Vitamin B1 aka thiamine may improve treatment with tricyclic antidepressants. Thiamine may also help in treating Alzheimer's Disease. Learn about the usage, dosage, side-effects of vitamin B1.

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Vitamin B1, also called thiamine, is one of eight water-soluble B vitamins. All B vitamins help the body to convert carbohydrates into glucose (sugar), which is "burned" to produce energy. These B vitamins, often referred to as B complex vitamins, are essential in the breakdown of fats and protein. B complex vitamins also play an important role in maintaining muscle tone along the wall of the digestive tract and promoting the health of the nervous system, skin, hair, eyes, mouth, and liver.

Similar to some other B complex vitamins, thiamine is considered an "anti-stress vitaimin" because it is believed to enhance the activity of the immune system and improve the body's ability to withstand stressful conditions.

Thiamine is found in both plants and animals and plays a crucial role in certain metabolic reactions, particularly, as mentioned, the conversion of carbohydrates (starches) into energy. For example, thiamine is essential during exercise, when energy expenditure is high.

Thiamine deficiency is rare, but tends to occur in people who get most of their calories from sugar or alcohol. Individuals with thiamine deficiency have difficulty digesting carbohydrates. As a result, a substance called pyruvic acid builds up in the bloodstream, causing a loss of mental alertness, difficulty breathing, and heart damage. In general, thiamine supplements are primarily used to treat this deficiency known as beriberi.

 

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Vitamin B1 Uses

Beriberi
The most important use of thiamine is in the treatment of beriberi, a condition caused by a deficiency of thiamine in the diet. Symptoms include swelling, tingling or burning sensation in the hands and feet, confusion, difficulty breathing (from fluid in the lungs), and uncontrolled eye movements (called nystagmus).

Wernicke-Korsakoff syndrome
Wernicke-Korsakoff syndrome is a brain disorder caused by thiamine deficiency. Replacing thiamine alleviates the symptoms of this syndrome. Wernicke-Korsakoff is actually two disorders in one: (1) Wernicke's disease involves damage to nerves in the central and peripheral nervous systems and is generally caused by malnutrition (particularly a lack of thiamine) associated with habitual alcohol abuse, and (2) Korsakoff syndrome is characterized by memory impairment with various symptoms of nerve damage. High doses of thiamine can improve muscle incoordination and confusion associated with this disease, but only rarely improves the memory loss.

Cataracts
Dietary and supplemental vitamin B2, along with other nutrients, is important for normal vision and prevention of cataracts (damage to the lens of the eye which can lead to cloudy vision). In fact, people with plenty of protein and vitamins A, B1, B2, and B3 (niacin) in their diet are less likely to develop cataracts. Plus, taking additional supplements of vitamins C, E, and B complex (particularly the B1, B2, B9 [folic acid], and B12 [cobalamin] in the complex ) may further protect the lens of your eyes from developing cataracts.

Burns
It is especially important for people who have sustained serious burns to obtain adequate amounts of nutrients in their daily diet. When skin is burned, a substantial percentage of micronutrients may be lost. This increases the risk for infection, slows the healing process, prolongs the hospital stay, and even increases the risk of death. Although it is unclear which micronutrients are most beneficial for people with burns, many studies suggest that a multivitamin including the B complex vitamins may aid in the recovery process.

Heart failure
Thiamine may be related to heart failure in two ways. First, low levels of thiamine may contribute to the development of congestive heart failure (CHF). On the flip side, people with severe heart failure can lose a significant amount of weight including muscle mass (called wasting or cachexia) and become deficient in many nutrients. It is not known whether taking thiamine supplements would have any bearing on the development or progression of CHF and cachexia. Eating a balanced diet, including thiamine, and avoiding things that deplete this nutrient, such as high amounts of sugar and alcohol, seems prudent, particularly for those at the early stages of CHF.

Other - Alzheimer's Disease
Some scientists have speculated that thiamine may have some benefit in treating Alzheimer's Disease. This theory is based on the effects that this nutrient has on the brain and the symptoms that people develop when deficient in thiamine. The studies on this subject to date are limited in number and inconclusive, however. Much more research would be needed before anything could be said regarding a possible use for thiamine in treating Alzheimer's Disease.

 

 

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Vitamin B1 Dietary Forms

Limited quantities of thiamine can be found in most foods, but large amounts of this vitamin can be found in pork and organ meats. Other good dietary sources of thiamine include whole-grain or enriched cereals and rice, wheat germ, bran, brewer's yeast, and blackstrap molasses.

 

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Vitamin B1 Available Forms

Vitamin B1 can be found in multivitamins (including children's chewable and liquid drops), B complex vitamins, or can be sold individually. It is available in a variety of forms including tablets, softgels, and lozenges. It may also be labeled as thiamine hydrochloride or thiamine mononitrate.

 

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How to Take It Vitamin B1

As with all medications and supplements, check with a healthcare provider before giving vitamin B1 supplements to a child.

Daily recommendations for dietary vitamin B1 are listed below.

Pediatric

• Newborns to 6 months: 0.2 mg (adequate intake)
• Infants 7 months to 1 year: 0.3 mg (adequate intake)
• Children 1 to 3 years: 0.5 mg (RDA)
• Children 4 to 8 years: 0.6 mg (RDA)
• Children 9 to 13 years: 0.9 mg (RDA)
• Males 14 to 18 years: 1.2 mg (RDA)
• Females 14 to 18 years: 1 mg (RDA)

Adult

• Males 19 years and older: 1.2 mg (RDA)
• Females 19 years and older: 1.1 mg (RDA)
• Pregnant females: 1.4 mg (RDA)
• Breastfeeding females: 1.5 mg (RDA)

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Doses for conditions like beriberi and Wernicke-Korsakoff syndrome are decided by a healthcare practitioner in an appropriate clinical setting. For Wernicke-Korsakoff syndrome, thiamine is administered by venous injection.

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

Oral vitamin B1 is generally nontoxic. Stomach upset can occur at very high doses (much higher than the recommended daily amount).

Taking any one of the B complex vitamins for a long period of time can result in an imbalance of other important B vitamins. For this reason, it is generally important to take a B complex vitamin with any single B vitamin.

 

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Possible Interactions

If you are currently being treated with any of the following medications, you should not use vitamin B1 without first talking to your healthcare provider.

Antibiotics, Tetracycline
Vitamin B1 should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. Vitamin B1 either alone or in combination with other B vitamins should be taken at different times from tetracycline. (All vitamin B complex supplements act in this way and should therefore be taken at different times from tetracycline.)

Vitamin B1 and Tricyclic Antidepressant Medications
Taking vitamin B1 supplements may improve treatment with tricyclic antidepressants such as nortriptyline, especially in elderly patients. Other medications in this class of antidepressants include desimpramine and imipramine.

Chemotherapy
Although the significance is not entirely clear, laboratory studies suggest that thiamine may inhibit the anti-cancer activity of chemotherapy agents. How this will ultimately prove relevant to people is not known. However, it may be wise for people undergoing chemotherapy for cancer to not take large doses of vitamin B1 supplements.

Digoxin
Laboratory studies suggest that digoxin (a medication used to treat heart conditions) may reduce the ability of heart cells to absorb and use vitamin B1; this may be particularly true when digoxin is combined with furosemide (a loop diuretic).

Diuretics
Diuretics (particularly furosemide, which belongs to a class called loop diuretics) may reduce the levels of vitamin B1 in the body. In addition, similar to digoxin, furosemide may diminish the heart's ability to absorb and utilize vitamin B1, especially when these two medications are combined.

Scopolamine
Vitamin B1 may help reduce some of the side effects associated with scopolamine, a medication commonly used to treat motion sickness.

back to: Supplement-Vitamins Homepage

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Supporting Research

Ambrose, ML, Bowden SC, Whelan G. Thiamin treatment and working memory function of alcohol-dependent people: preliminary findings. Alcohol Clin Exp Res. 2001;25(1):112-116.

Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.

Bell I, Edman J, Morrow F, et al. Brief communication. Vitamin B1, B2, and B6 augmentation of tricyclic antidepressant treatment in geriatric depression with cognitive dysfunction. J Am Coll Nutr. 1992;11:159-163.

