Category: Psychopharmacology

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Ketamine Depression Treatment Poses Unknown Risks

00Decision-Making, Depression, Education, Featured news, Health, Psychopharmacology, Suicide November, 18

Source: SnaPsi at flickr, Creative Commons

New evidence that ketamine, an anesthetic medication, might be effective in treating depression is leading to increased research on the drug. What’s significant is the rapid relief in symptoms seen in some patients. After just one dose of ketamine, their depression can decline within three days, much quicker than with conventional anti-depressants.

This finding is particularly meaningful for people at risk for suicide. Ketamine may provide an option for physicians to quickly treat acutely suicidal patients by creating a window of opportunity to begin long-term behavioral and pharmacological therapies. If a patient’s symptoms are relieved even for a short time, it may be long enough to intervene.

Recent excitement also surfaced when researchers from New York’s Mount Sinai School of Medicine demonstrated the drug’s ability to alleviate treatment resistant depression (TRD). TRD occurs when feelings of intense sadness, loss of energy, and inability to experience pleasure persist even after multiple attempts at treatment. In the study, a shocking nine out of 10 patients with TRD experienced significantly reduced symptoms after their first dose of ketamine.

Despite this finding, questions remain about the drug’s long-term efficacy, as well as its side effects.

Anthony (name changed) has first-hand experience with ketamine to treat TRD. In a Reddit thread and interview with the Trauma and Mental Health Report, he explained that, prior to receiving ketamine treatment, he had tried numerous anti-depressants. After spending weeks or months on each drug to no avail, his doctor would switch him to a new drug in hopes of finding one that worked, but nothing did. Anthony began researching alternative treatments himself. He explained:

“When you try so many drugs—SSRIs, SNRIs, TCAS, antipsychotics, lithium, depakote—you are pretty open to anything that will help.”

He discovered ketamine and was enticed by the prospect of its therapeutic benefits:

“Before ketamine, I was in a hole. This was as depressed as I had ever been. I was suicidal. I called my mom and dad. They rescued me, letting me live in their basement. There, I began researching ketamine until I knew almost every study. I convinced my doctor to let me try it.”

But ketamine is only approved for use as an anesthetic by the U.S. Food and Drug Administration (FDA). This provision means that any patient who receives ketamine treatment for depression must have it prescribed as an “off-label” treatment. In other words, the doctor prescribes the drug for a non-FDA-approved use.

Choosing to participate in an unapproved treatment may expose a patient to more risks than they are aware of. FDA approval for ketamine use in anesthesia indicates that one time treatments are not harmful, but it is uncertain whether repeated treatments are safe. And, the long-term effects are not known.

Not surprisingly, the off-label prescription of ketamine has been criticized. A study by Melvyn Zhang at the Institute of Mental Health in Singapore and colleagues cited multiple problems with ketamine treatment for depression. A major criticism was that current information is based on inadequately short periods of observation. These observations indicate depression relapse rates as high as 73% one month after treatment ends.

Nevertheless, after deciding he was scared, but prepared to do anything to overcome his depression, Anthony began intravenous (IV) ketamine treatment in his doctor’s office:

“[When taking the drug] I feel completely disconnected from my body. I cannot move. I feel partly elated, and partly terrified. Reality becomes distant. I have no awareness of my body; only my mind exists. In this space, I can see my own struggle with depression. I recognize in this strange way that the depression isn’t real, not a part of me. I realize that I am surrounded by people who love me. Slowly, I come back to the chair I’m in, back to the doctor’s office. Somehow, I already feel better.”

After his initial treatment, Anthony said that his thoughts of suicide disappeared. He remembers feeling clear-headed, not high or euphoric. He felt normal again. This realization was so profound, he was moved to tears:

“After the initial five treatments, I was having moments when it felt like all my symptoms of depression were gone. But they would always eventually return. I was prescribed a nasal spray about a month after my last IV treatment. That worked for a while.”

