Antidepressants & Self Harm

Taken from  the  Los Angeles Times   which can be found    HERE.

About a decade after the Food and Drug Administration first warned that antidepressant medications increase the risk of suicidal thoughts and behaviors in children, new research has found that kids and young adults starting on high doses of antidepressants are at especially high risk, especially in the first three months of treatment.

Among patients 24 and younger, those who started treatment for depression or anxiety with a higher-than-usual dose of selective serotonin reuptake inhibitor (SSRI) were more than twice as likely to harm themselves intentionally than those whose treatment began at the customary dose and increased slowly, the study found.

For every 150 such patients treated with high initial doses of SSRIs — antidepressants marketed under such commercial names as Zoloft, Paxil, Prozac, Celexa and Lexapro — the study suggests one additional suicide would be attempted. By contrast, young patients starting SSRI therapy at doses considered customary were at only slightly elevated risk of self-harm, about 12% above the level of their depressed peers not taking medication.

The latest research on depression treatment, conducted by epidemiologists at Harvard University and the University of North Carolina, was published Tuesday in JAMA Internal Medicine.

The researchers found no increased risk of suicidal behavior among adults older than 24 who started medical treatment for depression or anxiety at larger initial doses.

About 18% of young people diagnosed with depression were prescribed an initial antidepressant dose that was higher than that recommended by clinical guidelines: For the antidepressant fluoxetine (better known by its commercial name, Prozac), for instance, a standard dose would be 10 milligrams daily for the first week, increasing to 20 milligrams for the next three weeks, and only then considering any increased dose.

Given that antidepressants appear to be less effective in young people than in older patients, and that higher doses do not appear to bring more or faster relief, the author of an invited commentary in JAMA Internal Medicine suggested that prescribing physicians should abide by the well-worn maxim “start low, go slow,” and monitor patients closely during their first several months of treatment.

The study used medical records to track 162,625 U.S. residents, ages 10 to 64, who were diagnosed with depression and prescribed SSRI between 1998 and 2010. It found that more than half of antidepressants in that period were prescribed by primary care doctors, and about an additional quarter by practitioners not specialized in mental health. Even in children, fewer than 30% of antidepressant prescriptions were issued by psychiatrists.

The authors acknowledged that they could not discern why younger patients on high initial doses of antidepressant were more likely to try to harm themselves. Although it could have been the dose at which these young patients began their therapy, it is equally plausible that younger patients who are correctly perceived to be in a mental health crisis are more likely to be treated more aggressively, but not more likely to get better with SSRIs.

It might also be that those started on high-dose SSRIs are more likely to discontinue their therapy and to suffer from “discontinuation syndrome,” which can bring physical symptoms of anxiety and is sometimes linked to unpredictable behavior.

The Reinvention Of Rene Syler

Taken from  Hope to Cope  which can be found  HERE.

As co-anchor of The Early Show (as the CBS morning program was known for years), René Syler was at the top of the TV game. The first African-American woman to host a network news program, she spent her high-pressure workdays interviewing high-profile guests such as former President Bill Clinton and actor Will Smith.

Evenings found her contentedly heading out of New York City to the Westchester County home she shares with her husband, media executive Buff Parham, and their two children.

Then, in December 2006, Syler was let go from her job on The Early Show—just as she was about to undergo a preventive mastectomy. She was 43.

Syler had already weathered a couple of difficult years agonizing about her mammogram results, family health history, and the seemingly inevitable onset of breast cancer. Finding herself adrift professionally sent her into a tailspin.

“In retrospect, I had lived a pretty charmed life from my birth to age 42,” Syler says. “I had always been very driven, and had accomplished a lot.”

Having her first book published was a bright break in the dark clouds Good-Enough Mother: The Perfectly Imperfect Book of Parenting came out in 2007, a few months after her surgery—but as time went on good news seemed scarcer and scarcer.

After climbing to the pinnacle of success, she discovered that finding a new job in the ultra-competitive world of broadcast journalism was even harder in mid-life. Opportunity after opportunity fizzled out, until Syler felt her purgatory would never end. At one point, as an added indignity, all her hair fell out after a visit to the hairdresser to have it chemically relaxed.

In the face of repeated disappointments and rejection, depression took root in her mind and body.

“There were days when I’d drive the kids to school and then return home and go back to bed,” Syler says. “I kept waiting for someone to save me, but what I didn’t realize then, was that I had to save myself.”

In November 2008, a bout of asthmatic bronchitis landed Syler in the hospital. When her doctor asked how she was feeling, Syler answered in tears.

“I told my doctor how I couldn’t seem to see my way out of the depression, and how I had a hard time getting out of bed in the morning,” Syler says.

The doctor prescribed an antidepressant, which took the edge off her symptoms and gave her the respite she needed to reassess her views of herself and her future.

Perhaps most importantly for her mental health, Syler learned to embrace her own advice and cut herself some slack. The premise of Good-Enough Mother is that women need to let go of their unattainable ideals, figure out what works for their individual families, and practice self-care in order to care for others.

“I think there is value in the struggle that I went through,” Syler says. “I’m no longer interested in painting a rosy picture all of the time. I realize I’m allowed to have feelings.”

She had to redefine the meaning of success, both in terms of her career and her self-image.

“I try to do as much as I can in my life, but not to try to do everything perfectly,” she says. “I see so many women striving to be perfect, and then feeling depressed when they fall short. I think the most important thing we can do is to take a deep breath and focus on the things in life that really matter.”

For Syler, that includes her husband, her teenage children, and her beloved yellow Labrador retriever, Olivia. All of them served to motivate her when she was feeling down. Her dog needed walks, her children needed their mother. Wanting to be there for them forced Syler to get up each morning, and ultimately face her own challenges.

