Ketamine: The New Wonder Drug August 25, 2013Posted by Crazy Mermaid in Depression, Medication, Suicide.
Tags: Depression, Suicide
At our recent NAMI Washington conference in Ellensburg a few weeks ago, the most exciting thing I heard about was a drug called ketamine. It’s a drug that relieves severe depression symptoms almost immediately. It would save the lives of the 35,000 people who die of suicide in the United States each year and substantially improve the quality of life of those who suffer from depression.
But with all of the promise this drug elicits, the problem is that there aren’t enough studies to warrant adding “antidepressant” to its list of “on-label” uses. The best we can do right now is administer it as an “off-label” use at hospital emergency rooms or mental hospitals, which is where suicide wanna-be’s show up, or at psychiatrist offices, where people with severe depression seek help.
Ketamine has historically been used as an anesthetic in humans and animals, and its antidepressant quality was accidentally discovered when people undergoing surgery experienced a lifting of their depression upon awaking or shortly thereafter. The antidepressant effect was traced to ketamine.
Further studies, though limited in quantity, confirmed that 70% of people given ketamine injections experienced substantial relief of their depression symptoms after administration of this drug- some in as little as 2 hours after the drug was administered. That’s a world away from the 4 to 8 weeks needed for a traditional antidepressant to work. It can mean the difference between someone committing suicide and staying alive. Or it can mean a substantial improvement in quality of life for those suffering from depression.
One of the problems with getting enough documentation in order for the US Food and Drug Administration to approve ketamine as an antidepressant is that the drug is an old one, with an expired patent. That means that no drug company is willing to spend the money necessary to finance drug studies to prove the drug works as an antidepressant.
Although the cost of an injection seems like a lot of money to us, (about $900) that’s not enough money to entice drug companies to spend vast sums necessary to administer the necessary testing. So, instead of the traditional path through drug companies, testing will have to be done through grants from the National Institute of Mental Health or other bodies like that, with no financial interest in selling the drug. The best we can hope for from the drug companies is an isolation of the mechanism that works in ketamine, and a new drug developed from that mechanism. That could take years. In the meantime, its antidepressant use must be limited to “off-label”.
One of the challenges associated with ketamine is that it has an unfavorable image as a “club drug”, a drug used by young people frequenting clubs to get high. When used in large doses, it induces an out-of-body experience, something drug users are attracted to. This use impacts the politics of the drug, since no one wants to be caught developing a drug like LSD.
Since I haven’t seen him since my conference, I haven’t had the opportunity to talk with my psychiatrist about this drug. That conversation will be interesting. Stay tuned.
Suicide Attempts September 20, 2012Posted by Crazy Mermaid in Depression, Suicide.
Tags: Depression, Suicide
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A good friend’s 19 year old son has been suffering from depression for a few years now. Recently he started making suicide attempts. His mother is beside herself, not knowing what to do or where to turn. Her son is in counseling several times a week, and is now on antidepressants after checking himself into a mental hospital for five days. But he still talks about suicide. His psychiatrist recently added Lithium to the equation, which tells me just how serious the situation is. Lithium is a drug of last resort because of its severe side effects.
During the course of my involvement with NAMI (National Alliance on Mental Illness), I met a surprising number of people who lost children to suicide. Although these children were almost all over 18, that doesn’t make their deaths less painful. I know I can never truly comprehend the horribleness of the death of a child, but death by suicide is probably more painful, given the parent’s “beating themselves up” for their inability to stop it. Until their dying day, they will be asking themselves whether there was anything they could do to prevent it.
In my own case, the Haldol I was taking as part of my treatment (right out of the hospital) caused me to want to commit suicide. It’s difficult to put into words, but it’s an itch that has to be scratched. It turned out that a desire to commit suicide can be a side effect of high doses of Haldol or other drugs. My experience taught me that anyone, given the right brain chemistry, can be induced to want to commit suicide. It can be created by chemicals and stopped by chemicals (in many cases).
