I am so money!
Mood:  celebratory
Topic: School
Don't have much time to say this cause I've got stuff to do, but I got an A+ on my english paper.. 202 out of 200 points!

maybe I'm just too into this psych stuff now
Mood:  quizzical
Now Playing: Isaak
Topic: Work
But I'm convinced that this guy I work with has (untreated) borderline personality disorder. I was telling someone else earlier that I thought that he had bipolar, but was only being treated for run-of-the-mill depression. I started thinking about how he's acted, and he has pretty much all the behaviors of a borderline! It's my expert opinion that he should be institutionalized, lol. See, I don't need a psych degree to figure this out. :-P~

Speaking of which, my paper is all finished and revised -- at least as much as it will be before it gets handed in. ;-)

Back to work for me.

It's finished!!!
Mood:  celebratory
Now Playing: laptop crunching away
Topic: School
I haven't revised it yet, but it is FINISHED!! Well, okay, I went over it once, but haven't printed it out to really LOOK at it. I guess that it's taken me about... hmm... 9 or 10 hours? That sounds about right. ANyway, here it is:









SSRI Medications: Friend or Foe?







Lauren Grande


Psychology 111, Section 400
Professor Clagett
November 29, 2004

Abstract
SSRI medications are most commonly prescribed for treating depression. These medications have also been proven successful in depression remission and have enabled sufferers of this illness to live more fulfilling lives. Unfortunately, SSRIs also have a number of undesirable side effects, which may cause anything from mild discomfort to death, in the most extreme cases. Patients and their doctors must ultimately decide what treatments options are best for them, and whether taking an SSRI medication is worth the risk.

















