Anxiety and Depression Treatment

Madge suffered from anxiety most of her life. As she was growing up, she thought something was really wrong with her. She always felt like she was going to die or that something was going to happen that was just outside her reach. She had no real idea what this meant, but she couldn’t shake the feeling.

Although this is a fictitious person, there are many “Madges” in the world who are feeling the same way. Perhaps you know someone like Madge or you are experiencing the same kinds of feelings. What Madge is feeling is called anxiety and it is something that many people feel today.

In fact, some statistics estimate that 20 million people have some type of anxiety symptoms on a daily basis. You might be wondering what the symptoms of anxiety are and we can tell you that they are generally a feeling of nervousness. Some people will experience sweaty palms, heart palpitations, confusion and many have trouble concentrating.

There are also emotional symptoms that include feeling a sense of panic for no reason at all, feeling like something “bad” is going to happen for no rational reason or an actual panic attack for no reason at all. All of these symptoms can be helped through medications or natural treatments.

The good news is that there are several treatments for anxiety that are helping people stay in the world with less panic. The most common treatments for anxiety are psychotherapy, drug therapy or a combination of both. Here are how each of these works:

Psychotherapy – also called “talking therapy” many people do well to curb their anxiety through talking with a therapist. However, the best psychotherapy that has been shown to actually work is either behavioral or cognitive behavioral therapies.
Behavioral/Cognitive Behavioral Therapy — the greatest challenge that people with anxiety have is the self-talk. These two types of therapies help an individual change their thinking which acts to eliminate the anxiety.
Drug Therapy – Antidepressant medications have been shown to be the best in combating anxiety, though the individual may or may not be depressed. These drugs seem to have a calming effect on the individual who experiences anxiety.
Benzodiazepines–this is just another classification of drugs that are specifically for anxiety.
Alternative therapies — many people use herbs like Kava Kava, Valerian or Lemon Balm to create calm within themselves. Also massage, acupuncture and meditation.

Although all of these have helped some people the best way to find out what works best for you is to check with your doctor or naturopathic practitioner. Some therapies used together work best, and it is better to talk to someone who can help then to try these things on your own. This way you will save lots of time and money that you may have spent on experimentation.

The bottom line is that you don’t have to live with anxiety and have it interfere with your day to day life. Instead, you can find relief quickly and easily.

Tags: anxiety, depression?, Treating

How often do your listen to your heart beat? Do you place a hand over your heart and connect with the beautiful beats that bring experience to life?

The heart is the essence of where we want to be; hearing, feeling, and living from that sp hearts ace of love and connection. Yet, we often get carried away by our thoughts, neglecting our and taking advantage of its automatic functions.

Ever notice your heart beat when you’re really anxious? Guess what happens? Yep, your heart beat dramatically increases. It races, creating a state of panic and worry.

It’s very uncomfortable. When this happens, many people experience fear. We end up expressing the panic and anxiety, panting in freak out mode, shortening our breath, and reducing the oxygen to our brains and bodies.

It’s a vicious cycle. It can be really scary! What we need to do is to figure out ways to end the cycle. We need to create some healthy techniques we can utilize to help ourselves get more in touch with our hearts.

Anxiety is physiological and psychological. Our emotions and behaviors create painful feelings of apprehension and worry.  Often, this is unavoidable because it’s a normal reaction to stress.

When you experience anxiety, your body reacts. You’ll shorten your breath, sweat, get a headache, stomach ache, feel chest pain, nausea, or experience heart palpations.  When any of these reactions occur, the heart rate and blood pressure significantly increase.

Most people react to these physical changes with fear. As a result, your mind creates more havoc by generating thoughts that predict stressful situations in the future. You worry, and that feeds the fear and anxiety.

Coming back to the present moment is a way to have power over anxiety. Saying to yourself “its okay, I’m here. I’m breathing. I’m doing all right” will help you calm down and be more present.

What about your heart?

Since your heart pumps the blood, it is important to acknowledge it when you’re feeling anxious. Bring all of your mind’s awareness to your heart and its beats. Take the time to stop everything, place a hand over your heart, and feel or listen to its beats. If it is beating fast, consciously breathe more deeply and focus an intention of your heart slowing down.

With awareness of your heart, you will notice how quickly and effectively your anxiety reduces, slows the heart rate, and allows you to be more present to your inner being.