Unfortunately, these benefits had serious contraindications. Anthony experienced lingering feelings of being disconnected from his body and from reality. Another study investigating ketamine use for TRD found that three out of 10 participants experienced dissociative symptoms from the drug.

These side effects have yet to be fully understood. Although Anthony believes that the treatment saved him, it also opened the door for other mental-health problems:

“Looking back, I would do it over again, as ketamine literally pulled me from suicidal thoughts. But, in my opinion, ketamine opened the door for the feelings of disconnection. And they are a huge struggle for me every day now.”

With alarmingly high post-treatment relapse rates, little knowledge of long-term safety, and worrisome side effects, ketamine has yet to be proven as a lasting treatment for depression.

– Stefano Costa, Contributing Writer. The Trauma and Mental Health Report

-Chief Editor: Robert T Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Surprising Side Effect of Parkinson’s Drug: Creativity

00Career, Creativity, Dopamine, Featured news, Psychiatry, Psychopharmacology, Self-Control August, 18

Source: Image Credits Feature: Ingrid Hauff, Used With Permission

In 2014, Ingrid Hauff was diagnosed with Parkinson’s disease (PD), a degenerative disorder that attacks the nervous system, leading to speech impairment, loss of control over body movement, and a long list of other symptoms. Plus, there is no cure.

Struggling with the diagnosis, Hauff checked herself into a psychiatric clinic where she was introduced to art therapy. The clinic supplied her with materials, and the staff asked her to paint what she felt. She initially used painting as a way to cope with the illness.

Hauff tells the Trauma and Mental Health Report:

“Before my diagnosis, I never painted. I could never have imagined that painting would be so important to me like it is today. I paint every day. It is a great pleasure for me to paint. I forget every trouble, and I find the [disease’s] side effects are lessened.”

Painting has become more than therapy for Hauff. It’s now a fundamental part of her life, and her unique artistic style and choice of colour have helped her become a successful artist. She has even held an exhibition of her landscape paintings in Berlin.

But her story of artistic knack and creative development is, surprisingly, not a rare one for those diagnosed with PD. Some scientists are investigating whether medications, such as Levodopa and Pramipexol, prescribed to relieve PD symptoms, heighten creativity. These drugs increase the neurotransmitter dopamine, a chemical in the brain that regulates movement. Dopamine is gradually depleted as PD progresses, so boosting this neurotransmitter allows patients to retain regular movement and regain control over their bodies.

Like all medications, though, these drugs have a multitude of side effects, ranging from headaches and nausea, to tremors and hallucinations. Unlike other medications, however, one side effect stands out from the rest: uninhibited creativity.

Neurologist Rivka Inzelberg and colleagues published a study in 2014, finding that patients treated with dopaminergic drugs showed enhanced verbal and visual creativity in comparison to neurologically healthy individuals who were not on the medication. This is one of several studies where Inzelberg demonstrated that PD medications are associated with higher rates of creative capability.

But in some instances, patients claim to produce artwork to a point where they can’t restrain themselves. Eugénie Lhommée and her colleagues interviewed people with PD and published a case study on the influence of increased dopamine on creativity. In it, the patient reported:

“I transformed my home into a studio, with tables and canvases everywhere [and] started painting from morning till night. I used knives, forks, sponges […] I would gouge open tubes of paint—it was everywhere. I started painting on the walls, the furniture, even the washing machine. I would paint any surface I came across. I could not stop myself from painting and repainting every night in a trance-like state. My partner could no longer bear it. People close to me realized that I crossed some kind of line into the pathological, and, at their instigation, I was hospitalized.”

Hauff also experienced an “extreme influence” on her artwork when prescribed Pramipexol:

“I began painting for hours every night. I didn’t have any ability to stop. I lost a lot of sleep and was constantly without energy after these sessions, so I decided, together with my neurologist, to stop [Pramipexol]. I’ve been off of it since the beginning of February 2017, and now after one month [on new medication], I can declare that my feeling of control has come back.”