Boros LG, Brandes JL, Lee W-N P, et al. Thiamine supplementation to cancer patients: a double-edged sword. Anticancer Res. 1998;18:595 - 602.

Cumming RG, Mitchell P, Smith W. Diet and cataract: the Blue Mountains Eye Study.

Ophthalmology. 2000;107(3):450-456.

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Jacques PF, Chylack LT Jr, Hankinson SE, et al. Long-term nutrient intake and early age-related nuclear lens opacities. Arch Ophthalmol. 2001;119(7):1009-1019.

Kelly GS. Nutritional and botanical interventions to assist with the adaptation to stress. Alt Med Rev. 1999;4(4):249-265.

Kirschmann GJ, Kirschmann JD. Nutrition Almanac. 4th ed. New York: McGraw-Hill;1996:80-83.

Kuzniarz M, Mitchell P, Cumming RG, Flood VM. Use of vitamin supplements and cataract: the Blue Mountains Eye Study. Am J Ophthalmol. 2001;132(1):19-26.

Leslie D, Gheorghiade M. Is there a role for thiamine supplementation in the management of heart failure? Am Heart J. 1996;131:1248 - 1250.

Lindberg MC, Oyler RA. Wernick's encephalopathy. Am Fam Physician. 1990;41:1205 - 1209.

Lubetsky A, Winaver J, Seligmann H, et al. Urinary thiamine excretion in the rat: effects of furosemide, other diuretics, and volume load [see comments]. J Lab Clin Med. 1999;134(3):232-237.

Meador KJ, Nichols ME, Franke P, et al. Evidence for a central cholinergic effect of high-dose thiamine. Ann Neurol. 1993;34:724-726.

Meyer NA, Muller MJ, Herndon DN. Nutrient support of the healing wound. New Horizons. 1994;2(2):202-214.

National Academy of Science. Recommended Daily Allowances. Accessed at http://www.nal.usda.gov/fnic/dga/index.html on January 4, 1999.

Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons; 2000:4-5.

Omray A. Evaluation of pharmacokinetic parameters of tetracycline hydrochloride upon oral administration with vitamin C and vitamin B complex. Hindustan Antibiot Bull. 1981;23(VI):33-37.

Ott BR, Owens NJ. Complementary and alternative medicines for Alzheimer's Disease. J Geriatr Psychiatry Neurol. 1998;11:163-173.

Rieck J, Halkin H, Almog S, et al. Urinary loss of thiamine is increased by low doses of furosemide in healthy volunteers. J Lab Clin Med. 1999;134(3):238-243.

Rodriquez-Martin JL, Qizilbash N, Lopez-Arrieta JM. Thiamine for Alzheimer's Disease (Cochrane Review). Cochrane Database Syst Rev. 2001;2:CD001498.

Witte KK, Clark AL, Cleland JG. Chronic heart failure and micronutrients. J Am Coll Cardiol. 2001;37(7):1765-1774.

Zangen A, Botzer D, Zanger R, Shainberg A. Furosemide and digoxin inhibit thiamine uptake in cardiac cells. Eur J Pharmacol. 1998;361(1):151-155.

back to: Supplement-Vitamins Homepage

I don't have a family of my own. I don't have children and marriage is a remote prospect. Families, to me, are hotbeds of misery, breeding grounds of pain and scenes of violence and hate. I do not wish to create my own.

Even as adolescent, I was looking for another family. Social workers offered to find foster families. I spent my vacations begging Kibbutzim to accept me as an underage member. It pained my parents and my mother expressed her agony the only way she knew how - by abusing me physically and psychologically. I threatened to have her committed. It was not a nice place, our family. But in its thwarted way, it was the only place. It had the warmth of a familiar disease.

My father always said to me that their responsibilities end when I am 18. But they couldn't wait that long and signed me to the army a year earlier, though at my behest. I was 17 and terrified witless. After a while, my father told me not to visit them again - so the army became my second, nay, my only home. When I was hospitalized for a fortnight with kidney disease, my parents came to see me only once, bearing stale chocolates. A person never forgets such slights - they go to the very core of one's identity and self-worth.

I dream about them often, my family whom I haven't seen for five years now. My little brothers and one sister, all huddled around me listening cravingly to my stories of fantasy and black humour. We are all so white and luminescent and innocent. In the background is the music of my childhood, the quaintness of the furniture, my life in sepia colour. I remember every detail in stark relief and I know how different it could all have been. I know how happy we could all have been. I dream about my mother and my father. A great vortex of sadness threatens to suck me in. I wake up suffocating.

I spent the first vacation in jail - voluntarily - locked up in a sizzling barrack writing a children's story. I refused to go "home". Everyone did, though - so, I was the only prisoner in jail. I had it all to myself and I was content in the quite manner of the dead. I was to divorce N. in a few weeks. Suddenly, I felt unshackled, ethereal. I guess that, at the bottom of it all, I do not want to live. They took away from me the will to live. If I allow myself to feel - this is what I overwhelmingly experience - my own non-existence. It is an ominous, nightmarish sensation which I am fighting to avoid even at the cost of forgoing my emotions. I deny myself three times for fear of being crucified. There is in me a deeply repressed seething ocean of melancholy, gloom and self-worthlessness awaiting to engulf me, to lull me into oblivion. My shield is my narcissism. I let the medusas of my soul be petrified by their own reflections in it.

 

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next: The Magic of My Thinking

No woman has ever wanted to have a child with me. It is very telling. Women have children even with incarcerated murderers. I know because I have been to jail with these people. But no woman has ever felt the urge to perpetuate US - the we-ness of she and I.

I was married once and almost married twice but women are very hesitant with me. They definitely do not want anything binding. It is as though they want to maintain all routes of escape clear and available. It is a reversal of the prevailing myth about non-committal males and women huntresses.

But no one wants to hunt a predator.

It is an arduous and eroding task to live with me. I am atrabilious, infinitely pessimistic, bad-tempered, paranoid and sadistic in an absent-minded and indifferent manner. My daily routine is a rigmarole of threats, complaints, hurts, eruptions, moodiness and rage. I rail against slights true and imagined. I alienate people. I humiliate them because this is my only weapon against the humiliation of their indifference to me.

Gradually, wherever I am, my social circle dwindles and then vanishes. Every narcissist is also a schizoid, to some extent. A schizoid is not a misanthrope. He does not necessarily hate people - he simply does not need them. He regards social interactions as a nuisance to be minimized.

I am torn between my need to obtain narcissistic supply (the monopoly on which is held by human beings) - and my fervent wish to be left alone. This wish, in my case, is peppered with contempt and feelings of superiority.

There are fundamental conflicts between dependence and contempt, neediness and devaluation, seeking and avoiding, turning on the charm to attract adulation and being engulfed by wrathful reactions to the most minuscule "provocations". These conflicts lead to rapid cycling between gregariousness and self-imposed ascetic seclusion.

Such an unpredictable but always bilious and festering atmosphere is hardly conducive to love or sex. Gradually, both become extinct. My relationships are hollowed out. Imperceptibly, I switch to asexual co-habitation.

But the vitriolic environment that I create is only one hand of the equation. The other hand is the woman herself.

I am heterosexual, so I am attracted to women. But I am simultaneously repelled, horrified, bewitched and provoked by them. I seek to frustrate and humiliate them. Psychodynamically, I am probably visiting upon them my mother's sin - but I think such an instant explanation does the subject great injustice.

Most narcissists I know - myself included - are misogynists. Their sexual and emotional lives are perturbed and chaotic. They are unable to love in any true sense of the word - nor are they capable of developing any measure of intimacy. Lacking empathy, they are incapable of offering to the partner emotional sustenance.

I have been asked many times if I miss loving, whether I would have liked to love and if I am angry with my parents for crippling me so. There is no way I can answer these questions. I never loved. I do not know what is it that I am missing. Observing it from the outside, love seems to me to be a risible pathology. But I am only guessing.

I am not angry for being unable to love. I equate love with weakness. I hate being weak and I hate and despise weak people (and, by implication, the very old and the very young). I do not tolerate stupidity, disease and dependence - and love seems to encompass all three. These are not sour grapes. I really feel this way.