You’ve only got this moment, and that’s where the power resides!

To become more self aware, start practicing meditation. If you already meditate, start teaching someone else. This will deepen your practice. By practicing meditation, your self awareness  will develop and that will help you master your reactions to anxiety and worry; the culprits of stress.

 

Reid Peterson is has a C.M.T. certification (certified massage therapist) and is a AMTA associate member. You can also find out more about Reid and get more help with anxiety and meditation by visiting   his website and reading his blog, listed below.

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CONTRARY to what many believe, depression or generalized anxiety are not merely psychological problems. There is a physical component to it as well. That’s why different people in identical depression-causing situations experience different levels of depressive or anxiety symptoms. The physical component of depression/anxiety is related to a neurotransmitter called ’serotonin’ in the brain cells. Anti-depressant drugs address the issue of serotonin availability in the brain and thereby help in the healing the physical aspect of the affliction. The most popular of such anti-depressants is the SSRI family of drugs. SSRI is abbreviation for ’selective serotonin reuptake inhibitor’.

Start of treatment: A major issue with the treatment of depression/anxiety disorders is the long time it takes for the healing action to start showing positive results. In the mean time, most patients either experience no healing or even a deterioration in their condition. This is because it takes time for the physiological system to get acclimatized to the new substance (i.e., the drug), and the process of this acclimatization is fraught with usually minor side-effects. Once the system gets acclimatized to the drug, the side-effects usually fade away and the patient starts experiencing the healing effect.

Discontinuation of treatment: Discontinuation of treatment usually arises from one of the following situations:

The patient is completely healed.
The patient is not responding to the treatment; so a switch to another medicine is required. The new medicine could be another SSRI drug (e.g., Lexapro to Celexa) or a drug from another class of anti-depressants.
The patient is experiencing severe side-effects; so, again, a different drug has to be prescribed.

The issue with discontinuation: The issue with discontinuation is similar to that with the start of treatment. Just as it took time for the physiological system to get acclimatized to the drug and its effects on the brain, it will again take time for it to get ‘de-acclimatized’ to it. So, whatever be the reason for discontinuation, the system will revolt if it is suddenly deprived of what it has got accustomed to. This revolt will show up in the form of withdrawal symptoms, which can be particularly severe with SSRI drugs including Lexapro, the SSRI with supposedly the mildest and most manageable side-effects.

The withdrawal symptoms of SSRIs can be all the side-effects the patient experienced at the start of treatment, in the same or greater intensity, such as deepening of the depression / anxiety, possibly manic episodes, gastrointestinal disorders, renal problems, cardio-vascular problems, skin disorders, etc.

Therefore, when it is time to discontinue treatment with an SSRI drug, the physician will usually prescribe a tapering of the dosage rather than an abrupt halt. The tapering strategy will also enable both the physician and the patient to measure the degree of success of the treatment by watching for recurrence of any symptom (in which case, the tapering might be interrupted with a higher dosage).

Finally, and very importantly, if the discontinuation with an SSRI is to be followed by prescription with a drug from another class – such as tricyclics or monoamine oxidase inhibitors, etc. – there has to be a time gap of at least two weeks before the new medication starts. Else, there could be a fatal reaction.

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Did you know that as many as 90% of the people who have been diagnosed with depression also had anxiety symptoms? Similarly, people who have General Anxiety Disorder (GAD) are also often also diagnosed with depression. If you seem to be having anxiety attacks along with depression, it does not necessarily mean you have GAD. So, it is important that you see your doctor and talk to him or her about your symptoms to make sure you get the right diagnosis.

Prescription treatments

If your anxiety is interfering with your daily functioning, there are medications available to treat GAD from a class of drugs called benzodiazepines. These medications are often referred to as tranquilizers because they leave you feeling calm and relaxed. Common benzodiazepine lines are Xanax, Librium, Valium, and Ativan.

Natural treatments

If you are concerned about taking prescription medications, either because of how they affect you or because of their side effects, there are natural ways to treat depression anxiety.

Believe or not, Apple is one of the best remedies for mental depression. Apples contain helpful chemical substances such as vitamin D, phosphorus and potassium that help the synthesis of glutamic acid. Apple juice should be taken with milk and honey, and can be a very effective tonic and may also recharge your nerves.

