The following are my top tips for dealing with my ADD son Richard. Please remember that they have not worked every time and of course each child is different, but if they give you some food for thought, then all the better.

1. Stay Calm - Easy to say I know but if I get stressed out at one of Richard's moods, and I have, it makes him ten times worse.

2.Change The Subject - If the conversation seems to be leading to a stressful situation, I do what I call a 'Heslop'. Those of you who remember the T.V. comedy 'Porridge', may recall a chap called Heslop, who always cut a conversation dead with one line quips which had no relevance whatsoever to what was being discussed, the famous one being, 'My mother went to Sidcup!'.

3.Lots Of Praise - Even accomplishing a small task is a great feat for Richard, so I try and make sure he knows how pleased I am, by giving lots of praise and sounding as though I mean it. Picking out a particular part of the task and asking a question about it makes him realise, I am genuinely interested and pleased. I try never to say just ' Oh yes, that's good ' and then start talking about something entirely different.

4.I Can Do Lots Of Things - Richard sees his brothers and other children getting on with things easily and therefore his self esteem starts to slide when he finds he can't do the same. I try and boost him up by reeling off a list of things he does really well and you can often see him visibly fill back up with pride, especially if I can find something, however small, that he can do that others find difficult. There are many examples of this but the one that springs to mind immediately is his extraordinary long term memory. I try and call upon this whenever we need to remember an event or person, this really makes him feel important, and so it should because it's one of his strengths

5.Short And Sweet - I have found that Richard gets on better with a task if I break it down into manageable (for him) segments. An example of this could be, instead of asking him to clear his room, I would start with getting him to pick up just the books, then ask him to gather up any dirty clothes etc., etc. With little breaks and praise for what he has done after each mini task, he can accomplish a lot

6. Rewards - Star charts, smiley stickers - Richard loves them. They don't have to be for big achievements either. At one stage getting him to dress himself, brush his teeth etc., was a real struggle. It still is sometimes but following a period of sticker awards on a chart for doing these and other everyday tasks, he got into a sort of routine, which he mostly still carries on, with the odd hiccup. He likes my latest idea of printing out a picture and then cutting it into jigsaw pieces. He then gets rewarded with a piece for good work/behaviour etc., and builds up the picture.

7. Sleep - Richard feels comfortable with routines, so going to bed has turned into something of a ritual. Turning his covers down in a particular way, the door left in a certain position etc. Psychiatrists would have a field day but if it sets him up for a good nights' kip then I don't care. He still gets up at 5 a.m. and sometimes in the night but now he's got into a routine, he's much better than he used to be

8. Laugh - You could really cry sometimes, but having a laugh about a situation really can help in my experience to relieve the tension, even if the circumstances don't really call for it, who cares

9. Embarrassing Or What - Some of the things Richard has done in public really make you feel like disappearing down the nearest manhole but I try hard not to bother about what other people think, after all, he can't help it and that's what I tell myself in these situations

10.A Good Cuddle - Richard is a really emotional and loving child and a good old fashioned cuddle does us both the power of good

These are just a few of many tips. Mum operates them too but it was just easier to write them down from my perspective. I hope you find them useful.

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Bad sex. Unfulfilled sex. Miserable sex. It is a subject that most people don't want to think about, not to mention talk about--not in public, not at home, not in their bedrooms. But it is a problem that afflicts a great number of Americans. In fact, a recent University of Chicago study indicates that at any given time four in 10 American women and three in 10 American men suffer from some kind of sexual dysfunction.

The situation is worse in Black America. In general, African-Americans experience more sexual dysfunction than Whites, and Hispanics experience fewer sexual problems. Black women are much more likely to experience low sexual desire, and to report less pleasure from sex, than White women. Hispanic women consistently reported the most satisfying lives.

Many were shocked to learn that so many people are suffering from the bedroom blues. It is hard to believe that hundreds of thousands of men and women in this land of free sex and liberal love--where couples in bed area staple on daytime and evening television shows, where the average age of first-time sex is sinking lower and lower, where music and movies seem to be stuck on the same theme of sex, sex and more sex--that so many people are not enjoying what they spend so much time talking, reading, dreaming, bragging and lying about.

Sexual dysfunctions, according to the study, are "characterized by disturbances in sexual desire and in the psychophysiological changes associated with the sexual response cycle in men and women." The dysfunctions covered by the survey include lack of sexual desire, arousal difficulties, inability to achieve climax or ejaculation, anxiety about performance, premature orgasms, pain during intercourse and not finding sex pleasurable. In addition, the university study indicates that sex problems are more common among young women and older men.

