Frontline - News
Light Therapy Shows Promise for Treating Depression
April 1, 2005, Chapel Hill, NC-
Light therapy effectively treats mood disorders, including seasonal affective disorder (SAD) and other depressive disorders, suggests new research commissioned by the American Psychiatric Association and led by a psychiatrist at the University of Norrth Carolina (UNC) at Chapel Hill School of Medicine.
The study, which appeared in the April edition of the American Journal of Psychiatry, finds the effects of light therapy—also known as phototherapy—are comparable to those found in many clinical studies of antidepressant drug therapy for these disorders.
The findings were based on a meta-analysis, a systematic statistical review of 20 randomized, controlled studies previously reported in the scientific literature. The researchers said they found many other studies of light therapy were flawed.
“But when you throw out all the studies that are methodologically flawed and then conduct a meta-analysis of those that are well-designed, you find that light therapy is an effective treatment not only for SAD but also for depression,” Rover Golden, MD, professor and chairman of psychiatry and UNC and vice-dean of the medical school, says.
The research found that the effect of the light therapy was comparable to what has been described in clinical literature for conventional medications to treat depression but the exact mechanisms by which light therapy works remains unclear.
More research is needed on the safety of light therapy, particularly among children and the elderly.
Reprinted from Bipolar Magazine Summer 2005 Edition pg. 23
Suicide Risk Concerns Should Not Stop Placebo Studies
April 1, 2005, Alrington, VA
Concern over the risk of suicide or attempted suicide in clinical trials involving placebos should not be an argument against the use of placebos in controlled trials, researchers say.
Dutch researchers looked at whether there is a greater risk of suicide among people enrolled in double-blind placebo-controlled studies of medication for the treatment of acute manic episodes and the prevention of manic or depressive episodes. If a greater risk were found, they said, this would be a strong ethical argument against the use of placebos.
In double-blind placebo studies, both researchers and participants are unaware of who is receiving placebo and who is receiving active medication so the results cannot be prejudiced.
They examined data from studies dating from 1997 to 2003, involving consumers who received active medication, and those who received placebo. The study, published in the American Journal of Psychiatry in April, found very low rates of suicide or suicide attempts.
“Concern about greater risk of suicide or attempted suicide in the placebo group should not be an argument against the conduct of placebo-controlled trials for these indications, provided that appropriate precautions are taken,” the authors conclude.
Reprinted from Bipolar Magazine Summer 2005 Edition pg. 24
Veterinarian Suicide Rates Nearly Four Times the National UK Average
BBC News announced on Oct. 5 that according to the British Veterinary Association’s (BVA) journal, research found that UK veterinarians’ suicide rates outstrip the national average and are double that of doctors or dentists.
It is thought that the stress associated with putting down numerous animals and easy access to injections puts this group at risk. According to the BVA’s research, lethal injections were the most common method of suicide.
The BVA is considering setting up a support system for veterinarians in training in order to prepare future veterinarians for the stress that awaits them in this career field.
Professor Richard Halliwell of BVA attributes much of the stress of being a vet to “dual problem of coping with the animals and coping with the people, which can be very stressful.”
To deal with this stress and help vets cope, Halliwell says that vet schools need to teach work-life balance and coping skills from the beginning until after graduation.
To read more about the BBC News report visit:
http://news.bbc.co.uk/1/hi/health/4310596.stm
To find out more about the BVA visit:
University of Cincinatti Leads Study on African American Mood Disorder Misdiagnoses
Since the 1980’s the misdiagnosis of mood disorders among African Americans has been controversial. Although there is literature on the subject, it is ambiguous and indefinite as to the cause of these misdiagnoses.
The National Institute of Mental Health is funding a more than $10 million four year, multicenter, national study lead by the University of Cincinnati, on why African Americans are being misdiagnosed for schizophrenia when seeking help for mood disorders. Researchers also want to investigate if these misdiagnoses lead to excessive use of antipsychotic drugs and if misdiagnoses are occurring in the Latino population as well.
“Research has already shown that African-American patients are being improperly diagnosed,” said Stephen Strakowski, MD, professor in UC’s Department of Psychiatry and lead investigator for the study, “but we need to find out why.”
Misdiagnoses can be very dangerous since treatments for mood disorders differ from treatments for schizophrenia. Strakowski states, “ Untreated mood disorders result in functional impairment both at work and in the home. These patients are also at an increased risk for suicide."
According to the NIMH, more than 18 million American adults have a mood disorder.
To read more about the University of Cincinnati’s research:
http://www.uc.edu/news/NR.asp?id=3001
To read more about African American mental health misdiagnoses:
http://www.rcgd.isr.umich.edu/prba/perspectives/winter1997/hneighbors.pdf
TeenScreen: Violator of Parents’ Rights or Mental Health Advocate?
On September 19 th, 2005 an Indiana child’s parents filed a suit against Penn High School for violating their rights as parents by giving their child a mental health screening without their permission.
The mental health screen was given to students who did not have a form from their parents that was signed to show their disapproval. If a slip was not provided, students could take the screen. Many schools now do not practice this method of parent involvement, and require a permission slip in order for students to be able to take the screen.
The mental health screen, TeenScreen, that child Chelsea Rhodes took reported that she had risk factors for obsessive-compulsive disorder as well as social anxiety disorder. Rhodes’ parents argue that the screen’s results are subjective and that there is little proof to back up the screen’s effectiveness.
The TeenScreen program is run by Columbia University and is supported by 34 national organizations, including: the American Academy of Child and Adolescent Psychiatry, the American Psychological Association, and the American Federation of Teachers.
TeenScreen’s mission is to “help young people and their parents through the early identification of mental health problems, such as depression. Parents of youth found to be at possible risk are notified and helped with identifying and connecting to local mental health services where they can obtain further evaluation”.
The TeenScreen program has also received criticism from the Rutherford Institute. The institute filed a lawsuit in U.S. district court for the Northern District of Indiana on behalf of the Rhoades family. The Rutherford Institute attorneys charge, “that school officials violated Michael and Teresa Rhoades’ constitutional right, as parents, to control the care, custody and upbringing of their daughter when Chelsea was subjected to the mental health exam without their knowledge or consent”.
