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September 15, 2008

Making Darkness Visible - One Author (and Former Marine's) Attempt

William Styron Hand to Head Blue I read the classic Darkness Visible: A Memoir of Madness, by William Styron, the other night.  It's a quick but melancholy read and takes about an hour. (What I didn't realize at the time, and it's completely tangential to his story, which is really about a four year bout the well-known author had with clinical depression, and the closeness he felt to suicide, is that Styron was a former Marine.)  Styron died of pneumonia in 2006, at 81 years old.

In an obituary printed about Styron on Martha's Vineyard, where he had a home, the following information about his military service is revealed:

Following high school [Styron] joined the reserve officer training program for the United States Marine Corps, and enrolled at Davidson College. He was unhappy there and through the Marines transferred to Duke University in June of 1943. In October of 1944 he was called to active duty and in late July 1945 was commissioned a second lieutenant. He was assigned to participate in the invasion of Japan; a month later the atomic bomb attacks forced the surrender of Japan and he was discharged. ... In 1955 he published The Long March, originally a novella about his experiences in the U.S. Marine Corps.

The same obituaryalso makes clear the trajectory that led to Styron's depression, and the resultant book that introduced this highly personal experience of the author's to the American public:

[Styron] drank heavily and smoked cigars until the summer of his 60th birthday in 1985, when he decided that alcohol no longer agreed with him and gave it up. But the abstinence triggered mood disorders which required medication, and the drugs in turn brought on a deep, enduring and suicidal depression that required him to be hospitalized for more than two months. The experience prompted him to write Darkness Visible: a Memoir of Madness, after he had recovered.

The book earned Mr. Styron a whole new set of followers. "I think it causes people to realize two things," he told the Gazette in an interview in 2001. "That this is a pain that afflicts a lot of people; it's universal and if I could describe it in this way and people could relate to it, it meant they weren't alone; and the second thing - almost as important or more important - is stressing the truth that people can get well, and that it's not by any means fatal."

Styron's book is interesting, to a degree, mostly because of his prominence as an author at the time he wrote it, and because it is so uniquely personal: One person telling the story of his own descent into "madness." I wasn't a complete fan: it's a little hard to keep reading how marvelous Styron's life was, yet how unhappy he was within it -- true though that might be.  And the entire book, while short, is one continuous slog through the same miserable territory, until his case finally improves towards the end (mostly thanks to hospitalization, it would seem.)

However, there are some intersting parts.  One is near the beginning, where he quotes the French writer Albert Camus, "There is but one truly serious philosophical problem, and that is suicide."  In Styron's hands, the problem becomes more physiological than philosophical.  He tries to put off suicide, while coping with his depression -- but first, cataloging his depression fairly exhaustively for the reader (or himself, it's never too clear.)  He covers some standard themes, such as how self-medication with alcohol kept his demons at bay for years, until he cold turkey gave up drinking, and watched his depression take on form and substance.  He explains how the common response of depression is to be more interested in injuring self than others (small comfort, that).  And he mentions the unique aspect we discuss here from time to time, about how psychological pain can manifest as, or at least be accompanied by, physical pain.  In Styron's words, about his own case:

"What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain.  But it is not an immediately identifiable pain, like that of a broken limb.  It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room.  And because no breeze stirs this cauldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion." 

(Hmmmn.)

Styron indulges in one of the book's only tiny moments of humor when he describes the loss of his libido, which he says happened pretty much as soon as the depression settled in.  Describing a conversation with a doctor he felt 'just didn't get it,' Styron writes:

"...I wondered if he seriously thought that this juiceless and ravaged semi-invalid with the shuffle and the ancient wheeze woke up each morning from his [sleeping pill-induced] sleep eager for carnal fun."

Styron helpfully delineates his personal symptoms and by so doing, provides an example for others about what depression can look and feel like.  He describes his sensations of pain, his loss of libido, his weakness, his weak and distant voice that made him sound much older than his years, etc.