There are many factors that affect the quality of a couple's sex life. They include the stresses that consume so many of us--job, family, social obligations, as well as economic pressures --in addition to psychological and physiological factors. At the same time, many people don't acknowledge that they have problems and don't seek help. Consequently, sexual problems that can be treated often go unmentioned.

Author Audrey B. Chapman, a couples therapist and radio show host in the Washington, D. C., area, says she finds that for many Black people, the sheer stress of everyday life leaves little time and energy for quality sex. "These days, people are living racy and hectic lives," she says. "Everyone is stressed out trying to achieve so much with so little time and, for most Black people, with not enough resources. People are stressed, pressed and frustrated, and all that takes energy. By the time you get to the end of the day or the week, you are wiped out. It takes energy to be sexual, and that means physical and emotional energy."

Chapman and other relationship experts also emphasize that financial stress is major factor affecting the sex lives of Black Americans. When a man is unemployed, it affects his ego and consequently his sex life. When a woman is concerned about how to feed her children, she has little interest in sex. An interesting conclusion from the University of Chicago sex study is that more highly educated men and women seem to have greater sexual satisfaction. On the other hand, declining finances appear to contribute to sexual dysfunction, for women in particular. Financial and devastating life events such as job loss, death of a spouse and divorce all affect sexual desire and performance.

Dr. Paris M. Finner-Williams, a psychologist and attorney who operates a relationship counseling practice in Detroit with her husband, Robert D. Williams, a clinical psychiatric social worker and marriage and family therapist, agrees with Chapman that busy, hectic schedules interfere with quality sex lives. "There are performance issues and there are quality issues," she says. "Because we live very busy, demanding lives, we just don't seem to have the available time that we used to have for relaxing with our mates.

"We don't have energy for any foreplay, and if we do make love, the quality is that of stress-reduction lovemaking rather than the romantic kind. People are just trying to get physical release, which is quite different from the beauty, excitement and arousal you get from the old-fashioned, on-vacation, romantic type of lovemaking."

Another social factor that affects the sex lives of African-Americans is the fact that spouses don't make or take time to relax and enjoy each other intimately. "People don't take enough time to communicate with their partners, to have fun, to connect spiritually," says Chapman. "There is not enough communication and spiritual union among Black men and women. It is not a priority anymore. Getting a car is a priority, getting a house, getting clothes, getting hair done."

Marriage therapist Robert Williams says that couples who want to improve their sex lives must recognize that what and how you think rather than what you do is essential to eliminating sexual dysfunction. "Healthy sexuality and satisfying sexual encounters among African-Americans will enhance their self-esteem and self-worth, and improve their intrapersonal communication skills on all levels," he emphasizes.

There area number of physiological reasons that people don't enjoy sex. One is the inability of the man to get an erection; another is the pain that women sometimes experience. Individuals who experience these or other physical problems should seek advice from their physicians.

SUREFIRE REMEDIES FOR BAD SEX

1 Be More Creative In Sexual Thoughts And Performance. Husbands and wives should explore each other's bodies to discover their mates' erogenous zones. Unfortunately, many men as well as women do not discuss their sexual preferences, and the only way to find out what really turns your partner on is the art of exploration.

2 Share Fantasies. "Verbally sharing rich sexual fantasies with your spouse can greatly enhance your sex life," says therapist Williams. "We all need to have a complete sexual performance package with each other, and that includes intellectual stimulation." His wife, Dr. Finner-Williams, says couples should share and act out their fantasies. "They become the couple's secret and are very sacred between them," she explains. "Intellectual sharing can improve the performance and quality of the relationship."

Finner-Williams adds that new research indicates that African-Americans "seem to be more homogenous to our own race and culture" when it comes to fantasies. That is, we fantasize about Black men and women rather than about other ethnic groups. "We're now having fantasies within the realm of reality for us. Though some fantasies may be bizarre, they are feasible fantasies," she says.

3 Don't Criticize Your Partner's Performance. Relationship therapists say they are hearing from many female clients who say their husbands are experiencing premature ejaculation and other sex problems. At the same time, say the therapists, women are quick to express their displeasure. "Women are no longer holding back their opinions," says Finner-Williams. "They don't boost their husbands' egos the way women used to, like we were taught by out grandmothers and aunts. If a man didn't find the G-spot, the man will know it. The man's ego becomes defensive concerning performance." And when there is that kind of anxiety and tension, affects sexual performance.

