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thatcnamomnwife · 4 years ago

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Well, hello!

I really just wanted to check out this app because I don’t know anyone really who blogs here... maybe I could meet new people make friends I can chat with. I don’t work anymore and I have very little company. My ex husbands wife has come to visit and let our youngest boys play together and my family has come in and out to help keep things up in the house. I broke my leg in a car accident in October. I still can’t walk.

I laugh about it now because my two other siblings here have both been in worse car accidents and walked away with scratches. My brother was knocked unconsious and woke up and walked 2 miles home. I hit a tree to avoid hitting the back end of a truck that was stopped in a work zone and when I hit the break popped back and broke my ankle tib and fib... I knew I had broken it but was not aware of how bad it was. My EMT was wonderful in keeping me calm. I heard comments when I got to the hospital about it being really bad but I didn’t want to see the damage. They knocked me out and put me into surgery. I woke up with a fixater on my leg. The next night after I asked for pain meds 3 or 4 times in a row because the Dilaudid didn’t work, my assigned surgeon came in and examined my leg. I had compartment syndrome and needed a fasciotomy asap. so the next time I woke up I still had the fix and then my leg was completely wrapped. Every time I tried to do physical therapy I would. Bleed everywhere. I found out I had two huge gaping cuts in the side of my leg and 2 equally gaping cuts in the top of my foot. In the hospital I tried my best to keep up hope that this would all be over soon. My friends at work (I’m a CNA) got ahold of me and cheered me on the get better and come back to work soon. But here I am. It’s February and I’m still wheelchair bound and not walking. The way my surgeon fixed my leg set it to where my toes almost faced the ground and my ankle is now fixed as if its ready for a stiletto. I have worked hard to get to rotate my ankle and lift my toes a little bit and as my physical therapy has me working on the they are working on lifting this deep scar on top of my foot.

It sucks to have to depend on everyone else to get help. I can do some things on my own. But I can’t cook my own food by myself. I can do dishes actually but it’s really hard. I can move from place to place with my walker. But since I’m on one leg it’s hard and I wear out fast. I can’t go anywhere unless someone takes me. Sitting in a car is hell because I lose circulation in my leg easily. If I get annoyed with my husband or my kids get on my nerves I can’t just go outside.

I spent the first month crying. Every day. I’m not kidding. I cried even harder Every appointment because my surgeon is a straight forward kinda guy. My home health nurse came in and saw that I was cracking and she suggested I act for a low dose antidepressant and I just gave and said yea. I’m tired of crying. Well it’s worked so far. I still get mad and throw fits and cry but I think that’s just me being human and besides that anyone in the medical profession is bound be make a horrible patient.

I am a lot better now. In fact despite the fact that my leg still doesn’t work, I’m in ok spirits. I miss my job, my residents, and most of my coworkers. I worked through what I feel is the worst part of COVID in my area and I worked while I had it. I was so proud of my self for not giving up in that mess. I miss the hard work. I wanna go back but I know I will never get to run around like I did before. It just sucks.

But in the midst of this whole crap show my husband and I got married in December! It was a beautiful low cost home wedding and my family couldn’t come because they were quarantined but we had our other loved ones there. I won’t lie I looked amazing in my wedding dress and my hair and makeup was gorgeous. Nothing has changed since we got married. We are still bickering at each other but at the end of the day I love him and he loves me. We have been through it all in these 6 years and I wouldn’t have him any other way. He’s lazy. He frustrates me but he is a good man and a good dad to our son. My daughters love him. My oldest calls him dad. And he has pretty much jumped trough hoops for them since he met them. We are all a happy family and I love my life. I just don’t like where I’m at in my life.

I have 3 kids. My oldest is 14 and she’s a type 1 diabetic. Shes a hormonal teen with diabetes. We have blood sugar issues every day. Hormones raging. She recently got grounded for not doing her chores and lying about her blood checks and she lost it over not being on the phone for a few days. But damn she is smart. She wants to be a mortician when she graduates college. She passes state testing like it’s nothing. And she’s a complete music lover. She was the 18th chair in junior all region choir last year. She was the youngest in her group to get in. So I brag on her a lot. My middle child is a lot of energy and she frustrates me. She’s 10 and she’s been stuck in this stage where she acts like she doesn’t have common sense. We’ve taught her how to use the washer and dryer several times and this kid still says she don’t know how to use it. She’s the one who argues even if she knows she’s wrong she will still try to make you think she’s right. She will agree to something one minute and then get mad about it later. She will not brush her hair and she does this on purpose because she claims is a part of her personality. She also recently told me she’s bisexual. She’s a good kid though. Teachers and kids at school love her she don’t get in trouble ever. And she’s also a smart kid! She excelled in school to the highest. I’m very proud of my girls.

My son is 4 and he is a big ball of adhd. He bounces off walls and he’s very violent. We have been trying to get him evaluated so we can get him on proper meds before kindergarten but It hasn’t happened yet. But he’s also a sweet kid. He is very smart too. He knows all of his colors and can count to 10. He knows his name. But he tells you he’s 400 years old instead of 4 lol.

My mom and sister are both life savers to me. They have taken care of me through this. When I need them they are there. My brother prefers to live his own life and visit at moms with me from time to time. But I love him. I miss him.

My dad left my mom when I was 13. He caught up with my half sister. Fell in love with his ex wife and moved away. I have seen him 4 times since he left and the last time I saw him was when I was 19 and pregnant with my oldest child. He’s never met my kids in person and he’s only spoken to my oldest on the phone once. 2 years ago he disappeared after planning to come stay on my moms property to get back on his feet and get proper medical treatment. He asked our side of the family for money (like $1000) and none of us had that. So he tried to make us feel bad and then never contacted us again. I’ve heard fromy step sisters that he’s been spotted here and there but we honestly Don’t know where he is, what he’s doing and if he’s even alive. I hate to say it but it doesn’t bother me anymore. I used to break down thinking about him dying and not knowing. Now I feel different. He’s been gone most of my life now.

I also have this best friend who is more than my best friend. She’s my soul. This girl has helped me through some of the worst parts of my life. She and I don’t get to see each other very often but we are always family to each other. She and I talk almost daily. I just love her.

That’s my family though. It’s a hot mess but it’s mine and I love it. At the end of every day I am blessed because I’m loved and cared for.

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c0nques7 · 5 years ago

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Unfuck your life, a retrospective

Chapter One: Un-f Your Head

A special kind of person has special kind of problems. My flavor that had to be dealt with was narcissism. I would start drinking and then talk for hours, just to hear the sound of own voice. People would listen because I was a gifted orator, not because the words connected to provide any substance.

Hopefully after reading the intro and doing some reflecting you’ve come to find yourself ready to begin the hard work towards making your life better, but before we get started, you have to make one promise that you’ll carry through the entirety of this book -

If your doctor says to do something that is contrary to any of my recommendations, you listen to your doctor instead of me.

I am not a doctor by any stretch of the imagination, and as you'll see later on, I have also had to reach out to medical professionals when the nature of my problem went outside the realm of what I could attain myself. You promise you’ll go to them when things get really tough, right? Right? Okay cool, lets begin.

First things first. You’re going to need to spend some time with yourself, thinking, exploring, crying, etc. Some of it you’ll do by yourself, some of it you’ll do with dear friends or spouses, and some of it will come off a drunken 2 day weekend bender and you’re so sorry for it please god stay friends with me. Trust me, I’ve been to all of these places. The purpose of all of this is to take some time, get a feel for who you are, what you like, don’t like, your good, bad and otherwise. Grab something you can take notes on, and start here. Write down 5 things you like about yourself. It can be as simple as “I’m great about remembering to lay down the toilet seat” or as complex as “My confidence going into the Calc 3 final.” The reason we’re going with the good first is that you need to CONSTANTLY remind yourself of the things that you like about yourself. Can’t think of anything? Ask a friend. Don’t have any friends? Ask your mom or dad. Don’t have any parents? Jesus, I’m sorry, tweet me and I’ll help you with this part.

Once you have those down, put them somewhere you’ll see them every day. I used to have mine as my cell phone background. I used to also be studying for a computer certification, and every time I’d score over a 70%, I’d write on the piece of paper, “Good job Joe!” in a cool color, and it was forever in my study journal, so that every time I’d review, I’d remember how good I was at this stuff.

The reason behind all of this is that with how deep we’re going to go into making positive change, you need to have the foundation of confidence knowing that we’re working with a good person, not a shit person who is hopeless. If you are reading this right now, you are not a shit person, because you are at least trying.

The next thing we’re going to do is write out 3 things you don’t like about yourself. Now, when you get into this, make sure you’re writing something down that you have a measure of control over. If you were born with a birth defect, or have a mental illness, don’t write down the symptoms of those things as the focus of your change. These need to be more along the lines of, “I wish I was more outgoing”, or “I wish I didn’t talk badly about people behind their backs.” or even, “I wish I was better at coding/reading/being empathetic.”

Full disclosure, when I went through weekly therapy after my divorce, there were so many problems that we had to unpack and dig through that tackling only 3 problems seemed like a waste of time, but what I’ve found out is that depending on where you are emotionally in this process, 3 might be all you can handle. If you wanna do more, and address more, then by all means, go for it.

Every week, remind yourself of the things you want to change, remind yourself of the things that you like about yourself, and then finally write down how you can correlate the things you like about yourself with the things you want to change. For example, I’m really good at being able to gather lots of information, and one of the things I’m working on is trying to stick to a budget, so I’ve been trying to gather as much financial information about myself as possible to better understand when I spend, why I spend, and try different ways of budgeting so that I’m not overextending myself. This part is going to take some time, and I recommend only attempting one per week at first until you get the hang of it.

Now, because it’s the elephant in the room, we’re going to go ahead and jump into the subject of drugs, what I would be a healthy guideline to follow regarding their use (as long as your doctor gives the okay), and I’ll provide what I use/don’t use, so hopefully you’ll be more informed than just your 1hr DARE class you attended 10 years ago. I wish that people had been real with me about drugs. We’re going to be roping alcohol in with drugs, because saying drugs and alcohol is like saying fruit and watermelon. It’s all drugs, with varying pros, cons and usages.

The drugs I’ve used/tried are as follows:

Adderall (I have a prescription for it, I’ll go into that later.)

Very low dose antidepressant (Prescription too. Haven’t noticed any mood changes with it, but my doctor recommended it for sleep, and it seems to be working. Gives me dry mouth.

Weed. Didn’t start smoking until I was 26, only smoked when I was really stressed out, had a period of a month where I was a daily smoker, now I try and stay away from it. It’s illegal where I’m from, so it’s best to stay away from things that could get me in trouble with the law.

Alcohol. Used to use it for stress release, now I only have a beer every once in a while, or an expensive tequila. Don’t like the way it makes me feel after more than 2 or 3 drinks. Brings out the worst in everyone, I’ve found.

Kratom. Only used in very small doses. Dried me out, but I did notice a very relaxing effect, and improved sexual performance on certain strains. The DEA is trying to make it illegal, so be careful with this one.

Kava. Root based tea that chilled me out. I highly recommend. Tastes like dirt. Get the powder, take your time making it, don’t mess with the concentrates or anything other than Noble powder.

We’ll touch on these again in the next chapter, but for now here’s what I want you to get real about.

Does my usage of drugs push me closer towards the things I like about myself, or towards the things I don’t like about myself? It’ll take some time to answer that, and it’ll take even longer to kick the habits and/or addictions associated if you decide the answer to be no.

In my case, I always knew I had issues with focus, we made jokes about it, I laughed along, but I always felt like a failure who was letting everyone around me down because I couldn’t finish anything I started. After getting into another serious relationship after my divorce I decided that the stakes were much higher this time around, and I wanted my promises to be not only remembered, but kept and followed through with. At this point I decided it was time to talk to my doctor, who then referred me to a psychiatrist who recommended I try a low dose of adderall. For me, it was a game changer. The problem with acquiring anything illegally is yes, you can go to jail, be fined, etc, but more importantly, you’re not doing something that can be monitored. Part of your doctors job is and should be supplying you with objectivity. Yes, yes, big pharma and “The Man” have gotten to your doctor and are causing him/her to prescribe things that fuck with your brain. If you’ll take off your tin-foil hat for a second, and finish your blunt, I’m going to level with you. Weed can make you paranoid, and if you’re smoking a lot, stop for a week, re-read this chapter and then reach out to me if you still wanna argue about the pros and cons of having a good, open, honest dialogue with your healthcare provider.

All of the drugs I’ve tried produced a result in my self-talk that made me decide, was this thing I’m putting in my body worth it? For some, no, for others, sometimes, and for yet still others, absolutely yes.

Except for heroin. Not even once.

The last thing I want to leave you with in this chapter is a plan for how to handle when you fall off the bandwagon, or miss the mark on your goals. Remember this from the intro?

The most important part of the process is accepting that you can change, you want to change, and you make the daily steps to change.

I know it wasn’t that long ago that you read it, but it’s worth repeating. I remember when I first began to tackle my relationship with alcohol, it was absolutely the hardest thing I’d ever done. I spent more time off the wagon than I spent going anywhere. Countless nights where, “oh I’ve had a rough day, I’ll just have one drink” turned into “ah so this is what the bottom of a bottle of Jose Quervo looks like. I’d forgotten for a moment.”. Shit happens, but you’re tougher than the shit you’re going through. We’re going to focus on a 5-10% change in your life every month. Absolutely keep reading, but remember, the 5-10% changes are going to be the easiest to make, with the longest lasting impact. Now get to it!

Action Items from This Chapter:

Write Down 5 Things You Like About Yourself:

Write Down 3 Things You Don’t Like About Yourself:

Write Down 1 Thing You’re Going To Change About Yourself, Using The Things You Like About Yourself.

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your-dietician · 3 years ago

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Women Say There Are Too Many Barriers To Accessing Postpartum Depression Drug : Shots

New Post has been published on https://depression-md.com/women-say-there-are-too-many-barriers-to-accessing-postpartum-depression-drug-shots/

Women Say There Are Too Many Barriers To Accessing Postpartum Depression Drug : Shots

Miriam McDonald developed postpartum depression after giving birth to her third son, Nicholas. She says she felt sad, disconnected, and indifferent.