He also describes his troubling experience with several doctors (he calls them "careless") who overprescribed medications to him, including sleeping pills, at levels that were dangerous and could have provoked suicidal thoughts. It's unclear whether Styron ever considering a malpractice lawsuit against these doctors, but what he describes doesn't sound good -- and it sounds like he just took it in stride and was thankful he wasn't harmed, but didn't pursue any further action.  Ironically, eventually it's medication that helps him get well, once he is hospitalized.  Before he commits himself, however, he reaches the end of his rope and contemplates suicide.  When he finally realizes how sick he is, he heads for the hospital, and, there removed from other distractions, is able to (in his opinion) concentrate on his cure.From other things I've read since, it sounds like Styron continued to battle depression off and on for the rest of his life, and probably had struggled with it for many years beforehand, also.  At no point in the book is there any indication about his military service having an effect, pro or con, on his depression.  In fact, it sounds like his depression was both genetic and environmental -- but had nothing to do with being a Marine.

By page 84, the last page of the short book, there is finally a ray of at least faint light.  Styron is getting better, and he sums up -- neatly mentioning Dante, the subject of a previous post here on this blog:

For those who have dwelt in depression's dark wood, and known its inexplicable agony, their return from the abyss is not unlike the ascent of the poet [Dante], trudging upward an upward out of hell's black depths and at last emerging into what he saw as "the shining world."  There, whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair."

And then he concludes with a quote from Dante, mirroring the optimism that is finally able to see in his own situation:

"E quindi uscimmo a riveder le stelle.

And so we came forth, and once again beheld the stars."

Editor's note: If you want to read more about Styron's later work, referencing this book as well, there's a good article from 2003 in the Guardian, linked here.

July 21, 2008

There's a Revolution Going On: Users Rate Their Drug and Non-Drug Treatments for PTSD

IStock_000005128146XSmallWe're just about to wrap up our series here -- a cycle of blog posts about the various treatments available for PTSD from the pharmaceutical, Complementary and Alternative Medicine ("CAM"), and mind-body medicine worlds. We've talked about bodywork therapies that show promise. Heck, we've even talked about street drugs like marijuana and ecstasy that appear to have some beneficial effects as well! (Sheesh -- we're not recommending them, per se -- we're just trying to do a comprehensive look at everything reasonable that's out there, that might help sufferers.)

We started this cycle of blog posts back in the beginning of June, with one about how the military was expanding its concept of treatment options to include some "revolutionary" non-drug approaches, linked here.  (We'll add to the cycle of posts over time as the need indicates, but the bulk of it is already done on this topic. This post also builds on a previous post, which talked about how a layperson can learn more about the effects and side-effects of medications prescribed, as well as where to learn about possible warnings when used in combination with other medications.  That post is linked here.) 

One of the most interesting developments is something I get to share with you now -- that a year or so ago when I first learned about it, was not robust enough to be of much value to PTSD sufferers.  Perhaps by now it really is.  The "it" I'm talking about here is something called "Revolution Health," the brainchild of AOL co-founder and marketing genius Steve Case, a project he began in 2005, after he left AOL.

Revolution Health is a number of things, but particularly for our purposes here's it's an online "community" of other patients who give their impressions, pro and con, of the treatments they're using for various illnesses and conditions -- including PTSD -- and not just of all the popular pharmaceutical medications, but also the non-drug therapies as well.  Finally, in one place, patients can check out what other people's experiences of the same drugs or therapies they've been prescribed, along with more straightforward information about the treatments themselves, the possible side-effects.  Clearly, for something like this to work, there need to be a LOT of people checking in and providing their impressions. 

When I first checked out the site, those numbers just weren't there.  It's not so exciting, interesting, or frankly even helpful to learn what three people think of a medication or a non-drug treatment like acupuncture or craniosacral therapy -- it gets a LOT more interesting as more people participate.  Such seems to be the case these days (no pun intended) -- but act quickly -- the site has been experiencing layoffs, and with Web businesses, even those founded by geniuses like Steve Case, you never really can count on how long they'll be around.  So be sure to check out what interests you while you still can.

This is what the site said a year ago about itself, which is still good advice:

This service is in its infancy, but our philosophy is that if millions of people participate, it will emerge as a useful tool for people as they consider their treatment options. Please note that treatments include a mix of some that are designed to directly treat a condition, some that treat side effects, some that provide symptomatic relief.

While individual real-life experiences can be a valuable health resource, they must be viewed in the context of evidence-based data and are not a substitute for medical advice. You should always consult a qualified health care professional before beginning, changing or stopping a treatment.