Cashew nut

The cashew nut is rich in vitamins of the B group – especially thiamine — and is, therefore, another helpful remedy for general depression. Vitamin B can stimulate the appetite and be nervous system. It is also rich in riboflavin which help keeps the body active, cheerful and energetic.

Try rose

Try preparing a drink consisting of 15 gm of rose petals in 250 mL of boiling water. Drink this occasionally, instead of coffee or tea, and it may help treat the condition.

Lemon balm

Lemon balm, the herb, has been used successfully in the treatment of depression.. It can alleviate brain fatigue and help raise your spirits. It is best to take a cold infusion of the balm. Just place about 30 gm of the herb in half a liter of cold water and allow the mixture to stand for 12 hours. Strain this infusion and drink it in small doses throughout the day.

Vitamin B

Did you know that your diet can have a profound effect on your mental health? Eating foods rich in vitamin B., such as whole grains, green vegetables, eggs and fish helps restore vitality. This is because these foods will build up brain chemicals such as Serotonin and

Norepinephrine that you may be lacking and that can affect your mood substantially.

Talk with your doctor

Naturally, as with all natural supplements and remedies, be sure to discuss them with your doctor before beginning any treatment. Tell your physician what it is you intend to do and he or she will be able to counsel you in terms of dosages and whether they might cause an adverse reaction. Also, remember that even natural herbs and supplements can have side effects.

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The term “natural cures for depression and anxiety” and other associated disorders have to be taken with a pinch of salt. Why? Because the term “cure” is very strong. This is no reflection on natural treatments.

In fact, it’s the same with drugs. You may feel better, perhaps back to your old self again, even for years, but it can happen again. So even though we use the term “cure”, let’s take it to mean “a heck of a lot better”. I used to have a deadly phobia of elevators because of the way it made me feel when it moved. I overcame that with therapy. I still feel ‘funny’ in some elevators, but the fear is all but gone.

Some Natural Treatments Worth Trying

For natural ways to help with depression and anxiety, here are a few suggestions that you can look into and decide which is the one you want to try, to help you feel better.

Please make sure you’re not on any other long-term drug therapy. On rare occasions, it can cause a problem. Also, if you have severe depression, please speak to a doctor first. It might be better for you to have constant medical supervision. The best natural treatment I know of is using a combination of PureCalm, MindSoothe and Mood onic. PureCalm is used for anxiety, stress and panic attacks. MindSoothe is used for depression. Mood Tonic is used to promote a healthy, balanced mood and to decrease those times when you feel ‘the blues’.

If you’re just having general anxiety, then it’s best to take PureCalm. This should do the trick. For depression, use MindSoothe and / or Mood Tonic. If you just want one product, then go with MindSoothe. If you suffer anxiety and depression, then PureCalm and MindSoothe together will be the perfect combination. You can use Mood Tonic as well for maximum benefit, but it’s not necessary.

2 Products Of Note

Both Relagen and Anxius are natural cures for depression and anxiety and stress that you should at least look into. Anxius is an all-in-one natural product that’s probably one of the best around.

Relagen is pretty much the same concept as Anxius and probably a better way to go. My personal recommendation would be to combine PureCalm and MindSoothe, but for the convenience of one product, then Relagen is probably the best.

Tags: anxiety, depression?, natural

Anti-depressants are very effective treatments but come with some very serious side effects including suicidal thinking. If you or someone you know is at this point seek or get them help immediately. Every mention or threat of suicide is to be taken very seriously.

In an effort to avoid these side effects people are turning toward natural treatments. Herbal supplements and vitamins are the treatments of choice for many desiring natural treatments for their depression. There are other treatments that do not use anti-depressants, herbal supplements, or medical procedures. They are natural because the body uses energy. These treatments are often used with anti-depressants or herbal supplements.

Herbal Supplements Treatments

Herbal supplements are very popular and have been for centuries. Ancient tribes and Shaman used them in tribal ceremonies and in healing or treating injuries and illnesses.

Herbs that are known to affect mood are blended in a formula with vitamins and minerals as well as other nutritional substances.

Before they are manufactured each ingredient’s metabolism at the molecular level should be tested. The interactions of the ingredients’ should have been examined as well. When being manufactured they should have been made to pharmaceutical grade standards. This guarantees the potency, the safety, and the effectiveness of the supplements. It also tells you, the consumer, that what the label says is in the supplement actually is in there.