“I learned that even the strongest people get beat up and I made it my mantra to get through each day one step at a time,” Syler says. “Rather than trying to take on too much, I broke things down into manageable chunks.”

As it became more and more obvious that her path forward didn’t lie in traditional television, Syler looked to online options. In 2010, she rebuilt her book’s website, got serious about blogging, and converted a closet in her home to record videos to post.

She began to take a stand on current events and issues that affect parents. Before long, the site was attracting more than 50,000 visitors a month.

Syler says taking back control of her career was empowering. As part of re-establishing herself, she envisioned her life as a pond and realized that the more fishing poles she put into the pond, the better her chances of landing a fish.

“My first pole was carving out content for my website,” she says. “This was something that no one else could take away from me.”

And with each fish she landed, other nibbles followed. Because of a blog she wrote about theme parks, Syler was invited to be the keynote speaker at Walt Disney World’s annual Social Media Moms Conference in 2011. That led to a profile in an online magazine about her self-reinvention. That came to the notice of executives at the Live Well Network, a digital channel of the Disney-ABC Television Group, who approached Syler about hosting a new show. For Sweet Retreats, Syler travels the country to feature vacation destinations.

“I found you gain the most when you have nothing to lose, when there is nowhere to go but up,” Syler says. “It’s possible to rebuild after rocky times, but you must let your passion guide you, and surround yourself with others who support you. Most of all, understand no one will believe in you as much as you believe in yourself.”

What a difference seven years makes. In addition to Sweet Retreats, Syler is back in front of the cameras as a co-host of Exhale, a talk show on Magic Johnson’s new ASPiRE.tv network. She is a popular motivational speaker, a tireless breast cancer advocate, and continues to grow her Good Enough Mother brand.

“I never thought I’d ever be in this place I am today since I never saw myself doing anything other than anchoring the news,” says Syler, who turns 51 on February 17. “I lost my job, I lost my breasts, I lost my hair, and I fought depression, but in losing all of those things, I also found myself.”

René Syler’s tips

Kick fear to the curb. Syler has learned to challenge the phantoms that hold her back. “I’m able to recognize irrational thoughts for what they are, to realize where they are coming from, and to change my internal dialogue and challenge my fears,” she says. “When I look back at old pictures of me, the overwhelming thing I see is fear—fear of losing my job, or making people angry. Today, I’m fearless.”

Don’t fall for “Pinterest parenting.”
That’s Syler’s term for online images that project a false ideal. “For a mom who is sitting at home in sweats, covered in her baby’s vomit, looking at photos of these supposedly perfect families, it can create feelings of inadequacy,” she contends. She suggests staying away from social media when you’re feeling blue and likely to compare yourself unfavorably to others.

Take the long view. Syler has grown more accepting of the fact that life sometimes gives you a pie in the face. “The difference is I now try and look at a bad day as a bad moment and move on,” she says, “rather than letting it weigh me down.”

 

NAMI Celebrates Victory in Preserving Medicare Part D Access To Psychiatric Medications

The National Alliance on Mental Illness (NAMI) today issued the following statement by NAMI Executive Director Mary Giliberti in response to the announcement by the U.S. Department of Health & Human Services (HHS) that it will not move forward to “finalize” proposed rule changes under Medicare Part D that would have restricted access to antidepressant and antipsychotic medications:

“Less than one full working day since the official comment period on the proposed rule ended and one day before the House of Representatives is set to vote on a bill to block the proposed changes, HHS’s Centers for Medicare and Medicaid Services (CMS) has indicated that it has heard the concerns of people living with mental illness and others over the elimination of three protected drug classifications under Medicare Part D.

“In a letter to members of Congress, CMS has recognized ‘the complexities of these issues and stakeholder input’ and declared that it ‘does not plan to finalize the proposal at this time.’ The agency has promised not to advance ‘some or all of the changes’ in the future without first receiving additional stakeholder ‘input.’

“For now, for people living with mental illness the crisis has been averted. The threat of restricted access has essentially been stopped—although we will continue to support the pending legislation currently scheduled for a vote on Tuesday, March 11, if House leaders decide to complete that process.

“We thank CMS for responding to the concerns of individuals and families affected by mental illness and both thank and congratulate the thousands of individuals who responded to NAMI’s call by submitting official comments or signing NAMI’s online petition in opposition to the proposed rule. NAMI will of course continue working to protect access to necessary medications in all health care programs, whether today or in the future.”

Panic Disorder: An Example Of Fighting Against The Stigma Of Mental Illness

Taken from the  Huffington Post  which can be found   HERE.
I have panic disorder. I manage chronic anxiety every single day. I had my first panic attack when I was 15 years old and (at the time) I had no idea what was going on. I thought I might be having a heart attack. It seemed like a physical problem at first. I had an uncontrollable racing heart followed by sweating and shaking. But then I quickly realized that nervous thoughts were accompanying my physical symptoms.

Thankfully, I wasn’t alone. Anxiety and depression run in my family, and my mother knew exactly what was going on and how to help me. I started seeing a therapist and learned coping techniques to deal with anxiety. However, the techniques I learned were not enough. From ages 15 to 18, I still suffered from severe panic attacks that made it incredibly difficult for me to function.

For the most part, I suffered in silence. The only people who knew about my struggle with panic were my parents, my brother and my best friend, who didn’t attend my high school. I attended a performing arts high school where I studied theater. I was an excellent actress, but not in the way one might think. I was well adept at hiding my mental illness from my peers.

