#other than those that can already be prescribed to PTSD episodes.

[liedownquisition]

ugh, fuck freud. I hated when they made me learn his shit (which, admittedly i was already familiar enough to know was shit) but at least my teacher was kind of, approaching it as more of a "these ideas are prevalent and its important to recognize them so you can know when someone's a crock of shit" sorta thing (but also sometimes they're buried so deep its like you learn smth that sounds reasonable until you hunt down the origins of it). Alright, preemptive disclaimer: I am a few years out from an education that never actually got to the point of a degree due to complicated life upheavals. I try to keep up bcs it's a personal passion, but as you've said as well, psychology/ect is a rapidly-evolving field that is still divesting from a lot of older prejudices and yeah, it's very political. You DO have the more recent stuff and I do want to emphasize that I am not so much trying to discredit or outright disagree, just that with where there's overlaps in a lot of disorders (much like other illnesses), you know, understand why one thing vs another, ect. Bcs, again, you've got the most up to date resources, even if they might look different from the ones I'd get if I was able to immediately resume on the same level. (On a slightly other front, I also very much approach diagnosing a fictional character differently than I ever would even suggest IRL, largely in part due to the fact that many discredited or contested disorders, concepts, ect. are used as literary devices regardless of accuracy - Disassociative Amnesia/dissociative fugue, for example, is in particular a rather large one.)

Also some of my terminology is outdated as they frequently adapt them esp wrt as we gain greater understandings of what's actually going on behind the way things present. A vast majority of psychological terms, diagnoses, and symptoms currently do not have the same meanings or usages as their origins. Disassociation, as I recall, even started under the belief of being a "mental/cognitive deficit" and tied to a more archaic version of hysteria - which has a long political history esp tied towards the control & oppression of those diagnosed, often women.

DID is not something I necessarily was thinking of suggesting Jason might have, but rather wanting to bring in that Dissociative Fugue had been tied to other sources, & DID is frequently comorbid with other disorders that can sometimes make treatment of it, or the other disorders difficult due to the disparity - there's no medication for DID, and most treatment is directed largely at the others connected to it & regular counseling. Depression being most frequent esp treatment-resistant varieties, but PTSD & Borderline/BPD (which is also a very popular hc for Jason & includes dissociative episodes) are also not terribly infrequent (as well as any number of other personality, trauma, disorders, actually. It could be said that DID is almost an amplifier, in some ways). (DID, ftr, is also considered to be a trauma-induced disorder, especially tied to trauma starting in/induced in early childhood, and similarly to PTSD has been getting more momentum in recognition/study largely due to WW2. I have had multiple friends diagnosed with it and combined with my family history & OTHER friends who had schizophrenia it was a major factor in my interest in the field from the start, esp to understand where they diverge since they were frequently conflated. Also, an interesting note is that diagnosing DID is almost more about ruling out every other option than it is to diagnose DID itself. One of the biggest issues with it diagnostically is that a lot of the associated concepts for it are not clearly enough defined, & there are competing models for it. It may be the case that there are multiple "types" and it should be used more of an umbrella with more specific sub-branches or even just split into multiple concepts altogether, but admittedly that's a bit more of a personal theory than one I know to be actually considered.)

Where I was considering the Dissociative Fugue idea is largely more due to it's implications wrt mobility. ymmv on if "escaped the hospital and wandered around Gotham" constitutes a significant enough form of travel to qualify under "fugue", but given the emphasis on the comic even before he got hit on him walking several miles further than investigators suspected he could/would have, it seemed a viable consideration. It also apparently became More Explicitly part Dissociative Amnesia in the DSM-V which I guess was published the same year I was... studying... and my class at the time did not fully cover, jfc. That's kind of an embarrassing thing to have missed, actually. I was a bit focused on other things, but...

I believe you! Implicit learning is a good point, I was mostly concerned about how it would interact with, say, the dissociation in question. Using your house metaphor, if they're lower than the first basement, where they can't see or hear above, then how are they intaking and retaining that information. With a lighter dissociation it doesn't feel like a question, but the deeper in you get, it feels like there would be more of a struggle for that information to breach, you know? (Again, not saying you're wrong. This is just why I had the question/felt unsure of whether or not that specific concept(s) was still applicable under these conditions.)

Is it just me or does Jason not have catatonia in Red Hood: Lost Days?

It's been driving me crazy the more I think about it, his symptoms are way more consistent with dissociation than catatonia (not to mention the etiology fits much better. If you just gave me the list what happened to him and I had to pick what disorder he was most likely to suffer from (in RH: Lost Days) without describing anything, my bet would be on dissociation no question asked)

This is has enormous implications when it comes to the Lazarus Pit and what it can and cannot heal, how to calculate Jason's age, the diagnostic hypothesis we have for Jason and so much more. Am I missing something? Why does Winnick keep referencing to Jason's symptoms as catatonia?

[spookymultimedia]

ITS MY BLOG AND I GET TO INFODUMP ABOUT MY CHARACTERS >:D

Disability and gender experience

CW for ptsd, panic attacks, su*c*de [I will talk about at the end if you still want to read this and will add another warning] , gender dysphoria, mild transpobia and abelism both internal and external

Disability

Lyla has osteoarthritis that is due to Burns' pretty fucky genes. She found this out when one evening they literally couldn't get out of bed for anything due to intense pain in the knees. Waylon had to come and get them and when he got there Lyla was pretty much on the brink of tears. Lyla then got a diagnosis. At first she was frustrated because it changed everything about his daily life. He was prescribed pain medication that dulls the pain to a manageable degree and was recommended to use a cane to get around during mild flare ups. It initially upset her. He thought she was too young to be going through something like that and hated having to limit how much they work. They later realized that stigma was ableist and bullshit and eventually sucked it up and decided to just embrace his new way of life and let her Grandfather help him learn how to cope due to experience with chronic pain [which means its lifelong] . On some days they get around just fine with pain meds but on bad flare up days they have to use a cane or chair to get around. She eventually mastered working with the aids and can even pop a sick wheelie on his chair. The pain still gets to them and it really sucks but he does swallow his pride and allow themselves to rest and be supported by others.

Sometimes with her partner Ashley he'll get snuggled and taken care of by her. Lyla is pretty dang light like his grandfather and Ashley has no problem carrying him around. Lyla secretly loves being carried. He's pretty fucking privileged to have Mr.Burns allow her disability support. Lyla is very privileged. Sometimes they like to make his cane/chair look cool with spray paint and whatnot. Very cripplepunk. Lyla probably found a disabled community of people his age to help her feel less alone.

Abbey has undiagnosed innatentive type adhd and ptsd that she gets full on panic attacks from. Neurodiversity was something taboo and not talked about in her childhood and didn't even realize she was struggling more than she should be. As a child she struggled paying attention to long boring sermons/lectures and was shamed alot for it. She didn't understand how she occasionally made people uncomfortable with very weird and unconventional topics she talks about. Loud sudden stimuli and intense buzzing overwhelms her and can make her cry. She didn't do very well in school and barely graduated high school. She prefered watching her favorite movies and playing dolls with her sister over studying. She's extremely sensitive to fabric and only has certain types of blankets and clothes that she can stand. She absolutely hates the feeling of fabric draping against her legs too much so sometimes she either wears tight-ish pants and avoids skirts/dresses. She hates sitting and walking in dresses. She never wanted to wear them lol they feel bad to her. She refuses to sit up straight and will cross her legs. Abbey hyperfixates on animation, cinema, and dollhouses. She likes binging movies and making doll projects. She tends to bond with people through movies and model making. She struggled to make friends outside of her circle and just stayed friends with people she grew up with at her church. They all escaped that mormon hell. Abbey struggles with her emotions and usually gets overwhelmed too much which can often leave her drained and tired. She has an intense oral fixation and uses stim necklaces to chew on, before she would chew on her sleeves, pen caps, pens, her hair, her shirt, her sleeves, bottle caps, ect. She was a very curious kid and tried to eat playdough, dirt and grass lol. None of them where good. She is decent at working at the video store and feels happy with her job being related to her interests. Because hrt therapy is so expensive she doesn't feel she can afford any kind of therapy or medication and it's very overwhelming for her to have to prioritize one aspect of her health over another. But with financial support from close friends and her boyfriend Tim she gets by ok.

Gender

Lyla assumed that it was completely normal to have a fuzzy fluid gender due to believing gender is a lose concept for most people. He didn't realize most people have static genders that don't change at all. It wasn't something they never questioned. Later in Lyla's 20s they started to learn more on gender and realized she wasn't as cis as he thought they where. The term genderfluid fit his experiences perfectly. They never felt still in their gender. Even if they felt more towards one gender over another it wasn't a firm feeling. It felt fluid and lose. As a teen they dressed in goth fashion and was a self proclaimed tomboy. But they realized tomboys or most gnc women didn't dress up very feminine on somedays or even wear dresses. She loves wearing dresses and she loves wearing lose jeans and a lose men's tee.

Lyla's gender tends to shift weekly but it may present or change depending on who they're with or what media/environment they're exposed too. For example he might feel more feminine with certain friends and more masculine with strangers. Sometimes they feel more comfortable being agender or a nonbinary genders with certain people such as their partner. Sometimes they only use certain pronouns with certain people. He/she/they at work, she/he with parents, she/he/they/it with siblings, she/he with some friends, and she/he/moths/rots, rats, its with their partner. Lyla will either tell people upfront on pronouns for the week or use a pin.

Most of the time clothes don't dictate their gender that week but there are some key differences. Lyla will not wear dresses on more masculine days and may draw on facial hair with a mascara brush. On more feminine days they dress more like a nature witch and loves floral stuff. They are more likely to have fun with makeup on those days.

Lyla doesn't want to undergo any kind of surgery or hormone therapy. Lyla may bind a bit with a sports bra but doesn't really feel uncomfortable with his chest and mostly doesn't mind having visibile tits on masc days.

Abbey always felt different from her birth sex and felt very frustrated learning she wouldn't just naturally grow into the chest and genitals she wants growing up. It was an extremely taboo and forbidden subject but despite that something inside her soul knew she was a girl. Her parents pushed very strict gender roles on her growing up and causes her to struggle with her femininity as an infertile woman who could not stand dresses. It made her feel a bit lost but she later felt better knowing other women cis and trans who don't conform to gender roles.

Abbey gets intense physical dysphoria from her crotch and for a long time she had to just deal with it until surgery was an option. Some days she could tolerate it but some days [especially when she got on estrogen and felt very hormonal] it was unbearable and a wet dream or boner would trigger a depressive episode that consists of cacooning a cover, watching her favorite movies and long naps. It was a toll on her mental health that was already pretty bad. But emotional support, understanding and patience from her friends and boyfriend helped her carry on though it. She eventually does get bottom surgery and it's a HUGE weight off her chest.

Abbey usually dresses in sweatshirts, graphic tees and cute jeans. Whatever's comfortable on the skin. She wore tank tops more when her tits grew in. And they grew in pretty dang fast and big and ah it hurt. She's a c cup which she loves but God they where tender for awhile. Double puberty isn't fun. Her transition was a bit rough and long being low middle class but she pulled through.

TW for su*cide. Leave the post now if this triggers you.

Abbey is a suicide attempt survivor. She suffers ptsd from her own husband taking his life leaving her a widow. She felt trapped and tired in her unbalanced emotions and uncertainty of ever feeling okay or getting the medical attention she needed and attempted to OD. Fortunately she was with Timothy who immediately called an ambulance. She was very tired and at first a bit disappointed she was still alive but also a bit relieved. She then had to cope with feeling suicidal.

[clatterbane]

Among those prescription issues: Even the pregabalin/Lyrica for nerve/phantom limb pain vanished off the last request form, along with the tramadol--when I'm 95% sure they were both previously showing refills available. So yeah, I've been feeling great day to day. 👿

I don't think you're supposed to go off any anticonvulsant (the pregabalin) suddenly either, never mind the tramadol. Though thankfully I haven't noticed any issues besides basically untreated pain for the first time since the surgery. (I have needed to fill in with some OTC co-codamol, which is better than nothing but yeah.)

Not quite there yet, but looks like the pregabalin was doing more than I thought! 🙃

Really hoping that was "just" some kind of glitch. They really are not nearly as goofy about pain meds here. Even if they were? It makes even less sense that the new GP would just suddenly with absolutely no communication decide to yank me off the anticonvulsant for nerve pain with basically no abuse potential, unless you really really like feeling sleepy and stupid. And only a few months after a freaking amputation. ¯\_(ツ)_/¯

There's just enough medical PTSD anxiety there to have helped me put off getting onto eConsult to try and get it straightened out, though. If I don't ask about it, they can't tell me no! 🙄😵

(So now I can also get worried about a reaction along the lines of "See! If you really needed That Poison, you would have been on the phone immediately!!!")

Anyway, another issue was that they for whatever reason decided to prescribe little enough insulin per month that the pharmacist expressed "surely this is wrong!" surprise when Mr. C went in to pick up the last batch.

AFAICT, usually it just gets prescribed in multiples of a full box of 5 pens. And pharmacies prefer not to split boxes. I've been prescribed a whole two (2) pens a month. 🤔

At least at the current dosage requirements, that's been enough of the long-acting Lantus. Though it's always a good idea to have at least one extra (unexpired, perishable) insulin pen on hand, just in case. Sometimes they're faulty, sometimes they break, sometimes you lose them.

The shorter-acting Novorapid to use with food, though? Toward the end of the month, that started running low enough that I had to ration insulin like I was back in the US, and of course also what I was eating. 👿 And I had to try and get the repeat prescription request in as early as I dared.

I would have run completely out of fast-acting insulin the day that the pharmacy did finally get and fill the prescription. Before the whole month was up. ETA: And after about a week of rationing already.

(We hadn't heard from them yet, but Mr. C decided to check there, just in case, before going on an emergency run to raise hell at the GP's office. They had apparently just filled it, and hadn't even had time to bag it up yet.)

Besides that close a call being a Very Bad Thing? Maybe especially dealing with someone who was just recently in the hospital with DKA? (A.k.a. potentially very deadly insulin deficiency. 😩)

Needing to ration the insulin, and restrict food, is just about the last thing I need in my life. Especially with all the ED baggage. I barely escaped a serious relapse, by the skin of my proverbial teeth. And things were already dicey enough for months on end now, with all the ongoing triggers I can't do much about.

(Including "just" skating on the edge of clinically underweight. May well be over it by now. Plus, hello swallowing bullshit making it hard/unpleasant/kinda scary to eat. 🙄 Which damage AFAICT did indeed come straight from the DKA episode, but probably more on that later.)

Plus, you know, diabulimia is also an unfortunately common thing. And I can well imagine that actually needing to ration insulin could be a contributing triggering factor there, especially for someone who already had existing ED issues. Some others are actually mentioned through the link.

So many aspects of just dealing with diabetes day to day seem like they couldn't have been designed better to trigger/exacerbate disordered eating if someone had tried on purpose. And that's besides the fucked up attitudes around T2 in particular, with medical professionals definitely not exempt. 😬

(To make it clear: I really, really DO NOT want to go down any road like that. At all. Even if I hadn't already come within a hair of dying from consequences of badly treated diabetes--and lack of insulin!--just a few months back )

And of course I don't feel like I can say a word about EDs--much less in the context of personal triggers--to any medical professionals. 😑 We finally seem to be at least largely out of All In Your Head Land, and I really DO NOT want to risk getting sent back there.

(Oh yeah, I also need to get both lancets and needles changed to a more appropriate type. Plus more test strips a month, which thankfully we have been able to supplement out of pocket no problem.

They've been prescribing painfully long insulin needles, along with the same awful painful disposable single use lancing devices the hospital was using. Instead of the lancets to go with my meter lancing device?

Only really anticipate any problems with getting enough strips out of them for free, though. Assuming I'm not dealing with a complete butthead like the last couple of GPs. 😵)

I suspect the main problem with most of this is--other than the pain meds--is that they've just been automatically prescribing exactly the same that the hospital pharmacy sent with me when I got kicked out to that nursing home. I did attach a note to the last physical repeat prescription form that got turned into the doctor's, so not sure what's up with that. No changes or communication.

Anyway, apparently I really needed to bundle several vents together, which have been building up for a while! They are kinda connected.

But, here's hoping that this new GP will actually listen to (polite, reasonable, very basic!) concerns and requests regarding my prescriptions. And not be that kind of asshole to deal with right off the bat, before I've even had an appointment! (Because Pandemic Time.) That prospect has got me kind of concerned, though.

[amandaray-nature-vs-nurture]

Take a Mosey on Down the Diagnosis Trail

Was I depressed? How depressed? Was it “clinical” or “seasonal” or “major”? From what I remember, at first I was clinically depressed. Sprinkle some Zoloft on it.

I didn’t like taking the Zoloft and whatever else I was prescribed; didn’t like the notion of having to take pills to be “normal”. As I know now, that is not an uncommon sentiment. I am pretty sure I was diagnosed within those same few years as having some anxiety disorder, but it was not an “official” diagnosis at first. I remember going back and forth with trying to accept this diagnosis and take my medication when I was supposed to. I had access to the internet back then, but it wasn’t like it is now. Not for most of us, anyway. We didn’t think of searching for things online and definitely couldn’t just type a vague idea in the web address bar and get anything other than an error message. Back then, free AOL CD’s were everywhere by the thousands and I began collecting them by the pounds in my bag and would just hide them in random places all over any house or place of business I found myself at.

Within the same year of being released after my first committal, my sister got arrested after snitching on her own damn self and my mom and I moved to a one road, one grocery store, no red-light town. We lived in an itty-bitty house, my window looking out onto a massive lot for semi-trucks to back up and turn around in (at least, that’s all they ever did right there) at the cotton factory. I could jump out of my window and be in said lot before I even completed taking a single step. There were adventures to be had there many intoxicated nights (one more serious than the rest), of the infinite types of adventures that would have resulted in death in most other instances. I’m lucky to be alive. “Lucky” doesn’t even begin to describe it. I hear stories about young women or men just being in the wrong place at the wrong time, or making risky decisions, and not making it out alive -- and I feel like absolute shit knowing that I dodged so many bullets and they did not.

So, as I was saying, my mom and I lived in this house -- just us -- and things steadily devolved. Meaning: there was absolutely zero psychiatric care during that time. Loads and loads of self-medication, and lots of Live LiveJournal-ing (I have tried to recover the account, to no avail). Our house was the house for getting fucked up. It makes my heart palpitate and my guts twist to write this, so I am lucky (there’s that word again) that this is not a story detailing many of the happenings of that wretched place, or any of the wretched places that came after. This house is where my addict tendencies became known to me in a way, and where I developed an eating disorder.

I was never diagnosed with an eating disorder, but my best friend at the time Meghan and I would see who could go the longest without eating while taking fists full of diet pills (I always gravitated toward Metabolife) that we’d stolen up the street. We lived for the Pro-Ana sites/blogs that were around back then and used their tips and tricks and thin-spiration images daily. We ended up purging together after eating anything. We’d drink hot water and punch each other in the gut after jumping around for a while. We were competitive regarding things like who could get the next bone to be more pronounced, and how much we were able to purge vs how much we ate/drank, clothing size, weight, measurements, our side-effect symptoms of whatever we were taking or doing or just the whole mess in general, who bruised easier, who cut the most, the deepest -- who cut the most fucked up saying into which area of skin and using what -- and even our stools (speaks incredible volumes about your diet).

Meghan and I were extremely codependent. I spent those years with her cycling through an infinite amount of possible diagnoses, but I was never helped in any way. I remember a few episodes of psychosis or mania or whatever it was that are mixed with significant chunks of amnesia in my memory. When I think back on the few close friendships I had as an undiagnosed and untreated (or wrongly diagnosed and wrongly treated) person, I imagine that to the people who found themselves stuck in my orbit -- the people who found themselves hypnotized by my incredible vulnerability mixed with utter recklessness and abandon… it must have been awful for them. Especially when they eventually snapped out of their trance and saw what was happening to them because of my disastrous and dangerous ways. My willingness to go as low as one could imagine, at the blink of an eye. I annihilated souls one at a time -- but, for the very clear record, they were always willing participants. I never forced anyone’s hand. Maybe I obliterated the very essence of people, but by that point, they all chose their fates to be intertwined with my own.

