Category Archives: Psychiatric Medications

Lithium in your water? Might it be beneficial?


Here’s an interesting finding. A research team compared the top ten lithium-enriched regions of Austria (areas with naturally occurring lithium in the water) to the top ten lithium depleted regions of the same country. Those regions with greater naturally occurring lithium levels had statistically fewer suicides than those regions that had low naturally occurring lithium. The research does not prove a causal link between suicide levels and lithium levels in the water. It could be that there are better treatments or facilities in those regions. But, it does give you pause.

Lithium is, you may recall, a salt which is used to treat affective disorders like bipolar disorder. For many years doctors considered it the gold standard treatment. Many still do even though compounds like Wellbutrin and some anti-psychotics are also used to treat bipolar disorder.

While NO ONE is considering prophylactic use of Lithium (like we do now with fluoride in the water), this research does beg the question: at what point would preventative Lithium be appropriate? In other words, how many lives would need to be saved to make it something that we would want to give to everyone? Or, should we only give it to those who are deemed at-risk?

Assume for a moment that the cause for the lower suicide rate is the presence of Lithium in the water. Further assume that the research data is accurate in finding that the suicide rate in the Lithium enriched areas is 11:100,000 while the suicide rate in the depleted area is 16:100,000. I doubt that anyone would promote public distribution in order to save 5:100,000 but I do wonder what the number would need to be before anyone would recommend blanket addition to the water supply.

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Filed under Psychiatric Medications, Psychology

How many patients can you see in a day?


Ask a counselor and you might hear of one who has seen 10 clients in a day…10 hours of therapy. I suppose I”ve done as many as 12 or 13 but that was a rare case and likely some emergency.

What about seeing 40… in one day!?

That is what some psychiatrists do. Of course, to do that many, most patients are seen only for 15 minute med checks rather than the 90 minute first session for first-time patients. Psychiatrists used to be the primary therapists. But with the advent of psychiatric medicines,  many psychiatrists no longer do therapy and only make diagnoses and prescribe/manage medicines. For an interesting view from the psychiatrist’s chair, check out this NY Times article interacting with a local psychiatrist who has worked through the transition from therapist to med manager.  See how he tries to not get too involved with patient problems given that he hasn’t the time to do much on the fixing end.

There are only two reasons why anyone would see so many clients in one day

1. Economics. More volume, more money. Plain and simple.

2. Demand. Good psychiatrists are hard to come by. Even more true if you are talking about child psychiatry! If you find a good one, chances are you have to get in line.

Now, before anyone thinks I’m taking shots at psychiatrists, let me tell you I am not. A good psychiatrist is a very helpful aid to us psychologists. Family Docs and other general practitioners may be able to prescribe but I find psychiatrists (good ones!) really know their compounds and are much better at titrating doses. And not all of them just throw pills at the problem. Even in short interactions, the psychiatrist to whom I refer has been able to help my clients understand themselves just a bit better.

Back to the original question: just how many different people can you meet with in a day and still be attentive? When I started out counseling, I could barely see two people in a row before being overwhelmed. Now, I regularly see 8-10 on a day (okay, I only do this one day per week, but before becoming a prof I did 25-30 per week). I can attest that it is a learned skill and I don’t think the last client gets less of me than the first. That said, there is a limit and a point at which what I do suffers.

What is your patient/client limit?

For me, it is less about the number of sessions and more about whether I eat and have a moment to go to the bathroom. There’s nothing that kills the focus as much as a bursting bladder and 45 minutes to go!

I’ll leave you with a funny story. At a doctoral practicum I saw clients late into the evening. My last client of the evening (same person each week) had a habit of bringing me Starbucks coffee. I think he was trying to make sure he was going to get his money’s worth out of me!

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Filed under counseling, counseling skills, Psychiatric Medications, Psychology

Oxytocin and autism?


Anyone catch the oxytocin “news” item on NPR on Monday? If not, read/listen here.

The short of it is this: certain kinds of hormones are released during certain bodily functions: giving birth, breastfeeding, and orgasm. It seems that the hormone is involved in feelings of trust, connection, intimacy. Now comes a couple of small studies that indicate these feelings are increased when given a nasal spray version of the hormone. And the study talked about in the NPR story suggests that autistic individuals given the spray preformed as well as non-autistic individuals at recognizing (understanding?) emotional expressions on the faces of individuals in pictures.