While these experiences can be damaging to patients and their loved ones, Hauff was able to take advantage of this unique side effect by exhibiting and selling the artwork she had produced. Her solution to the problem was to switch to a different medication. The creative boost remained, but the compelling drive disappeared. Hauff explains:

“My creativity is still there, but the ‘painting time’ is now reduced radically. I am painting only during the daytime. My opinion is that Pramipexol limits my ability to maintain self-control.”

But Hauff has no regrets about her experience with Pramipexol:

“It let me find my creativity and showed me what I can do. It showed me secret parts of my soul. It showed me what has slept in my brain and in my heart for nearly 60 years. It showed me a way to live with my Parkinson’s.”

As is the case for most individuals considering a drug therapy, people with PD have to weigh the benefits and drawbacks of medication options. But as more research on this unexpected and artistic by-product emerges, it begs the question of whether similar medications can be used to boost creativity in the future.

– Ty LeBlanc, Contributing Writer. The Trauma and Mental Health Report.

-Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Pregnant Women Struggle with Managing Psychiatric Medication

00Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Pregnant Women Struggle with Managing Psychiatric Medication

60Anxiety, Featured news, Health, Pregnancy, Psychiatry, Psychopharmacology, Suicide November, 17

Source: Lauren Fritts at flickr, Creative Commons

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Medicating women’s sexual desire still highly controversial

00Featured news, Health, Integrative Medicine, Low Sexual Desire, Meditation, Psychopharmacology, Sex November, 17

Source: Minjung Gang at flickr, Creative Commons

On August 18, 2015, the U.S. Food and Drug Administration (FDA) approved Flibanserin, a drug that treats low sexual desire in women.

With the medication’s presence on the market, you’d think that low sexual desire in women would be well understood. In fact, there is still widespread debate on the issue. Marta Meana, a psychologist at the University of Nevada, writes:

“Desire is the most subjective and acutely amorphous component of sexuality.”

And Lori A. Brotto, a Professor of Gynecology at the University of British Columbia, offers a similar view, explaining:

“There is no clear consensus on the causes of sexual dysfunction in women.”

While women experience obstacles to fulfillment, the causes are complex. According to Brotto:

“An abundance of data indicates that low sexual desire is strongly influenced by a woman’s relationship satisfaction, mood, self-esteem, and body image.”

Medication is, at best, a partial treatment for problems with desire.

There are also differing perspectives on proper terminology around the issue. In an interview with the Trauma and Mental Health Report, Kristen Mark, Director of the Sexual Health Promotion Lab at the University of Kentucky, said:

“Sexual dysfunction may not be the most accurate way to describe low sexual desire. Women may experience sexual problems, but sexual desire ebbs and flows, so people should expect that it will fluctuate.”

Deciding between the word “dysfunction” or “problem” may seem trivial. But language creates meaning, and shapes how health professionals treat clients and conduct research.

Other clinicians agree. Leonore Tiefer, Associate Professor at the New York University School of Medicine, offers two metaphors for sex. The first is digestion. In this metaphor, sex is “just there”. Like digestion, it does not require learning, but is a natural or innate action that the body is equipped for at birth.

The other metaphor is dance. There are many ways to dance. Some people are better at dancing, and some people like dancing more than others. Tiefer argues that sex, like dance, is a learned skill.

Tiefer has advocated extensively against pharmaceutical interventions for female sexual problems. In 2000, she convened The New View Campaign, a collective of clinicians and social scientists dedicated to reframing the conversation around sexuality.

In a 2006 article on disease mongering, Tiefer explains why a purely biological approach to sexual health is inadequate:

“A long history of social and political control of sexual expression created reservoirs of shame and ignorance that make it difficult for many people to understand sexual satisfaction or cope with sexual problems.”

To emphasize that sex has a social context, the New View wrote an alternative system of classification for sexual problems. The first category is “sexual problems due to socio-cultural, political, or economic factors”, and the second is, “problems relating to partner and relationship”.

These categories includes specific causative factors, such as “ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints.”