Legislation prohibiting mental health screens was proposed in ten states: Alaska, Florida, Georgia, New Mexico, New Hampshire, New York, Pennsylvania, Tennessee, Utah and Vermont, according to the National Mental Health Association (NMHA).
“With statistics showing that mental health problems affect one in every five young people at any given time and that an estimated two-thirds of all young people with mental health problems are not getting the help they need, the enactment of this type of legislation could have further negative impact on children with mental illness.”
NMHA does not support nor admonish early identification but does “acknowledge that schools and other community institutions and voluntary associations should encourage teachers and counselors to communicate regularly with parents concerning their child, including counseling the parents to consult with their primary care physician or a mental health professional if any sign of significant physical or emotional illness is apparent. Without treatment, children with mental disorders are at risk of school failure, substance abuse, involvement with the criminal justice system and more serious mental health problems, including suicide.”
To learn more about the Teenscreen visit:
http://www.teenscreen.org/cms/content/view/36/65/
Aetna and Primary Care Physicians Work Together to Diagnose Depression
In response to national studies showing that 10 percent of the United States population may suffer from depression, the fifth largest disability affecting the U.S., Aetna announced a new program that will help primary care physicians diagnose depression.
The new program, Aetna Depression Management, will be a pilot program in DC, Maryland, New Jersey, Oklahoma, Pennsylvania, Texas, and Virginia. The program is based on the clinically proven Three Component Model (3CM ™) program. The model uses a standardized screening tool and outcome measurement tool. The three components include: a prepared practice, a care manager, and a behavioral health specialist.
"The incidence of depression is a significant national problem," said Aetna Chairman and CEO John W. Rowe, M.D. "Patients continue to forego treatment of depression, and their illness can result in symptoms that diminish their quality of life and personal productivity. By focusing our program on an integrated care model at the primary care physician’s office, we can improve the likelihood that depression will be diagnosed early and help clinicians better manage health problems that are attendant to depression. This program can make a real difference in the lives of the patients struggling with physical and behavioral health issues."
The program will provide necessary tools, training, and support for physicians and office staff. The program also offers incentives to those physicians who actively screen and talk to patients about depression. Hyong Un, M.D., Aetna’s national medical director for behavioral health, told Mental Health Weekly “primary care physicians will receive $15 per screening and assessment over and above their office fee.”
In the U.S. depression is managed by primary care physicians, with about 65 percent of antidepressants prescribed by primary care physicians.
News of the new program follows the Institute of Management’s report which addressed the essential role health care plays for both mental health and substance-use conditions regarding the improvement of overall health care.
To read more about the Aetna Depression Management program visit: http://www.aetna.com/news/2005/pr_20051102.htm
Understanding Suicide in the 21 st Century
In the neighborhood of Aliso Viejo, 19 year old William Freund dressed in a cape and mask left his home on November 1st. Freund shot and killed a father and daughter as they were walking outside and wounded another neighbor when he shot inside a house. When his gun misfired he retreated to his home where he took his own life.
Freund was suffering from Asberger’s Syndrome, a form of autism that hinders the ability to understand how to interact socially. Freund posted on wrongplante.net, a website for those with Asberger’s Syndrome, weeks before his shootings and sought help from peers on the site.
As referred in the LA Times, Freund posted on Oct 16 that “My future ended some time ago” and “Everybody hates me…I feel like I need to kill myself.” Members of the website as well as moderators tried to help by posting positive messages and trying to find his parents.
Alexander Plank, 19, the founder of wrongplanet.net, said "People at our site tried to contact his parents, but apparently there are a lot of Freunds in Orange County," Plank said. When news of the shooting got out Plank called the Orange County Sheriff’s Department and some of Freund’s postings were removed from wrongplanet.net.
The death of the father, daughter, and Freund leaves some ethical questions for those left behind. How can moderators help those who are suicidal with their limited contact through the internet? What is in the future for suicide prevention through the internet?
“I told u I was hardcore”
By H. Reese Butler II
These were the last coherent words Brandon Vedas, 21, typed into his computer. It was Jan. 12, and he was in the bedroom of his Phoenix, Ariz. residence when he entered the sentence on his p.c. Then, in front of a web cam, he overdosed on prescription drugs before a national audience.
His unfortunate death was not the first internet-related suicide. It was the first, however, to be documented by the media, and until the crisis center community learns how to deal more effectively with such internet related suicide, there will probably be many more deaths like his.
The ability for internet intervention exists, but it is still in its infancy. When asked to help find someone in serious crisis, some internet service providers (ISPs) will actually do a trace and notify police. Others, however, will not.
In the last four years, the Kristin Brooks Hope Center and its Hopeline member agencies have performed numerous successful internet interventions. Keep in mind that such interventions are always riskybusiness and must be performed with great care. What desperately needs to be in place is a system with the mechanics and the protocols, the lethality assessment tools and the levels of supervision for handling a suicidal person. To create this we must have a task force made up of internet service provider security people, crisis center directors, advocates, lawyers and clinicians. We at KBHC have started the process of creating such a task force, and we welcome your suggestions.
KBHC’s first encounter with online intervention began soon after the Hope Center was created. Our outreach before the creation of the 1.800.SUICIDE (784-2433) hotline was done on www.livewithdepression.org.
KBHC officially began doing internet interventions in mid-September, 1998. At that time, I met a woman online whom I shall refer to as Jane Doe. She was suicidal and wanted to know why she should not kill herself. Immediate intervention proved successful. Jane agreed to get mental health treatment, read books and basically live to fight another day.
After months of e-mailing back and forth and chatting online, I got to know her, and we developed a bond via the internet. Jane, it turned out, was in touch with several other suicidal young people. She introduced them to me and to the work of KBHC. These youths, who hung out in the same chat rooms she did, had found each other as they searched for common interests. Suicide was one of them.