SSRI Medications: Friend or Foe?
Depression is a devastating mental illness that harmfully affects millions of Americans each year. Unfortunately, it is often left untreated, resulting in thousands of deaths due to suicide annually in our country. It is regrettable that so many people resort to suicide, since most cases of depression can be effectively treated through antidepressant therapy, psychotherapy, electroconvulsive (ECT) therapy, or a combination of these methods. We are constantly bombarded with advertisements for antidepressant medications, commonly of the newer class of drugs called selective serotonin reuptake inhibitors (SSRIs). Selective serotonin reuptake inhibitors have been proven effective for the treatment of depression, but are they the best option? After a careful investigation of these medications, the patient and their doctor(s) must decide whether the benefits of taking SSRIs outweigh the risks and side effects.
Society wants a quick fix; a magic pill. Today, SSRIs are viewed as that magic pill. SSRIs made their first appearance in 1987 with the FDA approval of Prozac (fluoxetine). Prozac is one of the most commonly prescribed medications and has been prescribed to more than 40 million people worldwide (Prozac). How do Prozac and other SSRIs cure depression? According to Prozac's website:
[A] growing amount of evidence supports the view that people with depression have an imbalance of the brain's neurotransmitters, the chemicals that allow nerve cells in the brain to communicate with each other. Many scientists believe that an imbalance in serotonin, one of these neurotransmitters, may be an important factor in the development and severity of depression. PROZAC may help to correct this imbalance by increasing the brain's own supply of serotonin. Some other antidepressant medicines appear to affect several neurotransmitters in addition to serotonin. PROZAC selectively affects only serotonin. ("Prozac")
Eli Lilly, makers of Prozac, struck gold when the company discovered this drug. Since Prozac has been so effective at treating depression, other pharmaceutical companies have followed suit and developed their own medications.
At least seven new SSRI medications have gone on the market since Prozac was first introduced. These medications include Celexa (citalopram), Cymbalta (duloxetine), Effexor (venlafaxine), Lexapro (escitalopram), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline). Dr. Dennis Charney, M.D., Chief of Mood and Anxiety Disorder Research Program at NIMH and Dr. Charles Nemeroff, M.D., Ph.D., of Emory University School of Medicine discuss Celexa: "Celexa is a selective serotonin reuptake inhibitor (SSRI). The Celexa molecule more selectively targets the serotonin reuptake pumps than most other SSRIs do. It is as effective as other SSRIs and has similar side effects" (Charney and Nemeroff 106). What are these side effects? Celexa reports that the most frequent side effects reported are nausea, dry mouth, drowsiness, insomnia, increased sweating, tremor, diarrhea, and problems with ejaculation ("Celexa"). Although they claim that some patients notice an improvement (after taking Celexa) in as little as one week, as with most SSRI medications, Celexa states that most patients feel better after four to six weeks.
Cymbalta is a recent addition (2004) to the medication market and boosts levels of both serotonin and norepinephrine (another neurotransmitter implicated in the treatment of depression). In studies, this drug has had relatively mild side effects including nausea, dry mouth, constipation, decreased appetite, fatigue, sleepiness and increased sweating ("FDA Approves Lilly's Cymbalta"). According to an article published by the Associated Press, "Cymbalta is approved to treat major depression for up to nine weeks. In one study, Cymbalta users were almost three times as likely to achieve remission of their depression as patients given a dummy pill, said Lilly's Dr. Madelaine Wohlreich" (AP "FDA approves new antidepressant"). However, in February a college student taking part in a study of the drug hung herself in a company research facility. Lilly maintains that there's no evidence that the drug was to blame.
The next SSRI we will explore is Effexor, which raises the levels of serotonin and norepinephrine, like Cymbalta. Dr. Charney and Dr. Nemeroff state that "some patients, particularly those with severe depression, seem to respond better to Effexor than to medications that work primarily on only one neurotransmitter, though it may also produce a wider range of side effects" (Charney and Nemeroff 107). A check of the listed side effects of Effexor confirms Charney and Nemeroff's statements regarding side effects: nausea, vomiting, upset stomach, abdominal pain, or loss of appetite or weight; dry mouth; drowsiness or dizziness; mild tremor, anxiety, or agitation; insomnia; abnormal dreams; sexual problems such as impotence, abnormal ejaculation, difficulty reaching orgasm, or decreased libido; sweating; yawning; or increase in blood cholesterol levels ("Venlafaxine"). After viewing this list, it's not surprising that people often stop taking their medication due to negative side effects.
Lexapro is similar to Celexa and is made by the same company, Forest Pharmaceuticals. While Celexa contains two chemically similar molecules that raise serotonin levels, Lexapro only contains one of those molecules, which makes Lexapro effective at lower doses and is believed to have a reduced amount of side effects. Nausea, insomnia, problems with ejaculation, somnolence, increased sweating, fatigue, decreased libido, and anorgasma (inability to achieve orgasm) are the most commonly reported side effects ("About Lexapro").
We continue our journey through the pharmaceutical jungle with an examination of Luvox. According to Charney and Nemeroff, Luvox is an SSRI primarily used for treating obsessive-compulsive disorder (OCD), but is also effective for depression. The side effects of Luvox are consistent with most other SSRIs; insomnia, sleepiness, nausea, weakness, sexual dysfunction, nervousness, dry mouth, and constipation (National Alliance for the Mentally Ill [NAMI]).
Paxil is one of the most controversial drugs currently on the market; it was one of the first drugs that sparked debate over whether SSRI medications should be taken by children under 18. GlaxoSmithKline, the company that produces Paxil informs us of the side effects that have become all too familiar: nausea, injury, infection, diarrhea, constipation, decreased appetite, sleepiness, dizziness, yawning, sweating, abnormal vision, and sexual side effects ("Questions about Paxil"). What they mean by "injury" isn't clear, but it certainly does not sound like a positive side effect. Nevertheless, like its other SSRI counterparts, Paxil is an effective treatment for medication and many patients have found relief from their symptoms by taking it.
Finally, we arrive at Zoloft, which not only increases serotonin levels, but is believed to increase dopamine levels at higher doses. The increased dopamine levels has an energizing effect, which makes Zoloft a quality choice for people who feel lethargic. Following are the common side effects associated with Zoloft: upset stomach, difficulty sleeping, diarrhea, dry mouth, sexual side effects, feeling unusually sleepy or tired, tremor, indigestion, increase of sweating, feeling agitated, and decreased appetite ("How Zoloft can Help"). In addition to treating depression, Zoloft is also commonly prescribed for panic disorder, social anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder.
After learning the side effects of all of these medications, someone who is uneducated about depression might wonder why anyone would take these drugs. Unfortunately, depression can be an incapacitating illness and those afflicted with the disorder will go to any length to stop the pain. In most cases, this means either seeking treatment or resorting to suicide. According to the Depression and Bipolar Support Alliance (DBSA), if you experience five or more of the following symptoms for more than two weeks, or if any of these symptoms interfere with work or family activities, consult with your doctor for an evaluation:
Symptoms of depression include prolonged sadness or unexplained crying spells; significant changes in appetite and sleep patterns; irritability, anger, worry, agitation, anxiety; pessimism, indifference; loss of energy, persistent lethargy; feelings of guilt, worthlessness; inability to concentrate, indecisiveness; inability to take pleasure in former interests, social withdrawal; unexplained aches and pains; and recurring thoughts of death or suicide. (DBSA)
It is no wonder that these symptoms can overshadow the risk of side effects from SSRI medications.
Many patients taking SSRI medications do not experience negative side effects. When side effects do occur, they are usually not severe enough to cause the patient to discontinue treatment. Charney and Nemeroff explain:
Adverse events, of course, can occur after the administration of any drug, antidepressants included, and over the past few decades a handful of patients have experienced some unusual side effects, such as rashes, abdominal pain, agitation, and marked sleepiness. But such reactions are very rare and shouldn't deter people from trying antidepressants; every risk-benefit analysis done to date has shown the remarkable benefits of using these agents. (Charney and Nemeroff 106)
Since many experts in the psychiatry field are convinced that the benefits outweigh the risks, patients are often prescribed these drugs and aren't too concerned about side effects.
There are some exceptional examples of how these drugs have had a positive impact on the lives of patients suffering from depression. Dr. William S. Appleton, M.D. of Harvard Medical School shares the story of Laura, who moved to a new city and became depressed after not adjusting to her new surroundings:
A thirty-six-year-old stranger in a new city, Laura burst into tears at work, and felt lonely, less capable than the other middle managers, and unable to attract a suitable man. Prozac steadily raised her level of confidence and stopped her tears. Feeling better for six months, she decided to stop taking the drug, but her improvement continued. Performing well at work, she was promoted. She fell in love and has plans to marry. (Appleton 95)
According to Appleton, depressed people are negative about their lives - past, present, and future. They have no hope for any of this and are unable to plan their lives. He says that without hope, they are plagued by passivity and indecision. These things make the depressed person feel ineffective and worthless - it is a continuing downward spiral. SSRI medications restore hope for most patients, which results in the person being able to plan social activities, make decisions, and generally begin feeling good about the things that they can now accomplish (Appleton 92). This class of antidepressants has been lifesaving for many people, and the positive effects must not be discounted.
Regrettably, SSRI medications have come under fire recently for a believed increase in suicidal ideation and behavior in adolescents, and also a discontinuation or withdrawal syndrome in patients who stop taking the medication suddenly. On October 15, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory announcing a strategy to warn the public about suicidality in children and adolescents being treated with antidepressants, the list being made up of mostly SSRI medications. Their press release states:
In letters issued today, FDA directed the manufacturers of all antidepressant medications to add a "black box" warning that describes the increased risk of suicidality in children and adolescents given antidepressant medications and notes what uses the drugs have been approved or not approved for in these patients [...] A "black box" warning is the most serious warning placed in the labeling of a prescription medication. Advertisements that serve to remind health care professionals of a product's availability (so-called "reminder ads") are not allowed for products with "black box" warnings. Until now, only ten drug products approved for children contained a black box warning about their use in children. The new warning language does not prohibit the use of antidepressants in children and adolescents. Rather, it warns of the risk of suicidality and encourages prescribers to balance this risk with clinical need. (FDA)
Will this notice alarm parents; preventing children and adolescents from receiving the treatment that they need? Many experts in the psychiatry field are concerned about that issue.
One such expert is David Fassler, M.D., a trustee of the American Psychiatric Association (APA). He was at the FDA advisory panel's February 2, 2004 public hearing, and made the following comments:
"We are concerned that the publicity surrounding this issue may frighten some parents and discourage them from seeking help from their children. This would be a real tragedy, since the reality is that we really can help most kids who suffer from psychiatric disorders, including childhood and adolescent depression. The most important point that I can make is that the biggest risk for a child with depression is to be left untreated." (Jackim 32)
Comparisons have been drawn in the psychiatric community between "the slaughtering of one type of cow across the country due to the mad cow scare instead of increasing the testing and tracking [of the animals]" (Dr. John Rose, qtd. In Jackim 32). Perhaps there can be a compromise reached in these cases, and all parties involved can reach an agreement.
The recent FDA warnings on SSRI medications only comprise one part of the dilemma, however. Another trouble with SSRI medications is the problem of withdrawal reactions. A case is given in the American Family Physician journal of a patient who experienced withdrawal reactions after discontinuing Zoloft (sertraline):
The patient, a 43-year-old man, had been treated for depression with sertraline for about six months and was taking a maintenance dosage of 25 mg per day. Because the patient experienced drowsiness, the dosage was tapered to 12.5 mg per day for a week and then stopped. The patient began taking venlafaxine [Effexor], 37.5 mg, one-half tablet twice daily. Within 48 hours of discontinuing the sertraline, he noticed the onset of severe dizziness and lightheadedness, aggravated by sudden changes in position but without a sensation of spinning or nausea. Venlafazine was discontinued after five days without relief of symptoms. When the dizziness persisted for another week, sertraline was restarted at a dosage of 12.5 mg at bedtime, and the dizziness and lightheadedness ceased by the following morning. He was subsequently tapered slowly from the sertraline with no further symptoms. (Wolfe 455)
Patients experiencing SSRI medication withdrawal may have symptoms worse than their known side effects. Those side effects read like a medical encyclopedia: abdominal pain, anorexia, diarrhea, dry mouth, increased appetite, nausea, vomiting, blurry or double vision, chest discomfort, chills, coryza, fatigue, flu-like syndrome, headache, malaise, myalgia, sweating, weakness, palpitations, postural hypotension, disorientation, dizziness or vertigo, dyskinesia and dystonia, imbalance, jitteriness/tremor, impaired memory or thinking, paresthesias (burning, tingling or electric shock sensations in spine or perioral area), Lhermitte's sign (electric shock sensation in spine or limbs, elicited by neck flexion), transient "rushing" or "buzzing" in head, migraine-like scotomas, tinnitus, excessive, vivid and early-onset dreaming, insomnia, nightmares, anxiety, apathy, aggressiveness, confusion, depersonalization, hallucinations, lowered mood or depression, hypomania, irritability, and panic (Wolfe 459). Not all patients develop these symptoms after sudden cessation of SSRI use, but according to Dr. Kara E. Ditto, M.D., M.P.H., "discontinuation syndrome [...] is experienced by up to 25% of patients who abruptly quit taking these agents" (Ditto). While this figure means that roughly seventy-five percent of patients using SSRIs experience no withdrawal effects, the number of those suffering from withdrawal is still a contemptible amount.
There have also been class action suits filed against the pharmaceutical companies that manufacture these drugs. One particular suit against the makers of Paxil, GlaxoSmithKline, Inc., filed by Katherine Keith et al. in California makes the claim:
Thousands of Paxil users suffer dependency/withdrawal syndrome [...] Over the past two (2) years, plaintiff's attorneys have been individually contact by approximately 500 Paxil withdrawal victims. The pain and suffering experienced by each of these individuals is the direct result of GLAXOSMITHKLINE CORPORATION's failure to warn users of Paxil's addictive nature, the drug's inducement of physical or psychologic dependency, and its infliction of dependency/withdrawal syndrome when the patient's Paxil dosage is reduced or terminated. (Baum, Hedlund, Aristei, Guilford & Schiavo)
There are more cases all over the country, both class action lawsuits and individual cases that include a range of SSRI medications; Paxil, Prozac, Effexor, Luvox, and Zoloft. Does this mean that Cymbalta, Celexa and Lexapro are out of the woods yet? Probably not, since these are all relatively new medications and will require more time for a definitive outcome to treatment, either positive or negative.
Should SSRI medications be outlawed? Some medications certainly require closer review by the FDA. These medications are effective at treating depression, and should be used by those who are able to make an informed decision about their treatment. Parents of children on SSRI medications need to pay careful attention to the FDA reports on these drugs, but they should also beware of the consequences that may arise should their child stop taking their medication. There are many routes of treatment available for those with depression; SSRI medications are only one of them. SSRI medications can be used to treat depression, but only after all of the risks and benefits have been weighed.