According to Tiefer:

“Popular culture has greatly inflated public expectations about sexual function. People are fed a myth that sex is “natural”—that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, they are likely to look for simple solutions.”

The drug Flibanserin is one of these ‘simple solutions’. Its approval has been met with controversy.

According to Loes Jaspers and colleagues at Erasmus University Medical Center, the effectiveness of Flibanserin is very low. In a meta-analysis examining the effect of the medication in about 6000 women, Jaspers found that those receiving the drug experienced, on average, only 0.5 more “sexually satisfying” events per month compared to those receiving a placebo.

At the same time, it carries a black label, which the FDA assigns to drugs that include serious side effects. For Flibanserin, these include sedation and fatigue. When combined with alcohol and other common drugs, it can cause dangerously low blood pressure and fainting.

And non-medical treatments, such as mindfulness-based sex therapy, can be effective for treating low sexual desire. According to Brotto, mindfulness shifts attention away from negative, self-defeating thoughts, and towards sensation and pleasure.

Mark, however, thinks that hope should not be abandoned for a medical solution. She says:

“At this point, I would not recommend Flibanserin for most women coping with desire problems. There may be a medication in the future that meets women’s needs when used in conjunction with other approaches, but this just isn’t it.”

Whether women’s sexual problems should be medically treated is still debatable. But what is clear is that social and cultural factors shaping women’s sexual experiences should not be bypassed for a quick solution.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Medicating Women's Sexual Desire Still Highly Controversial

00Featured news, Health, Integrative Medicine, Low Sexual Desire, Meditation, Psychopharmacology, Sex November, 17

Source: Minjung Gang at Flickr/Creative Commons

On August 18, 2015, the U.S. Food and Drug Administration (FDA) approved Flibanserin, a drug used to treat low sexual desire in women.

With the medication’s presence on the market, you’d think that low sexual desire in women would be well understood. In fact, there is still widespread debate on the issue. Marta Meana, a psychologist at the University of Nevada, writes: “Desire is the most subjective and acutely amorphous component of sexuality.”

And Lori A. Brotto, a Professor of Gynecology at the University of British Columbia, has offered a similar view: “There is no clear consensus on the causes of sexual dysfunction in women.”

While women experience obstacles to fulfillment, the causes are complex. According to Brotto, “An abundance of data indicates that low sexual desire is strongly influenced by a woman’s relationship satisfaction, mood, self-esteem, and body image.”

Medication is, at best, a partial treatment for problems with desire.

There are also differing perspectives on proper terminology. “Sexual dysfunction may not be the most accurate way to describe low sexual desire,” says Kristen Mark, Director of the Sexual Health Promotion Lab at the University of Kentucky. “Women may experience sexual problems, but sexual desire ebbs and flows, so people should expect that it will fluctuate.”

Deciding between the terms “dysfunction” or “low desire” may seem trivial. But language creates meaning and shapes how health professionals treat clients and conduct research.

Other clinicians agree. Leonore Tiefer at the New York University School of Medicine offers two metaphors for sex. The first is digestion. In this metaphor, sex is “just there.” Like digestion, it does not require learning but is a natural or innate action that the body is equipped for at birth.

The other metaphor is dance. There are many ways to dance. Some people are better at dancing, and some people like dancing more than others. Tiefer argues that sex, like dance, is a learned skill.

Tiefer has advocated extensively against pharmaceutical interventions for female sexual problems. In 2000, she convened The New View Campaign, a collective of clinicians and social scientists dedicated to reframing the conversation around sexuality.

To emphasize that sex has a social context, the New View wrote an alternative system of classification for sexual problems. The first category is “sexual problems due to socio-cultural, political, or economic factors,” and the second is “problems relating to partner and relationship.”

These categories include specific causative factors, such as “ignorance and anxiety due to inadequate sex education, lack of access to health services, or other social constraints.”

According to Tiefer: 

“Popular culture has greatly inflated public expectations about sexual function. People fed a myth that sex is “natural”—that is, a matter of automatic and unlearned biological function—at the same time as they expect high levels of performance and enduring pleasure, they are likely to look for simple solutions.”

