Chapter 40: EGO

I believe the writing of Eckhart Tolle on the subject of egos in his book, A New Earth, is profound.  Applying these teachings to my life have helped me heal depression symptoms this past year.  My thinking has changed.  What do you think?  Do you think changing your thinking can help depression?  Do you think these concepts are truth?

 1.  p. 59  Chapter 3  The Core of Ego

"Most people are so completely identified with the voice in the head---the incessant stream of involuntary and compulsive thinking and the emotions that accompany it---that we may describe them as being possessed by their mind.  As long as you are completely unaware of this, you take the thinker to be who you are.  This is the egoic mind."

2.  p. 61-62  COMPLAINING AND RESENTMENT

Complaining is one of the ego's favorite ways to strengthen itself, and resentment is the emotion that goes along with it.  Mental labeling of people adds even more energy to the ego. 

"Name-calling is the crudest form of such labeling and of the ego's need to be right and triumph over others:  jerk, bastard, bitch ---all definitive pronouncements that you can't argue with.  On the next level down on the scale of unconsciousness, you have shouting and screaming, and not much below that, physical violence."

3.  p. 63  COMPLAINING AND RESENTMENT

"Complaining is not to be confused with informing someone of a mistake or deficiency so that it can be put right."  This type of complaining desires change, the ego kind enjoys making someone wrong.

4.  p. 68  IN DEFENSE OF AN ILLUSION 

"Every ego confuses opinions and viewpoints with facts.  Furthermore, it cannot tell the difference between an event and its reaction to that event.  Every ego is a master of selective perception and distorted interpretation.  Only through awareness--not through thinking---can you differentiate between fact and opinion."  The ego is strengthened by a sense of boundary, separateness, and superiority.

5.  p. 76  WAR IS A MINDSET  

"Recognize the ego for what it is:  a collective dysfunction, the insanity of the human mind.  When you recognize it for what is is, you no longer misperceive it as somebody's identity." 

6.  p. 77-78  BEYOND EGO:  YOUR TRUE IDENTITY 

"When the ego is at war, know that it is no more than an illusion that is fighting to survive.  That illusion thinks it is you.  It is not easy at first to be there as the witnessing Presence, especially when the ego is in survival mode or some emotional pattern from the past has become activated, but once you have had a taste of it, you will grow in Presence power, and the ego will lose its grip on you.  And so a power comes into your life that is far greater than the ego, greater than the mind.  All that is required to become free of the ego is to be aware of it, since awareness an ego are in compatible."

 7.  p. 79  BEYOND EGO:  YOUR TRUE IDENTITY

"What remains is the light of consciousness in which perceptions, experiences, thoughts, and feelings come and go.  That is Being, that is the deeper, true I.  When I know myself as that, whatever happens in my life is no longer of absolute but only of relative importance.  I honor it, but it loses its absolute seriousness, its heaviness.  The only thing that ultimately matters is this:  Can I sense my essential Beingness, the I Am, in the background of my life at all times?"  . . ."Or am I losing myself in what happens, losing myself in the mind, in the world?" 

 8.  p. 79   ALL STRUCTURES ARE UNSTABLE

"Whatever form it takes, the unconscious drive behind ego is to strengthen the image of who I think I am, the phantom self that came into existence when thought---a great blessing as well as a great curse---began to take over and obscured the simple yet profound joy of connectedness with Being, the Source, God."

  9.  p. 79-80  ALL STRUCTURES ARE UNSTABLE

"Whatever behavior the ego manifests, the hidden motivating force is always the same:  the need to stand out, be special, be in control; the need for power, for attention, for more.  And, of course, the need to feel a sense of separation, that is to say, the need for opposition, enemies."

10.  p. 85  Chapter 4 Role-playing:  The Many Faces of the Ego

"An ego that wants something from another---and what ego doesn't---will usually play some kind of role to get its 'needs' met, be they material gain, a sense of power, superiority, or specialness, or some kind of gratification, be it physical or psychological.  Usually people are completely unaware of the roles they play.  They are those roles."

11.  p. 86  Role-playing:  The Many Faces of the Ego

"All you need to know and observe in yourself is this:  Whenever you feel superior or inferior to anyone, that's the ego in you."

12.  p. 87  VILLAIN, VICTIM, LOVER

"The playing of negative roles becomes particularly pronounced whenever the ego is magnified by an active pain-body, that is to say, emotional pain from the past that wants to renew itself through experiencing more pain."

13.  p. 88  VILLAIN, VICTIM, LOVER

"What is commonly called 'falling in love' is in most cases an intensification of egoic wanting and needing.  You become addicted to another person, or rather to your image of that person.  It has nothing to do with true love, which contains no wanting whatsoever."

14.  p. 89  LETTING GO OF SELF-DEFINITIONS 

"Only rare beings at the time, such as the Buddha or Jesus, saw the ultimate irrelevance of caste or social class, recognized it as identification with form and saw that such identification with the conditioned and the temporal obscured the light of the unconditioned and eternal that shines in each human being."

15.  p. 90-91  PRE-ESTABLISHED ROLES 

"What really matters is not what function you fulfill in this world, but whether you identify with your function to such an extent that it takes you over and becomes a role that you play.  When you play roles, you are unconscious.  When you catch yourself playing a role, that recognition creates a space between you and the role.  It is the beginning of freedom from the role."

16.  p. 95-96  HAPPINESS AS A ROLE VS. TRUE HAPPINESS 

"If there is unhappiness in you, first you need to acknowledge that it is there.  But don't say, 'I'm unhappy.'  Unhappiness has nothing to do with who you are.  Say: 'There is unhappiness in me.'  Then investigate it.  A situation you find yourself in may have something to do with it.  Action may be required to change the situation or remove yourself from it.  If there is nothing you can do, face what is and say, 'Well, right now, this is how it is.  I can either accept it, or make myself miserable'."

17.  p. 96  HAPPINESS AS A ROLE VS. TRUE HAPPINESS

"Unhappiness covers up your natural state of well-being and inner peace, the source of true happiness."

18.  p. 98  PARENTHOOD:  ROLE OR FUNCTION?
 
"If their desire to control or influence the actions of their adult child is thwarted---as it usually is---they will start to criticize or show their disapproval, or try to make the child feel guilty, all in an unconscious attempt to preserve their role, their identity.  On the surface it looks as if they were concerned about their child, and they themselves believe it, but they are only really concerned about preserving their role-identity."