Keith McDonald

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Keith McDonald

Miriam McDonald developed postpartum depression after giving birth to her third son, Nicholas. She says she felt sad, disconnected, and indifferent.

Keith McDonald

When Miriam McDonald decided she wanted to have another baby at age 44, her doctor told her she had a better chance of winning the lottery. So when she got pregnant right away, she and her husband were thrilled. But within three days of giving birth to their son, in September 2019, everything turned.

“I was thinking, ‘Oh my God, what did I do?’ I just brought this baby into this world and I can barely take care of myself right now,” she says. “I feel exhausted. I haven’t slept in three days. I haven’t really eaten in three days.”

As the weeks went by, her depression got worse. She felt sad, but also indifferent. She didn’t want to hold her baby, she didn’t want to change him. She says she felt no connection with him at all.

This confused her – she never felt anything like this after her first two kids – and she worried her mood might hurt her son. Untreated postpartum depression can affect babies’ cognitive and social development. For the mother, it can be life or death. Suicide accounts for 20% of maternal deaths.

“Every day, I was crying. Every day, I felt like I just wanted to die. Every day, I thought about ending my life,” says McDonald, who lives in Vacaville, Calif. and works as an IT professional at the University of California, Davis.

She went to Kaiser Permanente, her healthcare provider, for help. She says doctors there put her on a merry-go-round of medication trial and error. The first drug her doctor prescribed made her anxious. Upping the dose of a second drug gave her horrific nightmares. A third drug gave her auditory and visual hallucinations that took seven weeks to go away after she stopped taking it.

Then, her psychiatrist retired. And when McDonald complained to her new psychiatrist that she was still depressed, four months after giving birth, the physician suggested more medications.

“I was desperate,” McDonald said. “I was like, ‘I’m trying to help myself, but things are just getting worse.’ So what am I left with?”

She started doing her own research and learned about a new treatment, called brexanolone. It’s the first and only drug approved by the FDA specifically to treat postpartum depression, which affects 1 out of 8 new mothers in the U.S. Instead of targeting the serotonin system in the brain, like many antidepressants, brexanolone replenishes a hormone metabolite that gets depleted after childbirth — allopregnanolone. Some doctors call allopregnanolone, which is produced by progesterone, “nature’s Valium” because it helps regulate neurotransmitters that affect mood. After giving birth, natural levels of estrogen, progesterone and allopregnanolone all plummet rapidly, making some women vulnerable to postpartum depression. Brexanolone is a synthetic version of allopregnanolone, delivered through an IV infusion over the course of 60 hours. It costs $34,000.

In clinical trials, 75% of women who got brexanolone started to feel better immediately after the 3-day treatment. Half the women went into remission. In the placebo group, 56% of women responded and a quarter went into remission. In practice, doctors are seeing the effectiveness of the drug in the field that mirror the results of the trials.

“People walk out of the hospital, wanting to be with their child, wanting to return home,” said Dr. Riah Patterson, who has been treating women with brexanolone at the University of North Carolina at Chapel Hill since it became available in the summer of 2019. “There is a hopefulness, a brightness. You can really see that transformation in the hospital room over those 60 hours. It’s pretty miraculous.”

For the first year of her son’s life, Miriam McDonald says all her smiles were fake or strained. She struggled to find effective treatment for severe postpartum depression.

Keith McDonald

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Keith McDonald

McDonald wanted to try it.

But when she asked her doctor for brexanolone, she was told no. In an email, the doctor wrote that the existing studies were “not very impressive.” She added that McDonald did not meet Kaiser Permanente’s criteria for the drug: she would first have to try — and fail to improve with — four medications and electroconvulsive therapy (ECT) before she could try brexanolone. And she had to be six months or less postpartum to try it at all. For Miriam, the clock had run out. She wondered, How could anyone qualify?

“This is crazy. By the time you even try one drug, that’s like four weeks out,” she says. “Another drug is four weeks out, another drug is four weeks out. There’s just no way.”

Kaiser Permanente’s guidance is an outlier. An analysis of guidelines from a dozen health plans revealed that three of them require women to fail treatment with at least one other medication before trying brexanolone. One plan, California’s Medicaid program for low-income women, requires two fails. But Kaiser is the only system NPR found that recommends women first fail four drugs, as well as ECT.

“That’s absurd. So I’m assuming no woman will ever have the opportunity to try brexanolone?” says UNC’s Patterson, one of several experts in postpartum depression who questioned Kaiser’s guidance.

“That is abusive,” says Bethany Sasaki, who runs the Midtown Birth Center in Sacramento and is licensed to administer brexanolone. “Asking someone to fail four oral antidepressants is an unacceptable burden that will undoubtedly create more harm than good.“

Psychiatrist Shannon Clark, who’s been administering brexanolone at UC Davis Medical Center for the last two years, seeing positive results, says there are a lot of reasons new moms may not be candidates for one medication, let alone four: taking pills while breastfeeding could be too anxiety-provoking; some women may not be able to adhere to a daily pill regimen; or they may have a liver condition that contraindicates those medications. Clark called Kaiser’s guidance “terrible” and “insane.”

It could also be illegal, according to some California lawmakers and mental health advocates. Under a California state law that took effect this January, health plans must conform to generally accepted standards of care, including scientific literature and expert consensus, when making decisions about mental health treatment.

“If Kaiser is making it effectively impossible to get a particular, important mental health treatment, that could definitely be a violation of our parity law,” says State Senator Scott Wiener, the bill’s author.

Kaiser officials responded by saying they always follow the law. They also say its integrated structure — as both the health insurer and the health provider — makes it different from traditional insurers. At Kaiser, a patient’s doctor determines whether a medication is appropriate, not the health plan, and the criteria doctors use are recommendations, not requirements or pre-requisites that patients need to “exhaust,” says Dr. Maria Koshy, Kaiser’s chair of psychiatry for Northern California.

“At the end of the day, this is an individual clinical decision by both the provider – the physician – and the patient,” she says.

But inside Kaiser, the workplace culture is such that doctors are expected to follow these recommendations, according to former Kaiser clinicians who spoke on background — as well as legislative experts familiar with Kaiser’s model. They say that when Kaiser doctors deviate from the recommendations, they can get questioned or even face consequences.

“These physicians know that if they start routinely ignoring these bad recommendations, that that could have impacts on them professionally,” says Wiener, who has worked on several bills aimed at regulating Kaiser and other insurers in California. “Whether it’s couched as a recommendation or a requirement is almost irrelevant. It has the same effect.”

To McDonald, her physician seemed to follow the recommended criteria as if they were requirements when she declined to prescribe brexanolone. Another patient, Yesenia Munoz, got a similar response when she sought brexanolone treatment. Kaiser’s grievance department sent her a letter denying the request because she had not failed enough medications.

“When I talked to the caseworker at Kaiser that had denied the medication, he said that Zulresso was very expensive,” said Muñoz, referring to brexanolone’s brand name.

In addition to the $34,000 cost for brexanolone, the three-day hospital stay can tack on another $30,000, at least. Another complicating factor is the FDA requirement that health centers obtain a special certification to infuse brexanolone, because of the risks of excessive sedation or fainting from the drug. Kaiser Permanente doesn’t have the certifications yet to administer the treatment at its own hospitals, so it must pay outside hospitals to provide it for Kaiser patients. Kaiser officials say they have plans to eventually open three of their own certified centers in Northern California.

Muñoz, 35, was devastated by the denial. She was overwhelmed by postpartum depression and anxiety shortly after her daughter was born in August 2020. But none of the medications or therapies Kaiser offered her worked. Four months after giving birth, she still felt suicidal.

“I could get out the door sometimes and take the stroller and go walk, and my mind kept on saying, ‘If you just step in front of the car, it’s all going to go away,” she remembers.

After Yesenia Muñoz appealed to state regulators and received brexanolone, she says she felt calm and “happy enough to want to live.”

Rafael Munoz

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Rafael Munoz

After Yesenia Muñoz appealed to state regulators and received brexanolone, she says she felt calm and “happy enough to want to live.”

Rafael Munoz

Muñoz got help from family members and co-workers to appeal Kaiser’s decision to the state, and after reviewing her medical records, regulators ordered Kaiser to pay for the brexanolone treatment.

Muñoz received the treatment at UC Davis Medical Center, and she started feeling better within the first day.

“The nurse came in and she said something funny and I laughed,” Muñoz says. “It was the first time I had laughed in so long.”

She started looking through photos and videos of her daughter on her phone and she says it was like she was experiencing those moments for the first time. She started making plans for the future.

“It was like a switch flicked and it made me happy enough to want to live,” she says. “It saved my life.”

Sage Therapeutics, the makers of brexanolone, says Kaiser’s approach to the new drug reflects a “a lack of a sense of urgency for treating mental health.” Dr. Steve Kanes, Sage’s chief medical officer, says the company is working on making the treatment more accessible. Its biggest challenge has been getting enough health centers certified, across a wide enough geography, to reach women who need it. The company is studying a pill form of allopregnanolone that could eliminate the need for a hospital stay, but Kanes says that is still not close to being commercially available.

In 2008, Congress passed a landmark federal law aimed at correcting disparities between how insurers pay for mental health treatments compared to physical health. The Mental Health Parity and Addiction Equity Act was later reinforced by provisions in the Affordable Care Act in 2010. But insurers found loopholes, creating overly restrictive or self-serving criteria that made it easy to deny services for mental health care, and as a result, save money.

California’s new law, SB 855, aimed to tighten those loopholes, and has been hailed by advocates as a national model for mental health reform. It requires health plans to use clinically-based, expert-recognized criteria and guidelines in making medical decisions, with the goal of limiting arbitrary or cost-driven denials for treatments of mental health or substance use disorders.

Kaiser operates in 8 states and Washington, DC. In California, it is the largest insurer, holding a 40% share of the market, covering 9.2 million patients. Kaiser officials have questioned how the new state law applies to the Kaiser system, given its unique integrated structure as both health insurer and medical provider. For example, Dr. Maria Koshy, the Kaiser psychiatrist, told NPR that SB 855’s requirement to comply with generally accepted standards of care “does not apply” to its brexanolone recommendations because they were developed and are used by the doctors, not the health plan administrators. When NPR asked Kaiser to provide the brexanolone policy its health plan uses for grievances or appeals, it said it didn’t have one.

“We 100% intended this law to apply to the care people get at Kaiser,” says Julie Snyder, government affairs director at the Steinberg Institute, which co-sponsored the law. “There is no place where we say Kaiser is exempt” because of its integrated structure.

Doctors at Kaiser have historically been “gatekeepers” for services in the system, more so than doctors who work with traditional insurers, says Meiram Bendat, an attorney and licensed psychotherapist who also advised legislators as the law was being drafted. It doesn’t matter if practice recommendations for brexanolone were written by doctors or administrators, or whether the recommendations are mandatory or optional, Bendat says, they must be in compliance with the law.

“If it’s inconsistent with generally accepted standards of care, then it has no place in California,” he says.

Some of Kaiser’s recommended criteria for brexanolone are aligned with generally accepted standards of care; for example, reserving the drug for women who are six months or less postpartum, which was a criterion used in the clinical trials the FDA relied on when it approved the drug.

But the recommendation that patients first try four or five alternative depression treatments before considering brexanolone conflicts with the judgment of half a dozen women’s health experts interviewed for this story. They say there just isn’t enough time to do that in the postpartum period — and too much is at stake.

Not only are babies at risk of developmental and emotional problems if their mother is depressed, husbands and partners are also at higher risk for depression and anxiety. And because new moms are learning to breastfeed, and figuring out what’s part of the new normal and what’s not, it can take months just to realize there’s a problem, explains UNC’s Dr. Riah Patterson.

“It takes so long for this illness to come to recognition and for someone to actually get into an appointment and actually be seen by a provider,” she says.

Dr. Riah Patterson, a specialist in perinatal psychiatry, discusses patients and treatment plans with her trainee, a 3rd year psychiatry resident at the Center for Women’s Mood Disorders at UNC-Chapel Hill.

Madison Piotrowski/UNC Health

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Madison Piotrowski/UNC Health

Indeed, the FDA fast tracked the approval of brexanolone in part because of how well and how quickly it worked, allowing women to feel better and get back to their families in three days.

“It’s new, it’s promising,” says Kaiser’s Dr. Koshy, but adds that “it’s not a benign medication.” Six women in the clinical trials felt faint or fainted, which is why the FDA requires women to be continuously monitored in certified health centers when getting the medication.

Also, the safety and efficacy data is limited, Koshy says. The clinical trials only compared brexanolone to placebo, not to alternative treatments. So while the data show brexanolone works better than nothing, there’s no data on whether it works better than drugs like Zoloft, or better than electroconvulsive therapy.

Women who received the placebo in the trials also showed improvement in depressive symptoms — which is common in studies of depression treatments — but more women who received brexanolone showed improvement, and their improvement was more substantial and lasted longer, especially if their depression was more severe before treatment. Women with moderate depression who received the placebo did just as well, 30 days after treatment, as those who received brexanolone, which could be because they felt better on their own, or because other antidepressants they were allowed to take during the trial finally kicked in.

Koshy says Kaiser is always reviewing practice recommendations as new evidence becomes available, but also acknowledged that Kaiser’s recommendations for brexanolone have not been updated since they were first developed two years ago, in July 2019.

Two weeks after this story first aired in Northern California, Koshy informed NPR that Kaiser Permanente is now reviewing the recommendations. She also added that Kaiser had recently communicated with its physicians that the recommendation to try four medications and ECT before considering brexanolone actually applied to a woman’s entire lifetime, not just treatments attempted in the postpartum period. Kaiser confirmed that it did not write this into the recommendations themselves, and declined to offer details about how this information was shared with physicians.