The drug Flibanserin is one of these “simple solutions.” Its approval has been met with controversy.

According to Loes Jaspers and colleagues at Erasmus University Medical Center, the effectiveness of Flibanserin is very low. In a meta-analysis examining the effect of the medication in about 6,000 women, Jaspers found that those receiving the drug experienced, on average, only 0.5 more “sexually satisfying” events per month compared to those receiving a placebo.

At the same time, it carries a black label, which the FDA assigns to drugs that include serious side effects. For Flibanserin, these include sedation and fatigue. When combined with alcohol and other common drugs, it can cause dangerously low blood pressure and fainting.

And non-medical treatments, such as mindfulness-based sex therapy, can be effective for treating low sexual desire. According to Brotto, mindfulness shifts attention away from negative, self-defeating thoughts, and towards sensation and pleasure.

Mark, however, thinks that hope should not be abandoned for a medical solution.

“At this point, I would not recommend Flibanserin for most women coping with desire problems,” she says. “There may be a medication in the future that meets women’s needs when used in conjunction with other approaches, but this just isn’t it.”

Whether women’s sexual problems should be medically treated is still debatable. But what is clear is that social and cultural factors shaping women’s sexual experiences should not be bypassed for a quick solution.

–Rebecca Abavi, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

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Biased Publication Standards Hinder Schizophrenia Research

00Addiction, Bias, Deception, Education, Ethics and Morality, Featured news, Psychopharmacology, Therapy September, 16

Source: Erin on Flickr

The effects of schizophrenia are profound. Characterized by delusions, hallucinations, and social withdrawal, the disorder has no known cure. The introduction of antipsychotic medications in the 1950s has helped many sufferers cope. Following diagnosis, patients usually take antipsychotics for the rest of their lives.

But recently, a 20-year study by professor emeritus Martin Harrow and colleagues at the University of Illinois found evidence to support alternative treatment methods. In fact, non-medicated patients in the study reported better community functioning and fewer hospitalizations than patients who stayed on antipsychotics.

So why do medications continue to be the most commonly prescribed treatment for schizophrenia?

Antipsychotic drugs are the largest grossing category of prescription medication in the United States, with a revenue of over $16 billion in 2010. And much of the research that exists on treatment of schizophrenia is directly funded by pharmaceutical companies, making it challenging for independent researchers like Harrow and his team to get studies published. A bias exists towards silencing unfavourable research.

An analysis looking into possible publications biases surrounding antipsychotic drug trials in the U.S. found that, of the trials that did not get published, 75% were negative, meaning that the drug was no better than placebo. On the other hand, 75% of the trials that did get published found positive results for the antipsychotics being tested.

The Washington Post wrote an article in 2012 claiming that four different studies conducted on a new antipsychotic drug called Iloperidone were never published. Each of the studies pointed to the ineffectiveness of the drug, finding that it was no more effective than a sugar pill for the treatment of schizophrenia. A publication bias like this is worrisome.

Research has also shown that staying on antipsychotic drugs for long periods of time negatively impacts brain functioning and could potentially lead to a worsening of some of the initial symptoms of the illness, including social withdrawal and flat affect.

A growing body of research is focusing on cognitive therapy and community based treatments for schizophrenia, as either a replacement for or in combination with traditional pharmacological treatments. So far, outcomes have been promising.

A study by Anthony Morrison, a professor at the University of Manchester found that patients undergoing cognitive therapy showed the same reduction in psychotic symptoms as patients receiving drug treatment. Likewise, research by psychiatristLoren Mosher, an advocate for non-drug treatments for schizophrenia, showed that antipsychotic medication is often far less effective without added psychotherapy. Onestudy by Mosher showed that patients receiving alternative community based treatment had far fewer symptoms of schizophrenia than patients who received traditional treatment in a hospital setting.