After three years of covering up my suffering, I was mentally and physically exhausted. In 1998, when I was 18 years old, I made the decision to see a psychiatrist. I started taking medication. My whole life changed after that. I didn’t suffer from intrusive thoughts anymore, I was able to breathe and was able to function like a normal human being. I thought to myself, Oh, this is what normal people must feel like.

I went on to attend NYU and graduate with a decent GPA. I could not have done this without the help of antidepressants.

Since college, the only time I have been off of antidepressants was when I was pregnant with my children or breastfeeding them. Other than that, I recognize and I know that taking antidepressants helps me to keep anxiety at bay.

In addition to taking antidepressants, I also eat mostly organic, take herbal supplements, see an acupuncturist and meditate daily. But these things are not enough. At this point in my life, I still need to take antidepressants to manage panic attacks.

As a person managing chronic anxiety, I have heard a lot of unhelpful advice from people who don’t understand mental illness. Here are some common things people have said to me:

1. Antidepressants are just a Band-Aid covering up the problem. Why don’t you stop taking them and try to deal with your anxiety?

This is analogous to telling a diabetic to stop taking their insulin and see what happens. Mental illness is a real condition that can be debilitating if left untreated.

2. You’re being dramatic. You think too much. Why don’t you just stop obsessing?

There is a chemical imbalance in my brain. My brain doesn’t produce enough serotonin. Therefore, the result is I have chronic intrusive thoughts, depression and anxiety. Unless you would like to talk to the neurotransmitters inside my head and tell them to stop firing, I think we’re done here.

3. You’re lazy.

Quite the opposite, actually. I have to work twice as hard to do the things “normal people” do, such as wake up, get dressed and leave the house. I am constantly battling the thoughts in my head. I would call myself a warrior.

Whether you’re dealing with anxiety, depression, ADHD, or any other mental illness, you are fighting a battle. To those around you, it may look like an invisible war, but it’s happening. You’re working hard to be able to function.

Mental illness is real. We need to be just as empathetic and sensitive to those who are managing depression as we are to people that are dealing with physical ailments or diseases. If your friend tells you she she’s having a panic attack, ask her what you can do to help. I promise you, she’s not being lazy. She’s trying to survive.

Veterans With PTSD Face New Problems… Their Medication

Taken from the Wall Street Journal  which can be found   HERE.

Desperation drove Timothy Fazio, a former Marine, to turn up around midnight at a veterans’ hospital near Boston. His post-traumatic stress disorder was causing flashbacks and blackouts. He had leapt from a balcony.

And he had overdosed, twice, on painkillers originally prescribed for a hand injury suffered in Iraq.

“I want detox,” Mr. Fazio told doctors that night in 2008, his medical files say.

 

After a week of withdrawal, Mr. Fazio checked himself out of the Veterans Health Administration hospital—and was given 168 pills of the same opiumlike drug he was already addicted to, according to his files, which The Wall Street Journal has reviewed. The next day, the hospital gave him another 168 pills.

PTSD and painkillers are the twin pillars of a new mental-health crisis in America. Many of the more than two million Americans who served in Iraq or Afghanistan suffer, as Mr. Fazio does, from a mixture of pain and PTSD. The VA treats many of them with powerful opioid painkillers for their pain. But opioids can be a combustible mix with mental illness because of a heightened addiction risk.

Effectively, some critics say, it amounts to treating mental illness with addictive narcotics.

A study by a VA researcher found that veterans with PTSD were nearly twice as likely to be prescribed opioids as those without mental-health problems. They were more likely to get multiple opioid painkillers and to get the highest doses. Veterans with PTSD were more than twice as likely to suffer bad outcomes like injuries and overdoses if they were prescribed opioid painkillers, the study found.

In Mr. Fazio’s case, between 2008 and 2011 the VA prescribed him more than 3,600 pills containing oxycodone, a narcotic painkiller from the same family as heroin and morphine, his records show. He overdosed a total of six times.

Timothy Fazio, a former Marine who suffers from PTSD, has struggled with addiction to prescription painkillers after tours of duty in Afghanistan and Iraq. M. Scott Brauer for The Wall Street Journal

“I was always a tough kid, but I feel like this has been the toughest fight of my life,” Mr. Fazio said in March, after a spell of homelessness that saw him sleeping in an ATM lobby. “I don’t know if I’m going to win it.”

The VA declined to comment on Mr. Fazio’s treatment and said it would review his records. It said it follows uniform guidelines and procedures for veterans’ pain care, adding that those are being reinforced with further training of doctors and patients in safe opioid use. “The Veterans Health Administration has worked aggressively to promote the safe and effective use of opioid therapy for veterans,” it said.

The number of vets with both PTSD and pain isn’t known. But some 30% of Iraq and Afghanistan veterans under VA care have PTSD, VA figures show, and more than half suffer chronic pain.

Last year, more than 50,000 veterans were treated by the VA for serious problems associated with opioid use, nearly double the number a decade earlier, according to VA data. By contrast, the total number of VA patients grew 30% over that time. The number of opioid prescriptions written by the VA has risen by 287% between 1999 and 2012, according to data obtained by The Wall Street Journal through an open-records request.

Drugs used to treat soldiers’ physical pain is exacerbating post-traumatic stress and other emotional issues, Thomas Catan reports. Photo: AP.

The rate of accidental drug overdoses among VA-enrolled veterans is nearly twice that of the U.S. population as a whole, according to a different study led by a VA doctor, which controlled the results for age and gender. Opioid medications were the leading cause.

The number of troops “retiring out of the Army on narcotics chronically is just absolutely unbelievable,” said Andrew Kowal, director of the pain-management center at Lahey Hospital in Burlington, Mass. As “Army Pain Champion,” an informal title given to him by the Army, Dr. Kowal helped develop in the late 1990s clinical guidelines for pain management used by the VA.