References
About Lexapro. (n.d.). Retrieved November 27, 2004 from
http://www.lexapro.com/english/about_lexapro/default.aspx
About Medications: Luvox. (June 2003). Retrieved November 27, 2004 from
http://www.nami.org/Template.cfm?Section=About_Medications
Appleton, W. (2000). Prozac and the New Antidepressants. New York: Penguin Books.
Associated Press. (August 4, 2004). FDA approves new antidepressant. CNN. Retrieved
November 27, 2004 from http://www.cnn.com
Baum, Hedlund, Aristei, Guilford & Schiavo. (August 23, 2001). Katherine Keith et al.
vs. GlaxoSmithKline, Inc. Retrieved November 27, 2004 from
http://www.baumhedlundlaw.com/media/ssri/paxil/paxil_complaint.pdf
Charney, D. & Nemeroff, C. (2004). The Peace of Mind Prescription. New York: Houghton
Mifflin.
Depression Facts, Symptoms, and Treatment. (November 22, 2004). Retrieved November 26, 2004 from http://www.dbsalliance.org/info/depression.html
Ditto, K. (August 2003). SSRI discontinuation syndrome: awareness as an approach to
prevention. Retrieved November 22, 2004 from http://www.postgradmed.com/issues/2003/08_03/ditto.htm
FDA Approves Lilly's Cymbalta for the Treatment of Depression. (August 4, 2004).
Retrieved November 27, 2004 from
http://newsroom.lilly.com/news/Product/2004-08-04_fda_approves_cymbalta.html


