May 30, 2008

Miracle Drug, Poison or Placebo? (Part II)

Continuing an article by Maia Szalavitz for MSN Health & Fitness, Part II:



A Complex Challenge: Finding the Right Drug


So, how can you find an antidepressant that will work, not make you feel worse? That’s the billion dollar question that pharmaceutical companies, psychiatrists and researchers are racing to answer.


The complexities, however, are daunting. A large proportion of human genes code for brain development and function, and they interact in complex ways not only with each other, but with environmental influences like stress, parenting and social support.


One intriguing study by Tranter and colleagues involved giving antidepressants to healthy people. The study compared the results of a drug similar to Prozac, which affects the serotonin system in the brain, to the effects of another drug, which affects the norepinephrine system.
Serotonin—a neurotransmitter that sends messages from one brain cell to another—is involved with regulating mood. Norepinephrine (also called noradrenaline) helps mediate attention and the brain’s response to stress. The antidepressants in the study affect these transmitters by keeping them activated for longer than usual.


“One of the effects of [the Prozac-like drug] was what you might call a ‘serenic’ effect,” Tranter says. “It’s this feeling of being aware of stressful things going on, but they don’t bother you much.”


Some people liked this effect—as did the people around them, who found them easier to get along with. Others, however, reported this same experience, but found it unpleasant. “They felt disconnected from their emotions, unpleasantly numb, and they didn’t like it at all,” Tranter says.


The participants in Tranter’s study had been given personality tests beforehand. Some of the traits measured on these tests are strongly influenced by genetics, reflecting inborn temperamental differences.


People who liked one of the drugs tended to dislike the other—and those high in a trait called “harm avoidance,” (basically, a sense of caution and worry) typically preferred the norepinephrine-affecting drug and disliked the serotonin drug.


Other studies have found possible links between particular genes and particular responses:
A gene associated with men’s ability to control anger was found to triple the risk that men would develop suicidal thoughts if given the drug citalopram (Celexa). The long version of a serotonin gene associated with the risk of developing depression following early life trauma was associated with a better or faster response to Prozac-like drugs, compared to the shorter version of that gene.Another serotonin-related gene was found to affect whether or not people experienced negative sexual side effects from one of these medications. Variations in genes for one of the brain’s opioid receptors have also been associated with positive responses to citalopram (Celexa).



Next: Part III

May 29, 2008

Miracle Drug, Poison or Placebo? (Part I)

This entry will be broken up into three parts. It's actually a copy of an article by Maia Szalavitz for MSN Health & Fitness.

Here is Part I:

Modern antidepressants have been blamed for deadly shooting rampages and violent suicides. At the same time, they’ve been hailed as miracle drugs that transform baleful Eeyore-types into bouncing Tiggers.

Now the latest review of the research claims that the effects of the drugs are only marginally different from those of placebos or sugar pills.

It seems impossible that the same substances in the same dosage ranges could simultaneously be poison, miracle drug and placebo. But the diversity of responses is remarkable—and it points to the possibilities and pitfalls of personalized medicine.

For example, Stacy*, a 48-year-old woman who works in public relations in Ohio, describes her experience with Zoloft like this: “It felt like water after being in the desert. It wasn't an experience of elation or anything bi-polar … I'm far happier, more confident, far more relaxed.”

Lisa*, a 33-year-old business consultant from Maryland, had experienced severe suicidal thoughts as early as kindergarten. She says of taking Effexor, “My entire life is different and I finally feel like a normal person with normal emotions. These days I can honestly say I am a happy, well adjusted person.”

But JoAnne*, a 35 year-old educator and dancer living in the Washington, D.C. area, reported that both Zoloft and Prozac produced muscle weakness and excessive sweating—and no benefits.
And Bernice*, a 53-year-old science journalist in California, described her experience with a Prozac-like antidepressant this way: “It made me feel disconnected from myself and my family, so that I no longer felt any empathy and did not really care what happened to them or to me. It was a terrifying sensation of flatness and I definitely felt depressed and hostile in a way that I had never felt before.”

Bizarre experiences abound as well: Bernice had “a vivid nightmare of being shot in the head,” and the sensation she felt of dripping blood did not immediately disappear on awakening. Others report elimination of sexual desire, weight loss, weight gain, heart palpitations and elevated blood pressure.