He now says those guidelines made doctors too comfortable prescribing the drugs. “The easiest thing for a physician to do is to simply refill the prescription,” he said.

VA doctors struggling to treat a complex mix of mental and physical problems in returning veterans are prescribing opioids, suggests one study led by a VA doctor. “It is possible that in the primary-care setting, opioids may be prescribed to treat a poorly differentiated state of mental and physical pain,” the authors wrote in the Journal of the American Medical Association, “perhaps because physicians do not know how else to handle these challenging patients.”

His parents Kathy and Mike Fazio. M. Scott Brauer for The Wall Street Journal

Derived from opium poppies, opioids were long shunned by doctors for their addictiveness. That changed in the 1990s when a group of cancer doctors successfully argued that opioids were wrongly stigmatized and should be used more widely to relieve patients’ suffering.

The VA has since been trying to trim its reliance on the drugs for veterans in pain. In 2010 it revised its guidelines to emphasize the risks, and the VA said it would make further revisions.

“It is of great concern within the VA to try to reduce the risk of harms for veterans with chronic pain who are prescribed opioids and to potentially provide for increasing alternatives,” said Robert Kerns, the VA’s director of pain management.

Mr. Fazio’s case embodies a problem these patients can face: The drugs prescribed for their physical pain also temporarily relieve their mental strains.

Mr. Fazio was originally prescribed narcotic painkillers after injuring his hand in Fallujah, Iraq. Once the pain subsided, he kept taking the drugs to help numb his troubled dreams and waves of anxiety. They helped “erase” his mind, he said.

He got hooked. When he couldn’t get more from the VA, he moved on to street heroin. His parents say he tried to provoke police into shooting him on at least one occasion. (When asked, Mr. Fazio sometimes denies doing that, while other times he suggests it is true.)

Now 30, Mr. Fazio grew up in a close Catholic family with two brothers and two sisters in Sterling, Mass., about an hour’s drive from Boston. He was a popular, scrappy hockey player who made decent grades, despite being hard-pressed to concentrate, his parents say.

In his senior year of high school, the Sept. 11, 2001, terror attacks happened. He graduated in 2002 and enlisted in the Marines. After training at Camp Lejeune, N.C., he arrived in Afghanistan in February 2004 and spent 3½ months as a machine-gunner on a grueling campaign.

The pace took a toll on the men’s bodies, particularly their backs and knees. They lost up to 30 pounds each, said his former commander, Lt. Col. Asad Khan.

“They didn’t let up,” said Lt. Col. Khan. “We killed them until the last man. That’s what it came down to.”

The Iraq tour was less arduous but more dangerous. Mr. Fazio’s unit relieved Marines who had taken the insurgent stronghold of Fallujah. In June 2005, a rocket-propelled grenade exploded near Mr. Fazio. A pallet he was helping to lift fell on his hand, severing a tendon.

Photos of Timothy Fazio as a Marine and his grandfather Joseph Fazio, also a veteran. M. Scott Brauer for The Wall Street Journal

Doctors operated and, for the first time, gave him painkillers including oxycodone, according to Mr. Fazio and his records. “That’s when I started taking to liking pills,” he said. “It helped with physical pain, but also emotional and mental pain, too.”

Mr. Fazio was honorably discharged in August 2006. He had civilian friends back home, he said, but felt alone.

“We’d have a party and all his friends would come,” said his mother, Kathy. “But he wouldn’t talk about the war with anybody.”

His best friend from Iraq, Eric Hall, faced a similar predicament after being injured by a roadside bomb. He also had PTSD and took opioid painkillers and antianxiety drugs. After leaving the hospital, Mr. Hall—thinking he was back in Iraq—brandished a gun at a carload of women wearing scarves, his mother said, thinking the women were tailing him.

“Eric didn’t smile no more,” Mr. Fazio says. “You could tell he was doped up from the pills because of the pain he was in.”

Mr. Fazio started getting oxycodone for back pain from his family doctor as well as the VA. He worked as a counselor at a state facility for troubled kids but found he had little patience. After an incident in which he tackled a resident in December 2007, he left the job. “I felt myself flipping out,” he said. “I thought I might hurt a kid.”

In January 2008, Mr. Fazio, who had moved back in with his parents, had what his mother calls “the Rambo incident.” His father woke him in the middle of the day to take him to drug treatment. Mr. Fazio went berserk. He brandished an ax, a knife and a fireplace poker, and jammed a knife into the table, saying he was ready to take on anyone who came in the house.

In February 2008, Mr. Fazio says, he realized he was addicted. According to his parents and his medical records, he flushed his drugs down the toilet and spent a week vomiting from withdrawal. His notes say he felt insects crawling under his skin.

He turned to the VA for help. “After reading online about the addiction potential,” his records say, “he was determined that no medication would have control over his body.”

He was released after a week. His records show that doctors, recommending that he withdraw slowly, sent him home with 30 pills containing oxycodone.

On March 9, 2008, Mr. Fazio’s friend Mr. Hall was found dead inside a drainage pipe in Florida. Mr. Fazio was inconsolable.

Three weeks later, Mr. Fazio’s then-girlfriend rushed upstairs at his parents’ house in the middle of the night, screaming “Tim’s not breathing!” His records describe an overdose of pain pills and alcohol.

He overdosed again two weeks later. Three weeks after that, he jumped from a second-floor balcony at his parents’ house but escaped serious injury. Mr. Fazio’s files at the time say “he doesn’t want to live any longer and also wanted to kill everyone.”

He later told doctors that was “a misinterpretation, it was only a little balcony.” Mr. Fazio denies ever trying to commit suicide.