Maybe autistic individuals have a deficit of oxytocin. Let’s hope this research helps discover how to raise the level of the hormone by natural means. However, do a Google search on the term and you will see a host of websites promoting the value of the hormone as if it is already well understood. Others seem to be selling a product. One in particular is trying to suggest that someone might use it to get the girl or close a sales deal (by increasing their trust). How? “Here, could I squirt this substance of your nose?”

Better to take a wait and see effort for now rather than get everyone’s hopes up just yet. Let the researchers do their work to find out just how this hormone works before hyping it yet.

 

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Serious mental illness and Christianity: Questions about responsibility


Today marks the end of the semester and the end of Counseling & Physiology. At the end of this course I ask students to talk amongst themselves regarding what they have learned in the course and what questions remain. The most frequent questions have to do with this:

What of a person’s struggles can be viewed as physiological; what is spiritual? What is the client responsible for?

[I should explain. We looked at problematic behaviors (e.g., cursing, aggression, etc.) after brain injury and the physiology of bipolar disorder. The class took bodily weaknesses quite seriously and recognized that sometimes our expectations of individuals exceeds capacity.]

At the end of this post I’m going to give you what I think are some better questions to ask. But first: Simultaneously, a couple of my old blog posts are getting a lot of attention these days–both having to do with the problem of serious mental illness, faith, and the response of the church. I highly recommend you skim the posts (both are incredibly short) but hang out with the comments.

https://wisecounsel.wordpress.com/2007/06/26/serious-mental-illness-and-faith-what-to-do/

https://wisecounsel.wordpress.com/2006/11/14/living-faith-bombshell-honest-wrestling-with-mental-illness-and-divorce/

These two posts are some of the most viewed and most commented on. Each and every comment reveals a world of heartache, alienation, and confusion about how one should think about mental illness, healing, responsibility, and the Christian faith. Clearly, we have not talked about this problem enough in the church–either to those with chronic mental illness or to their loved ones. Far too many are suffering alone.

Does it matter what of your problems are physical and what are spiritual?

Let’s say that you are a parent of a 3-year-old. Due to no fault of your own, your child misses their afternoon nap. It is now 6 pm and your child is both hungry and tired. She sees some candy and begins to whine for it. You know that you will feed the child in 15 minutes. You decline to give the candy and your child now has a temper tantrum. What do you do? Or, what SHOULD you do? You most likely provide mercy and kindness as you try to calm the child down. If the child screams, cries, and maybe even strikes you…has she sinned? Yes. Does it matter at the moment? Probably not so much as you acknowledge the child is limited by her lack of sleep.

Now, let’s extend the analogy. Would you treat your 40-year-old spouse in a different manner if they also had a tantrum because they were tired and they wanted dinner NOW? Of course, you would determine their moral capacity to be greater than the 3-year-old.

Back to our question…is it necessary to consider the division between spiritual and physical problems? Here’s why I think not. Problems are problems. Physical problems are spiritual problems in that we don’t do things only with our body and leave out our spirit. And spiritual problems always include the body. We don’t have spiritual experiences outside our neurons. Further, I still have to respond to the 3 or 40-year-old now (illustration above). Yes, I need to discern how to respond. Do I teach, comfort, discipline, rebuke, encourage? Am I responding with grace and mercy? Less important (though highly desirable) is my efforts in trying to keep the problem from happening again. Isn’t that really what is behind the physical/spiritual question: Who is going to make sure that x problem is taken care of?

Here are some better questions:

1. What can I do to help bring increasing comfort, hope, and encouragement–right now?

2. What response is my client capable of–right now (post hoc)?

3. What spiritual or physical interventions might be of help–right now?

4. How can I encourage my client to accept/respect their body (and its limits)–right now?

5. How can I encourage my client to see the hand of God in their life–right now?

6. What community resources and/or involvement can be made available–right now?

Notice the emphasis is on practical/mercy ministry, increasing insight, and commitment to seeing self from God’s point of view (rather than “normal”, “acceptable” as defined by church or larger community).

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Filed under biblical counseling, christian counseling, christian psychology, Christianity, Psychiatric Medications, Psychology, Uncategorized

Chantix and PTSD


For those of you who know, live with, or work with those diagnosed with PTSD, be aware that the smoking cessation drug, Chantix, has been found to be seriously problematic. Apparently, the drug has been linked to a number of suicides as well as to increased agitation, mania, panic, nightmares, and suicidal ideation. One might expect that those suffering the distress of PTSD might experience even more of these side effects.

This isn’t new information. There are news items you can find going back to 2008. Given that there is a lawsuit underway, probably most providers already know about it. But, it was news to me so I’m passing it on to you just in case you know of a vet who is trying to kick the nicotine habit.

