12% of United States troops in Iraq and 17% of troops in Afghanistan are on anti-depressants

On June 5, 2008, Time Magazine ran a story entitled, "America's Medicated Army". Here is a snippet from the article:

The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

It seems that fighting pre-emptive and immoral wars is not good for one's mental health. I wonder when we as a nation will realize the error of our ways and demand that our government do something about it?

I don't know of any other occupation that has this high a rate of mental illness. Would you want your loved one to enter such a career?

Prozac: The Military's Secret Weapon, MSNBC with Joe Scarborough. Video lasts 3:25

This is article #4 on militarism.

Pediatric drug samples unsafe practice

Drug pushing Free drug samples pose risk to children's health according to a study in the October, 2008 issue of the journal, Pediatrics, as reported by Reuter's HealthDay on October 6, 2008. Here is a snippet from the Reuters HealthDay article:

 Free prescription drug samples distributed to pediatric patients may be unsafe, research suggests.

The study, published in the October 2008 issue of Pediatrics, examined data on 10,295 children and adolescents from the 2004 Medical Expenditure Panel Survey.

The researchers found that one in 20 American children received free drug samples in 2004. And among those who took at least one prescription drug that year, nearly one in 10 received free samples.

This in concerning, since the researchers also found that some of the most frequently distributed samples may be unsafe.

Four of the 15 most frequently distributed samples in 2004 were identified by the U.S. Food and Drug Administration as having significant new safety concerns, including new black box warnings or significant revisions to existing warnings.

The top 15 samples included (among others) Strattera (atomoxetine) and Adderall (amphetamine/dextroamphetamine), drugs used to treat attention deficit hyperactivity disorder (ADHD). Both of those medications are Schedule II controlled substances, meaning they are controlled and monitored by the Drug Enforcement Agency due to high potential for abuse.

Some physicians welcome the use of free sample medications as a way to get medications to needy patients. But this study's findings showed that few free samples actually go to the children who most need them.

Only 16 percent of the children who received free samples were uninsured for all or part of 2004, and less than one-third had low family incomes, defined as less than $38,000 for a family of four.

This is article #2 in a series on medications.


Longer term psychotherapy works according to a study published in JAMA

Reuters Healthday reported on 09/30/08 on a study which appeared in the October 1, 2008 issue of the Journal of the American Medical Association which found that long term psychodynamic psychotherapy works. Here is a snippet from the article:

People with complex mental disorders or personality disorders would benefit from long-term psychodynamic psychotherapy that lasts at least a year or longer, according to new research.

Published in the Oct. 1 issue of the Journal of the American Medical Association, the German study found that compared to the more commonly used short-term therapy, long-term psychotherapy left people better off. In fact, the number of therapy sessions the patients had was directly correlated to improvements in symptoms.

"Long-term psychodynamic psychotherapy was significantly superior to shorter forms of psychotherapy applied in the control groups. This was true with regard to overall effectiveness, target problems, and personality functioning," said the study's lead author, Falk Leichsenring, a professor of psychotherapy research in the department of psychosomatic medicine and psychotherapy at the University of Giessen in Germany.

"With regard to overall effectiveness, on average, patients with complex mental disorders were better off after treatment with long-term psychodynamic psychotherapy than 96 percent of the patients in the comparison groups. Thus, this meta-analysis provides evidence that long-term psychodynamic psychotherapy is an effective treatment for complex mental disorders," said Leichsenring.

"This study provides a great value for doctors and for patients, and one would hope could have an influence on policy decisions," added Dr. Charles Goodstein, a clinical professor of psychiatry at the New York University School of Medicine and Langone Medical Center in New York City.


Purpose of marriage video 1

I am planning on doing a series of videos on marriage. I have been a licensed clinical social worker for 40 years and have accumulated a lifetime of experience which I think may be of benefit to people. Here is the first video in the series which I have entitled, "The purpose of marriage." Please leave your comments.

Purpose of marriage video 1, part 1 of 2. Video lasts 4:18.

Part 2 of 2. Video lasts 8:31


Children in U.S. 3xs more likely to be prescribed psychotropic medications than in Europe

Child taking pill Science Daily reported on September 25, 2008 on a study which will appear in an upcoming issue of the journal, Child and Adolescent Psychiatry and Mental Health, which found that children in the United States are three times more likely to be prescribed psychotropic medications than children in Western Europe. The authors speculate on the reasons for the difference in practice. If you would like to read more click here.


Antidepressant Scripts Up 16 Million Over 3-Year Period and most not prescribed by mental health professionals

Doctorwriting_18136 Reuters HealthDay reported on July 24, 2008 on a report from the Agency for Healthcare Research and Quality which found that the prescription of antidepressant drugs has increased significantly over a 3 year period from 2002 - 2005 and less than a third of the antidepressant prescriptions are prescribed by psychiatrists with the great majority prescribed by primary care physicians.

It is interesting that most of the antidepressant medications are not precribed by mental health professionals which leads to the assumption that most depression is being treated without psychotherapy. Most outcome research seems to indicate that depression is better treated by psychotherapy or a combination of psychotherapy and antidepressant medication.