In September 2008, Mr. Fazio decided again he needed to come off the painkillers, and made his midnight visit to the VA hospital near Boston. A week later, he checked himself out, against doctors’ advice.

At first, he was sent home without medication. But within hours, he was back with an injury to his hand, having punched a wall. “I’m withdrawing from my medication,” the notes show he said. “I need my meds.”

His records show he was given 28 days’ supply of a drug containing oxycodone that day, and another 28 days’ supply the day after. The psychiatrist appears to have agreed to issue the drugs after learning Mr. Fazio had been accepted into a mental-health program.

“I don’t think the VA can help my son,” the elder Mr. Fazio said when VA workers contacted him to leave a message for his son, records show. “They’re the ones who got him addicted in the first place. I don’t think he trusts the VA anymore, and neither do I.”

 

VA doctors also prescribed antianxiety drugs including generic Klonopin and Ativan. According to studies and government guidelines, these drugs put patients at greater risk of overdose when used with opioids.

Several independent psychiatrists and addiction specialists asked about Mr. Fazio’s treatment expressed surprise that he had been prescribed opioids after being treated for opioid addiction. Some also questioned a decision to couple his opioid prescriptions with antianxiety medications and amphetamines that also pose an addiction risk.

“Unfortunately it is typical; he’s not an outlier” among vets with PTSD and pain issues, said Reza Ghorbani, medical director of the Advanced Pain Medicine Institute near Washington, D.C., after hearing details of Mr. Fazio’s case. “But it’s the wrong way of treating a patient.”

A VA nurse-practitioner called for a review of Mr. Fazio’s drugs to “protect this veteran from access to multiple—and potentially dangerous—combinations and amounts of medications.” It isn’t clear if that happened.

In September 2008, he crashed his mother’s car into concrete barriers while high on pills and alcohol. The next month, he threw a desk phone at a nurse at UMass Memorial Medical Center. He was admitted to a PTSD and drug-detox program. A year later, his notes show, he was admitted to the Northampton, Mass., VA for PTSD, depression, panic disorder and opiate dependence.

Despite his addictions, the following month the VA resumed his prescriptions for an opioid painkiller. The VA refilled it several times a month for the next 20 months, until May 2011. The records don’t detail the reason the prescription was restarted, or stopped.

In July 2011, Mr. Fazio stole his parents’ TV and asked a girlfriend to report a break-in. The story fell apart. His parents didn’t want to press charges, but police charged him with intimidating a witness, a felony. He pleaded guilty and spent three months in jail.

After release, he began using heroin.

This past January, Mr. Fazio’s parents reached their limit. They kicked him out of their house and got a restraining order.

In March, Mr. Fazio moved in with another Marine in a needle-strewn apartment in Palmer, Mass. They sang songs about numbing themselves with drugs.

“I picture myself loading my rifle only to look down and see a needle in my vein,” said Mr. Fazio, reciting one verse. “Mom, I will always be that Marine on the wall. But somewhere along the line I lost it all.”

A little before his most recent overdose, last Christmas Eve, Mr. Fazio met his current girlfriend, Jennifer Dodge. A slim, blonde 32-year-old from New Hampshire, she took on a motherly role, driving two hours to the Palmer apartment with food.

In March, Mr. Fazio’s roommate overdosed and later died. Mr. Fazio moved in with Ms. Dodge and her three young kids in Newport, N.H. Mr. Fazio came off the painkillers and has remained off them since, according to him and Ms. Dodge.

That, however, brought his PTSD to the fore. “I wake up, and I’m freaking out,” he said in an interview in the Newport apartment in September. “I start fights. I’m really jealous.”

Recently, he says he was at a drive-through Taco Bell with Ms. Dodge and the kids. Reaching the microphone, he felt himself sweating, unable to remember the orders. He felt anger and humiliation as teen staff watched him from the takeout window.

“My rage wanted me to jump through the Taco Bell window and dump my Mountain Dew all over his f— head and make him eat a Soft Taco Supreme,” he recounted later.

Another time he suffered an outburst when he awoke startled one afternoon. “I had never seen him like this,” Ms. Dodge said in an interview. “The look in his eye. It wasn’t him, plain and simple.”

In June, he was walking in the neighborhood with Ms. Dodge when he got into an argument with some local kids. They beat him with aluminum baseball bats, his records show.

He was treated at the VA for concussion, facial abrasions and a possible broken nose. He was sent home with a 10 days’ supply of oxycodone. For two days he repeatedly opened the bottle, looked at the pills and put them back. Finally, he says, he dumped them down the toilet.

Cushion Of The Sea: Streams In The Desert, October 19th, 2013

“And the peace of God, which transcends all our powers of thought, will be a garrison to guard your hearts and minds in Christ Jesus” Philippians 4:7   (Weymouth).
There is what is called the “cushion of the sea.” Down beneath the surface that is agitated by storms, and driven about with winds, there is a part of the sea that is never stirred. When we dredge the bottom and bring up the remains of animal and vegetable life we find that they give evidence of not having been disturbed in the least, for hundreds and thousands of years. The peace of God is that eternal calm which, like the cushion of the sea, lies far too deep down to be reached by any external trouble and disturbance; and he who enters into the presence of God, becomes partaker of that undisturbed and undisturbable calm.–Dr. A. T. Pierson
***
When winds are raging o’er the upper ocean,
And billows wild contend with angry roar,
‘Tis said, far down beneath the wild commotion,
That peaceful stillness reigneth evermore.
Far, far beneath, the noise of tempest dieth,
And silver waves chime ever peacefully,
And no rude storm, how fierce soe’er it flieth,
Disturbs the Sabbath of that deeper sea.
So to the heart that knows Thy love, O Purest,
There is a temple sacred evermore,
And all the babble of life’s angry voices
Dies in hushed silence at its peaceful door.
Far, far away, the roar of passion dieth,
And loving thoughts rise calm and peacefully,
And no rude storm, how fierce soe’er it flieth,
Disturbs the soul that dwells, O Lord, in Thee.
–Harriet Beecher Stowe
***
“The Pilgrim they laid in a large upper chamber, facing the sun-rising. The name of the chamber was Peace.”  –Bunyan’s Pilgrim’s Progress

Soldiers Hospitalized For Mental Illness More Than Any Other Reason

 

Taken from  Forbes  which can be found   HERE.