In that itty-bitty house next to the cotton factory, my mom ended up abandoning me with a guy I had been dating for a couple of weeks, at most, and his mother ended up taking me in. I only have a few solid memories of that traumatic experience, as well as for the years that ensued at Robert’s house. I lived there, hurting myself in secret and having panic attacks and floating through the world only kind of remembering getting from one year to the next. There was more self-medicating and spiraling. Some cock fights. What I am saying is, there were a whole lot of years that I went untreated.

The next diagnosis that I remember is a Bipolar Disorder diagnosis. I have no idea if I was allegedly Bipolar I or II, but there were other diagnoses such as Obsessive Compulsive Disorder, Generalized Anxiety, Panic Disorder, and PTSD. Everyone uses OCD so loosely, “Omg, I know; I’m (or someone else they know is) so OCD about…” That, or they think that everything I do is going to be immaculate and organized;  perfect. They don’t talk about the intrusive thoughts or the weird obsessions that no one can know about or the compulsive rituals we do that often have nothing to do with anything but if they don’t get done, something awful will happen and it will be all our fault. I remember when I was young I had the literal Fear of God in me. I was obsessed with death and Heaven and Hell. Thought about it all the time. I was told that God heard our thoughts and that he could always see us. Every night when I would lay down to go to bed, I forced myself to think of every single possible infraction I made that day and to beg God’s forgiveness for it while clutching my Precious Moments Bible. I lost a lot of sleep due to this and so it became increasingly more difficult to stay awake each night. I would pinch and scratch and slap myself to stay awake and beg for forgiveness. At some point I also began praying for the health and safety of every single family member I could think of and then for the health and safety of every person I could recall in my memory from being out and about during the day. I spent entire nights probing my memories for every possible soul who needed my prayers in order to be safe. I had to cycle through them, imagining God cupping his hand down around their home like a shield to keep bad guys from breaking in and to keep fires from happening or violent weather or someone from inside the home from hurting them or aliens from abducting and probing them (Fire in the Sky ruined my life that extra layer) or just whatever else my mind could come up with to be terrified of happening. I had to do this, and I had to do it as many times as humanly possible every night. I would, of course, pass out sometimes. I’d awake with a jolt and grab for my Bible. But, wait… what if it is upside down?! I would think. Surely there are crosses and other things within this Bible that would only invite evil and ensure my spot in Hell if inverted?!  And so I would get up, turn the light on, and check. Getting out of bed every time I was unsure whether or not the Bible was facing the correct way was exhausting -- more exhausting than this whole thing already was. I came up with a solution: tie a cord from the string on my light to the rail of my daybed. That barely lasted a night because I was convinced -- despite the cord being nowhere near slack enough -- that the shit would get wrapped around my neck and kill me (and I would likely die with an inverted Bible in my hands, before I could finish my prayers). Solution? Super-glue a penny into the top left corner inside the front cover of the Bible so that I could just feel in the dark which way the hateful thing was facing. Problem solved (still have the thing).

The next diagnosis I had was Bipolar with Rapid Cycling (maybe some of the readers can see where this is going at this point). Also, the PTSD was bumped up to C (complex)-PTSD. I was put on mood stabilizers, lithium, some new anti-psychotic that was promoted as something else through the commercials on television and anxiety medications. I was in my early twenties at this time. Maybe mid. No later than mid. I had lost my mind after the death of a loved one and uprooted my life with Aidyn to move to Savannah at the petitioning of a couple I had met while I worked at Taco Mac. The wife worked there with me, and the husband came up to see her a few times. He was a tattoo artist and had found work in Savannah. They had outed themselves as swingers to me and requested my presence in their bed more than once. Oh, and they were also the most intensely religious people I’d ever met in real life. I was told that I’d have a job in the tattoo shop so I talked a coworker, Christine, into going down there with me to scout an apartment and “interview” at the shop. Fast forward to meeting my husband and a while with him, having Shane -- There’s a whole lot of dirty and dangerous detail in there, with another couple of stints in hospitals, and a whole lot of Ambien being used for everything but sleeping before this point, but they’re not important to this story.

I have just brushed over something here that is a big issue: skin picking. Excoriation. That has been a daily habit ever since I can remember. I think I have glossed over it so far now because it is not an issue which we are currently dealing with and focused on, but it has gotten so bad on a number of occasions that we couldn’t even go in public. That is not specifically my thing and so I am not very familiar with it, but I do have access to some of the memories we have about it. 

After a couple of stays in jail and yet another hospital stay, I had the diagnosis of Schizoaffective Bipolar Disorder with Psychotic episodes. That one got me to the medications I am currently taking. All of my previous diagnoses still stand. I hit one of my bottoms during this time. There’s a whole lot more that I don’t remember than I do.

A few more stays in jail and a few years of sobriety later, and I had a diagnosis of DID. Dissociative Identity Disorder. I am still navigating that one. I’ve definitely been back forth and all around with this. I have mapped out a timeline of sorts in a journal, and it’s astounding how much sense this diagnosis makes. Finally: A diagnosis that actually fits all the way around. It is still quite alarming, and I am still trying to establish good communication between alters within my inner world and be more okay with referring to us as us or we or a system. We know now that the path we took could have never led us anywhere but here. We understand that only due to our most recent move to a place where we are safe with the kids, were we able to come forward and be known.

DID is a disorder rooted in trauma, and usually only makes itself known after the system has moved away from the direct influence or vicinity of the family member, caregiver, or other person (or people) who make it unsafe for parts of the system to be known. They were birthed by severe trauma and have existed for strictly covert missions to protect the other parts. Walls of amnesia are typically built up around the fractured pieces of personalities (this is always done at a young age -- usually sometime before seven to nine years old -- before personalities integrate into one personality), and stay up and operational in order to keep awareness of the trauma from reaching certain parts. When there’s no longer present and persistent perceived danger, these alters are often left with not knowing what to do with themselves and questioning their own validity and justification for living in an environment where no one needs to be protected. They have been operating within the system for so long in their own way of doing so, and the reactions of parts and systems to no longer being actively life-saving vary widely. They will reach out knowingly or not, and sometimes a system will even break down. 

My story is not atypical. It is a classic story of a journey down Diagnosis Trail through the mental healthcare system. The average amount of time for people to get to a correct diagnosis of DID is seven years after initially becoming a patient  within the mental healthcare system. Finding professionals who are willing to diagnose and treat dissociative disorders is a challenge, because despite the presence of the diagnostic criteria in the DSM-5 and clear cut texts on the treatment of DID, there are many people out there who have so little experience and knowledge of our disorder that they don’t “believe” in it.

This was my diagnosis journey, made intelligible and digestible as I could manage. I know that I touched on several different stories, and I definitely had to skip over so many significant times that came up as I was writing. I mean, I summed up multiple years at a time with just a couple of sentences, some of the time without even one actual meaningful memory to go with them. That’s what this blog is going to be for, in part; though, most of the details of my life are going to be published in my Memoirs. Thank you for reading and feel free to email me with or comment below any questions, comments, or concerns. 

[shinneth]

SUF as a whole just left me with an empty feeling.

I feel you there, anon. In Dreams aside, I could take or leave the rest of this series (and in most cases, leaning well towards the latter sentiment). 

But I guess that’s to be expected when 90% of SUF focused squarely on Steven’s PTSD and need for therapy and the many, many red flags shown as early on as the beginning that signaled his eventual breakdown to where he ended up in the climax.

Especially with the fanbase itself constantly screeching that Steven needs therapy, Steven has PTSD, Steven’s gonna corrupt, et cetera… like, it was all laid on far too thick. So when we got to Growing Pains, it really didn’t move me like it did so many others because it came off as such a “No shit, Sherlock” moment for me when Priyanka finally addressed the underlying issues the show itself really didn’t even bother trying to be subtle about.

Don’t get me wrong; a lot of people who have suffered (or are presently suffering) from the same problems as Steven irl have been helped a lot by these kinds of episodes, and I do appreciate that.

But from my personal standpoint, yeah… I knew from the start that Steven’s underlying issues alone were not gonna be enough to sustain a full series, and sure enough, it wasn’t. We got to see some bits here and there with the other characters, but we also had a few choice characters be really shitty people in season 5 that never got properly addressed before it concluded, and with the timeskip in SUF, all of that just got handwaved off as “dealt with offscreen”, which is the laziest BS ever. 

And worst of all, at the end, they really didn’t stick the landing well at all. I’ll at least say SUF’s resolution wasn’t the mega levels of offensively terrible as Change Your Mind - but then again, it’s hard to out-do giving totalitarian space dictators with countless lives lost under their watch a fucking FACE-TURN out of nowhere. 

Like, really, the Diamonds’ presence (White especially) in SUF actively made my viewing experience even worse towards the end. Yes, I should be glad they’re establishing that the Diamonds are at least starting to use their powers for good and rebuild some of the lives they ruined.

But, y’know… doesn’t change the fact that they’re all responsible for multiple counts of global genocide. Like, any living creatures native to their colony planets? They’re still fucking gone. And the Diamonds themselves just come off VERY unnatural as “nice” guys - and in many cases, they’re even creepier now than they were as villains. Good god, White’s blubbering in the climax was fucking insufferable, though. 

Partially I think this comes from SU being a “kids show” so there’s this pressing need to end things as cleanly as possible. I’m more miffed that in the end, Steven still got pretty much everything he wanted.

They had some admittedly good set-ups to Steven’s growth, like having him accept that people grow up, change, and move on with their lives. We see the clear evidence that Steven’s got an unhealthy clinginess towards his human friends - and Connie’s no exception. 

And considering they took the time to establish that:

Connie has friends other than Steven. She gets along with them just fine, so it’s not like she’s totally lonely or isolated without him.

Connie is ambitious with many goals and aspirations when it comes to her education and potential career paths. She’s shown to have put a lot of thought into her options and at no point comes off as feeling pressured by her parents or friends into this.

Connie knows she has to work hard and often to achieve her dreams, and despite that rigid lifestyle, it doesn’t seem to bother her in the least. That would imply she really wants to reach these goals she set for herself, whether or not Steven’s in the picture at all.

Connie and Steven’s dynamic is a far cry from how it was when they started out in the original series. You can tell Steven has no clue what Connie’s talking about when it comes to her goals and just plays along, pretending he understands anything coming out of her mouth.

Connie, despite what her speech would lead you to believe, has been every bit as insufferably dense as the gems in SUF when it comes to Steven’s issues. In Bismuth Casual, Steven’s very specifically-worded concerns were misconstrued as a fear of skating (or his inability to, whatever) - and in the end, they just became Stevonnie rather than properly talked things through. You know, something PERIDOT 100% did in the prior episode.

Connie is very firm about wanting to live her life as herself. She’s not against being Stevonnie from time to time, but like hell does she want to be Stevonnie for the long term. 

Connie knows marrying in general at her age is a stupid-stupid-stupid idea, even if it is Steven. And considering her well-established commitment to her studies and reaching her lofty goals, Connie - at least at the time - seemed to know a relationship with anyone just wasn’t in the cards for her at this point in her life. There’s no need to rush that shit, and she won’t compromise her life just to give her needy friend this thing he wants that he doesn’t even fully understand truly is. 

Or, you know… just have Connie backpedal hard on a good chunk of that and date Steven so that he won’t become a monster again. I’m mostly kidding with that - but by kissing his monstrous self and that triggering his restoration, then soon later we see that even though Steven and Connie can only have a long-distance relationship at best, she’s dating him right now anyway even though this needlessly makes her life way more complicated than it needed to be - like seriously, how can I not take that as Canon Connverse being founded on the condition of “Okay, if it’ll keep you from losing your shit, going pink, and turning into a monster, I’ll date you”?!

And in the end it yet again gives Steven more-or-less exactly what he wants, even if it isn’t something he really needs. 

I’m glad Rebecca clarified that Steven would still visit Beach City often, because I had a very hard time buying him just traveling by himself on the road. And maybe it would have worked better if he was just doing it short-term to “find himself” or something along those lines, but nope! They’re basically saying this is what Steven wants to do.

And honestly, even that is dampened with his clearly-stated intention of visiting Connie way more than he intends to visit the gems. Even though Connie’s gonna be busy. With college.

This just… wasn’t a good ending. It had plenty of good moments - his goodbye to Bismuth, Lapis, and Peridot especially was very well-executed and the closest this finale came to drawing out any real emotion out of me. I loved the scene of Steven giving Greg his room; that was adorable. The last meeting with Tsundere Jasper was amusing.

But everything else… ehhh.

I mean, what can we really take from this season that I haven’t already outlined? The biggest takeaways were the plot points everyone saw coming a mile away that weren’t even executed all that well. 

In Dreams, as great at is was, might as well have not even happened - because what really carried over from that episode through to the end? Even though Peridot was the only one who got through to Steven, legitimately comforted him and addressed his fears, and the episode for once ended with Steven being happy with no underlying concerns about his problems - immediately he’s back to being awkward and depressed and frustrated by Bismuth Casual.

And I get that shit like trauma shouldn’t be resolved so easily, but for what In Dreams accomplished, I expected there to at least be a semblance of progress. Steven’s known since that episode he can hang out with Peridot and talk to her about whatever without needing a reason to do it, but he never ever takes her up on that again. 

So again, what was the point? 

You really get the impression that the quality of writing took a backseat just to emphasize the symbolism of an issue people commonly have, but SUF’s execution stretched my suspension of disbelief far beyond its limits. 

And nothing stretched that farther than Connie’s insufferable fucking speech in I Am My Monster; that pretty much completely made In Dreams feel like it never really happened in SUF’s continuity. 

In some ways, I just prefer to believe In Dreams was just a dream itself. An AU offshoot in SUF itself. Considering it’s so ridiculously good compared to the other nineteen episodes and by far the most pure and wholesome, maybe that’s the best way to see it. 

In Dreams was too good for its own series. That’s literally the only thing I personally took from SUF as a whole (at least in terms of lasting impact). 

So yeah, I guess for only one episode of twenty to really hit me in the feels, “empty” is an apt way to describe the series, anon. 

Seriously, if I didn’t have my own massive SU-AU to mess around in and do things properly, this probably would have upset me more. 

Instead, I just chuckle at Rebecca’s Monster Steven and raise her to what I’m putting my version of Steven through in my current story. Where I’m pulling all the stops to make other characters matter even though the stars are undoubtedly Peridot and Steven. 

And I’m actually making actions yield serious, lasting consequences.

(yeah, part of me wishes Jasper wasn’t revived - or alternatively, have Steven accidentally shatter White Diamond instead of Jasper since he came awfully close in canon

or even better, shatter Jasper and revive her, then accidentally shatter White and not be able to revive her since Steven used up ALL that diamond essence on Jasper…

yeah I’m kind of a monster)

Your pain is mutually felt, anon. So I’ll prescribe you endless refills of better-written and better-executed SU fanon to heal the emptiness SUF left inside you.

[lactosecarrotsoup]

My thoughts on Sean & Finn’s kiss

This will be long and of course contain spoilers, as if you can’t tell by the title... thingy. So, be warned. This will also contain my opinion(s); which is a very sensitive subject in this fandom. 

We’re all entitled to our own thoughts, opinions, beliefs, etc.

With that said, let’s get started!

For those who are new to this game... I will give you a short summery. Life is Strange is a video game series ran by DontNod. A great company who loves to make players cry. This season has new characters from the other season and DLC. This season takes place in Washington where you play as a 16 year old boy, Sean Diaz, who’s a regular teenager. He loves drawing, skating, and of course stereotypical teen stuff such as drugs and parties. Taking away the partying and drug usage, he’s your typical shy-ish guy. He also has a little brother named Daniel, he’s 9 years old.

Both of them are Hispanic, including their father (Esteban), making this season’s cast more diverse than the first season, where the main characters were mainly white.

Speaking of their father, he dies. Yep. After Sean forces Daniel out of his room, Daniel runs to their hot-headed neighbor and accidentally spills homemade zombie blood on him. Sean over see’s the neighbor about to hurt Daniel and rushes out the house, protecting him. After a few racial slurs/crude remarks to Daniel, Sean decides to fight him. Sean shoves the neighbor onto a small rock (which I still dont understand how that injured him), and he lays on the ground in shock/going unconscious.

A cop shows up and hell breaks loose. The cop only see’s the “blood” on the neighbors shirt and Daniels, thinking nothing but the worst of the situation rather than questioning them. The dad comes out, trying to reason with the officer and he gets trigger happy, shooting Sean & Daniel’s dad, killing him. Daniel screams in shock/anger/horror and Sean blacks out. Whenever he wakes up, the entire street is destroyed and more people are dead/unconscious. He grabs Daniel and they runaway, not wanting to get involved with the crime. It’s later found out that Daniel has powers (similar theme to LIS season 1) and can move objects with his mind.

More shit happens, yada yada yada.

NOW.

Episode 3 just released. In episode two, the brothers meet quite a few people. But most notably for this post, Cassidy and Finn. These two are regular friends (or maybe even “fuck buddies” as Finn and another girl described their relationship), who are a lot like Sean and Daniel. Cassidy left her old home life to live on the road. Finn, I can’t remember if he said anything or not. But I would think it would be for the same reason or something crime related.

Anyways, point is, they all group together and live in the woods. But, they all also work for this dude who runs a farm with nothing but pot.

Yep.

A nine year old and sixteen year old kid are working at a pot farm.

This leads to Finn, Cassidy, and Sean to get high, drunk, etc.

Finn get’s a hair up his ass and decides; “Hey, why don’t we steal all the cash from our boss? Who cares if he may know about Sean & Daniel’s backstory, has security footage evidence of them, and shotguns?!”

Cassidy is against this. But you, the player, have the option to accept or refuse his plan to rob the big dude with the cash.

And in the words of Chloe Price from season one; he’s got some “hella cash”

SORRY I HAD TOO.

But still, you can either rob from the guy or go against it. But HO HO HO! This choice doesn’t matter that much. Finn does it anyways (with a fUCKING NINE YEAR OLD HELPING HIM AND RISKING THAT KID’S LIFE) and Cassidy gets upset and worried. So, if you disagree with Cassidy, you end up meeting with them anyways so you can stop them. You get in trouble either way, btw.

But, let’s back it up.

If you agree to join Finn’s plan, he’s happy and you have the chance to romance him. Which, at first thought (including mine), was great! In the first season, Max was bisexual. You can flirt/romance with Chloe and/or Warren. With Sean romancing Cassidy and Finn, the developers made him bisexual.

But... it’s not all roses. Let me give you my first reaction. I do actually have it recorded.

https://www.youtube.com/watch?v=IGJ8lg5clHM

2:29:55 - 2:34:24

If you don’t watch it, basically I was excited and shocked. I didn’t like Finn at first but in that moment, I shipped them. I wanted Sean to be happy and happy enough to open up about his sexuality, if he hadn’t already.

But, I realized something.

Finn is most likely 20+. Sean is still 16. This means Finn is an older guy kissing a minor, which is of course, illegal. Not to mention that earlier in that episode, he was teaching Daniel to throw knifes and such. He smokes and drinks and admits his sexual relationships in front of a kid, too.

Speaking of his sexual relationships, it would be highly toxic if Sean and him dated/had casual sexual intercourse. Just based on Sean’s personality and how he had a crush on that Jen girl in the first episode, and how close him and Cassidy warmed up to each-other, he wears his heart on his sleeve. One thing this season has done WONDERFULLY is not distribute toxic masculinity. Sean and Daniel have both cried several times. Most men don’t like to talk/show their feelings because they feel weak and such, which is horrible. No guy should feel that way and should openly express them-self.