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Filed under Psychiatric Medications, ptsd

Who diagnoses ADHD? Comments on CNN story


CNN has run a story on the issue schools/teachers encouraging parents to get their child tested for ADHD and on medications. You can read it here. The writer quotes a doctor complaining about teachers who suggest diagnoses and treatment. Then parents go to their doctor and ask for meds to treat something that has yet to be properly diagnosed. Being a psychologist I am sympathetic with the Doc–but only to a point. True, many people fancy themselves as experts because a family member or some other experience with a mental health diagnosis. And so, whenever they see something that reminds them of it they talk as if they had done a thorough assessment. The Doc goes on to point out other problems that may create similar symptoms (anxiety, abuse, learning disabilities, etc.)–thus the need for professional evaluation.

But that is where my sympathy ends. Teachers do have front row seats to child problems. We need them to speak up. Yes, they needn’t throw out diagnoses as if they are experts. But we do want them to let parents know that something might be up and the need for further evaluation.

So, who should diagnose? Yes, ADHD is considered a medical diagnosis. But, counselors and psychologists are just as capable of making the diagnosis–sometimes even better.  If a Doc (psychiatrist, physician, etc.) makes the diagnosis, 9:10 times it is on the basis of 30 minutes to 1 hour of an interview with parent and child along with a physical examination. For most people with the symptoms, that is probably enough. However, most psychologists will collect data from 2-3 sources (parent, teacher, church) using interviews, checklists, psychological tests, and even computer based assessments. That kind of assessment may be more capable of ferreting out subtle learning disabilities or learning differences as well as developing a plan of action for changing the environment (school plans (IEP/504), parenting strategies, etc.

It is interesting that the article makes no mention of the use of counselors in this process.

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Ecstasy (MDMA) as treatment for PTSD?


Back from vacation and reading up on my piles of emails. This one came via my Medscape.com subscription to psychiatric news–Ecstasy-assisted Psychotherapy May Help Patients with Treatment-Resistant PTSD. You can read about it here on WebMD.

Interesting…a date rape drug being used to treat PTSD. There is some irony here I think in that many a date-raped woman was taken advantage of when slipped this drug.

How is it purported to work? By reducing or blocking symptoms (intrusive, emotionally laden feelings when thinking about traumatic events) and thereby allowing therapy to do its work. The therapy was done in an intensive manner rather than spaced out as most people do therapy. One wonders if prolonged exposure therapy was used as the therapy. If not, would PE therapy do as well or better than traditional PTSD therapy and MDMA?

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Filed under Abuse, Anxiety, counseling, counseling science, Post-Traumatic Stress Disorder, Psychiatric Medications, Psychology

Minimal Brain Damage?


I’m thinking about brain injuries today. On Sunday one of my son’s teammates got carted off the diamond after falling on his head while trying to make a play. Though scary, it seems he did not sustain an injury other than a headache. At least that what the initial scans suggest. Then today I heard a story on NPR about brain injuries of soldiers experiencing a “concussive” event–those who survived roadside bombs. These soldiers may not have been pierced by shrapnel and may not have had their heads slam into something (two obvious causes of TBI) but may have experienced injury from the impulse of the blast of energy hitting their brain. Pro Publica explains the injury and has the larger story about the many soldiers who fail to be properly diagnosed and treated in military care centers.

It stands to reason why this would happen. Minor brain damage is hard to quantify. Brain scans may not pick up these minor changes. The person isn’t missing a limb which visually reminds others of injuries. Some of the symptoms are similar to other mental health problems and so providers may wonder whether injuries are physiological or psychological.

Some of you have been around long enough to remember MBD or minimal brain dysfunction. This was a term used in the 1960s for a wide variety of problems that now go under the name of ADHD. MBD was a way of signaling that something wasn’t right in the brain even though no one could actually pin point where the problem lay. At this point we may not have ways to identify damage to cells (rather than whole structures) and cell communication and so much use the term concussion or minor TBI (mTBI).

Worse than missing the diagnosis is not having great solutions to deal with the wide variety of symptoms. Our best solution for civilian sports related concussions is to avoid having a second, even minor, head bump. We do so by banning participation in sports for a couple of weeks. It is often these second or third bumps that do the worst of the damage. But I suspect that having a soldier sit in Iraq for a couple of weeks after being dazed by a blast will not be anyone’s desire.

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Filed under counseling science, Psychiatric Medications, Psychology

Belief in a loving God and Depression?