4 Show Your Partner How To Please You. Instead of complaining about what your partner is not doing show him or her what turns you on. Dr. Finner-Williams says men are not taught to be romantic. They are not taught how to explore a woman's body to find out where her erogenous zones are. Women should take responsibility for their sexual pleasure. "A man has to be taught how to perform and how to satisfy his woman," she says.

At the same time, women must learn to express their sexual needs. Audrey Chapman says she notices that Black women don't tell their men what they want. "Some women tend to let the man do all the talking, make all the suggestions," Chapman explains. "They are very reluctant to let men know how they feel, what they want sexually. While we are said to be the most sexual, the most liberated, in fact, Black women are the most inhibited when it comes to expressing what we want and need."

5 Delete Distractions. When couples finally get in the mood and find time for love, that is not the time to focus on other issues or problems, no matter how pressing. While in bed, don't discuss paying bills, household chores, issues concerning children, what extended-family members might have said. Good sex is dependent on a relaxed state of mind.

6 Get Re-educated About Sex. Relationship therapists say that personal views on sex can greatly diminish the pleasure. Dr. Finner-Williams points out that while some women feel that sex can and should be pleasurable, other women learn that sex should not be enjoyable. She tells of counseling one Christian newlywed who had conflicting feelings about sex with her husband. "It's okay to enjoy making love to your husband; sex and orgasms are okay," says Finner-Williams. "Many women grew up learning that their bodies were there to serve their husbands rather than for a woman also to be satisfied. We should enjoy making love to out husbands and stop having all those inhibitions, all that miseducation."

Chapman also has found that many African-Americans hold religious views that inhibit sexual sure. "They feel that if you love God, you can't love sex," says Chapman. "That's a problem. Where did that come from? Some believe that sex is dirty, even with your mate. And then there are those who feel that it's okay to have sex with your mate, but it's just another duty, like household chores. In fact, sex should be pleasurable."

7 Put That Ego In The Closet. Marriage counselors say that some Black men are victims of the myth that all Black men are superb lovers. "Black men can be very [macho]," says Chapman. "They believe they are throwing down, but in fact they are not satisfying the women. Even when they are not in the mood, they feel the pressure to perform because they have been told that they are superstuds." Instead, says Chapman, men should put that ego away and talk to their women about their sexual anxieties and problems.

8 Medical Alert. Many men and women do not realize that their medications might affect their sexual appetite and performance. Some medications for hypertension, ulcers and certain heart conditions cause impotence in men. At the same time, the libido of men and women is affected by common ailments such as diabetes and clogged arteries. In addition, smoking as well as alcohol and substance abuse affect sex. Dr. Terry Mason, chief of urology at Mercy Hospital in Chicago, points out that many women who have been termed as "frigid" in fact have physiological reasons for their lack of sexual response. He and other specialists recommend that individuals experiencing sex problems check with their physicians

9 Fight Depression. Men and women both should be aware that depression greatly affects one's sexual appetite. "When you are stressed and depressed, you have no interest in sex," says Chapman. "Depression could be related to the job, to your sick parents, to your children. When men lose a job, they are depressed. Many women suffer from postpartum depression after having a baby. Some medications make you depressed. Sometimes it is just our complicated lives." Clinical depression affects at least 17 million Americans, and many of the medications prescribed as treatment cause sexual dysfunction. So don't downplay the effect that the blues might have on your sex life. Check with your doctor. If depression is the culprit, seek counseling to resolve the problem and reclaim your sex file.

10 Don't Have Unrealistic Expectations. Just because your coworker has sex every day or the character in a novel has incredible orgasms does not mean that your sex life is abnormal. Every individual is unique; every couple has its own rhythm. If you and your partner have a great sex life that is satisfactory for both of you, you are among the more fortunate.

next: Aphrodisiacs

men and sex

The fact that men are allowed to express themselves sexually from an early age gives them some confidence in the sexual arena. But the fact that they let their guard down here makes them more vulnerable than ever.

Women should be aware that men are particularly vulnerable to rejection before, during, and after sex. Sex opens men up to rejection and sexual rejects are often seen as personal rejections.

Their defenses are down and they are at risk. They are like a turtle without a shell-easily punctured and hurt. In addition, men often don't distinguish between the rejection of them sexually and the rejection of them as a whole person.

But will they act hurt when they are rejected? Probably not. That is not an acceptable emotion for men in our society. They are more likely to act mad or sullen, or merely withdraw. Their defensive reaction to the injury is detached, distant, or critical in keeping with society's expectations of men. Often the reaction is, "I'm gone; I'm out of here."

