Medication helps some with mild depression

By Genevra Pittman

NEW YORK (Reuters Health) - People with mild depression may benefit from taking antidepressants, suggests a new analysis of past studies that compared symptoms in people on the drugs to those given drug-free placebo pills.

Some earlier reports had suggested that antidepressants generally only improve mood in people with severe depression.

But that might be because those studies weren't precise enough to pick up on smaller changes in symptoms that can still make a difference for people with milder forms of the disease, researchers said.

"I think there's a valid concern... that if someone has not-that-severe depression that hasn't lasted that long, maybe it will get better itself or with therapy," said Dr. David Hellerstein, from the New York State Psychiatric Institute and Columbia University, who worked on the study.

Still, he said the question of whether or not to prescribe medication shouldn't necessarily come down to how severe the depression is, but how long symptoms have lasted.

People with "transient depression" that will improve with diet or exercise or after a few weeks of therapy "shouldn't be taking the risk of being on meds," he told Reuters Health.

"But people who have more persistent depression should be evaluated for treatment and medicine should be one of the options," even when the depression is more modest.

Hellerstein and his colleagues collected data from six studies done at the state's psychiatric institute between 1985 and 2000. Those included 825 people with non-severe, long-lasting depression enrolled in trials that compared symptoms with antidepressant treatment versus a placebo.

In three of the six studies, patients taking an antidepressant improved more on a widely-used scale of depression symptoms and severity than those taking a placebo, and in four studies, a higher percentage of patients taking antidepressants went into remission, meaning they were no longer considered to have clinically-significant depression.

Depending on the particular drug and study, the researchers calculated that between three and eight people with non-severe depression would have to be treated with an antidepressant for one to benefit substantially from it.

That, they wrote in the Journal of Clinical Psychiatry, is "a range considered by researchers as sufficiently robust to recommend treatment."

The drugs tested in those studies included Prozac, as well as older and now less-popular medications known as monoamine oxidase inhibitors and tricyclic and tetracyclic antidepressants. It's hard to know how well the findings would apply for newer antidepressants, the researchers said.

The results don't mean that everyone with mild depression should be on an antidepressant, a psychiatrist not involved in the study pointed out.

"People with these milder depressions also respond well to counseling and psychotherapy and can respond well to exercise," said Dr. Michael Thase, from the University of Pennsylvania School of Medicine in Philadelphia.

"This is basically saying, these antidepressants aren't that good, and you should also consider other treatment options and don't just focus on the thing that's the easiest," he told Reuters Health.

The researchers said that some combination of antidepressants and talk therapy is considered most effective in depression treatment -- but getting therapy is often more expensive and time-consuming than medication.

Talk therapy can run $100 or more per session, while generic brands of antidepressants usually cost about $20 per month. Drugs may come with side effects, including insomnia and stomach aches, but they're usually minor, according to Hellerstein.

Still, people on antidepressants should be followed closely by a doctor to see how they're responding to treatment, he said.

Several of the authors of the current study reported having received funding for other research projects from drug companies that make antidepressants.

One recent study found that some depressed people on the antidepressant Cymbalta did worse than the comparison placebo group -- but the majority got some benefit (see Reuters Health story of December 9, 2011).

"I believe the basic finding that drugs are more effective than placebo," Thase said.

But, "The benefits of antidepressants may not be that dramatic in patients with milder depressions for whom many other (non-drug) strategies can also be considered."

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Ending Nightmares Caused By PTSD

by

Amy Standen, KQED

Everyone has nightmares sometimes. But for people with PTSD, it's different.

Sam Brace doesn't want to talk about what he saw when he was a soldier in Iraq eight years ago. In fact, it's something he's actively trying not to dwell on. But what he can't control are his dreams.

They're almost always about the same explosion. "When I was overseas, we'd hit an IED," Brace says. "When I have a nightmare, normally it's something related to that."