Now let's get down to business:

Want to learn how other participants rank, rate and review the various treatments for PTSD, both drug and non-drug? (Currently there are dozens suggested!), say, Duloxetine? Click here, for a list of the various, searchable treatments. (Better yet, click herefor them ranked by users in order of effectiveness!)  Want to take a look specifically at the pharmaceutical drugs for PTSD? Click here.  How about the various non-drug treatments for PTSD?  They're there, too, by name.  (You can sort either set of results by "most helpful," "most recent," and "highest effectiveness" on any individual treatment (of the 363) or on the category as a whole.)

Note: Be aware that not everyone who's weighing in with their opinion on what treatment they're loving or hating for PTSD has combat trauma-induced PTSD.  They may have PTSD from some completely other cause.  However, as far as relatabilty goes, this is the best we're gonna get for now -- a "Revolution Health" for veterans only does not appear to be in the works.  Ahhh, but we can dream, can't we?!

To reinforce the warning, though -- given the fact that nothing's permanent on the Web, especially "revolutionary business models," get in -- get your information -- and get out -- in case the website goes away, and/or the company goes out of business.  We sincerely hope that Revolution Health sticks around, because it's performing a useful AND innovative, visionary function --  but even more than that, we want YOU to get the information you're looking for, while you still can.  Oh, and if you sign up to be a member -- I believe that it's free -- you can also contribute your ratings to the user-generated rankings.

There's a Revolution going on...in health care.  Get yours now, while it lasts.

Editor's note: The usual "yada."  Be sure to consult with a qualified health care practitioner before changing or implementing a course of treatment, to make sure that the choices you make are appropriate and best for you.  We are presenting this material as information only, and it's not to be construed as medical advice.  If we could, we would; but we can't, so we won't.  There, we've said it.

June 28, 2008

"Disposable Heroes" - Washington Times and ABC News Investigates Drug Testing on Veterans

Disposable Heroes On June 16th, the Washington Times, which has been following the "Chantix harm to veterans" story doggedly, and ABC News, produced an investigative piece called "Disposable Heroes," about the drug testing that takes place on veterans, sometimes with lethal consequences.   That interactive piece is linked here. (Ironically, earlier this week, we posted an entry about veteran' similar exposure, this time from the Vietnam War, that is still coming to light.  That post is linked here.)

Here's the lead from the Washington Times' story, by Audrey Hudson:

The government is testing drugs with severe side effects like psychosis and suicidal behavior on hundred of military veterans, using small cash payments to attract patients into medical experiments that often target distressed soldiers returning from Iraq and Afghanistan...

In one such experiment involving the controversial anti-smoking drug Chantix, the Department of Veterans Affairs (VA) took three months to alert its patients about severe mental side effects.  The warning did not arrive until after one of the veterans taking the drug had suffered a psychotic episode that ended in a near lethal confrontation with police.

If you want to find other entries in the Washington Times' extensive coverage of Chantix and veterans, use this link here, which will produce a list of the articles, or go to their website, linked here, and do a search for "Chantix".  Be forewarned, however. Although the information on the website is well worth learning, the Washington Times has an especially cumbersome user interface, irrespective of browser.  Get ready to enable popups, and then, even so, only be able to pull up the stories with great difficulty.  Someone really needs to improve that...)

Going Frantic over Chantix - Anti-Smoking Drug Causes Problems for Veterans with PTSD

Chantix PTSDAn anti-smoking drug, Chantix, prescribed to veterans, including those with PTSD, has been linked to significant health problems:

The Washington Times reported on February 2, "Government regulators said the connection between Pfizer's anti-smoking drug Chantix [Vanericline] and serious psychiatric problems is "increasingly likely." The Food and Drug Administration said it has received reports of 37 suicides and more than 400 of suicidal behavior in connection with the drug."

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On May 16, the FDA issued a Public Health Advisory, linked here, about the drug, and mentioned -- of particular concern to those with PTSD -- that use of Chantix "may cause worsening of a current psychiatric illness even if it is currently under control and may cause an old psychiatric illness to reoccur." The FDA warned those taking Chantix about the "possibility of severe changes in mood and behavior," as well as about "vivid, strange and unusual dreams" -- problems already for veterans with PTSD. Similarly, the FDA described symptoms that Chantix might cause may include "anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide."  Grrrreat.  Apparently, according to the health advisory, problems occurred both while taking Chantix, and during withdrawal.

Approximately a week later, on May 22, the Washington Times again reported that the FAA had banned Chantix for use by its pilots and air traffic controllers, after concerns about its use.