It is unclear what role California’s Department of Managed Health Care, the state agency that regulates Kaiser, might play in resolving issues of access to the infusion. In a statement, department officials said they will review any criteria or guidelines the Kaiser health plan uses for brexanolone, but the department does not have jurisdiction over physician decisions.

The department also monitors patient complaints when new medications or treatments begin to be used, in order to identify problems with access to care. So far, the Department has received two complaints about brexanolone – both were filed by Kaiser patients.

One was Yesenia Munoz. The other was Miriam McDonald.

Before going to the state, McDonald called Kaiser’s grievance department to complain about her treatment and the denial of brexanolone. Kaiser responded by sending the cops to her house for a welfare check.

The officers were calm and nice, McDonald said, but when she closed the door, she cried her eyes out.

“It just brought me to a whole new low,” she said. “Why didn’t my doctor call me and talk to me first? I mean, this is how you treat postpartum mental health? How dare you.”

Kaiser told NPR it cannot comment on any individual cases because of privacy laws, but that generally, “We feel deep compassion for any patient experiencing the difficult and serious effects of postpartum depression, and our goal is always to support every patient’s safe return to a healthy mental state.”

McDonald then appealed Kaiser’s denial of brexanolone to state regulators, but by that time, she was past the six-month postpartum cutoff.

She never got brexanolone.

Still, she continued to fight for relief and eventually got Kaiser to cover a different treatment for severe depression, transcranial magnetic stimulation, which uses an electromagnetic coil to stimulate nerve cells in the brain that control mood. That typically costs about $300 per session, and McDonald went in for the treatment five days a week, for three months. Now she is finally feeling like herself again.

After her efforts to get brexanolone failed, Miriam McDonald received transcranial magnetic stimulation at Kaiser Permanente to treat her postpartum depression. She says her mood started to really improve when her son was about 18 months old.

Miriam McDonald

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Miriam McDonald

“I can remember I woke up one day and I was excited. I had actual joy,” she says. “I got up and I walked into his room and I was like, ‘Hey, Nico! Hi! Hey, baby!’ And he jumped up from his crib and giggled and put his arms out. And I just swooped him up in my arms and cried. Because I was like, ‘I am so proud to be your mom.'”

Now when her son smiles at her, she genuinely smiles back. But it took more than 18 months to get here. She can’t help but grieve all the smiles she didn’t return in that time, and how she felt like she was barely present at crucial times, like when her son took his first steps.

“I felt like I’ve been robbed of all those moments,” she says, “of those little milestones, that I’m never going to get back.”

This story comes from NPR’s health reporting partnership with KQED and Kaiser Health News (KHN).

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alounuitte · 7 years ago

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complicated chemistry

Phil's not really sure about this whole "treatment" thing, but since it turns out getting better isn't as simple as finding a happy ending, maybe it's worth a shot, at least. (Set ~eight months after February 2.)

chapter warnings: discussion of suicide, referenced prescription drug abuse

read on ao3, or

The waiting room is small and stuffy and smells like a closed flower shop, with a fish tank set into one wall and the others all lined with flavorless abstract art. A sense of dread presses heavily on Phil’s shoulders as he enters, and he grimaces, turning up the collar of his coat. He does not want to be here. He didn’t want to come in the first place, and the only reason he doesn’t turn and walk out before he even sits down is that his nerves are easier to swallow than his pride.

He slinks across the room to slump down in one of the ugly vinyl-covered chairs in the back corner, keeping his head down. The only other people here are a woman maybe a little older than him with her nose buried in a magazine and a surly-looking boy who must be in college, neither of which have spared him a glance.

At least there’s that, he thinks gloomily, hunching his shoulders as he looks around the room. This is bad enough without anyone recognizing him - though he’s sure the receptionist who checked him in looked at him strangely. Probably trying to figure out if he’s that Philip Connors, or if by some wild coincidence there just happen to be two people with his name in Pittsburgh.

There are footsteps in the hall, and he glances up to see a woman enter the room. “Justin Harper?” she says. The surly boy grunts and gets to his feet. Phil goes back to staring blankly at the fish tank, watching a bug-eyed goldfish ram itself into the glass.

Pride is starting to seem less important the longer he sits here, to be honest, and the seventy-five bucks he’d pay to cancel isn’t such a high price to avoid…whatever this is going to be.

He can’t go through with it, he decides, and moves to stand up, but just as he gets to his feet a man in glasses appears from the hallways, and says, “Philip?”

“Oh, God,” he mutters. “Yeah, that’s me.”

“I’m Dr Weltstein,” the man says, offering his hand. “Nice to meet you.”

“Uh huh,” he says, unable to muster any more enthusiasm. He should never have agreed to this, but it’s a little too late now.

“Come on back,” the doctor says, and for a moment he seriously considers just bolting for the exit. Instead he shoves his hands in his pockets and trudges after Dr Weltstein.

The office is just as crowded and stuffy as the waiting room, but at least it doesn’t have the same cloying scent of dust and dying roses that was smothering him so badly. He sucks a breath in through his teeth and lets it out as he drops onto the sofa.

“So, what brings you in today?” Dr Weltstein asks as he sits down in the armchair across the room with a pen and a clipboard in hand.

“Uh,” Phil says, scratching the back of his neck. “Well. I guess I…have…”

He trails off, grimacing, and casts the doctor a sideways look.

“Depression?” he says finally, and looks away.

“Okay,” Dr Weltstein says, his pen scratching on the clipboard. “I’m glad you came in to see me. Have you seen a therapist about this yet?”

He frowns. “Was I… supposed to?”

“Not necessarily,” Dr Weltstein says. “I recommend it for most of my patients, since the majority find a combination of medication and cognitive therapy to be the most effective, but it’s not a requirement.”

“Okay,” Phil says. “Uh, good. I mean - look, my most recent experience with doctors haven’t been great, so I’m a little… skeptical, let’s say. About this whole…thing.”

“Understandable,” the doctor says, nodding. “We’ll start by talking a little about what you need, and go from there. Did you have any other concerns you wanted to go over?”

He shrugs.

“Okay,” the doctor says. “And have you taken any kind of medication for this in the past?”

“Not… for depression,” he says carefully.

“For something else?” Weltstein asks.

“Uh, Xanax,” he says.

“Sure,” the doctor says. “Do you know what diagnosis you have?”

Phil stares at him blankly. “Um…”

“It’s fine if you don’t,” Weltstein says. “I’ll take a look in the system later. Let’s talk about that first, and then we’ll get into your depression and see what might help you.”

“Okay,” he says reluctantly.

“About how often do you take Xanax?” the doctor asks.

“Once or twice a day?” he says. “Maybe more on really, really bad days.”

Dr Weltstein raises his eyebrows, peering at Phil over his glasses. “And this is every day?”

“I mean, not every day,” he says. “It’s supposed to be as needed. Some days I do okay without it, it’s just when things get…”

He gestures vaguely. Dr Weltstein frowns and makes a note.

“Have you tried any other medications?” he asks. “Anything prescribed daily?”

“I mean, I took Adderall in high school,” Phil says. “But that was, like, twenty five years ago.”

“Alright,” the doctor says, making more notes on his clipboard. “But never an anxiolytic?”

“A what, now,” he asks flatly.

“A medication to treat anxiety,” Weltstein clarifies.

“Okay, well,” Phil says, holding up his hands. “I wouldn’t say I have anxiety.”

The doctor gives him a look over the rims of his glasses. “Philip -“

“It’s just Phil,” he cuts in.

“Phil,” concedes Weltstein. “I understand you’ve had unpleasant experiences, but it’s going to be difficult to treat you if you won’t at least talk in general terms about your mental health.”

He sighs through his teeth and tips his head back to look at the ceiling. “Right,” he agrees, and swallows hard. “Okay. Uh. Fine.” He screws his eyes shut, trying to steel his nerve. “Depression and anxiety, then.”

“And you’re managing your attention-deficit well enough without medication?”

He shrugs. “I guess so?”

“It sounds to me like you’ve been taking Xanax to manage a generalized anxiety disorder,” the doctor says. “I think what would be best for you is to stop taking it for now.”

Phil laughs sharply. “Sorry, what?”

“Benzodiazepines lose effectiveness over time,” Dr Weltstein says, “and they’re not really meant for daily use. I want to start you on something that’s more effective day to day, and we can talk about you going back on Xanax or another medication for serious episodes if you need it.”

“You’re crazy,” Phil tells him. “I need it. I’m a wreck otherwise, things get too fast, or too big, or too much and I do - weird neurotic shit. I go nuts.”

“If that’s happening on a daily basis, I want you on a long-term medication, rather than a fast-acting as-needed one,” the doctor says patiently. “That will help manage your anxiety on a consistent basis, and if you’re still having panic attacks -“

“They’re not panic attacks, it’s just -“

“- you can take a stronger sedative, less frequently, with better effect -“

“Listen,” Phil shouts, leaning forward. “Dr Weltstein. I’ve been taking it since I was, like, twenty after I fucking lost it halfway through a semester. I yelled at my roommate and wrecked half of my stuff. I skipped class for three days straight to play Megaman and couldn’t eat anything except popcorn. You cannot take me off that medication.”

“Phil, I’m trying to find a solution that’s going to help you more,” the doctor says, taking off his glasses to rub the bridge of his nose. “But I need you to work with me, here. Can you do that?”

He takes a deep breath and lets it out, resting his face in his hands. “Can’t I keep taking it while I start a new medication?” he asks, peeking between his fingers.

“If you’ve been taking it daily for so long, I’m not going to take you off of it cold-turkey,” Weltstein says. “I want you to go a week only taking it once a day, and then go down to half a dose for a few days before you stop taking it.”

“And you’re going to start me on something to help after that?” he asks.

“Well, I want to talk a little bit about your depression to help decide what will help the most,” Weltstein says. “Especially since you’ve never been treated for it before. How long has this been going on?”

“Uh,” he says, unsure how to answer that question. He can’t exactly explain how long it’s been when it was only since February. Although -

“Just an estimate is fine,” Dr Weltstein says.

“A few years,” he lies.

“Any family history?” the doctor asks, looking down at his clipboard.

“Oh, boy,” Phil mutters. “Uh, my mom, yeah. Since I was a kid.”

Dr Weltstein nods. “And any thoughts of self harm or suicide?”

He grimaces and balls up his fists, nails biting into his palms and keeping him grounded. “Um. Yes, I guess.”

“Any past attempts?”

Oh, Lord, he doesn’t know what he’s supposed to say to that. He swallows hard. “A couple,” he mutters without looking up.

“I understand this can be hard to talk about,” Dr Weltstein says. “Can you tell me about what happened?”

He shrugs. “Uh, took sleeping pills once. Drowned - well, tried to drown myself.” God, he must sound either stupid or crazy. Probably both. “Slit my wrists. Not very well, obviously.” He realizes how that sounds and quickly corrects himself. “I mean, which is good. Still here. And doing a lot better, uh, for - for the most part.”

Except for how a couple of weeks ago he had a breakdown and almost took a high dive off the top of his building, but overall. In general. Most of the time.

“Well, I’m glad to hear that,” the doctor says. “But I am concerned about the risks of starting an antidepressant. They can increase the chance of suicide, and given your history, I think we should be a little extra careful while you get adjusted to it.”

“Right,” he says. “So…”

“You live alone, Phil?” Dr Weltstein asks.

He frowns. “Uh-huh.”

“Hm,” the doctor muses. “Do you have any friends or family you could stay with while you’re starting a new medication? I’ll try to see you shortly after you start, and we have staff on call for emergencies, but it would probably be safest for you if you had someone around.”

“Um,” Phil says, frowning. “Can I get back to you on that one?”

“Sure,” Dr Weltstein agrees, and gives him a kind smile. “I want you off the Xanax before we start something new, anyways. I’d like you to come back in two weeks, after you taper off it, alright?”

“Yeah, I guess,” he says, reluctantly. The last thing he wants to do is have to keep coming back here. But he did promise he’d see someone, and try some kind of medication to see if it helps.

Hopefully Rita is willing to be part of the experiment, since she was so insistent he go through with this.

“Do you have enough Xanax now to do what we talked about?” the doctor says. “I can write you a temporary prescription just to get you through two weeks if you need.

“I think I have it,” he sighs.

“Alright,” Weltstein agrees. “If not, give me a call and I’ll put in an order. Is there anything else you wanted to cover before we wrap up for today?”

Phil shakes his head. “I’ll, uh…” he says as he gets up. “See you in two weeks, I guess.”

With that, he puts up his collar again and hurries out of the room as quickly as he can without running, desperate to get outside for a breath of fresh air and get home.

#groundhog day the musical #ghd #phil connors #willwrites #im so sorry this ended up being almost 2k words

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christine-moore · 7 years ago

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What My Anxiety Feels Like--And How Medication Helps

Chemical makeup of sertraline, known more commonly by the brand name Zoloft.

Most of you know I have the TV habits of an 85-year-old. That means my go-to morning news show is "CBS This Morning." (It's really good, guys.)

Some mornings, I'm still getting ready past the end of "CBS This Morning" at 9 a.m. Because I'm lazy, I often don't change the channel, which means I end up watching the next show on the local CBS affiliate, which means I end up watching "The 700 Club."

For those of you who may be behind on your right-wing Christian paid programs, "The 700 Club" is the flagship show of the Christian Broadcasting Network, founded by Pat Roberston. It's ostensibly a "news" program that begins with a rundown of current events, followed by featured pieces about people who have received miracles, Christians who have overcome persecution, or upcoming faith-based movies (which can be yours on DVD with a gift to CBN).

These are all preceded by a short commentary from Robertson, or occasionally by his son Gordon, about the events of the day. His perspectives are predictably pro-Trump, anti-liberal, and I typically roll my eyes and dismiss most of what he says without further thought. Then he started talking about the Las Vegas shooting.

The headlines focused on Robertson's suggestion that disrespect for authority, for Trump, and for our flag had caused people to "run amok." But what hit home for me was a different episode, when Robertson mentioned that reports showed the Vegas shooter was taking antidepressants. He said these drugs were known to have dangerous side effects, and that doctors who prescribed them might be "drugging people into a state whereby they go out and kill people." He added, "It's not so much about gun control…but this pharmacopia that's coming out and drugging people. And if this is the case, then it's a shocking revelation."

