Reflection on Depression

FDA advisory panel requires new testing of ECT machines

I finally had a chance to catch my breath at work and can get back to blogging! There's a lot to catch up on because a number of interesting mental health issues have been in the news. In particular, this article describes last week's meetings of an FDA advisory panel to review the classification of ECT (electroschock therapy) machines.  

When the FDA put the current medical device rating system into effect in the 1970s it rated ECT machines as Class III devices, meaning rigorous safety testing should have been required for market approval. However, ECT had been around for decades and so the FDA grandfathered in the machines to exempt them from costly new trials. Recently, the Government Accountability Office eliminated this grandfathering, forcing the FDA to either reclassify the devices--in effect lowering restrictions--or require new (and costly) safety tests.  After two days of meetings the advisory panel decided to maintain the Class III rating.  As a result, new safety trials are necessary to keep the machines on the market. 

Psychiatrists worry that there could be an incipient ECT "shortage" because the two companies that make the devices may be not be able to afford the necessary clinical trials. Most patients' rights groups, however, are pleased with the FDA's decision to require new testing.  These ECT "survivors" are concerned about memory loss, ECT's most severe side effect, and would like to see more data on the efficacy/safety profile of the treatment. 

This tension between short term need and long term understanding is difficult to resolve. My first thought was that the FDA should have reclassified the devices in order to keep ECT widely available because ECT is thought to be the most effective and fastest acting treatment for severe depression. Eliminating it as an option is like taking morphine and other powerful painkillers away from doctors, asking them to rely on over-the-counter painkillers instead. The FDA, however, is taking the long-term view that new testing will ultimately clarify the risk/benefit profile of the devices, allowing doctors to make more informed decisions in prescribing the treatment. 

The new trials will have to be financed by a deep pocket--probably the government since ECT machine manufactures may not be able afford the clinical trials themselves. Let's hope the trials happen and, in the long run, we have more information about a treatment that (historically at least) has been a critical item in psychiatrists' tool kits. 

See you next week

I'm busy at work putting together long deposition outlines for a case that's heating up so I'll be taking a break from blogging this week.  Enjoy exploring the rest of the net, and see you soon!

Mental illness, violence, and psychiatric treatment

Ronald Reagan is more to blame for the shooting in Tuscon than Sarah Palin (of course, it's a simplification to blame any one person).  Still, Ronald Reagan did more to dismantle America's mental health system than anyone else.  Although he promised adequate "community care" in its place, a system of outpatient facilities capable of handling the country's mental health burden never materialized. 

 

In my opinion, at least two things necessary for adequate reform:  

1) A bigger budget for mental health care services.  This is probably unrealistic given the deficit and the economy. But I wonder if teaching children emotional resilience at an early age could help reduce the burden (and expense) of treating mental illness later on. Also, families need to get sick loved ones into care much sooner, since early intervention improves the prognosis of most mental illnesses. A great example of a program teaching kids emotional resilience skills is Project Happiness.

2) Changes to the legal criteria for involuntary treatment or commitment.  There's a fine line between providing psychiatric treatment and harming civil liberties, but it's a line that we need to look at more closely. In the following MSNBC interview a forensic psychologist discusses the need to loosen the legal criteria for involuntary commitment. Currently, only people who are seriously at risk of harming themselves or others (for instance, as he notes, people who have waived a gun at someone over the last 24 hours) can be held. He thinks that courts should also consider what doctors call "insight" when deciding whether to commit someone. Those patients who lack insight into their illness (i.e don't believe they are sick) should be easier to commit. 

  MSNBC forensic psychologist interview

The Dr. also makes the point that the main reason for getting the mentally ill into treatment is because they are suffering, not because they are dangerous. This suffering is undeserved and thwarts many people with mental illness from reaching their full potential.

Plus, as one commentator points out, a higher percentage of intoxicated people commit violent acts than people with mental illness. In fact, the mentally ill are far more likely to be victims of crime (given their vulnerability) than perpetrators of crime.  

 

Update on a father's journey

See a father's journey for updates on the progress of Guy Fessenden, who is running cross country to raise money for NARSAD (National Alliance for Research on Schizophrenia and Depression -- although NARSAD funds research into a lot of different disorders, not just schizophrenia and depression) in honor of his daughter who suffers from schizophrenia and depression.