I am an angry man - but not because I never experienced love and probably never will. No, I am angry because I am not as powerful, awe inspiring and successful as I wish to be and as I deserve to be. Because my daydreams refuse so stubbornly to come true. Because I am my worst enemy. And because, in my unmitigated paranoia, I see adversaries plotting everywhere and feel discriminated against and contemptuously ignored. I am angry because I know that I am sick and that my sickness prevents me from realizing even a small fraction of my potential.

My life is a mess as a direct result of my disorder. I am a vagabond, avoiding my creditors, besieged by hostile media in more than one country, hated by one and all. Granted, my disorder also gave me "Malignant Self Love", the rage to write as I do (I am referring to my political essays), a fascinating life and insights a healthy man is unlikely to attain. But I find myself questioning the trade-off ever more often.

But at other times, I imagine myself healthy and I shudder. I cannot conceive of a life in one place with one set of people, doing the same thing, in the same field with one goal within a decades-old game plan. To me, this is death. I am most terrified of boredom and whenever faced with its haunting prospect, I inject drama into my life, or even danger. This is the only way I feel alive.

I guess all the above portrays a lonely wolf. I am a shaky platform, indeed, on which to base a family, or future plans. I know as much. So, I pour wine to both of us, sit back and watch with awe and with amazement the delicate contours of my female partner. I savor every minute. In my experience, it might well be the last.

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next: Narcissist, the Machine

Does Internet addiction truly exist? Psychologists are debating the topic.

From Rider.edu ©

A heated debate is rising among psychologists. With the explosion of excitement about the internet, some people seem to be a bit too excited. Some people spend way too much time there. Is this yet ANOTHER type of addiction that has invaded the human psyche?

Psychologists are not even sure yet what to call this phenomenon. Some label it an "Internet Addiction Disorder." But many people are addicted to their computers long before the internet enters their lives. Some people are extremely attached to their computer and don't even care about the internet. Perhaps we should call the phenomenon a "Computer Addiction." Also, let's not forget the very powerful, but now seemingly mundane and almost accepted addiction that some people develop to video games. Video games are computers too... very single-minded computers, but computers nevertheless. Or how about telephones? People get addicted to those too, and not just the sex lines. Like computers, telephones are a technologically enhanced form of communication and may fall into the category of "computer mediated communication" (a.k.a., CMC) - as the researchers are dubbing internet activities. In the not too distant future, computer, telephone, and video technology may very well merge into one, perhaps highly addictive, beast.

Perhaps, on a broad level, it makes sense to talk about a "Cyberspace Addiction" - an addiction to virtual realms of experience created through computer engineering. Within this broad category, there may be subtypes with distinct differences. A teenager who plays hooky from school in order to master the next level of Donkey Kong may be a very different person than the middle aged housewife who spends $500 a month in AOL chat rooms - who in turn may be very different from the businessman who can't tear himself away from his finance programs and continuous internet access to stock quotes. Some cyberspace addictions are game and competition oriented, some fulfill more social needs, some simply may be an extension of workaholicism. Then again, these differences may be superficial.

Not many people are waving their fingers and fists in the air about video and work addictions. Not many newspaper articles are written about these topics either. They are passé issues. The fact that the media is turning so much attention to cyberspace and internet addictions may simply reflect the fact that this is a new and hot topic. It may also indicate some anxiety among people who really don't know what the internet is, even though everyone is talking about it. Ignorance tends to breed fear and the need to devalue.

Nevertheless, some people are definitely hurting themselves by their addiction to computers and cyberspace. When people lose their jobs, or flunk out of school, or are divorced by their spouses because they cannot resist devoting all of their time to virtual lands, they are pathologically addicted. These extreme cases are clear cut. But as in all addictions, the problem is where to draw the line between "normal" enthusiasm and "abnormal" preoccupation.

"Addictions" - defined very loosely - can be healthy, unhealthy, or a mixture of both. If you are fascinated by a hobby, feel devoted to it, would like to spend as much time as possible pursuing it - this could be an outlet for learning, creativity, and self-expression. Even in some unhealthy addictions you can find these positive features embedded within (and thus maintaining) the problem. But in truly pathological addictions, the scale has tipped. The bad outweighs the good, resulting in serious disturbances in one's ability to function in the "real" world. Almost anything could be the target of a pathological addiction - drugs, eating, exercising, gambling, sex, spending, working, etc. You name it, someone out there is obsessed with it. Looking at it from a clinical perspective, these pathological addictions usually have their origin early in a person's life, where they can be traced to significant deprivations and conflicts. They may be an attempt to control depression and anxiety, and may reflect deep insecurities and feelings of inner emptiness.

As yet, there is no official psychological or psychiatric diagnosis of an "Internet" or "Computer" addiction. The most recent (4th) edition of Diagnostic and Statistical Manual of Mental Disorders (aka, DSM-IV) - which sets the standards for classifying types of mental illness - does not include any such category. It remains to be seen whether this type of addiction will someday be included in the manual. As is true of any official diagnosis, an "Internet Addiction Disorder" or any similarly proposed diagnosis must withstand the weight of extensive research. It must meet two basic criteria. Is there a consistent, reliably diagnosed set of symptoms that constitutes this disorder? Does the diagnosis correlate with anything - are there similar elements in the histories, personalities, and future prognosis of people who are so diagnosed. If not, "where's the beef?" It's simply a label with no external validity.

So far, researchers have only been able to focus on that first criteria - trying to define the constellation of symptoms that constitutes a computer or internet addiction. Psychologist Kimberly S. Young at the Center for Internet Addiction Recovery (see the links at the end of this article) classifies people as Internet-dependent if they meet during the past year four or more of the criteria listed below. Of course, she is focusing specifically on internet addiction, and not the broader category of computer addiction:

• Do you feel preoccupied with the Internet or on-line services and think about it while off line?
• Do you feel a need to spend more and more time on line to achieve satisfaction?
• Are you unable to control your on-line use?
• Do you feel restless or irritable when attempting to cut down or stop your on-line use?
• Do you go on line to escape problems or relieve feelings such as helplessness, guilt, anxiety or depression?
• Do you lie to family members or friends to conceal how often and how long you stay online?
• Do you risk the loss of a significant relationship, job, or educational or career opportunity because of your on-line use?
• Do you keep returning even after spending too much money on on-line fees?
• Do you go through withdrawal when off line, such as increased depression, moodiness, or irritability?
• Do you stay on line longer than originally intended?

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In what he intended as a joke, Ivan Goldberg proposed his own set of symptoms for what he called "Pathological Computer Use". Other psychologists are debating other possible symptoms of internet addiction, or symptoms that vary slightly from Young's criteria and Goldberg's parody of such criteria. These symptoms include:

• drastic lifestyle changes in order to spend more time on the net
• general decrease in physical activity
• a disregard for one's health as a result of internet activity
• avoiding important life activities in order to spend time on the net
• sleep deprivation or a change in sleep patterns in order to spend time on the net
• a decrease in socializing, resulting in loss of friends
• neglecting family and friends
• refusing to spend any extended time off the net
• a craving for more time at the computer
• neglecting job and personal obligations

On a listserv devoted to the cyberpsychology, Lynne Roberts (robertsl@psychology.curtin.edu.au) described some of the possible physiological correlates of heavy internet usage, although she didn't necessarily equate these reactions with pathological addiction:

• A conditioned response (increased pulse, blood pressure) to the modem connecting
• An "altered state of consciousness" during long periods of dyad/small group interaction (total focus and concentration on the screen, similar to a mediation/trance state).
• Dreams that appeared in scrolling text (the equivalent of MOOing).
• Extreme irritability when interrupted by people/things in "real life" while immersed in c-space.

In my own article on "addictions" to the Palace, a graphical MOO/chat environment, I cited the criteria that psychologists often use in defining ANY type of addiction. It's clear that the attempts to define computer and internet addiction draw on these patterns that are perhaps common to addictions of all types - patterns that perhaps point to deeper, universal causes of addiction:

• Are you neglecting important things in your life because of this behavior?
• Is this behavior disrupting your relationships with important people in your life?
• Do important people in your life get annoyed or disappointed with you about this behavior?
• Do you get defensive or irritable when people criticize this behavior?
• Do you ever feel guilty or anxious about what you are doing?
• Have you ever found yourself being secretive about or trying to "cover up" this behavior?
• Have you ever tried to cut down, but were unable to?
• If you were honest with yourself, do you feel there is another hidden need that drives this behavior?