Does this mean women should have sex with men whenever or wherever the men wish, just to avoid wounding them in their vulnerable state? Of course not. But it does mean they should be aware that men are particularly vulnerable before, during, and after sex. This is not the time to launch into a ten minute dissertation of what is wrong with his sexual technique.

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next: Sex Facts for Women

Are you a victim of abusive behaviors? Here's a checklist with the signs of domestic violence, domestic abuse.

This is just one list. There are several, and they are all similar.

The Battered Women's Task Force of the NY State Coalition Against Domestic Violence asks women to answer "yes" or "no" to the following signs of domestic violence.

Does your partner:

1. hit, punch, slap, shove, or bite you?
2. threaten to hurt you or your children?
3. threaten to hurt friends or family members?
4. have sudden outbursts of anger or rage?
5. behave in an overprotective manner?
6. become jealous without reason?
7. prevent you from seeing family or friends?
8. prevent you from going where you want, when you want?
9. prevent you from working or attending school?
10. destroy personal property or sentimental items?
11. deny you access to family assets, such as bank accounts,
    credit cards, or even the car?
12. control all finances and force you to account for what you spend?
13. force you to have sex against your will?
14. force you to engage in sexual acts you do not enjoy?
15. insult you or call you derogatory names?
16. use intimidation or manipulation to control you or your children?
17. humiliate you in front of your children?
18. turn minor incidents into major arguments?
19. abuse or threaten to abuse pets?
20. The author of No Visible Wounds, Mary Susan Miller, adds one more:
    withhold conversation, sex, or affection from you?

Now, notice that only one, the first, is physical in nature. Here's the big one: If you answered yes to just one of the above, you are being abused. I don't care what the reasons he gives you for his actions. If he engages in just ONE of those listed, he is abusing you. As one woman put it, "It wasn't being hit or thrown against the wall that hurt most. It was having to live like a non-person." (from No Visible Wounds)

The worst of it is this: more often than not, the "threats" of hitting will grow into reality. What once was "just" name-calling becomes public ridicule, and eventually physical abuse.

The Myth about Eating Disorders

A common myth about eating disorders is that eating disorders only affect white, middle-to-upper class females in there teen or college years. Until the 1980's, little information was available about eating disorders and the information that was distributed was often only to the health professionals serving primarily upper class, white, heterosexual families. And the research made available to these professions supported the myth of eating disorders as a "white girl's disease." It wasn't until 1983 and the death of Karen Carpenter that any information let only accurate facts about eating disorders began reaching the public. Yet again, Carpenter's race supported the myth of a "white girl's disease." Where her death brought recognition of the disease to the public and allowed many women to name what their suffering was about, it did so only for white girls and women (Medina, 1999; Dittrich, 1999).

It is highly possible that up until recently many women of color were suffering from eating disorders and disordered eating behaviors in silence and/or without knowing the severity of their disease or even that it was a disease. In a recent phone call with a Latina friend that is suffering from anorexia she said, "After Karen died and all the media coverage, I went to the doctor to tell him that I also had anorexia. I was severely underweight and my skin had a yellow undertone. After examining me he told me, 'You don't have anorexia, only white women can get that disease.' It was 10 years until I went to another doctor" (personal communication, February 1999). The idea of eating disorders as a "white girls disease" still influences many health care workers.

Unfortunately, eating disorders do not discriminate. Individuals of any race, class, sex, age, ability, sexual orientation, etc. can suffer from an eating disorder. What can and does differ is the individual's experience of the eating disorder, how health professionals treat them, and finally, what is involved in treating a woman of color with an eating disorder. Research that is inclusive of the women of color eating disorder experience is still quite lacking in comparison to eating disorder research that is conducted from the white ethnocentric viewpoint.

Some current researchers are calling for a re-evaluation of the eating disorder diagnostic criteria for the DSM-V based on their belief that the criteria as defined in the DSM-IV (1994) is "white" bias (Harris & Kuba, 1997; Lee, 1990; Lester & Petrie, 1995, 1998; Root, 1990). Root (1990) identifies stereotypes, racism, and ethnocentrism as reasons underlying this lack of attention of women of color with eating disorders. Further, Root (1990) suggests that mental health professionals have accepted the notion of certain blanket factors in minority cultures. An appreciation for larger body sizes, less emphasis on physical attractiveness and a stable familial and social structure have all been named as rationalizations that support the stereotype of a "white girls disease" and suggest an invulnerability to the development of eating disorders in women of color (Root, 1990). This idea that these factors protect all women of color from the development of eating disorders "fails to take into account the reality of within-group individual differences and the complexities associated with developing a self-image within an oppressive and racist society" (Lester & Petrie, 1998, p. 2; Root, 1990).