19.  p. 100  PARENTHOOD:  ROLE OR FUNCTION?

"My parents should approve of what I do.  They should understand me and accept me for who I am."  "Really?  Why should they?  The fact is they don't because they can't.  Their evolving consciousness hasn't made the quantum leap to the level of awareness yet.  They are not yet able to disidentify from their role."  . . ."What difference does their approval or disapproval truly make to who you are?  All such unexamined assumptions cause a great deal of negative emotion , much unnecessary unhappiness."

20.  p.101  CONSCIOUS SUFFERING 

"If you have young children, give them help, guidance, and protection to the best of your ability, but even more important, give them space---space to be.  They come into this world through you, but they are not 'yours.'  The belief 'I know what's best for you' may be true when they are very young, but the older they get, the less true it becomes.  The more expectations you have of how their life should unfold, the more you are in your mind instead of being present for them.  Eventually, they will make mistakes, and they will experience some form of suffering, as all humans do.  In fact, they may be mistakes only from your perspective.  What to you is a mistake may be exactly what your children need to do or experience."

21.  p. 102  CONSCIOUS SUFFERING 

"As long as you resist suffering, it is a slow process because the resistance creates more ego to burn up.  When you accept suffering, however, there is an acceleration of that process which is brought about by the fact that you suffer consciously." 

22.  p. 103  CONSCIOUS PARENTING

"Many children harbor hidden anger and resentment toward their parents and often the cause is inauthenticity in the relationship.  The child has a deep longing for the parent to be there as a human being, not as a role, no matter how conscientiously that role is being played.  You may be doing all the right things and the best you can for your child, but even doing the best you can is not enough.  In fact, doing is never enough if you neglect Being."

23.  p.106  GIVING UP ROLE-PLAYING

"To do whatever is required of you in any situation without it becoming a role that you identify with is an essential lesson in the art of living that each one of us is here to learn."

24.  p. 112  THE PATHOLOGICAL EGO

"Negativity is not intelligent.  It is always of the ego.  The ego may be clever, but it is not intelligent.  Cleverness pursues its own little aims.  Intelligence sees the larger whole in which all things are connected."  . . ."Cleverness divides; intelligence includes."

25.  p.  114-115  THE SECRET OF HAPPINESS

"Being at peace and being who you are, that is, being yourself, are one.  The ego says:  Maybe at some point in the future, I can be at peace---if this, that, or the other happens, or I obtain this or become that.  Or it says:  I can never be at peace because of something that happened in the past."  . . ."The ego doesn't know that your only opportunity for being at peace is now.  Or maybe it does know, and it is afraid that you may find this out.  Peace, after all, is the end of the ego." 

26.  p.  115  THE SECRET OF HAPPINESS

"There are three words that convey the secret of the art of living, the secret of all success and happiness:  One With Life.  Being one with life is being one with Now.  You then realize that you don't live your life, but life lives you.  Life is the dancer, and you are the dance."

27.  p. 120  PATHOLOGICAL FORMS OF EGO

"The collective ego of tribes, nations, and religious organizations also frequently contains a strong element of paranoia:  us against the evil others.  It is the cause of much human suffering."  (Spanish Inquisition, burning of heretics and witches, First & Second World Wars, Communism, "Cold War", McCarthyism, violent conflict in the Middle East)

28.  p. 120  PATHOLOGICAL FORMS OF EGO

"The more unconscious individuals, groups or nations are, the more likely it is that egoic pathology will assume the form of physical violence.  Violence is a primitive but still very widespread way in which the ego attempts to assert itself, to prove itself right and another wrong.  With very unconscious people, arguments can easily lead to physical violence."

29.  p.  121  WORK---WITH AND WITHOUT EGO

"Most people have moments when they are free of ego.  Those who are exceptionally good at what they do may be completely or largely free of ego while performing their work.  They may not know it, but their work has become a spiritual practice."

30.  p.  122  WORK---WITH AND WITHOUT EGO

"They are one with what they do, one with the Now, one with the people or the task they serve.  The influence such people have upon others goes far beyond the function they perform.  They bring about a lessening of the ego in everyone who comes into contact with them.  Even people with heavy egos sometimes begin to relax, let down their guard, and stop playing their roles when they interact with them.  It comes as no surprise that those people who work without ego are extraordinarily successful at what they do.  Anybody who is one with what he or she does is building the new earth."

Chapter 39: The Constant Chatter In My Mind Is Not Me

I know my mind is not me.  I know the constant chatter in my head is not me.  If I do not become the watcher of my mind, my ego and pain-body analyze the past over and over and make up outrageous scenarios for the future.  They judge, criticize, compare, complain, lament, whine, degrade and take a position.

If I am present and watching what my mind is saying, I can question what is being said.  If it is not true and I recognize it, I will save myself from experiencing the emotions that go with the thoughts.  I do not want to waste time and energy trying to solve problems that have been made up by my ego or pain-body.  Staying in the present, living in the moment, has reduced the stress in my life.  For me, this has been an important part of the healing process from the disease depression. 

I learned how to change my thinking from Eckhart Tolle and his books.  I have talked about these books in many chapters of my blog.  "The Power of Now", Chapter 6, Chapter 14, Chapter 16, Chapter 18, and Chapter 19.  "A New Earth", Chapter 5, Chapter 6, and Chapter 19.  I don't agree with all of the concepts Eckhart Tolle teaches, but most of them I do.  Some of his beliefs do not correspond to the religious teachings I believe. I have written quite a bit about the things he taught me that have changed my life for the better.  I would also like to write about my religious beliefs that are different than his.  I will do that. =)       

There have been times in the past when a thought has come into my head that I didn't like, or wasn't consistent with what I believe.  It was awesome to learn that this type of thought came from my ego or pain-body.  The present part of me, or what I like to call my higher self, would not have a thought like that and I can dismiss it without feeling guilty about thinking it.  Being present, or in my higher self, brings more peace into my life.  I have to make a conscious effort every day to have my higher self be in charge of my life.

How Stress, Anxiety, and Depression Affect Your Health

WebMD

Reviewed by Amal Chakraburtty, MD on March 01, 2010

© 2010 WebMD, LLC. All rights reserved. 

How Does Stress Affect Health?