If you're getting a bit confused or overwhelmed by all these criteria, that's understandable. This is precisely the dilemma faced by psychologists in the painstaking process of defining and validating a new diagnostic category. On the lighter side, consider some of the more humorous attempts to define internet addiction. Below is one list from The World Headquarters of Netaholics Anonymous. Although this is intended as humor, note the striking similarity of some of the items to the serious diagnostic criteria... There is a kernel of truth even in a joke:

Top 10 Signs You're Addicted to the Net

1. You wake up at 3 a.m. to go to the bathroom and stop and check your e-mail on the way back to bed.
2. You get a tattoo that reads "This body best viewed with Netscape Navigator 1.1 or higher."
3. You name your children Eudora, Mozilla and Dotcom.
4. You turn off your modem and get this awful empty feeling, like you just pulled the plug on a loved one.
5. You spend half of the plane trip with your laptop on your lap...and your child in the overhead compartment.
6. You decide to stay in college for an additional year or two, just for the free Internet access.
7. You laugh at people with 2400-baud modems.
8. You start using smileys in your snail mail.
9. The last mate you picked up was a JPEG.
10. Your hard drive crashes. You haven't logged in for two hours. You start to twitch. You pick up the phone and manually dial your ISP's access number. You try to hum to communicate with the modem.

You succeed.

There's also the intriguing epistemological dilemma concerning the researchers who study cyberspace addictions. Are they addicted too? If they indeed are a bit preoccupied with their computers, does this make them less capable of being objective, and therefore less accurate in their conclusions? Or does their involvement give them valuable insights, as in participant observation research? There's no simple answer to these questions.

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next: Cybersex and Infidelity Online: Implications for Evaluation and Treatment
~ all center for online addiction articles
~ all articles on addictions

I always think of myself as a machine. I say to myself things like "you have an amazing brain" or "you are not functioning today, your efficiency is low". I measure things, I constantly compare performance. I am acutely aware of time and how it is utilized. There is a meter in my head, it ticks and tocks, a metronome of self-reproach and grandiose assertions. I talk to myself in third person singular. It lends objectivity to what I think, as though it comes from an external source, from someone else. That low is my self-esteem that, to be trusted, I have to disguise myself, to hide myself from myself. It is the pernicious and all-pervasive art of unbeing.

I like to think about myself in terms of automata. There is something so aesthetically compelling in their precision, in their impartiality, in their harmonious embodiment of the abstract. Machines are so powerful and so emotionless, not prone to be hurting weaklings like me. Machines don't bleed. Often I find myself agonizing over the destruction of a laptop in a movie, as its owner is blown to smithereens as well. Machines are my folk and kin. They are my family. They allow me the tranquil luxury of unbeing.

And then there is data. My childhood dream of unlimited access to information has come true and I am the happiest for it. I have been blessed by the Internet. Information was power and not only figuratively.

Information was the dream, reality the nightmare. My knowledge was my flying info-carpet. It took me away from the slums of my childhood, from the atavistic social milieu of my adolescence, from the sweat and stench of the army - and into the perfumed existence of international finance and media exposure.

So, even in the darkness of my deepest valleys, I was not afraid. I carried with me my metal constitution, my robot countenance, my superhuman knowledge, my inner timekeeper, my theory of morality and my very own divinity - myself.

When N. left me, I discovered the hollowness of it all. It was the first time that I experienced my true self consciously. It was a void, annulment, a gaping abyss, almost audible, an hellish iron fist gripping, tearing my chest apart. It was horror. A transubstantiation of my blood and flesh into something primordial and screaming.

It was then that I came to realized that my childhood was difficult. At the time, it seemed to me to be as natural as sunrise and as inevitable as pain.

But in hindsight, it was devoid of emotional expression and abusive to the extreme. I was not sexually abused - but I was physically, verbally and psychologically tormented for 16 years without one minute of respite.

Thus, I grew up to be a narcissist, a paranoid and a schizoid. At least that's what I wanted to believe. Narcissists have alloplastic defences - they tend to blame others for their troubles. In this case, psychological theory itself was on my side. The message was clear: people who are abused in their formative years (0-6) tend to adapt by developing personality disorders, amongst them the narcissistic personality disorder. I was absolved, an unmitigated relief.

I want to tell you how much I am afraid of pain. To me, it is a pebble in Indra's Net - lift it and the whole net revives. My pains do not come isolated - they live in families of anguish, in tribes of hurt, whole races of agony. I cannot experience them insulated from their kin. They rush to drown me through the demolished floodgates of my childhood. These floodgates, my inner dams - this is my narcissism, there to contain the ominous onslaught of stale emotions, repressed rage, a child's injuries.

Pathological narcissism is useful - this is why it is so resilient and resistant to change. When it is "invented" by the tormented individual - it enhances his functionality and makes life bearable for him. Because it is so successful, it attains religious dimensions - it become rigid, doctrinaire, automatic and ritualistic. In other words, it becomes a PATTERN of behavior.

I am a narcissist and I can feel this rigidity as though it were an outer shell. It constrains me. It limits me. It is often prohibitive and inhibitive. I am afraid to do certain things. I am injured or humiliated when forced to engage in certain activities. I react with rage when the mental edifice supporting my disorder is subjected to scrutiny and criticism - no matter how benign.

Narcissism is ridiculous. I am pompous, grandiose, repulsive and contradictory. There is a serious mismatch between who I really am and what I really achieved - and how I feel myself to be. It is not that I THINK that I am far superior to other humans intellectually. Thought implies volition - and willpower is not involved here. My superiority is ingrained in me, it is a part of my every mental cell, an all-pervasive sensation, an instinct and a drive. I feel that I am entitled to special treatment and outstanding consideration because I am such a unique specimen. I know this to be true - the same way you know that you are surrounded by air. It is an integral part of my identity. More integral to me than my body.

This opens a gap - rather, an abyss - between me and other humans. Because I consider myself so special, I have no way of knowing how it is to be THEM.

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In other words, I cannot empathize. Can you empathize with an ant? Empathy implies identity or equality, both abhorrent to me. And being so inferior, people are reduced to cartoonish, two-dimensional representations of functions. They become instrumental or useful or functional or entertaining - rather than loving or interacting emotionally. It leads to ruthlessness and exploitativeness. I am not a bad person - actually, I am a good person. I have helped people - many people - all my life. So, I am not evil. What I am is indifferent. I couldn't care less. I help people because it is a way to secure attention, gratitude, adulation and admiration. And because it is the fastest and surest way to get rid of them and their incessant nagging.

I realize these unpleasant truths cognitively - but there is no corresponding emotional reaction (emotional correlate) to this realization.

There is no resonance. It is like reading a boring users' manual pertaining to a computer you do not even own. It is like watching a movie about yourself. There is no insight, no assimilation of these truths. When I write this now, I feel like writing the script of a mildly interesting docudrama.

It is not I.

Still, to further insulate myself from the improbable possibility of confronting these facts - the gulf between reality and grandiose fantasy (the Grandiosity Gap, in my writings) - I came up with the most elaborate mental structure, replete with mechanisms, levers, switches and flickering alarm lights. My narcissism does two things for me - it always did:

• • Isolate me from the pain of facing reality
  • Allow me to inhabit the fantasyland of ideal perfection and brilliance.
  • These once-vital function are bundled in what is known to psychologists as my "False Self".

 

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next: Looking for a Family

female sexual problems

Many of our sexual problems and hang-ups that aren't caused physically (for example, through illness or injury) come from social conditioning - interaction with our peers as they talk about their sexual exploits, and exposure to sexual myths and fantasies in the media.

With better education, our expectations about many things in our lives - including sex - increase. Our partner expects more from us, we expect more from our partner; we see and read about sexual role models on billboards, television, movie screens and in magazines and popular novels.