Thanks to a friend’s sharp eyes, I learned of this news release from Rush University Medical Center:

Research suggests that religious belief can help protect against symptoms of depression, but a study at Rush University Medical Center goes one step further.

In patients diagnosed with clinical depression, belief in a concerned God can improve response to medical treatment, according to a paper in the Journal of Clinical Psychology.

The release goes on to say that the positive benefit did not stem from hope but in belief in a caring God. What it doesn’t say is whether or not those NOT taking medications get positive benefit from a belief in a caring God.

What do you make of this? Should we get excited when research confirms our established beliefs? Should we look for alternative explanations? I would be curious how they separated hope and belief. Hope and belief that God is active and looking out for you probably encourages you to look for and remember evidence! The more you look for the evidence the more you practice being mindful of something bigger than your despair.

What is your reaction?

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Filed under Depression, Despair, Psychiatric Medications

Some thoughts on “This Emotional Life”


Caught part II of a 3 part, 6 hour, series on PBS last night. This Emotional Life, moderated by Dr. Dan Gilbert. I recommend you check out, at minimum their website but if you get a chance, tonight your local pbs station may air the 3rd part. The website includes lots of info about the various topics, individuals interviewed, and the whole first episode (which I have yet to watch). The series focuses on love and family relationships and attachment (#1), negative emotions such as anger, fear, and depression (#2), and happiness (#3).

Now, there are a number of irritations I have about the program but the good outweighs the bad. What don’t I like?  I don’t like the way they say, “Science says…” and then do not discriminate between data and interpretation of said data. I don’t like the repetitive evolutionary comments. For example, “the newer part of your brain can’t communicate with the older part” assumes that because we have a cerebral cortex and animals don’t have as well-developed cortexes, that part of our brain is “newer.” Further, the view of humanity in episode 2 seems to be that of the human physical robot. There is no space for the spiritual. One quote from the episode, “Mental illness is nothing less than a physical illness that has psychological consequences.” It is as if emotions are only chemical.

But these small problems can be easily forgiven. Here’s what I like from episode 2:

  • The honest admissions of struggles of celebrities (e.g., Katie Couric’s admission she has intrusive thoughts of jumping off high balconies, Chevy Chase’s admission of depression, etc.)
  • The gripping stories of struggler’s with anger, anxiety, and depression (especially two vet’s struggle with PTSD) and the significant impact of the struggles on the other family members
  • You really get a window into their interactions with their therapists. Lots of good video that is rare to see!
  • The scientific discoveries relating to the brain and the experiences of these negative emotions. For example:
    • Stress hormones seem to strengthen memory formation. Thus traumatic experiences likely etch bad memories much deeper than other memories.
    • Re-appraisal (neutral re-evaluation) of events where you experience negative emotions supports more control of these emotions whereas rumination causes us to be more reactive
    • Prolonged exposure therapy (telling, retelling and retelling again) for PTSD patients seems to have significant positive benefits (though it defies logic–most people want to get away from their bad memories)
    • Depressed individuals tend to have reduced hippocampus volume. Antidepressants and ECT seem not merely to change brain chemistry but actually increase cell growth. Depression actually seems to change the brain and antidepressant use stops hippocampus shrinkage

A couple of other interesting tidbits:

  • Emotion regulation: not trying to turn off emotion but tools to change the course of emotion
  • “Don’t believe everything you think.” But, we tend to nonetheless
  • Struggling with overwhelming anxiety? Accept that you have these feelings (crying, tension, fear), accept that they are physiological experiences, avoid labeling them as awful. You will have scary thoughts and you can live with them
  • “What is the worst thing that could happen right now?” I might cry. “And what if you do?” That would be bad. By accepting these emotions you can distance from the meaning you are applying to them.
  • There are biological indicators in those who are highly reactive to stress. These folks can’t help their reaction but they can recognize their tendencies and respond differently to them.
  • Untreated mental illness is harder to treat if left untreated for long periods of time.
  • Richard Lewis on the benefits of therapy and getting to talk about things he never talked about with anyone: “Maybe for the time I left her (his therapist) office til I got in my car I was floating on air”. Hmm, is that worth the 150 dollars he probably paid?

Finally, I leave you with this. Perceptions of progress, or lack thereof, have a huge impact on your perceptions of happiness. One young girl thought her ECT would help sooner than it did. When it did not, she crashed even worse. Even more than our physiology of emotions, our perceptions of our well-being and our progress often dictate our beliefs about ourselves and our futures.

If you saw it, what did you think?

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Filed under anger, Anxiety, counseling, Psychiatric Medications, Psychology