After 10 months of communicating with Jane and her friends, I received, in mid-May of 1999, a panic-stricken “Instant Message” (I.M.) from a young woman I shall call Mary Brown. Mary had already begun the process of suiciding. She was cutting herself and told me she planned on bleeding to death. Jane gave me Mary’s I.M. handle and history, and I immediately sent her an I.M. based on information Jane had provided.
After engaging Mary in a long internet intervention I was able to glean from the two young women what Mary’s last name was and the town and state where she lived. I notified a female co-worker, online, of this development and she, in turn, notified Mary’s mother about what was transpiring in her daughter’s life and room. Mary’s mother responded first with disbelief and denial. Then my co-worker told her where the knife was that her daughter planned to use and suggested she check out both her child and her child’s room. Mary was hospitalized soon after this and agreed to mental health treatment. The latter resulted in her eventually completing high school and graduating with honors. She later enrolled in one of the nation’s top colleges.
Mary and Jane referred many of their suicidal online pen pals to the newly created 1.800.SUICIDE (784-2433) hotline for online interventions.
Not all stories have such happy outcomes. There is a list serve, alt.suicide.holiday, often referred to as ASH, which can be viewed on the internet as a website. It combines an unmoderated discussion board and provides detailed guidelines on how to commit suicide. It has been linked to 10 confirmed suicides and 14 other suicides. The site’s FAQ defines the forum as a place where visitors can “talk openly about suicide in a culture that regards suicide as a taboo.”
The critics of ASH include the relatives of some ASH regulars who died by their own hands. These survivors say the site encourages people to kill themselves. For more on this, go to (“No One Asked Why He Wantedto Die” by Julia Scheeres of Source: Wired 02:00 AM Feb. 04, 2003 PT) (http://www.wired.com/news/business/0,1367,57480,00.html). What follows is an excerpt from the second installment of a three-part series.
A month to the day before he killed himself, Michael Benjamins posted thefollowing message on the internet: “PLEASE help me,” wrote Benjamins, a 24-year-old computer programmer from Ohio. “I am looking for a fast, reliable wayto kill myself. I don't want to screw it up.” The message, posted on ASH Sept. 17,2000, also stated that Benjamins had spent time in a mental institution andfeared he might not pass the background check needed to purchase a gun in hishome state.
Responses to this posting ranged from instructions on how to slit his wrists toa suggestion that he drive his car into a brick wall at high speed. No one askedhim why he wanted to die or sought to change his mind. His subsequent posts onthe internet narrated his trajectory toward death. He wrote about his fear ofbeing in large groups of people, of the eight years he spent in therapy and his fearthat he might not find an end to his mental turmoil.
He also wrote a posting when he learned that his having been institutionalized would not prevent him from legally owning a gun. Soon after this, he bought a .410-gauge shotgun at Wal-Mart and posted online that he was “looking forward to death.” When Michael Benjamins placed a shotgun in his mouth and pulled the trigger Oct. 17, many ASHers—as they call themselves—had known of his plans for weeks. None, however, had tried to prevent his death by contacting his family or law enforcement officials.
His father, Gerry Benjamins, a 55-year-old electrical engineer, said after his son’s death that depression ran in both sides of the family and that Michael had had a long history of suicide attempts. His son’s first serious attempt reportedly occurred when Michael was six years old and was hospitalized for stabbing himself in the chest. In the next eight years, Michael Benjamins made dozens of other suicide attempts.
According to Gerry Benjamins, his son tried taking antidepressants but stopped because of their side effects. Soon after, he began hurting himself again. “What we saw was that he was going to get so bad that he’d have to be institutionalized or he’d eventually succeed at killing himself,” his father said.
Unlike many parents, Gerry Benjamins doesn’t blame ASH for his son’s death. “The reason he [Michael Benjamins] got on that website was because of his desperation to find someone else who felt the same way he did,” the elder Benjamins said. “If it wasn't this group, it would be another group. Sooner or later, people with this tendency are going to find each other. I think there is a real positive in that you can find someone who understands where you come from.”
Over the years, Michael Benjamins reportedly tried many strategies to fight his depression. He exercised, read self-help books, kept a journal, drew and took various medications, according to Matt Vanek, a friend since middle school. According to Vanek, nothing seemed to work long for his friend, who often complained his mind was “reeling, in a state of chaos.”
“[Depression] was pretty much a constant state of being [for Mike],” Vanek said. “That being said, he was able to hide it well. He could still laugh and have some amount of fun, at least externally. He was very, very good at hiding what he felt from the rest of the world.”
These tragic stories speak to why we must work now to create online intervention procedures and counseling. Please join me and KBHC in calling for a task force to put together the tools and resources needed to save lives.
H. Reese Butler II is publisher of this journal and president of the Kristin
Brooks Hope Center. Julia Scheeres is a reporter with Wired News.
Portions of this article are reprinted with
permission from Wired News.
Reaching Those in Trouble: A Plea for Improved Technology
To the Editor: On Monday, Feb. 24, I received an e-mail addressed to the American
Foundation for Suicide Prevention (AFSP), Midwest Chapter. The writer, who gave his name only as “Matt,” was clearly depressed. He had lost his job and his family, had been denied unemployment insurance and social security and was talking of ending his life, to “make room for the rest” of us.
Twenty-one months ago I lost my 25-year-old son to suicide. I didn’t have it in me to ignore Matt’s plea for help. To be able to help him, however, I needed to locate him. Time was of the essence. I called 9-1-1 and reached the Chicago police. I asked them to trace his e-mail address. I was transferred eight times to eight different officers, all of whom were actually very concerned. None of them could help me, however. Eventually I was given a telephone number for the Illinois State Police. I called it and was transferred six more times to six different concerned officers. From one I obtained the pager number of the officer in charge of computer crimes. I was told he had the technology that could help me. I left emergency pages for him three times. Four days later, as I sat down to write this letter, I had yet to hear back from him.