(*not their real names)

Same Drug, Different Results

How can similar—or even identical—drugs have such different effects? The explanation sheds light on some of the key questions that complicate research on depression and emphasizes the need for a science of personalized medicine.

“These are average changes,” explains Richard Tranter, M.D., consultant psychiatrist with the North West Wales NHS Trust in Great Britain. “They may actually mask wide variations in how individuals are responding.”

“If you look at a large scale trial,” Tranter continues, “You may get a slight shift overall. That could mean on the whole, everyone is a little bit better compared to placebo but it could also mean that within the group, some did really, really well and some did OK and some got worse, but overall, it looks like a small shift in the right direction.”

Two other complications are noted by psychiatrist Peter Kramer, author of Listening to Prozac. First, early data—of the kind included in the meta-analysis which found antidepressants no better than placebo—often fails to show results for drugs that later prove very effective. “We have medications that show effectiveness in post-stroke depression, in the elderly with multiple brain lesions, in people with chronic, intractable depression. Why do they only not work in the early trials?” he asks.

Second, people get excellent care in clinical trials, which makes the placebo effect especially strong. This means it’s harder to show a difference, even if a drug works well. “We may be losing effective substances, not approving ineffective ones,” Kramer notes.

Next: Part II

May 28, 2008

Having a child (Part I)

Please forgive the non-sequiter here on diving into this subject with no real set up as to why.

It was really borne out of the fact that I have been in contact with an ex-girlfriend of mine from college some 15+ years ago and she and her husband just welcomed their third child into the world. I am pleased for her and her happiness, but I'd be lying if I said there wasn't a brief sense of selfishness of by part.

You see, ever since I was a teenage boy myself, way before my depressive episodes and trials and tribulations I faced with employment and marriage, I too always thought someday I'd have my own son and/or daughter. I looked forward to the day where I could raise my own child, and give the gift to my parents as well who so desperately want to be grandparents.

Admittedly, I got married a little later than I ever thought I would and during that time (now that I look back) depression was just beginning to manifest within my being. The symptoms were there, I just wasn't 100% cognisant of them let alone knew what would be consuming my mind and spirit in the next few years to come.

In our first year of marriage (we were already in our mid 30's) we tried to have kids. After many unsuccessful attempts we went to a infertility clinic. My wife took the tests (as did I) and we began a regime of pills, shots, medical procedures, etc., to no avail. It was an emotional time for my wife and me as well.

Then things at home took a turn for the worst. My own personal demons began to manifest more and more and I was becoming angry with the world around me; my depression was kicking into overdrive. My stepdaughter was rebelling in school....bad grades, bad behavior, bad excuses. My wife was emotionally spent and realized that the grass may indeed be greener on the other side. Why hang out at home with a self-loathing husband who argued about money when I can go out with my girlfriends and drink to forget about the troubles at home. It didn't help that friends seemed to be getting pregnant all around us and the icing on the cake was her sister getting pregnant for her third time.

I never really spoke about my depression and children before. I believe that it was, and still is, a contributing factor to part of outlook on life and emotional growth. You see, I still want a child, and would like to give one to my parents. This has nothing to do with the fact that my mom and dad both occasionally mention the fact in their not-so-subtle ways that they would like a grandchild as well (Great, yet another way I have let them down I suppose).

After our two failed attempts at artificial insemination, we gave up, at least I thought we gave up temporarily. It wasn't too long ago I learned else wise....my wife had decided (without my input) we were not going to try again. That was very shocking and hard for me to digest, and if I could and hadn't desperately tried to calm my spirit at that exact moment, I most likely would have blown up. Needless to say, this was news I wasn't ready for, nor wanted to accept. A decision regarding my chance of having any offspring at all was summarily decided for me....and not in my favor.

The thing that hurt me the most...and I still hear those words in my head on occasion...is my wife stating to me: "In your emotional state, I don't think it would be wise to bring a child into this world considering your state of mind." Talk about a knock out punch. I can't believe I was still standing after that. It is as if I could feel all the blood draining from my being...what was left of any fragile emotions I had being ripped out from me. My wife was now verbally confirming to me that she thought I was indeed off my rocker, unfit as a husband, not ready to be a father, and questioned if I ever would be.

