If you've decided to investigate treatment options for your mental health, your health insurer will cheerfully refer you to a list of hundreds of providers -- but as STAT's Jack Turban discovered, this "network" of providers is actually a "ghost network," filled with wrong numbers that ring in McDonald's restaurants and jewelers. If you happen to reach an actual mental health professional, they'll probably tell you they're not accepting new patients.
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Ketamine is a sedative first synthesized in 1962; its patents have long elapsed and it costs pennies; it has many uses and is also sold illegally for use as a recreational drug, but in recent years it has been used with remarkable efficacy as a treatment for a variety of disorders, including depression, anxiety, and chronic pain (I have lifelong chronic pain and my specialist has prescribed very low doses of it for me at bedtime).
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Earlier today, the FDA approved esketamine (brand name Spravato), a chemical twin of the dissociative psychedelic/anaesthetic ketamine (Special K), as a treatment for depression. Spravato comes in nasal spray form meant to be administered weekly or every other week depending on the severity of the patient's depression.
"There has been a longstanding need for additional effective treatments for treatment-resistant depression, a serious and life-threatening condition," said the FDA's acting director of the Division of Psychiatry Products, Dr. Tiffany Farchione, in a press release. "Because of [safety] concerns, the drug will only be available through a restricted distribution system and it must be administered in a certified medical office where the health care provider can monitor the patient."
From National Public Radio:
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Many doctors who have become comfortable offering ketamine for depression probably won't switch to esketamine, said Dr. Demitri Papolos, director of research for the Juvenile Bipolar Research Foundation and a clinical associate professor at Albert Einstein College of Medicine.
For the past 10 years, Papolos has been prescribing an intranasal form of ketamine for children and adolescents who have a disorder that includes symptoms of depression.
"I'm very pleased that finally the FDA has approved a form of ketamine for treatment-resistant mood disorders," Papolos said. He said the approval legitimizes the approach he and other doctors have been taking.
But he hopes that doctors who are currently using ketamine continue to do so. "It'll be a lot less expensive and a lot easier for their patients [than esketamine]," he said.
Teams of researchers are developing sesame seed-size neuro-implants that detect brain activity that signals depression and then deliver targeted electrical zaps to elevate your mood. It's very early days in the science and technology but recent studies suggest that we're on the path. Links to scientific papers below. Fortunately, the goal is to develop tools and a methodology more precise than the horrifically blunt "shock therapy" of last century. From Science News:
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DARPA, a Department of Defense research agency, is funding (Massachusetts General Hospital's research on new brain stimulation methods) plus work at UCLA on targeted brain stimulation. Now in its fifth and final year, the (DARPA) project, called SUBNETS, aims to help veterans with major depression, post-traumatic stress, anxiety and other psychiatric problems. “It is extremely frustrating for patients to not know why they feel the way they do and to not be able to correct it,” Justin Sanchez, the director of DARPA’s Biological Technologies Office, said in a Nov. 30 statement. “We owe them and their families better options.”
These next-generation systems, primarily being developed at UCSF and Massachusetts General Hospital, might ultimately deliver. After detecting altered brain activity that signals a looming problem, these devices, called closed-loop stimulators, would intervene electrically with what their inventors hope is surgical precision.
In contrast to the UCSF group, Widge, who is at the University of Minnesota in Minneapolis, and his collaborators don’t focus explicitly on mood. The researchers want to avoid categorical diagnoses such as depression, which they argue can be imprecise.
Molly Russell, 14, took her life in November 2017.
I've played enough of Rockstar Games' Red Dead Redemption 2. Read the rest
I’ve always felt the urge to leave. Any place. No matter how beautiful. I want to go. When I was 18 and finished with high school, I attended my graduation ceremony, for the sake of my family, but I skipped my prom – Canada’s east coast was calling. I’d never been there before. I didn’t know what I’d find. But I was going. I made a life for myself out there, with university, work and music. I traveled up and down the coast. Cape Breton feels like a second home to me. I love the people of Maine. New Brunswick and Prince Edward Island have a place in my heart.
But eventually, I left the east. Rage, the self-entitlement that sometimes comes from surviving a shitty childhood and a need for control left me very much out of control. I destroyed a fine long-term relationship looking for who I was. I burned bridges. I did terrible things to myself and others. It was time to move on. My travels took me back home to Ontario. My father was dying. I loved and hated him for who he was and what he had done to our family. Coming home was a terror.
Uneasily settled back into my hometown, I fought to push the dogs of my recent past down into the cellar of my soul where their bark did not seem so loud. I’d gone to university for journalism, but felt too shattered by life to write. I took on a job I despised and worked it for years. Read the rest
Child psychologists have observed an increasing trend in which teens cyberbully themselves, creating anonymous accounts in which they post vicious insults and slurs that seem to be directed to them by strangers.
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Wil Wheaton has publicly discussed his anxiety and depression before; I know several people whose lives were improved by reading what he had to say.
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Being medicated is the best and the absolute worst.