When my husband told my psychiatrist that I was suicidal, he said to stop taking the Haldol immediately. But it took days to get it out of my system, so I was in danger that whole time. My family wouldn’t allow me unsupervised access to my medication,and my guns were gone (they had to be gone before I was released) for obvious reasons, but they allowed me to take my dog for a walk, something that seemed harmless enough. After all, how much trouble could I get into by walking my dog? It turns out I could have gotten into quite a bit of trouble. I had a tremendous desire to walk in front of a fast-moving car. That would probably have done the trick. The only reason I didn’t do it was that I was worried about what would happen to my dog. Ironically enough, I didn’t want to hurt him.
While in the mental hospital, I met lots of people who had tried to commit suicide. They are what is called “unsuccessful suicides”. Because so many people who try to commit suicide end up at mental hospitals, the place is so structured and prison-like that it’s stifling. For example, no shoe strings or hair dryers (hanging) or glass bottles or forks (stabbing) are allowed, and everyone is checked on every fifteen minutes by the staff. Many of those who tried to commit suicide were homeless. That makes it at least a little understandable. But some were not.
While there, I met a handsome 60+ year old man who ended up at the mental hospital because he tried to get the cops to kill him. There’s even a term for it. It’s called “suicide by cop”. He wanted to do it himself but was too chicken (his words). His big problem, after he got involuntarily committed (something he hadn’t counted on) was that he had to miss his return trip on an Alaskan fishing boat because he was locked up. He wanted to die, but he didn’t want to miss work. Go figure.
Suicide attempts, like relatives who have a mental illness, are more common than people realize. In fact, it’s the tenth leading cause of death among Americans. There are far more suicides each year than homicides. In 2009, the number of suicides was about twice that of homicides. More than 36,000 people kill themselves each year. There are an estimated 12 attempted suicides for every one suicide death, and suicide is the third leading cause of death among 15-to-24 -year olds. Those are scary numbers.
My friend’s son has had two attempts so far. I just hope they remain in the “unsuccessful” category while he tries to get his brain chemistry under control. He seems relatively stable at this point, but that could be a well-constructed illusion on his part. With those who want to commit suicide, danger is just a pill-swallow or car “accident”- away. She’s on pins and needles, and so am I.
Suicide January 19, 2012Posted by Crazy Mermaid in Depression, mental illness.
Tags: Depression, mental illness
Sons, daughters, mothers, and fathers have all committed suicide and left behind a train wreck of guilt for their friends and loved ones. “What signs did I miss? Is there anything I could have done to prevent it? I must have failed him/her in some way.” All these thoughts and more go through the brains of those left behind.
At the mental hospital, I got to know five people who ended up there because they tried to commit suicide. That isn’t really a big surprise, since suicide “failures” (people who were unsuccessful in their suicide attempt) usually end up at the psych ward of mental hospitals. I was shocked at how many people in the mental hospital made no secret of their desire to kill themselves.
In fact,the mental hospital went to extreme lengths to avoid having suicide on their premise. There are no glass makeup bottles allowed. No hair dryers (because of their long cords), no eating utensils except for a plastic combination fork and spoon (spork), no shoestrings, and obviously no razors. Although t is inconvenient for those of us who aren’t suicide risks to go without those things, it is worth it if someone is prevented from taking their own life.
As I said in previous articles, depression is by and large a brain chemistry issue. In fact, research suggests that there may be a relationship between suicidal behavior and decreased levels the neurotransmitter serotonin in the brain. While antidepressants, including the class of serotonin reuptake inhibitors (drugs that keep serotonin around longer) often successfully treat depression, researchers are currently investigating whether these medications can also reduce suicidal behavior.
Genetic factors likely contribute to the risk for suicidal behavior. It’s one of the many psychiatric disturbances associated, at least in part, with genetic causation. Major psychiatric illnesses such as major depression, schizophrenia, bipolar disorder, certain personality disorders, and substance abuse (including alcoholism), which run in families, increase the risk of suicide behavior. This doesn’t mean that suicide is inevitable. It just means that a vulnerability to suicidal behavior may exist and should be monitored if a psychiatric disorder is diagnosed.