When antipsychotic medication was introduced, many hoped it would represent themagic pill for an illness previously thought to be incurable. But little was known about the long-term effects, and even today, many claims of medication efficacy or lack of side effects remain questionable.

Research in schizophrenia is burgeoning and whether a safer, more effective treatment can be developed remains to be seen. Yet for such developments to be possible, it is important for the scientific and medical communities to open themselves up to the possibility of alternative treatments instead of limiting research that challenges the status quo. While antipsychotic medications offer great benefits in terms of reducing acute positive symptoms like hallucinations or delusions, they are by no means a cure.

–Essi Numminen, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

2 Documentary film tells story of race...-3b7dfcbb54e73e70fecec5726453d2f901a6fd3f

Documentary Film Tells Story of Race, Drugs and Baseball

00Addiction, Featured news, Personality, Psychopharmacology, Race and Ethnicity, Resilience, Therapy April, 16

Source: baseball971 on Flickr

Narratives surrounding professional sport often make stories about performance-enhancing drugs as common a spectacle as the sports themselves. As the story often goes, pressure to succeed and maintain peak physical form drives many professional athletes to substance abuse.

We hear this tale again in Jeffrey Radice’s biographical film, “No No: A Dockumentary,” titled as a play on the name of the story’s subject, Dock Ellis, a black Major League Baseball (MLB) pitcher famous for using drugs while on the mound. In the film, Radice examines Ellis’ struggle with drug abuse, digging deep into his life story and the environment in which he played.

Beginning his major league career in the late 1960s with the Pittsburgh Pirates, Ellis was no stranger to the racial stigmatization faced by many black Americans during this time. Through interviews with former teammates, family members, and childhood friends, Radice shows the pride Ellis had for his culture’s acceptance into MLB. In his time as a professional athlete, he became known for his strong verbosity – he was expressive, opinionated, and willing to disobey MLB rules.

He also established himself as an elite pitcher in the league. His success did not come easily or without a price. Of this experience, Ellis says:

“When you get to the major leagues, it’s easier coming up the ladder, but it’s hell to stay there.”

Ellis’ initial drug of choice was a stimulant called “dexamyl,” popularly known as “greenies” in the MLB. This type of drug is classified as an amphetamine; side effects include alertness, a decreased sense of fatigue, mood elevation, and increased self-confidence. According to Ellis, “greenies” made him feel sharper and allowed him to throw with pinpoint accuracy.

On the eve of June 12th, 1970, Ellis took LSD, a hallucinogen, which lead to his most memorable performance: throwing a perfect game.

In the first half of the documentary, Ellis’ life is described as erratic but exciting, colourful, and Hollywood-like. Radice depicts Ellis’ drug-abuse in a surprisingly lighthearted manner. Ellis chuckles as he reminisces about his high-flying lifestyle when he was at the top of his game. He is portrayed as a baseball superstar, his drug abuse merely a stepping-stone to his success.

In the second half of his film however, Radice shifts his perspective to view the film’s subject through the lens of mental health. While portraying Ellis as good at what he did, Radice asks whether his success in the MLB justified his drug and alcohol abuse.

At one point, Ellis is shown coming off drugs and tearfully admitting his dependence on them. After his retirement and an unfortunate drug-fueled spousal assault, he entered rehab and spent the rest of his life mentoring and counseling other drug-dependent individuals. He stayed sober up until his death in 2008.

The juxtaposition in the documentary – between an outlandish and erratic drug-using icon and a recovered, empathic individual – is moving and effective. It represents the highs and the lows drug users face when coming to terms with their addiction, and the fight to stay sober and live a more fulfilling life.

Toward the end of the film, Ellis reads a letter sent to him by Jackie Robinson, the first African American to play in the MLB:

“There will be times when you will ask yourself if it’s worth it all. I can only say, ‘Dock, it is’ and even though you will want to yield, in the long run your own feeling about yourself will be most important. Try not to be left alone.”