FDA Launches a Multi-Pronged Strategy to Strengthen Safeguards for Children Treated with
Antidepressant Medications. (October 15, 2004). Retrieved November 28, 2004 from http://www.fda.gov/bbs/topics/news/2004/new01124.html
How Prozac Can Help: Safety Facts. (n.d.). Retrieved November 26, 2004 from http://www.prozac.com/how_prozac/safety_facts.jsp?reqNavId=2.5
How Zoloft can Help. (2004). Retrieved November 27, 2004 from
http://www.zoloft.com/index.asp?pageid=44
Jackim, L. (April 2004). Clinicians say they're twisting in wind during FDA review of SSRIs.
Behavioral Healthcare Tomorrow, 13(2), 31-34.
Mundell, E.J. (September 15, 2004) Antidepressant Warning Might Keep Kids from Care.
Retrieved November 27, 2004 from http://www.med.miami.edu/communications/som_news/index.asp?id=267
Questions About Paxil. (n.d.). Retrieved November 27, 2004 from
http://www.paxil.com/about/nw_pxl.html
SSRI Withdrawal Syndrome. (1996). Retrieved November 26, 2004 from http://psychiatry.jwatch.org/cgi/content/full/1996/1201/1
Venlafaxine. (April 7, 2004). Retrieved November 27, 2004 from
http://content.health.msn.com/hw/drug_data/d03181a1?bn=effexor
What to Expect. (n.d.). Retrieved November 26, 2004 from
http://www.celexa.com/about_celexa/what_to_expect.asp
Wolfe, R. (August 1997). Antidepressant withdrawal reactions. American Family
Physician, 56, 455-463.

just registered for classes
Mood:  smelly
Now Playing: breaking benjamin
Topic: School
I'm taking psych of relationships and western civ. Of course, I'm only eligible to take the psych of relationships class if I finish this stupid paper!!! lol. Two and a half pages left. I think I can do it. I'll just utilize the block style of quoting heavily to take up space. There isn't a word requirement on this one, it just has to be 8-10 pages. Oh joy. I have 1,329 words, at any rate. So this is going to be longer than my english paper most likely. The words in this paper are longer, too! sheesh.

I don't feel like working, I really don't. OKay, I'm really going to get back to work, I swear.

sooooooo sleepy
Mood:  lazy
Topic: School
sooooooooo tired. I've been sitting at the computer for the better part of the day. Have I been working all of that time? Hell no!! I have 5 pages complete on my paper, I must have 8. I've finally talked about all of the SSRI meds....... man. Those are some wicked side effects! So. Here I am, taking a lil break so that my eyes don't bleed. My jaw is kind of sore, too. Must be grinding my teeth or clenching my jaw. Not surprising, I suppose.

I wonder if there was more that I was supposed to do for my English class monday? I've really been thrown through a loop (or is that 'thrown FOR a loop?' I can't remember?!) in the last week - week and a half. It's been incredibly difficult to concentrate with everything that has been going on in my life. Funny thing is that when final exam week comes, life might be less hectic! how ironic is that?

ugh.