Interestingly, when a suicidal adolescent or young adult is exposed to suicidal behavior in others (including friends and famous people), the risk for suicide goes up in that adolescent or young adult.
Eventually, hopefully in the near future, brain scans will routinely screen for depression. That’s important because over 90 percent of people who commit suicide have depression. That will move depression and other mental illnesses from a “mental” disorder to a physical disorder that can be detected by way of a scientific test, which should help reduce the stigma associated with mental illness and result in more people getting the help they need so they don’t want to commit suicide.
How big a problem is suicide? Over 30,000 Americans take their own lives each year, making suicide the 11th most common form of death in the U.S. Though exact numbers on attempted suicide are difficult to calculate, it is estimated that there are somewhere between eight and twenty five attempts made for every “successful” suicide.
Men complete suicide four times more often than females, though more women than men report suicide attempts. The most common method of suicide completion for both sexes is by firearms, with white males comprising seventy three percent of all suicide deaths and eighty percent of all firearms deaths. Suicide is the third leading cause of death among 15-to-24-year-olds, and white males 85 years old and older comprise the highest rate of completion (more than six times the national rate).
Those statistics are why my Least Restrictive Treatment plan, required before I could be released from the hospital, required me to get rid of all of my guns before I was allowed out of there.
If someone threatens suicide or starts giving away his/her possessions, please take them seriously and intervene. You will save their life.
Depression and the Holidays December 21, 2011Posted by Crazy Mermaid in Depression, Medication, mental illness.
Tags: Depression, mental illness
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Traditionally, this is the time of year that heralds short-term depression. Not clinical depression, but event-caused depression brought on by too-high expectations. For whatever reason- be it unwanted relatives, too much to do and too little time to do it in, or financial problems- life isn’t good for one reason or another. Generally speaking, problems with families or money problems lead to a case of depression. But make no mistake: this kind of depression is seasonal and temporary and not as debilitating as the clinically depressed.
Major depression, or clinical depression is a serious medical illness affecting 15 million American adults, in a given year. About 8% of the population is clinically depressed at any given time, and 16% will have a bout of clinical depression in their lifetime.
Major depressive disorder is a disabling condition that adversely affects a person’s family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major depression commit suicide and up to 90% of people who committed suicide had depression or another mood disorder.
Unlike normal emotional experiences of sadness, loss or passing mood states, major depression is persistent and significantly interferes with an individual’s thoughts, behavior, mood, activity and physical health. Clinical depression differs from short-term depression in several major ways. It impacts the ability to function, affecting everything from sleep cycles to weight loss or gain to not enjoying the present.
In some cases, for example if the person is genetically predisposed to clinical depression or suffers from post traumatic stress disorder, short-term depression becomes clinical depression. While the best way to prevent clinical depression is to minimize or eliminate short-term depression, doing this doesn’t preclude the possibility of it.
I have had one bout of clinical depression. It was when I was on massive doses of Haldol when my psychiatrist tried to stop me from having horrible visions. At the time, I couldn’t get out of my head pictures of gore and even murder and the voices in my head were exceptionally loud. When I called Dr. K’s emergency number and told him what was going on, he prescribed 5 mg of Haldol twice a day. To give you an idea of how much Haldol he gave me, the normal dose is .5 mg once a day. But the alternative was going back to the mental hospital, which I had only left a week before. So I agreed to this treatment.
After about 5 days, the feeling of clinical depression came over me, but I didn’t recognize it. At first, I couldn’t get out of bed. Then I sat around and cried. I had no reason to cry, even crying on my 25th wedding anniversary while we sat outside at a lovely restaurant in the middle of a beautiful summer day. After a few days of continuous crying, my thoughts turned to suicide. I so badly wanted to take a loaded handgun and blow my brains out that I would have done it in a heartbeat had I had the guns in the house. Incidentally, one of the requirements of my release from the mental hospital was that I had to get rid of all of my guns. As a hunter, I had two shotguns and a rifle in the house before they made me get rid of them. Now I know why.