Sean does this, which is amazing. Yet, still can harm him.

Right after you agree to Finn’s plan, you can kiss him. Throughout the episode, he also flirts with Sean. Of course you have the CHOICE to kiss him... but it’s only after you accept his agreement. You can kiss Cassidy (and sleep with her) but she will storm off, angry, without kissing you, if you agree to Finn’s plan. Which is reasonable. Or, you can lie to her, saying you thought his plan was dumb, and she’ll kiss you. Both reasonable (in my opinion) responses to each situations.

But, how come you can’t kiss Finn regardless? Sean can say no and they could still talk about their feelings, leading to a kiss. Instead, they do nothing.

Finn is manipulative. He used Sean’s emotions to get to him. He probably noticed how close him and Cassidy were and how much love he has for Daniel, openly saying it every now and then, and wanting to protect him. Finn noticed how open Sean is and took advantage. 

Imagine if this wasn’t a choice base game and the story automatically follows Sean agreeing with Finn.

He flirts with him throughout the episode and is very charismatic. Since Daniel notices how close Sean and Cassidy are getting, he rants to Finn. Finn takes in this information and uses it against them. He becomes “cool” in Daniel’s eyes by being super chill, rebellious, and showing him how to violently protect himself/hurt others. In a sense, he becomes Daniel’s temporary older and “cooler” brother, making Daniel look up to him. With Finn’s flirting, he admits (once again, if your choices didn’t matter) that he has feelings for some guys.

Finn takes note of this.

The idea pops into his head to steal from the man who runs the pot farm... thing. I’m an innocent bean who hasn’t done anything harder than prescribed drugs for anxiety and stuff. So forgive me if I’m getting these terms wrong, LOL! But, the point still remains, he tells Daniel who is automatically on board. I doubt a 9 year old boy truly cares if they have enough money or not. I bet his main thought was “If I do this, then Finn will think I’m cool! He’ll treat me like an adult and so will others.”

In fact, I bet you that was his exact thoughts, just based on what he said to Sean and how he acted towards others.

If you really look at it, guys... it looks similar to a Mark Jefferson/Nathan Prescott relationship in season 1. I’m not going to go into many details for the people who haven’t played/watched season 1 yet, but I’ll give you guys a basic rundown by what I mean.

Nathan was mentally ill. He suffered from possibly multiple disorders and had an abusive father. His father wanted him to be the best of the best, not for his sake, but for the families sake. This got to Nathan and he hated his father. Mark Jefferson was a teacher who noticed this, befriending Nathan, and becoming a fatherly figure. The two teamed up to do sickening plans and crimes together which ended up getting them caught in the end.

Now, who does that sound like?

Daniel just lost his father and he’s angry. He probably has PTSD and anger management issues, based on how he’s acting and the situations he’s been through. Finn is an older figure and tricks Daniel to follow his plans and crime, as they’re stealing. They end up getting caught by the boss no matter what they, Sean, Cassidy, or the player does.

Sean is in the same boat, minus the anger issues. He probably suffers more from depression and PTSD (since he talks about the past a lot to others and how they know their story). Since he does talk about his feelings, Finn uses to his advantage.

When Sean agrees to the heist, Finn and him (can) kiss as an award. An award for falling into his trap and doing whatever he wanted.

Nathan got fatherly love and praise from Jefferson, resulting in him to continue their disgusting plans in order to feel loved.

Sean (and Daniel) and becoming the Nathan of this season.

We have to watch out who will be our jefferson.

I also have to address another elephant in the room.

We’re the reason this happened.

If you go through old DontNod/Life is Strange official posts (I suggest instagram or facebook, where i saw mine), I saw nothing but comments saying how much they want Chloe and Max back. I assume this is because of how you can romance Chloe. They want their love story/friendship to continue. Even though we did get a comic series based on them, it wasn’t good enough.

DontNod probably got sick of it and forced this to happen. While they were probably writing Cassidy as a love interest in the beginning, and Finn as probably just a random stranger or a brother of hers, the noticed all the hate and said “fuck it!”

As a result, we got the chance to kiss Finn... before you could write him off by injuring or killing him. Which, many people were pissed about.

But if you REALLY think about it, we were the cause of that. They probably didn’t want that, wanting to focus on Cassidy and the actual story. But many people wanted LGBTQ+ moments (which is understandable) but didn’t want Sean and Daniel’s story. Or they did get involved in their story but wanted a LGBTQ+ character.

The story of Life is Strange (both seasons + DLC) is nothing more but teens/young adults finding themselves through very difficult times. This with the responsibility of super powers, which are hurting those around them. It’s not meant to be a romance. It’s meant to be a drama, sci-fi, and angst story. (And thriller bc of Max’s nightmare bc that shit scared me)

While yes, I was happy and excited at first about Sean & Finn kissing. I was happy that there was potential for things to be “normal” and Sean to be happy, there was a lot of red flags. The age differences, the manipulation, the parallel's, and how forced it was.

Thanks for coming to my TEDTalk! Before you leave a hateful response, please know my opinion is valid like yours and others. Not only that, but I’m not the first to point some of this out. :)

[buzzedbabe]

@thewolfdragon @richard-madden @maddennfl86 @thenorthremembersalways @thefashionprofessor @robbstarkmademedoit @what-would-wonderwoman-do

story below for those that can’t read it

How much time are you spending thinking about Bodyguard? A lot, I bet. The new BBC thriller, about the relationship between an ambitious and unknowable home secretary and her PTSD-addled protection officer, was written by Jed Mercurio of Line of Duty fame, and was cynically and artfully designed to hook, obsess and fixate an audience into appointment viewing.

Bodyguard is made to steal us away from all newly acquired suit-yourself, binge-watch and content-stream habits, with charismatic heroes who might actually be despicable antiheroes and a succession of frenzied plot twists that simply must be consumed on the night lest someone catch you out with a spoiler on social media. Even if that doesn’t happen, even if your viewing isn’t partly ruined by a stray Facebook comment, watch an episode even a little late and find yourself locked out of all the best conversations, the most detailed post mortems, most frenetic speculations. Bodyguard is, in essence, a middle-aged Love Island, a reason to gather excitedly round the screen at the prescribed hour in a way that hasn’t really happened since the late Nineties.

Bloody hell, it’s good, I tell its star Richard Madden. The 32-year-old Glaswegian actor made his name as Robb Stark in Game of Thrones and consolidated it as Prince Charming in 2015’s Kenneth Branagh-directed Cinderella. Now, after playing Mellors in Mercurio’s 2015 Lady Chatterley’s Lover for the BBC, he trembles on the verge of Poldarking himself into borderline indecent, heavily fetishised glory as Bodyguard’s David Budd, the protection officer at the heart of the story.

“Oh, right,” he says. His accent is broad, non-posh Scottish; unexpected to those who remember it as generically Yorkshire in Game of Thrones. His eyes are intense. He’s arch and funny; he’d probably qualify as dangerously charming if there weren’t also something watchful and cautious about him. “Thanks very much! I enjoyed playing something a bit more adult, less boyish. I’m keen to play more grown-up roles, without actually growing up myself. Pretending to be adult. I’m done playing princes. Princes and royalty and lords. Also, it’s nice not to do an accent.” David Budd is – conveniently – Scottish. “One less thing to think about. Shall we get a drink? It is a Tuesday night, after all.”

It’s a Monday, I point out, but all the same we order a beer and wine from the front desk of the photographic studio in which we sit.

This is not the first time Madden and I have met. Three years ago, he bowled up to me at a friend’s party and demanded to know why I hadn’t featured him in Grazia magazine’s Chart of Lust recently. A placing in the list (which I compile weekly, and does exactly as its title suggests – rates the most fanciable people of that moment’s news), is deeply coveted among those who present themselves as above that kind of vanity, but definitely aren’t. Newscasters, Hollywood A-listers, national treasures, disruptive artists (Grayson Perry once told me he’d pinned his mention up on the wall in his studio), award-winning novelists … I’ve been lobbied by spads chasing mentions for their political charges on more than one occasion. But this was the first time a candidate had ever approached me in the flesh. I was both impressed and amused by his front.

“It does my frail ego good,” he’d elaborated, which, I’d thought, demonstrated a surprising amount of self-awareness in a young actor.

I remind him of our first meeting.

“Oh, God. Great start,” he says. Then, “I’m just trying to work my way up [the chart].”

Well, let’s see how this goes, shall we.

One of the reasons I think Bodyguard resonates so hard with its viewers is that it’s dealing with themes of safety – and so are we all. Terrorist attacks, suicide bombers and rooftop snipers recur from episode to episode; our current nightmares, and most catastrophising daytime fantasies, the ones that flicker through our minds every time we board a plane, go to a concert venue or swipe into a subway system, are played out in high definition on our small screens. Madden’s David Budd thwarts and buffers and foresees and repels; a hero with a fantastically of-the-moment brief. If Poldark is our ultimate historical TV pin-up – manly, tortured, good with his shirt off – then Budd is our ultimate Threat Level: Severe pin-up – manly, tortured, good in a bulletproof vest (“An actual bulletproof vest,” he’ll tell me, “which is so comfortable, for five months”).

I run this theory past Madden. How nervy is he in London right now?

“I don’t feel unsafe. I used to be more panicky, but I’m just less uptight. A few years ago, I’d get off at Tube stations because I’d have a sense of something.”

How much of David Budd’s wariness did Madden inherit through the course of filming?

“You get to a point where you clock everything. That’s what I’m doing for 12 hours a day, so …”

Walk into a room, scope it out for the nearest exit?

“I did that anyway. My dad’s a fireman, so that’s built in. Check into a hotel, first thing I do, find the fire exit.”

Richard Madden was born just outside of Glasgow, an only boy among older and younger sisters. His mother, Pat, is a classroom assistant. There were no other performers in his close family – no pub-singer uncles, no sisters at dance school.

You’re, like, a rogue luvvie.

“Yup!” he says.

How does that happen?

“I don’t know. I was fat. And shy. Crushingly shy, going to what was a fairly tough high school. Aggressive. Masculine. So I thought the best thing to do would be to go and be an actor. Ha ha! Not go and play football. Or get good at boxing. I’ll go and be an actor. They’ll love that.”

Aged 11, Madden joined Paisley Art Centre’s youth theatre programme. “And of course, they did not love that. But then I managed to dodge a couple of years of school, because …”

Because he was good enough to be cast, as a young teenager, in professional roles: in the film adaptation of Iain Banks’ Complicity, and in a kids’ TV show called Barmy Aunt Boomerang.

“So I was like, ‘I’m going to be acting, and not go to school.’ And get paid.”

Did you realise you were good? “I don’t think you ever feel good at it.”

He gave up acting in his mid-teens – “Life got a bit shit, when you’re on telly, among your peers, and you’re 14 years old”. He returned to it when he was 17, “because you have a bunch of teachers going, ‘Right, now you must decide what to do with the rest of your life,’ and 17 is of course the best time to choose.”

In 2004, he began studying at the Royal Scottish Academy of Music and Drama. “I wasn’t allowed to apply for drama school unless I applied for a ‘real’ course as well, which was computing science. I didn’t even know what it was. Had no interest. And then, luckily, the day before my first exams, I received a letter saying you’ve got into drama school, so I went to my exams and just wrote my name.”

At 22, barely out of the RSAMD, he was cast as Robb Stark in HBO’s epic, fantastically successful Game of Thrones. Stark is the noble, brave, integrity-hampered son of Sean Bean’s Ned Stark; a character with a genuine and credible claim on the kingdom’s iron throne, all of which condemned him to a phenomenally gruesome death in an episode entitled The Rains of Castamere, only fans of the show (among whom I count myself, unashamedly) call it “The Red Wedding”, on account of the blood-drenched ceremony during which Madden, his pregnant wife and his mother all die.

Madden says he thinks that early, formative brush with a TV career was both “a head-f***” and, “I was so thankful for it, because, going into the world of Game of Thrones, I’d already learnt so much from doing it as a kid, of feeling isolated, or getting arrogant because you’re on a TV show. I’d kind of done all that. I could deal with it a lot better.”

A lot better than whom, among your co-stars?

He cackles. “Wouldn’t you like to know.”

Yes! Can I guess? “No.”

Madden went into Game of Thrones knowing he would die within three series – the books on which the shows are based spelled out Robb Stark’s demise long before Madden was cast – which he thinks is a good thing, professionally speaking. “I didn’t just want to be known as that guy from Game of Thrones.” It also meant that his celebrity has, until this point at least, been tinged with pity, partly for the grotesque manner of his fictional death, partly because he was booted out of that juggernaut of a TV sensation early.

That might be about to change with Bodyguard. I am reasonably confident Madden’s fame is about to be tinged with something rather more lecherous. David Budd is in no sense a straightforward romantic hero – physically and emotionally scarred, with an undivorced wife and kids squirrelled away in a safe house – but heavens, he does brooding intensity well. His love affair with Keeley Hawes’ home secretary, Julia Montague, is as intensely sexy as it is quietly subversive, for making no reference to Hawes’ Montague being ten years older than Madden’s Budd. The whole thing is designed to charm the pants off us, and I wonder how prepared Madden is to receive the unbridled lust of thousands of women on social media.

If Twitter erupts with lechery …

“I won’t look.”

Why?

“Because if I do, and if I believe someone going, ‘Oh God, he’s hot,’ then I’ll also have to believe the person that goes, ‘He’s got pumpkin teeth.’ Do you know what I mean?”

Yes, but, you are widely considered handsome, so …

“I don’t see it.”

Truly not?

“Truly not.”

It is form for beautiful young actors to deny their looks, in the interest of seeming more humble and likeable than they really are, but I think, in Madden’s case, he could mean it. He tells me fame has made him feel less attractive, not more. “You chat to a girl at a bar, have a couple of drinks, and shy Richard is slowly going. This is going well. And then it’s, ‘My boyfriend’s a really big fan. Can I get a picture?’ And you go, ‘F***.’ You think they think you’re hot, but it’s because you’re on telly.”

I ask Madden if he thinks he’s irredeemably defined by the chubby, shy child he used to be.

“I feel like I should lie down on that sofa and give you a hundred quid.”

Were you really so scarringly fat?

“Thirty-eight inch waist when I was 12. I didn’t wear denim until I was 19, because denim is really hard to take up. My mum couldn’t take my jeans up.”

Would you say you have body issues?

“Absolutely, yeah.”

Despite all of which, Richard Madden does OK with women. When I originally met him, he’d been in the final stages of a long-term relationship with the actor Jenna Coleman, who stars as Victoria in the ITV show, and who is now in a relationship with her onscreen Albert, Tom Hughes. Since then, Madden has been gossip-column-linked to a succession of beautiful women – model Suki Waterhouse and TV presenter Laura Whitmore among them – none of whom seem notably put off by his pumpkin teeth.

“I think in the last year I was, as far as the tabloids went, dating seven different people. And when you receive a text saying, ‘Are you sleeping with blah blah,’ and you go, ‘No,’ that’s a bit weird.”

Who are you sleeping with?

“I’m not saying.”

But you are sleeping with someone?

“I am sleeping with someone. I am very happy with someone. There are pictures of it on the internet.”

If it’s the one everyone thinks you’re dating, I say – by which I mean the 21-year-old Ellie Bamber, with whom he was pictured most recently at the Serpentine Gallery summer party – then she’s another actor. Is it really a good idea to go out with other actors?

“Yes and no. Yes, because you understand what each other’s going through. No, because, there’s a certain level of self-focus you need, in order to do the job you’re doing. That’s hard on all relationships, because what am I going to talk to you about? I walk up and down for 12 hours a day, dealing with this character’s shit. That’s all I’ve done, every day, for the past three months … I really haven’t got anything to offer you as a friend.”

We return, briefly, to Bodyguard. He says he got on brilliantly with Keeley Hawes. “Love her, love her to pieces. She saved my arse, because it’s not a fun job. It’s not a comedy. But then Keeley and me, me and her, off screen, were just like two kids.”

Were you paid the same?

“No idea. I imagine she earned more. I care less about how much other people are paid, and more what it takes for me to shut up and go and do my job. The equality thing needs to be addressed hugely between male and female co-stars; I know that from friends of mine. But there’s only so much I can do for myself. Agents and lawyers, they do all that stuff. I just kind of deal with what I need to, so I don’t look a producer in the eye and f***ing hate them when they’re talking about their villas, and you’re thinking, shit, I’m getting the bus at the weekend, because I don’t have the money for a cab, you know?”

How rich are you?

“Not very. People think I am, because of Game of Thrones, but you know, when I signed up for that I was 22, with f*** all on my CV, so I was paid f*** all.”

Then, somehow, we end up talking about his body again.

“In between filming, I eat pizza, drink, don’t work out, get fat, then it’s six weeks till you have to be naked again. It’s always six weeks. Actually, that’s if you’re lucky. I have ten days till I take my clothes off again this time.”

What’s the occasion?

“I’m filming Rocketman, the Elton John film, and I play John Reid, his first boyfriend, his manager for 28 years.”

A straight man in a gay role; casting that has become contentious after Disney named comedian Jack Whitehall, who is straight, as the voice of its first openly gay hero.

“Yeah, and Taron Egerton [who is playing Elton John] is a straight man in a gay role,” says Madden, “and I think we’re all f***ed if we start going down the route of you can only play a gay part if you’re a gay actor. Diversity, equality and pay – of course we need to make sure of all that, but at the same time … I read reports that so and so’s pulled out of this role because they’re not transgender, and you go, yeah, but they’re a f***ing actor, and they’re probably really f***ing good in the part, and maybe that is part of the reason why that film’s getting made …”

We wind up with him telling me he isn’t bothered about an Oscar. “Because, who won best actress last year? Best actor? Best supporting actor? What won best musical?”

No idea.

“So what does it matter?” he says.

After which, he is beautifully mocking (off the record) about a very famous actor’s latest endeavour, before hugging me goodbye and pretending – well – he hopes to see me again soon, socially. Richard Madden made it to No 2 in the current issue of Grazia’s Chart of Lust Bodyguard continues tomorrow at 9pm on BBC One. Episodes 1 and 2 are on BBC iPlayer

[perfectirishgifts]

Black Americans Are More Venerable To What Some Dismiss As The ‘Holiday Blues’

New Post has been published on https://perfectirishgifts.com/black-americans-are-more-venerable-to-what-some-dismiss-as-the-holiday-blues/

Black Americans Are More Venerable To What Some Dismiss As The ‘Holiday Blues’

Lonely black woman near window thinking about something and winter snow

The holiday season is typically a time of celebration and social gatherings. But for some, it can be a time of self-reflection, anxiety, loneliness, and depression — and the raging pandemic and subsequent social distancing restrictions have only made matters worse for many. Even in the best conditions, the holidays can pose anxiety and prove to be stressful. While many relish in the excitement of gift exchanges and breaking bread with their loved ones — shopping, gathering with family and friends, and holiday-related obligations and expectations can cause an added pressure to the already busy and stressful lives of many. The holidays seem to also highlight an absence that may exist in the lives of some people. Whether it be the absence of financial security, a loved one, or those who are already dealing with mental health conditions such as an anxiety disorder or clinical depression — the holidays can hit some people like a ton of bricks and members of the Black community might be even more at risk of finding themselves in the throes of depression and anxiety this holiday season. 

Depression and anxiety in the Black community 

It’s normal to experience feelings of sadness when a person is sick, over the death of a loved one, or any other traumatic life event such as the loss of a job, an accident, or a divorce. Although the grief experienced by such events might come and go, the initial persistent feelings of sadness tend to dissipate and become more manageable over time. But for some, those feelings of sadness and despair can be unrelenting and last for prolonged periods – months, and sometimes, years. In these situations, a person might be suffering from clinical depression which is markedly different from initial feelings of grief. Clinical depression is a whole-body experience that can affect a person’s thoughts, mood, behavior, appetite, energy, and level of interest in things they typically find interesting.

