Stress self-medication

Alcohol is one of the most commonly consumed drugs in the world and has been used by humans since the Stone Age. It is anxiolytic for this reason, it has been used not only for relaxation purposes but also by people with anxiety disorders to suppress their symptoms. Between 10% and 20% of agoraphobic patients are alcohol dependent. Thyrer et al. [1986] reported a 36% prevalence of alcoholism among socially phobic patients entering an anxiety disorders clinic, and [according to population studies] 20%-80% of people with posttraumatic stress disorder [PTSD] are dependent on alcohol. Sierles et al. [1983], in their study of Vietnam War veterans with PTSD, found that 64% were alcohol dependent. Since the Epidemiological Catchment Area study estimated the lifetime prevalence of PTSD to be 1% in the United States population, it is clear that self-medication with alcohol for anxiety symptoms will have a major influence on the development of alcohol dependency [Regier et al. 1990]. 

It must be stressed that self-medication or uncontrolled trial of zinc therapy are not advocated. The side effects of excess zinc dosage are not acute, at least at the levels proposed. Adverse metabolic effects include the induction of a secondary copper deficiency (Fischer et al., 1984). An impairment of laboratory indices of the immune response has been noted at a dosage of 300 mg Zn per day, over a 6-week period (Chandra, 1984). 

Nicotine has been shown to attenuate chronic stress-induced impairment of short-term memory [1], and LTP [2, 245], and facilitation of long-term depression (LTD) [96, 249] in area CAl of the hippocampus in adult anesthetized rats. Thus, the increase in tobacco smoking rate during stress may be a self-medication to counteract the harmful effect of stress on memory [250, 251]. 

If caused by maternal TSH-R Ab [stim], the disease is usually self-limited and subsides over a period of 4-12 weeks, coinciding with the fall in the infant s TSH-R Ab [stim] level. However, treatment is necessary because of the severe metabolic stress the infant experiences. Therapy includes propylthiouracil in a dose of 5-10 mg/kg/d in divided doses at 8-hour intervals Lugol s solution (8 mg of iodide per drop), 1 drop every 8 hours and propranolol, 2 mg/kg/d in divided doses. Careful supportive therapy is essential. If the infant is very ill, oral prednisone, 2 mg/kg/d in divided doses, will help block conversion of T4 to T3. These medications are gradually reduced as the clinical picture improves and can be discontinued by... 

Residents also report negative effects of sleep loss on their physical health. In one study of house officers in Scotland (71), both the number of hours worked and the number of hours slept while on call were associated with the number of somatic symptoms they reported experiencing over the previous year. In a recent resident survey study (72), sleep loss was associated with self-reported increased stress, accidents, and injuries, and alcohol and stimulant use sleep loss was correlated with stress and illness and injury levels, and with reported significant weight change and alcohol and medication use in a dose-dependent fashion. 

The duration of treatment is often a controversial issue. Anxiety disorders (apart from the self-limiting acute stress reaction) are chronic conditions and may require treatment for as long as that used in depression. In a first episode, patients may need medication for at least 6 months, withdrawing over a further 4-8 weeks if they are well. Those with recurrent illness may need treatment for 1-2 years to enable them to learn and put into place psychological approaches to their problems. In many cases the illnesses are lifelong and chronic maintenance... 

Two medications that have recently become more popular for the treatment of posttraumatic stress disorder (PTSD) and the symptoms of anxiety as well as panic and other conditions are Catapres (clonidine) and Tenex (guanfacine) (Dulcan, 1999). These medications were first used to treat high blood pressure but now have been explored as a potential treatment for a variety of disorders. Generally both of these medicines can help decrease symptoms of hyperactivity, impulsivity, anxiety, irritability, temper tantrums, explosive anger, conduct problems, and tics (Dulcan, 1999). When used with adults, there appears to be support that these medications can help improve self-control as well as increase cooperation with treatment regimens. 

Major depression (also called unipolar depression) is the most serious type of depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once-pleasurable activities and may reoccur several times during a lifetime (5). Many people with major depression cannot continue to function normally. Major depression seems to run in families, suggesting that depressive illnesses can be inherited. Early signs (prodromal symptoms) of major depression include changes in brain function in those individuals having low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress. The treatments for major depression are medication, psychotherapy, and in extreme cases, electroconvulsive therapy. 

Bartnick et u/. (1985) found that medical students with lower self-assurance than average were more likely to pursue specialities with low patient contact such as pathology or pharmacology. Firth-Cozens (1999) found that characteristics such as high self-criticism in medical students were highly predictive of stress and depression in doctors 10 years later, and proposed that speciality choice may be involved in this pathway. 

---