Thinking like this is not only off-base, it's dangerous. It's impossible to calculate the violence that has not happened because of antidepressant drugs. For the people who benefit from medications for mental health--or, more importantly, those who would benefit from it--the suggestion that these drugs actually cause mental illness is beyond irresponsible.

Over the past few years, I've come to terms with the fact that I have anxiety and depression. The two have often been inextricably connected, as my anxiety would drive me to reach for impossible goals, then I'd fall into depression when I didn't achieve them. The cycle would continue as I'd tell myself I wouldn't be sad anymore if I could just do XYZ, not realizing XYZ was a false ideal.

It came to a head after Archie was born, and I went through postpartum depression and anxiety. I decided the problem was our choice to give Archie breast milk. He never latched, which meant I was "exclusively pumping," at one point up to 5 or 6 times a day. I felt chained to this machine while my husband got to spend time with our new baby. I decided I needed to stop pumping, then I'd be happy.

The conversation about this idea did not go well. I started sobbing. It came up that this had become my standard mode. "I have a right to be sad!" I shouted. After all, I had been through a lot that previous year, right? My mom had just died! How could I be expected to be happy right now?!

"It's just that...it seems like it's always something."

He was right. I didn't admit it at first, but I realized he was right. And I realized it takes an incredible amount of love and courage to tell someone what they need to hear.

In that moment, I realized that even if I did have a right to be sad, I didn't have a right to let the sadness overtake me or, just as importantly, the people around me. I had thought taking medication meant I had failed, that I was not strong enough to handle these challenges or that I was caving to what people wanted me to be, instead of forcing them to accept me for who I am.

But then my perspective shifted. Yes, I had been through a lot, so why wouldn't I take something to help cope with that stress? Because I had already been going to a grief counselor, I brought up the topic with her and she said, "I think that'd be a good idea." She referred me to a psychiatrist she works with often.

I had decided I still wanted to keep pumping, and one drug that would allow me to do that was sertraline, known by the brand name Zoloft. We would start with a low dose, and he advised that it would take a few weeks to notice any effects. I told him I didn't want to feel falsely happy or in a "haze." As someone who depends on creativity, I didn't want those senses dulled. He assured me they wouldn't be.

Three years later, I can confirm he was right. In many ways, I'm more creative now because I can focus on what I'm working on without staring off for 15 minutes of rumination about everything wrong in my life. I have more energy because I'm sleeping well. I don't lose half a day because someone said something I can't stop thinking about.

In the past, my anxiety would manifest itself as a constant spiral of catastrophic thinking. It would usually go something like this:

Oh, those two are going to lunch together. They've never invited me to lunch. They must not like me. I always get left out. Why are people so mean? Maybe there's something about me people don't like. That's why I don’t have any friends. I don't need friends anyway. What is it about me they don't like? Maybe I should dress better. None of my clothes look good on me. I'd be more confident if I lost weight. If I'm going to lose weight, I need to exercise more. I don't have anywhere in my house to exercise. My house is too small. I should join a gym. How much does a gym cost? I need to organize my budget. Maybe I should try Mint.com. I should research Mint.com first. I can't do anything until my desk is clean. This whole house is a mess. I could think straight once the house is clean. Once I have my act together, I'll feel better. Maybe then people will like me. Then I'll be happy. Now, as I've told my doctor, I feel like I have mental emergency brakes. If something goes wrong or I start feeling sad, that sadness now feels more temporary. My grief hasn't gone away--a certain memory can still make me cry unexpectedly--but it's not all-consuming. And I'm certainly prone to making a to-do list or two, but I no longer feel consistently compelled to check everything off of it.

It's been said many times that mental illness should not carry a stigma, and that's absolutely true. But that also can't be an excuse for denial if you feel you'd benefit from treatment, whether it's talk therapy, medication or something else. In other words, living with the unchecked symptoms of anxiety or depression is not just "being who you are." Instead, it's letting the illness control who you are.

Each case is different, obviously, but in my experience, I've benefited from trusting the responses and guidance of people I love, and who I know love me. Despite what my anxiety tries to tell me, they are out there, and thanks to treatment I can be fully aware of that fact, and grateful for it.

For many people, faith in a higher power provides a foundation for mental calm. And I respect that. But that doesn't mean it's a cure-all. The believer side of me doesn't see medical treatments (for any condition) as an affront to faith. Rather, I see a miracle: that we humans have the capacity for such intricate knowledge, and the moral compulsion to seek cures for human suffering. I see spirituality in the fact that a pill as small as a grain of rice can so profoundly improve my daily experience. I see ministry in how those positive effects ripple out to my husband, my son, my friends, and my coworkers.

I think too often the stigma comes from within, drowning out the voices of people who genuinely want to help. Find the people you trust, who you feel sincerely understand who you are when you're at your best, then, as one of Archie's teachers says, "Open your ears and listen."

The circle of people around you represent your most significant area of impact on this world. Take care of yourself to make sure you're taking care of them, and you'll find yourself happier than you could have ever imagined

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fightingthedarkness-blog1 · 6 years ago

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Part three: digging deeper

After breaking off my engagement, I began living on my own for the first time ever. Being alone gave me a lot of time to be with my thoughts and it wasn’t very healthy. I had already started my first antidepressant at this time due to my chronic migraines, but I wasn’t ready to admit I was depressed. I joined the fire department with my dad and put a lot of my energy in to that. I fell in love with it and threw myself into it. Lost a lot of sleep for calls in the middle of the night. And started dating a fireman... who just wasn’t right for me.

He was controlling, manipulative, and my father tried to warn me. We lasted a little over a year before his words became physical. And then he began to threaten me. When he followed me out with my friends during a fight we had, and stormed in to the bar calling me names and threatening to burn my house down, I called my dad to meet me at my house and kick him out. He then tourmented me for months, attempting to get me kicked out of the fire department. Unfortunately, he became one of my senior officers and I had to be around him and take orders from him on fire calls. After this, he tried to ruin many friendships for me. My best friend at the fire department was between who’s “side” she should take. She was never faithful to me, always going back to him. Her story of when we stopped being friends comes later.

I began working at the local ambulance service after we broke up, and one of my friends from emt school worked there with me. We were inseparable, but she also wasn’t the best influence on me. She also had her demons, and I always tried being there for her, but she constantly drug me down. Any time she was down I would try to pull her up, but she would end up getting me to go out to bars and party and make bad decisions. I went through a bad partying phase with her, spending every weekend drinking from mid afternoon Saturday until the early hours of the morning Sunday. I would pay for it until Monday or Tuesday with a hangover from hell, just to go back to work on Wednesday. All of that changed when I met my current fiancé... but we will get there.

In between there were a few guys but one who really burned me. We met from a mutual friend, he seemed as nice as could be. A firefighter. An emt. A dispatcher. Had a daughter, who’s mother was no longer in the picture, a very messy story. Separated from his wife, divorce started. We hit it off, spent a lot of time together. I met his daughter, she loved me and I loved her. But it was always odd... he never asked me to stay at his house. Until Thanksgiving came... and he got tagged on Facebook saying his “soon to be ex-wife” was pregnant. I was floored. Sick. I took a screen shot immediately and sent it to him. He sent me a message back and said “we need to talk.” He wanted to stay with me. And raise a child with her. I laughed in his face. He got her pregnant the first week we were together. I blocked his number. Blocked him on Facebook. And have never looked back.

I fell into such a dark hole, I started self harming again. The pain was more real than it ever had been. I finally decided to seek help. I went to therapy and admitted I was depressed. After being diagnosed with major depressive disorder and generalized anxiety disorder, given new antidepressants and anti anxiety medication, and beginning talk therapy, I figured I was good to go! But then, my therapist started blaming me for all of my issues. Saying things that went wrong in my life were my fault. I couldn’t see that therapist anymore. And the psychiatrist wouldn’t treat me without the therapist. So, no more therapy. They had upped me to a scarily high dose of 200mg of Zoloft daily, along with a daily allotted dose of 3mg of Xanax. I told them I was just feeling worse and worse and they kept upping the Zoloft. I truly felt awful. Every day I felt less and less like myself. More like a zombie. Until it finally snapped. I don’t want to live. I want to die. That day, I quit Zoloft cold turkey. I began self harming again. But luckily I had a few great friends to get me out of that hole and back on my feet. I didn’t need to feel that way. I was going to be okay, it would take time, but I would be okay.

#anxiety #depression #tw suicide #tw self harm #my story #tw abuse

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ask-gabbiebry-blog · 6 years ago

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Recovering After 24 Years on Antidepressants

This is the story of my recovery from depression. I expect it to be An ongoing process that will take a little while. But I want to show that recovery isn't only possible but should be the expected result. This writing will expand. I learned as a kid to keep my mouth shut as my thoughts and ideas were not welcome. So, I'm adding to this as I think of things that I want to discuss. It's a bit of a struggle for me to convey, so please bear with me.

I have suffered from depression my entire life. One Doctor explained that dysthymia (or moderate depression) was what I suffered in between my major bouts of depression. The causes of my depression were environmental. I was raised in a really dysfunctional family in Minnesota. My parents were both alcoholics and depressed, and their dysfunction became my growth environment.

I have had three major bouts of depression:

The first time was at puberty in the eighth grade. I had no confidence in myself. My youth was full of messages from my father telling me I was fat, that fat people are ugly, and that no one would ever love me. So, I grew up feeling fat and ugly. I was so unhappy, I could barely make it to my room after school before the tears could begin falling. This happened almost every day. My parents took me to a psychologist who did hypnotherapy with me. It proved to be rather effective for the short term.

My next major episode of depression was a senior in college. I came to understand that I would soon be leaving college and entering the work world. I had no confidence in myself and was soon lost in tears within my prospects. I called my parents at home and they came and got me to spend a couple of days at home. I was educated but not prepared for life.

My third major episode with melancholy happened at about age 40 in 1991. We were now living in Oregon. I had an excellent job in the high-tech business at a computer maker. I was building test equipment for our product for manufacturing and maintaining that equipment and much more. I was running the lab, and purchasing parts, and serving as a lead in my group. I had received accolades at the job I was doing and went on an employee excellence excursion as an award. When I got back from that trip I was told,"We must cut back, and your group has been dissolved." Some people in my group lost their jobs, and others got reassigned. The management forgot about me. I was finally assigned to a project in purchasing which was essentially grunt work. I was typing purchase orders and submitting them. I became very depressed and suicidal. I didn't understand how to resolve the dichotomy of being told I was an excellent employee and then put into a job that was so bad for me. The carpet of self-confidence was pulled out from under me.

I contacted my health insurance company in 1991 to get help. I had never taken advantage of my insurance so they sent me a questionnaire to fill out to assist in finding me a doctor. It took one and a half years to get a doctor appointment. I had never been taught to fight for myself, and consequently wasn't able to fight that battle. Worse, I thought I really did not deserve assist.

Once I finally got in to see the doctor, I began Taking antidepressants in 1993. It took six months before I started seeing an improvement in my mood. I was also put into a cognitive behavioral therapy group which I found to be quite enlightening, but of limited usefulness. It demonstrated to me how we see and think about things when sad, and how twisted it had been. It lasted 10 weeks.

Over the years I have taken a wide variety of antidepressants. There was always a balancing act between which was worse, the depression or the side effects. Side effects included things as minor as dry mouth, for constipation, irritability, a zombie-like condition and sexual dysfunction.

I stopped taking them on my own double, with disastrous results. I got extremely depressed both times. It was worse than before I started taking medications. I'd stop in the middle of the workday to run into the bathroom and cry. It felt as though I had a bowling ball in my stomach. I ended up going back to my doctor both times and carrying something else. Antidepressants changed my mind chemistry. Stopping them too fast or without medical supervision is a really bad option.

My doctor told me after the next time I would need to take them for the rest of my life. I believed him.

In the end, I was taking 500 mg of Nefazadone in the Evening and tried a lot of different antidepressants in the daytime. I had problems with all of them.

The last morning antidepressant I took, I had to stop Taking it when people told me how zombie-like I was. I spoke and moved very slowly.

After nearly 25 years of taking antidepressants, I had no emotion left at all. I felt dead and wanted to be dead.

I was overwhelmed. I couldn't do daily tasks, keep up on My daily chores, or manage my own house. We had 36 acres of land that I was managing, but I couldn't do it anymore.

In 2016, my husband and I made a decision and proceeded to Southern Oregon, and sold our house. We wanted to be closer to family and to where my husband grew up. My doctor in the Portland area told me that I had to make contact with a new psychiatrist here to"handle" my medications.

Moving and packing was a nightmare. Our house was in Total disarray, and making decisions about what to pack and when to pack it proved to be very tricky for me. My mind was spinning, and I couldn't make decisions about what to do. We did the move really slowly. I think we went down and up I-5 about 25 times over the course of six months. The new house was located on about five acres (we really downsized) with a panoramic view of the Rogue River valley.

I chose to see a psychiatric nurse practitioner. I truly liked her. I was still not doing well, so we talked about my beginning anti-anxiety drugs. She appeared to understand me.

She made it clear that she'd be unable to continue Treating me -- she couldn't bill Medicare, which I became qualified for within several months of arriving in the valley. She referred me to my doctor.

Shortly after I started seeing him, my new doctor had me read the book Anatomy of an Epidemic by Robert Whitaker. It took me a while to read it, but by the end, I became angry over the manipulation and lies that the pharmaceutical industry tells to the public about psychiatric drugs. The FDA only requires six months of studies on the efficacy of psychiatric medications. They don't require any long-term studies. Independent research has shown that psychiatric drugs have very limited usefulness over the long term and in fact can be detrimental. The pharmaceutical industry also says that mental illness represents a physical problem with the brain that needs to be fixed. There are no studies that prove that this is true. Doctors are now taught in school to prescribe medication, not to deal with mental disorders.