Vitamins, B vitamins in particular, are an option for Depression treatments. B vitamins include a group of eight water-soluble vitamins. They must be restored daily since being water soluble they will pass through the body in urine. B vitamins are important in cell metabolism. The group of these vitamins is called B- Complex vitamins.

The B Vitamins are B1 called Thiamine. B2 is Riboflavin. B3 is Niacin and also known as vitamin P or vitamin PP. B5 is Pantothenic Acid. B6 is Pyroxidine. B7 is Biotin and is also known as vitamin H. B9 is Folic Acid and is known as vitamin M and vitamin Bc.

B12 is called Cobalamin.

The benefits of B vitamins include increased metabolism, muscle tone, and skin tone. They work to help fight symptoms of stress, depression, and cardio-vascular diseases.

They promote cell growth and metabolism including red blood cells which prevents Anemia.

Other treatments

Exercise helps to release brain chemicals to allow the muscles to be used appropriately. Meditation, Yoga, and Progressive Relaxation practices, help to allow the brain to relax and calm the nervous system and the mind.

Conclusion

The best all-natural Depression treatments include vitamins especially B vitamins. Herbal supplements are blended with vitamins, minerals and other nutritive substances. Exercise, Yoga, and Meditation are also options and mostly used in conjunction with other treatments.

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First, The Cause:

A large variety of circumstances and conditions may cause nervousness. The stomach and intestinal tract are very closely connected with the nervous system.

Many times a woman becomes extremely nervous because of overwork, worry, care of children, improper food, lack of sleep, and in many instances it is true that a woman’s work is never done.

Many times the husband finds fault and makes unpleasant remarks, which make her more nervous and which would be unnecessary if he understood the situation and lent a helping hand.

Excessive novel reading, sedentary or dissipating habits, and lack of exercise and fresh air are also causes.

Waste matter in the system gets into the blood affects the nervous system, especially the nerves of the brain, causing irritability and headaches. We must never forget that the food we eat affects all the nervous system, because what we eat and drink is what feeds and nourishes the nerves.

The Treatment:

A prolonged warm bath for about an hour or longer if agreeable, finishing with a cool bath or spray and vigorous rubbing is excellent. Gentle massage after a bath, or for that matter anytime, will help greatly.

A nervous person must also get the system cleaned out. Use herbal laxatives and cleanses. The bowels must move freely to maintain good health. Plenty of rest in a well-ventilated room is essential.

Some Medicinal Herbs:

Skullcap is the best:

One of the best nerve tonics there is. It’s very quieting and soothes the nerves for people who are easily wound up. Helps produce sleep

“Side Effects”

Reduces aches and pains

Hops:

It soothes and calms the nerves. It will produce sleep when nothing else will.

“Side Effects”

Tones up the liver and increases the flow of urine. It’s also great for toothache or earache and like ailments.

Vervain:

Very good for nervousness and sleeplessness and nervous headaches. It calms and soothes nerves and reduces tension and anxiety.

“Side Effects”

Good for throat and lungs problems like a coughs and helps bring on menstruation.

Tags: anxiety, Naturally, nervousness, Permanent, Removal, stress

Anticonvulsants and antidepressants are sometimes used as a drug treatment for panic and anxiety disorders. How effective and safe is it for controlling depression and anxiety disorder? Here is what I found after a bit of research.

What are anticonvulsants normally prescribed for?

Anticonvulsants are normally prescribed to adults for managing convulsions in people suffering from epilepsy.

How effective is anticonvulsants as a depression and anxiety treatment?

There seems to be some positive results in managing various anxiety disorders with anticonvulsants. Although it is still unclear about which mood disorders may benefit the most from this drug treatment. Some promising results have been obtained with people suffering from treatment resistant unipolar depression.

What side-effects are most commonly reported?

The most commonly reported side-effects are sleepiness, dizziness, nausea and fatigue. These side effects usually decrease after a few days. Psychiatric side effects may include agitation, mania and changes in libido.

What are the possible advantages of using anticonvulsants for depression and anxiety treatment?

It appears to be helpful for people suffering from bipolar disorder that have not responded well to lithium and other drugs.

What are the possible disadvantages of using anticonvulsants for depression and anxiety treatment?