Controlling stress is important to our health. Unrelenting stress can turn to distress. Stress is the body's reaction to any change that requires a physical, mental, or emotional adjustment or response. Stress is a normal part of life. Many events that happen to you and around you -- and many things that you do to yourself -- put stress on your body. Some stress can be good. It keeps us alert, motivated, and ready to avoid danger. But too much stress can make us sick.

Stress that continues without relief can lead to a condition called distress -- a negative stress reaction. Distress can disturb the body's internal balance or equilibrium, leading to physical symptoms such as headaches, an upset stomach, elevated blood pressure, chest pain, sexual dysfunction, and problems sleeping. Emotional problems can also result from distress. These problems include depression, panic attacks, or other forms of anxiety and worry. Research suggests that stress also can bring on or worsen certain symptoms or diseases. Stress is linked to six of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and even suicide.

Stress also becomes harmful when people engage in the compulsive use of substances or behaviors to try to relieve their stress. These substances or behaviors may include food, alcohol, tobacco, drugs, gambling, sex, shopping, and the Internet. Rather than relieving the stress and returning the body to a relaxed state, these substances and compulsive behaviors tend to keep the body in a stressed state causing more problems. The distressed person becomes trapped in a vicious circle. 

Link between Stress, Anxiety, Depression 

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 12, 2010  

PsychCentral

Source: University of Western Ontario

Researchers have discovered a biological link between stress, anxiety and depression. 

Lead researcher Stephen Ferguson believes that the connecting mechanism in the brain explains how stress and anxiety could lead to depression. The study also reveals a small molecule inhibitor, developed by Ferguson, which may provide a new and better way to treat anxiety, depression and other related disorders.

The findings are published online in the journal Nature Neuroscience.

Ferguson, Ana Magalhaes and their colleagues used a behavioral mouse model and a series of molecular experiments to reveal the connection pathway and to test the new inhibitor. 

“We’ve gone from mechanism to mouse, and the next step is to see whether or not we can take the inhibitor we developed, and turn it into a pharmaceutical agent.”

The research was conducted in collaboration with Hymie Anisman at Carleton University, and funded through the Canadian Institutes of Health Research (CIHR).

“According to the World Health Organization, depression, anxiety and other related mood disorders now share the dubious distinction of being the most prevalent causes of chronic illness,” says Anthony Phillips, the scientific director of the CIHR Institute of Neurosciences, Mental Health and Addiction.

“Using the power of molecular biology, Stephen Ferguson and colleagues provide novel insights that may be the key to improving the lives of so many individuals coping with these forms of mental ill health.”

The linking mechanism in the study involves the interaction between corticotropin releasing factor receptor 1 (CRFR1) and specific types of serotonin receptors (5-HTRs).

While no one has been able to connect these two receptors on a molecular level, the study reveals that CRFR1 works to increase the number of 5-HTRs on cell surfaces in the brain, which can cause abnormal brain signaling.

Since CRFR1 activation leads to anxiety in response to stress, and 5-HTRs lead to depression, the research shows how stress, anxiety and depression pathways connect through distinct 

processes in the brain.

Most importantly, the inhibitor developed by the Ferguson lab blocks 5-HTRs in the pathway to combat anxious behavior, and potentially depression, in mice.

While major depressive disorder often occurs together with anxiety disorder in patients, the causes for both are strongly linked to stressful experiences. Stressful experiences can also make the symptoms of anxiety and depression more severe.

By discovering and then blocking a pathway responsible for the link between stress, anxiety and depression, Ferguson not only provides the first biological evidence for a connection, but he also pioneers the development of a potential drug for more effective treatment.

Genetic Link Between Stress and Depression

Study Shows People With a Genetic Mutation May Be More Likely to Develop Depression

By Jennifer Warner
WebMD Health News

Reviewed by Laura J. Martin, MD

Feb. 7, 2011 -- A gene that influences how the brain responds to stress may also play a key role in depression.

A new study shows people with a certain genetic mutation that causes them to produce less of the brain chemical neuropeptide Y (NPY) have a more intense negative emotional response to stress and may be more likely to develop depression than others.

Researchers found low levels of neuropeptide Y caused a stronger emotional response to negative stimuli and physiological response to pain in the brain, which may make people less resilient in the face of stress and more prone to depression.

"We've identified a biomarker -- in this case genetic variation -- that is linked with increased risk of major depression," says researcher Jon-Kar Zubieta, MD, PhD, professor of psychiatry and radiology at the University of Michigan, in a news release. "This appears to be another mechanism, independent of previous targets in depression research, such as serotonin, dopamine and norepinephrine." 

Genetic Link to Depression

In three separate tests, researchers looked at the link between this genetic mutation and depression in 39 adults with depression and 113 healthy adults. The results are published in the Archives of General Psychiatry.

First, researchers measured the amount of NPY expression in each of the participants and used functional magnetic resonance imaging (fMRI) to measure the brain's response to positive, neutral, or negative words like "hopeful," "material," or "murderer."

The results showed people with low levels of this brain molecule had much more activity in an area of the brain associated with regulating emotions, the prefrontal cortex, than those with high levels. 

Response to Stress

In a second experiment, researchers measured the response to a stressful event involving injecting saline solution into a jaw muscle, which produces moderate pain for about 20 minutes, but no lasting harm.

The study showed those with low neuropeptide Y rated their emotional response as more negative while anticipating the event before and immediately after the event while reflecting on their experience.

"This tells us that individuals with the risk-associated NPY gene variant tend to activate this key brain region more than other people, even in the absence of stress and before psychiatric symptoms are present," says researcher Brian Mickey, MD, PhD, assistant professor in the department of psychiatry at the University of Michigan Medical School, in the news release.

Finally, researchers found participants with this genetic variation were much more likely to have been diagnosed with depression than those without it.

"These are genetic features that can be measured in any person. We hope they can guide us toward assessing an individual's risk for developing depression and anxiety," Mickey says.

SOURCES: Mickey, B. Archives of General Psychiatry, February 2011; vol 68: pp 158-166.News release, University of Michigan Health System.

©2011 WebMD, LLC. All Rights Reserved.

I am excited about the research that may lead to new treatment options for depression.  Below is a summary of the two research articles above. 