A Common Trait in the Development of Eating Disorders

Who gets eating disorders? The one thing that appears to be a required factor for the development of an eating disorder is low self-esteem. It also appears that a history of low self-esteem needs to have been present during the individual's formative and developmental years (Bruch, 1978; Claude-Pierre, 1997; Lester & Petrie, 1995, 1998; Malson, 1998). That is to say, that a woman who develops an eating disorder at the age of 35 years old, most likely dealt with low self-esteem issues at some time prior to the age of 18 years old whether or not this issue was resolved prior to the development of an eating disorder. This trait runs cross culture (Lester & Petrie, 1995, 1998; Lee, 1990). Individuals with eating disorders also seem to be more apt to personalize and internalize negative components of their environment (Bruch, 1978; Claude-Pierre, 1997). In a sense, low self-esteem combined with a high propensity towards personalization and internalization primes the individual for the future development of an eating disorder. Cultural influences self-esteem and aids in the maintenance of an eating disorder yet does not solely account for the development of an eating disorder.

Eating Disorders and Women of Color

The relationship between ethnocultural identity and eating disorders is complex and research in this area is just beginning. In the initial research in this area, it was believed that a strong perceived need for identification with the dominant culture correlated positively to the development of eating disorders in women of color. To put another way, the greater the acculturation the greater risk of the development of an eating disorder (Harris & Kuba, 1997; Lester & Petrie, 1995, 1998; Wilson & Walsh, 1991). Aside from the remaining ethnocentric quality in this theory, current research has found no correlation between general identification with dominant white culture and the development of eating disorders in women of color. Nor has it been found that a strong identification with one's own culture protects against the development of eating disorders (Harris & Kuba, 1997; Lester & Petrie, 1995, 1998; Root, 1990). Though it has been found that when a more specific and limited measure of societal identification is used, that of the internalization of the dominant cultures values of attractiveness and beauty, there is a positive correlation in the development of eating disorders with some groups of women of color (Lester & Petrie, 1995, 1998; Root, 1990; Stice, Schupak-Neuberg, Shaw, & Stein, 1994; Stice & Shaw, 1994).

African American Women and Eating Disorders

Although research is lacking in the study of separate groups of women of color, Lester & Petrie (1998) conducted a research study involving bulimic symptomatology among African American college females. Their results indicated that when "dissatisfaction with body size and shape was higher, the self-esteem lower, and when the body mass was greater, the number of reported bulimic symptoms was also greater" (p.7). Variables that were found to not be significant indicators to symptoms of bulimia in African American college women were depression, internalization of societal values of attractiveness, or the level of identification with White culture (Lester & Petrie, 1998). Whether or not this information could be generalized to African American women outside of college is at this time unknown.

Mexican American Women and Eating Disorders

Again, it is Lester & Petrie (1995) that conducted a specific study concerning this group of women of color. Again, this study was conducted with the focus on Mexican American females in a college setting and the information gathered may or may not be salient to Mexican American women outside of the college setting. Lester & Petrie's (1995) research revealed that unlike African American women in college, the adoption and internalization of White societal values concerning attractiveness were related positively to bulimic symptomatology in Mexican American college women. Similar to African American women, body mass was also positively correlated. Body satisfaction as well as age was found to be unrelated to bulimic symptomatology in this cultural group (Lester & Petrie, 1995).

Implications for the Counselor

One basic implication for counselors would be to simply be aware of the fact that women of color can and do experience eating disorders. A question a counselor might need to keep in mind would be: Do I think of the possibility of eating disorders in a women of color who comes into my office with the same quickness that I might if the individual had been a white girl? Root (1990) notes that many mental health professionals have unconsciously bought into the notion of eating disorders as a "white girls disease" and diagnosing a women of color with a eating disorder simply doesn't cross their minds. Considering the death rate of eating disordered individuals this mistake can be extremely costly.

Another suggestion made by Harris & Kuba (1997) was to note that the identity formation of women of color in the U.S. is a complex process and the counselor needs to have a working understanding of the developmental stages of this formation. Each developmental stage can take on quite different implications when combined with an eating disorder.

Lastly, due to the white bias within the diagnostic criteria in the DSM - IV (1994) clinicians need to be willing to use the category of "Eating Disorder NOS" as to justify insurance coverage for clients with atypical symptoms (Harris & Kuba, 1997).

next: U.S. Men Have More Distorted Body Image than Asians
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Moderate, regular exercise may be just as helpful in combating serious depression in older people as anti-depressant medication, says a recent report by scientists at Duke University Medical Center.

