our common problem has a name: atypical depression - the key symptom of which is hypersensitivity to rejection; social anxiety would be being afraid to start a conversation; I am more than sociable and love speaking with people - but if in the conversation I receive the slightest negative remark, that one little thing can screw my whole day (actually it happened on Christmas day). I opened up a thread in the supplements section on coping with aversive stimuli - it discusses some of the issues. I am not aware of good supplements for this - but am experimenting with Lysine, Rhodiola, Gotu Kola (hopefully Nicholas is right), Tryptophan, and soon with Resveratrol (for his anti-interleukin 6 activity).
A good cognitive technique for this is disputation: If x says that you are y, try to remember if you can find in your memory people who have said that you are the non-y (or other kinds of evidence that would contradict or at least qualify x). However, this technique helps only at a shallow intellectual level. The problem is much more visceral than this, I'm afraid.
I am also a bit sceptical about CBT, but there is a wealth of literature to support it, while very, very few studies show any improvement in anxiety disorders or depression in Lysine, Rhodiola, or Gotu Kola (im not saying they don't work, im just saying there is no literature to support their use in mental disorders)...
And resveratrol, until some formulation comes out to increase bioavailibility, than it definitely will do nothing, although the interleukin-6 thing is interesting. To my knowledge, inhibiting interleukin-6 is a end result of biological treatment for diseases such as rheumatoid arthritis and inflammatory bowel disease, so i will look into that.
Tryptophan has been found to be, somewhat effective in mild depression.
Here are a couple studies on therapy in general:
TI Cognitive therapy vs medications in the treatment of moderate to severe depression. AU DeRubeis RJ; Hollon SD; Amsterdam JD; Shelton RC; Young PR; Salomon RM; O'Reardon JP; Lovett ML; Gladis MM; Brown LL; Gallop R SO Arch Gen Psychiatry 2005 Apr;62(4):409-16. BACKGROUND: There is substantial evidence that antidepressant medications treat moderate to severe depression effectively, but there is less data on cognitive therapy's effects in this population. OBJECTIVE: To compare the efficacy in moderate to severe depression of antidepressant medications with cognitive therapy in a placebo-controlled trial. DESIGN: Random assignment to one of the following: 16 weeks of medications (n = 120), 16 weeks of cognitive therapy (n = 60), or 8 weeks of pill placebo (n = 60). SETTING: Research clinics at the University of Pennsylvania, Philadelphia, and Vanderbilt University, Nashville, Tenn. PATIENTS: Two hundred forty outpatients, aged 18 to 70 years, with moderate to severe major depressive disorder. INTERVENTIONS: Some study subjects received paroxetine, up to 50 mg daily, augmented by lithium carbonate or desipramine hydrochloride if necessary; others received individual cognitive therapy. MAIN OUTCOME MEASURE: The Hamilton Depression Rating Scale provided continuous severity scores and allowed for designations of response and remission. RESULTS: At 8 weeks, response rates in medications (50%) and cognitive therapy (43%) groups were both superior to the placebo (25%) group. Analyses based on continuous scores at 8 weeks indicated an advantage for each of the active treatments over placebo, each with a medium effect size. The advantage was significant for medication relative to placebo, and at the level of a nonsignificant trend for cognitive therapy relative to placebo. At 16 weeks, response rates were 58% in each of the active conditions; remission rates were 46% for medication, 40% for cognitive therapy. Follow-up tests of a site x treatment interaction indicated a significant difference only at Vanderbilt University, where medications were superior to cognitive therapy. Site differences in patient characteristics and in the relative experience levels of the cognitive therapists each appear to have contributed to this interaction. CONCLUSION: Cognitive therapy can be as effective as medications for the initial treatment of moderate to severe major depression, but this degree of effectiveness may depend on a high level of therapist experience or expertise. AD Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA. derubeis@psych.upenn.edu PMID 15809408
TI A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. AU Lam DH; Watkins ER; Hayward P; Bright J; Wright K; Kerr N; Parr-Davis G; Sham P SO Arch Gen Psychiatry 2003 Feb;60(2):145-52. BACKGROUND: Despite the use of mood stabilizers, a significant proportion of patients with bipolar affective disorder experience frequent relapses. A pilot study of cognitive therapy (CT) specifically designed to prevent relapses for bipolar affective disorder showed encouraging results when used in conjunction with mood stabilizers. This article reports the outcome of a randomized controlled study of CT to help prevent relapses and promote social functioning. METHODS: We randomized 103 patients with bipolar 1 disorder according to the DSM-IV, who experienced frequent relapses despite the prescription of commonly used mood stabilizers, into a CT group or control group. Both the control and CT groups received mood stabilizers and regular psychiatric follow-up. In addition, the CT group received an average of 14 sessions of CT during the first 6 months and 2 booster sessions in the second 6 months. RESULTS: During the 12-month period, the CT group had significantly fewer bipolar episodes, days in a bipolar episode, and number of admissions for this type of episode. The CT group also had significantly higher social functioning. During these 12 months, the CT group showed less mood symptoms on the monthly mood questionnaires. Furthermore, there was significantly less fluctuation in manic symptoms in the CT group. The CT group also coped better with manic prodromes at 12 months. CONCLUSION: Our findings support the conclusion that CT specifically designed for relapse prevention in bipolar affective disorder is a useful tool in conjunction with mood stabilizers. AD Department of Psychology, Institute of Psychiatry, London, England. spjtdhl@iop.kcl.ac.uk PMID 12578431