1.  CRFR1 (corticotropin releasing factor receptor 1) works to increase the number of 5-HTRs (specific types of serotonin receptors) on cell surfaces in the brain, which can cause abnormal brain signaling.  CRFR1 activation leads to anxiety in response to stress, and 5-HTRs lead to depression.  The research shows how stress, anxiety, and depression pathways connect through distinct processes in the brain.  This is the first biological evidence for a connection between stress, anxiety, and depression.  

The small molecule inhibitor developed by the Ferguson lab blocks 5-HTRs in the pathway to combat anxious behavior, and potentially depression, in mice.  The researchers are hoping to take the inhibitor they developed, and turn it into a pharmaceutical agent.

2.  People with a genetic mutation that causes them to produce less of the brain chemical neuropeptide Y (NPY), have a more intense negative emotional response to stress and may be more likely to develop depression than others.  People with low levels of this brain molecule had much more activity in an area of the brain associated with regulating emotions, the prefrontal cortex, than those with high levels. 

Individuals with the risk-associated NPY gene variant tend to activate this key brain region more than other people, and participants with this genetic variation were much more likely to have been diagnosed with depression than those without it.  This information will help in assessing an individual's risk for developing depression and anxiety, and may lead to a way to manipulate NPY to improve depression and anxiety symptoms.

Lowering my stress levels help me manage the depression symptoms.  Regular aerobic exercise and weight training help me reduce stress.  I feel the best when I use our Cross Trainer (eliptical) every day, but that doesn't always happen.  

Changing my thinking patterns have also been a great help in lowering stress.  Eckhart Tolle teaches, "Wherever you are, be there totally.  If you find your here and now intolerable and it makes you unhappy, you have three options:  remove yourself from the situation, change it, or accept it totally.  If you want to take responsibility for your life, you must choose one of those three options, and you must choose now."  "The Power of Now", page 82.

What do you do to reduce your stress levels?  Does it help manage your depression symptoms?  Please share.

Chapter 38: Depression & Inflammation ARE Linked

 Another excellent article explaining why inflammation can cause depression.

Strong link seen between depression, inflammation

Clinical Psychiatry News, June, 2006 by Damian McNamara

SAN JUAN, P.R. -- Growing evidence points to an association between inflammation and depression, according to a presentation at the annual meeting of the American College of Psychiatrists.

For example, depressed patients have elevated inflammatory markers--such as interleukin-6 and C-reactive protein. In fact, the levels of proinflammatory cytokines correlate with the severity of depressive symptoms in studies. In addition, administration of cytokine antagonists can effectively reverse depressive symptoms in patients, Dr. Andrew H. Miller said.

"We really stand at a point that is very exciting in terms of novel therapies and translation of research," Dr. Miller said. "The notion quite simply is that stress or depression affects the HPA [hypothalamic-pituitary-adrenal] axis, [affects] the endocrine system, alters the immune system, and leaves patients open to diseases."

Physicians from many specialties already recognize that inflammation plays a key role in cardiovascular disease, diabetes, metabolic syndrome, and cancer, said Dr. Miller, professor in the department of psychiatry and behavioral sciences at Emory University, Atlanta.

"We did not want to be left out in terms of psychiatry," said Dr. Miller, who also is director of the psychiatric oncology program at the Winship Cancer Institute at Emory.

There are multiple possible mechanisms whereby inflammation could cause depression. Inflammatory cytokines released peripherally might reach the brain through active transport, passage through leaky regions in the blood-brain barrier, or transmission through afferent nerve fibers (vagus nerve), Dr. Miller said. There is a cytokine network in the central nervous system, and glia and microglia are the richest source of cytokines in the brain. Neurons also produce and express cytokines.

"We've learned these cytokines have access to the brain and ... ultimately can change behavior," Dr. Miller said. Inflammatory cytokines cause anhedonia (an inability to experience pleasure), fatigue, cognitive dysfunction, and other flu-like symptoms in sick patients. In addition, researchers induced behavioral changes that resemble major depression in human and animal studies with administration of proinflammatory cytokines.

Some therapeutic cytokines cause depression. For example, interferon-[alpha] (IFN-[alpha]) is used to treat viral infections and cancer because it is a potent inducer of the inflammatory cytokine network, especially interleukin-6, Dr. Miller said. "Oncologists told us early on this drug causes a lot of depression."

A total of 60% of patients treated with IFN-[alpha] reported depressed mood in one study (Neuropsychopharmacology 2002;26:643-52). Dr. Miller and his associates also found a 45% incidence of major depression among patients with malignant melanoma treated with IFN-[alpha] (N. Engl. J. Med. 2001;344:961-6).

The good news is that paroxetine (Paxil) aggressively blocked development of depression. "Just 11% developed depression, so there was a fourfold reduction with this pretreatment.

"There is a caveat. If you give a drug that causes release of dopamine--for example, paroxetine--that dopamine becomes oxidized and in the long term can damage basal ganglia," Dr. Miller said in response to a question from a person attending the meeting. "So we're using dopamine antagonists to block this until we get more information about what we are doing to patients."

Physician reaction to his study varied, Dr. Miller said. "The people who got on us the most for that study with paroxetine were the ones who were treating hepatitis C. They said we'd expose a lot of people to antidepressants who don't really need them." However, "with melanoma, many patients will not go back on interferon therapy, and giving antidepressant prophylaxis might help."

In another study, patients with psoriasis treated with the cytokine antagonist etanercept experienced reversal of their depressive symptoms (Lancet 2006;367:29-35). Improvement in depression was independent of the drug's effect on disease progress.

The wider picture may be a link between stress, depression, and illness, Dr. Miller said. In one study in review, patients with major depressive disorder exhibited an exaggerated inflammatory response to stress.

"There is an interesting possible link between depression and a wide variety of medical disorders where inflammation plays a role," Dr. Miller said. It "may explain high comorbidity of some medical conditions with depression.

"Psychiatry is now catching up to other medical specialties in recognizing the adverse effects of inflammation," Dr. Miller added. "Psychiatrists need to keep an eye on this. The idea that the immune system might affect the brain and vice versa presents a lot of novel targets for treating psychiatric disorders."

BY DAMIAN MCNAMARA

Miami Bureau

COPYRIGHT 2006 International Medical News Group

COPYRIGHT 2008 Gale, Cengage Learning

My Summary of the Article:  Strong link seen between depression, inflammation

Clinical Psychiatry News, June, 2006 by Damian McNamara

1.  Patients with depression have elevated inflammatory markers in their blood such as interleukin-6 and C-reactive protein.  