Duke researchers studied 156 middle-aged to elderly individuals over a five-year period who suffer from major depressive disorder, also known as MDD. The participants were divided into three groups: one that exercised only, one that exercised and took anti-depression medication, and one that took medication only. The exercisers were asked to walk around a track for 30 minutes three times a week and had not been exercising previous to the study.

After 16 weeks, the scientists used structured interviews with and self-evaluation by the participants to measure their symptoms according to the definition of MDD found in the psychiatric reference book Diagnostic and Statistical Manual IV as well as on the Hamilton Rating Scale for Depression.

Symptoms of MDD by the DSM-IV definition involve depressed mood or loss of interest or pleasure combined with at least four of the following: sleep disturbances, weight loss, changes in appetite, psychomotor agitation, feelings of worthlessness or excessive guilt, impaired cognition or concentration and recurrent thoughts of death. Based on this definition, 60.4 percent of the patients who only exercised were no longer depressed after 16 weeks, compared with 65.5 percent for the medication group and 68.8 percent of the combination group.

The differences in results using both forms of measurement are not statistically significant, said Duke psychologist James Blumenthal, the lead researcher on the project. He and his colleagues did note that patients who took the anti-depressants saw their symptoms relieved sooner, but by 16 weeks the group differences had disappeared.

The statistical similarity came as a surprise, said Blumenthal. One possible explanation for this could be in the structured and supportive social environment that went along with participating in exercise part of the study. To test this hypothesis, Blumenthal intends to begin a study to gauge the effect of exercising in a less supportive atmosphere, where participants perform their exercise at home or alone. He also plans to include a no-treatment control group.

"If you bring up medication, often people don't want to take it," says Dr. Joseph Gallo, assistant professor of Family Practice and Community Medicine at the University of Pennsylvania in Philadelphia. He says that elderly patients often deny depressive symptoms, and that using exercise to treat those symptoms could be effective because exercise builds on "self-efficacy and self-confidence.- But not everyone will benefit from exercise, cautions Gallo. Because depression plays a role in how people take care of themselves, he points out it's unlikely all depressed people will be motivated to start or keep exercising. Additionally, older adults may have medical complications that prohibit them from being active. The disability can contribute to their depression, he says, but also makes movement an impossible treatment for them.

Blumenthal also suggested that exercise might be beneficial because patients are actually taking an active role in trying to get better. "Simply taking a pill is very passive. Patients who exercised may have felt a greater sense of mastery over their condition and gained a greater sense of accomplishment. They felt more self-confident and had better self-esteem because they were able to do it themselves, and attributed their improvement to their ability to exercise," he said.

"While we don't know why exercise confers such a benefit, this study shows that exercise should be considered as a credible form of treatment for these patients. Almost one-third of depressed patients in general do not respond to antidepressant medications, and for others, the antidepressants can cause unwanted side effects," said Blumenthal.

The anti-depressant used in the study was sertraline, which is a member of a class of commonly used anti-depressants known as selective serotonin reuptake inhibitors. The trade name for sertraline is trade name .

Blumenthal stressed that the study did not include patients who were acutely suicidal or suffered from what is termed psychotic depression. Furthermore, participants were recruited by advertisements and so were both interested in exercise and motivated to get better.

The results of the study were published in the Oct. 25, 1999 issue of The Archives of Internal Medicine.

next: Geriatric Depression Scale (GDS)
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Study finds it's also cheaper in the short run

Talking therapy is equally if not more effective as antidepressant drugs at preventing the return of severe depression over time, yet is cheaper than drugs in the short run.

A new study that says so-called cognitive therapy may trump medication for severe depression may strike many therapists as improbable. Psychiatric practice guidelines state most people with moderate or severe mood problems will need antidepressant drugs.

However, over the course of the 16-month study, the risk of relapse was no higher, and perhaps even lower, for those who received cognitive therapy than it was among patients taking antidepressants, the researchers found. Although mood medication led to much faster improvements in symptoms, that gap closed as the study progressed.

Antidepressants cost an average of about $350 more per patient than therapy alone -- $2,590 versus $2,250. However, the researchers say that's because cognitive therapy was front-loaded, and over the long term depression medication would be the cheaper alternative.