*yawn*

my back kinda hurts.

okay, 1.5 more pages and I'm calling it quits for tonight. then i'll watch TV until kurt gets home :P

Paper numero dos
Mood:  incredulous
Now Playing: my laptop crunching away
Topic: School
This has been an eye-opening paper... I can't believe all of these side effects! Here's what I have so far:







Depression is a mental illness that affects millions of Americans. Unfortunately, it is often left untreated, resulting in thousands of deaths due to suicide each year in our country. It is regrettable that so many people resort to suicide, since it is estimated that eighty to ninety percent of cases can be effectively treated. The universal options of treatment for those suffering from depression include antidepressant therapy, psychotherapy, and electroconvulsive (ECT) therapy. We are constantly bombarded with advertisements for antidepressant medications, commonly of the newer class of drugs called selective serotonin reuptake inhibitors (SSRIs). What medications are available? Why are they effective for treating depression and how do they work? How safe are SSRI medications? These are all questions that should be asked before beginning any medication treatment for depression. Selective serotonin reuptake inhibitors have been proven effective for the treatment of depression, but are they the best option? After a careful investigation of these medications, the patient must make a decision of whether the benefits of taking SSRIs outweigh the risks and side effects.
Society wants a quick fix; a magic pill. Today, most SSRIs are viewed as that magic pill. SSRIs made their first appearance in 1987 with the FDA approval of Prozac (fluoxetine). Prozac is one of the most commonly prescribed medications and has been prescribed to more than 40 million people worldwide (Prozac). How do Prozac and other SSRIs cure depression? According to Prozac's website:
[A] growing amount of evidence supports the view that people with depression have an imbalance of the brain's neurotransmitters, the chemicals that allow nerve cells in the brain to communicate with each other. Many scientists believe that an imbalance in serotonin, one of these neurotransmitters, may be an important factor in the development and severity of depression. PROZAC may help to correct this imbalance by increasing the brain's own supply of serotonin. Some other antidepressant medicines appear to affect several neurotransmitters in addition to serotonin. PROZAC selectively affects only serotonin. ("Prozac")
The discovery of Prozac has been the equivalent of settlers striking gold in California. Since Prozac has been so effective at treating depression, other pharmaceutical companies have followed suit and developed their own medications.
At least seven new SSRI medications have gone on the market since Prozac was first introduced. These medications include Celexa (citalopram), Cymbalta (duloxetine), Effexor (venlafaxine), Lexapro (escitalopram), Luvox (fluvoxamine), Paxil (paroxetine), and Zoloft (sertraline). Dr. Dennis Charney, M.D., Chief of Mood and Anxiety Disorder Research Program at NIMH and Dr. Charles Nemeroff, M.D., Ph.D., of Emory University School of Medicine discuss Celexa: "Celexa is a selective serotonin reuptake inhibitor (SSRI). The Celexa molecule more selectively targets the serotonin reuptake pumps than most other SSRIs do. It is as effective as other SSRIs and has similar side effects" (Charney and Nemeroff 106). What are these side effects? Celexa reports that the most frequent side effects reported are nausea, dry mouth, drowsiness, insomnia, increased sweating, tremor, diarrhea, and problems with ejaculation ("Celexa"). Although they claim that some patients notice an improvement (after taking Celexa) in as little as one week, as with most SSRI medications, Celexa states that most patients feel better after four to six weeks.
Cymbalta is a recent addition (2004) to the medication market and boosts levels of both serotonin and norepinephrine (another neurotransmitter implicated in the treatment of depression). In studies, this drug has had relatively mild side effects including nausea, dry mouth, constipation, decreased appetite, fatigue, sleepiness and increased sweating ("FDA Approves Lilly's Cymbalta"). According to an article published by the Associated Press, "Cymbalta is approved to treat major depression for up to nine weeks. In one study, Cymbalta users were almost three times as likely to achieve remission of their depression as patients given a dummy pill, said Lilly's Dr. Madelaine Wohlreich" ("FDA approved new antidepressant"). However, in February a college student taking part in a study of the drug hung herself in a company research facility. Lilly maintains that there's no evidence that the drug was to blame.
The next SSRI we will explore is Effexor, which raises the levels of serotonin and norepinephrine, like Cymbalta. Dr. Charney and Dr. Nemeroff state that "some patients, particularly those with severe depression, seem to respond better to Effexor than to medications that work primarily on only one neurotransmitter, though it may also produce a wider range of side effects" (Charney and Nemeroff 107). A check of the listed side effects of Effexor confirms Charney and Nemeroff's statements regarding side effects: nausea, vomiting, upset stomach, abdominal pain, or loss of appetite or weight; dry mouth; drowsiness or dizziness; mild tremor, anxiety, or agitation; insomnia; abnormal dreams; sexual problems such as impotence, abnormal ejaculation, difficulty reaching orgasm, or decreased libido; sweating; yawning; or increase in blood cholesterol levels ("Venlafaxine").



Yeah, the introduction looks familiar, doesn't it? I'm going to change it around a bit, I just needed a starting place. Back to work.

By the way...
Mood:  amorous
Now Playing: Christmas music (it's that time of year again)
Topic: Friends and Family
Happy Thanksgiving! Mine was pretty good... went to the LC show Thanksgiving night... it was one of the best that I've seen... I felt like I was seeing some famous ROCK GODS play instead of my favorite local band. Not that they aren't ROCK GODS, but just not a worldwide scale. Saw a lot of old friends last night, too. Definitely an awkward moment or two, as well. But overall things were fantastic. Saw Karen... and Donna was VERY pregnant... she's having a little boy, Dan Jr. :) Hung out with Ray most of the night... he protected me from people I didn't want to talk to, haha.