Anyway, when I became suicidal, my sister and husband insisted that I call Dr. K to tell him what was going on. The only thing I could think of was that I didn’t want to “bother” him so I didn’t want to call him. Finally, after they threatened to call him if I didn’t , I called him. He immediately reduced the Haldol. Funnily enough, I was willing to commit suicide but I wasn’t willing to disturb my doctor. Go figure.
Having suffered a major episode of clinical depression, I am empathetic towards those experiencing it . I wouldn’t wish it on my closest enemy. It wrecks your quality of life and the quality of life of those surrounding you.
I can’t get the statistics out of my head. For example, ninety percent of people who “successfully” commit suicide are depressed. I am more convinced than ever, given my experience, that clinical depression is actually a case of a chemical imbalance of the brain and is nothing to be embarrassed or shameful about. Detecting it earlier gives the person a better chance of being able to control it, both by medication and psychotherapy. I don’t know why the psychotherapy works, but I suspect it affects brain chemistry in the same manner that medication does.
In my blog, my articles are tied to search engines. They pop up when certain key phrases are written in a search engine. The saddest and scariest search engine terms I have repeatedly seen in my blog are “how to commit suicide without people knowing what it is”. Fortunately, my blog entryis more of a “prevention” article, citing all of the ramifications of the act, rather than be a “how to do it”. But even having that term come up on my search engine term at all is sad and scary.
Keeping holiday depression away is the best way to avoid clinical depression. But if you find yourself clinically depressed, it is critical to seek immediate medical help. A psychiatrist is preferable to a general practitioner because he is more experienced in mental disorders. It’s like going to a gynecologist rather than a general practitioner for a pap smear. The more cases he has handled, the better your treatment will be. Just remember: You don’t need to have your quality of life affected by this mental illness.
ADHD Is A Mental Illness September 21, 2011Posted by Crazy Mermaid in Depression, mental illness.
Tags: Bipolar Disorder, mental illness, Schizophrenia
It’s amazing how many people split hairs when it comes to having a mental illness. Take the cases of Attention Deficit Hyperactivity Disorder (ADHD) and depression, for example.
Although the National Institute for Mental Health considers ADHD to be a mental illness, few parents would put it in the same category as schizophrenia or bipolar disorder- what they perceive to be “real” mental illnesses. But that’s where it belongs.
I know that when my elementary aged child received the diagnosis of ADHD a number of years ago, I didn’t put that illness in the same category as a mental illness, and neither did my son’s doctor. That thought was the furthest from my mind. Had I identified ADD as a mental illness, things would have been different.
I wouldn’t have been so forthcoming about his illness, since the shame and stigma of a mental illness would automatically follow my son’s new identity as a mentally ill child. I would have vehemently disagreed with anyone who tried to tell me that my child’s brain chemistry problem shared many of the same characteristics as schizophrenia and bipolar disorder. Hell, I hadn’t even heard of bipolar disorder back then, and schizophrenia to me was a scary, violent disease that people needed to be locked up for. That was my perception of reality back then.
I have since met parents whose children have been diagnosed with schizophrenia, and I realize the fallacy of my previous assumptions. And then there’s the new reality that bipolar disorder is in fact diagnosable in children, contrary to what people perceived even ten years ago. In fact, scientists are now learning that many cases of bipolar disorder have been misdiagnosed as ADHD.
Things are not so black and white any more. There’s a lot of gray in the world of mental illnesses.
According to the National Institute for Mental Health, somewhere between 3% to 8% of children suffer from ADHD. About 1% of the population suffers from schizophrenia. Bipolar disorder occurs in about 4% of the population. And about 8% of people suffer from major depression in any given year.
That’s a lot of people with mental illnesses.