 2.  The levels of elevated inflammatory markers in the blood of depressed patients, called proinflammatory cytokines, correlate with the severity of depressive symptoms. 

 3.  Administration of cytokine antagonist drugs can effectively reverse depressive symptoms in patients.
 4.  Stress or depression affects the HPA [hypothalamic-pituitary-adrenal] axis, affects the endocrine system, alters the immune system, and leaves people open to diseases.

 5.  Inflammatory cytokines may reach the brain by transport through the blood, giving them passage through leaky regions in the blood-brain barrier, or transmission through nerve fibers to the central nervous system.

 6.  Inflammatory cytokines in the brain cause the inability to experience pleasure (anhedonia), fatigue, cognitive dysfunction, and flu-like symptoms in sick patients.

 7.  When researchers administered proinflammatory cytokine drugs in human and animal studies it induced behavioral changes that resembled major depression.

 8.  Interferon is a drug called a therapeutic cytokine used to treat viral infections and cancer.  It induces the inflammatory cytokine network, especially interleukin-6, and causes depression in patients taking the drug.

 9.  Dr. Andrew H. Miller and his associates found a 45% incidence of major depression among patients with malignant melanoma treated with IFN-[alpha], another therapeutic cytokine.

10.  Patients taking Paxil while using a therapeutic cytokine were relieved of depression symptoms.  This may help patients stay on a therapeutic cytokine drug that is causing depression.

11.  Patients with psoriasis were treated with the cytokine antagonist drug etanercept (Enbral). They experienced reversal of their depressive symptoms even if the drug wasn't effective on the psoriasis.
12.  Patients with major depressive disorder showed an exaggerated inflammatory response to stress.
13.  There is a possible link between depression and a wide variety of medical disorders where inflammation plays a role.
14.  Psychiatry is now catching up to other medical specialties in recognizing the adverse effects of inflammation.
15.  The immune system affecting the brain, and the brain affecting the immune system presents a lot of new ways to treat psychiatric disorders.

Cytokines were talked about so much in the above article, I wanted to learn more about them.  The following article is from BioPortal / Cytokines. 

  What are Cytokines? 

Cytokines, also known as immune factors, are protein produced naturally by the cells and organs of the human immune system. They act on other immune system cells modulating the body's response to disease and infection. Cytokines can also regulate the growth of new blood cells in the bone marrow.

Cytokines play a crucial role in the immune system response to all kinds of disease. They interact with organs and cells, alone and in combination with each other. The diverse role that cytokines serve in the immune system make them an ideal target for intervening or bolstering immune responses. Using recombinant DNA technology cytokines can be created in a laboratory. They have many treatment applications including cancer, multiple sclerosis, anaemia, and rheumatoid arthritis.

  Types of Cytokines

There are several types of cytokines with different varieties within each type. The following are the cytokines naturally produced by the body and the immune cells that produce them: 

Interferons (IFNs) have three main varieties. Produced by a number of immune system cells. Eg: White blood cells.  

Interleukins (ILs) have more than ten varieties. Produced by the white blood cells (leukocytes). 

Tumour Necrosis Factors (TNFs) have two main varieties. Produced by a number of immune system cells. Eg: T-Cells, white blood cells.  

Colony Stimulating Factors (CSFs) have many varieties and names. Produced by T-Cells and macrophages. 

Erythropoietin (Epoetin/EPO) has several varieties. Mainly produced by the kidney (10-15 percent originating in the liver). 

Thymopoietin has three main varieties. Produced by the thymus.

The Science - How do Cytokines Work?

Cytokines work in ways very similar to hormones. They are released by immune cells into the circulation or locally in a tissue. Cytokines interact with receptors on target immune system cells. This interaction triggers a cascade of biochemical reactions such as the release of other cytokines, cell division, or cell differentiation, that leads to a given event. Each type and variety of cytokine has distinct effects on specific targets: 

Interleukin 2 (IL-2) - This is the only variety of IL that is currently used therapeutically. It Interacts with T-cells that have been activated by an infection and triggers T-cell division increasing the number in circulation. IL-2 also stimulates the division of B-Cells and works in the bone marrow to promote the differentiation of stem cells into immune cells.

Interferon - Has numerous therapeutic applications including:

  Stimulating activity in other immune system cells,

  Inhibiting growth in some types of cancer cells,

  Increasing immune cell capacity to bind foreign particles,

  Modulating the production of antibodies, and 

  Inhibiting viral protein synthesis, through a system of interactions.

Erythropoietin - Stimulates stem cells in the bone marrow to differentiate into mature red blood cells. 

Colony Simulating Factors - Stimulate stem cells in the bone marrow to differentiate into immune cells called "neutrophils." Neutrophils are an important component of the body's inflammatory response to infection. CSF's can also stimulate activity in other immune system cells.

Cytokines can also work in combination to produce different effects in the body. Some therapies combine more than one cytokine to achieve their results.

  Biotechnology and Cytokines

Therapeutic cytokines are produced through recombinant DNA techniques. The human gene that codes for the desired cytokine is inserted into a host cell, such as the bacteria species E-coli, yeast, or the cells of mammals or insects. The cells then act as factories, producing the desired human protein.

Proteins produced by non-human cells (like those produced through yeast or E-coli) will vary slightly from the those produced naturally in the body. Small variations in structure can cause therapeutic cytokines to behave differently from their natural counterparts. Therefore, recombinant cytokines are studied further to determine if they will behave differently due to the variations.

I want to ask my psychiatrist if anti-inflammatory drugs may help my depression symptoms, or if there are other cytokine antagonist drugs that would be more effective.  This short abstract of an article talks about cytokine-based therapies.  An Overview of Cytokines and Cytokine Antagonists as Therapeutic Agents

Donnelly, R. P., Young, H. A. and Rosenberg, A. S. (2009), An Overview of Cytokines and Cytokine Antagonists as Therapeutic Agents. Annals of the New York Academy of Sciences, 1182: 1–13. doi: 10.1111/j.1749-6632.2009.05382.x

Keywords:

• cytokines;
• inflammation;
• interferons;
• interleukins;
• receptors

Cytokine-based therapies have the potential to provide novel treatments for cancer, autoimmune diseases, and many types of infectious disease. However, to date, the full clinical potential of cytokines as drugs has been limited by a number of factors. To discuss these limitations and explore ways to overcome them, the FDA partnered with the New York Academy of Sciences in March 2009 to host a two-day forum to discuss more effective ways to harness the clinical potential of cytokines and cytokine antagonists as therapeutic agents. The first day was focused primarily on the use of recombinant cytokines as therapeutic agents for treatment of human diseases. The second day focused largely on the use of cytokine antagonists as therapeutic agents for treatment of human diseases. This issue of the Annals includes more than a dozen papers that summarize much of the information that was presented during this very informative two-day conference.