Yet, clinical depression is far more common than many might think. According to the National Alliance on Mental Health, overall, about 1 in 5 adults will experience mental illness each year and Black Americans are 20% more likely to experience serious mental health problems than members from other racial groups. More specifically, each year 19 million Americans experience some form of depressive illness and according to a Surgeon General report Blacks are over-represented in populations that are particularly at risk for mental illness and when they do develop depression, they experience more severe and longer lasting symptoms. Although depression is pervasive and a challenge that millions of Americans face each year, anxiety is the most common mental health disorder in America.

Similar to feelings of sadness, everyone will experience anxiety throughout their life. However, according to the Mayo Clinic, people diagnosed with anxiety disorders such as generalized anxiety disorder, social anxiety disorder, or other phobias such as separation anxiety will experience frequent and intense feelings of persistent worry and fear about everyday situations that might cause others little to no anxiety. Symptoms are often difficult to control, last for extended periods of time, can interrupt daily activities, and are not proportionate to the threat posed. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear which can reach a peak within minutes (panic attacks). As with depression, symptoms can start during childhood, or as a teen and continue into adulthood.

Exposure to trauma has also been linked to anxiety disorders. The Census Bureau recently released a report that indicates that rates of depression and anxiety among Black Americans have increased since the killing of George Floyd. Research suggest that anxiety can present differently in Black Americans, who are more likely to develop post-traumatic stress disorder (PTSD) than white Americans. Because PTSD is classically a response to trauma, this suggests that high rates of racial trauma may play a significant role in Blacks being more likely to develop the disorder. Black adolescents are at a greater risk of being exposed to violence which makes them venerable to PTSD by over 25% compared to their white peers.

Even more disheartening, suicide rates are steadily increasing in the Black community, particularly in children. Among high schoolers, almost 10% of Black students report attempting suicide, compared to just over 6% of their white peers. Although it was reported that suicide attempts among white teens decreased between 1991 and 2017, suicide attempt rates rose among Black teenagers in the same period and were the leading cause of death among Black young people aged 15–24 in 2017. 

As previously mentioned, exposure to racial trauma and violence makes members of the Black community more at risk of being diagnosed with clinical depression or an anxiety disorder. However, other factors such as poverty, homelessness, racial prejudice, anti-Black racism among medical providers, and lack of access to health insurance and quality medical care also increase the likelihood of Black Americans experiencing more severe symptoms related to depression and anxiety. Social stigma about mental health challenges along with commonly held stereotypes both within and outside of the Black community also make Blacks more venerable to mental illness. There is a commonly held inaccurate belief that Black Americans are overly resilient and therefore do not need to seek therapy or mental health care, and that doing so is a sign of weakness. Inaccurate stereotypes are exceptionally dangerous and perpetuate avoidant help-seeking behavior that deters treatment and further exacerbates mental health challenges. 

What you can do 

Sadly, Covid-19 has cast an ominous cloud for many this holiday season and some are experiencing mental health challenges that are very new to them while others are waging an old and familiar battle with depression and anxiety. Although Black Americans are more at risk of experiencing depression and anxiety, both can be experienced across racial groups. But the good news is that whether a person is experiencing clinical depression, an anxiety disorder, or what some discount as “the holiday blues,” there are actions that can be taken toward treatment and relief. For those experiencing clinical depression or an anxiety disorder treatments typically include: 

Seeing a therapist or psychologist.

Take medication prescribed by a physiologist or physician.  

Lifestyle changes.

Alternative therapies such as acupuncture.

Residential treatment.

For others who are experiencing a more temporary holiday-related stress or sadness, a few suggestions for relief include: 

Speak with a mental health professional.

Eat healthy and balanced meals.

Get enough rest and sleep. 

Engage in healthy activities that are calming and soothing. 

Set realistic goals and expectations for the holiday season.

Keep track of holiday spending and stay within a budget.

Accept and make peace with what can and cannot be accomplished during that time. 

Limit drinking alcoholic beverages and the consumption of other things that might enhance sadness and loneliness. 

If feeling lonely, volunteer to help others less fortunate.

Limit comparisons of the past with the future.

Live and enjoy the present moment.

Look to the future with optimism.

While these suggestions might not completely alleviate feelings of sadness or anxiety, they can help to minimize those feelings during such a challenging time for millions of Americans. Mental health screenings are also a viable option for those who are experiencing depression or anxiety but are not sure if they are experiencing clinical depression or a diagnosable anxiety disorder.

From Diversity & Inclusion in Perfectirishgifts

[hempoilfrog1]

CBD Oil for OCD: How to use and Dosage?

Obsessive-Compulsive Disorder, or better known as OCD has been a topic of jokes, but in reality, it is never a laughing matter. And it is more common than most people think.

A study conducted by the National Institute of Mental Health revealed that 1.2 percent of all adults in the US have been diagnosed with OCD, out of which over 80 percent are seriously suffering due to this condition. Read Here: Does CBD Oil Really Help Anxiety And Relieve Stress?

Fortunately, there are various medications available for those suffering from it. And recently, there has been a growing interest in the potential benefit of CBD oil for OCD. In this article, we shall dive into the possible benefits and use of CBD oil for OCD.

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OCD: What Exactly Is It?

Looking at the records, 1 in 40 adults and 1 out of 100 children have OCD. And since the 90s, the number of cases only kept on expanding, leading to extensive research in this area.

Obsessive-Compulsive Disorder is a form of anxiety disorder that involves frequent and recurring obsessions and thoughts. It usually causes an individual to develop a strong urge to do things compulsively or repetitively— often called tics.

The urges and obsessions of those affected can become highly disruptive to their normal life, making changes in routines, social interaction, and productivity more difficult than normal.

Most people with OCD have compulsions and obsessions in combination together, while a few others only experience one of these conditions.

Common Obsessive Thoughts

Each person has various obsessive thoughts. Most of the time, however, for those suffering from OCD, they usually include:

Order and symmetry or the idea that everything needs to be “perfectly” aligned

Daily stress and angst

Superstitious or the excessive attention to something that’s considered unhappy or happy

Excessive concentration on moral or religious ideas

Violently intrusive or sexually explicit thoughts and images

An increased concern of losing control which causes harm to self or others

Fear in contaminating oneself or others with dirt and germs

Harmful thoughts toward yourself

Fear of forgetting an important date

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Does CBD Oil Really Help Anxiety And Relieve Stress?

Common Compulsive Behaviors

Compulsive behaviors, on the other hand, are used in an attempt to reduce the anxiety that an individual feels from their obsessive thought. A person will often repeat such behaviors which can help reduce their levels of anxiety, but only temporarily. The most common compulsive behaviors include:

Waste collection such as empty containers or old newspapers

Excessive organizing or sorting of things

Self-induced required activity

Spending a lot of time cleaning or washing

Excessive checking of things such as switches, appliances, and locks

Tapping, counting, or repeating of certain words or nonsense

Checking loved ones repeatedly to make sure they’re safe

Counting things over and over

Clearing throat more frequently

Skin-picking or excoriation

Nervous ticks such as muscle spasms or blinking

Hair pulling or trichotillomania Gambling addictions

The Causes of OCD

Anxiety and fear are both normal responses. We use such responses to cope with threats for our survival, such as coming face to face with threatening animals.

Feelings of anxiety and fear should be short-lived and only appropriate for the situation. Thus, the level of stress and anxiety that we experience should be enough to offer us an advantage for running away or getting out of danger, for instance running away or fighting off a threatening animal, but not too much that will make us freeze in fear.

Now, once the danger or threat is gone and we are back to safety, the feelings of stress and anxiety should also subside.

However, when the stress response becomes dysfunctional in various ways, then it can lead to anxiety disorders like OCD.

So, what are the signs of dysfunctional stress response?

An excessive intensity of the stress response for the level of the danger involved

Stress response lasts too long

The stress response activates more often that you need it to

Any issues with your stress response can result in problems over time which is referred to as poor stress adaptation. Meaning, your ability to adapt and react to stresses is no longer working properly.

Anxiety is the common term for this form of neurological disorder, however, there are several conditions associated with a dysfunctional stress adaption including:

Obsessive-Compulsive Disorder

Post-traumatic disorder

Panic disorder

Social anxiety disorder

General anxiety disorder

Medications For OCD

There are some psychiatric medicationsthat can help in controlling OCD. Most often, the antidepressants are the first to be prescribed.

Some of the medications for anxiety and OCD approved by the FDA include:

Anticonvulsant (Clonazepam)

Partial 5-HT1A receptor agonists

Tricyclic antidepressants (Doxepin, Amitriptyline)

Serotonin-norepinephrine reuptake inhibitors (Khedezla, Pristiq)

Serotonin reuptake inhibitors (Prozac, Lexapro, Celexa, Zoloft)

Monoamine oxidase inhibitors (Emsam, Nardil, Marplan)

Benzodiazepines (Librium, Klonopin, Xanax)

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Does CBD Oil Really Help Anxiety And Relieve Stress?

CBD Oil For OCD: Is It Effective?

First off, let’s understand about CBD.

CBD or cannabidiol is a cannabinoid compound derived from the cannabis plant (both marijuana and hemp varieties of cannabis). It is the non-psychoactive sibling of THC (tetrahydrocannabinol), meaning it will not give you the feeling of high, separating CBD from other controlled substances.

CBD has also been legalized across all 50 states of the United States, thanks to the 2018 Farm Bill. Thus, people are allowed to consume and buy CBD products in the US. Still, it is recommended that you check with the laws of your state before purchasing CBD-infused products.

So, what makes CBD popular?

Its numerous potential health benefits!

CBD is being studied for its potential ability to reduce pains and aches, control epileptic seizures, neuroprotective properties, improving heart health, and relieving anxiety and depression among others.

Although there have not yet been any specific studies published on the potential benefits of CBD for people suffering from OCD, there has been plenty of research that highlights its benefits on anxiety, in general.

In a 2015 preclinical study understanding the potential treatment of CBD for anxiety disorders concluded that CBD demonstrated efficacy in reducing the anxiety behaviors relevant to several disorders including OCD, PD, GAD, SAD, and PTSD, with its notable lack of anxiogenic effects.

The benefits of CBD oil for OCD and anxiety as a whole include:

Enhancing the endocannabinoid system to regulate the activity of the central nervous system

Regulating serotonin levels in order to support mood

Improving symptoms of OCD such as muscle tension and insomnia

Increasing the GABA levels in order to produce a calming effect on your mind

Most of the studies conducted on CBD investigating its effects on anxiety have discovered and successfully mapped out some of its specific biochemical processes to produce such benefits.

CBD activates the TRPV1 or the vanilloid pain receptors

CBD interacts with the ECS (both CB1 and CB2 receptors)

CBD activates the 5HT1A or the serotonin receptors

All these receptor systems have been shown to be playing a major role in the regulation of fear as well as other anxiety-related behaviors.

By supporting the dysfunctional stress-response system, we can relieve the underlying cause of OCD as well as other anxiety disorders. The main goal is to lower the excessive or inappropriate stress reactions and help the stress-response mechanism to shut down faster after the stressful episode.

And CBD studies shows that it can help with the goals. Although more specific studies are needed to explore the benefits of CBD oil for OCD, current findings already look promising.

Risks and Side Effects of CBD

In general, CBD is considered safe. However, some individuals who take CBD can also experience some side effects such as:

Changes in weight

Changes in appetite

Fatigue

Diarrhea

In addition, CBD can also interact with dietary supplements and other medications that you are taking. It is especially recommended that you exercise caution if you are taking blood thinner medications which come with the “grapefruit warning”. This is because both CBD and grapefruit interact with the same enzyme which is crucial to drug metabolism.

One mice study showed that CBD-rich cannabis extract can also increase the risk of liver toxicity. However, take note that in the study, mice were force-fed large doses of CBD.

In addition, you should not stop taking any medications that you are already using without consulting with your doctor first. Using CBD oil for OCD can help, however, you could also experience withdrawal symptoms when you suddenly stop your prescription medications.

The symptoms of withdrawal include:

Fogginess

Nausea

Dizziness

Irritability

Getting Started With CBD Oil For OCD

If you decided to try out CBD oil for OCD, then here are some things you need to follow.

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1) Choosing A CBD Product

CBD products come in various forms.

There are capsules, tinctures, oils, topicals, and edibles. Each one has its own set of pros and cons and is not all are suitable for every individual. However, the most common choice is CBD oil. CBD oil can be added to your beverages or food, consumed directly via the tongue, used in

aromatherapy via oil diffusers, and smoked via vape pens. IT usually comes with droppers for you to measure your own dosage.

However, edibles and capsules are also both excellent forms of CBD since they are a less obvious way of consuming CBD. Furthermore, they make dosing even easier since they come pre-measured for specific doses.

Topicals which include creams and lotions, on the other hand, can be applied directly to the skin. However, these forms of CBD are mostly recommended for treating underlying skin conditions such as inflammations that cause eczema and acne.

2) Research and Read Reviews

Once you have decided on the type of CBD product that you want, it is time to search the market for high-quality manufacturers and sellers.

Not all CBD products are the same.

Since the CBD industry is still unregulated, there are lots of cheap and poor-quality CBD products that do not contain any CBD at all or contains only artificial ingredients.

Make sure to do your homework and research through various companies and manufacturers. Have a look through reviews of the companies and products that you are interested in buying then compare in potency, price, and overall quality.

Check out their website and see if the company offers 3rd party lab testing of the CBD products to ensure their efficacy and potency.

3) Assessing The Optimal Starting Dosage

Everybody reacts to CBD differently. Some individuals will only need a small dose to feel its effects while others need a bigger dosage for its effects to be felt. This all depends on your genes, weight, and the specific set of symptoms you want to relieve.

Thus, there’s no single dosage that we can recommend.

Generally speaking, individuals with moderate to mild OCD report medium to low strength dosage is enough to offer relief of their symptoms. However, for the more severe OCD sufferers, a higher strength might be needed to deliver the same benefits.

Below is a chart that lists the general dosage requirements according to the desired strength and weight. Keep in mind that these are just guidelines.

The dose can still vary a lot from one person to another. Thus, always start with the low dosage, gradually building up to a higher dose once you know how it affects you individually.

Daily Dosage of CBD Oil for OCD by Strength and Weight

Weight by poundsLow StrengthMedium StrengthHigh Strength10010mg30mg60mg12513mg38mg75mg15015mg45mg90mg17517mg52mg105mg20020mg60mg120mg22522mg67mg135mg25025mg75mg150mg

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Final Thoughts

There are still no specific and dedicated studies that understand or investigate the use of CBD oil for OCD. Thus, we can’t conclusively say whether or not CBD oil helps with OCD.

However, there are plenty of studies published on the benefits of CBD for general anxiety. And since OCD is a type of anxiety and involves many of the same symptoms and underlying pathologies to other kinds of anxiety, it is highly likely that CBD oil supplementation can improve the symptoms of OCD.

Should you choose to use CBD oil for your OCD, make sure that you find only the highest quality product from reputable companies and manufacturers. Follow our above guideline on the recommended dosage and how to use CBD oil. Lastly, in order to get the most out of your CBD supplementation, it is recommended that you consult with your doctor first.

The post CBD Oil for OCD: How to use and Dosage? appeared first on Sell CBD Oils.

from https://hempoilfrog.com/cbd-oil-for-ocd/

[disaster-goose]

This is the story of how I tried to access mental health help in the United States and how it only made everything so much worse. It’s not meant to discourage anyone from asking for help or from taking medication if they need it. I just need to write it down, because at the moment I am on the verge of a panic attack and I need to do something with my hands. So I’m going to tell you the story. 

This is a long post, so I’ll save you all and put it under a “Keep Reading”

Content warning: This post contains discussions about mental health, including suicidal ideation and self harm. 

A little background: I was diagnosed with depression and PTSD when I was 14. I spent my teens and early twenties on various SSRI Antidepressants that only made things worse. I was extremely emotionally unstable. I was so unstable that I had a modified education plan in high school. My therapist had meetings with my school. That’s how serious it was. 

Sometime in my twenties, I stopped taking medication. I went to therapy. I got a degree in Psychology. I went to grad school. I left my abusive ex. I came out to my family. I got away from the toxic people in my life. My depression went into remission. I say remission because once you have depression, you’re always at risk of another episode. That’s just reality. 

Last fall a lot of things went wrong all at once. I had a huge falling out with my family after I put my foot down and refused to tolerate my mom’s manipulative behavior. I was on the verge of going no-contact. Two weeks later my dad was diagnosed with cancer. I was consumed by guilt. 

At the same time I was dealing with financial problems, physical health problems, and a variety of life stress that I wasn’t coping with very well. 

In October I spent two weeks in my home town while my dad received cancer treatment. Being in my home town was hard. I revisited a lot of painful memories. 

In November... Well, we all know what happened in November.

In December I called my mom. It was a few days before Christmas and I called for a friendly chat. I had decided we wouldn’t talk politics. She decided that we would talk politics. It was bad. I hung up the phone and fantasized about all the ways I might kill myself. I can’t even remember Christmas. 

In January I saw my primary care physician (Lana) for a follow-up on my various health conditions. In the fall I’d been told that I was critically anemic, so anemic it might kill me if I didn’t get it under control. By January not much had improved. Because I’d previously disclosed a history of mental health issues, my appointment included a depression screener. I was severely, dangerously depressed. 

Lana said she would refer me to the in-house counselor (Bret) who would then refer me to the in-house Psychiatrist (Colleen). Both of these people were so overbooked and overworked that it would be months before I could see them. I was hopeful. I wanted counseling. I wanted someone to sit with me while I unpacked my guilt and grief. 

Lana warned me that she was leaving the practice soon and that while she would be comfortable prescribing medication for my depression, none of the other doctors in the practice would prescribe psychiatric medications until I saw the Psychiatrist (in three months). 

I didn’t know how I would survive those three months of waiting, but I didn’t want medication either. I just wanted a counselor. I told her about how bad I reacted to SSRI antidepressants. I told her about the instability, the self-harm, the constant suicidal ideation. She agreed that SSRIs were a bad option for me, she thought I had Bipolar 2 (which is like classic Bipolar except the manic episodes are less severe. People with any kind of Bipolar disorder should not take SSRI medication alone. It causes exactly the kind of mood destabilization I’d experienced. 

Lana told me about a drug I’d never tried before. Lamotrigine. It’s a medication for seizures that has shown some promise in treating bipolar disorder. Before agreeing to take it, I did tons of research. A lot of people liked it. A lot of people called it a miracle pill. It had very few listed side-effects, as long as you weren’t one of the rare unlucky people that got a potentially deadly rash. 

I filled the prescription for Lamotrigine, but I waited to take it. I wasn’t sure. I had managed to get an appointment with Brett sooner than I’d expected, so I waited to see him. 

In the meantime, my most recent lab results came back. I was still severely anemic, and apparently I was also severely vitamin D deficient. Anemia can cause symptoms that mimic depression and low vitamin D can actually cause depression. 

I had my first appointment with Brett. I hated him instantly. He was smug. He didn’t listen to me. He was more concerned with filling out his case notes than actually talking to me. He was upset that I hadn’t started the Lamotrigine yet. He was dismissive of my concerns. He put “Noncompliant” in my chart. He talked down to me. I told him that I had gone to grad school and studied counseling psychology. He still talked down to me. 

Lana had said that Brett would do an intake and refer me to a counselor. “I just have to suffer through one intake with him,” I told myself. As it turns out, there are no other counselors. There isn’t a single other counselor within 50 miles of me that takes my insurance. The “counselor” Brett referred me to was himself, and because of the overburdened mental health system, I was entitled to just 20 minutes of “counseling” every two weeks. Five to ten of those 20 minutes were spent on a depression screener and the rest were consumed by Brett tapping away at his computer to fill in his case notes. 