Splitting hairs, separating depression and ADHD from “real” mental illnesses, has done no favors to those suffering from all mental illnesses. Were the umbrella reflective of real statistics, there would be much more money and energy available for studying more mental illnesses. It is difficult to sweep 20% of all people into the “mentally ill” category and not change people’s perception of mental illness. Let’s expand our minds to include mental illnesses like ADHD and depression in the category of “real” mental illnesses. It would make the world a much better place.
Note: Sarah sent an interesting article regarding the over-prescription of ADHD medication at http://www.psychiatrictimes.com/adhd
Depression versus Bipolar Disorder August 24, 2010Posted by Crazy Mermaid in Bipolar Disorder, Depression, Medication, mental illness, Mental Illness and Medication.
Tags: Bipolar Disorder, Depression, mental illness
The stigma of having a mental illness has hit in yet another tangible way.
For the second time in a row, a friend who has suffered for years from depression went to a psychiatrist because her medication was no longer working for her Or at least it was no longer working well enough for her. She had been on an anti-depressant for about 15 years, but had wearied of the side effects. So she had gradually weaned herself off all but a tiny amount of the medication. When she recently encountered a tremendous amount of stress, she got very depressed and a severe panic disorder reared its ugly head. In desperation, she went to see her General Practitioner, who referred her to a psychiatrist. She made an appointment with that psychiatrist but the earliest she could see her was 2 weeks out. So she waited it out, trying her best to work though her bouts of panic disorder and depression.
Two weeks later, arriving at her new psychiatrist’s office, she was given a battery of questions and interviewed at length by the psychiatrist. Finally, after much interrogation, she was diagnosed with Bipolar Disorder Type 2.She wasn’t devastated at the news but she was definitely unpleasantly surprised as she relayed the turn of events to me. She had expected her new psychiatrist to simply regurgitate the previous diagnosis of depression, and it hadn’t occurred to her that her diagnosis might be something else.
In her mind, she had depression. End of subject. She never considered the possibility that she might have anything else. In most people’s minds, depression doesn’t really qualify as a mental illness. It isn’t spoken of in the same breath as schizophrenia or Bipolar Disorder, which are both generally accepted by society as full-blown mental illnesses. With depression, it’s socially acceptable to admit you have it and that you’re taking medication for it because nobody considers you to have a mental illness. But with Bipolar Disorder you can’t hide from that label “mentally ill”.
With Bipolar Disorder, society in general puts that problem into the mental illness category. There’s no getting around the fact that it’s a genuine mental illness. And with having a mental illness comes all of the stigma associated with such a thing.
Furthermore, the use of an anti-depressant for treating depression is commonplace. There’s even a book called “Prozac Nation” that intimates that many, many people are on Prozac. It isn’t viewed as a mental illness in part because too many people have it. A mental illness is thought by the general public as being something that is uncommon. Depression is not uncommon.
According to her new psychiatrist, the medication for Bipolar Disorder Type 2 is a mood stabilizer. The concept of being put on a mood stabilizer rather than an anti-depressant is bad, because of the stigma associated with a mood stabilizer. By definition, it means that your mood needs to be stabilized. That your mood is unstable. That your mind is unstable. That you are unstable. All of the negative ramifications of having an unstable mind come to the forefront.
It’s okay to suffer from depression, which doesn’t have the connotation of instability. You might feel terrible- possibly like committing suicide- but at least you’re not considered to be unstable or out of your mind. But Bipolar Disorder Type 2 is another story. With Bipolar Disorder, you’re unstable. That’s why you need a mood stabilizer. And, as the theory goes, people who are unstable have all kinds of problems. They’re not to be trusted.
No matter than with the mood stabilizers the thoughts of depression go away. No matter that they feel better than they have for years. The important thing, in their mind, is the stigma associated with having to take a medication that makes them stable. It means that they weren’t stable to begin with.
It will take my friend awhile to come to grips with this new reality. In fact, she plans to visit another psychiatrist to get another opinion. In the meantime, although she can hope that her diagnosis is wrong, I hope that she will continue to take her mood stabilizer.