Realizing the importance of timing in relation to Matt’s call, I then telephoned the national headquarters of AFSP to see if anyone there had experience in tracking calls. I spoke with Bob Gebbia, our executive director. He suggested that I call KBHC, which manages the 1.800.SUICIDE Hopeline network, in the hope of finding the necessary technology. I contacted Melinda Moore, the executive director. She was very understanding. She suggested I call Matt’s internet company.
Using a search engine, I located it in St. Louis, Mo., and obtained from the internet the name and telephone number of its chief executive officer. I called him. I felt in this case that a deviation from the company’s normal privacy policies was in order.
I was directed to a customer service representative, who, upon hearing the word “suicide,” immediately transferred my call to his supervisor, Lori Jo. She was a winner. She worked with me for 30 minutes to try to locate Matt. She eventually sent me back home to my computer and had me send her a copy of the original e-mail, so she could try and locate Matt through the IP address on it.
About an hour after I got her the information, I received a call from Jason, who worked with Lori Jo. According to him, the provider had located Matt and planned to notify the police. The only information the company would release to me was that Matt lived somewhere in Wisconsin.
By this time, I had also received a response to my e-mail from Matt. His note, I thought, was a good sign, even though he still sounded quite depressed.
That night I sent Matt two or three more messages. I got little sleep because I was so concerned about him. All through the night I checked my e-mail. There was no word from Matt. When I arrived at work the following morning, however, I found a message from Matt, saying he would call me by ll a.m. He kept his word and we spoke. He gave me his phone number and address in Wisconsin.
Yesterday, there was a meeting with Matt to begin to get him the help he needs. We have yet to see where all this will lead.
The point of my sharing this story with you now is to make you aware of how difficult it is to locate someone in real trouble, someone who will not, or cannot, disclose his or her actual location. The anonymity of the internet is today a major challenge for those of us who wish to help those who are calling out.
This letter is a plea for help: WE NEED A BETTER SYSTEM. WE NEED BETTER LAWS. WE NEED TO BE ABLE TO TRACK DOWN PEOPLE IN DESPERATE NEED OF HELP. FINDING THEM IS A HUGE PROBLEM.
Stan Lewy
President AFSP, Midwest Chapter
Chicago, Ill.
Publisher’s Note: What Stan outlines in this internet intervention account highlights the need for a call to action. There are many crisis centers that will take internet e-mail pleas for help. One is Community Crisis Center in Maryland. It can be accessed by going to: info@communitycrisis.org. The hotline there is 24-7. However the e-mail responses are periodic and not instantaneous. KBHC’s policy on internet interventions, until the task force makes its rulings, is to “at first do no harm,” and sending an e-mail or having a crisis center send an e-mail before contacting the police or ISP is the first point of contact. In the first e-mail make sure you always include 1.800.SUICIDE (784-2433) as a point of contact for the person in crisis. Also include helpful web sites, many of which are linked from www.hopeline.com. Offering referrals for mental health assessment and simultaneously making the point that depression is treatable is a staple of all our e-mail interventions.
SAMHSA Awards 37 Grants with a Total of $9.7 for Youth Suicide Prevention
On September 20 the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that 37 grants with a first year total of $9.7 million supporting national suicide prevention. President Bush signed for the Garret Lee Smith Memorial Act for youth suicide prevention which made these grants possible.
The grants will be aiding the suicide prevention efforts of a suicide prevention resource center, campus suicide prevention, and state and tribal youth suicide prevention and early intervention programs.
The state and tribe sponsored youth suicide prevention program grantees include:
Native American Rehab Association of NW, Inc., Portland, Oregon, $400,000
Arizona Department of Health Services, Phoenix, Ariz., $400,000
Oklahoma Department of Mental Health, Oklahoma City, Ok, $400,000
Maine Youth Suicide Prevention Program, Augusta, ME, $399,997
Virginia Department of Health, Richmond, VA, $400,000
Missouri Department of Mental Health, Jefferson City, MO, $400,000
Tennessee Department of Mental Health, Nashville, TN, $400,000
State of Nevada, Carson City, NV, $400,000
NAMI New Hampshire, Concord, NH, $397, 573
New Mexico Department of Health, Sante Fe, NM, $400,000
Texas Department of State Health Services, Austin, TX, $399,921
New York State Psychiatric Institute, New York, NY, $388,803
Commonwealth of Massachusetts, Boston, MA, $399,787
Department of Public Health and Human Services, Helena, MT, $400,000
The Suicide Prevention Resource Center (SPRC) will be providing technical assistance to the grantees as well as continue to work with all states, whether included in the grant or not.
To find out more about the other grantees visit:
www.samhsa.gov/news/newsreleases/050920_grants.html
To get info about SPRC:
Frustration of Hurricane Katrina Evacuees: Crisis Centers Are Listening
In the wake of Hurricane Katrina call volume has more than quadrupled for the Integrated Health Resources/Behavioral Health Link in Augusta, Georgia. Just last week there were more than 2,000 total calls. Overflow calls come from Texas, Mississippi, New Mexico, and Alabama. As a result, there had to be an increase in the staff size. At the beginning staff members were overwhelmed by the number of calls, and although it has been weeks since evacuation, calls are increasing as the days go by.
The biggest difficulty for the crisis center was finding resources available to those affected by Hurricane Katrina, such as mental health facilities in their area, where evacuees could find the American Red Cross, and where callers could find a counselor in their area. This was the first major disaster that the crisis center staff has encountered and was not expecting the degree of emotional and mental strain on their staff.
According to Keely Foster, director of clinical services at Integrated Health Resources/Behavioral Health Link, as the evacuees find more permanent residences, Foster foresees a reduction in calls to the center. Most of the calls from those affected by Hurricane Katrina were those who were frustrated with being unable to access benefits provided by the government. “Until FEMA and others kick it into high gear we will probably continue to hear from those who are not able to access resources.” Callers wanted to know why wasn’t FEMA answering the phone, why wasn’t the American Red Cross answering the phone, and how and where could they find housing.
