Hello there,

what are the current treatment options for the following condition:

during the week I work extremely hard every day from 9am to 6pm until
I feel exhausted, go home, have dinner, hang around for a while and
then straight to bed.

The problem is the week end, especially the Saturday. Instead of
enjoying the break & relax, I start having obsessive thoughts, I
ruminate for hours and do nothing else. I feel dead inside.

Does depression cause such obsessive thoughts? (I have read about OCD,
but I don't seem to fit in the "ritual" bits etc...basically it's like
my brain get overloaded with obsessive thoughts and I have no control
over it. No compulsive action follows the thought(s)).

Please can you suggest all possible ways to tackle this extremely
distressing disorder. (By the way, I am married).

Thank you

DW

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Request for Question Clarification by chromedome-ga on 15 Nov 2003 09:55 PST

Hi, Dani.

Perhaps you could elaborate for us, just a little.  When you say
"obsessive thoughts"...

Are there specific recurring themes to these thoughts?  Does your
brain run on a few specific tracks, over and over?  Or are you
referring to a general inability to have your brain "sit down and shut
up" when you're trying to rest?

-Chromedome

Hi Daniela...

Having worked in the field of mental health for 20+ years,
I am empathetic to your situation. I am encouraged by the
fact that you have arrived at a place where you are willing
to reach out and make an investment in arriving at some
kind of resolution.

You note that you experience no compulsions or ritualistic
behaviors, and wonder if that doesn't exclude you from the
classification of OCD. Not necessarily.


OCD & OBSESSIVE THOUGHTS

HealthyPlace.com is an online "community of people providing
mental health information, support and the opportunity to
share experiences helpful to others".

Their Communities Index Page is here, and includes a site
for depression, should you wish to explore this further:
http://www.healthyplace.com/site/directory.htm

Their OCD Community Site is here:
http://www.healthyplace.com/Communities/OCD/site/index.htm

...and a very informative article by Dr. Alan Peck is here:
http://www.healthyplace.com/Communities/OCD/site/Transcripts/ocd_meds_therapy.htm

"Dr. Alan Peck has been working with OCD patients for
 over 20 years. He participated in the transition from
 therapy-only treatment to the addition of OCD medications.
 Dr. Peck helped bring the first drug that was authorized
 for Obsessive-Compulsive Disorder, Anafranil, into the
 U.S. in 1980."

Dr. Peck's own website is here:
http://www.drpeck.com/

He discusses OCD on his site here:
http://www.drpeck.com/ocd.html

Going back to the Healthy Place site, Dr. Peck notes
the following, with regard to OCD and compulsions:

"I think there are many types [of OCD]. The true classic
 type of obsessions and compulsions are not that common.
 At least 25% of people who are obsessional, do not have
 any compulsions. Then, there are degrees of this."

He also notes, regarding the most effective treatments:

"Obsessive thoughts are usually foreign in nature and can
 be often opposite to what a person wants to feel. I
 believe medication is the most effective treatment.
 Cognitive therapy is helpful as well, in that it can
 educate a person to understand his/her disease."

As for treating the condition without meds:

"David: Do you think that OCD can be effectively treated
 by therapy only, without medications?"

"Dr. Peck: Perhaps a mild case but when there is emotional
 pain, medications are necessary."

Dr. Peck also discusses the relative merits of various
medications on the same page:
http://www.healthyplace.com/Communities/OCD/site/Transcripts/ocd_meds_therapy.htm


On the same site, there are the following resources:

A self-screening test for OCD
http://www.healthyplace.com/Communities/OCD/nimh/screener.htm

Types of OCD
http://www.healthyplace.com/Communities/OCD/nimh/intro.htm

OCD brochure
http://www.healthyplace.com/Communities/OCD/nimh/ocdbro.htm

OCD Quick Facts
http://www.healthyplace.com/Communities/OCD/nimh/quick_facts.htm

Treatment of OCD
http://www.healthyplace.com/Communities/OCD/nimh/treatment.htm

Medications for OCD (about halfway down this page)
http://www.healthyplace.com/site/psychiatric_medications.htm


DEPRESSION & OBSESSIVE THOUGHTS

An excellent discussion of depression in its various forms
is on the University of Michigan Depression Center site,
which discusses the following variations of depression,
as well as screening questions, treatments and medications
(the frequent mention of CBT as the treatment-of-choice
refers to Cognitive-Behavioral Treatment/Therapy):

-Anxiety Disorders
-Panic Disorder
-Social Phobia
-Obsessive-Compulsive Disorder (OCD)
-Specific Phobia
-Generalized Anxiety Disorder
http://www.med.umich.edu/depression/anxietyprn.htm