Here’s a shocker: Mental illness is the only illness or injury for which hospitalizations have increased significantly in the past decade, and those diagnoses account for more hospitalizations of service members than any other major ailment, according to a recent report (p.4).

The hospitalizations have increased swiftly since 2000; the figure rose by 87 percent from the start of the decade until 2011 before declining slightly in 2012. Overall, 159,000 active-duty service members were hospitalized during that time as they battled post-traumatic stress disorder, depression, bipolar disorder, adjustment disorder and alcohol and substance abuse. Some soldiers were hospitalized multiple times.

The data point to an alarming vulnerability amongst American troops as patients hospitalized for mental illness have higher attrition rates and face a “greatly elevated” risk of suicide, according to the report.

The data also raise the vexing question of how combat correlates to the incidence of mental illness in the military. An editorial included in the report notes that, “When many service members return from deployments, they are confused and fearful and they experience high levels of depression, anxiety, or symptoms of PTSD they do not fully understand.”

Yet, despite this important acknowledgement, the report found that many soldiers were hospitalized for various mental health issues but had not deployed.

Of those diagnosed with adjustment disorder, for example, 35,000 had served in or near combat. By contrast, 9,800 soldiers hospitalized for the same diagnosis had been deployed one or more times. Similarly, more than half of those hospitalized for bipolar disorder, depression or substance or alcohol abuse had never deployed. PTSD-related hospitalizations were the only striking difference: only 22 percent had never been deployed while the remaining three-quarters had one to three deployments.

These findings put into perspective a recent report on deployment and suicide risk, which said that combat experience was not a factor for military suicide. That paper was the first of its kind, and as I wrote last month, will likely be followed by research suggesting a cloudier relationship between the two. In the meantime, this new data sheds light on the scale of mental illness in the military at large. Here’s the question I want to answer: Is it possible that combat, or the unique stresses of military life, exhaust the ability of an already vulnerable service member to cope?

Dangerous Discernings

I wrote this back in 2008. Sadly, it still applies today.  Allan

As a young Christian I lived in the days when many were looking for the Rapture of the Church.  It’s no secret that the year 1981 was seen as the latest that the church would be here by so many people in the Calvary Chapel movement I belonged to. Many lived their lives based on this erroneous teaching. As a result many saw their faith shipwrecked as 1982 dawned.

There were books, videos, and teaching that taught us to look up, for our redemption was near.  Reading the daily newspaper seemed to indicate that we’d gone about as far as we could go.  The earth was wrought with every type of sin and false religions were rampant. All prophecy had been fulfilled and we were getting the word out.

I recall taking people to church to see movies such as “A Thief In The Night” that drove home the fact that the end was near and you needed to get right with God.  Many folks walked forward to be saved after seeing the movies and hearing the Gospel message.  Those were “exciting” times.  Little did many of us think we would still be here thirty years later.  But here we are.

As we look at the news today we see how wrong we were back in the mid to late 70′s when we thought things couldn’t get much worse .  With the advent of the internet and cable television we really don’t need a morning paper as it’s old news by the time it’s delivered to our homes.  I won’t list all of the terrible things that are going on in the world but we now realize how much worse things could and have become.  Many of us are concerned about the world we will be leaving to our children and grandchildren. Things certainly have changed.

As Christians, we aren’t without hope.  We serve the living God and He promises to never leave or forsake us.  He has given His Spirit to indwell us and give us the power to live in this fallen world.  He has also left us His Word as a guide to live the Christian life. Most importantly though, He gave His only begotten Son to fulfill the law, die on the cross, and to rise from the dead in His physical body three days later. He then ascended to Heaven, where He sits at the right hand of the Father making intercession for each of us.  We have a hope beyond this life and it’s real and it’s forever.

We see the beginning of the New Testament church in the book of Acts when God’s Spirit fell upon those in the upper room and we see Peter preach the first sermon where three thousand were added to the church in one day.  What a glorious beginning!

History tells us that glorious beginning wasn’t to last.  Persecution came and Christians were killed in the most heinous ways.  Those saints died with the name of Jesus on their lips.  They would not deny Him.  It wasn’t long before the purity of the Gospel message was being challenged on every front.  Quite often it was the person of Jesus who was the focal point of these attacks.  He still is to this day.

Every cult and ‘ism that comes along will tell you that Jesus is not God the Son, second person of the Trinity.  They may say He is the son of God, but what they are really saying is He is not God the Son  but something a bit lower.  They have created a false Jesus that can not save

Through the centuries God has raised up men and women to defend Biblical truths.  They serve as “Watchmen” for the church as they discern false teachings and in turn educate the church so we won’t be taken in by a lie.

Some have been raised up to expose error in the church.  That is an important duty as we know that false teachers will and have infiltrated the church. We need to be made aware of this as these false teachers are quite cunning in their deception as they peddle their blasphemous teachings.  God bless those who look out for the spiritual welfare of the church.