It was at that instant I seriously began to question my marriage and who exactly did I marry. I wondered if I had made one huge mistake. I silently screamed to God and Christ for mercy. "What have I gotten myself into?" I wondered. I had made a contract with God at the altar on my day of marriage...and now everything I wanted left out of life was being told wasn't going to happen.

To be continued.....

May 12, 2008

What is going on in the world?

Is it me, or does it seem that the last few years that more and more natural disasters are taking place? For all I know, there may be a constant level of activity taking place all the time, but because the population of this planet keeps increasing and the fact that cameras, cell phones, and other technologies make news instantaneous, its just seems like this stuff is happening more and more often. And in greater magnitude.

In the last few years after 9/11, we've had hurricane Katrina, tsunami's, tornandos, more and more talk on global warming, Russia's military becoming strong again, Iran dabbling in nuclear power, violence escalting among youth, the cyclone in Myanmar (formerly Burma) with an esitmated death toll of 63K-100K, and now a devestating 7.9 earthquake in China with early numbers approaching 10k dead (and possibly more).

"I watched as the Lamb broke the sixth seal, and there was a great earthquake." (Rev 6:12)

I by no means claim to be a prophet of any kind. I know for a fact that I am not nor do I think I have any divine message, but the fact is all this stuff is really starting to spook me. My anxiety the last few days has been increasing. My sleep has been a little restless as of late and I mentioned a few weeks back that I had all these wierd coincidences in regards to coming across material about the end times, the rapture, and biblical prophecy.

I've been debating the last week or so to possibly jump back on my medicine, at the very least my clonzapen (and not tell my wife). My stress and the tightening in my chest has been escalating as I can feel it more prevelant lately.

I'm not kidding and not making light of the matter at all. I'm really starting to get nervous and I seriously believe that my mind is working against me...that maybe I really am turning paranoid as a symptom of depression or other mental illness. How crappy is that? As if I am convincing myself that I am indeed going crazy.

I seriously don't know what to make of any of this. My friends and neighbors and family all seem to be taking this in stride which just confounds me to no end. Like their attitude is, "Well, that's too bad, but that's life and we just got move on..." Literally, in the last week over 100K people between China and Myanmar have had their lives snuffed out in an instant. How many were saved or knew God? How many are in paradise today? How many more are not?

May 02, 2008

Weird introspective

"I am leaving you with a gift - peace of mind and heart. And the peace I give isn't like the peace of the world gives. So don't be troubled or afraid." (John 14:27)

I'm taking a break from the last two days postings. While I still have more to chew on and debate within my head on what I revealed in my last writings, I've had a strange feeling wash over me today.

I woke up a little groggy as usual and was thankful my wife bought some real fresh coffee to enjoy last night for our consumption. She's going out of town tomorrow on a business trip and will be gone a whole week. It really isn't that far away actually, something like only 45 miles away from our home, but she will be working long hours and I doubt we'll speak much, maybe a call in the evening.

Our financial status has been a little strained lately with me making some sacrifices (more brown bag lunches, limited driving, a few unexpected bills) that will put me on a very conservative spin the next few weeks. I was very open with my wife about our situation and I think she understood, but I am not 100% convinced as we still have separate checking accounts...but I know we are temporarily strained, at least until we get our stimulus package and regular IRS rebates. It's can't get here soon enough as I have a few bills that need to be paid, and I'm waiting until the almost drop dead deadline before I write a check.

It does tend to make me a bit nervous, and in some ways, perhaps its best my wife is gone for a week so she doesn't see me stress. On the flip side, I can imagine she may spend a few extra dollars we really don't have in going out at night, but I don't have the heart to tell her to watch her spending habits lest she takes it the wrong way. I just try and paint a very crystal clear picture of where we stand, and hope she can figure it out and make the right decisions.