 

June 23, 2008

PTSD Drugs: Better Living through Chemistry, or Purely Popping Pills for PTSD's Psychological Ills?

IStock_000005128146XSmall

There was a story in the news recently about four young combat veterans in West Virginia, all seemingly in decent physical condition beforehand, who nevertheless all died in their sleep recently.  Besides combat PTSD, one thing the vets all had in common was the cocktail of drugs they were taking: Paxil, Klonopin and Seroquel.  (The Charleston, West Virginia Gazette-Mail reported this story on May 24, 2008 - it's linked here.)  An investigation is pending, but the story obviously raises the question: what are vets with PTSD being prescribed, and is it really working, or what's best?  (Continue reading, and you'll learn more about those specific medications as well.)

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Where to go for information about PTSD medications?  Here are a few, carefully-chosen selections, and their pros and cons - as appropriate:

Jonathan Shay, M.D., Ph.D., well-known VA psychiatrist and outstanding veterans advocate, has written before about medications used to treat combat PTSD, and his impressions of them.  He wrote the material for a lay audience, in the version that's kicking around on the Web, in several different locations, and although it has been quoted by many as gospel, it's more than 12 years old by now (first published in 1995), and that's much too much time that's elapsed to consider that information really current. (The Dr. Shay list, "About Medications for Combat PTSD,"  is linked here.)  So that information is interesting for background -- and particularly for Dr. Shay's explanation of how things work and/or what makes a good PTSD medication, and what doesn't -- it out of date and should not be considered current. 

There's another list on the Web -- a table, really -- that's much more current (2006), and it lists the drug names, brand names, and how the drugs are thought to work with PTSD.  That list is linked here.  It may be a little difficult to read if you're coming to the topic cold, but perhaps not.

Some other suggestions:

If you have access to a public library or academic library, you can check out the PDR -- the Physician's Desk Reference -- and read up on a drug's profile, side effects, warnings, etc.  But since you're already on the Web, we can assume, reading this -- try going to PDRHealth.com, linked here-- and read up on the prescription drugs prescribed for PTSD.  Of the three drugs mentioned earlier, Paxil is linked here; Klonopin is linked here; and Seroquel is linked here.  You can also do a straight search for any OTHER drug used in PTSD treatment, or one with possible interactions with a drug used for PTSD, at the same site, by searching within prescription drugs by name (e.g., Zoloft, Chantix, etc.), at the general search interface, linked here.

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But the information in the PDR, whether on the Web or in the desk reference, is going to dry and technical, though worth reading -- pretty much exactly like the fine print that's packaged with the medications themselves. What you're probably going to want to know more about is what in software is called "the user experience" -- how other patients like you have experienced the medications.  For that you will need to turn to some other sources.

For what amount to "user reviews," try PsychCentral, or Revolution Health, both of which have increasingly robust user communities who will comment on their own experiences of the medications.  (Of course, not all their users taking medications for PTSD have PTSD from combat trauma, so be aware that their cases may be substantially different.)  Combined with the technical information about the drug's effects, side-effects and warnings (see links, above), it might be helpful in creating a broader picture of what the user experience is like:

Dr. John Grohol's PsychCentral website:  Paxil (Paroxetene) is linked here; Klonopin (Clonazapam) is linked here; and Seroquel (Quetiapine fumarate) is linked here. A general search through the medication library is linked here.

AOL Founder Steve Case's Revolution Health:  Users in the "User Community" provide "Community Ratings" on various medications.  The items on PaxilKlonopin, and Seroquel are linked here (click on any of those hyperlinks to take you to the community ratings), or, use a more generic search here, and look for the tab beneath that says "Community Ratings." (We will be blogging more about Revolution Health shortly.)

Don't forget books as well.  Mark Goulston, M.D.'s Post-Traumatic Stress Disorder for Dummies (2007), linked here, is very recent, and contains a whole chapter entitled, "The Role of Medication in Treating PTSD".

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You'll also want to learn as much as you can -- though this is primarily your healthcare provider's reponsibility, yet it's in your best interests to care about this as well -- about possible interactions, if you're taking a number of medications; as well as thinking through carefully whether the risks involved are ones you want to agree to, such as the potential that a medication -- bizarrely enough, prescribed for PTSD or depression -- may actually increase risk of suicide. (An example of news coverage about this is linked, here