Healthy dreams seem kind of random, according to Steven Woodward, a psychologist with the National Center for PTSD at the VA Medical Center in Menlo Park, Calif. "They're wacky," he says. "They associate lots of things that are not normally associated."

PTSD dreams are the same real-life event played over and over again like a broken record. "Replicative nightmares of traumatic events ... repeat for years," Woodward says. "Sometimes 20 years."

Scientists wanted to find out the reason why people with PTSD can't sleep and dream normally. One theory comes from Matthew Walker, a psychology researcher at the University of California, Berkeley. His particular interest lies in rapid eye movement, or REM. It's the time during sleep when a lot of dreaming occurs.

It's also a time when the chemistry of the brain actually changes. Levels of norepinephrine — a kind of adrenaline — drop out completely. REM sleep is the only time of day when this happens. That struck Walker as a mystery. "Why would rapid eye movement sleep suppress this neurochemical?" he asks. "Is there any function to that?"

Walker found that in healthy people, REM sleep is kind of like therapy. It's an adrenaline-free environment where the brain can process its memories while sort of stripping off their sharp, emotional edges. "You come back the next day, and it doesn't trigger that same visceral reaction that you had at the time of learning."

Emotions are useful, he says. They show us what really matters to us. "But I don't think it's adaptive to hold onto that emotional blanket around those memories forever," he says. "They've done their job at the time of learning, then it's time to hold on to the information of that memory, but let go of the emotion."

Walker's theory suggests that in people with PTSD, REM sleep is broken. The adrenaline doesn't go away like it's supposed to. The brain can't process tough memories, so it just cycles through them, again and again.

So, what if you could make the adrenaline just go away? Enter prazosin.

Pfizer Inc. introduced the drug under the brand name Minipress in the 1970s to treat high blood pressure. Dr. Murray Raskind, a VA psychiatrist in Seattle, says the drug, now generic, can cost anywhere between 5 and 15 cents. And, actually, it's not terribly effective as a blood pressure medication, he says.

But what prazosin does do is make people less sensitive to adrenaline. About a decade ago, Raskind starting giving prazosin to some of his PTSD patients, including one Vietnam War veteran.

"He had this recurrent nightmare of being trapped by the Vietcong forces in a landing zone and having his best friend killed in front of his eyes by a mortar round," Raskind says.

After a few weeks of treatment with prazosin, the veteran came in for a follow-up appointment. Raskind says the veteran told him that he wasn't sure the medication was working. He was still having the same dream over and over — just about something else. He told Raskind that in the new dream he was in his fifth grade classroom and there was a test. If he didn't pass the test, he wasn't going to be promoted to the next grade. But he never even got the assignment.

"I said, 'That's my nightmare!' " Raskind says.

Indeed, the veteran's new dream was the stress dream of a healthy brain trying to work things out, Raskind says.

This year, the VA is expected to finish up its trial for prazosin. It's already prescribing the drug to about 15 percent of its PTSD patients. Raskind, of course, would like to see that number rise.

"To us, it's a simple thing that works," he says.

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How to Train Your Brain to Alleviate Anxiety

By Margarita Tartakovsky, M.S.

Our thoughts affect our brains. More specifically, “… what you pay attention to, what you think and feel and want, and how you work with your reactions to things sculpt your brain in multiple ways,” according to neuropsychologist Rick Hanson, Ph.D, in his newest book Just One Thing: Developing A Buddha Brain One Simple Practice at a Time. In other words, how you use your mind can change your brain.

According to Canadian scientist Donald Hebb, “Neurons that fire together, wire together.” If your thoughts focus on worrying and self-criticism, you’ll develop neural structures of anxiety and a negative sense of self, says Hanson.

For instance, individuals who are constantly stressed (such as acute or traumatic stress) release cortisol, which in another article Hanson says eats away at the memory-focused hippocampus. People with a history of stress have lost up to 25 percent of the volume of their hippocampus and have more difficulty forming new memories.