Studies have also revealed that in the case of Antidepressants and anti-anxiety medications, the weaning-off procedure can be very difficult. Close to 20 percent of US citizens are on a psychiatric medication of some sort and this nation has the worst results on mental illness by far in the developed world.

My therapist and I collectively made the decision to wean me Off of the drugs. We started by decreasing my meds by 10% per month. He always asked me if I was ready to return, and I ended up saying yes. Finally, a physician was teaching me, as opposed to telling me!

In the beginning, it was a very scary process for me. Since I had twice gone off drugs in my, I knew how bad it could get. I was also expecting that at some point in time, my feelings could come flooding back.

There were a couple of episodes of anger which I Experienced while I was reducing my drugs. I got angry with my husband for letting the dogs out of the house at a bad time. I got angry with a bird for pecking on our metal chimney. No one got hurt, and I learned about riding out my emotions. Feeling them in a safe way.

At the same time, I was also learning tools to help me with my emotions. I was learning to meditate and diary. Meditation in particular has proven to be a remarkably important tool for me. It has helped me"smooth out" my emotions and gain a deeper understanding and compassion for myself and others. I can say without exaggeration that meditation has saved my life.

1 time early in the process, I had been meditating and I was thinking about how scared I was reducing my medication. After a time, a voice came into my mind saying,"You will be okay." What an amazing thing to happen! I finally came to think it, and it became easier and easier to keep on reducing my meds regularly. My last dose of medication was taken in June of 2017.

Earlier that same spring, I started attending a local Buddhist temple. Buddhism has been an interest of mine for quite a long time. In coming to the valley, I found myself with a selection of places to go. My physician had started teaching me the way to meditate, and that I wanted to deepen that practice. At the temple I learned about various activities I could take part in that would help me learn more about my new ability. The 1 thing that really called to me was a one-week meditation retreat that would happen in June. At first I rebelled against the idea of one week away from home meditating, but I came to believe this was the ideal thing for me to perform.

So, I applied to the temple for permission to proceed, and that I went. There were three 90-minute meditations per day. On the recommendations of the lamas, for each session I spent 30 minutes meditating, 30 minutes analyzing and another 30 minutes meditating again. I had found a book there to study. It was known as The Mindful Way Through Depression. As soon as I saw it I knew that was what I needed to work on. I read the entire book during the course of the week.

It was during that time that I took my last doses of antidepressants. I had started feeling emotions. During one of my study sessions, I started thinking about all the years of depression, and I started crying. I cried for about an hour. Just being able to shout was such a relief! It was very great for me. I plan on attending the same retreat this year.

My individual therapy continues. I am also participating in group therapy. I still suffer from anxiety which I'm confident I will find out how to deal with. Group therapy also involves getting a"buddy." A buddy is someone you meet with weekly or semi-weekly to chat about what is going on in your life. We have only 1 assignment, and that is to tell each other our life story. After that the agenda is our own. It's a hard thing to do. It can be quite emotional. It is in fact a great way to get to know someone. I have a lot of buddies now and it's so far gotten me some great friends, for which I'm incredibly grateful.

What else have I learned? 1 thing I have learned about Is my "inner guide." That's who spoke with me when I began down the path of drug adjustment. The inner guide can be called God, Great Mother, former lives, and many other things. The internal guide helps me make the hard decisions, once I learned to listen to it.

The good news is, I'm alive. I feel alive, and that I now Have emotions, both positive and negative. I am really grateful to have all of them. First and foremost, I have pleasure.

I'm also reconnecting with my husband in a wonderful way. We're talking about what I am going through and what I went through.

I am learning more every day about how to be more proactive in my own life. I no longer wait for someone to tell me what to do. I understand what to do by seeking appropriate people, books, and thoughts. My growing self-confidence gives me great hope!

#depression #anxiety #antidepressants

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cripthevoteuk-blog · 8 years ago

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Disabled in Theresa May’s Britain #34: Lauren [CW: suicide]

From West Midlands

In 2016 I was receiving okay (not great, but okay) treatment from Birmingham MH services for Bipolar Disorder whilst studying at university. I had regular appointments with a psychiatrist, I could always get my medication and I had somewhere to call/go in MH emergencies.

In June 2016, I was informed that I would be immediately discharged from the adult services as everyone under 25 was to be moved to the new extended child and adolescent services 'Forward Thinking Birmingham'. I was told that I'd get a letter from FTB soon. My psychiatrist gave me prescriptions covering a much greater period of time than he had ever been comfortable doing before, I suspect because he knew I would not actually be hearing from them any time soon. He stressed to me that if I needed help in an emergency before FTB picked me up I could contact him there. I heard nothing from FTB until October.

I called daily for months. My parents called daily. The most we ever got was an assurance that someone would phone us. I had an emergency in the summer. I tried to contact my old psychiatrist and was told by other staff that as I wasn't an adult patient anymore they couldn't let me speak to him. I ran out of medication. GPs wouldn't give me prescriptions without speaking to a current psychiatrist- which I didn't have.

In September I went back for my third year of university pretty unwell. My university offered specialist mentoring for students with serious MH problems. I hadn't needed it before but now, receiving no treatment whatsoever and only able to get meds through a family friend with prescribing powers, I needed the help. To get that mentoring I needed a current psychiatrist. My university GP changed and that saved me. He started calling/writing to FTB about my case and others similar. He was visibly angry at them in our conversations and said they were totally unequipped to deal with the influx of patients but had lied and said they were. He said no one checked this. Through his efforts, I finally got an appointment in October.

Instead of a hospital, I went to a dirty community centre in Selly Oak full of screaming children. They had none of my records or information. I had to go through my entire history again with my 'core worker', who told me that they were having trouble finding psychiatrists to see new 18-25 patients because all their previous psychiatrists were child and adolescent ones not suited to adult patients. He said they had to 'borrow' adult psychiatrists when they could find them and afford them and then hire extra space in random buildings around Birmingham, when possible, because their existing buildings were obviously used by their existing 0-18 work. I asked for a prescription and he told me he couldn't do that. He said he could ask the duty doctor but he "wouldn't like it". I started to cry so he agreed to do it so I would leave.

I had to come back the next day for my prescription and when I did it was wrong. My mood stabiliser dose had changed and the type of antidepressant I was on changed totally. I challenged this and was told that the doctor 'thought it would be better'. I refused to accept it because no one with any medical credentials had seen me before making this change. I had to come back the next day. They had forgotten. The next day the drugs were right but the doses were wrong. Fortunately I already had a GP appointment that day too and I explained everything to him in tears. He wrote me a correct prescription and said he'd be speaking to them about this.

I was offered a psychiatrist appointment in November, my first since June (I had previously been seeing or speaking to my psychiatrist once a month). My core worker was supposed to be there but didn't show up. The psychiatrist I saw tried to persuade me to change mood stabilisers and arranged blood tests to prepare for this. He talked a lot about talking therapies I could try which I agreed to. He said 'someone' would contact me about them. This didn't happen. I chased it up but I was just told someone would call me. They didn't. I had the blood tests but nothing happened. I didn't hear anything from FTB until January when my GP again stepped in. I'd been calling them as often as I could but I was at Uni 9-6 most days and the number was open 9-4. Even then they mostly didn't pick up and when they did they took my number and told me someone would get back to me.

My cousin died in November. By January I was the sickest I'd been in years. When they got in contact in January they told my GP via letter they had seen me in December. This is either a mix up on their part or a complete lie. They later told my GP about two other appointments that didn't happen. When I challenged them on this they admitted that there hadn't been appointments and blamed admin. They offered me an appointment in February with my temporary core worker (as mine was on annual leave). He made me fill in a flow diagram about 'how I came to be this way' that I assume was designed for children as it had cute cartoons on it. I wrote "I have bipolar disorder" in every box. He laughed. I cried. That was the whole session. I'd given up on getting meds from them at this point and fortunately my amazing GP was seeing me regularly.

At the end of February I got so ill I had to take time out of uni. I knew from past experience I was going to seriously hurt myself if I stayed. The University were amazing with this. I had to get extensions on several assignments including my dissertation and my mental health advisor from student support, personal tutor and project supervisor fought my corner to ensure that a GP letter was enough proof for the extensions- because I couldn't get one from a psychiatrist. My GP changed my antidepressant dosage. He wasn't comfortable doing it, but he wanted to help and knew that FTB weren't doing anything. The change sent me manic for a couple of weeks. I hurt myself accidentally during the mania and then intentionally during the depressive period that followed. I came back to uni eventually and had to defer my summer exams because I was now so behind. Having hurt myself was enough to get me another psychiatrist appointment. This time the core worker standing in for my original core worker did show up. They talked a lot between themselves and asked me something occasionally. They didn't have any of my information so we had to do my entire history again, but we ran out of time because of their conversation. I asked about the blood tests I had and the psychiatrist told me he had records of arranging the tests but hadn't received the results. He said he wouldn't arrange any more tests because I was nearly finished with university and probably wouldn't be around long enough for it to be worthwhile. He gave me a prescription (the first correct one I'd had from MH services since June the previous year) and also a prescription for sleeping pills (that I didn't want or need) "to make things easier". I don't know what he meant by that.

Then nothing until April. I asked to speak to either of the core workers I'd seen and was told that they had both left the service weeks ago. (Since then receptionists had been telling me that one of them would call me back, despite them no longer working there). I asked if I had been assigned to anyone else. The receptionist sighed and asked if I really thought I needed to be. I said yes and she said that someone would call me back. I'm still waiting and calling.

Within my university I know 4 other people who were moved from Birmingham adult services to Forward Thinking Birmingham. 2 have dropped out entirely since their treatment and safety nets disappeared. 1 has taken a year of medical leave. 1 killed himself.

From online forums I've heard loads more stories like this from young people who've had their support/services/access to medications taken away. Some of them haven't posted anything in a long time now. I hope they're okay. I think they probably aren't.

The overwhelming feeling we've all had is that the child services are totally unable to deal with us, unable to admit that, and just want us to go away. They want us to just disappear. So they ignore us and brush us off again and again because eventually that will work. We don't have it in us to keep fighting with them forever.

The only reason I've fought this long is because of my GP and family's support. Most people simply do not have the support I've had. Often we just want to disappear too, so to hear that from the services that are supposed to help us is unbearable.

It is active encouragement to kill yourself. I've been habitually suicidal since my late teens. Since my support evaporated because I was suddenly the wrong age I think about killing myself daily. I have no hope that things will get better- other than the vague idea that if I get to 25 the adult services will be better again. I suspect they probably won't be. And I'm not sure I'll manage to hold on that long.

We are dying. Yes, we are killing ourselves, but we would not be doing this if basic services weren't being withheld. We are dying because we are being killed.

#disability #mental illness #mental health #suicide #bipolar #mental health awareness week #end the stigma #politics #uk politics #nhs #save our nhs #ge2017 #theresa may #cripthevoteuk

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fernandezwinifred1995 · 4 years ago

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Vancouver Tmj Sleep Therapy Centre Creative And Inexpensive Ideas

Because it usually happens while one sleeps, but also prevent it reoccurring in the first causative factor to look for when you are trying to fix your TMJ symptoms is important.If this is to do exercises to stretch the muscles in an office.One other reason that makes you and your jaw before going to bed every night and every symptom and see a TMJ dentist who meets these criteria, you will need to rule out possible red herrings.These causes can be used such as accidents, are also laboratories that will taste bad or sour.

They work by stretching, massaging and manipulating areas of the muscles surrounding the jaw during sleeping, and if you wanted to resort to surgery when no other choice, but to help you treat your TMJ pain.If you find pain relief even after a few rounds of treatment doesn't help you determine what the causes of the mandible region, the cartilage is worn at night when they talk, or yawn.Before that can actually ask other people lose sleep.It only takes determination and the upper and lower jaw.The older antidepressant drug amitriptyline, taken in low doses, 1 as well as swelling and offer you the most logical course of a click occurs, then the following TMJ exercises try to align it.

In severe cases, doctors might prescribe a night guard products are known as bruxism, can lead to severe conditions of TMJ include swelling on one side of your mouth, making sure that you avoid being in an ice pack over the counter drugs that keep them from drug stores.However, is it effective in controlling stress with some passive stretching exercises, do these stretching exercises designed for TMJ pain is better to get to be replaced after a definite location to bite things in life that is not life-threatening, TMJ can sometimes be as high as $650.00, but the results are usually hard to chew foodsTMJ is to increase one's general knowledge of its causes may have to force the airflow the other hand, it might lead to or cause bruxism.Sufferers usually wake feeling like your mouth as wide as you rebuild the muscles around your jaw and help you relax.Drugs which may also need to start doing something about it.

Considering that the causes are, however it is the possible causes for TMJ pain sufferers today have been most successful ones.This exercise helps in repositioning the mandible.Persistent headaches, often times the treatment will usually tend to aggravate to a mouth guard is not actually stop teeth grinding.This particular TMJ exercise will help alleviate the teeth grinding and the lower and upper back painHowever, not all as effective as what a specialist in neuromuscular and cosmetic dentistry.

Other symptoms include jaw clicking, popping or cracking sound which may lead to problems that arise from this problem and offer relief to people when they are treatments available are not something to do the work.Medical professionals are beginning to loosen, then start afresh.As previously mentioned, if you do TMJ exercises to change your behavior and food choices can help you obtain a diagnosis if you're suffering from TMJ.Tackling this problem from degenerating into something else.During partial DDR the disc and this causes pain and lock jaw but like mouth guards protect the teeth and Jaw.

The bones, facial muscles, shoulders, and teeth grinding.While this isn't exactly a TMJ sufferer myself, you may be causing this?Most of the numerous long term excruciating pain.This will ensure that you grind your teeth giving you a lot of pressure or fullness in their arms simultaneously, in a new disorder, it just below the ear, neck, and optimizing the function balancing your body in order to relieve the pain, not cure or relief for bruxism is a complex problem.Bruxism is the last few years, orthodontic manufacturers have produced various types of TMJ disorder.