Although Robinson is referring to Ellis’ determination to gain equality in the MLB, his words also relate to the issue of drug-use and addiction in professional sports. The way “No No: A Dockumentary” approaches Ellis’ biography is unique: it idolizes a great baseball player, but also highlights his dark side and shows what Ellis ultimately lost because of drug dependence.

– Alessandro Perri, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Methadone Treatment May Prolong Addiction

60Addiction, Diet, Environment, Fear, Featured news, Health, Motivation, Psychopharmacology, Resilience, Sleep, Spirituality, Stress, Trauma January, 15

The conventional treatment for opioid dependence is to prescribe methadone.

Similar to morphine, methadone is a synthetic opioid sometimes referred to as a narcotic. It is useful at preventing opioid withdrawal, minimizing drug cravings, and is said to reduce the risk of HIV, Hepatitis C and other diseases associated with intravenous drug usage. Methadone is also cheap, and best of all legal.

Despite the advantages, methadone is highly addictive, and has many side effects such as dry mouth, fatigue, and weight gain.

Treatment involving methadone requires a weekly medical visit to renew the prescription, sometimes leading those who are addicted back to the very environment and people that they need to avoid to stay clean.

The Trauma & Mental Health Report recently spoke with Leslie (name changed for anonymity), a patient who has been receiving methadone maintenance treatment (MMT), who says, “Sometimes I wait all day to see the doctor. During that time, you can’t help but associate with other users, hear “drug talk”, or even see drugs being passed around. The methadone doctor doesn’t push counseling and is not there for support. I’m only going to get my prescription.”

Toward the end of treatment, methadone dose is slowly tapered to prevent withdrawal. But most users don’t wean off completely. Leslie says she didn’t have the motivation or tools to do so until she started seeing her drug addictions counselor:

“I’ve been trying to get off of methadone for 18 months now. It has helped with the withdrawal symptoms, and life is easier to manage since I’m not running the street 24/7 looking for my next fix. And I have more time to get my life on track. But, In order to ‘knock’ the addiction you need to figure out what your personal triggers are. My counselor has helped me with this. She also provides a safe place for me to go and discuss my problems and any issues I have with MMT.”

The greatest fear is relapse. Although part of the recovery process, relapse can have physical and emotional consequences. But it helps to identify personal triggers: cues that provoke drug-seeking behavior, the most common of which are stress, environmental factors such as certain people or places, and re-exposure to drugs.

The most important missing link in MMT is drug counseling. Meeting with a counselor is not mandated and patients seldom see one. Those who seek counseling benefit from help determining personal triggers, and preparing for potential relapse. A counselor may help create a healthy living plan that focuses on improving mental health with nutrition, exercise, sleep, building healthy relationships, and spiritual development.

Better family relationships also help with recovery. Including family members in treatment increases commitment to counseling and also helps family members understand what the person is going though.

Opioid addiction is more than physical dependence. Initial detox is a start. Methadone helps with the physical aspects of withdrawal, and helps users lead a more normal life. But without the help of a drug counselor, MMT isn’t enough.

Without counseling, social support, a drug free environment, and the desire to change, we lead the patient only part way there. And part way isn’t enough.

– Contributing Writer: Jenna Ulrich, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: www.123rf.com/stock-photo/lonely_man.html

This article was originally published on Psychology Today

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Myth Busting the Not Criminally Responsible Defense

00Altruism, Empathy, Ethics and Morality, Featured news, Guilt, Health, Law and Crime, Psychiatry, Psychopathy, Psychopharmacology, Therapy, Trauma December, 14

“I thought he must die. He had no future, nothing good. I thought I was saving the child.”

Nerlin Sarmiento had expressed disturbing thoughts about her children long before tragedy struck her small family of four. On many occasions the 32-year-old Edmonton mother had confessed to doctors and family members that she had thoughts of harming herself and her children.

Precautions were taken: Sarmiento was admitted to hospital several times, prescribed psychiatric medication, discharged, and had her mother move in to help care for the children. 

On the morning of February 12th 2013 in Edmonton, Alberta, Sarmiento sent her ten-year-old daughter to school, then forced her seven-year-old son into the bathroom where she held him under water until he stopped breathing.