In the future if another event like this were to occur, Integrated Health Resources/Behavioral Health Link staff will definitely be more mentally prepared when receiving calls. After routing thousands of calls from those in despair, who are hopeless, and have lost everything to Hurricane Katrina, we at the Kristin Brooks Hope Center are thankful to those who pick up the phone and extend hope and information.
In Jackson, Mississippi calls at Crisis Line have increased since their join with 1-800-SUICIDE due to Hurricane Katrina, although not overwhelmingly. According to Peter Meyers of Crisis Line, “the evacuees to Jackson and Baton Rouge may have had more personal resources to make the evacuation more comfortable (staying at a hotel or private home instead of a public shelter); they may have felt more in control. People in public shelters have difficulty charging their cell phones and run the risk of having them stolen. Pay phones are scarce; privacy is nonexistent. Calling out is a problem.”
Those evacuees who are managing to call out are frustrated, just as those whose calls are received in Georgia; they’re frustrated about the government. Meyers says, “Evacuee callers are frustrated; how could they not be! “I’ve tried FEMA 104 times and I still can’t get through.” We’re encouraging them to call after 7:00 p.m. and before 7:00 a.m. and not to give up, because that’s where the major help will come from, though local charities and churches have been amazing.”
Callers not only express frustration, but anger which could dissolve into depression. Meyers predicts when the shock of Hurricane Katrina wears off and access to phone lines improves there will be more calls to the Jackson Crisis Line.
“My expectation is that as the shock begins to wear off and access to, especially private, phones increases, people will call more and more. Anxiety levels will rise as people realize, as they did after 9/11, they cannot ever be entirely safe and their hold on life is tenuous. I also expect people increasingly to act out in antisocial ways as they feel less and less connected with the community that houses them and more and more frustrated with the seemingly unending situation they find themselves in.”
Since Hurricane Katrina many crisis centers have been completely wiped out or have lost their capability to function due to loss of power or telephone lines. Many other crisis centers like Integrated Health Resources/Behavioral Health Link in Georgia and Crisis Line in Mississippi have been able to take calls from other states and continue the link between those in need of help and those who offer hope.
Vagus Nerve Stimulation Therapy System
New Treatment Approved for Chronic or Recurrent Depression
On July 15 th, 2005 Cyberonics, Inc. announced that the Food and Drug Administration (FDA) approved the Vagus Nerve Stimulation (VNS) Therapy System. This small pacemaker like device is implanted in the chest and sends a preprogrammed, intermittent mild electrical pulse through the vagus nerve in the neck to the brain.
This is good news to those who are suffering from treatment-resistant depression (TRD). According to the National Institute of Mental Health, approximately 20 percent of depressed Americans experience chronic or recurrent TRD.
Author of Out of the Black Hole: The Patient’s Guide to Vagus Nerve Stimulation and Depression, Charlie Donovan, said, “This is great news for all of those desperate patients that have run out of treatment options (just as I did). I was so fortunate to have been included as a study subject in the investigational trial of vagus nerve stimulation and depression. It completely changed my life when everything else had failed.”
The VNS therapy system is intended for “the adjunctive long-term treatment of chronic or recurrent depression for patients 18 years of age or older who are experiencing a major depressive episode and have not had an adequate response to four or more adequate antidepressant treatments” according to the FDA.
The therapy system is intended to be used with other traditional therapies, such as medication, and these therapies should not be abandoned once a patient has the device implanted. Regular visits to a physician should be maintained.
To learn more about the VNS Therapy System FDA approval visit:
http://www.fda.gov/cdrh/mda/docs/p970003s050.html
To learn more about VNS Therapy:
Repeat Suicide Attempts Lessened by 50 Percent with Cognitive Therapy
Suicide attempters were less likely to repeat their attempts within 18 months if they had been treated with a form of cognitive therapy designed for suicide prevention, according to research by Gregory Brown, Ph.D., Aaron Beck, M.D. and other colleagues from the University of Pennsylvania. The researchers were supported by the National Institutes of Health’s National Institute of Mental Health and the Center for Disease Control and Prevention.
Researchers screened potential suicide attempters admitted to the emergency room of the Hospital of the University of Pennsylvania. Of the 120 patients for the study, 58 percent had attempted to kill themselves by drug overdose, 17 percent by stabbing, 7 percent by jumping, and 4 percent by hanging, shooting or drowning.
Averaging in their mid-thirties, 61 percent of the participants were female, 60 percent black, 35 percent white, and 5 percent Hispanic or other ethnicities.
After the clinical evaluation, participants were randomly selected to either receive cognitive therapy or usual care – services available to them in the community. The cognitive therapy was applied in 10 outpatient weekly or biweekly sessions specifically developed for preventing suicide attempts. The therapy, developed by researcher Beck in the 1970s, helped patients find a more effective way of looking at their problems by learning new ways to handle negative thoughts and feelings of hopelessness. Both groups were encouraged to receive usual care from clinicians in the community and were tracked by case managers.
Over the 18 month follow-up period, 24 percent of the cognitive therapy group made repeat suicide attempts, while 42 percent of participants in the usual care group made repeat attempts. Researchers say that the groups did not have a significant difference in their suicidal thoughts, but that those in the cognitive therapy group scored better on measures of depression and hopelessness severity. Researchers suggest that this may be associated with a reduced risk of repeat suicide attempts.
Researcher Brown said, “we’re surprised by the amount of energy and resources it takes to reach out to individuals who attempt suicide. This population lacks a positive attitude toward the mental health system and often fails to show up for scheduled appointments.” With the cognitive therapy’s short-term nature, researchers suggest that it makes it an ideal choice for the treatment of suicide attempters in the community mental health centers.
“This is something worth considering in communities, since according to NIMH Director Thomas Insel, M.D., “even one previous attempt multiplies suicide risk by 38-40 times, and suicide is the fourth leading cause of death for adults under 65.” “A proven way to prevent repeat attempts has important public health implications.”