"If this were a new drug, people would be getting enthusiastic about it," says Steven Hollon, a Vanderbilt University psychologist and a co-author of the study. Hollon says that while a single study would be unlikely to change practice guidelines, the new results should help move the field forward.

The researchers presented their findings at at the May 2002 meeting of the American Psychiatric Association in Philadelphia.

Cognitive therapy helps people with depression cope with stresses that might buffet them in the future. It teaches them to examine their thinking for whiffs of unreality, and asks them to test those beliefs against real events.

Hollon and his colleagues followed 240 people with severe depression for 16 months. The first four months focused on resolving the acute mood problem, while the next year involved preserving the gains for those who improved.

A third of the patients received cognitive therapy, a third got the antidepressant Paxil (sold by GlaxoSmithKline, which helped fund the study), and the rest were given placebo pills. People in the drug and placebo groups also received help and encouragement taking their medication, though neither they nor the therapists knew who was receiving what.

After the first eight weeks, the active drug proved superior to either therapy or sham treatment at improving symptoms of depression on a standardized scale, the researchers found. However, by 16 weeks, 57 percent of people in both treatment groups showed significant improvement. The rate of full recovery was somewhat higher in the antidepressant drug group.

For the next 12 months, people who improved on cognitive therapy stopped regular treatment, undergoing at most three more sessions through the end of the study. Half the rest either stayed on Paxil or were switched, with their consent, to placebo pills.

Yet, despite effectively suspending treatment, only a quarter of those receiving cognitive therapy suffered at least a partial relapse during the 12-month follow-up, compared with 40 percent of the patients on Paxil. The third group fared much worse, with 81 percent relapsing.

Robert DeRubeis, a University of Pennsylvania psychologist and study co-author, says the results show cognitive therapy has a lasting effect while depression medication only helps as long as it's being taken.

"It ought to make psychiatrists feel that there are still additional ways to treat" severe depression beyond writing prescriptions. In most states, psychiatrists, but not psychologists, can prescribe medication.

Still, while the two therapies may be equally effective, not all patients with depression are the same. In a related study, Dr. Richard Shelton, a Vanderbilt University psychiatrist, analyzed the 240 patients to see if some were more likely to respond to treatment than others.

Shelton, who also presented his findings at the psychiatry meeting, found people with underlying anxiety disorders did much better on medication than they did on cognitive therapy. Meanwhile, patients with chronic depression or a history of post-traumatic stress disorder were less likely to improve with either treatment.

Shelton's group also found that patients with a history of mood problems or chronic depression, and those whose depression appeared early in life, were most likely to suffer relapses during the year of follow-up.

A government panel has recommended that every American adult be screened at the doctor's office for depression. Clinical depression affects between 5 percent and 9 percent of people over 18 in this country.

Source: HealthScout News

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Eating Disorders Not Just a Girl Problem

Although fewer men than women suffer from eating disorders, a new study indicates that the number of men with anorexia or bulimia is much higher than previously believed. Despite this, men, whose treatment needs are the same as those of women, do not seek help and, therefore, do not get adequate treatment.

"[Eating disorders] have been seen largely as an issue affecting women, and because of that, I think men have been far less likely to identify themselves as affected by it or to seek out treatment -- much in the same way as men with breast cancer tend to show up in breast cancer clinics much, much later," says the study's author, D. Blake Woodside, MD.

Because there are few large studies of men with anorexia nervosa and bulimia nervosa, Woodside, who is with the department of psychiatry at the University of Toronto, evaluated and compared 62 men and 212 women with eating disorders with a group of almost 3,800 men with no eating disorders.

Although more than twice as many women as men had eating disorders, there were more men affected than would be expected, suggesting that the occurrence of eating disorders may be higher among men than the current National Association of Anorexia Nervosa and Associated Disorders estimates. According to the group, men are thought to make up about 1 million of the 8 million Americans with eating disorders.

In terms of eating disorder symptoms and unhappiness with their lives, there was little difference between men and women with eating disorders. Both sexes suffered similar rates of anxiety, depression, phobias, panic disorder, and dependence on alcohol. Both groups also were much more unhappy with how things were going in their lives than men with no eating disorders.

Woodside says his study supports the assumption that anorexia and bulimia are virtually identical diseases in men and women.

A number of reports in the medical literature suggest that gay men account for a significant percentage of male anorexia. Woodside's study did not look at this issue, but he says it should be studied further to rule out whether gay men may simply be more likely to seek treatment for anorexia, though not necessarily more likely to suffer from the disorder than heterosexual men.

"Perhaps it may have a bit of a 'snowball effect,' because men may feel if they come forward they will be thought of as homosexual, even if they are not," Woodside says.

