse in the past include:

• depression,
• anxiety and panic,
• difficulty establishing or maintaining intimate relationships,
• sexual difficulties,
• addictions or compulsions,
• eating disorders,
• self harm or other emotional issues,
• feelings of emptiness,
• a lack of reality,
• extreme mood fluctuations,
• difficulty managing anger,
• promiscuity,
• inability to say no,
• low self-esteem or self-worth,
• PTSD (post traumatic stress disorder),
• nightmares,
• chronic, unexplained pains (back, muscle, head, etc. often ache for no reason),
• intense fear of rejection,
• too passive or too aggressive,
• cannot tolerate conflict,
• explosive temper,
• afraid to feel anger,
• jumpy at slight touches or unexpected noises,
• intense fear of making others angry or disappointed,
• intense fear of abandonment,
• dysthymia (chronic, low-level depression),
• anxious or worried with no specific cause,
• supicious and untrusting of other people; paranoid,
• intense feelings of guilt or self-blame,
• believe they deserve to be abused or unhappy,
• difficult time relating sex to intimacy,
• sexual dysfunction,
• extremes in sexual behavior: promiscusous/ intense sexual desire, or complete lack of interest in sex/inability to be aroused or difficulty achieving orgasm,
• panic attacks,
• insomnia/sleep problems,
• drug, alcohol, or other addiction problems,
• weight gain,
• thoughts of suicide,
• fear losing control in relationships,
• pain during sex,
• confusion, detachment, or other problems that occur during sex,
• eating disorder,
• irritability,
• inability to commit to a relationship,
• relationship and marital problems.

If these signs sound like your loved one, they may have been abused. Be aware that different personalities will handle abuse differently. My brother and I experienced the exact same abuse, but we handle it differently as adults: I tend to be clingy, terrified of rejection, and very passive and afraid of conflicts. It's hard for me to feel loving and emotional during sexual activity. I suffer from panic attacks and chronic anxiety. My brother, on the other hand, has developed a terrible temper. He is defensive, angry, and aggressive. If you make him mad, watch out! Interestingly, we both suffer from depression and chronic stress-related pains, but we handle them differently. The point is, there is no right way to react to abuse.

From the list above, you may feel overwhelmed and wonder, "What could make a relationship with all those bad things worth it?" But to understand why abused people do this, you should understand what happened to them to make them react this way. Some common traits of physical, sexual, and emotional abuse during childhood are:

• Using Emotional Abuse - calling victim names, degrading, humiliating victim, putting victim down, ridiculing, treating him like a servant, bossing her around, finding fault in everything, being hypercritical, making victim feel they're crazy, silent treatment, laughing at victim, ignoring victim, withholding affection as punishment, manipulation, being controling, making victim doubt his own abilities and sanity, holding grudges, using guilt
• Using Physical Abuse: hitting, pushing, tackling, restraining, pulling hair, biting, slapping, twisting arm, throwing victim, hitting with objects, throwing things at victim, choking, scratching, dragging, standing too close (not allowing personal space), using physical intimidation, smashing things, making threatening guestures, cutting, knifing, shooting, threatening to kill or injure victim
• Using Sexual Abuse: unwanted sexual discussion or innuendos, being viewed naked, forcing victim to view abuser naked, showering or bathing together, touching inappropriately, raping, fondling, harrassing for sexual contact, sleeping naked in bed with victim, any contact with breasts, buttocks, or genitals.

Not only do many abusers exhibit these symptoms, but they blame the victim, deny it happened, or shift guilt on the victim's actions ("I wouldn't hit you if you weren't so mouthy."). Given these terrible things, it's no wonder these children grow up to have psychological and emotional problems, unhealthy sex drives, and confused ideas of love and relationships!

The fact is, the traits that seem unhealthy to you now, were one healthy habits your partner picked up to deal with being abused. That's right, they were being healthy! When in an incredibly traumatizing situation with a parent or other adult, a child will naturally shift to make the best of the situation: a sexually abused child will try to feel loved and aroused during abuse, an emotionally abused person will shut down emotionally or learn to throw temper tantrums to protect herself, and a physically abused person may learn to have an incredibly high tolerance to pain without ever crying or showing distress.

A counselor once told me that it is natural for abused children to block out memories they will only later remember as adults, as a way to deal with the abuse. They will also sometimes find sexual pleasure and love from being abused, because that is the only way their poor, victimized bodies can cope with such an awful situation. People who were abused will often completely shut down during conflict (my mother calls this my "Ice Queen" phase)-- adults who do this are reacting instincitvely to danger, because they learned at a young age that being vulnerable, crying, and begging would not help. Given this, it is no wonder these people grow into adults who have difficulty being vulnerable and open!

Some may fantasize about re-creating the abuse, and they may crave it in their lifestyles. Some may only be turned on by someone who pretends to be abusive or mean. Others may not be able to get aroused at all, or will lose arousal suddenly during making love. As I said, there is no wrong way to deal with abuse.

If you notice your partner phasing into one of the symptoms listed above, it may just be a natural reaction; most abused people will show these symptoms from time to time. Or, it may be something you're doing that causes it: pressuring him to have sex, bullying him, or yelling and getting angry. If you trigger memories of the abuse, the victim will naturally react. The best thing to do in this case is to stop what you're doing and comfort your partner. Those of you in relationships with an abuse victim should be very, very cautious of her feelings and reactions during a fight or while making love, or any other scene liable to provoke unpleasant memories. Of course, if the abuser was a parent, you should also expect strange mood swings and regression to victimized behaviors when your spouse visits or talks to that parent!

So your partner was abused, and picked up a host of habits that, at the time, were necessary and healthy to deal with the situation. But now, a grown man or woman and ready to move on from the past, he is finding it hard to let go of those habitual actions or feelings of guilt and anxiety. This is natural, and often it just takes time, counseling, and lots and lots of love and support from you to heal.

The sad truth is, those of us who were abused will never be "fully healed." We will always fight the desire to be an abuser or a victim, to suffer from anxiety and mental disorders, and to compensate by falling into addiction and dependence. The more we heal, the less we will be drawn to these behaviors, but they will always haunt us. That is why abused children, once grown into adults, are always "living in the shadow of the past." That is why they are often the strongest people you will meet. That is why many of them grow into counselors or volunteers who find healing in turning back to help those victims who come behind to climb up into the light of healthy, fulfilling lives--even when it means delving into deep, painful wounds themselves.

It may be hard, but it is possible to live a normal, healthy life. It may be difficult, but it is possible to choose to stay in the sunshine...even for those of us living in the shadow of the past.

For more information on this subject, see my resources:

"Abuse Symptoms and Counseling."

"Consequences of Sexual Abuse."

"Dancing in the Shadows."

"Deleterious Effects of Child Abuse, The."

"Effects of Child Abuse on Adults."

"Victims by Chance, Survivors by Choice."