For more information visit:
http://www.nimh.nih.gov/press/ctsuicide.cfm
My Brother’s Keeper
Study finds suicide watches of inmates by inmates successful
A new study by the Federal Bureau of Prisons found that prison suicide watches done by other inmates, instead of prison staff, reduce the frequency and duration of watches, benefit inmate observers and reduce costs.
In the study, led by psychologist Gary Junker, Ph.D., researchers at the Federal Medical Center in Butner, N.C., tracked suicide watches for two 12-week periods. They tracked inmates at the Federal Bureau of Prisons Medical Referral Center, which provides mental and physical health care to inmates throughout the federal penal system. During one of those sessions, institution staff conducted the watches; during the other, inmates did the watching.
The inmate observers were selected from a group of inmates that work and live at the medical center, but who are not mentally and physically ill. They were trained by a psychologist to watch their suicidal peers, record log entries at 15-minute intervals and call for assistance during emergencies. The inmates were also given information about suicidal behaviors, active listening and confidentiality. They did not have access to patient records and were instructed that their job was to observe, not counsel.
The study found that the average number of hours spent under watch dropped significantly for psychotic inmates, when inmates were doing the watching -- going from 100 hours with staff observers to about 65 hours with inmate observers. Results for inmates with personality and mood disorders were less clear, but the researchers found no negative effects.
It is not yet clear why suicide watch durations shrink with inmate watchers, but Junker said it could be that spending time with a peer reduces stress.
“Several of these individuals were actively delusional while on watch,” the study said. “The use of an inmate observer (rather than an authority figure) may provide a safer venue for the suicidal inmate to converse and identify with a peer.” The study also said that because prison is a stressful environment, in which suicidal ideation is more common that in society as a whole, “the support of a peer who is coping more effectively may serve as an encouraging protective factor for the suicidal inmate.”
In addition, suicidal inmates sometimes harm themselves to manipulate staff, a situation removed by the inmate observers.
The arrangement can also benefit observers and prisons alike. Being an observer is a chance for inmates to demonstrate social interest and practice prosocial behavior, which increase the chance for success upon leaving prison. “Perhaps even more important,” the study said, “anecdotal evidence suggests that inmate observers realize personal gain by having an opportunity to give back to the community in which they live.”
The prison benefits too: In this case, the medical center saved $300,000 in overtime pay by using inmate observers for a year. “Innovative programs such as IOP (inmate observer program) foster sensitivity and responsibility for community care, while providing potential benefit to administrators, inmate observers, and the suicidal or parasuicidal inmates themselves,” the study said.
To learn more about the study, see:
http://www.apa.org/journals/features/ser2120.pdfAn Interview with Julie Fast
Fast offers alternative treatment for bipolar disorder
Bipolar disorder is a biologically-based chronic mental illness that affects an estimated 2.5 million Americans. Without effective treatment, the disease can lead to suicide in nearly 10 to 15 percent of cases, according to the National Mental Health Association.
While psychiatric medicines are effective for consumers with bipolar disorder, they are ineffective for others. Author and columnist Julie Fast is in the latter group.
According to Fast, traditional psychiatric care that relies on prescription medicines is “crisis control instead of prevention.” She also blames managed care companies for requiring doctors to see patients at an assembly-line pace that makes discussion of alternative treatments almost impossible.
After a 20-year quest to find an alternative way to treat and manage bipolar disorder, Fast created The Health Card System. The system, which focuses on “prevention rather than crisis control,” is a hands-on, interactive treatment program. The 148-page book teaches people with bipolar disorder how to cope with the illness and identify triggers and mood swing symptoms. Some other topics include improving relationships, returning to work, and reducing the need for medications.
Fast is the author of two books: “Bipolar Happens” and “Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner.” She also writes a column that appears in BP Magazine, a publication for people with bipolar disorder.
A recent interview captured her struggle with and triumph over bipolar disorder. Her website is www.bipolarhappens.com.
What has been your experience with doctors?
Doctors are trained to help people and I believe they truly are committed to helping the people they serve. The problem is that because of the Western system we have created where the outcome is all that matters, some doctors have lost sight of the process. They can no longer give each patient the time they need to feel cared for and respected. When a psychiatrist sees a patient in the States, he or she usually gets only a few minutes each week to help the person in need. Is this the fault of the psychiatrist or the system that pays the psychiatrist? That is a tough question.
Because the minute a person switches to natural medicine and sees a naturopath or any other holistic health care practitioner, they will see that it's totally possible to be a doctor and still have time to help patients one on one - but it's not possible to do this and please a huge HMO or an insurance company. (HMO's are hospitals in the United States that are run for profit as a business.) So why has Western medicine completely lost sight of the fact that people with mental illnesses need time with their doctor in order to get better? Because time is money and our medical system now seems to be about money and not about healing. I don't say this lightly. I feel that doctors have their hands tied completely and totally by the bottom line: profit. The ironic thing is that by not treating mental illness effectively, society often pays with lost work, violence, and homelessness. Dealing with these problems cost a lot more money than prevention. Why is it so hard for business and government to see this? I am sure the doctors are as frustrated as I am.
I have had three psychiatrists. My first was a woman who wanted to help me, but truly was so overworked and burned out from the constant stream of patients I got the feeling she didn't even know who I was as a person. This doctor was my only resource for saving my life when I first got diagnosed and I was scared of her.
My next doctor was new to the hospital and was very kind, but was just as limited in his treatment plan as my first doctor. When you are given 20 minutes a week to see someone as ill as I was, there's no way that is enough time to discuss alternative treatments. There's only time for pills and more pills. These doctors had no idea what to do with me when they realized I could not tolerate medications.
My final doctor changed my life. He too worked at a large hospital and offered medications as a treatment option, but he had somehow managed to retain his enthusiasm, compassion and true interest in the people he treated. I only saw him for 20 minutes a week, but these minutes were productive. He was my doctor when I decided to go off all mediations and he totally supported my desire to treat myself holistically. (Please note that I believe in using medications to treat bipolar disorder. I just happen to be someone who can't take them. I wish I could.) He was interested in my new programs and was supportive of all of my changes. He also found me a therapist who worked with people with bipolar disorder and this made so much difference in my life. He was limited to helping me with medications, but at least I knew I had his support. Just the fact that he believed in me and took the time to know me as a person helped me heal in many ways.