The opposite also is true. Engaging in relaxing activities regularly can wire your brain for calm. Research has shown that people who routinely relax have “improved expression of genes that calm down stress reactions, making them more resilient,” Hanson writes.

Also, over time, people who engage in mindfulness meditation develop thicker layers of neurons in the attention-focused parts of the prefrontal cortex and in the insula, an area that’s triggered when we tune into our feelings and bodies.

Other research has shown that being mindful boosts activation of the left prefrontal cortex, which suppresses negative emotions, and minimizes the activation of the amygdala, which Hanson refers to as the “alarm bell of the brain.”

Hanson’s book gives readers a variety of exercises to cultivate calm and self-confidence and to enjoy life. Here are three anxiety-alleviating practices to try.

1. “Notice you’re all right right now.” For many of us sitting still is a joke — as in, it’s impossible. According to Hanson, “To keep our ancestors alive, the brain evolved an ongoing internal trickle of unease. This little whisper of worry keeps you scanning your inner and outer world for signs of trouble.”

Being on high alert is adaptive. It’s meant to protect us. But this isn’t so helpful when we’re trying to soothe our stress and keep calm. Some of us — me included — even worry that if we relax for a few minutes, something bad will happen. (Of course, this isn’t true.)

Hanson encourages readers to focus on the present and to realize that right now in this moment, you’re probably OK. He says that focusing on the future forces us to worry and focusing on the past leads to regret. Whatever activity you’re engaged in, whether it’s driving, cooking dinner or replying to email, Hanson suggests saying, “I’m all right right now.”

Of course, there will be moments when you won’t be all right. In these times, Hanson suggests that after you ride out the storm, “… as soon as possible, notice that the core of your being is okay, like the quiet place fifty feet underwater, beneath a hurricane howling above the sea.”

2. “Feel safer.” “Evolution has given us an anxious brain,” Hanson writes. So, whether there’s a tiger in the bushes doesn’t matter, because staying away in both cases keeps us alive. But, again, this also keeps us hyper-focused on avoiding danger day to day. And depending on our temperaments and life experiences, we might be even more anxious.

Most people overestimate threats. This leads to excessive worrying, anxiety, stress-related aliments, less patience and generosity with others and a shorter fuse, according to Hanson.

Are you more guarded or anxious than you need to be? If so, Hanson suggests the following for feeling safer:

• Think of how it feels to be with a person who cares about you and connect to those feelings and sensations.
• Remember a time when you felt strong.
• List some of the resources at your disposal to cope with life’s curveballs.
• Take several long, deep breaths.
• Become more in tune with what it feels like to feel safer. “Let those good feelings sink in, so you can remember them in your body and find your way back to them in the future.”

3. “Let go.” Letting go is hard. Even though clinging to clutter, regrets, resentment, unrealistic expectations or unfulfilling relationships is painful, we might be afraid that letting go makes us weak, shows we don’t care or lets someone off the hook. What holds you back in letting go?

Letting go is liberating. Hanson says that letting go might mean releasing pain or damaging thoughts or deeds or yielding instead of breaking. He offers a great analogy:

“When you let go, you’re like a supple and resilient willow tree that bends before the storm, still here in the morning — rather than a stiff oak that ends up broken and toppled over.”

Here are some of Hanson’s suggestions for letting go:

• Be aware of how you let go naturally every day, whether it’s sending an email, taking out the trash, going from one thought or feeling to another or saying goodbye to a friend.
• Let go of tension in your body. Take long and slow exhalations, and relax your shoulders, jaw and eyes.
• Let go of things you don’t need or use.
• Resolve to let go of a certain grudge or resentment. “This does not necessarily mean letting other people off the moral hook, just that you are letting yourself off the hotplate of staying upset about whatever happened,” Hanson writes. If you still feel hurt, he suggests recognizing your feelings, being kind to yourself and gently releasing them.
• Let go of painful emotions. Hanson recommends several books on this topic: Focusing by Eugene Gendlin and What We May Be by Piero Ferrucci. In his book, Hanson summarizes his favorite methods: “relax your body;” “imagine that the feelings are flowing out of you like water’” express your feelings in a letter that you won’t send or vent aloud; talk to a good friend; and be open to positive feelings and let them replace the negative ones.