During one session Brett told me to choose a word that represented a “safe place” and to repeat that word to myself when I was anxious or upset. In another session he told me to dunk my head in a bucket of water when I was having a panic attack. 

After a particularly bad session wit Brett, I go home in tears and call my insurance company and every counselor in my town. No one accepts my insurance. No one can help me. 

In four months of bi-weekly sessions with Brett, he has never once asked about the events that precipitated my depressive episode. He never asks me about ANYTHING except my work life and my relationship. Every session he forgets the details of both. 

After two horrible sessions with Brett, I caved and started taking the Lamotrigine out of pure desperation. Because of the risk of a life-threatening rash, I had to increase my dosage very slowly over the course of two months. In those two months nothing improved and my anxiety actually got worse. 

In May I finally increased my dosage of Lamotrigine to a theraputic level. I met with Colleen (the psychiatrist) and liked her immediately. She listened to me. She respected my autonomy. She considered the physical, psychological, emotional and social aspects of my depression. She told me to give Lamotrigine a try and see her again in two months. 

It’s June and I’ve been on a therapeutic dose of Lamotrigine for a month now. Every day feels worse than the last. I am so anxious that I have to take sleeping pills to get to sleep at night. I’m so depressed that I just want to lie down and go to sleep in the middle of the day. I cry over small frustrations. I am plagued by intrusive thoughts and obsessions (new symptoms that I’ve never experienced before). I put clothes in the dryer and obsess over the idea that the dryer will catch fire. Car headlights flash in my bedroom window and I am consumed by the idea that home intruders are coming to kill us all. 

In the evenings when I’m done with all of my responsibilities, I obsess over the idea that if I just cut myself I’d feel so much better. The thought replays through my head over and over, like a fucking Linkin Park song that won’t get out of my head. 

I feel dull. I feel flat. I can’t enjoy anything. I feel emotionally disconnected everyone around me. I have two emotional states: numb and angry. 

I try to distract myself with my hobbies, but I’ve lost interest in everything. I play Stardew Valley for hours. I don’t enjoy it anymore, but it’s calming. It’s something to do. It’s something to keep my hands occupied. 

Besides all these psychological symptoms, I’m physically sicker than I was before. I have headaches every day. I grind my teeth and now have to wear a night guard so that I don’t wake up in excruciating pain. My neck is so tense that I can’t turn my head. 

A few days ago I had another session with Brett. I tell him all of this in detail. I describe the intrusive thoughts, the new symptoms, the misery. I tell him I feel worse than I did before. He taps away on his computer, sending a message to Colleen. 

Brett reframes my statements and says that my mania is well controlled but that my depression is lingering. I wasn’t manic to begin with, so how is my mania now well controlled? I tell him firmly that this isn’t lingering depression. This is something new. It’s horrible. It’s intolerable. It’s worse than it was before. I look at his screen as he types away. I’m now “high risk”. 

This morning I woke up to a call from Colleen. Despite all my efforts to explain things clearly to Brett, the message he sent her includes none of my own words. He’s told her that the medication is controlling my mania very well and that I have lingering depression. His notes don’t include anything about the new symptoms, the obsessions, or the intrusive thoughts. 

I spend 30 minutes explaining myself all over again, but Colleens’ judgement has already be clouded by Brett’s assessment. I can already imagine exactly what my case notes say. “Non-compliant, poor insight, high risk.” I know what my case notes look like because I had peers just like Brett when I was in grad school. Arrogant pricks who couldn’t listen to what their clients were saying. I wouldn’t be surprised if my file also includes something like “suspected borderline personality disorder” because even though I don’t meet any of the criteria, I’m a woman, I’m queer, and I have a history of self-harm. Often, that’s all it takes. 

Fortunately, Colleen isn’t like Brett. She respected my autonomy, and though her tone indicated that she thought I was making a mistake, she respected my decision when I said I wanted off the Lamotrigine. I explained to her that I wanted to consider the possibility that this depressive episode was triggered by physical problems (Anemia, Vitamin D deficiency). She said she understood, but she seemed skeptical. She gave me instructions on how to safely discontinue the Lamotrigine, and what dosage of Vitamin D to take. 

I see Colleen again in a month.  She will probably be waiting for me to crash and burn before I agree to try another medication.

I see Brett again in two weeks. He will write “Non-compliant” in my case notes again and probably tell me to stick my head in a bucket. 

I still have no access to a counselor. 

[psychotherapyconsultants]

CBD Oil for Depression, Schizophrenia, ADHD, PTSD, Anxiety, Bipolar & More

You can extract over 70 different components from a marijuana plant, technically known as cannabis sativa. Two of the most common constituents are delta-9-tetrahydrocannabinol (known colloquially as THC) and cannabidiol (CBD).

Because CBD is not as regulated as THC (though may be technically illegal under federal laws), nor does it provide any accompanying “high” as THC does, it has become increasingly marketed as a cure-all for virtually any ailment. You can now find CBD oil products online to treat everything from back pain and sleep problems, to anxiety and mental health concerns.

How effective is CBD oil in the treatment of mental disorder symptoms?

Unlike it’s sister THC, CBD doesn’t have any of the associated negative side effects of tolerance or withdrawal (Loflin et al., 2017). CBD is derived from the cannabis plant, and shouldn’t be confused with synthetic cannabinoid receptor agonists like K2 or spice.

Because of its relatively benign nature and more lax legal status, CBD has been more widely studied by researchers in both animals and humans. As researchers Campos et al. (2016) noted, “The investigation of the possible positive impact of CBD in neuropsychiatric disorders began in the 1970s. After a slow progress, this subject has been showing an exponential growth in the last decade.”

Research has shown that CBD oil may be effective as a treatment for a variety of conditions and health concerns. Scientific studies demonstrate effectiveness of CBD to help relieve some of the symptoms associated with: glaucoma, epilepsy, pain, inflammation, multiple sclerosis (MS), Parkinson’s disease, Huntington’s disease, and Alzheimer’s. It appears to help some people with gut diseases, such as gastric ulcers, Crohn’s disease, and irritable bowel syndrome as well (Maurya & Velmurugan, 2018).

You can find low-end and high-end CBD oil products. The most popular CBD oil product on Amazon.com retails for around $25 and contains only 250 mg of CBD extract.

ADHD

In a pilot randomized placebo-controlled study of adults with attention deficit hyperactivity disorder (ADHD), a positive effect was only found on the measurements of hyperactivity and impulsivity, but not on the measurement of attention and cognitive performance (Poleg et al., 2019). The treatment used was a 1:1 ratio of THC:CBD, one of the common CBD treatments being studied along with CBD oil on its own. This finding suggests more research is needed before using CBD oil for help with ADHD symptoms.

Anxiety

There are a number of studies that have found that CBD reduces self-reported anxiety and sympathetic arousal in non-clinical populations (those without a mental disorder). Research also suggests it may reduce anxiety that was artificially induced in an experiment with patients with social phobia, according to Loflin et al. (2017).

Depression

A review of the literature published in 2017 (Loflin et al.) could find no study that examined CBD as a treatment for depression specifically. A mouse study the researchers examined found that mice treated with CBD acted in a way similar to the way they acted after receiving an antidepressant medication. Therefore, there is virtually little to no research support for the use of CBD oil as a treatment for depression.

Sleep

Loflin et al. (2017) only found a single CBD study conducted on sleep quality:

Specifically, 40, 80, and 160 mg CBD capsules were administered to 15 individuals with insomnia. Results suggested that 160 mg CBD was associated with an overall improvement in self-reported sleep quality.

PTSD

There are currently two human trials currently underway that are examining the impact of both THC and CBD on posttraumatic stress disorder (PTSD) symptoms. One is entitled Study of Four Different Potencies of Smoked Marijuana in 76 Veterans With PTSD and the second is entitled Evaluating Safety and Efficacy of Cannabis in Participants With Chronic Posttraumatic Stress Disorder. The first study is expected to be completed this month, while the second should be completed by year’s end. It can take up to a year (or more) after a study has been completed before its results are published in a journal.

Bipolar Disorder & Mania

The depressive episode of bipolar disorder has already been covered in the depression section (above). What about CBD oil’s impact on bipolar disorder’s manic or hypomanic episodes?

Sadly, this has not yet been studied. What has been studies is cannabis use on the effect of bipolar disorder symptoms. More than 70 percent of people with bipolar disorder have reported trying cannabis, and around 30 percent use it regularly. However, such regular use is associated with earlier onset of bipolar disorder, poorer outcomes, and fluctuations in a person’s cycling patterns and severity of manic or hypomanic episodes (Bally et al., 2014).

More research is needed to see whether supplementing CBD oil might help alleviate some of the negative impact of cannabis use. And additional research is needed to examine whether CBD oil on its own might provide some benefits to people with bipolar disorder.

Schizophrenia

Compared to the general population, individuals with schizophrenia are twice as likely to use cannabis. This tends to result in a worsening in psychotic symptoms in most people. It can also increase relapse and result in poorer treatment outcomes (Osborne et al., 2017). CBD has been shown to help alleviate the worse symptoms produced by THC in some research.

In a review of CBD research to date on its impact on schizophrenia, Osborne and associates (2017) found:

In conclusion, the studies presented in the current review demonstrate that CBD has the potential to limit delta-9-THC-induced cognitive impairment and improve cognitive function in various pathological conditions.

Human studies suggest that CBD may have a protective role in delta-9-THC-induced cognitive impairments; however, there is limited human evidence for CBD treatment effects in pathological states (e.g. schizophrenia).

In short, they found that CBD may help alleviate the negative impact of a person with schizophrenia from taking cannabis, both in the psychotic and cognitive symptoms associated with schizophrenia. They did not find, however, any positive use of CBD alone in the treatment of schizophrenia symptoms.

Improved Thinking & Memory

There is little to no scientific evidence that CBD oil has any beneficial impact on cognitive function or memory in healthy people:

“Importantly, studies generally show no impact of CBD on cognitive function in a ‘healthy’ model, that is, outside drug-induced or pathological states (Osborne et al., 2017).”

If you’re taking CBD oil to help you study or for some other cognitive reason, chances are you’re experiencing a placebo effect.

CBD Summary

As you can see, CBD research is still in its early stages for many mental health concerns. There is limited support for the use of CBD oil for some mental disorders. Some disorders, like autism or anorexia, have had little research done to see whether CBD might help with its symptoms.

One of the interesting findings from research to-date is that the dosing found to have some possible beneficial effects in research tends to be much higher than what is found in products typically sold to consumers today. For instance, most over-the-counter CBD oils and supplements are in bottles that contain a total of 250 to 1000 mg.

But the science suggests that an effective daily treatment dose might be anywhere from 30 to 160 mg, depending on the symptoms a person is seeking to alleviate.

This suggests that the way most people are using CBD oil today is not likely to be clinically effective. Instead, at doses of just 2 to 10 mg per day, people are likely mostly benefiting from a placebo effect of these oils and supplements.

Before starting or trying any type of supplement — including CBD oil or other CBD products — please first consult your prescribing physician or psychiatrist. CBD may interact with psychiatric medications in a way that is unintended and could cause negative side effects or health problems.

We also do not really understand the long-term effects and impact of CBD oil use on a daily basis over the course of years, as such longitudinal research simply hasn’t yet been done. There have been some reported negative side effects experienced in the use of cannabis, but it’s hard to generalize such research findings to CBD alone.

In short, CBD shows promise in helping to alleviate some symptoms of some mental disorders. Much of the human-based research is still in its infancy, however, but early signs are promising.

  For further information

Reason Magazine: Is CBD a Miracle Cure or a Marketing Scam? (Both.)

Thanks to Elsevier’s ScienceDirect service in providing access to the primary research necessary to write this article.

  References

Bally, N., Zullino, D, Aubry, JM. (2014). Cannabis use and first manic episode. Journal of Affective Disorders, 165, 103-108.

Campos, AC., Fogaça, M.V., Sonego, A.B., & Guimarães, F.S. (2016). Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacological Research, 112, 119-127.

Loflin, MJE, Babson, K.A., & Bonn-Miller, M.O. (2017). Cannabinoids as therapeutic for PTSD Current Opinion in Psychology, 14, 78-83.

Maurya, N. & Velmurugan, B.K. (2018). Therapeutic applications of cannabinoids. Chemico-Biological Interactions, 293, 77-88.

Osborne, A.L., Solowij, N., & Weston-Green, K. (2017). A systematic review of the effect of cannabidiol on cognitive function: Relevance to schizophrenia. Neuroscience & Biobehavioral Reviews, 72, 310-324.

Poleg, S., Golubchik, P., Offen, D., & Weizman, A. (2019). Cannabidiol as a suggested candidate for treatment of autism spectrum disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 90-96.

from World of Psychology https://psychcentral.com/blog/cbd-oil-for-depression-schizophrenia-adhd-ptsd-anxiety-bipolar-more/

[thesleepstudies]

Sleep Dread aka. Fear Of Going To or Dying in Sleep – We Asked Experts About It

Sleep dread is real and nothing to be shrugged of. Over the past few years, we interviewed a few dozen of of sleep therapists and one of the questions was always regarding sleep dread - its causes, whether it's a phobia or not, the forms it can take and finally, what you can do if you can relate to what you'll read you'll see below.

Having a good night’s sleep is vital for our overall health and daily functioning. During the 7, 8 or 9 hours, our brain process information gathered during the day and helps our body heal and re-energize.

Disturbance of this process night after night, leads to chronic discomfort, panic attacks, sleep disorders and it can develop into a sleep phobia known as "sleep dread."

What’s causing the fear of going to sleep?

Sleep dread can be caused by number of reasons, including come conditions like PTSD, depression, anxiety disorders or fear of sleep paralysis - https://thesleepstudies.com/sleep-paralysis/ (if you already experienced episodes).

Most commonly, however, it’s a side effect of insomnia.

However, in most cases the main trigger is one simple, everyday thing- fear, irrational and exaggerated fear, to be precise.

How our body reacts to this

When we are scared, our body’s natural reaction is to activate the “flight or fight” mode. This is normal and necessary human reaction, and when it’s reasonable we can benefit from it.

But our sleep is time when we need to go completely opposite from it. Having this mode on when you need to rest is counterproductive. And that’s an understatement. When your mind is telling that you need to be prepared to run from a threat, you can’t rest.

If you do manage to fall asleep at some point, the brain will stay highly alerted during whole time, making the quality of sleep low. Because of the hyper arousal of your nervous system, you will feel more aware of your surroundings, and will probably have nightmares. In this case it’s common to wake up few times during the night, which breaks sleep cycle, so don’t be surprise when you get up in the morning feeling like you worked the graveyard shift.

When mornings feel everything but good

After sleeping in this state you wake up feeling less rested and refreshed. The brain not only didn’t get the chance to store all the data from previous day, but was infused with new information throughout the night.

This leaves you feeling tired, forgetful, and with weakened state of awareness, prone to injuries and accidents during the day. It’s easier to break a glass or cut yourself feeling this way, not to mention more serious stuff.

Bad quality of sleep is often a main reason for the poor performance at job or school, and it also affects our emotional state.

In the long term, disturbance of sleep can play a significant role in causing the variety of health problems, from mood disorders to heart diseases and stroke.

What causes sleep dread

Think about the quality of your life. If you are often isolated and your social life is close to non-existing, this can make you more subjective to influence of bad news. We are social beings; we need to be in touch with each others and share our thoughts and experiences. When a lot of ordinary good things are happening to you on a daily basis, you feel happier and calmer.

If you watch TV and read newspapers, you are probably up to date with all sorts of bad and disturbing news out there. It’s hard to avoid them, to be honest. The world is definitely not a rosy place these days.

This is not something that can be tossed aside. Remember, our brain process information, and the source of information is everywhere. If you think that doesn’t have any effect on you, think again.

Beside that, try to remember all of the movies and TV shows with violent and aggressive scenes in them. Personally, I’ve lost count. And if you are highly sensitive person, or have a wild imagination that likes to visit dark places, even worse. It can take you further and the dread can turn into fear of dying in sleep.

So, even if you’re not suffering from anxiety, or any other mental disorder per se, if you are scared to fall asleep for no real reason, that’s a problem that needs to be taken care of.

The fear of sleeping alone

If you are scared of sleeping because you have bad dreams, that’s one thing, but in most cases, sleep dread gets triggered when sleeping alone.

It’s proven that women are battling this problem more often than man. They usually don’t have trouble sleeping when their family members or partner are in the house. My friend once told me that she feels safer sleeping when “man is in the house”, and I am talking here about the girl that trained martial arts for years.

This irrational fear comes from the idea that we might get attacked during the night, and staying awake will keep us safe. When there are no men to protect us, we must rely on ourselves. This feeling of vulnerability makes our primal fears alive.

We can talk about the century’s old roll of women being a “weaker sex” embedded in our minds, but it’s not just that. For this we can also thank a huge number of movies with highly aggressive scenes that include women getting attacked in the middle of the night in their beds. We are not accusing anyone, this is a simple fact.

How to threat sleep dread and stop it from happening again

Bear in mind that even if you get rid of your fear for a night, or week, the feeling itself casts a very long shadow that can affect you for months or even years, and can make sleep dread episodes reoccur at any time.

This problem needs to be approached directly and systematically. You really need to work on this, by yourself or with doctor’s help.

It takes time, but it’s worth it.

Let’s start simple, small steps

Minimize the flow of violent images and stories that comes to your mind. If you watch a lot of horror movies or crime shows, stop doing that, or at least don’t watch them right before you go to bed. You don’t need to have a sleep phobia to feel frightened to fall asleep after watching some of those, so think logically. Good idea is to move the TV from your bedroom, if you have one there. If you really can’t stop watching movies at night, switch to something relaxing and funny.

Restrain yourself from short-term solutions, like sleeping with your TV on, or lights on, or asking your friend to stay the night. It may help you once, but not in the long run. You can’t erase the fear this way, it will keep coming back.

If you don’t exercise, this is something you really need to consider doing. Not just because of obvious health benefits, but as they say “make your body tired and the brain will follow”. When we exercise, our bodies release serotonin and dopamine, hormones that are responsible for feeling of happiness. With tired body and happy mind it’s a lot easier to hit the bed.

Meditation, positive affirmations and mindfulness have a strong positive influence on our mind. If you think that’s a bit silly, let’s talk about how silly it is to deprive yourself from sleep due to irrational thoughts.

Fight the bad thoughts with positive ones. You already know that the sleep dread is caused by fears that are not justified, that negative state of mind didn’t come from nowhere. Change the way you talk to yourself, and you will change the way you see the world. Practicing yoga, keeping a journal in which you can write down things you are grateful for every day, or just saying positive phrases few times a day like “I am safe in my home”, can be really helpful.

You should also work on your bedtime routine. Your sleep time should be sacred, literally. In general, your bedroom should be dark, well aired and peaceful, so that vibe can be transferred to you. Make your bedroom as cozy as possible, and avoid using computer or telephone before going to bed. Take a bath, or read a nice, relaxing book, or play some of your favorite music. There is even music for sleeping; tracks with calming sounds that help you fall asleep. If you like to sleep with radio on, you should do it, but because you are enjoying it, not because you are terrified of sleeping in silent room.

A more serious approach to sleep dread

In cases of anxiety disorders that affect sleeping and cause insomnia, cognitive behavioral therapy (CBT) has proven to have great results. In sessions with the therapist the focus is on indentifying the fear and getting over it. Your doctor will lead you to confront the actual cause of the problem and together you will work on establishing a healthy sleeping routine. The key thing is to stick to the therapy even if it’s hard to handle in the beginning.

In some cases, medications like alpha-blockers are prescribed to keep the sympathetic nervous system under control.

We believe that consulting with your doctor is the way to go, and that with a right treatment you can overcome sleep dread. This is something it should be discussed with psychologist, especially if you are already battling some type of mental disorder. It can be solved and there is no need to panic.

If the situation is less serious, natural ways we talked about are proven to be effective (even doctors agree on this), and you should try at least one of them.