Another expert who treats eating disorders says society has a tendency to glamorize eating disorders while at the same time making fun of the people who have them.

"The media and society believe it's all about these beautiful models trying to lose weight, when that's really not what eating disorders are about," says Mae Sokol, MD. "They're less about food and eating and much more about people's sense of self-esteem and identity and who they are."

Sokol says anorexia may be less noticeable in men than women because men can still have muscle mass even though they are thin.

"In fact, it's more dangerous for men to develop anorexia nervosa than for females ... because when males get down to the lowest weight ranges, they've lost more muscle and tissue, whereas [fat] is something you can lose for a period of time without repercussions," says Sokol, a child and adolescent psychologist at Menninger, a psychiatric hospital in Topeka, Kan.

Despite the media's focus on anorexia, bulimia, and other eating disorders, Sokol says that men are still brought up to believe it's not something that's supposed to happen to them.

"The public thinks of it as a 'girl disease,' and these guys don't want to have to come out and say, 'I have a girl disease.' Plus, to have to come to a [eating disorder treatment facility] where most of the patients are women -- they don't feel good about that at all," she says.

Woodside agrees that feeling uncomfortable may be a big part of why men are less likely to go for help for an eating disorder.

Intervention to Help Someone with Bulimia Nervosa

"I think, for a lot of them, it's definitely a case of 'Do I fit in here?' when men come in [to a treatment center]," he says.

In an editorial accompanying Woodside's study, Arnold Anderson, MD, writes that men seeking treatment "are often excluded from programs by gender alone or are treated indistinguishably from teenage girls."

Anderson, of the department of psychiatry at University of Iowa Hospitals and Clinic in Iowa City, says more research comparing men and women with eating disorders is welcomed because it will help identify factors that may lead to different treatment approaches.

next: Eating Disorders: Men Have Body Image Problems Too
~ eating disorders library
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Diana, Princess of Wales, one of the world's most beloved women, suffered from bulimia. It is said to have developed during her unhappy marriage to Charles, Prince of Wales. When she married, Princess Diana was normal weight. By 1987, she was emaciated. She helped women worldwide face their own eating disorders when she publicly discussed her own. At the time of her tragic death in an auto accident in 1997, she seemed to be in recovery.

People admired Diana for her warmth, beauty and devotion to her sons. But most of all, they identified with her exquisite vulnerability.

(See "The Tarnished Crown," Anthony Holden, Random House, 1993)

Jane Fonda, actress, activist, athlete, wife and mother, was one of the first famous women to openly discuss her eating disorder. In the late 1970s, she went public with her "bulimarexia," the binge-and-vomit cycle that nearly ruined her health. Overwhelmed by the the demands of the Hollywood culture, she spent nearly 20 years in the relentless pursuit of thinness. She changed her life by opening her heart and mind to Buddhism, yoga, healthy eating and the relentless pursuit of exercise.
Women all over the world see Jane Fonda as a beacon of light in the eating disorders awareness movement. She is a role model of strength, determination and honesty. "Go for the burn" rings in their ears as they push themselves towards ever-greater physical endurance.

(See "Jane Fonda's Workout Book," Jane Fonda, Simon and Schuster, 1981)

Joan Rivers, commedienne, author, entrepreneur and mother developed "acute onset" bulimia after the tragic suicide of her husband, Edgar Rosenberg. Devasted by the loss, her appetite went into orbit as she launched her gastronomic space program--bags of cookies, whole cakes and ice cream by the gallon. She was so angry and despondent that for a moment she too considered suicide. The love of those around her caused her to take stock. She began to count her blessings, not her losses. She sought counseling. She volunteered to help others. She learned that the long journey back to health begins with small steps. Step-by-step, she recovered.

(See "Bouncing Back," Joan Rivers, Harper Collins, 1966)

next: Loss and Bulimia
~ all Beat Bulimia articles
~ eating disorders library
~ all articles on eating disorders

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1. Intimacy Issues Homepage
2. What is Intimacy?
3. How Important is Sex to Intimacy?
4. Intimacy Not Just Sex
5. Sex and Intimacy
6. The Relationship Between Sex and Intimacy
7. Understanding Intimacy
8. Fear of Intimacy
9. Clearing the Roadblocks to Intimacy
10. Why Men Pay For Sex
11. How To Develop Intimacy With Your Partner
12. Tips for Showing You Care
13. Starving for Emotional Intimacy - Why Wait For Sex?
14. Talking to Your Kids About Sex

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