Margarita Tartakovsky, M.S. is an Associate Editor at Psych Central and blogs regularly about eating and self-image issues on her own blog, Weightless.

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The case for medical marijuana research on PTSD

My colleagues and I have a going "battle" over is it worth it for PTSD or not.. I'm the only one that seems to be against it's use for PTSD





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San Diego naval hospital testing unusual PTSD treatment

By Tony Perry, Los Angeles Times

December 26, 2011

Reporting from San Diego -- The Pentagon is spending hundreds of millions of dollars searching for a treatment for post-traumatic stress disorder, the overarching term for the nightmares, flashbacks, anxiety and restlessness suffered by many troops returning from Iraq and Afghanistan.

Nearly all of the dozens of research projects involve long-term counseling and prescription drugs.

But researchers at the Naval Medical Center San Diego believe that something as seemingly simple as injections of an anesthetic given to women during childbirth may be effective in alleviating the symptoms associated with PTSD.

Early testing on several dozen veterans of the Iraq and Afghanistan conflicts has proved promising, with some, although not all, showing signs of relief from stellate ganglion block treatment, researchers said.

"It may be a significant tool in our armory" to fight PTSD, said Dr. Robert McLay, a psychiatrist and director of mental health research at the medical center.

McLay, whose book "At War With PTSD" will soon be published by Johns Hopkins University Press, says he was skeptical when he first heard about the treatment.

"I thought this was a little wacky when it was mentioned," he said.

But now McLay and Dr. Anita Hickey, a Navy captain and pain control specialist, are midway through a two-year study of 40-plus active-duty Marines, sailors and soldiers diagnosed with PTSD. One of the early findings is that volunteers receiving the injections are doing better than those receiving placebos.

McLay and Hickey hope to present their findings to the American Psychiatric Assn. at its May convention in Philadelphia.

Many questions are yet to be answered: Why does the treatment appear to work on some patients but not others? How many shots are needed? What about side effects? Are combat cases of PTSD different from non-combat cases?

"There is a lot to be studied," Hickey said.

Still, if the treatment proves effective, much of the credit will go to Dr. Eugene Lipov, a Chicago anesthesiologist who has pioneered its use among his patients, many of them former military personnel.

"If we don't get PTSD under control, our crime rate and social disability are going to be out of control," said Lipov, founder of Chicago's Advanced Pain Centers.

In hopes of treating recent veterans or active-duty personnel, Lipov submitted three applications for federal research funding. He was rejected three times by the Pentagon despite, in 2007, having support from the junior senator from Illinois at the time, Barack Obama.

Then, a Navy doctor from San Diego heard Lipov's impassioned testimony before a congressional committee and was intrigued. That led to a $250,000 grant to the Naval Medical Center San Diego, a modest amount in the world of medical research.

In fiscal year 2010, the Navy's Bureau of Medicine and Surgery allocated $800 million for more than 80 research projects on PTSD.

One of Lipov's patients, Raleigh Showens, 64, of McHenry, Ill., had suffered from PTSD since returning from service as an Army medic in Vietnam. "All I saw was torment, death and destruction," he said in a telephone interview.

A year ago, frustrated with counseling and medication, Showens said, he was on the verge of suicide. He took up Lipov's offer of free treatment and received an injection on Dec. 20.

"That was the first night in 40-plus years that I'd slept all night," he said. But three days later, the effect seemed to wear off, and Showens needed a second injection.

Showens said he feels so good that he has quit all counseling and medication.

McLay said his theory is that if the injection method proves effective, it will be best used in addition to therapy, not as a substitute. "I think it will be good to have a variety of treatments," he said.