One step at a time...

We understand how troubling sleep dread can be, and that’s why we worked very carefully on this guide. We hope you will find it useful and follow the advices.

If you are experiencing the fear of sleep, or have a story related to it, please share it with us in the section below.

Don’t be scared to go to bed. Good night

The article Sleep Dread aka. Fear Of Going To or Dying in Sleep – We Asked Experts About It was originally published to www.thesleepstudies.com

[docboots]

On Escaping Dragons

I have written quite a bit about pain, both in fiction and on my reality. We ponder and write as one of the many ways we attempt to justify and process all that happens to us, and for me, pain is a constant part of that equation. I have written about a lot of my troubles and there are still many I have yet to put down, be it from not getting to it or wanting to keep the full memory repressed. Unburying from around the fragments that like to sprout back up, from experience, just leads to more headache.

   With my disorder, everything has to be taken into consideration. Every stressor, every potential jab, every headache into a complex hypothetical equation. One of those equations you don’t quite have written out or structured, but your gut will give you an answer. I have to do this with every interaction. Consider the idea I was born with a rapidly-speaking dragon tethered to my soul.

If it is too stressful, my dragon will surface itself. The dragon that gnaws at my limbs and squeezes at my organs at a moment's notice. The dragon spewing controlled flames over the areas that flair and burn seemingly from the slightest stress, but then won’t appear when you attempt to replicate the circumstances to understand the disorder. The dragon you try desperately to understand, but it refuses. Imagine everyone had the potential to spew, out of nowhere, the stress no matter how mild that will spark it. That it could be literally anywhere, literally anything.

   It won’t even arrive immediately. The dragon waits. The dragon is patient, it doesn’t want you to be able to track its movements and avoid it. It doesn’t want you to understand it, it only wants you to suffer. It even found new ways to do so. All those attacks on your stomach taking its toll, having a hidden secondary effect that would come closely. The stomach acid washing over your teeth every few minutes on those horrid days not seeming to harm them at first, but as time goes on they crumble from the back forward. Chipping away and cracking new teeth as you try to enjoy your meal, exposing nerves so your every waking moment becomes an agonized nightmare. Your smile, though others say they hardly notice it, is not the smile YOU once knew. The smile you saw everyday of your life now stuck with lines.

   This is not decay, though it does allow decay to spread. This doesn’t always have warning. One night a tooth looks healthy, and the next? Half of it has come off as you try eating French Toast. The dragon doesn’t attack the body, it attacks the mind. Already knowing you have a crumbling self-worth from the demons of your childhood and teenage years, it strikes your self-worth. It leaves you paranoid, for you see it is smart enough not to take your front teeth first. It only takes one, like a warning. It doesn’t even take all of it, only half. Like a morbid before and after picture.

   Then the dragon takes your teeth from the upper back. Where the stomach acid arcs on its way out when you vomit with the violence the dragon desires. Like it is squeezing it out of your guts with a bear hug. One by one your teeth from the upper wisdoms forward crumble. The dentists tell you your insurance will not cover it, they quote you numbers that seem similar to sports cars than dentures or implants. You have to bite back the pain. You have to get used to it.

   Whether it is attacking you or not, the dragon whispers sweet nothings to you. Memories and quotes from your past that, like everything in your imagination, is detailed enough it is only one step away from your mind's eye. It convinces you that telling anyone would force their perceptions of you to become closer to your own, which the dragon has made certain isn’t sturdy with its rapid-fire commentary.

    Now imagine you are fighting with this dragon one day. Let lift the veil of metaphor and get real. Picture a teenage me. I know it was sometime after I was 18, and I hadn’t started smoking cigarettes until then. I specifically remember my first encounter with pot to include a cigarette, but this isn’t about my first time. This is about when I found out Pot was magic. Stay with me now, I am not going to “hippy talk”, and if you consider it that... Well, I hope my explanation might help break down that backwards belief.

   All I want is peace. All I want is for my life not to be endless agony. I do not speak merely of mental anguish. Real, burning, physical pain. Complete with seeing your body shift and morph. Your hand swells to a hand-shaped blob that can’t flatten into a palm nor curl into a fist. Frozen like a statue, surrounded by an inflatable glove or pulsing, throbbing pain. Not just on my hand. If it can swell, the dragon can find it. The dragon can mold it.

    Imagine a young adult. Body attempting to curl itself into the fetal position with every body spasming heave. This isn’t typical vomiting, my entire body wants what is clogging my gastrointestinal system out. The problem? It is a portion of that system. Swollen and molded by the dragon. It can puke out every little drop from my stomach, it can heave until all the energy I gathered from that food is spent. It forces me to erupt in heaves that sound like someone is shoving their fist down the throat of a banshee. It forces me to understand the minute details of dehydration, make me delirious in fatigue. My body would tremble through the process and feel like I am in a freezer from the combination of the sweat clinging to my skin and my lack of energy. It is a unique cold. The cold of having no energy for your body, which you are used to pumping out an odd amount of heat, to keep a normal body temperature. Least, that is what it feels like. I have been the colds of Tahoe, I have fallen into a frozen lake... And nothing quite matches this cold. It isn’t colder, it isn’t cold to the bone like ice water. It isn’t an empty cold like depression.

    You are frigid to the soul and every inch in between. Possibly because, at that moment, you truly feel that nature hates you. As pain like you never felt radiates from the swollen cluster that makes your belly mildly bloat, you feel like a god is stabbing you with every spasm. You can feel the blade of pulsing flesh churn in your guts with every dry, spittle spraying upchuck. You have prayed and cursed to EVERY major deity you had heard about. Being a fan of mythology since I was a child, I had a MASSIVE catalog of them. I even tried Nyarlethotep.

   Having been taught the wonders of crazy by Susan, my..grandmother/mother-through-adoption, when they did not answer the first year or so (specifically while curled up in the emergency room the first time this happened.) you switch to cursing all these gods. Being the weirdo I am, I am also thought-cursing these deities while simultaneously apologizing for not knowing their language. So I can properly smack talk their asses.

   Imagine a friend of yours, that pot-smoking friend everyone has, offering you something that might help. He doesn’t offer it with the hissing smile and wily eyes D.A.R.E. tried to claim. It was a concern. It was genuine, somewhat frazzled, concern. So I did.

   The first puff of pot and the pain began to subside. It never went away, even with all the puffs, but instead of feeling like I had a lost chestburster in my stomach, it now felt more like as healing punch to the gut. Better yet, my nausea cleared up IMMEDIATELY. Not mild nausea either. This was a motion-sick child forced onto a gravitron kind of nausea. This was world turning nausea. GONE.

   I COULD DRINK WATER, GUYS. This sounds simple, but the dragon attack would last for days. The time I went to the hospital and had to stay there? Doc said I was a day away from death by dehydration. I was 15 or 16. There was, at that time, no medication that worked. There were other things, but the pills didn’t work well, threatened my liver, and would be useless if I vomited them up. I am trying medication now, but I only learned about it a couple months ago. Given the manufacturing issues and how I haven’t received my preventative still, only notes saying it has been delayed, I am not putting faith in it saving my life.

    As time went on, I learned that not only did it assist with my symptoms when swelling, it made my symptoms clear up quicker. Episodes that could last a week or a month (depending on how much the situation was affecting me) now lasted one or two days. If they even happened, because I noticed the more I smoked the less I swelled up.

   But what about the mental side-effects? You may ask. Well, I noticed something else. I wasn’t losing focus, I was GAINING IT. You see, I have ADHD. I used to, through my childhood and up until I was maybe 17 or 18, be medicated. Once I was an adult, suddenly, every shrink and pill-pusher I met REFUSED to give me ADHD medicine. Instead, they gave me anti-depressants that made my ADHD worse. Even told me that was a common side-effect, even if I went to them FOR MY ADHD. People refuse to prescribe for it. To diagnose it. TO EVEN FUCKING TREAT IT.

   ADHD sufferers often suffer from a lack of proper dopamine creation. Also known as the thing Pot helps you create. I had a LOT of trouble focusing. Not because I didn’t want to. Not, I REALLY wanted to. I wanted to focus on everything. Read everything. See everything. EXPERIENCE EVERYTHING.

  Or at least, my mind thought I did. I was both engaged and disengaged at all times. Smoke enough pot? I am not what I was like on ADHD medication, but I can write. I can focus on my thoughts better. I can push away the PTSD mental snowballs and flashbacks away and better mold them into my stories and characters. I can see my worlds clearer, I can interact with people better. I can see through the agony and the pain.

   I can be human again.

   So, why am I ranting about your blood disease and pot like this? Well. This has gone on a bit long so I will write that in my next post. My post on the fucking horror that the medical marijuana system is. A glorified subscription service pretending it has my health in mind.

   I would like to end this on the reason I kept describing my blood disease as a dragon. It wasn’t purely for metaphor, you see, people throughout my life have argued on pot and drugs. I am not saying everyone using them is good. No, I am talking about me as a fucking DISABLED American needing the only fucking thing I found that works for my problems, so far like magic.

   They say we are eternally chasing dragons when we smoke pot. I am afraid I am not, and never was. The high does not interest or appeal to me. When I smoke, I am not chasing dragons.

   I am trying to escape from them.

[microhealthllc]

Move over, pot: Ketamine, MDMA are potential treatments for depression and PTSD

Written By: Neha Ogale

August 11, 2017

Major depressive disorder (MDD) is among today’s most debilitating chronic illnesses, mental or physical. The World Health Organization (WHO) reports that over 300 million people worldwide suffer from MDD, but fewer than half receive treatment – the rates are as low as 10 percent (often lower) in some countries. Depression is a master of stealth cloaked in social stigma and misinformation: Silent yet ruthless in its destructive path, MDD claims nearly 800,000 lives to suicide each year, making it the second leading cause of death among people ages 15-29.

In the United States alone, depression is the leading cause of disability among those ages 15-44. The Anxiety and Depression Association of America (ADAA) reported that in 2014, 15.7 million adults had experienced at least one major depressive episode in the past year. At any point in time, 3 to 5 percent of adults suffer from major depression, and the overall lifetime risk is about 17 percent. The situation is dire, and the outlook bleak: The National Center for Health Statistics revealed that suicide rates in the U.S. have soared to a 30-year high, increasing by 63 percent among women and 43 percent among men.

If MDD is a silent killer, then post-traumatic stress disorder (PTSD) is its wayward cousin: More sinister, more terrifying and more than willing to crash the party. The Department of Veterans Affairs (VA) estimates that 7 to 8 percent of the U.S. population will develop PTSD at some point in their lives, and as many as 8 million U.S. adults have the disorder in any given year. According to the WHO, the prevalence of PTSD is about 3.6 percent worldwide; it is especially common in war-torn areas of the Middle East and Africa. Combat veterans suffer at an even higher rate than civilians: the RAND Center for Military Health Policy reported that 20 percent of veterans who served in Iraq or Afghanistan suffer from either major depression or PTSD.

The evolution of treatments: We’ve come a long way since bloodletting

DEPRESSION HAS TAKEN CENTURIES TO DECIPHER

Humans have been trying to explain bouts of the blues or “melancholia” since ancient times. For centuries, the sad mood, fatigue and feelings of hopelessness accompanying depression were thought to be a result of bodily fluids (especially “black bile”) or demonic possession. Not until the 17th century was depression even considered to be a disease of the mind. The idea that MDD could be a mental disorder was pioneered by an English neurologist named Thomas Willis, regarded by many as the father of neuroscience.

Ancient people’s bizarre explanations for depression were matched by their equally outlandish remedies. Induced vomiting or bloodletting – as in, cutting open the skin to supposedly let the “bad blood” out – were among some of the more gruesome approaches to treatment. Other, fairly innocuous (if fruitless) methods included diet, exercise and herbal remedies.

The first real venture into technology-based treatment came in the 20th century with the introduction of electroconvulsive therapy (ECT) in 1938. Also known as shock therapy, it was widely considered to be the only effective modern treatment for depression at the time. One round of ETC is effective in about 50 percent of people with treatment-resistant MDD. The procedure, however, may be accompanied by side effects such as memory loss, disorientation, nausea and muscle pain. ETC machines have been categorized high risk by the U.S. Food and Drug Administration (FDA), earning a place in the Class III category.

Some years later, scientists began their foray into pharmacological approaches to treating depression. In 1958, their efforts yielded the introduction of iproniazid: the first drug of the monoamine-oxidase inhibitor (MAOI) series. MAOIs prevent the enzymatic breakdown of norepinephrine, a neurotransmitter involved in emotional stimulation. Iproniazid was temporarily hailed as an effective treatment until it was found to cause liver damage in 1961.

However, hope was not yet lost: Just before iproniazid burst onto the pharmaceutical scene, another drug called imipramine was discovered to treat depression in 1957. It was the first drug discovered belonging to the class of tricyclic antidepressants; “tricyclic” refers to the three-ringed molecular structure of the drug. Its side effects were markedly less severe, though still present in the form of dry mouth and blurred vision among other discomforts.

Studying MAOIs and tricyclic antidepressants gave rise to the development of selective serotonin reuptake inhibitors (SSRIs). Serotonin is a neurotransmitter that regulates mood, appetite and sleep, and triggers hormones like oxytocin that are associated with feelings of trust. Scientists discovered that in addition to norepinephrine deficiency, depleted amounts of serotonin and dopamine (a neurotransmitter that produces feelings of pleasure) can cause depression. The first SSRI to hit the market was fluoxetine, better known by its brand name Prozac. Introduced in 1987, the drug became an almost instantaneous success, so much so that by 1990, 2 million people were taking it worldwide.

Three decades and five presidents later, the popularity of SSRIs has hardly declined: The Mayo Clinic reported that 70 percent of Americans take some type of prescription drug and approximately 13 percent are on antidepressants.

PTSD TREATMENT HAS TAKEN A MUCH SHORTER PATH

PTSD is considered a comorbid disorder, which means that it often occurs in conjunction with other disorders.  For example, a combat veteran with PTSD is likely to also suffer from depression, anxiety or alcohol/substance abuse problems. Unlike depression, however, PTSD is a relatively new entity in psychiatrics. It slowly began getting attention in the 1970s and 80s during the aftermath of the Vietnam War and the rise of the women’s rights movement.

The return of battle-hardened troops was instrumental in prompting recognition and awareness of PTSD, which was commonly referred to as “shell shock” to describe traumatized veterans of war. Meanwhile, women all over the country were growing emboldened: Scores of survivors found the courage to voice their harrowing accounts of domestic violence and sexual assault, horrors that had been previously swept under the rug in fear of retribution. The frenzied circulation of these reports sent shockwaves across the nation. In 1974, Ann Burgess and Lynda Lytle Holmstrom of the Boston Medical Center penned an article called “Rape Trauma Syndrome.” For the first time, the plight of women was featured in the public spotlight, further paving the way toward trauma awareness and intervention.

Finally, in 1980 the American Psychiatric Association (APA) added PTSD to its Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Since then, the diagnostic criteria for PTSD have undergone several revisions. The most recent and consequential change appeared in the DSM-5, where PTSD was no longer classified as an anxiety disorder; it now falls under the category of trauma- and stressor-related disorders.

Once PTSD was officially legitimized as a psychiatric illness, the approach to treatment became much clearer. To reiterate from earlier, PTSD has a high rate of comorbidity, often accompanied by MDD. So, there was much less experimentation among psychopharmacologists in the search for the perfect chemical concoction: It was already available in the form of SSRIs, which remain the most common drug treatment for PTSD.

Still, drug interventions varied (and still do) case by case. In the past, benzodiazepines – tranquilizers, sleeping aids or anxiolytics – have been prescribed for rapid anxiety relief, but are associated with dependence. Antipsychotics are among some of the more useful drug treatments as they ease the agitation, dissociation and paranoia that accompany PTSD. Mood stabilizers, though less effective than antipsychotics, are also useful.

Cognitive behavior therapy (CBT), in conjunction with prescription drugs, is found to be the most effective long and short-term treatment. It focuses on identifying, understanding and changing thinking and behavior patterns, and usually lasts 12 to 16 weeks.

Exposure therapy is one form of CBT. It desensitizes patients to their trauma over time by exposing them to traumatic memories in a controlled environment. This might entail mental imagery, writing or visiting places that remind patients of their trauma. The use of virtual reality is gaining popularity as well. One non-CBT treatment that may be effective is stress inoculation training (SIT), which reduces anxiety by teaching coping skills like breathing retraining and muscle relaxation. SIT aims to teach patients to react differently to symptoms and triggers.

Ketamine: From clubgoers’ kryptonite to rapid-acting antidepressant

Though they have no doubt lined the pockets of pharmaceutical companies, antidepressants are not a miracle drug. They typically take four to eight weeks to start working; symptoms often worsen before starting to improve. As a matter of fact, only 35 percent of people taking SSRIs experience full remission and 30 percent are what psychiatrists call “treatment-resistant.” This means that 5 million people taking antidepressants do not respond adequately – if at all – to the available treatments.

The shortcomings of modern antidepressants coupled with a drive for innovation has led scientists to investigate novel methods of treating MDD. Their answer? Ketamine.

Discovered in 1962, ketamine hydrochloride – better known as just ketamine – is a general anesthetic used for short-term diagnostic and surgical procedures. It was originally developed as a fast-acting replacement for the drug phencyclidine (PCP). A dissociative anesthetic, ketamine is arguably more famous for its psychedelic properties than for its use as a numbing agent. The drug, dubbed “Special K” in the streets, quickly rose to prominence in the party scene of the 1980s.

Even today, ketamine remains a somewhat popular choice among recreational drug users. In 2013, the National Survey on Drug Use and Health reported that 12 percent of people ages 18-25 had used ketamine in their lifetime, and 6 percent in the past year. So, it shouldn’t come as a surprise that ketamine is one of the most strictly regulated psychedelic drugs on the market today: The DEA classifies it as a Schedule III controlled substance.

HOW IT WORKS

Drugs are exogenous substances, which means they occur outside the body. They are classified as agonists (meaning they act like or enhance the effects of certain neurotransmitters) or antagonists (meaning they block or counteract the effects of certain neurotransmitters). Ketamine is the latter: It blocks NMDA receptors (structures on brain cells whose membrane is permeable to calcium) for glutamate, an excitatory neurotransmitter involved in cognitive functions such as learning and memory.

The effects are almost immediate, appearing within ten minutes of taking the drug. Ketamine’s hallucinogenic effects last about 60 minutes when it is injected, and up to two hours when taken orally. These effects, however, are different from those produced by classic psychedelic hallucinogens. The specific dissociative state that comes from taking ketamine is characterized by perceived detachment from one’s body, stripping users of their grip on reality and causing them to exist in a strange, dreamlike state. High doses of the drug can induce schizophrenia-like symptoms such as hallucinations and delusions – this extreme state of dissociation is dubbed the “K-hole” by many users, who regard it as a particularly bad trip.

WHAT THE RESEACH SHOWS

In 2013, the American Journal of Psychiatry published a study on the antidepressant efficacy of ketamine in treatment-resistant major depression. The researchers designed a double-blind, randomized controlled trial comparing the effects of a single infusion of ketamine to an active placebo in the form of the anesthetic agent midazolam. The researchers recruited 73 subjects with treatment-resistant depression experiencing a major depressive episode: a two-week period over which someone experiences symptoms of MDD.

The treatment group received one IV infusion of ketamine while the control group received one IV infusion of midazolam. The primary outcome to be measured was a change in the severity of depression symptoms 24 hours post-treatment, assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS). The researchers found that the treatment group showed greater improvement in their MADRS scores than did the control group. Those who received the ketamine infusion scored 7.95 points lower on the MADRS overall.

Of course, research with ketamine has raised concerns regarding its safety and potential toxicity. Some researchers have expressed qualms over impact on brain structure and function. In 2015, a team of researchers decided to investigate these claims and published their findings in the Journal of Neuropsychopharmacology. Their study examined the neurocognitive effects of ketamine and its association with antidepressant response in individuals with treatment-resistant depression.