More later, maybe. I've written almost an entire paragraph on my paper. Not enough. Not going too well. Time for dinner.

better day, but still not 100%
Mood:  not sure
Now Playing: Isaak
Topic: Introspection


I was pretty down yesterday. I think I said in another post that this death has affected me more than I thought it would... not that death shouldn't have an effect. It's just that I hadn't seen Kyle in years, since Heather's (Levengood) funeral several years ago... we were somewhat close (at times) in high school, but it's been a long time. You always wonder if there was something you could have done to prevent it. I've read that coping with loss after suicide is different than death from other causes... there's a certain quotient of guilt to it. My guilt (and grief) of course can't be anywhere close to what close family and friends are experiencing. Then you wonder why? You would assume depression; statistics say 90% of suicides are the result of undiagnosed (or untreated) psychiatric disorders, commonly depression. But then again, he had served active duty in Iraq. Who knows what he saw over there? War probably causes more psychological scars than it does casualties. (This is all conjecture, of course. I can say whatever the hell I want!) This tragedy has helped me in one way, however -- my career choice (psychology). Of course, if someone doesn't want help or doesn't ask for it, there wouldn't be anything I could do. I wonder what I could do to save more lives... how I could help the (huddled) masses understand mental illness, or reach people with depression and prevent suicides. *sigh* I'm sure there is something I could do to help. I think as my first step, I'll put a page of resources onto my webpage... it may not be much, but at least it's a start. That whole think globally act locally thing. Hmm. But this is the world wide web - so I'm really doing both! ;-)

As I'd said in an earlier post, this was the most heartrending funeral I've ever been to. Since it was a military funeral, the service was conducted with full military honors. After the service in the chapel at the cemetery, the firing party fired the three shot volley and afterwards the bugler played Taps. Witnessing these rituals was a bit much for me... it really emphasized the finality of it all. Of course wanting to make sense of it all, I looked up the meaning of all these things. The three shot volley is commonly confused with a "21 gun salute", but the two are different things. Here's some info I found on the origins of these customs:

Graveside military honors include the firing of three volleys each by seven service members. This commonly is confused with an entirely separate honor, the 21-gun salute. But the number of individual gun firings in both honors evolved the same way.
The three volleys came from an old battlefield custom. The two warring sides would cease hostilities to clear their dead from the battlefield, and the firing of three volleys meant that the dead had been properly cared for and the side was ready to resume the battle.
The bugle call "Taps" originated in the Civil War with the Army of the Potomac. Union Army Brig. Gen. Daniel Butterfield didn't like the bugle call that signaled soldiers in the camp to put out the lights and go to sleep, and worked out the melody of "Taps" with his brigade bugler, Pvt. Oliver Wilcox Norton. The call later came into another use as a figurative call to the sleep of death for soldiers.

The flag folding ceremony was intense as well... very precise and deliberate, if that's the correct word. I found information on the meaning of each fold and such, but I don't know if it's correct, so I won't post it. The entire ceremony was incredible, really. It was like witnessing a piece of history; witnessing every military funeral that has ever taken place in our country since our country's independence... very steeped in tradition. It was beautiful and heartbreaking at the same time. I imagine that anyone who has attended a military funeral understands what I'm saying.

Time for me to get home... I haven't gotten much work done today. Now I go home to prepare for Turkey day. It would seem that there isn't much to be thankful for this Thanksgiving, but there are many things to still be thankful for.

Finalized paper
Mood:  sad
Now Playing: Isaak -- Things go wrong
Topic: School
I'm going to write a post later on about Kyle's viewing and funeral. It seems that I'm not as desensitized about death as I thought I was. It was one of the saddest (if not the most) funerals I've ever been to... I'd never seen a full military funeral before, with the 3 shot volley (I'm pretty sure that's what it's called) and taps being played... it was an emotional moment. Of course during the funeral they played "Angel" by Sarah MacLachlan... at Heather's funeral they had played "I will remember you." Anyway, I'm getting carried away here -- here is my final paper:



Double Therapy: A Lifesaving Treatment
Depression is a serious illness currently affecting millions of Americans, as well as over one hundred million others worldwide. Regrettably, it is often left untreated which results in tens of thousands of deaths due to suicide each year in the United States alone. There is hope, however: depression is a treatable condition, and with the right tools, it is possible for those suffering from this disease to find relief from their symptoms. There are three basic types of treatment for depression: psychotherapy (also known as talk therapy), electroconvulsive therapy (ECT), and medication. The two most common and widely accepted forms of treatment are psychotherapy and antidepressant medication. Lately, it seems that society has become increasingly dependent on drugs to make them content: people want instant happiness without resolving the true nature of their problems with psychotherapy. Nevertheless, antidepressants are effective and those who take them often feel better before those who opt for talk therapy treatment alone. Neither of these methods should be discounted for their efficiency, as antidepressants mend the mind, while psychotherapy mends heart and soul. A combination approach of both psychotherapy and antidepressant therapy is the most effective treatment for adults experiencing major depressive disorder.
Many people will have some experience with a major depressive episode at some point in their lifetime. Either they will know a coworker, friend, or family member affected by this illness, or they will be affected by it themselves. According to Liora Nordenberg of the U.S. Food and Drug Administration, of the millions of cases of depression that occur annually in our country, it is estimated that as many as eighty to ninety percent can be effectively treated. Nordenberg cites the regrettable statistics of those who do not seek help:
Depression strikes about 17 million American adults each year--more than cancer, AIDS, or coronary heart disease--according to the National Institute of Mental Health (NIMH). An estimated 15 percent of chronic depression cases end in suicide [...] two-thirds of the people suffering from depression don't get the help they need, according to NIMH. Many fail to identify their symptoms or attribute them to lack of sleep or a poor diet, the APA says, while others are just too fatigued or ashamed to seek help" (Nordenberg).
This data is depressing in itself; depression is an easily treated disease, yet so many people continue to live in misery because they do not seek treatment.
There are three main types of depressive mood disorders: major depressive disorder, dysthymic disorder (dysthymia), and bipolar disorder (previously called manic depression). Major depressive disorder is characterized by one or more major depressive episodes, where the sufferer feels persistently said for two weeks or longer. Symptoms of major depressive disorder include sleep problems, loss of appetite, inability to concentrate, and memory problems. This disorder also tends to be a recurrent illness and frequently occurs after a significant life event. Dysthymia is a constant low-grade depression which is not debilitating, but still affects the sufferer's life in a negative manner. Dr. Dennis Charney, M.D., Chief of Mood and Anxiety Disorder Research Program at NIMH and Dr. Charles Nemeroff, M.D., Ph.D., of Emory University School of Medicine define bipolar illness as "[M]ajor depression that alternates with periods of abnormally high mood in which a person feels energized, buoyant, and outgoing - sometimes to a pathological degree" (Charney and Nemeroff 85). A common theory of these disorders is that they are caused in some part by chemical imbalances in the brain. Dysthymia and bipolar are most frequently associated with these chemical imbalances, while major depressive disorder commonly arises after a negative life experience. Since major depressive disorder usually has both biological and external causes, the combination approach of medication and psychotherapy will be the most suitable method to utilize in its treatment.
Despite its success in treating many patients with depression, medication may not be safe for everyone. Recent studies have suggested that antidepressant use for children and adolescents may be dangerous. Elizabeth Mechcatie, a reporter for Family Practice News, notes a public health advisory which was publicized by the Food and Drug Administration:
The FDA released the advisory to alert physicians to reports of suicidality in clinical studies of various antidepressants in pediatric patients with major depressive disorder (MDD). Although cases of suicidality "are not unexpected in patients with MDD, preliminary data suggest an excess of such reports" among patients who have been on some of those drugs compared with those on placebo, the advisory states. (Mechcatie)
Due to this declaration, it is not safe to assume that antidepressant usage should be recommended for those under the age of eighteen. We should instead focus on the way that these medications may help adults.
Society needs to recognize that depression is often a biologically based disease. As previously mentioned, it is believed that depression is caused by chemical imbalances in the brain. The National Alliance for the Mentally Ill identifies the neurotransmitters implicated in this condition:
Norepinephrine, serotonin, and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Scientists believe that if there is a chemical imbalance in these neurotransmitters, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers (Frank).
New clinical trials and studies regarding depression are being investigated continuously. As a result of this research, medications are being developed that are more effective at treating depression with reduced side effects.
Antidepressants play an important role in treating the biological origins of depression; however, there are new treatments on the horizon that may be a better fit than the current antidepressants on the market. Recent research has found that enduring stress can essentially reshape the brain. It is thought that stress may shrink the hippocampus (structure in limbic system of brain involved in memory formation) and also obstruct a process called neurogenesis (growth of new brain cells), causing depression. A hormone called corticotrophin-releasing hormone (CRH) stimulates the pituitary gland, which elicits a signal for release of glucocorticoids (stress hormones i.e. cortisol) from adrenal glands in the endocrine system. Constance Holden, a Mental Health Reporter and winner of a 2003 award from the National Mental Health Association (NMHA) elaborates on these findings, citing research performed by Dr. Charles Nemeroff:
Animal models, too, show that early stress, such as that induced by maternal deprivation, causes depression-like behavior [...] Such animals also hypersecrete CRH. "Many of the established neurobiological findings in depression may indeed be due to early life stress," when the young nervous system is still tender and impressionable, according to Nemeroff. His research has revealed that among adults who have been sunk in depression for 2 years or longer, 45% experienced abuse, neglect, or parental loss as children. (Holden 811)
These findings are exhilarating for those in the fields of psychiatry and psychology. This means that pharmaceutical companies will work to develop new drugs that will likely work by suppressing corticotrophin-releasing hormones. Nemeroff's figure of adults experiencing abuse, neglect, or parental loss gives support to why psychotherapy should play a role in treating depression.
If medications treat the mind, then it is psychotherapy which treats the soul. There are several types of psychotherapy recognized as effective methods of treating depression. The National Alliance for the Mentally Ill (NAMI) identifies them as Cognitive-behavioral therapy (CBT) and Interpersonal therapy (IPT). According to NAMI, Cognitive-behavioral therapy "[H]elps to change the negative thinking and unsatisfying behavior associated with depression, while teaching people how to unlearn the behavioral patterns that contribute to their illness; Interpersonal therapy focuses on improving troubled personal relationships and on adapting to new life roles that may have been associated with a person's depression" (Frank). Both of these psychoanalysis methods achieve desirable results with regard to alleviating depression. It is through psychotherapy that the person afflicted by this illness truly begins to recover; the patient can explore their minds and discover the genuine reasons causing their depression. Medications can not do this; they must do it themselves.
There can be innumerable external contributing factors that may cause someone to lapse into depression. Charney and Nemeroff discuss these factors:
All types of depression usually arise from a combination of inborn vulnerabilities [...] and the interaction of those vulnerabilities, for better or worse, with life experiences, such as upbringing, education, culture, stress, or trauma. A particular case of depression may arise more from genetics, say, than upbringing, but no depression is all genetics, or all stress, or all upbringing. (Charney and Nemeroff 89)
These life experiences play a significant role in a depressive episode. It is because of these external factors that psychotherapy is imperative for treating depression.
Recent research has shown that antidepressants and psychotherapy are similarly effective for treating a major depressive disorder. Nicola Casacalenda, Christopher Perry, and Karl Looper, all psychiatrists with the Institute of Community and Family Psychiatry at Jewish General Hospital in Montreal, examined random controlled trials that evaluated medications and psychotherapy. The doctors found these results:
Tricyclic antidepressants, phenalzine and psychotherapy [...] were more effective at promoting remission than control conditions. There was no difference in remission between antidepressants and psychotherapy regimens. Antidepressants and psychotherapy may both be effective first-line treatments for outpatients with mild to moderate depression. (Casacalenda, Looper, and Perry 1186)
While some might argue that these findings could be a detriment to either drug companies or psychotherapists, it is in fact a benefit to both. Since both therapies have been found equally effective, the most successful depression treatment will be found when both sides agree to combine medication and psychoanalysis.
Many other professionals in the psychiatry and psychology fields agree that the combination approach to treating depression is ideal. Professor Raymond Lam, M.D., Head of the Division of Clinical Neuroscience, Department of Psychiatry at the University of British Columbia, supports this idea:
We need to move away from simple comparisons of psychotherapy versus pharmacotherapy to consider combined therapy [...] there is preliminary evidence that combining antidepressant medications with psychotherapy may increase remission rates over monotherapy in severe depression and in chronic depression. (Lam 46)
The clinical trials cited in Lam's viewpoint are in progress and expected to be completed in March 2006 (McCullough). A combination approach of pharmacotherapy and psychotherapy has been endorsed by a myriad of professionals besides those already mentioned. Charney and Nemeroff feel that "The multiple roots of the condition [depression] mean that using multiple treatment approaches usually works best" (Charney and Nemeroff 89). All of these people are respected individuals within their fields and their ideas should be held in high esteem. Since both psychotherapy and pharmacotherapy have been found to treat depression effectively, using them in conjunction is logically the most efficient way to put a depressed person on the road to recovery. The medications will help the patient feel better in the beginning, and talk therapy will keep them in remission and sustain them through the years.
The Band-Aid approach to treating depression has gone on long enough. If we have the research and understanding to prove that antidepressant medication and therapy are the most effective means of treating depression, then that is what we must utilize. Those suffering from depression must move toward this choice and recognize its value. In treating major depressive disorder, we have to care for the whole patient, and not just one part of the person. If patients and doctors follow this advice, the rates of depression remission will rise and the number of suicides will fall. It is time for the medical community to embrace this strategy and save lives.