I hope research in the link between inflammation and depression will lead to new, effective treatment options for depression!

Chapter 37: Treat INFLAMMATION Ease DEPRESSION?

"By 2020, depressive disorders are projected to be the 2nd leading cause of worldwide disability. The burden of Mood Disorders is rising both for the individual, the family, and for the society. Currently, most people who are treated for depression are partially responsive or non-responsive. New tools are needed. One of these tools involves a focus on the inflammation, immune dysfunction, and infections that are often associated with depression."  

Above quote by:

Robert J. Hedaya, M.D., D.F.A.P.A., a Clinical Professor of Psychiatry at the Georgetown University Hospital and Founder of the National Center for Whole Psychiatry; from an article he wrote for, Psychology Today, published on March 31, 2009, called Depression, Inflammation, Immunity and Infection.

I agree that many people treated for depression are only partially responsive or non-responsive, and new treatment tools are needed! I believe the research in inflammation, immunity, and infection could lead to new types of therapy for depression.  What do you think?

The following disorders are caused by immunity-inflammation:  Heart disease, diabetes, Crohn's disease, autoimmune diseases, cancers, HIV, and Multiple Sclerosis.  Depression is a second condition that goes along with these diseases.

I believe the information in the article written by Dr. Robert J. Hedaya is so important I have included all of it in my blog.

"The brain and the immune system talk to each other, and the communication is bi-directional. This means that inflammation (such as that which occurs due to infection) affects the brain. It also means that changes in brain immunity and inflammation affect the body. A meta-analysis of several studies on this issue found that several cytokines (hormones of the immune system) and markers of inflammation (C-reactive protein, interleukin 1 and 6) were positively correlated with depression. This means the more depression there is, the more inflammation there is. Cytokines seem to trigger a quick onset of what is called ‘sickness behavior'-meaning malaise and fatigue, as well as a delayed onset of depressed mood. One study found the same very close correlation between certain cytokines, mood, anxiety and memory. 

Reducing inflammation may help alleviate depression: In a randomized placebo controlled trial of a COX-2 inhibitor -celebrex-(celecoxib-blocks pro-inflammatory eicosanoids) with reboxetine (a noradrenergic-reuptake inhibitor antidepressant) augmentation with celecoxib was superior to placebo.

A second randomized double blind placebo controlled study showed that etanercept (a TNF-tumor necrosis factor-blocker) reduced depressive symptoms in people with psoriasis, independent of improvement in the psoriasis. This is consistent with elevated levels of plasma TNF elevations found in depressed patients.

Of further relevance is the fact that the core stress response system in the brain activates and regulates the adrenalin-immune connection in the body (this includes the bone marrow and the thymus gland), as well as secondary immune organs (spleen and lymph nodes). Thus, through this pathway (and there are others), stress affects immune function. On the other hand, not only do the brain stress circuits affect the immune system, but the hormones of the immune system-the cytokines referred to above-are known to make the stress circuits of the brain more sensitive.

Another interesting linkage path between the immune system and the brain is the vagus nerve. This nerve system, when activated, opposes the adrenalin system. When it is activated it stimulates the motivational centers in the brain directly, and through the brain's own immune cells (called microglia) increases nor-adrenalin and serotonin.

Chemicals of inflammation, the cytokines I referred to above, can be released by the brain microglia, causing a shift in the balance between helping neurons to grow, and putting them to death. When shifted in the wrong direction, these microglia actually stop the brain from making serotonin, and in that case, any medication that works on serotonin-such as Prozac, Zoloft etc-can not work. (This is part of the reason for ‘Prozac poop out', and this is why I regularly tell my patients that if an anti-depressant has worked for you for 6 months, and then stops working, something else is going on.) The brain production of serotonin does not return to normal for months after an infection.

How can you know if inflammation, infection, or immune dysfunction are playing a role in your depression? Ask yourself these questions: Yes answers imply immune/inflammatory/infectious processes. The more ‘yes' answers the higher the likelihood.

Do I have a physical sense of ‘brain fog'?

Do I have a recent reduction in ‘room-to-room' memory (short term memory)?
Do I have trouble finding words?
Do I sometimes feel confused?
Do I have learning disabilities, or neurodegenerative disorders (e.g.,Alzheimer's is an inflammatory disorder)
Do I feel that if I had plenty of energy my depression would be gone?
Do I have a lot of muscle or joint aches?
Do I feel swollen, puffy?
Do I have a lot of pain?
Do I have gastrointestinal problems?

What to do? Get your doctor to work you up for inflammatory processes, and then try to get to the underlying causes. You will notice an improvement in your depression, if you are on medication it will work better, and many of your symptoms will clear gradually. Remember inflammation is like a smoldering fire. When you treat it, it can take several months for the fire to go out. But the juice is worth the squeeze-you will not only have less depression, but your risk for a host of other diseases will go down."

To Life,

Robert Hedaya, DFAPA
WholePsychiatry.com

Mark Hyman, M.D. also has strong feelings about inflammation causing depression symptoms.  I talked about Dr. Hyman and his book, The Simple Way to Defeat Depression, Overcome Anxiety, and Sharpen Your Mind-The UltraMind Solution-Fix Your Broken Brain By Healing Your Body First, in Chapter 7 and Chapter 22 if you are interested in looking at them.

I want to have the C-reactive protein (CRP) (and the interleukin 1 and 6 if my doctor recommends) blood tests done.  C-reactive protein measures general levels of inflammation in the body.  A CRP test will not show exactly where the inflammation is located or what is causing it. Other tests are needed to find the location and cause.

 

I recently had my blood drawn to check my vitamin D level, and to see if I have had recent mercury exposure from silver lined dental implants. So I will probably wait for a little while before I have the CRP test done. I finally got my vitamin D level up to 72. Find out more about vitamin D and depression in Chapter 10 and Chapter 29.  Find out more about mercury toxicity and depression, and the controversy about testing in Chapter 27 and Chapter 28.