TI A pilot study of cognitive therapy in bipolar disorders. AU Scott J; Garland A; Moorhead S SO Psychol Med 2001 Apr;31(3):459-67. BACKGROUND: The efficacy and effectiveness of cognitive therapy (CT) is well established for unipolar disorders, but little is known about its utility in bipolar disorders. This study aimed to explore the feasibility and efficacy of using CT as an adjunct to usual psychiatric treatment in this patient population. METHOD: Subjects referred by general adult psychiatrists were assessed by and independent rater and then randomly allocated to immediate CT (N = 21) or 6-month waiting-list control, which was then followed by CT (N = 21). Observer and self-ratings of symptoms and functioning were undertaken immediately prior to CT, after a 6-month course of CT and a further 6-months later. Data on relapse and hospitalization rates in the 18 months before and after commencing CT were also collected. RESULTS: At 6-month follow-up, subjects allocated to CT showed statistically significantly greater improvements in symptoms and functioning as measured on the Beck Depression Inventory, the Internal State Scale, and the Global Assessment of Functioning than those in the waiting-list control group. In the 29 patients who eventually received CT, relapse rates in the 1 8 months after commencing CT showed a 60 % reduction in comparison with the 18 months prior to commencing CT. Seventy per cent of subjects who commenced therapy viewed CT as highly acceptable. CONCLUSION: Although the results of this study are encouraging, the use of CT in subjects with bipolar disorders is more complex than in unipolar disorders and requires a high level of therapist expertise. The therapy may prove to be particularly useful in the treatment of bipolar depression. AD Department of Psychological Medicine, University of Glasgow, Gartnavel Royal Hospital. PMID 11305854
TI Psychological therapies for generalised anxiety disorder. AU Hunot V; Churchill R; Silva de Lima M; Teixeira V SO Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001848. BACKGROUND: Generalised anxiety disorder (GAD) is a highly prevalent condition, characterised by excessive worry or anxiety about everyday events and problems. The effectiveness and effectiveness of psychological therapies as a group has not yet been evaluated in the treatment of GAD. OBJECTIVES: To examine the efficacy and acceptability of psychological therapies, categorised as cognitive behavioural therapy (CBT), psychodynamic therapy and supportive therapy, compared with treatment as usual/waiting list (TAU/WL) and compared with one another, for patients with GAD. SEARCH STRATEGY: We searched the Cochrane Depression, Anxiety & Neurosis Group (CCDAN) Controlled Trials Register and conducted supplementary searches of MEDLINE, PsycInfo, EMBASE, LILACS and controlledtrials.com in February 2006. We searched reference lists of retrieved articles, and contacted trial authors and experts in the field for information on ongoing/completed trials. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials conducted in non-inpatient settings, involving adults aged 18-75 years with a primary diagnosis of GAD, assigned to a psychological therapy condition compared with TAU/WL or another psychological therapy. DATA COLLECTION AND ANALYSIS: Data on patients, interventions and outcomes were extracted by two review authors independently, and the methodological quality of each study was assessed. The primary outcome was anxiety reduction, based on a dichotomous measure of clinical response, using relative risk (RR), and on a continuous measure of symptom reduction, using the standardised mean difference (SMD), with 95% confidence intervals. MAIN RESULTS: Twenty five studies (1305 participants) were included in the review, of which 22 studies (1060 participants) contributed data to meta-analyses. Based on thirteen studies, psychological therapies, all using a CBT approach, were more effective than TAU/WL in achieving clinical response at post-treatment (RR 0.63, 95%CI 0.55 to 0.73), and also in reducing anxiety, worry and depression symptoms. No studies conducted longer-term assessments of CBT against TAU/WL. Six studies compared CBT against supportive therapy (non-directive therapy and attention-placebo conditions). No significant difference in clinical response was indicated between CBT and supportive therapy at post-treatment (RR 0.86, 95%CI 0.70 to 1.06), however significant heterogeneity was indicated, which was partly explained by the number of therapy sessions. AUTHORS' CONCLUSIONS: Psychological therapy based on CBT principles is effective in reducing anxiety symptoms for short-term treatment of GAD. The body of evidence comparing CBT with other psychological therapies is small and heterogeneous, which precludes drawing conclusions about which psychological therapy is more effective. Further studies examining non-CBT models are required to inform health care policy on the most appropriate forms of psychological therapy in treating GAD. AD Institute of Psychiatry, Section of Evidence Based Mental Health, Health Services Research Department, PO Box 32, De Crespigny Park, London, UK, SE5 8AF. v.hunot@iop.kcl.ac.uk PMID 17253466
TI Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up. AU Addis ME; Hatgis C; Cardemil E; Jacob K; Krasnow AD; Mansfield A SO J Consult Clin Psychol. 2006 Apr;74(2):377-85. Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally. AD Department of Psychology, Clark University, Worcester, MA 01610, USA. maddis@clarku.edu PMID 16649882
i would go for the CBT, might as well try the supplements since they have a clean side effect profile... The gentleman above mentioned Nardil,, which is a fantastic, but iffy side effect profile, drug.
Edited by medicineman, 29 December 2008 - 08:40 PM.