There are differences between the work of Lipov and the Navy researchers involving what drug is best (obstetricians use several different ones for epidurals) and what is the best method for locating the precise location in the neck for the injection (Lipov likes X-ray, Hickey prefers ultrasound).

The treatment aims to affect the body's sympathetic nervous system through the nerves in the neck. The bundle of nerves that control the "fight or flight" syndrome in the brain are known as the stellate ganglion.

The injection, Lipov said, "resets" the nerve bundle to calm down the agitation and "hypervigilance" that are common to PTSD sufferers. Although denied federal funding, Lipov has received $81,000 from the Illinois Department of Veterans Affairs and has 10 veterans enrolled in his own study.

Lipov and Maryam Navaie, president and chief executive of the La Jolla-based Advance Health Solutions, plan a trip to Washington early next year to lobby key members of Congress.

And in February, Military Medicine, the monthly publication of the Assn. of Military Surgeons of the U.S., will publish an article by Lipov, Navaie, Hickey and four other researchers discussing Lipov's findings and the early results from the Naval Medical Center San Diego study.

On one point all the researchers agree: PTSD will remain a medical challenge long after the end of the wars. McLay said PTSD, by different names, can be traced to the days of Achilles and the Spartans.

"I see Marines, SEALs, Green Berets — the toughest men on earth — and they still have PTSD," McLay said.

tony.perry@latimes.com

Copyright © 2011, Los Angeles Times

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Fewer veterans with PTSD using anti-anxiety drugs

NEW YORK (Reuters Health) - Use of a class of anti-anxiety drugs fell during the past decade among veterans with posttraumatic stress disorder, a large U.S. study shows.

The trend is encouraging, researchers say, because current guidelines recommend against using the drugs, benzodiazepines, to treat symptoms associated with posttraumatic stress disorder (PTSD).

"One of our concerns is that it's very, very difficult to get patients off benzodiazepines," said Dr. Matthew Friedman, executive director of the National Center for PTSD and a professor of psychiatry at Dartmouth, who co-authored the study.

Benzodiazepines include the medications alprazolam (Xanax), diazepam (Valium) and clonazepam (Klonopin). They are used to manage conditions such as anxiety and insomnia, which are often linked to PTSD. Long-term use of the drugs can lead to high tolerance and addiction.

The study, which looked at data from more than 498,000 patients in the Veterans Affairs health care system between 1999 and 2009, found decreases in the frequency, duration and doses of benzodiazepines given to veterans with PTSD.

Treating veterans with PTSD will become even more important in coming years, the team notes, due to recent and ongoing U.S. military conflicts. The number of veterans with PTSD treated in the Veterans Affairs health care system rose nearly 200 percent between 1999 and 2009.

The percentage of PTSD patients given benzodiazepines fell from about 37 percent in 1999 to about 31 percent in 2009. Of patients taking the drugs, the proportion of long-term (more than 90 days) users dropped from about 69 percent in 2000 to about 64 percent in 2009. Daily doses fell 14 percent on average, according to findings published in the Journal of Clinical Psychiatry.

Veterans with PTSD have an increased risk for harm because they often also suffer from substance abuse disorders, the researchers note. Estimates place the co-occurrence of alcohol abuse and PTSD around 25 percent, or higher, nationally.

Emerging evidence also suggests benzodiazepines may interfere with prolonged exposure therapy, which has been one of the most effective treatments for PTSD, Friedman said.

Guidelines issued by the departments of Defense and Veterans Affairs earlier this year recommend against using the drugs to treat veterans with PTSD. Instead, experts generally recommend psychotherapy to treat core symptoms such as hypervigilance, avoidance and flashbacks. The guidelines also recommend using antidepressant medications to treat PTSD symptoms.

"We believe a lot of benzodiazepines are being prescribed for problems with sleep, which is also a symptom of depression," Friedman told Reuters Health. "If we treat the depression, perhaps the insomnia will also go away."