I take a cocktail of anti-anxiety and anti-depressive drugs on a daily basis to help me deal with the symptoms that come with my PTSD. Most of the time, I'm grateful for them: They've helped to numb me, just enough so that I can use the techniques I've learned in therapy to help ground myself during a flashback or panic attack. Now that I'm medicated – I refused treatment for years – I'm able to maintain a healthy relationship.
The rage and detachment I've experienced these past 20 years have been tamped down far enough that I can empathize, fully, with my wife, friends and colleagues. It's hard work, sometimes! But I feel healthier than I have in years. A lot of the time, I'm even able to sleep through the night. The paranoia I deal with and the thoughts that refuse to stop tumbling around in my head give way to slumber, most evenings. It's still a frequent thing for me to wake up, sweat-drenched and alert in the dead of night, but it feels manageable. Before, it was just exhausting and sad.
But then, on occasion, a doctor decides that maybe I should be on something new; something different. This happened two days ago. I'm not digging it.
I was warned: when starting on these new pills (no, I'm not going to tell you what they are) I'd experience more anxiety for the next few weeks as the old drugs leave my system and my new pharmaceutical hotness takes hold. Read the rest
Since the earliest days of Facebook, social scientists have sent up warnings saying that the ability to maintain separate "contexts" (where you reveal different aspects of yourself to different people) was key to creating and maintaining meaningful relationships, but Mark Zuckerberg ignored this advice, insisting that everyone be identified only by their real names and present a single identity to everyone in their lives, because anything else was "two-faced."
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The prohibition on psychedelics was memorably described as "the worst case of scientific censorship since the Catholic Church banned the works of Copernicus and Galileo" by former UK Drugs Czar David Nutt, and despite the ban, there has been a consistent, determined, very promising (sometimes surprising) drumbeat of scientific papers about the use of psilocybin ("magic mushrooms") and other psychedelics in treating a range of chronic illnesses, including mental illnesses.
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A newly-published overview of self-reported ayahuasca experiences indicates that the hallucinogen can help alleviate eating disorders and reduce alcohol consumption. Now, more scientists are pushing to make it easier to study the drug legally. Read the rest
In High intelligence: A risk factor for psychological and physiological overexcitabilities, a group of academic and industry neuroscientists survey a self-selected group of 3,715 MENSA members about their mental health history and find a correlation between high IQ and clinical anxiety and depression disorders, an effect they attribute to "overexitabilities" -- "the same heightened awareness that inspires an intellectually gifted artist to create can also potentially drive that same individual to withdraw into a deep depression." Read the rest
John Brownlee lost his father to a heart attack. But it was Bruce Brownlee's depression that slowly killed him: My Father The Werewolf.
"I think about my father’s generosity a lot. My father was generous, but he was also depressed, and the nature of depression is to be selfish: to starve those who love you of the best of you, in the relentless feeding of that which can never be nourished. In that, he—the most depressed person I ever met—was also the most selfish. For my entire life, he would give me anything I asked for, as long as it was a movie or a book. But when my mother and I begged him half a dozen times to go see a doctor if he loved us, he wouldn’t lift a finger. How do generosity and selfishness co-exist like that in a person without destroying him?
I don’t know. And, of course, it did eventually destroy him. But that was my father: a lycanthrope of contrasts. Whatever he was, he was also the opposite."
I met Bruce just once and it struck me that every path to him was gated with thorns, and I thought it grew from the reading. But I'm struck more by his son's effort to break through, to finish a story that couldn't be written until the last word was said.
My Father The Werewolf [Pillpack] Read the rest
Ketamine is a short-acting dissociative anesthetic commonly used on animals and sometimes people. Of course it's also beloved by many psychonauts for its unusual dreamlike or "out of body" psychedelic effects. While Ketamine has been shown for years to help treat depression, anxiety, and obsessive-compulsive disorder in adults, researchers at Yale School of Medicine now report that it has great promise as a fast-acting intervention for children in crisis. From Scientific American:
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It was less dramatic to watch than I expected, but the kids were definitely high. There was a lot of giggling involved, and they often said that they felt like time was changing and that their bodies felt ‘funny’ and sometimes numb. Nicole, (a suicidal 14-year-old,) admitted, “I’m not gonna lie. I like the feeling of it.”
Perhaps more dramatic than the trips themselves, which happened in a carefully controlled procedure room with a psychiatrist and anesthesiologist ready to intervene if needed, were the interviews that came after. I could see the weight of depression lifted from these patients within hours. Adolescents who were previously ready to end their own lives became bright and hopeful. Psychiatry has never seen a drug intervention so powerful and fast acting. While most anti-depressants take weeks to work and offer modest improvement, ketamine offers dramatic improvement in less than a day...
Dr. Michael Bloch, Yale child psychiatrist and principal investigator of several controlled trials for ketamine for adolescents, points out that the drug is only used for select patients who have severe mental health problems that have not responded to other medications.
A pair of social scientists from UCSD and Yale conducted an NIH study published in the American Journal of Epidemiology on the link between Facebook use and mental health, drawing on data from the Gallup Panel Social Network Study combined with "objective measures of Facebook use" and self-reported data for 5,208 subjects, and concluded that increased Facebook use is causally linked with depression. Read the rest