Works Cited
Casacalenda, Nicola, Karl Looper, and Christopher Perry. "Comparing Depression
Treatments." American Journal of Psychiatry. 160 (2003): 1186-1187.
Charney, Dennis, and Charles Nemeroff. The Peace of Mind Prescription: an
authoritative guide to finding the most effective treatment for anxiety and
depression. New York: Houghton Mifflin, 2004.
Frank, Ellen. "Major Depression." NAMI: National Alliance for the Mentally Ill - The
Nation's Voice on Mental Illness. May 2003. 13 November 2004
nagement/ContentDisplay.cfm&ContentID=7725>.
Holden, Constance. "Future Brightening for Depression Treatments." Science. 302.5646
(2003): 810-814.
Lam, Raymond. "Antidepressants and psychotherapy may be equally effective for promoting
remission in major depressive disorder." Evidence-Based Mental Health. 6.2 (2003): 45-
46.
McCullough, Ph.D., James P. "Research Evaluating the Value of Augmenting Medication with
Psychotherapy." National Institutes of Health. April 2003. 16 November 2004
.
Mechcatie, Elizabeth. "Antidepressants may boost suicide risk in Children: FDA
advisory." Family Practice News. 34.1 (2004): 78.
Nordenberg, Liora. "Dealing with the Depths of Depression." U.S. Food and Drug
Administration. August 1998. 12 November 2004 features/1998/498_dep.html>.


Is it ironic that this paper was due on the same day that I went to the funeral? :-/

posted by a cautiously optimistic Redskins fan at 10:50 AM EST

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tired
Mood:  lazy
Topic: Weekend happenings
Was at Tiffer's house last night until 2 a.m... didn't get home until about 2:30... kept waking up this morning too early... now I'm just tired...... watching football........ I'll be going to Kyle's viewing tonight.............. *sigh* Nobody at the party had heard, so I got to be the bearer of bad news.

THat's it I guess..... watching the Cowboys get their asses handed to them........ just what I love!