We talk and hear more about sex - we know things about our friends and the famous, that we would never have contemplated hearing about even 20 years ago. This exposure to information is not necessarily a bad thing. It demonstrates that our society is feeling more relaxed about sex as a natural and enjoyable part of life. But having this information becomes a problem if we feel we can't compete with the sexual 'standards' that now abound.

There have been many changes over the last two decades in the way men and women relate to each other: women, quite rightly, expect more from men, women are encouraged to be more 'up-front' and men are encouraged to discover the 'feminine' side of their character. Both sexes find themselves conforming to or reacting against these new sets of standards. Gay activism has made it easier for homosexual and bisexual men and women to express their sexuality. The question is raised however - 'where do I fit in?'.

Many causes of sexual problems can be traced back to when we were young. A strict or deeply religious home life can make us feel embarrassed, shy or even afraid of thinking about or exploring sex and our bodies. Some people believe, mistakenly, that it is 'dirty' to derive pleasure from touching and feeling your own body, let alone someone else's. Others, particularly those who have been sexually abused, suppress sexual feelings or think about sex in a non-pleasurable way.

People whose sexual self-esteem is low approach sex with the feeling that they will not be good at it, or will not be able to give, or even experience, sexual pleasure. Many of us think too much during sex, rather than 'going with the flow' and allowing true sexual feelings to take over.

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Sometimes our problems involve unresolved or pent-up anger, suspicions or guilt - are we sleeping with the right person? Are we cheating? Is our partner cheating? Am I good enough? Is he/she good enough?

Sexual problems within a relationship may also have non-sexual causes: worries about finance, children, problems at work - these difficulties need to be worked out before any sexual problems can be dealt with.

Some partners have non-complementary libidos - she 'wants it' all the time, he wants it occasionally - or vice versa. Some partners place unachievable expectations on the other partner - to come quickly and often, to enjoy every position, to 'lie there and take it', to do it at any hour, to do it better. Some people draw inappropriate comparisons between their partner and the sexual prowess of ex-lovers or even fantasy characters depicted in fiction or pornography.

There are some people whose sexual problem is that they think they have no sexual problems. They regard themselves as studs, good in bed; yet often they don't take the time to make sure their partner is enjoying the sexual experience, sex for them is a one-way street.

Nearly everyone experiences some form of sexual problem at some stage, but unresolved sexual problems and hang-ups can compound - one bad sexual encounter can amplify and affect another, until finally we may have fears about every potential sexual encounter and this fear can become a pattern.

Read more about the specific sexual problems women here.

next: Women and Orgasm

Psychotherapy, esp cognitive behavioral therapy, is very effective for treating depression. Relaxation techniques and mindfulness meditation also help.

Mind/body therapies and techniques that may be useful as a part of an overall treatment regimen for depression include:

Psychotherapy for Depression

Cognitive-behavioral therapy is a type of psychotherapy in which individuals learn to identify and change distorted perceptions about themselves and adopt new behaviors to better cope with the world around them. This therapy is frequently considered the treatment of choice for people with mild to moderate depression, but it may not be recommended for those with severe depression. Studies of people with depression indicate that cognitive-behavioral therapy is at least as effective as antidepressants. Compared to those treated with antidepressants, people treated with cognitive-behavioral therapy demonstrated similar, or better, results and lower relapse rates.

Other therapeutic approaches that may be applied by a psychiatrist, psychologist, or social worker include:

• Psychodynamic psychotherapy- based on Freud's theories about unresolved conflicts in childhood and depression as a grief process
• Interpersonal therapy- acknowledges childhood roots of depression, but focuses on current problems contributing to depression; considered very effective treatment for depression
• Supportive psychotherapy- nonjudgmental advice, attention, and sympathy; this approach may improve compliance with taking medication.

Relaxation

One study suggests that relaxation techniques, such as yoga and tai chi, may improve symptoms of depression in people with mild depression.

Meditation

Some researchers theorize that mindfulness meditation may prevent depression from recurring in people who once had the condition.

Learn how some foods can cause depression, whereas other foods, vitamins and supplements can actually enhance your mood and relieve depression symptoms.

by Julia Ross, author of The Diet Cure

Are you an emotional basket case who can't get by without comfort food? If you had more strength, could you power through your problems without overeating? Should you feel ashamed of yourself for needing emotional sustenance from foods? No! I hope to help you understand why you are using food as self-medication. It's not because you are weak willed, it's because you're low in certain brain chemicals. You don't have enough of the brain chemicals that should naturally be making you emotionally strong and complete.

These brain chemicals are thousands of times stronger than street drugs like heroin. And your body has to have them. If not, it sends out a command that is stronger than anyone's willpower: "Find a druglike food or a drug, or some alcohol, to substitute for our missing brain chemicals. We cannot function without them!" Your depression, tension, irritability, anxiety, and cravings are all symptoms of a brain that is deficient in its essential calming, stimulating, and mood-enhancing chemicals.

Why Are Your Natural Mood-Enhancing Chemicals Sometimes Deficient?

Something has interfered with your body's ability to produce its own natural brain drugs. What is it? It's obviously not too unusual, or there wouldn't be so many people using food to feel better, or taking Prozac for depression relief. Actually, there are several common problems that can result in your becoming depleted in your feel-good brain chemicals, and none of them is your fault!

You may have inherited deficiencies. We are learning more all the time about the genes that determine our moods and other personality traits. Some genes program our brains to produce certain amounts of mood-enhancing chemicals. But some of us inherited genes that undersupply some of these vital mood chemicals. That is why some of us are not emotionally well balanced and why the same emotional traits seem to run in families. If your mother always seemed to be on edge, and had a secret stash of chocolate for herself, it should come as no surprise that you, too, need foods like candy or cookies to calm yourself. Parents who have low supplies of naturally stimulating and sedating brain chemicals often produce depressed or anxious children who use food, alcohol, or drugs as substitutes for the brain chemicals they desperately need.

Prolonged stress "uses up" your natural sedatives, stimulants, and pain relievers. This is particularly true if you have inherited marginal amounts to begin with. The emergency stores of precious brain chemicals can get used up if you continually need to use them to calm yourself over and over again. Eventually your brain can't keep up with the demand. That's why you start to "help" your brain by eating foods that have druglike effects on it.

Regular use of druglike foods such as refined sugars and flours, and regular use of alcohol or drugs (including some medicines), can inhibit the production of any of your brain's natural pleasure chemicals. All of these substances can plug into your brain and actually fill up the empty places called receptors, where your natural brain drugs - the neurotransmitters - should be plugging in. Your brain senses that the receptors are already full, so it further reduces the amounts of neurotransmitters that it produces. As the amounts of these natural brain chemicals drop (remember, they can be thousands of times stronger than the hardest street drugs), more and more alcohol, drugs, or druglike foods are needed to fill newly emptied brain slots. This vicious circle ends when these substances you ingest are unable to "fill the bill" any longer. Now your brain's natural mood resources, never fully functional, are now more depleted than they ever were, and you still crave your mood-enhancing drugs - whether it's sugar or alcohol and cocaine.

You may be eating too little protein. In fact, you almost certainly are if you've been dieting or avoiding fatty foods, many of which are high in protein, too. Your brain relies on protein - the only food source of amino acids - to make all of its mood-enhancing chemicals. If you are not getting enough protein, you won't be able to manufacture those crucial chemicals. A little later in this chapter and in chapter 18, you'll learn about complete and incomplete proteins, and what is "enough" protein for you. Simply put, eating the equivalent of three eggs, a chicken breast, or a fish or tofu steak at every meal might get you enough protein to keep your brain in repair.

The Physical Cause of Emotional Eating

In the late 1970s, I was the supervisor of a large San Francisco alcoholism treatment program. Our clients were very serious about getting sober, and we gave them the most intensive treatment available anywhere. Yet they could not stop drinking. Eighty to ninety percent relapse rates were standard then, and still are, in the alcohol and drug addiction fields.