The researchers recruited 62 individuals ages 21-80 diagnosed with MDD. Each subject had a history of at least one previous major depressive episode before their current one, or had a chronic (at least 2-year-long) episode and a score of 32 on the Inventory of Depressive Symptomatology. The subjects underwent a series of neurocognitive tests at least a week before receiving treatment and again 7 days post-treatment. Among these tests were the Wechsler Memory Scale (WMS) Spatial Span, Brief Assessment of Cognition in Schizophrenia (BACS) Digit Symbol and the Hopkins Verbal Learning Test (HVLT).

The researchers randomly assigned the patients to either the treatment group or the control group. Over a span of 40 minutes, those in the treatment group were given a 0.5 mg/kg infusion of ketamine, while those in the control group received a 0.045 mg/kg infusion of midazolam. The patients were discharged 24 hours following the infusion, but were subject to outpatient evaluations at 48 and 72 hours and 7 days post-treatment. The change in severity of depression symptoms was assessed using the MADRS scale, with a categorical response defined as at least a 50 percent reduction in the score compared to pre-treatment.

In terms of cognitive effects, participants’ performance improved in terms of processing speed, verbal learning and visual learning across both the treatment and control condition. The researchers also discovered that poor processing speed at baseline was associated with an improved antidepressant response to ketamine at 24 hours post-treatment. Most importantly, the researchers found no evidence of adverse effects on neurocognitive functioning due to ketamine use.

MDMA: From accidental diet pill to promising new treatment for PTSD

In 1912, a German chemist by the name of Anton Köllisch developed what he had intended to be an appetite suppressant. It was patented in 1913 by Merck & Co., the company by whom he was employed. Turns out his diet pill was actually a chemical concoction called MDMA: a synthetic psychoactive drug that alters mood and perception. Also known as “ecstasy” (the tablet form of the drug) or “molly” (a so-called pure crystalline powder), MDMA is an amphetamine derivative whose chemical composition resembles that of stimulants and hallucinogens.

Unlike ketamine, MDMA has no use in medicine – according to the government, that is. After years of rising tensions toward the drug, the DEA classified it as a Schedule I controlled substance in 1985 due to its high potential for abuse, admittedly with good reason: The National Survey on Drug Use and Health reported that in 2015, 13.1 percent of adults ages 18-25 had used MDMA in their lifetime, with 4.1 percent having used it just in the past year. It isn’t difficult to understand the bureaucracy’s misgivings: Surely the clandestine powders and pills lurking in shadowy corners of raves and pockets of inner-city ruffians could serve no therapeutic purpose.

Well, it wouldn’t be the first time the government was misconstrued in its suspicions. In the 1960s and 70s – long before it was criminalized – MDMA was legally prescribed in conjunction with psychotherapy because of its potential to work as a rapid-acting antidepressant. One notable advocate of the drug was the American chemist and psychopharmacologist Alexander Shulgin, who promoted its use in therapy to foster a sense of trust between therapist and patient. Outspoken and unorthodox in his practices, Shulgin himself was an occasional user of MDMA. He praised its stress-relieving properties and recommended it to his colleagues, devoting much of his career to psychoactive drug research.

HOW IT WORKS

When taken orally, a single dose of MDMA generates a rush of physiological and psychological effects in 30 to 45 minutes. MDMA is an agonist: It increases the activity of dopamine, norepinephrine and serotonin in the brain. Optimum dosage produces a high lasting 3-6 hours on average, during which users report increased energy, pleasure and empathy or emotional warmth. These effects are a result of serotonin’s ability to trigger the release of oxytocin, which is often called the “cuddling hormone” because it increases feelings of trust and bonding.

This explains why Shulgin and others in his field encouraged the use of MDMA in psychotherapy, and why it would be useful in treating PTSD. Because MDMA improves the ability to categorize positive mental states such as friendliness and impairs the ability to categorize negative states like hostility and fear, it would increase communication and decrease fear response in patients. Some experts speculate that MDMA could also optimize exposure therapy by widening the window of tolerance: Patients would remain emotionally engaged with the therapist without succumbing to anxiety while revisiting traumatic memories.

Scientists have slowly begun recognizing MDMA’s potential to revolutionize trauma- and stress-related disorders. In 2016, the FDA approved a series of phase 3 clinical trials for PTSD research. This has drawn the attention of nonprofit research and educational organizations such as the Multidisciplinary Association for Psychedelic Studies (MAPS). MAPS is currently funding pilot studies and clinical trials investigating the use of MDMA as a drug therapy for PTSD, social anxiety in autistic adults and anxiety in terminal illness.

WHAT THE RESEARCH SHOWS

In 2010, the Journal of Psychopharmacology published the first-ever completed clinical trial evaluating MDMA as a therapeutic supplement. The researchers randomly assigned 20 patients with chronic PTSD to either drug-assisted psychotherapy or an inactive placebo. Every subject in the treatment and control group underwent non-drug-assisted psychotherapy as both a preparatory and follow-up measure.

The primary outcome measure used was the Clinician-Administered PTSD Scale (CAPS), which was given at baseline, 4 days post-treatment and 2 months after the second session. The researchers found that the treatment group showed a significantly greater decrease in CAPS scores from baseline compared to the control group. The rate of clinical response was 83 percent in the treatment group compared to 25 percent in the control group.

Like most synthetic substances, MDMA can have devastating physiological effects if misused, wreaking havoc on the nervous system. The drug causes an upward spike in body temperature, which can induce hyperthermia. It can also cause excessive sweating and subsequent dehydration, blurred vision and more, potentially lethal consequences. However, the researchers found no adverse effects – neurocognitive or otherwise – or any clinically significant increases in blood pressure.

Two years later, in 2012, the Journal of Psychopharmacology published a smaller-scale pilot study examining the effect of MDMA-assisted psychotherapy on patients with treatment-resistant PTSD. The randomized, double-blind and active placebo controlled trial featured 12 patients who received treatment in three experimental sessions. These were alternated with weekly, non-drug-based psychotherapy sessions. The researchers administered MDMA in either a low dose (25 mg with 12.5 mg supplement) or a full dose (125 mg with 62.5 mg supplement). The patients showed statistically significant improvement on the self-reported Posttraumatic Diagnostic Scale (PDS).

These preliminary findings showed that MDMA-assisted psychotherapy can be safely administered in a clinical setting, corroborating the data that was gathered from the completed clinical trial from two years before.

Global impact: What this means for mental health worldwide

People tend to be shortsighted when discussing mental health; as Americans, it is especially easy for us to turn a blind eye to issues outside our own backyard. The WHO estimates that 20 percent of the world’s children and adolescents have mental disorders. Yet regions with the highest percentages of their population under age of 19 tend to have the greatest paucity of mental health resources: Low- and middle-income countries have only one child psychiatrist for every 1 to 4 million people.

This deficit represents the global inequity in the distribution of skilled human resources for mental health. The availability of psychiatrists, psychologists and social workers worldwide is scarce. According to the WHO, low-income countries have just 0.05 psychiatrists and 0.42 nurses for every 100,000 people. Comparatively, the rate of psychiatrists in high-income countries like the U.S. is 170 times greater. 

Mental health disorders are also a burden on global health, acting as risk factors for other diseases such as HIV, heart disease and diabetes. Psychiatric disorders quite literally come with a price: MDD alone costs the U.S. $210 billion a year in lost productivity, missed workdays and depression-related illnesses like anxiety, PTSD and sleep disorders. Suicide racks up an additional $1 billion. Clearly, mental illness affects us all whether we realize it or not, forcing us to bear that collective burden.  

Societal inadequacies in addressing mental health remain a key issue today. Stigma, discrimination and human rights violations against mentally ill patients are rampant, creating a barrier between healthcare accessibility and recovery. Scant financial resources only add fuel to the fire. However, the WHO estimates that implementing mental health services in low-income countries would only cost US$2 per capita per year, and only US$3-4 in lower middle-income countries. Doing so is only a matter of cooperation between the public and private sectors.

As a highly industrialized nation, we must use our power and influence to shape the future of mental health. With diligent research and systematic allocation of resources, cultivating the therapeutic power of recreational drugs could pave the way toward effective, inexpensive and widely accessible treatments on a global scale. The world is waiting.

via MicroHealth http://ift.tt/2vWKQTH phillip mazzotta

Written By: Neha Ogale

August 11, 2017

Major depressive disorder (MDD) is among today’s most debilitating chronic illnesses, mental or physical. The World Health Organization (WHO) reports that over 300 million people worldwide suffer from MDD, but fewer than half receive treatment – the rates are as low as 10 percent (often lower) in some countries. Depression is a master of stealth cloaked in social stigma and misinformation: Silent yet ruthless in its destructive path, MDD claims nearly 800,000 lives to suicide each year, making it the second leading cause of death among people ages 15-29.

In the United States alone, depression is the leading cause of disability among those ages 15-44. The Anxiety and Depression Association of America (ADAA) reported that in 2014, 15.7 million adults had experienced at least one major depressive episode in the past year. At any point in time, 3 to 5 percent of adults suffer from major depression, and the overall lifetime risk is about 17 percent. The situation is dire, and the outlook bleak: The National Center for Health Statistics revealed that suicide rates in the U.S. have soared to a 30-year high, increasing by 63 percent among women and 43 percent among men.

If MDD is a silent killer, then post-traumatic stress disorder (PTSD) is its wayward cousin: More sinister, more terrifying and more than willing to crash the party. The Department of Veterans Affairs (VA) estimates that 7 to 8 percent of the U.S. population will develop PTSD at some point in their lives, and as many as 8 million U.S. adults have the disorder in any given year. According to the WHO, the prevalence of PTSD is about 3.6 percent worldwide; it is especially common in war-torn areas of the Middle East and Africa. Combat veterans suffer at an even higher rate than civilians: the RAND Center for Military Health Policy reported that 20 percent of veterans who served in Iraq or Afghanistan suffer from either major depression or PTSD.

The evolution of treatments: We’ve come a long way since bloodletting

DEPRESSION HAS TAKEN CENTURIES TO DECIPHER

Humans have been trying to explain bouts of the blues or “melancholia” since ancient times. For centuries, the sad mood, fatigue and feelings of hopelessness accompanying depression were thought to be a result of bodily fluids (especially “black bile”) or demonic possession. Not until the 17th century was depression even considered to be a disease of the mind. The idea that MDD could be a mental disorder was pioneered by an English neurologist named Thomas Willis, regarded by many as the father of neuroscience.

Ancient people’s bizarre explanations for depression were matched by their equally outlandish remedies. Induced vomiting or bloodletting – as in, cutting open the skin to supposedly let the “bad blood” out – were among some of the more gruesome approaches to treatment. Other, fairly innocuous (if fruitless) methods included diet, exercise and herbal remedies.

The first real venture into technology-based treatment came in the 20th century with the introduction of electroconvulsive therapy (ECT) in 1938. Also known as shock therapy, it was widely considered to be the only effective modern treatment for depression at the time. One round of ETC is effective in about 50 percent of people with treatment-resistant MDD. The procedure, however, may be accompanied by side effects such as memory loss, disorientation, nausea and muscle pain. ETC machines have been categorized high risk by the U.S. Food and Drug Administration (FDA), earning a place in the Class III category.

Some years later, scientists began their foray into pharmacological approaches to treating depression. In 1958, their efforts yielded the introduction of iproniazid: the first drug of the monoamine-oxidase inhibitor (MAOI) series. MAOIs prevent the enzymatic breakdown of norepinephrine, a neurotransmitter involved in emotional stimulation. Iproniazid was temporarily hailed as an effective treatment until it was found to cause liver damage in 1961.

However, hope was not yet lost: Just before iproniazid burst onto the pharmaceutical scene, another drug called imipramine was discovered to treat depression in 1957. It was the first drug discovered belonging to the class of tricyclic antidepressants; “tricyclic” refers to the three-ringed molecular structure of the drug. Its side effects were markedly less severe, though still present in the form of dry mouth and blurred vision among other discomforts.

Studying MAOIs and tricyclic antidepressants gave rise to the development of selective serotonin reuptake inhibitors (SSRIs). Serotonin is a neurotransmitter that regulates mood, appetite and sleep, and triggers hormones like oxytocin that are associated with feelings of trust. Scientists discovered that in addition to norepinephrine deficiency, depleted amounts of serotonin and dopamine (a neurotransmitter that produces feelings of pleasure) can cause depression. The first SSRI to hit the market was fluoxetine, better known by its brand name Prozac. Introduced in 1987, the drug became an almost instantaneous success, so much so that by 1990, 2 million people were taking it worldwide.

Three decades and five presidents later, the popularity of SSRIs has hardly declined: The Mayo Clinic reported that 70 percent of Americans take some type of prescription drug and approximately 13 percent are on antidepressants.

PTSD TREATMENT HAS TAKEN A MUCH SHORTER PATH

PTSD is considered a comorbid disorder, which means that it often occurs in conjunction with other disorders.  For example, a combat veteran with PTSD is likely to also suffer from depression, anxiety or alcohol/substance abuse problems. Unlike depression, however, PTSD is a relatively new entity in psychiatrics. It slowly began getting attention in the 1970s and 80s during the aftermath of the Vietnam War and the rise of the women’s rights movement.

The return of battle-hardened troops was instrumental in prompting recognition and awareness of PTSD, which was commonly referred to as “shell shock” to describe traumatized veterans of war. Meanwhile, women all over the country were growing emboldened: Scores of survivors found the courage to voice their harrowing accounts of domestic violence and sexual assault, horrors that had been previously swept under the rug in fear of retribution. The frenzied circulation of these reports sent shockwaves across the nation. In 1974, Ann Burgess and Lynda Lytle Holmstrom of the Boston Medical Center penned an article called “Rape Trauma Syndrome.” For the first time, the plight of women was featured in the public spotlight, further paving the way toward trauma awareness and intervention.

Finally, in 1980 the American Psychiatric Association (APA) added PTSD to its Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Since then, the diagnostic criteria for PTSD have undergone several revisions. The most recent and consequential change appeared in the DSM-5, where PTSD was no longer classified as an anxiety disorder; it now falls under the category of trauma- and stressor-related disorders.

Once PTSD was officially legitimized as a psychiatric illness, the approach to treatment became much clearer. To reiterate from earlier, PTSD has a high rate of comorbidity, often accompanied by MDD. So, there was much less experimentation among psychopharmacologists in the search for the perfect chemical concoction: It was already available in the form of SSRIs, which remain the most common drug treatment for PTSD.

Still, drug interventions varied (and still do) case by case. In the past, benzodiazepines – tranquilizers, sleeping aids or anxiolytics – have been prescribed for rapid anxiety relief, but are associated with dependence. Antipsychotics are among some of the more useful drug treatments as they ease the agitation, dissociation and paranoia that accompany PTSD. Mood stabilizers, though less effective than antipsychotics, are also useful.

Cognitive behavior therapy (CBT), in conjunction with prescription drugs, is found to be the most effective long and short-term treatment. It focuses on identifying, understanding and changing thinking and behavior patterns, and usually lasts 12 to 16 weeks.

Exposure therapy is one form of CBT. It desensitizes patients to their trauma over time by exposing them to traumatic memories in a controlled environment. This might entail mental imagery, writing or visiting places that remind patients of their trauma. The use of virtual reality is gaining popularity as well. One non-CBT treatment that may be effective is stress inoculation training (SIT), which reduces anxiety by teaching coping skills like breathing retraining and muscle relaxation. SIT aims to teach patients to react differently to symptoms and triggers.

Ketamine: From clubgoers’ kryptonite to rapid-acting antidepressant

Though they have no doubt lined the pockets of pharmaceutical companies, antidepressants are not a miracle drug. They typically take four to eight weeks to start working; symptoms often worsen before starting to improve. As a matter of fact, only 35 percent of people taking SSRIs experience full remission and 30 percent are what psychiatrists call “treatment-resistant.” This means that 5 million people taking antidepressants do not respond adequately – if at all – to the available treatments.

The shortcomings of modern antidepressants coupled with a drive for innovation has led scientists to investigate novel methods of treating MDD. Their answer? Ketamine.

Discovered in 1962, ketamine hydrochloride – better known as just ketamine – is a general anesthetic used for short-term diagnostic and surgical procedures. It was originally developed as a fast-acting replacement for the drug phencyclidine (PCP). A dissociative anesthetic, ketamine is arguably more famous for its psychedelic properties than for its use as a numbing agent. The drug, dubbed “Special K” in the streets, quickly rose to prominence in the party scene of the 1980s.

Even today, ketamine remains a somewhat popular choice among recreational drug users. In 2013, the National Survey on Drug Use and Health reported that 12 percent of people ages 18-25 had used ketamine in their lifetime, and 6 percent in the past year. So, it shouldn’t come as a surprise that ketamine is one of the most strictly regulated psychedelic drugs on the market today: The DEA classifies it as a Schedule III controlled substance.

HOW IT WORKS

Drugs are exogenous substances, which means they occur outside the body. They are classified as agonists (meaning they act like or enhance the effects of certain neurotransmitters) or antagonists (meaning they block or counteract the effects of certain neurotransmitters). Ketamine is the latter: It blocks NMDA receptors (structures on brain cells whose membrane is permeable to calcium) for glutamate, an excitatory neurotransmitter involved in cognitive functions such as learning and memory.

The effects are almost immediate, appearing within ten minutes of taking the drug. Ketamine’s hallucinogenic effects last about 60 minutes when it is injected, and up to two hours when taken orally. These effects, however, are different from those produced by classic psychedelic hallucinogens. The specific dissociative state that comes from taking ketamine is characterized by perceived detachment from one’s body, stripping users of their grip on reality and causing them to exist in a strange, dreamlike state. High doses of the drug can induce schizophrenia-like symptoms such as hallucinations and delusions – this extreme state of dissociation is dubbed the “K-hole” by many users, who regard it as a particularly bad trip.

WHAT THE RESEACH SHOWS

In 2013, the American Journal of Psychiatry published a study on the antidepressant efficacy of ketamine in treatment-resistant major depression. The researchers designed a double-blind, randomized controlled trial comparing the effects of a single infusion of ketamine to an active placebo in the form of the anesthetic agent midazolam. The researchers recruited 73 subjects with treatment-resistant depression experiencing a major depressive episode: a two-week period over which someone experiences symptoms of MDD.

The treatment group received one IV infusion of ketamine while the control group received one IV infusion of midazolam. The primary outcome to be measured was a change in the severity of depression symptoms 24 hours post-treatment, assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS). The researchers found that the treatment group showed greater improvement in their MADRS scores than did the control group. Those who received the ketamine infusion scored 7.95 points lower on the MADRS overall.

Of course, research with ketamine has raised concerns regarding its safety and potential toxicity. Some researchers have expressed qualms over impact on brain structure and function. In 2015, a team of researchers decided to investigate these claims and published their findings in the Journal of Neuropsychopharmacology. Their study examined the neurocognitive effects of ketamine and its association with antidepressant response in individuals with treatment-resistant depression.

The researchers recruited 62 individuals ages 21-80 diagnosed with MDD. Each subject had a history of at least one previous major depressive episode before their current one, or had a chronic (at least 2-year-long) episode and a score of 32 on the Inventory of Depressive Symptomatology. The subjects underwent a series of neurocognitive tests at least a week before receiving treatment and again 7 days post-treatment. Among these tests were the Wechsler Memory Scale (WMS) Spatial Span, Brief Assessment of Cognition in Schizophrenia (BACS) Digit Symbol and the Hopkins Verbal Learning Test (HVLT).