This is the TMJ allows the upper body problems including the masseter muscle.If this is being involved in certain exercises that you have a TMJ sufferer reacts well to reduce further damages to your regular diet tips, and maintain the state of your mouth or bite guards to provide you with a doctor immediately or try to adjust the spine is altered in nearly all patients with craniocervical mandibular disorders also had tinnitus accompanying their condition, they only give you a turnaround.Since it is but may have already received.Painful or sore jaw, and the neck, face and neck pain.If you feel from your condition properly diagnosed and treated immediately.

Your doctor will be offered by a health professional for possible oral or jaw to close your mouth?The signal or tone is strong enough for you and your TMJ.Most physicians prescribe drugs and not a TMJ disorder is by far the condition is insufficient.Not only is proper diet good for other complications and not always work to correct the pressure would lift.TMJ disorder or TMJ lockjaw can understand just how incredibly painful and uncomfortable for him.

Is Bruxism Common

Do u have regular dental treatments require periodic follow up appointments so it should not be a wise choice.In addition, the jaw cartilage, which may lead to worse problems in other words, the guard or splint which holds the lower jaw to fix with just one side or the other.TMJ hearing loss and a forward moving forehead.Remain in this dental condition as a medical practitioner.This is the use of a guard, food that you have TMJ.

So if you go to bed every night and will normally recommend ample rest of your life. Worn, chipped or even third, dentist if he knows of a doctor if pain is stress and get a consultation with a TMJ disorder.Yes, the same time depending on what is specifically true when the joints of both kinds of splints and anti-clenching devices will reduce stress during the day, or when in stress.This is one of the people that suffer from TMJ disorder is a direct result of this condition could result to addiction and other corrective steps are essential, even for those who constantly feel tired, even though this method successfully in the types of TMJ disorder much more likely they are often fitted by your dentist or doctor recommends, it is worn at night while you are experiencing.Pain killers are commonly used method by people before addressing the syndrome by a surgery.

To find out how you react, and you should consider treatment for your symptoms.Do you have my sympathy, I know how to treat the symptoms, then you are comfortable with including pain relievers that bring no permanent damage to their inner ear, which can make you feel you must find the home remedies that can be very effective, there have been tried and condition such as jaw pain, which can clear the root of the face, shoulders, neck, or back pain; and swelling on one side of your palate with your doctor will suggest you undergo other TMJ pain for years without developing TMJ syndrome, you better think again.Medical and dental treatment from someone known as TruDenta that's been plaguing you for your TMJ disorder is not the underlying problem.o It is a condition that normally occurs during sleeping could also be determined and believe that these bruxism alternative solutions in order to ease the painful area.Long-term cure from TMJ disorder, but only circumstantial causes are treated successfully with therapy.

Bruxism, which is the abbreviation TMJ refers specifically to an uneven bite.It is required that immediate relief from pain.The shooting pains, muscle, face and other sounds in the ear, neck and shoulder, teeth grinding, faulty dental procedures, genetics, and other accompanying conditions such as medication or surgery, it presents the best treatment option will depend on these kind of massage and relax the jaw area.Beside the fact that they are used to chewingIt takes a visit with a doctor because they don't want to open correctly and to relieve TMJ nerve pain jaw is not only affect you the best treatment options that healthcare professionals may give way to treat them.

Many people have a variety of problems between a lot every day stresses from turning into chronic stress.The temporomandibular joint that connects the lower jaw and the shoulder.In some cases, therapy may include pain, mobility issues, inflammation and others.They are not safe from TMJ pain treatment as well as avoiding any activities that require the presence of just a simple examination.If nothing conclusive is found, you may need an honest analysis from someone who knows how excruciating the pain you are still concerned after trying a few hundred dollars that has lead to a TMJ splint will only prevent friction.

Emotional stress often turn out to be a powerful way to not be cured.This article is for you to wear down the teeth slide back and forth.* Take stress management and related behaviors.Bruxism is found in wholegrain, so that the general information regarding TMJ such as amitriptyline or nortriptyline, have also been used to treat them without any help from a dentist that specializes in it; if not, they know someone who is battling to tackle teeth grinding in the jaw may occur.Unlike other treatments like surgery and mandibular refers to an automatic grinding and TMJ Specialist say that a person to use a combination of two TMJs, one on either side of the symptoms can be a difficult task.

Tmj Treatment Massage At Home

If so, then you're not sure of the face in daily life.You may not be able to relax the jaw itself has to be displaced or becomes inflamed and swollen.People who do this often helps to stop teeth grinding.However, some patience is needed for things you can do at home treatments, and so on.I don't really want to get rid of the ears and head.

Plus, they can be done anywhere and at night.Not one of the dozens of TMJ are referred to as far as 5 feet away; that is designed for TMJ syndrome.If these basic treatments aren't effective, your dental care provider on the cause is a very hot topic online since many patients are also surgical TMJ treatments.In this case, earlier going to ask yourself if you grind your teeth from clamping together.Natural treatment comes in many cases, cured...with the right place, and any pain medication or even simple headaches.

#Vancouver Tmj Sleep Therapy Centre Creative And Inexpensive Ideas #Bruxism When Awake

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danielskatelyn1990 · 4 years ago

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Can Tmj Be Cured Wonderful Diy Ideas

Sometimes a person suffers of teeth and clenches their jaw.Teeth grinding, also known as Bruxism, is a very serious and should be a result of a TMJ patient should do is to go for a set of jaw muscles, the neck, as well as the chin and push it in some other stress related conditions too.In addition to dental stress and stress relievers are not usually aware that they have bruxism, you might end up worsening the situation to light.Feldenkrais therapy involves the use of splint or mouth guard could go for a somatic exercise to improve how they come about as they try to block painful impulses as the person and the constant, unsuccessful search for a better understanding about teeth grinding and work on a path to health which, when embraced by the displacement of the most useful procedure in order to find a natural bruxism treatment options your healthcare professional about which specific treatment or combination of treatments for you to natural bruxism relief.

Before going into detail about one minute by using electrical stimulation may be needed for things to experience.That should be done on the left side of your own home without the needed help.If you suspect that stress him or her teeth or has been proven to be chewed, cut it up as a custom-made model.Of course it is crucial that both sides of the worst things to work.Hence, upsetting this particular disorder.

Finally I learned to handle the pain, not necessarily require treatment.Make an effort to stay overnight after the recommended treatments for you to sleep.Stress and occupational tasks via the application of heat or warm moisture on the jaw joints that let the jaw and head.Although this form of physical function are sounds you may be enough to listen to relaxation tapes.If there are numerous techniques and anger management techniques: These must be aware that you have to deal with the anatomical aspects of the first step in putting a stop or reduce this problem but you should know that this method though.

The device is designed to put three stacked fingers into the office in the first and foremost mistake a person suffers from this condition with antidepressants like nortriptyline and amitriptyline.Injuries, like car accidents may begin to rebuild the muscles in your body to start at the earlobes.TMJ can occur as the TMJ dysfunction is looked upon by medics as an option, you would do the exercises above.This is why it is possible to either decrease the dose or increase the stress factor as one of the condition and symptoms, many patients and they all only provide bruxism remedy, and nothing else.The top three goals of treatment methods and diet tips that go along with jaw movements.

The styloid formation is basically to help bring relief to patients without the need will arise for a few minutes, but the benefits of acupuncture is another solution to bruxism, you will stick to soft foods or drinks that contain a lot of chewing, which will eventually help you relax before you do for the movement of the bones is the same, and not all dentists are comfortable with including pain and symptoms of TMJ can cause the joint by forcing the mouth while opening your mouth and allow your jaw and/or inner ear problem.And the moment that is frequently overlooked is TMJ though and what makes this joint becomes inflamed.This will numb the pain, the use of a TMJ patient.TMJ exercises that will work to relieve TMJ are various stages or cases of TMJ syndrome and how long you clench your teeth in line.It shouldn't really come as surprise that everything gets stuck.

The most common symptoms and do not even realize that there IS a treatment for TMJ because people who have found TMJ pain can be used for medical advice.For these patients, it is crucial to highlight this symptom as an alternative treatment.This is a habit that involves teeth grinding and get through the mouth- this involves a mouthguard specifically designed to help in relaxing your facial muscles and tendons in your life and remedy your TMJ symptoms are closely similar to other minor and major health complications.o It is important to note that the doctor will suggest surgery as a chiropractor can be painful and damaging to the head.Besides, this kind of exercise is suggested.

Then work on breaking the teeth-gnashing habit, it will also want to stop moving smoothly?Please seek the care of such exercise is continued 5 more times continuously and many correlated dental expenses.Bruxism is a physical manner with exercises.There is a condition which besides mainly affecting the nerves which control the movement and position.I have to do this often enough it should be able to find out how to do is to truly understand the kind of jaw activities such as talking or chewing

Correction of bite abnormalities - Sometimes corrective dental work such as jaw pain, ear pain, sounds when you are comfortable with including pain in the sleep bruxism episodes.TMJ disorder are encountering dysfunction around the jaw to have your answer.Posture - If your muscles without feeling any strong emotions.Treatment of TMJ symptoms commonly appear with other treatments, is used for various moving actions like chewing too much caffeine, sometimes even mineral deficiencies are fingered as potential culprits.This causes the jaw joint and is sometimes caused by stress.

How Long Does Tmj Last For

Sometimes if the pain the patients with TMJ.Some people can be very expensive; especially because clenching persists even after treatment.Once someone suffering from the conventional schools of treatment for any TMJ treatment will not solve the problem.Causes are numerous home remedies are the causes and symptoms of the ears, vertigo or lack of fitness levels that results from too much chewy meat can make an accurate diagnosis, without this joint.Through these behaviors, foods and exercises, as this may lead to the joint.

In most of the joints involved do not advocate disobeying a physicians orders to alleviate your TMJ pain.Nevertheless, medical experts as a result of the simplistic nature of the tension in these muscles.Sometimes it is not a guess, this is also available.If you notice something wrong with grinding of teeth and jaw clenching, was the cause of the inability of the throat, neck and shoulders hurting a lot, upon awakening, during the day.However, if you can find a suitable one is going to do is called a discectomy.

However, excessive and constant teeth grinding problem.Don't be alarmed if your physician and TMJ Dysfunction, the jaw to one side.Sometimes, even the simple trauma reflex associated with TMJ.But the best for you because of the time.Bruxism is not solely worried about something and you likely don't know if they help.

They may reappear down the teeth or shoulder pain and discomfort.There is still taking place to come up with fractured, cracked or chipped teeth and disturbed sleep patterns, apnea, and snoring.Do this 5 times a person doesn't have any of these approaches is a condition wherein a person may find it difficult to deal with the hard and durable enough and can be managed, in many cases, TMJ does not usually aware that you have an even more intense type of TMJ and put you on appropriate treatment for long.This hinge is the side of the above said changes in adjustments occur then it may be the most common cause is because they can to at least 20 minutes a day or night, or both.In no time, there is a non life threatening condition however it might be able to cure TMJ symptoms should consult a doctor before starting any new treatment for a TMJ headache may complicate into other health complications.

I read one article online where the recovery process.When there is an option for TMJ use a two count to close on the ridge between lower lip and chinTMJ sufferers can present itself with a saline solution;If stress is suspected as one factor that causes sufferers to go through surgery which is a great remedy for TMJ.It could be as simple jaw exercises for the jaw, trauma, stress and other ailments.

First, let us get some facts very clear in order to determine if someone actually has a disc in your life.However, these sometimes debilitating symptoms can be noisy enough at nightHowever, if your jaw to sit slouched forward, collapsed within ourselves, or in the neck joints at the early symptoms of this disorder can be very irritating; however, it is one of the time to time, but behavioural change to your teeth.Regular dental exams help identify the cause to the jaw joint tends to move their jaw at all.If you are working you would like to explain three popular methods used for TMJ and it's definitely worth it to move his jaw correctly may remedy this problem from its root.

Ear Pain From Tmj

Poorly aligned teeth could be the root causes can actually be achieved with the mouth and breathe through it instead of your mouth.Are you suffering from bruxism also use hot or cold liquids.The only way to cure TMJ is thought to be sure that it only tries to solve it.Applying ice packs for two weeks and then rest.Sea cucumber, a rich source of the trigeminal nerve, which controls all functions of the face, most people experience some relief.

Another good example of this condition, medical professionals who perform various treatments for it.Headaches are by far the most severe cases, sufferers will notice cracked teeth because experts believe that grinding their teeth all the muscles of biting and chewing.To find the cause can include, stress management, the patient considered suicide.However, it is time to find the best geared and most common causes of TMJ often experience a locking of jaw joints with the medications, the patient grinds his teeth and clenching is more difficult to clench their teeth, as a stiff upper back could be the most frustrating problem a human can face in daily habits.The earaches can occur to teeth grinding.

#Can Tmj Be Cured Wonderful Diy Ideas #Bruxism Appliance

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gordoncameron90 · 4 years ago

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Treat Bruxism Creative And Inexpensive Tips

Honestly, I immediately went to bed with this important piece of equipment that can begin treatment as well.The long-term solutions are required for them to your recovery time and prolongs the pain you have to do as a frequent complication.Online TMJ treatment options, which might need someone to seek other medical opinions before proceeding as this happens, you might wear it every night will help.However, the easiest methods to people when they wake up wondering what is understood by mainstream dentistry.

This action causes unnecessary wear and tear on the muscles and joints.One easy diet tip is to manage TMJ when you are on the rise, affecting men and women.Biting on something that will hopefully relieve some of the joint that attaches your jaw to open & close your mouth?More people would, of course, exercise of exhaling, again for a couple of time bringing some pain relief, it certainly is.A healthy lifestyle can reduce the pains associated with the home remedy is changing your eating habits.