As I studied these heartbreaking relapses, I began to see a pattern. Our clients had stopped drinking, but they had quickly developed a heavy addiction to sweets. Sugar is almost identical to alcohol biochemically. Both are highly refined, simple carbohydrates that are instantly absorbed, not needing digestion (complex carbs, like whole grains, need time to be digested). Both sugar and alcohol instantly skyrocket blood sugar levels and temporarily raise levels of at least two potent mood chemicals in the brain. This high would be followed by a low, of course. So, just as when they were using alcohol, our clients who had switched to eating large amounts of sugar were moody, unstable, and full of cravings. Since alcohol usually works even faster than sugar does, at some point, caught in a particularly low mood, they would break down and have a drink to get some relief. One drink would become a full-blown relapse.

In 1980, when I became the director of the program, I began hiring nutritionists to help solve this disturbing relapse problem. They suggested to our clients that they quit eating sweetened foods, foods made from refined (white) flour, and caffeine, and that they eat more whole grains and vegetables. Unfortunately, these nutritional efforts didn't pay off. For reasons that we understood only later, our clients just couldn't stop eating the sweets and starches that eventually led them back to alcohol. For six years we struggled for a solution, then, in 1986, we found one.

The solution came from Dr. Joan Mathews Larson, the director of a nutritionally oriented alcoholism-treatment center in Minneapolis, Minnesota. This brilliant pioneer, the author of Seven Weeks to Sobriety, introduced me to a technique that was quickly eliminating her alcoholic clients' cravings and raising her center's long-term success rate from 20 percent to 80 percent! The technique involved the use of specific amino acids that could rapidly feed the addicted brain exactly the type of protein that it needed to naturally fill up its empty mood-chemical sites. The results were spectacular. No longer did alcoholic clients need sweets or alcohol to feel good! Amino acid therapy revolutionized the work at our clinic, too, dramatically raising our success rates with alcohol and drug-addicted clients. Moreover, we were able to successfully treat clients with other addictions as well. In fact, our most spectacular successes were with food-addicted clients. Ninety percent of the compulsive overeaters we have treated with amino acid therapy have been freed from their food cravings within forty-eight hours.

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Using Amino Acids to End Emotional Eating

When psychological help does not clear up emotional eating, we need to look at the four brain chemicals - neurotransmitters - that create our moods. They are:

1. dopamine/norepinephrine, our natural energizer and mental focuser
2. GABA (gamma amino butyric acid), our natural sedative
3. endorphin, our natural painkiller
4. serotonin, our natural mood stabilizer and sleep promoter

If we have enough of all four, our emotions are stable. When they are depleted, or out of balance, what we call "pseudo-emotions" can result. These false moods can be every bit as distressing as those triggered by abuse, loss or trauma. They can drive us to relentless overeating.

For some of us, certain foods, particularly ones that are sweet and starchy, can have a druglike effect, altering our brains' mood chemistry and fooling us into a false calm, or a temporary energy surge. We can eventually become dependent on these druglike foods for continued mood lifts. The more we use them, the more depleted our natural mood-enhancing chemistry becomes. Substituting amino acid supplements for these drug foods can have immediate and dramatic effects.

Toni, a 26-year-old Native American, was referred to our clinic because she was exhausted, profoundly depressed, anxious and suffering lifelong trauma from the physical and emotional violence of her family.

Toni drank alcohol and ate sweets to cope. She went regularly to her scheduled counseling sessions but was unable to rouse herself to communicate with her counselor. She had volunteered to come to Recovery Systems, hoping that a new approach would help. Toni had already been through three long-term treatment programs for alcohol addiction. Clearly, she was motivated to solve her problem.

When we saw Toni's condition, the nutritionist and I conferred and decided to give her amino acids on the spot. I asked her to tell me one thing: What was the worst thing she was experiencing at that moment? She said "I'm sooooo tired." Her slumped body and still, dull eyes confirmed this.

Our goal? To treat her lack of energy and depression by raising her levels of the neurotransmitter norepinephrine, the body's natural energizer. We gave her our smallest dose - 500 milligrams of L-tyrosine. While we waited and hoped for an effect, I spoke about how and why amino acids can be helpful.

After about ten minutes, Toni said, "I'm not tired anymore."

"Great!" I said. And then I asked my next question: "What is the worse thing you are experiencing, now that your energy is better?"

She answered by bending over and grasping herself around the stomach. "I'm really uptight."

We then gave Toni the smallest dose of GABA - 100 milligrams - a natural Valium-like chemical along with 300 milligrams of L-taurine. We suspected that together these supplements would help relieve her tension and allow her to relax - and they did. She stretched her legs out in front of her and then stood up, got a glass of water, and went to the bathroom. While she was gone, her counselor came in and happened to tell me that Toni was in a lot of emotional pain because of the chronic alcoholic violence in her family. When her family members drank alcohol, they all became different people, vicious and cruel. And they had never been able to stay away from alcohol.

When Toni returned, I asked her, "Can we give you something to help you endure the emotional pain that you are in?" She said yes, so I gave her a supplement containing 300 milligrams DL-phenylalanine and 150 milligrams L-glutamine. (DL-phenylalanine is the amino acid used to alleviate emotional pain.)

In ten minutes I asked Toni how she was feeling, and she smiled and said, "Just right."

I was incredulous. How could these small amounts really be helping her? Our European American clients usually need two to four times as much of each type of amino acid to get such dramatic effects.

I asked if she would like any more of any of the aminos I had already given her for energy, relaxation, or pain relief. Her answer: "Just right," and a shake of her head.

By this time Toni's eyes were sparkling. Weeks later her counselor reported that by continuing with the amino acids she had first used in our office, Toni was actually talking for the first time in their counseling sessions, and was being praised at work, was being noticed for the first time by men, and was staying sober and sugar-free.

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Mood Foods: How Amino Acids Feed Your Brain

The four key mood chemicals (neurotransmitters) are made of amino acids. There are at least twenty-two amino acids contained in protein foods. High-protein foods, such as fish, eggs, chicken, and beef, contain all twenty-two, including the nine amino acids that are considered essential for humans. Other foods, such as grains and beans, have some but not all of the essential nine aminos, so they need to be carefully combined to provide a complete protein (for example, rice and beans, or corn and nuts).

If you are eating three meals a day, each meal including plenty of protein (most people with eating and weight problems are doing neither), your positive moods and freedom from cravings can be maintained. But most people need to kick-start the brain's repair job, using certain key amino acids. This will allow you to actually enjoy eating protein and vegetables instead of cookies and ice cream. After a few months, you will be getting all the aminos you need from your food alone and won't need to take amino acids as supplements any longer.

Restoring depleted brain chemistry sounds like a big job - but it isn't. Three of the four neurotransmitters that color all your moods are made from just a single amino acid each! Because biochemists have isolated the key amino acids, you can easily add the specific ones that may be deficient. These "free form" amino acids are instantly bioavailable (in other words they are predigested), unlike protein powders from soy or milk, which can be hard to absorb. Hundreds of research studies at Harvard, MIT, and elsewhere (some of which date back to the early part of this century) have confirmed the effectiveness of using just a few targeted amino acid "precursors" to increase the key neurotransmitters, thereby eliminating depression, anxiety, and cravings for food, alcohol and drugs.

Stopping Carbohydrate Cravings

It may sound impossible, but you can stop your food cravings almost instantly with just one amino acid supplement. Any absence of fuel for your brain's functions is perceived correctly by your body as a code-red emergency. Powerful biochemical messages then order you to immediately eat refined carbohydrates to quickly fuel your brain. There are only two fuels that the brain can readily use:

1. glucose, which is blood sugar made from sweets, starches, or alcohol
2. L-glutamine, an amino acid available in protein foods (or as a supplement, carried in all health food stores). L-glutamine reaches the starving brain within minutes and can often immediately put a stop to even the most powerful sweet and starch cravings. The brain is fueled by L-glutamine when glucose levels drop too low. Don't be intimidated by the strong effects of supplementation. L-glutamine is a natural food substance; in fact, it's the most abundant amino acid in our bodies. It serves many critical purposes: stabilizing our mental functioning, keeping us calm yet alert, and promoting good digestion.