So today, maybe because it's in the back of my mind (the money stuff that is), and the fact I will be alone for the next 8 days, but I am feeling a little anxiety within. There's a bit of tightening in the chest today and I've caught myself taking some deep breaths. But the weird thing is, I also have a certain un-explaneable peace about it today. My paycheck from yesterday is already accounted for, and I'm already counting down days until the next one (something I never did before), and yet I know we'll be okay for some reason. I just need to continue to really think wisely for the next few weeks and really limit myself to get back into the black.

I think about missionaries and wonder 'How do they do it?' I watch the news and see devastation in Arkansas and read articles on how minimum wage earners can barely scrape by. I have a friend right now who is married with a few kids who just learned that his position will be eliminated in a few weeks and he's already began looking for a new job, and I continue to wonder 'How do they do it?'

What is their secret for moving on and waking up? Is it the human spirit and will to always keep fighting? Is it God's grace that He will always look after His children? Is their faith stronger than my own, and am I jealous because of that?

Is Jesus finally having me really turn a corner, at least for this week? To know there is a light at the end of the tunnel albeit a few weeks from now, but until then we must endure living paycheck to paycheck wondering how the next bill is going to be paid? Today I thank Jesus for giving me the strength I have right now, because I know I didn't have this strength a year ago. I can just imagine how my mindset would be were it another time in my past.

May 01, 2008

Christ does not teach confusion.... (Part II)

So confusion........I started an entry yesterday, and as often happens, they seem to take on a life of their own and before I knew it, I wasn't going to get to the meat of the matter I had originally intended, thus I broke it up into parts.

Today is part 2. Maybe I'll wrap this up, maybe not and you'll be reading part 3 in a few days, so bare with me.

Being a loner most of my life, and especially the last few years have lent to a special air of isolationism on my part. Not that I ever made a conscious decision to end up that way, but circumstances as they have played out I suppose led me there. It's a mixed blessing. There are numerous days I seek companionship and yearn to return to the times where I was a much happier and 'go-lucky' person.....To be the 'life of the party' and everybody's friend as I was a decade ago.

On the flip side, there are days I enjoy the solitude and wish to block out all the madness and corruptness of the world. I want to be left alone and be in my own thoughts. Sometimes its a pleasurable experience, sometimes a very frightening one.

It's during these times of solitude that my mind works overtime and I think about so much and so many questions begin to surface. These are also the times I truly wonder if I do have a 'tinge' of mental instability as a result of imbalanced chemicals, or a lingering symptom of continued depression. When I should be day dreaming of puppy dogs and ice cream and warm beaches and sunsets, my mind tends to drift to apocalyptic events, relationship woes, death, etc.

I mentioned that my wife and I had an 'episode' about two weeks ago. And she made some very valid points. Valid enough that I have to take stock in myself and wonder if my prayers sometimes are not 'pure' enough to be answered. What does God have intended for me, and when will the continuous testing stop and the healing actually begin? Perhaps the healing has begun, but my stubborn side is looking for something more overt, like the Jews looking for a more 'kingly' messiah, than a simple man born in a manger who was and continues to be humble.

After that episode with my wife a lot of strange co incidents started to become very overt to me. It started with church. That Sunday my pastor was teaching from the book of Daniel....and drawing a parallel from Daniels visions to those events to come in Revelations.....a scary subject. On Monday as I was driving home from work, I turned on Christian radio (something I very rarely do) and the message happened to be that of the book of Daniel...again. It was the same message!!!

It gets stranger....

Tuesday I was reading a book, and it just so happens that I came across a chapter (unplanned) that spoke of the end times. And finally Tuesday evening I turned on talk radio late at night (it helps me sleep at times) and the whole two hour block again was on the end times and prophecy. By this time I was spooked! I still am. Two events may be a coincidence, but 4 in the span of 48 hours all talking about the 'end times'? Of course now I can't sleep at this point as I am convinced (at least in my mind) something very suspicious and abnormal is going on here. Why am I hearing these things? Am I being driven mad? Is God trying to tell me something? Or is it Satan having a good laugh at my expense?

But Christ says only He knows the hour and the time. He says not to worry, cast your burdens upon Him, for those that are faithful and have accepted Him should be in peace and care not of the trivialities of this world, for it shall perish, and we will be reborn into glorified bodies and live in the Kingdom forever!!!

However, the confusion begins to escalate for me and I need to seek out some reassurance...

(to be continued...)