Zyban, or Wellbutrin (in this case, taken in conjunction with
Xanax) has been mentioned as a source of relief from obsessive
thoughts, on this page from IVillage.com:

"I had an obsessive thought for 3 years (something I was
 embarrassed about). After my doctor gave me drugs for
 other problems -- Zyban to stop smoking and Xanax to help
 me sleep -- the obsessive thoughts went away. Are these
 medicines responsible?"
http://www.ivillagehealth.com/experts/emotional/qas/0,,166206_372,00.html

Effexor is also mentioned, in regard to obsessive thoughts,
in this bulletin board on the Depression Center Support Group:

"I am taking Effexor and it seems to take the edge off."
http://www.depressioncenter.net/support/viewmessages.cfm?Forum=3&Topic=64

Of course, there are numerous medications which may have
a beneficial effect, but these should truly be explored
with the help of a prescribing physician.


An article by Robert A. Seybold, Ph.D., on the University
Counseling & Consulting Services website addresses 
suggestions for coping with obsessive thoughts without 
medications. In brief:

quote:
- First recognize that you are wound-up.

- Learn to recognize and act on the signals that suggest
  your mind is stuck in a rut.

- Set aside designated obsession time.

- Talk to a friend about what?s bothering you.

- Write about your concerns in a journal.

- Engage in aerobic physical activity.

- Practice mindful breathing.

- Get involved in distracting activities you enjoy.

- Give yourself a reality check.

- Try classic thought-stopping techniques.

- Imagine pleasant, relaxing images in your mind.

- Don?t try to control everything.
unquote

Each point is expanded, on the page:
http://www.ucs.umn.edu/counsel/depression3.html

Tips for coping with depression in general are available
on this page, from the same site:
http://www.ucs.umn.edu/counsel/depression1.html

Symptoms of depression are listed here:
http://www.ucs.umn.edu/counsel/depression2.html


In light of all of the above, I would encourage you to
obtain a psychological evaluation by a therapist with
whom you feel comfortable. If you want to explore
approaches other than medication, such as Cognitive
Therapy, I can recommend the following site, authored
by Robert Westermeyer, Ph.D.

Cognitive Therapy Pages
http://www.cts.com/crash/habtsmrt/cogtitle.html


Another approach, which is similar to Cognitive Therapy,
but offers more subtle insights based on experiential
realizations having to do with the basic elements of
awareness, consciousness, will, attention and beliefs
is a course in human potential called Avatar. I am
a licensed Avatar master, authorized to deliver the 
course, but I mention this only to assure you of my
considerable experience the the course and its results.
If you decide to take the course, you can shop for a
master in your area from the Stars Edge website:
http://www.avatarepc.com/html/localmaster.html

The full course is about 10 days, 12 hours a day,
and is an intensive (though highly enjoyable) 
experiential process aimed at exploring your 
consciousness and beliefs and putting you back
in charge of them. It is delivered by an Avatar
master who oversees your progress, and is presented
in three parts.

Part One is available as ReSurfacing, and can be taken
as a Playshop, with others, or you can obtain the 
Workbook, either by itself, for $15, or as part of
the 'Power Package', which also includes the book
'Living Deliberately', by Harry Palmer, author of 
the Avatar materials:
http://www.avatarepc.com/html/books.html

If you'd prefer to purchase only the ReSurfacing Workbook,
you can download a free pdf version of Living Deliberately
from the same page, or from this link:
http://www.avatarepc.com/html/LivDelElectronic.pdf

There's also an audio ReSurfacing Workshop, available on
cassette tapes, from this page:
http://www.avatarepc.com/html/audio.html

"RESURFACING refers to the action of disentangling yourself from 
 old creations and rising back into awareness. The ReSurfacing 
 workbook is an Avatar guide for exploring the inner workings of 
 your own consciousness." 
http://www.avatarepc.com/html/resurfacing.html 
 
While not as intensive as the Avatar Course, The ReSurfacing 
Workbook provides an effective introduction to the transformations 
which the experiential exercises of the Course can produce in 
awareness. It can be explored individually, as well as in a group. 
This book represents the purest exploration of the dynamics 
of awareness, consciousness, thought, will and creation, and 
is free of any tradition of beliefs, religious or otherwise. It is  
about regaining the ability to examine beliefs and their effects 
on our lives, rather than adding to them.