Sadly something has happened along the way when it comes to discerning what is truth and what is error.  That something has been individuals and ministries who have gone too far with their search for that which they deem as false, dangerous, and at times even non-Christian.  As a result nobody is safe as someone has deemed them or their ministry dangerous.  Many Christians are left wondering what exactly is a safe church or ministry as so many have been “exposed” in one fashion or other.

As many are left to try and figure out what church is safe to attend or what ministry is worthy of financial support others are discovering that now they have been “exposed.”

Some well meaning people and some who are not so well meaning in the church have decided to expose the myth of Christian counseling and the use of medication to help those in the church who are suffering mentally.  As the number of books and ministries who have condemned the world of mental illness as it relates to the church continues to grow innocent Christians are stigmatized.  These individuals include Christian counselors, Christian psychiatrists, and Christians who suffer with a mental illness.

Christian counselors are painted as taking their cues from godless individuals who had no room for God in their lives.  They go about telling us all we need is more self esteem and to love ourselves more.  Sin is never mentioned but these “sold out” counselors find ways to pepper their counseling sessions with a few feel good scripture verses while doing nothing but further damaging their Christian counselees.  Hurting Christians are seen as cash cows being fed counsel that is not Biblical and therefore powerless to offer anything of value.  They are accused of demeaning the word of God as they have elevated the ways of man to the same level as the Bible itself.

Christian psychiatrists are seen as passing out mind altering medication like candy to people who don’t need it.  Their vocation has been likened to voodoo and withchcraft.  They supposedly create a population of drug addicts that provide them a lucrative income.  Their clients are seen as victims more than anything else.

It would be unfair not to mention that there are counselors and psychiatrists who advertise themselves as Christian but are guilty of the things that are being used to broad brush ALL Christians who make their living as counselors or psychiatrists.  At the same time it is unfair to think that all Christians who counsel or offer psychiatric services for a living are compromised in any fashion.

Where this really hits home for untold numbers of Christians suffering with mental illness is that their faith in God is now up for speculation and with some outright judgment.  The fruit of the above is why this blog exists.

We live in a day when science demonstrates that mental illness is a PHYSICAL issue just as cancer or the common flu.  Christians who would never think of calling the faith of a cancer sufferer into question don’t understand the damage they inflict upon the mentally ill when the same love is not extended to them.

Biblical discernment is desperately needed in the church today.  We need to protect each other from the spiritual dangers that lurk around every corner.  The enemy of our souls is deceiving untold millions with his various perversions of Biblical truth.  We need to stand up for the truth of the Gospel, no matter the cost.  Nobody wins when the church becomes the target of the church.  God has called us to higher things.

Scan Predicts Whether Therapy or Meds Will Best Lift Depression

Taken from the  National Institute of Mental Health (NIMH)  which is located    HERE.

Pre-treatment scans of brain activity predicted whether depressed patients would best achieve remission with an antidepressant medication or psychotherapy, in a study funded by the National Institutes of Health.

“Our goal is to develop reliable biomarkers that match an individual patient to the treatment option most likely to be successful, while also avoiding those that will be ineffective,” explained Helen Mayberg, M.D., of Emory University, Atlanta, a grantee of the NIH’s National Institute of Mental Health.

Mayberg and colleagues report on their findings in JAMA Psychiatry, June 12, 2013.

“For the treatment of mental disorders, brain imaging remains primarily a research tool, yet these results demonstrate how it may be on the cusp of aiding in clinical decision-making,” said NIMH Director Thomas R. Insel, M.D.

Currently, determining whether a particular patient with depression would best respond to psychotherapy or medication is based on trial and error. In the absence of any objective guidance that could predict improvement, clinicians typically try a treatment that they, or the patient, prefer for a month or two to see if it works. Consequently, only about 40 percent of patients achieve remission following initial treatment. This is costly in terms of human suffering as well as health care spending.

Mayberg’s team hoped to identify a biomarker that could predict which type of treatment a patient would benefit from based on the state of his or her brain. Using a positron emission tomography (PET) scanner, they imaged pre-treatment resting brain activity in 63 depressed patients. PET pinpoints what parts of the brain are active at any given moment by tracing the destinations of a radioactively-tagged form of glucose, the sugar that fuels its metabolism.

They compared brain circuit activity of patients who achieved remission following treatment with those who did not improve.

Activity in one specific brain area emerged as a pivotal predictor of outcomes from two standard forms of depression treatment: cognitive behavior therapy (CBT) or escitalopram, a serotonin specific reuptake inhibitor (SSRI) antidepressant. If a patient’s pre-treatment resting brain activity was low in the front part of an area called the insula, on the right side of the brain, it signaled a significantly higher likelihood of remission with CBT and a poor response to escitalopram. Conversely, hyperactivity in the insula predicted remission with escitalopram and a poor response to CBT.

Among several sites of brain activity related to outcome, activity in the anterior insula best predicted response and non-response to both treatments. The anterior insula is known to be important in regulating emotional states, self-awareness, decision-making and other thinking tasks. Changes in insula activity have been observed in studies of various depression treatments, including medication, mindfulness training, vagal nerve stimulation and deep brain stimulation.

“If these findings are confirmed in follow-up replication studies, scans of anterior insula activity could become clinically useful to guide more effective initial treatment decisions, offering a first step towards personalized medicine measures in the treatment of major depression” said Mayberg.

Right anterior insula

 

If a patient’s pre-treatment resting brain activity was low in the front part of the insula, on the right side of the brain (red area where green lines converge), it signaled a significantly higher likelihood of remission with CBT and a poor response to escitalopram. Conversely, hyperactivity in the insula predicted remission with escitalopram and a poor response to CBT. Picture shows PET data superimposed on anatomic MRI scan data.