I believe that the only way we can change the way doctors treat bipolar disorder -- and a change is certainly needed -- is to make our needs clear and demand that doctors give us more time and offer us more alternative treatments for the illness. As family members, we have to demand tools that help us help someone with bipolar disorder. As a society we have to try to change the money-driven system that is run by drug companies that seem to care little that many of their drugs can cause someone to become suicidal or ruin their quality of life because of side effects. I was one of them, so I'm not saying this lightly. We have to work together to create a system that respects us as patients and respects the role friends and family play in healing.
What prompted you to make your site?
I made a promise to myself that when I got better, I would help others get well so they would never have to go through the hell I went through for most of my life. I knew that our medical system with its total focus on medications was missing such a large group of people - those of us who either do not find full relief from medications or can't take them because of severe side effects. I always knew I wanted to write books - especially self- help books and a website seemed less stressful than getting a book deal. I had no trouble writing the books. It was the thought of finding an agent and then a publisher that stressed me and made me ill. So, I thought to myself, how can I get my work to the most people in the shortest amount of time? And that led to the website. The website represents so much to me. I wasn't able to work or create anything for years and then when I got better and was able to work again, I found that I still couldn't work at a traditional job. This website helped my self esteem and gave me back a lot of the dignity I lost when I was not able to make money traditionally.
I want to help people with bipolar disorder who can't work in a regular setting find what they can do in order to be productive and satisfied with the working part of life. This is a goal of the website.
Finally, the website got me my first book deal. A publisher called after seeing the site and commissioned a book for couples where one partner has bipolar disorder. Now this is the way to get a book deal when you have trouble with stress! The book is called “Loving Someone with Bipolar Disorder: Helping and Understanding Your Partner.” It was published by New Harbinger Publications in February of 2004.
Describe your 'high 'phases and how one could control them.
I have bipolar II, which is quite different from bipolar I. I think that people get very confused between the two. I explain to people that the difference has to do with mania. People with bipolar I have severe manias that put them into the hospital. People with bipolar II have hypomania.
My high phases are often "wonderful" for weeks. I can do anything, meet anyone, create anything, stay up all night, never eat, talk forever and just have the greatest time. Everything tastes great, looks great and smells great. Things are just so interesting! I'm a magnet for people. I can get anyone to do anything. My mood is contagious. I spend money like crazy because my brain tells me it is the thing to do. I have no limitations in my behaviors and this includes work, life, sex, anything. I'm so in the zone that I just do what I want. When it's happening, I have no concept of how this is affecting my life and simply don't understand why everyone around me is asking what's wrong.
The only way I can explain what this feels like is to ask people to imagine the first weeks of being in love with someone when they tell you they love you as well. Remember walking on clouds, how beautiful the flowers looked, how great everything tasted and felt? That is what the first stages of mania are like for me. It's fantastic and unbelievable.
The problem is that none of it is real. These are manufactured emotions by my brain. Mania seriously impairs my thinking. Terrible decisions are made, such as marrying someone after knowing them a few weeks (I DID IT!) or having dangerous sex, quitting work or charging thousands of dollars on a credit card. Irritation is soon a problem as is psychosis. In other words, the euphoria (if you have it at all) is always followed by pain.
Soon it gets out of control and if it's combined with psychosis, it can really ruin lives whether you have bipolar I or II. I've made terrible decisions when depressed, but I made destructive and life altering decisions when I was manic. This is why I treat mania so carefully today.
I control my mania with the Health Cards. This is the holistic system I created to treat bipolar disorder. This system takes time and a lot of self awareness, but it works.
I will describe how I came up with the system and how I use it now:
I believe that ultimately mania must be prevented instead of treated when it just happens to show up. Mania has a very small treatment window. (Depression has a much larger treatment window.) In order to prevent mania, a person has to learn the very first signs of their personal mania. It manifests differently in everyone. For example, my mania always comes with increased sight, taste and feeling in everything I do. I now know the minute I have the thought that the world is so beautiful (!!), I have to start using my tools to prevent the mania from going any farther. I also have a lot of impatience and irritation. My spending increases immediately in small and subtle ways. (I talk about this in the book Bipolar Happens!) I justify a lot of behaviors I know will make me more ill in the future such as wanting to party, drink and go to Las Vegas. These are all very particular signs that a manic episode is starting. It starts small, but it always starts the same.
People seem to think that bipolar disorder is random. It's not random at all, as I am sure you know. It feels random to those of us who have the illness because there are so many mood swings. But mania shows its signs the same way every time and if a person can learn those signs, write them down and then have a plan ready to stop the mania; they can prevent manic episodes from ruining their lives. This is what I teach in the Health Cards. I also emphasize the importance of checks and balances. For example, if you're prone to manic episodes, you have to have a plan set up to protect your money. For many people this means no credit cards, checks or debit cards. For others, it means that they ask friends and family to monitor them closely by using the Health Cards. Then, when the first signs of the mania come up, people know what to do.
Describe yourself when you are very, very low.
There are so many types of depression. There is irritated depression, catatonic depression, psychotic depression and daily low grade depression, but I would have to say that the very lowest of the low for me is suicidal depression with hallucinations and paranoia - so I will talk about this here. I would like to say that I no longer let myself get this low. Depression really does work on a continuum. It's not as though we simply wake up one day and want to kill ourselves. Unlike mania, I feel that depression has a big treatment window. In the same way that I treat mania, I treat the first signs of depression. My first depressive thought is always the same: I wake up with the thought, "What's the point?" I have learned that this is a very strong sign that I need to stop what I'm doing and focus on getting well immediately. Because if I wake up with this thought and just get up and go on with my day, the depression will build into - “I’m a failure and will never be successful," and ultimately to, " I want to die."