 

To get my vitamin D level up from 45 to 72, I have been taking a 50,000 iu tablet (prescription) every two weeks, and 3,400 mg in daily supplements. I will continue this regimen to keep the level up. I don't absorb vitamin D very well, but I need to be in the sun more often. =)

 

I am going to ask my psychiatrist about having the CRP and interleukin 1 and 6 blood tests done.  If my results are high (normal CRP levels vary from lab to lab, but generally there is no CRP detectable in the blood) I am going to ask him if I could try an anti-inflammatory drug to see if it helps my depression symptoms. Dr. Hedaya (quoted above) said if I am on medication it could help it work even better!

Chapter 36: Blood Type & Diet, Healing Depression Symptoms

Have you heard about the diets based on your blood type?  I decided to find out more about them. I have made many diet changes to help heal the depression symptoms and I want to consider making more changes based on my blood type.  Dr. Peter J. D'Adamo has written a book called 4 Blood Types, 4 Diets, Eat Right For (4) Your Type, The Individualized Diet Solution to Staying Healthy, Living Longer & Achieving Your Ideal Weight.  Dr. D'Adamo gives an overview of the 4 blood types and the 4 diets in the video below.

I

Karl Landsteiner, a medical doctor born in Vienna, Austria in 1868, discovered that people had different blood types in 1901.  He made numerous contributions in pathological anatomy, histology and immunology, but his name will be honored for his discovery and outstanding work on the blood groups.  He was given the Nobel Prize for Physiology or Medicine in 1930.  Here is more information about his work taken from Karl Landsteiner - Biography.

In 1875 it was reported that, when man is given transfusions of the blood of other animals, these foreign blood corpuscles are clumped and broken up in the blood vessels of man with the liberation of haemoglobin. In 1901-1903 Landsteiner pointed out that a similar reaction may occur when the blood of one human individual is transfused, not with the blood of another animal, but with that of another human being, and that this might be the cause of shock, jaundice, and haemoglobinuria that had followed some earlier attempts at blood transfusions.

His suggestions, however, received little attention until, in 1909, he classified the bloods of human beings into the now well-known A, B, AB, and O groups and showed that transfusions between individuals of groups A or B do not result in the destruction of new blood cells and that this catastrophe occurs only when a person is transfused with the blood of a person belonging to a different group. Earlier, in 1901-1903, Landsteiner had suggested that, because the characteristics which determine the blood groups are inherited, the blood groups may be used to decide instances of doubtful paternity.

Much of the subsequent work that Landsteiner and his pupils did on blood groups and the immunological uses they made of them was done, not in Vienna, but in New York. For in 1919 conditions in Vienna were such that laboratory work was very difficult and, seeing no future for Austria, Landsteiner obtained the appointment of Prosector to a small Roman Catholic Hospital at The Hague. Here he published, from 1919-1922, twelve papers on new haptens that he had discovered, on conjugates with proteins which were capable of inducing anaphylaxis and on related problems, and also on the serological specificity of the haemoglobins of different species of animals.

His work in Holland came to an end when he was offered a post in the Rockefeller Institute for Medical Research in New York and he moved there together with his family. It was here that he did, in collaboration with Levine and Wiener, the further work on the blood groups which greatly extended the number of these groups, and here in collaboration with Wiener studied bleeding in the new-born, leading to the discovery of the Rh-factor in blood, which relates the human blood to the blood of the rhesus monkey.

I have Blood Type O+.  The + means I have the Rh-factor in my blood.  A person's Rh type is usually significant only with respect to pregnancies.  An Rh-positive child born to an Rh-negative woman runs the risk of developing Rh disease.  More than 85% of people have the antigen, Rhesus factor, in their blood.  People that do not have the antigen in their blood are Rh-negative. You can find out more about the Rh-factor below and at Rhesus Factor (Rh-Factor). 

The Rhesus factor, also known as the Rh factor, gets its name from experiments conducted in 1937 by scientists Karl Landsteiner and Alexander S. Weiner. These revolutionary case studies involved rabbits which, when injected with the Rhesus monkey's red blood cells, produced an antigen present in the red blood cells of many humans. The Rhesus factor is an antigen, or more specifically a protein, that exists on the surface of red blood cells. 

Originally, Karl Landsteiner listed the blood groups as A, B, and 0 (zero).  (Type AB was found later.)  He called it zero because this blood type did not have the A antigen or the B antigen on the surface of red blood cells.  People assumed this blood type was the letter O because the other types were a letter.  People in the United States have continued to call this blood type O instead of 0.  People in other countries and languages call it zero, or null.

Dr. D'Adamo talks about the diets he recommends for the different blood types.

Blood Type O

Blood Type A

Blood Types B & AB

Dr. D'Adamo talks about each blood type in more detail on his website.  He writes about lifestyle, wellness, stress, exercise, and personality of individuals with each blood type.  If you are interested, go to Eat Right For Your Blood Type, The Official Website of Dr. Peter D'Adamo &The Blood Type Diet.  See if you agree with the characteristics he attributes to your blood type.

These are characteristics Dr. D'Adamo states to describe people with my blood Type O.  They describe me well.

1.  People with Type O blood are vulnerable to inflammation and depression.  

2.  People with Type O blood digest animal protein well because of more stomach acid and an    enzyme in the intestinal tract.  I feel better if I eat protein in every meal.  The only way for my body to get amino acids is from protein. 

3.  Eggs are a poor source of protein for Type O's.  The Elisa food sensitivity test rated my sensitivity to eggs at +4.  That is the highest number on the sensitivity scale.  After eliminating eggs from my diet for 3-4 months my cholesterol count came down from 213 to 163.

4.  People with Type O blood can not digest dairy products and grains efficiently.  I have a +1 sensitivity to casein in dairy products and a +1 for wheat.  My digestive tract has appreciated my eliminating these foods from my diet and I lost 10-12 pounds without trying.

5. The system of a Type O does well with intense aerobic exercise.  Exercise will help eliminate stress.  I feel aerobic exercise is as important to my depression treatment as my antidepressant medications.