Guy is now in Arizona (after starting in Georgia). He runs a marathon a day and has "only" 650 miles to go, after already running 2,000.  On his website you can donate to NARSAD.

Preventing Suicide: The Facebook Help Center

Suicide is an admittedly somber topic to start off the work week (I promise to be more uplifting later this week if you keep reading), but this blog is designed to address any and all issues regarding mental illness, however unpleasant. No sugar coating. No denial. No avoidance.

Last week the friends of a British woman who posted suicidal content on Facebook mocked the facebook suicide note that she left and failed to call police in response to her post. As a result, she died. The incident reminded me about the Florida teenager who streamed his suicide live via webcam in 2008 while 1500 people watched. It was 12 hours before anyone called for help.

For those who have trouble understanding suicide--who understandably feel betrayed in the wake of what seems like a selfish act of abandonment--there is a beautiful column in Salon today by a woman who couldn't comprehend her mother's reasons for committing suicide until, decades later, she experienced her own devastating depression. It's the interesting perspective of someone who has experienced anger in the aftermath of a loved one's suicide, and, later, understanding in the wake of her own attempt.

Anyway, I just learned about the Facebook Help Center. It's a place where you can report suicidal content you may see on the site (please also reach out to the person yourself and/or call someone who can get to them). Once notified, Facebook will report the content to a national suicide crisis center that will step in and try to reach out to the person.

On a related note, I know I've neglected to write about the nationally publicized suicides of several LGBT teens recently. I need to get to that . . . . I sometimes find myself avoiding writing about tragic current events, especially when they involve children, because it's really tough to think about them long enough to compose a post without getting pretty sad. 

The issue of child and teenage bullying also makes me feel helpless, because I don't know what the answer is. I feel like I don't have expertise in the area because I was never bullied in school. I can't imagine what some of these kids have to go through, and I don't know what to say it make it better.

Outstanding Charlie Rose episode on mental illness

Here's a link to an excellent episode of Charlie Rose that features nobel laureate Eric Kandel, Helen Mayberg (an expert on deep brain stimulation for depression), Elyn Saks (a law professor and McArthur Genius Grant award winner who has schizophrenia), and Kay Redfield Jamison (bipolar patient, bestselling author, and a professor at Johns Hopkins Medical School).

These are four of the most outstanding mental health advocates and researchers in the world, all of whom are very articulate authorities on mental illness. Kay Jamison makes some especially insighful comments on the difference between depression and grief in this episode.

How thoughtful!

Starbucks' non-fat miso is my favorite morning beverage (I have no idea why it's called a miso--it has nothing to do with miso soup. Plus, everywhere else the drink is called a cafe au lait).  [Jan. 5 update:  someone explained that it's actually called a "misto," the Italian word for "mixed".]

Anyway, I overheard a barista talking with another customer while I waited for my misto on New Year's Eve.  The customer commented that she came to Starbucks on Christmas day and was surprised the store had been so busy.  "Maybe it's because there are so many people here from other cultures--cultures that don't celebrate Christmas."  (Not that there's anything wrong to going to Starbucks on Christmas even if you do celebrate it--I did :) ). 

The Barista agreed and added "It's good people come in. You know, there're a lot of suicides around the holidays. It's better people come here than stay at home." 

Next he called my name because my drink was ready. And as I approached the counter to grab my miso he looked into my eyes and said "Happy New Year. Have a great day."  He said it in a way that was more engaging that the normal exchange between employees and customers. His eyes said he cared and they gave me the impression that I could remain and talk to him if I needed someone to listen. His friendliness wasn't over the top or creepy. It was genuine and uplifting.

I got the impression that his behavior was tied to his prior comment about suicide--he wanted to touch every life and every path he crossed during the holidays. He was attuned to the pain that the holidays bring to some people, but still able to spread the joy that's at the heart of the season. Most of all, he was aware of the impact he could have on his customers. And he knew that, in rare instances, his kindness could be lifesaving.

To someone suffering from depression, that outreach, resulting in a very real and genuine positive interaction, is a much needed moment of recognition that warms the soul enough to survive the cold and sometimes unrelenting loneliness of the winter holidays. 

This man epitomized the holiday spirit. He didn't have much--being a barista is a pretty low-paying job--but he offered his customers what he could, and it was no doubt more valuable than money to some.