The long term side-effects of this drug treatment has not yet been established. It may also induce manic episodes in some people suffering from bipolar disorder. More studies may need to be done in future to demonstrate its effectiveness as a depression and anxiety treatment.

What are the risks associated with antidepressants?

1. Antidepressants may increase suicidal thoughts or actions within the first few months of treatment.

2. Antidepressants can have other side effects.

3. Antidepressants can interact with other medicines.

4. Suddenly stopping use of antidepressants may cause other symptoms.

It is important to keep your doctor or health care provider informed about physical symptoms as well as anything that worries you while on a drug treatment for depression and anxiety.

Tags: anxiety, depression?, treatment

Snake oils and magic bullets are offered to depression sufferers by the dozen, offering plenty of hope but very little in conquering and managing stress, depression and anxiety effectively by delivering a definitive and lasting cure.When it comes to successfully managing depression, stress and anxiety I’m always in a state of alert regarding the latest (so-called) cures. I want to be aware of any new breakthroughs that happen and I also want to be equally aware of new solutions that simply offer false hope.

A solid fact to realize about foods: In modern society, we are very lucky there is an abundance of fresh food and it’s easily and cheaply available. But what about our ancestors or forefathers? Go back to the years before now and you’ll see that life for majority of them was very hard and food wasn’t anywhere near as plentiful as it is today. So did they all suffer from stress, depression and anxiety? Of course not!

Eating a very healthy diet will not in the least cure stress depression and anxiety and eating a poor diet won’t cause them either. This is because the main cause of these problems lies totally beyond the foods that you eat and it should be made quite clear that managing stress, depression and anxiety successfully means addressing and treating the root cause. What is the root cause of your depression, stress and anxiety…

This is the reason why all of the snake oils and magic bullet solutions simply don’t work. They address every other thing than the root cause and apart from giving you a brief lift and lighter wallet, they will only provide temporary and illusory comfort. Is that what you want?

The three main foods you are continually advised to avoid are saturated fat, refined sugar and salt. And for your weight and your physical well-being, restricting your intake of these foods will provide a huge boost

But, let’s ask a question: Does everybody who eats a poor calorie diet with high levels of

fat, sugar and salt gets depression, stress or anxiety? The answer is a clear and absolute NO! And also, does it mean that everyone who eats a good diet with high levels of fresh fruit and vegetables lean meat, fish and chicken never enter into these illnesses? Of course NO! is the answer…

Surely if healthy eating is a major factor in effectively managing and conquering stress, then anybody who eats a healthy diet would never experience stress, depression or anxiety. But it is very obvious that such people are not exempted from these problems.

When it comes to over weight, over-eating will have a huge impact on the physical well-being. But can the foods you eat – the quality of your diet – be a factor in successfully managing stress, depression and anxiety?

In short, No! The foods you eat and the fluids you drink CANNOT cause you to become stressed, anxious or depressed and they certainly cannot cure any of them.

See you soon.

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Depression, anxiety, phobias and mental health feature almost daily in the media and it appears that depression is fast becoming one of the biggest problems experienced within society. These conditions increasingly affect people living in the modern world and research has led to estimates that at least 17% of the adult population have had, or will have, an episode of depression of sufficient clinical severity to warrant treatment. A special national Institute of Mental Health report on Depressive Disorders in 1973 stated that depression accounts for 75% of all psychiatric hospitalisations and that during any given year 15% of all adults between 18 and 74 may suffer significant depressive symptoms. Current studies indicate that the lifetime risk of depression in an adult population could be as high as 30%.

Along with the increased incidence of depression has been an explosion in the use of prescription drugs to treat the condition, but recent reports have questioned whether these are effective or indeed simply create more problems for the patient. Accordingly there is a growing interest in finding a fresh approach to the treatment of these conditions. Having trained in clinical psychology and psychotherapy I am able to incorporate a lot of the accepted practices. However, the more I worked with individuals and with groups I found that by integrating the eastern inspired approaches that I learnt in India, I was able to achieve far more effective and lasting results within a shorter period of time.

Understanding Depression

In Psychiatry depression is referred to as a mood disorder. Mood disorders have been known to man since antiquity; the old Testament describes King Saul as suffering from severe depressive episodes. However, the term encompasses a wide spectrum of emotions ranging from deep depression to unbounded elation and mania and so understanding the behaviour of individuals suffering from depression can be very challenging.