Brain PET scans prior to treatment predicted whether a patient’s depression would best respond to an antidepressant or a psychotherapy. Higher resting activity in the right front insula identified cognitive behavior therapy non-responders (CBT NR) and patients who achieved remission with escitalopram (sCIT REM). Conversely, lower activity in that brain area signaled remission with cognitive behavior therapy (CBT REM) and a poor response to escitalopram (sCIT NR). Each circle or square represents a patient in the study. Most patients in each group clustered either above or below the dotted line demarcating high and low activity, indicating that the insula may hold promise as a biomarker of brain states associated with differential response to these treatments.

Source: Helen Mayberg, M.D., Emory University

Sharp Rise In Women’s Deaths From Overdose Of Painkillers

Taken from the New York Times  which is located    HERE.

Prescription pain pill addiction was originally seen as a man’s problem, a national epidemic that began among workers doing backbreaking labor in the coal mines and factories of Appalachia. But a new analysis of federal data has found that deaths in recent years have been rising far faster among women, quintupling since 1999.

ore women now die of overdoses from pain pills like OxyContin than from cervical cancer or homicide. And though more men are dying, women are catching up, according to the analysis by the Centers for Disease Control and Prevention. And the problem is hitting white women harder than black women, and older women harder than younger ones.

In this Ohio River town on the edge of Appalachia, women blamed the changing nature of American society. The rise of the single-parent household has thrust immense responsibility on women, who are not only mothers, but also, in many cases, primary breadwinners. Some who described feeling overwhelmed by their responsibilities said they craved the numbness that drugs bring. Others said highs made them feel pretty, strong and productive, a welcome respite from the chaos of their lives.

“I thought I was supermom,” said Crystal D. Steele, 42, a recovering addict who said she began to take medicine for back pain she developed working at Kentucky Fried Chicken. “I took one kid to football, the other to baseball. I went to work. I washed the car. I cleaned the house. I didn’t even know I had a problem.”

Ms. Steele, now a patient at the Counseling Center, a rehabilitation center here, remembers getting calls about deaths of high school classmates while working at an answering service for a local funeral home. She counted about 50 women she had known who had drug-related deaths. She believes that had it not been for a 40-day stint in jail for stealing pain pills, she would have been among them.

“I felt like I sold my soul somewhere along the way,” said Ms. Steele, whose father was an alcoholic and abusive. “I didn’t feel like I deserved to be given a second chance. I thought my kids would be better off without me.”

For years, drug overdose deaths in the United States were seen as mostly an urban problem that hit blacks hardest. But opioid abuse, which exploded in the 1990s and 2000s and included drugs like OxyContin, Vicodin and Percocet, has been worst among whites, often in rural places. The C.D.C. analysis found that the overdose death rate for blacks in 2010, the most recent year for which there was final data, was less than half the rate for whites. Asians and Hispanics had the lowest rates.

According to the report, 6,631 women died of opioid overdoses in 2010, compared with 10,020 men.

While younger women in their 20s and 30s tend to have the highest rates of opioid abuse, the overdose death rate was highest among women ages 45 to 54, a finding that surprised clinicians. The range indicates that at least some portion of the drugs may have been prescribed appropriately for pain, Dr. Nora Volkow, director of the National Institute on Drug Abuse, said in an interview. If death rates were driven purely by abuse, then one would expect the death rates to be highest among younger women who are the biggest abusers.

Deaths among women have been rising for some time, but Dr. Thomas R. Frieden, the C.D.C. director, said the problem had gone virtually unrecognized. The study offered several theories for the increase. Women are more likely than men to be prescribed pain drugs, to use them chronically, and to get prescriptions for higher doses.

The study’s authors hypothesized that it might be because the most common forms of chronic pain, like fibromyalgia, are more common in women. A woman typically also has less body mass than a man, making it easier to overdose.

Women are also more likely to be given prescriptions of psychotherapeutic drugs, like antidepressants and antianxiety medications, Dr. Volkow said. That is significant because people who overdose are much more likely to have been taking a combination of those drugs and pain medication.

Broader social trends, like unemployment, an increase in single-parent families, and their associated stressors, might have also contributed to the increase in abuse, but they are slow moving and unlikely to be a direct explanation, Dr. Volkow said.

Stella Collins, who runs group therapy sessions at the Counseling Center, said her patients, most of whom are poor, feel trapped. They are squeezing a living out of tiny paychecks. Many get no financial support from the fathers of their children and come from families where alcohol or drugs were abused. Their feelings of inadequacy and shame over not properly caring for their children help drive their addictions, she said.

“Poverty is depression, it’s failure, it’s sadness, it’s low self-esteem,” said Ms. Collins. Her mother, an addict, died of a heart attack at age 56 after spending money meant for heart medication on pain pills, she said.

“These women are stuck, emotionally and financially,” Ms. Collins added.

But some of the women also fight their way back.

Kathy Newman, 35, who started using pills in her 20s, after her older sister overdosed, and whose oldest son was born addicted, has been drug-free for two years. She now takes classes, and travels around the county telling her story at schools.

For Ms. Steele, the most motivating image is that of her 12-year-old son’s face streaked with tears, looking at her through the glass of the prison visiting area. Her eldest son now has custody of him.

“I was at a big stop sign and it was like, ‘O.K., which way are you going to go?’ ” she said.

Portsmouth has worked hard to stop addiction. Easy access to prescription pain pills has been shut down. Mothers of dead addicts give talks at schools. And while Ohio’s death rate from overdoses, like the national rate, is still climbing, the rate in Scioto County, where Portsmouth is located, has declined in recent years, according to the city health department.

Ms. Collins works with women in group sessions, teaching them how to like themselves again.

“Watching them die is the hardest part,” Ms. Collins said. “You sit in this room and you don’t know who’s going to make it.”

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