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.
Over at YR (formerly Youth Radio), Desmond Meagley wrote and illustrated a moving, sad, and ultimately hopeful personal story about being committed to the psych ward at age 14. From "5150'd: My Journey Through a Psych Ward":
After I had a meltdown in the middle of my sixth grade class, my school gave my family an ultimatum: if I was going to be enrolled there, I also had to be in therapy. Just like that, my struggle to be heard was confined to dimly lit sessions with the school counselor and an outside therapist. I tried to be honest with them, but I was a little too young to grasp what was at the root of my mental health issues. I was also scared of what might happen if I was *too* honest.
I was getting used to pushing my mental health aside, believing that I would eventually grow out of my depression and anxiety… even though they were getting worse.
That’s the thing about chronic mental illness: you don’t grow out of it. It grows with you, getting smarter, more mature, more convincing. Constantly having to outsmart the worst parts of your own brain is a nightmare.
"5150'd: My Journey Through a Psych Ward" (YR)
illustration: Desmond Meagley
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The active ingredient in Ecstasy, MDMA, is safe and can help to treat post-traumatic stress disorder, a new clinical psychotherapy trial shows.
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Hopes&Fears has a beautiful feature up today on the lives of service dogs for people with psychiatric disabilities and mental illnesses. Read the rest
In children, symptoms of sleep deprivation include hyperactivity and impaired interpretation of social cues.
Michael sez, "The American Psychiatric Association recently released a new version of its Diagnostic & Statistical Manual - basically a catalogue of the categories into which they divide suffering. This entertaining review treats the text as a sprawling dystopian novel." Read the rest
In this video, Sidney Cohen (author of The Beyond Within: The L.S.D. Story, administers LSD under clinical conditions to an unnamed "normal person" (her description), some time in the 1950s. Her description of her experience is really wonderful -- you can tell she's going through something profound and amazing. As Reason's Jacob Sullum wrote in 2011,
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The experience she describes includes familiar themes such as gorgeous colors, geometric patterns, microscopic particles suddenly visible, and a sense of transcendence, oneness, and ineffability:
"I can see everything in color. You have to see the air. You can't believe it....I've never seen such infinite beauty in my life....Everything is so beautiful and lovely and alive....This is reality...I wish I could talk in Technicolor....I can't tell you about it. If you can't see it, then you'll just never know it. I feel sorry for you."
Today all this may sound hackneyed, but what's striking about this woman's account is that her expectations were not shaped by the huge surge of publicity that LSD attracted in the next two decades. Although she had not heard what an LSD trip was supposed to be like, her experience included several of the features that later came to be seen as typical—a reminder that, as important as "set and setting" are, "drug" matters too.
Despite the similarity between this woman's description of her experience and testimonials from acid aficionados of the '60s and '70s, her presentation is so calm and nonthreatening that it is hard to imagine how anyone could perceive this drug as an intolerable danger to society.
This is a really important long read that we all need to pay attention to. It concerns how we treat people with who are suffering from paranoid delusions — and how we treat people whose families worry that they are a threat to others. It concerns the relationships between doctors and the pharmaceutical industry. It concerns the ethics of clinical trials — the risks we run as we test potential treatments that could help many, or hurt a few, or both. If we want to reform mental health care, this needs to be part of the discussion.
In 2004, Dan Markingson committed suicide. The story behind that death is complicated and depressing. At the Molecules to Medicine blog, Judy Stone documents the whole thing in three must-read chapters. Many people find help in psychiatric drugs, and credit those drugs with making their lives better. (Full disclosure, I'm one of them. I have used Ritalin for several years. I am temporarily on an anti-depressant.) But we have to pay attention to how those drugs get to us. This isn't just about treating people. It's about the process that gets us there. Because, if that process is compromised, the treatments we get won't be as effective and lives will be lost along the way.
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Markingson began to show signs of paranoia and delusions in 2003, believing that he needed to murder his mother. He was committed to Fairview Hospital involuntarily after being evaluated by Dr. Stephen Olson, of the University of Minnesota. He was subsequently enrolled on a clinical trial of antipsychotic drugs—despite protests from his mother.
The American Psychiatric Association is set to add "disruptive mood dysregulation disorder" to the Diagnostic Statistical Manual (DSM), the bible of psychiatric disorders. A kid has "DMDD" if she or he has "severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation... at least three times a week."
As Wired's David Dobbs notes, this describes basically all kids ("No, I don't want to wear my rain boots!") at some time or another. So why is this being considered? Here's Neuroskeptic's explanation:
DMDD seems to be nothing to do with mood, but instead covers a pattern of misbehavior which is already covered by not one but two labels already. Why add a misleadingly-named third?
Well, the back-story is that in the past ten years, many American kids and even toddlers have got diagnosed with ‘child bipolar disorder‘ – a disease considered extremely rare everywhere else. To stop this, the DSM-5 committee want to introduce DMDD as a replacement. This is the officially stated reason for introducing it. On the evidence of this paper and others it wouldn’t even achieve this dubious goal.
The possibility of just going to back to the days when psychiatrists didn’t diagnose prepubescent children with bipolar (except in very rare cases) seems to not be on the table.
Psychiatry Set to Medicalize Hissy Fits Read the rest
Psychiatry is "committing professional suicide" because psychiatrists are far too willing to accept gifts, food, trips, and free samples from the pharmaceutical companies that push psychiatric drugs, says psychiatrist David Healy. Worse, he says, those same drug companies have been caught hiding dangerous results from the FDA and doctors, covering up that malfeasance, and attempting to silence critics (including Healy himself). At Time's Healthland blog, Maia Szalavitz shows that Healy makes a persuasive case against the pharmaceutical giants and in favor of patients, doctors, and the federal government doing more to hold these companies accountable. Read the rest