Sarmiento did not deny murdering her son. She called the police herself to report the crime. Her lawyers, however, argued that she should not be held responsible on account of her mental illness that prevented her from appreciating the moral wrongfulness of her actions.

Two psychiatrists testified at Sarmiento’s trial. They explained that she was experiencing a severe depressive episode as part of her previously diagnosed bipolar disorder. She felt despair so extreme she became convinced she was committing an altruistic act, saving her son from a life of predestined poverty and hardship. 

On September 12th, 2013, Justice Sterling Sanderman agreed. Nerlin Sarmiento was found not criminally responsible (NCR) on a charge of first-degree murder. 

The public outcry against the ruling was reminiscent of the aftermath of the Vincent Li and Guy Turcotte trials; they were found NCR on charges of second-degree murder and first-degree murder respectively.

NCR has been a hot topic featured prominently in the press following several high profile cases, but is often misunderstood.

In Canada, if the court decides that an individual has committed a criminal act (i.e., they are guilty), but lacked the capacity to know that their actions were not only criminally wrong, but also morally wrong at the time, a verdict of not criminally responsible may be given.

Psychiatrist Robert Dickey with Correctional Service Canada and the University of Toronto helped the Trauma & Mental Health Report gain a better understanding of NCR and bust some of the myths surrounding the defense. 

Myth 1: Almost anyone can claim they have a mental disorder and use the NCR defense.

Technically, this is true. But whether or not they would be successful is another story, says Dickey, explaining that if you don’t have a severe mental illness, it is very hard to malinger your way through an NCR assessment and defense.

He further explains that the finding of NCR is based on the exact mental state of the accused at the time of the crime. By the time someone is referred for assessment by the courts, their state of mind may be quite different than it was when the offense was committed. 

A good clinician will seek clear corroborating information that the individual was suffering from a psychotic illness at the time they were arrested. The police, jail and institutional records should give information as to the individual’s mental state at the time.

This is not a matter of being a little depressed, states Dickey. The individual must be so ill that they would not have been able to tell right from wrong, appreciate the wrongfulness of their actions or engage in rational choice when the crime occurred.

Myth 2: The NCR defense is a tactic for offenders to skirt the justice system.

Mostly false, says Dickey. If an individual does not suffer from a psychotic illness, pure psychopathy or criminality alone is not considered – by the law – to be a disease of the mind severe enough to qualify for a finding of NCR.

If the NCR defense is successful, the individual is remanded to the custody of the Provincial Review Board, where the offender is encouraged to receive treatment. Interestingly, the board itself has no power to order the accused to engage in treatment. 

But if an accused does refuse, they are often detained in a secure facility. Dickey explains that with cases of major mental illness and the refusal of treatment, the physician can refer the offender to the Consent and Capacity Review Board. And the individual may be declared incapable to refuse psychiatric treatment and treated against their will.

Myth 3: When a person is found NCR for a crime, they essentially walk free. 

False. The vast majority of offenders found NCR spend a lot more time detained in a secure facility than if they had been found guilty and served a regular prison sentence, Dickey explains. Because the consequences of NCR are more restrictive and more ensuring of treatment, the issue is now more readily raised by the crown (prosecution) than the defense.

After the individual has been remanded to the Provincial Review Board, the forensic psychiatrist will testify as to the necessary level of security needed to manage the offender and their psychiatric care, while still ensuring the safety of the community.

So what’s in store for Nerlin Sarmiento?

When her trial concluded, she was remanded to the custody of the Alberta Review Board (ARB). At a hearing within 45 days from the end of her trial, the ARB determined whether she would receive an absolute discharge, a conditional discharge or be detained in custody. The results of Sarmiento’s hearing have yet to be made public.

 – Contributing Writer: Jennifer Parlee, The Trauma and Mental Health Report

 – Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

 Copyright Robert T. Muller

Photo Credit: Shutterstock

This article was originally published on Psychology Today