The researchers randomly assigned the patients to either the treatment group or the control group. Over a span of 40 minutes, those in the treatment group were given a 0.5 mg/kg infusion of ketamine, while those in the control group received a 0.045 mg/kg infusion of midazolam. The patients were discharged 24 hours following the infusion, but were subject to outpatient evaluations at 48 and 72 hours and 7 days post-treatment. The change in severity of depression symptoms was assessed using the MADRS scale, with a categorical response defined as at least a 50 percent reduction in the score compared to pre-treatment.

In terms of cognitive effects, participants’ performance improved in terms of processing speed, verbal learning and visual learning across both the treatment and control condition. The researchers also discovered that poor processing speed at baseline was associated with an improved antidepressant response to ketamine at 24 hours post-treatment. Most importantly, the researchers found no evidence of adverse effects on neurocognitive functioning due to ketamine use.

MDMA: From accidental diet pill to promising new treatment for PTSD

In 1912, a German chemist by the name of Anton Köllisch developed what he had intended to be an appetite suppressant. It was patented in 1913 by Merck & Co., the company by whom he was employed. Turns out his diet pill was actually a chemical concoction called MDMA: a synthetic psychoactive drug that alters mood and perception. Also known as “ecstasy” (the tablet form of the drug) or “molly” (a so-called pure crystalline powder), MDMA is an amphetamine derivative whose chemical composition resembles that of stimulants and hallucinogens.

Unlike ketamine, MDMA has no use in medicine – according to the government, that is. After years of rising tensions toward the drug, the DEA classified it as a Schedule I controlled substance in 1985 due to its high potential for abuse, admittedly with good reason: The National Survey on Drug Use and Health reported that in 2015, 13.1 percent of adults ages 18-25 had used MDMA in their lifetime, with 4.1 percent having used it just in the past year. It isn’t difficult to understand the bureaucracy’s misgivings: Surely the clandestine powders and pills lurking in shadowy corners of raves and pockets of inner-city ruffians could serve no therapeutic purpose.

Well, it wouldn’t be the first time the government was misconstrued in its suspicions. In the 1960s and 70s – long before it was criminalized – MDMA was legally prescribed in conjunction with psychotherapy because of its potential to work as a rapid-acting antidepressant. One notable advocate of the drug was the American chemist and psychopharmacologist Alexander Shulgin, who promoted its use in therapy to foster a sense of trust between therapist and patient. Outspoken and unorthodox in his practices, Shulgin himself was an occasional user of MDMA. He praised its stress-relieving properties and recommended it to his colleagues, devoting much of his career to psychoactive drug research.

HOW IT WORKS

When taken orally, a single dose of MDMA generates a rush of physiological and psychological effects in 30 to 45 minutes. MDMA is an agonist: It increases the activity of dopamine, norepinephrine and serotonin in the brain. Optimum dosage produces a high lasting 3-6 hours on average, during which users report increased energy, pleasure and empathy or emotional warmth. These effects are a result of serotonin’s ability to trigger the release of oxytocin, which is often called the “cuddling hormone” because it increases feelings of trust and bonding.

This explains why Shulgin and others in his field encouraged the use of MDMA in psychotherapy, and why it would be useful in treating PTSD. Because MDMA improves the ability to categorize positive mental states such as friendliness and impairs the ability to categorize negative states like hostility and fear, it would increase communication and decrease fear response in patients. Some experts speculate that MDMA could also optimize exposure therapy by widening the window of tolerance: Patients would remain emotionally engaged with the therapist without succumbing to anxiety while revisiting traumatic memories.

Scientists have slowly begun recognizing MDMA’s potential to revolutionize trauma- and stress-related disorders. In 2016, the FDA approved a series of phase 3 clinical trials for PTSD research. This has drawn the attention of nonprofit research and educational organizations such as the Multidisciplinary Association for Psychedelic Studies (MAPS). MAPS is currently funding pilot studies and clinical trials investigating the use of MDMA as a drug therapy for PTSD, social anxiety in autistic adults and anxiety in terminal illness.

WHAT THE RESEARCH SHOWS

In 2010, the Journal of Psychopharmacology published the first-ever completed clinical trial evaluating MDMA as a therapeutic supplement. The researchers randomly assigned 20 patients with chronic PTSD to either drug-assisted psychotherapy or an inactive placebo. Every subject in the treatment and control group underwent non-drug-assisted psychotherapy as both a preparatory and follow-up measure.

The primary outcome measure used was the Clinician-Administered PTSD Scale (CAPS), which was given at baseline, 4 days post-treatment and 2 months after the second session. The researchers found that the treatment group showed a significantly greater decrease in CAPS scores from baseline compared to the control group. The rate of clinical response was 83 percent in the treatment group compared to 25 percent in the control group.

Like most synthetic substances, MDMA can have devastating physiological effects if misused, wreaking havoc on the nervous system. The drug causes an upward spike in body temperature, which can induce hyperthermia. It can also cause excessive sweating and subsequent dehydration, blurred vision and more, potentially lethal consequences. However, the researchers found no adverse effects – neurocognitive or otherwise – or any clinically significant increases in blood pressure.

Two years later, in 2012, the Journal of Psychopharmacology published a smaller-scale pilot study examining the effect of MDMA-assisted psychotherapy on patients with treatment-resistant PTSD. The randomized, double-blind and active placebo controlled trial featured 12 patients who received treatment in three experimental sessions. These were alternated with weekly, non-drug-based psychotherapy sessions. The researchers administered MDMA in either a low dose (25 mg with 12.5 mg supplement) or a full dose (125 mg with 62.5 mg supplement). The patients showed statistically significant improvement on the self-reported Posttraumatic Diagnostic Scale (PDS).

These preliminary findings showed that MDMA-assisted psychotherapy can be safely administered in a clinical setting, corroborating the data that was gathered from the completed clinical trial from two years before.

Global impact: What this means for mental health worldwide

People tend to be shortsighted when discussing mental health; as Americans, it is especially easy for us to turn a blind eye to issues outside our own backyard. The WHO estimates that 20 percent of the world’s children and adolescents have mental disorders. Yet regions with the highest percentages of their population under age of 19 tend to have the greatest paucity of mental health resources: Low- and middle-income countries have only one child psychiatrist for every 1 to 4 million people.

This deficit represents the global inequity in the distribution of skilled human resources for mental health. The availability of psychiatrists, psychologists and social workers worldwide is scarce. According to the WHO, low-income countries have just 0.05 psychiatrists and 0.42 nurses for every 100,000 people. Comparatively, the rate of psychiatrists in high-income countries like the U.S. is 170 times greater. 

Mental health disorders are also a burden on global health, acting as risk factors for other diseases such as HIV, heart disease and diabetes. Psychiatric disorders quite literally come with a price: MDD alone costs the U.S. $210 billion a year in lost productivity, missed workdays and depression-related illnesses like anxiety, PTSD and sleep disorders. Suicide racks up an additional $1 billion. Clearly, mental illness affects us all whether we realize it or not, forcing us to bear that collective burden.  

Societal inadequacies in addressing mental health remain a key issue today. Stigma, discrimination and human rights violations against mentally ill patients are rampant, creating a barrier between healthcare accessibility and recovery. Scant financial resources only add fuel to the fire. However, the WHO estimates that implementing mental health services in low-income countries would only cost US$2 per capita per year, and only US$3-4 in lower middle-income countries. Doing so is only a matter of cooperation between the public and private sectors.

As a highly industrialized nation, we must use our power and influence to shape the future of mental health. With diligent research and systematic allocation of resources, cultivating the therapeutic power of recreational drugs could pave the way toward effective, inexpensive and widely accessible treatments on a global scale. The world is waiting.

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Legal MDMA Therapy Could Be Just a Few Years Away

The trauma of war can rage on long after the fighting is over.

"Each patient of mine that died, I felt like their soul was wrapped around my body, constricting me like a snake," said James, a former Army medic who served in Afghanistan in 2011 and 2012 when he was still a teenager.

"After Afghanistan I had to sever the connection between my heart and head because a lot of fucked-up shit happens there," he recalled. "Once I came back I was very emotionally numb."

James, who asked that his last name be withheld due to the stigma surrounding psychedelic substances, said he eventually found relief from post traumatic stress disorder by way of MDMA-assisted psychotherapy. He started on that path by participating in a Phase 2 trial of the treatment three years ago. The sponsor of the study, the Multidisciplinary Association for Psychedelic Studies (MAPS), is currently waiting on a pair of final approvals from the FDA, expected this summer, to start Phase 3 trials and continue its decades-long march toward a legal therapy.

The group's goal is to receive prescription approval from the FDA by 2021.

So far, results have been promising. In a pilot MDMA study, 83 percent of subjects no longer met the criteria for PTSD following the treatment protocol. A long-term followup from one of the initial studies, administered 17 to 74 months following treatment, found that only two out of 19 subjects had relapsed, and none reported harm from their participation in the therapy.

For a year and a half after James returned to the United States, he said, he didn't even seek treatment. After all, he lacked the major physical wounds—missing arms or legs—haunting many of his fellow service members. But soon his symptoms became undeniable. "Every time fireworks went off, I saw mangled bodies," he told me. "And I had horrible anger episodes. I'd go from a neutral mood to just being fucking furious. I'd break anything around, punch holes in things. It got really bad."

The veteran sought various treatments through the military, including seeing psychologists, taking prescription medication, attending group therapy—he even tried a controversial cranial electrotherapy stimulation. But nothing worked, or helped for very long, until he discovered the MDMA trials. "It confronts you with who you are, the skeletons in your closet, makes you face them and work through them or at least be okay with it," he said. "It makes you look yourself in mirror and challenges you to be OK with who's looking back at you."

Dr. Will Van Derveer, a psychiatrist who helped administer the Phase 2 trials in Boulder, was skeptical when he first heard about MDMA-assisted therapy. But the more he learned, the more intrigued he was. "I'm interested in using the least amount of medication possible in getting people well," Derveer said. "Giving people drug three times only over the whole course of treatment is a lot less than when I use traditional pharmaceuticals that people end up taking for years and years. Those drugs tend to work like anesthesia, which is helpful for repressing symptoms but doesn't get to the bottom of the problem." During the trials, a team of therapists held about three-dozen total sessions with each patient. In three of the sessions, the subject was given an MDMA pill and laid on a couch with an eyeshade while the drug took effect. Other sessions focused on screening, preparation and integration of the experience into the patients' everyday lives.

During the treatment, James said, "it felt like love was coming out of every cell in my body. I hadn't felt relaxed for like two years at that point." He compared the therapy to a carnival game that consists of fishing ducks out of a pond. "Each one of those duckies going around was like a trauma," James said. "It was like I was picking them at random."

Although MDMA, technically known as 3,4-Methylenedioxymethamphetamine, was originally developed over a century ago, it went largely unused and unexplored until the 1970s. That's when psychiatrists began administering it to patients during couples therapies. But around the same time, the chemical started popping up in clubs as the main ingredient in ecstasy or molly. Once it gained a reputation as a party drug, the nation's drug warriors swept in and slapped MDMA with a Schedule I label under the Controlled Substances Act in 1985, classifying it as a drug of abuse with no medical value. Official research ground to a halt—at least until MAPS picked up the baton. A spokesperson for the FDA explained that while the agency cannot discuss specific drug trials, Schedule I substances can be the subject of clinical research under an Investigational New Drug Application and are held to the same standards as other drugs considered for FDA approval.

Of course, there's still a long way to go before this treatment is accessible to the general public. In the event the FDA does grant prescription approval, MDMA-assisted therapy would still be illegal as long as the chemical remains on Schedule I. However, any interested person or group could petition the DEA to reschedule it, at which point the agency might be compelled to conduct an investigation soliciting information from the FDA and other federal agencies. These medical and scientific evaluations are considered binding. FDA approval could therefore force the DEA to move MDMA down to at least Schedule II, which recognizes accepted medical use for a substance and permits doctors to prescribe it to patients.

From there, individual states would have to loosen their own restrictions on MDMA. Not to mention that insurance issues would have to be worked out, and professional guidelines clarified. (A spokesperson for the American Psychiatric Association said the group does not have a position on using MDMA to treat PTSD.)

Meanwhile, MAPS and other groups are looking into using MDMA—as well as psychedelics such as psilocybin and LSD—as a treatment for other mental disorders, including anxiety, depression and addiction. If approval for PTSD treatment does move forward as hoped, it could open the door to an entire new wave of psychedelic-assisted therapies.

For some patients, the treatment has already made a world of difference. "It gave me my life back," James said. "I really mean that."

Follow Aaron Kase on Twitter.

Source: Legal MDMA Therapy Could Be Just a Few Years Away Source: Legal MDMA Therapy Could Be Just a Few Years Away

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Many of Us Suffer from Mental Disorders but Most Choose to Ignore Them

As time goes on, discussing mental health and the disorders so many of us face has become less and less taboo. With shows like ’13 Reasons Why,’ we seem to all be open to discussion suicide and bullying far more often than we would have just a few years ago.

But the ability to discuss it more freely does not mean mental health is improving. In fact, 1 in 5 adults in the U.S. experience mental health, and as many as 6.9% of adults in the U.S. had at least one major depressive episode last year. Of these, only about 41% of adults in the U.S. received mental health services during that time.[1] But why? It seems like media is more willing to talk about things like bipolar disorder and depression, but despite it being all around us, many are choosing to just ignore their problems.

Mental health matters and we should face it.

We’ve all seen the commercials about depression. The scene usually involves an attractive young/middle-aged woman lying on her couch or longingly staring out the window. We hear the voice-over comment on how living with depression can make you feel like a prisoner. You don’t want to engage with your friends or family anymore. In fact, you sometimes don’t even want to get out of bed. For some people, that commercial is an accurate representation of their life. But for others, their depression may not look that way. In fact, they may only feel sad or mildly moody a few times a week. To them, that’s their normal. Perhaps that’s why it can be difficult to know you should seek help.

Unfortunately, choosing to do nothing, or failing to recognize you need to do something at all, can have heartbreaking consequences. More than 90% of children who commit suicide were living with untreated mental health issues. More so, those living with mental illness are more likely to develop chronic medical conditions and even die 25 years earlier than others.

While it can sometimes feel embarrassing to seek help for something you may not truly understand, it is never embarrassing to want to help yourself and be healthy. So if you’re thinking you may have a problem, know you aren’t along, and know what to look for.

There are different types of mental health disorders we might be experiencing.

There are numerous types of mental health disorders. The following lists out the most common ones and summarizes what they are:[2]

1. Social or general anxiety disorders

People who suffer from these disorders respond to situations with fear and panic attacks. For anxiety sufferers, something as normal as walking out their front door can lead to complete fear and an emotional breakdown. This disorder affects about 1.5% of the U.S. population of those aged 18 and up.[3]

2. Depression, bipolar and cyclothymic

These are classified as mood disorders, and they typically involve intense feelings of sadness or periods of being super happy followed by being super sad. While anyone undergoing stress can experience mood swings, those with diagnosed mood disorders tend to fluctuate more frequently and intensely. Mood disorders affect almost 10% of the U.S. adult population.[4]

3. Psychotic episodes such as hallucinations and delusions

Psychotic disorders involve distorted awareness. People who live with psychotic disorders often see things or hear things that are not real. Schizophrenia is a common example of a psychotic episode. 4% of the U.S. adult population has been diagnosed with a psychotic disorder.

4. Anorexia, binge eating and bulimia

While many young girls (and some boys) may think eating disorders are a phase everyone goes through, that’s not the case. Extreme emotions and attitudes toward your weight or the things you eat/don’t eat are actually examples of an eating disorder that should not be ignored or accepted. Don’t be embarrassed to talk to someone and get help. Eating disorders affect about 30 million people of all ages and genders in the U.S.[5]

5. Pyromania, kleptomania and other impulse disorders

As the name suggests, impulse disorder sufferers are unable to ignore their impulses. It is common for people with impulse problems to lose sight of things that are important, such as responsibilities and relationships. These disorders affect 10.5% of the American population of men and women.[6]

6. Alcoholism and drug addiction

This addiction disorder goes hand-in-hand with impulse disorders, as those who struggle with alcoholism and drugs are unable to deny their craving for things they shouldn’t abuse. This heartbreaking disorder affects over 13% of the U.S. population.[7]

7. Obsessive-compulsive disorder (OCD)

Movies and books can sometimes make OCD look funny or endearing depending on the habit of the person exhibiting the behavior. In reality, those with OCD can live challenging lives, as small tasks like turning a door knob can turn into long and complicated rituals. Those living with OCD experience constant thoughts and fears known as obsessions. Those obsessions lead the person to perform rituals, or compulsions. About 2.3% of the population (ages 18-54) suffer from OCD.[8]

8. Post-traumatic stress disorder (PTSD)

PTSD is a heart-breaking condition which is common in veterans and victims of crime such as assault. People with PTSD often have lifetime fears and memories and can have problems dealing with their emotions. This disorder affects 8% of Americans.

It’s not a shame to seek help if anyone has mental disorders.

Mental disorders are not new to us but not everyone knows how to cope with them. Like every other physical illness, mental disorders should be treated. If you find yourself or your friend having any symptoms of mental disorders, it’s better to get help as soon as possible.

How to get help for a friend or a loved one: be understanding.

Some of you may be reading about these disorders and, instead of recognizing yourself, you find yourself thinking of a friend. If you feel you know someone who may have a mental health disorder, there are steps to take to ensure you are respectful in reaching out.

First of all, don’t try to play psychologist. Even if you mean well, trying to “fix” your friend, or offering advice can sometimes make things worse. It is most important to listen. Be very patient and don’t expect anything to be resolved immediately. If you are afraid to start the conversation for fear you will say the wrong thing, Help Guide.org offers conversation starters and sample questions to aid you in being a helpful friend.

Perhaps most importantly, never downplay what they are feeling. Even if the frustration you feel is with yourself because you don’t feel helpful, don’t ever tell someone struggling with something like depression to “snap out of it” or that “it’s all in your head.”

If you feel conversations with your friend or loved one are going well, encourage them to reach out to a physician they trust. You can even offer to accompany them on their first visit. The first step is being able to tell a professional they feel upset or “just not right.”

How to get help for yourself: talk about it.

Even if you know you want to get help, finding that assistance can still feel overwhelming. MentalHealth.gov offers suicide prevention hotlines, treatment referral helplines and more. If you’ve already talked to your physician about how you feel and what you want to do about it, great! If not, what’s holding you back from taking that first step?

You don’t ever need to feel embarrassed about your mental health. Remember there are people who want to help you and will do whatever it takes to give you that help in the way that’s right for you. Start by talking to your family doctor. In some cases, she/he will be able to prescribe something or recommend someone to talk to. If not, they can refer you to a specialist for more in-depth help.

Check in often to see if everything’s okay.

If you or your friend have gotten help and even started talking to a therapist or taking a specific medication, consistently check in with how you’re feeling. Remember that medicine doesn’t always get it right the first time. Be aware of side-effects and reach out to someone you trust before hand to look out for any negative changes in your attitude or strange behaviors. It can sometimes be necessary to change prescriptions one or more times before finding what works best for you and your body. And that’s okay!

Mental Health America has a list of what to look for in adults, adolescents and children that may indicate you or your loved one should speak to a medical or mental health professional.

Take care of yourself for yourself.

Sometimes mental health disorders can trick you into believing you’re a burden to your family or friends. Remember that voice is a liar and you are so worthy and loved. Mental illness affects nearly 44 million people; you are not alone.

Get help because you deserve it. You deserve to be happy, healthy and energetic for many, many years to come.

Featured photo credit: The Miracle Forest via 1.bp.blogspot.com

Reference

[1]^NAMI: Mental Health By the Numbers[2]^WebMD: Types of Mental Illness[3]^Anxiety and Depression Association of America: Facts & Statistics[4]^Depression and Bipolar Support Alliance: Mood Disorder Statistics[5]^ANAD: Eating Disorder Statistics[6]^Psych Central: Mental Health Statistics[7]^Psych Central: Mental Health Statistics[8]^Understanding OCD: Some OCD Facts & Figures

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