Restoring Energy and Focus

When your brain is adequately fueled with its back-up emergency supplies of L-glutamine, you are ready to rebuild your four key neurotransmitters, starting with dopamine/norepinephrine, your natural caffeine. Without this natural brain stimulant, you can be slow and tired and have a hard time concentrating. You don't sparkle and can't stay on track mentally. It's hard to get things done and you can feel dull and sometimes just want to stay in bed. Your physical as well as your mental energy drops without adequate norepinephrine. The amino acid that provides this jet-fuel is the nutritional powerhouse L-tyrosine. L-tyrosine produces thyroid hormones and adrenaline as well as well as norepinephrine. Like L-glutamine, L-tyrosine goes to work in minutes to perk you up.

Enhancing Your Ability to Relax

The next key mood-enhancing chemical is GABA (gamma amino butyric acid), our natural . GABA acts like a sponge, soaking up excess adrenaline and other by-products of stress and leaving us relaxed. It seems to drain the tension and stiffness right out of knotted muscles. GABA can even smooth out seizure activity in the brain. My colleague, Elliot Wagner, a specialist in drug detox, taught me that GABA can even give relief to heroin addicts going through the severe anxiety of early withdrawal. Think what it can do for garden variety stress and uptightness!

When Food is Comfort

For many people, overeating helps compensate for a depletion of the natural pain relievers, the endorphins. Life's pain can be unendurable without adequate amounts of these buffer chemicals. Some of us (for example, those of us from alcoholic families) may be born with too little natural pain tolerance. We are overly sensitive to emotional (and sometimes physical) pain. We cry easily. Like our alcoholic parents, we need something to help us endure our daily lives, which seem so painful. Others of us use up too much endorphin through trauma and stress. We just run out, especially if we were born short on endorphins to begin with. When our comfort chemicals run low, many of use turn to comfort foods.

If you need food as a reward and a treat, or to numb your feelings, your natural pleasure enhancers, the pain-killing endorphins, are probably in short supply. Foods that elevate your endorphin activity can easily become addictive. If you "love" certain foods, those foods are firing a temporary surge of endorphins. Euphoria, joy, the "runner's high" - these are all feelings produced by endorphins. Some people have so much natural endorphins that they smile all the time and get great pleasure from everyday life. Of course, we all endure suffering and loss. But, with enough endorphins, we can bounce back.

For anorectics and bulimics, the trauma of starving and vomiting can trigger an addictive endorphin high, because trauma of any kind can set off an automatic burst of soothing endorphins. You may know of people who felt no pain for hours after a terrible physical injury. Runners don't get their big endorphin high until they have run past "the wall of pain." At that point, they have run too far!

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Raising Serotonin, Our Natural Prozac

Low serotonin can be the easiest deficiency of all to develop. Very few foods are high in the amino acid tryptophan, which is the only nutrient that the body can use to make serotonin. According to a 1997 Lancet study, tryptophan is one of the first nutrients to be depleted by weight-loss dieting. If, in addition to dieting, you inherited low serotonin levels and experience a lot of stress, your levels can fall low enough to set off a major eating disorder or serious emotional disturbances.

Restoring your serotonin levels can be a life-or-death matter. Suicides and violent crimes are closely associated with deficiencies of serotonin. The sometimes fatal obsessions and self-hate of bulimics and anorectics are clearly linked to low serotonin levels as well.

Do you have any obsessions that might be caused by low serotonin levels? The women I have worked with who report obsessive behavior tend to be "neat-niks" and suffer from negative obsessing about their physical appearance, while the men are often "neat-freaks," although they also complain about troubling sexual fantasies they can't stop. As we all know, anorectics (who are low in serotonin) are driven to obsessive control of their food intake. Obsessive fears and phobias are common among people with low serotonin levels.

It may be a difficult adjustment for you to begin to see symptoms like control, fear, and low self-esteem as biochemical problems, not just psychological ones. But the success of drugs like Prozac has already alerted us to the biochemical nature of many symptoms that don't respond to psychological help alone.

Drugs like Prozac are called serotonin reuptake inhibitors (SSRIs) because they keep whatever serotonin we have active. But they do not actually provide additional serotonin. For this reason, most people using SSRIs often continue to have some low-serotonin symptoms. Before there were SSRIs, the pharmaceutical compound L-tryptophan was commonly used to increase serotonin levels. For more than twenty years, psychiatrists and health food stores enthusiastically recommended it for relieving depression and food cravings and normalizing sleep without side effects. Many people found that their symptoms were eliminated permanently after only a few months of L-tryptophan use.

In 1989, a series of bad batches of L-tryptophan, which filled forty people and made many more very sick, prompted the Food and Drug Administration (FDA) to stop all U.S. sales. One Japanese company, Showa Denko, had produced all of these batches, which, it was found, were contaminated because they had eliminated three filter systems that they'd been using for years - just why they chose to take away these safety filters is a question that remains unanswered. Showa Denko has never made tryptophan again. Despite evidence that no other manufacturer has ever made a problem batch, the FDA recommended for years that L-tryptophan not be used as a supplement. (Interestingly, they have made no effort to stop the sale of infant formulas, most of which contain added L-tryptophan.)

With L-tryptophan unavailable, drugs like Prozac, , and Redux have become our primary tools for combating the crippling symptoms of low serotonin. Unfortunately, these drugs provide only temporary and incomplete benefits, and often have uncomfortable or dangerous side effects. Fortunately, in 1996, many compounding pharmacies began providing L-tryptophan again, by physician prescription, and a new version of tryptophan called 5HTP (5-hydroxytryptophan) became available over the counter in 1998 without FDA opposition. In 2000, Lidtke Technologies Corporation of Phoenix, Arizona, made L-tryptophan available through health professionals without prescription. Look for other supplement suppliers to follow suit, as the FDA has never formally banned the sale of this essential amino acid.

Whatever mood-enhancing brain chemicals you have in short supply, they can be replenished quickly, easily, and safely.

Tryptophan Depletion: The Path to Depression, Low Self-esteem, Obsession and Eating Disorders

Serotonin, perhaps the most well known of the brain's four key mood regulators, is made from the amino acid L-tryptophan. Because few foods contain high amounts of tryptophan, it is one of the first nutrients that you can lose when you start dieting. A new study shows that serotonin levels can drop too low within seven hours of tryptophan depletion. Let's follow this single essential protein (there are nine altogether) as it becomes more and more deeply depleted by dieting. To see how decreased levels of even one brain nutrient might turn you toward depression, compulsive eating, bulimia, or anorexia.

In his best seller, Listening to Prozac, Peter Kramer, M.D., explains that when our serotonin levels drop, so do our feelings of self-esteem, regardless of our actual circumstances or accomplishments. These feelings can easily be the result of not eating the protein foods that keep serotonin levels high. As their serotonin-dependent self-esteem drops, girls tend to diet even more vigorously. "If I get thin enough, I'll feel good about myself again!" Tragically, they don't know that they will never be thin enough to satisfy their starving minds. Extreme dieting is actually the worst way to try to raise self-esteem because the brain can only deteriorate further and become more self-critical as it starves. More and more dieters worldwide are experiencing this miserable side effect of weight reduction on the brain.

When tryptophan deficiency causes serotonin levels to drop, you may become obsessed by thoughts you can't turn off or behaviors you can't stop. Once this rigid behavior pattern emerges in the course of dieting, the predisposition to eating disorders is complete. Just as some low-serotonin obsessive-compulsives wash their hands fifty times a day, some young dieters may begin to practice a constant, involuntary vigilance regarding food and the perfect body. They become obsessed with calorie counting, with how ugly they are, and on how to eat less and less. As they eat less, their serotonin levels fall farther, increasing dieters' obsession with undereating. As their zinc and B vitamin levels drop low as well, their appetite is lost. This can be the perfect biochemical setup for anorexia.

What so many therapists and others have observed as the central issue of "control" in anorexia often comes down to this: just as vitamin C deficiency (scurvy) results in an outbreak of red spots, do does tryptophan (and serotonin) deficiency result in an outbreak of the obsessive-compulsive behavior that we call "control." There may be psychological elements in the picture, too, but a low-serotonin brain is ill equipped to resolve them.

 

Source: excerpted with permission from The Diet Cure: The 8-Step Program to Rebalance Your Body Chemistry and End Food Cravings, Weight Problems, and Mood Swings-Now, by Julia Ross.