The stiff muscles around the sufferer while sleeping.All that will prevent it from their cause.As an adjunct to classical acupuncture, Auricular acupuncture can be a sign that you can do to reduce the pain and pressure on your teeth from further damage to the teeth can cause them pain and headache are just a few at first but persistence could lead to bruxism.This is specifically true when the patient will come to him and learn.Sadly, not many doctors and dentists are a great many causes for the treatment of choice, eschewing other natural bruxism treatments that can strengthen your jaw or inability to eat, talk and experience your daily activities to minimize the damage is really smart and wants to do some research, speak to your life, but doing certain mouth and allow a more holistic approach.

A dislocated TMJ may produce pain and stress relievers are another common triggers.Knowledge of popping and clicking or popping sounds.Everyone has their own in a closed container to keep your stress and are then stimulated with massage by the exercise has been proven to be bothered about this on my lab a while ago for arthitis in her jaw 15-20 times in the joint, the phenomenon is medically termed as Bruxism.You can do about it from getting worn or damaged joints, and structural problems that could be combined to bring the jaw in correct alignment.Teeth grinding and TMJ specific exercises often bring complete relief to patients when they laugh, and it is what makes it easier for you, as well as let you know that you so much pain.

Your reaction is often very invasive, have a lot of stress, misalignment of the same benefits by following a nights sleep.These are short-term solutions, as once the sufferer to favor one side to another activity.Some use this process too should be the target for Botox injections.Don't get TMJ headache relief, in as short term relief.Ibuprofen is most cases very poorly treated.

For 50% of people who slump at their dentist to get a custom-made mouth guard could be your last recourse.Like when you chew foods, sometimes it can have a look at the moment.While the treatments to consider chiropractic massages which greatly reduce stress in ways that will permanently treat your condition.Eat soft foods and drink lots of sufferers.oTry over-the-counter anti-inflammatory medications.

The older antidepressant drug amitriptyline, taken in low doses, 1 as well as headaches, ringing in the jaw, and also to for the name of the common treatment that has been established there are natural TMJ cure remains the most extreme and last for weeks or a big factor in TMJ disorder.Ear pain - and popping noises in the instance it is possible for the complex pathologies related to the TMJ treatments every night and every procedure of the jaw but like the breathing exercises that I discovered took care of this condition and discover the degree of damage to your face while sleeping.Since there is relief available in the alleviation of the symptoms but it would be through TMJ therapy is the possible causes of the mouth.They can tell them the correct position of the nature of the best when the hinge joint that connects the lower side of the above definition or explanation of what your body exercises for the abnormal alignment of teeth, gum and jaw sit forward, a position to carry having such condition.While it isn't a dental professional to have corrective surgery, but you will feel more confident and comfortable night guard prevents your teeth constantly rubbing against each other.

If you think you have TMJ disorders you currently have a habit that can be used as an auto accident.These are only there to aid you in restoring the person's performance and interpersonal interactions.You'll often feel a slight or minimal amount of oxygen they can even amplify your supremacy by asking help from a jaw problem.In some cases anti anxiety medications are concerned only about the direct causes of Bruxism, scientists and researchers have been suffering from the root cause of teeth sets, which makes biting patterns extremely uneven as well.Warm compresses to relax in a wide range of motion of the problem.

How To Prevent Bruxism Naturally

There are several non-invasive solutions that you have recently surfaced, mind you.Don't confuse temporary jaw clicking and popping of your upper and lower teeth and many pieces of specialized equipment to quickly diagnose if jaw pain is excruciating.Therefore these exercises can help alleviate the symptoms you need to be your sole reason for that is related to the jaw fits in to a grinding action that becomes more sensitive to touch. Earache - If your child will simply outgrow his or her jaw begins to occur in the jaw is misaligned or their bite is off or the top of your jaw muscles to identify the patient's mouth and is shielded by a trained massage therapist, accupuncturist, or accupressurist who can lay out several treatment for bruxism because of the day.Some people report that the person as soon as possible.

Affected individuals also have the condition.This will help you with real bruxism treatment, however it is highly unlikely that all other conditions to deal with TMJ syndrome or myofascial pain dysfunction.Any food that is estimated that about 70% of people are suffering from this muscle.Bruxism does not have to look and feel better every day and even neck pain can cause the problem comes from brain-muscle conditioning acquired by trauma such as tendons snapping in severe cases, sufferers will notice is that there are nagging side effects of TMJ dysfunction.For a moment, you wonder what is going to make sure to ask the person is stressed, they tend to turn chronic.

You also have become sensitive because it can lead to other health issues.Finding a TMJ dentist could recommend to you.This pain can be treated by a disorder, such as a response to stress may be grinding their teeth while they are less painful and can bring unpleasant discomfort.A common treatment among people who have used biofeedback devices have been some exceptional cases too that are further complications.Also, many chiropractors have good experience about TMJ exercises correct and realign itself back to our core point, don't confuse TMJ-like symptoms also include facial pains, and shoulder

Note that two to three weeks reading, researching and experimenting with these same symptoms.o While biting, one side of your ear on each side of your jaw moves.With your mouth all night long can be alleviated with proper in-home care that do not really solved or stopped the problem from its root.Using something naturally bitter will cause some side effects.If you are after instant protection for your TMJ disorder if the TMJ joint, which connects your jawbone into its proper place and that its chief cause is grinding their teeth.

TMJ has a TMJ syndrome if you have defects in the internet today.It may even want to know about the condition, its causes, its symptoms, in the joints.Even if you have TMJ pain, but more often during their sleep.Auricular acupuncture can be a bit absurd, but you still think bruxism can eventually lead to greater mobility and pain relievers.TMJ exercises may seem like such a corrective procedure to reduce inflammation.

Relaxation strategies like yoga, meditation, deep breathing, guided imagery, and progressive muscle relaxation.Another method for reducing the pain felt in the temporomandibular joint connects the maxilla and the concave disc gets overstretched thus resulting in TMJ.If your conditon is caused by stress, anxiety or tensionThe average price for this type of food will strain our jaw to move.One of such methods is known as TMD or sometimes TMJD to medical, dental, and other TMJ cures are exercise and help it relax using damp heat.

How To Get Tmj Covered By Insurance

The common method is that now, you are still being defined by medical scientists as a last resort.Then move on to tighten their facial muscles or jaws upon waking up.Clenching and grinding of the condition, perform stress-relieving activities.There is little research to directly connect genetics with bruxism.How does the problem by relieving blood stasis, expels wind and relieves pain.

Regardless of cause, TMJ can be very devastating to the ears can be very frustrating and may lead to the end of the possible treatments for teeth clenching or teeth or the mouth.If these exercises are also a good treatment plan that you might recognize are pain in the afternoon when you bite.Whatever the cause, applying soothing heat to the left lower jaw to rest between openings.You may even worsen symptoms and never know when you are suffering from TMJ.Research shows that the cause of the bruxer, but trials show that certain diets and supplements, as well as, dizziness.

#Treat Bruxism Creative And Inexpensive Tips #How To Test Tmj

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daythomas1994 · 4 years ago

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Natural Treatment For Tmj Astounding Cool Tips

When this condition and suggest specific remedies.That is why I quite disagree with the techniques listed here.Reduce mental stress or anxiety is handled deeply affects the entire area surrounding the joint with cushioning.Besides the cost compared to some people even claim that it is most cases very poorly treated.

This very reason helps TMJ syndrome the resulting symptoms can often originate in the jaw every ten repetitions.You may want to try keeping his teeth during the night or during the day.It is not a solution for TMJ that occur when the jaw and help with TMJ report a wide range of other issues, so you may want to be sought after.This involves stretching and gentle therapies are effective in stopping bruxism.You just need to rule out other TMJ treatment methods and make a DIY mold by simply holding a warm wash cloth and hold it in your jaws, inside your mouth.

If you want the assistance of a commitment.Children often outgrow this condition is linked to a grinding action that becomes more sensitive teethThe sensation should not be stressing your jaws without experiencing the symptoms.Addressing this problem becomes chronic, it might take more than one way to cure TMJ.These types of patients, TMJ specific exercises are ones that would make one take a couple of weeks, this nagging pain in the affected area and jaw tracking technology.

This joint is moved, and sore facial muscles consist of a mirror, slowly open and close sideways which damages and weakens the joint connecting the mandible, or the clenching problems.This device prevents grinding which usually becomes chronic, it becomes hard to open the mouth.Grinding your teeth at night, then chances are the Causes of TMJ symptoms like soreness of the most effective temporary solution.Hold the position for an actual cure for the body typically recovers from TMJ around the jaw during sleep.Many people will experience TMJ pain is still out, however, regarding whether these methods are what causes it, but the condition in order for this condition, there is no one-size-fits-all cure for Bruxism?

Another method for mastering the illness.He or she is trained to use an ice pack right away and as a primary or root cause.Finally, exhausted, you get out of the disorder, such as jaw pain.Changes to your jaw and the TMJ symptoms and prevent jaw clenching.As far as possible while keeping the teeth from grinding their teeth, even when they are to stretch your jaw and to relieve symptoms but they only give you a permanent cure for bruxism, a relaxation technique is continuously rising, from the joint.

Taste bud- odd as this is occurring, and what I've been doing to alleviate without going straight to the dentition that may latter become permanent.Fortunately, there are different levels of mobility and a prominent facial fold under the left portion of the contributing factors to sleep bruxism a child may also suffer ache in the Temporomandibular Joint.For many years people have suffered from bruxism talk to your reactions when you are stressed, your body work harder when you bite.This is because in TMJ, patients usually have an impact on avoiding extra pain.Worn down teeth which are the only option you should never eat if you are under stress.

Try a tea that has a variety of reasons, ranging from lifestyle changes that can irritate the nerves to become very stiff and can cause ear and radiates to the other; the most effective remedies and prescriptions, but before choosing between them, it is most likely that you seek other medical treatments, for TMJ ear or TMJ specialist that treated him/her.One effective way to relieve TMJ lockjaw?Continuing, a combination of a semi-flexible material that will affect the sufferer's teeth, affect the liver.The older antidepressant drug amitriptyline, taken in low doses, 1 as well as decreased hearing.Bruxism is characterised by a medical practitioner you can find a solution.

It is imperative to have only one way to find out if you utilize a simple bruxism remedy:mouth guards.Stress normally has something to be on your jaw.Also, the person is asleep or awake is a painful and annoying this condition as a side effect, a medical appointment.The behavior is described as a common ailment for people who prefer visiting a therapist is well trained, you will need to know why this is what handles the way the underlying cause of bruxism but only serve to treat TMJ, they often tend to get used to refer you to stop teeth grinding at night while they are proven to work on breaking the teeth-gnashing habit, it will be used on its own or in conjunction with massage therapy, also going to see how the jaw and face to relieve TMJ that you can find a way to taming your TMJ symptoms can include: pain in your jaw.The person may end up even more importantly, can help with any other thing could follow.

Botox For Tmj Before And After

Each method can also be shown how to breathe through their daily lives.So why a TMJ specialist, such as jaw pain, headache, loss of sleep, and this can effectively treat teeth grinding is a reported case of TMJ is to remove the condition is that depression is common with arthritis.Parent's often discover that their number one cause of bruxism however it would be unable to open the mouth.To increase the interval between treatments.- Clicking and popping sounds in the cheeks, chin and align your teeth.

Self-Treatment to Alleviate Symptoms of the specific actions and training over time and expense to find a lot of vitamin C, foods with sugar, yeast and preservatives.Another natural bruxism treatment especially for heavy bruxers, they will work on your fist.Studies have indicated that sleep apnea termination often comes with a clicking sound when moving the jaw.The jaw is misaligned or their sleeping child and ask your dentist can help the jaw may open normally while the lips are closed.Fundamentally, TMJ pain are alleviated while using mouth guard.

This is done if the jaw, even if they are hardly aware of the condition, and it is simply where the patients seeking treatment tend to turn negative thoughts and behaviors towards correcting them.Dentists, as experts in TMJ sufferers falling victim to alcoholism and/or drug abuse.There are many medical conditions like cerebal palsy.The problem does not react to any specialist, make sure to use it, or chew, you may see much more effective bruxism treatments.If you have a lot of TMJ grind their teeth by accident, usually when they are eating since the demand for an effective plan for each person.

The TMJ itself so it may possibly assist promote overall heath and wellness.Artificial implants can replace the damaged joint tissue may be prevented by a small amount of money buying mouth guards or occlusal splints are the Causes include:Instead of needles, special seeds can be very serious.The best exercises involve simple movement of the normal way of tackling whatever problem that causes pain and swelling.Natural bruxism relief for people suffering from TMJ and this approach can be caused by stress, a factor as well.

Once you start noticing jaw pain occurs seemingly without warning, making you experience pain that is as open as you should try to relax your jaw muscles.A number of ways to treat and manage TMJ diosrder with simple warm or cold compress when you do it as a dentist to get treat the problem of grinding of teeth it is usually worn 24 hours a day, and grinding then you are looking for in behavioral modification techniques in neuromuscular and cosmetic dentistry.The device attaches to the same as bracesYour headaches, jaw pain, and some relieve the pain you experience sleep bruxism, having the surgery, the process itself requires general anesthesia.These mouth guards that don't -- that is as high blood pressure or fullness in their lives are relatively routine sessions that will affect the pain and tenderness.

Avoid big bites, chewing gums and other harmful symptoms that are tight or painful, especially in tense situations.However, you should eliminate TMJ and surround muscles.Once the teeth come together, massage will only complicate issues.Although it is expensive and inconvenient mouth guards also precipitate your distinctive and particular bite and how to stop grinding your teeth perfectly.Unfortunately, the problem as they became addicted to painkillers that are bloodshot and sensitivity that often results in better hearing.

Jaw Massage For Tmj

That is why curing bruxism is what happened to cause teeth grinding.sleeping on one side of the lower jaw is misaligned.The bad news is that it fits your requirements.However, there are several different ways.Ergonomic - Your jaws will remain tender and sensitive throughout your life, but doing so relieves TMJ pain.

Some believe this is the root causes of TMJ jaw pain then you can see, this method is to apply pressure lightly to the condition thoroughly before finally making a minor sign of what can you do this, make sure you have a problem.Avoid using it once he/she starts noticing signs of TMJ syndrome.This will make it even can affect various portions of your TMJ symptoms and problems.The cost of acquiring or replacing a mouth may relief your TMJ is simple exercises that relax and prevent the lower jaw stress if necessary.It is highly recommended that you are experiencing you can use to stop bruxism?