All people experience a range of emotions and in general they are a healthy part of life and feeling appropriate emotions contributes positively to our well being. However, emotions are of two main types; firstly affective emotions, in other words a short lived emotional response to an event, and secondly mood, which is a lasting and dominant emotional response which colours the whole psychic life.

More than 90% of depressed people experience prolonged moods of sadness, discouragement or a sense of not caring any more. However, to classify someone with a major depressive episode clinicians look for five or more of the following symptoms to have been present during the preceding two weeks. There should also be a noticeable change in previous functioning with at least one of the symptoms being either a depressed mood or loss of interest or pleasure.

Symptoms:

1. Depressed mood most of the day.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day.

3. Significant weight loss when not dieting, or weight gain eg. A change of more than 5% of body weight in a month. Or a decrease or increase in appetite nearly every day.

4. Insomnia (sleeplessness) or hypersomnia (excessive sleep) nearly everyday.

5. Psychomotor agitation or retardation nearly every day.

6. Fatigue or loss of energy nearly every day

7. Feeling of worthlessness or excessive or inappropriate guilt

8. Diminished ability to think or concentrate or indecisiveness

9. Recurrent thoughts of death

No single casual factor as to why people get depressed has been identified. Research points to many factors that seem to contribute to its development, including genetics, biochemical changes and personality theories. Several research papers have reported findings which suggest that relatives of patients with major depressive disorders have a higher prevalence of depression than people in the general population. Other research has focussed on biochemical correlates of depression and studied the role of chemicals that transmit nerve impulses from one neuron to another in the brain. Whilst several theories related to depression have been developed regarding personality types.

My experience as a Doctor has led me to view each client as an individual whose requirements need personalised attention. Human beings are a complex creation whose health and wellbeing depends on a balance in all dimensions of their lives, from physical health to behavioural, energy and even environmental aspects.

Treating Depression

Conventional western medicine generally treats depression using medication eg. Tricyclic, heterocyclic anti-depressants and the new SSRT drugs. The commonly used psychological therapies for the treatment of depression are individual psychotherapy, group psychotherapy and cognitive behaviour therapy. Eastern Psychotherapy integrates eastern methods, such as meditation, yoga, pranic, or energy, healing, mantra and sound healing, with elements of the traditional psychotherapy developed in the West. When treating depression and other mental health conditions it is vital to look for the causative factors and explore the issues using ayurvedic principles as well as acknowledging the spiritual component. It may sometimes also be appropriate to study the astrological chart of the person being treated to seek a better understanding of the influences affecting the individual and gem therapy, which is a commonly accepted practice in many parts of Asia, may be recommended.

The treatment of conditions such as depression, addiction and anxiety is undoubtedly enhanced by the use of complementary techniques. The value of seeking help from professionals who have worked with both approaches is they can select the right choice of treatment for each individual. Orthodox techniques often deal effectively with the symptoms, however eastern practices can be more helpful with the underlying causes. A therapist who understands the personal needs of each individual is more able to provide them with an empowering approach to their illness. For some the focus may be on the traditional Western methods, but for others accelerated and positive results can be achieved by blending the best of East and West in an integrated treatment programme.

With an integrated approach to depression most individuals are able to benefit within 3 or 4 sessions, sometimes even less, depending on the nature of their condition. It is important with any therapeutic approach to ensure clients do not develop a dependency on the treatment or only enjoy a temporary respite because the underlying causes have not been addressed.

CASE STUDY

Miss K, a 35 year old female failed to respond to conventional treatment. An holistic approach included energy and environmental assessments as well as her medical background. She had a five year history of depression which had been particularly severe in the preceding six months. She was using anti-depressants and had undergone several sessions of counseling which she did not like.

The assessment on the energetic level revealed some blockages in the heart and solar plexus chakras. The environment at home was dark and sombre with black and grey being her main choice of colours; there was no flow of energy.

She was recommended to try a combination of energy therapies including Reiki and music/mantra treatment along with some suggestions of changes to the home environment. She also used a herbal remedy (St John’s Wort), massage and acupuncture and embarked on six sessions of cognitive behavioural therapy. Her programme lasted six months, but she responded very well and has been free of depression for more than a year reporting that she feels generally well, is taking an active interest in her life and in her personal development.

TEXT ENDS

November 2008

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