 

 

next: Psychotherapy, Light Therapy, Dietary Supplements for Depression
~ depression library articles
~ all articles on depression

Author Andy Behrman, aka "Electroboy," discusses the stigma attached to living with bipolar disorder and how he dealt with it.

Personal Stories on Living with Bipolar Disorder

For years, I suffered with a mental disability. I still do - no one has found a cure for manic depression (bipolar disorder) yet. During those crisis years, though, nobody knew anything was really wrong with me. I was experiencing a wild roller coaster ride of frightening highs and lows that put my life in jeopardy, but my disability was completely invisible.

Granted, I was behaving rather erratically, flying from New York to Tokyo to Paris on business three or even four times a month, counterfeiting art and smuggling tens of thousands of dollars back into the United States. At the same time, I was drinking heavily and indulging in drugs (self-medicating my mental illness), engaging in sex with complete strangers that I would meet in bars and clubs, staying up for days on end, and in general living on the edge ...

but my disability was an invisible one.

Friends and family were convinced I was functioning just fine because I was efficient, productive and successful - who wouldn't be, working twenty-hour days? I had everybody fooled with my illness. While my manic depression remained undiagnosed, I secretly wished that my disability was a physical one - one that others would notice. Maybe people would be supportive and help me if I had diabetes or, God forbid, cancer. Maybe I needed to show up to the next family function in a wheelchair to get somebody's attention. I was helpless living with this invisible illness.

Once I was diagnosed, though, and given what I refer to as my "death sentence," things changed quickly. And no, my family and friends did not come rushing to my side to support me in battling against my illness - somehow I fantasized that this was going to happen.

All of a sudden I realized the stigma of having a mental illness - it hit me smack between the eyes. And the stigma was almost as bad as having to come to terms with the fact that I was mentally ill and needed treatment.

The stigma, I realize now, "started" with me. I initiated it. It was my own fault and a result of my own naive at age 28.

When the doctor diagnosed me and used the words "manic depression" and "bipolar," I had no idea what he was talking about. "Manic" sounded like "maniac" and "bipolar" sounded like "polar bear," so I was completely confused (in retrospect I should have aligned myself with the term "bipolar" then because of the "polar bear" association, but I didn't).

I was under the impression that the illness was degenerative and that I probably wouldn't live to see my next birthday. I asked the doctor how many other people there were like me - 2.5 million people in America alone.

He tried to calm me down and talk me through the diagnosis, but I was self-stigmatized by my new label. And then, of course, he had to remind me that I was now part of a category of people called "mentally ill." Oh, God. I was a lunatic, a freak, a psycho, a crack-up and a mental case.

When I left his office on the Upper East Side of Manhattan and walked home across Central Park that snowy morning, I imagined being forced to have electroshock therapy like Jack Nicholson in One Flew Over The Cuckoo's Nest. I persuaded myself that I was overreacting, taking this too far. That could never happen to me. But actually, I wasn't taking it too far. Less than three years later I found myself in the operating room of a psychiatric hospital in Manhattan, lying on a gurney with electrodes attached to my head and receiving electroshock treatments - 200 volts of electricity through my brain.

The stigma first hit me from the "outside world" with a little help from the written prescription my doctor gave me. It was filled out for medications thought to control my manic depression. The prejudice began then.

On seeing it, my own neighborhood pharmacist remarked, "Your doctor's putting you on all of this medication? - are you okay?" I didn't respond. I paid for my four prescription drugs and left the pharmacy wondering exactly what he meant by "all of this."

Was I some sort of "mental case" because I was now taking four different medications? Did the pharmacist know something about my condition that I didn't know? And did he have to say it in such a loud voice, just hours after my diagnosis? No, he didn't, that was unkind. It seemed that even the pharmacist had an issue with mentally ill patients, and trust me, mentally ill patients in Manhattan were the "bread and butter" of his business.

Next I had to tell people about the diagnosis. Scared to death, I waited a week until I got up the nerve to ask my parents to dinner.

I took them for a meal at one of their favorite restaurants. They seemed suspicious. Did I have something to tell them? They automatically assumed I was in some sort of trouble. It was written over both of their faces. Assuring them that I wasn't, but had some news that might surprise them, I just spilled the beans.

"Mom, Dad, I've been diagnosed as a manic depressive by a psychiatrist," I said. There was a long silence. It's as if I'd told them that I had two months to live (interestingly, the same reaction that I had when my doctor told me).

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They had a million questions. Are you sure? Where did it come from? What's going to happen to you? Although they didn't come out and say it, they seemed concerned that I was going to "lose my mind." Oh, God. Their son had a mental illness. Was I going to end up living with them for the rest of their lives? And of course, they wanted to know if it was genetic. My telling them that it was didn't exactly make for a pleasant conclusion to the dinner. Not only were they now faced with the stigma that their son had a mental illness, but the stigma that mental illness ran in the family.

With friends, it was easier to break the news of my mental illness.

They seemed to know more about manic depression and were supportive of my getting well and staying on a medication regime. But all hell broke loose when medication didn't manage my illness and I opted for the last resort - electroshock therapy.

My friends had had a really mentally ill friend who had to be hospitalized and "shocked" to maintain an even keel. This was too much for some to handle and those people simply disappeared. Nobody seemed to want a friend who was now officially a psychiatric patient and, after electroshock, a certifiable zombie.

In fact, everybody seemed frightened of me, including my neighbors, my landlord and shopkeepers who I had known for years. They all looked at me "funny" and tried to avoid making eye contact with me. I, however, was extremely up-front with them. I told them all about my illness and was able to explain my symptoms to them as well as my treatment. "Have faith - one day I'm going to be just fine," I seemed to cry out inside. "I'm still the same Andy. I've just slipped a bit."

As no one knew much about my mental illness, a lot of people had the attitude that I had the capability to "kick it" and get better instantly. This was the most frustrating attitude for me. My manic depression was ravaging my life, but because nobody could see it, many people thought it was a figment of my imagination. Soon I started thinking this too. But when the symptoms were out of control - the racing thoughts, the hallucinations and the sleepless nights - the fact that I really was ill was reassuring.

The guilt I felt for having a mental illness was horrible. I prayed for a broken bone that would heal in six weeks. But that never happened. I was cursed with an illness that nobody could see and nobody knew much about. Therefore, the assumption was that it was "all in my head," rendering me crazy and leaving me feeling hopeless that I'd never be able to "kick it."

But soon, I decided to cope with my illness like it was a cancer eating away at me and I fought back. I dealt with it like it was any old physical illness. I dumped the stigma and focused on recovery. I followed a medication regime, as well as my doctor's orders, and tried not to pay attention to the ignorant opinions from others about my illness. I fought it alone, one day at a time, and eventually, I won the battle.

About the author: Andy Behrman is the author of Electroboy: A Memoir of Mania, published by Random House. He maintains the website www.electroboy.com and is a mental health advocate and spokesman for Bristol-Myers Squibb. The film version of Electroboy is being produced by Tobey Maguire. Behrman is currently working on a sequel to Electroboy.

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The role of powerlessness in recovery is a wonderful paradox. At first glance, one might think that powerlessness suggests vulnerability or defenselessness. But in actuality, powerlessness is the better advantage.

As with all recovery tools, the secret is awareness. Powerlessness is an awareness of where the true power lies. Armed with this awareness, a recovering co-dependent is freed from the insanity of power and control games.

For example, I am powerless over a family member's addiction. I jeopardize my own sanity when I invest my own emotional time and energy into figuring out how to coerce, control, or threaten another person into giving up their addiction. I can best help that person with a professionally-guided intervention that keeps me out of the middle.

The same is true for separation, divorce, abuse, and any other relationship issue. I am powerless over the parties involved; however, I do have the power to help them get professional help. I have the power to let go and let God handle situations. I have the power to own my power when others try to exercise power and control over me.

I have the power to choose my responses to a given situation, rather than jumping in and getting enmeshed in someone else's stuff. I have the power to maintain my own serenity and sanity and take care of myself, with the help of my Higher Power.

Dear God, help me to see when I am powerless over people and situations and turn those people and situations over to You. Help me to own and exercise the power I have to care for myself, so I can be the best, whole person I can be. Help me to remember that knowing where the true power lies is a clean, healthy gift I can give others.

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