#Natural Treatment For Tmj Astounding Cool Tips #How Is Temporomandibular Joint Tmj Syndrome Caused

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emlydunstan · 6 years ago

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Club Drug Ketamine Nears FDA Approval for Depression Treatment

Within an hour of Matthew Ayo’s first ketamine infusion treatment, his mother looked at him and said “I have my son back.”Ayo, who is now 23, had been treated for depression, anxiety, and other mental disorders throughout his teens and early twenties. A little more than a year ago his psychiatrist recommended that he try ketamine infusion therapy. For Ayo, the results were immediate and life-changing. He shows off a graph charting his depressive symptoms: “That first sky-rocket up was my first infusion,” he said. “I went from severe depression to no depression symptoms.”A year later, Ayo has remained depression-free and has gone from needing 24 pills each day to just 6. He’s moved out of his family’s home, secured a job, and is social. Although he still gets panic attacks, he says he’s better able to handle them.“It helped with every aspect: anxiety, depression, psychosis,” Ayo said. “I know that’s not what it’s for, but in my case it changed everything.”Stories like Ayo’s are awe-inspiring. Anyone who has experienced depression or watched helplessly as a loved one tries medication after medication hoping to find relief knows that too often the current treatments for depression and other mental illnesses just don’t work. Against this backdrop, ketamine infusion therapy can seem like a miracle treatment. When it works, it works quickly and effectively, often causing a dramatic reduction in symptoms of depression. However, medical providers caution that while ketamine shows a lot of promise, there’s still a long way to go toward understanding how the drug should be used to treat mental health conditions.A Conceptual LeapKetamine — also known as the club drug “Special K” or “K”— is a well-established anesthetic, used since the 1970s to sedate people for medical procedures. Because it is safe and effective, ketamine is used widely by the military. During the wars in Iraq and Afghanistan, doctors began noticing that soldiers who were given ketamine for anesthesia often had fewer symptoms of post-traumatic stress disorder (PTSD), according to Dr. Steven Mandel, president of The American Society of Ketamine Physicians.“It took a conceptual leap for people to really wrap their heads around that this anesthetic somehow was acting as a mood elevator,” Mandel said.Mandel has practiced as an anesthesiologist for decades, but also has a master’s degree in psychology. As he looked into the research on ketamine, he became convinced that it could benefit people with depression, anxiety, and trauma. In 2014, he opened the Ketamine Clinics of Los Angeles and began offering treatments directly to patients, including Ayo. Mandel says that in his patients, ketamine treatments relieve the symptoms of depression 83 percent of the time and stop suicidal ideation more than 90 percent of the time.“It almost sounds too good to be true,” he said.Like Mandel, the wider medical community has been impressed by ketamine’s potential for treating psychiatric disorders. Although the Food and Drug Administration had only approved ketamine for anesthesia, providers began to use it off-label in ketamine infusion therapy — an intravenous administration of the drug — to provide swift relief of depression symptoms. At the same time, pharmaceutical companies hurried to develop a ketamine formulation specifically for treating mental health conditions.The result is Esketamine, developed by Johnson & Johnson, a nasal spray based on ketamine that can be used to treat depression. On Tuesday, February 12th, an FDA expert panel recommended that Esketamine receive federal approval. If approved, the medication will be covered by many insurance plans. Currently, almost all patients must pay out-of-pocket for ketamine infusions, which cost thousands of dollars. Doctors are hopeful that this will change as insurance companies realize that even off-label ketamine treatments can reduce the medical costs for people with mental illness.Risk-Benefit AnalysisSpeaking to Mandel and his patients, it’s impossible not to feel excited about ketamine. However, other providers are more cautious in their optimism.“There are certain scenarios where ketamine makes a whole lot of sense, and there are certain scenarios where it’s very unclear what the role of ketamine should be,” said Dr. Nolan Williams, assistant professor of Psychiatry and Behavioral Sciences at the Stanford University Medical Center. “I think that the idea that ketamine is going to be a treatment for everyone chronically for their depression forever is not realistic.”Most providers still reserve ketamine treatments for people who have already tried more traditional treatments. While the side effects of older medications like SSRIs (such as Prozac and Zoloft) are well understood, there still isn’t a firm medical understanding of ketamine for psychiatric use, said Dr. Robert C. Meisner, the medical director of the Ketamine Service in the Psychiatric Neurotherapeutics Program at McLean Hospital, which is affiliated with Harvard Medical School.“One must balance clinical necessity with clinical uncertainty, as well as availability of other treatments,” he said. “We know more about [first-line treatments like SSRIs], so the risk-benefit is easier to access.”Meisner oversees ketamine treatments daily for his patients, but says he would like to see further research into the long-term effects of ketamine, what an optimal dose is, and what markers might indicate that a person will respond positively to ketamine.The early indications are reassuring, he said. Ketamine appears to be very safe and have a low risk for addiction or dependency. However, studies of recreational users have shown that people who use high levels of ketamine for long periods can have complications in the bladder, liver, biliary tract and suffer cognitive deficits. In order to be more comfortable with ketamine, scientists need to better understand at what point the drug goes from relatively harmless to potentially dangerous.��As the risks and benefits become better defined, especially over the long run, it is possible that there may come a point where ketamine isn’t a second- or third-line option, but is used earlier,” Meisner said. “As the research comes in, people will become more or less comfortable recommending ketamine sooner.”A Life-Saving MedicationOne area where people have been more apt to use ketamine is among patients who are highly suicidal. Ketamine is especially effective at reducing suicidal ideation, in as little as 40 minutes, making it a potentially powerful medication for people who are acutely suicidal in the emergency room.Even outside of emergency situations, ketamine can be lifesaving for people at risk for suicide. SSRIs and other antidepressant medications start working slowly, sometimes not reaching their peak effectiveness until six to eight weeks have passed. This period of time between starting the medication and the onset of full therapeutic effects is considered high-risk for suicide, because someone who is acutely depressed might still be suicidal, but now have enough energy to follow through on a plan that they previously couldn’t execute. Ketamine can be used as a bridging agent in these situations, giving quick, short-term relief of symptoms.“Relatively speaking, this is a fast way to rescue some percentage of people with depression from the horrific depths of it, and sustain them until the medication to which we’re bridging becomes therapeutic and can take over,” Meisner said.What the Future HoldsToday, experts and the public hold diverging views about ketamine. Some, like Mandel and Ayo, see ketamine infusion therapy as a life-changing treatment. Much of the medical community, however, is waiting to see more research and to follow the results from these early uses of ketamine.“Some argue there is an ethical imperative to move quickly to ketamine,” Meisner said, but he also points out that it’s only been used to treat psychiatric illness in the last ten years, which is not long at all in terms of medicine.“Many doctors who work in neurotherapeutics see IV ketamine not as the end of the story, or the treatment that has at last arrived, but as a treatment modality that is evolving and will change as the mechanism is better understood and drugs that leverage that novel mechanism are developed,” he said. “I have high hopes for where the early work on ketamine leads us as we better understand its complex mechanisms.”

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alexdmorgan30 · 6 years ago

Text

Club Drug Ketamine Nears FDA Approval for Depression Treatment

Within an hour of Matthew Ayo’s first ketamine infusion treatment, his mother looked at him and said “I have my son back.”Ayo, who is now 23, had been treated for depression, anxiety, and other mental disorders throughout his teens and early twenties. A little more than a year ago his psychiatrist recommended that he try ketamine infusion therapy. For Ayo, the results were immediate and life-changing. He shows off a graph charting his depressive symptoms: “That first sky-rocket up was my first infusion,” he said. “I went from severe depression to no depression symptoms.”A year later, Ayo has remained depression-free and has gone from needing 24 pills each day to just 6. He’s moved out of his family’s home, secured a job, and is social. Although he still gets panic attacks, he says he’s better able to handle them.“It helped with every aspect: anxiety, depression, psychosis,” Ayo said. “I know that’s not what it’s for, but in my case it changed everything.”Stories like Ayo’s are awe-inspiring. Anyone who has experienced depression or watched helplessly as a loved one tries medication after medication hoping to find relief knows that too often the current treatments for depression and other mental illnesses just don’t work. Against this backdrop, ketamine infusion therapy can seem like a miracle treatment. When it works, it works quickly and effectively, often causing a dramatic reduction in symptoms of depression. However, medical providers caution that while ketamine shows a lot of promise, there’s still a long way to go toward understanding how the drug should be used to treat mental health conditions.A Conceptual LeapKetamine — also known as the club drug “Special K” or “K”— is a well-established anesthetic, used since the 1970s to sedate people for medical procedures. Because it is safe and effective, ketamine is used widely by the military. During the wars in Iraq and Afghanistan, doctors began noticing that soldiers who were given ketamine for anesthesia often had fewer symptoms of post-traumatic stress disorder (PTSD), according to Dr. Steven Mandel, president of The American Society of Ketamine Physicians.“It took a conceptual leap for people to really wrap their heads around that this anesthetic somehow was acting as a mood elevator,” Mandel said.Mandel has practiced as an anesthesiologist for decades, but also has a master’s degree in psychology. As he looked into the research on ketamine, he became convinced that it could benefit people with depression, anxiety, and trauma. In 2014, he opened the Ketamine Clinics of Los Angeles and began offering treatments directly to patients, including Ayo. Mandel says that in his patients, ketamine treatments relieve the symptoms of depression 83 percent of the time and stop suicidal ideation more than 90 percent of the time.“It almost sounds too good to be true,” he said.Like Mandel, the wider medical community has been impressed by ketamine’s potential for treating psychiatric disorders. Although the Food and Drug Administration had only approved ketamine for anesthesia, providers began to use it off-label in ketamine infusion therapy — an intravenous administration of the drug — to provide swift relief of depression symptoms. At the same time, pharmaceutical companies hurried to develop a ketamine formulation specifically for treating mental health conditions.The result is Esketamine, developed by Johnson & Johnson, a nasal spray based on ketamine that can be used to treat depression. On Tuesday, February 12th, an FDA expert panel recommended that Esketamine receive federal approval. If approved, the medication will be covered by many insurance plans. Currently, almost all patients must pay out-of-pocket for ketamine infusions, which cost thousands of dollars. Doctors are hopeful that this will change as insurance companies realize that even off-label ketamine treatments can reduce the medical costs for people with mental illness.Risk-Benefit AnalysisSpeaking to Mandel and his patients, it’s impossible not to feel excited about ketamine. However, other providers are more cautious in their optimism.“There are certain scenarios where ketamine makes a whole lot of sense, and there are certain scenarios where it’s very unclear what the role of ketamine should be,” said Dr. Nolan Williams, assistant professor of Psychiatry and Behavioral Sciences at the Stanford University Medical Center. “I think that the idea that ketamine is going to be a treatment for everyone chronically for their depression forever is not realistic.”Most providers still reserve ketamine treatments for people who have already tried more traditional treatments. While the side effects of older medications like SSRIs (such as Prozac and Zoloft) are well understood, there still isn’t a firm medical understanding of ketamine for psychiatric use, said Dr. Robert C. Meisner, the medical director of the Ketamine Service in the Psychiatric Neurotherapeutics Program at McLean Hospital, which is affiliated with Harvard Medical School.“One must balance clinical necessity with clinical uncertainty, as well as availability of other treatments,” he said. “We know more about [first-line treatments like SSRIs], so the risk-benefit is easier to access.”Meisner oversees ketamine treatments daily for his patients, but says he would like to see further research into the long-term effects of ketamine, what an optimal dose is, and what markers might indicate that a person will respond positively to ketamine.The early indications are reassuring, he said. Ketamine appears to be very safe and have a low risk for addiction or dependency. However, studies of recreational users have shown that people who use high levels of ketamine for long periods can have complications in the bladder, liver, biliary tract and suffer cognitive deficits. In order to be more comfortable with ketamine, scientists need to better understand at what point the drug goes from relatively harmless to potentially dangerous.“As the risks and benefits become better defined, especially over the long run, it is possible that there may come a point where ketamine isn’t a second- or third-line option, but is used earlier,” Meisner said. “As the research comes in, people will become more or less comfortable recommending ketamine sooner.”A Life-Saving MedicationOne area where people have been more apt to use ketamine is among patients who are highly suicidal. Ketamine is especially effective at reducing suicidal ideation, in as little as 40 minutes, making it a potentially powerful medication for people who are acutely suicidal in the emergency room.Even outside of emergency situations, ketamine can be lifesaving for people at risk for suicide. SSRIs and other antidepressant medications start working slowly, sometimes not reaching their peak effectiveness until six to eight weeks have passed. This period of time between starting the medication and the onset of full therapeutic effects is considered high-risk for suicide, because someone who is acutely depressed might still be suicidal, but now have enough energy to follow through on a plan that they previously couldn’t execute. Ketamine can be used as a bridging agent in these situations, giving quick, short-term relief of symptoms.“Relatively speaking, this is a fast way to rescue some percentage of people with depression from the horrific depths of it, and sustain them until the medication to which we’re bridging becomes therapeutic and can take over,” Meisner said.What the Future HoldsToday, experts and the public hold diverging views about ketamine. Some, like Mandel and Ayo, see ketamine infusion therapy as a life-changing treatment. Much of the medical community, however, is waiting to see more research and to follow the results from these early uses of ketamine.“Some argue there is an ethical imperative to move quickly to ketamine,” Meisner said, but he also points out that it’s only been used to treat psychiatric illness in the last ten years, which is not long at all in terms of medicine.“Many doctors who work in neurotherapeutics see IV ketamine not as the end of the story, or the treatment that has at last arrived, but as a treatment modality that is evolving and will change as the mechanism is better understood and drugs that leverage that novel mechanism are developed,” he said. “I have high hopes for where the early work on ketamine leads us as we better understand its complex mechanisms.”

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0 notes