I lived with suicidal depression off and on for 18 years simply because I didn't know any better. I now know that severe depression is totally preventable - even without medications. Medications definitely help, but the real cure comes from accepting that it's normal to be depressed and suicidal if you have untreated bipolar disorder and that there is a way to stop the episodes. Of course, this means a person has to have the tools to prevent the episode from getting this far. I believe totally in medications for stopping a severe mood swing, but I have learned that combining the tools I now use to prevent the mood swings along with medications if a person can tolerate them is a much more powerful and successful treatment for depression than medications alone.
How does your illness impact on your life?
Bipolar disorder affects everything I do every day of my life. This isn't fair and I don't like it, but it is reality and I decided that I could live with this once I got well enough to have my life back. Now that I know how to control it and keep my symptoms to a minimum, I have been able to go back to many of the things bipolar disorder took from me when I was very ill. But it's a constant struggle. Writing about it in this way is depressing for me because when I really examine what I have lost, the loss is so huge it's hard to describe. But I'm a bipolar optimist and I've decided to work with what I do have. I try to accept that I can't work like other people and that the high-powered job I wanted for myself (and my family wanted for me) is not going to happen.
The illness has impacted me positively as well -- and this is what I focus on now. I have learned so much about myself. I literally have learned to control my moods -- what triggers them and what helps them. I always know where I am with myself and what I need to do to stay well. The Health Cards taught me this. In my life experience, I would have to say that there are not many people who know how to do this. So many of us tend to float through life day to day. I can't. I'm aware of every day all day because I have to monitor myself so closely. This has led me to great happiness in that I now live my dream. It's taking time - it's slow, but nothing will stop me from anything that I want to do - as long as I am able to do it without getting sick. I still get sick often, but in my heart I know it is temporary and that I have all the tools I need to get back on track.
How to you feel about mental illness stigma? How do you feel doctors can assist in improving this?
Doctors play a huge role in stopping the stigma of having bipolar disorder. They are the first contact most people have with the illness have. Doctors must examine how they talk about the illness and present the diagnosis to people. For example, look at these two ways of telling someone their son, who is in the hospital has bipolar disorder:
I'm afraid I have some bad news. Your son has a mental illness called bipolar disorder that is characterized by mood swings. It will last the rest of his life. There are medications for this illness. (Stigma!)
The other response:
I'm happy to tell you we have found an answer to all of the questions you have about your son's erratic behavior. It's a treatable illness called bipolar disorder. You may have heard of it. Now that we know what we are dealing with, we can get him on the right medications and start him on a holistic treatment plan that will help him get his life back to normal. (No stigma!)
I would be a different person today if I had heard my diagnosis in this way, especially if there truly was a holistic treatment plan ready for me when I went into the day program at the hospital. My goal today, along with stopping the stigma, is to get the Health Cards into hospital treatment plans so that family members have a treatment plan to work on and have ready while their loved one is so sick.
So, overall I believe that doctors can play a positive and affirming role in accepting this illness and the "label" of bipolar disorder by changing the way they see and talk about the illness with their patients. The day that Western medicine joins hands with natural medicine will be a happy day for all people with bipolar disorder and will help end the stigma by helping us get well so that we can show people that this illness is nothing to be ashamed of.
Pharmacy Program Meeting Needs of Uninsured
More than 29 million people in the United States have salaries that are less than two times the federal poverty level and have no health insurance.
The Partnership for Prescription Assistance allows people who lack prescription coverage the opportunity to get the medicines they need through public and private programs. The Partnership for Prescription Assistance offers access to more than 275 public and private patient assistance programs.
Its mission is to increase the awareness of patient assistance programs and boost enrollment of those who are eligible.
The National Mental Health Association recently joined more than 50 other national organizations who are working with America’s pharmaceutical companies in order to promote the program.
“Until now, there was no central information clearinghouse for prescription assistance programs sponsored by government agencies and pharmaceutical companies, leaving consumers to navigate two complex systems for prescription assistance,” explained Michael Faenza, president and chief executive of NMHA. Patients, caregivers, and prescribers can access the Partnership for Prescription Assistance website and retrieve information about patient assistance programs, view a list of participating programs in their state, and even get help filling out forms. The website is also available in Spanish.
For more information, visit:
Or call:
1-888-4ppa-NOW
(1-888-477-2669)
Suicide screening programs not associated with increased risk
Evaluating Iatrogenic Risk of Youth Suicide Screening Programs: A Randomized Controlled Trial Madelyn S. Gould, PhD, MPH; Frank A. Marrocco, PhD; Marjorie Kleinman, MS; John Graham Thomas, BS; Katherine Mostkoff, CSW; Jean Cote, CSW; Mark Davies, MPH
JAMA. 2005;293:1635-1643.
Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention, yet no study has directly addressed the potential harm of suicide screening. Because of this, a study was conducted to examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students or among high-risk students reporting depressive symptoms, substance use problems, or suicide attempts.
A randomized controlled study was administered within the context of a two-day screening strategy. Participants in this study included 2342 students in 6 high schools in New York State during 2002-2004. Classes were randomized to an experimental group, which received the first survey with suicide questions, or to a control group, which did not receive suicide questions. The distress of the students was measured at the end of the first survey and at the beginning of the second survey, two days after the first.
The results from the randomized controlled study showed that there was no evidence of iatrogenic effects, or inadvertently imposed effects, of suicide screening. The distress levels from the experimental and control groups did not differ. Students exposed to suicide questions were no more likely to report suicidal ideation after the survey than unexposed students. High-risk students (defined as those with depression symptoms, substance use problems, or any previous suicide attempt) in the experimental group were neither more suicidal nor distressed than high-risk youth in the control group; on the contrary, depressed students and previous suicide attempters in the experimental group appeared less distressed.
From this study it would be safe to conclude that students are not at risk of iatrogenic effects due to suicide screening programs. Suicide screening programs in a high school environment are a safe component to youth suicide prevention efforts.
To read more about the study, visit:
http://jama.ama-assn.org/cgi/content/abstract/293/13/1635