6.  Type O's respond well to oils, especially olive and flaxseed, for nutrition and an aid in elimination.  I have been taking 6,000 mg of fish oil since March of 2010.  It is part of my depression treatment.  My fingernails grow faster and are stronger, the acne on my face has improved, and my hair looks healthier.  I hope my arteries and heart are seeing improvements too. =)

I have talked about other diet changes I have made to help heal my depression symptoms in Chapter 7: Keys to UltraWellness, Food Sensitivity and Chapter 32: 6,000mg Of Fish Oil A Day. 

I am feeling pretty stable on 150 mg of Effexor XR.  I don't feel great, but I am doing better!

Chapter 35: FEELING SOME RELIEF! Antidepressant Medications

It has been 9 months since I went to the Amen Clinic in Newport Beach, California.  It has taken this long to make all of the medication changes recommended by my doctor at the clinic.  I am starting to feel better, FEELING SOME RELIEF!  I have an atypical depression that needed to be treated in layers.  The anxiety symptoms needed to be treated first, and I talk more about this in Chapter 9 of my blog.  There is a detailed treatment plan from the Amen Clinic in Chapter 10.

I am now taking 150 mg of Effexor XR in the morning with breakfast.  I have come down from 300 mg because I was not feeling any improvement of depression symptoms, and side effects were not going away.  The higher dose was causing insomnia and anxiety, flushing several times a day, and constipation.  These are the only side effects I have experienced with Effexor XR, and they are just about gone on 150 mg.

 




 

I am also taking generic Luvox, fluvoxamine.  I take 50 mg in the morning and 50 mg in the afternoon.  I was already on this drug when I went to the Amen Clinic and my brain scans showed it was helping to quiet the activity in the deep limbic system; but it was not completely effective.  Depression symptoms originate in the deep limbic system.  I am using fluvoxamine for depression, and I do not have any side effects strong enough to notice.  I have been on fluvoxamine for over a year, and a pharmacist told me the brand Luvox is no longer made. The extended-release capsule is a new medication.

Information on generic Luvox, fluvoxamine from:  PubMed Health - Fluvoxamine

 

Why is this medication prescribed?

Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs).

 

How should this medicine be used?

Fluvoxamine comes as a tablet and an extended-release capsule to take by mouth. The tablet is usually taken either once daily at bedtime or twice daily, once in the morning and once at bedtime. The extended-release capsule is usually taken, with or without food , once daily at bedtime. Swallow the extended-release capsules whole; do not crush or chew them.

Your doctor may start you on a low dose of fluvoxamine and gradually increase your dose, not more often than once every week, depending on how well the medication works for you and the side effects you experience.  It may take several weeks or longer for you to feel the full benefit of fluvoxamine. Continue to take fluvoxamine even if you feel well. Do not stop taking fluvoxamine without talking to your doctor.

If you suddenly stop taking fluvoxamine, you may experience withdrawal symptoms such as irritability; agitation; dizziness; extreme worry; uneasiness; confusion; headache; tiredness; mood changes; difficulty falling asleep or staying asleep; or pain, burning, numbness, tingling or 'electric shock' sensations in the hands or feet. Your doctor will probably decrease your dose gradually.

 

Other uses for this medicine

*Fluvoxamine is also sometimes used to treat depression. Talk with your doctor about the possible risks of using this medication for your condition.  This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

 

What side effects can this medication cause?

Fluvoxamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:  drowsiness, difficulty concentrating, dry mouth, headache, nausea, vomiting, diarrhea, stomach pain, constipation, indigestion, gas, change in taste, decreased appetite, weight loss, nervousness, weakness, unsteadiness, and changes in sex drive or ability.

I am taking generic Neurontin, gabapentin, to help calm the activity in the basal ganglia where anxiety begins.  I take a 300 mg capsule four times a day,1,200 mg total.  Neurontin is an anticonvulsant medication the Amen Clinic has found to be effective for anxiety.  I started on this drug as soon as I got home from the clinic to help me get off the drug clonazepam.  I have written quite a bit about clonazepam in Chapter 12 - I Hate Clonazepam and Chapter 15 - Clonazepam The Beast.  (I have been off The Beast for 7 months! =)  My doctor at the clinic chose gabapentin for me because of its low side effect profile, but you will see there are many side effects listed for this drug in the following article.  I did not experience any of these side effects.

Information on generic Neurontin, gabapentin from: PubMed Health - Gabapentin

 

Why is this medication prescribed?

Gabapentin is used to help control certain types of seizures in patients who have epilepsy. Gabapentin is also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain.

 

How should this medicine be used?

Gabapentin comes as a capsule, a tablet, and an oral solution (liquid) to take by mouth. It is usually taken with a full glass of water (8 ounces [240 milliliters]) three times a day. Gabapentin may be taken with or without food. Take this medication at evenly spaced times throughout the day and night; do not let more than 12 hours pass between doses.

If your doctor tells you to take one-half of a tablet as part of your dose, carefully split the tablet along the score mark. Use the other half-tablet as part of your next dose. Properly throw away any half-tablets that you have not used within several days of breaking them.

Your doctor will probably start you on a low dose of gabapentin and gradually increase your dose as needed to treat your condition. If you are taking gabapentin to treat PHN, tell your doctor if your symptoms do not improve during your treatment.

 

Other uses for this medicine

Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes), and to treat and prevent hot flashes (sudden strong feelings of heat and sweating) in women who are being treated for breast cancer or who have experienced menopause (''change of life'', the end of monthly menstrual periods). Talk to your doctor about the risks of using this medication for your condition.  This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

   

What side effects can this medication cause?

Gabapentin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:  drowsiness, tiredness or weakness, dizziness, headache, shaking of a part of your body you cannot control, double or blurred vision, unsteadiness, anxiety, memory problems, strange or unusual thoughts, unwanted eye movements, nausea, vomiting, heartburn, diarrhea, dry mouth, constipation, weight gain, swelling of the hands, feet, ankles, or lower legs, back or joint pain, fever, runny nose, sneezing, cough, sore throat, or flu-like symptoms, ear pain, and red, itchy eyes.

My favorite website to learn about medications is Crazy Meds! The Good, The Bad, and The Funny.  It will tell you about uses, pros and cons, effects, side effects, and stuff your doctor usually won't tell you.  "Crazy Meds Suck Donkey Dong"  If that quote is offensive to you, you may not like this site.

I hope you are FEELING SOME RELIEF from your antidepressant medication, or will be soon!!