The study found that new PTSD patients -- those who were diagnosed and began treatment at a Veterans Affairs medical center -- in 2009 were prescribed benzodiazepines at the lowest rate, about 21 percent. Newly diagnosed patients are often the first to benefit from updated treatment guidelines.

TRADING ONE RISK FOR ANOTHER?

But the possibility that benzodiazepines are simply being swapped out for other risky drugs concerns some experts.

Substituting more modern medications such as zolpidem (Ambien) or quetiapine (an antipsychotic) is not the answer, said Dr. Alexander Neumeister, a professor of psychiatry and radiology at New York University.

"Unfortunately, when you look into databases like the VA's, it is pretty evident that there is a lot of off-label use of medications like quetiapine to treat sleep issues," Neumeister told Reuters Health, referring to the ability of doctors to prescribe drugs approved for conditions other than PTSD.

"Even if you avoid the abuse problem, you're nevertheless treating a patient with a medication that really should not be used for that indication. Not at all."

The study authors also recognized that possibility.

"We are trying to characterize these diagnoses to get a better handle on who's prescribing what, who's getting what, and for what reasons," said Friedman. "Based on that information, we can develop our educational approaches to inform clinicians who may not be as familiar with clinical practice guidelines."

SOURCE: http://bit.ly/rAcuOG Journal of Clinical Psychiatry


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Hidden Self in the Healing Processes

Working toward healing the hidden being, for some is next to impossible. Most of the problems people have when working toward self-healing arises from misconceptions, doubts, or fears. The fear is often the root of the problem that hinders the person from discovering self.

The hidden self is buried in the subliminal conscious, which makes up our unconscious and subconscious mind. In this area, the mind is unintentional, yet millions of problems emerge because it is triggered.

When the mind is triggered, the emotions kick in and react to whatever memory the trigger hit. For instance, if the trigger stimulated a sad memory, such as the loss of a loved one, thus the emotions will react accordingly. You may find yourself in tears and many times not know why despite that memory emerged. This is because you did not have a resolve. Rather you repressed memories of the loved one dying. The repressed memories sunk, deep in your subliminal mind, which they rest until you are willing to discover why you feel the way you do.

Of course, grievance comes along with death. You probably openly grieved during the time your loved one died, which is normal, yet instead of facing the reality and going on with your life fully; you likely buried some of the pain in the subliminal mind. Moreover, something in your past could have triggered you.

In other words, perhaps long ago in your past, a similar action occurred, which at this time you were not ready to handle the stress and pain. You perhaps repressed the memories, which may had triggered other memories during the time of the loved ones death.

All of our pain and suffering comes from our past experiences, knowledge, learning, observations and so on. Everything we feel develops over the years and builds up. Most of the memories we may recall, yet many of these memories we often repress, which later nags us until we explore the subliminal conscious mind to find answers.

In this turn of events, hidden self in the healing processes becomes a task, yet if we have useful techniques and practice them daily, the task of subliminal learning becomes lighter.

How to discover useful techniques for self-healing:
Visiting the Internet is the place to find useful techniques for self-healing. Over the past 3 or 4 years, self-healing has been a major topic. You will find scores of articles that can assist you with the processes of healing the subliminal self. In the meantime, consider meditation.

Go to a peaceful environment. Recline, lying back, stretching your entire body in a comfortable position. Make sure that all distractions are removed.

Close your eyes. If you feel uneasy when closing your eyes then leave, your eyes open. You will need your visual tools. Using visualization picture yourself anywhere you wish to be. Put your self in natural surroundings. Studies show that people who connect with nature often heal sooner. Go to a faraway land. Visit any country you like, or any area in the world that you like. Allow your thoughts to express memories. Even if the memories come in parts, allow your memories to show you to the way to self-healing.

With each thought, move to acceptance, Even if the memory is something that causes you pain. Learn to accept that these are the things you can’t change; rather these memories are part of what made you who you are today. Continue. As you meditate, continue into the faraway area you visualized. Upon the point of complete relaxation, commence to explore your mind.



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