Here is a snippet from the HealthDay article:

Between 2002 and 2005, the number of prescriptions filled for antidepressant drugs increased from 154 million to 170 million, according to a report released Thursday by the U.S. government.

The analysis, by the Agency for Healthcare Research and Quality, of antidepressant prescriptions (not including refills) written after doctors talked with patients in-person or over the phone found that in 2005:

  • 29 percent of prescriptions were written by psychiatrists -- medical doctors who specialize in the treatment of mental disorders.
  • 23 percent came from general practitioners -- physicians who provide primary care but are specialty-trained.
  • 21 percent came from family practitioners -- primary care physicians who complete a residency in family medicine.
  • 10 percent came from internal medicine specialists -- physicians who complete a residency in internal medicine and who focus on the diagnosis and non-surgical treatment of adults with illnesses that are difficult to diagnose or manage.

The data used in the summary are from the Medical Expenditure Panel Survey of health services used by Americans.

 

MedlinePlus: Antidepressant Scripts Up 16 Million Over 3-Year Period.


Unproven therapies used on traumatized kids

Puppet therapy Reuters reported on September 9, 2008 on a CDC report which will appear in the American Journal of Preventive Medicine that a lot of therapies provided to kids with PTSD are not proven. Here is a snippet from the article:

Many doctors and therapists use unproven approaches such as drugs, art or play therapy on children suffering trauma when old-fashioned talk therapy has been shown to work, a report released on Tuesday said.

A review of a dozen different studies showed no evidence that alternative therapies helped children traumatized by violence or abuse, even though more than 75 percent of U.S. mental health professionals who treat children and teens with post traumatic stress disorder may use them.

But cognitive therapy -- a type of talk therapy aimed at changing negative thoughts -- does work, the group at the U.S. Centers for Disease Control and Prevention said.

"The good news is there is substantial research showing the effectiveness of group or individual cognitive behavioral therapy in treating children and teens experiencing the psychological effects of trauma," the CDC's Robert Hahn, who led the study, said in a statement.

"We hope these findings will encourage clinicians to use the therapies that are shown to be effective."

Children can be traumatized by many things including physical or sexual abuse, witnessing domestic violence, community violence or natural disasters.

In my office, I use cognitive based therapy and, when relevant, include parents and/or caretakers in on the sessions. I find that children and adolescents usually do very well. I am chagrined to hear about the play therapies, sand tables, EMDR, and other things my colleagues are doing with kids which they usually learned at some workshop and now have become born again disciples of the technique. I have often wondered, as the research report above suggests, why they didn't take a workshop and learn how to do therapy that works instead of the latest fad? Like many things in life we are enamored with the new, the novel, the gimicky approach which promises quick and almost miraculous success.

I find it increasingly difficult to find good therapists to refer people to. The mananged care system and the atrophy of the community mental health centers have made it difficult for young therapists to find adequate training environments.

MedlinePlus: Unproven therapies used on traumatized kids -study.


40 Years - Chapter two - Manipulation

            Dr. Maureen Didier, my Casework Professor at SUNY Albany, where I got my Masters In Social Work degree in 1972 also told me that as a Social Worker clients would manipulate me. I remember her telling me that it is OK to be manipulated if you know you are being manipulated and agree to it, but to be manipulated and not realize it will lead to a world of trouble and is incompetent practice.

            Over the course of 40 years of practice, I can’t tell you how many thousands of times I have been manipulated and have known it and gone along with it. Over the same period of time I have been manipulated also by my wife, my children, my neighbors, my friends, my colleagues, my employer, my political representatives, business people, and the list goes on.

            Dr. Didier told me it is OK to be manipulated as long as I am aware of it, and I have struggled for years to become more and more aware. Developing awareness takes ongoing effort. It never ends. Being aware of the need to continually increase one’s awareness requires ongoing willingness to learn, to approach life in a “not knowing” and open hearted way, and to reflect on one’s own experience and sift it for nuggets of wisdom.

            This self-reflection often requires a discussion with trusted others who have the time and interest and willingness to listen carefully, ask good questions, and provide honest feedback. Seeking out consultation and supervision is critical to good Social Work practice and to just about any other endeavor in life whether to manage your own emotions, manage your intimate relationships with others, parent your children, take care of your health, manage your finances, develop your spirituality, or learn any new skill or master any new body of knowledge.

            On the other hand, Social Workers also manipulate clients all the time under the guise of providing service or “treatment”. Social Workers value the client’s right to self determination and we have an ethical responsibility to obtain a client’s informed consent before we engage them in service activities and yet formalizing this idea of protecting clients from unwanted and involuntary manipulation often is illusionary because we are manipulating people all the time when we interact with them to get what we want and to influence other people’s behavior and to move situations in our desired directions.

            Manipulation has taken on a pejorative meaning in our current terminology but if we change the word from manipulation to influence it doesn’t seem so bad. The point to this chapter is that manipulation goes on all the time. It is part of life. There is nothing wrong with it necessarily as long as you are aware, and when ethically required, we disclose our intentions and obtain consent. It is the way we give respect and maintain our self-respect.