You can also obtain a free subscription to the Avatar Journal,
a publication which comes out 6 times a year, and contains
articles by Harry and other masters, as well as the occasional
exercise from the ReSurfacing Workbook (there are 30 in the book):
http://www.avatarepc.com/html/freejournal.html

The Avatar Journal is archived here, on the Stars Edge site:
http://www.avatarepc.com/html/journal.html

Another site which has archives of the Avatar Journal is Avatar
Overdrive: 
http://www.avataroverdrive.com/avatar_journal/avatar_journal_archive.htm


An example of one of the exercises from ReSurfacing is 
number 12, 'Releasing Fixed Attention'. This seemingly
simple exercise can have profound and powerful results,
if you stick with it:
http://www.avataroverdrive.com/inside_avatar/etcetera/exercise_12.htm


Additional information can be gleaned from an exploration of
the links resulting from the Google searches, outlined below.

Please do not rate this answer until you are satisfied that
the answer cannot be improved upon by means of a dialog
established through the "Request for Clarification" process.

sublime1-ga


Searches done, via Google:

depression "obsessive thoughts"
://www.google.com/search?q=depression+%22obsessive+thoughts%22

depression "obsessive thoughts" treatment
://www.google.com/search?q=depression+%22obsessive+thoughts%22+treatment

depression "obsessive thoughts" treatment medications
://www.google.com/search?q=depression+%22obsessive+thoughts%22+treatment+medications

OCD medication
://www.google.com/search?q=OCD+medication

Cognitive Therapy
://www.google.com/search?q=Cognitive+Therapy

exercise site:www.avataroverdrive.com
://www.google.com/search?q=exercise+site%3Awww.avataroverdrive.com

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Request for Answer Clarification by dani2000-ga on 15 Nov 2003 14:24 PST

Hello, sorry about the delay. My answer is: I seem to experience both
types of patterns described. I have to emphasise that during the 7-10
days before my period the general "racing thoughts/brain never at
rest" pattern prevails.

Hope this helps

Dani

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Clarification of Answer by sublime1-ga on 15 Nov 2003 15:46 PST

Dani...

You have posted a Clarification in response to chromedome-ga's
Request For Clarification, which requires me to post a response
in order to clear the notification which appears on my screen
as a result, since I have posted an answer to the question in
the interim. At this point, only the researcher who formally
answered the question can post a Clarification, though others
can still add comments.

I believe you'll find that my answer addresses all the patterns
of obsessive thinking which you describe, as well as numerous
options for addressing them. Please explore my answer and the
related links, and feel free to request clarification if anything
is unclear.

Best regards...

sublime1-ga

Very detailed and thorough answer. I also liked the fact that the
comment from the second researcher somehow challenged the actual
answer. This may create confusion but at the same time it provides the
client with unbiased and objective information. Ultimately the
responsibility for the final choice must be ours.

Obsessive thoughts as part of depression is called rumination.  It is
somewhat like obsessions that are part of OCD, but not really.  I
obviously can't definitively say that it isn't OCD (which is more
anxiety based), but it definitely sounds more like rumination. 
Basically because of the depression people have difficulty getting
their mind off the troubling thoughts.  When you're busy during the
week, you're able to keep yourself distracted enough so that the
thoughts don't bother you.  In some ways, the rumination serves to
continue the depression because people continue to focus on the
negative and troubling thoughts.  In addition, keep in mind that
between 2 and 9% of the population is depressed at any one time, so
this certainly is not an uncommon difficulty.

Cognitive-behavioral therapy itself basically focuses on challenging
the thoughts you are having and the beliefs that you hold which
underlie them.  That said, there are many forms of interventions which
can be effective in treating depression.  I would recommend consulting
a LICENSED (not sure what the Avatar thing is) mental health provider.
 Approach finding a counselor or therapist like you do any other
consumer service, try to find the best fit for you.  However, instead
of focusing on a specific approach, I would recommend trying to find
someone that you connect with and trust.  Ultimately, it is the
relationship you will be able to build with that person that will help
more that any specific treatment orientation.  Best of luck to you.

Dear Daniela,

I have the same sorts of symptoms as you do.  Sublime1 provided a
really good overview of the issue.  In my experience the best book on
the subject is, Tormenting Thoughts and Secret Rituals: The Hidden
Epidemic of Obsessive-Compulsive Disorder by Dr. Ian Osborn (available
in paperback from Amazon.com).  Dr. Osborn is a psychiatrist who also
experiences the same sort of purely obsessional symptoms as you.  He
recommends a combination of medication (Anafranil--which has not
worked for me) and a type of behavioral therapy called Exposure and
Response Prevention (ERP).  In your case that would involve a type of
meditation where instead of trying to rid yourself of the thoughts,
you go towards them and embrace them which seems to help them go away
(see his discussion in chapter 4).  I think you'll really like Dr.
Osborn's book, he's really compassionate, he looks at the issue from a
variety of angles, and he provides real solutions that you can use
independently or in conjunction with a qualified therapist.     Best
wishes, Toby